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.