Extra-Time

“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.

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

The all-star Brazil football squad entered the 2010 FIFA World Cup as early favourites to make it to the finals and hope to lift the golden trophy. And similarly in Médecins Sans Frontieres / Doctors Without Borders (MSF) upcoming HALFTIME! tournament in South Africa sees a strong Zimbabwean team as one of the top contenders to take home the title five days before the kick-off here in Newtown Park, Johannesburg on 2 July. 

ARV Swallows. Photo: Joanna Stavropoulou/MSF

The ARV Swallows, an all female football team from the Epworth township near Harare are coming to South Africa with an impressive track record – they have won the HIV women’s league championship in their home country and are motivated to take victory in on Friday as well. HALFTIME! and the tournament featuring people living with HIV and MSF staff from four countries in Southern Africa in an effort to raise awareness on the continued battle for funding to fight HIV/AIDS. The tournament sees six football teams playing matches to raise the alarm about the ongoing HIV/AIDS emergency.

The ARV Swallows formed in 2009 when a group of HIV positive women, all seeking treatment at an MSF clinic in Epworth decided to form a football team to take on two stereotypes: that HIV is a death sentence and that women cannot play football.

This year, the ARV Swallows find themselves taking on a different challenge – to spread the message that the HIV/AIDS emergency is not over and HIV treatment funding needs to be secured. In order to do this they have had to make some changes. They have reduced the team from 11 to five players and they have had to draft a man into their ranks, their coach Jonas Kapakasa, as an additional member to meet the mixed gender requirement for teams to participate in HALFTIME!

And China is also going to play in this Zimbabwean team, too… A multinational team? No, no, no… “China” is the nickname of Janet Mpalume, the ARV Swallows’ star striker!

It has been Janet’s dream to play football abroad and this week her dream comes true when she and her team mates take to the HALFTIME! pitch in Johannesburg along with five other teams.

“We are training as hard as we can and I believe that we are going to beat the other teams. Playing soccer makes me feel like I am alive. It allows me to feel like I am valued and that I am seen amongst other people,” Janet says.

They clearly have the guts and determination, but will they be able to fend off challenges by countrymen the OI Bombers, Swaziland’s HIV Conquerors, Mozambique’s lightning fast Mambinhas, and the South African hopefuls, Siyaphila and Fluconazole Pirates?

We’ll have to wait and see if the ARV Swallows team will be victorious again. Visit the tournament in Johannesburg on Friday, or if you can’t make it find out more about the teams and the tournament here www.msf-halftime.info.

For more information on ARV Swallows visit www.thepositiveladiessoccerclub.com

- PK Lee, MSF Communications Officer

In January this year I travelled to Cameroon to make a health promotion film that featured Sylvestre, a patient who motivate others to seek treatment. Sylvestre is a soft spoken man in his 30’s and at the hospital in Akonolinga town in East-Cameroon he is the master of the television set – especially when there is football to be watched. During my visit the national football team was competing in the 2010 Africa Cup of Nations in Angola.

Outside the hospital ward built by Médecins Sans Frontierès / Doctors Without Borders (MSF), around 50 patients suffering from the rare skin disease Buruli Ulcus were huddled around the Sylvestre’s TV to watch Cameroon’s compete in the 2010 Africa Cup of Nations in Angola. There was an almighty cry and shout at every shot at goal, but their pride and hope was not rewarded. Cameroon was defeated.

Patients in the MSF-ward of the hospital in Akonolinga, Cameroon, watch their national football team competing in the Africa Cup, January 2010. Photo by MSF.

Sylvestre is an ardent football fan and he loves to talk about his hero, Roger Milla, once voted Africa’s best player. It seems that for Cameroon, every decade holds a challenge and a possible victory. In the 1990 FIFA World Cup, the national team surprised the football world when then 38-year old Milla scored four brilliant goals, securing Cameroon’s place in the Quarter Finals. Never before has an African team performed better in the World Cup tournament. Before Milla’s and the Cameroonian team’s performance on that year, naysayers wrote off African teams as serious contenders. “No discipline,” said some. “No endurance,” said others.

Ten years later Cameroon stood facing a far larger challenge, a challenge against all odds. And here MSF was able to play its part. In 2000, MSF set up its first HIV treatment programme in Cameroon’s capital Yaounde and delivered proof: those first patients leapt at the chance of a new lease on life and stuck to their treatment with determination.

Naysayers again said Africa had no money and no medical facilities, and they thought that African patients lacked discipline to adhere to treatment.

Now in 2010, the Les Lions Indomptables (The Indomitable Lions) and people living with HIV/AIDS (PLHWA) in Cameroon are facing new challenges again both on the field and in the treatment clinics.

In football Les Lions Indomptables are qualified to be around the best of the world. But in the match against HIV/AIDS, Cameroon still has a long way to go. At present only half of the people in need of ARVs receive treatment. So to use a football metaphor: For 11 people on the field battling HIV with ARVs, there are another 11 on the bench, waiting desperately for treatment.

But one out of 11 players develops resistance to ARV drugs. Patients face the old barriers of second-line HIV treatments being too expensive and complex to administer. Again, MSF together with Ministry of Health set out to deliver not only treatment, but proof that it is possible yet again.

As Cameroonian football fans prepare to cheer on their team to victory, scores of patients are sure to huddle around Sylvestre’s TV again in Akonolinga. And as Cameroonian Lions find the back of the collective roar will go up signaling the pride and hope of a nation for their team and for PLWHA.

Marcell Nimfuehr is MSF Communications Advisor for Cameroon

“Truly speaking, the little I know about morality, I learnt it on football pitches.”   French philosopher and Nobel Prize Laureate in Literature, Albert Camus.

In four days time the sound of a whistle and crisp thud of a boot on a football will herald a month when the world’s eyes are fixed on South Africa.

In the coming weeks, billions of people will watch the spectacle of the much anticipated FIFA World Cup 2010, held for the first time in its 80 year existence in Africa.

A group of HIV-positive women in Epworth, one of Zimbabwe's poorest townships, decided to form a soccer team and to compete in tournaments. Photo: Joanna Stavropoulou/MSF

For the most part the global television audience of over 300million will be focussed on what happens on the 10 football pitches around South Africa and celebrating the winning teams.

But Médecins Sans Frontières / Doctors Without Borders and other organisations want the world to see the full picture. While the unifying power of football is celebrated 1,4million people are still dying needlessly of HIV/AIDS each year in sub-Saharan Africa. The majority of these deaths could be averted by increased access to antiretroviral therapies (ART) and a right to treatment.

MSF wants to remind the world that the HIV/AIDS crisis is not over.

MSF teams are present in several countries of the Southern African region and provide assistance, treatment and care in numerous communities affected by HIV/AIDS and its deadly associate-disease, tuberculosis.

During the following six weeks, this blog will give people living with HIV/AIDS, MSF doctors, nurses, lay counsellors and football supporters the opportunity speak out about this reality while the world’s media and competing nations focus on the football matches.

The world has witnessed the remarkable achievements in the fighting HIV/AIDS during the last 10 years which saved the lives of millions in developing countries through the scale-up of treatment and care for people living with HIV/AIDS.

Over 4 million people in developing countries now have access to life-saving ART – an incredible medical feat. However all these efforts are not enough as 9,5million more people in the developing world who are need of ART but are still on the waiting list for access.

But a treatment funding deficit will condemn these millions of people living with HIV/AIDS to death.

These millions of people are almost all entirely dependent on donor countries and institutions like the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in order to survive. But there has been a perceptible shift among donor countries in the G8 away from promises they made to keep up with long-term commitments to fund ART for people living with HIV/AIDS.

So, what we are seeing now is t that the much anticipated happy and normal full time that life prolonging funded ART would have brought is now under threat.

All members of the team called ARV Swallows are MSF patients and receive antiretroviral treatment at the Epworth Polyclinic, where MSF treats almost 7.000 HIV-positive patients a year. Photo: Joanna Stavropoulou/MSF

The effect of a donor retreat on funding the HIVAIDS fight is like having the referee blow his whistle to stop the World Cup final match halfway through. It would cause an outrage,with nations and people up in arms over the match being stopped at halftime. But the sad fact is when donors and the rich nations start turning off the HIV funding tap off – an action that will result in the premature and preventable death of millions of people needing immediate treatment for HIV/AIDS – it happens with little or no reaction or outrage. This is not acceptable.

We call on the world to protest against lives being lost because poor nations cannot afford treatment. .

By reading this blog and contributing your views, you can take a stand in support of universal access to treatment and care for ALL people living with HIV/AIDS. By doing this you’ll stand in support of giving people in developing countries living with HIV/AIDS a sporting chance. The world needs to demand Extra-Time in the deciding match where scoring for treatment, saving the lives of people and beating HIV/AIDS is the ultimate goal. Let the provision of funded and scaled-up antiretroviral treatment and saving millions of lives be the winner, then only will the world triumph.

ABOUT EXTRA-TIME!

Extra-Time! is an internet blogging experience with first-hand accounts and stories of field workers, staff and patients of the international humanitarian medical organisation Medecins Sans Frontieres (MSF), gathered and presented during the FIFA World Cup in South Africa, from June 7th to July 14th, 2010.

With Extra-Time! MSF aims to provide the worldwide audience with an alternate view on the first FIFA World Cup hosted in Africa and to chronicle the positive stories of perserverence in the Southern African region’s struggle to fight the dual epidemics of HIV/AIDS and tuberculosis.

In the coming weeks Extra-Time! will include narratives, photographs and short videos from countries where MSF field workers provide care to people living with HIV and tuberculosis including Malawi, South Africa, Swaziland, Zimbabwe, Mozambique and as well as other places in the world.

Information on HALFTIME!, an MSF event in the form of one-day soccer tournament involving people living with HIV as well as MSF which will be hosted in Johannesburg, South Africa on July 2nd, will also be featured. HALFTIME! is an initiative to raise awareness about the HIV/AIDS epidemic and the need to keep up international funding for antiretroviral treatment in developing countries.

DISCLAIMER
The opinions expressed in the Extra-Time! blog are those of the authors or the persons interviewed and can not be considered or quoted as MSF’s official position on the matters concerned.