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A recent petition by researchers, clinicians and activists made on behalf of the Treatment Action Campaign and published in the Mail & Guardian Newspaper, 28 November, 4 December 2014 Edition, The Case for Saving the TAC is Compelling, left me with mixed views on the TAC’s plight as petitioned. The TAC is evidently not unique in its current funding crisis in South Africa. Many vibrant organisations have, more recently, closed their doors, and many more are going through rugged terrains to remain relevant and afloat while meeting much needed social and health needs.

While the petition is commendable and substantial, given the respectable calibre of its signatories, as a reader, I was left with many questions. What happened to what had become (and still is) a beautiful and reflective recent case study of civil society action in South Africa? From a business case’s point of view, how did the TAC lose its competitive advantage? What influenced the change in business confidence among social investors (funders) thereby leaving it on a financial decline to the extent of facing closure? Sometimes, it is easier to blame external forces. Even much easier, as I have grown to know, to point fingers at donors for withdrawing funding.

It is important to note that the petition is silent in attributing the TAC’s own shortcomings to adapt to the times after its successes. In playing the devil’s advocate, with hope that it will help all of us with interest in social change through civil society structures, I am of the view that the two reasons given in the petition i.e. withdrawal of funding because South Africa is viewed as a middle income country and the belief that AIDS is nearing the end are not good reasons for its looming demise.

Social movements, by their very character, are based on a particular pertinent social justice issue at a particular time in society. Their existence and longevity in context, are key characteristics that define their relevance. Historically, social movements have played a significant role in ending apartheid. The transition to democratic rule witnessed the demise of many social justice movements that were on the cutting edge in fighting apartheid. In many instances, these movements were generously funded by the local and international donor communities who believed in the cause.

Progressively so, many donors changed their funding focus to reconstruction and development post 1994. It was left to social movements to transform and align themselves with the collective agenda of the day. Others successfully changed their mission statements, while others could not comprehend the reasoning to transform and align or merely found themselves incapacitated to adapt. As a result, many failed to embrace change as a constant and closed down voluntary and others involuntarily.

In my view, nobody or any institution that I know of, I stand corrected, has been complacent, or sought to dismantle and demobilise civil society in South Africa as suggested in the petition. Instead, many donors continue to demonstrate commitment in aiding all progressive and relevant development actors in their work. I believe, it is all about the TAC’s business case and what it is they are offering social investors who have interest in furthering the objectives of an effective and sustainable health system. When such is appealing, like in any case, there is no investor who would think otherwise.

At the same, be that as it may that South Africa is a middle income country, comparative studies will indicate that the social investment environment is more conducive elsewhere on the continent in which countries are much poorer. Therefore, business logic also would suggest a drive towards such. Gross unspent budgeted funds year on year, perceptions of corruption and blatant opulence in the midst of unacceptable levels of poverty, blend poorly in seeking donor funding in South Africa.

As a lay man, deeply concerned and seeking to be of assistance, albeit, not in financial terms, I humbly submit a few points for us to consider in TAC’s case:

  • The TAC can review its mission in relation to its relevance in the current public health development trajectory. Is it better to respond to the challenges noted in the system from a protestant perspective or as an institution that can support rather than oppose current efforts by government and other structures including donors already committed  to doing so;
  • Linked to the above, reconsider an alternative move from a membership organisation with 182 branches to a much more centralised and specialised institution with a niche service and product offering. The 8 000 members and 182 branches across the country that the TAC has might not be the best way to put up a case for sustaining the organisation. More so, to what extent are the current members experiencing value from TAC’s services as would be expected from a membership organisation? Answers to such will assist in decision making if the R10 million needed is nor received by February 2014;
  • There are a number of bi-lateral agreements between government and donors that are aimed at strengthening the capacity of South Africa’s health and social systems for service delivery. These agreements have also considered the global decline in funding. As a result, many have found it necessary to fund the strengthening of government systems and its human resources skills base for sustainability purposes. You will agree with me that civil society organisations come and go and yet government systems and its institutions will exist longer. This commitment includes support of locally based development actors to be able to work hand in hand with government. It may therefore not entirely true that all donors are moving away because SA is thought to be a middle income country. It is the funding focus areas that are changing which have also become highly technical and specialised hence funding being readily available for such than protest action;
  • The assertions that the gains achieved so far in the fight against HIV and AIDS could go into reverse if the TAC is allowed to die ‘for lack of funding will have grave consequences’ is a bit exaggerated. I do not by any chance suggest that the TAC’s contribution has been insignificant, actually it has been a key landmark in public health as far as HIV and AIDS is concerned. The point is that, there are many other actors, even smaller in size and public posture, than the TAC, which are helping to sustain the gains achieved to date. I do not think it is in the mind of government to wash down the drain the gains achieved to date. Instead, I guess, there is a greater call for civil society to be of help in moving towards the zero targets. Therefore, the question to TAC is, how does it become a strategic partner to current collective efforts that are supported by donors? More so, acknowledge the fact that the TAC is not entirely synonymous with the gains achieved to date neither the sustenance of such into the future;
  • South Africa has a rich culture of protest action. While we have well recorded successes of such action, it is important to also reflect on the effectiveness of such action beyond marches and placards in the TAC case. We have tended, through protest, to talk past each other and consequently not achieving the common good. To achieve what you desire, sometimes it means partnering with the most unlikely of partners even if its government in its perceived incompetence. So if the desired is achieved as a result, who cares? The TAC may need to let go of its former glory and consider new avenues waiting to be explored in strengthening South Africa’s response to HIV and AIDS;
  • Sustainability is not always about funding and having financial reserves, it is also about the relevance of a service or product offering in the market place. If such is still needed, funding will come easily. If not, scan and define a new market or gap. One cannot help but observe the shared leadership between the TAC and Section 27. Could it be that the later usurped the next phase or prophetic call of the former?

There might be, as is usually the case, a silver lining in all this. Perhaps an opportunity to reflect and learn from past experiences for the benefit of all. One lesson for all to think about is the fact that we cannot continue to sub-contract our own development as Africans. At some point, we must take responsibility and devise our own sustainable and innovative means to fund, strengthen and improve the effectiveness of our social and health service delivery systems.

As a treatment campaign, the TAC did well. Modern history in public health attests to such. Civil society campaigns, have always come to an end once the goal has been achieved. I can perhaps ascribe the same to the TAC. I do not think the TAC will be judged harshly if at all it closes its doors. As a social movement or rather a campaign, it need not be compelled to continue to exist even when circumstances do not allow. It perhaps needs to seize this opportunity to reform, rebrand and transition from a campaigning approach to an institution, adapting and adopting the key priorities in the public health sectors. At its disposal is a deep, solid and profound foundation upon which to resurrect itself, that is, its successes in the echelons of access to treatment for people living with HIV and AIDS in South Africa.

Today SA stands with about 2.7 million people on treatment, the largest ARV roll out programme in the world. This cannot be mentioned on podiums without boldly stating the TAC’s contribution if the truth can be told. The TAC can take pride in that.

In his personal capacity, Thami Sonile offers regular commentary on nonprofits and social development issues and loves a robust and constructive debate. He can be contacted via email thamisonile@gmail.com.  

By Wezi Nyirongo

As countries take stock of efforts aimed at ending gender violence (GBV) during the Sixteen Days of Activism, a close up on Malawi shows that this country has a long way to go to eradicate the GBV, gender inequality and other social inequalities what weigh heavy on women's shoulders. Despite Malawi's Domestic Violence Act and legislation on sexual harassment, gender violence persists due to lack of implementation, missing legislation and contradictory laws that negatively impact on women's rights.

According to the 2014 Southern African Development Community (SADC) Gender Protocol Barometer, Malawi joins Angola, Botswana and Namibia - the four Southern African countries that do not have specific legislation on human trafficking. Malawi is also one of 10 countries in SADC where marital rape is not recognised as an offence. Botswana, Lesotho, Malawi, Mauritius and Swaziland include claw back clauses in their constitutions. In Lesotho and Malawi the recognition of cultural and customary rights mitigates against gender equality. Women are prejudiced in customary legal systems, for example child marriage and female genital mutilation. Such harmful traditional and cultural practices continue to drive GBV and gender inequality.

Wezi Nyirongo interviews Agnes Jere, a survivor of GBV, who touches on a number of these issues and how these intersecting inequalities have negatively affected her life.

Click here to listen to the interview.

This podcast is part of the Gender Links News Service Sixteen Days of Activism Special series. Bringing you fresh views on everyday news.

Programme Director,

Minister of Health, Dr Aaron Motsoaledi,

Acting Premier of Free State,

Ministers and Deputy Ministers,

MECs and Mayors,

United Nations Resident Coordinator, Gana Fofang and Representatives of development partner organisations,

SANAC Deputy Chairperson, Mmapaseka Letsike,

Ladies and gentlemen,
 
We gather here on World AIDS Day to reaffirm our determination to work together to overcome this global epidemic.

We remind ourselves of the devastating effect that AIDS has had on communities and societies.

We recall the progress we have made, but we also acknowledge the great effort that still lies ahead.

Our experience tells us that we cannot hope to succeed in our efforts unless we work together. When we are divided, we flounder.

We therefore need to place greater emphasis on community engagement and dialogue.

Earlier today, I had the opportunity to participate in a session where community members shared experiences and insights. They offered solutions to the challenge of stigma and discrimination.

This experience drove home the message that to make progress, we need to place community voices at the centre of our response.

We need to do more to involve, capacitate and support civil society.

Despite the advances we have made in the fight against HIV and AIDS, stigma and discrimination still persist.

This can have a devastating effect on the lives of people living with HIV and on those closest to them.

It also undermines our efforts to tackle the epidemic. People are reluctant to test for HIV, to disclose their status, or to access treatment, care and support.

This World AIDS Day, let us redouble our efforts, wherever we may find ourselves, to fight against prejudice, stigma and discrimination directed at those infected and affected by HIV.

Like racism, sexism, homophobia and other forms of intolerance, the stigmatisation of HIV is driven by ignorance and fear.

We need to work overcome ignorance and address fear.

Ladies and gentlemen,

As we mark World AIDS Day, we should reflect on what progress is being made in responding to the dual epidemics of HIV and TB.

We assess the impact of our response so that we can identify what challenges, gaps and systemic issues we must confront in order to meet our objectives.

We expect the upcoming mid-term review of the National Strategic Plan on HIV, TB and Sexually Transmitted Infections 2012-2016 to provide detailed insights into the work we still need to do.

The task is huge. South Africa has the largest prevalence of HIV in the world.

Our country has more than 6.4 million people living with HIV.

We have about 400,000 new HIV infections each year.

The social and economic cost of AIDS is enormous.

It has decreased life expectancy and, consequently, increased our mortality rates. It has placed the health and social services under strain, affecting our families, communities, schools, work places, places of worship and institutions of higher learning.

Most of all, it has affected millions of families and thousands of communities throughout the country.

Yet, we have not stood still in the face of this crisis.

The number of people on treatment has steadily grown over the last 10 years. Today, we have 2.7 million South Africans initiated on antiretroviral treatment.

Life expectancy increased from 53 years in 2006 to 61 years in 2012.

HIV associated deaths in pregnant women, infants and children under five have also declined.

We have also seen a decline in new HIV infections since its peak in 2004.

The incidence of HIV decreased from 1.79 percent in 2008 to 1.47 percent in 2012.

Despite this decline we continue to have a significant number of new HIV infections every day.

One quarter of these new infections are in young women between the ages of 15 and 24.

Therefore we have to do much more to promote prevention.

Unlike many other communicable diseases, HIV prevention is very much within the power of the individual.

Everyone, especially young people, should use condoms consistently, stick to one sexual partner and delay the age at which they first have sex.

Government, civil society, non-governmental organisations (NGOs) and the private sector need to do much more to educate, create awareness and promote this message.

All leaders - whether in government, the religious sector, traditional leadership or business - need to speak about safer sex practices.

We are concerned about the number of South Africans who do not know their HIV status.

We had a very successful HIV counselling and testing campaign in 2010. In a period of 20 months we were able to test 20 million people.
However, this has to be a continuous process.

A recent survey estimated that two million South Africans who are living with HIV do not know their status.

Without this essential information, it is not possible for these individuals to seek medical help or to act appropriately to protect their partners from becoming infected.

We must ensure that every South African tests for HIV and is screened for TB annually.

We have prioritised offenders in our correctional facilities and mineworkers in our fight against the dual epidemics of TB and HIV.

With high levels of TB and HIV in these two groups, we successfully applied for funding from the Global Fund to expand our services for these two groups.

In the next two years we will use the US$54 million to:

  • Improve TB and HIV services to 500 000 mineworkers and 600 000 people living in 6 peri-mining communities;
  • Strengthen services in correctional facilities in all 48 correctional services management areas; and
  • Strengthen multi-drug resistance TB services in all 52 health districts.

Despite the progress that we have made in the past five years, the end of AIDS is not as near as we would like.

At the International AIDS conference in Melbourne, Australia earlier this year, the Joint United Nations Programme on HIV/AIDS (UNAIDS) announced global targets that will move us closer to the end of AIDS.

These are the 90, 90, 90 targets.

This means we need to test 90 percent of South Africans for HIV, initiate 90 percent of those that are HIV positive on treatment, and ensure that 90 percent of those on treatment are virally suppressed by 2030.

As a recent detailed analysis that we undertook has shown, reaching these ambitious targets is affordable over the mid-term.

The same analysis has also pointed to a number of ways in which we can spend our money better, by ensuring that everyone gets tested for HIV, uses condoms all the time, and gets onto treatment as soon as needed. We also need to encourage as many men as possible to undergo circumcision.

One of the major barriers to achieving these targets, however, is the stigma that still exists in South Africa and other parts of the world.

Stigma is the prejudice, exclusion and isolation of an individual by another or by a group.

It is irrational. It is hurtful. It is unacceptable.

While HIV has had an unprecedented impact on global health, it is like any other disease. There should be no shame and no blame.

This is not the first time we have had to confront discrimination.

South Africans have fought against discrimination for over three centuries.

We overcame a system of institutionalised racism, a system described by the world as a crime against humanity. We set our country on a path towards a non-racial future.

We can do the same with HIV.

The South African National AIDS Council (SANAC) Secretariat, working with the sector of People Living HIV and the Human Sciences Research Council, is conducting a survey to gauge the levels and identify the forms of stigma in South Africa.

While we know that stigma exists in South Africa, the survey will help us understand it better and identify areas for intervention.

In South Africa, as is the case around the world, HIV and AIDS is a source of social concern, personal anxiety and economic impairment.
Yet it has also been a source of courage, fortitude and hope.

Today, we are honoured to have among us some people who became infected with HIV and experienced different forms of stigma.

These people have bravely availed themselves to speak out against discrimination on World AIDS Day 2014.

Their stories are being broadcast on television and radio and shown in taxis and shopping malls. The video clips will reach thousands of people on Facebook and Twitter and will be shown at UN agencies throughout the world.

It is now my honour to read out the names of these eight very special individuals who have volunteered their stories to advance the campaign for Zero Stigma and Zero Discrimination.

Please join me in thanking Koketso, Cindy, Mmabatho, Phindile, Nomasomi, Mongezi, Simphiwe and Yvette for championing this important cause.

Fellow South Africans, it is almost one year since the passing of our founding President Nelson Mandela.

Madiba dedicated his life to the struggle against discrimination in all forms and manifestations.

He campaigned for the recognition of the rights of people infected with HIV. He broke down the walls of ignorance and fear.

We need to honour his legacy by breaking our silence.

We need to say no to stigma and discrimination.

We need to embrace our common humanity, our diversity and our unique - and equally valid - identities.

Let us honour the memory of those who have lost their lives because of the violent prejudice of the few. Let us carry forward their aspirations to be recognised, respected and valued.

We have overcome before. We can do so again.

I thank you.

For more about the Presidency, refer to www.thepresidency.gov.za.

 

By Jose Tembe

As we commemorate Sixteen Days of Activism, it is important to consider all the forms of violence that women and girls are subject to and how these forms fundamentally effect their access to education, employment and the economy. This disempowerment perpetuates gender inequality and renders women more vulnerable to other forms of gender-based violence. According to the 2014 Southern African Development Community Gender Protocol Barometer gender violence and sexual harassment in schools and in work places remains a major problem across the region.

Reporter Jose Tembe investigates the problem in Mozambique. According to those interviewed in the report, sexual harassment is a matter of serious concern in Mozambican schools, contributing to poor education performance among school girls, dropouts, early pregnancies, and a rise in HIV infection in the country. One can also tell from this story that fuelling this scourge - as it is across the globe- is a culture of silence and victim-blaming, since people are of the misguided belief that girls wearing mini-skirts "provokes" sexual harassment. Both the authorities and people working in the education sector agree that a lot remains to be done to curb this form of gender violence and to ensure women are safe and free from harassment in schools and work places.

Step-up Shoe Drive is a project meant to help alleviate some of the socio-economic hardships experienced by children affected and infected by HIV. The aim is to ensure that these children get the primary basic needs to help keep them in school so that they can get a quality education to better the chances of survival in future. This project was initiated by Dr Sinah Vlug, the Foundation for Professional Development (FPD) clinical mentor and team leader of the Tshwane North-West Sub-districts roving team.

“The project was initiated in 2012 as a personal fundraising challenge. In February 2012, I challenged myself to donate R25 for wearing a different pair of shoes everyday of the month and posted the proof on my Facebook page. This made me realise how fortunate I was to have so many pairs of shoes while most of my patients (mainly children) did not even have one decent pair to use for important occasions like going to school. So the challenge was to raise enough money to buy a few pairs by winter of that year and to donate to needy children in the hope of making their lives much better, shared Dr Vlug.

Since 2012, interest in the project has grown beyond Facebook. Many people who are supporting the project donate through buying school shoes, stationary, standard school uniform, 2nd hand and new children's clothes as well as money. The money is used for buying stationary and help towards paying school fees and buying groceries for the children in need.

Since the beginning of the project, 56 pairs of school shoes, five sets of school uniform and stationary worth R3 000 have been donated. R1 200 worth of school fees has been paid for two High school pupils in Soshanguve. Two orphans who are looked after by a pensioned grandmother receive ongoing support in the form of groceries and clothes and many more families have received 2nd hand clothes to help them get by.

The recipients of the donations are mainly affected and infected by HIV and orphans. Some of the recipients are identified through interactions during medical consultations and some are identified during events held at Healthcare facilities. Recently, children living on the streets have been added to the list of recipients, those children are occasionally supplied with old clothes, shoes, toiletries and blankets.

FPD staff members have been generous with donations and well wishes.

Donations that are mostly needed include:

  • School uniforms and shoes;
  • Old stationary;
  • Conference and school bags in working condition; and
  • 2nd hand clothes.

“I usually encourage people to add things like toothpaste, sanitary pads, wash cloths, soap bars and other toiletries and stationary in the school bags if possible. Anything is welcome as other people can benefit greatly from it. Money is mostly necessary at the beginning of the year where the need for stationary is the greatest,” said Dr Vlug.

People who interested in donating can contact Dr Vlug on ms-vl@hotmail.com, and arrangements for collection points can be made if they are outside FPD offices.

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