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Archives for Sub-Saharan Africa

Coordinated Efforts Needed to Combat Infant Mortality in Africa

At the Africa regional conference of the International Confederation of Midwives (ICM) held last month in Nairobi, Kenya, one thing was clear. In order to meet the United Nations Millennium Development Goal (MDGs) of reducing infant mortality by two thirds before 2015, birth attendants in large numbers must acquire the basic skills and equipment to help newborns breathe.

The WHO estimates that one million babies die each year from birth asphyxia, the inability to breathe immediately after delivery. Simple means to stimulate breathing that could easily be done by a birth attendant could save a majority of these babies. However, such lifesaving care is not available in much of the world’s poorest regions.

Attendees at the session get a primer on the HBB program. Photo credit: Johnson & Johnson

Attendees at the session get a primer on the HBB program. Photo credit: Johnson & Johnson

As part of its MDG commitment, Johnson & Johnson is working with USAID and many partners globally to address birth asphyxia through its support of the Helping Babies Breathe (HBB) program in a number of developing countries where infant mortality from birth asphyxia is still high. HBB is a global public-private partnership working towards achieving a significant reduction in newborn mortality by increasing the availability of skilled birth attendants at every birth. Nurses and midwives with HBB training have the skills to save over 90% of babies with birth asphyxia.

The ICM meeting dedicated a core session to HBB, including providing attendees hands-on HBB introductory training and a related symposium that debated why little progress has been made in combating infant mortality in Africa.

The discussion continued at the stakeholder consultation meeting the morning after the conference ended, with a more specific focus on Kenya, where five babies die every hour. These discussions were attended by representatives from the HBB global alliance, including USAID, AAP, AMREF and Johnson & Johnson. Dr. Santau Migiro, head of reproductive health in Kenya’s Ministry of Health (MOH), was also in attendance.

What became increasingly evident was that to accelerate progress, all HBB activities need to be implemented in coordination. Rather than small scale activities done in isolation, the key to making a high impact is to address the issue on a much larger scale. Collaboration and synergy among players is important to maximize efforts, funding and resources, and to advocate for policy change.

To that end, all stakeholders agreed that the best way to push HBB forward in Kenya is to work under the MOH umbrella, making it part of the overall MOH maternal and child health strategy. Already, the Kenyan MOH has made HBB competency part of the core curriculum of medical training, recognizing that all health workers have a role in impacting maternal and neonatal health.

In addition to making the most effective use of resources and funding, a harmonized approach lends itself to better monitoring and evaluation. Standard guidelines for implementation will provide more meaningful data about the results of the program.

While the immediate focus of the stakeholders meeting was implementing HBB effectively in Kenya, there was general consensus that this direction is the right way to move the HBB initiative forward across the continent.

The evidence that HBB can be effective in Africa is there already. Tanzania, where over 3000 health care workers have been trained, has seen a drop of over 47% in infant mortality.

The conference was an opportunity to get all players in the region, including over 400 midwives from 20 African countries, on the same page. While recognizing that a lot more needs to be done, attendees left with a feeling of optimism, celebration and camaraderie overall.

Rene Kiamba manages the Johnson & Johnson Family of Companies corporate contributions community support programs and initiatives in sub-Saharan Africa.

From the Field in Zimbabwe: Unexpectedly HIV-Free

For a pregnant woman, it takes courage to visit Epworth Clinic in Harare, Zimbabwe. Many must travel long distances to get there, but that is not the only reason. They come to the clinic to learn their HIV status or to receive antiretroviral (ARV) medication, and when they first arrive, many of the women have little hope of giving birth to a healthy child. Once they get there, however, they learn that although they have HIV, they do not need to pass it to their children.

I visited the clinic to learn how USAID is supporting the delivery of high-quality HIV/AIDS services in Zimbabwe.

Rosemary proudly holds her HIV-free baby after receiving prenatal treatment from a USAID-sponsored clinic outside Harare, Zimbabwe. Photo credit: Zoe Halpert, USAID intern

In the waiting room, I spoke with Rosemary, a 40-year-old, HIV-positive mother who was holding an 8-month-old baby. Rosemary came to the clinic for the first time several years ago when her husband’s health began to deteriorate and she suspected that they might both be HIV-positive. She was right; she tested positive for HIV and began ARV treatment several weeks later. While I was talking with Rosemary, her baby sleepily opened her eyes and chewed her blanket. She was born healthy and HIV-free.

The prevention of mother-to-child transmission of HIV-AIDS program at Epworth clinic started in 2001. USAID provides infant HIV test kits and ARVs to many clinics throughout Zimbabwe, including Epworth. USAID’s partner, the Organisation for Public Health Interventions and Development (OPHID), provides training and supervision to the health-care workers in the clinic.  With support from USAID, this local organization is quickly increasing its ability to better address the HIV-AIDS epidemic in Zimbabwe.

Epworth clinic sees about 80 pregnant women and nursing mothers each day. When they first arrive at the clinic, they are tested for HIV and educated about family planning. As a result of the support the clinic has received from USAID, through OPHID, the number of HIV-positive babies has gone down significantly. Today, 98 percent of babies that are part of the program test negative.

When I talked with the clinic’s nurses, they told me, “If we didn’t have the USAID program, 98 percent of our patient’s babies would be HIV positive.” They also acknowledged that there would be a significant population decline.

As my visit came to a close, I asked Rosemary what advice she would give to other pregnant women. “Every woman should know her HIV status,” she said. She has found the courage to tell some of her friends her status, and strongly encourages them to get tested for their entire family’s benefit.

Visit OPHID for more information about OPHID.

Learn more about USAID’s work in Zimbabwe

From the Field in South Sudan: Mother of Nine Helps Rural Women Deliver Safely

At age 38, Mary Konyo has nine children, including a set of twins. She has been a traditional birth attendant since 1997, before South Sudan became independent, and has helped 23 women deliver children safely women in the last 16 years. Two years ago, she decided to stop having children so she could focus more on helping other pregnant women in distress.

I was touched by Konyo’s story when I heard it at a public forum in Juba (South Sudan’s capital), and I contacted her to learn more about her work to save the lives of pregnant women in her community.

Mary Konyo (right) testifies on the benefits of using misoprostol to reduce severe bleeding after childbirth.  Photo: Victor Lugala

Mary Konyo (right) testifies on the benefits of using misoprostol to reduce severe bleeding after childbirth. Photo credit: Victor Lugala

Her personal experiences with childbirth have inspired her. “When I delivered my first child, I bled excessively for three days. I was very weak,” Konyo told me.

A majority of rural South Sudanese women deliver at home, mostly without the help of a midwife, and some of them die from complications. Excessive bleeding after childbirth, or postpartum hemorrhage (PPH), is one of the leading causes of maternal death in South Sudan.

In recognition of her community work, Konyo was among a few women nominated from her community to attend a USAID-funded workshop on reducing PPH. Workshop participants gained knowledge and skills to help them talk with their communities about the importance of using misoprostol — a medicine that can prevent severe bleeding — to prevent PPH. They also learned what to do when a woman experiences PPH.

In addition to practical skills, the workshop emphasized the need for community outreach to help people understand the importance of giving birth in a health facility, where it can be easier to address complications. Konyo returned to her community as a home health promoter and started a door-to-door awareness campaign. She advises pregnant women to regularly attend antenatal clinic to help ensure that they have safe deliveries. “I particularly tell them about the dangers of excessive bleeding after birth,” Konyo said.

She is also able to give pregnant women misoprostol to take immediately after giving birth. But, she added, “I always tell women to deliver safely in the clinic.” Aware of rural poverty, Konyo advises pregnant women to save a little money for their transport to the hospital for delivery. In her community, women in labor are often transported to the nearest clinic on motorbike taxis, called boda-bodas.

Konyo told me she also encourages husbands to accompany their wives to the clinic, adding that men are expected to pay the hospital bills when their wives give birth.

She believes misoprostol will help drastically reduce severe bleeding immediately after childbirth in her community, pointing out that women who take misoprostol regain strength on the third day after delivery and can return to their everyday activities more quickly. Konyo says the men whose wives have used misoprostol are also happy: “Now they are asking for a ‘wonder medicine’ that will reduce birth pangs and hasten childbirth.”

Learn more about USAID’s work in South Sudan and follow USAID South Sudan on Facebook and Twitter (@USAIDSouthSudan)!

Creating Partners in Conservation in Rwanda

Dr. Jane Goodall and the Critical Role of Development in Environmental Conservation

Tucked in the corner of southwestern Rwanda, along the borders of Burundi and the Democratic Republic of Congo and about four hours outside of Rwanda’s capital city is one of the most beautiful places in the world, Nyungwe Forest National Park.

Dr. Jane Goodall in Nyungwe. Photo Credit: USAID

Officially established as a national park in 2004, Nyungwe is a moist, cool rainforest that is home to a wide variety of rare plants and animals, including more than 13 different primates, 275 birds, and 1,000 plants, some of which have only been found in Nyungwe.

This past week, we had opportunity to welcome a very special guest visiting the park for the very first time — Dr. Jane Goodall.

Dr. Goodall is the famed primatologist who has dedicated her life to studying chimpanzees and traveling around the world telling people about the importance of conservation. Even at nearly 80 years old, she literally never stays in the same place for more than three weeks at a time. Dr. Goodall came to Rwanda to highlight the importance of protecting natural resources like Nyungwe and to explore future partnerships in conservation education between her organization, the Jane Goodall Institute, and local and international organizations already working in the Park.

During her visit, we had the opportunity to hear to her speak to park staff. What really stuck out was the emphasis she placed on the critical linkage between community development and conservation efforts. They go hand and hand.

“The poverty of people is one of the biggest problems for the environment. People must choose between eating today by destroying nature, or starving.” She acknowledged that anyone faced with that choice would choose food, but when you first acknowledge and meet the needs of people, they then “become your partners in conservation.”

Dr. Goodall also challenged us to think a bit deeper and more long-term. If we don’t act, what happens when all of the natural resources are gone? What happens when animals go extinct or water sources have dried up because we didn’t protect the forests that sheltered them? History tells us the unfortunate truth: in many cases, conflict ensues.

Here’s a real life example. Nyungwe supplies 70 percent of Rwanda’s water and is a source of water for people who live as far north as Egypt. What would happen if Nyungwe were destroyed and the water was all gone? Dr. Goodall was blunt: “If water runs out in Nyungwe, people will pick up guns.”

Dr. Jane Goodall in Rwanda. Photo Credit: USAID

But when investing in the environment, we must also invest in people. We need to teach people about the importance of conservation, and more importantly help individuals and communities maintain their livelihoods in sustainable ways.

USAID has been working in Nyungwe since the mid-1980s. Our work there has helped to build an eco-tourism industry through activities like trail maintenance, training park guides, and creating partnerships with the private sector to invest in things like lodging around the park. We’re also working with communities living in and around Nyungwe to help them earn steady incomes in ways that don’t deplete the park’s resources.

One community just outside the park entrance has formed a cooperative and created what they call a “cultural village,” giving visitors another place to stop and a fascinating peek into Rwandan culture. The community has replicated traditional Rwandan houses (including the King’s Palace) where you can stay overnight, see traditional dance performances, and have a snack with a spectacular view of the forest. The community is doing quite well, and many of the cooperative members have said that instances of villagers engaging in activities like poaching for income has decreased as a result.

Dr. Goodall’s guidance about the necessity of pairing environmental conservation with development rings true in places like Nyungwe National Park as well as the communities we all live in. And as Dr. Goodall stressed – in her seemingly endless optimism – it’s up to us: “Every single one of us matters, every single one of us has a role, and every single one of us can make a difference.”

 

 

Study Highlights Way Forward for African Higher Education Institutions

What do leadership, governance and management have in common? According to a recently released study by the Association of African Universities (AAU) commissioned by the U.S. Agency for International Development through the Higher Education for Development (HED) program they are three main obstacles to growth and sustainability in African Higher Education Institutions.

The Sub-Saharan Africa Higher Education Leadership Development (SAHEL) Study maps a strategy for institutional capacity building in senior- and middle-level management and leadership. The study identified the following challenges:

  • Lack of clear strategy for leadership development
  • Differences across countries and institutions regarding government appointments versus merit-based appointments
  • Poor or lack of succession plans
  • Lack of policies and/or commitment to implementing gender policies that support the advancement of women in leadership roles

Students in the Tabia Debre Abay community at an Alternative Basic Education Center in Tigray, Ethiopia. The community is now actively involved in the education of their youngsters. Photo by Nena Terrell, USAID

“Leadership and administration capacity are the most critical challenges in the effort to make higher education in sub-Saharan Africa more effective and responsive to development, while ensuring its quality and relevance,” stated Teshome Alemneh, Africa program officer at HED. “Access to higher education in sub-Saharan Africa is expanding. This study has reaffirmed the importance of leadership and administration capacity and proposes several mechanisms of developing such capacities in Africa.”

The SAHEL study offers an analysis of AAU’s Leadership and Management Development programs and recommends strategies to build upon achievements by designing new elements that draw from the experiences of regional and international leadership training organizations.

AAU and HED presented the findings during AAU’s 13th General Conference held in Libreville, Gabon in May 2013. USAID and HED commissioned the study in an effort to gain a better understanding of the causes and current climate of leadership and management inefficiencies in tertiary education.

Read the complete Sub-Saharan Africa Higher Education Leadership Development (SAHEL) Study Report.

Sharing Agricultural Success with President Obama

This originally appeared on the Feed the Future blog

When I first got the idea back in 2008 that the women farmers like myself in central Senegal should join together to help one another succeed, I never would have guessed that five years later I would be sharing that story of success with the president of the United States.

On June 28, I found myself before President Barack Obama himself, explaining to him how bringing my producers’ network together with others in the Kaolack region and receiving assistance from a USAID project, part of the Feed the Future initiative helped us help each other, leading to the formation of a federation of some 3,000 producers who last year produced and sold 13,000 tons of corn on 5,000 hectares of land to feed our families and plan for next season.

Nimna Diayaté showed President Obama how technology helps her corn growers federation in Senegal. Photo credit: Zach Taylor, USAID

In our conversation, President Obama explained my story back to make sure he understood: “So you’ve got all these small farmers, and they all came together to better compete with big agribusiness.”

“That’s right,” I told him. “We created a network in the villages and each network worked together as the Saloum Federation of Corn Producers.”

I explained that our larger numbers afforded us better access to credit, with which our federation was able to access modern farm equipment, like the 12 tractors we have today. I pointed to a picture of the tractors on the display at the agricultural technology marketplace prepared for the president, and he asked me if I could drive a tractor myself.

“No, but I want to learn,” I said, knowing he was teasing me. But I really am going to learn.

To meet President Obama was wonderful. He seemed very happy to hear how a U.S. Government project was helping me and the members of our network. He was also very happy to hear that we now have enough good-quality, locally-grown corn for our own consumption and enough left over to sell, and that we are improving the quality of our seeds and equipment for the next growing season.

We want to make all producers in south-central Senegal aware of how we are producing quality corn so that we can be competitive with imports, find business opportunities, and sell our products at good prices.

Going back to before I had ever heard of USAID or Feed the Future, I was planting two hectares of maize a year. With USAID’s support, Feed the Future helped my little group access seasonal bank credit, with which we bought more seed and fertilizer than ever previously possible.

A year later, I planted 13 hectares and my income tripled. The 2011 harvest was a bad one, with a severe drought hitting our region hard. But the quality of the new seed was so good that despite the lack of rain, I still managed to increase my yield to 15 tons and earn close to $5,000 that year.

That money helped the federation qualify for a loan big enough to buy a brand-new tractor worth $35,000. The tractor has helped us prepare more than 350 hectares of land in our area. In 2012, my own cultivation grew to 18 hectares, including three hectares in new high-yielding hybrid varieties.

All this time our network was growing. In 2012, I was elected president of the new federation, which by then had 2,500 members. Now we can negotiate directly with banks, agro-dealers and buyers from the animal feed industry and today can speak for more than 3,000 corn farmers, both women and men, with the Senegalese government and the private sector with which we deal each day. This last season we produced nearly 4,500 tons, 3,000 of which was sold for a profit that will help us increase our yields still more next year.

Like the corn we cultivate, I feel the success of our federation can grow as high as our dreams. For a simple farmer from rural Senegal, to be successful enough to meet the American president shows that big dreams can come true after all.

Learn more about President Obama’s trip to Africa and view an infographic of the agricultural technologies marketplace where Diayaté met Obama.

(Translated from French by Zack Taylor)

Photo of the Week: Learning How to Read

 

In the second grade, students learn to read through new learning techniques at USAID-supported Kakila Primary School in the Democratic Republic of the Congo. Photo is from Alain Mukeba USAID/DRC.

 

“Come Back at Night and You Will Understand”

Rajiv Shah serves as Administrator at USAID

This plain-spoken answer—from a father who lived in a village without access to electricity—came in response to the question: What is life like without electrical power?

For most of the world, electricity allows business to flourish, students to study, and clinics to run long after the sun goes down. But for 600 million Africans, these opportunities simply don’t exist.

As a result, a sick child in Nigeria is unable to take antibiotics because the medication has to be refrigerated. A farmer in northern Ghana purchases a cell phone to connect himself with the world, but every other day he has to walk to the nearest electrified village and pay to charge the phone—a waste of time and money.

These difficulties are repeated on a large scale across the continent. Nearly half of all businesses try to cope with frequent power outages by using expensive stand-alone diesel generators that also pollute the environment. These stop-gap measures are no basis on which to build a modern economy.

In order to shape a brighter future, we cannot rely on donors alone. African countries must have transparent, accountable, and streamlined systems that attract private investors and developers. To help shape this environment, the United States, together with African governments and the international business community, is kicking off an initiative to bring more reliable, clean power to Africa. Announced by President Obama in Cape Town, Power Africa will create the conditions needed for long-term investments in energy infrastructure – generators, transmission lines and distribution systems. In ten years, we’ll bring 10,000 megawatts on line – and bring power to millions of African homes and businesses.

At its core, Power Africa represents a new model for development that is beginning to define the way we work around the world. Like the New Alliance for Food Security and Nutrition and the Call to Action in Child Survival, Power Africa harnesses public-private partnerships and demands greater accountability from our partners to deliver incredible results.

On his trip to Africa, the President recognized the profound potential of this new model. “[Power Africa] is representative of my new approach when it comes to development,” President Obama explained in Tanzania. ”I believe the purpose of development should be to build capacity and to help other countries actually stand on their own feet… Instead of perpetual aid, development has to fuel investment and economic growth so that assistance is no longer necessary.”

Through Power Africa, we will help create incentives and reduce risk for American investors in Africa, while working with African governments to modernize inefficient old networks and establish fair and transparent partnerships with the private sector. We will also be working with businesses themselves – American, African, and others. Investment specialists will analyze barriers to investment and then work with all parties to remove those roadblocks.

Once the first Power Africa projects succeed in bringing electrical power to African communities, the impact of those examples will encourage other ventures to follow in their footsteps. Electricity provides the countless opportunities and freedoms that define development.  It will take a great deal of commitment and patience to solve this problem, but today we know it can be solved.

Resource:

Follow @USAIDAfrica on Twitter to learn about our global development work in the continent!

Youth Empowerment is Key to President Obama’s Vision for Africa’s Future

Throughout his recent trip to Africa, President Obama returned again and again to the theme of economic opportunity and empowerment: building the capacity of people and institutions to lead their countries forward. Central to his vision is the critical role that African youth must play in the region’s social and economic transformation. The USAID-funded Youth:Work program is already at work to make this a reality.

In partnership with the International Youth Foundation (IYF), the Youth:Work project is working in eight countries in Sub-Saharan Africa to assess the needs and aspirations of young people, the hurdles they face in seeking employment, and the opportunities that can help them improve their lives and prospects. This holistic mapping exercise, called Youth:Map, is developed through interviews with business, community, government, and youth leaders. The resulting assessments consolidate critical evidence and expand our knowledge about youth issues in Africa that will help the private sector and governments alike to make smart, targeted investments in the years ahead.

Group of African young adults. Photo credit: USAID

In fact, this comprehensive information gathering has already become the basis for designing and implementing innovative pilot programs to specifically address the issues raised through the studies. One consistent theme from all Youth:Map studies is that Africa’s young people do not have access to the life skills and vocational training they need to get good jobs or start their own businesses. USAID and IYF are addressing this deficit in a number of ways.

In Uganda, for example, a 6-month internship program has been launched to help young people join the labor market and contribute to the country’s broader economic development. “This is the kind of program that we need to ensure that Uganda’s youth have real opportunities to achieve their dreams and build their futures,” said Commissioner Kyateka F. Mondo of Uganda’s Ministry of Gender, Labour and Social Development, at the program’s launch.

In Tanzania, orphans and vulnerable youth are gaining access to education and job training opportunities through the Tanzania Youth Scholars program, which offers educational scholarships and livelihood training.

Passport to Success®, a global life and employability skills curricula that has been translated into 18 different languages, is improving the employment prospects of young people in Senegal, Zimbabwe, and Mozambique. Build Your Business, an entry-level curricula for young people interested in starting their own micro-businesses, developed by IYF in collaboration with Microsoft, is being used to teach entrepreneurship and life skills to young people in Liberia and Uganda.

USAID and IYF are also joining forces to respond to another significant assessment finding – that young people feel marginalized and seek a greater voice in society. Two regional youth leadership institutes are opening in Senegal and Uganda to ensure more African youth become strong, innovative, and confident leaders in their communities.

In his speech in Johannesburg, President Obama declared that Africa’s young people “are going to determine the future” of their countries. While significant challenges lie ahead, USAID is working with IYF and many others to help build the kind of infrastructure and enabling environment needed to ensure Africa’s youth can fully realize this vision of hope.

About the International Youth Foundation
The International Youth Foundation (IYF) invests in the extraordinary potential of young people. Founded in 1990, IYF builds and maintains a worldwide community of businesses, governments, and civil-society organizations committed to empowering youth to be healthy, productive, and engaged citizens. IYF programs are catalysts of change that help young people obtain a quality education, gain employability skills, make healthy choices, and improve their communities. To learn more visit www.iyfnet.org

A Roadside Attraction in Djibouti: Community and Condoms at the SafeTStop

Whether on foot, camel, dhow, containership, tanker, or truck—traders have likely criss-crossed Djibouti and its waters for as long as there has been trade. Today, the Port of Djibouti, one of Africa’s busiest, lies at the nexus of major shipping routes between Asia, Africa, and Europe.

From Djibouti, most goods travel inland by trailer-truck: some 800 Ethiopian truckers arrive every day. After offloading coffee, cotton, beans and other commodities from Ethiopia, truckers wait 4 to 6 days to reload with imported electronics, spare parts, construction materials, food aid and much else.

This range of activity makes a small community, virtually unknown outside Djibouti, both important and vulnerable. It’s called PK-12 for “Point Kilometre 12″ in French, the official language. Meaning that it’s 12 km from Djibouti town, the capital and site of the port. PK-12 looks like the mother of all truckstops. Colorful vehicles lie like flattened dominoes as far as the eye can see—thousands of them.

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, the little container-hut at PK-12 will be replaced by a larger center.The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation plus HIV and other health services. Photo credit: Dubai Ports World

Understandably, drivers with several days on their hands also ferry back and forth another invisible item. About 25 percent are thought to be HIV-positive. The number of HIV-positive young women and men from the community is not known, and the stigma is too strong for even the boldest to disclose their status.

As late as 2004, HIV was a taboo subject, along with condoms. Voluntary testing did not exist. A lot of young women in this small roadside settlement were not only getting pregnant out of wedlock, they were also dying. If someone got a positive diagnosis—usually by showing up at a hospital with TB or another disease—they often took their own life.

“I got involved in HIV education because I used to lie awake at night worrying about my two daughters,” says Zahra Daher.  ”They were very young then, but what would happen later? There’s so little opportunity here except sex work.  It seemed like a death sentence.”

Zahra and I, along with three bearded imams and several peer counselors, are talking on the second floor of a little building made, fittingly, from one transport container atop another. This center for recreation and HIV education is a “SafeTStop”—one in a network of 52 in communities along the main highways of East Africa. The SafeTStops are part of the ROADS II program funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID and implemented by FHI 360.

Zahra Daher and Hussein Houmed, founders of the PK-12 SafeTStop. Photo credit: Carole Douglis, USAID/East Africa

A decade ago, before the SafeTStop existed, Daher and others here were chased, stoned, and accused of infecting people simply for talking about HIV. In 2004, Daher assembled a concerned women’s association. Hussein Houmed put together a youth association. Together, they sought support and funding. By 2005, they received both from PEPFAR through USAID/Djibouti.

The clerics—initially far from enthusiastic—were invited to join the initial training. They did, and today they preach prevention at community mosques. “Our target,” says Houmed, “was to inspire people to go for voluntary counseling and testing, so if they’re positive they start taking ARVs [antri-retroviral drugs] if needed. That way they can stay healthy and are also unlikely to pass the virus on.”

Peer counselors roam the local bars and restaurants, befriending people in Arabic, Afar, Somali, or Amharic, distributing condoms, and encouraging truckers and community members alike to be tested.

“The progress is very visible,” says Daher. “Before, no one mentioned the disease. Today we see people talking about it. We see people easily asking for condoms, going for testing, then going back for the results. People who are positive approaching us for advice. And undesired pregnancies are much rarer than they were.”

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, which operates the port of Djibouti, the little container-hut at PK-12 will be replaced by a larger center nearby. The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation, plus HIV and other health services.

“I’m taking this opportunity to thank American taxpayers and the Ambassador,” said Houmed after our interview. “Long life to the U.S. and the Government of Djibouti, who have made this partnership possible.”

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