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Feminist Majority Foundation Chat Series of 2003

SOPHIA MUKASA MONICOGlobal Health Council
Wed., March 19, 3-4 pmEST

Part of the March Series: Global Women's Voices, HIV/AIDS Speakers

Sophia MonicoSophia Mukasa Monico is the Senior AIDS Program Officer for the Global Health Council. She has headed up TASO, The AIDS Support Organization, which provides counseling, medical support, education and training related to HIV and AIDS in Uganda, and she served as the HIV Vaccine Project Coordinator for a global network of AIDS service organizations based in Toronto. She is especially interested in discussing the current prevention interventions--Abstinence, Be faithful and Condom use--and their effectiveness in preventing HIV infection among women in a developing countries.

She recently did a presentation titled "HIVAIDS in Africa What Works?" In the presentation she emphasized the need for comprehensive programs, which include voluntary testing, counselling, medical care, and economic assistance; and integrated services for AIDS care, prevention, family planning, and STDs. Sophia received her law degree from Makere University in Kampala and her doctorate in modern languages and literature from the University of Bologna in Italy.

Cecilia Snyder: Hello Everyone. My name is Cecilia Snyder. I work as the Senior Associate/Executive Editor of PLANetwire.org, which is managed by CCMC (Communications Consortium Media Center). I will be moderating today's chat. I would like to thank Sophia Mukasa Monico for joining us in the chat today.

Sophia Mukasa Monico: Thank you for having me.

Johnny: What is Global AIDS?  Please define the global AIDS crisis. Thank you.

Sophia Mukasa Monico: Global AIDS can be interpreted as the HIV/AIDS epidemic outside the domestic borders. At the same time Global AIDS can also be interpreted as the AIDS epidemic that is affecting the whole world more or less in the same way.  It knows no frontiers.

Nakayinga Ritah: Just wondering whether TASO services have got as far as Karamoja?

Sophia Mukasa Monico: Direct TASO (The AIDS Support Organization) services are not available in Karamoja yet. However, indirect services - building capacity of communities and institutions to handle their own HIV/AIDS issues are being implemented. For example, TASO is working with the Moroto Missionary Hospital there. TASO is training the hospital to integrate TASO-like activities.  These include training nurses in HIV/AIDS counseling, medical personnel in HIV/AIDS/STD/TB management and community volunteers in AIDS education, information and communication

James M. Nordlund: If the roots of lack of compassion for the diseased and the en vogue economic tool war, one being psycho-pathic greed, aren't addressed in western societies sociological programming of their populaces, won't the corporate structure's convolution's devolutionary direction eventually determine more apathy and social pathos in global society; ergo less funding for prevention, treatment, and research into curing AIDS, in the longrun?

Sophia Mukasa Monico: Wow! That is quite a question - I read the question as--Can profits for some undermine the philanthropic and humanitarian spirit? There is no easy answer to such a question, but what I know from my experience is that so far foundations which are largely corporate institutions have been very supportive both financially and technically in responding to the HIV/AIDS epidemic. Some examples are the Gates Foundation, Kaiser Family Foundation, Rockefeller Foundation, Shell, etc, and you can find what they have done and are doing on their websites. I only hope and pray that the caring spirit will never die in us as human beings, otherwise, we shall lose direction of why we are here on earth.

Roz: Hello, how are you? Well, I took a HIV test in December it was negative. My husband's job often requires an AIDS test and his are always negative. We have been married for one year and I was active with someone else about three months before I meet him. So, what are the chances of a next HIV test being negative?

Sophia Mukasa Monico: From your question, the quick straight forward answer is that, if you tested HIV negative a year ago and have not been exposed to HIV infection, then the probability of you not being infected or HIV negative is 100%. There is what they call the window period - which is usually calculated to be 14 days to 3 months from the time you were exposed to HIV infection. This is the time when the body is still figuring out what is happening and has not produced enough antibodies, that are detectable as evidence of HIV infection in most of the HIV tests they use. If there is high suspicion of HIV infection, the probability of getting a false positive or you are using a rapid test, you may be asked to take another test using a more complicated procedure to confirm it. 

Amy: What can other countries learn from the success of Uganda in terms of dealing with HIV/AIDS?

Sophia Mukasa Monico: I think so many countries can learn some of the key elements that led to the success, including political commitment.  The president did not just talk about the epidemic, he also made sure that policies were implemented. Another big lesson learned is that a country needs a multi-sectoral response.  If everyone looks at HIV/AIDS as just a health issue, you are missing the bigger picture of all the sectors that HIV/AIDS touches. In addition, Uganda was very frank in talking about sexual issues, and was instrumental in promoting the ABC approach, abstinence (actually phrased as delaying the first sexual encounter); Being faithful to one partner, and Consistent condom use. One last thing: Uganda was very successful in decentralizing the planning and implementation for prevention interventions, for example behavior change communication, care and support of people living with HIV/AIDS.  These reached both the general population and key target groups.

Kerry: Have the actions of the Bush administration made you more or less engaged in politics?

Sophia Mukasa Monico: Well, I am apolitical, but what I am learning about this administration is that how much we are engaged determines what is going to happen in terms of war and other big issues that are still on their radar screen.  For instance, I have been asked to testify before Congress about HIV/AIDS in Africa. Also his passionate speech during the State of the Union address has helped keep the issue in the spotlight.

Lydia: How can people in the U.S. help AIDS orphans in Africa?

Sophia Mukasa Monico: One answer, which might not work for everyone, is to adopt. Another is to provide financial support to those institutions that are caring for the orphans, such as World Vision (http://www.worldvision.org/worldvision/master.nsf/), Save the Children (http://www.savethechildren.org/), and the Hope for African Children Initiative (http://www.hopeforafricanchildren.org/). But the best would be to help them in their own environment.

Jim: What are some barriers in terms of effective treatment for HIV/AIDS in Uganda? What are some factors that treatment programs should consider to make sure they are effective?

Sophia Mukasa Monico: A huge barrier is cost. Although the prices have gone down tremendously in the past year, we are talking about people who earn about $50 a month. Also in many African families, more than one person--typically about three--are infected with HIV in one family; so the cost is even more. Another barrier is the inadequate infrastructure that makes it difficult to disseminate information. Also the lack of commodities, such as condoms, which in many African countries is not available, so we must wait for them to be delivered.  The same applies to drugs.

Jonathan: What are some innovative programs that are helping to prevent HIV/AIDS in Uganda? Is there still a stigma attached to condom use? Are female condoms available?

Sophia Mukasa Monico: Female condoms are available in Uganda, and they are supplied by the Ministry of Health. Many of the programs that we have done specifically target women, youth, stigma, and discrimination. For example, TASO worked to demonstrate --not just talk--that eating, caring for someone with HIV does not mean you will get infected. We de-mystified HIV by caring for infected people and educating the general public by creating more awareness. In addition, our president advocates and ensures that women are in more leadership positions.

Mary: Do you think we can we learn from traditional medicine in terms of prevention or treatment of HIV/AIDS?

Sophia Mukasa Monico: Yes, a lot. 90 percent of most Ugandans I know who are infected run to traditional healers. In Uganda, the concoctions of traditional healers for skin conditions are much better than the commercial ones available. An organization called THETA (Traditional and Modern Health Practitioners Together against AIDS) is currently working with them in Uganda to help educate people about HIV/AIDS and the means of transmission, for example educating people not to use the same knife on different people without cleaning. Instead they advocate that the clients bring their own sharp instruments for circumcision, etc.

Brad: How did you react/respond to the removal of information re: condom efficacy in preventing HIV/AIDS and STIs (Sexually Transmitted Infections) from the CDC website?

Sophia Mukasa Monico: It's unfortunate.

Gina: What do you think about investing more funding into the development of microbicides?

Sophia Mukasa Monico: If we are talking about effective prevention of HIV infection in women, then we have to invest in microbicides. For most African women and other women in general, the ABC method is not very applicable.

Paula: Are there South to South initiatives in terms of linking governments, businesses and NGOs in different regions of the world to deal more effectively with the HIV/AIDS issue?

Sophia Mukasa Monico: Yes, the biggest initiative is UNDP's initiative called South-to-South Techical Collaboration. Another one, is the Mayor's Initiative --a response to AIDS at the local and national government level. All the mayors from around the world get together to talk about HIV/AIDS.

Joanna: What do you think about the current vaccine initiatives? Which one seems to be the most promising?

Sophia Mukasa Monico: We all heard the news about the most recent trials, and I think one piece of good news is--we know what works and what does not work. VaxGen laid a good foundation for building the case that a vaccine can actually be developed. We are still waiting to hear the results from Thailand. Another promising initiative comes from IAVI (International AIDS Vaccine Initiative http://www.iavi.org/) , they are still in the very early stages, but for the first time, we are getting candidates that are targeting African sub-types. But we still need as many candidates as possible.

Julia: What role should local businesses and multinational corporations play in the fight against HIV/AIDS?

Sophia Mukasa Monico: If we are talking about big money, we should press them. And if we are talking about influencing government opinion, we should do that as well. But remember that big institutions also include pharmaceutical companies, so from a health care point of view and treating morbidity --they are the ones that have the answer. As long as they look at only profits, those of us in the developing countries are bound to die, even when treatments are available. This goes back to my answer to the question by James M. Nordlund above.

Lynn: Can someone have sex with someone who has HIV/AIDS and not get infected? Does there have to be exchange of blood or can other bodily fluids also transmit the virus?

Sophia Mukasa Monico: Yes, the other bodily fluids are semen and breast milk. According to some studies in Uganda, the probability of getting HIV in each sexual encounter is 0.1 percent. That does not mean you should not protect yourself each time, because infection also depends on your body's constitution and other factors.

Jeff: Hi Sophia. I was at the screening of the new film A Closer Walk last Wednesday. The director, Robert Bilheimer, said the ultimate goal of the film is to raise awareness among regular Americans about the global AIDS epidemic and hopefully spur them to take action. I was hoping you could talk a bit about the film (and your involvement with it) and perhaps why AIDS should matter to the average American, who never sees or experiences it firsthand. Thanks.

Sophia Mukasa Monico: I am actually in the film, talking about Olivia, who is a girl I adopted. She died of AIDS when she was 21 years old. Her mother died when she was 12, and she joined TASO--that is where I met her and started taking care of her. Films like this help bring this issue to others who normally do not experience this and help them to understand the crisis.  It gives a human face to this issue. Hopefully the average American will be touched enough to turn concern into action.

Peter: The HIV/AIDS epidemic is creating communities where there are many orphans. How are communities coping with this? What kind of programs are most successful in helping these communities?

Sophia Mukasa Monico: We are barely coping. The most outstanding feature is that elderly people, grandmothers, are looking after them--and they have no means of financial support. The spillover of children take to the streets--unsupported, parentless, with no food, no education, nothing. The worse thing is that this cohort of young people, with nothing to lose, might become prime candidates for recruitment of terrorist activities.  We have to come up with ways to support these youth and give them a solid identity and a reason to live.

Beatrice: How have you personally been affected by the HIV/AIDS crisis? Do you have advice for others who are dealing with it on a regular basis?

Sophia Mukasa Monico: My sister and three brothers died of AIDS, and I have adopted two children who lost their parents to AIDS. In addition, I am paying the school fees for 24 children in Uganda. My advice is counseling for the caregiver as well. We are all human beings, and this is a long-term disease that takes its toll emotionally and physically, and we need to take care of the infected and the affected, equally.

Cecila Snyder: Thanks Sophia for taking the time to share your thoughts with us today. Good luck in your work. Thanks also to all those who joined in the chat.

Sophia Mukasa Monico: Thank you so much.