LESSON 21
The Role of the Community
After completing this lesson, you should be able to:
Role of Community Participation in the AIDS Control Programme
Some
people with HIV or AIDS think everyone is looking at them or talking about them.
This makes them want to hide. Sometimes they feel rejected by other people or
they reject themselves. Sometimes they feel guilty. And some people with HIV or
AIDS feel there is no good reason for living. Sometimes they stay at home, not
eating, nor talking to anyone. If we have a friend who has HIV or AIDS we should
be supportive and kind. We can also help our friend to live positively. We
should give them moral support.
It is our moral duty to get the messages across to all members of the society
who need to share the prevention challenge. Herein lies the role of the
community. The community is very important in supporting people with HIV and
AIDS. The community can be a shelter where infected persons can be assured that
they are loved, accepted and where they do not have to hide their feelings. If a
friend or someone we know in the community has HIV or AIDS, we can encourage
them to continue leading a normal life.
We can ensure that they take healthy food, enough rest, avoid stress, take light
exercise and continue with their work. It is good if a community feels free to
talk about AIDS, just as it talks about any other sickness. Then the people who
want to gossip in an unkind way
will find themselves isolated and with nothing to say.
We should also have continuous interaction with the people about how can we
prevent AIDS from spreading. It must be emphasized that if we want to help the
person affected with AIDS, we must have complete knowledge about AIDS - what it
is, how it is caused, how spread and how not spread etc.
There are countless ways to spread awareness on HIV/AIDS in the community. We
can consult about HIV/AIDS with knowledgeable persons or doctors. Thereafter, we
can make ourselves individual helpers or we can form a social organization,
clubs etc. In the community hall or in the club, we can organize an audiovisual
program on AIDS awareness or a public interaction with a knowledgeable person.
Training programs on AIDS for the teachers especially the schoolteachers should
be organized. School students, who are in the teenage stage, cannot decide what
is good or what is bad, and require guidance from teachers to steer them away
from risky behavior. So, interaction on AIDS between teachers and students is a
must in every school. Students are the pillars of the nation, so it is quite
important that they be healthy and AIDS free.
We need to remind the people that the AIDS virus is not spread through:
(i) Casual touch, hugging, kissing, tears and sweats.
(ii) Sharing food and drinks with an HIV Positive person.
(iii) Sharing toilets, towels and clothes, combs, sheets.
(iv) Bites from mosquitoes, bed bugs or any other insect and cats.
There is currently no treatment for AIDS. But the people with AIDS and HIV
should be comforted by the fact that there are medicines that can help them to
fight off sickness that come with HIV infection or AIDS. Antibiotics and other
medicines can help people with AIDS to feel much better and to live longer.
Unfortunately, these drugs and medicines are often very expensive and not yet
available in sufficient quantities in our state. Until such time as they are and
until a treatment is found, we in the community have the task of helping the
HIV/AIDS in dealing with the disease and living as normal a life as possible.
It is natural that fear of the unknown should haunt many people with HIV or AIDS
get fear of the unknown who are afraid to die. At such moment they need people
who can share their thoughts and comfort and encourage them. If death comes,
they must be helped to accept it with courage and dignity. We may tell them that
if they accept death in serenity, their courage can transform the lives of those
they leave behind.
The community should work with open heart and open mind with the goal of
prevention further spread of HIV infection and providing care and support to
those affected by AIDS in the spirit of joint solidarity without considering for
reward.
Coming to grips with the challenges
• Experience shows that controlling the epidemic depends in large measure on communities’ and families’ abilities to confront the gender-driven behaviour that increases the chances of infection for girls and boys, men and women. That, in turn, calls for strong and coherent national policies, strategies and plans.
• The Convention on the Elimination of Discrimination Against Women (CEDAW) is a key basis for legal reforms and other steps aimed at countering the violation of women’s human rights and protecting women who are infected and affected by HIV/AIDS.
• Comprehensive prevention and care programmes that take into account a wide range of social, economic, cultural and political factors are more likely to stem the epidemic. Such programmes should be marked by high-level political commitment for steps that tackle the gender dimension of the epidemic in a variety of ways (including legal reforms, as provided in CEDAW, and national HIV/AIDS policies, plans and strategies).
• Such programmes would also ensure that health information, care and other services are improved and provided in ways that are culturally appropriate and gender-sensitive. As important is the development of sex-specific, gender-balanced information about HIV/AIDS and other sexually transmitted infections for different audiences in different settings (for example, for young people in and outside school, or for workers at home or in the workplace).
• Innovative activities targeting boys and girls are needed to promote more equitable and mutually respectful attitudes and behaviour, especially in sexual relationships. Also needed are targeted anti-poverty programmes that extend credit and other forms of support to both women and men in need, as well as measures that address the special needs of widows and child-headed households.
The
Role of Religious Organisations in HIV Prevention
The AIDS epidemic has preyed upon our fear, ignorance, lack of leadership
in mobilising prevention strategies, and our non-support of people infected and
affected by the disease. Throughout the world the AIDS epidemic is completely
out of control.
Combating HIV requires bold, steadfast leadership. To stop the escalating slaughter of African peoples by HIV, we must seek and receive leadership from the religious organizations such as churches and mosques. Churches and mosques remain the cornerstone of the African global community. They are institutions with ability to mobilise the masses and disseminate appropriate information. It can be effective in doing so because it still enjoys the respect and the support of the people. In the face of a disease that is 100% preventable, our churches and mosques must begin to provide prevention education and to support those persons who are infected and affected by HIV. No longer can we afford the luxury of succumbing to the "NIMBY" syndrome: "not in my backyard." Only when churches and mosques are willing to admit that people living with AIDS are not "them;" only when our churches recognize that AIDS is not, by any stretch of the imagination, confined to those outside the faith community, can we begin to be effective. We look out over the casualties of the AIDS war-children homeless and orphaned; teens who for lack of information will become infected and who will not live to be 25; mothers suffering from abuse and obligated to have unprotected sex with their husbands who are known to be infected. We are numbed by the chilling fact that there is neither a vaccine nor a cure.
Role of National Communities
National communities can engage in the following roles:
What about the international community? Jacqui Ala in the article below, provides some perspectives.
|
The role of the international community a in combatting HIV/AIDS in sub-Saharan Africa |
Jacqui
Ala
University of the Witwatersrand
Southern Africa is at present the epicentre of the global HIV/AIDS pandemic. Statistics for seven countries in this region indicate that one out of five adults are HIV positive. The region is classified by epidemiologists as having a generalised epidemic. Botswana currently has the world's highest infection rates with approximately 36 per cent of the adult population HIV positive. South Africa as the highest number of people living with HIV globally. Out of a population of 40 million an estimated 4,2 million South Africans are HIV positive.1
Governments on the whole have failed to deal with their epidemics timeously, resulting in enormous infection rates which are set to stabilise at exceptionally high levels. The political, social and economic ramifications for this region are enormous.
The
rationale for the involvement of external actors
The challenge of
HIV/AIDS for southern African countries awesome. It is vital that prevention
efforts targeted the entire population. What further exacerbates the situation
is that in addition to these preventative measure, provision also needs to be
made to assist those already infected.
Providing both preventative and treatment programmes for the entire population
places an enormous burden on the already hard pressed economies of sub-Saharan
countries especially those in the southern cone. HIV/AIDS threatens to destroy
much of the economic progress made to date by many of these states. A government
report states that Botswana's epidemic will cost almost one-third of the
country's economic potential over the next ten years. Government revenue is also
expected to drop over the same period while expenditure is set to rise, creating
a budget deficit of 21 per cent.2 These predictions are very serious as the
country is one of the wealthiest in Africa.
The
report labels HIV/AIDS as the single greatest threat to human welfare and
development in Botswana. UNAIDS believes that the South African economy would be
17 per cent smaller in 2010 than it would have been without HIV/AIDS. By that
time the disease would have cost the country in excess of $ 22 billion.3
HIV/AIDS is expected to continue to dominate the business environment over the
next five to fifteen years. Metropolitan life forecasts that 20 per cent of the
workforce will be HIV positive by 2005 and 22,5 per cent by 2010, if no
inventions were taken.3 A
report compiled by the Namibian Health Minister Libertina Amathila states that
the government health system will not be able to sustain treatment for its
growing HIV-positive population. At present, Namibia has approximately 150 000
HIV positive adults and 67000 AIDS orphans.3 Since 1996, the cost of treating
HIV/AIDS patients has risen to an estimated $ 61 million. At present, most
HIV-positive people rely on their family for care. This burden falls largely on
rural women who often have to care for two or three people. Unfortunately,
having to care for HIV-positive family members places an enormous economic
pressure on these women, one that many are unable to cope with. In addition,
HIV/AIDS is not the only crisis faced by many of these states. There are other
pressing issues requiring government resources.
Although, these countries can make an impact on their epidemics by wisely employing the resources at their disposal, their financial and often their technical resources are limited. Thus, to sustain the fight against HIV/AIDS in Africa it is imperative that the international community or more broadly speaking global civil society render as much assistance as possible. Without this external assistance the war against HIV/AIDS in sub-Saharan Africa promises to be short lived and futile.
External
assistance to sub-Saharan Africa: The current state of play
A myriad of actors
are currently involved in assisting African states with their HIV/AIDS policies
and programmes. The contribution of some of these organisations is discussed
below.
The
United Nations
The United Nations
has placed the issue of HIV/AIDS firmly on its own agenda. Last year Richard
Holbrook, United States ambassador to the UN placed the issue before the
Security Council citing it as a threat to international security and stability.
This was the first time that a health issue has been afforded this type of
attention. Subsequently, it unanimously adopted a resolution calling for
increased international co-operation and for concrete action by member countries
to counteract the impact of HIV/AIDS on the health of international
peacekeepers. In June, the General Assembly will hold a special session devoted
to HIV/AIDS with emphasis on the developing world. The session will then put
forward a resolution to the Security Council. Following recent trends in such
events, individuals, CBOs and NGOs will be allowed to give input to the process.
Thereby allowing civil society a voice in the process. Whether this initiative
will deliver a positive outcome is unclear.
Under the auspices of the UN there are plans to launch a global AIDS fund. The project intends to raise approximately $6 billion dollars annually from industialised countries, including $2 million dollars a year from the US. Initially 50 per cent of the funds would be used to purchase HIV/AIDS medicine for more than 10 per cent of the estimated 25,3 million infected Africans. The remaining 50 per cent will be used to strengthen and accelerate existing prevention programmes.4 Although the fund will almost exclusively focus on HIV/AIDS, the project also aims to improve treatment for other killer diseases in developing world countries such as malaria and tuberculosis. The AIDS fund is an attempt to create a public-private partnership similar to the Global Alliance for Vaccines and Immunisation. It has endeavoured to include key non-state players in the field of HIV/AIDS such as the Gates Foundation, the Rockefeller Foundation as well as the pharmaceutical industry.
In addition, to the work being done at the upper echelons of the organisation Secretary General Kofi Annan has been an active participant in launching the International Partnership Against AIDS (IPAA) in Africa which was formally established in December 2000. According to Annan, the Partnership will be the focus for a new spirit of co-operation in building the response to AIDS. It seeks to galvanise intensive efforts bringing together African governments, the United Nations, donors, community organisations and the private sector. The Secretary General acknowledged that so far the response to the epidemic in Africa has been far from adequate. The IPAA aims to rectify this problem. Its goals over the next decade are to reduce the number of new HIV infections in Africa, promote care for those who are already HIV positive and mobilise society to halt the advance of HIV/AIDS.
Although an initial meeting took place in December 2000 it is too early to determine the kind of contribution it will make. The IPAA appears to be a move in the right direction. It has attempted to be inclusive in its membership, especially by bringing CBOs and NGOs to the table. However, success will probably be determined by the type of commitment individual governments make to the adopting recommendations made by the partnership. One only has to look at South Africa to see the detrimental impact of minimal government commitment to the issue of HIV/AIDS.
UNAIDS
Initially, as
HIV/AIDS was perceived by the UN as a health issue the World Health Organisation
was tasked with addressing the issue. However, due to the dramatic increase in
the spread of the virus globally it was determined that a specialised UN agency
sole devoted to HIV/AIDS was necessary. The scope of the pandemic meant that no
single UN agency was equipped to deal with the problem. Greater co-ordination
was necessary to maximise the impact of the UN's efforts. Thus, in 1996 UNAIDS
was created. It draws on the expertise of 7 other international organisations
namely UNICEF, UNDP, UNFPA, UNESCO, WHO, UNDCP and the World Bank. These
organisations were included as the pandemic has impacted upon their work.
The following are the goals of the UNAIDS co-sponsors:
At country level UNAIDS' function is to inform, plan and monitor co-ordinated actions, and advise government. It assists the host country in mounting an effective and comprehensive response to HIV/AIDS and attempts to ensure that each state employs a multisectoral response to its epidemic.
In principle, the concept of UNAIDS is excellent. The UN has attempted to adopt a multisectoral approach by main streaming HIV/AIDS into work of all seven co-sponsors. However, a major problem with the UNAIDS partnership is its size. Co-ordinating HIV/AIDS policy among seven co-sponsors is extremely difficult. Each organisation has a different agenda and therefore a different focus. Unfortunately factors that make populations vulnerable to high rates of HIV infection are interconnected. Thus, for the UNAIDS partnership to be effective and efficient there needs to be considerable interaction between the members.
What weakens UNAIDS is the appearance of competing agendas between agencies. The rivalry between the various UNAIDS co-sponsors is well documented. The WHO wants to take the lead on technical issues. In addition, the UN Children's Fund and the UN Development Programme also desire to assume leadership roles. The World Bank has lobbied the US Congress to enable them to determine how money allocated to HIV/AIDS is spent. 5 The pharmaceutical industry has used this rivalry and lack of co-ordination to play UNAIDS off against WHO in order to negotiate the best deal for itself with regards supplying low-cost anti-AIDS drugs to the developing world.
Individual
states
Many Western states
have also assisted African states with various initiatives. The range of
projects funded by foreign governments are enormous. Not only do they fund
initiatives directly but they are also contribute indirectly through their
financial support of UN agencies. For example, Mozambique is receiving both
bilateral and multilateral assistance in dealing with its AIDS orphans problems.
HIV/AIDS is spreading so rapidly through Mozambique that there are already an
estimated 350 000 orphans. According to a UNICEF study, this figure will
probably rise to 1 million within the next five years. The international donor
community is actively assisting the government in its fight against the disease.
UNICEF is currently spending $ 3 million on HIV/AIDS projects in the central and
northern provinces. 6
The new Bush administration in the United States has committed $200 million dollars to the Global AIDS and Health fund. However, activists have criticised this contribution as being far too small. Nevertheless, this contribution is being used by the UN to leverage donations from other governments.
Although the West seems quite content to dole out aid they seem reluctant to support initiatives that will substantially empower the developing world in the area of HIV/AIDS. It is acknowledged by UNAIDS that debt write off would make an enormous contribution. The money freed up by this could be employed in HIV/AIDS prevention and treatment programmes. However, despite the promise that the 2000 G-8 Conference would address this issue very few developing world states have benefited from debt write off. Harvard economist, Jeffrey Sachs, believes that for debt write off to be effective it must be a 100 per cent write off. Unfortunately the West is extremely reluctant to do this. Furthermore, many HIV/AIDS projects are funded by loans for external actors. The implications of this is that ultimately African states will have to pay these amounts back further increasing their debt burden which once again feeds into the poverty cycle in these states. Considering how much money states need to spend to effectively cope with their HIV/AIDS crisis, obtaining most of this money as loans will have serious ramifications for their economic development. Where possible financial assistance for HIV/AIDS projects should be given as aid so as not further pressurise these states.
The
private sector/multinational corporations
As we enter the
21st century there seems to be a trend towards the private sector becoming
involved in humanitarian assistance. The area of HIV/AIDS has seen considerable
support from the private sector. In fact it is probably the private sector that
could most effectively mobilise the resources required to adequately respond to
the HIV/AIDS crisis. What are of particular interest are the public-private
partnerships currently being formed. Beside their money the private sector also
brings novel and innovative approaches in dealing with problems.
Currently this type of public-private partnership is being used in Botswana. The key players are pharmaceutical company Merck and the Bill and Melinda Gates Foundation working in conjunction with the Botswana government. Other partners included various Western governments, academic institutions such as Harvard University's AIDS Institute and global health and development agencies including UNAIDS. Titled the Botswana Comprehensive HIV/AIDS Partnership, the programme aims to increase public awareness, prevention, diagnosis and treatment of HIV infection. The initial five-year programme will be overseen by an international advisory panel managed by an in country multidisciplinary team which aims to develop local leadership and commitment to ensure its long-term sustainability In terms of the plan, the Gates Foundation will contribute $50 million to improve the primary health care system. Merck will fund the development and management of the programme and contribute antiretroviral drugs. The project is one of the first to come from an agreement brokered between UNAIDS and five other drug companies which undertook to slash drug prices to developing world companies by 90 per cent. It is hoped that lessons learnt by the project will strengthen the global response to HIV/AIDS.6
Mining
house Anglo American has also joined the fight against HIV/AIDS. In its HIV/AIDS
strategic plan launched in February 2001 it announced that it would provide HIV
employees with free antiretroviral drugs.7 This a significant move given the
fact that HIV prevalence rates among miners are extremely high due to their
engaging in high-risk behaviour. Anglo's plan to provide HIV/AIDS care not only
to South Africa but also to all its mining ventures throughout the southern
African region. Ironically it is local government, NGOs, CBOs, the private
sector and the
international community, which appear to be spearheading the fight against
HIV/AIDS in South Africa.
Anglo's bold strategy has been welcomed by South Africa's National Union of Mineworkers (NUM) as a step in the right direction. However, NUM is concerned that Anglo's real motive for encouraging testing and counselling is to enable it to close down those units where the majority of people are HIV positive. It also fears that the company will not back up its rhetoric with hard cash. 7 Anglo has realised that NUMs support of its project is crucial for its success and has agreed to consult with Union regularly.
Aside from Anglo American other South African companies doing business in southern Africa have also been proactive. Transnet has devised HIV/AIDS programmes for its workers. Eskom has offered its employees the opportunity to be tested for HIV and counselled. It has also allocated R30 million over the next three years to assist in research for the development of a HIV/AIDS vaccine.
Despite the bold initiative adopted by many in the private sector there is one set of players who seem incapable of acting in a dynamic manner, namely the pharmaceutical industry. Unfortunately they are key players in any successful HIV/AIDS venture in Africa. It is vital that Africa which has the worst HIV/AIDS epidemic has access to affordable anti-AIDS drugs. Although much negotiation has been done in this area with some success, large-scale access for African states remains elusive.
Suggestions have been made that a segmented pharmaceutical market be created where AIDS drugs are sold to the developing world at cost or marginally above cost in exchange for high prices in the developed world. This would improve access to drugs while still protecting drug companies' intellectual property. This idea is beginning to find credibility among a few drug companies. Other proposals by UNAIDS to increase access to affordable AIDS drugs include:
It is interesting to note that the United States has strongly opposed the invocation the above clause in TRIPS . It seems that US possesses a rather duplicitous standpoint on the HIV/AIDS issue where it supports giving aid but not those measures that would provide sustainable solutions to the problem.
Drug manufacturers have offered to reduce the price of AIDS drugs to the Southern African Development Community (SADC) and assist these countries establish a health infrastructure. However, SADC Health Ministers believe that this is not a sustainable solution. They accuse drug manufacturers of not putting forward a clear offer. Instead they argue that manufacturers do not want to negotiate with the SADC but prefer to price their products according to what they believe each individual country can afford. Nevertheless, Rwanda, Senegal and Uganda have benefited from the above offer.7
A study released by Harvard University in April 2001 stated that delivering HIV/AIDS drugs, specifically highly activate antiretroviral therapy (HAART), to Africa is within the realm of possibility. It documents a scientifically based plan and guidelines for providing HIV/AIDS drugs to Africa. The plan also addresses many of the practically concerns raised by the pharmaceutical industry in the large-scale distribution especially those concerning lack of medical infrastructure in these states. The Harvard study endorses the creation of a global AIDS fund, which would finance HIV/AIDS treatment programmes. The study will also feed into discussion at the June 2001 Special General Assembly on HIV/AIDS.
Conclusion
Despite the fact
that there is considerable activity in many southern African states HIV/AIDS
infection rates have not seen a dramatic decline. The bottomline is that more
attention needs to be given, more innovative programmes need to be created and
more money needs to be spent on the disease. Public-private partnerships such as
the one proposed by Harvard University and the United Nations could hold the key
to winning the HIV/AIDS war. However, these still seems to be reluctance on the
part of key players within the international community to make the
kind of commitment that would make this a reality.
References
In this lesson we learned that:
· Education - seminars, training programmes and workshops
· Youth activities - education on HIV/AIDS and narcotics awareness, prevention and care through youth camps and other youth activities.
· Home/Community visits - to provide moral support, counseling, advice on self/home-based care and give donations.
· Vocational training - provide venues and materials, coordinate with trainers, funding sources and marketing
· Resource centre - printed/audiovisual materials, brochures, posters and speakers.
· Education Fund - for children orphaned or affected by HIV/AIDS.
· Milk Bank - for children orphaned or affected by HIV/AIDS.
· Medicine Bank - for people living with HIV/AIDS.
· Funeral robes bank - for families of people who have died of AIDS.
The international community should provide funding support for HIV/AIDS projects.
