Since the emergency of HIV and AIDS around about 1983, which come to over thirty years ago, the government, donor funders and other many Organizations have joined efforts to fight the pandemic.
In this Second and last part of the interview, THE NATIONAL COUNCIL OF PEOPLE LIVING WITH HIV (NACOPHA), TANZANIA CEO DEOGRATIUS PETER RUTATWA elaborates more to the Guardian Reporters, DANIEL SEMBERYA AND MARY MAZANZA on themany initiatives together with others have taken to beat the pandemic. READ ON …
Q: We understand the war against the HIV/AIDS pandemic involves many players, could you tell us what are these 13 networks NACOPHA is reported to be working with, and how beneficial is your collaboration with them?
A: As mentioned earlier, NACOPHA believes in and respects freedom of association. Individuals’ members of NACOPHA have their own networks that are registered as independent entities serving different interests of PLHIV from various social and professional backgrounds.
Such networks include Networks of young people living with HIV such as Network of young People living with HIV(NYP+), National network of Young people living with HIV (NNEYOP), Tanzania Young Positive Ambassadors (TAYOPA), Networks of women Living with HIV such as Tanzania Network of Women Living with HIV(TNW+), and Network of Tanzania Women's organizations living with HIV(NETWO+).
Others are the Networks of professional organizations such as Tanzania Positive Teachers Initiative (TAPOTI), Tanzania Journalists Living with HIV (YNJ+)Others include Services for
Health Development of People Living with HIV (SHDEPHA), Network of Disabled People
Living with HIV (NEDIPHA), Tanzania Network of Organizations of People Living with HIV ( TANOPHA, Tanzania Network of People living with HIV(TANEPHA) and Tanzania network of Religious leaders affected and infected with HIV/AIDS(TANERELA).
Q: At several seminars and other platforms on HIV and AIDS which The Guardian has attended, one common cry from HIV/AIDS agencies has been with relation to critical shortage of funding, general scarcity of resources and “deficient” support from the government. With most traditional sources of funding gradually reducing their assistance even further, do you see the likes of NACOPHA having a future – that is, being sustainable in the long run?
A: Public financing of the HIV/AIDS response interventions is probably the most important and decisive subject when it comes to future consideration of efforts in the response to the epidemic control In Tanzania, the challenge is compounded around three major factors; firstly, the total amount of resources available is only about half of the required level,.
According to TACAIDS analysis, secondly, some 95 percent of all HIV/AIDS resources (recurrent expenditure) has been coming from external development partners, which is not safe and, thirdly, the overall trend of available resources has been going down over the last three or four years, as you correctly suggested.
The obvious consequences of low financing include the widespread insufficiency of service supply compared to the needs and national plans. This is a serious and worrying trend, calling for immediate and decisive actions by our policy makers.
It is our view and urge to the Government of Tanzania to consider the HIV/AIDS epidemic as a key social and economic issue, just like construction of roads, railways or the national push towards industrialisation of the economy. A careful analysis of nearly all key goals, results and indicators of the national development planning, which are supposed to guide national budgetary allocations, will show that these goals, results and indicators will be negatively affected by the insurgence of HIV in the population.
Some of us remember very well what happened some years back in highly infected areas like the regions of Kagera, Iringa and Mbeya before the introduction of ART services, which pushed back that perilous tide, thanks to scientific innovations and many partners who spent resources on procuring and distributing the antiretroviral drugs. This means, spending public resources on HIV/AIDS is an investment in social economic development rather than a humanitarian service to PLHIV.
For us at NACOPHA, our spirit is more important than the financial or other resources. Even if there is no single financial support, NACOPHA will still prevail because HIV/AIDS is our own life. When we first decided to come together and raise our voices there wasn’t much financial help coming our way. We have learned to cope and survived a lot of challenges, and are proud of our accomplishments.
The recent efforts by the government to officiate AIDS Trust fund are highly appreciated to ensure self dependency and sustainability in funding HIV response from own country resources. The funds target to reduce 40 per cent from donor funding. Despite all these efforts, we do not underestimate the consequences of dwindling financial support.
We need scaling up the access to treatment services, we need the services quality to be improved, the social and economic impacts of the epidemic within our community effectively addressed, we need to empower our members so that the voices of PLHIV are stronger, etc. If we get sufficient financial support needed in the health sector and to the meaningful engagement of communities of PLHIV, the likelihood to have a nation with HIV free generation tomorrow is guaranteed.
Q: In a presentation at The Positive Leadership Summit held in Durban (South Africa) on July 16, 2016, you personally advocated the need to ensure that domestic funding for HIV is directed into “the right things”. What exactly did you mean – and how clean is your own house (Nacopha) on that score?
A: Based on the experience and lessons leant form HIV programming and its associated HIV financing, the current NMSF (III) has prioritized on key strategic primary and secondary areas of investment. We must be guided by results oriented programming.
We must invest our resources where there is more impact. In this case for instance, the
MNSF has prioritised five key strategic areas including Antiretroviral Therapy (ART), HIV
Counseling and Testing, Elimination of mother to child HIV Transmission (eMTCT) Comprehensive Sexuality, gender, Health education and services, and Condom provision and programming.
This means that financing of HIV intervention must primarily focus on these interventions, and their enablers (secondary areas of investments) given the scenario that we have mentioned above on HIV financing, one needs to differentiate where impact can easily be seen if given resources.
Q: How do you see the future of donors funding the national HIV response, particularly in providing support to and engaging PLHIV in delivering HIV services?
A: It is evident that the major share (over 95 per cent) of the current funding on HIV response in the country is funded through foreign support. Development partners-It is also true that since in the recent past, there has been a decreasing rate and commitment of foreign support to fund the response.
However, few bilateral and multilateral agencies including the, US Government, Global
However, few bilateral and multilateral agenci s including the, US Government, Global fund, and the UN family have continued supporting the implementation of the national multi-sectoral strategic framework (NMSF III) including the PLHIV to achieve the national goals in addressing the HIV epidemic to-date.
The constituency of PLHIV hereby acknowledges the support of these agencies, and in particular the US Government through PEFFAR and USAID that are currently supporting our engagement as PLHIV in delivering HIV services in the community through the SAUTI YETU programme.
The US Government, the Global Fund and other partners are also supporting the country treatment programme, which is key to the quality life of PLHIV and the national prevention efforts against HIV new infections.
While we still hope that development partners will continue supporting the national and PLHIV efforts to combat HIV in the country, we remain optimistic that government efforts to reduce dependence on donors and sustain the HIV response efforts will remain its highest priority. The already established AIDS Trust Fund (ATF) needs to be quickly operationalised and expedite its efficiency.
Q: Figures by Tanzania’s National AIDS Control Programme for 2013 show that only 720,000 (0r 52 per cent) out of some 1.4 million PLHIL had access to treatment – that is, with a whole 680,000 out in the cold. What do you make of this scenario?
A: The treatment of HIV/AIDS, particularly by putting PLHIV on antiretroviral (ARV) drugs, is certainly the most important and helpful innovation we have seen as far as global efforts to address the epidemic are concerned. To a very large extent it changed the entire history of the epidemic in a number of ways.
Before introduction of ARV drugs, to most people, contracting HIV was quickly leading to bad health condition, body weakness and regular multiple illnesses. To many of us, ARV drugs have reversed that, people remain strong and productive, hence capable of supporting their dependents; the cost of treating opportunistic infections has been significantly reduced, and therefore relieving our public healthcare systems and many deaths have been averted.
It is estimated that between 2005 and 2013, the number of people dying from an AIDSrelated illness decreased by 44 per cent as the total number of people living with HIV in Tanzania has declined from 7 per cent to 5.1 per cent from 2003/4 to 2011/12. It is worth noting that proper application of ARV also reduces chances of new HIV infections We understand that availing ART services is very expensive.
In fact, it is the area consuming about 70 percent of the entire HIV/AIDS expenditure in Tanzania. It requires significant of investment including for conducting efficient and safe diagnostic services to detect HIV infections, several other laboratory services for management of the treatment programme training of health workers, procurement and distribution of the ARV drugs, which for many years were all being imported from outside Tanzania, nd all that is in addition to the development of physical infrastructure where Tanzania, nd all that is in addition to the dev lopment of physical infrastructure where the services can be provided well.
In organising the delivery of all such services considerations have to be made on factors like whether the client is an infant, child or adolescent; a pregnant woman, do they have other co-infections, etc. It is a complex process, and as I pointed out at the beginning of our discussion, it was a new disease and ART was even newer, so the systems have had to be built progressively.
In addition, the World Health Organization (and hence our Ministry of Health) has set several clinical criteria for initiation of ART to a person infected with HIV, especially in resource-poor countries like Tanzania. That is, not every PLHIV is immediately eligible for enrolment to ART services.
Having said that we also believe that every PLHIV will need ARV treatment at some point in their lifetime. In fact, in resource-rich countries every HIV diagnosis is instantly supported by ART access because the earlier one starts using ARV drugs the better. In the final analysis, it all boils down to the level of investment injected into the treatment program.
To date, with only about half of the PLHIV having been enrolled to ART, nearly the entire recurrent cost of the program is borne by external support, especially the United States Government (USG) through the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Global Fund for AIDS, Tuberculosis and Malaria (GFATM).It is a lingering dilemma to millions of PLHIV, especially in Sub-Sahara Africa, as to what would happen if these two global programs were to come to an end.
Enrolling more PLHIV to the treatment program demands additional financial investment, and that is the reason of our continued call upon our own Government of the United Republic of Tanzania to significantly increase its share of costs for HIV/AIDS activities. Not only that will enable extension of the services to more people in need, it will also help improve the quality of services by strengthening our health systems.
Will bring more health facilities closer to where the people live, avail medications for treating opportunistic infections, enable recruitment of more health workers and give necessary trainings needed to serve our own people and more equipment such as for laboratory services be functioning all the time.
Q: Where do you think the government, media, religious, educational/training, and other institutions as well as medical experts ought to work harder in a bid to fight HIV and AIDs?
A: To each one of these agencies and institutions, I think, their primary goal should be fulfilling their own roles and responsibilities with the common purpose of ensuring that Tanzanians, and all Tanzanians, are living better lives tomorrow than they did yesterday. With regard to the HIV and AIDS, the gaps are known and fulfillment of roles and responsibilities should seek to bridge those gaps.
The Government should aim to put in place good rational policy environment and strive to ensure th t are implemented fully, for the benefit of the people. The media’s role could be ensure th t are implemented fully, for the ben fit of the people. The media’s role could be about collecting and disseminating information that is educative but also mobilizing sense of accountability among agencies and the citizens, among others.
We should all be using the platforms bestowed upon us to remind each other of our roles and responsibilities. In that way we can listen to each other, find common grounds and move into the next step forward without intimidations or fear.