Continuing the theme of reflection on HIV/AIDS which we have seen on this blog in recent posts I have been further working on research data from Tanzania. The data is from interviews with people living with HIV/AIDS who are members of locally-based support groups. Tanzania has chosen to legally enshrine rights for people living with HIV/AIDS into law. Examples of laws in this area relate to the prevention of stigmatisation, rights to access school and rights to access Anti-Retroviral treatment.
For context- the latest figures on HIV/AIDS in Tanzania (from 2008 Tanzania HIV and Malaria Indicator Survey (THMIS) show prevalence rates declining to 6.6% for women and 4.6% for men (out of 15,000 people tested). These figures are restricted to those over 15 so do not tell us about the prevalence in children who may have been infected in Mother to child transfer or through sexual abuse.
A UNAIDS situation analysis from 2009 suggested that there has been a significant increase in the numbers of people who can access ARVs (almost 250,000 in May 2009). I cannot find more recent figures so let me know if you have some.
250,000 still only represents approx 18% of the 1.4 million estimated by UNAIDS to be living with HIV/AIDS in Tanzania in 2009. Certainly, the data we have collected in Same and Moshi Rural Districts suggested that many people living in remote rural areas were unaware of their rights to ARVs. Awareness of this legal right came through involvement in NGO-supported (but not funded) activities. However even armed with this new awareness fundamental livelihoods constraints mean that people don’t have the means to travel to health facilities to collect the ARV medication.
To work effectively it is also known that people taking ARV medication require good nutrition -see this briefing from ODI. Again our series of interviews in Northern Tanzania emphasise the problems around food security. For example some widowed women have faced in being pushed of land they had farmed with their husbands. There are also continued allegations of food aid from WFP being diverted by local NGOs who have been entrusted with distribution. Some projects have been started by other NGOs such as fish farming but these activities have not been sustainable as people have not been given sufficient skills to ensure the projects are sustainable. Responses in this area appear to be inconsistent and patchy and left in the hands of a multiplicity of NGOs.
Therefore perhaps we can conclude that rights are useful- they can help people to ask questions and demand their entitlements but there are very real livelihood and structural problems that limit substantial progress. This will require more concerted efforts on the part of public agencies preferably as part of an integrated strategy to combat chronic poverty.