What breakthrough is needed to combat HIV/AIDS?
For an HIV/AIDS breakthrough to happen in Tanzania, a radical approach to tackling HIV/AIDS and its impact is needed, writes Salma Maoulidi, who asks “How can any progress be made in the HIV/AIDS battle if current strategies are superficial and isolated?"
It is over two decades since the first AIDS patient was diagnosed in Tanzania. In response, a number of measures were devised and adopted by the government to respond to the pandemic. These measures reflect the progress in official understanding and attitudes about the disease. Initial responses were comprised mainly of health measures designed to address curative aspects of the disease. Then, denial about HIV/AIDS, even in official quarters, hampered more effective responses to the disease.
The rise of associations of people with or affected by HIV/AIDS, parallel to existing responses, spearheaded psycho-social and policy responses. This brought about two major benefits in the fight against HIV/AIDS. Foremost, it “outed” the disease enabling HIV/AIDS activists to focus more deliberately on addressing stigma, a major barrier in addressing the pandemic at the personal and institutional level. Similarly, concerted advocacy by HIV/AIDS activists brought the disease out of a medical isolation where it was viewed purely in health terms, to the level of considering non-medical dimensions.
The progression from National AIDS Programmes to an AIDS Commission in the late nineties heralded the multi-sectoral approach currently adopted.
For the most part, HIV/AIDS associations have confined their responses to the impact on the individual and community. Overwhelmingly, their response is service oriented e.g. provision of home based care; nutrition programmes; provision of legal services; widow or orphan care; and HIV/AIDS support groups something that hinders their ability to focus on more strategic concerns related to HIV/AIDS. Only a small number of associations mix advocacy with service provision. Accordingly, while Tanzania in the mid nineties declared HIV/AIDS a national calamity, few organizations have built upon this opportunity to advance HIV/AIDS advocacy efforts in a meaningful manner.
Instead, what is new in existing and upcoming HIV/AIDS initiatives is the location; or the gender and youth focus.
HIV/AIDS organizations, mainly veteran associations that have introduced policy advocacy initiatives in their programming, require capacity in translating this in practical policy results and interventions. For example, some HIV/AIDS organizations are pressurizing the government to make ARVs accessible to People Living with HIV/AIDS (PLWHA). While the government receives due attention in taking measures to make this a reality, little attention is given to the role of pharmaceuticals in facilitating treatment options. Surely, other than an official commitment in principle to facilitate treatment, there is very little the government can do, in practical terms, to provide ARVs on a mass scale.
This, however, is something local pharmaceuticals can and should be obliged to do. And a few have risen to the challenge, leading discussions with the government under various trade agreements like the East African Community Treaty on Common Markets. Local pharmaceutical companies like the Tanzania Pharmaceutical Industries (TPI), not HIV/AIDS associations, are challenging the monopoly of foreign companies in the production and distribution of ARVs. They capitalize on their geographical location to build a case for ARV production more suited to local populations and at more affordable rates. An added benefit to their proposal is the prospect of creating jobs for local the population. Certainly this development presents an opportunity for partnership between the HIV/AIDS community and the business community that includes aspects of HIV/AIDS advocacy and corporate social responsibility yet to be explored. However, it is a sector HIV/AIDS activist are noticeably absent and silent from.
Equally important is the need for more strategic responses vis á vis the HIV/AIDS pandemic, not only by the government but also by community institutions. The policy and legal framework focuses on “formalized” aspects of discrimination against PLWHA or those affected by HIV/AIDS. Thus due attention is given to the employer-employee relationships; access to health care; and to a smaller extent the question of legal services to PLWHA and their families. These measures, however, fall short of infusing the radical spice to significantly impact PLWHA or their families since they fail to address the primary cause of unhindered HIV/AIDS transmission: the traditional interpretation of the family institution and the unequal relationship between parties in the family union.
Indeed, transmission patterns in Africa, Tanzania included, are largely heterosexual.The majority of those affected or infected with the HIV/AIDS virus are married men and women - not sex workers and not single women or homosexuals. This is important to consider as it dispels a major stereotype of HIV/AIDS victims and transmission of the virus.
It was this breakthrough that enabled HIV/AIDS researchers in the west to begin expanding their investigation of the disease and its transmission beyond the homosexual community or intravenous drug users. The fact that HIV/AIDS in Africa and Asia is transmitted mainly through heterosexual contact debunked the Sodom and Gomorrah theory which confined the problem to a particular group in the society considered immoral to be dispelled.
What is interesting is that in spite of this knowledge, most institutions representative of patriarchal authority lack the will to redress this situation. For example, they fail to focus on the unequal relationship between man and wife that allows the man unfettered sexual access, thereby compromising the health and life of his spouse. Many times this is done with the full endorsement of public and legal institutions under the rubric of preserving the religious or cultural order. In effect, the interest is rather in preserving the status quo rather than guaranteeing equal protection and treatment to both spouses even when this is required by the constitutional order.
Indeed, women the world over, and particularly in Africa, are vulnerable to HIV transmission not only from their partners but also when performing reproductive functions e.g. during childbirth or taking care of family members infected with the disease. Yet, we are yet to have legal mechanisms that address this aspect of their vulnerability. If anything, there is resistance and denial about what is at issue in empowering women in exercising greater control over their bodies and lives.
Additionally, whereas the individual is sanctified under most religions, and cultures recognize ungendered interpretations impose limits to the exercise of individual authority when it relates to the female sex, confirming the continued discrimination against women in public and private spheres: Under the constitutional and civil orders, men and women have equal rights by virtue of their citizenship. In practice, however, women continue to be considered second-class citizens and consistently denied the protection of the law due to any citizen of a nation state. Widows with HIV/AIDS are doubly punished: they are recklessly infected with the virus and then dispossessed of jointly acquired property from the investments made to their families. In most cases, the law requires that they be looked after by their children or in-laws, even those they brought up!
This is a moral aspect that is yet to be addressed.A recent High Court decision on the inheritance status of widows raises serious questions about the willingness of key public sectors to transform our thinking beyond the cultural rubric, one that is parochial and unsuitable to present realities. In the case of Elizabeth Stephen and another vs. the Attorney General (Miscellaneous Civil Cause no. 82 of 2005) High Court Justice Mihayo dismissed an application lodged by the applicants, two widows, requesting the court to uphold their constitutional and civic rights by declaring discriminatory customary laws and provisions that continue to deny women property rights as unconstitutional. The judges declined to do so, fearing opening up a Pandora’s Box of legal challenges to the practices of about 120 tribes following the same path. Interestingly, while Tanzania gained her independence four decades ago, the legal fraternity represented by these justices seems oblivious to this fact. They choose instead to invoke and apply a reasoning based on a colonial reference, one that reflects a narrow appreciation of African culture as being homogenous and static not dynamic.
In my long legal and activist carrier I know of very few families, affected or not with HI/AIDS, being provided for by the “guardian” as required by courts or some religious orders. In fact, cases of maladministration of family property, whether by self appointed guardians or those appointed by the court or clan, abound with many families being impoverished by greedy relatives with no effective recourse to oblige performance or restitution of the plundered property. Importantly, in this day and age, what is the logic of requiring a blood relation who may be a stranger to the family to assume responsibility of family affairs he has little competence in or will to execute? Does the experience of the female spouse who for years looked after the family count for nothing? This is a clear case of de facto discrimination and should be termed as such.
Undeniably, significant progress has been made with in responses to the pandemic. In this respect, the introduction of a policy and legal framework on HIV/AIDS in Tanzania provides a wider focus on addressing existing and potential challenges related to HIV/AIDS, though presently more attention is given to issues of labour discrimination and treatment options reflecting present, not strategic concerns. Until now the war against HIV/AIDS is defined in militaristic terms: strategies to combat HIV/AIDS; bracing for a national calamity; fighting the scourge etc. We are yet to define it in human terms not only in so far as the health or economic implications but also in so far as the political implications to a class that is vulnerable to the infection.
How can concerted efforts against HIV/AIDS succeed if, at its outset and at the most fundamental level, the effort is not collective? How can transmission be curbed when one party is unsuspecting and not empowered to suppress transmission? How can any progress be made in the HIV/AIDS battle if, current strategies are superficial and isolated? Recognizing women’s bodily integrity and full agency in the family are important ingredients in transforming the HIV/AIDS menace. It is in this regard that I call for a radical response in tackling HIV/AIDS and its impact. I believe rather than viewing HIV/AIDS solely in a negative light, it offers us immense possibilities to re-define social relations and values a new, in ways that are more suited to our present realities and experiences.
• Salma Maoulidi, Executive Director of Sahiba?Sisters Foundation, a women’s development network based in Tanzania.
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