TANZANIA - AIDS IN AFRICA: a battle which can be won CUAMM Statement on AIDS by Marzia Franzetti, co-ordinator AIDS group

Saturday, 3 April 2004

Rome (Fides Service) - CUAMM - Doctors with Africa, which has worked to improve the health of people in Sub-Saharan Africa since the 1950s found itself faced with the HIV/AIDS pandemic from the start and it has sought to live up to its principles with the sources available and together with the health policies of the countries in which its operates.
International attention for the problem of AIDS in poor countries particularly in Sub Saharan Africa has grown. Public opinion has been mobilised and many voices have been raised to deplore the injustice that 80% of patients have no access to treatment and a Global Fund to fight AIDS, TB and malaria has been set up.
CUAMM, Doctors with Africa felt the need to verify its position and plans with regard to AIDS aware that today it is impossible to engage in programmes of health-care cooperation without addressing the problem of AIDS.
With this in mind CUAMM, Doctors with Africa formed a work group of persons competent in the various disciplines inherent to the problem of AIDS which started a debate on the subject involving other NGOs with similar objectives and fields of intervention. The first result was a Statement on Aids in the World, in English and Italian presented in November 2001. The second results was a statement on CUAMM, Doctors with Africa position with regard to HIV/AIDS in Africa open to constant verification and possible changes on the basis of scientific progress and changes in the situations in countries of intervention.
The statement does not offer a “magic formula” to solve the problem of AIDS in Africa: the means we present are the same as those suggested by WHO and specialised International bodies. But it does try to adapt the methods of fighting AIDS to the different countries and concrete situations in which we are present. Not everything suggested and written in the guidelines is immediately possible or applicable. We give some principles and general values which cannot be overlooked when dealing with AIDS in Africa and we identified essential requisites to be presented in view of a properly planned and effective project
Here are the main points of the statement:
 Poverty - income, education, healthcare and social services - is the main cause of uncontrolled spread of AIDS pandemic in Africa and the south of the world.
 The fight against AIDS is therefore a fight against poverty calling for major commitment for social justice and equity at the planetary level.
 Fighting poverty in the field of health-care means first of all, rebuilding and re-vitalising local health care systems, to enable them to meet the primary health needs of the people including the poorest and weakest people.
 Activity to prevent and stop AIDS must not be seen as something isolated, a vertical project, it must be part of basic health care services, Primary Health Care: only then will it be available for all.
 It is therefore indispensable to take into account social-cultural aspects: decisions must be taken in view of the local context in collaboration with the people and its institutional representatives.
> Project to address HIV/AIDS must be thought in multi-disciplinary terms, using medical and anthropological competencies to optimise interventions “with” the people.
> It is fundamental to promote and protect the position of women, who play a crucial role in social relations and family management;
> The extreme peculiarity of the HIV/AIDS pandemic presents a serious risk of violation of human rights and discrimination for infected persons or persons in danger of being infected: any intervention demands therefore respect on the part of health workers for the dignity and the rights of persons infect by the HIV virus. The HIV test must never be imposed or carried out without the person's knowledge or consent. It must be preceded, accompanied and followed “counselling”: Voluntary Counselling and Testing = VCT is the key to every activity of prevention and treatment.
> An essential and indispensable element of programmes to fight AIDS is social support for the patients and their families with special care for the problem of orphans.

Aware of the enormity of the difficulties CUAMM is convinced that it is possible to fights AIDS in Africa with appropriate activity, effective and lasting to counter the spread of AIDS in Africa and reduce its effects.
We believe Africa has the human resources and courage necessary to face the challenge: our unavoidable duty is to offer concrete and consistent financial and technical support, discreetly and with respect, without any imposition or force with an attitude of sincere solidarity and collaboration.
(AP) (3/4/2004 Agenzia Fides)

Dr. Leopoldo Salmaso, project co-ordinator explains finalities and objectives

Rome (Fides Service) - The CUAMM statement on fighting AIDS in Africa identifies the sight against AIDS wit the fight against Poverty and that activities to stop the pandemic must be part of Primary Health Care.
These general criteria are respected in all CUAMM programmes and especially in its projects to fight AIDS centre on the prevention of HIV/AIDS mother/child infection. The project AIDS-FREE BIRTH IN TANZANIA ” is part of a network of maternity and infant care organised by 13 maternity centres in the poor outskirts of Dar Es Salaam which CUAMM has helped to rehabilitate and for which it guarantees good functioning.
CUAMM works closely with Pasada a diocesan organisation active in the field of HIV/AIDS in Tanzania to provide the best that can be offered today to Africa in the field of AIDS, health-education, test e counselling, assistance to the sick including home visits, support for families and orphans…
Should a pregnant mother ask for an HIV test we are able to offer her a series of free services with competence and continuity. CUAMM intends to base all its AIDS projects along this line because this is the only way to reach the people most in need and to obtain lasting results.

Dr. Leopoldo Salmaso, what is so special about the AIDS-Free Birth project?
AIDS not only threatens the lives of many millions of people in Sub-Saharan Africa it is cancelling progress made with great difficulty in health care and development in recent decades and threatening the social and political stability of many countries.
AIDS-Free Birth consists in this: … Meeting the AIDS emergency with routine mobilisation- says Dr Leopoldo Salmaso, project co-ordinator. These are not only words. AIDS is an emergency but we strive to use ordinary means to address the situation including more than 400 local health care workers and volunteers all Tanzanians and strongly motivated since they realise they are in the front line to fight a war which involves their own families, friends, neighbours. They are aware that they are part of a church community animated by Christian charity.
«This is part of a journey started 24 years ago with the local community, its leaders, religious and civil, in fact-Salmaso explains - if I have any regrets is that today for a project like this we must rely on diocesan resources, private resources whereas 20 years collaboration with government institutions was predominant: this would not appear to be progress from the point of view of social and political self support of a country. Government/Church collaboration in Tanzania has always been excellent. Both sides have always been sincerely and concretely dedicated to the common good, but ten years ago the government had to bow to the liberal dictates of the International Monetary Fund and the World Bank: cuts in education, health care social services to make space for private initiatives…clinics which only take credit cards. In this situation the only hope of poor people is the Church which strives to fill the void left by the government and the request is enormous.
Here in Dar es Salaam, about 800.000 persons, 60% Muslim rely on the local Catholic Church for health care at accessible costs and even free in the case of the very poor. There is a good home-care network and solidarity finds new paths every day as well as initiatives of self-help, chain-help, and mini-businesses. Of course robust outside support is still necessary especially for the families, and there are many, where AIDS killed one or both parents and it is necessary to help the orphaned children to continue with school to prevent a vicious circle of poverty, ignorance and marginalisation.
So our project is not out of the ordinary because outside help passes by local channels and criteria with transparency to support hospital care, school fees, vaccination, repairing a roof, a mini-loan for a small business run by women.
NSA project consists of treatment to prevent transmission of HIV virus mother/child in pregnancy and at birth or immediately afterwards. «This is the first time that we are able to offer a concrete, acceptable and sustainable means to stop the transmission of the HIV virus. And this reinforces all the other work we undertake in health care education for responsible behaviour, HIV testing for persons at risk, treating infections, economic, social and spiritual support to individuals and families». (AP) (3/4/2004 Agenzia Fides)


Project: Prevention of mother/child transmission of the HIV in pregnancy and at birth
Method: anti-HIV therapy is given to mother and child during labour and for the next few days
Place: in Dar es Salaam, capital of Tanzania population 2.4 million.
Length of time: three-year project - can be repeated
Local collaborators: Dar es Salaam Catholic diocese network of social assistance and healthcare government approved structures
Persons treated: 5,000 mothers and babies per year.
Project in detail
> Area: it is one of the first projects of its kind in Sub-Saharan Africa (hitherto activity was restricted to experimental research in big hospitals).
> Types of assistance: preventive therapy is combined with a variety of other assistance: health-education for individuals husband and wide, and groups; ordinary medical care; food aid; psychological, social and economic support for orphans and families in need; scholastic support; micro-loans for businesses mainly for women.
> Integration of services: 2 networks: one to fight AIDS the other to care for mother/child; they are interconnected to offer complete packets with one contact and increase follow-up capacity also at home.
> Sustainability: the project is run almost entirely by Tanzania personnel with local resources (outside assistance is mainly professional updating, supervision and counselling).
> Rooted in the community: parish group youth groups, professional groups, pastoral councils are all involved to overcome prejudice.
When it started: 16 February 2002 mother Saphia and baby Julius were the first to receive preventative therapy
Promoters: CUUAM Doctors with Africa; Italian organisations: Ulss 16 Office; Padova Hospital; Caritas Antoniana.
The work of the HIV laboratory is profitable in quantity and quality with an average of 1,000 closely monitored HIV tests per month. The basis have been laid for a pilot project to prevent HIV mother/child transmission (Pmtct +) - with three antiretroviral drugs for mother and baby for six months instead of one dose, as soon as the government authorisation is obtained.
What can be done to help?
HIV test costs 1 Euro.
Antiretroviral treatment for mother and child 5 Euro.
Caesarean birth 30 Euro.
Training social worker 50 Euro.
One year schooling for orphaned child 100 Euro.
(AP) (3/4/2004 Agenzia Fides)