Dynamic leadership in the fight against HIV/AIDS was called for- and demonstrated- at the opening of the ADF Forum in Addis Ababa yesterday afternoon.

In a riveting personal account of living with HIV/AIDS, twenty-two year old Charlotte Mjele from South Africa called on African leaders to "break the silence" and lead by personal example in reversing the stigma that accompanies the disease.

Earlier, the Secretary General of the Organisation of African Unity, Salim Ahmed Salim asked pointedly where Africa had failed. "When a band of armed invaders cross a national border and destroy a single village… the whole nation will be mobilized to rise up," he observed. Armed forces would be deployed, militia mobilised, priorities rearranged, and the whole society "directed to confronting the threat to national survival."

Ironically, he said, HIV/AIDS had in many respects been "far worse than an armed invasion" yet had barely commanded such a response.

In a dramatic twist, Ethiopian President Negaso Gidada, who is also Chair of the Ethiopian National AIDS Commission, departed from his prepared text to agree with the OAU Secretary General. "I would like to state that I accept the criticism by Dr Salim Ahmed Salim that countries react spontaneously and in an organised way to foreign invasion. In my country we have been fighting against Eritrea and we have succeeded. But we have not spontaneously fought in the same organised way against HIV/AIDS."

To loud applause, Gidada called upon "all my countrymen and community leaders, religious leaders, youth leaders, and women, who have shown the commitment to the fight against Eritrea, to do the same in the fight against HIV/AIDS. This is also in respect of other African leaders who have not shown an interest in fighting collectively on this issue and this where most of the work needs to be done."

Hailing this show of political commitment as what distinguished ADF 2000 from other AIDS conferences that had preceded it, ECA Executive Secretary K.Y. Amoako called for bold leadership in the struggle against AIDS.

In an emotive plea to African leaders, Amoako said he had resisted pressure on him to "lay into our friends from richer countries around the world" over their lukewarm response to Africa’s AIDS crisis. While Africa had a right to expect international solidarity, "no one is going to save us from this crisis but ourselves," Amoako said. "What I am going to stress is that if we show the desperately needed leadership at all levels...here, first, we have the sequence right."

What is called for, he said, is "leadership which is boldest, most persistent, most insightful, compassionate, forceful, co-operative and imaginative." African leaders, he said, needed to:

• Ensure that AIDS orphans are not lost to the world. Dynamic leadership in the fight against HIV/AIDS was called for- and demonstrated- at the opening of the ADF Forum in Addis Ababa yesterday afternoon.

In a riveting personal account of living with HIV/AIDS, twenty-two year old Charlotte Mjele from South Africa called on African leaders to "break the silence" and lead by personal example in reversing the stigma that accompanies the disease.

Earlier, the Secretary General of the Organisation of African Unity, Salim Ahmed Salim asked pointedly where Africa had failed. "When a band of armed invaders cross a national border and destroy a single village… the whole nation will be mobilized to rise up," he observed. Armed forces would be deployed, militia mobilised, priorities rearranged, and the whole society "directed to confronting the threat to national survival."

Ironically, he said, HIV/AIDS had in many respects been "far worse than an armed invasion" yet had barely commanded such a response.

In a dramatic twist, Ethiopian President Negaso Gidada, who is also Chair of the Ethiopian National AIDS Commission, departed from his prepared text to agree with the OAU Secretary General. "I would like to state that I accept the criticism by Dr Salim Ahmed Salim that countries react spontaneously and in an organised way to foreign invasion. In my country we have been fighting against Eritrea and we have succeeded. But we have not spontaneously fought in the same organised way against HIV/AIDS."

To loud applause, Gidada called upon "all my countrymen and community leaders, religious leaders, youth leaders, and women, who have shown the commitment to the fight against Eritrea, to do the same in the fight against HIV/AIDS. This is also in respect of other African leaders who have not shown an interest in fighting collectively on this issue and this where most of the work needs to be done."

Hailing this show of political commitment as what distinguished ADF 2000 from other AIDS conferences that had preceded it, ECA Executive Secretary K.Y. Amoako called for bold leadership in the struggle against AIDS.

In an emotive plea to African leaders, Amoako said he had resisted pressure on him to "lay into our friends from richer countries around the world" over their lukewarm response to Africa’s AIDS crisis. While Africa had a right to expect international solidarity, "no one is going to save us from this crisis but ourselves," Amoako said. "What I am going to stress is that if we show the desperately needed leadership at all levels...here, first, we have the sequence right."

What is called for, he said, is "leadership which is boldest, most persistent, most insightful, compassionate, forceful, co-operative and imaginative." African leaders, he said, needed to:

"These children are formidable," said Dr Peter Piot, Executive Director of UNAIDS. "They have made a difference in the fight against AIDS and we are sure their actions will bear fruit." Mr Mark Malloch Brown of the United Nations Development Programme had this to say: "All those who pass by this road will be reminded that AIDS exists. It is marvellous," said the diplomat.

The paintings are accompanied by text in French, English, German, English, Amharic and others. With the level of awareness of these children, the world just may be saved from AIDS. — Doua Gouly

Hundreds of African leaders and activists from all walks of life arrived in Addis Ababa this weekend for a no- holds-barred conference on AIDS- the disease billed the greatest threat to the continent since the struggle for independence in the late fifties and early sixties.

The largest gathering of Africans, by Africans, focussing exclusively on this pandemic that afflicts 25 million people on the continent, the African Development Forum 2000 is also the first to focus squarely on leadership as the critical missing ingredient in Africa’s response to date.

"It has been more than twenty years since AIDS afflicted Africa," Claire Mulanga, Co-ordinator of the ADF Secretariat, reflected in an interview. "Why is Africa still under the burden of the disease, when we know how to prevent it, we know how to reduce the transmission from mother to child? If we have all the information, then what is it that is missing? Lets put into action what we know. Lets empower people to do this. That is where leadership comes in- not only at the political level, but at the grassroots level, at the community level, at every level."

Steering away from the myths and controversies that have dogged this disease and focusing instead on the threat posed to Africa’s fragile economic recovery by AIDS, organisers and delegates appeared unanimous in their view that it’s time to pipe down the rhetoric and get down to the specifics of dealing with HIV/AIDS.

Said one participant " It is time to put diplomacy aside and say that we must have new leaders to deal with the problem… the consensus should not be a document of rhetoric but a concrete document with meaningful follow-ups."

According to the latest report of UNAIDS released on World AIDS Day on 1 December, of the 36.1 million people suffering from HIV/AIDS worldwide, 70 per cent are African, and 55 per cent of these are women. The average adult HIV prevalence rate in Africa is 8.8 per cent, compared with a global average of 1.1 percent. More than 80 percent of AIDS deaths worldwide are in Africa. The majority of these are in the economically active category.

Noting that overall new infections in Africa in 2000 numbered 3.8 million, compared to 4 million in 1999, the latest UNAIDS report carries a glimmer of hope. It says that "there may be a new trend on the horizon: regional HIV incidence appears to be stabilizing." But the report warns that "the trend will not hold if countries such as Nigeria begin experiencing rapid expansion."

Otula Owuor, a science writer specialising in HIV/AIDS, said African leaders should begin the renewed onslaught on HIV/AIDS by admitting that they have failed their people. Then they should look into how to make drugs available to those infected. "We should look into messages that result in prevention and behavioural change in terms of cultural activities and beliefs," he added.

Speaking on behalf of the Network of People Living with HIV/AIDS in Africa, Millie Katana urged delegates to focus on ways to promote access to drugs. "The main breakthrough in fighting HIV/AIDS will be making treatment available to those who are infected. This will encourage many people who are infected to come out in the open and make them more responsible," she said.

ADF, an annual forum convened by the ECA to forge consensus on key development issues in Africa by bringing together academics, government, private sector and civil society representatives, is designed to seek holistic, multi- sectoral approaches to key development problems. Mulanga stressed that by making HIV/AIDS its theme for this year, ADF aims to ensure that the disease is seen as central to development, rather than just a health issue.

Among the hot button issues that can be expected to arise over the next four days are:

Among those expected to attend the final forum on Thursday are Presidents Festus Mogaue of Botswana, Paul Kagame of Rwanda and Yoweri Museveni of Uganda. Prime Ministers Moustapha Niasse of Senegal and Nagoum Yomassoum of Chad, as well as Vice President Justin Malewezi of Malawi will also attend. The UN Secretary General, Kofi Anan, will chair the session.

The consensus document from the conference will be placed for adoption before African Heads of State at a summit convened by President Olusegun Obasanjo on Nigeria in Abuja in April 2001.

"The good news is that many leaders are speaking more openly about AIDS, and peer pressure can make a difference," says ECA’s Amoako. " If there is one thing I hope will come out of (ADF 2000) it is the feeling that we can do it."

Faced with the stigma of HIV/AIDS, workers all over Africa are making a case for job protection and social dialogue to ensure their rights are not infringed upon.

At an International Labour Organisation-led pre-forum meeting bringing together workers’ representatives, employers and government delegates, it was suggested that workplace policies should be revised to reflect the interests of people living with HIV/Aids.

The code of practice developed should then influence existing laws and take into account the specific needs of each nation. Members of the Southern African Development Corporation announced that they already have a code in place.

Nevertheless, there was a consensus that laws touching on the workplace will not only need to be revised but key players also need to be sensitised to the requirements. This would lead to communities understanding and accepting infected people.

Zimbabwe has taken steps to deduct three per cent of workers’ salaries to the national council appointed to take care of the needs of AIDS orphans and those infected, said a participant. The laws were not discriminatory and the authorities were making efforts to sensitise the people on the needs of those infected.

In Ghana, education and training on the different facets of the AIDS crisis has been incorporated in the workplace routine, leading to significant breakthroughs. The experiences of Kenya, Tanzania and Zimbabwe enabled development partners to more critically into mechanisms aimed at combatting AIDS in the workplace.

The fundamental role of progressive leadership in the fight against AIDS in the workplace was stressed. Employers and the labour unions were challenged to eliminate behaviour that encourage exclusion and stigmatisation of people living with HIV/AIDS and to come up with initiatives aimed at taking care of the needs of sick people.

Confidentiality and the right to privacy came up as a key issue. The social partners were also encouraged to provide moral and material support to promote voluntary counselling and testing, which is crucial to developing databases to determine the number of workers infected with AIDS.

This would help in estimates of the costs of prevention and providing services for people living with HIV/AIDS. Given the absence of accurate statistics on the number of workers infected, some participants said, it is highly likely that the problem of AIDS in the workplace is seriously underestimated.

In Kenya, however, data has been collected on the number of teachers infected. Nevertheless, it will still be necessary to develop systems and structures to support more research in the wider context.

The fact that the African continent is worst affected highlights the question of inequality and misuse of resources, some participants said. They argued that there are clear links between poverty and AIDS and suggested that the creation of employment be boosted.

The ILO representative, Franklin Lisk, affirmed that his organisation was willing to support a tripartite programme linking government, employers and workers for purposes of strengthening their capacity to find effective solutions at the level of individual countries.

HIV/AIDS may have devastated Africa emotionally, but it is the largely unacknowledged economic and social costs that will linger on to wreak the greatest damage on a continent already under immense pressure to provide basic services to its people.

"HIV has a trenchant effect on the economy and the economy in turn affects the level and distribution of HIV," says the theme paper AIDS and Development, which points to a ripple effect of poverty beginning from the household to the community and on to the national levels.

Early studies on the economic cost of HIV/AIDS came up with findings based on reduced growth, declines in savings and investment rates and huge health care costs. But they failed to take into account the "disease burden on future generations and even the full measure of indirect costs of today’s generation".

While acknowledging that the full impact of HIV on economic development in Africa is underestimated—the long incubation period of the virus serving to distort the effects—AIDS and Development stresses that the consequences and effects can be averted by "conscious" policy action.

Says the report: "Current estimates suggest that HIV/AIDS has reduced the rate of growth of Africa’s per capita income by 0.7 percentage points a year. Not only is HIV/AIDS having a detrimental effect on the growth of African economies, it is reversing the modest gains made in recent times."

At the household level, savings are reduced and there is less investment in retirement due to the expectation of a reduced life-span. At the national level, HIV/AIDS affects budgets not only by way of increases in costs associated with treating and caring for patients but also through expenditure such as pension payments, increase in civil servants forced to take early retirement and training for newly-hired replacements. "Fiscal deficits tend to worsen generally, as few countries are able to offset the fiscal costs of the epidemic by cutting other expenditures or raising taxes," says the report, written by Kwesi Botchwey of Harvard University’s Centre for International Development.

Because HIV/AIDS affects the most productive age groups, Africa is losing entire generations of skilled professionals. Consequently, the short-term returns on the cost of schooling and training are significantly reduced. Children, too, often drop out of school and seek work to replace lost household income. Social networks and traditional support systems have also been stretched to breaking point, leading to a large number of children growing up without emotional and financial support.

It is estimated that the cost of treatment and foregone productivity in Tanzania for a single infection ranges from $2462 to $5316—virtually guaranteeing that the affected household will sink into dire poverty, given that most countries badly-hit by the disease have low incomes and slow growth.

Analysis of the impact of HIV/AIDS on young widows in Uganda indicates that the epidemic leads to a rise in female-headed households, the feminisation of poverty, "crippling anxiety" of one’s sero-status and infection of extended family members by the young widow.

Whereas it may not be possible to measure the social and psychological impact of the disease, there is no doubt about the direct and indirect effects of HIV/AIDS are felt throughout the economy—in the workplace, in terms of health care and in the education, agriculture and business sectors. But, perhaps, the greatest impact springs from the stigma that is attached to the disease—with dire consequences: It is reported, for example, that the Kenya Government’s delay in establishing a national prevention policy was driven by the fear of losing its crucial tourist industry.

When 24-year-old Holo Hachonda contemplates the future, he sees little to look forward to. Not only is AIDS wiping out thousands of people around him and clipping the development gains of his country, but it is also saddling his beloved Zambia with a growing debt burden.

Hachonda is a youth activist from Lusaka who has been working in the area of reproductive health and AIDS since he was 18. He is at the Africa Development Forum pushing an issue close to his heart – that Africa adopt a collective position against loans to finance HIV/Aids programmes. "Saying yes does not make sense,’’ says Hachonda. "Aids is not an income-generating project and Africa should adopt a common position to say no to interest bearing loans. It is youth who will inherit the debt.’’

Hachonda says he is opposed to concessional lending facilities such as the $500 million Multi-Country HIV/AIDS Program (MAP) for Africa which the World Bank is floating. In September, the World Bank approved the first batch of loans under the programme for Ethiopia and Kenya. It approved about $50 million apiece to the two countries in soft loans that mature in 40 years’ time, when Hachonda will be in his mid-60s.

Debrework Zewdie, the lead AIDS co-ordinator for the World Bank, says they have already received applications for $515 million in loans under the programme and the Bank’s board ‘’is ready to replenish the money as soon as we use it up. The intention is to use up the $500 million during this fiscal year".

Numerous other facilities are being dangled in front of African nations and some nations have swallowed the bait. However, a $1 billion United States Export Import Bank initiative has been slow of the ground.

Under the programme announced in July, major US drug companies are offering their products at a discount to 24 African nations and the Export-Import Bank will finance their export through five-year loans, at commercial lending rates. "Blessed are the youth,’’ quips Hachonda, "for they shall inherit the debt.’’

Hachonda is part of a growing international NGO campaign arguing that the continued payments of debt service by heavily-indebted poor countries hampers their ability to confront urgent health crises such as HIV.

Taoufik Ben Abdallah of the international organisation ENDA, says that while ADF 2000 delegates will be discussing the immunity of the human body, the conference should also focus on "the immunity of our countries to defend themselves at the World Bank and the World Trade Organisation’’.

He adds: "The real issue is not these small loans the World Bank and the US are giving Africa, but what Africa stands to lose through WTO regulations that will prohibit them from making or importing generic Aids drugs.’’

The agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), adopted in 1994 and requires all WTO member countries to adopt new standards for intellectual property including the recognition of patent protections for pharmaceutical products.

The fact that medicines can be patented means access to drugs and their prices depend on decisions made by the patent holder – usually large multinational - and this is where Africa will be hit hardest, especially with an epidemic that is continuing to develop.

International anti-debt campaigners are also arguing that urgent social needs such as malaria control and HIV/AIDS cannot and need not wait the completion of the World Bank and International Monetary Fund (IMF) enhanced Heavily Indebted Poor Countries Initiative (HIPC)

Some 16 African countries are expected to make up the 20 HIPC countries that should qualify for debt relief by year-end, under the programme which started in 1996. International anti-debt campaigner Jubilee 2000 has long argued that HIPC will not do much to benefit poor countries because it fails to eliminate all multilateral and bilateral debt.

Sub-Saharan Africa’s debt of nearly $200 billion is a complex array of short and long-term debts owed to multilateral institutions such as the IMF, to bilateral creditors and to the private sector. Zambia, which is under consideration for HIPC, owed nearly $7 billion in 1998. Jubilee 2000 says that in 1999, Zambia spent 72 per cent of total donor support on repaying external creditors.

ADF 2000 hopes to add its voice to the debt issue and ECA executive secretary KY Amoako says he expects the conference document to deal with how the continent should approach the financing of AIDS programmes. "The issue is broader than just HIV/AIDS and encompasses the whole issue of debt cancellation. It is clear that we need to cancel as much as possible of Africa’s debt. Some progress has been made but we need to move further. We are arguing that as much as possible of new support for HIV/AIDS should be in the form of grants or highly concessional lending.’’

The scenario is even more disturbing in situations of rape and other forms of violence against women. Faced with few or no alternatives, they find themselves exposed to HIV. It is not just about women, but about men too. Unconscious of the risks they bring to their girlfriends, wives, or casual sexual encounters or to women they violate, they also expose themselves to the risks of contracting STDs and HIV/AIDS.

In response to the magnitude of the question of the role of leadership in addressing the link between gender and HIV/AIDS, a group of men, women and youth met at the weekend to draw up key issues for discussion. The participants elaborated on gender-justice, women’s rights and inequality between men and women as the dominant ethos in the HIV/AIDS discourse. Yeni Assegid of GTZ’S Project Support Unit on HIV/AIDS noted that women could negotiate sex in relationships only if they were empowered to do so and if they were guaranteed support.

However, gender is still considered an alien "western" idea of interpreting the relations between men and women. "Women’s rights are not well understood," said an Ethiopian participant from the Red Cross, "when combined with the spread of HIV/AIDS, most people in leadership find it even more fuzzy."

He emphasised the need for the forum to address the gaps in creating a gender-aware society that would lead to policies that address women’s needs. Speaking at the Civil Society forum earlier, Ambassador Steven Lewis said HIV was a gender issue and pointed to the widespread violence and discrimination against women as a root cause of the epidemic.

Participants stressed the need for a distinctly committed leadership that can competitively scale-up the approaches already in place and enable the public to break the silence and act collectively. The group noted the need to address access to care and drugs, especially for expectant mothers, to prevent mother-child transmission of HIV. This is intrinsically linked to reproductive rights and access to reproductive health, however. Access to drugs is a thorny issue, particularly where costs are prohibitive for the majority. More often than not, pregnant mothers may have information related to reproductive health but have little access to treatment for opportunistic illnesses.

Ashenaife Aman, a youth representative, noted that 80 per cent of Africa’s population lives in the rural areas and that information on HIV/AIDS is often not factual or dissagregated by gender, leading to confusing messages and responses. Open and comfortable discussions are important if youth are to play a more effective role in anti-AIDS campaigns, he said.

Whereas those living in the diaspora are considered privileged in terms of access to drugs and health care, the meeting noted, it is necessary to address the discrimination and disempowerment faced by a large number of women living overseas who end up on the streets as commercial sex workers or sex slaves. Contrary to popular belief, they are neither financial stable or sufficiently informed.

More than anything else, these statistics capture the spirit driving the 2000 World Aids Campaign, whose theme is "Men make a difference". Whereas considerable attention has been paid to the impact of HIV/AIDS on women’s lives, there has been little engagement with the dangers to men.

Says the UNAIDS document Men and AIDS – a gendered approach: "All over the world, women find themselves at special risk of HIV because of their lack of power to determine where, when and whether sex takes place. What is perhaps less often recognised is that cultural beliefs and expectations also heighten men’s vulnerability."

The two-year campaign is informed by five key pointers—that men’s health is important but receives inadequate attention; that men’s behaviour puts them at risk of HIV; that men’s behaviour puts women at risk of HIV; that unprotected sex between men endangers both men and women and that men need to give greater consideration to AIDS as it affects the family.

The campaign traces men’s vulnerability in the AIDS crisis to the bigger picture of concepts of manhood that encourage them to take risks and use violence. "While biological factors contribute to the behavioural differences between men and women, in every society, men’s conduct is determined at least in part by expectations of how men should act—expectations often shared by women as much as men."

Studies world-wide indicate that, on average, men have more sex partners than women. Consequently, they are likely to pass the virus to a greater number of women, especially since women are more biologically prone to infection. Over 70 per cent of infections occur between men and women. Another 10 per cent of infections are transmitted between men and another five per cent due to sharing of needles and syringes between people who inject drugs—four-fifths of whom are men.

The focus of the campaign is to persuade men to change some of the attitudes and behaviour that expose them and their families to the threat of HIV/AIDS. There have been breakthroughs worthy of note among long distance truck drivers in Africa, Central America and Asia, who have been encouraged to reduce the numbers of their sexual partners en route and to consistently practice safe sex.

The campaign also aims to encourage men to play a greater role in caring for orphans and sick family members. Whereas behaviour change is a long term process, the idea is to begin challenging harmful concepts of masculinity—beginning with how men are socialised to become men.

In Africa, HIV/AIDS is transmitted largely by heterosexual activity. Over 20 per cent more women than men are living with HIV, with young women being at the greatest risk. HIV threatens women as individuals, mothers and carriers. The challenge of gender and HIV is linked with the problem of poverty. Women are generally poorer than men.

The powerlessness of women is a crucial factor in Africa not only in the context of sexual relations but also in the broader leadership context. The political leadership is overwhelmingly male. Equally disturbing is the dominant masculinity in African forms of government. Many leaders are military men, for whom "masculine" modes of behaviour are indicators of power, authority and legitimacy.

Here are elements of gender relations that require urgent attention:

Sexual violence: rape statistics are very high, but it is a crime often committed with total impunity. Women and girls are often coerced into sex by criminals. Rape is also common in war-time and it is used as a weapon of war.

Economic pressure: the economic crisis in Africa has compelled many young women to turn to commercial sexual activity. They include wives and partners of migrant workers, students, unemployed young women, single mothers, refugees and young widows. Economic disadvantage pressures women into unequal relations with older men.

Multiple sexual relationships: many women and girls enter into many relationships in search of financial security from boyfriends and sugar daddies.

Power relations: women are often unable to insist that their partners use condoms. The poorest commercial sex workers are least able to insist on protection. Female-controlled methods of barrier contraception are largely unavailable in Africa.

Domestic violence: female victims of domestic violence are least able to influence their partners’ behaviour in terms of extra-marital sexual activities and use of condoms. Besides, rape within marriage is not uncommon.

Polygamy, early marriage and sexual activity of girls: multiple marriages, especially to younger women, are common in Africa. Men also believe that ever-younger partners are less likely to be infected.

With the ADF taking place here this week, Africa’s moment of truth has arrived — some might say two decades too late — but we all must say: better late than never.

When AIDS arrived 20 years ago, we sat back in disbelief. Valuable time was wasted in denial and debates around the origins and causes of the disease. These are important. But there is an African saying that when you have a snake in the house, you first get rid of it, and then work out where it came from. We have tended to operate the other way around. The result: millions dead- many Africa’s brightest and best. Hundreds of thousands of children left homeless. Declining life expectancy. Declining growth in GDP- just as Africa was beginning to make a fragile economic recovery.

Unlike other epidemics, AIDS is not just a medical problem. It is deeply ingrained in social and cultural mores. It has major economic and political ramifications. It requires far more than medical magic to resolve. It requires a massive societal shift in mindset and behaviour. It requires leadership.

This of course is where ADF differs from the many other gatherings on AIDS that have preceded it. By placing the accent on leadership, at all levels, in all spheres of life, ADF lifts the disease from the narrow corridors of medicine to one of a continental crisis.

It has been said that AIDS is Africa’s greatest leadership challenge since the struggle for independence in the 1950s and 1960s. Perhaps it is an even greater challenge. For it might prove far easier to mobilise people around the objective of political freedom than to induce life-saving behaviour change.

There are many strengths in African society that leaders can draw on: oral traditions in public education; community vibrancy; and the strong ethic of care, for example. AIDS is a threat, as well as an opportunity, to mobilise around a common cause of no less import than survival; to develop true partnerships between government, the private sector, civil society and the international community.

There is a saying that leaders must lead, follow, or give way to others. Stark words indeed. But with a ring of truth where the fight against AIDS is concerned.

You have to understand this conference as part of the Africa Development Forum. Every year, we take a theme and galvanise the whole of Africa around that theme, bringing together all stakeholders, leaders, civil society, policymakers and youth. What’s unique about this conference is that it is the first time all of Africa is meeting on HIV and Aids. The Durban Aids conference was global. We have had a lot of conferences that have brought together health ministers, for example, but this involves everyone — ministers of finance, gender, education and the whole range of actors and civil society.

Political leadership is crucial. But we are talking here about leadership at all levels. It is unfortunate that many of our political leaders did not talk about HIV/AIDS two or three years ago, but I think we are beginning to talk more openly about it. If Africa can tell the world from this conference that AIDS is our greatest development challenge, we will have made a good start. We need to ensure that the fight against AIDS becomes part of the poverty strategy so that it is a major component when governments plan their budgets.

We are getting President Yoweri Museveni. We want to hear from him because Uganda has been quite exemplary in terms of leadership. Because Botswana has the highest HIV infection rates and also because President Festus Mogae has been very strong and committed, we thought we should hear from him too. President Paul Kagame of Rwanda will also be here because of the post-conflict situation there and also because Rwanda has done a lot on dealing with HIV in the military. We had hoped to get President Olusegun Obasanjo of Nigeria but his schedule did not allow him to be here. He will host a summit next April and we will take the results of this conference to that summit, for all African leaders. The prime ministers of Senegal, Chad, Namibia and Ethiopia will also be here.

All these options are necessary. It is like a war. You have to use all the ammunition and all the strategies you have. We have to work out how to ensure that we can get access to cheap drugs that are important to us, but also take international partnerships into consideration. I think it is important that this meeting comes up with a strategy for Africa on how to engage with this issue.

In the preparation process, we felt it was important to involve the countries. We have about 10-15 people here from each country, selected by the UNAIDS country teams in consultation with the governments and national aids co-ordinating bodies. From the consensus and from the discussions and recommendations that will emerge here, we expect them to help develop national strategies in cases where they do not have them and fine tune them where they do.

For this type of conference, the follow-up cannot be done by one agency. That is why we have involved the entire UN system. UN country teams are going to play a key role working with governments and following up on recommendations.

Going to the South Pole? Er, no, just to Addis Ababa. Except my plane left four hours early. And I got stuck in transit because I did not have a visa. It took three days to get here, only to find my luggage was no longer with me. And now that I’m here, I don’t have a badge. Security says there is no way I can get into the conference centre without it. I have a new name for the conference: "Addis: Africa’s greatest travel challenge!"

A frustrated senior UN official was spotted sneaking dignitaries who did not have their badges through a side door near the press centre, having also been refused entry to the ECA conference centre. They say necessity is the mother of invention. Could we come up with a vaccine for AIDS while we are about it?

On one point, the ADF has scored well. Tucked away in each conference bag is a box of condoms — essential to the tool kits of all dedicated conference-goers. While some religious leaders got a bit of a fright, other delegates were spotted counting their supplies, just to be sure adequate provision had been made.

The US, of course, continues counting, providing light relief for delegates drained by the heavy subject matter at hand. One journalist ventured that the Florida recount is better than any soap opera ever to come out of Dixieland, and its even for real! His proposal: Bill Clinton should stage a coup d’etat and stay in office another term. Any offers of technical assistance to the reigning US President?

Simply but neatly dressed, Worke looks like any other young woman in Ethiopia’s highland town of Bahir Dar, the capital of the Amhara Regional State.

But the smile on her pale face is tinged with sadness, and a look of deep frustration and resentment sets in as she talks to us.

Worke tested positive for HIV, the virus that causes AIDS, some nine years ago, when she gave birth to a sickly child who was soon diagnosed as having AIDS. She contemplated suicide, but stopped short out of concern for what would become of her two children.

Two years ago, Worke decided to come out in the open and started to appear before meetings to teach about the threat of HIV/AIDS. ‘I saw how people were dying left and right, but no one seemed to be taking it seriously,’ she said.

But the decision has cost her dearly. All her sources of income immediately dried up. ‘Those I used to bake injera for would not only have nothing to do with me now, but could also be heard accusing me of putting their children at risk because they had eaten food prepared by my hands,’ she explained.

Worke’s life story is fairly typical in these parts. Like many others before her, Worke had given in to the allure of the town and left her village at a young age. Dazzled by her new life, she married a soldier and moved around with him, eventually giving birth to their daughter.

Trouble started when their second son died soon after his birth. Worke left her husband and moved with her daughter to Bahir Dar. To make ends meet, she worked as a prostitute in one of the many bars dotted around Bahir Dar. Prostitution was also what she turned back to after the shock of her diagnosis wore off.

But after several intense sessions one of the local counsellors managed to persuade her that she would cope better with the virus if she gave up prostitution and took better care of herself and the baby.

Worke set to work baking injera, the traditional Ethiopian bread, in people’s homes, and washing clothes for the town’s bachelors. Baking injera for five households earned her 25 birr (equivalent to around three dollars) and five pieces of injera. Worke steadily regained her strength and her baby son grew up and enrolled in school. It was then that she decided to join the anti-AIDS campaign.

Worke is only one of two Bahir Dar residents with AIDS to publicly speak out and join public awareness campaigns. But hidden from the public gaze, some 35 others regularly meet to talk and offer each other support.

The meeting is held under the guise of yetsebel mehaber , a traditional religious gathering of close friends and neighbours to eat and drink in celebration of a given saint’s day. In a place where there seems to be little sympathy for people living with AIDS, the members of this ‘secret society’ have decided not to risk stigmatisation.

‘Our members include government workers, teachers and others who still work and go about their normal tasks,’ Worke confided. " Once they saw how I had lost all means of supporting myself, they were more determined than ever not to let anyone outside of our group know of their status."

Worke is now living off the 50 birr a month (equivalent to around six dollars) she receives from a local NGO working in the area of HIV/AIDS. She is deeply uncomfortable with relying upon this small handout that depends on availability of foreign funding. Recently, recipients had their allowance cut off for several months as the NGO sought out funding.

"‘Why is the government not establishing some regular form of support for us?" she asks, ‘if the NGO fails to get adequate funding, we will be left without any means of feeding ourselves and our family.’"

Pointing to her dress and netela, a light Ethiopian shawl, she explains that one of the sisters working at the NGO had bought them for her so she can make her ‘public appearances’ looking ‘presentable’.

Worke is not the only member of her family to face the wrath of the public. "It is not bad enough that people shun me but there also some who pick on my daughter, calling her all sorts of names just because her mother has AIDS," Worke said bitterly.

She feels lucky that she is still strong, but she knows it will not last long and has already started making plans for her children, especially her nine-year-old son. The boy is now in a special home for AIDS orphans run by an NGO in the capital, Addis Ababa. "My boy was not scared to go off alone but waved to me as they drove off," she said with pride. She knows she will never see him again.

Worke has refused to become a passive victim. But she feels society has turned its back on her overtures. The public has managed to defeat her spirit where AIDS itself had failed to do so. "I have had enough," Worke says with a tired shrug of her shoulders.

The ADF Daily is produced by a team of independent African journalists working with the ECA Communications Team.

Editorial Advisory Board: Vera Oloo (UNICEF); Obinna Anyadike (UNOCHA/IRIN); Ann Winter (UNAIDS), Mercy Wambui (ECA); Nii K Bentsi-Enchill (consultant)

Colleen Lowe Morna; Lucy Oriang; Nana Rosine Ngangoue; Gumisai Mutume; Rosemary Okello; Jamilah Mwanjisi; Marie Noel Guichi; Hamadou Boulama; Marithe Kapinga; Dona Gouly.

Translators: Celestin Nsengiyumva ; Daliso Chaponda

Photographers: Antonio Fiorente, Lydia Mulugeta