Tuesday, February 20, 2007

Final Thoughts

Well, I'm back in the States and finally beginning to process all the fascinating and wonderful experiences I had with my colleagues in South Africa. I've posted a sort of wrap-up on another blog, RH Reality Check, a blog that focuses on reproductive health rights, including the intersection of HIV/AIDS and violence against women and children. So check out my final installment at http://www.rhrealitycheck.org/blog/2007/02/18/the-deadly-intersection-of-hiv-and-violence-against-women-and-children and then explore RH Reality Check (the homepage of the blog is http://www.rhrealitycheck.org/).

Saturday, February 10, 2007

A Global Movement

There is something wonderful about being part of a global movement, particularly when your work is in solidarity with the people whose lives you are working to improve, tethered to a reality beyond the gilded marble halls of Congress. Yesterday’s National Executive Committee meeting of the Treatment Action Campaign (TAC) was so inspiring, a real reminder of why I do the work I do. Paul and I were invited to observe the meetings with a range of South African partners and TAC’s coordinators from the 6 provinces in which they work. The day began with a long delay, because it was the opening of Parliament. This meant that there was a series of parades, a band in kilts (why kilts I have no idea!) and then all three branches of the South African National Defense Forces and the police. After a long while motorcades made their way down the street and to Parliament, where President Mbeki gave his State of the Nation speech. He mentioned HIV/AIDS, apparently for the first time. But whether this will lead to actual change remains to be seen. The pomp and circumstance was typical of governments everywhere, and only reminded me of the incredible economic disparities in and around Cape Town, and in all of South Africa, for that matter. It was very interesting to stand in the 15th floor window and watch this hoopla on the street below.

When the meeting finally began, we had a fascinating briefing on the current court case in India against Novartis, a case that will hopefully result in lifesaving (and expensive) AIDS drugs being available in cheaper generic versions (for more information see the website of Doctors without Borders, www.doctorswithoutborders.org). We also learned about Extremely Drug-Resistant Tuberculosis (XDR-TB), which appears to be exploding here in South Africa. TB is the number one killer of people living with AIDS, so a version of TB that essentially cannot be treated is a very serious concern. And then one of the women present began a beautiful song, I believe in Xhosa but possibly in Zulu. A minute later, almost everyone was on their feet singing along, clapping, dancing in their places. A reminder that we were in Africa, and a spirited beginning to a really powerful day.

The folks from TAC discussed the current political climate here, but also the programs they will focus on in 2007. One of these is violence against women and children. TAC is supporting a few of its members in their court cases regarding rape, trying to ensure that the investigations and cases are carried out appropriately and in full respect of equal dignity and human rights. This program is called Access to Justice. I really like that name; it mirrors the common AIDS-related phrases “access to comprehensive prevention” and “universal access to treatment,” situating violence against women and children squarely within the context of HIV/AIDS.

Throughout the day I really came to feel that the work we do at the Global AIDS Alliance—fighting for evidence-based prevention and universal treatment access, for primary school for everyone, for the protection of orphans and other vulnerable children, and of course, for the prevention of and appropriate response to violence against women and children—is exactly the work that people in South Africa need, and are doing themselves. I felt empowered. And inspired to go home and continue this work. And hope that I get to come back to South Africa again to see my new friends and get a renewed lease on my conviction that we can do something about this terrible pandemic that will eventually kill some of these new friends, and will certainly kill many people that they know and love. It’s good, righteous work, and I’m glad to be in an international community of people doing it together.

Thursday, February 8, 2007

Thursday in Cape Town

Today was so full of fascinating conversations, powerful history and inspiring efforts to change the world that I really don’t even know what to write. The first thing I’ll say is that Cape Town is absolutely beautiful. I could live here. Those of you who know me well know what a high complement that really is. The attitude is different here—more laid back, friendlier, less afraid. Maybe that’s in part because people here are surrounded by big craggy mountains and rough coastlines and beautiful blue-green ocean, but also by reminders of everything South Africa has been through and the country’s hope for the future.

But there is also so much poverty here. Soweto was poor, that much was clear, but not in a noticeably abject way, at least not from what I saw. Today Paul (Executive Director of GAA, arrived in SA last night to join me) and I went to Khayelitsha, a large township near Cape Town, basically a shantytown. The poverty there was abject, with a huge sea of shacks topped with metal roofs sinking into sand with mountains on one side and ocean on the other. The disparity between this and the V&A Waterfront in Cape Town was hard to get over.

Paul and I visited a really amazing service program in Khayelitsha. Simelela is a one-stop rape crisis center. This means that when a woman or child has been sexually assaulted, he or she can go to Simelela to have an exam, file a police report, get medicines to prevent HIV, other sexually transmitted diseases and pregnancy, and get a clean change of clothes. Looking at a spare bathroom with chipping tiles and a pair of underwear hanging on the towel bar, I thought for a moment about what it would be like to be in that room, washing up after having had your body violated in a way that can never really be cleaned. I am so thankful that I do not know that pain firsthand—but I know many women who do, and it makes me so angry that our patriarchal society allows such atrocities to continue.

South Africa’s Simelela and Thuthuzela Care Centers (rape crisis units in hospitals and clinics) really are model programs. They follow best practices, making sure the right preventative medicines are on hand and that forensics capacity is available to get any DNA evidence that might remain from the assault. These care centers really need to be scaled up. Our friends at the Treatment Action Campaign (there’s a link to their site at the bottom of this page) are calling for there to be 53 in South Africa ASAP; right now there are only 6.

Despite the fact that these programs are an important step in providing good care to people who are sexually abused, I was concerned at the apparent lack of ongoing psycho-social care. My mother is a social worker who specializes in working with survivors of child sexual abuse. I know how damaging that sort of trauma can be, how it can lead to risky choices, to an inability to ever really love anyone in a healthy way, even to suicide. Earlier today, while we were meeting with folks at the Treatment Action Campaign about their exciting new women’s rights program, we got to talking about how important mental health care is from the perspective of survivors of sexual assault. I know it’s not just in the US that we value good mental health, that we understand the difference between happiness and unhappiness (even if we have different criteria or definitions). I hope that as these one-stop care centers are taken to a national scale that real, sensitive and ongoing mental health care will become part of the package.

After spending the afternoon in Khayelitsha visiting Simelela and chatting with the director of Doctors Without Borders’ TB-HIV clinic across the street, we ended up getting tickets for the day’s last tour of Robben Island, where Nelson Mandela was imprisoned for 18 years. Our guide through the prison was himself a political prisoner there, and he spoke words of kindness, reconciliation, healing and forgiveness. And this was during and after his tale of blinding hatred, brutal torture, and hopelessness. His honesty was incredible. I have heard testimony from torture survivors in the past, so while his story wasn’t shocking to me I was surprised that he would be so public about it without any warning (not that he owed us warning that we were about to be faced with the Truth). I wonder how people reacted…that sort of story can be very traumatizing. But, in fairness, people should be a bit traumatized when confronted with the horror that was apartheid. Just as people should be horrified by the millions of people dying of AIDS as I type; the young women and children being infected with HIV because they don’t know how to use a condom, are being raped, or both; the millions of women and children who will be beaten and violated this year simply for being who they are. We should all be horrified. But the message of our tour guide today was one of hope, of empowerment to make the world a better place. So that’s the take-home message. There are horrible things in this world. But once we see them, it’s up to us to make them end.

Day 2--Fighting for Rights in SA

It’s impossible to ignore the powerful experiences of the South African people. I remember learning about apartheid in high school. In college I had a wonderful professor who was South African, who taught us South Africa’s history of struggle and resilience while exposing us to literature from the range of cultures in this diverse country. Today has shown me the commitment South Africans still have to human rights. The theme among the people I’ve met so far is that, with apartheid done and democracy in place, South Africa’s biggest struggle now is HIV/AIDS and gender-based violence. Yesterday I met with two more Johannesburg-based organizations that showed me how this new struggle might be overcome.

Yesterday morning, I met with staff from the gender unit at the Center for the Study of Violence and Reconciliation (CSVR). I first discovered this organization during grad school, while researching my thesis on using restorative justice to help torture survivors heal. South Africa’s post-apartheid Truth and Reconciliation Commission (TRC), which takes testimonials from those who lived the horrors of apartheid and tries to provide emotional and spiritual healing, is one of the best examples of restorative justice in the world (similar exercises have been conducted in, for example, post-war Guatemala and Sierra Leone). Now that I have moved away from working with torture survivors and into supporting those who have been raped and abused in less political settings and those who have become infected by the world’s deadliest disease of poverty, CSVR is still relevant to my work.

CSVR is a strong voice for survivors of violence, but also recognizes the importance of figuring out why people (mostly men) rape and abuse women and children, since without understanding their motivation reconciliation and prevention may never be possible. I see CSVR as an organization not unlike the Global AIDS Alliance, one that speaks truth to power by revealing the extent of the violence that goes on here in South Africa, and its disastrous impacts. CSVR is also a leader on the national coalition of NGOs working to pass the Sexual Offenses Bill in the best form possible. South Africa already has a progressive domestic violence law, and Parliament here is also considering what seems to be a very good law to protect children. With organizations like CSVR pushing the government to make the law as good as possible and watching to see that implementation is also good, I hope that their research will soon be obsolete. But there is a long way to go here before a human rights culture will be firmly in place and needless suffering can mostly end.

One of the issues that must be addressed in order to make good laws work with society for positive change is gender norms. On Monday I visited Men As Partners. On Tuesday I visited Sonke Gender Justice Network, an indigenous organization started by men who had in some fashion been working on gender issues in South Africa, and who realized that men needed to be engaged if South Africa is to have the sort of success with gender violence that it had with the apartheid regime. Sonke works with men by adapting positive parts of traditional culture and religion to help men see that hitting and raping women is not what is expected of them, and in fact that this behavior is bad for the community as a whole. By mapping men’s and women’s 24-hour days, participants come to see that women often work the entire day, toiling while their male relatives read the paper or drink beer with their buddies. And women’s work is rarely paid. The men of Sonke told me that this exercise often makes men go home and begin to share chores with their wives, and to teach their sons to do the same. To me, this is a real sign of success and needed change…I so admire feminist men!

Sonke also has a really exciting and innovative program to get men involved in prevention of mother-to-child HIV transmission (PMTCT). PMTCT is a really simple, cost-effective intervention that can keep HIV-positive mothers from infecting their babies. But access to PMTCT services in horribly minimal around the world. So Sonke is going into communities to talk to men about supporting their wives during pregnancy and the benefit to the future of their families and communities. This is good public health and human rights practice, since it keeps babies from being unnecessarily infected and helps to ensure that women can access healthcare, a basic human right like the freedom South Africans sought during the fight against apartheid. Plus, Sonke is training local communities to advocate for access to these PMTCT services, to tell their local leaders and provincial governments that they are obligated to provide health care, including PMTCT. Once people know how to seek their own rights, the possibilities for change are endless.

After work I visited Soweto, the township that was basically a ghetto when apartheid first began, and the site of the Soweto students uprising in 1960, where police killed almost 70 students who were, by most reports, marching peacefully to protest policies requiring them to be educated in the colonizers’ language, Afrikaans. It’s incredible to see the way people are reclaiming Soweto, staying and making improvements rather than moving into the city where there are fewer memories of that harsh time. It is also really sobering to think of the lengths that South Africans went to to secure their freedom. I’m so glad they succeeded. They really are a sign of hope to so many people around the world whose basic rights still aren’t being met. Their history also makes me believe that the people of South Africa, led by strong civil society organizations like CSVR and Sonke Gender Justice, can overcome the twin disasters of violence against women and children and HIV/AIDS. All over Soweto I saw signs about HIV testing and treatment, and even a billboard for Project RED, which contributes a portion of proceeds from certain products to the Global Fund to Fight AIDS, Tuberculosis and Malaria. It seems Soweto will remain a community with its eyes on the future. They just have to work together. And we can all help.

Monday, February 5, 2007

Day 1--Johannesburg

So far, South Africa has been a sensory sensation. This is a middle-income country. I have never spent much time in major African cities, and am more familiar with poor villages in very poor countries. The contrast is stark. The roads here in Johannesburg are well paved; electricity, television and cell phones ubiquitous; and high-end shopping almost a given. At least where I am. I know there is still poverty here…

Today I visited two outstanding organizations to learn more about their work. First I went to ActionAid International, to meet staff from the international secretariat’s women’s rights program and a member of the new ActionAid South Africa women’s program. One of the most interesting aspects of this conversation was these women’s take on the role of men in the feminist agenda, the ways in which South African civil society does—and sometimes does not—work together on the intersection of HIV/AIDS and violence against women, and the poor implementation of South Africa’s good laws.

With these comments in mind, I went on to EngenderHealth South Africa to meet a handful of staff members working on engaging men in changing gender norms and empowering women. They told me about their One In Nine Campaign, which reflects the statistic that only one in nine South African women who are raped actually report the crime, meaning that many South African men will see no repercussions for abusing the women and girls in their lives. We then went to visit their renowned Men As Partners program. Men As Partners (or MAP) is often held up as an example of how we should be working to change gender norms that result in women’s disempowerment and social tolerance for violence against women and girls. I believe that involving men in this fight is essential, since without their participation women will be constantly fighting an uphill battle. But frankly, I couldn’t understand how this would be done in practice.

We went into the city of Johannesburg (in itself welcome since my hotel and meetings are in the posh northern suburbs) to an area filled with refugees and asylum seekers from all over Africa. Most of the 30 men and adolescent boys in the workshop are street kids or otherwise highly mobile. Some of them gave off a really tough vibe, yet when the workshop leader introduced me as a special guest and said that I work at Global AIDS Alliance, they all started cheering and clapping and several reached out to shake my hand and said “welcome sister.” It was a very warm welcome! It didn’t seem that my presence there really interrupted their honesty either, something I was a bit concerned about before going. When I arrived, the workshop was focused on expressing emotions. I immediately had my first impressions shattered, as expressionless street-wary teenage boys said that they have learned that women’s emotions are important too, and that relationships are supposed to be mutually supportive, sex included. They even mentioned male privilege and talked about how the men in the room (all black) can understand women’s disempowerment because they know what white privilege feels like. It was a fascinating correlation, and probably quite effective. While there were two or three participants who felt that there is so much attention on women’s issues now that men are left aside, it seemed that most of those in the room were genuinely coming to recognize that they live in a man’s world. Some of them even said so directly!

I know that EngenderHealth has data to show attitudinal change as a result of the MAP program—participants fill out a questionnaire at the beginning and end of the 5-day workshop regarding their views about relationships with and treatment of women—seeing the program in action definitely gave me hope that a whole set of men and boys are being reached, encouraged to think about their roles in women’s lives and to value the women and girls in theirs. I still feel that it is difficult for many men to really champion a feminist agenda, but I am grateful to those men who are willing to challenge and break gender norms, to put themselves at risk of being seen as outsiders by refusing to allow the status quo to continue. Men can be feminists, too! So, in addition to beautiful weather (oh, it’s so warm here! How will I go home to winter?), birds singing new and amazing songs, and more to look forward to, I now have some new friends and a new perspective on including men in the fight against gender-based violence.

Thursday, February 1, 2007

Going to South Africa

One of the things that drew me to my field is that I love to travel. I love to meet people whose lives are completely different from mine and realize how similar we are. So of course when my boss called me a few Fridays ago, apologizing for bothering me after work, and then asked me to go to South Africa to meet with an advocacy partner, I was really glad he had called!

I think the world imagines South Africans as brave, heartfelt people who are willing to fight for their freedom and their rights. They did so when they went up against the apartheid regime and won. Now they are doing it again, only this time the aim is to protect themselves, their loved ones and their communities against the twin crises of violence and HIV/AIDS. I feel so honored that I get to meet some of the activists doing this work. There's nothing like being fascinated by your job to make a work trip feel like a holiday.

Violence against women and children takes place every minute of every day, mostly beneath a veil of silence. Worldwide, one in three women will be abused sexually, physically or emotionally in her lifetime. Around 20% of girls and 10% of boys are sexually abused before they are 18 years old. These numbers are absolutely shocking. People who are beaten and violated have a hard enough time recovering emotionally, mentally and spiritually. But in a lot of cases, they also have a lot of physical recovery to do, particularly when they come away from their experiences infected with HIV. I'm not going to get into the sociology or physiology of how violence increases the risk of getting HIV (I wrote a paper on it called Zero Tolerance; if you want to know more just follow the link to the report on this blog). Suffice it to say that violence and HIV/AIDS often go hand in hand.

South Africa has one of the highest rates of HIV/AIDS in the world. But it also has one of the highest rates of interpersonal violence, especially rape. Maybe the highest rate in the world--without good laws and reporting mechanims it's hard to know for sure. But our South African partners and the data the government there has collected tell us that someone is raped every 26 seconds in South Africa. Stop and think for a moment: EVERY 26 SECONDS!!! Even though this may seem a bit hopeless, pervasive HIV/AIDS and rape, there is hope, because South Africa is filled with motivated people and organizations who are determined to make changes and help their country thrive. The Global AIDS Alliance is in solidarity with these outstanding people...and I get to go meet them!