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EATAM is composed of representation from all 14 countries forming the greater Eastern Africa region (Full representation is yet to be realized) EATAM like all other sub-regional treatment access movements under the Pan African Treatment Access Movement (PATAM) advocates for universal and free access to treatment for AIDS for all PLHA who need it . The movement also calls for greater input from People living with HIV and AIDS in decisions that affect their lives at local, regional and international level. 1.1 EATAM TREATMENT LITERACY WORKSHOP The EATAM treatment literacy workshop was organized by a workshop steering committee consisting of 15 people from the three East African countries, namely Kenya, Uganda and Tanzania. The meeting took place in Dar es Salaam from 16th to 21st of May 2005. Each country was represented by 5 people making a total of 15 people. The committee representation was identified at country level by country treatment access movements affiliated to EATAM and PATAM namely; KETAM, UTAM. The East African Treatment Access Movement (EATAM) conference, the first of its kind in East Africa drew participants from Uganda, Kenya, Tanzania, Rwanda, Ethiopia and Sudan. This was as a follow up of the PATAM conference that was held in South Africa, which recommended replication of treatment literacy conferences in different regions. The committee members were charged with the responsibility of coming up with the conference agenda; Conference logistics and coordination, Identification and preparation of the participants list and ensure a balance in representation from country movements. The committee members held several conference preparatory meetings where conference chores were shared out based on national representatives’ strengths. Tanzania being the venue of the conference was responsible for the both conference and ground logistics, including identifying a suitable venue for the conference. 1.2 CONFERENCE THEME AND OBJECTIVES EATAM convened a conference that brought together over 70 treatment activists from Eastern Africa, mainly local community leaders and a few regional and international collaborators. The theme of the conference was ” Local community mobilisation and empowerment for increased access to HIV/AIDS care and treatment” 1.2.1 Conference Objectives The first EATAM conference was highly participatory in nature with the aim of reviewing some of the obstacles to universal access to anti-retroviral therapy and other essential medicines, and drawing up strategies for activists to pursue towards ensuring that people living with HIV and AIDS in the region in need of treatment receive it in a timely manner. The objectives of the conference were: To bring together a group of East African people to share experience around care and treatment To provide space for skills building on HIV/AIDS treatment literacy and related strategies To create a network of skilled PLWHAs to advocate for treatment of PLWHAs in East Africa To create a strong voice to advocate for rights of PLWHAs To discuss funding possibilities for networks and communities interested in treatment literacy and community preparedness. To elect a core group of leaders as country representatives to EATAM’S steering committee and to identify members to serve in the CRP. Most of these objectives were achieved through group sharing, presentations and plenary discussions. 1.3 OFFICIAL OPENING The conference was officially opened by a prayer led by Bishop Masereka, a Ugandan delegate. 1.3.1 Remarks by: Ms. Grace Muro - Conference chair Ms. Grace Muro, the Conference chair welcomed all the participants to the conference and hoped that the deliberations would lead to a brake through in terms of access to treatment to people in Eastern Region. She gave gratitude to Mr. David Barr from Tides Foundation, for the social, moral and financial support towards the conference. She urged participants to actively participate in the conference so that they would come up with strategies for ensuring a strong advocacy team to ensure access to treatment at all levels. Grace further thanked and commended the governments that have been at the forefront of ensuring that treatment, care and support is made possible to people in need thus mitigating the impact of HIV & AIDS. She said that this conference was as a result of the 1st conference in S. Africa two years ago, after which participants from East Africa decided to form an East African chapter (EATAM). EATAM focuses on successful activism, brings together a multi disciplinary group of activists to advocate for treatment. 1.3.2 Remarks by: Mike Angaga - NAP+ Mr. Angaga, the Coordinator of NAP+ noted that this was an opportunity for the participants to relate and deliberate on issues related to treatment access. About NAP+, he said it has a board of management in the whole of Africa with gender balance. Membership comprises national networks of PHA in Africa. He urged members to ensure that the future of the young generation is protected. He congratulated the conference organising committee for the work well done, thanked Tides Foundation for the financial support towards this conference. He requested for a scaled up advocacy and ensuring that many people come out and know their status and those who test positive are helped to cope with their HIV + status and those negative remain negative. He emphasised that the role of PHA must be seen at the forefront at all times and voices of PLWHA must be heard all relevant places. Further remarks were made by representatives of TACAIDS, TATAM, UTAM and all speakers congratulated EATAM for having organised the conference. 1.4 SPEECH BY THE GUEST OF HONOUR: IRENE ANDREW The conference was officially opened by Irene Andrew, a young girl aged 12.5 years, who was accompanied by her mother, Ms. Fitina. In her speech, the guest of honour said HIV had impacted greatly to the development of many countries in Africa. She acknowledged that ARVs have greatly improved the lives of PHA that have had an opportunity to access them. She therefore hoped that activists would put in place strategies to ensure increased access to treatment to all who are in need. She said she has been on treatment for 3 years and her CD 4 count are over 500 and still improving. She was however quick to note that many children can’t afford treatment and yet are in dire need. She concluded by appealing to all to come up with strategies of ensuring access for all. 2.0 PRESENTATIONS 2.1 PRINCIPLES OF HIV & OPPORTUNISTIC INFECTIONS Dr. S.S. FAYA About 20 000 new HIV infections occurred in a day in 2004 and more than 95% are in developing countries, 2000 are in children under 15 years of age and about 15000 are in persons aged 15 to 49 years, of whom: almost 55% are women and about 50% are 15–24 year olds It is 20 years since HIV gained prominence and advances have been made in understanding the disease and its treatment, which treatment is an evolving science and requires a detailed knowledge of disease as well as advances in therapeutics. Effects of treatment noted in the reduced morbidity and mortality and improved quality of life to those affected. The objectives of treatment are: to support the immune system, to slow down the growth of HIV in the body and to prevent, control or eliminate OIs. In addition to treatment, Counseling, Education and emotional and social support are and should be provided. As activists and advocates, it is important to know the side effects of ARVs, which information should form the literacy education. The goal of ARV therapy is to bring down the viral load to undetectable levels, usually below 50 copies/ml. Implementing the therapy is a wide topic, is full of so called expert opinions and peer view influences, there is no universal acceptance and continually changing - what is current now may be history by tomorrow. During the discussion, it was noted that Africa has a large proportion of people infected and members said it could be due to poverty, while some people said that there are other things we are doing that others are not doing. Our role is to find out what this is. We need to educate the persons who have the disease to take care of themselves and they do not need to see the doctor every day. We have drugs that work e.g. ARVs hence have evidence. The argument that Africans can not take their regimens on time and correctly is not true. Studies have shown that one does not need to do a viral load for one to start on ARVs. A Doctor Can actually use clinical diagnosis if monitoring equipment is not readily available to start treatment. 2.2 THE MAGNITUDE OF TB LUCY CHESIRE In the presentation, it was mentioned that TB is killing 5,000 people a day globally, while HIV/AIDS was killing 8,000 people a day globally and yet TB is curable. HIV leads TB to progress to active TB disease, reactivates latent TB infection and increases rate of TB recurrence. It was further noted that up to 50% of PLWHA develop TB and that up to 50% of PHA were dying of TB. Lucy called upon the participants to acknowledge the challenge of TB and HIV and that advocacy and activism should be geared towards ensuring collaboration between the two programmes and ensuring access to TB and HIV services in order to decrease the burden of TB and HIV in dually affected populations. She further noted that governance and mobilization of resources for TB/HIV activities, capacity-building including training, ensuring coherence of communications about TB/HIV, participation of the community in joint TB/HIV activities and overseeing the preparation of the evidence base (operational research) was paramount. During the discussions, it was recommended that: There is need for increased advocacy for TB/HIV to ensure quick, proper and effective diagnostics. It was noted that men have not been brought on board and thus the participants recommended to ensure that groups of men where they already exist, are supported and where they don’t, are formed so that they compliment what women are doing in the region. As many countries are now scaling up of treatment of HIV/AIDS, it was recommended the role of activists and advocates was to get all the information regarding the availability of drugs, where and how they can be accessed and share this information widely but also do the monitoring and evaluation to ensure that those in need are benefiting and inform the policy makers of the situation on ground. 2.3 NUTRITION & HIV LUCY CHESIRE Malnutrition and HIV are inter-related. Malnutrition fuels HIV/AIDS and in-turn aggravates the rate of malnutrition. Therefore good nutrition plays a major role in the management HIV/AIDS. Good nutrition helps to build the immune system where as poor nutrition leads to a weakened immune system and this in due course leads to decreased appetite and negative effects on digestion and absorption of nutrients and thus micro-nutrient deficiencies HIV & AIDS decreases the amount of food consumed, leads to impaired nutrient absorption and changes in metabolism. 2.3.1 Components of nutrition care Nutrition education/counseling Water, hygiene and food safety interventions to prevent diarrhea Food preparation techniques Income generating activities Nutrition supplementation Food security strategies 2.3.2 Body changes Metabolic changes in HIV infection result in Increased resting energy expenditure Prompter use of amino acids to fuel energy needs Continued fat accumulation More adipose tissue compared to lean tissue Lack of preservation and restoration of lean tissue Weight loss (HIV-associated wasting syndrome) High triglyceride levels in blood 2.3.4 Conclusion Nutritional status affects HIV disease progression and mortality. Improving nutritional status may improve some HIV-related outcomes. Nutritional supplements, particularly antioxidant vitamins and minerals, may improve HIV-related outcomes, particularly in nutritionally vulnerable populations. 2.4 PRINCIPLES OF HIV CARE Care involves the health worker, the community and the family all working together and this should be comprehensive care, and person-focused services. During the discussion, it was recommended that before anybody starts on ARVs, they should have enough information regarding what treatment to take and diagnostics should be done e.g. the liver functioning. Such information is helpful and important more especially where certain drugs are not meant to be taken with others, and efevarenz with pregnancy especially in the 1st 3 months which is vital for the formation of vital delicate processes, use of oral contraceptives some of which have particular products that have an interaction with certain ARVs – could have low levels of either and thus may not get the expected results etc.. It was also noted that fighting stigma and discrimination was vital as it would help many people disclosing their status which greatly contributes to prevention e.g. a mother who is open may not breast feed. The Doctor further explained that positive living entails acceptance of the positive result, one’s understanding that their lives are important, the importance of disclosure – which increases the health seeking behaviour. On drug holiday, Dr. said research has shown that it is very bad to have drug holidays and thus advised participants to take their ARVs as prescribed and “religiously”. “As of now, ARVs are for life”. On alternative feeding for children, Dr. said goat’s milk has been proved more nutritious and useful than cows’ milk. He however noted that mothers need to be advised on proper preparation of the milk which must be very hygienic. 2.5 TREATMENT BUDGETARY ALLOCATIONS Civil Society’s Involvement in HIV/AIDS – Resource tracking in Africa URBANUS M. KIOKO Questions that the presenter had at the beginning of his presentation: Interpretation of statistics vis a vie analysing the figures. How much resources are going to HIV/AIDS? Who is benefiting? How much are PHA getting and how much is going to various activities and interventions? Is the problem absorption like some partners claim or other problems? He noted that with HV/AIDS, households are spending much more than the private sector and thus overburdened. The government is further overburdening the “common man”, who is bluntly carrying all the burden of prevention, care and support and mitigation of the impact. While it was noted that there lots of resources and funds for HIV & AIDS, much of the funding is from the donor countries and governments are contributing hardly nothing, which is dangerous in terms of sustainability more especially when it comes to treatment. 2.5.1 Why budgets Fundamental tool in implementation of public policy Sets out the allocation of public resources More telling indicator of the priority accorded to fighting HIV/AIDS than policy or legislation National budgets are key to sustainability of any government programme-who is financing various programmes? % of government, donors, private sector etc. Enhance ability of governments to plan and implement HIV/AIDS interventions effectively Budgets are a clear indication of the governments commitment 2.5.2 The following recommendations were made On increased funding for and sustainability of ARVs, it was recommended that the civil society organisations need to be empowered so that they are aware of the situation, have evidence and information and thus advocate for the same. Need for improved system for tracking HIV/AIDS funds Harmonization of all HIV/AIDS funds from various sources Determine progress made towards equity goals in HIV/AIDS financing and expenditure Clear outputs and performance indicators Increase allocations to resource tracking activities Improved equity in distribution of resources Increased impact assessment of HIV/AIDS budget Resource allocation between geographic areas must balance need (disease burden and demand for services) with absorption capacity (ability to spend). Mix of funding channels – earmarked and unconditional –required to provide flexible financing. Mix of funding sources necessary to ensure sustainability – public and donor. Increased resources – financial, personnel, infrastructural – required for roll out of ARV treatment. Strengthening of health care system required. 3.0 COUNTRY PRESENTAIONS 3.1 HIV/AIDS CARE AND TREATMENT STATUS IN TANZANIA Dr. B. BWIJO National AIDS Control Programme, Ministry of Health HIV/AIDS care and treatment status in Tanzania was at an advanced stage. The Doctor noted that after one year of rolling out ARVs in Tanzania, it has been found out not to be very easy. It has been a process: looking for funds, expatriates in the field to train the personnel, development of the curriculum and finally the clinicians have undergone a one week’s training. While the drugs are available, noted that there are some issues like the viral load, CD 4 machines, nutritional supplement and general costs which must be addressed. CD 4 count machines are only all the regional hospitals. These are complemented by those owned by some FBOs. Activists and advocates thus need to have knowledge of where these are so that they pass on the information to the rest of the community members. TB has been recognised as critical in HIV/AIDS and thus collaboration activities have been put up. TB/HIV collaboration is very important in the national treatment and with support from round three of the global fund, Tanzania is conducting training in TB diagnostics and care. 3.1.1 Recommendations Adaptation of best practices of programmes like vaccination which reach far places and many people should be replicated. Where CD 4 count and viral load machines are not available, use of clinic signs which is already being used as a step forward. Offering a comprehensive continuum of care including nutrition which is very critical for successful ART programme.. Ensuring sustainability of the ART programme – governments to allocate funds from within their budgets. Governments should translate what is on paper into action A strategic programme is needed to ensure PLHA come for treatment e.g. fighting stigma and discrimination. Desegregation of data to ensure that it captures how many women, children, men etc. are accessing treatment. This would facilitate planning and programming. Scaled programme to ensure adherence. An adherence tool which has been developed should be disseminated and used. 3.2 UGANDA SITUATION DR. LYDIA MUNGHERERA The first case of HIV/AIDS was identified in Kasensero - Rakai district, which led to President Yoweri Kaguta Museveni calling for help. Uganda later on developed a multi-sectoral program approach to HIV/AIDS and AIDS Control Program (ACP) in 12 nine ministries and district focal AIDS people. In 1987, The AIDS Support Organization (TASO, the first support group was formed and in 1992, the Uganda AIDS Commission was established by the statute of parliament to coordinate HIV/AIDS in the Country. In response to care support and treatment, the following policies are in place: The National ARV, VCT, PMTCT, OVC, Septrin Prophylaxis, and TB/HIV policies. Currently over 40000 people are accessing ARV’s through both private and public institutions. Uganda’s target according to 3 by 5 WHO targets is 60000. To reach the targets but also bearing in mind other people who are in need of ARVs right now and those in future, activism and advocacy has to be strengthened. 3.3 THE EXPERIENCE OF GERTRUDE (REPRESENTING THE COMMUNITIES) Gertrude told her story: “After losing my husband and all my children, I started mobilising PHA and we would always meet at my home. At first they were 40 members. I went and told the doctors about what was happening, and they would come and treat us for OIs. I was doing all this without any financial assistance or support. Every week about people meets at my place and it has become a routine. People usually refer patients to me. None of these members are accessing ARVs” During the discussions, it was noted that if we have to have an effective response, we need to have consistent messages and not using A, B & C when it is convenient for us. This was in reference to the statement made by the Ugandan president in Bangkok regarding condom use. There is need to strengthen the collaboration between governments and CSOs. 3.4 RWANDA HIV/AIDS SITUATION K. SHAKILLA UMUTONI Rwanda is one of the least developed countries, where nearly one million people were massacred during the genocide of 1994 implying that many highly-skilled people and infrastructure were lost. 64 % of the population lives below the poverty level and Rwanda is associated with other problems like high number of orphans, female-headed households (34%), increased sexual violence and psychological trauma. A National Policy for caring for people living with HIV/AIDS is in place to: Improving links between TB and HIV/AIDS control (ex. Integrated VCT Integrating HIV/AIDS into all sectors (Umbrellas of NACC in all sectors) Reinforcement of education in the community and a focus on prevention PRSP / Vision 2020 RWANDA NATIONAL ART PLAN Vision Increased longevity and improved quality of life for people living with HIV/AIDS (PLWHA) in Rwanda Approach Integration with existing health infrastructure Community mobilization Linkage between treatment and care and prevention Procurement economies of scale Rapid scale-up, including iterative learning Philosophy of Rwanda’s HIV/AIDS Program Ensure that patients have equal access to the drugs. Patients who cannot afford to pay should be able to get drugs. No discrimination on the basis of gender, income, age, ethnic group or nationality (as long as one has been staying in Rwanda for over 6 months). Ensure that patients on ART take their drugs properly so that resistance does not develop. 3.4.1 Patient selection committees Members: head of ART program at the facility, medical representatives involved in ART at the facility, laboratory rep, 2 reps from PLWHA associations, psychosocial support unit rep, matron of the service. The Committee meets at least once a fortnight. Doctors present their cases to the committee for selection. Patients not selected can be presented repeatedly, or waitlisted. Appeals can be filed with the NACC. Quarterly report submitted to the TRAC, MOS and NACC. 3.4.2 Priorities Patients are given ART if they meet the criteria as applied by the Patient Selection Committee. If there are not enough drugs: Health workers at that facility meeting all medical and social criteria are selected first Health workers can receive ART for post-exposure prophylaxis Then all other patients are selected, first come, first served SPECIAL ISSUES AND CONCERNS Should certain groups have priority – teachers, health workers, military, and genocide widows? Rwanda has decided no, but allows special programs to make exceptions if they bring their own funding, have clear rules, and the prioritization is approved by the Government of Rwanda 3.4.3 Challenges High demand of ART (10%) Disproportion between ART and prevention structures (VCT/PMTCT). Human Resource problems (quantity and quality) Slow staff motivation Limited nutritional support leading to problems of adherence Stigma Limited social support Poverty Weakness on peadiatric treatment (500/60000) Meanstreaming 3.5 RWANDA MODEL OF CARE AND SUPPORT TO PLWHA: ENSURING CONTINUUM OF CARE & CLIENTS PARTICIPATION The principles of continuum of care take into account linking health and social services, ensuring that PHA are partners in service provision, collaborative efforts with all services providers for a comprehensive package, case management and sustainability through local capacity-building Objectives Facilitate early and continuous care seeking behavior among PLWA Facilitate access (transport, tests, hospitalization fees Foster a supportive family and community environment for ARV adherence Activities Capacity-building of HF for case management, and home based care: human resources, training/exchange trips Promotion of community solidarity through volunteerism Motivation and reward for volunteers Training of family members on home based care and ARV adherence support Provision of materials for home based care Training of associations on business literacy, IGA Provision of funds for IGA So far the following have been provided Counseling positive living, ARV literacy Peer Education trainings VCT for family members Materials provision - water purification materials, hygienic kits Economic security: IGAs, business literacy, home garden and livestock Care for children through OVC program: education, health/nutrition Referrals for food aid and others (WFP) Motivation of community volunteers Hygienic kits to PLWA How does the Continuum of Care to PHA work out? Results oriented Decreased stigma and discrimination which generates care seeking behavior and increase in associations Community-based interventions reinforce attendance of hospitals and compliance to treatment Home garden and livestock increase auto-sufficiency and decrease food aid seeking behavior Case management enabled prioritization and outreach to more clients Challenges of the programme Gap between needs of PHA and available services even after prioritization Coordination of services particularly food aid to ensure they reach the most vulnerable Need for integration of interventions into a broader community development - IGAs, education support etc. Conclusion Continuum of care is possible if HFs are reinforced with HR and linked to communities with active involvement of PHA associations Case management and coordination among social services providers can increase cost-effectiveness of care/support Discussions There is lack of activism in Rwanda; they need support so that they can go forward. Most of the programmes that have been presented are government programmes. Activists in Rwanda noted that they need to do their own research so that they have a picture to compare with that presented by the government 3.6 ETHIOPIA: HIV/AIDS SITUATION IN ETHIOPIA KASSAHUN-ARGAW Ethiopia is situated in the horn of Africa, bordering with Djibouti, Eritrea, Sudan, Kenya and Somalia. It has a population of about 70.7 million and a total area of 1million sq.km. About 85% of the population live in the rural areas, agriculture accounts for 54% of the gross domestic product and Christianity and Islam are the major religions; 51% of the population is orthodox christian,33% Muslim and 10% protestant. Ethiopia is the home for over 80 ethnic groups hence increased vulnerability to HIV/AIDS. Ethiopia is one of the hardest HIV/AIDS hit countries with a national prevalence rate at 4.4% (12.6% urban and 2.6% rural). Over 6.6% of Ethiopia's adult population is thought to be HIV positive. It is estimated that 2.2 million people are living with HIV, of which 817,000 are women and 96,000 are children under 15 years. 200,000 people are estimated to be living with AIDS. The largest proportion of new infection is occurring in young people (<25 years old). It is also estimated that there are 537,000 orphaned children due to AIDS in Ethiopia. EFFORTS BY THE GOVERNMENT Established the AIDS control programme at the department of MoH in September 1987. Issued a National HIV/AIDS policy in 1998 followed by the development of thee strategic frame work of the national response in 1999. In April 2000 the national AIDS council (NAC) was established under the chairmanship of the country's president, and with a composition of representatives from relevant government, private, ,FBOs ,NGOs ,PLHA etc. A secretariat accountable to the prime ministers office was also established to coordinate the national multi -sectoral response. Similar structures with similar constituencies were also established in the regions and at lower administrative levels 3.6.1 Status of ART in Ethiopia The ART program in Ethiopia started in 2003. While it is estimated that 300000 PHA in Ethiopia are in need of ARVs, it is only estimated that 36300 people are currently accessing the same. Fifty (50) hospitals throughout the country provide fee-based ART for 12,000 persons and free ARV to 24,300 patients. Twenty seven (27) hospitals that are providing free ART are beneficiaries of PEPFAR while 23 health institutions are benefiting fro the Global funds. On a small scale FBOs and NGOs have already started interventions in ARV therapy in two regional towns. Ethiopians in the Diaspora has also initiated ARV for 600 PHA in the sub city of Addis Ababa. Some organisations also provide ART for their staff. The Government and different Associations have started to raise Social (AIDS Fund). It has been noticed that provision of ART requires competent health care system and health care workers, sustainable financial support, reliable drug procurement systems, well developed national strategy and effective coordinating mechanism of the various stakeholders. To meet these requirements, the Ethiopian government has put in place ART policy and guidelines for drug supply, use, procurement and distribution and manual for formulation and dosage of ARV. The government has also put an initiative of making ARV available at reduced price for those who can afford in the major urban areas. By 2008, the country hopes to have 210,000 PHA on ART. The challenge however is that not all who are in need are able to access ARVs currently. 3.6.2 So far the following are the successes of ART Programme Reduce disease burden and dependence Increased well-being and productivity Restored hope of individuals Motivator for people to seek counseling and testing The following are the challenges to the implementation of safe and effective ART Programme Adherence Side effects Stigma Cost ISSUES THAT CAME UP DURING THE DISCUSSION Ethiopia lacks activism and the levels of participation are still low more especially at planning and decision making levels. Most of the decisions are made by the Catholic Church and this is also a problem. RECOMMENDATIONS Next conferences could be held in countries where the problem is still high and with big problems. This would help in engaging more PHA in those countries. Involvement of men at all levels and men should be encouraged to form their own networks 3.7 SUDAN: KNOWLEDGE, ATTITUDES AND PRACTICES (KAP) ON HIV/AIDS IN MAGWI COUNTY, SOUTHERN SUDAN The Sudan experience featured a study on the KAP of the factors that may promote spread of HIV/AIDS in Magwi County. FINDINGS: Limited access to information./knowledge Institutional coordination not comprehensive No dependable data High interest in accessing services STI & TB services needed Urgent need for IEC, messages/materials in local languages RECOMMENDATIONS: HIV/AIDS Awareness creation at all levels Community mobilisation and sensitization Strengthening VCT services Increased access to ARVs Introduction of sanitel surveillance sites Mainstreaming ANC HIV testing & PMTCT Condoms distribution Involvement of the media in transmitting the messages Training of peer educators 3.8 TANZANIA: COMMUNITY INITIATIVES FOR HIV/AIDS AND IMPCT MITIGATION – WAMATA EXPERIENCE CONRAD MUSHI Background Wamata is a non governmental organization that was established in 1989. It was at first recognized by government as the first NGO struggling against AIDS. It later grew into 12 coordinating branches in the region. Dar Es Salaam branch is coordinating 2 branches in Coast region. Objectives Prevention and control through, awareness building, education and communication Counseling Care and support to PLHWA and orphans Building community capacity initiatives Lobbing and advocacy on issues pertaining to HIV/AIDS VIZIWAZIWA CASE STUDY Area 5 villages 140 households 560 population 86 orphans PHA not known Community Initiatives Identified common problems and listed them Identified community available resources Human Material Identified gaps Formed committees to seek external resources Strategies Skills training Home based care Peer education Counseling Resource mobilization Outcomes Home based care team established Counseling team established Peer education team established Other Wamata Support Establishment of field offices Provision of 15 bicycles for home based care Home based care kits Regular monitoring and supervision IMPACT Some changes in cultural practices facilitating HIV spread Existence of OVC community support fund Communal farm Reduced drop outs in primary schools Established VCT centre CONCLUSION By supporting community initiatives we are sure of community ownership, sustainability, effective utilization of resources and added value for community resources. 3.9COLLABORATIVE FUND FOR HIV TREATMENT PREPAREDNESS DAVID BARR & MERCY OTIM The Collaborative fund for HIV is treatment preparedness is a partnership of the International Treatment Preparedness Coalition and Tides Foundation. It is a community-driven funding mechanism that provides small grants to community organizations for treatment education, support and advocacy projects and funding for regional networks to share information and advocacy strategies. A partnership of Tides Foundation and the International Treatment Preparedness Coalition (ITPC) ITPC was formed following ITP Summit in Cape Town, 2003 and is made up of treatment advocates from all over the world. PATAM coordinates the Collaborative Fund and ITPC activities throughout Africa. A Community Review Panels is selected in each region and their roles and responsibilities are to make all funding decisions, set funding priorities based on conference discussions, which is the first activity, review grant applications and decide which projects to fund. The CRP must be transparent in granting making process and a conflict of interest and confidentiality policies have to be developed and abided by. The selection of panelists must put into consideration the geographical aspect, gender balance and inclusion of people living with HIV/AIDS. People living with HIV/AIDS play leadership roles in all aspects of Collaborative Fund activities. The application format should be a very simple format for people to understand and complete with ease. In addition, the application should provide guidance and explain the program priorities. The grants can be accessed by any community-based organization, a group of organizations and national or regional networks. For the organisations that are not yet registered, another group can act as a fiscal sponsor for the same and for profit groups cannot apply. Tides Foundation can also help some organisations with registration especially those that are finding it difficult. So far over $4 million US raised has been raised and $200,000 will be distributed as grants in East Africa. The grants will be between 5,000 and 10,000 but the CRP has the responsibility of deciding. Financial and narrative reports will be submitted stating whether what was planned is actually what was implemented. Spot on visits to sub-grantees will be made to assess the success, challenges and gaps being faced, thus support will be provided. This will form part of the monitoring and evaluation of the programme. It was noted that so far there are challenges that are being faced and thus the region need to bear these in mind as they start on implementation: Fundraising Donors change their taste hence Treatment may not be an issue forever Development of the CRP – the fairness, transparency etc. Building and sustainability of the programme Interested CBOs in applying vis a vis expertise 4.0 SKILLS BUILDING FOR GRANT APPLICATION WRITING AND PROGRAMME IMPLEMENTATION DAVID BARR & MERCY OTIM During the conference, participants were given skills in grant writing. Tips of how to write grants Knowing what one wants Being very clear about what one wants funded Stating outcomes and describing how to reach them Discussing the goals and approaches with those involved in the project Assessing the needs which could be done through research, gathering firm facts and figures and getting some technical assistance The involvement of the community has to be spelt out Possible structure Summary of the proposal The Background: Give the state of situation, give the statistics – prevalence, orphans, research, impact of the programme etc Justification - the role of the target group and the contribution Goals and objectives – e.g. improve the quality of life Goals – What you want to achieve Overall approach: methodology that will be used, state where you are based and where the project is going to be implemented, describe how the programme is going to be supervised Activities: activities should be described in detail A budget should be included Describe who will be responsible and Give a realistic time line Budget: list of resources required Monitoring & Evaluation approach and system Background on organisation making request Other Support committed Summary Sustainability of the programme must be spelt out Why most grant proposals are rejected Not stating any other Support Not mentioning nay other partners that one will work with on this project Other funders supporting this project Outside resources and technical assistance one will draw on Inconsistency with the Grant Difficulties in writing up a grant application Too restrictive Over-budget and under budget Conditionalities Assume that you already have funds available Time consuming May write much more than required Demand a lot Any grant that is funded must be reported on. These could be monthly, quarterly, annual or end of project reports. Any report should include the following: Parts of a Report: Data on activities Identify indicators in application The limitations No. of participants Whether the activities were held, how many and in case not, why Ask participants what they have learned Beneficiaries of the services e.g. women, children etc. Materials produced and in how many languages if any Track the impact beyond the how many Find out whether there has been any change in the attitudes of the people by the activity 4.1 IMPORTANCE OF TREATMENT LITERACY MARC DE BACKER & AMANI HITIMANA Treatment literacy provided information which information is crucial for each action and decision. Thus for any adequate action, there is need for adequate information. During treatment literacy there is involvement of the communities affected which creates autonomy and a sense of responsibility. Treatment includes prevention, and prevention includes treatment, so treatment literacy starts long before treatment, even before infection. ISSUES AROUND ARVS Before starting ARV treatment the following questions should be asked: The importance of taking medicines How and when should one take medicines and how much to take (with food or empty stomach) How one’s medicine’s work The side effects of the medicines one is taking How the medicines should be stored A copy of one’s treatment plan(that lists each medication) IMPORTANCE OF TREATMENT LITERACY It is important to educate patients before starting ARV treatment; this involves clinicians, nurses, pharmacists, social workers, counselors etc It is advisable not to start ARVs at the first clinic visit It gives basic information about medicines: adherence, when to start medicines, drugs interaction, storage etc Manage side effects and prepare patient on it Helps to adjust treatment and patients life style TREATMENT ADHERENCE This includes taking the correct dose at the correct medicines at the correct time Keep a medication diary: check off dose, name of drug.... Taking medications each day and at the same time Keep medications in the place where one will take it Co-worker or family members or friends to remind one to take their medications 4.2ADHERENCE COUNSELLING AND FAMILY INVOLVEMENT SERO PATRICIA OCHIENG Objectives of adherence Counseling Help patients develop an understanding of their treatment and its challenges Prepare the patients to initiate treatment Provide ongoing support for clients to adhere to treatment over the long term Help clients develop good treatment taking behavior Help patients in setting realistic goals for their treatment Attributes of a good adherence counselor Adherence counseling is a long term requirement of patients on ARVs, its based on an understanding of the clients’ life situation and needs. The relationship is strengthened over time. Adherence counselors need to have ability to listen, non judgmental attitude , unconditional positive regard Ability to provide scientific, accurate and complete information on HIV disease and ARV treatment in an objective manner Ability to encourage patients to take decisions, make commitments to treatment Ability to develop a long term trusting relationship with patients Problem solving ability Ability to link patients with other support services Effective counseling techniques Active attending or listening Reflection of feeling Questioning Paraphrasing Interpretation Repeating Summarizing Respecting Structuring or prioritizing and fixing goals THE ROLE OF THE FAMILY Provide shelter. Give love, care and support. Provide nutritional needs. Remind the patient to take the drugs; the correct doze at the right time. To share in the patient’s burden. (Anxiety, fear, among others) In case of changes in the patient inform the service provider During the counseling session, it is important to continue discussing and not evaluating, repeat information where necessary, re-emphasize important issues and use dummy pills to repeat instructions. STEP I Review and assess the patient’s understanding of his/her HIV disease and health status (A family member learns in the process.) What’s HIV/AIDS? Opportunistic Infections. CD4/VIRAL Load. Effects of treatments. STEP II Review and assess the patient’s understanding and recall of treatment and follow up plans. Drug regimen. Dummy pills demonstration. What ART does – Improves immunity/Less OIs/ART not acure. Need for continued prevention Follow up Importance of adherence and consequences of non – adherence. STEP III Provide information on side effects. Expected side effects. How to manage them (the effects) When to seek care. How to contact health worker. STEP IV: Review proposed adherence strategy. Discuss the role of family member. Provide shelter. Give love, care and support. Provide nutritional needs. Remind the patient to take the drugs; the correct doze at the right time. To share in the patient’s burden. (Anxiety, fear, among others.) STEP V: PILL DIARY: Review barriers to adherence and progress made: Lack of social support. Low literacy. Alcohol and drug use. Mental state. 4.3 PRESENTATIONS FROM GROUP DISCUSSIONS ON TREATMENT ADVOCACY PRESENTATIONS FROM GROUP WORK Questions Identify barriers & gaps to HIV treatment & Probable solutions to the same Identify barriers & gaps to Care & support and Probable solutions to the same Barriers and gaps to treatment literacy Lack of interest to learn HIV/AIDS –denial Lack of knowledge by health providers on HIVAIDS Distance to the health facility Lack of treatment sites / health facility Religious practices Availability of drugs and cost (ART/OIs) Access to monitoring tools e.g. CD4 count machine Lack of self awareness on facts of HIV/AIDS Government policies on treatment (taxation) Lack of infrastructure – e.g. electricity Ignorance Communication Human resource Cost implications Poverty – why many people aren’t able to get to hospitals Information which is still inadequate and not well disseminated Access in terms of distance, costs, monitoring e.g. the CD 4 count machines, viral load etc. Budgetary allocations Taxes on the drugs Limited/lack of commitment on the part of the policy makers Self stigma Stigma and denial Cultural beliefs and practices – wife inheritance, myths and misconceptions Poor infrastructure Lack of political will – still a lot that needs to be done that even when budget allocations are done are adequate Solutions to the above barriers and gaps: Increased communication mobilization, sensitization and advocacy GIPA/MIPA Provision of IGAs Developing IEC materials in local Training of all stake holders in treatment care and support Advocate for programmes that target prog. Literacy from donors, govt and provision of IEC materials in the local languages Advocate for generic drugs and provision Facilitate training of PHA – TOT, facilitators, counsellors etc. Construction of health centres and infrastructure Economic empowerment of PHA User friendly IEC materials Good PHA leadership for the movement Resource mobilisation and allocation Effective M & E tool Improved drugs procurement process Enhanced community mobilisation for ownership of the programme Male involvement in HIV/AIDS activities and initiatives Literacy for men Men activists should endeavour to reach their fellow men Increased community mobilisation, sensitisation and advocacy Training of all stakeholders 4.3.1 Information required for treatment Eligibility requirements Sensitization i.e. therapy Communication of services of ARVs Use of ARVs WHO both for PHA and the whole community Opportunistic infections and ARVs availability Prophylaxis Monitoring Nutrition and psychosocial support Availability of ARVs Accessibility of ARVs Sustainability Adherence and compliance Changing regimens 4.3.2 Modes of dissemination: Public dissemination Print media Electronic media Audio visions cinema halls Work shops Community health workers Institutions like schools etc Tracking impact of treatment literacy By collecting data from VCT sites Conferences / seminars Dialogue/home visits Theatre Leaflets / fliers`/ banners Books, newspapers/posters Internet Understanding the level of literacy of a given community Using widely understandable language 4.3.3 Ensuring treatment literacy at community level Understanding community norms and culture Formation of community level resources Mobilisation of community resources Community participation like food security 4.4 ADVOCACY & TREATMENT ADVOCACY DR. BACTRIN KILLINGO Definitions Advocacy is the standing up for the things in which you believe. Activism is the intentional action to bring about Social/Political change. Campaigns are series of organized activities to accomplish a goal. WHO & THE 3 BY 5 INITIATIVE WHO in partnership with UNAIDS launched a 3 by 5 initiative on Dec 1 2003 whose aim was to have ARV therapy become part of the primary healthcare package provided in developing countries across the world. WHO hoped to see 700,000 people on ARV therapy by December 2004, 1.6 million people by June 2005 and 3 million by December 2005. The estimated total number who should be receiving ARVs is 5.9 million people and currently there are 400,000 people who are living with HIV and accessing ARVs in developing countries, which is 7% of the total percentage of people who need treatment. In Africa alone, only 2% of those who need treatment are receiving it. Discussed how the countries were fairing in terms of commitment, policy, strategy, plans, implementation and monitoring. While it was agreed that the WHO 3 by 5 initiatives is very good, there are still financial, organizational, physical, social barriers that need to be addressed. 4.5 CONCEPTS OF COMMUNITY MOBILISATION MIKE ANGAGA Principles of community mobilisation Bottom up approach Involvement of all the stakeholders right form the beginning Transparency Accountability Learn from the community and only give them information Build consensus around a manageable agenda Involve new voices and leaders Seek out for new allies e.g. the private sector Barriers to community mobilisation Negative attitude One person feeling superior and others inferior Ltd involvement Socio-cultural issues being ignored Language Not identifying the potentials within the communities Rushed programme Recommendations for community mobilisation Building upon the community resources that are available Leadership skills available within the community Successful mobilisation and sensitisation 4.6 PARTNERSHIP DEVELOPMENT PROCESS MIKE ANGAGA Session Objectives To have a shared vision of what strategic partnership is To identify strategic partnerships and partners To identify ways partnerships can be sustained. A partnership is a mutual cooperation and shared responsibility for the achievement of specific goals or legal contract entered into by two parties in which each party agrees to finish a part. Guiding questions Do PHA need to engage in partnerships? What kind of partnerships do we need? What are partnerships? 4.6.1 Steps to follow before entering into a partnership Contact Knowing each other in terms of what each is doing Assess the availability of the other party for added value Identifying a common agenda Sustainability of the partnership Develop a shared vision Identify shared priorities – do you have the same interests or is there any complimentarily? Common tools for priority setting Need to reach a consensus Choices aimed at achieving greater impact using minimal resources Narrow down and prioritize Identify common resources – financial, human etc. 4.6.2 Common grounds for partnerships Enabling membership reach together potential Empowering each other to identify the set objectives and the objectives of the organisation Put around the table what you can offer to the partnership Create a supportive environment to the partnership Shared leadership – each partners should be able to articulate the mission and vision of each organisation any time Resolving the issues and meeting the needs and interests of constituents 4.6.3 Principles of partnership Accountability Transparency Vision Mutual trust Sustainability Respect & looking at each other as equals Team building Results oriented Consensus building Trust 4.6.4 Who is your partner in treatment access? International and regional development agencies Civil Society Organizations and Corporate sector National Governments Individual experts, FBOs, political and opinion leaders 4.6.5 Partnership development steps Develop a shared vision of partnership goals and objectives Identify shared priorities Identify common tools for priority setting Identify priorities via consensus Choices aimed at achieving the greatest impact with minimum resources Narrowing down, mapping and doing final ranking of activities to be carried out Identify common resources (putting of resources, common baskets Common grounds for partnerships Enabling all members of organization to reach their full potential Empowering each member to achieve identified objectives Creating a supportive environment of trust, openness to communication, respect for each others’ position, values, beliefs, positions and contributions Shared leadership Resolving issues and meeting the needs and interests of constituents Positive relationship between members 4.6.6 How to develop partnerships Strive to forge relationships of mutual respect and sustained commitment to shared goals Understanding the environment where each partners operates Develop joint plan of action and know what is expected in terms of reporting results Develop a common framework to track progress and report results Institute a planning cycle to ensure achievement of joint goals and objectives over time Be proactive rather than reactive 4.6.7 How to engage within a partnership Learn the strength and attributes of your partners Understand what resources they bring Develop a shared plan of capacity building Take time to clarify roles and responsibility Respect lives of authority “Authority zones with the job, not the person” with authority comes responsibility Modify assumptions and expectations Trust the process Determine your organizations’ relative strengths, interests, and history Identify conditions for successful collaboration with each group (force field analysis) Set realistic and clear limits of what your organization can support and influence Set realistic visions, goals and targets Establish a shared process for monitoring and tracking progress Use participatory process to define boundaries and needs of target audience Communicate constructively 4.6.8 What needs to be done? Enable the organization membership to reach their full potential Empower each member to achieve identified objectives Create a supportive environment of trust, openness to communication, respect for each others’ values, positions and contributions Resole issues and meeting the needs and interests of constituents Ensure Positive relationship between members 4.6.9 Role of partnerships Resource base Engaging sectors with limited capacity to act Influencing collective positive change Expanding and sustaining responses Creating space for achievements allowing responsive engagement JUSTIFICATION FOR TREATMENT PARTNERSHIPS & MEANINGFUL PARTNERSHIPS SHOULD TRANSLATE INTO: Increased resources for treatment access Increased visibility of PHA Greater organizational support, visibility and stronger voice to lobby for critical issues Stronger political and community support Access to other resources e.g. media Wider outreach to vulnerable and marginalized groups Support in technical issues e.g., monitoring and evaluation, program design and implementation Increased efficient task sharing 4.6.10 Conclusion Be “persistent” and “proactive”. Build sustainable partnerships based on shared leadership, shared goals and shared vision Use participatory approaches to problem solving and conflict resolution Use constructive communication methods Leverage available resources to achieve greatest impact Be accountable for results 5.0 TREATMENT ACCESS MOVEMENTS & THEIR IMPORTANCE: UTAM, KETAM, TATAM 5.1 UGANDA- Uganda Treatment Access Movement (UTAM) The movement is in its initial stages and was as a result of limited services. The movement is working in collaboration with PSI and generally in the country there is increased number of people accessing ARVs. There are however weak referral systems, governance and managerial weakness that need to be addressed. Leadership too needs to be addressed. 5.2 TANZANIA Treatment Access Movement (TATAM) TATAM was founded in August 2003 with the major purpose is to lobby for access to HIV/AIDS treatment and strengthen the existing treatment programs in the country. The movement comprises of HIV/AIDS network organizations dedicated to mobilizing communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Tanzania. Some of the member organizations include: TANOPHA, TANEPHA NETWO+ TATAM is a registered organization (Reg. No. SO.NO. 13051) The objectives of TATAM are: To advocate for affordable treatment for all people with HIV/AIDS Campaign and support the prevention and elimination of all new HIV infections Promote and sponsor legislation and policies to ensure equal access and equal treatment of all people with HIV/AIDS Educate, promote and develop an understanding and commitment within all communities of development in HIV/AIDS Treatment and Care Advocate and campaign for affordable and quality access to health care for all HIV/AIDS people in Tanzania. Train and develop a representative and effective leadership of People Living with HIV/AIDS on the basis of quality and non-discrimination irrespective of race, gender, sexual orientation, disability, religion, social-economic status, nationality, marital status or any other trends. TATAM Office bearers Grace Muro Chairperson Bartolomeo Tarimo Vice Chair Dr. Herman General Secretary Jamillah Mwanjisi Deputy Secretary Julius Kaaya Treasurer 6.0 EAST AFRICAN TREATMENT ACCESS MOVEMENT (EATAM) STRUCTURE AND SELECTION PROCESS An EATAM Steering Committee will be created to build a treatment access movement throughout East Africa. EATAM is the East African regional body of PATAM. PATAM is African network associated with the International Treatment Preparedness Coalition (ITPC) EATAM Steering Committee representation will be by country with 13 countries participating. Kenya, Uganda, Tanzania, Ethiopia, , Sudan, Djibouti, Somalia, Rwanda, Burundi, Comoros, Seychelles, Mauritius One representative and one alternate representative will be selected for each country. Representatives will attend meetings and conference calls. When they are unable to do so, their alternate will replace them. There will also be ex-officio members from other, established regional networks, e.g. ICW, NAP+. Countries presented at the conference will choose their representatives during this EATAM meeting, if possible. The current East African PATAM Steering Committee members (James Kamau and Grace Muro) will contact PATAM members in the countries not represented here to select their representatives immediately following the conference. EATAM Steering Committee will select the two new East African representatives to the PATAM Steering Committee. The Steering Committee will develop Terms of Reference for its members. The first meeting of the Steering Committee will be held in six weeks from the end of this conference. The Steering Committee will select a Coordinator to coordinate EATAM activities and Collaborative Fund grant making for East Africa. Funding for this position and coordination efforts will be provided by the Collaborative Fund. The Steering Committee will develop Terms of Reference for the Coordinator. The selection of the Coordinator will be a competitive and transparent process. CRITERIA FOR SELECTING EATAM REPRESENTATIVES To ensure continuity, selected individuals should have current involvement with PATAM and knowledge about treatment access movement activities. The term of a country representative is one year. After that time, the alternate will become the representative and a new alternate will be selected by the EATAM members from that country. To ensure good gender balance, if the representative is male, the alternate must be female or visa versa. The active involvement of people living with HIV/AIDS is a high priority. If the representative is NOT living with HIV/AIDS, then the alternate MUST be living with HIV/AIDS. Both the representative and alternate can be HIV+. The representatives must be able to communicate regularly with the Steering Committee and share information with the EATAM members in their country. They must attend meetings, participate in conference calls, and respond to e-mail. They must have regular access to a computer and internet services. The representatives must be affiliated with an organization n their countries. The representatives should be committed individuals, who are passionate about building a treatment access movement to save the lives of people living with HIV/AIDS. 6.2 COLLABORATIVE FUND COMMUNITY REVIEW PANEL The CRP’s role is to develop a grant making process, including the development of a grant application, a plan to distribute the application broadly throughout the region, develop methods of review, review applications and select grants for funding. The CRP reports to the EATAM Steering Committee. One round of grant making will take place in 2005. The EATAM Steering Committee will develop the selection criteria for the CRP and select the CRP members. EATAM Steering Committee may be CRP members. Term limits, terms of reference, and policies regarding CRP conflict of interest and confidentiality will be developed by the Steering Committee. All these documents will be distributed to EATAM membership. The Regional Coordinator is responsible to arranging CRP meetings, distributing and collecting grant applications, providing information and support to grant applicants, and assisting Tides Foundation in grant disbursement and grantee monitoring. 8-10 members Based on the above criteria, each country was given an opportunity to select their representatives and report to the plenary. The countries that were not represented in the conference would be communicated to and would elect their representatives and forward the names to the secretariat. The following are the members of the steering committee: Uganda Dr. Lydia Mungherera Representative Mr. Walter Okumu Alternate Kenya Mr. James Kamau Representative Ms. Asero Patricia Alternate Tanzania Mr. Batholomeo Talimo Representative Ms. Mpendwa Abineri Alternate Ethiopia Mr. Mengistu Zemene Representative Ms. Desta Girma Alternate Rwanda Ms. Shakilla UMutoni Representative Alternate to be elected and name f orwarded to the secretariat Burundi Marc De Becker Regional Networks Lillian Mworeko (ICW) Ex-officio Mike Aganga (NAP+) Ex-officio The CRP would be elected by the steering committee members. 7.0 WAY FORWARD Ms. Mercy Otim was designated to draw up a work plan and circulate to members for their comments. The following were emerging issues that needed to be included in the work plan/way forward Complete election of steering committee members Elect two representatives from the steering committee to represent EATAM at PATAM Complete and circulate the conference report by 20th June 2005 Election of the CRP Dissemination of workshop report Tentative work plan Managing the list server Send and receipt of articles for the newsletter Send recommendations for PATAM Newsletter Demands and deliverables for advocacy for 2005 Orientation of the steering committee Development of terms of reference for the committee Formation of committees at the country level for feeding into the EATAM. The list should be sent to EATAM Steering Committee Come up with a criteria of nominating a young person to the steering committee Adaptation of PATAM strategic plan by EATAM 8.0 OFFICIAL CLOSING OF THE CONFERENCE REMARKS BY DR. LYDIA MUNGHERERA She congratulated everybody for their active participation and noted that the success of the conference depended on each of the participants. She further noted that the purpose had been achieved. She called on all the members to go back to their respective countries and make sure they preach the gospel of advocacy and activism. REMARKS BY MR. KAMAU Mr. Kamau noted that the conference had come to a successful conclusion. She pledged that in the near future, there would be another meeting. She further noted that EATAM was all inclusive and that each participant in this conference had a duty to participate fully in EATAM activities and also make sure they bring many more people on board. REMARKS BY MR. DAVID BARR David thanked everybody for their contribution during the conference. REMARKS BY MS. GRACE MURO Grace conveyed her sincere gratitude to all who contributed towards the success of the conference. She further noted that it was important for all to learn from all that happened during the conference for the success of EATAM. REMARKS BY THE GUEST OF HONOUR The closing ceremony was officiated by Bishop Masereka who noted that the opening of the conference by a 12 year old and a closing by a participant was unique and gave confidence to all the participants. Representing Bishop Masereka Foundation and Uganda network of Religious leaders personally affected and infected with HIV/AIDS, said he had a personal and deeper understanding of HIV/AIDS as his foundation has got 400 clients which they have been assisting for the past 4 years. He further noted that they have over 500 orphans, whom they are paying for school fees. Because the problem is enormous, bishop Masereka noted that it is important to work together for a common goal and HIV/AIDS is a common enemy and thus have to join hands and fight it and not fighting human beings. He thanked the organisers of the conference for having invited him to participate in this important conference, called upon all the participants to go back to their respective countries and share the knowledge and information that they had acquired and fight as a team, together with God who is of mercy, compassion and care. He further emphasised that there is need to challenge whoever is acting differently. He finally gave God’s blessing as he officially closed the conference. 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