Tough women

Photo from Flickr/khym54. Creative Commons licence.

Like tens of thousands of other grandmothers in Malawi, this "Go Go" is taking care of her grandchildren because their parents have died of AIDS.

Photo from Flickr/khym54. Creative Commons licence.

This is Harriet -- one of millions of Go Go's in Sub-Saharan Africa. Harriet is a grandmother in her early 70s. She is taking care of 16 children who have no parents. Only one of Harriet's own children is still alive. The rest have died.

14% of the population in Malawi has HIV/Aids. There are 84,000 more orphans every year. Very often these children, roughly half of them, are taken in by grandmothers, sometimes leaving these older women with several children from different families to support.

Like Harriet above, most are of an age when they might be enjoying a more peaceful and restful life. Instead they are struggling first with the grief of having lost their sons or daughters, then to raise young grandchildren, often HIV positive, on a meagre income and with little or no support. They are unsung heroes.

Look again at those women above. How many of us could raise, or have raised, our own children in those circumstances? And yet these women are taking on their HIV positive grandchildren and at times other children as well.

There are so many courageous and tough women in the world, often struggling quietly in difficult circumstances. Not all of them perform spectacular feats which catch the eye or the attention of the press, but they are every bit as deserving of our recognition and, more to the point, our help.

You change your wife the way you change a car in Kano

Photo from Flickr/MikeBlyth. Creative Commons licence.

In northern Nigeria, according to the Population Council, 45% of girls are married by the age of 15, and 73% by the age of 18. Most marriages are arranged by the family to men who are on average 12 years older than their wives. Girls are brought up to believe it leads to freedom, independence, but the sacrifice is education and real independence.

Kano is an ancient city in northern Nigeria, the second largest in Nigeria. There is a high divorce rate here, where a new bride is considered a status symbol, adding to the vulnerability of the young wives. A girl can be divorced by the age of 18 and have children to support. "The way you change a car is the way you change a wife in Kano. You give birth to a few children and you can find yourself divorced for the slightest excuse," says Salamatu Da'u, a worker with a Nigerian AIDS service organisation, the Society for Family Health.

So they find themselves with limited education but having to earn in income. Inevitably this leads to menial jobs, but can also lead the way to sex work in a region where condom use is very low. Kano itself has an HIV/Aids rate that is below the national average, but among the brothel based sex workers in the city, this rises to 49.1%. These sex workers were also least likely to use condoms with their customers, and had limited understanding of how to prevent HIV transmission. Almost all the women working in the brothels had either been divorced or had run away to avoid being forced into marriage.

Northern Nigeria is very conservative, where discussion about sex is less open and literacy is low. The Society for Family Health workers are encouraging traditional leaders to promote the use of condoms. Some have, others lend silent support, but there is a long way to go, and so many different but inter-relating strands. to the problem.

Source IRIN: Underground sex in the conservative north
Child marriage
Education: the social vaccine

The Grandmother Project

The Grandmother Project is a non-profit organisation set up to develop strategies which explicitly and actively involve grandmothers as active resource persons for their communities. In most non-western countries, older women play an important part in their communities and in bringing up families. Many development programmes focus on women of childbearing age regardless of the fact that young mothers will listen to their own mothers and their mothers-in-law.

The role of the elderly, and in particular grandmothers, has been changed in sub-Saharan Africa by the prevalence of AIDS. It is estimated that 40-60 percent of the estimated 13 million AIDS orphans live with their grandmothers who often struggle with little or no support. The 'Grandmothers to Grandmothers' campaign was launched to "twin" groups of grandparents in Canada and South Africa, to the benefit of both groups.

In Swaziland, where the average life expectancy has fallen to 31, the over 49s are taking on an increasingly vital role because they are largely free of HIV. In spite of this vital role, they often slip through the safety net of humanitarian organisations.

Falling rates of HIV in Africa

There have been a number of reports of falling, or better than expected, HIV rates in sub-Saharan Africa, for example in South Africa, Liberia, Kenya.

On the face of it, it seems good news but a report today gives some reasons why this might not give the whole story. Factors which could distort the figures are:

• Initially, rates were obtained from testing in ante-natal clinics but, because they were naturally a young age group compared with the whole population and, since they were pregnant, clearly were having unprotected sex, these figures could have produced an inflated rate.
• More recently household surveys have been conducted, but high numbers refused to be tested and many others were absent from home, both of which could lead to apparently lowered rates of infection.
• The variety and unreliability of many survey methods, many being highly selective.
• Anti-retroviral drugs keep people infected with HIV alive and so boost the rates of HIV in the population. It could then follow that countries which do little by way of treating their infected population appear to have a declining rate.

The contributors to the report are suggesting that the story is a very complex one and that some comprehensive and long-term studies are carried out.

Too many women

Some time ago a couple of articles, one in the Journal of Acquired Immune Deficiency Syndromes and the other in Pediatrics, were published which demonstrated that in Africa more female babies than male babies were born infected with HIV . There could be two reasons for this: first that female foetuses were more susceptible to HIV infection than males, or secondly, that just as many male foetuses were infected but that they perished before being born, resulting in spontaneous abortions.

The latter reason appeared to be the case and would tie in with a study of elderly patients which suggests that men with particular genotypes may be less likely to survive.

I cannot find any further reference to this study of HIV infections leading to a higher birth rate of females but it seems to me that there are huge implications because of the resulting distortion of gender balance in the normal population.

Already in many African countries, women are having to shoulder the burdens left by war and AIDS.

In Swaziland, many farms have been left in the hands of women as a result of the world's highest HIV/AIDS infection rate. Until last year women were not allowed either own property or open a bank account.

In Mozambique, 30% of households are headed by women but although poverty has declined by 18%, in the female households it has declined by only 4%.

In Kenya, women are more likely to be illiterate (leading to ignorance) and living in poverty and this increases the likelihood of HIV infection. Cases in four districts had doubled to 20,000 and most of them women. Only 30% of women believe HIV could be avoided.

And of course, if there is a disproportionate number of women in the population, in some societies this could lead to an increase in female genital mutilation, in order to ensure the “attractiveness” of young women to the fewer potential husbands. A very full report on FGM can be found on the Integrated Regional Information Network (IRIN) website. IRIN is part of UN Office for the Coordination of Humanitarian Affairs.

A vicious circle

In Africa, one of the most straightforward ways of establishing HIV infection rates is by screening pregnant women when they attend ante-natal clinics. For some however this appears to promote the idea that there is a link between HIV infection and women, and this is reinforced when the statistics are quoted, as they often are. In addition many don’t realise they are HIV positive until they are screened so the first a family may know of their HIV status is through the mother.

Disastrously, in Mozambique it has led to women who find they are HIV positive being abandoned by their families. Because they fear what might happen, women are either refusing to be tested, or hiding their HIV status from their husbands and families. In both cases, those that need anti-retroviral drugs and help in preventing mother to child transmission are not receiving them, nor are they able to take precautions against further spread of the virus.

It is estimated there are 30,000 HIV positive babies born every year in Mozambique.

Original report from IRIN

Climate change affects us all

I have a bad habit of reading climate change reports and looking at how it will have an effect on my own life. But I live in a part of the world which could adapt: many don't.

ActionAid is an international agency fighting poverty in 42 countries worldwide. They have published a report that says climate change is being felt very acutely by some of the poorest communities. (The full report can be downloaded as a pdf file).

Of particular interest to me is the report, that in Malawi 90% of the 6.3 million living below the poverty line rely on subsistence farming to survive at all. They are already farming in fairly extreme conditions, so any changes in climate have considerable impact. They are themselves aware that their food production has decreased because of frequent flooding and drought.

1. They no longer know when is the best time to plant. The rainy season used to start in October but during the 70s started moving to November and now starts in December. They therefore ought to be using a fast-maturing crop to allow for the shorter season but
   privatisation of seed companies means that hybrids developed are too expensive for many.
2. The change in rainfall has caused an increase in certain diseases such as malaria, cholera and dysentry. It falls to the women to care for the sick, and this then prevents them working in the fields.
3. The floods and droughts happen more often, leaving little time to recover and adapt.
4. Deforestation is increasing and existing laws to control it are not being enforced.
5. The decrease in livelihood is forcing more people to look for work elsewhere, which in turn is forcing women into unsafe sex, thus increasing the risk of HIV/AIDS.

These findings are echoed by the IPCC (Intergoernmental Panel on Climate Change) report which is a pdf file of 23 pages. See also this IRIN report.

Update on the need for molecular condom research

If you wonder why it might be needed, read this article in AllAfrica.com, Malawi: Condoms Get a Bad Rap.

Selected quotes:

The least popular form of behaviour change reported by the study was the use of condoms.

despite surveys showing awareness of how HIV is contracted, condom use remains unpopular among Swazis

The conservative nation's top traditional leader, Jim Gama, and Nhlavana Maseko, who heads the Traditional Healers Organisation, have both condemned condoms as "unSwazi".

In Malawi, Kaler noted that "skin-to-skin ejaculation is the marker of a real man - one who uses condoms is being cheated out of his right to a high-grade sexual experience, or may even be the subject of gossip or ridicule"

The molecular condom would be a huge step forward in overcoming the problem, but it's just a pity that the lead time is so great. In the meantime, it must be down to education, education, education.

The incredible melting condom

The title, a great one if a little misleading, has been taken directly from the Economist article .

The problem with condom use, particularly in sub-Saharan Africa, is that there is often resistance to using one. The idea behind this new research is to provide women with a method of preventing infection that doesn't have to be used immediately before sex, perhaps just once a day.

The research is in its very early stages but has considerable promise. A water-based gel has been developed which changes state from a solid at body temperature and in an acidic environment, such as a vagina, into a liquid when in contact with an alkaline substance, such as semen. It is however liquid at room temperature so a liquid as it is applied which turns to a solid in the vagina, and then, when intercourse takes place, it re-liquefies and releases microbicides held within the structure.

It could take five years before it is ready to be tested in humans, and ten before its use is widespread.

The University of Utah press release gives more detail, and it is also written up in the Scientific American.

Exclusive breastfeeding reduces HIV transmission

The subject of breastfeeding is complicated when the baby's mother is infected with HIV. Breastfeeding does carry an increased risk of HIV transmission but in Africa, with widespread poverty, the alternatives are not practical, so any way breastfeeding can be made safer is important.

The Lancet this week publishes the results of a study which demonstrates that babies who are exclusively breast-fed for six months are significantly less likely to acquire HIV from their mothers. If the babies receive other milk, the risk is doubled, and if they are given solids, the risk is increased eleven times.

There is an accessible report on the study in Science Daily, though I'm concerned to see a Google ad in the sidebar, promoting a tea as having 80% success rate for AIDS and HIV. Reuters Africa also have a report.