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Friday, June 10, 2011

"Yes we can".... Can we?

Some interesting things have transpired this week during the ZACP workshop (round 2!)...

Monday was the beginning of round 2 for the ZACP strategic planning workshop. The last ZACP workshop I blogged about was in regards to a performance review of the previous ZACP strategic plan. During this 3 day workshop we reviewed the strategic activities, achievements, challenges and gaps in responses. From the  gaps we created new strategic issues at each identified intervention level that need to be addressed in the next strategic plan (2011 to 2016). 

This week's edition of the ZACP workshop is 6 days (Monday June 6 to Saturday June 11) during which time we are taking the identified strategic issues from each intervention level (ie: BCC, Home Based Care, Key Populations, etc...) to create outcomes, outputs and activities. This has been an amazing learning experience for me because I have been able to put my Results Based Management (RBM) skills to the test with the help of some really great minds. I ended up working with the Director of ZACP and an M&E Consultant who works for UNAIDS, to name a few. The M&E consultant was great as he was able to pin point the exact phrases and words that needed to be use to make each sentence either an outcome, output or activity. It may sound easy, but it's really a lot work! 

During Tuesday's workshop there was an American lady present who works for the Center for Disease Control (CDC) in Dar es Salaam. She made a little speech regarding the topic "yes we can" stop HIV and AIDS transmission in Zanzibar. I added "Can we?" to the title of this blog because I don't necessarily agree with her theories on this topic.

The theory was that since Zanzibar is a small island with an already relatively small rate of transmission, if we were to scale up prevention methods (focusing on early treatment) we could eventually stop new infections. Ok, that makes sense, but her implementation process would never fly especially in Zanzibar due to cultural and religious sensitivity.

She compared the implementation process of halting new HIV infections with the same tactics used to control malaria in Zanzibar which was achieved through 2 methods:
  1. Prevention - providing bednets to everyone
  2. IRS - indoor residual spraying 
She went on to say that we can use the same methods to stop transmission of HIV thus being
  1. Prevention - providing condoms to all 
  2. Door to door HIV testing
Both of these methods would never work in Zanzibar. First of all, I have spent the past 5 days discussing how highly regarded religious leaders are in Zanzibar and how difficult it is for them to allow the distribution of condoms in the public, an issue that was discussed heavily in my behaviour change communication (BCC) group. Second of all, it is difficult enough to get people, especially those who fall in the "Key Populations" group (MSM, IDUs and FSWs) to be tested for HIV due to the stigma and discrimination surround the disease. Therefore, it is in violation of a person's human rights to be forced into testing, even if it is in their benefit to know.

These were my opinions on her "yes we can" speech and I was curious to know what people from Zanzibar thought about her theories. I decided to do some reconnaissance work and ended up speaking with a few different people to hear their views. The first was a Zanzibari nurse who works for ZAPHA+ and she also said that it wouldn't work due to cultural factors. The next man I spoke with was a Zanzibari gentleman working for the Department of Substance Abuse. He said it would never fly because you would never be able to go door to door and test people as it's a violation of their human rights. Lastly, I spoke with a Tanzanian man who works for CDC in Dar es Salaam (a colleague of the lady who made the speech). He didn't agree with her and he told me that she had pitched the same idea to other people within the Ministry of Health and no one would really back her ideas. His issues were:
  1. You will have a hard time convincing health people to go on ARVs at a young age for the rest of their life
  2. There are 1.4 million people living with HIV in Tanzania and not even half of them have access to ARVs. Once funding is gone how will Tanzania be able to afford to keep 1.4 million people on ARVs for over 20 years.
Don't get me wrong, I enjoyed her optimism and if you do your research into early treatment as prevention for HIV you will find a lot of information. I just think that before she pitched this idea she should have had more support from Tanzanians in order to address cultural issues within this theory.


I'd love to hear your thoughts, please share with me!

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Quick Research: Early treatment as prevention

Treatment as prevention works

New Support for "Treatment as Prevention" Approach to HIV

Early treatment reduces HIV transmission in heterosexual serodiscordant couples

2 comments:

  1. So is anyone going to tell the US woman that she is not right and to check her facts out before she says anything else??

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  2. I would hope that someone will explain the cultural issues surrounding her 2 methods of intervention. However, seeing has she has been living in Dar for a while I would think that she already knows. But maybe some people are oblivious -- how? I don't know

    ReplyDelete