Nothing could be as much a mirror of poor people’s food plight as Thai farmers reportedly conducting armed vigils in their rice fields at night to prevent thieves from reaping the crop.

As a measure against nocturnal rice thefts, Thai authorities introduced a 6 p.m. curfew on combine harvesters, vehicles used to harvest the crop.

In Thailand, as in many parts of Asia, the price of rice has gone up dramatically in recent months tempting greedy and corrupt dealers to use any means available to get a hold of the pricey grain for either sell or hoarding. In fact, the hoarding of rice has been blamed for the price spirals forcing governments to impose buying rations.

According to the Asia Development Bank (ADB), approximately 1 billion Asians need assistance to cope with soaring food prices and shortages.

The purchasing power of many of Asia’s poor has been seriously eroded reversing previous gains made in fighting poverty.

The International Herald Tribune describes rice, a staple food for half of the global population, as one of the “world’s most politically fragile crop.”

Like the price of rice, general food prices are on the rise in many parts of the world, forcing poor people to protest — sometimes violently — against governments.

Food riots have erupted in countries such as Haiti, Cameroon, Egypt, Indonesia, Senegal and Somalia, among others, threatening national stability or exacerbating conflict. Poor people, particularly children and those living with diseases, face the risk of malnutrition or death due to inadequate diets.

“It’s the worst crisis of its kind in more than 30 years,” Jeffrey Sachs, and economist and UN special adviser recently told The New York Times. “It’s a big deal and it’s obviously threatening a lot of governments. There are a number of governments on the ropes, and I think there’s more political fallout to come.”

Experts say that food reserves are at their lowest in 35 years, and there is a systemic imbalance between the forces of supply and demand that cannot be fixed in the short term. UN statistics show that global food prices have risen by 65 percent since 2002 to levels increasingly beyond the reach of the poor.

The current food quagmire has been festering over the years with little to no media attention.

“In the seven of the last eight years consumption has exceeded production, which can happen only if we draw down our stocks. The carryover, the grain in the bin when a new harvest begins, is the seminal indicator of food security, and it’s now down to 54 days consumption, not much than is needed to fill the supply line,” says Lester Brown, president of the Earth Policy Institute.

Nearly 1.7 billion people in Asia — three times the population of Europe — live on less than US$2 a day, and to them the spiraling food prices are like a shockwave.

“The world’s food import bill will rise in 2007 to $745 billion, up 21% from last year, the FAO estimated in its biannual Food Outlook. In developing countries, costs will go up by a quarter to nearly $233 billion,” reports Time Magazine.

Asia’s poor are particularly vulnerable to rising food prices for staples such as rice because 60 percent of their spending goes toward food and the figure rises to 75 percent if transport costs are included, according to the ADB.

Many countries in the region have resorted to banning food exports and imposing price controls; however, the ADB warns that this could worsen the crisis, as farmers will stop growing crops that bring a negative return on investment.

An assortment of causes have been cited for the ongoing food crisis from climate change, population growth, increased consumption of meat in Asia, particularly India and China, a ballooning oil price, focus on bio-fuels to greed and corruption.

According to experts, the transportation of specific commodities over long distances chews up a lot of oil, which in a context of a skyrocketing oil price is responsible for the food price hikes.

Also, the fact that many people in Asia and other parts of the world now eat like North Americans is also an underlying factor for the upward spiral of food prices. The more people eat meat, the less food will be available to satiate empty bellies of the poor because grains meant for human beings go to fattening chickens and animals for meat. Continued growth in meat output is dependent on feeding grain to animals, creating competition for grain between affluent meat-eaters and the world’s poor, says the World Watch Institute.

In addition, the increased commercialization of agriculture has negatively impacted the productivity of small farmers. Consequently, small farmers opt to abandon the land, and trek to urban areas in search of proverbial greener pastures.

According to a United Nations Population Fund (UNPFA) report between 2000 and 2030, Asia’s urban population is expected to increase from 1.36 billion to 2.64 billion, putting pressure on urban areas which are already incapable of meeting everyone’s food needs.

As the Asian food story reveals, to avert a global food crisis requires a multi-disciplinary and multi-dimensional approach that employs short term and long-term measures.

In the short term, bilateral and multi-lateral agencies can lend monetary support and food aid to help seriously affected countries cope with the food crisis. While government subsidies can help the poor to withstand the food crisis, it is not a sustainable strategy in the long-term.

National governments will need to invest in agricultural systems in a manner that keeps small farmers engaged in the production of food with a guarantee of support, fair compensation and improved access to market information.

The ADB recommends that farmers need to have access to reliable and affordable seed, fertilizers, pesticides and credit.

In the long-term, agricultural research, improvement of irrigation systems and the development of new technologies, including improved seed and crop varieties suited to specific climatic conditions, are essential to improving yields.

The use of low cost technologies such as drip kits and treadle pumps can also help farmers to make optimum use of land and water in the face of global warming. Labor-saving technologies that will adapt agriculture to new conditions generated by rural-to-urban migration can help to compensate for the depletion of labor.

As UN Secretary General Ban Ki-moon succinctly put it, the longer-term challenge is to boost agricultural development, particularly in Africa and other regions most affected.

With increased political will, fair trade and investments into agricultural systems, hopefully rice farmers in Thailand will, once again, have nights filled with sleep unafraid of waking up to a bare rice field harvested by some unscrupulous characters bent on making a quick dollar.

Across sub-Saharan Africa, new moms are at risk of falling into depressive states that can potentially damage their own mental health and well-being of their new born child.

In many parts of the continent, public health systems are ill-equipped to deal with post-partum depression which affects a significant number of women after giving birth. The situation is made worse by the absence of psychiatrists or clinical psychologists trained to help women cope with the condition.

According to researchers, post-partum depression (also called post-natal depression) affects as many as one in five women, particularly during the first year of motherhood. Less than 2 in 1,000 women are also at risk of developing postpartum psychosis.

The condition causes mothers to feel exhausted and emotionally empty and can potentially destroy the bonding between a mother and her new-born baby.

“Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth,” reports the Scientific America journal.

According to the journal, dramatic hormonal fluctuations that occur after delivery may contribute to postpartum depression in susceptible women, but causes of the disorder are not fully understood.

“A longer term consequence of not diagnosing and treating postpartum depression is the effects it can have on the family, including the parental relationship and the development of the child. Children of depressed women have been found to have attachment problems, higher rates of behavioural problems and lower vocabulary skills,” states a report titled Postpartum Depression: A Literature Review.

For some new moms, the situation can be so severe it can lead to cases of infanticide and suicide.

However, among African women, little to no studies have been conducted to better understand the condition, and the way that women cope in the absence of appropriate public health services.

It is possible to surmise from existing data from other parts of the world the general experience of African women following childbirth.

A study by the University of Iowa revealed that low-income women are much more likely to suffer from postpartum depression than wealthier women.

The research revealed that women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills.  

The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman’s ability to cope with these already difficult circumstances, according to the study.

The study which focused on a sample of 4,332 new mothers from four Iowa counties showed that that compared to white or Latino mothers, African-American mothers are more likely to experience depression after having a baby.

Furthermore, the study revealed that African-American women tend to have weaker support networks, a major predictor of postpartum depression.

Like African-American women, African women that give birth are also affected by low incomes and high levels of general and live in stressful contexts which increases the onset of depression.

While there is clearly  a need for more research into the coping methods of African women, simple screening methods can be utilized to identify women that are at risk of postnatal depression. Nurses in public health settings need to be provided with training so that they are able to detect and assist new mothers from post-partum depression. The use of a simple tool, the Edinburgh Postpartum Depression Scale, translated into local language, can assist nurses, family members and new moms to detect depressive symptoms.

If anything, public educational and awareness raising programs or simple pamphlets and posters describing the condition need to be displayed in ante-natal clinics so that women are mentally prepared to deal with the problem.

As research shows, social support networks can also play a key role in helping women deal with postnatal depression.

Overall, it is essential for national government throughout the world to guarantee that new moms have access to clinical and maternal services that can help to avert the emotional upheavals associated with giving birth.   

Although the female condom has been heralded as a way for women to protect themselves from HIV and STI infections, its impact has been severely limited due to several reasons including its design, cost, access, stigma, and lack of political will.

Given the fact that women are the most affected and infected by HIV (in 2007, women represented half of all HIV infections worldwide, and 61% of HIV infections in sub-Saharan Africa) it is an imperative that evidence-based measures be undertaken to reduce their vulnerability.

The female condom is an essential sexual reproductive health tool that women can control but, disappointingly, it remains confined to the fringes of the response to the global AIDS epidemic.

According to a report by the Center for Health and Gender Equity titled “ Saving Lives Now: Female Condoms and the Role of US Foreign Aid” the US has an important role to play in the procurement, distribution and programming of female condoms.

As a leading provider of funding for HIV and AIDS prevention, treatment and care, and reproductive health supplies worldwide, the US can promote the wider use of the female condom, including reducing the cost which is beyond the reach of many of the affected women. 

The report notes that there is little knowledge among policy makers and advocates about what the current US role is and, thus, a lack of understanding of what more the US should do.

“Bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms have significantly hindered the expansion of U.S.-funded female condom distribution efforts,” says the report.

“The U.S. government has no policy guidance encouraging missions or contractors to promote female condoms, which has meant that female condom procurement is dependent on a few field-level champions who are committed to the method,” adds the report.

Currently, international donors and government are investing millions of dollars and energy into promoting initiatives such as male circumcision, and little attention is being paid to promoting female condoms which allow women to initiate protection.

“While the unique nature of female condoms in providing women with their own source of protection should be reason enough for donors and governments to promote the method, female condoms hold other advantages as well. They fill their own niche, as consumers often alternate their use with that of male condoms, thus increasing the total number of protected sex acts,” states the report.

“They can be used by women living with HIV who do not wish to become pregnant, to protect against superinfection and to reduce the chance of HIV transmission to seronegative partners.”

In addition, female condoms also provide an additional option for protection during anal intercourse for men who have sex with men and heterosexuals, says the report.

In spite of the apparent benefits of the female condom, there are still major challenges in promoting its use.

Apart from the fact that female condoms are prohibitively expensive in many parts of the world, users find them noisy, physically unappealing, or difficult to use.

“However, female condoms are a cost-effective mechanism for HIV prevention when measured against thevcosts of potential HIV infections or other HIV prevention mechanisms. Also, as more and more female condoms are produced and purchased, their cost will drop,” states the report.

With greater financial investment and commitment, the design of the female condom can be improved increasing the likelihood of uptake by women.

Furthermore, there is need for educational and social marketing programs aimed at reducing the stigma associated with use of the female condom as well as improving consistent and accurate use.

According to the report, civil society groups can be extremely valuable in developing effective programming because of their access to populations vulnerable to HIV infection and their experience working with these groups.

The report makes the following recommendations to improve US’s role in the distribution and use of female condoms:

• USAID and OGAC should issue policy guidance promoting female condom procurement and programming within US-funded development programs, including PEPFAR. As a signatory of ICPD, the US should promote female condoms as a vital tool to prevent both pregnancy and HIV infection.
• The US should expand technical assistance for female condom logistics and procurement to additional countries to increase HIV prevention efforts.
• The US should apply intensive programming efforts to an additional three countries for scale-up and replication. These efforts could be used to create a more realistic assessment of global female condom needs for scale-up.
• The US should increase HIV prevention efforts by expanding the scope of female and male condom promotion to encompass the general public. Programming for female condoms will depend on each area’s epidemiological profile, and should be free of messages and attitudes that stigmatize condom use.
• The US should invest more funds in female condom promotion and programming. The US should subsidize female condoms for PEPFAR-funded programs.
• At the country level, the US should include civil society, especially women’s health and rights groups, in stakeholder meetings and encourage financing mechanisms that increase government-civil society collaboration in female condom programming.
• Congress should remove all earmarks and funding directives for abstinence-only, abstinence-until-marriage and fidelity prevention programs and fund comprehensive, integrated, and evidence-based HIV prevention programs that include female condoms and that promote and protect women’s health.

To respond effectively to the growing epidemics of AIDS and TB around the world, a strategy for communicating messages that influence change of individual behavior, community attitudes and socio-political dynamics is absolutely critical.

In order to make communication effective, there is a need to fully and rigorously understand the audiences, including contextual factors (political, cultural, economic, gender etc.) that determine the health choices people make.

The underlying factor is that communication does not occur within a vacuum, and thus it is essential to be aware of elements that may deter effective communication in the design, distribution and measurement of AIDS or TB messages.

Communication that saves people’s lives, improves health and enhances well being is about ideas, creativity, research, knowledge and money. Given the fact that resources are finite, strategic communication needs to consciously build upon existent social capital to ensure sustainability of processes.

Strategic communication can help to shape context and build relationships that enhance the achievement of objectives to respond effectively to AIDS and TB.

To be effective, strategic communicators must understand attitudes and cultures, respect the importance of ideas, adopt advanced information technologies, and employ sophisticated communication skills and strategies. To be persuasive, they must be credible.

More importantly, strategic communication for better health appreciates what works scientifically combined with flexibility to adapt it to specific cultural contexts.

As already stated, it should go beyond simply addressing individual behaviour to structural and institutional realities that are largely responsible for driving diseases and epidemics. In many ways, public policies tend to be responsible for social and health inequalities and cannot be ignored in the communication process.

Therefore, an effective communication strategy puts people and structural realities at its heart in the design, development, implementation and evaluation of messages.

In essence, strategic communication for better health needs to be informed by a process that identifies behaviours and attitudes, identifies policy priorities, and embarks on a process to influence a broad section of society through appropriate themes and messages.

In that respect, communication is not an end goal, but rather a means to influence dialogue and engagement through relevant mediums.

Labouring over which medium to choose when targeting a specific audience is a critical component in the communication for health process. In many ways, the medium defines the message in as much as does the target audience. A chosen medium has its limitations, and key messages and themes have to be aligned to the limitations of the medium to ensure effective message delivery. Obviously, the research-based needs of a target audience determine what delivery mechanisms to utilize.

It is important to know at the outset what goal seeks to be achieved with the particular choice of a medium so that the measurements of success or failure are specified.

Events, activities, messages, and materials must be designed with your objectives, audiences, partnerships and resources clearly in place. Building a communication strategy is about directing and focusing evidence-based messages and themes according to clearly defined pathways to achieve intended objectives.

The process of strategically positioning communication needs to ensure the participation of intended beneficiaries in the designing of messages, no matter what the level of focus.

Strategic communications shifts away from communicating to, and instead focuses on communicating with target groups in order to establish solutions., with emphasis being on how to build a relationship that allows for communication to take place so that appropriate action is taken. In that sense it is a significant shift from the magic bullet theory of communication which treats audiences as inactive recipients of messages.

Fact-based communication research is necessary for demonstrating and validating the need for resources required to increase the impact of communication. It is also essential that message platform for key initiatives are identified through the research process.

According to Wikipedia, “strategic communication provides a conceptual umbrella that enables organizations to integrate their disparate messaging efforts”. In other words, it enables organizations to “create and distribute communications that, while different in style and purpose, have an inner coherence”.

New media offers a significant opportunity to unify organizational health communications in order to achieve that inner coherence which is often times based on the vision, mission, goals and values of the organization.

New media offer an opportunity to encourage conversation and promote collaboration in creating appropriate messages. It is essential to integrate social media into the communication infrastructure and tap into its potential to create dialogue and reach a wide audience. New media make it easier and faster to communicate and collaborate, and essential element to public health communications.

The ability of new information tools to alter the way we communicate needs to be tapped into but as with any component of the health communication process the focus must be on people and not just the technology.

Overall, a strategic communication process needs to be planned, directed, coordinated, funded, measured and conducted in ways that promote the wellbeing of individual in a manner that aligns with organizational values and goals.

Lusaka, Zambia - Just a stone’s throw away from the posh Manda Hill Shopping Mall in Lusaka, Zambia’s capital city, little kids mill around traffic lights sniffing glue and pestering motorists and pedestrians alike for money, food and whatever else they can scrounge.

Many of the kids, dressed in filthy rags, are regarded as a menace to society due to their antisocial behavior. Near the traffic lights a big poster warns the public not to give money or food to the children, euphemistically referred to as “street kids.”

According to the poster, giving money or food only causes the children to remain on the street. Put in other words, the social menace that many of the nouveau rich in this leafy and suburban area fear will continue to grow.

Many of the so-called street kids are part of a generation of children in Zambia that is growing up without parental care, support or guidance. The children are vulnerable to exploitation, abuse and disease.

The United Nations Children’s Fund (UNICEF) estimates that there are approximately 1,250,000 orphans in Zambia — that is, one in every four Zambian children — with about 50 percent under nine years of age.

Orphans are defined as children who have lost one or both parents. The extended family network, a traditional safety net for orphaned children, is breaking apart due to the enormity of the HIV crisis throughout the country.

Additionally, the huge number of orphaned children is overwhelming national health, social welfare and education systems in Zambia, as in many parts of sub-Saharan Africa.

Most of the children face a bleak future, without parents to care for them and with little, if any, assistance offered by the government.

The children are often traumatized by the death of parents, stigmatized through association with HIV and often thrown into desperate poverty by the loss of breadwinners. They live under enormous pressure and suffer depression and other psychological problems.

Young girls, in particular, are the first to be denied educational opportunities in favor of boys and are forced into early marriages with older men, which put them at higher risk of HIV infection.

Children, both girls and boys, turn to the streets in search of a better life but the reality that confronts them can only be described as grim. Street life creates extreme vulnerability to violence, exploitative and hazardous labor, sex-work and trafficking.

In fact, internal trafficking of children has become rampant in Zambia. Sadly, there is little to no awareness of this social malaise.

Nothing short of a Herculean effort is required to help the growing legion of orphans in Zambia to lead normal lives. A holistic approach that includes provisions for nutrition, health and cognitive development, and educational and psychosocial support is required to effectively respond to the orphan crisis in the country.

Addressing these basic needs at an early age would give orphaned children a healthy start and a more-hopeful future.

Strengthening family systems and community care mechanisms is fundamental to this holistic approach because putting children into institutional homes can have a devastating effect on their self-worth and identity.

Furthermore, there needs to be a concerted effort to keep children in school because school is one recognized shelter that can help the children to discover their own potential.

The government must protect the children of Zambia with improved institutional, legal and social conditions, hopefully bringing an end the need to “protect” motorists from “street kids” at traffic lights.

On a scorching day in Zimbabwe’s Buhera District, approximately 300 people queue to receive food handouts. All of them are beneficiaries of the food packs that local NGO Dananai Home-Based Care (HBC) has been distributing to people living with HIV and AIDS for the past five years.

Though Dananai HBC’s main mandate is to provide care and support to critically ill people living with HIV and AIDS it became apparent to the group that further interventions were needed to help improve patients’ living conditions.

In 2002, Dananai HBC partnered with Africare and WFP to provide food handouts in an attempt to meet the nutritional needs of people living with HIV and AIDS involved in the home-based care program and their dependents.

As the sun threw its hot rays across the sky, a slight easterly wind breezed through the slender gum trees at the local clinic, which serves as the food distribution point. The hordes of people chatted among themselves, some waiting for their turn to receive the food handouts, while others pushed wheelbarrows filled with maize sacks back and forth.

Some sat on the sacks, waiting for cattle-driven scotch carts to take them across the hot landscape to their homes. Meanwhile, an old woman crouched onto her knees and began picking at the grains of maize that had fallen to the ground, putting them slowly into a green plastic bag. As the bags of maize are pushed and shoved, some inevitably tear, and maize grains fall out.

Three women in the queue told her stop but she shot a retort back at them and they turned their attention back to the business of receiving food rather nonchalantly. The old woman began curtsying as she concentrated on picking the fallen maize grains.

‘We see this all the time. The people cannot tolerate the sight of maize grains on the ground. No grain can be wasted, so they pick it, one by one,” an Africare program officer responsible for overseeing food distribution said.

Africare, an INGO is responsible for the actual distribution of the food and the recipients of the aid are identified through the Dananai Home-Based Care project. If a recipient living with HIV dies, their family is allowed to continue collecting the food for six months before their handouts are cut.

The food handouts are popular in the community due to the high levels of poverty. The rainfall pattern in the area is erratic and subsistence farming, which many of the people in the district practice, has suffered immensely as a result. The district has experienced four consecutive droughts in the past decade alone.

“I have been to many households in the district, and many do not have any grain stocks. The situation is pathetic,” said Nonia Temberere, coordinator of Dananai Home-Based Care project.

Many of the households in the community are headed by women, either because they have been widowed or because their husband works and lives elsewhere. It is through the eyes of women that the impact of HIV and AIDS on this community is best reflected because they have been forced to work hard to feed their families as well as to provide care and support to the sick.

It is no coincidence that many of the people in the food queue are women. According to Africare workers, special care is taken to make sure that women are the main recipients as men tend to be less responsible with the provision of the stocks.

But the availability of food is creating a schism within the community and has resulted in increases in the numbers of people requesting HIV tests. Due to the levels of food, those receiving food through the home-based care program are perceived as better off than others because they have access to food.

So the demand for inclusion in the program is growing and hordes of people have been reporting to the HIV-testing facility at the Roman Catholic-funded Murambinda Mission Hospital.

“Some people get sad when they test HIV-negative,” said the coordinator of the New Start Voluntary Counselling and Testing centre, which conducts provider-initiated HIV testing at the Murambinda Mission Hospital.

If patients tests positive for HIV, they are immediately referred to the hospital or the Medecines San Frontieres (MSF) opportunistic infection clinic that distributes antiretroviral drugs (ARVs). Critically ill patients are incorporated into Dananai HBC programs through volunteer caregivers living in their community.

But testing positive for HIV is not enough and to enroll in the program patient must be on ARVs, in a critical and disadvantaged state and they must need food assistance.

This message does not seem to have reached some members of the community and there have been some accusations that community leaders, responsible for selecting beneficiaries, are biased and have only selected their friends and relatives.

As the old grandmother picked the fallen maize, it was clear from her bedraggled stature that she badly needed some assistance. She is, however, not on the list of beneficiaries and she is angry at the blood tests she took.

“I have taken three blood tests but they have not said anything to me. They can take more of my blood if they want, but for God’s sake, they should also give me food,” she said, scooping a handful of maize grains mixed with soil from the parched ground.

“I have a problem with my back from a pregnancy operation that I had in 1952,” she said, adding, “If my son was still alive, this could never happen to me.”

She pulls a wad of documents out of her green plastic bag and selects the record of her son’s death.

“I look after his three children. I also showed them this but they still refused to include me in the list. These organisations should go to the community and see the favouritism that takes place in the selection process,” she said.

“One of the problems is that as sick people receiving ARV treatment become well, and are able to perform normal duties and still receive food ahead of household that may be less privileged. There are always accusations of favouritism,” an Africare worker said. “The food is meant for those that are ill.”

According to Africare’s records, the number of people on the waiting list for food aid is overwhelming. MSF, which is also partnered with Dananai HBC, has seen a huge increase in the number of people needing ARVs.

The availability of food is one of the keys to helping Dananai HBC recipients to regain control of their lives. In the absence of nutritious food, the success of ARV treatments is severely compromised.

Many of the households in this district, which relies on subsistence farming, face food insecurity and find themselves hard hit by a disease that preys on society’s weakest. The challenges faced by Dananai’s HBC project mirror the challenges facing the country in general. At the heart of the problem is the need for food.

Poor access to water is also a problem for many communities. It is ironic that though the Bangure area in Buhera has the large 1970s Rundi Dam, the only benefit to the community is the supply of fish from the water catchment.

The need for food makes many of the communities in this area overly dependent on external assistance. Hungry stomachs appear to make many of the communities lie on their backs with legs crossed and lethargy seems to stalk the land.

The communities are just beginning to awaken to the need for HIV testing and the power of ARVs, but they are also fully aware of the fact that food security remains a big challenge.

Most Zimbabweans -  about 70 per cent of the population - live in rural areas and are engaged in smallholder agriculture. These smallholder farmers, particularly in the country’s low rainfall areas, are extremely food insecure and have little or no access to new technology.

They suffer from low incomes and a generally low standard of living, poor health and nutrition, poor housing and an inability to send children to school. Soil degradation and outdated farming methods have kept rural families trapped in poverty.

Inadequate and unreliable rainfall and the recurrent threat of drought also restrict the potential of rain-fed agriculture, on which the livelihoods of most smallholder farmers depend. In a word, access to water for irrigation is one of the most critical constraints that small farmers face.

Making matters worse, AIDS is undermining agricultural systems and affecting the nutritional situation and food security of rural families. As adults fall ill and die, families face declining productivity as well as loss of knowledge about indigenous farming methods and loss of assets.

The devastating consequences of the epidemic are plunging already poor rural communities further into destitution as their labour capacity weakens, incomes dwindle and assets become depleted, with the latter affecting mostly women and children who have few property rights.

According to a survey conducted by the Zimbabwe Farmers’ Union, agricultural output in communal areas has declined by nearly 50% among households affected by AIDS in relation to households not affected by AIDS. Maize production by smallholder farmers and commercial farms has declined by 61% because of illness and death from AIDS.

Women and girls are especially vulnerable. They face the greatest burden of work - given their traditional responsibilities for growing much of the food and caring for the sick and dying in addition to maintaining heavy workloads related to provisioning and feeding the household. In many hard-hit communities, girls are being withdrawn from school to help lighten the family load.

The International Fund for Agricultural Development (IFAD) describes household food security as “the capacity of households to procure a stable and sustainable basket of adequate food” (IFAD, 1996). It incorporates: (a) food availability; (b) equal access to food; (c) stability of food supplies; and, (e) quality of food. All aspects of this are affected by both the household-level impact of HIV/AIDS and the wider impacts of a generalised HIV/AIDS epidemic.

In households coping with HIV/AIDS, food consumption generally decreases. The household may lack food and the time and the means to grow and prepare some food. For the patient, malnutrition and HIV/AIDS can form a vicious cycle whereby under-nutrition increases the susceptibility to infections and consequently worsens the severity of the disease, which in turn results in a further deterioration of nutritional status.

The onset of AIDS, along with secondary diseases and death, might be delayed in individuals with good nutritional status.

Nutritional care and support may help to prevent the development of nutritional deficiencies, loss of weight and lean body mass, and maintain the patient’s strength, comfort, level of functioning and self-image.

In effect, the nutritional status of HIV/AIDS patients can also help improve the effectiveness of antiretroviral therapy, when it does become widely available to poor rural people.

In such a context, labour-saving technologies that will adapt agriculture to new conditions generated by HIV/AIDS can help to compensate for the depletion of labour caused by sickness and death.

Drip-irrigation is a low pressure, low volume irrigation system suitable for vegetables, shrubs, flowers and trees, and can be helpful when water is scarce or expensive.

Already popular in countries such as Israel and India, drip-irrigation has been gaining attention because of its potential to increase yields and decrease water use, fertilizer, and labour requirements, if managed properly.

Drip irrigation (sometimes called trickle irrigation) works by applying water slowly and directly to the soil. It is the slow drop-by-drop, localised application of water at a grid above the soil surface. Water flows from a tank through a filter into lines then drips through emitters into the soil next to the plants. The high efficiency of drip irrigation results from two primary factors. The first is that the water soaks into the soil before it can evaporate or run-off. The second is that the water is only applied where it is needed (at the plant roots), rather than sprayed everywhere as in sprinkle or furrow irrigation systems.

Nutrients can be applied through the drip systems, thus reducing the use of fertilizers. Soil is maintained in a continuously moist condition. With a 100 square meter garden, equipped with low cost drip kit technology, a family of five can grow nutritious vegetables for consumption throughout the year.

This inexpensive kit offers a 50 per cent savings on water, over 80 per cent yields, and better quality vegetables and herbs. Because of its minimal labour requirements, the kit is well suited to serve HIV and AIDS affected households headed by orphans or their grandparents, where labour maybe in short supply.

In Zimbabwe’s rural areas, HNGs are widespread, yet they are largely neglected in spite of their potential to cushion disadvantaged and AIDS-affected families from food insecurity. Ordinarily, a HNG is cultivated close to home, thus eliminating the need for farmers to travel to distant fields.

HNGs can play a significant part in enhancing food security in several ways, most importantly through: 1) direct access to a diversity of nutritionally-rich foods, 2) increased purchasing power from savings on food bills and sales of garden products, 3) availability of food throughout the season and especially during seasonal lean periods, and 4) savings on water, time and labour.

Improving household gardening requires the optimal use of land and irrigation, as well as a dynamic integration of additional crops and crop varieties with specific value and uses. A well developed HNG has the potential, when access to land and water is not a major limitation, to supply most of the non-staple food that a family needs every day of the year, including roots and tuber, vegetables and fruits, legumes, herbs and spices.

Roots and tubers are rich in energy and legumes are important sources of protein, fat, iron and vitamins. Green leafy vegetables and yellow-or orange-colored fruits provide essential vitamins and minerals, particularly folate, and vitamins A, E and C. Vegetables and fruits are a vital component of a healthy diet and should be eaten as part of every meal, and are highly recommended for people living with AIDS

Smallholder farmers generally grow three cycles of crops per year. Typically, this includes at least one cycle of vegetable crops during the winter months, and an early maize or bean crop that can be harvested in December. The exact cropping cycles and systems will depend on regional climate, soils and input availability, in conjunction with the specific skills and nutritional needs of the household.

Farmers are encouraged to grow locally available indigenous crops that are highly nutritive but often neglected. The crops contain good nutrients and often require low labour-input. They represent a flexible source of food supply and can be easily preserved. Besides providing a source of income, they are adapted to cultural dynamics and local food habits.

They produce ample seeds without creating a dependence on external resources. Because the technology is new, smallholder farmers require technical support and training to help them tap into the full potential of the kit.

By strengthening the capacity to produce food at household level using low-cost technologies, negative impacts can be mitigated for AIDS-affected communities. Labour saving technologies and improved seed varieties can help to compensate for the depletion of labour caused by sickness and death, and assist farm-households to survive prolonged crisis, such as that caused by AIDS. Through agriculture and rural development, resilience against HIV can be built.

Drip irrigation technology offers much promise for landholders in the communal areas of Zimbabwe, where water application has traditionally involved the use of surface irrigation and “bucket watering”. Both methods are inefficient and waste a lot of water. Using the bucket involves hard work especially when the water is far away and scarce.

With drip irrigation, communal farmers, especially women, who are the primary carers and pillars of the community, can be able to maintain their gardens with ease, efficiently and at a low cost.

Also, drip technology will give quick returns on a small investment, and growing vegetables will provide both nutrition vegetables and year-round incomes.

As the old Chinese saying goes: “Give a man a fish; you have fed him for a day. Teach a man to fish; and you have fed him for a lifetime.”

 ”If you’re a man, get cut today”

Male circumcision (the cutting of the foreskin from the male penis) is increasingly gaining currency among medical researchers as an alternative method to reduce HIV-infection.

But will this solution really work? 

Researchers say that if all men in sub-Saharan Africa — the worst HIV/AIDS affected region in the world — were circumcised over the next decade, roughly two million new infections and 300 000 deaths could be averted. 

An additional 3.7 million new HIV infections and 2.7 million deaths could be avoided in 20 years.

Put simply, while the benefit of male circumcision to an individual man is immediate, a large scale impact of the intervention will be realized in two decades. 

AIDS risk lowered by 60% 

In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60 percent the risk of men contracting HIV through sexual intercourse with women. 

The study focused on 3000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group. 

For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study. 

The argument is that the inner surface of the penile foreskin contains Langerhans cells, which have HIV receptors, and is also vulnerable to disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition.

Furthermore, the virus’ chances of survival might be higher in a warm, wet environment like the one under the foreskin. 

How will it affect society? 

The evidence that circumcision may protect against HIV infection is now considered strong enough that further trials evaluating the efficacy of circumcision as part of an HIV prevention program have been advocated.

This could herald a new era in HIV-prevention methods. But the question remains: what are the societal implications of such a solution? 

Male circumcision has been practiced extensively in some sub-Saharan communities in rites of passage ceremonies from boyhood to manhood. The gruesome circumstances under which such practices occur may be exacerbated in the light of this new evidence. Other communities have not practiced it at all. 

However, qualitative studies in the Botswana, Haiti, Tanzania, Zambia, and Zimbabwe revealed positive attitudes toward male circumcision in populations that do not traditionally practice it.

From 45 to 85 percent of uncircumcised men in surveys expressed interest in the procedure if it is safe and affordable. In spite of the interest in male circumcision, it is not a magic bullet in the fight against HIV-infection. To be effective, circumcision has to be promoted alongside condom use and faithfulness, long-established approaches in the fight against HIV. 

Education and money will be essential 

Some men may be tempted to engage in unprotected sex because they perceive they are protected by male circumcision. And some women may get a false sense of security when having sex with a circumcised man. 

In itself, male circumcision provides little or no protection against urethral STDs such as gonorrhea and chlamydia and certainly cannot prevent unwanted pregnancies. This issue will need to be strongly emphasized in social campaigns. 

To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs. There will be need for widespread and culturally sensitive dissemination of information that outlines the benefits and potential complications of male circumcision. 

Another danger is that male circumcision can be risky or fatal if conducted by untrained personnel. There’s no doubt that with increased knowledge of male circumcision as a barrier against HIV, many men will try to perform it on their own.

There will be obviously costs involved in getting circumcised which some people will try to circumvent. Circumcising large numbers of adult men will be a major undertaking. If circumcision is not performed correctly it will increase the risk of infection.

A major surgical system infrastructure needs to be developed. Who will fund this and how long will it take? Also, most health facilities in sub-Saharan Africa are in a shambles and ill-equipped to perform widespread male circumcision.

In addition, there’s also lack of social acceptability of circumcision in many of the sub-Saharan communities that have not traditionally practiced it. Besides the safety and acceptability issues, perhaps the greatest drawback is the financial means required to undertake circumcision whole scale.

Male circumcision will come with high costs through social mobilization efforts and upgrading of medical facilities. The more the men get circumcised, the more the success — and that’s tough ground. 

Imagine the social marketing message: If you’re a man, get cut today.

Imagine four African countries without any living soul - Botswana, Namibia, Lesotho and Swaziland - all because of deaths to preventable, treatable and manageable diseases.

Across Africa, public health systems are in a ramshackle state, as a result, over 8 million African lives are being lost annually to diseases, because people have little or no access to public health services.

“That figure of 8 million people dying annually is easily the combined populations of Botswana, Namibia, Lesotho and Swaziland dying in one year. At this rate, many countries will run out of burial space. Consequently Africa’s fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria - at 130 million - Africa’s most populous country,” said Rotimi Sankore, coordinator of the Africa Public Health Rights Alliance which is promoting the 15% Now! campaign to push African governments to adopt appropriate health policies.

“Investment in health is key to resolving this situation”

Maternal and child mortality, HIV/AIDS, malaria and tuberculosis are the main diseases affecting the populations yet governments are doing little to reverse the ide of deaths.

“It is clear that the vast majority of African governments have under-invested in health systems and there has been no long-term planning and understanding of health needs of citizens by government,” said Sankore

Heads of State African Union (AU) meeting in Abuja, Nigeria in 2001 agreed to commit at least 15 per cent of national budgets to health. But, six years later, only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge.

“To say it is tragic that in 2007 only two out of fifty three AU member countries have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy,” said Sankore.

Since the pledge was signed in 2001, Africa has lost a staggering 40 million lives due to a failure by African governments to develop, implement and fund comprehensive public health policies.

Worryingly, many of the governments are relying mainly on external efforts and donor funding to resolve their numerous public health problems.

“The leadership of most of the governments have not had to depend on the health systems of their countries for treatment and are therefore not committed to resolving the problem,” said Sankore.

According to the 15% Now Campaign, African governments must urgently implement their 2001 Abuja Declaration pledge to dedicate 15% or more of annual budgets to health care within three years. Commensurate to this must be a commitment to dedicate a significant chunk of the money to resolving the brain drain of health care workers, and addressing key concerns such as reproductive health, child mortality, HIV and TB.

“If you look at countries where health systems can meet the needs of citizens, anything from 15 to 30 percent of budgets have been spent on public health. In Africa, the lion’s share of budgets goes to military and defense spending,” said Sankore.

“The consequence is that once a higher percentage of citizens need health services, it becomes impossible for grants to deliver services.”

Currently, the doctor per patient ratio in Africa is appalling.

For example, the Democratic Republic of Congo (DRC) with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the France’s 203,000, Italy’s 241,000 and the UK’s 160,000.

Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years.

“To come anywhere near meeting the WHO recommended health worker to patient ratio or meeting the health based millennium development goals (MDG), these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years,” states the 15% Now! petition. “This is Africa’s priority.”

The 15% Now! campaign urges African governments to make the adoption of comprehensive health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress.

Some people argue that funding the health sector is not the solution, but if all the people are dead, what will the other sectors be for, said Sankore.

The loss of health care workers to developed nations is also a major factor contributing to the poor state of health care system in Africa. Some developed countries maintain domestic public health policies that promote the recruitment of health care workers from Africa.

Improving health care systems in Africa will require developed nations to abandon such practices. Because developed countries have benefited from poaching African health care workers, they have a moral responsibility to promote the training of healthcare workers to improve Africa’s health care workforce.

However, ordinary citizens in Africa are not informed enough to lobby their governments to adopt proper public health policies.

“The citizens are not adequately informed and it’s the job of organized civil society to inform and mobilize ordinary people to campaign for their right to health and life,” said Sankore.

Given the critical importance of good health to national development, an obvious question is why African governments pay little attention to the matter.

“There’s phenomena that health is a private matter, but the truth is every single citizen’s health issue when brought together presents a collective challenge. We may die individually of TB or HIV, but collectively our deaths impact society as a whole,” Sankore commented.

“Ordinary citizens in Africa have two choices - either they campaign for governments to accord their right to health, or they will die.”

But the fact is that if African governments do not meet their obligations, they will soon find themselves presiding over countries without people, added Sankore.

Implementing the agenda of the 15 percent Now! campaign, coupled with international donor support and policy change, offers the best chance for African governments to address the health needs of ordinary citizens.

“Doing nothing is not an option because if the situation persists, some countries in Africa will cease to function,” said Sankore.

Tuberculosis (TB) has a major impact on women’s sexual reproductive health and that of their children.

For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth.

The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality.

Unfortunately, there is little to no attention about women’s vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women’s health needs at the core.

More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fueling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world’s population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women’s specific needs.

Given the high rates of HIV infection among women in the region - the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.

Even with the availability of TB drugs women’s socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.

For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives.