SD : Knowledge : Strategic approaches to HIV prevention and AIDS mitigation in rural communities and households in Sub-Saharan Africa. Part 4.

The pyramid shows the increasing levels of involvement of PWHA. The GIPA principle advocates for involvement at all levels.

Annex 2: Cooperation Framework UNAIDS/FAO

Cooperation Framework
between
Joint United Nations Programme on HIV/AIDS (UNAIDS)
and
Food and Agriculture Organisation of the United Nations (FAO)

Whereas it is FAO's constitutional mandate to improve food production and distribution as well as the condition of rural population and to promote international action for the implementation of the Plan of Action adopted by the World Food Summit;

Whereas UNAIDS has been given the primary task of mobilizing a broad-based response to the global health and development challenges posed by HIV/AIDS, in view of the fact that the HIV epidemic has reached every country in the world, and more than 95 percent of all HIV-infected people live in the rural and urban areas of developing countries;

Whereas FAO and UNAIDS recognise that it is in their mutual interest to intensify cooperation between themselves and to establish appropriate working procedures to that effect;

Bibliography

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1996. Fighting AIDS in rural areas: Why and how should extension workers help, Ideas Book, SDRE/FAO, Rome.

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1998. Rural children living in farm systems affected by HIV/AIDS: some issues for the rights of the child on the basis of FAO HIV/AIDS studies in Africa, by J. du Guerny. Paper presented at the UNHCR Committee on the Rights of the Child: day discussion on "Children living in world with AIDS", FAO, Rome. Also available on the Internet at the following address: http://www.undp.org/popin/fao/faohome.htm

1999. HIV/AIDS and the commercial agricultural sector of Kenya - impact, vulnerability, susceptibility and coping strategies, by G. Rugalema with S. Weigang and J. Mbwika, FAO/UNDP,. Also available on the Internet at the following address: http://www.undp.org/popin/fao/faohome.htm

1999. AIDS and agriculture: can agricultural policy make a difference, by J. du Guerny, FAO, Rome.

FAO/UNAIDS. September 1999. Sustainable agricultural/rural development and vulnerability to HIV/AIDS, by D. Topouzis and J. du Guerny, FAO/UNAIDS joint publication

2000. HIV/AIDS in Namibia: the impact on the livestock sector, by Engh, I., Stloukal, L. & du Guerny, J., FAO, Rome.

(forthcoming) HIV/AIDS and nutrition: helping families cope, by F. Egal and A. Valstar, FAO, Rome.

FAO communication for development publications

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1994. Applying DSC methodologies to population issues: a case study in Malawi, by Decock, A., Kavinya, A. and Alam, S., Communication for Development Case Study 12. Extension, Education and Communication Service, Research, Extension and Training Division Sustainable Development Department

1995. Understanding farmers' communication networks: an experience in the Philippines, Communication for Development Case Study 14, Extension, Education and Communication Service, Research, Extension and Training Division Sustainable Development Department.

1996. Artists as Experts: a participatory methodology to produce traditional and popular media. Based on population communication experiences in Africa, by Decock, A. and Van Poelje, R. Communication for Development Branch, Population Programme service.

1998. Knowledge and information for food security in Africa: from traditional media to the internet, Communication for Development Group, FAO Extension, Education and Communication Service, Research, Extension and Training Division Sustainable Development Department

1998. The first mile of connectivity. Advancing telecommunications for rural development through a participatory communication approach. by Richardson, D. and Paisley, L. in collaboration with the FAO Extension, Education and Communication Service, Research, Extension and Training Division Sustainable Development Department Communication for Development

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Jenkins, C. & Mugrditchian, D. (August 1994) STD/AIDS prevention among commercial sex and transport workers in Papua New Guinea, Paper drafted in collaboration with the Papua New Guinea Institute of Medical Research and AIDSCAP/ Family Health International

Okatcha, K. 1999. The impact of AIDS on older people, in The Courier Africa-Caribbean, Pacific European Union

Over, M. 1998. Coping with the impact of AIDS. AIDS Analysis Africa (Southern Africa Edition), 9 (3)

Piotrow, T.P. et al, . 1997. Health communication: lessons from family planning and reproductive health, Praeger, Westport-Connecticut-London.

Pisani, E. December 1999. AIDS in the 21st Century: some critical considerations, in SAfAIDS News Vol. 7, No.4 December 1999. Also available on the Internet at the following address: http://www.safaids.org/nl26feat.html

Restrepo-Estrada, S. & Fraser, C. 1998. Communicating for development: human change for survival. London: I.B. Tauris Publishers.

Royal Tropical Institute. 1999. Draft Workshop Report: The impact of AIDS of food security, organised by TANESA, Mwanza, Tanzania, Lake Zone ARI Ukiriguru Client Oriented Research Project, Mwanza, Tanzania, ARI Maruku, Bukoba, Tanzania & Royal tropical Institute, Amsterdam, The Netherlands.

Rugalema, G. 1998. It is not only the loss of labour: HIV/AIDS, loss of household assets and household livelihood in Bukoba district, Tanzania, Paper presented at the East and Southern Africa Regional Conference on Responding to HIV/AIDS: Development needs of African Smallholder Agriculture, Harare (June 8-10)

SADC-CCD/FAO. 1998. Participatory rural communication appraisal: starting with the people, by Anyaegbunam, C., Mefalopulos, P. & Moetsabi, T. in collaboration with the SADC Centre of Communication for Development, Harare, and the Food and Agricultural Organisation, Rome.

SAfAIDS & Commercial farmers union. 1996. Orphans on farms: Who cares? An exploratory study into foster care for orphans children on commercial farms in Zimbabwe, SAfAIDS, Harare.

SAfAIDS. 1999. "ILO tackles HIV/AIDS at workplace", in SAfAIDS News Vol.7, No.4, December 1999, SAfAIDS, Harare, Zimbabwe.

"The impact of HIV/AIDS: a case study of SAfAIDS", in SAfAIDS News, Vol.7, No.4, December 1999, Harare, Zimbabwe.

Sauerborn, R. et. al (1996) "Household strategies to cope with the economic costs of illness", Social Science and Medicine, 43 (11).

April 1997. Community mobilization and AIDS, Technical Update, Best Practice Collection, UNAIDS, Geneva, Switzerland.

1998. Expanding the global response to HIV/AIDS through focused action. Reducing risk and vulnerability: definitions, rationale and pathways. Key Material, Best Practice Collection, UNAIDS, Geneva, Switzerland.

July 1998. HIV/AIDS and the workplace: forging innovative business responses, Technical Update, Best Practice Collection, UNAIDS, Geneva, Switzerland.

October 1998. AIDS education through IMAMS: a spiritually motivated community effort in Uganda, UNAIDS Case Study, UNAIDS, Geneva, Switzerland.

March 1999. Funding priorities for the HIV/AIDS crisis in Thailand, UNAIDS Best Practice Collection, UNAIDS, Geneva, Switzerland.

March 1999. HIV/AIDS prevention in the context of new therapies. Report of a meeting organised by UNAIDS and the AIDS Research Institute of the University of California at San Francisco, Geneva 23-24 February 1998. Key Material, Best Practice Collection, UNAIDS, Geneva, Switzerland.

June 1999. Comfort and Hope: Six case studies on mobilizing family and community care for and by people with HIV/AIDS. UNAIDS Best Practice Collection, UNAIDS, Geneva, Switzerland.

June 1999. Acting early to prevent AIDS: the case of Senegal. Key Material, Best Practice Collection, UNAIDS, Geneva, Switzerland.

September 1999. From principle to practice. Greater involvement of people living with or affected by HIV/AIDS (GIPA), by Roey, J., UNAIDS Best Practice Collection, Geneva, Switzerland.

December 1999. Peer education and HIV/AIDS: Concepts, uses and challenges. Key Material, Best Practice Collection, UNAIDS, Geneva, Switzerland.

December 1999. Statement of the Joint United Nations Programme on HIV/AIDS at the Third World Trade Organisation Ministerial Conference Seattle, UNAIDS Document, UNAIDS, Geneva, Switzerland. Also available on the Internet at the following address: http://www.unaids.org/publications/documents/health/access/wtostatement.html

1999. A review of household and community responses to the HIV/AIDS epidemic in the rural areas of sub-Saharan Africa, by Mutangadura, G., Mukurazita, D. & Jackson, H., UNAIDS, Geneva, Switzerland.

1999. Draft Guidelines for preparation and execution of studies of the social and economic impact of HIV/AIDS, by Barnett, T. & Whiteside, A., UNAIDS Best Practice Collection, Geneva, Switzerland.

April 2000. HIV/AIDS and the education sector, Paper presented at the Fifteenth Meeting of the Committee of Cosponsoring Organizations (CCO) 8 April 2000, Rome.

UNFPA (April 1999) Support to HIV/AIDS-related interventions, Part I: Approaches to integrate HIV/AIDS concerns into UNFPA programme, Issue 11, UNFPA

Support to HIV/AIDS-related interventions, Part II: HIV/AIDS-related training, Issue 12 , UNFPA.

Support to HIV/AIDS-related interventions, Part IV: IEC and Advocacy, Issue 14, UNFPA.

Wageningen Agricultural University. April 1999. Conference Communique: AIDS, livelihood and social change in Africa. Position papers also available on the Internet at the following address: www.sls.wau.nl/crds/congress/thm_05.html

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Useful HIV/AIDS websites

Activist organisations and links

Conference sites

United Nations Organisations

Others

Africa Southern Africa AIDS Information Dissemination Service (SAfAIDS)
www.safaids.org

Global forums

Regional forums

Topic-specific areas

National forums

Endnotes

¹See "FAO and the socio-economic impact of HIV/AIDS on Agriculture" (updated 1998) for a history of FAO activities and research in the area of HIV/AIDS. In 1993-1994 FAO conducted a first set of studies in East Africa to determine the impact of the HIV/AIDS epidemic on agriculture: "The effects of HIV/AIDS on farming systems in East Africa" (FAO 1995). This paper can also be found on the internet: http://www.undp.org/popin/fao.faohome.htm
²"In 1982, there was only 1 country in Africa, Uganda, with an adult prevalence rate higher than 2%. Today there are 21 countries with prevalence rates of more than 7%."( World Bank, Dec. 1999)
³From now on, whenever needs will be mentioned in this paper the author would like to show that she is clearly aware of the problematic definition in that there is no clear-cut, homogenous, fit-for- all "need". Hence, the definition of "need" is open to discussion as well as to subjective interpretations.
⁴There is an urgent need for more action- research to define the types of problems encountered, to identify the different needs of families (particularly of orphan-headed households), communities and support groups and consequently to plan a participatory process of problem-solving and socially appropriate interventions.
⁵From now on FAO will be referred to as the Organisation, unless otherwise specified.
⁶Stakeholders are the people the project, programme or intervention is trying to involve and assist. Stakeholders are those people who have a particular interest in solving a specific problem or improving a situation.
⁷See Annex 2 describing the Pyramid of Involvement of People Living With HIV/AIDS (PLWHA) developed by UNAIDS.
⁸Agricultural education and training policies need to take into account the gender implications and socio-economic impact of the epidemic on rural households and communities.
⁹This should not mean excluding those households perhaps not affected by AIDS-driven poverty yet still in dire straits and equally in need of assistance.
¹⁰Community ownership of programmes is critical for success therefore programmes need to be based on the felt needs with active participation of those whose livelihoods are most affected.
¹¹This approach is in line with the "Call for Action for the children left behind by AIDS " drafted by UNAIDS, UNICEF and the BLCA in December 1999 in occasion of World AIDS DAY.
¹²From a personal communication with Robert van Poelje 1999, from KIT, the Royal Tropical Institute in The Netherlands
¹³This paper is available on the internet at the following website: http://www.safaids.org/nl26feat.html
¹⁴"A shock to an existing system of livelihood at the national, regional, communal or household level which reduces the levels and expectations of life and welfare. It may mean the dissolution of the unit and involve the loss of individuals from poverty related causes other than as a direct result of HIV/AIDS illness or death." taken from Draft "Guidelines for preparation and execution of studies of the social and economic impact of HIV/AIDS", prepared by A. Whiteside and T. Barnett for the UNAIDS Best Practice Collection (1999).
¹⁵"Age and sex distribution of the labour force will change, due to the rising number of widows and orphans seeking a livelihood and the large proportion of people with AIDS in the age group 20-49 years, resulting in early entry of children into the active labour force due to economic need" (ILO: June 2000). The entire report is also available on the new ILO website on AIDS: http://www.ilo.org/aids
¹⁶For more information on the impact of HIV/AIDS on households see "The impact of HIV/AIDS on rural households/communities and the need for multi-sectoral prevention and mitigation strategies to combat the epidemic in rural areas"(Baier FAO: 1997)
¹⁷The impact of HIV/AIDS begins as soon as a member of a household starts to suffer from HIV-related illnesses and worsens after death.
¹⁸A recent study carried out by FAO in Namibia demonstrated that HIV/AIDS affects livestock production by: decreasing management of livestock resources, decreasing ability to control livestock pests and diseases, prompting the loss or impeding the transfer of livestock in accordance with inheritance norms, increasing the sale and slaughter of livestock (sacrifices, funerals), diminishing availability and consumption of livestock products, and finally by reducing the transactions and sales of livestock and their products. (Engh, Stloukal & duGuerny 2000). This paper is also available from the internet: http://www.fao.org/waicent/faoinfo/agricult/aga/agap/factfile/draught.htm
¹⁹For purely analytical purposes the author has distinguished between prevention of HIV and mitigation of the impact of AIDS, unless otherwise specified.
²⁰Communities can be grouped in pre-impact incidences of infections but the impact is not yet visible; early-impact: the impact is visible but community and household coping strategies are still effective; and full-impact: breakdown of socio-traditional coping strategies. (Baier FAO: 1997)
²¹In Africa, 23 countries fall into this category. "HIV in these countries remains predominantly in groups whose behaviour places them at high risk but has the potential to spread rapidly to the general population. " ( World Bank 1999)
²²For more information on prevention see the recommendations listed in a Paper prepared by UNAIDS: "HIV/AIDS prevention in the context of new therapies" , Report of a meeting organized by UNAIDS and the AIDS Research Institute of the University of California at San Francisco, UNAIDS 1999.
²³Concerns can be raised on this approach. However, the intention of this exercise should be (1) to foster the active participation of PLWHA and affected families/communities and (2) contribute to breaking the standardised fear and stigmatisation of PLWHA, i.e. moving from the view that PLWHA are victims/patients/passive to a more positive view that PLWHA can be knowledgeable/active participants in society by contributing to the education and learning of others.
²⁴ As mentioned above these would need to be identified during the research process. The ones presented have been identified only to give the reader an idea of the various types and levels of needs. Inevitably the nature and content of the needs will be context- specific as well as actor-specific.
²⁵Education as it is intended here is about learning skills, knowledge, values, decision making, problem-solving, life skills. It is not necessarily in-school education, and neither is it intended to exclude adults. On the contrary the definition of of education
²⁶This does not mean that programmes and activities can take place only if there is an enabling policy environment.
²⁷The policy document is also available at the following internet address: http://education.pwv.gov.za
²⁸Initiating prevention programmes in schools, will allow many teachers and students, are already affected by HIV/AIDS, to get more involved in the fight against the epidemic. It would also create a forum for social dialogue on issues related to sexuality in general and HIV/AIDS in particular.
²⁹The model used to develop a strategic communication can also be adapted to education.
³⁰For more information on the Rural Youth Programme see the website address: http://www.fao.org/ruralyouth/
³¹An example of a sound peer education programme is the Save Your Generation Association in Ethiopia. The goal of the association was to change health behaviours of out-of-school young people through peer education. This was achieved through the use of puppet drama, educational materials, training of peer counsellors/educators, youth income generating projects and advocacy. (see UNAIDS website http://www.unaids.org for more details)
³²In line with the Strategic Framework for FAO 2000-2015 corporate strategy A.3. Preparedness for, and effective and sustainable response to, food and agricultural emergencies states: "The challenge is to increase the resilience and capacity of countries and their populations to cope with the impacts of disasters that affect national and household food security, and when disasters do occur, to contribute to emergency operations and foster the transition from relief to recovery of the food and agricultural sectors."(FAO 1999:15)
³³Definition: "A group of people who have something in common and will act together in their common interest" (UNAIDS 1999, Best Practice Collection on Community Mobilization). Although definitions do facilitate common understanding, we must beware of externally constructed definitions for they are usually incomplete. People must identify themselves as belonging to a community.
³⁴For further details on Project Hope, see the UNAIDS website: http://www.unaids.org in the publications section.
³⁵In addition, projects supporting agricultural extension services need to review the impact of HIV/AIDS both in terms of increased mortality among agricultural extension staff, but also in terms of the reduction of the work time as a result of the increase in funeral attendance. For more information on this topic see FAO/UNDP study on HIV/AIDS and the commercial agriculture sector of Kenya by Rugalema et.al (1999)
³⁶Research-based prevention, care, support and impact-mitigation activities are the inseparable ingredients of a meaningful response to HIV/AIDS.
³⁷For further details see the Telefood website: http://www.fao.org/Food/Default_e.htm
³⁸These recommendations are in line with the corporate strategies presented in the Strategic Framework for FAO 2000-2015. A.1: Sustainable rural livelihoods and more equitable access to resources; A.2: Access of vulnerable and disadvantaged groups to sufficient, safe and nutritionally adequate food.A.3. Preparedness for and effective and sustainable response to food and agricultural emergencies
³⁹For more information on this topic see IMAU FAEPTI Project (UNAIDS) as a good example for diversification of income. ⁴⁰FAO, UNDP and the World Bank have developed a Socio-Economic and Gender Analysis (SEAGA) training programme to help countries formulate gender-responsive, pro-poor and environmentally sustainable programmes. For more information on SEAGA see the corresponding website: http://www.fao.org/sd/seaga/default.htm
⁴¹An example is the website developed by the United Nations Development Programme (UNDP) and the Asia Pacific Development Information Programme (APDIP) on HIV and Development in Asia and the Pacific: http://hivundp.apdip.net
⁴²The Guidelines for preparation and execution of studies of the social and economic impact of HIV/AIDS prepared by Whiteside and Barnett (UNAIDS 1998) deal with the question of assessing socio-economic impact. The document provides the basic concepts to guide thinking about the social and economic implications of HIV/AIDS, to assist those planning or commissioning socio-economic impact studies and consequently to develop effective responses to the immediate and long-term impacts.
⁴³This does not imply that that there is a need to shift from high-input to low input in all AIDs-relates contexts, on the contrary, it should only take place where no other solution can be found. High-input could still be feasible in high prevalence areas if group formations are encouraged along with rotating work shemes so that the tasks are well distributed according to the special requirements of PLWHA and their caretakers.
⁴⁴Two conferences have dealt with the need for a new agricultural research agenda, they are: (1) The Regional Conference for Eastern and Southern Africa held in Zimbabwe in June 19998 entitled "Responding to HIV/AIDS: technology Development Needs of African Smallholder Agriculture. The other one is the Conference AIDS, Livelihood, and Social Change in Africa which took place in Wageningen, the Netherlands April 1999, addressed the issue of a new agricultural agenda.
⁴⁵Extension can assist farm households and specific target beneficiaries most affected to become organized into functional groups and community organizations (commodity groups, cooperatives)
⁴⁶There is an urgent need to refocus farming research towards needs of youths, widows and widowers, elderly and orphans instead of exclusive attention for healthy, middle aged male farmers
⁴⁷Source adapted from: From principle to practice. Greater involvement of People Living With or Affected by HIV/AIDS (GIPA). UNAIDS Best Practice collection (1999).