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A world without AIDS: One Zimbabwean at a time
Amanda Atwood
October 01, 2007

When Lynde Francis contracted HIV 21 years ago, the prognosis was bleak. There was no known treatment, no cure, and people were not expected to live more than five years. She founded The Centre in the back of her house in 1991, with the vision "to give hope to the hopeless." 16 years later, Francis, The Centre and the perceptions of HIV in Zimbabwe and globally have all changed. In a recent interview with Kubatana, Francis shared her unique perspective on issues such as the holistic perspective on health, the table of nutrition, and AIDS' role as "the great revealer."

The Centre's vision: A world without AIDS

At a recent strategic planning meeting, The Centre redefined its vision to be "a world without AIDS." Ambitious? Francis doesn't believe so at all.

"AIDS is a construct," she says. "With the availability of treatment, HIV has segued into a chronic, manageable disease." The Centre isn't working for a world without HIV; that would be unrealistic. But a future where HIV does not progress into AIDS and is instead viewed as a lifestyle illness like diabetes? "It's doable," believes Francis.

And it's a world without AIDS, not a Zimbabwe without aids, because, says Francis, "Why stop at Zimbabwe? The Centre is regional and international. We don't live in a village any more; we live in a global village. So what happens to my brother affects me."

Essential to achieving a world without AIDS are the other two aspects of The Centre's vision - MIPHA (the meaningful involvement of people living with HIV/AIDS) and a holistic approach to health.

Holistic approach to health

The holistic approach to health runs through The Centre's work and Francis' own philosophy. "You cannot have a world without AIDS," she says, "until you have healthy people. And you can't have healthy people unless you have a healthy planet. Everything is linked. You can't deal with one part of the conundrum. You have to deal with the whole thing."

Francis finds the focus on sexual behaviour blinkered. Rather, she advocates for a change in "health seeking behaviour" as a whole, so that individuals and the health care system change their approach towards wellness and disease in general.

"Health is treatment, care, love and support," says Francis. "It is a continuum. We believe that health has to be a holistic issue. There is a table of health, whose legs are mental, physical, spiritual and social health. The top of the table is nutrition. You don't treat a disease, you treat a person." Francis has a dream of 'wellness clinics,' instead of illness clinics, where "people could go to learn to be healthy and stay healthy and could celebrate their health."

This change in attitude and behaviour is easier when someone has a life-threatening illness. "People who regard themselves as healthy don't want to make changes," Francis explains. "But when somebody comes to The Centre they have 8 CD4s and they've had meningitis and TB and they can't afford the drugs, then they're willing to try something new."

AIDS as "the great revealer"

Despite the many tragedies of HIV/AIDS, Francis has come to value the ways in which the reality of AIDS is transforming perspectives on gender, sexuality, health and development. Like the holistic approach to health, Francis believes a holistic approach to the epidemic is essential.

"HIV rights are human rights," she says. "Women's rights are human rights, children's rights are human rights, and you cannot deal with this pandemic unless you look at all of these areas."

AIDS is forcing people to look at the interconnectedness of different issues, and to confront topics they have previously been reluctant to broach.

"My name for HIV is the great revealer," says Francis. "It is a vehicle that is enabling us to put onto the table things which were taboo, the things that were there but nobody talked about. It is enabling us to find a platform for moving those issues."

She has observed a shifting understanding of the epidemic over the years. Francis has begun to see a coming together of activists across issues such as HIV, the environment, and appreciates the ways in which it is forcing conversations to be held across previously separate sectors such as health, women's issues, the environment, activism, and development workers.

"I have had the pleasure three or four times in the last two years to be in fora and conferences where everybody was reading from the same page," says Francis with excitement, "where the development people are beginning to see that you can't have development unless you mainstream HIV, and the HIV people are finally seeing that you can't have HIV alleviation unless you mainstream development. It's all the same struggle. We just use different vehicles."

Local inspiration

When asked what inspires her most in her work, Francis says without missing a beat: "My children." She is referring to participants in The Centre's youth programmes, Teen Spirits and Bright Futures. These programmes give young, HIV positive Zimbabweans a place where they can define their own future and have their voices heard.

The Centre runs progammes with school children which, Francis says, are often initially viewed with some resistance. But the organisers of these programmes are themselves HIV positive, and they become the best representatives of the organisation. When the school children meet the education officers from The Centre, who were themselves infected at a young age, but who look good and are in control of their lives and have a positive take on what they can do, it changes their whole attitude.

According to Francis, "Aids is its own best ambassador for overcoming the stigma. When it started, people could say 'it's them, it's those people.' But now there is nobody, no household, no workplace, no village, no street that isn't directly affected."

This isn't to say that the stigma around HIV doesn't persist. Francis says it remains incredibly difficult for people to disclose their status, in part due to the years of blaming and moralizing messages.

But, she says, the reality of young people, who were born with HIV and are now adolescents and young adults, is forcing everyone to reconsider their view on the virus.

When HIV was first discovered, says Francis, "the whole attitude was that children born with HIV wont live past the age of five." But things have changed. "The kids who I have in my group were born with HIV. They are adolescents. They're young adults. They are trying to have a family, to have a normal emotional life. But there are no messages for them."

The Centre has 800 youth group members aged 16-25 who, says Francis, "were born in the era of HIV and will spend the whole of the rest of their lives with HIV. You have to stop the idea that the only way to get HIV is to be promiscuous and immoral and a degenerate."

While the discourse around sex and sexuality, morality and gender inequality has not completely shifted, Francis notes that the HIV epidemic will force these conversations to happen, and, she hopes, will eventually see even those dynamics transformed.

Funding and indicators

As international attitudes towards HIV have shifted, funding for HIV programmes increased, after many years of lobbying for it. In Zimbabwe, the shifting attitudes have arrived, but not the resources. According to Francis, the average per capita funding for HIV programming in Zimbabwe is $4 per year, as opposed to $340 per head per annum for other SADC countries. Francis attributes this far lower funding to Zimbabwe's status as a "political pariah."

Francis is firm that the knowledge and capacity for better addressing AIDS in Zimbabwe is there, but without financial and political support, the effectiveness of these efforts will continue to be limited.

The main challenge for Zimbabweans living with HIV is not simply access to medicine. "It's access to care," says Francis, "to food, to transport to get to the clinic, to reagents that can do the tests, to drugs that don't need refrigeration." The lack of resources affects HIV positive Zimbabweans across a range of issues, and the solution is not as simple as fast tracking more drugs to more people.

"Here people don't have food to take the drugs with," Francis explains. "They don't have the bus fare to get to the clinic."

As the economic situation worsens across the country, Francis has observed worrying ways in which those infected with HIV become seen as "privileged" compared with the rest of the population. "A vicious aspect of the crisis," she explains, "is that people want to get HIV because it's the only way you can access some of these things. They see HIV orphans as more privileged as ordinary orphans. They see people with HIV getting free medication and food packs because they're HIV positive, so they want to get HIV because they might get a food pack. They see their children might get into the BEAM programme and have their education paid. You can no longer say it's the people with HIV who are starving, or whose lives are threatened; it's everybody."

Francis also describes the challenges of measuring the quality of HIV prevention and treatment programmes, not simply the quantities of condoms distributed or the number of HIV education speeches given.

She points out, "Distributing condoms doesn't say they've been put on willies." Counting the number of children who have had a one hour HIV/AIDS lecture "says nothing about the quality of that education, the applicability of that education to the children who were being taught, or the usefulness of that information."

There is a tension, Francis explains, between the donor community that views indicators as quantifiable numbers that can be reported on, and those working on the ground who appreciate the need to look at the quality of intervention and what kind of difference that is making in people's lives. Putting it starkly, she says, "The donor has to go back to her constituency and say we reached so many people, we distributed so many condoms, we provided so many thousand test kits. They don't have to tell their funder the number of people who committed suicide after the test because there was no access to treatment."

What's missing?

In addition to resource constraints, Francis sees the lack of an activist HIV movement as another obstacle in the way of changing health seeking behaviour in Zimbabwe. Like other social justice movements, she says, HIV activism is constrained by Zimbabwe's political climate, and the current levels of fear and intimidation.

"The problem is that AIDS activism is political," she says. "We have an activist movement - ZAHA (Zimbabwe Activists on HIV/AIDS) - and we do a lot on the Internet and internationally. But activism here is different from say in South Africa where there is a long history of civil disobedience."

In Zimbabwe, Francis claims, "civil disobedience gets you beaten up, shot, gassed, jailed. Any protest is seen as dissidents against the government, so it is hard to be even a treatment activist."

Francis believes the real social change around HIV will happen as people begin to stand up for what they need themselves. "The biggest challenge," she says, "is teaching people to ask questions. People are taught that the doctor sits on the right hand side of God. You don't ask your doctor questions. You say yes sir. Thank you sir. Change will come with emancipating people to know the questions to ask and that they have a right to ask them, that they have a right to information."

Background on The Centre

The Centre is playing its part in changing the health seeking behaviours of its clients. With 27 employees, 32 volunteers and two or three interns at any given time, the organisation serves over 2,800 clients through its Milton Park office alone, in addition to home-based care groups in Hatfield, Epworth, and high-density areas across Harare. It also has outreach offices across the country in places like Buhera, Makoni and Binga. The Centre trains local members of existing Community Based Organisations so that they may return to their communities and serve as health officers there.

The Centre's adult treatment programmes, access to medication, its children's group Teen Spirit and its youth group Bright Futures are all run through a membership card system that helps the organisation track individuals, their medical history, and the treatments they have received in the past.

To help raise funds for its community and youth work, The Centre runs its Wellness Campaign. These services to business include assistance in setting up work place policies on HIV, welfare support for staff, nutritional and herb gardens, overhauling the company canteen so that it offers healthy food to staff, and education for management, staff and family members.

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