Your Excellency, Madam Lucy Kibaki;
Your Excellencies, First Ladies and Members of OAFLA;
Hon. Minister, Charity Ngilu, and other Ministers;
Prof. Were, Chair of the National AIDS Control Council of Kenya;
Ladies and Gentlemen.
It gives me great pleasure to Chair this morning session on best practices, care, treatment and support at this Satellite Conference of OAFLA.
- UN-HABITAT is the Human Settlement Programme of the United Nations. Our mandate is to promote the implementation of the Habitat Agenda, which has two main goals: (1) adequate shelter for all, and (2) sustainable human settlements development in an urbanizing and globalizing world.
- Although considerable progress has been made, the HABITAT Agenda remains a challenge: 1.2 billion people are without adequate shelter; living in overcrowded conditions in slums, without access to safe drinking water, sanitation, recreation, and safety.
- This situation has been aggravated by the HIV/AIDS pandemic, which as you may be aware, has already claimed over 25 million lives and which continues to spread at an alarming rate. As is well known, the epicenter of the epidemic is Sub-Saharan Africa, which has over 75% of the victims, both deaths and infections, and over 13 million orphans.
The theme of this conference is treatment and care. Our analysis at UN-HABITAT shows that the starting point in achieving this objective is secure shelter. Why? Because without a secure home, and a caring family and community, it is difficult, if not impossible, to provide health care and effective counselling to both the infected and affected. UN-HABITAT has therefore joined the concerted efforts of the UN-family to assist countries all over the world particularly in Africa in their struggle against the scourge from a shelter dimension.
Before elaborating on this, let me start by associating myself with the statement of The Special Envoy of the UN Secretary-General for HIV/AIDS in Africa, Mr. Stephen Lewis, who made a compassionate plea to all of us to act, at the opening ceremony. Coming from a UN-agency based in Africa and being an African woman myself, let me add some local insights which may assist this meeting in your laudable efforts and struggle in the search of more effective approaches to fight AIDS and to provide treatment and care.
First, treatment and care presuppose access of the populations to HIV screening facilities. Our research at UN-HABITAT has shown that voluntary counselling and testing centres remain a city phenomena. Slum areas, small towns and rural health centres, remain mostly unserved. For example, last month, in my own home country of Tanzania, in my home district of Bukoba, which lies in the epicentre of the pandemic, that is, West of Lake Victoria, I visited a Rural Health Centre, which handles around 4-5 deliveries a day without HIV screening facilities. The Medical Officer told me that they have never had them, neither are they giving expectant mothers the drugs to prevent mother to child transmission. So my request to our esteemed First Ladies and all of us present here is to work towards ensuring that HIV screening facilities reach every Rural Health Centre and every slum. I can assure you that, on my part, I have already informed my colleagues, the heads of UN-agencies of this aspect of the “GRIM REALITY” if I may quote from our young presenter, Grace Gathoni, at the opening ceremony yesterday.
Secondly, we have to put in place a campaign to overcome the social stigma that, even with facilities and drugs and other resources for treatment and care, is itself a hindrance to our mission. I have argued and I will argue again that HIV/AIDS is a disease like any other disease for which a cure is yet to be found, for example, cancer. The victims of this deadly disease do not deserve to be condemned as irresponsible people who got themselves into this situation. It is true that the virus is most prevalently sexually transmitted, and that we all have a duty to observe social propriety in this matter. We have to encourage fidelity and faithfulness and refrain from irresponsible and meaningless sexual encounters. Young people should be discouraged from engaging in pre-marital sex as far as possible – and condoms have to be available as measure of last resort. However, it is also true that a good number of AIDS victims have contracted the virus through non-sexual means.
Apart from the unfortunate babies infected at birth, poverty and the unhygienic conditions in which the majority of people live are contributing to the spread of the virus in places like slums, substandard and often unregulated health centres and health practitioners, beauty salons, the ubiquitous traffic accidents in overcrowded buses (for example, matatu), etc. If this second “GRIM REALITY” is accepted we shall be able to encourage our medical practitioners to spearhead the fight against the stigma.
Unfortunately, presently they are encouraging it albeit unwittingly. Patients are normally tested as a matter of routine for the possible cause of their health problem, for example, for malaria parasite, cancer, worms, etc. But for HIV the patient is asked to give his or her approval. In itself, this very act puts the patient in an awkward situation. It is awkward because ordinarily it is for the doctor to decide what is to be done for the patient, and if treatment is required, to proceed to prescribe treatment. My submission therefore is, let the doctor do his/her job, as long as he/she follows the ethic of his/her profession, namely counselling and confidentiality – on whatever might be the problem facing the patient.
This conference has seen and heard courageous testimonies from people living with HIV/AIDS. We can only admire their sacrifice in breaking the curtain of silence that continues to fuel this pandemic. But at the same time we have to recognize that not all victims are as courageous, and the majority would prefer to keep their HIV status and general health condition confidential. If we are to succeed to encourage a lot of people to test for HIV and therefore provide them with appropriate treatment and care, thereby avoiding the deterioration of their status to AIDS, we need to guarantee confidentiality. This is a human right. Presently victims of HIV are urged to declare their status and this is discouraging many people particularly the youth from testing. Yet, testing is very crucial because the majority of people are not yet infected. I believe once they establish their status they will be encouraged to avoid infection.
The final “GRIM REALITY” that I want to highlight is that of the challenge to care for the orphans. This issue has been discussed by a number of speakers, so I will focus on how my agency, UN-HABITAT, is trying to help.
According to UNAIDS, Sub-Saharan Africa presently has 13 million orphans, and their number is expected to climb to 40 million by the year 2015, even if we are successful to combat the pace of spread of the virus.
This conference has heard the accounts of grandparents caring for tens of orphans as it has also heard the plight of child headed households – as siblings struggle for survival. We all have seen the growing army of street children in African cities.
Ladies and Gentlemen,
This is a clear testimony that the ability of African traditional mechanisms and safety nets to provide care has been overwhelmed and is no longer sustainable. We have to move from family to community if we are to bolster care capacities.
UN-HABITAT has therefore launched a Community-Based Shelter Initiative for the orphans and other children in distress. With a support of the Rockefeller Foundation we are developing this programme which seeks to establish in every locality a community ombudswoman or ‘Mama Mkubwa’. This is a woman with a secure home and counselling skills and basic supplies such as blankets, food, etc., to house orphans from the village or the neighbourhood as and when the families and/or clan networks caring for them fail to do so. The approach is frontal and seeks to keep the orphans in their traditional communities as far as possible. While hailing those establishing conventional shelters, it has to be pointed out that the sheer size of the orphans limits the possibility to care for orphans in such facilities.
Conventional shelters are likely to be too costly and should therefore be reserved for special cases, for example, for children who for a number of reasons, such as poor health or difficult behaviour, have to be cared for at that level. I would like to appeal to all the First Ladies present here and through you to the other OAFLA members, to kindly accept to become patrons of this UN-HABITAT initiative that will start to operate next year in your respective countries. Pilot schemes are now underway in a number of countries in Sub-Saharan Africa – to establish the kind of support that must come from outside the community for this scheme to succeed and be sustained. Such support ranges from food to clothing to drugs and educational support in an environment of a secure and loving home for each child. It also entails a legal framework to protect the rights of orphans, including restraining greedy relatives from taking over property rightfully belonging to orphans as they drive them onto the streets. The ombudswoman or ‘Mama Mkubwas’ supported by the community elders should be empowered to intervene in defense of the orphans.
In short it is imperative that gender and HIV/AIDS, especially as it affects women, orphans and vulnerable children, become part of the mainstream women's agenda. Countries and regions will soon begin to prepare for the review of the implementation of the Beijing Platform for Action and also to develop plans of action for the next 10 years. Using your positions as First Ladies you could individually influence national and local level activities, and collectively you could influence sub-regional and regional activities to ensure that problems of the rural and urban poor women affected by the AIDS pandemic as well as those of orphans are appropriately addressed.
The holistic approach involving governments, civil society, and donor community is paramount. This also involves engaging with local government councils and municipalities in addressing the pandemic.
I commit UN-HABITAT to join OAFLA in this noble mission.
I thank you for your attention.