As a gender and HIV activist, getting the opportunity to attend the 26th UNAIDS Programme Coordinating Board (PCB) meeting in Geneva, Switzerland, as a female youth observer was very important for me.

Coming from Zimbabwe where HIV infection leans more towards women than men, I am always aware of the need for women and girl’s empowerment against oppressive gender norms if my nation is to ever overcome the epidemic which still stands towering above us at over 14% prevalence.

Prior to the two-day PCB meeting, and as part of the programme, I attended a thematic session on integrating sexual and reproductive health (SRH) and HIV services.

Quite honestly, I had never really thought of the intricacies of linking Sexual Reproductive Health (SRH) and HIV services, although I had always known about the importance of providing HIV testing and treatment services within antenatal care for pregnant women and girls.

At the thematic session, however, I learnt just how far back we are falling on this.

As Gottfried Hirnschall of the World Health Organization (WHO) shared, HIV is currently contributing to 19.2% of global maternal deaths in the 15-44 year age group. And TB is contributing a further 6.4%.

Imagine that.

TB and HIV – both manageable diseases, when early detection and treatment are available – are accounting for a quarter of the deaths of all pregnant women in the world.

And with southern Africa, my region of the world, being the area most affected by HIV, that means that even more women here are dying needlessly. National HIV statistics from all over the region consistently show that HIV prevalence among pregnant women who attend antenatal clinics is usually much higher than overall national figures.

It was therefore heartening to hear about some of the good work being done in the region to begin to address the urgent need for stronger integration of services.

Dudu Simelane of the Family Life Association of Swaziland gave a perspective from her country of the successes and opportunities for integration.

Her organisation is working with various development partners to provide youth-friendly SRH and HIV services that integrate interventions such as screening for STIs and TB, HIV tests, pap smears for cervical cancer, pre-and post abortion care, male circumcision, ART and the promotion of condoms for dual protection (that is, using condoms not only to prevent contracting HIV but also to prevent unwanted pregnancies).

What’s good about such sites is that they provide a broad range of services under one roof.   And ultimately, this cuts down on a woman’s use of usually scarce resources such as money and time. So instead of spending two amounts of bus fare to first get to an HIV testing centre and then to the STI clinic where she’s been referred, a woman only spends one amount to get all the services she needs. This also saves her time for travel, which is also often a very practical barrier to a woman being able to access services.

But perhaps even more importantly, such integration helps to reduce stigma. As a visitor to one of the Swazi sites noted, “It’s not like other clinics where I have to go to the ART wing. I go to the same dispensary as everyone else to get my medicine.”

That sort of set-up does a world of good to fight stigma and discrimination. I have heard ghastly stories in Zimbabwe about how people who visit the opportunistic infections clinics of hospitals are set apart from other people receiving services and labeled imi vanhu veHIV (you people with HIV).  Such treatment has serious influence on whether a person will continue to come to collect their medicine every month and can actually lead them to stop taking drugs completely, thereby building up drug resistances and damaging the immune system.

If you think stigma doesn’t kill, think again.

As Sofia Gruskin of the Harvard School of Public Health reminded us, one of the main obstacles to integration is stigma and discrimination. And sadly, this is usually perpetuated by the very workers in the health sector. Gruskin cited examples of the prejudice of healthcare workers in many parts of the world who refuse to offer contraceptives and STI services to unmarried women (who in the eyes of the workers should not be having sex in the first place). And on the flip side of the coin, there are health workers who will not give a married woman contraceptives in the belief that she should be having as many children as possible.

In its most extreme manifestation, stigma and discrimination has seen healthcare workers sterilisng HIV positive women, after childbirth, to ensure that they do not have the option to have any more children.

Also, what’s been found at the sites in Swaziland is that there has been increased male involvement through the provision of male circumcision (MC) as an entry point. Studies have already shown that MC has high efficacy rates of around 60% when it comes to HIV prevention (if practised with correct and consistent condom use) and providing it in such a setting seems like a good way of ensuring that men don’t shy away from being seen with their partners at sites which they would ordinarily think of as places for women.

Morolake Odetoyinbo of Nigeria’s Positive Action for Treatment Access pointed out how culture and socialisation leads to the detachment of men from SRH issues by always teaching girls about SRH and not doing the same for boys.  In many African cultures, it is acknowledged that a woman’s virginity is the greatest prize that she can ever give a man. And also, it is commonly emphasised that her role within sexual intercourse is solely to please her man. To this effect, women in some Zimbabwean cultures are instructed to pull on their vaginal labia from an early age so that these lips protrude. Apparently, this has an effect on sensation and stimulation for a man during sex.

But nothing is without its challenges. As Simelane pointed out, healthcare providers can become overwhelmed by demand for the integrated services, seeing more patients than usual. Also, there tends to be increased client waiting time due to provision of HIV counselling and testing which is a time-consuming process.

For such service integration to be successful, there is need for a range of competencies, including capacity building as well as the fostering of strong partnerships with national and international organisations that may be able to provide staff on secondment or funds towards integration.

And a word of warning.

Integration doesn’t necessarily mean cost saving. In order to be effective, it requires a lot of investment and patience. It takes time to change perceptions and attitudes. Donors need to be aware of this and should not expect radical results within a short amount of time.

And you can’t put all expectations of success on the donor’s shoulders either.

A comprehensive country response to SRH and HIV integration will require the cooperation of civil society, government and the private sector with overall leadership and coordination by the national AIDS authority. National HIV plans will need to be better linked with national SRH plans. Funding streams will need to stop supporting vertical structures.

So how can all of this work in the real world?

The most important thing is for healthcare workers to stop moralising and stigmatising patients. Rigorous training and monitoring is required. Journalists and the media should be mobilised to write articles on the matter so that the general public can know when they are receiving sub-standard services.  A healthcare worker’s role is to provide quality service – and not an opinion.

Secondly, I believe that current upscale of MC in Africa provides an immense opportunity for SRH and HIV integration.  Rather than set up stand alone MC sites that drain resources in terms of infrastructural development and staff recruitment, let’s look at integrating them into pre-existing sites. Also, when we finally develop an effective HIV-preventing microbicide, this must be accessible in terms of cost, as well as available as part of a holistic range of sexual and reproductive health services. In other words, I should be able to get my microbicides at my local clinic, and not at some high-tech lab.

And let’s make sure that everyone who needs to get HIV services can do so. Antenatal care coverage in Africa is still too low. In fact, some women still don’t know about it. Let’s take the information and the services to the people and build the capacity of community-based initiatives.

But most importantly, let’s remember that sexual and reproductive health rights are human rights. No, they aren’t a passing fad or the latest NGO buzz. When implemented, they represent human lives saved and money well spent.

So there’s this thing that we Africans do that is a little bit funny, but also actually quite a serious issue.

Let me set the secenario for you by introducing you to the imaginary Mr. Y and his wife, Mrs. Y who will help me illustrate my point.

The Ys are a family who earn enough money from their combined salaries just to get by each month, as well as take care of their three young children. Mr. Y works with an NGO where his pay is lukewarm, and Mrs. Y is a nurse in a public hospital. Her pay is definitely cold.

So you would think that the Ys try by all means to live within their means right?

Far from it!

Rather, they rent out a house in some  plush suburb (though they are three months behind on paying up and the landlord is threatening to take them to court) and their children go to that private school up the rolling highlands where the red-hot fees ensure that Mr. Y can never save enough money to fix that dent on the bonnet of his car.

Speaking of his car, Mr. Y drives a C Class Benz – black in colour, tinted windows with reams gleaming that seem to make time slow down with each revolution of the fine specimen’s tyres.

Oh, and doesn’t Mrs. Y just love to drive that Benz to church on Sundays and ‘humbly’ remind Jehovah’s children how blessed in the blood of Jesus  she is to be in possession of this stunning vehicle.

If only they knew that it wasn’t actually her car, or even her husband’s. Nope. The car belongs to Mr. Y’s brother who’s fled to the UK and entrusted the keys to his most prized possession to Mr. Y. whose old tired jalopy is now hidden from public view, locked up in the car shed.

So you get the picture, right?

This is a story about a family that on first appearance seems to have it all going on BUT is actually living a horrible lie.

What for?

Esteem in the eyes of society, of course. Hey, you gotta show that you’ve done something right with your life and the Ys are just trying to ‘keep up with the Moyos’.

I remember an American friend visiting Zimbabwe once asking me a very interesting question.

“Why do so many African families have this fixation with flat screen TVs and leather sofas ?!”

She just couldn’t get why everyone either had those two items, or was saving up towards them.

It got me thinking.

Why is that so many people own terribly expensive phones, and yet can’t even afford to load air time onto the things every month? Why is it that every woman worth her salt in society owns a microwave or washing machine and often never actually uses them?

Like I said before, it’s all about APPEARANCES. When purchased for all the wrong and misguided reasons, these things become status symbols that people use to say, “I’ve made it, unlike you!”

Such reasoning reflects an innate fear of inadequacy that many of us have. You must have a legacy, you must show up all those people who said you wouldn’t amount to much, you must have something to show for all that suffering you endured growing up in some rural area reading for your exams by candlelight.

It’s really sad that in African cultures, we tend to gauge success by trivial things like possessions. And it’s sad too that so many young people strive for that ideal with such singular purpose that they lose sight of the real dreams for their lives.

Who cares what the neighbours think? They will talk regardless of what you do, or don’t do; own or don’t own. A life lived on behalf of the perceptions of others about you is not your life, especially if you really don’t like leather sofas anyway!

When I tell people that I am saving up to travel somewhere distant and exotic, they tend to look at me quizzically, as though I have lost my marbles.

“But why don’t you rather buy something sensible – say furniture or a car or a plot of land? Travel is surely not that important!”

More often than not, I am met with such responses when I start talking about my longed-for road trips through west Africa or some unexplored part of Asia.

It would seem to me that we as Zimbabweans, and Africans I dare say, don’t place much significance on becoming global citizens who know their world better.

Rather, when we travel, we’d prefer it to be on someone else’s tab – a workshop or conference where one spends the whole time in a hotel and then takes snaps around anything that bears the visited country’s name and proudly announces to all their Facebook friends, “Ndanga ndiriko! I was there!”

I will admit that once upon a time, I used to be like that. Back then, I figured that having a stamp in my passport that proved I had been to a place gave me authority to speak about it as though I had been born and bred there, even if I had only taken a few paces around some touristy places.

But then over time, I have come to realise that travel is more than just the physical act. There is such a wealth of learning – about people’s cultures and ways – waiting for you if you just take up the challenge.

I think that such experiences can be more valuable than buying things. Don’t get me wrong, it’s definitely important to invest in property . But there are things that travelling teaches you about yourself, about humanity and the sameness of us all amid our differences in geography, language, race and religion.

And also when I talk about travel, please don’t start pointing that accusatory finger at me and telling me that travel is for rich people.

Some of the best travel expeditions I have had have been on a shoestring budget and loads of adrenaline. Last year, a few friends and I bundled into a bus to Victoria Falls and stayed at a $5-a-night ‘lodge’ and had the most amazing time (eating baked beans and dry bread for breakfast and lunch, I might add!) interacting with the locals and just taking in the beauty of the majestic smoke that thunders.

And what about an even cheaper trail? How’s about a weekend exploring a part of your own city that you’ve never really paid attention to? Mbare, with all its history has a great atmosphere of life and living. Makokoba township, with its lively arts scene, is another place worth a visit.

I know there’s people living in their leafy suburban homes who would never dream of going on such tours fearing being seen ‘kughetto’. But those places we tend to look down upon harbour some of the most amazing experiences and people.

My favourite memory of visiting the Vic Falls last year was going to a bar in Chinotimba township where the music was far too loud for my ears and the half-drunk male revelers kept buying drinks for the designated ‘queen bee’ who stood in a corner gently tapping to the beat, making the jelly in her backside quiver to the men’s delight and unending attention. But each time one of them came up to her, she would shoo them away and say that she would only consider the guy’s advances on one condition – that he buy her some bottles of the beer she was plying herself with. Turns out she didn’t like any of the men anyway and used their interests to get herself sloshed! She left, very much alone, and very much unbalanced.

What a sight, and all on a working Wednesday night!

Here’s to travel and all the hilarious and mind-opening experiences that it brings.

And so next time I tell you my heart’s in Accra, please understand the itch in my blood to go to that legendary land. One day, just one day, my body will follow!

When I was a little girl of just four, I remember the family maid calling me to the spare bedroom to play a game with her. The game, she explained, would entail her lying down on the spring base single bed  and me jumping over her stomach.

Initially, I had concerns that such a game would cause her pain. But, in the way that only four-year olds can be convinced, she reassured me that the game would not hurt her at all and that it would instead be a good workout for her belly.

Somewhere in my mind, I can still hear the sound of those springs squealing as I jumped away to my heart’s content.

Recounting the new game to my mother that evening however,  put an end to it immediately.  It also put an abrupt end to Sisi Anna’s job.

A few months later, we heard that Anna had given birth to a healthy baby girl, thereby bringing unspeakable shame to her family who had already cast her off as a moral felon.

Her crime?

Anna was unmarried and the father of her child, who was apparently the married gardener from a few houses away, was refusing to take responsibility.

I am still filled with abhorrence at the thought of the role that Anna had wished me to play as her abortionist.

But with the passage of the years, I have grown to appreciate what levels of  desperation and despair must have led her to approach a clueless little child to assist her in finding a way out of her predicament.

Make no mistake; I don’t condone the measures that she took, especially since they involved an innocent party, myself. Rather, I am more open to understanding why she took such recourse.

Abortion is a topic that leaves a sour taste on many people’s tongues.

Walk the streets of Harare in Zimbabwe and you will come across many metallic placards featuring messages against the act, even citing biblical scripture about the detestability of murder in God’s eyes.

But just as we moralise and rationalise on end about whether or not sex work represents deviant behaviour, and whether or not it should be decriminalised, we go down the same torturous path when it comes to the abortion debate.

And the simple truth – as with sex work – is that regardless of the discourse and debates that take place, abortions continue to happen, whether sanctioned by the state, or deemed illegal.

Every day, young women all over Africa are having abortions.

According to research released by the Guttmacher Insitute last year, 5.6 million abortions were carried out in Africa in 2003. Only 100 000 of these were performed under safe conditions – that is, by individuals with the necessary skills, and in an environment that conformed to minimum medical standards.

And with only three African countries (Cape Verde, South Africa and Tunisia) giving unrestricted legal access to abortion to women, it would be safe to assume gross underreporting when it comes to figures pertaining to rates of abortion on the continent.

I’ll give a practical example of why I believe this is so.

Some years ago, when I was in university and living in a hostel, one of my hostel mates had an unsafe abortion. She told no one about it until she was forced to. Having  bled continuously for three weeks and in the process having exhausted her supply of sanitary ware at a time when this was a scarce commodity in Zimbabwe, she was forced to confide in a few of us that she needed help.

It’s not that we couldn’t tell that she was unwell. She had stopped interacting with anyone and when she surfaced in the communal bathrooms she looked wan and weak.

But finally, she decided to break her silence and share that she’d visited an old woman who’d given her a tablet to take for her ‘condition’. This tablet, my hostel mate, confided, made her uterus burn with acid pain and soon, she began to bleed.

She bled for all of a month and prohibited us from telling the matrons or even seeking medical assistance for her. All we could do was supply her with iron tablets, cotton wool and pads and eventually even mutton cloth to help her cope with the bleeding.

And that abortion, as well as many others, was not ever officially registered.

Why, you might ask, would women go to such desperate lengths to have an abortion?

For many young women, the cultural stigma of being an unwed mother is so strong that they feel they have to go to any length to avoid bringing shame and disgrace to their families in this way. A few years ago, a family friend committed suicide because her boyfriend had disowned the five-month-old foetus burgeoning within her womb. In her note to her parents she stated that it would be better that she died than bring humiliation to their Christian name.

Inherent in this cultural stigma is often the desertion of the partner or male responsible for the pregnancy, thus relegating the woman to position of a single mother.

And let’s not also forget that sometimes, a pregnancy is unexpected and unwanted and that the woman decides that she is simply not prepared for motherhood.

I doubt that this is ever an easy decision, but it is surely made more difficult not only by the lack of access to services such as hygienic abortions and counselling, but also by patriarchal hegemony that still prescribes the roles of women in society (ie. if you are unmarried you have no right to know anything about sex, let alone have a child).

Also, I am sure that the social perception of contraceptives, particularly condoms( which research has shown diminish in levels of usage as a relationship grows) plays a large role in the frequency of unprotected sexual acts, thereby putting women at risk of unplanned pregnancy as well as a host of other sexual infections.

Culture is the cohesive glue that binds communities together, but for many women, it is the hangman’s noose on which their freedoms are choked.

As I write, I wonder whatever became of Anna and her daughter; whether she grew to accept the child that separated her from her family; or whether her family ever took her back into their fold.

It is indeed a tragedy that so many women have to sacrifice one thing or the other for the sake of saving face in society.

For us, freedom and parity are still but utopian concepts.

If you have spent any amount of time in Harare, you’ll know of a popular spot called Mai Faffy’s. Located in the heart of Avondale – at one of the city’s busiest shopping complexes – Mai Faffy’s serves some of the tastiest sadza and relish to be had in Harare.

And as with any place named in such affectionate terms, there is a story behind  Mai Faffy’s – a story  I recall Faffy herself telling me.

After a spell of giving birth to only baby boys, Faffy’s mother finally had a baby girl – a girl she named Tafadzwa.

Faffy was the term of endearment that the family used to call Tafadzwa and it stuck so hard that everyone called her Faffy from then onwards.

Even to the day she died.

Faffy died in a car accident last week Monday, on the 12th of April  – a needless loss at the young age of 24. She would have turned 25 in October.

I only learnt of her death last Thursday from her best friend who sent me an SMS to tell me the shocking news.

It’s still unbelievable.

You may not have known Faffy, but on behalf of all who did know her – and in particular her friends and family – there is need to remember this remarkable young woman who has left this earth too soon.

What do you say when someone so full of life and promise dies so prematurely? Where do you start?

I remember getting a call from Faffy the day before I left to relocate to South Africa in November last year.

Faffy called me early in the evening wanting to make a plan to go out as her farewell gift to me.

I told her that I had a heap of ironing to do and would have to think about it first. Her response was typical Faffy.

“Stuff the iron in your bag and get all that done when you get to SA!”

In her world, there was too much living to be done without having to worry about mundane chores. I obviously didn’t listen to her, but now I wish I had and had just seized the moment and added yet another memory to the collection of brief moments that I spent with her.

When I asked her best friend, who’s also called Tafadzwa, what she’d like me to share about Faffy, she gave me  a long list of things.

But perhaps the most striking thing she shared was the range of people who attended Faffy’s funeral this past Saturday to pay their final respects to her. The lady who sold tomatoes from the corner of the block where Faffy lived came. Her neighbour, who named her child in honour of Faffy for escorting her to hospital in the desperate final stages of labour, also came.

Her kindness and accommodation of all people was well known and celebrated by those who loved and appreciated her most as they bade her a fond farewell.

Tafadzwa and I wanted to let you know about our remarkable friend, about the girl who always made time to brighten someone’s day, about the girl behind Mai Faffy’s.

She will live on in the vibe and atmosphere of Mai Faffy’s, in the laughter and chatter of friends and strangers alike who gather there each and every day.

So long Faffy, and thank you for the memories of a life well lived.

Growing up, an interesting predicament always befell my family. We lived next door to a family, highly prolific in gardening; and to show for their obvious passion, they had a yard abundant in flowers in kaleidoscope bloom, as well as all kinds of fruit and vegetable that could whet every visitor and passer by’s appetite, guaranteed.

One of their most productive exploits was the tall mango tree that grew in the backyard. Every year, the family was assured a harvest of juicy red-yellow fruit from it, heralding the arrival of summer.

And this is where the predicament came in.

Because the tree literally hunched over the low Durawall that separated our properties, a fair share of the harvest often fell into our yard.

Now it’s not that our neighbours didn’t try to avoid this happening. Often, I could spot the gardener on a stepladder doing his damndest to fish the fruit hanging in our territory with some form of hook or walking cane. But inevitably, a few mangoes were always missed and when their time came, they would fall daintily onto our patch of the world.

Each time that this happened, we were never sure what to do.

Should we get a bowl and gather that sweet juicy windfall, or return it to its ‘owner’?

Who was the owner anyway – the person who’d planted and nurtured the tree, or the one who benefited from its yield?

That is a scenario we can ponder for several minutes, hours even.

And the only reason I use it is because it perfectly mirrors a question posed by a few fellow Zimbabweans as we recently tried to rationalise the sad state of affairs in our nation.

We are all new ‘Diasporans’ – that term used to define Zimbabweans living and working out of the motherland – and were pondering the irony of our situation.

Born and raised in Zimbabwe, completely educated in-country, we are all now externalising the collective wealth of our knowledge to live and work in South Africa.

I believe that this is the saddest of all fates of the political and economic meltdown of our nation. We can bemoan the fact that all of our valuable natural resources, like gold and platinum and granite are being externalised to ‘friends’ in the East. But nothing is as precious to a nation as its pool of skilled persons.

Nothing shows more evidence of a robust social system (that includes positive socialisation at familial and educational level) than a capable, committed and diversified workforce.

And to prove the quality of Zimbabwe’s workforce, let me offer an example. Many of the young professionals Zimbabwe has recently produced have been trained under a plethora of trying circumstances which include a crippled economy that has led to endless academic strikes (by university and college lecturers, and teachers alike) and therefore limited learning; as well as hardships among scholars trying to raise fees for their education

The fact that even with all these factors working horrendously against them, Zimbabweans can compete with professionals trained at far more renowned institutions than the few semi-reputable (at least for now) institutions that the nation has is a testament to the great resource that is Zimbabwe’s people.

But boasting aside, there is a predicament in this scenario; much like the one I set out at the beginning of this piece.

Just like the neighbour who receives a windfall from a tree that he hasn’t planted, so do foreign nations who harvest the fruit of the Zimbabwean crop. This isn’t to say that this is a bad thing, but with the current state of socio-economic affairs in Zimbabwe, it is an unfortunate thing.

Zimbabwe’s soils are fertile for nurturing capable intellectuals and professionals – but not for retaining them. Instead, they are often forced to seek greener pastures elsewhere.

So the question remains, the question that we few Zimbabweans found ourselves asking ourselves that day.

Who owns our output – the nation that has nurtured us, or the one that benefits from our yield? Who ought we plead allegiance to?

And as with the mango tree and its fruit, this is a scenario we can ponder for several minutes, hours even.