Many people have criticized a new program in Tanzania that gives people economic rewards when they test negatively for STIs (sexually transmitted infections). Congo Girl calls this “derogatory.”

Yet, one of the many purposes of this program would be to give people money so that they don’t have to have sex for money, or engage in other risky sexual behavior associated with economic gain, a fate far more derogatory, in my opinion, that participating in this program.

(The program has other purposes and aims, but here, I’ll mainly be discussing this one.)

So, here’s the thing, sex, in an African context, is NEVER the kind of glamorous-I’m-wiedling-my-all-powerful-feminitiy-to-make-loads-of-money kind of thing. No Eliot Spitzer Number 9 here. More often than not, “risky sexual behavior” isn’t sex work as an employment category but as a means to put a coin in your pocket. The line between a sex worker and someone who has a sugar daddy is practically nonexistent, as is the line between a sex worker and someone who is hungry.

In a western context, the idea of sex work as a woman’s prerogative is controversial, but valid as a hypothesis. In Africa, it is not. The question that needs to be asked here is, why are women having risky sex? And the answer, always (okay, almost always, like 99.9 percent of the time always), is that they need the money.

They need money to buy food. To pay for shelter. To survive.

If they’re only saying yes to risky sex because of extreme poverty, then it is the poverty that is derogatory and the payout that is empowering.

One interesting comment on Congo Girl’s blog is that this will perpetuate economic inequality between postives and negatives. This is a valid point, as is another point by a reader who asks what happens to someone who is raped. These are things that the researchers should consider.

The jury is still out on whether or not this will work. I’ll be curious, along with a lot of other people, to see what happens. One thing that I worry about is the fact that women are paid out every six months: this may not be frequent enough to cover the daily grind. It’s a lot of money, as much as the annual income of most participants, but I fear the long wait in between payouts might cause participants to engage in risky behavior to cover costs in the immediate present.

But this is a concern with the program design, not the program concept. The design will be tweaked over time as the researchers figure out what does and doesn’t work.

The concept, however, is far from derogatory in my opinion. One comment on Congo Girl’s blog says that this program makes her “uncomfortable.”

The only thing that makes me uncomfortable is the thought of women having sex for the cost of a plate of beans and posho. If this program can reduce that kind of occurrence, then the commenter should handle her discomfort while the program participant is eating.

New stories I’ve written for PlusNews.

Hard labor for HIV-positive IDPs in Kampala
KIREKA, 1 May 2008 (PlusNews) – Melia Alanyo, 46, left northern Uganda for the capital city, Kampala, in the late 1980s when the rebel Lord’s Resistance Army (LRA) started abducting, attacking and killing people in her village.

She has spent the last 20 years in Kireka, a low-income suburb on the city’s outskirts, collecting and breaking rocks into chips at a local quarry. For every 20-litre jerry can she fills, she earns 100 Ugandan shillings (US$0.06). On a good day, when she is feeling strong and can take the sun beating down on her back as she chips away at the rocks, she takes home about 1,000 Ugandan shillings (US$0.60). (MORE…)

Hear Our Voices: I tell everyone I’m HIV positive
KIREKA, Carmela Acen fled her home in northern Uganda when the rebel Lord’s Resistance Army (LRA) began its insurgency campaign in 1986. She told IRIN/PlusNews about her life in Kireka, a poor township in the capital, Kampala.

“I couldn’t stay longer in Kitgum [district in northern Uganda]. Two uncles and two relatives were killed. I couldn’t stay in my village, Lukung.

“I went to Kampala and stayed with a sister in Kibuli [suburb of Kampala], and then moved to Kireka. I am caring for 28 children left behind by my brothers and sisters and in-laws. Most of the parents have died of AIDS, one of cholera and the others in the war. (MORE…)

I admit that I haven’t followed the US Presidential race as closely as I might have were I still living in the USA, but this is a salient example of why it so acutely affects things in Africa. And a salient example of why McCain is an idiot who doesn’t deserve to run a country.

The following is from the NYT Political Blog (though all emphasis is mine):

A transcript of the encounter follows. (Weaver is John Weaver, his senior adviser, and Brian is Mr. Jones, his press secretary):

Reporter: “Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?”

Mr. McCain: “Well I think it’s a combination. The guy I really respect on this is Dr. Coburn. He believes – and I was just reading the thing he wrote– that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn’t succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I’m not very wise on it.”

(Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

Mr. McCain: “I haven’t thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don’t know if I would use taxpayers’ money for it.”

Q: “What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush’s policy, which is just abstinence?”

Mr. McCain: (Long pause) “Ahhh. I think I support the president’s policy.”

Q: “So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?”

Mr. McCain: (Long pause) “You’ve stumped me.”

Q: “I mean, I think you’d probably agree it probably does help stop it?”

Mr. McCain: (Laughs) “Are we on the Straight Talk express? I’m not informed enough on it. Let me find out. You know, I’m sure I’ve taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception – I’m sure I’m opposed to government spending on it, I’m sure I support the president’s policies on it.”

Q: “But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we’re not going to distribute them,’ knowing that?”

Mr. McCain: (Twelve-second pause) “Get me Coburn’s thing, ask Weaver to get me Coburn’s paper that he just gave me in the last couple of days. I’ve never gotten into these issues before.”

This went on for a few more moments until a reporter from the Chicago Tribune broke in and asked Mr. McCain about the weight of a pig that he saw at the Iowa State Fair last year.

I don’t know what’s wrong with me sometimes. I spend the majority of my life as cynical as can be, but when I see these little kids groups performing at various conferences I’m covering, I just tear up.

Watoto is actually a musically talented group, but they’re a little too polished for me to be really affected (and the picture of the bazungu pastors on the front of their webpage seems a little off to me). But today, at the Uganda Aids Conference, these fifteen little kids in yellow tshirts with overalls on sang “Lean on Me,” and one of their own creation called “I am special,” and I just melted. Maybe it’s the maternal instinct catalyzed by off key singing. Or more likely my desire to find something redeeming about Speke Munyonyo.

Then Glibert Bukenya, the Vice President of Uganda, walked in and tear evoking singing came to an end, to be replaced by the Ugandan National Anthem. It’s not that the anthem isn’t touching, but I need more than nationalism to make me shed a tear.

Bukenya proceeded to make a speech in which he ad libbed a reference to his speech writer, then he told HIV/AIDS researchers to not complicate their research when presenting it to the government.

Maybe we should have researchers train children to sing about circumcision and home-based health care? That could bring a tear to my eye.

IRIN and PlusNews don’t use bylines, but yes indeed, this is my work. A lot of the time I do work to finish it and invoice for it, but this is a story that I’m pretty happy with. Oh, and if you read my previous post about the taxi to Jinja, this article explains why I spent two hours going to Jinja, two hours on the way back, for a one and a half hour interview – ie, nearly four out of six hours in transit.

KAMULI, 17 March 2008 (PlusNews) – Admitting to being HIV-positive is a difficult task for anyone, but David Balubenze was faced with some special challenges as the pastor of Deliverance Church Nankandulo, in Kamuli, about 100 kilometers from the capital, Kampala.

READ MORE…

I’m filing left and right, so I won’t put the full text of the stories here, just some links to my work (PlusNews doesn’t use bylines, but if you check the page, the Uganda stories are mostly ones I’ve written.)

Women shoulder AIDS burden

Home-based HIV treatment extends lives

Africa worst affected by shortage of health workers

I’m filing left and right, so I won’t put the full text of the stories here, just some links to my work (PlusNews doesn’t use bylines, but if you check the page, the Uganda stories are mostly ones I’ve written.)

Women shoulder AIDS burden

Home-based HIV treatment extends lives

Africa worst affected by shortage of health workers

KAMPALA, 4 March 2008 (PlusNews) – Much excitement greeted the opening of Quality Chemicals in 2007, the first manufacturer of antiretroviral (ARV) medication in East Africa, but six months later the production lines are still idle.

The spacious factory, which cost about US$38 million and covers roughly 1,115 square metres, can produce around two million ARV tablets in an eight-hour shift, but the National Drug Authority (NDA) of Uganda has not yet granted it a license to produce the life-prolonging pills.

A long inspection process required for licensing and manufacturing the drugs has caused the delay, but factory officials expect it to be granted in the very near future.

Quality Chemicals managing director Emmanuel Katongole said the cost of their ARVs would be significantly lower than the $15 per month the government paid for imported generics; he also anticipated orders from the ministries of health in neighbouring Kenya, Rwanda and Tanzania.

Uncertain market

But until the factory gets the go-ahead from the UN World Health Organisation (WHO), and ARVs from Quality Chemicals are added to its list of recommended drugs after a WHO-NDA joint inspection, neither governments nor non-governmental organisations (NGOs) will buy.

“There is an understanding that if Quality Chemicals produces commodities of international standards, approved by the WHO at a competitive price, then the Ministry of Health will procure,” said Kenya Mugisha, director of clinical and community health services for the Ministry of Health. “But they must meet general manufacturing practices.”

An estimated 300,000 Ugandans need the life-prolonging medication. About 50,000 of the 106,000 people receiving ARVs in Uganda are supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), a worldwide initiative by the US government to combat the spread of HIV/AIDS; most of the rest obtain their ARVs via the US-based Global Fund to Fight AIDS, Tuberculosis and Malaria, in conjunction with Uganda’s Ministry of Health.

PEPFAR has strict procurement regulations and procedures that must be followed before its money can be spent on ARVs from Quality Chemicals, including an inspection by the US Food and Drug Administration (FDA), a regulatory body.

“There’s no reason why it shouldn’t happen, it’s a question of making it happen,” said Permilla Bartlett, the PEPFAR coordinator in Uganda. There is no FDA inspection planned in the near future, and even after an FDA inspection, “procurement has to follow certain regulations”. PEPFAR already has procurement partners, so it may be difficult for Quality Chemicals to become a supplier.

Quality Chemicals will also produce the anti-malaria medication, Lumartem, which contains artemisinin and lumefantrine but is significantly cheaper than Coartem, the WHO-recommended first-line brand containing the same ingredients.

“Nairobi called, I have to go,” I say to David, very often these days.

Sometimes, I feel like an entire city in Kenya owns me. And I guess they kind of do. When “Nairobi Calls,” it is someone from AP asking me to go somewhere, usually about twenty minutes after they call, or someone from my brand-spanking-new position at PlusNews, where they seem to have a previously unheard of appetite for HIV news. All HIV all the time.

It’s great – I’ve never been so busy and my days at Daily Monitor are finally numbered (and yes, yes they do still owe me a lot of money per contract, but no, no I don’t think they will ever actually pay me). I won’t miss the pig-pen o’ journalists also known as a news desk, with 40 people queuing for one phone, but I do miss the more leisurely pace, the time to blog, the time to respond to emails.

So yes, yes this is really an excuse disguised as a blog post. An excuse for not blogging more, and for not writing back to you, dear friends. Sorry, Nairobi called.

Reuters AlertNet link to my story
(but more pictures if you read it here…)

The gate of Mityana Prison, an hour east of Kampala, is guarded by a single khaki-clad officer with a rifle. As prisons go, it’s not large, housing just 107 inmates.

Zaini Kizire, 28, is one of two HIV-positive prisoners here. Sitting with a group of female inmates, all wearing beige smocks, untailored except for sleeves, she folds her body into the smallest space possible on the concrete floor.

Asked what they know about AIDS, no one replies. Then Kizire says: “First, you get tested, then retested, then they do a CD4 count, then you take two tabs, one white and one yellow.”

Her understanding of HIV/AIDS isn’t technical or epidemiological, but Kizire is one of the few prisoners with even a basic grasp of how the disease works.

In one of the men’s cells, measuring five by five meters (16 by 16 feet) and holding about 20 inmates, an older man says AIDS is a disease that affects the young and the aged, that you catch it through sex or sharing sharp objects like razors, and there wasn’t a cure.

Another prisoner, wearing a faded Nokia t-shirt, spoke up after a few minutes: “AIDS is a biological weapon. The only solution is that the physicians who manufactured it be kind and find medicine.”

In the next cell, similarly small and with just as little natural light, it was the inmates who asked the questions. “If someone has not been tested, what should he do?” asked one. “If I have the disease and my wife has it as well, will our child have it?”

Kizire and the other HIV-positive inmate make a trip to a local hospital once a month to collect their anti-retroviral drugs (ARVs), as upcountry prisons have no health facilities. The hospital is 1.5 km (1 mile) away and the prison has no form of transportation for the inmates. She fears the day when she’s too ill to walk.

LIVING ON ARVS

In Luzira Prison on the outskirts of Kampala, the situation is different. Luzira houses 25 percent of Uganda’s 27,000 prisoners, and at least 300 are HIV-positive, although most inmates have not been tested.

Here there is a medical centre, Murchison Bay, within the prison compound that distributes ARVs and the prophylaxis Septrin (which helps prevent opportunistic infections, though it isn’t always effective.).

Unlike many African prison systems, Uganda’s recognises the threat posed by AIDS. “These walls are temporary,” says Michael Kyomya, the medical superintendent at Murchison Bay. “Prison can be an incubator for infection, and it will spread to the community.”

Though Kyomya and his staff try to serve the vast needs of the prisoners and the community – who also visit Murchison Bay as a referral clinic – he says they are grossly underfunded. Their budget of 130.5 million shillings ($77,000) per annum is about half what a centre their size usually receives.

“The UPS (Ugandan Prison Service) is working hard to scale up provisions of care,” said Megan Rock, protection coordinator for the International Committee of the Red Cross (ICRC) in Uganda. “There’s a lot of good will and mobilization of external partners.” Currently, the ICRC is working in active partnership with the UPS and the health ministry on a joint pilot project to address the problems of malaria, tuberculosis and HIV/AIDS.

Ugandan President Yoweri Museveni was one of the first African leaders to acknowledge the HIV/AIDS pandemic sweeping the continent, and made tackling it a priority. The country’s prevalence has dropped to about 8 percent from around 15 percent in the early 1990s. But critics say rates are on the up again due to the government’s decision to shift emphasis in AIDS education from condoms to abstinence.

Condoms are not available to prisoners, despite acknowledgement from officials that some of the inmates were having sex. “Although (homosexuality) is not culturally accepted, one cannot deny that it is there,” says Mary Caddu, prison commissioner for support services. “If infected prisoners don’t get information, they will infect others through homosexuality.”

Charles Bagenda, a prisoner in charge of AIDS-control activities in Luzira’s Upper Prison maximum security unit, says the ratio of AIDS counsellors to prisoners was one to 160. “Living with HIV in prison is different than outside,” says Bagenda. “People who are incarcerated are alienated from their families, so all the support comes from within the system.”

One of Bagenda’s duties includes running a support group for HIV-positive prisoners called the “Post Test Club,” which meets on Fridays. At a recent meeting, prisoners in yellow uniforms with thin black stripes complained about the scarcity of Septrin and a lack of proper nutrition, blankets, and other supplies.

They also shared practical tips for living on ARVs in prison. “We watch when the Muslims begin to pray to mark time to take our ARVs,” said one prisoner, who declined to give his name. He later added: “The club gives us courage and we don’t worry because you know you are not alone suffering. We get confidence and it gives us a go-ahead to tell our friends about the disease.”

But Zaini Kizire, the HIV-positive female inmate at Mityana Prison, has no such support system. Recalling how it was when she first entered prison, she said: “The other ladies feared me, didn’t want me to touch the cups and plates.”

With her next trial date approaching, she doesn’t know which would be worse – to serve more time with the disease or try to cope in the outside world. At least in prison, the government gives her ARVs once a month.