The HIV/AIDS response: Co-ordinating chaos

Once again, apologies for the hiatus on the blogging front. In my defence I have been very busy and when I have been ‘relaxing’ I have found myself incapable of arranging the thoughts buzzing around inside my brain on a daily basis into anything coherent enough to post. Instead I have been drinking and singing karaoke, but I won’t bore you with that now.

Over the last month or so I have been engaging with the Global Fund (for AIDS, Tuberculosis and Malaria – GFATM for short…oh yes, another acronym). Of course I’m after their money to fund our projects (that’s my job after all) but the process of working with them has been a very interesting experience in itself.

As many of you will know, HIV/AIDS is a huge problem in Africa. Liberia is not currently in the same situation as some countries in Eastern and Southern parts of the continent where, in some cases, as many as one in three people are thought to be infected with the virus. Estimates are a bit sketchy but the general consensus seems to be that the prevalence here is somewhere in the region of 2.5%. That’s still a pretty shocking statistic and, what’s worse, an antenatal survey showed that the rate in pregnant women was closer to 5%. This is effectively a ticking bomb. If pregnant women are infected there’s a very high chance they will pass on the virus to their children and the pandemic will become even worse in generations to come.

Hopefully most people reading this know how HIV spreads so I needn’t go into details there. However, the problem is often framed purely as a health issue when in fact there’s a huge socio-economic aspect as well. People in poor countries are more likely to become infected. Why? Several simple reasons include the fact that they may never have heard of HIV; if they have they don’t know how it spreads; and if they know they may not have access to condoms.

A range of other factors often go unconsidered. HIV is heavily stigmatised and so it is very uncommon for people to reveal their status if they are HIV positive. This pushes the virus underground. Apparently 90% of people lining with HIV in Africa don’t even know they are positive. Even if they are able to go and get tested they often don’t want to simply because they are afraid of being ostracised by their families and communities if they discover the worst. The common conception is that HIV/AIDS is a death sentence since it is incurable. However, antiretroviral drugs now exist which mean that HIV positive people, assuming they have access to the right cocktail of medicines, can lead a long and relatively ordinary life.

And then there’s the whole gender aspect. HIV is often associated with homosexual men in the West. In Africa there’s actually a higher prevalence among women. There are biological reasons why women are more susceptible to the virus but again, there are also social ones. Rape was commonly used as a weapon of war during the civil conflict. Violence against women is deeply ingrained and continues even after the end of the war. The old mantra to fight AIDS used to be the ‘ABC’ approach – Abstain, Be faithful, use a Condom. You don’t need to be a rocket scientist to understand that none of these are particularly helpful to a woman who is raped. For this reason ActionAid has been campaigning to highlight the link between gender-based violence and HIV.

Unfortunately though there are even more reasons why women here may fall prey to the disease. One quite gruesome example is the practice of FGM – female genital mutilation. This is a form of initiation rite for women and girls in many tribes. I don’t know very much about it but suffice to say it involves sharp implements and delicate regions of the body and infection can be transmitted in a similar way to when drug users share needles. It’s quite horrible to think about I know. It’s also a tradition and a very taboo subject which makes it much harder to advocate against.

So what to do? How do we stop this virus from spreading? The Global Fund is a bit unique as far as donors go in that they ask for a national proposal to be submitted rather than organisations sending in their contributions individually. This has meant a lot of meetings with the various NGOs and government departments doing HIV/AIDS work here to try and reach a consensus about what we want to put in Liberia's proposal.

It actually hasn’t been that difficult to agree on what needs to be done. Health systems are weak and need to be strengthened. Infrastructure must be improved. People living with HIV/AIDS must be supported. Stigma must be reduced and myths about the virus dispelled. Drugs and testing services must be made available for free. Condoms must be distributed. People must be informed of the risks. Women must be empowered to negotiate safe sex and…the list goes on (and on). Obviously each of the organisations involved has been trying to push their own agenda (I’m no exception to that rule) but if the agenda is for a good cause then who can argue? The problem has been trying to arrange all of the ideas into a coherent package with activities that compliment one another and that will (hopefully) be accepted by the donor.

Generally speaking I think this is a very good way to do a proposal though i.e. by consulting with all of the stakeholders involved. One thing I’ve discovered since working here is that the development world is often incredibly uncoordinated. There are probably thousands of NGOs all doing very valuable work but there seems to be a near total lack of communication about exactly who’s doing what sometimes. This results in interventions being carried out on a somewhat ‘ad hoc’ basis. Small ‘islands’ of development are dotted around the country where, for example, health services are available while other areas get completely forgotten.

This general lack of coordination seems to be a recurring theme here but I suppose it’s no surprise. After all, if the government functioned properly and was sufficiently well-organised then Liberia wouldn’t be in such a mess and people like me wouldn’t be here trying to look for order in the chaos!