Why Do Pendulums Have to Swing?

by Janine Schooley, PCI's VP for Technical Services & Program Development

August 6, 2008 :: Mexico City IAC

For every 2 persons starting anti-retroviral therapy (ART), there are 6 new infections. Clearly we cannot treat our way out of this epidemic….

At the first World AIDS Conferences, the discussions were all about prevention because, well, there wasn’t much else to talk about. There was no ART; there were no vaccine trials; there was only prevention. Then for years the focus became almost exclusively on treatment. At this year’s conference however, there is a lot of talk about prevention and, more importantly, there is a lot of talk about there being no one silver bullet, about the need for an integrated, comprehensive approach. Peter Piot, Director of UNAIDS, was philosophical about this development. He said that paradoxically perhaps we had to go through this process of veering from one to the other before we could finally come back to the realization that we need it all. He said that we left prevention in the dust of treatment, but that perhaps we couldn’t truly do what was needed in prevention until we had figured out the ART side of things. I don’t know about that (smacks a bit of a rationalization to me), but the change sure is welcome.

Not only are people this year talking about the need for both treatment and prevention, but thankfully, they are talking about something called “combination prevention” which means the kind of prevention that works on multiple levels, using multiple strategies, with none of them working in isolation – a larger, more systematic response that effectively combines biomedical, behavioral, and structural interventions and matches that combination to the particular situation and nature of the epidemic..

Oversimplification is out and context, finally and thankfully, is in. A new paradigm for monitoring, evaluation, and documentation of evidence will be needed and there must also be a realization that social change is messy and takes time. We need to focus more on the “how” and less on the “what” and we need to take into account the interplay between treatment and prevention. New partners in social and behavioral change will need to join the rank and file of HIV/AIDS combatants. In addition, prevention must be seen not as stopping something, not as preventing something, but actually as something more positive, allowing hope and sexuality to flourish and bringing out the best inour humanity and in our protection and promotion of health and wellbeing.

This theme of integration is winding its way through discussions about prevention of mother to child transmission (PMTCT), the need for family-centered approaches to care and support, and the need to focus on good primary health care and social protection when addressing the needs of vulnerable children. This is all music to my ears and is in keeping with my tongue-in-cheek suggestion of a new definition for the acronym PMTCT: Promotion/protection of Mother Together with Child Total health, as opposed to just stopping vertical transmission of one virus.

Someone joked that if we think in more integrated terms, perhaps we will all have less meetings to attend. There are of course many more compelling reasons why this pendulum swing is most welcome, not the least of which is that it means that we will finally have a good chance of making a dent in this still raging pandemic and do so in a way that is as cost effective and lasting as possible.

Easing Burdens for Orphan Caregivers

Goats Provide Nutrition and Income

Ethiopia has one of the largest populations of persons living with HIV/AIDS in the world and, as the number of children losing parents to HIV/AIDS increases, an enormous burden is placed on extended families to meet the needs of these children.

Lack of food is often a major obstacle to improved health and nutrition, as well as recovery from tuberculosis and other debilitating infections for adults living with HIV/AIDS. For children, the lack of food leads to greater health problems due to weakened immune systems, poor school performance, and diminished quality of life.

With funding from Alternative Gifts International, PCI is providing HIV/AIDS-affected and vulnerable families in Ethiopia with goats and sheep to ease their burdens, help avert their deteriorating nutritional status, and generate income.

Goats are considered optimal for families affected by HIV/AIDS because they are small and can be easily handled by the sick, young, and elderly. The milk from goats is improving the quality of children’s diet and can also be sold for $0.44 US per liter to generate vital income for families. As of June 30, 2008, PCI expected to distribute over 2,500 goats and sheep to 1,700 caretakers of orphaned and vulnerable children.

A Grandmother Finds WORTH in Zambia

Maweta Tembo sits among her four small grandchildren in the village of Chiwala, part of the Chongwe District outside of Lusaka, Zambia. A 72-year-old widow, Maweta has already raised six children of her own but now must care for her grandchildren, whose parents were killed by AIDS.

Before the PCI-led WORTH program, each day was a struggle for the grandmother. With little money, her grandchildren often went without food and she could not afford the fees required for them to attend school. But now, there is hope for Maweta.
In the Chongwe district, there are currently 5,000 women enrolled in the WORTH program. Combined, these women provide care for 11,550 orphans and vulnerable children. WORTH empowers these women by providing them access to literacy classes and economic training. With help from local organizations, women are encouraged to form self-managed community groups and taught how to manage and save money. The savings are used to create village banks that can provide local women with microenterprise loans.

After attending a WORTH community orientation, Maweta began mobilizing women in her village to form a group. After nine months, Maweta has learned how to read and write and gained basic math and accounting skills.

In January 2007, Maweta sold mangoes and managed to save $60. She used the money to buy school requisites for her grandchildren so they can continue with their education. She also received a loan from the village bank in order to start a business. Maweta is currently buying fast selling food items and re-packaging them into smaller and affordable sizes for her customers. The profit realized from the business goes towards meeting her grandchildren’s basic needs and she no longer feels the worrisome financial burden she once did.
"If WORTH had been launched years back in my area I would have been rich and my own children could have been educated!" Maweta said.

For more information on PCI’s work in Zambia, visit http://www.projectconcern.org/site/PageServer?pagename=Responding_to_the_AIDS_Crisis_in_Zambia.

Tijuana, a city of 1.2 million people, is located amidst the busiest land border crossing in the world. Commerce, employment, migration and tourism bring a constant flow of millions back and forth across the border each year, and with the multitudes of people come a multitude of issues. One of the most serious issues is a growing HIV infection rate in the Tijuana border region that is estimated to be three times higher than Mexico's national average.
There a many factors contributing to the spread of AIDS in Tijuana, including a booming sex tourism industry – a business being fueled affordable prostitution rates and Americans willing to pay good money for services and will pay more if not required to wear a condom.
A study published last year by researchers at the University of California, San Diego School of Medicine indicated that the rate of HIV/AIDS infections in Tijuana, Mexico are increasing and numbers are much higher than had been previously estimated.
According to the study, the number of men and women aged 15 to 49 years who are infected with HIV may be as high as one in 125 persons – a dramatic increase from 20 years ago. In turn, infection rates on the San Diego County side of the border are spiking as well.
San Diego County currently ranks third highest in the state of California for HIV infections, trailing only behind Los Angeles and San Francisco. As of October 2007, the California Department of Health Services found over 13,000 people infected with HIV/AIDS in San Diego.

Saturday, December 1st is World AIDS Day. In recognition of this annual event, here are a few things YOU can do to help fight this global epidemic:

> Be a part of the solution! Volunteer with PCI on December 1st at the San Ysidro-Mexico border port of entry as we raise HIV/AIDS awareness in our region.
> Educate yourself about the ever-present dangers of HIV/AIDS and understand that no person or region is immune from this disease.
> Talk to your partner, children, younger siblings, or other young people in your life, about the dangers of HIV/AIDS and methods of prevention (using condoms, avoiding illegal drugs).
> Learn more about PCI’s HIV/AIDS programs in Africa and India.
> Urge your government representatives to support HIV/AIDS eradication programs.
> Get tested.