ANSA International Program Blog

One day I stood in a foster home in the Western Cape township of Phillipi looking at a beautiful 12-year old boy who had been dropped off the day before with his little sister.  The boy had been beaten by his father; the childrens' mother had died years ago.  They joined nine other foster children being cared for by Tuka, a lovely elderly woman who has been caring for orphans and vulnerable children for years in her cramped two-bedroom house.

It is no wonder that most HIV and social programs focus heavily on addressing the needs of women and children in the townships.  According to the United States Agency for International Development, there are over 12 million AIDS orphans living in sub-Saharan Africa, a number expected to rise to 20 million by 2010.  Ninety percent of all children living with HIV in the world live in sub-Saharan Africa.  These orphaned, sick, abandoned or otherwise vulnerable children overflow in foster homes and creches (daycare centers) in every township.  Some less fortunate children remain in their homes without adult care; the average child-headed household has three or more children cared for by someone under the age of 17.

Girls between the ages of 8 and 15 are the most frequent targets for rape.  Teen pregnancy rates are over 30% in some schools.  (Representatives from both the Ministry of Health and Hope Worldwide quoted the statistic that one in three girls/women in the townships report their first sexual experience was not voluntary.)  Sugar daddies, who are a real temptation for young girls desiring money and affection, contribute equally to teen pregnancies and the spread of disease.  The large number of men who don't stay put in one household are speading HIV and other STIs to multiple girls and women - as well as TB, the number one killer of people living with HIV in South Africa.  In the end, grannies, or elderly 'mamas" frequently end up caring for or burying their grown children and raising their grandchildren and other neighborhood children, just like Tuka.

Because men are popularly viewed as the perpetrators of HIV and other diseases, they face significant difficulties in accessing services that could reverse the loss of self respect that fuels the risky behavior.  Support services are not generally designed for men, so psychosocial programs, nutrition, healthcare and economic empowerment are rarely available for them.  Meanwhile, the women and children in their communities are receiving compassionate care through support groups, PMTCT clinics, feeding and life skills programs, income generating projects, and myriad other social services intended to encourage well-being and hope for the future.  Given that township unemployment rates are 40 - 80% and access to the few good jobs in the bigger cities is fraught with a wide range of significant obstacles (transportation, skills, days or weeks away from home, etc.), men have a lot of free time together to consider their ever-decreasing sense of self worth.  It's no surprise to see so many finding escape through alcohol, drugs, sexual promiscuity and violence.

Hope Worldwide, Catholic Welfare and Development, and Treatment Action Campaign all have programs operating in the Western Cape that target services to men, mostly to encourage them to be part of the solution, not the problem.  Most of the CBOs I spoke with agreed enthusiastically that increasing services to men is necessary, and all were interested in helping to link the men in their catchment area to existing programs or revising/expanding their own programs to address their need for support. 

WC NACOSA (Western Cape Networking AIDS Community of South Africa) is an association that promotes dialogue, empowerment, and coordination of AIDS services with over 400 entities across the Western Cape region.  Through quarterly meetings and biennial summits they provide a forum in which government ministries and CBOs can come together and share information and resources, assess gaps in services, and collectively look at the ways to fill those gaps.  While expanding services to men is recognized as a gap, comprehensive nutrition education and care is at the top of list for resource needs among their members. 

After discussions with folks from Ikamva Labantu and WC NACOSA, numerous other CBOs, the Ministries of Health (provincial and city), five clinics and three dieticians working in policy and service delivery, the bottom line on community-based nutrition services in the Western Cape area is this: There are many ad hoc feeding programs that are components of broader-focused programs, but there aren't coordinated nutrition (vs basic feeding) programs that offer CBOs and people of all ages ready access to illness- and medication-appropriate food and menu planning, and in-depth education on food content, safety, cooking, economics, food-drug interactions, symptom management, or skills training in the nutrition or culinary fields.    

While the challenges are daunting, a powerful resilience is very much alive in these communities.  ANSA can play an important role in supporting, strengthening and linking together existing agencies and individuals to integrate comprehensive, sustainable nutrition support programs into the continuum of care for peole living with and affected by HIV in South Africa.  People are eager to work in partnership to turn their sense of hope into a reality of good health and prosperity.  The possibilities are endless!

Next time, I'll talk about who is a part of that partnership work as we take the first U.S. team representatives to South Africa and Namibia!

Peace to all...Mary