Bhuvana is a lively girl aged about 18 in the village of Alankuppam.  When we conducted the classes for the girls, she watched in rapt attention.  There was a sparkle in her eyes as she understood the issue of HIV/AIDS and a sense of wonder came over her as she learned facts about body organs and growing up.  For any group work or need for volunteers, invariably Bhuvana was the one to come forward first. Her participation was lively and was an encouragement to any trainer.When we decided, therefore, to rope in the Peer Educators, she was obviously the first choice. The choice was not only Bhuvana's family wanted to know with what authority we were teaching that young girl about “all those filthy matters” like sex, HIV and AIDS etc.due to her participation, but also due to the influence she had over the others- she commanded their respect.  Even in the peer educators training, the first session she attended she was outstanding.  But for the second session, she did not turn up. We were naturally got worried and decided to investigate and went to her house.  There we found her sitting in a corner doing some household chores.  When we tried to talk to her, we were met with a hostile mother and two brothers.   We tried to explain but they would not have anything to do with us “bad people”. At the end, we went to the village leader and told him, about the matter.  The village headman himself was actually reluctant in the beginning, but when we explained about the importance of adolescence education and the need for girl’s empowerment, he had agreed and also inaugurated the session. he head also met Bhuvana.  When we again went to their house, with the village headman, they became angrier and tried to complain to the leader.  But the chief asked them to shut up and first listen to what we had to say.Slowly but with conviction and firmness, we explained about UNICEF, ARM (NGO) and its activities, the present HIV/AIDS scenario in India and Tamil Nadu and Villupuram.  The need to protect oneself, HIV is not a “bad” disease, the need to show love and affection to the PLHA etc.  The knowledge slowly sunk in.  The brothers relaxed.  The mother started to prepare tea.  Seeing that we have their attention, we proceeded.  We explained why the scientific knowledge about body changes and growing up is important to their daughter/ sister.  How the shield of knowledge would help her to protect her self in life.Tea arrived.  The mother smiled.  The two brothers spoke to us.  They said that Bhuvana would not be able to go to other villages. We said that she would not be asked to go to other villages and we would take care of her.  We also explained about NGO work, the nobility of the work and the opportunities she might have in that sector later on. They understood and shook our hands, apologetically. Bhuvana jumped up in joy.  A Peer Educator was born.  She might have been lost, but due to the efforts of the village leader, facilitators and others she was brought into the Peer Educators fold.

National strategic information related to the scale-up of programmes on HIV/AIDS and other integrated programmes has taken an increasingly important role as countries strengthen their health systems. To support the effective use of strategic information on health, an international group of organizations has joined forces; collaborators include the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Centers for Disease Control and Prevention (CDC), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM).In this case study, we document Botswana’s experience in country-enhanced monitoring and evaluation of antiretroviral therapy scale-up, and show the feasibility of applying well-known triangulation methods to integrate multiple data sets from national monitoring mechanisms. Together with capacity building, innovative approaches help to create stronger health information systems, and we hope that this case study will contribute to the adoption of bold new methods. We will summarize triangulation, and other analysis methodologies that have been effectively applied at the national and subnational levels, in a forthcoming resource manual (to be published in 2007). 

DREAM

An integrated faith-based initiative to treat HIV/AIDS in Mozambique

With 33 million people now living with HIV/AIDS, expanding access to antiretroviral treatment for those who urgently need it is one of the most pressing challenges in international health. Providing treatment is essential to alleviate suffering and to mitigate the devastating impact of the epidemic. It also presents unprecedented opportunities for a more effective response by involving people living with HIV/AIDS, their families and communities in care and will strengthen HIV prevention by increasing awareness, creating a demand for testing and counselling and reducing stigma and discrimination.

The challenges are great. Sustainable financing is essential. Drug procurement and regulatory mechanisms must be established. Health care workers must be trained, infrastructure improved, communities educated and diverse stakeholders mobilized to play their part.

This series, Perspectives and Practice in Antiretroviral Treatment, provides examples of how such challenges are being overcome in the growing number of developing countries in which antiretroviral treatment programmes are underway. The case studies and analyses in this series show how governments, civil society organizations, private corporations and others are successfully providing antiretroviral treatment and care to people with HIV/AIDS, even in the most resource-constrained settings. In documenting these pioneering programmes, WHO hopes that their experiences will both inform and inspire everyone who is working to make access to treatment a reality

His call is simple: provide anti-Aids, or anti-retroviral drugs to pregnant mothers and tens of thousands of unborn babies can be protected from HIV infection. It's a call that the government has chosen to ignore.

"All we've had is a series of excuses," he says. "They started by saying that anti-retroviral drugs are too expensive, then they were toxic, then they said we must examine the whole science of Aids. There's no seriousness on the side of the government, except that they don't want to spend more money on public health."

The HIV virus can be transmitted in breast milk

The voices of black patients from the township of Mdantsane, echo down the bare corridors of the Cecilia Makiwane hospital in the city of East London where Dr Gazi works. Named after South Africa's first black nurse, under apartheid it used to be the blacks-only hospital. In the new South Africa it has remained that way - a decrepit building of crumbling walls and leaking roofs, where open drains carry dirty water past overcrowded wards.   The metal gates that  bar entry to the  wards in the Cecilia Makiwane hospital are there to stop criminals stealing blankets and medicine. Poverty is so widespread in East London, that even the dying are not safe from the hands of thieves. The hospital iS desperately under-resourced, and now it is becoming increasingly overburdened by patients suffering from opportunistic illnesses associated with their HIV status. Dr Gazi believes there is a strong argument for the provision of anti-retroviral drugs because of the impact they would have in cutting the transmission of HIV from pregnant mothers to their unborn babies. He has gone so far as to buy his own supplies of the anti-retroviral, Nevirapine, and intends to use it in the hospital. It's a move that is getting him into trouble with the local health authorities. "They are threatening to punish me again," he says. "But I'm going ahead anyway. The dispensary here is keeping its own supply of Nevirapine. I'm bringing it in to give it to them. We have to have good security because this is going to be popular stuff. You give the Nevirapine to women in labour, and then three drops are given to the baby after birth, and that's it! One tablet for the mother, three drops for the baby, end of story! You can save half the babies that would have been born with HIV."