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Archive for August 20th, 2009

SOUTH AFRICA: SANAC CEO charts new direction for slumbering giant

Posted by African Press International on August 20, 2009

Photo: International Planned Parenthood Federation
Dr Nono Simelela: We have a lot of good policies, but when it comes to implementation they falter”

JOHANNESBURG, – The South African National AIDS Council (SANAC), long perceived by activists as largely dormant, awakened to make groundbreaking recommendations to government earlier this month. Dr Nono Simelela, who takes over as the new CEO on 1 September, spoke to IRIN/PlusNews about where she would like to take the council.

Despite the challenges, Simelela said she was drawn to her new post at SANAC primarily because it would offer her a chance to work in a sector she feels passionately about, and in what she called a conscious environment given current political leadership which the country desperately needed.

Simelela was the first South African black woman to qualify as a specialist obstetrician and gynaecologist, which led to a 20-year career in the Department of Health, culminating as chief director of the National HIV, AIDS and TB programme in 1998 until she left in 2004. It was a time when HIV treatment was largely unavailable and the fight against HIV/AIDS under the countrys then health minister, Dr Manto Tshabalala-Msimang, was heavily politicized.

I think everyone knows it was a very challenging time in South Africa in many ways. The magnitude of the epidemic was really brought to the fore, and the need to move quickly, in terms of treatment and care, was evident, Simelela told IRIN/PlusNews on the phone from London, where she heads the technical knowledge and support division of the International Planned Parenthood Federation (IPPF).

It was tough and you had to hang in there, [but] I think that it was necessary. The fact that we did get a plan and have people accessing treatment has been a huge positive outcome.

She said South Africas antiretroviral programme one of the worlds largest remained one of its biggest achievements, but also noted the recurring drug shortages, poor monitoring and evaluation, and the need to slow new infections.

We haven’t really established a robust monitoring and evaluation system across all sectors, including government. Weve got the National Strategic Framework, and targets that have been set, but we need a robust tool to monitor progress so we know what needs to be done, she said.

The fact is that we have an epidemic that is raging, and new infections are still occurring. We need to go back to the prevention side of things to look at what were not doing well enough.

The road ahead

Simelela said she hoped the mix of local and international experience of the HIV epidemic would help her and SANAC make much needed changes. At the forefront would be strengthening provincial and district AIDS councils, which are not only points of service delivery but also collect crucial data.

''For me, it’s almost about an agenda for social justice, not only to provide people with treatment''

We have a lot of good policies, but when it comes to implementation they falter, she said. We need to be sure provincial and district councils are able to implement their HIV/AIDS plans. It should almost be a bottom-up approach – issues would come up at the district level and the national council would then look at ways of resolving them.

Although long inactive, SANAC still provides a crucial interface between government and civil society, ensuring that the people implementing policies at whatever level are held accountable. Simelela told IRIN/PlusNews that the reawakened giant meant a renewed opportunity to make a difference in peoples lives.

For me, its almost more about an agenda for social justice, not only to provide people with treatment but to raise issues around HIV, such as the economic issues that, I think, South Africa is grappling with now, she said.

Theres a way to respond but at the moment we need to coordinate that response I get the sense that if we work collaboratively across all sectors, there is a chance we can turn things around.


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UGANDA: Justice slowly meted out in Global Fund corruption trials

Posted by African Press International on August 20, 2009

Photo: Georgina Cranston/IRIN
The Global Fund has disbursed more than US $164 million to Uganda

NAIROBI, – The Global Fund to fight AIDS, Tuberculosis and Malaria is one of Uganda’s key health partners; over the past six years it has disbursed more than US$164 million in programme grants.

But the fund’s relationship with the government has not always run smoothly; in 2005, the discovery of serious mismanagement in the Ministry of Health led to the brief suspension of financing.

Stakeholders have criticized the government for being too slow in its investigations and prosecutions, but the wheels of justice have finally begun to turn; an anti-corruption court has charged more than 300 people with crimes ranging from embezzlement and causing financial loss to abuse of office and defeating the ends of justice. Four convictions have been made so far.

Below is a chronology of events:

August 2005 – The Global Fund suspends more than $150 million in grants to Uganda after a review of one of the five grants by auditor PricewaterhouseCoopers revealed “evidence of serious mismanagement” by the Project Management Unit in the Ministry of Health.

More than $1.6 million is later found to have been embezzled, misappropriated or not accounted for.

October 2005 – A six-man judicial commission of inquiry – led by High Court Judge James Ogoola – opens to investigate the allegations of mismanagement of fund grants.

November 2005 – The fund lifts the suspension and releases a grant package worth $367 million; executive director Richard Feachem said the move followed the country’s “intensive efforts” to rectify the serious mismanagement of funding.

May 2006 – President Yoweri Museveni leaves the Health Minister, Jim Muhwezi, and his two deputies, Alex Kamugisha and Mike Mukula, out of the cabinet during a reshuffle. Although the president gave no reason for their exclusion, all three were implicated in the scandal.

June 2006 – The commission of inquiry recommends that former health ministers and other managers of the fund’s grants be investigated for possible criminal prosecution.

Justice Ogoola described the embezzlement as a tragedy in which “the greatest losers have been the people of Uganda. As the sick lay dying, the greedy middlemen dived for the kill.”

August 2006 – European envoysexpress concern at the lack of urgency in the government’s efforts to prosecute culprits in the scandal; they ask the government to take “expeditious” action. The envoys would repeat this call several times over the next two years.

''As the sick lay dying, the greedy middlemen dived in for the kill''

March 2007 – The fund turns down a grant application by the Ugandan government for $16 million. According to Aidspan, an NGO that describes itself as an independent watchdog over the fund, the decision was made because of Uganda’s “unsatisfactory performance”.

April 2007 – The government directs the police to commence investigations into the mismanagement of fund grants.

January 2008 – David Apuuli Kihumuro, executive director of the Uganda AIDS Commission, reports to the parliamentary public accounts committee that about $1 million has been recovered from individuals and institutions implicated in the misappropriation of fund money.

July 2008 – An anti-corruption court is created; the fund trials are its first order of business. Justice John Baptist Katutsi is named head of the court.

December 2008 – Teddy Seezi Cheeye, a senior figure in the national Internal Security Organization, becomes the first suspect to be charged before the anti-corruption court. Cheeye faces 26 counts stemming from his role as chief of the NGO, Uganda Centre for Accountability, which was paid about $60,000 to supervise fund activities in several districts in western Uganda. Justice Ogoola’s commission found that Cheeye spent $33,000 of fund money on a private trip to China.

April 2009 – Fred Kavuma, a former television producer, becomes the first person to be convicted of misuse of fund money. He is sentenced to five years in prison for obtaining $19,000 under false pretences and ordered to refund the money; he obtained the money for HIV sensitization projects but put it to personal use and submitted forged receipts to the health ministry.

Cheeye is also convicted of forgery and embezzlement and sentenced to 10 years. Fund director of communications, Jon Liden, lauds the conviction as a sign that Uganda “is a country based on the rule of law”, adding that, “this firm action sends a signal that corruption is unacceptable and will not be tolerated”.

July 2009 – The anti-corruption court makes two more convictions – Analiza Mondon and Elizabeth Ngororano, directors of the NGO, Value Health, are each sentenced to five years in prison for mismanaging fund money, making false entries and false documents between March and December 2005.

The trials continue.


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SOUTH AFRICA: “Agony Aunts” don’t do HIV

Posted by African Press International on August 20, 2009

Photo: Edgar Mwakaba/IRIN
Colomnists rarely mention HIV in their relationship advice

JOHANNESBURG, – Dear Abby, Dear Dolly, Ask Amy- advice columns are always popular in the print media, and South Africa is no exception. The “Agony Aunts” daily solve problems about love, lust, romance and other relationships, but one thing is consistently left off the page – HIV.

Flip through the country’s most widely read magazines and one story in the advice columns soon appears to be a theme: girl meets boy, boy meets girl, boy cheats on girl.

A report released on 19 August by The Soul City Institute for Health & Development Communication notes that about 40 percent of letters to agony aunts asked for advice about multiple concurrent partnerships, but less than half received answers that included anything related to HIV and the increased risk of infection that accompanies such relationships.

Research into advice columns in 13 mainstream publications over a three-month period found the columnists chose to focus on the emotional or “moral” issues of concurrent partnerships.

''I cannot condone the practice of dating married men. I understand you’ve gotten used to this way of life, but it’s wrong and nothing will make it right.''– Advice column in Sunday World, a weekly newspaper

Sue Goldstein, Soul City’s senior executive of South African programmes, conceived of the study after listening to a radio call-in show. She said the report highlighted a missed opportunity to address HIV, especially given the target audience of these columns – mainly women in their mid-20s.

South Africa’s 2007 antenatal survey showed that women between the ages of 25 and 29, with a prevalence rate of almost 40 percent, were among the hardest hit by HIV. According to UNAIDS, the national prevalence is at 18 percent.

Among the report’s recommendations were that columnists talk more about HIV-risk behaviours, avoid moralizing and provide readers with additional resources for further information. It also recommended that editors set guidelines on what “good advice” should or should not include.

In response to the study findings and workshops with journalists, Soul City has developed a programme that pairs major print outlets with HIV-savvy organizations, in the hope that these partnerships will lead to more sensitized coverage of the epidemic.

“[Journalists] argued that people were tired of hearing about HIV, or that their aim was to entertain their audiences,” Goldstein told IRIN/PlusNews. “They may be trying to entertain their audiences, but the reality is that these letters are often serious requests for advice, and one often finds young people reading them … it’s critical they be given the appropriate information.”


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BURKINA FASO: When is malaria not malaria?

Posted by African Press International on August 20, 2009

Photo: WHO/TDR/S.Lindsay
If not malaria, what then? (file photo)

ZIGA, – Two months into using malaria rapid tests, some health facilities in Burkina Faso continue treating for malaria despite negative test results, according to community health workers.

Since June 2009, the government has made available 240,000 rapid malaria tests in half of its 63 health districts, the national anti-malaria programme coordinator, Laurent Moyenga, told IRIN.

In northwestern Burkina Faso, at a district health centre in Ziga, which serves 13 villages with more than 10,000 people, centre director Soumala Salembere told IRIN that children who were at least six years of age and suspected of having malaria were given a rapid test.

He told IRIN that if the child had a fever, headache, loss of appetite, or was vomiting, his centre automatically administered malaria treatment even if the test result was negative. “The test result could be a false negative. If the malaria treatment does not work, then we search for another solution.”

Moyenga said this treatment was incorrect. “How can health workers decide what is positive and negative? They cannot say a test result is a false negative without saying there are also false positive results.”

In a recent World Health Organization (WHO) evaluation of rapid tests, two brands accurately detected malarial parasites 95 percent of the time, but researchers said quality varied depending on the test manufacturer, and storage and transport conditions.

Burkina Faso’s malaria policy – in line with WHO recommendations for negative rapid test results – was to research other causes of febrile diseases (those characterized by fever), including meningitis, respiratory infections and typhoid fever, Moyenga told IRIN. But he also admitted that not all health facilities had the equipment to diagnose typhoid fever.

David Bell, a scientist at the Geneva-based non-profit Foundation for Innovative New Diagnostics, told IRIN that new approaches were needed to diagnose febrile diseases in addition to malaria.

“There needs to be a lot of investment in diagnostics appropriate for this [community] level to guide health workers to at least identify and treat, or refer, those patients who have a non-malarial infection that is likely to kill them. Most African children who die have diseases other than malaria.”

According to WHO, the deadliest childhood illnesses worldwide are malaria, pneumonia and diarrhoea.

In 2008 Burkina Faso had three million officially reported cases of malaria with a 2 percent mortality rate, but it was not clear how many of these were in fact malaria. “We will analyze rapid test results and the number of malaria treatments administered to learn the true disease burden,” Moyenga said.

When asked whether his analysis might be skewed by health centres treating suspected but unconfirmed cases as malaria regardless of the rapid test results, Moyenga said the situation would change.

“Health workers are undergoing training about the tests. Rapid tests are still relatively new here … health workers still automatically treat for malaria, and this will take time to change.”


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Robbed Zimbabwe minister ‘did not follow protocol’

Posted by African Press International on August 20, 2009

Zimbabwe Prime Minister Morgan Tsvangirai. Photo/REUTERS

Zimbabwe Prime Minister Morgan Tsvangirai. Photo/REUTERS


HARARE, Wednesday

Zimbabwes ambassador to South Africa has accused a minister who was assaulted by robbers in the neighbouring country of not following protocol, in another display of friction within President Robert Mugabes unity government.

Mr Fidelis Mhashu, the Minister of National Housing and Social Amenities was among quests at a dinner hosted by a Zimbabwe businessman based in South Africa when armed robbers pounced on them last Friday.

The minister sustained head injuries and lost cash during the attack.

He received five stitches and two other people who were in the house are still in hospital.

Zimbabwean state media said Mr Mhashu had gone to South Africa to discuss construction business with Mr Mutumwa Mawere who lost his business empire to President Mugabes previous administration after he was accused of externalising foreign currency.

Mr Mhashu, an MP from Prime Minister Morgan Tsvangirais Movement for Democratic Change said he received cabinet authority for the trip.

But Ambassador Simon Khaya Moyo, a strident loyalist of Mr Mugabe said he was not aware of the trip and the embassy did not organise any security for the minister.

The embassy must be informed of any impending visit so that we liaise with the authorities, he told the state owned Herald.

We also have to know if the visit is official or personal business.

If the visit is official we work with the authorities so that the visiting government official is cleared at the airport.

South African police also accused Mr Mhashu of circumventing protocol by failing to request VIP protection from authorities.

However, the ministers office today insisted he had cabinet authority and a letter from the Ministry of Foreign Affairs confirming he was going to South Africa on an official visit.

The Herald quoted an unnamed government official accusing MDC ministers of embarking on irregular and unprocedural trips, which had the potential to compromise personal and national security.

Mr Mugabe formed the coalition with his former arch rivals in February following years of intense infighting.

The coalition has stumbled from one crisis to another since its formation and of late the partners have been trading accusations about lack of commitment to the inclusive government.

There is a serious problem of some ministers clandestinely holding foreign meetings, the government controlled paper claimed.

When they leave the country they say they are going on official business but when they get to those countries they hold meetings that were never on the agenda and that cabinet is not aware of.

The ministers just travel without notifying authorities and this causes problems especially when you have an incident like the attack on Minister Mhashu.

What these people must know is that they are part of government and should follow laid down procedures for their own safety and for national security reasons.

Zimbabwes notorious Central Intelligence Organisation (CIO), which provides VIP protection for ministers, is deeply distrusted by MDC members in government because of its unmistaken loyalty to Mr Mugabe.

Zanu PF also accuses MDC of trying to use the inclusive government to topple the ageing ruler from power.

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AIDS battle takes a tragic turn in Uganda

Posted by African Press International on August 20, 2009

By Rodney Muhumuza, Special to The Kansas City Star

After a study showed that circumcision reduces the incidence of HIV infection in men, circumcision providers in Uganda have been enjoying brisk business.

The drumbeat for circumcision has been so loud that by December, when a document detailing the official circumcision policy is made final, authorities may have no reliable estimate of how many Ugandans have heeded the call. Whats more, Ugandas born-again attempts to curtail a resurgent AIDS crisis would have been done no favors.

How did we get there? Its complicated.

Uganda was long hailed as a beacon of hope in the AIDs battle, for its success in bringing down the HIV prevalence rate from double digits in the early 1990s to as low as 5 percent by 2001. Such was Ugandas reputation that it soon became a global exemplar of what it took to credibly fight AIDS.

The problem is that the figure didnt keep going down, with prevalence rates in some parts of the country now much higher than the national average of about 6 percent. And by some accounts that figure is inaccurate, as the rate is said to be rising fast.

Today, the Kampala governments willingness to embrace mass circumcision as a viable tool in the AIDS battle captures the desperation that has come to define Ugandas AIDS outlook. In fact, the hysteria says less about what can be done to control the situation and more about what was not done but should have been. The missed opportunities are staggering.

Nearly all households in Uganda, including mine, have lost someone to AIDS. For the younger generation of Ugandans, however, the stories of the human losses may sound distant, in large part because fewer people die of AIDS today.

With more Ugandans accessing treatment, the debilitating effects of the disease are no longer as obvious, much less imagined. The tough message that AIDS kills, the prevention-rich mantra that was responsible for Ugandas old success, has been lost at the altar of a policy that subtly emphasizes treatment.

Some critics allege that health authorities in Uganda sold their souls to the wallets of the pharmaceutical companies, but it may well be that they simply took a success story for granted. The authorities deny both accusations.

Ugandan health authorities previously fought AIDS with an attitude that proclaimed the fear of AIDS was the beginning of wisdom.

The evidence shows that it worked, with millions of Ugandans embracing the so-called ABC, a strategy that called for abstinence or fidelity or the use of condoms. But somehow that message stopped being mainstream. What happened to all the street posters that preached prevention? Though its hard to say that ABC has reached its tipping point, and even as it remains clear that the old prevention messages no longer are nearly as ubiquitous as they once were, the conversation has suddenly turned to circumcision.

The resulting crusade makes a mockery of a serious situation, a campaign whose ideas fly in the face of common sense.

In America, most babies are circumcised at birth; in Uganda and elsewhere in Africa where circumcision is catching on, old men are undergoing the procedure to avoid catching HIV. Its ridiculous. As a strategy, circumcision doesnt inspire changed behavior, the very essence of ABC.

It discounts the idea that a once-high prevalence rate dramatically went down because more Ugandans were compelled to revise their sexual behaviors. Beyond perverting ABC, a circumcision-based strategy ignores why the rate is rising again.

Until circumcisions actual benefits and limits are made clear to everyone, illiterate or not, a circumcision drive thats linked to HIV prevention is bound to be a spectacular failure. The comedians in Kampala know it when they claim that circumcision can cure AIDS. They measure the pulse of the country.

Rodney Muhumuza, a Ugandan journalist, is an Alfred Friendly Press Fellow at The Kansas City Star. To reach him, call 816-516-9707 or send e-mail to //


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