Interview with WHO Assistant Director General for Family and Community Health
Sunday 22 August 2004
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AFRICA: Interview with WHO Assistant Director General for Family and Community Health

[This report does not necessarily reflect the views of the United Nations]

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Women and children are bearing the brunt of the AIDS crisis

GABORONE, 28 July (PLUSNEWS) - Joy Phumaphi, the World Health Organisation's (WHO) Assistant Director General for Family and Community Health, highlighted the need to prioritise women and girl children in the fight against HIV/AIDS during an interview with IRIN. She spoke after a two-day meeting of the Commission on HIV/AIDS and Governance in Africa (CHG) in Gaborone, the capital of Botswana, which ended on Tuesday.

QUESTION: Why should women and girl children be prioritised in the fight against HIV/AIDS?

ANSWER: It is not that women and children should be prioritised - what happens in the provision of services is that women and girl children are left behind ... In a lot of African countries health is not free, and those with resources dictate how resources are spent. When a women cooks for the family, she gives them the best food and takes what is left behind. Women do not have equal access to health services because they do not command resources, and in a family they come last.

So you have to find special ways to bring them in. Fifty-eight percent of infected people in Africa are women and girl children. In some countries, among certain age groups like teenagers and young adults, the majority of infected people are female. In some countries the figure is as high as 65 percent.

The major factor is inter-generational sex, and [most commonly] older men with younger women, and older married men and young girls ... having inter-generational sex will infect both his wife and this young girl.

Prevention messages must focus on older men and young girls - she must be able to resist cellphone, cash and car [the three C's]. We have to craft messages for men and women where they need to be empowered.

Q: Is there not a risk that the boy child and men will feel excluded?

A: The risk is there - that is why we should have special focus on men and youth. The fact of the matter is that we must be focused on target groups. The services must be very friendly to everybody ... it is a difficult balance to keep, but one that must be maintained.

Our messages must be accessible to all age groups, cultures and all classes. They must not favour rich or poor people.

Q: Are prevention of mother-to-child transmission (PMTCT) interventions producing the desired results?

A: Prevention of mother-to-child transmission is producing the desired results because we are protecting 40 percent of those on PMTCT [therapy] in Botswana. In Africa ... under 10 percent are on PMTCT. The problem in Africa is that we tend to pilot instead of pursuing the accelerated scaling up model ... When you are piloting it takes two to three years to start, which delays the rolling out of the programme. In a phased approach you continue, and pick up lessons as you go. In Botswana we did a pilot and then accelerated a phased in approach. We had originally planned to scale up until 2005 but, at the time, I was able to push them to agree to a deadline ... Piloting antiretroviral drugs is a waste of time ... We should have basic staff at all centres and then scale up per centre, rather than per district. It is much easier that way.

Q: Given the strength of men in relationships, shouldn't there be a greater focus on the role of parents and not only mothers?

A: This should definitely be the case. Most caregivers are women and this compromises the quality of care, because they do not have resources. Men should be brought on board, so that they can also be accountable for prevention, treatment and care. We were pleasantly surprised when we visited the Botswana-Baylor Children's Clinical Centre of Excellence at Princess Marina Hospital and saw men who cared about children as much as women. The fact of the matter is that there are some men who play positive roles as caregivers and are hurt by perceptions of men as indifferent.

Q: What do you think the role of guardians should be?

A: We need to recognise that children as minors are supposed to be legally incompetent, but they also have rights. The role of the parent is to protect the rights of the child. I think this is not what we appreciate - people think the role of parent is to instruct ... We need to look at guardians who refuse children treatment or do not tell them their status, so they learn their status from other sources.

The legislation must be very clear in defining the role of guardians and the rights of children, and administrative legislation should identify tools that can be used to monitor the interests of the child as well as what health workers can do ... Usually when a parent refuses [to disclose a child's status to him/her] they think they are protecting the welfare of the child because a child does not understand implications of HIV/AIDS.

Q: What was the purpose of these [CHG] discussions?

A: The discussion was for us to learn from practitioners from Botswana, Swaziland, Mozambique and Zimbabwe to identify policy directions for Africa. We will write a report to Kofi Annan, the United Nations Secretary-General, so that he can advocate for its use in programmes for Africa.

Q: Any parting thoughts?

A: I think that we need to go back to basics and not isolate HIV/AIDS - you cannot handle HIV/AIDS alone. HIV/AIDS found other diseases and other weaknesses in the health care system and took advantage. In order to successfully defeat HIV/AIDS, we need to perfect our health system and fight those other diseases as well. If a person has TB [tuberculosis] they are more likely to contract HIV/AIDS because their immune system is weakened. Weaknesses in our health system, like the delivery of ante-natal care to mothers, can fuel HIV/AIDS ... if laboratory support services are weak, and the drug management system is weak, then we will not be able to test for HIV/AIDS, check the viral load and determine the CD4 cell count. You will also not be able to secure ARV drugs.


Recent AFRICA Reports
IRIN PlusNews Weekly Issue 195, 20 August 2004,  20/Aug/04
HIV-positive women speak out,  17/Aug/04
Sexual Offences bill raises many concerns,  13/Aug/04
IRIN PlusNews Weekly Issue 194, 13 August 2004,  13/Aug/04
Removal of generic drugs from WHO list a wake-up call,  6/Aug/04
The Global Fund to fight AIDS, Tuberculosis & Malaria
International Community of Women Living with HIV/AIDS
The Global Fund to fight AIDS, Tuberculosis & Malaria

PlusNews does not take responsibility for info in links supplied.


PlusNews is produced under the banner of RHAIN, the Southern African Regional HIV/AIDS Information Network. RHAIN's members currently include:

  • IRIN
  • Inter Press Service (IPS)
  • Health Systems Trust
  • Health & Development Networks
  • GTZ/Afronets

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