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Casual Sex, Ignorance and Denial: A Lethal Combination    [
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    In the Heart of the Capital, Despair
    By Sarah Fort
    The Center For Public Integrity

    Thursday 30 November 2006

With few resources, a church named Redemption takes on poverty, hunger and other staggering causes in Haiti.

    Port-Au-Prince, Haiti - A mile or so down the street from the U.S. Agency for International Development offices in Port-au-Prince, on top of a former dump, is the neighborhood of Cit de Dieu. It is adjacent to Portail de Leogane, a neighborhood nicknamed Kosovo by the locals for the violence that has taken place there in the last couple of years. The whole area, located in the middle of the capital city, has suffered an increase in rapes, violent clashes with Haitian National Police, and gang activity.

    People here are poor, but not unaware of the violence not only at home, but elsewhere. "Haitians are very aware of what's going on in the world and always have a transistor radio to their ear," said Catherine Maternowska, a professor of anthropology and social medicine at the University of California, San Francisco, who did research in Haiti over the last two decades. "So when they hear about conflicts in areas around the world, they relate to them."

    In Cit de Dieu ("City of God"), women balance buckets of water on their heads, and children carry home used U.N. World Food Programme rice bags filled with food they've purchased from the market. Most of the houses have corrugated tin roofs; if they are separated, it's only by garbage-strewn paths. Some have walls that are also made of tin, instead of sturdier cement blocks. Rivers of sewage run through the neighborhood directly to the sea.

    This community is one of many here that have fallen off the radar screens of governmental and nongovernmental organization programs. The World Food Programme had a food distribution project in Cit de Dieu, but it stopped in 2005, leaving families to find food on their own. The one organization still helping to feed the community is a neighborhood church named Redemption.

    The church has a small clinic with a few bottles of medicine but not enough resources to serve this community with high rates of HIV/AIDS. People seeking treatment must walk about a mile to GHESKIO (Le Group Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), the nation's leading HIV/AIDS clinic and research institution.

    The crushing poverty of the area and its lack of resources present overwhelming challenges, and both factors contribute to the spread of HIV/AIDS.

    Mona Louis Juste, the pastor's wife and a nurse, says the biggest problem the community faces is hunger. Then come insufficient health services, education and jobs.

    At the edge of the neighborhood, down a rutted side street strewn with trash, is her husband's church. Founded in 1983 by Pastor Nicolas Louis Juste, Redemption Church sits on top of what used to be a dump. The people who moved there named the community Cit de Dieu.

    Madame Louis Juste says the church serves 2,000 to 3,000 locals. It also offers boarding rooms and runs a school, a clinic and a food program. Although the church serves a very needy population in Port-au-Prince, its only financial support comes from Pastor Louis Juste's concrete block business and bakery, U.S. church groups and individual donors.

    Jerry Bryant has been helping to spread the word about Redemption Church and Cit de Dieu. Although he lives in Indiana, he has been working with Louis Juste since 1999. He first heard about him through a handwritten letter on yellow ruled paper sent to his church.

    After many visits to Cit de Dieu over the years, Bryant now helps to collect money from around the U.S. to support church-based programs in Cit de Dieu and other Haitian neighborhoods. In 2006 he was able to send more than $100,000. Last year was less successful, and he sent about $30,000 to help support the food programs, orphanages and schools run by Redemption Church.

    The malnutrition is evident in some of the children's reddish-tinted hair and, according to Madame Louis Juste, most people in the community eat just one meal a day. It might be rice and beans or corn and rice. Haiti, along with Afghanistan and Somalia, has one of the worst caloric deficits per inhabitant (460 kilocalories per day) in the world.

    Families cook their meals with charcoal, but there isn't enough to spare to boil water, so it goes untreated. Women and girls are sometimes forced to walk for up to an hour to collect water. In a community that experiences violence on a daily basis, "one of the biggest things [that is needed to protect women] is ensuring proper infrastructure: water, electricity and fuel," said Nata Duvvury, director of the Gender, Violence and Rights group at the International Center for Research on Women. "These are the daily tasks that women have to engage in."

    Bryant said that with unemployment rates so high, "people will work for anything." He said that the pastor is particularly concerned about the older teenage girls in the community. The orphanage and schools have no programs for the girls after a certain age, and many of the girls turn to the street in order to survive.

    Madame Louis Juste says the life expectancy in this neighborhood is 45, but many people live to be 60 and she once knew one congregant who lived to be 80. There were many HIV/AIDS cases in the community when she first arrived, but now there are fewer because so many have passed away.

    HIV infection rates have decreased in Port-au-Prince in the past five years, but several sources, including the U.S. government's Country Operational Plan for Haiti in 2005, indicate that one of the primary reasons is that many of those who were HIV-positive have died.

    Maustere, 24, who goes by one name, is president of the youth group at Redemption Church. He is tall and thin, and because it's Sunday, he's wearing a suit. As he sips Coke from a plastic cup, he explains that two people volunteered to speak about HIV and abstinence to the youth at his church. But he says that although he thinks the message of abstinence was important for the youth, very few of them even attend the youth group anymore. There used to be about 100 members, but now there are only 20 to 30, he says.

    "I want you to know, I try my best without resources to keep people coming to the meetings, but it's difficult," Maustere said. "Youth are looking for better situations. There isn't so much faith in church leaders, and it's harder and harder to have faith that things will get better."

 

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    Casual Sex, Ignorance and Denial: A Lethal Combination
    By Olayinka Oyegbile
    International Consortium of Investigative Journalists

    Thursday 30 November 2006

Nigeria has been slow to respond to the HIV threat, and may be understating the epidemic's reach.

    Lagos, Nigeria - In Mushin, a threadbare suburb of Lagos, Hafsat Jamiu wipes away tears as she ponders the injustice of her fate. Through the window of her cramped, two-room apartment drifts the melodic voice of the muezzin summoning Muslims to prayer at the local mosque. Jamiu cannot hear the call. It is because of her HIV infection, which has left her hard of hearing.

    Instead, as three younger children swarm around Jamiu's frail frame, the eldest, an 8-year-old, puts his mouth to Jamiu's ear and repeats a visitor's questions loudly enough for her to comprehend.

    Jamiu explains that she has lived all her life in purdah, or wearing the veil, and has remained chaste. She was a virgin when she married her husband, a Muslim scholar, and was faithful to him.

    As it turned out, he was not as virtuous as Jamiu, and now she struggles not to be bitter. "I seek forgiveness from Allah," she says. When she was pregnant with her two youngest, a twin boy and girl, the maternity clinic tested her for HIV - the practice in Lagos state - and discovered that she was infected. She is grateful, at least, that the twins were not.

    As for her husband, he would never consent to being tested, but when he died five years ago, the doctor confirmed that the cause was HIV/AIDS.

    Jamiu's sad situation is all too common in Nigeria, the most populous nation in Africa and a society still deep in denial about HIV/AIDS. Despite Nigeria's relatively low HIV/AIDS prevalence rate of 3.9 percent for people ages 15-49, because of its sheer size it has the third-largest HIV-positive population in the world.

    Roughly 3 million Nigerians are infected with the virus, placing a staggering load on an already overburdened health care system. HIV-positive Nigerians still find themselves stigmatized and shunned, and a vast segment of the population remains ignorant of basic information about how to avoid infection.

    Worse yet, dangerous practices - including sex work, polygamy and female genital mutilation - put vast numbers of Nigerians at risk.

    Not surprisingly, Nigeria has been designated by the Bush administration as one of the 15 "focus countries" for the President's Emergency Plan for AIDS Relief, or PEPFAR, the five-year, $15 billion effort to combat HIV/AIDS around the world. Of the $110.2 million that PEPFAR spent in Nigeria in 2005, most went toward desperately needed antiretroviral (ARV) drug treatments and health care for HIV-positive Nigerians. Antiretroviral drugs are credited with transforming HIV/AIDS from a fatal condition to a manageable illness.

    But PEPFAR's $21 million prevention effort in Nigeria is more problematic. Few of the faith-based organizations involved in the effort are Islamic - despite the fact that 50 percent of Nigerians are Muslim. And while PEPFAR's ideological preference for abstinence and faithfulness over condom use for prevention meets with approval from Muslim as well as Christian leaders, it does little to protect women like Hafsat Jamiu, whose male partners' infidelities endanger their lives.

    n a speech in July, President Olusegun Obasanjo touted Nigeria's success in fighting HIV/AIDS, citing government surveys showing that the HIV infection rate among pregnant women at maternity clinics has fallen in recent years, from a national average of 5.8 percent in 2001 to 4.4 percent in 2005. Even so, he admitted, some parts of Nigeria - such as Iquita-Oron, a rural area in Akwa-Ibom state, which reported an alarming 14.4 percent antenatal HIV rate - had significantly higher rates. And some experts question whether the Nigerian government's seemingly encouraging data really is accurate.

    "I don't think these figures very accurately reflect the situation on the ground," UNICEF's Joshua Emmanuel, project officer on HIV/ AIDS, based in Abuja, told a U.N. news service in September. "I think we are seeing only the tip of the iceberg."

    Indeed, a 2002 report by the U.S. National Intelligence Council estimated that HIV prevalence in Nigeria might actually be as high as 10 percent. The NIC painted an exceedingly grim picture of Nigeria's future.

    "Given the already advanced state of the disease and the government's limited capacity to respond, we expect HIV/AIDS to infect as many as 10 to 15 million people by 2010," the report concluded. "This number would constitute roughly 18 to 26 percent of adults - close to the current rates in some of the hardest-hit countries in southern Africa."

    Young Nigerians are endangered when they engage in high-risk behavior. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), 78 percent of men and 29 percent of women in Nigeria ages 15 to 24 have had sex with a casual partner in the past 12 months.

    Not only that, but they're seldom taking precautions - only 46 percent of men in that age group used condoms in their casual sexual encounters, and just 21 percent of men and 18 percent of women in that age group can identify the ways HIV can be prevented.

    It would appear that many live in denial. A truck driver from Ikeja, for example, told a writer for the Nigerian Web site www.nigeriahivinfo.com that he has two wives at home and three other sexual partners as well but that he never uses condoms because he doesn't like them. Despite all that high-risk sexual activity, the truck driver didn't worry about becoming infected with HIV. "As you see me, do I look like an AIDS patient?" he asked.

    Sex with multiple partners is pervasive in Nigeria. In a 2000 adolescent health study, 41 percent of high school students said that they came from polygamous families. According to the study, 30 to 50 percent of adults in Nigeria reported current or past polygamy.

    Another problem that may contribute to the spread of HIV/AIDS is female genital mutilation. One study estimated that 19 to 25 percent of Nigerian women are subjected to the procedure, usually at a young age. A paper presented at the International AIDS Conference in Bangkok, Thailand, in 2004 estimated that 50 percent of Nigerian women undergo the cutting and documented the case of a 6-year-old Nigerian girl who became infected with HIV as a result of the practice.

    In July, Hajia Memunia Yakub Mohammed, director of coordination and support programs for the Nigerian National Action Committee on AIDS (NACA), complained to the Nigerian newspaper This Day that most Nigerians aren't taking prevention messages to heart. "Nigerians are yet to come to terms with the ugly consequences of the disease," he said. "We have not imbibed the lessons, nor seen the reason to change our bad habits which fuel the spread of HIV."

    In addition to Nigerian society not grappling with preventing HIV/AIDS, the country has been slower than others to respond to the threat of HIV/AIDS. According to a 2004 study funded by the U.S. Agency for International Development (USAID), it was not until 1999 that the Nigerian government began serious efforts to fight the epidemic, establishing national and state action committees.

    Our culture is very hostile to condom use," said Yemi Osilaja, executive director of Hope worldwide Nigeria, which receives PEPFAR funding to run an HIV/AIDS prevention program for youth. "For that reason, it makes a lot of sense to talk about abstinence. We tell them to abstain from sex until they are old enough for marriage, and thereafter remain faithful."

    PEPFAR has emphasized working with faith-based organizations, and Nigeria is no exception. But despite the high proportion of Muslims, most of the faith-based organizations working with PEPFAR are Christian. Of the PEPFAR sub-partners listed on the U.S. State Department Web site for Nigeria, most appear to have Christian religious affiliations, including such organizations as the Redeemed Evangelical Mission, the Christian Health Association of Nigeria and the Catholic Secretariat of Nigeria.

    In comparison, only two of the Nigerian faith-based groups listed in PEPFAR documents - the Muslim Action Guide Against AIDS, Poverty, Illiteracy and Conflict (MAGA) and the Muslim Sisters Organisation - seem to be Islamic. (Both are sub-partners of Family Health International, a U.S.-based NGO that received $29 million in PEPFAR funding in 2005.)

    MAGA's prevention activities include an HIV/AIDS awareness campaign for Muslim youth in the Mushin, Agege, Mosan-Okunola, Ayobo-Ipaja and Lagos Island areas of Lagos state. The group has organized training workshops for local Muslim clerics to teach them how to spread MAGA's primary prevention message - that abstinence and marital fidelity are the best protection against contracting the disease.

    "Our primary aim is to enlighten our people and add the Islamic values to the knowledge and counseling about the disease," said Abdulsalam Adetokunbo, program manager for MAGA. "We can counsel people in the areas of faithfulness and abstinence, which are the focus of PEPFAR."

    Before MAGA began its work a year ago, Adetokunbo said that some Nigerian Muslims refused to go to Christian organizations for HIV testing or counseling. "Some of them believe that Christians do not like them, therefore they could be injected with the virus," he said. "We are Muslims, and they trust us to give them correct information and attention. We meet with those who are in purdah and they are ready to speak with us. Some of them ask us to give them the address of our center because they feel that they do not want to go to kafiris [unbelievers] for treatment."

    Adetokunbo admits that MAGA's appeal to Muslims' virtuosity doesn't always work. "Even in the time of the prophet, 1,500 years ago, people fornicated. What about now? There are cases of people who fornicate. How do you stop this? You say 'be faithful', but if you fail to be faithful you can use a condom. We don't preach it openly, but we say it among scholars to help those we counsel. There is the case of a widow whose husband died recently. He died of AIDS, but the wife never knew. It was on his dying bed that she knew. The wife is in purdah, we advised her to go for test and she went and found out that she is [HIV-]positive. She is now living with HIV/AIDS. There are two or three of such cases that we have now. We now take them to the group they belong to and say, 'Well, you said AIDS is not real. Now you have a member living with it, so what do we do?'"

    But many Christian churches and organizations in Nigeria take a more unyielding position. In January, Cardinal Anthony Okogie, the leader of the Catholic Archdiocese of Lagos, condemned a proposed government effort to manufacture condoms, telling This Day that the effort would "encourage immorality, sex on demand, promiscuity, irresponsibility and prostitution."

    Brown University anthropologist Daniel Jordan Smith, who has studied the intersection of religion and HIV/AIDS, noted in a 2004 scholarly article that many Nigerian evangelical pastors view HIV/AIDS not as a health problem, but as the result of immorality. In his visits to Nigerian church services, Smith saw HIV-positive converts encouraged to testify about having led sinful lives before accepting Christ and he even heard stories of HIV/AIDS being cured through faith healing.

    "[T]he larger religious message that HIV/AIDS is the result of immorality and can be prevented by being a good, moral Christian contributes to a social environment in which the disease is highly stigmatized," he wrote.

    At the Redeemed Action Program Against AIDS (RAPAC), a PEPFAR-funded organization that is part of the Redeemed Christian Church of God, peer education programs for men, women and youth focus almost exclusively upon the "Abstinence" and "Be Faithful" components of the ABC approach to HIV/AIDS prevention. "We are a bit silent about the 'C' part, because we do not want to be seen as supporting or preaching the use of condoms," said program manager Laide Adenuga. "You cannot be telling people to abstain and still be giving them a condom on the other hand." Condom use is discussed only with couples in which one partner is infected with HIV - but only if they request it, she said.

    But while the abstinence-and-fidelity style of prevention that PEPFAR favors is approved of by Nigerian religious groups, some question whether it is the best approach in a country where alarming numbers of people - including those who are religious - engage in sexual behavior that puts them at risk of contracting HIV.

    In his article, anthropologist Smith cited the example of a 23-year-old hairdresser's apprentice in the Nigerian city of Kano, who said religious faith was the reason she didn't insist that her boyfriend use a condom when they had sex. "I met my boyfriend in church," the woman told Smith. "We are both children of God, and I know I can trust him. I only have sex with him because I love him and I know that he is only with me. I protect myself from pregnancy [using the pill], but I know he will not give me AIDS."

    In August, Peter Ebigbo, deputy vice chancellor of the University of Nigeria, called upon faith-based organizations to consider advocating condom use, instead of merely preaching abstinence, and asked them not to see HIV/AIDS as "a disease brought by God's anger."

    "In view of the alarming prevalence of HIV/AIDS among young people who get older and older before marriage, and become more and more involved in relationship before marriage, let massive ministering and advocacy be accompanied by the possibility of the use of condom, and let the rest be left to the person and his or her conscience, since we cannot change our faith because we want to prevent somebody from dying," Ebigbo said.

    But so far, Ebigbo's plea seems to have had little impact. Meanwhile, back in Mushin, Hafsat Jamiu's life is increasingly hard. As often happens to those with HIV in Nigeria, she has been shunned and abandoned by her relatives, left to support her four children on whatever she can earn as a seamstress. But Jamiu's sewing machine has grown old and is broken, and she cannot afford to have it repaired, so lately she has been unable to work. She worries about what would happen to her children if her health deteriorates further. Already, her eldest sometimes has to miss school, because she needs him to escort her to the hospital where she gets her antiretroviral medication. How will he get an education? And though she diligently takes the drugs that might prolong her life, what will happen to her family if she does become ill? Seeking forgiveness from Allah is all she feels she can do.

 

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    About This Data
    By Helena Bengtsson and Alejandra Fern a1ndez Morera
    The Center for Public Integrity

    Thursday 30 November 2006

    Washington - In the course of the investigative reporting for the Divine Intervention project, the Center for Public Integrity sued the U.S. State Department on behalf of the International Consortium of Investigative Journalists (ICIJ) to gain access to funding information for the President's Emergency Plan for AIDS Relief (PEPFAR).

    The government refused to release a database known as COPRS (the Country Operational Plan Reporting System), which is a massive collection of PEPFAR financial and program data. Instead, the State Department agreed to release two different PEPFAR grant datasets.

    One file contained a list of 2004 and 2005 PEPFAR grants called "central awards," funds awarded and managed by the U.S. Agency for International Development directly out of its headquarters in Washington, D.C. The second file was a list of PEPFAR grants allocated for the same period by U.S. government offices abroad.

    After reviewing the data, the Center decided to make available to the public only the centrally awarded grant dataset. This decision was made because the Center identified a number of errors and omissions in the second file with information regarding the grants allocated by the U.S. offices abroad.

    The flawed dataset shows PEPFAR money flowing from U.S. government primary contractors (prime partners) to their indigenous sub-partners in the field. The Center found more than 100 instances in which the total amount awarded to sub-partners was listed as being greater than the total amount received by their prime partners.

    For example, the dataset shows that prime partner International Rescue Committee in Uganda was awarded $294,690 for 2005, but that the amounts for its three sub-partners add up to $727,738 - more than double the prime partner's total.

    In another case, Africare in Tanzania got $150,000 in 2004, but its sub-partners' amounts total $285,134.

    Finally, Christian Reformed World Relief Committee was awarded nothing in 2005, according to the database, but its sub-partners reported receiving $851,986 from CRWRC.

    The State Department acknowledged "some sort of error in the data" and said it "continually works on improving data quality."

    Available to the Public

    The dataset of centrally awarded grants released here as part of this project corresponds to programs new to the U.S. HIV/AIDS foreign policy and with "high levels of congressional interest," according to the government. These programs include abstinence and fidelity programs, blood safety, safe medical injections, antiretroviral treatment and care for orphans and vulnerable children.

    Central awards are one-time, five-year grants. The dataset shows yearly obligated amounts for 2004 and most of 2005.

    The file released by the Center can be sorted by several criteria: country; program type; implementing organization; organization type (host government, faith-based, nongovernmental, multilateral agencies, private and universities); or fiscal year.