Women’s Equity in Access to Care & Treatment, or WE-ACTx, aims to provide the women and children of Rwanda with proper access to healthcare and treatment. Nearly 10 years after the Rwandan Genocide, this HIV/AIDS initiative brought much needed aid to communities of women and children in Kigali. Now, more than 12 years later, the organization continues its work, offering not only clinical care and mental health services for people infected with HIV/AIDS, but also youth programs and support with income generation—aimed at addressing both poverty and malnutrition.
I caught up with Mardge Cohen, co-founder of WE-ACTx, and spoke a bit about the organization’s origins, progress and successes, which have allowed this quite exceptional organization to thrive among the people of Kigali, Rwanda.
Tell me, how did WE-ACTx begin?
“The organization was started in 2004. We went to Rwanda because one of the other people who formed the organization, named Anne-Christine d’Adesky, a journalist, had been writing a book about HIV and women. She had been to Rwanda and these heads of associations talked to her about how the women of Rwanda, who had been raped during the genocide and were then infected with HIV, were not getting access to medicines for HIV. But the men who raped them, who were in jail, were getting medicines for their HIV. These women thought that was very unfair, and they asked Anne-Christine to bring a bunch of physicians and advocates to help fast-track medicine for these women because they were getting very sick and dying.
The genocide was in 1994 and this was in 2004, and it takes about a decade, 10 years, after you’re infected with HIV to become very sick. The women were just getting sick and the leaders of these associations wanted to do something about it.”
Do you feel that these at risk populations of Rwanda are ignored by the government, or were ignored?
“In 2004, nobody was getting medications for HIV. It was before PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief). It was before the global fund. It was at a time… you know I’d been working on HIV since 1987, and people were saying things about Africa: ‘Well, we’ll just give them medication for pneumonia, for prophylaxis. We can’t afford… and the people in Africa wouldn’t know how to manage, there isn’t a good enough infrastructure to manage the antiretroviral therapy, so we’ll just ride them off.’ And they were going to ride them off. You know, right now there are 36 million people living with HIV worldwide and 26 million of them are in Africa, and most of them are in Sub-Saharan Africa.
That’s an enormous number of people that people were thinking of just riding off, so the governments of those countries in Africa really had no wherewithal to actually help people. The drugs weren’t there. They weren’t letting the drugs get there, so my feeling is my experience in Rwanda was in fact the government seriously wanted to help people. Once medication became available, they figured out ways to actually control the dispersal of the medicine so that it got out to people, and they tested everybody. I was aware of some countries where tests got outdated, expired, in garages and never got to people—that’s not what happened in Rwanda. In Rwanda, they really tried.”
You didn’t face much resistance from the government?
“Well, our approach was a little bit different from the government’s because our approach was very women-centered and youth-centered, and their approach was more decentralized… sort of a public health model where people would just go to the nearest clinic to where they lived. Everybody would sort of be engaged in the healthcare system that way, but because HIV comes with a lot of stigma people didn’t really want to go to clinics near where they lived. Women sort of liked the idea of going to a place that cared about women and worried about their emotional reaction to HIV, gender-based violence and helping them try to become productive members of society—not just worrying about HIV as it affected the baby or the husband, but rather cared about them as real people. So, people wanted to come to our program even though it may not have been a neighborhood clinic.
That was a little bit problematic for the Rwandan government. They didn’t like that so much, but they then saw that we did very well with connecting women to care and having people with very good retention rates and adherence to medication. Then, after a while, we had a lot of good youth programming because we had so many women who they had kids—a lot of attention to youth friendly programs. Then we got on better with the Rwandan government public health system and now we’re in very good shape. We do a research program with their principal investigators, and we’re principal investigators; It’s much more collegial.”
What did you have to do to overcome cultural differences? I know that specifically in Rwanda, people don’t very much like to talk about things involving sex.
“So, there was a pretty big public health campaign to get people tested. And, you know, in Africa it’s said that one of the major risk factors for a woman having HIV was being in a monogamous relationship with her husband. It’s just that he probably is not in a monogamous relationship with her. Women who had done everything they were supposed to do, get married, have children, they were at risk for HIV. As a result, we didn’t really have to have that many difficult conversations with them, but they were reticent to talk about things… but after a while, we used a model of peer advocacy.
We found some Rwandan women who were HIV-infected who were sort of a bit more leader-ish and wanted to sort of help other women. We utilized them to help us understand what the cultural differences were and for them to sort of share with the other women what efficacy the drug we had and the approach we were taking. That really, really helps—a peer model really got through some of those cultural differences. I think one of the things that I learned was that you have to be very patient; I’m a very impatient person and things are very slow, and change happens over a long period of time. It’s not quick. There was a lot of stigma related to HIV and there still is because we went there 11 years ago and now its 2015 but there’s still a lot of stigma.”
Did you do some advocacy in the community to try to change that perception?
“We did, especially if there were kids in schools or if there were neighborhoods that were giving people a hard time or landlords who kicked people out of their homes. We did legal training of advocates to sort of have the people… you see, there aren’t that many lawyers in Rwanda and the case loads that they have are so great that there’s sort of a paralegal system and we try to train our patients—a significant number of them—to participate that way in dealing with those issues. That sort of helped. We also tried to provide a very joyous atmosphere for the children because their lives are pretty rough, and every year we have this thing called ‘Day of the African Child’—a big party for all the families, like 1,200-1,400 people come and have a big party and its just to celebrate that they’re alive. Those kind of thing help the parents and the patients realize that we were not trying to get away with anything or do anything bad, but really just trying to provide a better quality of life for people who are HIV-infected.”
Was it a bit difficult to break into the community in Kigali?
“Well, luckily, these groups—these women’s groups, these leaders who had spoken to my friend Anne-Christine d’Adesky—they were still there. Initially, it started with 5 groups, and they called us in and told us where to go and they told us what to do, so I never felt like I was . . . bringing our stuff and putting it on people in Rwanda. I felt that the Rwandans had called us in. I thought that we were very lucky to have that approach, and they told us what they wanted from us. That made it, I think, a good way to be in another culture, in another country, and we’ve maintained that. We have partner association meetings four times a year where we review what’s going. We didn’t have to put up a shingle and hope people would come. Basically, those associations keep bringing their members to us, so I think it a pretty good model for being connected to community groups. You know, AIDS groups, women groups, local groups, service groups…
Then there’s the issue of the genocide and I think those are some of the lessons we learned, too. In some of the groups, people didn’t always want to work together, and we had a sort of… We didn’t understand that, or we didn’t think of that as behind some of the problems that we encountered, but it sometimes was. But now, the staff is sort of mixed grouping and everybody have bought into the mission to provide good HIV care for children, women, their partners and their families. And I think everybody does the best they can to make that happen.”
Do you feel that a substantial amount of progress has been made?
“Oh yeah! I mean, HIV is a deadly disease. We now have about 2,600 people—I’d say 90 percent—of those over 25 adhere wonderfully to their medicines and are doing great. A small percentage need a lot more help to take their medicine and keep doing well. The younger people, who have had the disease longer because most of them were born with it, have sometimes become resistant to some of the medicine. So, we have to put them on more complicated regimens.
Some of the good medicines we have in this country are not readily available there. When I first started that was true. Then for a while, the medicines we had in Rwanda and the medicines we had in the U.S. were the same. Now the U.S. is way, way passed Rwanda and a lot of countries in Africa and Latin America. They don’t have the medicines we have, which are really excellent medications. So, that’s a problem, but there is generally progress. I watched, at this ‘Day of the African Child,’ I watched kids who I knew when they were 10 who are now 21 years of age, and they’re confident, they’re strong, they’re going to university—it’s amazing! It’s an enormous amount of progress!”
Was the genocide the main reason why you chose to work in Rwanda?
“It was more HIV, but in the context of the genocide. I had an interest in intimate partner violence because I had seen a lot of that in the care I gave women in Chicago who were HIV infected. We’ve done studies, and there’s just high prevalence of gender-based violence, like 62 percent lifetime—here [in the U.S.]—experience with either sexual, physical, or emotional abuse. Then, we looked at it in Rwanda, in our clinic, post-genocide, and it was 62 percent also. It was the same in both countries—you know poor population, difficult situation of sexually transmitted disease where people go off to try to make a living somewhere else… In the U.S. there was lot of drug use and a lot of difficult relationships with partners. There had been issues [in Rwanda]—people had lost partners during the genocide, people had been raped during the genocide. I was interested in Rwanda because my friend had been here and we had been asked to go, but I thought that because of everything that I had learned related to women with HIV and their experiences, it would be useful in this ultimate experience of gender-based violence, which was the genocide, where about a quarter of a million women were raped. So it was sort of both things.”
What do you think the main difference is between the government in Rwanda and in a country like Zimbabwe, which has seen a lot of resistance to NGOs that are trying to come into the country trying to help people with HIV?
“I think Rwanda sort of benefited post-genocide and by the 2001-2003 people coming in. A lot of Western and European countries that felt so guilty of not helping during the genocide were now giving lots of money. At the same time, there was lots of money going into HIV in a lot of countries, but the difference was that . . . there was money straight to the government and there was NGOs’ money, but what Rwanda did—very importantly—was it controlled the NGOs a lot, or tried to. There was a very strong government presence… very strong. One can’t write anything related to Rwanda without mentioning how wonderful the Rwandan government is. One can’t really be there without somehow being acknowledged by or understand the relationship with the Rwandan government, but its not just that; It’s that there was a lot of government will in Rwanda to do well in terms of the HIV epidemic, and in some sense, I think they wanted to be a poster-child for being able to distribute medicines well and lower the prevalence as opposed to be known for the genocide. It was a way to sort of make history—current history—much more positive as a country. And they were one of the best at utilizing the many millions of dollars that were given to them to help with the HIV epidemic. I think it was disproportionately more than what other countries got, but they utilized it extremely well. The other countries who maybe should have gotten more never used it well, often. There wasn’t the same governmental will, which I think you need.
It’s not just an issue of, are the NGOs disorganized? are they sort of stepping all over each other? and are they not doing what’s right? There are those issues, which I did see a bit in Rwanda and I had seen in a lot of other countries, but what I didn’t see in Rwanda was a government that wasn’t taking the epidemic seriously. They really put energy and resources… they used the resources they got to have a very strong public health system which helped HIV and other things along the way. It really addressed maternal mortality, infant mortality… When I started in Rwanda there were 30 doctors for 10 million people, and now there are so many more physicians and nurses who are trained related to HIV. And I think it’s an issue not just of the government’s relationship to NGOs, but of the government itself, having a strong presence related to the problems that the society is facing. I think that’s different from Zimbabwe and other countries.”
What do you think is lacking in terms of support for NGOs that do the same work that you do?
“Well, we have to do a lot of fundraising and I mean that is hard . . . that is one of our issues and it is a lot of work to raise money. I think what we do is really deliver the product we say we’re going to deliver, and I think that’s why we’ve been successful so far in our fundraising. We’ve been sustained for 11 years, so that speaks to our success in itself.
What I think we did that was good is that right now in Rwanda there is a local NGO called WE-ACT for Hope. It’s all Rwandan-run and they now manage the entire clinic, so our job is to fundraise a certain amount that we commit to, along with a few other groups that they get money from, and we do a lot of guidance related to program and other things, research… but they’re responsible—they are running the show. I think if you have local folks running the show, not just in a body, but rather the responsibility of a true locally credentialed NGO, which is also what Rwanda encourages, that’s a good way to go!”
– Jaime Longoria
Sources: Mother Jones, WE ACTx
Photo: WE ACT
Coffeed Chain Helps Charities
Coffeed’s CEO and founder, Frank “Turtle” Raffaele, was a stock trader on Wall Street before the 2008 stock market crash. After the crash, he decided to pursue a new path and started Coffeed along with three other former traders. The flagship café opened in 2012 in Long Island City. Currently, there are six Coffeed stores in New York City, and, to take the company international, a seventh café is planned for Seoul. Each location is partnered with a different local nonprofit, such as Community Mainstreaming Associates or the Refugee and Immigrant Fund.
One shop is located in Chelsea at the headquarters of the Foundling organization, a nonprofit that provides foster care and adoption services. Coffeed donates to Foundling in exchange for reduced rent in this busy location. They also dedicate a portion of the café to displaying information about Foundling’s work and issues related to poverty and inequality. Furthermore, they employ some of Foundling’s clients, including developmentally disabled adults and teenaged foster children.
Coffeed’s flagship café partners with Brooklyn Grange, a small farm located on their rooftop. They source most of their produce from this farm and support the City Growers organization, which educates the community about sustainability and agriculture.
Raffaele operates Coffeed on a number of important principles. They serve only Fair Trade coffee and try to keep business local by sourcing high quality ingredients from local vendors and supporting local charities. The cafes are meant to be safe, comfortable spaces for customers where they can enjoy food and coffee at reasonable prices. They work to promote sustainability by engaging in environmental practices such as composting. They regularly refine their coffee roasting and prep procedures. Staff members are carefully selected and work to educate consumers about their products. But the guiding principle for this company is putting charity first.
Raffaele hopes to open 15 to 20 locations in the next five years by connecting with fundraisers and investors. One of his main objectives for Coffeed is to prove that business can be both charitable and profitable. The model has been successful so far and could inspire more businesses to follow suit as the chain goes international.
– Jane Harkness
Sources: Coffeed, Huffington Post, Inc., Small Business Trends, The Times Ledger
Photo: Daily Coffee News
Good Books Gives Retail Profit to Oxfam
It’s possible through the Auckland, New Zealand based company, Good Books. Just by shopping for books on their website, one can directly help the world’s poor through an automatic donation to Oxfam New Zealand, a partner of the general Oxfam family.
This is possible through a business plan by Good Books, which includes several partners that can donate their time or services to make the operation have zero operating costs.
For example, all the workers directly associated with Good Books are unpaid. The organization’s book distributor, Paperback Shop UK, handles the actual moving of the merchandise and supplies the website and management services. Also, the organization is able to build the company’s brand through media support and customers spreading the word.
But this specific labor is for a great cause since all retail profits are sent to Oxfam, an organization that works on many fronts trying to end global poverty.
Oxfam’s work is varied; the Oxfam America website specifically says the following about their work which is indicative of the organization’s work as a whole:
“No one should go hungry.”
“We all have the right to clean water.”
“All people deserve to live safely.”
“Women and girls are crucial to reducing poverty.”
“We all deserve the opportunity to earn a decent living.”
“People have a right to participate in decisions that affect their lives.”
“We must help poor communities cope with climate change.”
“Poverty is not inevitable.”
“People have the power to end poverty.”
While the purchase/donation cannot be earmarked through the Good Books’ website, purchasing the books matches well with the statements, “women and girls are crucial to reducing poverty,” and “we all deserve the opportunity to earn a decent living.” Both of those ideas hinge on education for the masses to move people out of poverty.
Oxfam New Zealand says that “every extra year a girl spends in school could reduce child mortality by ten percent.” So, much of their good work is built around education initiatives to help the community.
Oxfam and their partners have helped rebuild schools in Pakistan, get clean water for students in Nairobi, teach about women’s rights in Guatemala, and even giving goats to families in Ethiopia where the selling of offspring and goods provides money to send daughters of poor families to school.
By buying books from Good Books, consumers can use their purchasing power to help all the areas listed above. Specifically though, one can use their money to directly aid the fight against poverty while also reading a book that can change the mental attitudes for those in developed countries. Awareness and change concerning poverty can be worked on in two very distinct ways through the purchase of books.
– Megan Ivy
Sources: Good Books, Oxfam America, Oxfam New Zealand
Photo: Oxfaminternation
Can the Infectious Disease Yaws Be Eradicated?
Yaws is the most common endemic treponematoses, a group of bacterial infections that also includes nonvenereal syphilis and pinta. All of these infections are transmitted through non-sexual contact with an infected person. They can cause skin lesions, bone pain, bone lesions, nose deformities and the thickening or cracking of a person’s hands and soles of the feet. The World Health Organization (WHO) estimates that 75% of infected people are under 15 years of age, with most cases seen in children aged 6 to 10. Gender is not a determining factor of infection.
Yaws is spread through skin-to-skin contact, usually after a small injury occurs, something common when children play. Yet, WHO states that “overcrowding, poor hygiene and socioeconomic conditions facilitate the spread of the yaws.”
The disease is not life-threatening, which is likely why it became a neglected disease in the scope of global disease work. But if left untreated, a person can become permanently disfigured and disabled. Such a diagnosis is bad for anyone infected with the disease, but since mostly children suffer from yaws, it becomes a life-long issue if not resolved quickly. When a child contracts yaws, their ability to go to school is jeopardized. If left untreated, absenteeism rises among children and their future employment, especially feeding their families through farming, is impacted.
It has long since been thought that yaws could be a disease that can have complete eradication since humans are the only carriers of the disease. Previously, initiatives to eradicate yaws were undertaken with almost complete success. But the mass effort was prematurely lifted and the disease returned, though not quite on the same scale as before.
Recently, the idea of complete eradication has come back up. The two most effective antibiotics to treat yaws are azithromycin and benzathine penicillin, both of which can be given with relative ease. Even though no vaccine is available for yaws, if early diagnosis is achieved, treatment with the antibiotics can occur and sanitation can be improved to help stop the spread of the disease. With the steps, the end of yaws is in sight.
There have already been cases of previously endemic countries achieving complete eradication, including India. The Yaws Eradication Programme (YEP) was launched in India in 1996 with the goal to have complete eradication in the country. In 1997, 735 cases of yaws were reported; in 2004, the country was considered to have achieved “Zero Case.” Because not all cases of yaws are reported, only time will tell if complete eradication can be sustained, but right now all signs are pointing to success.
With great things already happening in India and a plan in place to achieve more success globally, yaws should be eradicated from remaining endemic countries by 2020.
– Megan Ivy
Sources: PubMed.gov, WHO 1, WHO 2
Photo: Chacha
Ultimate Frisbee Encourages Prosperity in Chennai
Sports have rules and require dexterity. Ultimate frisbee gives players the freedom to set their rules without referees. It is a leisure sport in the United States, where teams wear matching uniforms and have decorated discs. Often times, events are scheduled at parks, where participants plan day-long activities.
The challenge by Sundance asked for submissions of videos or fictional narratives featuring positive stories about individuals or groups who are beating poverty. There were 90 countries that participated, but a moviemaker in India named Mirle won the competition with his documentary of teens in India’s slums who play ultimate frisbee.
Of the 1.1 billion residents in India, approximately 231,631,442 have been recorded as living in poverty, as of 2010. In coastal areas, fishermen live in depleted conditions. The environment deteriorates because it is vulnerable to natural disasters.
Manu Karan spent time in Boulder, Colorado and returned to Chennai, a city on the coast, in 2007 to complete his MBA program. He had learned how to play ultimate frisbee while in Colorado and brought the game back with him, becoming the founder and president of Chennai Ultimate Frisbee.
The city has 300 players and is home to most of India’s participants in the sport. Children of fishermen, ragpickers and shopkeepers watch other players and eventually join the fun.
Ultimate frisbee cut into bad habits adopted by teens, bringing purpose to lives that had previously felt directionless. These adolescents would often steal mangoes and get into fights on the streets. But all, even those who didn’t have shoes, televisions or enough money to play other sports, were welcome to play ultimate frisbee.
This sport can lift people out of poverty and halt repetitive bad habits. A code of ethics is passed on to both participant and bystander. “175 Grams,” the film created for the Sundance Institute Short Film Challenge, features a team called Fly Wild, where a certain player is determined to continue schooling and maintain a humble reputation.
Teams contain a mixture of social divisions. Many players have different backgrounds, speak different languages, follow different religions and have different amounts of wealth. Men and women are mixed together in teams. There are usually three women for every four men.
Because of this sport, teenagers are learning how to respect others and dress professionally. Nongovernmental organizations such as Pudiyador and IndiCorps are using the sport to educate youth about leadership practices, the importance of unity and gender equality.
Facing separate creeds used to be intimidating, but ultimate frisbee essentially forces others to interact or reconcile, ignoring these differences for the sake of sport. People from the slums and people from upper-middle class families inspire each other. The poor aspire to learn English and desire higher education and opportunity.
Dan Rule, the coach of Australian ultimate players, helped to develop low-cost ways to keep Chennai’s under-23 team players in shape since they do not have access to a gymnasium or other basic equipment. The players of the Australian ultimate team also donated cleats to the players.
It has been seven years since the game was introduced to Chennai. The players of India’s first under-23 team are scheduled to fly to London in mid-July for an opportunity to compete for the World Championship. They have already won 11th place in competition for the World Championship in Dubai.
There are approximately five million people enjoying the sport in the United States. Ultimate frisbee creates family ties, inspires children and gives adults the opportunity to share their excitement for the game.
Fly Wild and U23 are responsible for shaping lives. People in impoverished India are encouraged to rise out of poverty. Teams are inspiring and uniting the youth of their communities through the sport.
– Katie Groe
Sources: Global Post, Fast Company, Rural Poverty Portal, Huffington Post
Photo: Global Post
Wealth and Violence Collide in Buenaventura, Colombia
Colombia has been described by some as a country with two faces: one face is the Colombia of the elite and wealthy, while the other is a Colombia marked by violence, gang lords and a vicious drug trade. Once considered too dangerous for visitors due to a brutal civil war between various factions of the government and paramilitary groups, which began in 1964, Colombia has since cleaned itself up, with major cities like Bogota and Medellin now considered hot-spots for tourism. Despite massive improvements that have benefitted the country in recent years, as of 2013 an astonishing 30.6 percent of the population was living below the poverty line, according to the World Bank. Colombia also remains the world’s largest cocaine producer, supplying 90 percent of the cocaine consumed in the United States.
Buenaventura, a port town located on the Pacific Coast, is a perfect example of the way in which these “two faces” can collide.
On the one hand, Buenaventura struggles with a legacy of violence that continues to characterize the culture of the city today. During the 1980s, the city was a battleground between leftist guerrillas of the Revolutionary Armed Forces, or FARC, and right-wing paramilitary groups. When the FARC were driven out, paramilitary groups established themselves and began to engage in gang activity, helping to carve the city into rival gang territories and the port into an important regional focal point for the export of cocaine. According to a Human Rights Watch report, these groups have taken the lives of many Buenaventura residents, who are often dismembered in so-called “chop houses” for unwittingly crossing between gang territories.
On the other hand, due to its strategic location on the coast, Buenaventura has recently become the centerpiece of a government strategy to increase Colombian trade with Asian and Western countries on the Pacific, such as the United States, Chile, Mexico and Peru. To achieve this goal, the central government in Bogota has invested millions in development projects, such as the construction of a container port and industrial park, as well as the construction of a major waterfront development project that authorities hope will help attract tourism.
Residents, however, have argued that there is a link between the recent rise of violence in the city and the development projects. Locals, for instance, point to the fact that much of the violence has been concentrated in and has affected locals living in areas along the port. Residential habitation of the area obstructs government plans to turn the area into a tourist destination.
In response to protracted levels of violence in the town, which has recently received increased media attention, Colombian President Juan Manuel Santos finally intervened last year, sending in an emergency infusion of cash as well as police officers from the capital.
According to Colonel Marcelo Russi, the police commander in Buenaventura, the added law enforcement has helped to dramatically reduce the murder rate and number of disappearances in the city. Alexander Micolta, the executive president of the Buenaventura Chamber of Commerce, however, has stated that not enough is being done to effectively eradicate violence from the city. “Here, everything that has to do with the port advances. But the city doesn’t advance,” Micolta said.
In order to save Buenaventura, it is evident that money invested in the city needs to be focused on protecting the people who actually live there instead of in efforts to attract foreign investment and tourist capital. Otherwise, the city’s long history of violence and gang activity will continue to perpetuate itself and invade every corner of the city once the police presence leaves. If that happens, then Colombia’s “two faces” will persist to rear their ugly heads in tandem in the country’s small, sea-side city of Buenaventura.
– Ana Powell
Sources: New York Times 1, New York Times 2, World Bank
Photo: War on Want
Interview with Mardge Cohen, Co-Founder of WE-ACTx
I caught up with Mardge Cohen, co-founder of WE-ACTx, and spoke a bit about the organization’s origins, progress and successes, which have allowed this quite exceptional organization to thrive among the people of Kigali, Rwanda.
Tell me, how did WE-ACTx begin?
“The organization was started in 2004. We went to Rwanda because one of the other people who formed the organization, named Anne-Christine d’Adesky, a journalist, had been writing a book about HIV and women. She had been to Rwanda and these heads of associations talked to her about how the women of Rwanda, who had been raped during the genocide and were then infected with HIV, were not getting access to medicines for HIV. But the men who raped them, who were in jail, were getting medicines for their HIV. These women thought that was very unfair, and they asked Anne-Christine to bring a bunch of physicians and advocates to help fast-track medicine for these women because they were getting very sick and dying.
The genocide was in 1994 and this was in 2004, and it takes about a decade, 10 years, after you’re infected with HIV to become very sick. The women were just getting sick and the leaders of these associations wanted to do something about it.”
Do you feel that these at risk populations of Rwanda are ignored by the government, or were ignored?
“In 2004, nobody was getting medications for HIV. It was before PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief). It was before the global fund. It was at a time… you know I’d been working on HIV since 1987, and people were saying things about Africa: ‘Well, we’ll just give them medication for pneumonia, for prophylaxis. We can’t afford… and the people in Africa wouldn’t know how to manage, there isn’t a good enough infrastructure to manage the antiretroviral therapy, so we’ll just ride them off.’ And they were going to ride them off. You know, right now there are 36 million people living with HIV worldwide and 26 million of them are in Africa, and most of them are in Sub-Saharan Africa.
That’s an enormous number of people that people were thinking of just riding off, so the governments of those countries in Africa really had no wherewithal to actually help people. The drugs weren’t there. They weren’t letting the drugs get there, so my feeling is my experience in Rwanda was in fact the government seriously wanted to help people. Once medication became available, they figured out ways to actually control the dispersal of the medicine so that it got out to people, and they tested everybody. I was aware of some countries where tests got outdated, expired, in garages and never got to people—that’s not what happened in Rwanda. In Rwanda, they really tried.”
You didn’t face much resistance from the government?
“Well, our approach was a little bit different from the government’s because our approach was very women-centered and youth-centered, and their approach was more decentralized… sort of a public health model where people would just go to the nearest clinic to where they lived. Everybody would sort of be engaged in the healthcare system that way, but because HIV comes with a lot of stigma people didn’t really want to go to clinics near where they lived. Women sort of liked the idea of going to a place that cared about women and worried about their emotional reaction to HIV, gender-based violence and helping them try to become productive members of society—not just worrying about HIV as it affected the baby or the husband, but rather cared about them as real people. So, people wanted to come to our program even though it may not have been a neighborhood clinic.
That was a little bit problematic for the Rwandan government. They didn’t like that so much, but they then saw that we did very well with connecting women to care and having people with very good retention rates and adherence to medication. Then, after a while, we had a lot of good youth programming because we had so many women who they had kids—a lot of attention to youth friendly programs. Then we got on better with the Rwandan government public health system and now we’re in very good shape. We do a research program with their principal investigators, and we’re principal investigators; It’s much more collegial.”
What did you have to do to overcome cultural differences? I know that specifically in Rwanda, people don’t very much like to talk about things involving sex.
“So, there was a pretty big public health campaign to get people tested. And, you know, in Africa it’s said that one of the major risk factors for a woman having HIV was being in a monogamous relationship with her husband. It’s just that he probably is not in a monogamous relationship with her. Women who had done everything they were supposed to do, get married, have children, they were at risk for HIV. As a result, we didn’t really have to have that many difficult conversations with them, but they were reticent to talk about things… but after a while, we used a model of peer advocacy.
We found some Rwandan women who were HIV-infected who were sort of a bit more leader-ish and wanted to sort of help other women. We utilized them to help us understand what the cultural differences were and for them to sort of share with the other women what efficacy the drug we had and the approach we were taking. That really, really helps—a peer model really got through some of those cultural differences. I think one of the things that I learned was that you have to be very patient; I’m a very impatient person and things are very slow, and change happens over a long period of time. It’s not quick. There was a lot of stigma related to HIV and there still is because we went there 11 years ago and now its 2015 but there’s still a lot of stigma.”
Did you do some advocacy in the community to try to change that perception?
“We did, especially if there were kids in schools or if there were neighborhoods that were giving people a hard time or landlords who kicked people out of their homes. We did legal training of advocates to sort of have the people… you see, there aren’t that many lawyers in Rwanda and the case loads that they have are so great that there’s sort of a paralegal system and we try to train our patients—a significant number of them—to participate that way in dealing with those issues. That sort of helped. We also tried to provide a very joyous atmosphere for the children because their lives are pretty rough, and every year we have this thing called ‘Day of the African Child’—a big party for all the families, like 1,200-1,400 people come and have a big party and its just to celebrate that they’re alive. Those kind of thing help the parents and the patients realize that we were not trying to get away with anything or do anything bad, but really just trying to provide a better quality of life for people who are HIV-infected.”
Was it a bit difficult to break into the community in Kigali?
“Well, luckily, these groups—these women’s groups, these leaders who had spoken to my friend Anne-Christine d’Adesky—they were still there. Initially, it started with 5 groups, and they called us in and told us where to go and they told us what to do, so I never felt like I was . . . bringing our stuff and putting it on people in Rwanda. I felt that the Rwandans had called us in. I thought that we were very lucky to have that approach, and they told us what they wanted from us. That made it, I think, a good way to be in another culture, in another country, and we’ve maintained that. We have partner association meetings four times a year where we review what’s going. We didn’t have to put up a shingle and hope people would come. Basically, those associations keep bringing their members to us, so I think it a pretty good model for being connected to community groups. You know, AIDS groups, women groups, local groups, service groups…
Then there’s the issue of the genocide and I think those are some of the lessons we learned, too. In some of the groups, people didn’t always want to work together, and we had a sort of… We didn’t understand that, or we didn’t think of that as behind some of the problems that we encountered, but it sometimes was. But now, the staff is sort of mixed grouping and everybody have bought into the mission to provide good HIV care for children, women, their partners and their families. And I think everybody does the best they can to make that happen.”
Do you feel that a substantial amount of progress has been made?
“Oh yeah! I mean, HIV is a deadly disease. We now have about 2,600 people—I’d say 90 percent—of those over 25 adhere wonderfully to their medicines and are doing great. A small percentage need a lot more help to take their medicine and keep doing well. The younger people, who have had the disease longer because most of them were born with it, have sometimes become resistant to some of the medicine. So, we have to put them on more complicated regimens.
Some of the good medicines we have in this country are not readily available there. When I first started that was true. Then for a while, the medicines we had in Rwanda and the medicines we had in the U.S. were the same. Now the U.S. is way, way passed Rwanda and a lot of countries in Africa and Latin America. They don’t have the medicines we have, which are really excellent medications. So, that’s a problem, but there is generally progress. I watched, at this ‘Day of the African Child,’ I watched kids who I knew when they were 10 who are now 21 years of age, and they’re confident, they’re strong, they’re going to university—it’s amazing! It’s an enormous amount of progress!”
Was the genocide the main reason why you chose to work in Rwanda?
“It was more HIV, but in the context of the genocide. I had an interest in intimate partner violence because I had seen a lot of that in the care I gave women in Chicago who were HIV infected. We’ve done studies, and there’s just high prevalence of gender-based violence, like 62 percent lifetime—here [in the U.S.]—experience with either sexual, physical, or emotional abuse. Then, we looked at it in Rwanda, in our clinic, post-genocide, and it was 62 percent also. It was the same in both countries—you know poor population, difficult situation of sexually transmitted disease where people go off to try to make a living somewhere else… In the U.S. there was lot of drug use and a lot of difficult relationships with partners. There had been issues [in Rwanda]—people had lost partners during the genocide, people had been raped during the genocide. I was interested in Rwanda because my friend had been here and we had been asked to go, but I thought that because of everything that I had learned related to women with HIV and their experiences, it would be useful in this ultimate experience of gender-based violence, which was the genocide, where about a quarter of a million women were raped. So it was sort of both things.”
What do you think the main difference is between the government in Rwanda and in a country like Zimbabwe, which has seen a lot of resistance to NGOs that are trying to come into the country trying to help people with HIV?
“I think Rwanda sort of benefited post-genocide and by the 2001-2003 people coming in. A lot of Western and European countries that felt so guilty of not helping during the genocide were now giving lots of money. At the same time, there was lots of money going into HIV in a lot of countries, but the difference was that . . . there was money straight to the government and there was NGOs’ money, but what Rwanda did—very importantly—was it controlled the NGOs a lot, or tried to. There was a very strong government presence… very strong. One can’t write anything related to Rwanda without mentioning how wonderful the Rwandan government is. One can’t really be there without somehow being acknowledged by or understand the relationship with the Rwandan government, but its not just that; It’s that there was a lot of government will in Rwanda to do well in terms of the HIV epidemic, and in some sense, I think they wanted to be a poster-child for being able to distribute medicines well and lower the prevalence as opposed to be known for the genocide. It was a way to sort of make history—current history—much more positive as a country. And they were one of the best at utilizing the many millions of dollars that were given to them to help with the HIV epidemic. I think it was disproportionately more than what other countries got, but they utilized it extremely well. The other countries who maybe should have gotten more never used it well, often. There wasn’t the same governmental will, which I think you need.
It’s not just an issue of, are the NGOs disorganized? are they sort of stepping all over each other? and are they not doing what’s right? There are those issues, which I did see a bit in Rwanda and I had seen in a lot of other countries, but what I didn’t see in Rwanda was a government that wasn’t taking the epidemic seriously. They really put energy and resources… they used the resources they got to have a very strong public health system which helped HIV and other things along the way. It really addressed maternal mortality, infant mortality… When I started in Rwanda there were 30 doctors for 10 million people, and now there are so many more physicians and nurses who are trained related to HIV. And I think it’s an issue not just of the government’s relationship to NGOs, but of the government itself, having a strong presence related to the problems that the society is facing. I think that’s different from Zimbabwe and other countries.”
What do you think is lacking in terms of support for NGOs that do the same work that you do?
“Well, we have to do a lot of fundraising and I mean that is hard . . . that is one of our issues and it is a lot of work to raise money. I think what we do is really deliver the product we say we’re going to deliver, and I think that’s why we’ve been successful so far in our fundraising. We’ve been sustained for 11 years, so that speaks to our success in itself.
What I think we did that was good is that right now in Rwanda there is a local NGO called WE-ACT for Hope. It’s all Rwandan-run and they now manage the entire clinic, so our job is to fundraise a certain amount that we commit to, along with a few other groups that they get money from, and we do a lot of guidance related to program and other things, research… but they’re responsible—they are running the show. I think if you have local folks running the show, not just in a body, but rather the responsibility of a true locally credentialed NGO, which is also what Rwanda encourages, that’s a good way to go!”
– Jaime Longoria
Sources: Mother Jones, WE ACTx
Photo: WE ACT
Mobile Family Planning in India
The vans specifically visit regions where family planning is unavailable and where birth rates are exceptionally high, like Bihar and Uttar Pradesh. According to the last India National Family Health Survey in 2005-2006, the average birth rate in Bihar was 4.0 children and the average birth rate in Uttar Pradesh was 3.82 children. Bihar and Uttar Pradesh have the highest and second highest birth rates in all of India. Even so, the mobile family planning project can help women postpone or eliminate the option of pregnancy.
Janani offers IUDs, tubal litigation, condoms, oral contraceptives, injectables and emergency contraceptives for women. Additionally, the project offers non-scalpel vasectomies for men. This project helps promote long-term contraceptives, like the IUD, and permanent methods, like tubal litigation and vasectomies.
Doctors, nurses/midwives, van coordinators, attendants and drivers all make up each team. About four to nine people are in each van to serve Indian communities. The vans have a counseling chamber, audio-visual equipment and medicines and equipment needed for IUD insertion. The nurse/midwives are trained for counseling and IUD insertion in Patna at the Surya Clinic and Training Centre, which is owned by Janani.
The teams in each van serve around 10 to 15 new clients and about five to eight follow-up clients per day. Each team also makes up to 15 days of visits per month. Janani serves between 2,000 and 3,000 new clients and 1,000 and 1,500 follow-up clients each month. While it is important to care for new clients, it is also beneficial to conduct follow-up appointments with previous clients.
Janani aims to help women and men in rural and low-income areas. Improved access to family planning can help individuals who do not want to have children. Additionally, this could help keep more children out of poverty, considering that women may not want to have children if they are in a low-income household. Furthermore, this could help address the issue of overpopulation in India. Solutions such as mobile family planning are innovative and reach individuals who previously may not have access to family planning options.
– Ella Cady
Sources: DKT International, Impatient Optimists
Photo: Needpix.com
Thailand: An Experiment in Family Planning
In order to combat this decline, Mechai Viravaidya decided to start at the root of the issue — the women who had no control over how many children they would bear. After discussing family planning with several women, they decided that providing a pill was a great option for some women. However, this only covered around 20 percent of the population.
This did not hinder them.
Adapting the Coca-Cola model, Viravaidya and his team sought out well-respected individuals in each community to provide locals with family planning advice and devices, primarily birth control pills and condoms. It was the condom that took off. They were sold at local stores, on floating markets, handed out by the police, given to children in school, handed out in key chains, they were taking the nation by storm.
Soon, the team met some push-back from the religious community, but after talking with leaders, several monks actually blessed the condoms and contraceptives with holy water, thus making them something that everyone could utilize without feeling as if they were sinning. They then went to the military, which helped to advise local populations on the risks of HIV and AIDS, and they handed out condoms at traffic stops. Mechai became Thailand’s own “Mr. Condom.”
They soon went to the schools to educate children on the risks associated with unprotected sex, but they made it enjoyable. The team developed games that promoted family planning initiatives and condom balloon competitions, and in five years trained over 300,000 teachers in family planning methods. This meant that students now had people to talk to should they have any questions, and were thus able to advise their own parents on proper methods of family planning.
By 2000 the average amount of children per family was 1.5 and the growth rate had dropped to 0.5 percent, which meant that there were fewer individuals living in poverty and more children with greater opportunities for education and work in the future.
As the AIDS epidemic hit Thailand, their contraceptive commotion kicked into high gear, they were providing education on safe sex throughout all the villages, targeting high school students who then taught younger students, who then taught their parents. Thanks to the safe-sex brigade, Captain Condom and several other key players, the AIDS rate in Thailand went down by 90 percent, and the World Bank estimates that 7.7 million lives were saved because of this.
Thailand should act as an example for the rest of the world. Currently, sex and contraceptives have such a taboo upon them that several kids are petrified to even ask questions about basic safety precautions. They are afraid of judgment from store clerks and doctors, but if we normalize sex as a part of culture, we allow people to be more open and thus safer. If we take away the taboo associated with sex and perhaps even hand out free condoms and have free consultations with nurses and midwives about pills, we can reduce the rates of teenage pregnancy and STDs in our own nations. Although Thailand is a relatively small nation, it has shown us that small changes can make a huge difference.
– Sumita Tellakat
Sources: TED talks, Advocates for Youth
Photo: Flickr
Are Drought-Resistant Crops the Solution to World Hunger?
However, genetic engineering remains a technique of key significance in food sciences. Researchers have aimed their endeavors towards manipulations of crop genome that could alleviate hunger and malnourishment worldwide. New strains of food crops are being engineered that are better in nutritional value and resistant to environmental disasters.
One of the most significant research areas in this field focuses on making the crops drought-resistant. Drought remains one of the biggest challenges in the provision of food worldwide. Most of the world’s undernourished population is geographically concentrated in the driest areas of the world; this makes their food supply even more susceptible to droughts. The United Nations Food and Agricultural Organization (FAO) reports droughts to be more severe in effect than any other physical hazards. The recent droughts in Kenya and China are proof of the calamitous effects of droughts on food production.
To offer a solution to this problem, many researchers globally are focused on introducing drought-resistant genes into common staple food crops, such as wheat, rice and barley.
In any plant organism, there are multiple genes that interact to form a complexity of arrangement that affects the plant’s response to a stressor, such as drought. One of the most important known plant chemicals that affects a plant’s reaction to the environment is abscisic acid.
Abscisic acid is a plant regulatory hormone that controls a plant’s osmotic responses to external stimuli at a cellular level. As the water level available to the plant drops, abscisic acid regulates the ionic flow through the cellular membranes. This changes the osmotic pressure within the cell, which ultimately leads to closing of stomata — the pores in the leaves of a plant that are responsible for loss of water to the environment. This conserves water within the plant, allowing it to survive in dry conditions.
To enable the plant to survive in dry conditions, the loss of water from the plant body has to be minimized. This can be achieved through abscisic acid dependent regulatory pathways. This is done by increasing the expression of abscicic acid, but only under certain conditions.
Transcription factors in a genome are non-coding parts of the organismal DNA that control the rate of transcription of a particular gene, and therefore the amount of transcribed product—usually a protein—produced. By increasing the amount of osmotic regulators in the plant as a response to environmental stimuli, the plant can conserve water resources and tolerate drought much better. The abscisic acid molecule then regulates the gene expression of other genes within the genome that are induced or repressed to tackle external stress on the plant.
So far, much progress has been made in this field: successful transgenic manipulations have resulted in more drought-resistant lines of wheat and rice. However, as with all genetically engineered products, the progress made is only a fraction of the knowledge that is necessary for reliable products. The genome of any plant is vastly complex: many different genes, transcription factors, and regulators interact simultaneously to generate any desired phenotype, such as drought-resistance. More research efforts are necessary in successfully implementing these crops as an effective solution to hunger.
– Atifah Safi
Sources: National Center for Biotechnology Information 1, SpringerLink, National Center for Biotechnology Information 2, Oxford Journals – Journal of Experimental Botany
Photo: Wikimedia Commons
Drug Wars Wounding HIV Prevention in Brazil
The strategy meant that citizens who would be caught using drugs, such as crack, would be sent to health facilities to be rehabbed, thus allowing law enforcement to deal with more pressing concerns, such as drug trafficking cartels.
Brazil is known to be one of the most dangerous and captivating places in the world. It is also one of the most active drug trafficking countries in the world. According to a United Nations Office on Drugs and Crime report, Brazil has become the largest cocaine market in South America.
In 2014, the Brazilian government allocated over $2 billion on the “Crack: É Possível Vencer” law, which literally translates to “Crack: It Can Be Overcome.” The law is supposed to be managed by the healthcare, education and social justice ministry, but also includes funds for drug interdiction along Brazil’s borders.
Providing drug users with treatment would allow them to rejuvenate their life and help strengthen their communities. Unfortunately, standards such as the crack law have led to blurred policies that are crippling the healthcare system, specifically in Rio de Janeiro and Sao Paulo.
Police raids have led to many youths being incarcerated in the two cities. Most of these children are petty users or traffickers for bigger cartels. The police remove them off the streets and pressure them to feel that they need rehabilitation and treatment.
In turn, pressure from politicians in the city forces medical personnel to give these children medical treatment, even when it is unnecessary. Although it is campaigned as a successful and strategic method to clean up the city, it is in fact wasting precious resources that could be used to successfully fight problematic drug abuse or other diseases, such as HIV.
Brazil has one of the highest HIV rates in Latin America. This is troubling especially in light of the fact that it is considered to be one of the most developed countries in all of South and Central America. According to UNAIDS, Brazil, whose total population was about 200 million, had an HIV/AIDS population of 730,000 in 2013. Compare this to India, a country whose population is five times the size of Brazil’s but whose HIV/AIDS population is only 2.1 million.
HIV prevention and testing have suffered greatly due to these policies. There was a 32% increase in HIV testing between 2004 and 2013. By 2014, that progress had decreased by almost 13%. This is because resources are being strained by the drug prevention laws.
A shift in policies and implementation is needed in order to combat the real health issues in Brazil, which are diseases such as HIV. If the Brazilian government does not allocate resources correctly, the war on drugs will have failed on both fronts: Brazil will have failed to prevent both drugs from entering the country and HIV populations from increasing.
– Adnan Khalid
Sources: UNAIDS 1, UNAIDS 2, UNAIDS 3, UNODC, Washington Office of Latin America
Photo: WBUR