Please enjoy this recent article I wrote about Botswana and the country’s No New HIV Infections by 2016 goal!
This is the first of several articles I’ll be writing for the Botswana Guardian and Midweek Sun.
Light poured into the one-car garage meeting room of the Francistown Network of Support Groups as Edward Moreki opened the heavy, vertically swinging door. “Today we are meeting to approve our new constitution,” said Moreki, chairman and founding member of the organisation, and eight core members took their seats around a wooden conference table that almost entirely filled the dimensions of the room.
The Francistown Network of Support Groups (FNSG) is a tiny, influential, and at times life saving organisation with a history of growth and struggle. Started in 2005 to fill a gap left by the closure of COCEPWA – Coping Center for People Living with HIV/AIDS, it served as the umbrella organisation supervising eight HIV/AIDS support groups in the Francistown district. Through its counselor training programmes for people living with HIV, FNSG has helped hundreds accept their positive status and correctly adhere to treatment programmes, and has mobilized other infected and affected individuals to lead healthier and more fulfilling lives.
But since late 2009, the organisation has been in danger of folding. Once fully supported through the District AIDS Office and by the African Comprehensive HIV/AIDS Partnerships (ACHAP), funding ended when ACHAP’s focus shifted from HIV treatment programmes to organisations that specialise more directly in prevention.
“We were impressed with what they were doing, “says Charles Olenja, Senior Programme officer at ACHAP. Olenja says they were so impressed that in 2008 they produced “Prevention with Positives,” a thorough documentation of FNSG that would be used as an example to help similar fledgling organisations throughout Botswana grow into what FNSG was at the time. “I still feel they are an important group in prevention, but if the principals say no, I have no control over it, “he says.
The funding cut left FNSG with an inability to retain members. Both the organisation’s lay counsellor programme, which focused on counseling patients in clinics, and focal person programme, which spearheaded support groups, required putting in full-time work. ACHAP’s funding included small incentives to these trained members, and as a result of the cessation of funding, support groups collapsed and FNSG’s membership dropped significantly – falling from over 100 to five in a matter of months.
“It was a blow to us,” recalls Moreki. “Most have gone to greener pastures and joined other organisations.”
Without money or members, FNSG lost its structure as a multi-tiered organisation offering counseling and support to hundreds, and has instead whittled down to a group of determined members meeting once a week and now offering their support towards resuscitating the organisation.
To make matters worse, at the time of ACHAP’s withdrawal FNSG was not a fully registered organisation and had no other backup funders. They relied solely on the District AIDS Office, the HIV/AIDS Technical Advisory Committee (TAC), and ACHAP for their technical and financial support. Part of this, says Sibatheni Phakala, FNSG member and lay counselor, was due to the fact that they were concentrating all of their efforts on their operations. Funding seemed secured.
“We focused too much on clinics,” says Phakala, “we realized that some of the important things are not done.”
The HIV/AIDS Technical Advisory Committee was also caught off guard by the withdrawal. “TAC was not prepared for the withdrawal of ACHAP,” says Dr. Paul Nashara, Public Health Specialist and TAC Coordinator. “Since this happened we have run out of ideas,” he says, adding that he hoped to include FNSG in the next meeting’s agenda.
While FNSG fights to regain its financial security and status, HIV positive patients who would be receiving benefits from the organisation are now left without much help to turn to. Mopati Mompati, FNSG member and lay counselor, says since he stopped working in his clinic in Gerald he has already noticed the situation regarding patient adherence to anti-retroviral therapy changing rapidly. He explains that people are not receiving the right counseling to help them accept their status and thus feel uncomfortable waiting in the lines to receive medication.
“Since we left, the number of people who have defaulted has gone up. The number of people who have died has gone up,” says Mompati.
He also believes the FNSG lay counselor programme is essential and irreplaceable.
“The relationship that we have with them is the kind of relationship even a doctor cannot have with a patient. That’s why I think we are different,” he says. “We feel it’s only at FNSG where HIV positive people can find comfort within people they share the same feelings with.”
It is this aspect he and many other members feel sets FNSG apart. While other organisations offer support groups and systems for treatment, FNSG employs those who are already HIV positive to work with patients having a hard time dealing with the realities of an HIV positive life. They believe this helps new members feel confident about disclosing their status and beginning a new life, free of denial.
Aware of the vital role they play in Francistown, FNSG is now scrambling – implementing a new constitution, writing proposals to other donors and thinking of new ways to survive. It became a fully registered organisation in April last year, and in October it began a door-to-door campaign aimed at educating young adults on the importance of eliminating multiple concurrent sexual partnerships. This campaign, which is currently ongoing, is also geared at recruiting new members interested in volunteering.
In April 2010 FNSG began a catering service that provided traditional Setswana food both for individual and hired events and at a food stand outside Francistown’s government offices. Although it did not earn FNSG much money and eventually was put on hold, Wynter Mmolotsi – the Francistown South MP, occasionally still hires them to cater for his meetings. For the past year and a half he has continued to share his office space, electricity and water – a donation carried over from the previous Francistown South MP.
“We are working so well,” says Mmolotsi. “I wish I could do more for them. My office has limited resources – there is little that we can offer, but I wish we had more to share with them.”
I wouldn’t normally use this forum just to post a Youtube video, but I felt this one hits pretty close to home with what’s going on with the HIV/AIDS scene here in Botswana. During a TED talk, Hans Rosling, a doctor and researcher who is especially enthusiastic for giving visually stimulating presentations on global statistics, discusses the changing percentages of HIV infections over time, income, and location. He highlights Botswana, and shows just how relatively high the HIV rate is here as compared to the rest of the world. It’s important to also note that the issues he brings up in terms of why HIV is so abundant in Southern Africa – multiple concurrent partnerships, lack of condom use, and intergenerational sex – are some of the key issues we face on a daily basis in our behavior change and prevention programs.
Click here for more info and presentations from Hans Rosling.
The day after the big storm the DAC office driver, Bob, picked me up from my house in a government truck and drove me, the DAC office supplies keeper, Albert, and about 200 meat pies over to a residential part of town called Area W. We were headed to the sports field to fulfill some of our duties as DAC officers, representing the office to show support and take note of the success level of the event. This match wan’t created solely to play football, but because more and more HIV/AIDS based organizations are using tactics like football tournaments to reach out to young men.
Area W is a residential part of town with low to middle income housing. It’s just a few blocks from Francistown’s ritzy outdoor mall and big box store (think Wal-Mart but slightly more upscale), but our group conversations with community members reveal that the area, like many areas in Francistown, has a substantial problem with brothels, over drinking, out-of-school youth, and consequently, HIV. These problems can be well hidden from outsiders – one would probably not know it if he were to walk past a brothel as they look like any other home. Because the problem areas can be so hidden, penetration into the community and implementation of behavior change can be much more difficult.
The day’s organizer was Ultimate Youth of Destiny, an up and coming NGO in Francistown that caters to educating young people on the benefits of abstinence until marriage. It’s also one of many organizations that occasionally uses football as a bridge to bring a message of HIV/AIDS awareness to young men and women, but especially men. Men in Botswana statistically don’t test for HIV as often as women, and therefore have a greater chance of infecting several partners before becoming aware of a positive HIV status. So, ideally, the men hear news of the game, come out to play, eat a meat pie provided and paid for with government District AIDS Office money, and leave with a message of healthier living. Positive reinforcement through food and sports.
I was amazed at how many people turned up. Six teams worth, or about 30 players, came out to play while onlookers sat on the roads nearby or walked through the field as the games commenced. The game field was just a large patch of ground enclosed by street and trees. Off to the right from where I sat was a huge pool of rainwater from the storm the night before that repeatedly floated the football during a play. The teams trickled in over the course of the morning, each with their own impressive uniform shirt, and jumped right into the game with intense energy under the hot and humid sun. They seemed totally unphased by the sweltering heat.
The Saturday was turning out to be an excellent day for a football match, but a pretty unlucky day for the real purpose of the game – getting the message of abstinence and the dangers of multiple-concurrent partnerships (MCP) out to the players. Though the organizer from Ultimate Youth gave a brief pre-game talk on the goals of the organization, only one team out of 6 had arrived by that time. Once the games started, Bob and Albert attempted to set up the sound system and some large speakers so Ultimate Youth could play music and occasionally talk about MCP, but this plan fell through when the cord was too short to reach the power source, the Area W clinic, down the street. Bob and Albert left during a match to get a longer cord, and meanwhile more teams arrived and played and left and some didn’t receive the message. So when they were finally able to set up the sound system there were only a few matches left, and Ultimate Youth was only able to squeeze in a few last minute reminders towards the end.
The other issue with events like this is that even if the sound system had worked from the beginning, it’s still very difficult to determine how effective these types of events are. There isn’t really a quantifiable way to measure the effects of a message-based football tournament because behavior change is such a gradual process and can come from a number of different factors. And in a country of only 2 million with one of the most highly concentrated HIV positive populations in the world, all efforts need to be worthwhile. We are presented with a constant tug-of-war between reaching out to the community in an enriching way that produces a quick enough turnaround reduction of HIV infections, and fighting with the fact that poverty and lack of education lead so many so quickly down a destructive path. Regardless, we assume that a football tournament is a failsafe way to reinforce positive behavior by keeping people, at least temporarily, away from an abusive lifestyle and focused on healthy living and camaraderie.
Last week I helped plan my first event. As a PCV, I’m not really supposed to be planning or leading, but more acting as co-facilitator. Whatever it was, leaders from the Catholic Relief Services, District AIDS Office, Ghetto Artists (an amazing local acting troupe that specializes in promoting messages of healthy living), and the Francistown Network of Support Groups (support for people living with HIV/AIDS) met together and planned a beautiful memorial for those who have died from complications due to AIDS. This is an annual worldwide event that usually takes place in May.
I learned a lot about how events can come together. Some planners arrived (with me) at least an hour early. Others arrived after it had already started. The even took place in the Tatitown Customary Court, or Kgotla as it’s known in smaller villages, which serves as a community center. As per usual with community events held at the Kgotla, our driver strapped a PA to the top of a truck and drove around advertising the event. Loud, festive music blared from speakers as children from the community came to help set up. Chairs were arranged in the shape of a large red ribbon, everyone received a red ribbon and a candle, and as always, a pastor opened and closed the event with a prayer. The Assistant District AIDS Coordinator gave a speech centering around the theme of the event, “Many lights for Human Rights” and spoke about how we need to stop turning our backs on vulnerable and underrepresented populations like the homosexual community, people living with HIV/AIDS, commercial sex workers, youth, orphans, and drug users. A passionate woman named Grace gave a testimony about the stigma she faces living with HIV, mentioning at one point (or so it was translated to me) that when people in her office found out about her status they would not use the restroom after her until it was cleaned at the end of the day. They would instead rather wait until they got home.
Ghetto Artists put on a musical performance illustrating the effects of multiple concurrent partnerships (a very common practice in Botswana that significantly contributes to the HIV spread), and they did a really beautiful job of pantomiming sensitive topics in a way that could be appreciated in a family setting.
Though the event took place on a Saturday, and usually I would have wanted to stay home and enjoy my time off, I was so glad to be there! Close to 100 people attended, and many of them were community leaders and members that I will work closely with. To see everyone come together for such an occasion and interacting with them on this level was really beneficial. I left thinking about how much my job rocks, and how happy I am to be working with the people I do.