Photo: The Presidency

Deputy President and SANAC Chairperson Kgalema Motlanthe

JOHANNESBURG, (PlusNews) – The South African National AIDS Council (SANAC), long inactive, is showing signs of life. The revived secretariat moved out of the Department of Health and acquired a new CEO on 1 September, and recently flexed some of its new-found muscle when it recommended that government change outdated treatment guidelines.

IRIN/PlusNews introduces some of the faces behind what could soon be one of the country’s most influential HIV/AIDS bodies.

Chairperson: Kgalema Motlanthe, South Africa’s Deputy President

Motlanthe assumed the post of SANAC chairperson, always held by the country’s deputy president, after national elections in May 2009. He earned praise from AIDS activist for replacing controversial health minister Manto Tshabalala-Msimang with the popular and efficient Barbara Hogan during his brief tenure as South Africa’s President from September 2008 to May 2009.

Photo: IPPF

Dr Nono Simelela, SANAC CEO

Chief Executive Officer: Dr Nono Simelela

After becoming the first black South African woman to qualify as a specialist obstetrician and gynaecologist, Simelela spent 20 years working for the Department of Health before becoming head of the National HIV/AIDS/TB Programme in 1998 under Tshabalala-Msimang.

She stayed in the post until 2004, when she left for Britain to lead the International Planned Parenthood Federation’s technical knowledge and support division in London. She outlined some of SANAC’s future priorities in an August interview with IRIN/PlusNews.

Deputy Chairperson and Law and Human Rights Sector: Mark Heywood

Heywood was active with the local AIDS lobby group, Treatment Action Campaign, and spent years lobbying to revive SANAC before being elected its Deputy Chairperson in 2007. He also represents the Law and Human Rights Sector in SANAC, which works to safeguard the rights of people affected by HIV and AIDS.

He currently serves as executive director of the AIDS Law Project, which uses the law to protect the human rights of those with HIV/AIDS.

Children’s Sector: Dr Ashraf Coovadia

One of the country’s best-known HIV paediatricians, Coovadia was an obvious choice to represent the sector charged with ensuring that children’s HIV care, treatment, support and prevention receive adequate attention.

Coovadia heads paediatric HIV services at the Rahima Moosa Mother and Child Hospital in Johannesburg, and has been a vocal advocate for scaling up prevention of mother-to-child HIV transmission services (PMTCT). He argues that improving these services is one of the sector’s biggest challenges, along with reducing delays in diagnosing and treating HIV-positive children.

Photo: Global Campaign for Microbicides

Dr Samukeliso “Samu” Dube, head of SANAC’s Women’s Sector

Women’s Sector: Dr Samukeliso “Samu” Dube

A public health physician, researcher and activist, Dube says women need their own sector, with its own specific agenda, because of their greater biological and socio-economic vulnerability to HIV. “It’s not a case of one size fits all; what works for men does not necessarily work for women.”

The sector’s priorities include increasing access to the female condom and ensuring that research addressing HIV prevention among women remains a priority.

Dube is the Africa programme leader for the Global Campaign for Microbicides, and a committee member of Physicians for Human Rights in her native Zimbabwe. She was co-investigator on several HIV-prevention trials at the University of Limpopo in South Africa.

Deborah Baron, coordinator of the Microbicides Media and Communication Initiative, noted that Dube’s scientific background and passionate advocacy for women are critical to the sector.

Business Sector: Brad Mears

Before becoming CEO of the South African Business Coalition on HIV and AIDS (SABCOHA) in 2005, Mears worked as an industrial relations consultant and was head of the HIV and AIDS programme of the Chamber of Commerce and Industry in the east-coast port of Durban.

“He understands the business environment very well,” Paul Davies, chairman of The Aurum Institute, a health NGO that has helped several large companies implement HIV policies in the workplace, told IRIN/PlusNews. “He brings a different perspective to SANAC in representing a sector that is quite capable and willing to participate in the management of HIV.”

People Living with HIV/AIDS Sector: Vuyiseka Dubula

Dubula is the secretary-general of the Treatment Action Campaign (TAC), a well-known AIDS lobby group that won a court case against the government in 2002, forcing it to begin providing prevention of mother-to-child HIV transmission (PMTCT) services.

She was diagnosed HIV positive in 2001, joined the TAC months later and worked her way up from local organizing in and around Cape Town to her current position, which she took up in 2008.

The sector advocates for the needs, rights and concerns of people living with HIV (PLHIV), but Dubula has her work cut out trying to unite the representatives of TAC and the National Association of People Living with HIV/AIDS (NAPWA), which each have their own PLHIV sector in SANAC and have yet to join forces.

Denise Hunt, executive director of the AIDS Consortium, a membership organization for local NGOs working in HIV and AIDS, said: “She’s been at all the different levels of activism and … is able to apply [that understanding] at a strategic level.”

Photo: Nelson Mandela Foundation

Dr Olive Shisana is leading the Research Sector

Research Sector: Dr Olive Shisana

As head of SANAC’s research sector, Shisana will help formulate a research agenda that provides scientific support to national HIV/AIDS policies. In 2005, Shisana became the first black woman to be appointed president and CEO of South Africa’s Human Sciences Research Council (HSRC).

In her almost 20 years in public health she has overseen the World Health Organization’s Family and Community Health Cluster, served as director-general of South Africa’s Health Department, and worked as principal investigator on a number of large studies, including the third National HIV Prevalence, Incidence, Behaviour and Communication Survey, released in June.

Shisana cites lack of funding for the sector’s work as the main challenge to achieving top priorities such as further research into male circumcision and re-examining prevention approaches.


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KENYA: Alcohol counselling programme improves ARV adherence

Photo: Kenneth Odiwuor/IRIN

The gatherings are structured along the lines of Alcoholics Anonymous meetings

BUSIA, 7 September 2009 (PlusNews) – Christopher Orodi admits he has a pretty serious drinking problem; the weekly support group he attends not only helps keep him off the bottle, it keeps him on his life-prolonging antiretroviral (ARV) medication.

“I realised that if I did not stop drinking, I was going to die from HIV… I cared more about alcohol than my drug timetable,” he told IRIN/PlusNews in his hometown of Busia, western Kenya.

The Busia Alcohol Counselling Programme, helps alcohol abusers form support groups where they can learn healthy habits and encourage each other not to take risks with their drug regimens.

The programme was established in 2007 with support from the Regional Outreach Addressing AIDS through Development Strategies Project, funded by the United States Agency for International Development’s East Africa office and managed by the NGO, Family Health International. In 2009, the programme transitioned to support from the AIDS, Population, and Health Integrated Assistance Programme in western Kenya, funded by USAID/Kenya.

Studies have shown that hard drinking is associated with decreased ARV uptake and adherence.

“Many people have died because they could not take their drugs due to drinking; some were re-infecting themselves due to risky sexual behaviours as result of alcoholism,” Orodi said.

The gatherings are styled along the lines of Alcoholics Anonymous meetings and convened by a trained counsellor.

“Most members of these groups are people who joined voluntarily and who approached us to admit that drinking was affecting not only their lives, because they were not taking their drugs consistently, but [also] … their families because of the correlation [between] alcoholism and gender based violence,” said Ronald Barasa, a counsellor and former addict.

Research by Horizons, a USAID research project, called for alcohol counselling to be included in voluntary counselling and testing; it found that 33 percent of drinkers interviewed were violent towards their partners when drunk.

I realised that if I did not stop drinking I was going to die from HIV

For Orodi, the meetings are already paying off. “My wife and I are now adhering to our ARVs and we make sure our last-born daughter – who is also positive – takes her ARVs on time,” he said.

“I can now work and earn a living to support my family; the violence that was the norm in my marriage is now behind me,” he added.

Since its formation in 2007, the alcohol counselling programme has created 106 groups with more than 1,600 members; the model is being replicated in Uganda and Tanzania with the help of the Kenyan groups.

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Photo: World Vision

Buying ARVs in large volumes does not necessarily make them cheaper

JOHANNESBURG,  – Many countries struggle to pay for antiretroviral (ARV) drugs for all those who need them, but a new study has found that some nations are paying up to three times more for the life-prolonging medicines than others with similar HIV prevalence and income levels.

In 2007 Nigeria paid US$334 per patient per year for a combination of first-line ARVs that cost Congo only US$95. Both are low-income countries, but Nigeria has a higher HIV prevalence of 3.1 percent, compared to Congo’s 1.2 percent.

A working paper released last week by the AIDS2031 project, which draws on expertise from around the world to consider the most effective long-term responses to the HIV/AIDS epidemic, looks at why the prices of ARVs vary so widely from one country to another, and what can be done to improve affordability.

The price of first-line ARVs has dropped substantially in the last decade, but affording them is still a problem in low-income countries with high HIV burdens, many of which are experiencing the effects of the global economic downturn in donor countries.

About 4 million people are accessing ARVs worldwide, out of an estimated 10 million thought to be in need of them, and the need is expected to grow to around 22 million by 2015.

Moreover, an increasing number of people will develop resistance to first-line ARVs and need second-line regimens, which currently cost at least nine times more.

The authors of the working paper looked at price variations in 12 ARVs between 2005 and 2008, and identified some of the key factors behind the differences.

Pharmaceutical companies have long used a sliding scale to set ARV drug prices according to a country’s socioeconomic status, but this was not the only reason for the cost variations.

The ability of the Clinton HIV/AIDS Initiative (CHAI) to negotiate price reductions for its member countries, particularly for second-line drugs, was identified as one factor.

Whether countries purchased generic or brand-name versions of ARVs also played a major role – strict patent laws prevent some countries from buying generics.

The World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (TRIPS) allows countries to override patents – for public health purposes – by issuing “compulsory licenses” that enable the generic manufacture of drugs still under patent.

However, few developing countries have exercised this right, citing a lack of capacity and legal know-how to negotiate the complicated paperwork required, and political pressure from foreign governments.

Surprisingly, the volume of drugs a country purchased did not significantly affect price; higher-prevalence countries buying large quantities of ARVs often paid more than lower-prevalence countries.

“On one hand, volume gives countries more power to negotiate,” the authors wrote. “On the other hand, the higher volume means that there are more people who will demand treatment, and the countries are facing political pressure to respond to this need, which could reduce their negotiating power.”

The paper recommends various strategies to ensure that all countries obtain the best possible prices for ARVs: strengthening the ability of lower-income countries to take advantage of compulsory licensing, and providing technical assistance for the production of generic ARVs, could help increase competition among manufacturers; improving production efficiency and buying cheaper active ingredients could reduce manufacturing costs.

The authors also note that prices of first-line ARVs are unlikely to decline much further, but there is ample room for reduction in second-line drug prices.

“Many more patients could be treated if second-line therapy were closer to manufacturing costs,” they commented. “Reducing the price of second-line therapy should remain a priority.”

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Photo: Mohamed Amin Jibril/IRIN

Knives recovered from street children in Hargeisa on display at the town’s police station

HARGEISA,  – The number of street children in Hargeisa, capital of secessionist Somaliland, is on the rise as more Ethiopian children cross the border in search of a better life.

The immigrant children are adding to the burden of local street children, most of whom have been forced on to the streets by drought and insecurity within Somaliland and further south, in Somalia.

“You can see old women accompanying about 20 children, of different ages, crossing the border into Somaliland from Ethiopia. These women may be their grandmothers, aunts or mothers,” Khadar Nour, chairman of the Hargeisa Child Protection Network (HCPN), told IRIN.

“The children, who are mainly from the Oromo [region of Ethiopia], beg in the streets of Hargeisa with their mothers,” Nour said. Some work as shoe shiners, sending their earnings to relatives in Ethiopia.

Hargeisa is also a popular transit point for those seeking to travel further. “About 100 to 200 immigrant children cross the border from Ethiopia into Somaliland [annually] on their way to [the self-declared autonomous region of] Puntland, or to Yemen,” he said.

Poverty and family break-ups have also fuelled the rise in numbers. There are about 3,000 children, most of them boys between five and 18, living on Hargeisa’s streets.

Crime threat

With the rising numbers, officials are concerned about an upsurge in crime. “They [the street children] are becoming a threat to the town’s stability,” said Nour.

“When they grow up, they still find themselves living in difficult conditions; it is for this reason that they grab mobile phones.”

Consequently, a number of the children are now in conflict with the law. In August, Nour said, a 16-year-old was sentenced to death in a Berbera regional court after being found guilty of murder.

Photo: Mohamed Amin Jibril/IRIN

A young boy makes a living polishing shoes on the streets of Hargeisa, Somaliland (file photo): Immigrant children are working in Hargeisa to support their families

“The grown-up street children have become the new gangsters,” Mohamed Ismail Hirsi, Hargeisa’s Central Police Station commander, told IRIN.

“In the last 72 hours, we have arrested more than 30 street children who have committed crimes such as stealing mobile phones in different parts of the town.”

In the past two years, some 5,000 knives and other weapons, which are commonly used in robberies, have been recovered from the street children, prompting calls for more focused interventions.

“People say good words in workshops, but few interventions for street children have been [implemented],” said Nour of HCPN, which recently started providing food and education support for the children.

Once arrested, the children are charged as adults because a 2008 juvenile justice law has yet to be implemented.

Glue sniffing

The children living rough are turning to drugs. “I use glue because when first I came to the streets I saw my friends sniffing it,” Ahmed Omar, 12, told IRIN. “Whenever I use it, I am able to survive a difficult situation.”

The lack of a family support system also means more children may end up on the streets, as Abdi-Qani Ahmed’s experience illustrates. “When my mother and father divorced, there was no one left to take care of me,” Ahmed, 11, said. “I used to get my food from restaurants in Hargeisa where I fed on leftovers.”

During Ramadan, however, few if any restaurants are open. “I have to wait to see if someone gives me something to eat or not,” he said.

Living on the streets puts the children at risk of abuse from other street children as well as strangers. For protection, the children often seek refuge outside the police station at night.

maj/aw/mw source.www.irinnews.org

By Maore Ithula

A picture taken in 1987 shows a man in a grey, three-piece suit, standing with then Minister for Energy Nicholas Biwott and another Government official.

Another picture, taken last week, can barely match the frame of the haggard man standing beside a rusty wood saw, with the first picture.

When the first picture was taken, Zakayo Kamenchu was Kenya’s High Commissioner To Australia. He later became a civil servant in various ministries and his profile in public office ranked high.

Zakayo Kamenchu at his rundown sawmill at Kianjai, Tigania West.

Those days now look like a distant dream, another era for Kamenchu, who we found at his run-down sawmill at his Kianjai village home, Tigania West District.

Cutting Wood

His latest engagement, cutting wood for sale, has run aground. After the failure of his manual wood-cutting machine, the hands that used to wield the official seal of Kenya at the Australian High Commission, between 1984 and 1987, are now adept at lifting an axe to burst cyprus blocks, which he sells as fire wood.

Kamenchu’s descent from high public office to saw-dust took just over ten years. He was retrenched from public service just after the 1992 General Election and retreated to his rural home.

In the run-up to the 1997

General Election, he went for the Tigania West seat on a Kanu ticket. But he now looks back and says he made a blunder that he thinks doomed a budding political career.

During a campaign tour by former President Moi to the Meru region, Kamenchu told the President, in the hearing of other party officials, that he was wasting money and time looking for votes in the larger Meru district. “I told him the area was then a Mwai Kibaki Democratic Party zone,” he says.

Kamenchu says, from then his bid for the party ticket was thwarted from the top-most organ of the party. So, instead of becoming a politician of substance, he decided to concentrate on running a saw-mill. Fate handed him a downturn two years ago when raw material (logs) became a rarity, forcing him to scale down the business. He scaled down from selling wood to fuel wood to residents of Kianjai village.

Showing his dusty wood cutting machine, Kamenchu recalls his hey day with an evident tinge of nostalgia on his face.

Masters Degree

Born in 1945, Kamenchu holds a Masters degree in Public Administration from the University of Pittsburg, Pennsylvania, USA which he acquired in 1980. An Alliance High School student, he went to the then Dares-salaam University College of East African University where did a Bachellor of Arts degree. He graduated with his first degree in 1968 and was recruited as DO and headed straight to the Kenya Institute of Administration.

The then High Commissioner to Australia, Kamenchu, (left) with former Energy Minister Nicholas Biwott and former Australian Minister for Energy Garreth Evans in a 1987 picture. [PHOTOS:MAORE ITHULA AND FILE/STANDARD]

He started off as District Officer, served in two governments and rose through the ranks to become Kenya’s High Commissioner in Australia in 1984 before being recalled to serve as a Permanent Secretary in several ministries.

Having been suspected of working closely with opposition politicians, he was retired prematurely after the 1992 General Election.

Nevertheless, he recollects:

“On January 13, 1992 President Moi announced his Cabinet. Being the incumbent PS for Home Affairs, I was listening to the 1pm news like everybody else of my ilk.”

“My name was not among the appointed PSs and having served in the system for long, I did not wait to be told what to do. I packed and left office the same day,” he says.

During those days, he says, if one’s name wasn’t on the appointment list, it meant you were not supposed to be in office the following day.

“If you did not take away your personal things on the day of your demotion, you may never access your former office again,” Kamenchu says.

Hard Choices

Kamenchu, who has three sons and a daughter, says his eldest son was in Standard Seven while the last born was still in kindergarten. He says he had, therefore, to make hard choices. Back in the rural area, Kamenchu had built a home just a few kilometers outside Kianjai market, where he now lives with his wife Hellen. He had earlier acquired a few milling machines which a close relative was using to run a small timber milling industry at his yard in the market. He is currently offering free service to his community.

source.standard.ke