Extra-Time

From where Esther Goba sat watching two football teams clad in “HIV POSITIVE” t-shirts competing in a football tournament in Limbe, Malawi, she wouldn’t strike you as someone who is at the frontlines of the life-or-death match against HIV/AIDS.

Dozens of participants in MSF’s HALFTIME! football tournament in Limbe, Malawi take part in a march to raise awareness of the consequences of international HIV/AIDS funders cutting back on spending. Photo: P.K. Lee/MSF

But Esther, aged 53, is doubly affected: she has been living with HIV for the last 8 years and she is a nurse with a passion for supporting people like herself and ensuring that they stick to their life-saving antiretroviral (ARV) treatment. 

Last week she was one of the scores of supporters I saw next to a football pitch at the Chiwembe Technical Centre, in Limbe, where people living with HIV and staff from Médecins Sans Frontières / Doctors Without Borders (MSF) HIV treatment projects in Malawi, played football as part of MSF’s HALFTIME! initiative. Representatives from the Malawi Ministry of Health (MoH), the support organisation NAPHAM (National Association for People living with HIV/AIDS in Malawi) and Dignitas International also participated.

HALFTIME! is an MSF initiative to raise awareness of the impact of international donors withdrawing from funding HIV/AIDS projects and treatment. While the other HALFTIME! events around the world (in Johannesburg, Brussels, Geneva and Berlin) were hosted in cities, HALFTIME! in Malawi had a very different backdrop – beautiful mountain views, clear blue skies and villages dotting surrounding areas.

Esther has been working as an MSF staff nurse in Malawi’s Thyolo district for nine years now.

In 1995 when Esther’s husband died of AIDS it was at a time when people in Malawi still knew very little about the disease. Later she started working with MSF in a prevention of mother to child transmission programme, motivating pregnant women to get tested for HIV. “One day I told myself: ‘Why don’t you get tested as well?’ ” Esther told me.

Esther Goba is an MSF nurse working in an HIV/AIDS treatment project in Thyolo, Malawi. She has been living with HIV since 2008 as both a patient and medical worker. “We have the right for life. We have the right for treatment,” Esther says. Photo: P.K. Lee/MSF

“I tested HIV positive in 2008 and I started ARV treatment later in the same year. To me ARV treatment means life and hope,” she said. “Since I learnt of my status, I had one hope – to educate my children. That’s the only thing I wanted to do in my life.”

Thanks to the ARV treatment, Esther achieved more than she hoped for. Not only is she able to see her four children growing into adults, but she is also able to make a difference in the lives of dozens other people living with HIV by working as a nurse.

As a medical worker in the battle against the HIV/AIDS crisis, Esther has also witnessed the importance of continued funding for ARV drugs which has brought treatment closer to people in need. “By now I thought we would be talking about the improvement of ARV treatment, the management of side-effects and access to newer and better treatments. But instead now we hear the international donors talking about cutting funding,” Esther explained to me.

“If the donors cut the funding on ARV treatment, it’s like saying that they just want us to die, they want our children to suffer again, they want our children to be orphans,” said Esther. “We have the right for life. And we have the right for treatment.”

- PK Lee, MSF Communications Officer.

“HALFTIME! is no time to quit” footballers living with HIV tell international donors

Nomcebo Dlamini pumps her feet into the sparse turf of Newtown Park. “Being HIV positive is not the end of life,” she says with gutsy determination. It is just minutes before the kick-off of HALFTIME! – five-a-side football tournament organised by international medical humanitarian organisation Médecins Sans Frontières / Doctors Without Borders (MSF) in Johannesburg, South Africa.

HALFTIME! football tournament in Limbe, Malawi. Six teams participated in the tournament. The players of which some are people living with HIV/AIDS are all alive today because of the availability of ARVs. They are calling on donors to stay in the life-or-death match against HIV/AIDS. Photo by: P.K. Lee/MSF

Nomcebo, aged 30, is a mother of three and one of the stars of the HIV Conquerors team from Swaziland playing against five other teams featuring people living with HIV from South Africa, Mozambique and Zimbabwe in the HALFTIME! tournament.

HALFTIME! is an initiative which seeks to raise awareness of the consequences of international donors’ growing disengagement from HIV/AIDS treatment funding in recent months. Through HALFTIME! in South Africa people living with HIV make their voices heard during the 2010 FIFA Soccer World Cup, telling international donors that it is no time to quit on funding treatment, when millions of lives are at stake in the life-or-death match against HIV/AIDS.

It is thanks to major international funding that 4 million people worldwide are alive and on life-saving antiretroviral (ARV) treatment today. Four years ago Nomcebo was able to start on ARV treatment. Thanks to the drugs and a prevention of mother to child transmission programme she is living a healthy life and her children are not HIV positive. “ARVs were the beginning of life for us,” she says.

But Nomcebo’s gains and those of millions of other people dependent on donor funded ARV treatment are under threat. Their health and lives are at risk as major international donors including the US President’s Emergency Plan for AIDS Relief (PEPFAR), the World Bank, UNITAID, and donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria have started capping, reducing or withdrawing their spending on HIV treatment and ARV drugs during the last 18 months.

All the participants and MSF staff took a march from the MSF office to the venue to before the HALFTIME! football tournament began in Limbe, Malawi. Photo by P.K. Lee/MSF

Apart from the flat-lining of funds and dwindling donor commitments, few African countries have lived up to the Abuja Declaration of 2001 where African leaders committed to spend 15 percent of their expenditure on health care. All this does not bode well for people like Nomcebo.

HIV/AIDS crisis is not over

With an estimated 33.4 million people worldwide living with HIV and 2 million people dying of AIDS each year the HIV emergency is far from over. Today more than 9 million people living with HIV who are in urgent need of ARV treatment still do not have access to it – this in 2010, the year by which world leaders had committed to reach universal access to ARVs for all those who need it as part of pledges to achieve the Millennium Development Goals.

“Only one in three people living with HIV in urgent need of ARVs have access to it. So we are not halfway there yet in treating everyone. The HIV/AIDS emergency is not over and we are saying halftime is no time to quit! Millions of people are at risk of dying within the next few years if we don’t do more now to keep donors to their promises. It is unacceptable; it is a moral betrayal to back out of these promises,” says Dr. Gilles van Cutsem, MSF project coordinator in Khayelitsha, South Africa.

In the field MSF has already observed in several sub-Saharan African countries that a reduction of funding means fewer ARV treatment slots are available and that treatment is being rationed. Already in Uganda, people must wait for patients on ARVs to die before they can begin treatment, while in other countries like Zimbabwe there are limits to when people are enrolled on treatment. “Instead of building on it, we see signs of punishing the successes of the last decade,” says Dr. Van Cutsem.

All the participants and MSF staff took a march from the MSF office to the venue to before the HALFTIME! football tournament began in Limbe, Malawi. Photo by P.K. Lee/MSF

Dlamini puts it more bluntly: “If the donors are going to leave us, then we are dead.” She describes how she has already lost both her sister and her mother to AIDS – a shockingly common occurrence in Swaziland, where one in four people are infected with HIV/AIDS and less than half of those in need of ARV have access to it.

What about the future?

On the pitch all 36 players in the tournament are kitted out in brightly coloured t-shirts with the “HIV Positive” slogan emblazoned on the chest. Over 200 supporters in similar t-shirts line the field, cheering on the teams with every shot at goal. Curious passersby stop and watch the matches. They amazed when they hear that the players exhibiting such vigour on the field are people living with HIV.

One of the participating teams from South Africa has a poignant name to embody the change ARVs have brought to their lives and those of millions more in the rest of sub-Saharan Africa. They are called Siyaphila, a word in the locally spoken Xhosa language which means “we are alive, we are well.”

“I was privileged enough to enjoy life with ARVs. But what about the people on waiting lists? What about the people who are getting infected with HIV every day? Will they get the opportunity that I have; to stay alive and well, and to enjoy life? I want to urge donors to stay in the fight and not to drop their commitments to funding ARVs,” says Siyaphila team member Nonqaba Jacobs. 

• The HALFTIME! five-a-side football tournament in Johannesburg, South Africa, took place on 2 July 2010. The event was part of several other activities in Switzerland, Belgium, Malawi and Germany during the international HALFTIME! initiative. For more on HALFTIME! visit www.msf-halftime.info 
• Médecins Sans Frontières/Doctors Without Borders (MSF) provides treatment and support for more than 160,000 people living with HIV and AIDS in over 27 countries through different programmes.

The 2010 FIFA World Cup is in its final stage and the excitement in Southern Africa is still palpable even in Zimbabwe where I work in a nurse for Médecins Sans Frontières / Doctors Without Borders (MSF) in an HIV/AIDS treatment project, n north of host nation South Africa. It’s an excitement that has not been dampened despite the disappointment of Ghana’s Black Stars are now out of the running.

South Africa’s Siyaphila team goalkeeper Nandipha Makhele tries her best to stop a shot at goal by Janet Mpalume, star striker of Zimbabwe’s ARV Swallows during the HALFTIME! 5-a-side football tournament in Johannesburg, South Africa. Photo by Lisa Skinner

Seeing as this is the first time I’ve written a blog I was stuck with the inevitable “where do I start?’ dilemma. But a discussion with our outreach staff and information, education and communication (IEC) department set me on a journey into understanding how our patients view the topic of HIV relating to soccer. As it turns out, one of the many IEC activities that MSF carries out in Bulawayo is to support the monthly recreational activities hosted by the HIV peer support groups.

There are a total of 145 support groups in Bulawayo, which meet weekly. And once a month, all the districts (made up of ten support groups each), meet and play football and netball together. MSF provides logistical and material support, which includes the supply of soccer balls, refreshments, transport, and a first aid kit. We also facilitate an empowerment program for focal persons in the support groups.

So, last week I decided to go along and meet everybody and hear their thoughts on HIV, football and the World Cup. These are their stories:

Shedias, peer support group leader:

Shedias was treated for tuberculosis in 2002 and also tested HIV positive. “Being HIV positive is like a game of football: you either win or lose. I take it as winning. By working as a team and living positively we can beat HIV. One of the key players is the goalkeeper, he stops HIV from scoring! Soccer is a fast game, it moves fast like HIV but by playing soccer we can also spread important messages about HIV by networking and sharing stories,” says Shedias.

Swaziland’s HIV Conquerors go head-to-head with South African health activist group Treatment Action Campaign team Flucanozole Pirates in one of the most exciting challenges in the HALFTIME! tournament. HALFTIME! in Johannesburg, South Africa, was part of an international initiative to raise awareness about the impact of dwindling commitments by international donors to fund HIV/AIDS. Photo by Lisa Skinner

Junior, peer support group leader:

Junior tested HIV positive in 2006 and started the Victory support group which now comprises 59 members. They do candle-making, make peanut butter and all have vegetable gardens in their backyards. The money they receive from selling these items helps pay for their children’s school fees, medications to treat opportunistic infections (these medications are not always available and they have to buy them at private pharmacies).

“Antiretrovirals (ARVs) are the defenders in the game of soccer. They stop re-infection and help us to have a stress-free life,” Junior says.

Dick, peer support group member:

Dick tested HIV positive in 2009 and started ARVs in January 2010. He has been a Level 3 soccer coach for twelve years and has helped develop a boys’ team to make it to the national level. He then became sick and started to withdraw from his involvement in football. He has recently disclosed his status, which has helped with his adherence to taking his ARV drugs. His family members now remind him that it is time to take his treatment Now that he is beginning to feel better, he wants to become more involved in football again.

I found the experiences of talking to people who are open and living positively with HIV incredibly inspiring and real. It makes me think that HIV is not only about receiving ARVs, but also about being able to conquer the mental aspect of this disease.

- Joanne Sage is an Australian nurse working with MSF in Bulawayo, Zimbabwe. Joanne joined the MSF in 2004, and has also worked in Sudan and Ethiopia.

How strange it would be if the players in a World Cup winning side were to meet just five days before the deciding match for the very first time to train together and then take the title with a convincing victory…

Taking the HALFTIME! title: Munyaradzi Dodho, coach of Zimbabwe’s Opportunistic Infection Bombers (OI Bombers) celebrates his side’s victory in the final match of the HALFTIME! tournament. The team was the top scoring side in the tournament, with 12 goals out of the total of 34 being off the boots of OI Bombers’ strikers. Photo by: Lisa Skinner

But when Médecins Sans Frontières / Doctors Without Borders (MSF) promised you an alternate take on football through the HALFTIME! initiative during the 2010 FIFA World Cup, that is perhaps exactly what was to be expected: unexpected success against the odds.

HALFTIME! brought together six teams of people living with HIV from across Southern Africa to compete in a 5-a-side football tournament in Johannesburg, while similar football matches and events took place around the world. We did this to raise the alarm about waning funding for life-saving antiretroviral treatment needlessly risking millions of lives when international donors back out of financial commitments.

Unlike the other teams in the HALFTIME! tournament the OI Bombers (Opportunistic Infection* Bombers), only met for the first time as a full team in Harare, Zimbabwe just days before their departure to Johannesburg and entered the tournament as underdogs.

Not only did the Bombers have to overcome the fact that they come from two different towns more than 500km apart, where MSF operates HIV/AIDS treatment projects in Tsholotsho and Murambinda, but they were also divided by language. Three of the members are Shona speakers, while the other three speak Ndebele. But despite this the team quickly banded together, finding a common goal in their quest to remind the world the HIV crisis is not over and that international donors should stay in the HIV/AIDS funding match.

“Many people have been asking me about how I feel about coaching this team and whether we are going to win any games. But we are taking this game seriously. For us it will be an opportunity to raise the flag high by winning. Winning is anything that comes from doing our best and we will do our very best,” coach Munyaradzi Dodho told us.

On the eve of the tournament they told the other teams: “We are going to bomb you on the field like ARVs bomb opportunistic infections like TB.”

And on Friday 2 July when they took to the field against the other five teams from South Africa, Mozambique, Swaziland and Zimbabwe they proved their mettle and did just that.

South Africa’s Siyaphila team goalkeeper Nandipha Makhele tries her best to stop a shot at goal by Janet Mpalume, star striker of Zimbabwe’s ARV Swallows during the HALFTIME! 5-a-side football tournament in Johannesburg, South Africa. Photo by: Lisa Skinner

First they trounced Mozambique’s Mambinhas 2 – 0. In their next game they blasted their way to a massive victory 8 – 0 victory over South Africa’s Siyaphila when they unleashed their full arsenal, just as they had promised.

The Bombers went from zeroes to heroes in an instant, becoming the team to beat and even surpassing the ARV Swallows – fellow Zimbabweans and early favourites to win HALFTIME!. By the time they met South Africa’s rough and ready Fluconazole Pirates in the final the Bombers were a force to be reckoned with.

The final came down to a penalty shoot-out and the Bombers clinched a 2 – 1 victory to take the tournament title and to become the top scoring team with a total of 12 goals – proving to the world and international HIV/AIDS treatment funders that halftime is NO TIME TO QUIT!

MSF staff and people living with HIV participating in the HALFTIME! tournament in Johannesburg, South Africa take to the streets for a celebratory march to conclude the tournament. Photo bu Lisa Skinner

“If the funding ceases, my life will be no more. These international funders should not retreat now. They should continue supporting us. And even African governments should chip in what they have, so those outsiders [international donors] can do more with their efforts to keep on funding,” OI Bombers defender, Cloud Mapiti says.

– Maureen Mazibisa, OI Bombers team leader and Borrie La Grange, Head of Communications MSF South Africa

*[Opportunistic infections such as tuberculosis are the most dangerous enemy people living with HIV/AIDS face and antiretroviral drugs help combat this by improving the ability of the body’s depleted immune system to fight back]

Learn more about HALFTIME! visit: www.msf-halftime.info

MSF footbal event in Geneva. Photo: MSF

Around 50 Médecins Sans Frontières members based in Geneva got together on the evening of July 1st, to play in a friendly football tournament, to kick some HIV balls and to enjoy a picnic dinner with families and friends on the grass by the Lake. The white team, led by advisors to the Swaziland and Mozambique missions, was highly motivated and scored numerous goals !