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‘No One Loved Me – Not Even God’

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When Irene Nkosi took to the stage at a glossy Moms+SocialGood event in New York recently, it was hard to pair the confident woman in a striking, Swazi-inspired dress with her tragic story: “By the age of 16, not really even a woman yet, I was a parent. I was also a victim of rape and my attacker was never jailed,” Nkosi told the stunned audience.

She went on to say how – after the birth of her second child – she was diagnosed with HIV.

“Now I was sure no one loved me – not even God.”

Nkosi, from Bronkhorstspruit, on the border between the Gauteng and Mpumalanga provinces in South Africa, said the clinic didn’t educate her about HIV “or how to prevent my baby from infection”.

“I was heart-broken and frustrated. I feared for my life and the baby I was carrying.”

Hoping for support after sharing her status with family and neighbors, she was instead isolated and called names. Although she gave birth to an HIV-negative baby, it died after being smothered by a blanket. Nkosi believes crèche staff neglected her baby because of her own positive status.

Nkosi’s story took me back to 2005, to Chris Hani Baragwanath Hospital in Soweto, South Africa, where I was researching the challenges faced by HIV-positive, pregnant women for a Media Fellowship on HIV at Wits University’s Journalism School.

The stories those women told were just as heartbreaking.

Most of the women I interviewed were following the correct antiretroviral regimen to prevent HIV transmission to their babies, but for some it was too late. Almost all of them carried the terrible burden of stigma and rejection by their families, partners and communities. Often, they were “outed” after feeding their babies the free government-issue formula milk in its distinctive orange tins to prevent HIV transmission. They would tell elaborate lies to explain why they were not breastfeeding.

“My grandmother forced me to breastfeed. I told her my breasts were dirty, the nipples were cracked. Then I just take a razor blade and then I just cut… and I tell her that there is blood in my breast, it is not good to breastfeed,” one woman told me.

Another I interviewed had been hounded out of the house by her mother and sisters and forced into a shelter. One frightened young mom said she had been too scared to disclose her status at a hospital in KwaZulu-Natal and now had an HIV-positive baby. Several told me that their partners had rejected them and blamed them for “bringing the disease into the house”.

I can only hope that the lives of those women and their children have improved since then. But, more than a decade later, what are the prospects for the HIV-positive women who are pregnant now?

The big picture is hardly rosy, with an estimated seven million South Africans living with HIV (according to 2015 figures). And it is women and young girls who still carry the greatest burden, with HIV prevalence in women almost double that in men, and with the rate of infection in young women aged 15-24 almost four times higher than in males of the same age bracket. Among certain vulnerable groups like sex workers, HIV rates are sometimes as high as 40-88%, according to the Human Sciences Research Council.

But without a doubt, massive strides have been made in putting people who need treatment onto it (now 48% of all those infected in the country are on antiretroviral treatment) and in reducing HIV transmission from mother to child. According to UNAIDS, more than 95% of the country’s pregnant, HIV-positive women are accessing antiretroviral treatment to prevent transmission to their babies.

In 2011, UNAIDS and PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) launched the Global Plan to lower mother-to-child transmission by 90%. After four years, six priority countries – South Africa, Swaziland, Botswana, Mozambique, Namibia and Uganda – had met this target. Mother-to-child transmission rates in South Africa currently stand at 4%. If the rate of infection is under 5%, the UN considers mother-to-child transmission to be virtually eliminated, since 100% elimination cannot be achieved.

Over the years, the guidelines and treatment for HIV-positive mothers and babies have changed too. Now, the World Health Organization recommends that all pregnant and breastfeeding mothers begin lifelong antiretroviral treatment. And in 2011, the South African government phased out supplying free formula milk in public hospitals and clinics. Unless medical conditions dictate otherwise, breastfeeding is now recommended.

But what of the people behind the statistics, people like Nkosi, and the mothers I interviewed? Nkosi says her life changed dramatically when she came into contact with mothers2mothers, an organization that deserves much credit for helping to reduce transmission rates to babies as well as for improving the health and emotional states of HIV-positive mothers. The organization employs HIV-positive Mentor Mothers to help women access treatment and health services for themselves and their families and bring them out of isolation.

When Nkosi signed up as a mentor for mothers2mothers, her confidence grew daily. Now she is happily married to an HIV-positive man and together they have a four-year-old daughter, Nothando, who is HIV-negative. Their status is out in the open and the children compete to give their parents their daily medication, she laughingly tells me later.

Nkosi ended her short, powerful speech with the following words: “(My children) have a mother who they can be proud of, a woman who was once a victim. But now I can strongly say I’m a survivor.”

Stigma, she tells me, is gradually diminishing. “Even though some people still lack knowledge, in the support group sessions we share our challenges and fears, the problems we encounter in our households. We find out how best we can help each other.”

A mothers2mothers press release captures the organization’s simple but highly-effective approach: “The epidemic may be global but the solution is local.” When marginalized HIV-positive mothers are trained to be healthcare workers in understaffed health centers, and paid for their work, they become role models and leaders in their communities.

The results of this formula have been astounding. Studies showed that women who received two or more mothers2mothers visits were seven times more likely to test their babies for HIV at six weeks, than those who only received one visit. Among their clients, the rate of transmission is only 2.1%. A recent external study in Uganda also showed the model to be a huge money saver by avoiding treatment costs.

Launched in Cape Town in 2001 by Dr Mitch Besser, an American gynaecologist and obstetrician who fell in love with South Africa as a high school exchange student and returned to work there, mothers2mothers started out with five Mentor Mothers. Now it services 860,500 women and families in eight sub-Saharan countries and is partnering with both the South African and Kenyan governments.

In South Africa, mothers2mothers had by 2015 reached close to 51,000 HIV-positive women and 27,800 babies exposed to HIV. The organization also offers early childhood services and HIV counseling, testing and sex education for adolescents, through a peer mentorship program.

Robin Smalley, Co-founder and Director of mothers2mothers U.S., explains why the model is so successful. “If you empower women to take control of their health and their families’ health, they’ll move mountains to do this. We give them the tools to succeed and they do. We are not coming in as outsiders and telling them what they should be doing. We give them the information and employment and let them do what comes naturally, which is to support one another and their children.” Mentor mothers are employed for two years before they phase out, and let others take over.

Smalley’s own involvement with mothers2mothers came about when, in a grief-stricken state, she visited Besser after his sister (her close friend), died unexpectedly after minor surgery. Smalley was so taken by the work that Besser was doing in Cape Town, and the invincible spirit of the HIV-positive mothers she encountered, that she immediately persuaded her family to join her there and began working to grow the organization. Years later she moved back to the US to look after her ageing father and to keep building mothers2mothers’ financial base by lobbying US donors.

Since then, she has been working 24/7 to keep up with the organization’s expansion. Although mothers2mothers has had requests from India, Thailand, Haiti and Central American countries to open up branches there, it is staying focused on sub-Saharan Africa, where the need is greatest. – Written by Philippa Garson

Health

Local Solutions Can Boost Healthier Food Choices In South Africa

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The crisis in health triggered by cheap food that’s high in fat and sugar is now well documented. Obesity related diseases such as cancer, heart disease and diabetes are rapidly overtaking HIV as the top causes of death in South Africa. A bad diet is a major contributor to this epidemic because people increasingly opt for unhealthier, processed and fast foods.

But how should countries like South Africa go about making sure that people – particularly poor people (where the burden of non-communicable diseases is highest) – have access to healthy food?

Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities.

This demonstrates the need for the government to intervene urgently. One possibility is to create new policies or adapt existing policies to promote the creation of healthy food environments. In particular, local governments have a unique opportunity to intervene.

What food’s available where

The research used a distinction between unhealthy and healthy foods drawn up by the Centres for Disease Control and Prevention. This categorises grocery stores and supermarkets as “healthy” and fast-food restaurants, for example, as “unhealthy”.

The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded.

The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”.

The results showed how fast-food outlets, and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets.

Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas.

The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice.

This is a big problem. But it can be fixed.

Changes

One possible strategy is to introduce policies that limit the number of fast-food outlets in communities. But what would these policies look like, and who would implement them?

Local as well as national government structures have the authority to license and control food retailers.

In addition, local governments have extensive powers over planning and zoning. They could be required to consider the impact on the food environment when granting zoning approvals or business licenses.

This would require filling a gap in municipal bylaws. For example, the City of Johannesburg municipality has passed two bylaws regulating informal or street trading and one on spatial planning.

But neither of these link municipal planning obligations to the placement of food retailers. This gap can be filled by explicitly taking saturation or scarcity of different food retailers into account. This could include, for example, creating a zoning exemption or special approval for healthy retailers.

Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area.

For example, the framework used to grant business licenses is set out in national legislation, the Business Act, but implemented by local governments. This framework might require conditions that are more stringent for food retailers before they set up shop.

Currently, businesses are required to submit a copy of the menu of a food trader and a zoning certificate when applying for a license. This means that municipalities are aware of what kind of retailer is applying for a licence and the nature of their food offerings. Municipalities could use this information to control the number of fast-food retailers in a given area.

Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. By creating a separate, simpler process of approval for healthy retailers, it would potentially encourage more of them to open. Alternatively, they could introduce a certificate of “need exemption”. This system could then allow a waiver of some requirements for a license if that business can demonstrate a need for healthy food retailers in an area.

Local governments have already exercised this kind of power to further public health. Cape Town passed a law that prohibited smoking within a certain distance of doors and open windows.

Municipalities could also put regulations in place that restrict the sale of unhealthy food near schools. In addition, they could incentivise retailers to move to under-served areas. Steps like this are already being explored and are set out in detail by the World Health Organisation guidelines.

Challenges

The research shows that poor South Africans have little choice when it comes to purchasing healthy food in their own neighbourhoods. In addition, municipal governments aren’t doing enough to preserve and improve access to healthier foods.

This must change. There’s a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable. A good place to start in South Africa would be Gauteng.

Noluthando Ndlovu, a public health researcher at the Health Systems Trust was a leading member of the research team. -The Conversation

-Karen Hofman: Professor and Program Director, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand

-Safura Abdool Karim: Senior Project Manager, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand

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Danai Gurira: The Celluloid Warrior Fighting Against HIV

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HIV/AIDS remains a global concern. International star and Zimbabwean playwright Danai Gurira is using her celebrity to battle for its elimination.


A superhero on the big screen and now a possible superhero in real life, actor and playwright, Danai Gurira, is making it her mission to join the fight against HIV/AIDS.

She is known for playing General Okoye in one of last year’s biggest films, Black Panther, which grossed over a billion dollars worldwide.

The famous Zimbabwean says the fight against the epidemic has been evident in her life ever since she was a little girl.

Recently appointed a United Nations Goodwill Ambassador, she chats to FORBES AFRICA about her work.

READ MORE | Danai Gurira: ‘Fully Feminine And Fully Fierce’

On December 3, 2018, a day after the Global Citizen Festival where Gurira made an appearance as a co-host to rapturous applause from an audience of 75,000 in Johannesburg, we meet her at an HIV clinic on the outskirts of the city in a township called Tembisa. It’s a trial clinic called Imbokodo for testing a combination of two experimental vaccines to prevent HIV.

At the clinic, Gurira meets with a group of women heading it, to discuss and learn how the trials work.

One of the women, dressed in a pink blouse, responsible for creating the trial vaccine, talks to Gurira about their work. Maria Grazia Pau is the Senior Director, Compound Development Team Leader, for the HIV vaccine programs at Janssen.

 Pau has over 18 years of experience in the field of viral vectors.

“We have seen responses in the body systemically when we check the blood but also we have checked other studies, and we do see responses there,” she tells Gurira.

Everyone in the room pays attention.

“The composition is complex, we want to protect from many different types of HIV because there are so many traits everywhere,” Pau says.

“Right,” Gurira nods attentively.

“It is the answer to elimination,” Gurira says.

The group of women join in the conversation.

They may just be on a breakthrough to finding an HIV vaccine.

The study is being conducted by the HIV Vaccine Trials Network, Janssen Vaccines & Prevention B.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson, and all the participating study clinics.

These partners are working in collaboration with community stakeholders to ensure this research is acceptable to the local community and respectful of local cultures.

With 27 sites on the continent alone, they have clinics in countries including Zambia, Malawi and Mozambique.

Gurira has recently collaborated with them to help further their research and spread awareness about the disease.

Gurira was born in the United States (US) and later moved to Zimbabwe, when she was a young girl.

Growing up in Harare, she saw and heard a number of stories relating to HIV that touched her deeply.

The 1980s were a time when the disease had started spreading globally.

“I can’t really extricate my upbringing from understanding how this epidemic hit southern Africa and how it changed the tapestry of life,” she says.

The stigma around the disease and how women were treated were some of the issues that concerned her.

“Growing up, I witnessed how it was affecting, not only cultural dynamics, but also exacerbating issues around gender dynamics and various things that filled me with great passion,” she says.

“How women were dealing with a great amount of stigma in the family; if HIV was in the homestead, the involvement of even in-laws and how that was being interpreted –  about faulting a woman. [As well as] blame imposed upon women and the loss of a spouse and how that would affect how a woman was treated post that time. So there were a lot of things affecting me as I grew up and as I watched these things happen.”

 It was those personal experiences that shaped how she viewed HIV and the importance of eradicating it.

It was later that she moved back to the US and pursued a career in psychology and then a masters in Fine Arts.

How people perceived HIV there, was not what she expected.

“Coming to the US and seeing how the African was viewed as a statistic; I was seeing real people with real stories and experiences who were truly people who had aspirations and careers and had many things going for them that they were working towards.”

READ MORE | 2010 all over again: a musical extravaganza to honor Nelson Mandela

At the time, antiretroviral (ARV) therapy had not yet been introduced and there was no way to manage it.

“It was such a death sentence at the time,” she says.

“And to come to the US to find that what we were dealing with in southern Africa was statistical, that also gave a great amount of need to bridge that very unfortunate disconnect between the actual human experience of it and the value of people who were being affected by this… and how they were being viewed.”

While there, she connected with some of her friends who did field work around the issue while she was more focused on her advocacy in the field of arts.

She married her advocacy for HIV with her passion for the arts.

Gurira began writing plays in an effort to use her strengths as an actor, and tell stories about issues she felt strongly about.

She co-wrote and co-starred in In the Continuum, a play about HIV/AIDS from the perspective of a married Zimbabwean woman.

With this play, her aim was to break away from the “statistical component of how the African is viewed often”.

In December 2011, In the Continuum commemorated World AIDS Day.

Little did she know that was the beginning of her activism against HIV/AIDS.

The ‘golden age’ of HIV science

Glenda Gray, a National Research Foundation A-rated scientist, CEO and President of the South African Medical Research Council. Picture: Motlabana Monnakgotla

The same year, a woman in South Africa by the name of Dr Glenda Gray, was elected into the US Institute of Medicine, National Academies, as a foreign associate for her research on preventing HIV-infected mothers from passing the virus to their newborns.

She is a National Research Foundation A-rated scientist, CEO and President of the South African Medical Research Council (SAMRC).

She is a qualified paediatrician and clinician and co-founder of the internationally recognized Perinatal HIV Research Unit in Soweto, South Africa.

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5 Things You Should Do The Night Before A Job Interview

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Preparation is key for having a successful a job interview. What you do the night before a job interview has an impact on your interview. What can you do to make sure this impact is a positive one?

1.Get a good night’s sleep.

Getting a good night’s sleep is the most important thing you can do before an interview. When you’re well rested, you’re more alert and focused, and you won’t have to resort to caffeine or sugar to stay awake. Being sleep deprived can also increase feelings of stress or anxiety, neither of which is helpful going into a job interview.

Of course, it can be hard to sleep because you’re anxious about the interview. If you find yourself having trouble getting to sleep, try a relaxation exercise like meditation or yoga. Whatever you do, take your mind off of the interview – overthinking it is most likely what’s keeping you awake.

READ MORE | 5 Questions You Should Never Ask During A Job Interview

2.Review your resume and cover letter.

Review your resume and cover letter, as well as any answers to questions you might have filled out on the job application. Focus on key statistics you’ve listed, major accomplishments, and relevant skills. This is especially important if you’re applying to multiple positions and sending out different versions of your resume and cover letter.

By reviewing your documents, they’ll be fresh in your mind and you’ll be able to answer any questions relating to them quickly. This shows the hiring manager that you are confident, both in your abilities and in the interview itself. If you have to think too hard about a question relating to your resume or cover letter, it could signal to the hiring manager that you weren’t truthful on your application and raise a red flag.

3.Prepare a list of questions to ask.

Asking questions is one the most critical things you must do in a job interview, so it’s important to prepare some questions in advance. By having a few questions already prepared, you won’t draw a blank when the hiring manager asks you. Great questions to ask inquire about the company culture, job responsibilities, or what a typical day looks like. Review the job description to see if there’s anything from there that you’d like clarified. This will often be covered during the interview, but if not, you’ll be ready to ask about it.

4.Plan out your route.

Plan out your route and how long it will take you to get to the interview location. If you’re driving, consider traffic conditions and weather that could cause delays. If you’re taking public transportation, check to make sure that the subway or buses are running on schedule and nothing has changed due to planned work. If you’re doing a video interview, plan out your location, and check your video and microphone to make sure they work.

Always leave yourself a minimum of 30 extra minutes, regardless of how you’re getting to the interview. If you’re early, you can find a nearby cafe or just sit in your car and relax. Nothing is worse than stressing about being late, except for actually being late. Avoid both of those things by leaving much earlier than you think you need to. For a video interview, get yourself set up 15 minutes early.

5.Plan what you’re going to wear.

Deciding what you’re going to wear in advance takes one less thing off of your mind in the morning and allows you to focus your energy on more important things. Make sure your clothes are free of wrinkles, stains, and pet hair. You can also pack your bag the night before, so that all you have to do is grab it and go in the morning.

By starting your interview preparations the night before, you’ll be able to focus fully on the interview itself during the day and put 100% of your energy into it.

-Ashira Prossack

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