Communication Knowledge

April 2001

Strategic approaches to HIV prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa

Part 3

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2.3. Mitigation and support32

Low prevalence areas

In low prevalence areas, the emphasis should be on developing long-term strategies that address the underlying problems that make rural households vulnerable to the impact of HIV/AIDS. This would include developing sustainable strategies aimed at eliminating agricultural constraints (poor access to land especially for women, credit, markets, mitigation of droughts and pests) and those aimed at alleviating, and/or reducing vulnerability to the effects of poverty (see also UNAIDS 1999).

FAO has a key role to play in vulnerability reduction and needs to engage in a systemic approach to improve inputs for the development of less labour-intensive crops as well as socially appropriate agricultural technologies and alternative income-generating activities and production methods. (See section Agricultural research: towards a new agenda? in this paper).

The focus should also be on strengthening the household and community response capacity which would include amongst others the installation of (agricultural) early warning systems, training in community-based mutual aid, training in community mobilisation, empowerment strategies for women, adapting the extension system to the new clientele and their specific needs, agricultural education for children and youth.

Further research will need to be undertaken to familiarise with local coping strategies, especially those of orphan- and widow-headed households. This will help to identify their specific needs and consequently develop technologies and plan interventions accordingly.

Community mobilisation33

UNAIDS (Project Hope34 ) has outlined some principles of community mobilisation projects that need to be considered. Community mobilisation should:

The emphasis should be on techniques that help communities to formulate their own responses. The key to community mobilisation is participation: this requires that members of the community genuinely consider it in their best interest to take primary responsibility for solving a particular problem.

Community mobilisation needs

Box 9: Project Hope Brazil

Extension

Extension services/agents must also get involved in both communication and education programmes and activities since they are at the front-line of impact, even though they are part of the problem they have the potential to contribute to prevention and mitigation.

Where appropriate, and depending on the role and influence of extension system in a given country, extension services could be re-oriented and adapted to deal with the emergency situation triggered by the high incidence of AIDS-related mortality. This would involve assisting households and communities directly by:

Agricultural extension should therefore reorient their programmes and place special emphasis on problem-solving activities for affected households and /or communities and on the initiation of collective efforts to strengthen community and group organisation in support of traditional coping mechanisms.

In countries where there are Telecentres (Uganda, Mali, etc.) extension agents could be trained to act as intermediary, translator of information and serve as link between the ICTs applied in the Telecentre and the local people. They could contribute to transforming some of the Telecentres into community development centres (Uganda) since they are at the front line of the impact of AIDS and in a position to conduct regular needs assessments.

Box 10: FAO/UNDP/UNAIDS Study on the impact of HIV/AIDS on agricultural extension in selected countries in Sub-Saharan Africa

High prevalence areas

High rates of infection require more urgent measures. In countries with a high adult HIV prevalence rate, a strategy is required that will move beyond prevention and seek ways to mitigate the impact of the epidemic.

It is possible to distinguish between two approaches: (1) those that are intended at building the economic resources of households and, (2) those that support and strengthen community safety nets and support groups. The emphasis is on strengthening not replacing community-based initiatives and fostering the involvement of affected households and communities as well as PLWHA.

All the activities and interventions proposed below cannot be planned for externally and must be research-based, executed with the active participation of PLWHA, affected families and the community at large.36

Women and credit. There is a strong need to increase women's access to credit. This involves encouraging the formation of women's groups and offering incentives for Income-Generating Activities (IGAs). One possibility is to engage in income-generating activities where widows, or adolescent girls/boys, get together to work on a micro-project. These groups should be flexible with regards to membership so that if one person cannot show up one day, somebody else can replace them. IGAs must be relevant to (1) the community/group skills and resources; (2) the agro-ecological conditions; (3) the farming systems; (4) socio-cultural norms and values, and (5) sensitive to the existing gendered division of tasks.

Micro-credit services along with income-generating activities can be effective tools for strengthening the economic resources of households.

Example 1: The FAO Telefood campaign has been very successful in supporting these projects in many African countries (there are many examples of successful micro-projects available). So perhaps there could be a "Food for AIDS" section as part of Telefood.

Example 2: In Uganda, many women part of the Islamic Medical Association of Uganda Project (UNAIDS) said that their IGAs kept them from looking outside their marriage for other partners to contribute to expenses.

Box 11: Income-generating activities with ACTIONAID in Malawi

Strengthening the household. In order to strengthen the household agricultural production capability, it will first be necessary to improve access to labour, land and resources particularly for women, children, orphans and widows. Secondly, the goal should be to re-orient food production to facilitate access to a more nutritious, safe and sufficient diet. This would involve pinpointing, and consequently promoting, labour- and capital-saving technologies including those already in place:

Box 12: IGAs lessons learned (UNAIDS 1999)

Nutrition projects. The FAO Food and Nutrition Division has developed a participatory approach to nutrition projects which could be applied in the context on HIV/AIDS mitigation. The Participatory Nutrition projects approach consists of the joint development of local household food and nutrition strategies by the different stakeholders. It can also help identify affected households and clarify local dynamics between HIV/AIDS, food insecurity and malnutrition.

Nutrition education. Provide specific information and training on nutritional care and support for PLWHA and members of affected households. Nutrition education will need to be provided at different levels, addressing the public as well as service providers; capacity building at various levels, but in particular at local level, will be crucial. It will be essential that information is prepared and provided in manner which strongly considers local conditions.

Emergency food aid. Early diagnosis and access to food and care can prolong life and keep a person healthy and productive for a longer period. It can also help those members of families indirectly affected by HIV/AIDS, especially infants, children, pregnant women and elderly by guaranteeing a regular quality food-intake and reducing the need for adopting short-term irreversible coping mechanisms by cushioning against the loss of assets and allowing for income to be invested in education and IGAs.

Capacity building. One of the main scopes of capacity building should be to engage in activities that facilitate and/or strengthen the autonomous AIDS responses of communities. This includes (1) reinforcing the management and mobilisation skills of NGOs, CBOs, ASOs, extension services and government institutions at local level; (2) training of NGOs, CBOs, ASOs in project design, participatory research, participatory and bottom-up planning40 , management, monitoring and evaluation; (3) establishing fora to facilitate communication and information sharing between NGOs, CBOs and other support organisations (e.g.: the internet be used to allow for the exchange of information about best practices/training in mitigation and prevention of HIV/AIDS, or new agricultural technologies and market prices)41 , (4) encouraging the creation of community safety nets such as communal fields for agricultural production and community-run enterprises, and, (5) supporting trainers working with at risk and/or affected farmers.

Support creation of community safety nets: communal fields for agricultural production, community-run enterprises, build linkages with civil organisations, NGOs, government institutions (ICTs).

Children and youth. Support needs to be provided to orphaned children and adolescents through life skills training, transfer of technical knowledge related to food security, nutrition and agriculture but also by supplementing household income through income-generating activities/projects or provision of small credit. Special attention needs to be given to girls who are taken out of school to work and care for their family. They must be targeted specifically through education, training and special assistance programmes. These interventions require an initial assessment (PAR, PRA) of the problems and constraints faced by adolescent girls from HIV/AIDS affected households and of the corresponding training needs. There is also the need for identifying and mobilising the local institutions that are or could be involved in training and assisting adolescent girls.

The activities proposed herewith are intended to serve as a menu of options and can be used according to needs of the people concerned and specific circumstances. They are by no means complete, definite and are therefore open to discussion and changes.

2.4. Agricultural research agenda

Conducting research into the socio-economic impact of HIV/AIDS has a dual purpose: to provide a rationale for both prevention and mitigation. Showing impact is also an important tool for advocacy to encourage politicians, leaders and policy-makers and can offer more realistic grounds on which to base prevention and mitigation. Since action is needed immediately, research should therefore be linked directly to the development of interventions.42

Research is thus needed for two reasons:

  1. To serve as a basis for action
  2. To further understanding for theoretical and scientific purposes

On a thematic level, there is a definite need to examine (1) how macro level political economy affects socio-cultural dynamics at micro-level, (2) how HIV/AIDS affects the livelihood of children and youth, and, (3) how children, youth and women develop coping mechanisms to deal with this impact. (This type of research should reflect their active participation and promote their interests and rights.)

Below is a list of recommendations that point towards a new agricultural research agenda:

It should be of direct concern for FAO to incorporate HIV/AIDS concerns into the agricultural research agenda especially due to the pressing need for alternative labour-saving technologies to assist the households most affected in sustaining their livelihoods. On the other hand, as aforementioned, agricultural research can help to identify the most the areas most vulnerable to HIV/AIDS.

3. The next steps

3.1. Recommendations

All of the actions proposed above cannot be carried out without the active participation of the affected communities and families and PLWHA.

Advocacy

Policy

Programs and activities: General

Programs and activities (1): Prevention

Programs and activities (2): Mitigation

Agricultural research

Partnerships

3.2. Planning for action

Strategic planning for HIV/AIDS implies and includes processes and approaches that allow all those concerned-central and local governments, non-governmental organisations and communities, national and international partners-to define strategies that are tailored to the different and changing contexts within which HIV/AIDS evolves.

A strategic planning process involves:

  1. Assessing and analysing the situation and the response
  2. Identifying obstacles to effective interventions and looking out for opportunities
  3. Setting priorities and objectives in priority areas
  4. Formulating strategies to accomplish these objectives
  5. Defining targets and indicators for monitoring and evaluation

3.3. The role of institutions

The foregoing section has outlined a set of policy and programme oriented recommendations yet did not specify whose responsibility it would be to undertake a particular recommendation. Clearly, the government organisations in Africa do not always have the means or skills to deal with interventions on their own. They will need to collaborate with international and national development agencies (CBOs, NGOs and ASOs) and communities if efforts to mitigate the impact of HIV/AIDS are to be successful.

3.4. Examples of partnerships

The Joint United Nations Programme on HIV/AIDS (UNAIDS)

UNAIDS is the leading advocate for world-wide action against HIV/AIDS. The global mission of UNAIDS is to lead, strengthen and support an expanded response to the epidemic aimed at preventing the transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities to HIV/AIDS, and alleviating the impact of the epidemic.

World Bank Rural AIDS Initiative (WB-RAI)

The WB has been involved in the fight against HIV/AIDS since 1986 by providing grant support, technical assistance and economic and sector analysis to member countries. Recognising the importance of mobilising human and financial resources to supplement the efforts of Ministries of Health and Population and NGOs in order to expand HIV/AIDS interventions to the rural areas, the WB launched AFRICA Region's Rural AIDS Initiative in 1999. Intensifying Action Against HIV/AIDS in Africa was introduced as strategic plan in September 1999. A WB implementing team , the AIDS Campaign Team for Africa (ACTAfrica) coordinates the technical and operational support, advice and referrals for the Africa Region.

The International Partnership Against AIDS in Africa (IPA)

The International Partnership Against AIDS in Africa is working to combat HIV/AIDS epidemic through stronger national programmes backed by four main lines of action: (1) encouraging visible and sustained political support; (2) helping to develop nationally-negotiated joint plans of action; (3) increasing financial resources (4) strengthening national and regional technical capacity.

The Southern African Development Community Centre of Communication for Development (SADC CCD)

The Centre promotes the sustainable and systematic use of communication in the development process. It aims to ensure people's participation and sense of ownership to identify and implement appropriate development programmes, technologies and policies for the reduction of poverty. The Center for Communication for Development can play an important role in the development of locally-induced communication programmes for HIV/AIDS prevention and mitigation as well as be a leading hub of information and dissemination.

4. Conclusions

4.1. Suggested actions to be undertaken by FAO

4.2. General conclusions

Participation. Those most affected must be closely involved. PLWHAs could be teachers for the community at large on HIV/AIDS. (See Annex 2)

Equity. An important aspect of assistance programmes is the fact that poor households which are not facing AIDS need a similar type of assistance as their children are also malnourished. Targeting AIDS-affected households would be unethical. Equity can be achieved when assistance is targeted at the most needy regardless of the immediate cause of their poverty. (Over 1998; Donahue 1998)

Long-term and short-term interventions. Relief-oriented must be combined with investment-oriented strategies to ensure that when funds are finished, projects are able to continue. Long-term strategies should continue to address the underlying problems that make rural households vulnerable to the impact of HIV/AIDS. The main focus should be on enabling households and communities to avoid irreversible coping strategies particularly those that reduce future income-earning potential and destroy their productive capacity.

Combined efforts. No single action can make a meaningful and lasting impact on the AIDS crisis. Development agencies whether national or international, governments, civil society, NGOs, CBOs, academic institutions, religious authorities, private sector, farmers and teachers, all stakeholders need to join hands in an effort to the fight against, and alleviate the impact of AIDS. They must contribute to providing an integrated, multi-sectoral response to the epidemic.

In Zambia, for instance, different ministries have made specific commitments to addressing HIV/AIDS. The Cabinet Office has developed HIV counselling services. The Office of the President has encouraged inclusion of HIV prevalence messages in all speeches of the country's top political leaders. The ministry of Defence has developed a plan for creating an orphan's fund to help upkeep education of orphans of officers and men of defence forces. The Ministry of Agriculture, Food and Fisheries has proposed to train extension workers in social mobilisation techniques for HIV/AIDS prevention and mitigation, and in coping mechanisms for rural populations.

Partnerships. Partnerships are key, as are increased resources, policy development, social mobilisation and co-ordination among various sectors of government, the private sector and civil society. Build up technical and programme expertise in collaboration with other partners. Coordinate more closely with UNAIDS.

Sensitive approach. Prevention and mitigation programmes/strategies need to take into account the production system, agro-ecological zone, mobility patterns, household types, gender relations, cultural and social norms and values. The strategies will also have to deal with the fact that needs is an ever-changing category, so whatever will be identified as an urgent need today may no longer be urgent or the same tomorrow.

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