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African Development Forum 2000 AIDS: The Greatest Leadership Challenge |
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ONLINE DISCUSSION SUMMARY - PART I
Introduction This is a summary of the Online Discussion on AIDS: The greatest leadership Challenge that has preceded the African Development Forum (ADF). The discussion started at the beginning of July and continued through November. The primary aim of the online discussion was to invite broader participation in to the ADF and was open to participants from around the world interested in the issues of AIDS and African Development. The full archive of the messages in the discussion is available at (http://www.bellanet.org/adf/2000). THEME 1: HIV/AIDS AND DEVELOPMENT Introduction The "Report on the Global HIV/AIDS Epidemic", UNAIDS, June 2000, states that the figure of People Living with HIV/AIDS in Africa has reached a staggering 24.5 million. The demographic impact of this is changing the fabric of many African countries. AIDS is a disease but of such a magnitude and with such consequences to the fabric of African societies that it has become a development crisis and should be addressed as such. In countries with high prevalence rates the impact of AIDS can only be mitigated through intensified development strategies. Human resources that are crucial for development are falling ill and dying, sometimes at even higher rates than the general population. Households and communities suffer human and economic losses in a magnitude no other disease can match. Income is halved, savings are lost and sometimes food consumption is threatened. The coping strategies include taking children out of school with girls to go first, and thus influencing future development prospects. The public services that are essential for society to fight back against the epidemic are suffering too. Teachers and other key staff in the education sector are dying at least at the same rate as the general population, decreasing the quality of basic skills. The extension workers who are key to farmers to adapt to the situation are also hurt and health service workers who have never been more in demand are also falling ill and dying. Business is under pressure - especially businesses which are labour intensive or have few key staff that are not easily replaced. Costs are increasing in all production sectors including the public sector thus consuming the savings of society and in the end all citizens are paying a prize. To minimize this
impact, countries need to urgently establish human resource policies on absenteeism and
recruitment while stepping up workplace AIDS prevention programmes. The coverage of social
assistance programmes must be expanded to a wider group of households, defined by both
poverty and AIDS indicators. Existing mechanisms for improving people's access to land,
capital, education and other limited resources must be African Governments and Leadership In recent years African governments and leaders have increased their efforts to combat the HIV/AIDS epidemic. Action so far has however been ad-hoc, insufficient and uncoordinated and unsustainable with too much reliance on the international community and NGOs to find solutions to the epidemic. HIV/AIDS responses need to be included into all development efforts and should be co-ordinated at local, national and international levels. In order to increase popular participation in the overall national development endeavours and HIV AIDS programmes African governments need to democratize their governance. Citizens should be empowered to actively engage in prevention programmes since this will trigger a collective response to combat AIDS. For this to happen, first African leaders should take the initiative and publicly declare that they will lead the fight against HIV/AIDS. To date some African leaders have not yet publicly acknowledged the existence of AIDS in their countries and their commitment to tackle the scourge of HIV/AIDS. Rural Communities The Food and Agriculture Organisation (FAO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recently released a publication entitled, "Sustainable Agriculture/Rural Development and Vulnerability to the AIDS Epidemic". The document emphasises the importance of recognizing the burden of HIV/AIDS on local communities. According to this report recent studies have shown that HIV is spreading faster in some rural areas than in urban ones. It states that all rural development programs should focus on combating the HIV/AIDS epidemic and that particular attention should be paid to the infrastructure needed for prevention programmes, i.e. counseling and testing, condom availability and AIDS information- to succeed. HIV/AIDS and Security HIV/AIDS is potentially threatening to national security. High prevalence rates impact on the African workforce and may leave national forces significantly weakened. While millions of dollars are spent on wars, less attention is given to social and economic development. Priority should be given to targeting armed forces in AIDS prevention and education. Some governments have gone public announcing the gravity of the AIDS epidemic and, as a way of mitigating the problem, they have advised particularly the army to take precautions The UN Security Council has recently discussed and adopted its first resolution on a health issue, urging countries to consider developing long term strategies to combat AIDS\and to educate troops who may be deployed on UN peacekeeping missions. The resolution also asks the United Nations to take additional steps to train peacekeepers on preventing the spread of HIV. National Campaigns to Combat AIDS African must begin to utilize their own resources in their response to HIV/AIDS. This could be done through the use of existing structures. In Ethiopia a national literacy campaign employed students and teachers at all levels. Examples of similar activities should be investigated and adapted to launch national campaigns that create awareness about the disease and the available prevention mechanisms to the people at the grassroots level. International Response To the Crisis Not enough funding has
been made available by the International Community to mitigate the AIDS epidemic. The
International Community also has an important role to play in lobbying pharmaceutical
companies for access to drugs and treatment. The lack of resources remains an
international issue and financial constraints are killing many initiatives. However, it is
accepted that there is too much emphasis on external assistance in the Africa region. The
lack of assistance is often given as an excuse for not doing anything nationally.
Countries should put more emphasis on experiences of self-reliance that became giants of
success. External assistance should be seen just as a complementary component of the
entire process. HIV/AIDS and Debt Recently the World Bank and the US Import-Export bank made available loans to developing countries to fight the HIV/AIDS pandemic. This is an important concern to all Africans since already heavily indebted African countries can not afford too enter into further loan agreements. The issue of loans to fight AIDS is also linked to the debt. African should continue their debt cancellation efforts so that higher proportions of budgets can go towards restoring public health and fight the HIV/AIDS epidemic. It however remains important that ADF develops a position on whether all assistance to fight HIV/AIDS should be in grant form. Conclusion HIV/AIDS is having a severe impact on the economies of African countries. It also impacts social infrastructure, the reproduction of culture, people's belief systems and generally people’s ways of doing things - which are and will be hugely costly. It has thus become imperative for African countries and leaders to intensify their responses to the HIV/AIDS epidemic. UN Security Council,
The impact of AIDS on peace and security in Africa The New York Times,
U.S. Loans to Fight AIDS in Africa UNAIDS, International
Partnership against AIDS in Africa THEME 2: LEARNING FROM COUNTRY RESPONSES Introduction An important first step for effective action is to develop a leadership willing to lead on the issue of HIV/AIDS, or to let others do so freely on their behalf without undue interference. Intensive advocacy to convince leaders in Africa to provide unlimited support to the fight against the epidemic is therefore, urgently required. The examples of Senegal and Uganda clearly demonstrate the effectiveness of intensive information campaigns with high-level government support. In Kenya, President Daniel Arap Moi has declared AIDS a national disaster. The Attorney General Amos Wako called on all Kenyans to support the National AIDS Control Programme’s objective of reducing HIV prevalence rates. Wako said that he would take a leading role in highlighting the legal aspects relating to all matters of HIV/AIDS such as professional ethics, voluntary testing, and the observation of human rights. On the basis of political willingness, as well as expertise and imagination capacities targeting social mobilization, each country should adopt what is related and relevant to them. Responses have to be designed on a case-by-case approach even within and among communities in the same country. Moreover, in order to have broad community support, the type of actions to be adopted for combating the disease should not be subjected to controversy. Preventive actions should be well thought out as well as acceptable by the population, especially the target population. Examples Of
Sustained Actions With Positive Results Information And
Capacity Building Proposing New
Strategies The overwhelming priority in Africa is human capacity building. This would ensure the development of African solutions, the undertaking of innovative "pilot project" research, and the definition of made-in-Africa agendas. African countries need to be able to conduct and experiment with research findings, and learn lessons on their own and on an on-going basis. Resources:
UNICEF, The Progress of
Nations 2000 - Annual report, with The Acacia Initiative, at the
International Development Research Centre The United States
Department of Health and Human Services Simultaneous Policy Building on Lessons Learned From Intensified Responses Introduction For more than 15 years various initiatives have been taken at international, national and local levels to fight the HIV/AIDS epidemic. Although responses to HIV/AIDS cannot merely be replicated from one country to another, we need to build on the lessons learned from these responses. UNAIDS currently documents "Best Practices" which should serve as a tool to those working on HIV/AIDS in Africa. In learning from different responses we also need to develop mechanisms that would allow us to measure the outcome of interventions without necessarily interrupting such interventions. Using Traditional
Healers In The Fight Against HIV/AIDS Reusable Needles The use of dirty needles was highlighted as key in spreading disease, especially HIV/AIDS in Africa. We need to either ban reusable needles or investigate possibilities for increasing the supply of needles to African countries at a reasonable price. Providing health education, training and support to unregistered clinics about the use of needles is very crucial in the African context. Confronting AIDS:
Public Priorities in a Global Epidemic The World Bank released a revised edition of "Confronting AIDS: Public Priorities in a Global Epidemic" The report offers examples of successful programs from different countries; and presents an analytical framework for deciding which government interventions should have high priority for addressing the epidemic in developing countries. It advocates a broad strategy that can be adapted by countries according to their resources and the stage of their epidemic. The book's combination of epidemiological and economic arguments will provide useful material for courses in development economics, health economics, and public health. This updated edition of Confronting AIDS also includes a new statistical appendix that assembles information about the levels and determinants of the HIV/AIDS epidemic and selected policy variables for low- and middle-income countries. Conclusion African governments and civil society organisations have to document and share successful prevention programmes. Innovative programmes of treatment and care for People Living with HIV/AIDS should also be shared widely. All governments should establish, in accessible way, resource centers on HIV/AIDS. Such centers should provide information to public healthy professionals, NGOs, People living with HIV/AIDS, youth centers, women’s groups and the general public. A concerted effort should also be made to give rural communities access to such information. UNAIDS, Best Practice HIV Insite - Gateway to
AIDS Knowledge, ICTs and HIV/AIDS Introduction Electronic networking has significantly increased the amount of information on HIV/AIDS being exchanged globally. In most African countries this is happening more through e-mail based forums rather than through web sites. Electronic forums help people identify others working on similar topics, or trying to cope with similar challenges. The value of e-mail forums and electronic networking are that it allows participants to exchange information as well as bringing people together to share their experiences on common objectives and needs. In Africa this kind of information sharing is however often limited to a fairly small group of the population and mainly exists in the context of organisations often based in capital cities. ICT Projects Two successful projects highlighted in the discussion from different parts of the continent were the Nigeria-AIDS e-group discussion and the MESOB HIV/AIDS Networking project in Ethiopia. Nigeria-AIDS is an internet based discussion forum and news group on HIV/AIDS in Nigeria that was started in 1988 as a monthly email news bulletin. Members exchange ideas and circulate information on their work or development on the AIDS situation in Nigeria. Subscribers and visitors to Nigeria-Aids come from varied backgrounds, such as UN agencies, media organization, public service, educational institutions, community organisations, scientific organisations and human rights organisations. About fifty per cent of the subscribers are based in Nigeria. On the Nigeria-AIDS forum members discuss current issues and information about HIV/AIDS in Nigeria. They receive a monthly Nigeria AIDS bulletin containing news and views on HIV/AIDS from Nigerians across the world. The bulletin also includes information on grants and resources, international vacancies, conferences and other relevant news. Members can also post information about their work and organisations or make enquiries on health issues. The MESOB HIV/AIDS Networking Project, sponsored by the InterAfrica Group, is an information and networking project seeking to support Ethiopian actors addressing HIV/AIDS. The project makes use of the Internet, informal consultations, meetings and print newsletters for networking activities. The project sought particularly to identify who the HIV/AIDS actors are and the information and other challenges they face, as well as to encourage information-sharing among them about current and future initiatives and potential resources. A brief, unscientific survey of some 20 organizations found that information about international and local prevalence of infection and initiatives and models of programs came a close second to information on resource mobilization among the challenges noted by those who responded. The results of the project, thus far, include: an action inventory, of HIV/AIDS organisations in Ethiopia, an information meeting of about 20 HIV/AIDS organisations the World Bank staff and the National HIV Prevention and Control Council; sharing information with local organisations including national association of HIV+ persons, NGOs, faith-based groups and international actors working in Ethiopia; and an email based new bulletin on available resource, interested actors and sources of every kind of information desired. Conclusion Although a number of African NGOs and others have established successful projects using new information communication tools the problem of access to computers and the high cost of connectivity remains. It has been proved that e-mail-based forums are more accessiblethan web-based programmes. An important initiative to provide for broader access to ICTs is the telecenter initiative that has been started in several African countries. In the fight against HIV/AIDS it will however be important for organizations to not neglect older technology such as the television and especially radio that provides access to a much broader audience. Resources Health and Development Network http://www.hdnet.org Nigeria-AIDS (a internet based discussion forum and news group on HIV/AIDS in Nigeria) http://www.egroups.com/group/nigeria-aids HIV/AIDS in Ethiopia http://www.mesob.org/hivaids.html Partners Against HIV/AIDS in Ethiopia (PAHA) http://paha.listbot.com [Go to Top] GENDER AND HIV/AIDS SUMMARY Introduction Numerous studies have shown the gender disparities in the HIV/AIDS epidemic in Africa. Such studies have emphasised that women, especially young women and girls, are more vulnerable to HIV/AIDS than men. This is a global phenomenon, which is in part due to sexual differences, that is women's biological vulnerability to the infection. A person's gender is however one of the most important determinants of individual risk. Socially constructed gender norms, beliefs and practises impact on women's vulnerability to HIV/AIDS. Women are more vulnerable due to lower levels of education, economic dependence and lack of power to negotiate safe sex. Violence against women and children, and specifically sexual violence further increases their individual risk of HIV. Women furthermore disproportionately carry the burden of AIDS-related care (financial, medical, and psychological). Poverty Two recent reports -- The State of South Africa's Population 2000 and The State of the World Population 2000 -- stressed the relationship between poverty and women's vulnerability to HIV/AIDS. The South African report states that inequality has increased the number of HIV-positive women by 10% compared with men. In Southern Africa two million more women than men are infected with the virus. Women's economic dependence on men result in them having limited control over their sexuality and their ability to demand safe sex from their partners. Young girls often enter into sexual relationship with older men who support them economically. Prevention strategies should thus also focus on improving women and girls' access to economic resources. Culture And Tradition Unequal power relations between men and women limit women's control over sexual activity and their ability to protect themselves. Cultural practices such as wife inheritance and polygamy were highlighted as factors that further increase women's vulnerability to HIV/AIDS. IN the case of polygamy the relationship is treated as a monogamous relationship and thus protection is not used. In many African cultures talking about sex and sexual relationship is still considered taboo, and especially by women who are often expected to be sexually inexperienced. Such cultural expectations limit women’s ability to negotiate safe sex. Conclusion National prevention programmes should stress the importance of educating women and girls. Prevention programmes need to address gender-related factors that influence vulnerability to HIV/AIDS. In order to reach young girls secondary and high schools curricula should include substantial education programmes on HIV/AIDS. Intensive campaigns of Information, Education and Communication using radio and national languages should also be implemented to reach a broader female audience. Resources The State of South Africa's Population 2000, http://population.pwv.gov.za/state.htm The State of the World Population 2000 http://www.unfpa.org/swp/swpmain.htm HIV Variability http://www.unaids.org/hivaidsinfo/faq/variability.html YOUTH AND HIV/AIDS Introduction At the World AIDS
Conference in Durban UNICEF released "The Progress of Nations 2000" report. At
the launch Ms. Carol Bellamy, executive director of UNICEF, stated that the global
spread of HIV/AIDS among young people is emblematic of the world's failure to
promote and protect children's rights. She emphasised that young people "hold
the key to breaking the transmission rate and ultimately defeating AIDS." Focusing on Youth When focusing on youth
it is important that we recognise that on a continent as diverse as Africa, the notion of
an "average youth" is problematic. Young people are: rich and poor, male
and female, HIV-positive, HIV- negative, adolescents in their early teens and
young people who are into their early twenties, employed and unemployed, living in
countries that are ravaged by civil conflict and living in states that have never
been at war. All these differences matter in terms of HIV/AIDS programming because they
determine the ways in which young people choose between survival and sex or learn how to
negotiate safer sex (especially young women who have little power in the heterosexual
interactions). Unfortunately young women and men are too often seen as an undifferentiated
mass who should either be lectured to, shamed into abstinence or thrown condoms every once
in a while. There are hard working, professional young women and men and
volunteers who are fighting against AIDS by being peer educators, defending the
rights of PLWHAs, and running organisations that are a vital part of civil society and
building democracy. Consulting young people on the most effective approaches to
developing HIV/AIDS prevention programmes has been proposed as a key strategy for
understanding and reducing HIV risk. Economic Opportunities for Young People The challenge in ensuring safe lives and livelihoods for youth is complex. Economic opportunities and options for youth and especially for young women are often crucial in order for them to negotiate livelihoods that are safe from HIV/AIDS. It is important to note, that employment offers adolescents the opportunity to expand and develop their skills and learn work-related behaviors that offer them a lifetime of benefits. Studies have shown that employment can be especially beneficial for adolescent girls in delaying early marriage, reducing dependence on older men and deferring child bearing. Addressing the needs of youth requires balancing their current livelihood needs with the long-term benefits of more and better education, their current need to work with the right to grow and develop freely and safely without being exploited in the home and work place. Conclusion
Resources The Progress of Nations Report http://hivinsite.ucsf.edu/medical/conference_updates/3098.0712.html#children PEOPLE LIVING WITH HIV/AIDS Introduction
AIDS Orphans Currently it is estimated that there are about 11.2 million children orphaned by AIDS of which 95% are in Sub- Saharan Africa. These numbers are expected to escalate in future, as those now infected with HIV die leaving further orphans. These children have often cared for parents and younger siblings, who may have died in succession. Whilst struggling to take over adult roles, not only do they have to cope with their own grief, but they also often face severe poverty as well as stigma and discrimination. Some face growing up alone or being reared in psychologically damaging and inappropriate institutions, alienated from their families and communities - their only 'social security' network. Traditional African extended family and community care systems have developed over the centuries to provide economic incentives to excellence in childcare and cost effective solutions to the care of children in need and elderly persons. Although there are variations in different cultures and countries within Africa, the extended family system of care predominates and has been observed to minimise destitution amongst all members of society and ensure that children are cared for in the within the extended family. Today in many African countries the extended family and community care system persists under enormous strain. The influence of more individualistic philosophies from the West, socio- economic pressures, increased geographic mobility and urbanisation, education and the institutional care of children and HIV/AIDS all challenge and erode the traditional systems of care. With the additional pressures of the AIDS orphan crisis, it is now essential that there is proactive support and development of traditional extended family and community care systems, in partnership with traditional leaders, local communities, families and children. This would enable the development of appropriate community based resources as well as beneficial, cost effective and culturally appropriate individual care plans for each AIDS orphan and other child in need. Formulation of National Policy for orphans and children in need based on the support and development of extended family and community care systems is recommended and a coalition to work towards these aims. Conclusion In order for HIV/AIDS programmes to be successful the empowerment of PLWA and true partnerships with them and among them is fundamental. Stigma and discrimination are two of the most crucial issues to be tackled and both very vital for the quality of the response to the epidemic. THE DIASPORA AND HIV/AIDS Introduction The African Diaspora has an important role to play in the fight against HIV/AIDS. The Diaspora community is an important resource and African governments should set and facilitate programmes that encourage this community to participate in HIV/AIDS intervention programmes. Important areas that will benefit from the participation of the Diaspora are in collaborating on research, supporting training programmes and mobilising resources to support work on the African continent. Diaspora Initiatives Following are three projects highlighted initiated by member of the Diaspora that were highlighted during the discussion. The AfriFund Initiative aims to create a framework that will enable African in the Diaspora to team up to deliver funds to communities in Africa. It also aims to build a network in Africa that can utilize AfriFund resources and to serve to validate their use and the results achieved. Part of the framework is an internet database to provide for accountability and the ability to "tell the story" in a positive way so that more resources can be mobilized. The Association of Ethiopian Professionals in Sweden, started by health professional living in Sweden, is primarily involved in the improvement of primary health care in Ethiopia through making available financial resources. This association has made a significant difference in the health development of the targeted community in the country. Currently, the Association is participating on the fight against HIV/AIDS in Ethiopia. An emerging organization called 50 Lemons is active in HIV/AIDS work through research, data dissemination and sponsoring of AIDS orphans. The overriding aim of the organization is to spur members of the African Diaspora into using their own resources and being actively engaged in shaping the outcome of Africa’s future. With Diaspora leadership and resources of two Africans, 50 Lemons completed a research study targeting 1500 students in six regional high schools in Ethiopia. The data is being distributed to those working on the ground. The organization has also provided prevention education to almost 1000 students so far. In two months, the Diaspora leadership power multiplied to ten and started a sponsorship initiative targeting children who have lost their parents to HIV/AIDS. Each member is linked to one child and have committed to provide a nominal financial contribution to guarantee school, uniform, meal and primary care access fees Conclusion Africans in the Diaspora are in a better position to make a significant contribution to the fight against HIV/AIDS. They have access to information on HIV/AIDS, research material and others resources that can be applied HIV/AIDS programmes. Currently various activities sponsored by the African Diaspora are often linked to countries of origin. IN order to broaden their impact it may in future be more strategic to cultivate a regional capability of tackling the development problems that Africa faces. Resources The AfriFund Initiative http://www.profitinafrica.comCONCLUSION The theme of Leadership does not appear as a separate theme in the summary but throughout the discussion it became clear that communities value the input of their leaders. It has been demonstrated in both Senegal and Uganda that when leaders (both political and religious leaders) take an active role in the fight against HIV/AIDS intervention programmes are more successful. The positions (often controversial) taken by African Leaders are critical to how others respond. Communities look to national, international and community leaders at different levels and pay attention to what they say and their actions. If leaders stay silent or adopt controversial stands these it impedes action against HIV/AIDS.
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| 3-7 December 2000, Addis Ababa, Ethiopia | ||
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