Freeing Women from HIV/AIDS Chains and Donor Agencies, Anambra State Government in Alliance Against HIV/AIDS

By

Nduka Uzuakpundu

Women are dissatisfied with governments, international organisations, global institutions and multi- and trans-national corporate bodies for their less helpful role in the fight against the global pandemic: HIV/AIDS. And, so, they are renewing a series of long-standing demands, which, they believe, are central to meeting their health rights. As they marked this year’s International Day of Action for Women’s Health, on May 28, they demanded raising awareness and knowledge levels about HIV transmission and how to prevent it, an inclusion by government of facts on HIV transmission and prevention in sexual education programmes at schools, promotion of gender equity and women’s values, human rights of women and girls. Their 13-point demand also included immediate implementation of measures to meet the Millennium Development Goals (MDGs), an end to monolithic world political organisation and a shift towards democratic global governance, in which women are equally represented, an access to treatment for HIV/AIDS, and a refusal by government never to bow to pressure from pharmaceutical companies and government of countries with large pharmaceutical industries, and put the survival and quality of life of people living with HIV/AIDS before profit.

These demands are being made as part of the theme of this year’s call for action, which is “Breaking the ties that bind us: A call for action against Women’s Vulnerability to HIV/AIDS.” The global activities designed to meet these ambitious - and rationale demands are being co-ordinated by Centre for Women’s Health and Information (CEWHIN) - a Lagos-based non-governmental organisation - on behalf of the Women’s Global Network for Reproductive Rights (WGNRR), based in The Netherlands. Mrs Atinuke Odukoya of CEWHIN said that the global activities, which would be in keeping with Women’s Access to Health Campaign (WAHC), would be on for the rest of the year - “to mobilise women’s and youth groups, individuals and other social movements connected with the deteriorating situation of women’s health around the world, with an emphasis on women’s sexual and reproductive rights.” She noted that part of women’s dissatisfaction with influential stakeholders, who take decisions that affect women’s health rights had to do, in part, with the serious opposition they face when in came to basic forms of protection against HIV/AIDS . Said she “Asking a man to use a condom can be seem as challenging his sexual authority and the communities’ cultural norms.” Worse, still, women’s roles as wives, mothers, daughters-in-law, domestic workers and care-givers, together with pressures to perform marital duties and produce children, give them, it’s true, “little bargaining power, when it comes their sexual and reproductive rights.” It’s no less true that, in some cultural milieu, women, who attempt to protect themselves from HIV, can face serious, even tragic consequences. They risk psychological and physical abuse, abandonment, eviction, excommunication, shunning, and being stripped of resources. Social, economic, political, religious and cultural realities and customs join biology to make women especially vulnerable to HIV/AIDS. The unequal gender roles of women and men, often as a product, and cause of these various factors, function to bind women to their circumstances, so as to make their vulnerability to HIV/AIDS seem, sometimes, insurmountable. Women and girls represent 75 percent of those caring for people living with AIDS. The impact of poverty could be monumental, when family members are sick, due to HIV/AIDS. Caring for sick members of the family can be a tremendous burden. With the most active bread-winners in the family sick or dead, due to HIV/AIDS, financial support and skills are lost, and the potential for loss of knowledge, skills and culture looms large. That affects not only women, but whole communities, nation and region.
 

The HIV/AIDS scourge, which seems - more than two decades on, to have no medical cure - appears to have exacerbated an already unfair global gender relation. The WGNRR observed that global macro-economic policies had been unhelpful to women’s access to health care. A variety of neo-liberal policies, it said, “frustrate the exercise of that right in concrete ways.” Take the policies of such international financial institution (IFIS), like the World Bank and International `Monetary Fund (IMF), which compel governments of low-income countries to incorporate economic and political conditions in a comprehensive action plan for national poverty reduction, called Poverty Reduction Strategy Paper (PRSP). Capitalistic in spirit and aim, IFI conditions focus on trade liberalisation, privatisation of various social services and user fees. Thus, the national budget gets lean, causing health centres and clinics to close. When that happens, women can lose the only clinic within many miles, from where they live. Some clinics have been able to survive by cutting services; even through they should be expanding services to address HIV/AIDS, through providing voluntary testing and pre- and post-counselling or screening for cervical cancer for women affected with HIV/AIDS.

This has been the unseemly development, since the ’80s, when low-income countries took hefty loans, on very stringent conditions, from the World Bank and the IMF, to finance what were said to be development programmes. Not only were such loans flagitiously mismanaged - almost with the immoral connivance of the officials of the lenders - since, until recently, they had a tacit rule never to see evil, in the manner such loans were stolen by godless operatives of the borrowing states. It was the evil effects of the stringent conditions of such loans that led to most bread riots in African countries in the ’80s, when governments went about belt-tightening, as required o the conditions of the loans from the World Bank and the IMF. Such policies, far from helping poverty, have worsened matters: most African states, for instance, are, to this day, still groaning under the burden of dubious foreign debts; some their best their professionals health workers - doctors and nurses, say, are being forced to migrate to the European Union, North America and the oil-rich sheikhdoms of the Arabian Gulf in search of brighter opportunities for a more fulfilling life. These negative indexes of human development tend to give the World Bank and the IMF the impression that the real intent of their tough loans is being registered.

Besides, the WGNRR said integrated reproductive health services were often the first victims of budget cuts - slashed or replaced with basic family planning or population control programmes. “An alternative or companion to service reduction has been the introduction of user fees for health services, which cuts access for poor women.” Just as budget cut tends to increase the price of anti-retroviral drugs, a majority of which are still less accessible to HIV/AIDS patients, the somewhat ineluctable changes to public health care delivery translate into lost opportunities for women. Women’s take on a gender-friendly anti-HIV/AIDS campaign could be helped - beyond mere policy pronouncements and wasteful jamborees, conferences, irrational budgetary and harmful cultural practices - when government and policy-makers take not only the views and demands of women into consideration, but co-opt them into the national implementation, monitoring and inspection team. This is partly because women are mothers, whose reproductive roles are crucial to the survival of the family and success of national development. More than that, it is morally binding that because almost all the chief health policy-makers, worldwide, are products of women, some level of honour should be done them. That, alone, ought to engender a global campaign to shield them soundly from the killer scourge.
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DONOR AGENCIES, ANAMBRA STATE GOVT IN ALLIANCE AGAINST HIV/ AIDS

By

Nduka Uzuakpundu  

The pressing need to neutralise the effects of HIV/AIDS, while providing mother, child and general healthcare, has made Anambra State an attractive operational base for some international donors and development agencies. Currently, officials of the Ministry of Health in the state capital, Awka, and some captains of the organised private sector (OPS) are in active liaison with six such agencies run by the United Nations, the United States and Britain .There is Unicef, which is mainly involved in mother and child care, the United Nations Fund for Population Activity (UNFPA), which is mainly involved in mother and child and adolescent healthcare, Family Health International (FHI) and the United States Agency for International Development (USAID), for HIV/AIDS, World Health Organisation (WHO) for general healthcare and Department for International Development (DFID), which is active in funding health system reform and equipping more than 100 health centres in the state.

The coming of these agencies to the state, as development partners, was the brain child of the Dr. Ben C. Anyene, while he was the Commissioner for Health, at the beginning of the Fourth Republic. He designed the blueprint in use called Friends of Healthcare Delivery in Anambra State (FHDAS). In a recent interview, he said the essence of the blueprint was to produce “a healthcare system that is efficient, effective, equitable and accessible to the people of the state.” Matters have been helped by the these international donors and development agencies and the response by some indigenes of the state, who are based in New Orleans in Mississippi, in the United States of America, who have donated a container load of hospital equipment.

There was a recent case of an indigene of the state, Mr. Oli Obi, who built and equipped a theatre ward in his home town - Nimo, near Enugu Ukwu, in memory of his late brother - and donated it to the state government. Still in the spirit of FHDAS, some women from Oraeri, in Aguta Local Government Area, collaborated with Ministry of Health in organising a four-day workshop on preventive and public health issues. The focus of workshop, Anyene recalled, was in recognition of the fact that most of the health problems in the country - alongside public health - were not curative, but preventive, which had so much to do with personal hygiene, and teaching people that little healthy habits do matter, not only in terms of cost, but, also, in terms of individual life expectancy. It was Anyene’s calculation that the FHI, which had at its disposal a lot of resources, should be active in the rural areas of the state where children are being orphaned. But a greater part of the campaign against HIV/AIDS in the state is being carried out in Onitsha. Anyene explained that because of the demographic and economic profile of Onitsha and its environs - including Nnewi - with a huge market, which is considered the largest in both West and East Africa, and “where a lot of the people are not of the upper class, in terms of academic feats and placements”, it becomes fairly easy to appreciate the level of HIV/AIDS crisis in the state. From the economic perspective, Anyene argued that Anambra was a transit state, with Onitsha as the most popular entry and exit port. Indeed, the available statistics, as of the time of Anyene’s stewardship, showed that to 650,000 people - a majority of them less educated, long distance truck- drivers and traders, who are also traditionalists - pass through other state each day. He said the state’s story of HIV/AIDS would have been a lot less worrisome, if it were not a transit one with a very attractive commercial tug. What that entails, in satisfying some of the private emotional and psychological cravings of long distance truck drivers, say, is a given . In the early days of the HIV/AIDS crisis in the ’80s, Anambra had a below-one-percent representation, but, in over a decade later, in 2001, Anyene disclosed, “We crossed the barrier up to 5.9 percent. When you get to that point, then, you’ll really be faced with a crisis.” The Anambra situation has been augmented, this far, because the state is one with a quite visible young population - young adults, who are more than 45 percent of the population, and who are also sexually active. In large part, this rather worrisome development it was that informed the decision of the state government - during Anyene’s time - to emphasise preventive and advocacy anodynes - abstention and decent sexual behaviour, for instance - to a killer syndrome that has, in the past two decades, defied the medical world. Selling the preventive approach to the Anambra public was initially greeted with suspicion and disdain, even by the educated elite - a majority of whom felt that the thought of the infection itself was like an official cod to deny them sexual pleasure. That negative, if foolhardy, disposition was not enough to discourage Anyene and his team, who had to invite FHI to add Anambra - alongside Lagos, Kano and Taraba - to its turf. But it took the completion of a three-day training and advocacy workshop by the State Government and the National Action Committee on HIV/AIDS (NAC HIV/AIDS), for FHI to join Anambra in the crusade against the infection. Since then, FHI has been quite active in the rural areas, where the rate of death amongst the young population, husbands and wives need’n’t be rife.

The FHI experience in Anambra - as elsewhere - presupposes that managing HIV/AIDS, as a global pandemic, is certainly not for everybody. “You have to have the know-how, such that you can apply it, to throw back the effects of the infection.” That, in itself, says Anyene, “calls for a new, socially-helpful behaviour on the part of the populace.” There is, at the Ministry of Health, and in all the 21 local governments, active state versions of (NAC HIV/AIDS). For their strategic location and standing in the public health policy of the state government, the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, General Hospital Onitsha, General Hospital, Amakwu, Awka and General Hospital, Ekwulobia, have been designated for investigation, treatment, care and support management. The Anyene-led team did carry the campaign against the killer infection to meeting with people living with HIV/AIDS, commercial sex workers, truck drivers, road transport workers - about 500,000 of them - and teachers. Working with these groups, the state chapter of the Nigerian Medical Association (NMA) and the Nurses and Mid-wives Association of Nigeria, was informed by a desire to reach a greater part of the population through their organisations. “We had workshops with them and made visits to their various stations to discuss top issues with them, and our involvement with the activities of the FHI,” Anyene said, was a fantastic, symbiotic relationship.” For all that, it was Anyene’s expectation that, by 2007, there would have been a promising reduction in the cases of HIV/AIDS in the state - through preventive measures, availability of anti-retroviral drugs for patients. And, come that time, the youths would have been equipped as foremost campaigners against the infection. The FHDAS policy was informed by the fact that since 1989, two years before the creation of new Anambra State, there had been some visible attrition in the health sector: no employment of new hands, some staff had resigned, there had been no manpower development and some employees has passed way. And, in order to meet the shortfall in manpower need, the Ministry of Health had to reach out to the healthcare professionals, especially in the organised private sector, to complement its efforts towards producing an effective and people-oriented health strategy for the state.

Indeed, the professionals at the University of Nigeria, Nsukka and NAUTH - in liaison with their colleagues in the OPS, have, since 2002, been in the forefront of implementing the new health policy. It is a policy that recognises - as does the 1999 Constitution - the role of alternative health practitioners, which includes homeopaths. Although the government says alternative medicine is legal, Anyene observed that a majority of the skippers of that sector were practising unregistered. But far from sealing up the premises of such individuals, he said the Ministry of Health had to embark on an historical project concerning them: a directory of all healthcare facilities in the state. Anyene’s professional colleagues in the orthodox circle, also, had to be registered - in order to distinguish the qualified from the fake. Besides, the Ministry of Health has long started the “School Health Programme” at the Federal Polytechnic, Oko, and Nnamdi Azikiwe University (UNIZIK) Awka - through which health clubs would be developed in both secondary and tertiary institutions in the state. “It is” said Anyene, “a novel programme aimed at inculcating students with sound health habits. It’s about good health practice, on which you can’t place a financial value.” The FHDAS is also about a reliable and regular drug supply and a new orientation for the state healthcare workers. Anyene, who is one of the country’s 29 Change Agents in Health Reforms, said the policy was to let Anambrarians enjoy what they were entitled to; not, necessarily, as part of the plums of a democratic dispensation. “It should be a natural part of living; as one of the responsibilities of a people-oriented government.”