How To Stop AIDS From Spreading Across Africa's Borders

HIV testing has been set up at border-crossings, with particular attention on truck drivers and prostitutes who may be particularly vulnerable.

A "safe stop" in Rwanda
A "safe stop" in Rwanda
Fulgence Niyonagize

KIGALI - The Gatuna border between Rwanda and Uganda is bustling. Next to the truck stop, passengers disembark from the large buses that travel between the respective capital cities of Kigali and Kampala.

The people from both countries make their way across the border, and ahead toward the side of the road where little white tents are set up with nurses inside in white lab coats.

In these tents, Family Health International (FHI), an international organization working with the Rwandan Ministry of Health, has installed a “safe stop,” a place where people can get tested for HIV/AIDS.

“Here, people are more likely to be infected than in other places. Truckers, for instance, spend a lot of time on the road, away from their families and tend to have unprotected sex," explains Isaie Nsengiyumva from FHI. "There are also the prostitutes that cross the border over to Uganda or the other way around.”

He says the mobile clinic also targets the communities living near the border, from currency exchange clerks to public and private sector employees.

“I got tested a few months ago, and now I know what my status is. We are too swamped to go to the hospital to get tested, but now that the clinic is close to where we work, anyone can go, without wasting too much time,” says Janvier Uwimana, who works at the currency exchange.

Since June 2012, more than 1,300 people have gotten tested here – with 14% of them finding out they were HIV positive. To monitor and treat those who are infected with the disease, FHI has set up other mobile clinics in “hotspot” transport corridor towns in Kenya, Tanzania, Congo, Zambia, Burundi, Uganda and Djibouti, targeting approximately 2.2 million people, including 300,000 truck drivers.

According to a survey by the Rwanda Biomedical Center (RBC) in 2012, only 10% of the 530 truck drivers they interviewed said they used condoms. Two hundred of them agreed to get tested, and four tested positive for HIV/AIDS. “They have very frequent relations. But what is terrible is that few of them use condoms,” says Doctor Sabin Nsanzimana from the RBC.

Mobile clinics for a mobile population

Thanks to the FHI program, people can get treated in any one of the countries where there are mobile clinics, regardless of nationality and even if they are refugees. The goal of the clinics is to stem the HIV/AIDS epidemic that has plagued this region since the 1990s and has spread massively through cross-border conflict, displacements and returning refugees.

Refugees fleeing the war in Congo or Rwandans returning home after being displaced by conflict, represent a massive number of people coming and going, many of whom will have unprotected sex during their travels.

According to the Rwandan Ministry of Disaster Management and Refugee Affairs (Midimar), in refugee camps, tests are carried out upon arrival, while the refugees are filling out their paperwork. “We do this for their own good. Some of these people are coming in from the forests, they have no way of knowing whether they are contaminated or not,” says Dr. Nsanzimana from Midimar. “When they test positive for HIV/AIDS, we send them to state-run – free – clinics, where they can get treatment and can be given antiretroviral drugs.”

According to Midimar, the refugee camps located in south and western Rwanda (Kigem and Kiziba camps) provide testing and treatment for HIV/AIDS. They also provide condoms and use posters and pamphlets to raise awareness on the disease and how it spreads.

Another initiative is the Jeunesse Nouvelle Vision (New Youth Vision), a youth organization. “UNICEF and the UNHCR asked us to talk to the young refugees of the Nkamira about HIV/AIDS and sex education using sports and culture. Our counselors teach them to be responsible,” explains Immaculée Mukamuhiz, the organization’s coordinator.

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Feed The Future

COP26 Should Mark A Turning Point In Solving The Climate Crisis

Slow Food calls for an action plan to significantly reduce and improve the production and consumption of meat, dairy, and eggs by 2050.

A new dawn?

If, as the saying goes, we are what we eat, the same also goes for the animals that end up on our plate. How we feed our own food can have knock-on effects, not just for our own health but also for the planet. We are now aware of the meat and dairy industry's significant carbon footprint, responsible for more than a third of global anthropogenic greenhouse gas emissions.

Large-scale cattle productions that favor pure profit over more sustainable practices also add to environmental woes through biodiversity loss, deforestation and pesticide use — with some of the world's richest countries contributing disproportionately: The five biggest meat and milk producers emit the same amount of greenhouse gases as the oil giant Exxon.

The good news is that we could meet — if we would — some of these challenges with an array of innovative solutions, as the fields of farming, breeding and nutrition look at ways to shift from centralized intensive agro industry toward a more localized, smaller-scale and more organic approach to production.

Cows fed corn and grain-based diets may grow larger and are ready to be processed at a younger age — but this requires significant energy, as well as land and water resources; in contrast, grass and hay-fed cows support a regenerative farming model in which grazing can contribute to restoring the health of soil through increased microbial diversity. Compared to highly processed GM crops, natural-grass diets with minimal cereals also lead to more nutrient-rich livestock, producing better quality meat, milk and cheese. Farmers have started focusing on breeding native animal species that are best adapted to local environmental contexts.

This new approach to agricultural practices is closely linked to the concept of agroecology, where farming works in tandem with the environment instead of exploiting it. If mowed a few times a year, for instance, natural meadows produce hay that is rich in grasses, legumes and flowers of the sunflower family, like daisies, dandelions, thistles and cornflowers. These biomes become reservoirs of biodiversity for our countryside, hosting countless species of vegetables, insects and birds, many of which are at risk of extinction. Until recently, these were common habitats in meadows that were not plugged or tilled and only required light fertilization. Today, however, they are becoming increasingly threatened: in the plains, where the terrain is used for monocultures like corn; or in hills and mountains, where fields are facing gradual abandonment.

It is worth noting that extensive agriculture, which requires smaller amounts of capital and labor in relation to the size of farmed land, can actually help curb climate change effects through carbon dioxide absorption. Researchers at the University of California, Davis determined that in their state, grasslands and rangelands have actually acted as more resilient carbon sinks than forests in recent years. Through a system of carbon uptake, these lands provide a form of natural compensation, going as far as canceling the farms' impact on the planet, rendering them carbon "creditors."

In the meantime, grasslands and pastures allow animals to live in accordance with their natural behavioral needs, spending most of the year outside being raised by bonafide farmers who care about animal welfare. A recent study by Nature found that allowing cows to graze out of doors has both psychological and physical health benefits, as they seem to enjoy the open space and ability to lie on the soft ground.

Some might worry about the economic losses that come with this slower and smaller business model, but there are also opportunities for creativity in diversifying activities, like agro-tourism and direct sales that can actually increase a farm's profit margin. This form of sustainable production goes hand-in-hand with the Slow Meat campaign, which encourages people to reduce their meat consumption while buying better quality, sustainable meat.

Others may assume that the only environmentally-conscious diet is entirely plant-based. That is indeed a valuable and viable option, but there are also thoughtful ways to consume meat in moderation — and more sustainably. It also should be noted that many fruits and vegetables have surprisingly large carbon footprints: The industrial-scale cultivation of avocados, for example, requires massive amounts of water and causes great hardship to farming communities in Latin America.

But forging a broad shift toward more "biodiversity-friendly" pastoralism requires action by both those producing and eating meat, and those with the legislative power to enact industry-wide change. It is urgent that policies be put into place to support a return to long-established agricultural practices that can sustainably feed future generations. Although no country in the world today has a defined strategy to decrease consumption while transforming production, governments are bound to play a key role in the green transition, present and future.

In Europe, Slow Food recommends that the Fit for 55 package include reducing emissions from agriculture activities by 65% (based on 2005 levels) by 2050. Agriculture-related land use emissions should also reach net-zero by 2040 and become a sink of -150 Mt CO2eq by 2050. But these targets can only be met if the EU farming sector adopts agroecological practices at a regional scale, and if consumers shift to more sustainable diets. If we are indeed what we eat, we should also care deeply about how the choices we make impact the planet that feeds us.

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