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AAI Tribute to Prudence Mabele: Accountability Champion

Prudence Mabele

AIDS Accountability International pays tribute to Prudence Mabele, a true accountability champion for women’s and girl’s rights and people living with and affected by HIV, who sadly passed away this week.


Comrade Pru as she was fondly known has left a legacy and deep footprints in South Africa and globally in the fight against HIV and AIDS and championing the rights of women and girls. As tributes poured in from across the world this week, Prudence has been described as warrior, a global icon, a dedicated, fearless fighter and a committed human rights activist who cared deeply about the communities and the people who she was serving.


Anele Yawa, General Secretary of Treatment Action Campaign said about Prudence in an interview “during the days of AIDS denialism, she was among those who stood up to demand for access to ARV treatment in public health care sector for all. When stigma and discrimination against people living with HIV and AIDS was still high Prudence was amongst the comrades who was running an HIV awareness and education programs.”


Prudence’s spirit was larger than life, she had a vision and inner pursuit that drove her to respond to the humanity of people, someone who held herself accountable but also had no qualms with holding governments accountable. She spoke truth to power and said what no else would dare say. She was passionate about young women and girls as reflected through her organisation, Positive Women’s Network.


Prudence said in an interview, “The AIDS message will start with us but it can’t stay with us alone, it has to spread to the community and it must always be a non-judgemental one. We have to keep an open mind and be non-judgemental, identify challenges and try and resolve it” She also said “my personal commitment is to truly work with younger women to make sure that they remain an AIDS free generation.”


Prudence understood that all struggles are connected and this showed through her work and she understood that people are at the centre of the struggle for human rights.


We have lost a great activist, a visionary, a friend and a true leader.  We cannot thank her enough for the legacy she has left behind. We celebrate her life and her work which will be remembered and valued for generations to come.


AAI offers our sincere condolences to the Mabele family and the staff at Positive Women’s Network.


The AAI African Child Marriage Snapshot Scorecard

Child_Marriage_LogoChild marriage is a practice that adversely affects girls[1] and usually leads to violations of their human rights[i].


The AU Campaign to Eradicate Child Marriages sends out a strong message that, “Child marriage is defined as a formal marriage or informal union before age 18 or any marriage carried out below the age of 18 years, before the girl is physically, physiologically, and psychologically ready to shoulder the responsibilities of marriage and childbearing. Child marriage has devastating and long term effects (health, education, psychological, emotional, mental etc.) on the life and the future of girls. The negative effects of child marriage, include but are not limited to, less education, lower earnings, health complications due to early pregnancy, compromised psychological well-being, intimate partner violence and lack of participation and voice for the girls in their community and society at large[ii]. It is a human rights, gender, health and culture, as well as a development issue.”[iii]


According to the AUC Campaign the drivers of child marriage include poverty, discriminatory cultural and religious practices and a lack of political engagement.[iv] Conflict aggravates child marriage, and girls in conflict zones are forced both into marriage but conflict as well. They are unaccounted for due to the core family unit being broken up, and thus have no one searching for them as they are often suspected to be dead.


Solutions vary from greater accountability from political leaders, to better and more widespread birth registrations (to determine exact age in order to provide legal protection), providing empowering education, community support and community and religious leader support, economic support for girls and their families, and a consistent and enabling policy environment, amongst others.


The AAI Child Marriage Snapshot Scorecard uses an accountability lens to create transparency around data on child marriage in Africa, contribute in a small way to more dialogue by all stakeholders, and inspire further action towards eliminating child marriage in Africa and globally.


The AAI African Child Marriages Snapshot Scorecard examines data presented under 4 Elements:

  • Element 1: Data reporting on child marriage prevalence

  • Element 2: Minimum age of sexual consent

  • Element 3: Policy on age of marital consent and ending child marriage

  • Element 4: Budget allocation to education


The AAI African Child Marriage Snapshot Scorecard will be launched on July 20th at the International AIDS Conference, and will be uploaded here at that time.

Read the AAI African Child Marriage Snapshot Scorecard here

Launch of two reports on Access to Medicine

In 2015 the Open Society Initiative for Southern Africa (OSISA) approved funding for AAI to co-ordinate a new project to promote transparency and accountability initiatives within Southern Africa with a particular focus on access to medicines.

The overall aim of the project is to increase confidence and capacity by citizens through the civil society in selected SADC countries to demand effective and efficient access to medicines services from governments, private sector and funding partners.


Mapping Report of Civil Society and A2M – November 2015

As part of the preliminary process in terms of rolling out the new project, during November 2015 a special mapping exercise was conducted to collate information needed for a database of all key organisations actively involved on access to medicines issues across Southern Africa.

In particular, the outcome of the mapping process will seek to provide a map of civil society and other relevant stakeholders who could be engaged in advocacy work focused on the promotion of transparency and accountability issues with regards to access to medicines across Southern Africa.

In general terms, the mapping exercised was spread across all the ten countries that are covered by OSISA. Namely, Angola, Botswana, DRC, Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe. There was also an analysis of the entire pan African and global organisations that are also active in the region.

Further to that, a special and more detailed mapping exercise was conducted in four of the targeted ten countries. Namely, Botswana, Malawi, Zambia and Zimbabwe. This is so because the four countries are set to be the ones most likely to be targeted in terms of the initial advocacy interventions to be conducted under this initiative to promote increased transparency and accountability on access to medicines issues across Southern Africa.



The State of Transparency and Accountability on A2M – 2016 

As part of the preliminary process in terms of rolling out the new project, during November 2015 a special survey was designed to collate information needed in the development of a special report focusing on the ‘State of Transparency and Accountability in Access to Medicines in Southern Africa’.

The survey constituted a series of inter-related questions that sought to clarify the situation with regards to access to medicines related issues from an accountability perspective.  Among highlighting some of the key aspects on transparency and accountability with regards to access to medicines in Southern Africa, the survey also sought to establish the status of missed targets by SADC governments

Further, the survey sought to shed more light on the current capacity of civil society to play its role as a trusted and reliable watchdog for society in terms of access to medicines in the SADC region. The responses from the survey developed the basis for this report focusing on the ‘State of Transparency and Accountability in Access to Medicines in Southern Africa’. 


Destabilizing Heteronormativity in Institutions of Higher Learning


On the 11 August 2016 the University of Venda (UNIVEN), in collaboration with the University of the WItwatesrand (Wits) and the University of South Africa ( UNISA), successfully hosted its 1st Annual LGBTI+Q symposium under the theme “DESTABILIZING HETERONORMATIVITY IN INSTITUTIONS OF HIGHER LEARNING”. The symposium, whose objective was to reflect on university policies and practices and to share strategies for navigating heteronormative University spaces, brought together staff members and students. The symposium was opened by the Deputy Vice Chancellor academic, Professor Crafford; a sign that the university managemnet lives by its promise to make UNIVEN a discrimination-free university.


In his opening, the DVC said, “…when it comes to sexual orientation and differently gendered individuals we find oppression and othering …We must be very clear colleagues that we as a people are only as free as any lesbian, gay, bisexual, transgender, intersex or queer person amongst is allowed to be free”.  The symposium kicked off with a video presentation by Prof Mzikazi Nduna on Walter Sisulu University’s lesbian students’ experiences of violence at the Mthatha campus.

Prof Mzikazi Nduna

Prof Mzikazi Nduna from Wits University, Psychology department is the leader of the regional project. The project is aimed at increasing regional scholarship on sexual orientation and gender identity in Southern Africa.  The documentary highlights violence used to punish young female students for being lesbian at Walter Sisulu University. This was followed by presentations from UNIVEN, Wits University and UNISA.

Ziggy Nkosi

Ziggy Nkosi (Wits) presented on “Invisible Students”.  He asserts that “Globally, transgender people are invisible and are at times complacent to this invisibility to protect themselves. But this does not address the social injustices they experience”. Just like Ziggy, some young people transition during their time at university; and young transgender students experience lectures and peers who are ignorant and sometimes outright prejudice towards trans* students.

Prof Azwihangwisi

Prof Azwihangwisi Helen Mavhandu-Mudzusi’s (from UNISA) highlighted that “LGBTI +Q identifying students experience violation of the Human Rights of LGBTI, particularly in terms of those which relate to safety, association, education, expression, privacy, and visibility”. She reported that “these rights are repeatedly and frequently violated by heterosexual students and university employees, including academic staff. These have negative impact on academic, social, mental and Physical health of LGBTI + Q students”. UNIVEN has not been spared this. Published research by Prof Mavhandu-Mudzusi reports on these experiences.

Malethabo Sedibe

Malethabo Sedibe, a UNIVEN fourth year student in Environmental sciences and an LGBTI activist, presented on “Gender Neutral Spaces in higher education institutions”.  She believes that “Planning for gender inclusive spaces will help to build a unified society which interacts together without boundaries. Higher education institutions should prepare global citizens who will live in an interconnected world” This is possible, as demonstrated by other South African universities.

Dr Peace Kiguwa

Dr Peace Kiguwa  in her presentation on media response to Wits policy on ‘gender neutral bathrooms spoke about "the Recent focus on re-engaging safe zones on campus for different minority groups such as gender non-conforming and trans community."

 Ms Faith Musvipwa

Ms Faith Musvipwa, a UNIVEN sociology MA student and Dr. Rendani Tshifhumulo presented on “Voicing the challenges of LGBTI within the Vhembe district, Limpopo province, South Africa”. She reported that “Traditional beliefs combined with homophobic stereotypes have resulted in traumatic experiences for lesbian and gay youth in South Africa. Young lesbians have been raped by older males ‘teaching’ them to be real women or ‘curing’ them of lesbianism. Young gay men are beaten by other males in order to make them ‘real men’. Further, ignorance, stereotypes, and lack of medical resources in impoverished communities compound the problems of HIV education and AIDS.

Robert Mohale

Robert Mohale a UNIVEN MA in Gender studies student presented on an exploration of the challenges faced by young people who are in homosexual relationships at Mkhuhlu location, Mpumalanga Province, in South Africa. He decries that “homosexuals are more likely to experience intolerance, discrimination and the threat of violence due to their sexual orientation in all societal institutions, including Schools, universities, churches, police station”.

Tumelo Mashiane

Tumelo Mashiane a UNIVEN MA in Gender Studies student presented on challenges that the effeminate closeted gays are faced with within their families. He asserts that “heteropatriarchy which presents itself as compulsory compels closeted effeminate gays to conform to heteronormativity and are silenced and unacknowledged by the hetero-patriarchal system which perpetuate and forces them to live a double life and putting on a façade”

Cindy Maotoana

Cindy Maotoana, a founder and director of Limpopo PROUDLY OUT emphasized that “We do not hope for change…we implement change…we are change!” Her presentation was a highlight, demonstrating the valuable collaboration of universities and civil society in rights realization. Cindy reminded the audience that this campus has come a long way with acknowledgement of LGBTI rights. In an emotional speech, she reminded the audience that a gathering such as this, free of censorship could not have happened in this campus ten years ago. Now with this project, UNIVEN was able to host this symposium with blessings from the University management.


The saying ‘nothing for us without us’ was lived at UNIVEN in this momentous day as the symposium was closed with LGBTI+Q Student activists’ panel; presenters and audience discussions were facilitated by the student representation council (SRC) Minister of Gender, Blessing Mavhuru.

SRC Minister of Gender, Blessing Mavhuru

SRC Minister of Gender, Blessing Mavhuru addresses the audience. The main issues raised by the symposium were the invisibility of the LGBTI+Qs, non-conducive environment, LGBTI+Q unfriendly support services, policy exclusion of and lack of institutional support for LGBTI+Q staff and students.

The message for the day was that human rights are homosexual rights too. In this light, infrastructural challenges such as bathrooms and student residences were felt to be non-conducive for the LGBTIQ+ student community and one of the challenges that UNIVEN has when it comes to the safeguarding of LGBTIQ+ student’s rights. The students on this campus, like many others expressed mistrust and living in ‘FEAR’. They also mentioned experiences of discrimination, stigma and rejection within HEIs, communities and employment, which are common experiences for LGBTIQ+ individuals. Hate or homophobic crimes against the LGBTI+Q community was given as real life example of their lived vulnerability in society, while closer to home, they narrated stories of intimidation, harrassment, exploitation, inappropriate jokes and banter, insult and ridicule from lecturers, admin staff, campus health. What was also believed be both impediments and important aspects of their social lives, culture and religion, was analysed as a significant characteristic of their context and an error for intervention.




The symposium came up with the following recommendations:

  • There is a need for policy change. These should be proactive policies and procedures that address LGBTIQ+ related challenges. Such policies should foster the creation of a conducive and inclusive campus environment. ‘Gender identity’ should added to non-discrimination policies

  • There is also a necessity for the training of staff and student affairs administrators on gender and LGBTI+Q to create strong advocacy units for LGBTI students who are likely to experience obstacles in pursuit of their education.

  • LGBTI+Q-specific services and programs should be introduced. Support groups for trans and gender questioning students should be made available or incorporated into existing LGBTI support structures

  • The transforming and monitoring of on-and-off- campus university residences should be prioritized and advocacy and interventions for gender neutral or unisex restrooms must take place

  • Orientation on LGBTI could be conducted at the beginning of every academic year and benchmarking of best practices from other institutions should be done and followed.


This work will be taken forward and a national symposium will be held at the University of Kwa-Zulu Natal on the 5th of October 2016. More information about this project can be obtained from Ziggy Nkosi at


Authors: Dr Lucille Nonzwakazi Maqubela, Senior lecturer Institute for Gender studies, Dr Pfarelo Matshidze, Senior Lecturer, African Studies, Prof Vhonani Netshandama, Director of community Engagement, University of Venda.


Read more about AAI’s Destabilising Heteronormativity Project here:

Destabilising Heteronormativity Project

How to know if your Valentine is a Virgin. Valentines Day 2016

AAI Happy Valentines 2016 How to know if your Valentine is a Virgin.

Ebola crisis: Vaccine ‘too late’ for outbreak

How bad can it get 9UK pharmaceuticals firm GlaxoSmithKline says its Ebola vaccine will "come too late" for the current epidemic.


GSK is one of several companies trying to fast-track a vaccine to prevent the spread of Ebola in West Africa.


But Dr Ripley Ballou, head of GSK's Ebola vaccine research, said full data on its safety and efficacy would not be ready until late 2015.


The World Health Organization (WHO) says more than 9,000 people have been infected and more than 4,500 have died.


Health workers are struggling to contain the spread of the virus, which is mostly affecting people in Liberia, Guinea and Sierra Leone.


The WHO has warned there could soon be 10,000 new cases a week.


Leading experts who have previously tackled Ebola believe the only way to contain the outbreak is with a vaccine.


Several trials

Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine, first discovered Ebola in 1976. He is worried that the outbreak could last well into next year.


"Then only a vaccine can stop it, but we still have to prove that this vaccine protects, we don't know that for sure," he said


There are several vaccine trials under way. The Public Health Agency in Canada has started human testing, and a Russian project is planning to do the same.


At GSK's vaccine research laboratories outside Brussels, they are trying to compress trials that would normally take up to 10 years into just 12 months.


They have already given the vaccine to volunteers taking part in the trial in Africa, the US – where they are working alongside the National Institute of Health – and the UK.


'Small sacrifice'

Volunteer Nick Owen was injected two weeks ago at the centre for Vaccinology and Tropical Medicine in Oxford and will have regular check-ups for the next six months.


He said he had not hesitated to take part.


"It's a horrific disease, it's unimaginable what people are going through and it seemed like a really small sacrifice to make," he said.


In the next phase of the trial, the company hopes it will have 20,000 doses ready to be tested by health workers early next year.


When the outbreak was first declared in March, GSK had discussions with the World Health Organization about accelerating the development of the Ebola vaccine, Dr Ballou said. But they had decided, together, not to.


"No-one anticipated we would need a vaccine," said Dr Ballou. "And so both internally and, I think at the WHO, we felt the best approach was to watch very closely".


Seven months on, with the virus out of control, he now concedes: "I think in retrospect we should have pulled that trigger earlier.


"But, you know, it is what it is and we are working very closely with WHO.


"There shouldn't be any finger pointing around this."


Dr Ballou said it would now take some time to assess all of the data to establish the correct dosage and for how long the vaccine was effective. He said that could not be done in time for this latest epidemic.


"At the same time we have to be able to manufacture the vaccine at doses that would be consistent with general use, and that's going to take well into 2016 to be able to do that," he added.


"I don't think this can be seen as the primary answer to this particular outbreak," he said, but the trials under way could help in the future.


"If it does work then to be able to be prepared so that we don't have to go through this again in five years, or whenever the next epidemic is going to break out."


Even if GSK's vaccine does not work, other Ebola vaccines being developed by researchers in Canada and Japan could provide hope for future outbreaks.


By Simon Cox

17 October 2014


We Can’t Have a Post-2015 Agenda Without SRHR

In 2000, the creators of the Millennium Development Goals (MDGs) completely overlooked sexual and reproductive health and rights (SRHR), a mistake that, if repeated, would cripple the dreams of millions of young girls and women for years and generations to come.


Access to SRHR enables individuals to choose whether, when, and with whom to engage in sexual activity; to choose whether and when to have children; and to access the information and means to do so. To some, these rights may be considered an everyday reality. However, that is not the case for millions of young people in the world – particularly girls and women.


On Tuesday night, I had the fantastic opportunity to listen to some of the foremost global leaders speak on behalf of ensuring access to sexual and reproductive health and rights in the post-2015 agenda. The benefits of ensuring SRHR are society wide and inevitably translate into improved education, economic growth, health, gender equality, and even environment.




“At my high school, you would be expelled if found with a condom.” – Samuel Kissi, former President, Curious Minds Ghana


When girls are healthy and their rights are fulfilled, they have the opportunity to attend school, learn life skills, and grow into empowered young women. Wherever girls’ SRHR are ignored, major educational barriers follow. Child marriage and early pregnancy are major contributors to school dropout rates. In South Asia and Sub-Saharan Africa, girls are married before age 18 at an alarming 50 percent and 40 percent respectively. And in Sub-Saharan Africa, where 90 percent of adolescent pregnancies occur in marriage, it is safe to assume that not all those sexual acts were consensual and not all those pregnancies were planned.


Economic Benefits


“Initially I used to oppose family planning, but now I fully support. I support it because my wife has more time to work and earn money.” – The Honorable Dr. Tedros Adhanom Ghebreyesus, Minster of Foreign Affairs for the Federal Democratic Republic of Ethiopia, sharing the story of an Ethiopian man’s changed opinion regarding the importance of SRHR


Protecting SRHR not only saves lives and empowers people, but it also leads to significant economic gains for individuals and for the community as a whole. As previously stated, ensuring SRHR helps to decrease school dropout rates and, as a result, leads to a more productive and healthy workforce as each additional year of schooling for girls increases their employment opportunities and future earnings by nearly 10 percent.


Broader Health Agenda


“We cannot eliminate new HIV infections without providing SRHR services to women so they can make informed decisions to protect themselves and their children in the future. Yes, we will end the AIDS epidemic, but first we need to respect the dignity and the equality of women and young girls.” – Dr. Luiz Loures, Deputy Executive Director, UNAIDS


Access to SRHR guarantees quality family planning services, counseling and health information. These services are critical, particularly because women are often victims of gender-based violence and sexual assault and thereby face greater risks for sexually transmitted diseases like HIV/AIDS. Failing to secure and uphold SRHR dooms women and girls with an increased risk of unsafe, non-consensual sex and maternal mortality.


Gender Equality


“How can you control your life if you cannot control your fertility?” – Helen Clark, UNDP Administrator


When a woman can easily plan her family, she is more equipped to participate in the economy alongside her male colleagues. When the sexual rights of a woman or girl are fulfilled, she will experience decreased rates of sexual violence and enjoy a healthy relationship with a respectful partner. When a woman or girl does not fall victim to child marriage and early pregnancy, she can stay in school and achieve anything she puts her mind to.




“The woman continues to bring life, to bring up the next generation, to stand before you and say, ‘I am ready to embrace my rights and to deliver a better planet to humanity.’” – Joy Phumaphi, former Minister of Health, Botswana; Chair, Global Leaders Council for Reproductive Health


A 2012 study found that community water and sanitation projects designed and run by women are more sustainable and effective than those that are not. Similarly, women produce 60 to 80 percent of food in developing countries and, with the economic and educational gains that coincide with secured SRHR, a woman is better equipped to effectively manage her land.


The post-2015 Sustainable Development Goals will not happen without SRHR being addressed. So far, the world has failed to recognize that SRHR are equally as fundamental to global development as finance and trade. We can no longer afford to view SRHR as a taboo or promiscuous topic. When 90% of first births in low-income countries are to girls under 18; when the leading cause of death among adolescent girls aged 15 to 19 is pregnancy and childbirth; when two-thirds of new HIV infections in sub-Saharan Africa are among adolescent girls; and when 200 million women want to use family planning methods but lack access, the young girls and women of the world do not have a promiscuity problem – they have a human rights problem.


By Elisabeth Epstein

25 September 2014


Experts demand strong, public, SA government support for proposed ECHO trial

The South African HIV Prevention Research Advocacy Expert Group  & partners are writing to request strong, public, SA government support for the proposed ECHO trial which we understand to be in jeopardy of cancellation.

26th September 2014: World Contraception Day


Minister Aaron Motsoaledi, Minister of Health, South Africa
Prof. Glenda Gray, President – Medical Research Council of South Africa
Dr. F. Abdullah, Chief Executive Officer, South African National AIDS Council

The South African HIV Prevention Research Advocacy Expert Group  & partners are writing to request strong, public, SA government support for the proposed ECHO trial which we understand to be in jeopardy of cancellation—a development that would be a blow to SA AIDS and reproductive health programming on the status of the Evidence for Contraceptive Options & HIV Outcome (ECHO) Trial. We strongly believe that the ECHO trial could be one of the most important reproductive health and HIV trials of this decade and further strengthen South Africa’s position on the global stage as a leader in generating scientific evidence that has meaningful impact on improving the lives and wellbeing of all its citizens, especially women via informed, innovative programming.

The ECHO Trial has the potential to provide high quality, evidence based answers to questions about whether three specific contraceptive options (Depo Provera, the Jadelle implant and the copper intrauterine device) might increase women’s risk of HIV acquisition. These questions are of utmost relevance to South Africa. Excluding condoms, injectable contraceptives make up nearly 75% of the contraceptive methods dispensed in South Africa. Within this, the majority of women are receiving Depo. Modeling studies designed to gauge the impact on HIV infections in a scenario where Depo does increase risk, show that the highest burden of new infections attributable to this method is in South Africa. 

The RSA’s new contraceptive policy stresses an increase in the range of options offered to women, and a shift away from Depo based on the current uncertainty regarding its impact on HIV risk. These are key steps and we believe they should proceed with urgency. However, there are no data on the other hormonal methods, such as the implant, that are being introduced today. ECHO will provide an answer for multiple methods—not just Depo—laying the basis for sound public health policy and clear communication. 

We seek to engage with you on ways in which we may see the full funding of the trial to ensure that it takes place. At present, there is a funding shortfall. Unless additional funds are committed, the trial may not take place We welcome South Africa’s current financial commitment to the trial and ask that you consider increasing this amount as well as making a strong, public statement that this research is a priority for our country and the region.

We the undersigned therefore stand in solidarity with the women of South Africa, one of the Sub Saharan countries with the widest use of depot medroxyprogesterone acetate (DMPA) in encouraging our Department of Health, the Medical Research Council, and the South African National AIDS Council to ensure that the ECHO trial is fully funded – as a national imperative, especially as a country whose response to and recent leadership in the national response to HIV is world renowned. 

As we move forward to urgently explore ways to mobilise South African’s en masse to express their support for this trial to be fully funded, and trial recommendations urgently acted upon, we wish to categorically state that our expectation is that our Government in partnership with the Medical Research Council fill the funding gap that is needed to get the ECHO trial underway, not only as a public health imperative, but as an urgent human rights issue.

Media Contact:  Tian Johnson , +27 73 4324069 , 

The SA HIV Prevention Research Advocacy Expert Group has been established to provide senior level advocates and programme leaders a platform to: enhance their individual capacity relating to all aspects of HIV Prevention Research, build the capacity of key individuals in their organization and circles of influence including policy makers, donors and strategic partners on issues of HIV Prevention Research, accelerate the pace and level of public discourse around HIV Prevention Research Advocacy as it pertains to existing as well as potential technologies in their conceptualization, development, trial, piloting, procurement, distribution & marketing stages, serve as a point of entry and access to the HIV Prevention Research Science communities for advocates. 

The SA HIV Prevention Research Advocacy Expert Group is:

Dr. Ntlotleng Mabena – Centre for HIV & AIDS Prevention Studies

Ntando Yola – Desmond Tutu HIV Foundation

Sisonke Msimang – Graca Machel Trust

Phillipa Tucker – AIDS Accountability International

Dr. Johanna Kehler – AIDS Legal Network

Tian Johnson – Sonke Gender Justice

Ebola outbreak in DRC: same virus, but different


New cases of Ebola in the Democratic Republic of the Congo are raising fears that the virus will spread further across Africa. Yet the variety found in Central Africa might be of a different kind.


The Ebola River is a small stream running through the forests of the Equateur province in the northwest of the Democratic Republic of the Congo. It is in this region that the deadly disease was first recognized by Belgian scientists, who named the worm-looking virus after the river in 1976. Now, the virus has once again returned to the Equateur province with two confirmed cases of people who died from Ebola.


"In this region especially, the Ebola virus is circulating and has caused some smaller and larger outbreaks in the past", says Dr. Schmidt-Chanasit, head of the viral diagnostic unit at Hamburg's Bernhard-Nocht-Institute. "So this outbreak, most probably, is not associated with the outbreak in West Africa."


Less deadly


Almost 1,500 people have died so far in Liberia, Sierra Leone, Guinea and Nigeria in what has become the deadliest outbreak of Ebola in history. Yet the virus that has now caused an outbreak in the Democratic Republic of the Congo differs substantially from the one in Western Africa.


"Case fatality rate is much lower when we compare this to West Africa – it's around 20 percent," says Schmidt-Chansit. "So it might be possible that this is a different strain of the Ebola virus that is less pathogenic."


Some Ebola strains are even harmless for humans and will only cause disease in monkeys. The so-called Reston virus is such a mutation of Ebola. It has been found in China and the Philippines. The current strain that is wreaking havoc across West Africa, on the other hand, has a case fatality rate of up to 90 percent.


Confidence in Kinshasa


It might take another one or two days until laboratories have identified the exact strain of the virus that caused the two deaths in the Equateur province in northern Congo. The newest outbreak of Ebola would be the seventh recorded so far for the Democratic Republic of the Congo.


It is the country's history of Ebola outbreaks that makes Felix Kabange Numbi, health minister of the Democratic Republic of the Congo, confident.


"The experience we have gathered during the last six Ebola outbreaks will be helping us contain this disease now," he said in a televised speech on Sunday.


Numbi announced a multitude of measures to counter the outbreak, listing protective equipment for all medical personnel as a top priority. Moreover, he said his government would make sure "all burials are securely done for those confirmed cases, but also those unexplained deaths in the communities."


Experts needed at home


A country plagued by ongoing armed conflicts and a continual fight over natural resources, the Democratic Republic of Congo might be a place where one would suspect the disease to spread quickly – ever more so since it is a country the size of Western Europe with little developed infrastructure, be it roads of hospitals.


Yet this might not be fueling the disease, says Schmidt-Chanasit. Authorities have already imposed quarantine around the affected area in Jera in the Équateur province. "They are very well prepared. They know how to isolate the patients."


He adds that the outbreak occurred in a remote region, "So there is no chance that this outbreak will come into a capital like Kinshasa, because it is hundreds of kilometers away."


Just last week, Health Minister Numbi announced plans to send experts from Kinshasa to West Africa in order to help quell the Ebola epidemic there.


Now, it looks as if the Democratic Republic of the Congo will first have to deal with its own outbreak of the disease.


By Peter Hille


The silent crisis: Mental health in Africa

Steadily approaching the title of the second highest cause of disability in the world, mental health disorders are an international health concern that is gaining considerable attention.(2) Of the global burden of disease, 14% is attributed to neuropsychiatric disorders, indicating a 2% growth since the year 2000.(3) It is believed that the figure will have increased by another percent by 2020.(4) According to the Mental Health and Poverty Project, one in five individuals will suffer from a diagnosable mental disorder in their lifetime.(5) Among the adults who suffer from these disorders, 75% are found to have developed them in their youth.(6) In fact, sufferers of persistent mental disorders in adulthood tend to be those whose condition first arose between the ages of 12 and 24.(7)


The 2011 World Health Organisation (WHO) Mental Health Atlas reveals that 110 of its 184 member states have an identifiable mental health policy.(8) Of the 45 African member states surveyed, 19 reported to have mental health policies in place.(9) This paper discusses current deficits in mental health services in Africa, as well as the challenges faced by mental health patients and practising mental health professionals on the continent. The paper also illuminates strides made by groups in various parts of the continent in improving service provision to affected populations.


Services available


To describe the current accessibility of mental health services in the majority of African countries as deficient would be an understatement. The psychiatrist-to-patient ratio in Africa is less than 1 to 100,000,(10) and it is reported that 70% of African countries allocate less than 1% of the total health budget to mental health.(11) Liberia is a case in point. A 2008 report compiled by the WHO states that there are only 0.06 mental health professionals per 100,000 people in Liberia,(12) where, the S. Grant Mental Health Hospital is the sole inpatient facility for those suffering from mental disorders. A study conducted by the American Medical Association found that 44% of Liberian adults exhibit symptoms indicative of post-traumatic stress disorder (PTSD).(13) The likelihood that these individuals are receiving treatment is very low, when taking into account the scarcity of mental health facilities in that country. The Liberia National Mental Health Policy found that of those living in low income areas that need mental health services, only 15% actually receive treatment.(14)


Similarly, in Ghana only 1.17% of those who are suffering from mental health problems have received the required treatment.(15) There are only three major psychiatric hospitals in that country, all of them located in the southern region. Furthermore, there is only one psychiatrist allocated to 1.5 million people. With such limited accessibility, many mental health sufferers seek treatment from traditional and faith healers.(16)


Compared with the West African countries mentioned, the situation in East Africa is similarly dire. There is an evident shortage of mental health professionals in public practice. In 2001, Tanzania recorded 10 active psychiatrists catering to a population of 30 million. Of the 10, four work at Muhimbili, a teaching hospital, where patients with serious mental health disorders are referred.(17) Kenya is regarded as comparatively better prepared to cater for those suffering from mental health disorders, with 47 practising psychiatrists in the private and public sectors. Twenty-two physicians exclusively provide services in Nairobi, while the remaining 22 practise in other parts of the country.(18) Mathari Hospital, located in Nairobi, is the national referral and teaching hospital for mental health patients. Its 750-bed facility is divided into two wings, a civil wing for stable patients and a maximum security unit for those suffering from severe mental problems.(19) Middle and upper class citizens have the option of seeking services from psychiatrists in private practice.


Risk factors in the African context


Mental health issues among African populations are instigated by an assortment of factors. The financial standing of populations in many African countries may be predisposing them to mental health problems. Various studies state that individuals of a lower socio-economic status are twice as likely to suffer from common mental health disorders, as compared to the wealthy.(20). Furthermore, populations in East African countries such as Somalia, Ethiopia, Sudan, Rwanda and the Democratic Republic of Congo (DRC) have encountered armed conflicts and natural disasters in varying degrees. This has resulted into the displacement of more than 1.5 million individuals from the East African region.(21) A consequence of these hardships may be the emergence of mental disorders. The WHO estimates that 50% of refugees have mental health problems ranging from post-traumatic stress disorder to chronic mental illness.(22) The rise in the numbers of individuals who present with mental health problems places an even greater burden on an already under-resourced healthcare service in Africa.(23)


Mental health stigma


In many African countries, communities are often not empathetic towards mental health patients. The mentally ill face discrimination, social ostracism and the violation of basic human rights, all due to an on-going stigma associated with mental health problems. Ironically, some of these violations occur in institutions where people with ill mental health seek treatment. Mental health facilities have been found with unhygienic and inhumane living conditions, such as the use of caged beds with netting or metal bars to restrain patients.(24) There are documented cases of individuals having been tied to trees and logs far from their communities for elongated periods of time without adequate food or shelter.(25) A study performed in Uganda revealed that the term ‘depression’ is not culturally acceptable amongst the population, suggesting that mental health issues are not acknowledged or considered a legitimate affliction.(26) In another study conducted in Nigeria, participants generally responded with fear, avoidance and anger to those who were observed to have a mental illness. The stigma linked to mental illness in that country can be attributed to a variety of factors, including lack of education, fear, religious reasoning and general prejudice.(27) When surveyed on their thoughts on the causes of mental illness, over a third of Nigerian respondents (34.3%) cited drug misuse, including alcohol, marijuana and street drugs as the main cause. Divine wrath and the will of God were seen as the second most prevalent reason (18.8%), followed by witchcraft/spiritual possession (11.7%). Very few cited genetics, family relationships or socioeconomic status as possible triggers.(28)


Challenges faced in improving services


There are many barriers faced by African mental health workers in their efforts to improve and increase the availability of services in their regions. As mentioned earlier, the lack of funds allocated by most African governments to the mental health field poses a problem in expanding services so as to adequately meet demand. Furthermore, difficulties such as finding adequate transportation and medication are general obstacles for health workers attempting to reach rural dwellers.(29)


Limited research in mental healthcare has also been cited as a major concern. A study spear-headed by the United States National Institute of Mental Health and the Global Alliance for Chronic Disease found that one of the biggest barriers in mental healthcare is the lack of global collaboration in the conduction of research.(30) Research is essential for determining general needs when treating mental health disorders, as well as for creating and monitoring cost-effective interventions.(31) A WHO mapping project on research capacity for mental health in low and middle income countries indicates that epidemiological studies focusing on burden and risk factors, health systems research, as well as social science, were regarded as most desirable by researchers and other mental health stakeholders.(32)


Emerging efforts


Despite the many shortcomings in their field, mental health professionals are resilient in their efforts to serve and challenge the status quo. For example, the Ministry of Health and Social Welfare in Liberia is working towards increasing access to mental health services throughout the country. The Ministry has partnered with organisations such as the Carter Center and Doctors of the World, with the intention being to establish wellness centres in each of Liberia’s 15 counties.(33) The Carter Center is also currently training 150 mental health clinicians in Liberia. Staffed with trained mental health workers, these organisations will offer treatment to mentally ill individuals in the affected communities. In the event of a case requiring knowledge beyond the expertise of clinicians at the centre, referrals will be made to specialists located in Monrovia.(34) Dr Meiko Dolo, the Director of the Mental Health Department in Liberia, is confident that these plans will come to fruition. A recently released draft of Liberia’s national budget for 2013 depicts, for the first time ever, provisions made for mental health.(35)


Following its 11-year civil war, Sierra Leone, established a child-solider rehabilitation project, providing counselling and other support to children living with war trauma.(36) In the DRC, women facing gender-based violence can now go to ‘listening houses’ where they can talk through their trauma in a secure setting.(37) In addition, the University of Cape Town in South Africa completed a project on mental health and policy, whose goal was to expand mental health research in Africa, evaluate existing mental health policies in Uganda, South Africa, Zambia and Ghana, as well as develop new ones.(38)




Though not as notorious as HIV/AIDS, tuberculosis and malaria, mental health is a global issue that is in need of more attention than it is currently being given. In 2003, 450 million people worldwide were estimated by the WHO to have some type of mental health issue.(39) Eleven years later, it is likely that this number has increased. The WHO also reports that expenditure on mental health is less than US$ 0.25 annually per person in low income countries.(40) Currently, Africa has the lowest rate of mental health outpatient facilities, at 0.06 per 100,000 people.(41) Given the steady rise in the number of mental health sufferers, African countries need to optimise the delivery of mental health care services and take steps towards making this crisis silent no longer.

By Modupeola Dovi