HIV: Donation safari in Africa

20. December 2011

The battle for HIV prevention in Africa is also a contest for the best use of funds. From Big Pharma to Big Gates, all are on-site and distributing money in large volumes. Success follows suit, where each finds its niche – and especially where those in power go along with it.

The report is highly topical: The rate of global HIV infections has declined by 21 percent since 1997, UNAIDS reports in the run up to this year’s World AIDS Day on 1 December. Even in sub-saharan Africa, where 68 percent of all HIV-infected people live and 70 percent of all new infections occur, the infection rate since 1997 has declined by 26 percent. That this important first hurdle in the global fight against HIV was able to be negotiated is due to a number of factors. The first one normally worth mentioning is the significant body of funds which have for some years been flowing into the fight against AIDS particularly into Africa. Something also not to be underestimated however is the significance of national governments.

Fight against HIV: Drugs are not everything

Developments in Tansania make a good subject of study. The country has, in pure numerical terms, the fourth highest number of HIV infections worldwide. Because it is a large country, this rate is not greatly reflected in overall average prevalence within the populace, which is given as three to four percent of the total population and for adults the figure is around six per cent. Such figures in other, small countries in Africa are far higher. The really acute problem in Tanzania is regions such as those in the north around Lake Victoria or even some poor provinces near the capital Dar-es-Salaam, where the rates in places are clearly in double-digit figures.

Tanzania tried to sit out the HIV epidemic for a long time: it was only in 2007, a quarter of a century after the discovery of the virus, that the government declared a national anti-HIV strategy. Previously, antiretroviral medications were often hard to get. And those affected often had to pay at least in part for the HIV-test themselves. Since 2007 things have been different : “Around western Lake Victoria alone there are over 50 Care and Treatment Centres”, says Dr. Jonathan Stephen of the Tanzanian non-governmental organisation TADEPA in the village of Bukoba on the western shore of Lake Victoria. This is one such place where TADEPA operates, by means of mobile diagnostic and consulting teams, carriying out identification and preventative work through the fishing villages of the region.
The Care and Treatment Centres cover the whole country. They form the backbone of the national treatment infrastructure. Every HIV-infected patient receives antiretroviral combination therapies there free of charge. Rapid HIV tests are also available free of charge throughout the country. This has been made possible by the “very big fish” in the funding landscape. Organisations such as the Gates Foundation and Global Fund not only give money for medicine, but sometimes even go into partnerships with “Big Pharma” or “Big Diagnostics”, or they negotiate directly through integrated involvement with local governments’ budgets. The result: “Drugs are today no longer the problem”, says Stephen.

Empower your granny!

Some years ago numerous smaller funding initiatives got into trouble when they were forced to suddenly re-orient themselves. The initiative Secure the Future of the Bristol-Myers-Squibb Foundation (BMSF), for example, started in Africa in the ’90s with anti-AIDS projects. Equipped with a foundation capital of 150 million Euro, it slipped into a kind of identity crisis, as Bill Gates and the Global Fund suddenly shovelled tens of billions into southern Africa. “We had to reorient ourselves”, says Phangi Manciya Mtshali, director of the foundation. The situation was not at all hopeless, for the HIV problem in Africa cannot be solved with money alone. Like some other funding organisations, the BMSF has been focusing for the last few years on social, community-based projects, be it in the care of children who have lost their parents to HIV, or in the organisation of mobile diagnostic and advisory networks such as TADEPA.

What it actually looks like in practice is something that can be seen in the Kibaha region, a one and a half-hour drive northwest of the coastal metropolis Dar-es-Salaam. Anyone driving around there will in places find villages, in which half the children have lost their parents to HIV. In the village squares, things are lively and cheerful as is so often the case in Africa. Only under closer inspection does it become clear that the middle generation is largely absent, or at least greatly thinned.

The fight against HIV as part of such a systemic constellation means two things. On the one hand, the remaining adults are supported, so as to provide for the livelihood of themselves and their children, regardless of whether or not these are their own. As part of the Secure the Future program, in the Kibaha region alone 45 grandmother groups with over 700 grandmothers have been put together, to whom industrial arts and agricultural skills are taught and are supported by the fund in other ways, for example, by provision of tractors.

Microcredit for HIV orphans

Secondly, the children have to obviously become very self-sufficient much earlier than happens “normally”. Not just self-sufficient in any way whatsoever, but rather a kind of self-sufficiency that preferably gets them through their education. On this point as well, innovative paths are taken in Kibaha: micro-credit programs, which the children and young people organise themselves, have been constructed. It looks like this: Shareholders meet once a week, exclusively children, who pay the weekly fee of 200 Tanzanian shillings, about 10 euro cents. Via their regular contributions shareholders acquire the right to apply for micro credit when needed, which is awarded by the three members of the so-called Directory – three girls in their teens. The loans are usually sought for school supplies and have a flat interest rate of two percent. Whoever needs therefore 10,000 shillings, gets handed 9,800.

If the entire collected capital is not issued out as microcredit in the one session, the rest goes into a pot with three locks. Only if all three “bank directors” open their respective locks is the money accessible. The goal is clear: a capital pool has been created, to which no adults have any access at all. The money allows for the children to help each other in order that they complete a fairly smooth schooling path. The first such projects were so successful that there are now in the Kibaha region alone over 100 such children-controlled micro-credit cooperatives. Almost incidently it works out that such social mechanisms can then also be used in order to pass on education on HIV matters and thus prevent that this generation ends up on the same fateful path as their parents.

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