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



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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 | <a href="https://www.forbesafrica.com/woman/2019/02/18/danai-gurira-fully-feminine-and-fully-fierce%EF%BB%BF/" target="_blank" rel="noreferrer noopener" aria-label="Danai Gurira: ‘Fully Feminine And Fully Fierce’ (opens in a new tab)">Danai Gurira: ‘Fully Feminine And Fully Fierce’</a>﻿



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.



&nbsp;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.



<blockquote class="wp-block-quote">“The composition is complex, we want to protect from many different types of HIV because there are so many traits everywhere,” Pau says.</blockquote>



“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 &amp; Prevention B.V., part of the Janssen
Pharmaceutical Companies of Johnson &amp; 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 –&nbsp; 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.”



&nbsp;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 | <a href="https://www.forbesafrica.com/arts/2019/02/11/2010-all-over-again-a-musical-extravaganza-to-honor-nelson-mandela/" target="_blank" rel="noreferrer noopener" aria-label="2010 all over again: a musical extravaganza to honor Nelson Mandela (opens in a new tab)">2010 all over again: a musical extravaganza to honor Nelson Mandela</a>



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



<div class="wp-block-image"><figure class="aligncenter"><img decoding="async" loading="lazy" width="411" height="603" src="https://www.forbesafrica.com/wp-content/uploads/2019/03/Danai4.png" alt="" class="wp-image-39618" srcset="https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai4.png 411w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai4-300x440.png 300w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai4-204x300.png 204w" sizes="(max-width: 411px) 100vw, 411px" /><figcaption> Glenda Gray, a National Research Foundation A-rated scientist, CEO and President of the South African Medical Research Council. Picture: Motlabana Monnakgotla</figcaption></figure></div>



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.







In December 2018 on the same day of the interview, Gray and
Gurira meet at the Imbokodo clinic.



Gray is one of the leaders of the trials at the clinic. 



“We are in a golden age in terms of HIV science and hopeful about making huge advancements in HIV vaccine developments,” she says.



Much like Gurira, Gray was also confronted with the epidemic
at a young age. 



“As a young doctor, I saw HIV explode in my face and imagine
if we can, in my medical career, go from the beginning of an epidemic to the
end of an epidemic; that would be an amazing feat to be part of the team that
finds an HIV vaccine.” 



What Gray has endeavored to do is to find an HIV vaccine
that protects women and in the future, children and adolescents as well.



READ MORE | <a href="https://www.forbesafrica.com/health/2019/02/18/what-does-it-mean-to-be-hiv-undetectable-or-to-have-a-suppressed-viral-load/" target="_blank" rel="noreferrer noopener" aria-label="What does it mean to be HIV-undetectable or to have a suppressed viral load? (opens in a new tab)">What does it mean to be HIV-undetectable or to have a suppressed viral load?</a>



“We definitely are not going to be able to treat ourselves
out of this epidemic if we don’t find potent biomedical interventions, we are
not going to be able to turn off the tap,” she says.



Gray has dealt with innumerable women affected by HIV.



“I am sick and tired of HIV and I am sick and tired of how
it devastates lives and I am sick and tired of how it impacts women in Africa,”
Glenda says.



Gray, together with Dr Paul Stoffels, who is the head of
research and development for Johnson &amp; Johnson, have been trying to prove
HIV vaccines work.



Stoffels and his team have been working with HIV for more
than 25 years, developing ARV medication.



The medication has evolved from many pills a day to one a
day, he says.



“We are working on new medicines to bring it to an injectable to once every day to once every month. But we can treat HIV patients but they need to be treated for the rest of their lives,” he says.



“People can have normal life expectancy and live normal
lives with medicine but we won’t be able to stop the epidemic if we don’t get
to a vaccine.”



<div class="wp-block-image"><figure class="aligncenter"><img decoding="async" loading="lazy" width="418" height="536" src="https://www.forbesafrica.com/wp-content/uploads/2019/03/Danai3.png" alt="" class="wp-image-39619" srcset="https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai3.png 418w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai3-300x385.png 300w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai3-234x300.png 234w" sizes="(max-width: 418px) 100vw, 418px" /><figcaption> Dr Paul Stoffels, who is the head of research and development for Johnson &amp; Johnson. Picture: Motlabana Monnakgotla</figcaption></figure></div>



He says that the vaccine they have been working on has been
very active in animal models and they have now shifted to clinical trials in
humans to prove that it works.



“We are at a stage that we do the first efficacy study and
at the same time first we prove that it is safe and that it can be used by
people and then we prove that it is efficacious,” he says.



The people who become part of the vaccine study will be part
of the trial for years.



However, one of the challenges, he says they face is finding
people who are at risk to commit to being part of the long-term study.



Therefore, it is important to bring awareness to the public
about such studies being done.



“HIV prevention needs important people such as global stars
to step in and with Global Citizen, we had a perfect platform to be on the
global stage. And Danai is one of the people well known in Africa and she is
very committed to this objective and so we started collaborating with her to
bring the message of prevention, and also the message of importance of research
in getting to the HIV vaccines, in getting people to participate as well as to
stay on,” he says.



Other celebrities also known for the advocacy of HIV include
musician and actor Lady Gaga, musician Bono, television host Ellen DeGeneres
and musician Alicia Keys.



“What’s very important, I think, for a person like her
[Gurira] is to give the message of hope that one day we will be able to combat
the disease but at the same time, it is a message of ‘at this moment we need to
prevent’,” says Stoffels.



Gray agrees.



“She [Gurira] understands what it’s like to be a young
woman, she understands what it’s like to be a black young woman and how
difficult it is to navigate safe sex, masculinity, patriarchy and so she comes
with a lot of soul and insight.”



Eliminating the epidemic



After the release of In the Continuum, Gurira toured her play in South Africa and Zimbabwe.



<blockquote class="wp-block-quote">“I met some courageous people on the ground at the front line of this epidemic.”</blockquote>



Through that, she was able to connect to a number of
organizations which she then got involved in.



“It not only allowed me to learn more but become more of a
vessel for advocacy and awareness,” Gurira says.



“It is really powerful to me that these women are here [at
the clinic] helming this study that could really eliminate this epidemic.



“There have been epidemics that have existed in past human
history that have been eliminated through vaccination and we could actually see
that come to pass. I am sitting on a site where this could come to pass for
HIV/AIDS, which is the epidemic of our time,” she says, hopeful.



“I’d like to see it eliminated.



“There are times when we tend to think that ‘oh HIV it is
being managed, and ARVs exist,’ and we forget that it is still a very active
fight.”



According to AVERT, an international HIV and AIDS charity,
in 2017, there were roughly 1.8 million new HIV infections, the same as in 2016
–&nbsp; about 5,000 new infections per day.



Therefore, Gurira says awareness is very important to avoid
the “issue fading in the background”.



<figure class="wp-block-image"><img decoding="async" loading="lazy" width="928" height="616" src="https://www.forbesafrica.com/wp-content/uploads/2019/03/Danai5.png" alt="" class="wp-image-39620" srcset="https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai5.png 928w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai5-300x199.png 300w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai5-600x398.png 600w, https://cms.forbesafrica.com/wp-content/uploads/2019/03/Danai5-768x510.png 768w" sizes="(max-width: 928px) 100vw, 928px" /><figcaption>From left to right, Dr Paul Stoffels, Danai Gurira and Dr Glenda Gray. Picture: Supplied by Global Citizen</figcaption></figure>



Having been born in the US and being Zimbabwean, her fight
for HIV has become global.



&nbsp;Since her appointment
by the UN, she aims for a larger reach.



Gurira says despite women being the focus of her advocacy,
everyone, including men and boys, need to be a part of this fight.



“As Canadian Prime Minister [Justin] Trudeau recently said,
which I really appreciated, he called himself a feminist. He said, ‘I am a
feminist and to be feminist you believe in the equality of men and women and
you believe there is a lot of work to do to get to that place’.”



The fight against HIV continues to be a global phenomenon, but with more awareness raised and efforts from everyone, we could be one vaccine away from eliminating it.

Danai1

Danai Gurira: The Celluloid Warrior Fighting Against HIV

HIV1

What does it mean to be HIV-undetectable or to have a suppressed viral load?

Crossing the Oshoek Border Post from South Africa to Swaziland, I was excited to be visiting the realm of Africa’s last absolute monarchy. Not realizing that it was the Easter weekend, I got caught standing alongside Swazis trying to re-enter their country for the holidays.
I also realized that I was entering a country with the highest incidence of HIV in Africa with a stabilized number reported at up to 30% of the population. While this is not the subject of this article, I must satisfy the curiosity of the reader nevertheless. Social scientists have determined that the itinerant workers with whom I was lining up were one of the major reasons for this scourge.
<div id="attachment_34571" style="width: 510px" class="wp-caption aligncenter"><img aria-describedby="caption-attachment-34571" decoding="async" loading="lazy" class=" wp-image-34571" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Swazi-dance-e1512028782448-300x180.jpg" alt="" width="500" height="300" />Swazi women perform a traditional dance. (Photo by Ramdas Iyer)</div>
Being away from home and working in the mines and timber industries of South Africa, these men infect their many wives in a polygamous society, along with their girlfriends. In addition, traditions such as the inheritance of widows from a deceased brother, does not help HIV’s continuing spread.
The border crossing was smooth confirming my notion that the Swazis were a relaxed and nice people. Though lacking in size, this interesting country makes up for it with its rich culture. While the monarchy has its critics, the history of Swazi resistance to the British, Boers and the Zulus has fostered national pride. As a result, local culture is flourishing along with Christianity.
Many Swazis combine Christianity with indigenous beliefs, and religious freedoms are written into the country’s 2005 constitution. However in January, the education ministry instructed all head teachers to ensure that the syllabus would not mention any religion other than Christianity, including Islam and Judaism.
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Driving into Mbabane, the capital city, I found it to be an attractive and functional place perched in the cool highveld (4,000ft) of the Dlangeni Hills. Swaziland with its population of 1.5 million is a low middle income country where most citizens are ethnic Swazis. The official languages are both Swati and English.
Its ruler, King Mswati III, is one of the world’s last absolute monarchs, and a man who is not too keen on handing his throne over entirely to parliament. The Borgen Project, a nonprofit organization, reports that about half of <a href="http://borgenproject.org/poverty-hunger-swaziland/" target="_blank" rel="noopener">Swazis</a> live in poverty. Forty percent of Swazis are unemployed and 70% of the workforce is employed in sustenance farming. But it’s not all bad news. Roads are well-paved and <a href="http://borgenproject.org/combating-rural-poverty-in-swaziland/" target="_blank" rel="noopener">far-reaching</a>. The literacy rate is over 91%, which might be expected when 8.3% of the GDP is spent on education; which is why I saw the entire city swarming with nicely-uniformed schoolchildren in the afternoon.
<div id="attachment_34572" style="width: 260px" class="wp-caption alignleft"><img aria-describedby="caption-attachment-34572" decoding="async" loading="lazy" class=" wp-image-34572" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Swazi-dance-1-200x300.jpg" alt="" width="250" height="375" />A drummer provides the beat for the traditional dance. (Photo by Ramdas Iyer)</div>
In order to find the old Swaziland, which has rapidly modernized itself, I went in search of old villages and cultural events. More than 70% of Swaziland’s population is of ethnic roots, which means that all the traditions and beliefs are upheld throughout the year and are evident in daily life through dress and other activities.
I soon arrived in Mantetenga Swazi Cultural Village, a living museum of old traditions and representing a classic Swazi lifestyle during the 1850s. The village is a large family homestead of 16 huts, each with its own specific purpose as well as kraals for cattle and goats, reed fences that serve as windbreaks and various other structures. The building material is strictly traditional: poles, grass, reeds, leather stripes, earth and dried cow dung. The adjacent 725-acre Mantenga Nature Reserve is made of a combination of middle and highveld habitat, and more than a third of the reserve is covered by eucalyptus (gum) forest. I explored the reserve by foot, with two walking trails leading up the mountain towards the summit of Sheba’s Breast, made famous by the book King Solomon’s Mines written by Sir Rider Haggard, a Victorian adventure writer in 1885. Birdlife in the reserve was good, with wildlife such as baboons, vervet monkeys, nyala, duiker and mongoose regularly seen.
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After visiting the village, I patiently waited for a large contingent of dancers to perform the Umhlanga followed by the Incwala dance. There are two main kinds of dances, each done by women and men respectively and done at most of the celebrations and gatherings throughout the year, but predominantly at the two most popular events: Umhlanga in August and Incwala in December. The spectacle I enjoyed seemed to be a hybrid version of both.
<div id="attachment_34573" style="width: 260px" class="wp-caption alignleft"><img aria-describedby="caption-attachment-34573" decoding="async" loading="lazy" class=" wp-image-34573" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Swazi-dance-2-200x300.jpg" alt="" width="250" height="375" />A man performs a traditional Swazi dance. (Photo by Ramdas Iyer)</div>
Umhlanga attracts thousands or women from near and far and once the entire group has concluded dancing and singing, different villages take center stage and put on a display as a sign of respect for the Queen mother. The different villages are distinguishable by their beaded outfits and jewelry. Even the king’s daughters are involved and distinguishable by the bright red feathers they wear in their hair. The king will usually pick his new wife from the crowd of dancers.
Incwala, which means first fruits, is probably the most important and significant of the two. Dancing plays a prominent role here as men gather at the Royal Kraal at Ludzidzini and dance for a few days. Known to be the most honorable on the Swazi events calendar, the Incwala dates are determined by the phases of the moon and begins with a journey to the Indian Ocean to collect water. The third day sees the men slaughter a bull with the fourth day welcoming the arrival of the king who dons his traditional dress and joins in on dances with the other men before returning to his hut to enjoy the first fruit of the season.
However, these aren’t the only dances in Swaziland; other events boast their own dances such as the Sibhaca dance performed by groups of men throughout the country at any opportunity. One cannot but appreciate this gentle land with its handsome men and women and their penchant for dance.

A Land Of Many Dances

Idrisu Ali grimaces as he recalls the day he sent his 12-year-old daughter, Fatima, away to live with a 65-year-old man.
Although the practice is common in Nigeria’s remote northern state of Bauchi, Ali did not feel entirely comfortable with the idea of giving away his little girl’s hand in marriage – to a man old enough to be her grandfather.
“I was sad because he was too old. I wanted her to marry someone younger, say 55 or 50 because he could take care of her for a longer time before he dies. But he was a successful farmer in the village and he paid a good dowry,” says Ali in his rundown shack in Bauchi, the state capital.
The dowry consisted of some kola nuts (native to the African tropics), a cow, a bag of salt and a sewing machine. To protect his daughter from the negative glares of society, Ali accepted the generous offer and sent Fatima on her way to her new life as a wife.
“This is what happens when a girl reaches puberty. It is our culture and that is the right thing for a woman to do. She will grow up quickly and learn how to take care of a man and the home and bring honor to her family,” says Ali.
For Fatima and many other young girls in Northern Nigeria, their demise into forced marriages is puzzling.
Fatima’s marriage is prohibited under Nigeria’s Child Rights Act (CRA), which bans marriage before the age of 18. But federal laws are at loggerheads with age-old customs, as well as the implementation of Sharia law or Islamic law in some Muslim states.
“As a father you have to do what is best for your family. If your daughter is ready for marriage, you do what you must to make sure she finds a good man,” says Ali.
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Nigeria is home to the largest number of child brides in Africa, with 23 million girls and women who are married in childhood according to the United Nations Children Fund (UNICEF). GirlsnotBrides.org asserts that globally, the number of teen brides is expected to reach 1.2 billion by 2050 if there is no reduction with one in three girls in the developing world married before age 18.
The practice has continued to gain prominence in northern Nigeria due to prevailing attitudes in an area with gender disparity. The grim situation is particularly pronounced in this region due mainly to strong resistance to CRA with opponents stating that some aspects of the Act are against religion and therefore cannot be followed.
“According to current figures, more than 50,000 girls worldwide are married while still children, often before they may be physically and emotionally ready to become wives and mothers and this endangers the life trajectories of these girls in numerous ways,” says Oby Ezekwesili, Senior Economic Advisor and Co-Founder of #Bringbackourgirls campaign.
Such was the case for Mamuna Ibrahim. At the age of 14, she is already a divorcee.
“When I was 13, one of my father’s friends came to the house and asked for a bride. My father chose me because I was the oldest out of my three siblings. I did not want to go with him. I wanted to go to school and be an air hostess but I could not disobey my father so I accepted,” says Ibrahim.
Her husband, a 38-year-old trader, took her away to the remote dust-blown state of Borno in north eastern Nigeria. Immediately after the marriage, Ibrahim’s problems began.
“I wanted to continue my education but he said no. One day he came home and I was reading a storybook and he got really angry and beat me. He said a wife’s place is in the house not at school. He was abusive and demanded sex every evening. It was painful,” says Ibrahim.
To escape the traumatic ordeal, she ran home to her mother and begged not to be returned. Her angry husband divorced her immediately under Sharia Law, which requires a man to say out loud “I divorce you” three times for a marriage to be over.
“My father was very angry and embarrassed. He threatened to kill me but my mother and other elders of the family pleaded with him. He stopped talking to me because I brought shame to the family. He disowned me,” says Ibrahim.
She stays with her mother’s sister on the outskirts of Kaduna. Her situation is worsened due to her early pregnancy. At three months in and with no education or prospects of finding a job, Ibrahim roams the streets of Kaduna selling bean cake and mobile phone vouchers to make ends meet.
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According to the International Center For Research on Women (ICRW), the impact of the practice of child marriage is felt both at the individual and societal levels and it is therefore imperative in alleviating poverty and subsequently, promoting economic development.
“Child marriages have an adverse impact on the economy by limiting opportunities for career and vocational advancement for young girls. It therefore disempowers women and stifles the prosperity of a country because when a significant number of the workforce is rendered economically inactive, the nation will suffer,” says Bismarck Rewane, CEO, Financial Derivatives Company in Lagos.
Its health implications are just as dire.
“There are several health risks that these young girls are exposed to. Most of them get pregnant at an age where normal vaginal births are difficult because their hips are not wide enough for the baby to be pushed through the vaginal canal and this can lead to the death of the mother and the baby. Also, the babies are exposed to diseases due to the lack of micronutrients in the girl’s body and most often babies do not survive,” says Dr. Mariam Doku, a pediatrician at the Korle-Bu Teaching Hospital in Ghana.
Her claims are further buttressed by the International Women’s Health Coalition (IWHC) that asserts that teen brides are more likely to contract HIV and are also exposed to sexually transmitted infections due to their inability to negotiate safer sexual practices. As President of the IWHC, Françoise Girard, has played a key role in advocacy on sexual and reproductive health and women’s rights with UN agencies.
It is her belief that ending the practice of teen brides is a smart thing to do as it falls in line with the Sustainable Development Goals (SDGs) which has made ending child marriage by 2030 a key target.
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Organizations like the World Bank, the United Nations Population Fund (UNFPA) and UNICEF continue to support efforts in many countries but according to Rewane, much more must be done.
“The notion that sending girls off to marry much older men is a better option is also partly attributable to poverty. For instance, a very poor family is likely to reason that marrying their daughter off early will provide her basic needs and in addition, the gains gotten from her marriage may be part of the survival strategy of the family. So we need to tackle the root of the issue, which is poverty and that means efforts to abolish this practice needs to be a state-level intervention,” asserts Rewane.
For those in remote areas who are dependent on subsistence farming, the practice can be influenced by seasonal conditions. For example, in the years when rains or crops fail, the practice of “drought brides”, thus girls who bring in a dowry, while being one fewer mouth to feed, contribute to pushing up the numbers of teen brides dramatically. Four of the 10 countries with the highest rates of child marriage are in West Africa’s Sahel and Sahara belt, according to UNICEF.
In many of these communities, a family’s wealth is measured in terms of the herd of cattle they own and young girls are the medium of payment. As policy makers continue to lobby traditional heads to implement the CRA in local communities, the dilemma continues for girls like Ibrahim whose cries for freedom continue to fall on deaf ears.

Fatima, 12, Husband, 65 – The Dire Story Of Child Brides

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&#8217;t educate her about HIV “or how to prevent my baby from infection”.
<blockquote>“I was heart-broken and frustrated. I feared for my life and the baby I was carrying.”</blockquote>
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. &#8211; Written by Philippa Garson

Tag: HIV

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