San children, D'kar, Botswana. 
When the Group Study Exchange ended on May 10th, I decided I would try to visit a couple of community-based projects run by the San, a marginalized indigenous group that lives in the Kalahari Desert of Botswana. Probably most famously depicted in the cult movie "The Gods Must Be Crazy," the San are the original inhabitants of Southern Africa, having lived in the region for the last 30,000 years. Hunter-gatherers, the San roamed what is modern-day Zimbabwe, Zambia, Botswana, and South Africa. As agriculturalist Bantu tribes migrated south from the Congo basin, the diminutive and pacifistic San were driven to the inhospitable regions of Botswana and Namibia. Living in the Kalihari Desert, the San were, until recently, able to preserve their millennia-old traditions. In 1961, the Central Kalihari Game Reserve was set aside as traditional hunting and gathering ground for them; however, since independence in 1966, tourism has become an increasingly important industry in Botswana. The Reserve became a tourist destination and the San again found themselves displaced. In 1998, the Botswana government relocated the San outside the borders of the reserve, where many of them languish as labourers on private ranches or in squalid settlements. Their situation echoes that of First Nations in Canada and Aborigines in Australia. Sometimes referred to by black Botswanans as 'Basarwa,' a derogatory term that means 'people from the sticks,' the San experience a standard of living lower than that of the rest of the population. Alcoholism, unemployment, and HIV/AIDS are serious problems within their settlements (Botswana is one of the richest African countries, but it also has one of the highest HIV prevalence rates on the contentinent, over 30%). Progressive by African standards, the government of Botswana is working with San communities develop income-generating community projects and health programs that will deal with some of the problems they face. I'd heard that there were projects being run in a couple of settlements in the far west of Botswana, in the northern part of the Kalihari, so I set out in that direction. Botswana is big and sparsely populated. Public transport is available, but it's slow and relatively infrequent, so I decided to hitchhike. Starting from Victoria Falls, I hitchhiked across the Caprivi Strip, a 350-km stretch of brushy trees and talcum-fine dust in northeastern Namibia, and down into the panhandle region of Botswana's enormous Okavango Delta. For a weekend break, I spent a couple of days in a fishing village in the Delta, exploring the lily-choked waterways by mokoro (dugout canoe) with a guide from the River Bushmen tribe (no relation to the San, also sometimes known as Bushmen).  From there I hitched into the Kalihari, arriving in the tiny San settlement of Kuke after dark. I hadn't really thought ahead about where I was going to stay. There was no electricity but the moon was out, thankfully, so I was able to find a tiny dry goods shop on the edge of town. I asked the proprietor, a friendly woman in her thirties, if I could camp in her yard. She seemed to find this hilarious — I guess it's not often that a tired, dirty, and unshaven white man shows up in her village looking for place to stay — but in the end agreed. The next morning she even offered me water to bathe. A not-so-subtle hint that I was becoming pretty ripe, I think. Eight days alone in a tent will do that to a person.
As the sun rose, I wandered around the village, asking about HIV/AIDS and other community projects. No one seemed to know much about them. Language was part of the problem. A few people spoke broken English, but most seemed to speak only San, which is probably the most distinctive language I've ever heard, full of pops and clicks, sounds I can't even begin to approximate. Finally I found the village health centre, which looked relatively new and well-maintained, but again I had difficulty making myself understood. The caretaker suggested I try D'kar, another San village about 100 km away. Riding along the highway in the back of a lumber truck, I made it to D'kar, and was again told to look elsewhere. I hung around for awhile, had a delicious lunch of smoked fish and rice, and was (I think) propositioned by one of the village women: Village woman: You have a tent. Me: Yes. Village woman: It is a two-people tent? Me: Yeah, it fits two people. Village woman: You have a comforter? Me: You mean like a blanket? No, but I have a sleeping bag. See? Village woman: No, a comforter. Someone to comfort you. Me: Oh. Um, I guess I do. In Canada. Thank you. Village woman: [Laughter] I moved on, travelling a little further into the Kalihari, to Ghanzi. It would take a couple of days to get back to Zimbabwe to catch my flight home and by now I was running out of time. Eventually I gave up, having spent a couple of days in San villages, where I saw. . . I'm hesitant to draw any conclusions about what I saw. They seemed like ordinary African settlements. People were getting by, but traditional San culture seemed to me nowhere in evidence. I hitched a ride back towards Zimbabwe with a white Botswanan safari guide who had grown up near a San settlement and spoke the language fluently: "There are a lot of problems, man. The San are an amazing people. Loyal and kind to a fault — never aggressive. But their way of life is disappearing. And the settlements - so many problems. They don't know what to do with themselves. They're restless and they have nothing to do. And the Tswana (majority black Botswanans), some of them treat the San poorly, very poorly. Where I grew up, in Ghanzi, they do." 
Miss Patience Nyamupfukudza, Harare, Zimbabwe. 
The past five weeks have been intense. We've spent so much time meeting with AIDS organizations and visiting community groups that there hasn't been much time to relax and just enjoy Africa. Last weekend, in Harare, we finally had a few days off. I spent two nights at the Harare International Festival of the Arts (HIFA). The highlight, for me, was a performance by Zimbabwean musical hero Oliver Mtukudzi. Best of all, though, I had the distinct pleasure of delivering a care package to the lovely Miss Patience Nyamupfukudza, the seven-year-old daughter of ACT's own office manager, Grace Chiutsi. Patience sends her love to her mom in Canada. 
Grave, Livingstone, Zambia. The tombstone reads: "Christine Kalowa, 1979 - 2000." 
One of the things you start to notice, as you travel around Southern Africa, is the abundance of young people, of babies and children and teenagers, and the absence of the middle-aged and elderly. Look at a demographic chart of just about any country outside of sub-Saharan Africa, developing or developed, and you'll see a bell-shaped curve. There'll be some variances — the developing countries will tend to have more young people and fewer elderly than the developed ones — but the able-bodied, people aged 24 - 49, will make up the biggest segment of the population. This is key; the able-bodied care for the young and the old; they provide the labour and skill that make the economy run. As the first generation of Africans who grew up with AIDS reaches middle age, their numbers hugely diminished, the impact of AIDS on future generations becomes clearer and clearer. In terms of demographics, what you have is nearly the inverse of that of countries like Canada, Japan, even India: a massively disproportionate number of young people, many of them orphans, and a small 24 - 49 year-old age group. People over 35 are especially rare in Southern Africa, not much more common than the elderly, the generation that had left this high-risk age group at the beginning of the epidemic. Without an able-bodied population to shoulder most of the burden of caring for the young, providing them with food, shelter, and education, we can expect spiralling poverty and illiteracy. Economies will bottom out. It's hard to fathom, but we're already seeing the future: We're seeing households run by 12-year-olds. We're seeing families of six, eight children cared for by a single grandparent. As of 2003, nearly one million Zimbabwean children — that's one-twelfth of the entire population — had lost one or both parents to AIDS. 
Maramba Old People's Home, Livingstone, Zambia. Having dwelled on this for the past few days, I relish the opportunity to see something positive in the form of the Maramba Old People's Home in Livingstone, Zambia. We meet people in their sixties, seventies, eighties, even nineties. The oldest resident of the home is ninety-six and he looks good. All of the residents enter the home as single people — it's one of the requirements, that applicants be without family or any other means of support — but many of them get together once they've settled in. I meet one happy couple, both of them blind, one from cataracts and the other from what looks like river blindness (most of the residents seem to have eye trouble). I greet the woman, shaking her hand, and she carefully passes my hand on to her boyfriend so that he won't have to grope for it. It is one of the tenderest things I've ever seen. The home itself is a small compound of tin-roofed buildings that house maybe twenty-five residents on a budget of about $250 USD per week. While it receives some support from the Ministry of Community Development and Social Services and from a few local businesses, the home needs all the support it can get. If you're interested in helping out, contact Margaret Whitehead, Chair of the Maramba Old People's Home board of trustees, at denmar@zamnet.zm. 
GALZ staff Keith Goddard and Sam Matsikure, Harare, Zimbabwe. 
My visit to Gays and Lesbians of Zimbabwe (GALZ) coincides with a government raid on NGOs around Harare. I half expect their offices to be cleaned out, their staff gone. But it's the major players, development and relief agencies like World Vision, the ones that could be sending reports out of the country about the dire food situation (drought and mismanagement have created a serious shortage of mealie meal, the staple diet of rural Zimbabweans), which have been raided. GALZ is a very active and, not surprisingly, very outspoken gay, lesbian, and trans organization that focuses on GLBT rights and HIV/AIDS. GALZ provides counselling and support groups for people in Harare; this past year they extended the reach of these programs to other parts of Zimbabwe. They provide full medical aid to a number of HIV-positive clients through their Positive Image Access to Treatment Scheme. They monitor public debate about homosexuality and advocate for the normalization of GLBT identity, publishing reports on LGBT human rights and HIV/AIDS issues. One of the difficult issues they're contending with is gender inequality and the impact this has on women who have sex with women, particularly their ability to be open about their sexuality — the organization is working to increase its programming for lesbians. Finally, GALZ focuses on networking with GLBT organizations around Africa and abroad, with a view to creating momentum for the small and beleaguered African gay rights movement. In a country whose leader, President Robert Mugabe, calls gays and lesbians worse than animals, you'd expect the situation to be, at best, difficult. In fact, there is a small but active community of openly gay Zimbabweans, black and white, who live relatively trouble-free lives. Keith Goddard, executive director of GALZ, and Samuel Matsikure, health officer, are sanguine about the situation: "The media make it sound terrible for us, but in all honesty, there are much, much worse places in Africa to be gay," says Goddard. "Some Muslim countries come to mind. Here the abuse is verbal rather than physical most of the time." "You have a lot of people in the closet, and you have cases of blackmail, especially among the professional classes. A couple of well-known politicians had their careers ruined by scandal. But there are openly gay Zimbabweans of all classes, white and black," adds Matsikure. "Some of our clients come from the townships, the low income districts, and they don't hide the fact that they're gay. They do not go so far as to flaunt their sexuality, walking around hand in hand with their boyfriends, but in the case of some of our more, well, flaming clients, they do not hide this." Aren't they afraid of being bashed? What about religion? Are they shunned from their religious communities? "Sure, there are cases of assault, but from what we've seen, in a lot of cases, the fact that the person is gay is just a pretext. The assault has less to do with hate than to do with robbery," Matsikure says. "And as far as religion goes, if you want to go to church, and many of us do, it is an important part of our lives, then you accept that you're going to hear sermons that revile homosexuality. Leviticus and so on." Goddard interjects: "GALZ tries to work with religious leaders. We've not had much success, but I heard recently that at a Seventh Day Adventist church here in the city, the topic of discussion was family, and the pastor offered up same sex partners as one possible alternative to the traditional nuclear family." "Attitudes are changing, especially among educated young people. There is obviously still a lot of opposition to homosexuality in Shona (the local majority ethnic group) culture, but there is also a lot of curiosity and a kind of acceptance. We've even reclaimed the Shona word for faggot or queer - 'ngochani.' This used to be a derogatory term but now you'll find that it's got a softer edge. Kind of like the word 'queer' in English," says Matsikure. How much of this reflects changing attitudes and how much is just wishful thinking? "Let me give you an example," says Goddard. "Every year we organize a drag show, The Jacaranda Queen. Last year the Criminal Investigation Department of the Harare police [CID] sent a couple of undercover police supposedly to monitor the morality of the event — a lot of people really do think that all gay people do is have orgies, and that the GALZ office is some kind of gay brothel. They came to us the next day saying that they had a good time. Their attitude was that they wanted to know more about why men would want to dress up as women. The local police division, too, has always been respectful towards us. They come to our offices to do their photocopying." Of course, benign curiosity is not the response of all the authorities. Last year Mugabe's Presidential Guard beat up Goddard and his partner for parking too close to the presidential palace. Goddard's arm was broken in the assault. The Guard tend to respond very severely to anyone caught near the Palace, but Goddard is well known to the authorities, and they were hauled into the central police station for interrogation. "They were very aggressive with us," Goddard recalls, "but then the CID were brought in, and they were very good. They seemed almost embarrassed that we were singled out. Now, Mugabe famously hates gays and lesbians, so you never know where you stand with the authorities. But overall it's better than what gets reported in the media, here and internationally." "The next step, and it is a crucial one," says Matsikure, "is for some of our community leaders to be brave enough to come out of the closet. They need to lead by example. Right now, in the current political climate, that would mean career suicide. But eventually it will happen. We at GALZ have to keep interjecting in public debate, make our voices heard, normalize gay identity. As a gay Shona man I've managed to gain the acceptance of my parents and siblings. It's a start, isn't it?" Goddard has the last word: "The other crucial step is to build a real gay rights movement with organizations in Africa and abroad. We need to amplify our voices by speaking out together." 
Sipho and Clever M. in their home, Harare, Zimbabwe. 
Clever and Sipho M. live in the Jo'burg Lines, a shantytown in the Mbare District of Harare. The beating heart of the city, some people call it. The population density is high — three, six, eight people to a shanty — and the poverty is extreme. It's a vibrant place, though, and the sense of community is strong. The Mugabe government is wary of the district for its revolutionary potential. Having shouldered the burden of the dictator's disasterous economic policies, Mbare is a hotbed of opposition support. Clever and Sipho are married. Like many people here, they rent a tiny one-room cement shack. They cook outside in a courtyard they share with a constellation of other shacks. Like many people here, they are HIV-positive. Sipho is healthy. A women's community group supplies her with free antiretroviral drugs (ARVs) and she has recently overcome tuberculosis. She looks, feels strong. Her husband, however, does not. Clever struggles to sit up when we arrive. He insists on greeting us properly, so Sipho lifts him into a sitting position. Propped awkwardly on their bed, Clever can barely lift his head. He can't weigh more than eighty pounds. In better times, before Clever became too sick to work, the couple shared their home with their two young children. Poverty has since forced them to send their kids to live with family in the country. Sipho supports herself and her husband with what money she makes as a street vendor. She sells vegetables donated by a local community health organization. It's not enough to pay for antiretrovirals for Clever, though, and the Department of Social Welfare, ever wary of prescription drug fraud, does not make it easy for people to access free ARVs. This is one of the reasons we're here today. The community health organization has a working relationship with Social Welfare, so one of the organization's field counsellors will apply for ARVs on Clever's behalf. We tell Clever he needn't sit up, but he persists. Only when we get up to leave, having dispensed antibiotics and soap, does he ease himself, painfully, back into bed. UPDATE: In late May, the Zimbabwean government launched Operation Murambatsvina (which translates from the Shona as 'Operation Sweep Out the Rubbish'), a series of police and military raids on the low-income districts of Zimbabwe's cities and towns. The raids have left more than 700,000 people homeless, Clever and Sipho among them. For more background information, click here and here. The satellite images posted here convey the scope of the destruction. 
Crumbling tuck shop, Chimoio, Mozambique. 
Today we visit Kubatsirana, a local AIDS service organization. Julio Manuel Samundire, Kubatsirana's home-based care coordinator, insists on taking us to meet some of their clients. He leads us through a strange, half-built house to a room at the back. An emaciated man in his early forties sits wrapped in a blanket on the floor, his young daughter squatting beside him. He sees us and weakly he tries to tidy the room. With a stick he sweeps some rubbish underneath a cabinet. It's 30 degrees outside and he's using a hotplate to stay warm. He stares listlessly at the wall while a Kubatsirana volunteer explains his situation. In the hallway his wife is complaining in a low voice. She left him three months ago, taking their youngest daughter with her, and has just returned. In her absence the couple's 11-year-old son has been caring for the father, cooking and tending to the chores. We shouldn't be here. I feel like a voyeur. The man refuses to believe he has AIDS. He believes sorcery is the cause of his sickness. His wife complains that he berates her for bringing evil into their household when, she says, it is he who has brought the sickness upon himself by taking up with other women. It's obvious that she's sick, too, but she has never been tested for HIV. Samundire speculates that their oldest child, the 11-year-old, is HIV-positive. Maybe their younger children, too. One of the reasons that so many Africans — especially peasants — do not believe in AIDS is because the symptoms are so diffuse. The opportunistic infections that define AIDS vary from person to person; without a good understanding of the immune system, it's difficult to conceptualize AIDS as an illness in itself. So it's not hard to see why people believe that the wasting of their faces or the weeping sores in their mouths are the result of black magic. I've had enough. I pass through the barren rooms and down the narrow, cobwebbed hallway to the street. The man probably started building the house with the best intentions for his family. Now he's too sick to finish it and the entire family faces an uncertain future. 
Chief and Mrs. Kumtamanje of Malemia, Zomba District, Malawi. 
A rare rest day on the Mozambican coast (hello Indian Ocean!) gives me some time to reflect on the trip so far: Over the past few weeks I've asked a lot of questions about traditional cultural practices in Malawi and Mozambique. I've talked to HIV educators, doctors, traditional leaders, activists. It's fascinating and frustrating; the more I learn, the less I feel I know. One of the things I have come to understand, though, is the centrality of traditional authority in village life. Chiefs, imams (in Muslim villages), priests (in Christian ones), traditional healers, ritual initiators, and midwives command incredible respect within their communities. Their authority in matters political, moral, and spiritual tends to be accepted with little or no opposition.  The most successful African AIDS organizations I've seen are the ones that work with these leaders, the ones that work within the context of tradition rather than alongside or against it. Change - real, sustainable change - comes slowly.
The Umoyo Project in the Zomba District of Malawi exemplifies this approach. Established seven years ago by a group of volunteers from area villages and now supported by Stephen Lewis's Dignitas Foundation, Umoyo brought together all of the different traditional authorities mentioned above to develop a comprehensive approach to HIV/AIDS that addresses all aspects of village life. Here's an example of how Umoyo works within tradition to effect change: Umoyo works with traditional healers on health delivery. Instead of seeking to discredit their naturopathic approaches to HIV, the Project incorporates traditional medicine into their treatment programs. The result is that area healers do not feel threatened by the new ARV programs, and area AIDS organizations have come to realize that many of the medicines the healers dispense do indeed have palliative properties. Because they have a role to play in HIV/AIDS care and support, the healers are more willing now to admit that HIV has no cure - they needn't fear that such an admission will put them out of work. 
Imam, Malemia area. Versed in the ways HIV is transmitted, the healers have also become more mindful of safety when they dispense their cures. Herbs are sometimes applied to the body through small incisions made in the arms or legs of the patient. In the past, dirty razors spread HIV; now it's standard practice to use a clean razor with every patient. The Project's give-and-take approach to HIV prevention won the support of Kumatamanje, the highest chief in the area. His approach has been to lead by example. To help reduce stigma around HIV/AIDS, he and his wife volunteered to be the first participants in the area's pilot voluntary HIV testing and counselling program (VTC). (Mrs. Kumatamanje herself supervises initation rites to ensure that they are safe.) Several years on, the VTC program is an unqualified success. 
View of Mt. Mulanje, the highest peak in Southern Africa 
An interesting discussion with Seodi White, a well-known women's rights activist in Malawi: "The national HIV prevention campaigns you see everywhere, they do not work. You can spend all the money in the world on them, but unless you speak to the lived realities of the people, the ads will do nothing. You can tell people to use a condom everytime or abstain from sex before marriage, but it won't work. "Let me give you an example. Not too long ago I met with a group women from one of the districts near the lake. They come from a tribe that believes a baby must be protected from evil spirits from a very early age. When a baby reaches 40 days, they perform a series of elaborate rituals — anointing the child with oils, passing it over fire, shaving its head, and so on. "It is believed that these rituals give the baby protection and strength. Around the fortieth day, the mother must lay with her husband and he must ejaculate inside her. This also gives the baby strength. However, many people believe that the baby will be stronger if the mother lays with the strongest man in the area, so it is not uncommon for the most vigorous men in the village to be called upon to perform this duty instead of the husband. "I asked the women, there were ten of them, whether they had lain with their husbands at this time. Two of them said they had; the rest of them were silent. I pressed them and they admitted to laying with the village strong man. I asked them if they used condoms. They said no, of course not: The man must ejaculate inside for the baby to gain strength from the ritual. "So these women, even if they normally used condoms, they made an exception here. They put themselves at risk for the sake of their babies. Now how does a simple safer sex message speak to this tradition? It doesn't. "As HIV/AIDS educators we must deconstruct these practices and their underlying beliefs. These beliefs are so deep-rooted that de-legitimizing them will never work. We must understand them, and offer alternatives within the context of the tradition. That is the only way." 
Masonry classroom, part of Samaritan's vocational training for street-involved youth. 
Every year, about 70,000 children in Malawi lose one or both parents to AIDS. Some of these kids are taken in by their extended families or, if they're old enough — say, 12 — they raise themselves and their younger siblings under the on-again, off-again supervision of their villages. In the cities, many end up on the street. They join the children of physically disabled or extremely poor parents and children from physically or sexually abusive homes. Their prospects are poor. According to Jeffrey Mbuzi, Executive Director of Samaritan Trust, a sort of all-in-one orphanage and vocational training centre for street-involved youth, many end up supporting themselves by begging and through sex work. Many end up HIV-positive. Child trafficking is a problem in rural areas near Lake Malawi; less so in the cities. One of the few benefits of Malawi's extreme poverty is the inaccessibility of hard drugs. Drug use tends to be limited to marijuana and alcohol. Established in 1993, Samaritan Trust sends outreach workers into communities to recruit children living on the streets for their training programs. Social worker Joseph Banda explains: "It can take many visits with the child to establish trust. We talk with them and explain how our programs can help them. Sometimes they've formed makeshift family lives on the street and it can be hard to leave these behind. So when the children are coming to Samaritan trust, they live at the dormitory while they study but we send them back to their communities for a few weeks between each term. It makes the transition into and out of the program easier." The vocational training program lasts two years. The students, about 120 in all, ages 12 to 20, most of whom are male (plans are in the works to expand programming for girls), specialize in masonry, carpentry, weaving, and other commercial trades. The Trust provides them room and board. Depending on how young the students were when they ended up on the street, they may be illiterate, and their English language skills are typically poor to non-existent. The program includes basic Chichewa and English language lessons and mathematics. Students receive counselling during the course of their studies. I'm surprised to hear Mbuzi explain that the counsellors talk about homosexuality with the students. Homosexuality is one of the great taboos in African culture, and even the European expatriates I've spoken to (Tony Harris at the Malawi Ministry of Health, for example) tend to minimize its impact on HIV/AIDS transmission in Malawi. 
Samaritan instructor. Mbuzi is a little uncomfortable when I ask him to elaborate; it's a sensitive issue, so I don't push it. I gather from the rest of the visit that Samaritan takes a rudimentary harm reduction approach to sex and homosexuality. During a tour of the library, we come across stacks and stacks of a 1970's sex education manual called "Sex Before Marriage." The images and messages are dated, almost quaint, but very liberal by Malawian standards. Homosexuality is treated gently, as natural rather than pathological, as something that most people grow out of but some do not. The book seems to be a tool to help students cope with the guilt and shame they may feel about past behaviour as sex workers. It encourages them to look at homosexuality as an episode of their youth, something they can feel okay about as heterosexual adults. By our standards, the book's message is wrong-headed and patronizing, but it's a start. Better than treating homosexuality as a moral sickness, which is the most common approach here. At the end of the program the students write the exam for the National Trade Certificate, which qualifies them as tradespeople. The pass rate is low. "Typically, the children pass the practical section easily, but they struggle with the written theory. The exam is administered only in English and their English skills are not strong enough. We try, but two years is not always enough time for them," says Mbuzi. Isn't there a Chichewa-language version of the test? I ask. "There should be, but there isn't. That's just the way it is right now." As they near the end of their two-year stay, the students do not want to leave. "There are discipline problems at the end. The students do not want to go back home. They will stop going to classes. They try to sabotage their studies so that we will keep them on. But we cannot. We do not have the resources so they must go home. We give them a starter kit and help them to start a small business or find work, but that's all we can do. Many succeed with or without the National Trade Certificate. Many do not." 
Women's group at NAPHAM offices. 
Headquartered in the dusty low-income Kawale district, the National Association of People Living with HIV/AIDS in Malawi (NAPHAM) is a community-based AIDS organization that works primarily with women. Christopher Chisendera, a counsellor at NAPHAM, agrees to show us around. He explains NAPHAM's programs: "NAPHAM has three counselling services. We are doing pre-HIV test counselling, which prepares people for a positive test result. We are doing post-test counselling, and we have care counselling for HIV-positive clients and their families. Care counselling is very important. Many people are keeping their HIV status secret for fear of rejection. It is a great psychological burden to be HIV-positive and have no one to talk to. So we are counselling family members. We show them that AIDS is nothing to be ashamed of. We show them how to support their loved ones when they are healthy and care for them when they are sick" NAPHAM runs a home care program similar to ACT's Buddy Program. Volunteers visit the homes of HIV-positive people. They help with household chores, sweeping and cleaning and preparing food for clients when they are sick. The volunteers show family members how to take care of their loved ones and they promote acceptance and openness about HIV/AIDS. "Having an HIV-positive mother or father or sibling," Chisendera says, "is a psychological burden for the whole family. There is stigma from outside, from neighbours and so on. People think that if your parent or sister is sick, you are sick too. And there is also fear about the future. What will happen when the person is too sick to take care of their children, or their siblings, or their elderly parents? People are not wanting to think about this. We must make them think about it," Chisendera says. Another key part of NAPHAM's anti-discrimination strategy is their volunteer program. Most of NAPHAM's clients double as volunteers. The healthy, HIV-positive volunteers are out in the community, taking care of other clients too sick to care for themselves and in the process demonstrating to the clients' families that people with HIV/AIDS are as capable and valuable as anyone else. NAPHAM also recruits HIV-negative people. By tending to desperately ill clients without themselves becoming sick, these volunteers show their communities that they need not be afraid of infection. 
Pins designed and sold by NAPHAM clients. Finally, NAPHAM offers therapy groups and income-generating programs for HIV-positive women: "We operate a small poultry farm and a crafts collective for our women clients. We teach them how to raise and sell chickens and create various crafts. The money these projects make funds NAPHAM programs and the women learn valuable skills. They get to take home some of the chickens they raise." The amount of freedom women have in Malawi varies depending on whom you ask. As an outsider, it's difficult to understand the complicated gender roles dictated by traditional culture. The Chewa are the majority ethnic group in Malawi. When Chewa marry, it is the husband who moves into the woman's community. The husband must prove himself to the family and friends of his wife. If he wants to take a second wife, he must have the consent of his first wife's parents. Even if they consent, he cannot bring the second wife into his home. He must establish a separate household in the second wife's community and prove himself all over again. All of this ensures that the women receive a resonable amount of respect and freedom from their husbands. As one woman I met put it, " I kneel before my husband, but I expect him to jump for me." Nevertheless, women here shoulder the burden of childrearing, housekeeping, and in the rural areas, much of the farming as well. They have little in the way of property inheritance rights, so when they are widowed, they may lose their property to their dead husband's eldest brother and be left to fend for themselves, more or less. Skills training and microloan projects are a couple of the ways that organizations such as NAPHAM address the problem. 
Dr. Tony Harris. Malawi Ministry of Health. 
Today we meet with Tony Harris, a physician at the Ministry of Health. A cheerful British expatriate in his mid-fifties, Harris has worked in healthcare in Malawi for the past 20 years. He is, we've been told, an authority on HIV/AIDS treatment and care. Harris leads us into his modest office at the Ministry and begins right away. Since about 2001, he explains, Malawi has made significant progress in the treatment of people living with HIV/AIDS. Several years ago, the World Health Organization (WHO) ruled that countries could legally manufacture and export generic antiretroviral AIDS drugs (ARV's) to developing countries. Soon after, Malawi began importing ARV's from India and distributing them to HIV-positive people. For the past eighteen months or so the government has distributed ARV's to Malawians free of charge. Demand for the drugs far outstrips supply, of course, and waiting lists are about three months long. Approximately 18,000 Malawians have begun ARV therapy since the program began. It's a start, Harris says, but the Malawian government is looking for ways to step up ARV therapy. Currently, drugs shipped from India to Africa must pass inspection at WHO facilities in Europe before reaching their destination. The government is talking about developing its own facilities to manufacture the drugs, but it's a long way off at this point — funding from the UN's Global Fund runs out in 2008. What ARV funding will look like from that point on remains to be seen. One of the problems Malawi and other southern African countries face is a shrinking labour force. Malawi has suffered a net loss of about 2% of its teachers to AIDS each year for the past few years. The statistics would be, Harris suspects, similar in other sectors of the economy. By the end of the decade the labour shortage will be acute across all sectors of the economy. There are, however, reasons to be optimistic. About 25% of people on ARV therapy are farmers from rural areas and another 25% are women from these communities. This is no mean feat, when you think about it. For ARV's to be effective, patients have to travel to and from the capital every month or so to pick up their medication; they have to eat a diet more nutritious than the national staple of nshima (maize dough) and vegetable sauce; and they have to manage their households and their crops even when debilitated by the side effects of the drugs. None of this is possible without the support of their family and neighbours, so the numbers suggest that attitudes towards HIV/AIDS are changing for the better in Malawi, if slowly. People are becoming more willing to talk about HIV/AIDS and care for friends and family living with HIV/AIDS. Stigma and taboo remain serious problems here, but anti-discrimination campaigns such as the ones run by the National AIDS Commission (NAC) and the National Association for People Living with HIV/AIDS in Malawi (NAPHAM) are making a difference. 
Village boy. Lake Malawi. 
First, some context: Starting today, I will be travelling across Southern Africa with a group of four other people sponsored by Rotary International as part of the organization's yearly Group Study Exchange. This year's exchange is HIV/AIDS-themed and all of the team members work in AIDS-related fields in Toronto. They are: Hannah James, a freelance journalist who writes for NOW and Elle magazines; Julie Hard, a physiotherapist who works at St. Michael's Hospital in the HIV/AIDS unit; Andrea Burridge, a respiratory therapist from Ajax; and Christian Madigan, a teacher who works with immigrant and refugee children in Scarborough. I'm pounding out this entry at a cottage on the shore of Lake Malawi in central Malawi. Village kids play on the beach just beyond the table where I sit. Beyond them, the silhouettes of distant mountains slowly melt into the dusk. Soon I'll crawl under a mosquito net and sleep off the jetlag. Tomorrow we drive 120 km to the capital, Lilongwe, where our work begins. I'm told our Rotary hosts have arranged meetings with the National AIDS Commission, the Ministry of Health, and the National Association of People Living with HIV/AIDS in Malawi, a grassroots NGO, over the next few days. I look forward to them. |