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.

Some of the Kubatana team have been moving around various pubs in Harare to watch world cup games. Our favourite haunt so far is Boleros in Chisipite. Cold beer, warm peanuts, friendly staff and a very laid back clientele. For the next game go along to Boleros and have a blast.

Scanning The Herald newspaper today, I noticed how women hardly feature and when they do, they’re generally criticised. We live in a such a man’s world. A world where the emphasis is all on men. Women are still treated as inferior beings whether it be in the classroom, office, or on the sports field. In society women are often treated as if they are a piece of meat. A lot of women are harassed and treated disrespectfully by men. They are whistled at and flirted with constantly.

This disrespectful treatment is extremely evident in the case of sport and particularly in the case of sports magazines that feature half naked women in bikinis. Women let themselves down by allowing themselves to be exploited for a male dominated market where sex sells. Let’s see some actual sports women on the cover of Sports Illustrated, instead of wafer thin super models with bleached blonde hair.

In October 2009 Sports Illustrated featured an article in which they suggested “Sports men who score the most  . . . talent for the game leads to spotlight of fame. Fame leads to money. And money leads to . . . honey” – sports stars get the hottest dates. Fact. Those who score on the field usually score off it too . . .who is complaining?”

I am.What message are they trying to put across? Women are simply regarded as an accessory. What is this saying to the youth of today? It portrays women purely as sex symbols and nothing more .

Then when Sports Illustrated finally features an article on an actual sports woman, its high jumper Blanka Vlasic winner of the gold medal at the world championships in Berlin and she is given absolutely no recognition for her true talent and ability but rather credited as “hottie of the year”.

I find this completely demeaning.

Trudy Stevenson, one of Zimbabwe’s most energetic and people focused politicians has become Zimbabwe’s Ambassador to Senegal. I miss her vibrancy but her Letters from Dakar are both inspiring and informative. Here’s a short excerpt from her latest one:

Meanwhile two of my three phases of electricity were inadvertently dug up by the nearby road works two weeks ago, so once again I had an emergency – on opening night of the World Cup, OF COURSE!!  So we couldn’t watch South Africa play the opening match, except that by amazing luck I have the MOST GENEROUS NEIGHBOURS!  They are Australians, and had organised a TV in the road reserved outside for all our security guards to watch the month-long World Cup, and the TV is connected both to their mains electricity and to their generator – so when the power went off, we sheepishly wandered outside, and were welcomed to join the guards – and watched Bafana Bafana draw 1-1!  There were about 25 people watching that TV, including another diplomat, the Hungarian consul-general who lives 3 houses away!  We were terribly bitten by mosquitoes, but we didn’t notice at the time!  Now we’re heavily into World Cup – but also terribly disappointed by our African teams, all of whom we have been supporting.  Tonight we’re undecided who to switch our allegiance to, after watching Nigeria’s defeat by Korea . . . we shall see!

Here is another article from Rejoice Ngwenya entitled The Folly of African Entrepreneurship:

Zimbabwe, like most developing African countries burdened with the yoke of authoritarian oppression, force-feeds citizens with policy prescriptions only meant to satisfy political egos of ruling elite.  Imposing government ministries of ‘small and medium enterprises’ and ‘indigenisation’ would not suddenly turn Zimbabwe into an industrialised country.

Similarly, investing millions of United States Dollars in education infrastructure to offer business administration training would by itself not achieve much in economic growth.  It is in this context that my cousin who teaches block release students of Masters of Business Administration at a derelict Zimbabwean state university in the midlands city of Gweru makes a stunning observation about the folly of African entrepreneurship.  Notwithstanding the exploits of world-renown African businesspersons like Mo Ibrahim [Sudan], Patrice Motsepe [South Africa], Strive Masiyiwa [Zimbabwe] et al, there is a tendency for emerging economies to over emphasise the virtues of trading as symptomatic of entrepreneurial instincts in Africans.  Vast flea and vegetable markets in Cairo, Casablanca, Accra, Nairobi, Lusaka, Harare and Johannesburg cannot be credible litmus test for successful business, because, according to my cousin, they do not contribute to real economic development. This school of thought is supported by 20th Century economist Joseph Schumpeter.

Zimbabwean ministers of ‘small enterprises’ and ‘indigenisation’ – Sithembiso Nyoni and Saviour Kasukuwere respectively – epitomize the flourishing species of authoritarian regime praise singers who perpetuate the lie that simply buying and selling amounts to entrepreneurship.  Ironically, it is dictators that buy votes by deceiving citizens into non value adding, non innovative ‘income generating’ activities only meant to fill up ballot boxes. Wikipedia isolates Israel Kirzner as one in a few economists who associates entrepreneurship with innovation or value addition.  Importing clothes and cars from Dubai and disposing them off to Harare consumers has no value addition. Countries like Zimbabwe, Swaziland and the Democratic Republic of Congo are politically unstable, with a productive industry decimated by decades of senseless dictatorship, yet their economies are said to have ‘survived’ because of ‘enterprising and resilient citizens’. What a load of hogwash!

Says Wikipedia: “The entrepreneur is widely regarded as an integral player in the business culture of American life, and particularly as an engine for job creation and economic growth.” A country develops while its economy grows when citizens create new products and services that result in more people being employed, consuming and adding to the national fiscus. During electoral campaigns, dictators like Robert Mugabe splash out computers, buses and money to political sympathisers under the guise of ‘economic development and empowerment’. As a result of this patronage, the country fails even to produce cooking oil, soap and shoes because there are no efforts to encourage sustainable innovation. My cousin therefore is correct that Zimbabwe, like most African countries suffering from authoritarian dictatorship, will remain underdeveloped until we transform our political thinking.

No doubt the MBA students he encounters are victims of an education system that was meant to produce workers rather than innovators. It is a poisonous system that infects even financial institutions like Standard Bank Zimbabwe who seek survival from customers with ‘proven’ salary and wages rather than ‘risky’ entrepreneurship.  There is a link between sustainable entrepreneurship and financing, and this chain translates into long term survival of the banking sector.  In a 2009 paper entitled “Banking Deregulations, Financing Constraints and Firm Entry Size” Harvard academics William R. Kerr and Ramana Nanda quote Michelacci and Silva who stress that “better financial access explains why local entrepreneurs operate larger firms…”  In other words, the nexus between finance, entrepreneurship, sustainability and long term growth is an undeniable fact of life.

The Standard Bank, like most conservative ‘orthodox’ commercial banks, has this skewed policy imprint confusing innovation with entrepreneurship. And for good reason. The default rate for unsecured loans has been known to bring down the banking sector. Yet Kerr and Nanda have it on good authority that restrictive regulations in financing innovation are a negative force in the economic growth projectile. This is why it is critically important for us Africans to understand and appreciate the meaning and implication of true entrepreneurship. We must exorcise the demon afflicting banks like Standard that only salary cheques are safe as collateral in securing loans.

At one time in the early part of this decade, Zimbabwean banks or more specifically the financial sector, was registering phenomenal ‘growth’, yet citizens were getting poorer and GDP was shrinking. This was prelude to the ‘annexation’ of banks by Reserve Bank Governor Gideon Gono, and eventually others collapsed under accusation by [Gono] of perpetuating impropriety.  It was during the same period that inflation spiralled to six digits while Zimbabwe’s productive sector almost disappeared. But the strange phenomenon was of a booming ‘entrepreneurship’ in cross border trade, flourishing flea markets and countless trips between China, Dubai and Zimbabwe. In rural areas, young men were digging up the country side to extract and sell gold. Something was clearly wrong.

I therefore conclude this treatise by reasserting the need for us Africans to create new social and business solutions as an entry point to entrepreneurship. Deficits in public communication, governance, food, education, health, industry, commerce and infrastructure are an ideal opportunity to innovate for profit. This is what drives industrialisation, not selling jeans at open markets or vegetables and curios along the freeways. Moreover, financial institutions like the conservative Standard Bank of Zimbabwe defeat the cause of entrepreneurship by not promoting individual inventors but relying on wage and salary remittances. At a time when national productive capacity is below 40%, it is difficult to perceive how a serious bank can ignore entrepreneurs and non-profit organisations on its menu of attracting business. In its haste to pour scorn on ‘flea market entrepreneurs’, the bank has adopted collective condemnation even of those self-employed consultants  who sustained it with valuable foreign currency deposits when the Zimbabwe dollar was toilet paper.  What is now urgent is to overhaul Zimbabwean national economic policy to foster a commitment to innovation rather than flea markets and Chinese toy shops.

Late yesterday afternoon I got a Big Shock. While I was at home there was a hoot at the gate and lo and behold, a Zimbabwe Electricity Supply Authority (ZESA) meter reader had arrived to do an Actual reading rather than the usual Estimate.

I took the opportunity to ask him two (2) questions:

1) If I only get power between 8 or 9 at night until about 5am most days then surely my electricity bill shouldn’t go up, or stay the same, it should go down? He nodded his head in profuse agreement but said that ZESA seldom does actual readings so they continue to estimate useage and don’t take into account the fact, the sad, sad, fact that they supply very little power to home owners. In other words, every month, if ZESA doesn’t actually read your meter and do some accurate calculations, they’re robbing you and me, all of us, blind.

2) Why doesn’t ZESA publish a load shedding schedule so that we know when to plan to eat and all that stuff? Well the ZESA meter reader said that ZESA can’t vaguely guarantee any kind of regular supply and that the power deficit is so huge that they have to flip the switch Off at any given moment.

I said thanks a lot – its not his fault – and said see ya later. I watched him drive away, clutching his meter readings, in a brand spanking shiny new mini bus.

What sense does this make? This 15 seater mini-van hopping from house to house when ZESA should have a fleet of motor-cycles moving around our city, doing Actual meter readings.