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HIV/AIDS Mainstreaming:
A Definition, Some Experiences and Strategies
A resource developed by HIV/AIDS focal points
from government sectors and those that have
been working on HIV/AIDS mainstreaming.
January 2003
Produced and developed by:
Helen Elsey
Prisca Kutengule
In collaboration with:
Sue Holden
Dinah Kasangaki
Rachel MacCarthy
Akua Ofori-Asumadu
Alfred Okema
Rose Smart
With funding and support from:
Department for International Development’s HIV/AIDS & STI Knowledge Programme, Liverpool School of Tropical
Medicine
Health Economics and HIV/AIDS Research Division, University of Natal, South Africa
Department for International Development Ghana Office
Produced and developed by:
Helen Elsey - Associate Professional Officer, Department for International Development on
secondment to the Liverpool School of Tropical Medicine
Prisca Kutengule - Intern to the Gender and Health Group, Liverpool School of Tropical Medicine
from Ministry of Gender and Community Services, Malawi
In collaboration with:
Sue Holden - independent consultant, UK
Dinah Kasangaki - Ministry of Agriculture, Animal Industries and Fisheries, Uganda
Rachel MacCarthy - Ministry of Local Government and Rural Development, Ghana
Akua Ofori-Asumadu - Ministry of Education, Ghana
Alfred Okema - Ministry of Finance Planning and Economic Development/ Uganda AIDS
Commission, Uganda
Rose Smart - Health Economics and HIV/AIDS Research Division, University of Natal, South Africa
This research study was funded by Department for International Development (DfID). However, DfID can
accept no responsibility for any information provided or views expressed.
Table of Contents
Acronyms
Section 1: What is the aim of the resource pack and who is it for?
Section 2: Why has the pack been developed?
Section 3: How was the resource pack developed?
Section 4: Background Information: Countries and SWAps
SWAps (Sector Wide Approaches)
Ghana
Uganda
South Africa
Section 5: Definition of Mainstreaming
Section 6: Conceptual Framework for HIV/AIDS mainstreaming
Section 7: Strategies for Mainstreaming
Research, impact and models
HIV/AIDS Focal Points
Training
Influencing
High Level commitment
Financing of Mainstreaming
Section 8: Internal Mainstreaming
8.1. Measuring and predicting the impacts of HIV and AIDS on an organisation
8.2. HIV/AIDS work with staff to reduce susceptibility to HIV infection and to support PLHAs
8.3. Minimising the impacts of AIDS on the functioning of the organisation
Section 9: External Mainstreaming
9.1.1 Does the Education Sector increase vulnerability?
9.1.2 What is the Impact of AIDS on Education?
9.2.1. Does the Agriculture sector increase vulnerability?
9.2.2. What Impact is HIV and AIDS having on Agriculture
Section 10: Indicators for Mainstreaming
10.1 Process Indicators
10.2 Impact Indicators: Education
10.3 Impact indicators: Agriculture
Section 11: Useful Resources on Mainstreaming
Appendix 1: Informal Contributors
Appendix 2: Mainstreaming Ideas from Malawi
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Acronyms
AIDS
CSO
DFID
DRI
FAO
GAC
GTZ
HEARD
HIV
MAAIF
MAP
MoE
MoES
MoFPED
MoGLSD
MoH
MoLG
MoLGRD
NGO
NSF
PLHA
PRSP
SANAC
SWAp
STI
UAC
UACP
USAID
UNAIDS
UNDP
Acquired Immune Deficiency Syndrome
Civil Society Organisation
Department for International Development, UK
District Response Initiative, Ghana
Food and Agricultural Organisation, United Nations
Ghana AIDS Commission
German Government Development Programme
Health Economics and HIV/AIDS Research Division, University of Natal, South Africa
Human Immunodeficiency Virus
Ministry of Agriculture, Animal Industries and Fisheries, Uganda
Multi-country AIDS Programme, World Bank
Ministry of Education, Ghana
Ministry of Education and Sports, Uganda
Ministry of Finance, Planning and Economic Development, Uganda
Ministry of Gender Labour and Social Development, Uganda
Ministry of Health
Ministry of Local Government, Uganda
Ministry of Local Government and Rural Development, Ghana
Non Governmental Organisation
National Strategic Framework, Ghana
People Living with HIV/AIDS
Poverty Reduction Strategy Paper
South African National AIDS Council
Sector Wide Approach
Sexually Transmitted Infection
Uganda AIDS Commission
Uganda AIDS Control Programme
United States Agency for International Development
United Nations organisation on AIDS
United Nations Development Programme
Section 1: What is the aim of the resource pack and who is it for?
This resource pack brings together experiences, ideas and strategies for mainstreaming HIV/AIDS
into government sector ministries at all levels, whether national, regional or district. The pack uses
experiences and ideas which come mainly from countries currently working through sector-wide
approaches (SWAps) and may be of particular use to countries and sectors also using this
approach.
The two main aims of the pack are:
> To contribute to clarity of understanding of HIV/AIDS
mainstreaming,
> To share experiences and strategies from those who have been
mainstreaming HIV/AIDS in practice within government sectors.
The pack is aimed at managers and decision-makers within government ministries, at all levels,
who are devising strategies to mainstream HIV and AIDS within their sectors. The pack also
targets HIV/AIDS Focal Points within sector ministries, however, the working-group felt it was
important to target higher level managers and decision-makers, as focal points may often not have
the power and influence to make the necessary changes on their own. In addition, the pack may
be useful for other stakeholders working within sectors, such as donor agencies and non
governmental organisations (NGOs).
Section 2: Why has the pack been developed?
Whilst there is a growing body of evidence of the impact HIV and AIDS are, and will have, on
different sectors now and in the future, a review of the available literature and experiences from
several countries in sub-Saharan Africa has shown that there is very little documented on what
HIV/AIDS mainstreaming means in practice for different sectors. Many international and national
organisations advocate an integrated, multi-sectoral or mainstreamed approach. However, there is
little clarity about what this involves and how sectors should respond in practice. Such lack of
clarity has lead to a number of different interpretations of the meaning of HIV/AIDS
mainstreaming and a sense of confusion within government sectors as to what exactly they should
be doing to mainstream HIV and AIDS.
This does not mean that this resource pack sets out a step-by-step guide of 'how-to' mainstream.
Each sector and country face such different dynamics, that an exercise of this nature would be of
limited use. However, the pack does bring together experiences from particular country situations
and ideas based on the realities of those contexts, in the hope that they may be of value to others
struggling with HIV/AIDS mainstreaming. Of course, this does mean that none of the strategies
documented in the resource pack can be lifted in their entirety and applied elsewhere - the real
world is never that simple - however, they may give inspiration and trigger ideas in the minds of
others working on these issues.
Section 3: How was the resource pack developed?
This resource pack has been developed by a small working group of people involved in HIV/AIDS
mainstreaming in various sectors. The working group consisted of Alfred Okema, with experience
of HIV/AIDS mainstreaming with Uganda's Ministry of Finance, Planning and Economic
Development and the Uganda AIDS Commission; Dinah Kasangaki, HIV/AIDS focal point from
Ministry of Agriculture, Animal Industries and Fisheries, Uganda; Akua Ofori-Asumadu, HIV/AIDS
focal point in Ghana's Ministry of Education; Rachel MacCarthy, HIV/AIDS focal point from the
Ministry of Local Government and Rural Development, Ghana and Rose Smart, research associate
with the Health Economics and HIV/AIDS Research Division (HEARD), University of Natal, South
Africa who brings significant international experience on HIV/AIDS mainstreaming.
The working group came together for a workshop at the Liverpool School of Tropical Medicine,
during December 2002, to share and develop their experiences and ideas on HIV/AIDS
mainstreaming in their different contexts. The workshop followed much the same format as this
resource pack and was facilitated by Sue Holden, an independent consultant currently developing
a book for NGOs on mainstreaming HIV/AIDS in development work and Helen Elsey, a research
associate working with the Department for International Development (DfID) and the Liverpool
School of Tropical Medicine (LSTM). The workshop also benefited from the experiences of other
colleagues at the Liverpool School of Tropical Medicine, particularly those working specifically on
HIV/AIDS and its social and economic impacts and on mainstreaming gender. A list of informal
contributors is given in appendix 1. The aims and objectives of the workshop held in Liverpool are
given below.
Aims and Objectives of the HIV/AIDS Mainstreaming Workshop
Aim: To develop practical approaches and suggestions on how to mainstream HIV/AIDS within
development sectors, with a focus on government ministries working towards Sector Wide
Approaches.
By the end of the workshop, the participants will have:
1. Reached a consensus of understanding on what HIV/AIDS mainstreaming means in practice.
2. Heard and analysed experiences of mainstreaming HIV/AIDS, and where appropriate gender,
within government ministries and elsewhere if applicable.
3. Identified strategies and approaches to mainstreaming HIV/AIDS within government sectors including all stages of sector programme design, planning, implementation, monitoring and
evaluation as well as human resource/personnel issues.
4. Contributed ideas on the content and presentation/targeting of the HIV/AIDS mainstreaming
resource pack.
After the workshop, two editors working at the Liverpool School of Tropical Medicine, Helen Elsey
and Prisca Kutengule (an intern from the Malawian Ministry of Gender and Community Services),
pulled together the experiences and strategies discussed during the workshop combined with
other documentation on HIV/AIDS mainstreaming. The working group commented and further
developed the draft versions of the pack to provide an accurate account of their experiences and
ideas.
The process has been supported and funded by the Department for International Development's
(DfID) HIV/AIDS Knowledge Programme, based at the Liverpool School of Tropical Medicine.
DfID's Ghana programme supported the Ghanaian workshop participants and HEARD supporte
the South African participant.
Section 4: Background Information: Countries and SWAps
As Section 3 explains, the working group who have developed the resource pack have experiences
of mainstreaming HIV/AIDS in Ghana, Uganda and South Africa with added consultancy
experience from elsewhere in sub-Saharan Africa. In order to provide the background context
needed to understand these experiences, this section describes briefly the situation of HIV and
AIDS in each country and the policy environment within which mainstreaming is being
implemented. Both Uganda and Ghana are using the sector wide approach (SWAp) to develop
their sector work, as this approach is increasingly common among high prevalence countries and
offers some opportunities and constraints for mainstreaming, a brief explanation of the sector wide
approach is given below.
SWAps (Sector Wide Approaches)
The defining characteristics of Sector Wide Approaches is that government takes the lead in
negotiating with donors coherent policy and expenditure programmes for the application of aid
within a particular sector. Donors contribute to a single pool of funding to support the
development of the entire sector within the framework of a locally owned strategy and approach.
SWAps are being developed in countries with a high dependency on aid in sectors such as health,
education, transport and agriculture.
This approach developed in the late 1990s due to criticisms of the ineffectiveness of a multiplicity
of donor projects, which create excess work for recipient governments and can lead to over-lap,
uneven coverage, inconsistent approaches and a lack of sustainability. Hence, the
acknowledgement that pooling donor funds within the framework of a locally owned strategy and
approach is more likely to achieve stated goals of more equitable service provision.
One of the main theoretical aspects of SWAps is that while they represent a partnership between
government and donors, the government is the final arbiter. If this could be achieved, it would
represent a real shift in the relationship between donors and governments. In the short-term, this
has placed a great emphasis on strengthening the capacity of governments to develop policy,
manage resources and evaluate progress towards goals.
The sector is defined in its broadest sense to include private and non-governmental organisations
(NGOs). It is further recognised that civil society has an active role to play in the design and
monitoring of the SWAp. However, there are concerns that due to the emphasis on strengthening
NGOrnrn|fb'
*pS and fac*^,es/ donors and governments will dominate policy development and
SWAps provide an opportunity for refocusing the work of a sector to provide services more
sensitive to those in greatest need whether by gender, age, social group, HIV status or geographic
location. The recognition of civil society's monitoring role increases the likelihood of this
happening. In addition, public sector institutions can potentially be reshaped to become more
9FFn^r^Sunf!Twe aJnd resP°ns've to previously excluded groups, including those infected and
affected by HIV and AIDS.
Ghana
HIV/AIDS situation: By the end of 2001, UNAIDS1 estimates that 360,000 adults and children were
livingiwrth HIV or AIDS in Ghana. The percentage prevalence rate among the adult population is
3 /o. This is still a relatively low prevalence rate and Ghana has not, as yet, been hit by the severe
epidemics facing other countries in sub-Saharan Africa. This means that the full impacts of the
eP'demic have yet to be felt, during 2001 there were an estimated 28,000 deaths among adults
and children due to AIDS. This has resulted in an estimated 200,000 orphans under the age of 15
years (total population in 2001: 19,734,000 source: UNPOP).
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1 All HIV/AIDS statistics in the section can be found on the UNAIDS website http,7/www.unaids.org
Policy Environment and Background to mainstreaming: From the mid to late 1990 onwards Ghana
has been moving towards sector wide approaches in key sectors, such as education and health. As
well as the reforms in the various sectors, a National Strategic Framework (NSF) for HIV/AIDS was
developed in 2000 to cover the period 2001-2005 and states that all ministries must mainstream
HIV/AIDS. The NSF has provided space for mobilising all sectors, including the Ministries,
Departments and Agencies, the private sector, NGOs, districts, communities and other
stakeholders to respond to HIV and AIDS. The Ghana AIDS Commission was established in 2000
and given legal status in 2001, it has the mandate of supporting sectors in their HIV and AIDS
mainstreaming activities, the Commission is seen as a supra-ministerial and multi-sectoral body
responsible for policy formation, coordination, direction, supervision and resource mobilisation.
The establishment of a Commission with this level of authority is a bold step in a country where
the prevalence rate is still relatively low and the full impacts of AIDS deaths and their wide social
and economic repercussions have not, as yet, been felt.
The Ghana AIDS commission is currently leading a major initiative which involves working closely
with all sectors to support them to develop sector plans to address HIV and AIDS. Given the stage
of the epidemic that Ghana is experiencing the focus of interventions within the different sectors is
on prevention of new infections, for example in the education sector the main objective is:
To ensure that Education Sector personnel, students and pupils are provided with the
relevant knowledge, desire and skills to protect themselves from infection and from
infecting others. (Education Sector HIV/AIDS Work Plan, 2000)
A further objective focuses on care and support for all those involved in the Education Sector who
are living with HIV/AIDS or are in someway affected by the impacts of HIV or AIDS.
While Ghana is moving in the direction of sector wide approaches, there are still large donor
funded projects which fall beyond the central sector budget. For example, UNAIDS, WHO and GTZ
have collaborated to fund the District Response Initiative (DRI) to build local level capacity to
develop, manage and implement a multi-sectoral response to HIV/AIDS. The DRI has progressed
steadily beyond the 10 initial districts and expanded into all districts and sub districts in Ashanti
and Eastern Regions, 65 out of the total of 110 districts in the country have developed a locally
specific HIV/AIDS profile encompassing a situation and response analysis and a medium-term
HIV/AIDS strategic framework and annual action plan, each of these is guided by the NSF
(MacCarthy 2002) Further, the Ministry of Local Government and Rural Development is being
supported by DfID to mainstream HIV/AIDS within the sector plans, with a particular focus on
preventing new infections and supporting staff, with special attention to rights of staff within the
ministry, regional and district authorities, as well as capacity building of local government staff to
mainstream HIV/AIDS.
These early attempts to respond to HIV/AIDS within the sectors have created a very positive
environment for mainstreaming, the experiences in the resource pack will highlight some of th
challenges and successes of this approach.
Statistics'from s^edf^
.T'0
prevalence in 1992 to 11.25% in 2000 among antenatal clinic attendees in the capital, KamPa1^
These reductions have been linked to behavioural changes. Surveys have shown an increase in the
average age for first sex for girls from 15.9 years in 1989 to 16.5 years in 1995. Furthermore, the
proportion9of people using a9 condom in their last sexually encounter with a non-regular sexual
partner in the last 12 months more than doubled from 33% in 1995 to 50.7% in 1998. However,
Uganda is still suffering the impacts of the high-prevalence years with 84,000 adults and children
dying because of AIDS in 2001, the estimated number of orphans is now 880,000 (total population
in 2001: 24,023,000 source: UNPOP).
Policy Environment and Background to mainstreaming-. Since 1992 the Uganda AIDS Commission
(UAC) has had the remit for promoting a multi-sectoral response to HIV/AIDS. This puts Uganda
as the first country to acknowledge the all-pervasive nature of the pandemic and the need for a
far-reaching response from every sector, not just the health sector. The first step in implementing
a multi-sectoral response was the creation of AIDS Control Programmes (ACPs) in all 17 ministries.
The most recent National Strategic Framework of HIV/AIDS activities (2000/1-2005-6) restates the
need for:
Sector ministries to revise and develop strategic action plans. These plans should describe
the comparative advantages and planned interventions of each ministry in the fight against
HIV/AIDS, including the problem of orphans in Uganda. (Uganda AIDS Commission, 2002)
However, while the overall policy environment may be conducive to a response where HIV/AIDS is
mainstreamed into core sector activities, the challenge comes when sector ministries have to
interpret what is meant by mainstreaming and what activities they actually need to do in order to
address HIV/AIDS within their sector.
A key player within the policy environment for HIV/AIDS mainstreaming is the World Bank; since
2000 they have funded the Uganda AIDS Control Programme, managed through the Uganda AIDS
Commission, to work with all the sector ministries to develop sector specific plans. Uganda has
been developing sector wide approaches (SWAps) since 1998, these are now becoming well
established in the key sectors of health, education and agriculture. World Bank funding through
UACP was seen by some as a contradiction to the SWAps environment, as UACP funds are not
pooled with the main sector budgets but remain earmarked for HIV/AIDS work. This controversial
decision was justified by the fact that HIV/AIDS and its impacts can be seen as an emergency
situation in need of an immediate response and therefore cannot wait for the longer-term
improvements promised by sector wide approaches.
South Africa
HIV/AIDS situation: South Africa has the highest prevalence rate of the three countries, with an
estimated 5,000,000 adults and children living with HIV or AIDS at the end of 2001. The
prevalence rate among antenatal attendees has been increasing rapidly, from 0.7% in 1990 to
24.5%in 2000. The prevalence rate among the general adult population is now 20.1%. The
impacts of the epidemic are being severely felt with 360,000 deaths due to AIDS and 660 000
orphans by the end of 2001. With such a high prevalence rate, the future impacts are likely to be
even more severe.
Policy Environment and Background to mainstreaming-
or all sectors to develop their own strategic and operational plans. Furthermore, the National
Strategic Plan stipulates that every ministry and sector should have a dedicated HIV/AIDS focal
person. Also in 2000, the South African National AIDS Council (SANAC) was formed, with a remit
and trXnnthVemm^nt' aJvocate f°r the involvement of all sectors, monitor implementation, create
d strengthen partnerships, mobilise resources and recommend appropriate research.
^9-Sla?°« fPr a" 9°vernment sectors to develop HIV/AIDS workplace policies on
HIV/AIDS for their staff for example the Department of Public Service and Administration has
developed an Impact and Action Project (2000) which:
"aims to ensure that the Public Service is able to sustain a quality service in spites of the
progression of the AIDS pandemic. The Department of Public Service and Administration has
developed a policy framework to guide departments on the minimum requirements to effectively
manage HIV/AIDS in the workplace and ensure a co-ordinated Public Service response." (Dept of
Public Service and Administration, 2002 pl.)
Unlike almost all other sub-Saharan African countries, South Africa is not dependent on donor aid
to fund its health and social services and hence has not moved to a sector wide approach in the
same way as other sub-Saharan countries keen to coordinate donor aid and gain greater national
control over policy development. However, the country's National AIDS Program has received
significant foreign aid and technical assistance. While South Africa may not be developing its
sector work in quite the same way as other sub-Saharan African countries, i.e. through SWAps,
the South African context is included here due to the progress they have made in mainstreaming,
many of the examples given later in the text come from South Africa.
Section 5: Definition of Mainstreaming
While governments and donors are increasingly talking about HIV/AIDS mainstreaming, few give a
clear definition of what they mean by the term. To further confuse matters, the term
mainstreaming is often used interchangeably with terms such as 'the multi-sectoral response7 or
'integrating HIV/AIDS7 (Holden, 2003, forthcoming). In order to bring some clarity to the term, the
workshop participants used examples of the HIV/AIDS related activities in different sectors to
discuss whether they could be termed as AIDS work or mainstreaming. Three definitions of
mainstreaming supplied by the working group members were then reviewed and combined to form
one definition. While this definition has been agreed by the working group, it should be stressed
that it is a working definition; there may be aspects that you feel the definition does not cover in
your context.
Working Definition of HIV and AIDS Mainstreaming
Developed by HIV/AIDS Mainstreaming Working Group, December 2002
Mainstreaming HIV/AIDS can be defined as the process of analysing how HIV and AIDS impacts
on all sectors now and in the future, both internally and externally, to determine how each sector
should respond based on its comparative advantage.
The specific organisational response may include:
> putting in place policies and practice that protect staff from vulnerability to infection and
support staff who are living with HIV/AIDS and its impacts, whilst also ensuring that
training and recruitment takes into consideration future staff depletion rates, and future
planning takes into consideration the disruption caused by increased morbidity and
mortality.
> refocusing the work of the organisation to ensure those infected and affected by the
pandemic are included and able to benefit from their activities
> ensuring that the sector activities do not increase the vulnerability of the communities
with whom they work to HIV/STIs, or undermine their options for coping with the affects
of the pandemic.
Section 6: Conceptual Framework for HIV/AIDS mainstreaming
Internal: staff and
organisation issues the sector as employer/
EG: Planning staff
receive HIV/AIDS
sensitisation training
EG: Transport sector
staff hand out condoms
to workers during road
construction
_ V
EG: Water and Sanitation staff at
district level place new boreholes in
well-lit, easily accessible areas to
reduce vulnerability of young
women to sexual harassment when
collecting water, in an attempt to
reduce HIV/STI transmission.
JBiomfedical
EG: education sector
increases the number
of teachers trained to
overcome depletion
rates due to AIDS
HIV/AIDS
work
Mainstreaming
External: service
delivery work
The diagram above can be understood on a number of levels. Firstly, if one imagines each circle‘ as
into water, it shows the evolution of the approach to
a ripple caused by dropping a pebble
[
• • responsej was to look at the epidemic from a bio-medical
responding to HIV/AIDS. The initial
perspective, looking at the clinical aspects of the virus and its progression in the hope of finding a
viable cure and vaccine. As it became obvious that this process was by no means straight forward
and would take many years, so the response turned to specific HIV/AIDS work to prevent further
infections and provide care and support for those already infected. Mainstreaming as an approach
has developed more recently as there has been increasing recognition that HIV/AIDS is not just a
health issue, but has vast implications for all sectors of development.
The diagram has also been divided in half; the upper half represents the internal issues within an
organisation, this refers to any human resource issues or issues related to organisational
development, with the government as the employer; the lower half represents the external work
of the sector which refers to the service delivery work or functions of the sector, for example
providing agricultural extension advice to communities or delivering health care to the local
community.
The diagram is not only representative of a progression of the HIV/AIDS response over time, but
also illustrates how a sector can respond to HIV and AIDS in different ways. The examples given in
the call-out boxes show what activities in each of the bands might look like
----- -------for different sectors and are based on the definition of
Think of examples for the
mainstreaming given in Section 5.
Lively debate during the workshop highlighted how activities (
may not fit exactly in each band of the diagram; they may
overlap one or two bands, for example training on HIV/AIDS //
basic facts for teachers can be both an internal and an
external HIV/AIDS work activity. It should help reduce the teachers'
'HIV/AIDS work' band and
the outer 'mainstreaming'
band for both external and
internal issues in your
sector.
vulnerability to HIV infection (internal) but may also - if they pass on the information to their
pupils, and are less likely to have unsafe sex with pupils - reduce vulnerability among the pupils
themselves (external).
The way in which activities are framed and delivered may also affect their classification, For
example, if agriculture sector staff develop labour saving farming tools in response to labour
shortages among AIDS-affected communities, the activity could be seen as external
mainstreaming as it is about refocusing the core work of the agriculture sector to take into
consideration the impacts of AIDS on farming communities. However, if the tools were specifically
aimed at and only delivered to households where a labourer is sick with or lost due to AIDS, it
could also be described as external HIV/AIDS specific work as it focuses directly on those living
with AIDS and its consequences. This example is debateable, a more straightforward example of
HIV/AIDS specific work - NOT mainstreaming - would be if the agricultural extension workers
were to distribute HIV prevention leaflets and condoms to the farmers.
What HIV/AIDS Mainstreaming is NOT
It may help in understanding what HIV/AIDS mainstreaming is by thinking what it is not. The
following are some examples developed by one of the working group members of what HIV/AIDS
mainstreaming is not:
> It is NOT simply providing support for a Health Ministry's programme.
> It is NOT trying to take over specialist health-related functions.
> It is NOT changing core functions and responsibilities (instead it is viewing them from a
different perspective and refocusing them).
> It is NOT business as usual - some things must change.
(Smart, 2002)
Defining the exact meaning of HIV/AIDS mainstreaming and highlighting the differences between
mainstreaming and HIV/AIDS work may seem like a theoretical exercise, however it has become
clear from literature and research work that often when sectors claim to be mainstreaming
HIV/AIDS, they are in fact engaged in HIV/AIDS specific work. This means that very few sectors
are actually considering and responding to the complex inter-linkages between the work that they
do and HIV/AIDS.
1
During discussions among the working group, there were few examples of external or internal
mainstreaming, instead the majority of activities described by the working group could be
classified as HIV/AIDS work. This in itself may, not necessarily be a problem, however, it is
important to go back to the definition of mainstreaming which states clearly that a sector should
respond within its 'comparative advantage'. For example, it may not be advantageous for
agricultural extension workers to take on a whole new workload of HIV prevention activities within
the communities they serve. This may not only lead to ineffective HIV prevention work, but could
also undermine the time and capacity they have to do effective agricultural extension work. In
this example it may be more effective for the agriculture sector to recognise their comparative
advantage and concentrate on reshaping the agricultural activities so they better meet the needs
of households affected by AIDS. A local NGO or staff skilled in health promotion from the Ministry
or Health could carry out the HIV prevention work more successfully.
However, for a sector to truly take on HIV/AIDS mainstreaming work, it may require extensive
changes anri refocusing within the sector. As stated in the box above, HIV/AIDS mainstreaming
does NOT mean business as usual! Given this realisation, it is easy to understand why sectors may
prefer to develop HIV/AIDS activities, particularly prevention activities, like IEC and condom
distnbution, rather than mainstreaming;, carrying out HIV prevention work appears fairly
straightforward when compared to a complete shake-up of the entire sector
Section 7: Strategies for Mainstreaming
This section looks at some of the common strategies used by ministries at all levels to implement a
mainstreamed approach to HIV/AIDS. The strategies described are:
• the use of research and impact/predictive studies,
• the use of HIV/AIDS focal points,
• the use of training,
• influencing strategies,
• and building structures for enabling high-level support,
While these are not the only strategies, and there are certainly more that other sectors and
country experiences might highlight, these were the key strategies discussed by the
mainstreaming working group. The final part of the section looks at issues of the financial
sustainability of HIV/AIDS mainstreaming and documents some of the approaches adopted in
different countries.
Research, impact and models
As HIV/AIDS is a relatively new phenomena, understanding the impact it has on all dimensions of
society and economy is challenging but vital. Methodologies for carrying out impact studies have
been developed and refined and can offer governments valuable information for reshaping their
work to respond to the effects of the pandemic. Predictive models, which estimate the future
impact of the pandemic, are clearly important if sectors are to be able to plan their response over
the coming years. Universities and institutions involved in research into the social and economic
impacts of HIV and AIDS and in modelling the future predictions of the pandemic have much to
offer governments particularly in feeding their findings into planning processes and advising on
monitoring. Close links can also help governments to set the research agenda and ensure that
research is of relevance to government work.
Impact Assessments
UNAIDS (Barnett and Whiteside, 2000) have produced some very clear guidelines on how to carry
out an assessment of the social and economic impacts of HIV/AIDS. These can be found at
http://unaids.org. The guidelines cover issues relating to collection and analysis of a wide range of
data including surveillance, demographic, economic, social, sectoral and epidemiological data, as
well as ideas on setting the terms of reference, choosing the project team and presenting the
findings of the study.
It is important for each sector to develop an understanding of the situation of HIV/AIDS and their
sector - a situation analysis. A key starting point to this process is to think through what
questions need to be asked within an impact study to ensure that the sector ^ets the answers that
will help decision-makers in responding to and planning for the impacts on HIV/AIDS on their
sector's own area of work. An analysis of any response to HIV/AIDS within the sector is clearly
another key element in determining what future actions the sector should take Within these two
elements of situation and response analysis both the internal and external dimensions must be
understood.
For ideas on how to develop a situation and response analysis of HIV/AIDS and internal
organisational issues, see section 8.2.
Looking into the Future: Modelling the HIV/AIDS Epidemic
Several different types of models are used to attempt to predict the future of the HIV/AIDS
epidemic. Chris Desmond from HEARD has summarised the types of models most frequently
used into four types:
1. Prevalence Projections:
These typically involve fitting curves of the epidemic to one or more points of data,
normally data from antenatal surveys. This can be done as most epidemic follow similar
patterns over time and hence produce relatively predictable curves. A variety of computer
packages have been developed to help in fitting the appropriate curve. 'Epimodef is used
by UNAIDS and can be downloaded from their website http://www.unaids.org and
'AIDSproj' which is a more advanced model produced by The Futures Group and can be
found on their website http://www.futuresgroup.com. Others include the ASSA AIDS model
from the Actuarial Society of South Africa and the Doyle model.
2. Demographic impact:
Taking prevalence projections, the impacts of illness and death on the population can be
modelled. This could include impacts such as the number of deaths, of orphans and
changes in population structures. A computer package know as Spectrum can be used.
Using such packages does require the use of certain assumptions and the results of the
package will only be as good as the data and assumption that are used.
3. Simulation models:
These more complicated models are used to investigate the dynamics of the epidemic in
various population groups. Simulation models are currently being developed by the US
government and Oxford University in the UK, these are very complex, expensive and have
some way to go before they are of practical use.
4. Intervention evaluations:
Attempts have also been made to model the impacts of various interventions in order to
better target interventions and allocate resource appropriately. These are available on the
UNAIDS website.
(Smart, Dennill and Pleaner, 2001)
Some Words of Warning
;
The mainstreaming working group were quick to point out some words of warning concerning
large impact studies or prediction models. Firstly, the body or department responsible for
commissioning such studies must be clear on how they will use and disseminate the findings.
There is a real danger that impact and prediction studies will produce frightening findings which
show high levels of infection among public sector workers and predict even higher prevalence
rates for the future, it may also become obvious that some groups of public sector employees are
at greater risk than the general public due to their high levels of mobility. Before commissioning
such studies it is important that the commitment exists to be open about these challenges and find
appropriate ways for the sector to respond. If this commitment does not exist such studies are
not only a waste of valuable resources, but the lack of dissemination and disclosure can fuel fear
and denial and impact negatively on the leadership role that the sector could otherwise play.
Five Cities Study: An example of an inclusive process
One study that was carried out using an inclusive participatory approach was
the Five Cities Study in Namibia. The study assessed the impact of HIV and
AIDS on both the internal issues of human resources and organisational
functioning, and the effects of HIV and AIDS on the external work of the
sector. The study collected data on levels of absenteeism, sickness and
death among civil servants and then combined this with information from
census data and other relevant surveys to estimate the predicted impacts of
HIV and AIDS on the public sector. A key feature of the study was the way
the research team involved managers and civil servants throughout the
process, for example, agreeing on the data to be collected and analysed and
the process to be followed at an inception workshop and then presenting the
findings to the public sector management committee to validate the results.
Because of this inclusive approach, managers and decision-makers within the
public sector felt some ownership of the study and the findings proved to be
a valuable planning and advocacy tool. This was further enhanced during a
final workshop at which representatives met to plan their city's HIV/AIDS
responses, based on the study findings. For more information on the 5 Cities
Study contact siapac(g)mweb.cQm.na or www.siapac.com.na
Another consideration when undertaking impact and prediction studies is that they can be costly
and take time to produce. It is vital that the response of the sector to HIV and AIDS is not put on
hold until the findings of these studies are reported. Smaller scale studies on particular aspects of
the inter-relationship between HIV/AIDS and the work and staff of the sector can give valuable
information for policy decisions. There may be opportunities for assessing studies and information
from other countries and sectors, however, clearly the context will be different and results cannot
be applied uncritically.
Where sector staff themselves are involved in the design, implementation and analysis of such
studies the findings are more likely to have a direct influence on work of the individual involved
and their department. There are few examples of such 'operational research' however, more and
more sectors are beginning to see the value of this approach. The example below comes from the
NGO sector and describes some qualitative research by Oxfam in Malawi on the impacts of AIDS
on all aspects of the life of community members and the organisations they are involved in.
XE'cfhe - SOCHAS*
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ko fa m a n g a I a
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An example from Oxfam of small scale, in-depth qualitative research
Oxfam conducted this piece of qualitative research in Mulanje district in Malawi.
The aim of the research was to look at how HIV/AIDS affects different people,
how it undermines organisations and how people and organisations respond.
Much emphasis was on how HIV/AIDS changes people's daily lives especially in
productive activities such as agriculture, trading, household tasks and community
involvement. Managers and staff from different organisations and representatives
from local communities were interviewed using focus group discussions. The
research helped to link theory with practical situations as well as developing
relationships with those affected and infected who are mostly excluded from the
development interventions.
After the research Oxfam produced a report on the findings which was shared
with several organisations and government departments. Follow up in-depth
group discussions and individual interviews with the affected families on issues
that arose from the research were made. This formed a basis for Oxfam to modify
their objectives, indicators and work’ plans so that they were more relevant to
families affected.
Some of the key findings:
Impact on Communities
> Some families are more affected than others.
> The illness of a mother is a double blow in matrilineal societies.
> Badly affected people and households can become invisible to
development interventions, as they do not participate in many activities.
> Poverty escalates as a result of death or illness of older, more skilled family
members.
> Women and girls take on greater burdens as both parents fall ill.
> AIDS affected households have limited access to education, especially
young girls who may be forced to drop out of school.
> Although those outside view the extended family and institutions as key
sources of support, they often prove to be unreliable social networks.
> Poverty is the driving force of. HIV transmission, as poor women and girls
engage in occasional commercial sex.
Impact on Organisational Capacity
> Absenteeism, lower productivity, vacant posts, high cost and overloading
of others
> The internal response on mainstreaming is predominantly AIDS work, not
mainstreaming
• > Challenge for improving internal policies which is not easy for most
managers at district level
(Oxfam, 2001)
HIV/AIDS Focal Points
One of the first steps that many government sectors take in starting to mainstream HIV/AIDS is to
establish focal points who have the responsibility of acting as a catalyst to mainstream HIV/AIDS
activities within their department and/or sector. The number and level of the focal points vary
from country to country. For example, in Ugarida, ministries such as the Ministry of Education and
Sports have nominated focal points in each department with one lead focal point in a more
influential position, in this case, the commissioner for secondary education.
The Ministry of Education in Ghana have one focal point at the national level ministry and one in
each of the 15 agencies responsible for the different roles of the MoE. Each of these agencies have
appointed one focal person per region, giving a total of 150 focal points.
♦
Mentoring of Focal Points in Ghana
In the initial workshops held to design the sector's response to
HIV/AIDS, the focal points were twinned with consultants with
expertise in mainstreaming. The focal points then returned to their
own departments to develop HIV/AIDS plans. Once this was
completed, they meet up again with their twinned consultants to
review their plans and resolve any concerns they had. This
example of mentoring for focal points proved a very positive
experience as it provided the focal points with much needed
support.
While the number and structural placement of the focal points may be different from ministry to
ministry and country to country, the working group identified some common challenges and also,
some positive experiences of working as an HIV/AIDS focal point in a government ministry at any
level.
Some of the challenges facing focal points:
> Focal points and those around them have limited knowledge and experience of what is
involved in the job, what the difference between mainstreaming and HIV/AIDS work is and
how they should implement a mainstreamed response. Many focal points have described
how they received a letter or formal request from a superior to take on the role HIV focal
point but had very little support in establishing what was expected of them and how they
should go about mainstreaming in their sector.
> In the majority of cases, HIV/AIDS mainstreaming is an add-on to the existing workload of
the focal points. Very few focal points shed any existing tasks to take on mainstreaming
work. This causes real concern for government focal points; if they spend too much time
on HIV/AIDS related work and neglect their official post within the ministry they risk
loosing their job and all associated benefits, including their pension.
> Focal points have found it difficult to convince others within their department or ministry
that mainstreaming HIV/AIDS is an important issue within the sector, especially when no
training on how to address mainstreaming has been provided.
> HIV/AIDS focal points often have limited or no budget to carry out mainstreaming
activities. Many focal points must also negotiate complicated and time-consuming
bureaucratic processes to access money for HIV/AIDS related work. Often a programme
outside the official systems of their sector holds the funds earmarked for HIV/AIDS
mainstreaming work. This then requires separate reporting and monitoring systems, often
directly to the donor providing funds.
The working group also identified some rewarding and positive aspects of being an HIV/AIDS focal
point:
Some positive aspects of being an HIV/AIDS Focal Point
On the personal level it can be:
> Challenging
> Worthwhile
> HIV/AIDS focal points can get a high level of exposure to decision makers and
implementers throughout the sector, not only within government at all levels, but also
with donors, NGOs and researchers.
> There are opportunities for building personal capacity, particularly improving
interpersonal communication, strategic thinking and influencing skills.
> There may be opportunities for travelling worldwide
> Focal points feel that they are contributing to the achievement of national goals - often
these can not be achieved if HIV and AIDS issues are not taken into consideration, so
effective mainstreaming of HIV/AIDS can help the sector achieve its targets and goals.
As the working group have clearly identified, the challenges facing HIV/AIDS focal points are
considerable. Many of these challenges are similar to the constraints that have faced focal points
attempting to mainstream gender within government sectors. In many cases these challenges
have proved insurmountable and have resulted in very little progress in mainstreaming gender.
The strategy of establishing HIV/AIDS focal points is more recent than the attempts at
mainstreaming gender, so it is vital that the HIV/AIDS focal points and more importantly, those
promoting their establishment and managing them, take note of these very real constraints and
adopt approaches and practices that mean they can carry out their work effectively. The working
group felt that many of these challenges could be overcome if the managers and those in positions
of authority over the work of the focal point could put in place certain structures and conditions to
support and facilitate the work of the HIV/AIDS Focal points, these are given in the box below.
Advice to managers supporting HIV/AIDS Focal Points
When appointing focal points, managers must ensure that they are at a high enough level
of superiority and in a strategic position to influence the core work of the sector.
> Ensure that the focal point's job description is rewritten to include the new HIV/AIDS
mainstreaming responsibilities, and to ensure that enough time is allowed within the focal
point's existing workload to carry out the new mainstreaming responsibilities.
> Build strategic alliances in order to link with other relevant organisations. For example
development strong ties with the national AIDS commission could help to provide training
for the focal point on what HIV/AIDS mainstreaming means for the sector and what the
role and responsibilities of the new focal point are.
> Define the reporting lines of the focal point. The focal point may effectively have two
managers, one for their existing work and one for the HIV/AIDS mainstreaming work, the
managers must decide how the system can be coordinated, so that unrealistic" and
conflicting demands are not placed on the focal point. The working group also felt that the
focal point should not report to a politician as this can politicise and potentially undermine
their work.
> Provide the focal point with the office and transport facilities necessary for them to carry
out their mainstreaming work.
> Consider the possibility of having a small fund with more relaxed accountability limitations
which HIV/AIDS focal points could draw on as needed to carry out their mainstreaming
work. Structures to limit abuse of such a system would also have to be thought through.
The working group also came up with some words of advice for HIV/AIDS focal points just
starting their work within a sector, see box below.
♦
>
>
>
>
>
>
>
>
Words of advice for new HIV/AIDS mainstreaming Focal Points
Find out what is expected of you in your new role as HIV/AIDS focal point.
Start by having a meeting on AIDS and development and what HIV/AIDS mainstreaming
is all about for your manager and other key decision makers whose support you will
need in the future and who must appreciate your new role and responsibilities as focal
point.
Carry out a desk study on HIV/AIDS mainstreaming to find out what has happened in
the ministry /local government already, what the plans are for the future, who the key
players are (including NGOs, donors, researchers and others within your sector and
other government departments).
Develop strategic alliances and support structures - talk to collaborators, these may
include staff sympathetic to mainstreaming HIV/AIDS in your own department/sector or
other organisations outside, including NGOs, donors, researchers and HIV/AIDS focal
points in other sectors and ministries.
Demand that the work involved in mainstreaming HIV/AIDS is included in your job
description, or rewrite your job description yourself and persuade your manager and the
human resource department to agree to it.
Seek support from all key stakeholders within and outside your department/ministry
(this should include financial resources that are well targeted and /or earmarked).
Build support among colleagues and peers
Seek practical support e.g. office facilities and resources
In an attempt to institutionalise good practice in appointing focal points and ensuring they can
work effectively, the Ministry of Education in Ghana have developed a manual to be used by focal
points and their managers. The box below highlights the criteria for appointing focal points and
their roles and responsibilities once in place.
Ministry of Education, Ghana: Criteria, Roles and
Responsibilities of HIV/AIDS Focal Points.
Criteria for selecting HIV/AIDS focal points:
> Aged not more than 55 years in order to avoid loss of focal points
through retirement
> Education a minimum of senior secondary or its equivalent
> Experience and training in HIV/AIDS related issues
> Interest in HIV/AIDS issues and initiative
> Confident personality
> Good communication skills r
> High sense of humour and good interpersonal relationship
> Ability to work with minimum supervision and able to meet
deadlines
The roles and responsibilities of the focal points are to:
> Circulate information on HIV/AIDS
> Organise meetings and seminars on HIV/AIDS at the work place
> Organise activities on public holidays and celebrations on AIDS day
> Keep logbook of HIV/AIDS activities to enable them to write
quarterly reports
> Monitor and supervise where applicable
> Basic counselling of staff
> Networking with other focal points and other organisations
> Act as a resource person for MOE HIV/AIDS programmes
> Develop proposals
> Conduct periodic reviews - of the agency's action plan for
implementation
> Organise and coordinate in consultation with the national coordinator
emerging HIV/AIDS training needs.
> Write and submit reports to the relevant quarters
—
How many of these roles and
responsibilities refer to HIV/AIDS specific
work and how many refer to
mainstreaming? What other roles and
responsibilities do you think should be
added to encourage a mainstreamed
approach to HIV and AIDS in the
education sector?
Given the challenges facing focal points and the level of commitment and patience required, it is
inspiring to read the quotation below from a gender focal point within the Trade Union
Congress in Ghana:
"It has not been an easy road at the local front...Readiness to accept modest gains and
sometimes make compromises as against maintaining an entrenched position becomes
necessary at certain points in the process. It is important to realise that some brilliant ideas
and proposals simply have to be shelved or frozen for a while before raising them again.
Such situations call for extra courage and strength to deal with an inevitable event that can
hurt the ego. Even though it is difficult, the word 'frustration' should not be entertained.
Simply refuse to get to that point." (Veronica Ayikwei Kofie, Head of Women's Desk, TUC
Ghana in Akpalu et al. 1999)
Training
Training staff within the sector is another strategy commonly used to kick-start the mainstreaming
process. Many people and institutions with experience of HIV/AIDS mainstreaming have pointed
out the importance of providing training programmes for staff that focus on the personal
dimensions of HIV and AIDS by looking at facts about transmission and the progression of HIV to
AIDS as well as attitudes, myths and misconceptions about the virus. Such training can help staff
to deal with their own feelings and ideas about HIV and AIDS. Once staff feel comfortable with
these issues on a personal level they are then ready to look at how HIV and AIDS affect their
work, both now and in the future.
It is vital that training does not stop with the personal issues, but goes further to look at
mainstreaming, by addressing how HIV and AIDS impact on the work of the sector and on the
particular work of the individual staff member. Staff should also be given time and support to
consider whether their work or the work of others in their sector may actually increase
001™™™^ vulnerability to HIV or may reduce their capacity to cope with the impacts of AIDS.
Deciding at whom the training should be targeted is another key issue, it is unlikely that the
resources (both time and money) exist to train all staff in the sector, so it is important to think
who the key staff are in driving forward the mainstreaming agenda. The example below shows
how, in South Africa, staff from the Planning Departments of ministries at national and provincial
level, and local government planners were targeted for mainstreaming training due to their key
role within the various sectors.
Training is an area where those involved in HIV/AIDS mainstreaming could potentially learn a
great deal from the experiences of gender mainstreaming. The learning points are covered in
depth in the Gender, Health and Sector Wide Approaches Resource Pack (Gender and Health
Group, Liverpool School of Tropical Medicine 2003) which is available at www.liv.acuk. However,
to summarise:
.
It has become obvious that a one-off training, however well-planned and participatory, will
not have a lasting impact and continual follow-up and opportunities for the participants to
to
access further support and reflect on what gender means in their own context is vital.
•
The training must be well tailored to the work of those participating in the training. It is hard
for participants to relate generic training on issues such as HIV/AIDS and gender to their own
every-day work.
•
Given the lack of lasting impact of training sessions, other more innovative approaches such
as mentoring need to be considered seriously.
•
A trainer with experience in the sector, rather than just HIV/AIDS is likely to provide more
relevant training that will have a lasting impact on the day-to-day work of the participants.
Having two trainers, one with HIV/AIDS expertise and the other with sectoral expertise may
be a valuable approach.
HIV/AIDS and Mainstreaming Training For Government Planners:
An example from South Africa
This training programme was developed in response to the devastating rate at
which the epidemic is growing in South Africa and the impact it has on all
aspects of development both now and in the future. Government departments,
South African universities and HIV/AIDS researchers and trainers collaborated
to develop a manual to run short courses for government planners from
national, provincial and local levels. The aim of the training course was to
enhance sectoral planning by creating an awareness of how the HIV/AIDS
epidemic is impacting and will increasingly impact on policies, programmes and
services delivered. The training also aimed to develop the basic skills of
planners needed to analyse and interpret HIV and AIDS related data and
projections. Each course was planned to have 30 participants and run for 5
days.
Beyond the development of the manual, facilitators from participating
universities were trained to be able to offer standardised courses based on the
approved training curriculum. Universities were awarded contracts by the
Department of Social Development based on their capacity to deliver the
courses and their ability to collaborate with other institutions and departments.
Course Content
The courses made use of experiential and participatory approaches such as
group work, experience sharing and case studies of people living with
HIV/AIDS and covered:
1. The basic facts about HIV/AIDS - transmission and the progression of
HIV to AIDS
2. Key concepts such as living positively and the links between gender
and HIV/AIDS.
’
3. The dynamics of population, development and HIV/AIDS in South
Africa, in the southern African region and globally and how these can
be integrated into planning
4. The impact of HIV/AIDS at various levels on different groups within
society and possible responses. The statutory environment, including
policies, laws and regulations, particularly the constitutional and human
rights of people living with HIV/AIDS, planning in accordance with the
bill of rights, the HIV/AIDS and STD Strategic Plan for South Africa and
Integrated Development Planning
5. Tools, data assessment and integrated planning, including modelling of
the present and future impacts of HIV/AIDS how this feeds into the
planning process and how indicator can be identified.
(Smart, Dennill, Pleaner, 2001)
Influencing
A key part of the work of HIV/AIDS focal points is to effectively influence a wide range of
individuals at all levels both within the government sector and other key stakeholders. As many of
the high prevalence countries are also countries moving towards the SWAp, the working group
looked at two key moments in the development of SWAps - the design and review stages - and
identified who the most important targets were and how the focal points could influence them.
The table below highlights these key times in the SWAp cycle as well as who should be influenced
and with what information.
When to
influence
During the
initial
design
phase of
the SWAp
Who to target
•
How to influence
Planners within the
central ministry
•
District level planners
•
Consultants or
researchers involved
in any base-line
studies or
participatory poverty
assessments and in
the design of the
SWAp
Donor partners
•
•
•
Those within the
ministry organising
the review (probably
Planning Dept)
Annual (or
bi-annual)
reviews of
plans and
budgets
and larger
Mid-term
reviews
District level staff and
those meeting with
the review missions
during district visits
•
Managers and other
high-level staff
interested in
mainstreaming
•
•
•
Illustrate that the key goals of the sector cannot be
met with attention to HIV and AIDS. Goals that
focus on improving equity are particularly relevant.
Collect existing research on the impacts of HIV/AIDS
and if possible, any future impact information, or if
not available to make use of data from other
countries with similar epidemics. Retrospective
studies can also be useful e.g. to show changes in
agricultural production due to AIDS
Collaborate and link with civil society organisations
working on HIV/AIDS and development who may be
invited to the design meetings and can raise points
that may be difficult for someone within the
government to raise.
Link with universities and research bodies to collect
information and/or encourage them to carry out
studies.
Personal testimonies from PLHA can help to raise
awareness of the link with your sector, particularly
to ministry officials.__________________________
Lobby for HIV/AIDS concerns to be part of the
review check-lists (this may require prioritising one
or two key HIV/AIDS related areas)
Attend review meetings and raise questions on
HIV/AIDS mainstreaming, gain support from
managers to give weight to your arguments
Share information and ides with civil society
organisations that may be able to add weight to you
arguments and raise issues during the reviews that
you may feel uncomfortable with as a government
employee.
High Level commitment
As has been illustrated in Section 6, HIV/AIDS, mainstreaming can involve fundamental changes in
the core work of a sector. In order that an enabling policy environment exists for these farreaching changes, high-level support is need within the sector and among those that are influential
in determining the policy, practice and resources of the sector.
Several countries have established high-level inter-sectoral committees on HIV/AIDS, Uganda is
one such example and has also very recently established a Parliamentary committee on HIV/AIDS
which will be key in developing legislation to support the sectoral work on HIV and AIDS, see box
below for more details:
__________ _______
_
Ugandan Parliamentary Committee on HIV/AIDS
This committee, which has recently been established, is responsible for all
legislation relating to HIV and AIDS and for monitoring all HIV/AIDS related
programmes in the country. It is now effectively the first point of reference for
parliament on HIV and AIDS and will remain in its current form until the end
of the current parliament in 2006. The committee has 15 members - 7 women
and 8 men - all MPs from a wide range of backgrounds including the military
and from a number of faiths. The Chair and Vice Chair are both medical
doctors. So far it is not clear how this committee will ensure that HIV/AIDS is
not just seen as a health issue, but that each sector takes on the full
development implications of the epidemic. However, this high-level
parliamentary commitment will clearly assist in increasing the profile of the
response to HIV/AIDS.
High level commitment in South Africa
In South Africa several high level committees have been established to raise
HIV/AIDS issues at the macro policy level, to the sectoral departmental level and
the provincial level. These structures aim to work in partnership and collaboration
with donors and other stakeholders. They include:
1. At the national policy level:
The South African National AIDS Council (SANAC) acts as an advisory body to
the government on matters of national priority in relation to HIV/AIDS.
SANAC is chaired by the Vice President and is made up of representatives
from government departments and civil society, including NGOs, PLWHAs,
trade unions, women's groups, youth celebrities and traditional healers.
2. Coordinating a multi-sectoral response:
The interdepartmental Committee on HIV/AIDS (IDC) consists of HIV/AIDS
coordinators of different government departments, who meet monthly to
coordinate information, build the capacity of their members, plan and
implement joint programmes, monitor departmental responses and advocate
on HIV/AIDS
3. At the provincial level:
Provincial HIV/AIDS structures made up of representatives from various
government departments to support the development of integrated HIV/AIDS
policies and programmes within the government and communities. A good
example of these structures is the Eastern Cape committee, details available
at http://www.ecprov.qov.za
High-level commitment is particularly necessary at budget time, and it may be valuable to have
key Ministry of Finance staff sitting on inter-sectoral committees so they appreciate the value of
finding resources to support mainstreaming activities within the plans and budgets submitted from
the various sectors.
Financing of Mainstreaming
.
Financing mainstreaming, particularly within the new environment created by SWAps and their
pooled funding, creates many tensions and: contradictions. Clearly the ideal situation is that
HIV/AIDS will be so well mainstreamed within the core department budgets of the sector that
there is no need for separate 'mainstreaming funds'. However, it is clear from the current work of
various sectors — from agriculture, to education, to transport — that the inter-linkages between the
sector, its work and HIV/AIDS are not being taken into consideration in policies, plans and
implementation processes. Hence, funds are. heed to 'kick-start' the mainstreaming process. The
areas described above in this section illustrate just some of the strategies that a sector may wish
to implement to start the mainstreaming process, some of them may not require extra funds, but
some clearly do.
Many countries are currently receiving funding from donors specifically for HIV/AIDS
mainstreaming, the World Bank's Multi-country AIDS Project (MAP) is a good example of this.
Started in September 2000, the overall development objective of the MAP is to increase access to
HIV/AIDS prevention, care, and treatment programs, with emphasis on vulnerable groups, MAP
also supports government sectors to develop plans and scale up their own response to the
epidemic. This provision of earmarked funds for sectoral AIDS work or mainstreaming causes a
tension in countries working through sector wide approaches as the HIV/AIDS funds are effectively
seen as separate project funds that are not paid into the general sector pot and then allocated by
the Ministry of Finance and sector managers. In Uganda this apparent contradiction has been
overcome as HIV/AIDS is seen as an emergency that cannot wait for the longer term benefits of
SWAps in order to be addressed. While this approach does mean that a sector can move quickly
to start implementing mainstreaming activities, there is a real danger that these activities will not
be sustainable as they are not embedded in the sector's general planning, monitoring and
resource allocation systems. Experiences from gender-mainstreaming highlight how separate
donor funded mainstreaming projects rarely have any lasting impact once the donor funding dries
up.
In Uganda attempts have been made to bring mainstreaming activities within the normal resource
allocation processes of the Ministry of Finance Planning and Economic Development (MoFPED).
Originally MoFPED were unwilling to fund separate mainstreaming budget lines, particularly when
sectors face resource constraints for what are seen as core activities. Recent negotiations between
the sectors and MoFPED have taken place and the Ministry of Education and Sports and Ministry of
Gender, Labour and Social Development have now been able to access central government
resources for these activities, this increases the chances of sustainable mainstreaming activities as
the funding is now within government systems. Other sectors hope to follow suit in accessing
funds for mainstreaming through MoFPED and the Ministry of Agriculture, Animal Industries and
Fisheries are expecting funds from MoFPED in the 2003/4 financial year. Furthermore, in Uganda
there are currently moves to include HIV/AIDS related activities within the Poverty Action Fund
(PAF). These are funds from debt relief which are a ring-fenced or protected pool of resources
priority development areas such as education and health. PAF is not vulnerable to budget cuts as
other sector budgets are and reflect the highest priority areas of the Government.
In Ghana, while funds to establish the mainstreaming process are not provided from within the
general sector budget, but are instead held separately by the Ghana AIDS commission, the
problem of lack of sector buy-in and potential unsustainability has been addressed by demanding
that the sector must contribute 5% of mainstreaming budget costs. It is only when this 5% has
been agreed to by sector managers that the remaining 95% can be released from the Ghana AIDS
Commission.
Section 8: Internal Mainstreaming
This section looks at how a government sector can address issues relating to the staff and internal
functioning of the organisations that make up the sector. The section is divided into three main
components:
8.1 Measuring and predicting the impacts of HIV and AIDS on an organisation and its
staff: this includes not only the number of staff that will become sick and die because of AIDS,
but also the impacts of HIV and AIDS on the morale of staff, the lack of skills transfer and other
factors that may disrupt the functioning of the organisation.
8.2 HIV/AIDS work with staff to reduce susceptibility to HIV infection and to support
PLHAs: this includes all areas of prevention, care and support for staff.
8.3 Minimising the impacts of AIDS on the functioning of the organisation: this looks at
the ways organisations can respond to the impacts that HIV and AIDS is and will have, on the
ability of the organisation to carry out the work effectively, it includes areas such as time needed
for funeral attendance, skills transfer and morale levels
Each of these components documents the experiences of the working group members to-date, the
problems and potential problems of the approaches they have used and their ideas on how to
better to address these issues in the future.
8.1. Measuring and predicting the impacts of HIV and AIDS on an organisation
What has been done?
In Ghana the impact of AIDS on teachers within the sector has been
measured through the annual basic school census, which includes an
indicator on the number of teachers who have gone to hospital or taken
sick leave in the last year. The number of orphans attending school is
also measured. The Ministry of Education in Ghana has also developed
some less intensive methods for establishing the impact that HIV and
AIDS is having on the civil servants working within the ministry and at
district level.
The HIV/AIDS focal points based within various
departments report monthly on the number of staff that have disclosed
their status to them and any deaths that have occurred among the staff
of their department.
Such regular, small-scale methods for measuring the impacts of HIV and AIDS can be fairly
straightforward and low-cost to carry out, once they become engrained within organisational
systems, so they are likely to become institutionally and financially sustainable over time. In
conjunction with these regular methods for collecting information on the impacts of HIV and AIDS
on the staff and organisations of the education sector, the Ministry of Education in Ghana has also
recently commissioned a consultancy body to carry out a large-scale impact studies to give a more
in-depth and accurate picture of the impacts of HIV and AIDS on the sector. If resources allow,
such studies can be vital for feeding into the planning cycle of the sector and also as an advocacy
tool to convince top management and donors of the need to address the impacts of HIV and AIDS
on the sector staff and organisations.
It is hoped that the process of the impact study in Ghana will help the various ministries to see
which impact measurement tools can be integrated and modified to fit within the Management
Information Systems (MIS) so regular data on the impacts of AIDS can be collected. Redesigning
the Management Information System can be quite an- ambitious task as forms must be
redeveloped, and records staff within different departments and at field level must be retrained to
collect the new data. There may also be a need for technical assistance in order to integrate AIDS
impact data into existing management information systems. Where there are concerns about the
quality of data recorded on the MIS forms, annual reviews and monitoring of the system can be
implemented to reduce the chance of collecting poor quality data.
The working group identified some of the challenges they and their organisations have faced in
trying to establish the impact of HIV and AIDS on their organisations and staff. Communication of
study results seems to have been particularly problematic in several countries. Involvement of a
wide range of public sector decision-makers and careful thought given to the dissemination of
study findings is a key lesson, the Namibian Five Cities Study (see Section 7) is a good example of
an impact study that included key decision makers throughout the study process. The
development of a strategy for ensuring wide organisational ownership and dissemination of the
findings should be a key objective within the terms of reference given to any team commissioned
to carry out such studies.
The challenge of raising funds for large impact studies was also raised. This problem appears to
have its root in the fact that HIV/AIDS mainstreaming work is so often interpreted as 'doing AIDS
work' - such as distributing condoms and prevention posters. While carrying out an impact study
may be a vital building block to mainstreaming HIV/AIDS within a sector, it does not fit neatly into
commonly held ideas of AIDS work. In order to gain support and buy-in for such studies and
changes to the internal information systems, HIV/AIDS focal points need to draw on all their
influencing strategies identified in Section 7.
A further challenge arises when a study which has achieved strong buy-in and interest of public
sector staff, fuels unrealistic expectations of access to support, particularly medical support for
people living with HIV and AIDS. The Namibian Five Cities study calculated the costs of medical
treatment for all those within the public sector; tackling such issues head-on with a realistic
assessment of medical, support costs and the ability of the sector to find resources to meet these
costs. This approach can help to keep expectations within the realms of reality.
The working group came up with several ideas that the public sector can implement without
excessive cost, for example making use of existing data sources, in many sectors personnel
records may provide a wealth of information on sickness and absenteeism among department
staff. Another useful and low-cost exercise would be to establish strong links with universities and
NGOs in order to track down any relevant data which has been collected and even analysed, but
not properly disseminated. Building strong working relationships with the planning department
within the sector would help to ensure that the findings are fed into the planning cycle.
Internal Impact and Response Studies
The following checklist of questions has been developed for local government in South Africa and
provides a good starting point for framing the questions that need to be asked to collect
information on impact of HIV and AIDS on the internal, workplace of an organisation:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
What is the structure of the workforce? Are there any identifiable 'risk' categories in the
workforce?
Is drug and/or alcohol use common? Where and when?
What are the common health problems of staff?
Are there any categories of staff who are exposed to 'risky' situations, e.g. required to live
away from home for long periods?
What are the levels and trends in staff turnover? What percentage is related to HIV/AIDS?
Do systems exist to measure and record these levels and trends?
What is the absenteeism rate? What are common reasons and what percentage is related to
HIV/AIDS? How is this currently measured?
What are recruitment and training costs? Has there been an increase in costs and, if so,
why?
Will training and recruitment cope with the pressures created by HIV and AIDS?
Are systems in place for planning and monitoring ongoing skills requirements?
Can recruitment and appointment processes be streamlined to ensure timely replacement of
ill employees?
Which work processes are most vulnerable to the impact of HIV/AIDS?
What are the potential skills shortages?
What are the expected claims on sickness or any other benefits offered to staff and their
families? Is there any evidence of an increased number of claims for benefits?
What access is there to health care services and voluntary testing and counselling?
Do supervisors feel confident that they can manage HIV issues in the workplace?
Does a workplace policy exist and is it implemented or know about by staff and managers?
Have there been instances of stigmatisation /denial/discrimination and, if so, what are the
factors driving this?
What services are available to support affected employees?
(Adapted from Smart, R. 2001)
8.2. HIV/AIDS work with staff to reduce susceptibility to HIV infection and to support
PLHAs
As identified in Section 7, reducing staff susceptibility to HIV infection and providing a supportive
environment for those already infected is often the first step in encouraging staff to look at the
inter-relationships between HIV/AIDS and their own work. When staff are uncomfortable and in
denial about HIV/AIDS they are unlikely to be prepared to look at HIV/AIDS in relation to their
own work. Hence, helping staff to look at these issues on a personal level particularly through
thoughtful training sessions potentially has benefits for both the individual by helping them to
address their own status and have safer sex, and for the organisation by allowing staff to become
comfortable with the issues around HIV/AIDS and hence, address them in relation to their own
work.
In Ghana there has been a strong focus on prevention work with
government workers, sensitisation and education on HIV and AIDS have
been delivered through durbars (public gatherings with entertainment and
speeches) for staff at all levels including the district level, these events
stress the importance of participation of PLHAs. The Ministry of Local
Government has been active in targeting chief executives from local
authorities. Chief executives from 44 districts have been trained on the
basic facts about HIV and AIDS, the Education Sector HIV/AIDS Work
Plan. The training also included an interactive session with PLHAs;
personal testimonies from PLHAs can have a lasting impact and help to
ground discussion of HIV/AIDS in personal realities. The training was so
successful that the chief executives extended the session from half a day
to a full day and developed their own resolutions and communique on
HIV/AIDS. A challenge facing the ministry is that it is assumed that the
remaining 66 districts already know about HIV/AIDS and do not require
training. Their exclusion from the training programme has led to an
imbalance in the amount of progress that can be made on mainstreaming
HIV/AIDS issues as the 44 who have been trained are noticeably more
receptive to becoming more involved in mainstreaming work. At central
government level in Accra, staff are further able to benefit from a clinic,
which has been located in the middle of the ministries and covers all
A significant problem area in HIV/AIDS care and support work with staff is how an organisation
can ensure confidentiality. Any suggestion that the uptake of testing and counselling services or
HIV/AIDS related benefits may not be absolutely confidential has severely undermined the
attempts of many organisations to provide such services for their staff. Taking this into
consideration, when the Department for International Development in Uganda decided to supply
vouchers for free testing and counselling services to staff, they ensured confidentiality by keeping
the vouchers in the office bathrooms so that they can be taken anonymously by staff and used at
a local testing and counselling centre.
A specific problem facing HIV/AIDS mainstreaming work in Ghana is that ministry staff are feeling
that the work on AIDS is really 'crying wolf. Ghanaians were warned that 200 people would die
every day, however this level of impact has not, as yet, been experienced. Furthermore, a recent
Knowledge, Attitudes and Behaviour study (2000) found that staff from the Ministry of Education
were actually low risk. Clearly, such studies cannot predict the future and Ghana's foresight in
facing the problem of HIV/AIDS before prevalence rates have risen to the extent of its neighbours
is admirable. However, carrying out prevention work in this environment clearly raises new
challenges and steps must be taken to ensure that the sensitisation does not backfire.
Establishing workplace policies on HIV/AIDS is another key component of the internal response.
In Uganda the Ministry of Agriculture has been sensitising staff on HIV/AIDS
for some time. Recently, a new phase of awareness-raising has started at the
central level and senior managers and support staff within the ministry have
been trained. The training took one day and concentrated on HIV/AIDS
awareness and the work of the AIDS Control Programme within the ministry.
Evaluations of the training have been positive showing increased awareness
among senior staff. A tangible development that focal points believe has its
roots within the sensitisation programme is that funds from within the
ministry budget have been allocated to the sector's AIDS Control Programme.
Such internal commitment offers hope for long term sustainability and
support to the ministries mainstreaming activities. MAAIF's training has also
targeted some national NGOs h order to build partnerships to address the
wide variety of inter-relationships between AIDS and agriculture and in
recognition that the ministry alone cannot address all these problems.
Another innovation within the MAAIF has been the development of a nutrition
handbook to encourage all staff to eat well and particularly includes advice for
those with HIV.
Developing a Workplace
HIV/AIDS Policy
This guide to the process of developing a workplace policy comes from an HIV/AIDS toolkit for Local
Government in South Africa and may provide some ideas for initiating a similar process in your own
context:
1. Establish a representative task team
2. Prepare a draft policy document with input from technical experts if necessary
3. Consult with employee representatives
4. Revise the policy
5. Develop a marketing plan to popularise the policy, e.g.:
• display in public place
•
provide copies to all employees
(Smart, R., 2001)
See Section 11 to find out how to get a copy of: 'An Action Guide for Managers' by Bill Rau (2002) which
outlines practical steps in developing a workplace programme of prevention and care, as part of internal
mainstreaming of AIDS.
As yet there are no special care and support measures for staff within MAAIF and the regular
welfare measures and medical benefits apply. There have been no particular costing exercises to
establish whether these measures are still viable in a time of HIV/AIDS. However, the focal point
within the ministry is keen to propose that PLHAs are better supported, possibly through an
informal fund with colleagues raising enough money for affected colleagues, a revolving fund might
be a practical way of establishing this level of support. There are also plans to train peer
counsellors, by using trainers from The AIDS Support Organisation (TASO) or other local HIV/AIDS
organisations.
In order to monitor and evaluate internal AIDS work, the Ministry of Education have developed
performance indicators, but as yet it is to early to measure progress against them as the focal
points have only just been trained. They include quantitative indicators such as the number of
teachers trained, the number of departments with trained focal points. Within the Ministry of Local
Government there will be monitoring and evaluation focal points who will develop indicators and
monitor activities, for example seeing if the workplace policy is being used. They will also make use
of proxy data from the census, and the M&E department plans for yearly dissemination workshop
for focal points to share experiences and review methods.
8.3. Minimising the impacts of AIDS on the functioning of the organisation
There are clearly strong linkages between prevention, care and support work with staff and work
that can help to minimise the wider impacts on the functioning of the organisation. For example
work on sensitising staff may help to reduce stigma and boost morale, which may in turn reduce
absenteeism and sustain productivity. However the impacts of the pandemic are so profound that
in countries of high prevalence they are having, and will have, potentially devastating implications
for the functioning of organisations. The working group identified:
•
loss of staff due to sickness and death and the corresponding loss of skilled workforce and
institutional memory,
•
absenteeism due to funeral attendance and
•
low morale as key factors in disrupting the productivity of public sector organisations.
To respond to the inevitable loss of staff due to sickness and death the working group primarily
recommended the development of strategies to prolong the lives of PLHAs and to provide support
to ensure that they can continue working for as long as they are able to. Workplace policies that
support a positive environment free from discrimination clearly contribute to this objective. One
concern has been the delays in the payment of medical benefits and disability grants. Such delays
can be detrimental to the health and well-being of PLHAs and from an organisational perspective
this not only reduces their productivity but can add to low morale and general dissatisfaction in the
workplace. There is a need to monitor sickness and disability benefits closely over time to ensure
they are being taken up and provided in a timely fashion and also to estimate future costs and
budget viability.
Mentoring programmes where junior staff learn from older staff are one strategy for ensuring
institutional memory is passed on and not dependent on one key staff member alone. There was
much discussion among the working group as to whether this strategy should be targeted to PLHA
staff alone, however, it was decided that this would undermine confidentiality, create stigma and
possibly encourage PLHAs to leave work even sooner than necessary. It is more important to
identify the really critical staff, without whom activities would grind to a halt - this may not be only
senior management, but for example an individual responsible for the functioning of all the
computers. Once these critical staff have been identified at all levels, contingency plans and
mentoring programmes can be put in place. This could be measured by interviews with the
mentored staff, review of appraisals to see if they've taken on the skills of other critical staff and
the existence of critical staff documents and evidence that these are revisited regularly.
Many sectors are considering multi-skilling programmes to develop the skills of all staff to
overcome the problems of loss of critical staff. In Ghana, a guide to help government departments
to plan for skill succession has been developed and is being used by human resource departments
across the government.
A major concern was the time and number of staff that attend funerals. Several ideas for
regulating this were noted, for example In Botswana 2 days have been added onto public sector
workers annual leave to allow staff to attend funerals, but no extra days are allowed. Other more
informal arrangements are being developed elsewhere, for example keeping one day a week free
of meetings in recognition that many staff will be attending funerals. Monitoring of these
arrangements can be done by reviews of attendance records, where such records are kept.
Monitoring the amount of sick leave that staff take is another way of keeping track of staff
absentee rates, linking this with the mentoring programmes and critical skill assessment can help
to ensure that key posts are not left uncovered for long periods of time.
Section 9: External Mainstreaming
This section looks at the external work carried out by a sector - that is, the services the sector
provides to the general public. A basic framework (see below) has been devised to help think
through the issues to be considered in external mainstream. This framework could be used by any
sector, however to illustrate the kind of issues that are important to consider in external
mainstreaming, examples from the education and agriculture sector were developed by the
working group.
A framework to think through issues for external mainstreaming
1) How might the work of the sector
increase vulnerability to HIV infection
or reduce the capacity of
households/communities to deal with
the impacts of HIV and AIDS?
2) How
might HIV
and AIDS
impact on
the work of
the sector?
3) What
should the
sector do to
respond to
these issues
4) How can
this be
done in
practice?
5) How could
progress in
this area be
measured?
The examples below from the education and agriculture sector follow the format of the framework
given below, but for ease of reference have been displayed as separate sections.
9.1.1 Does the Education Sector increase vulnerability?
Below is a list of activities carried out by the sector that either could potentiallyjncrease
susceptibility to HIV or reduce/fail to improve the capacity
of households to respond to the impact of AIDS on their
If you work with the education
lives and livelihoods.
sector, what other ways might
the sector increase vulnerability?
Do you think the points below
are relevant in your context?
Also increases
vulnerability to HIV as
students/pupils may
be tempted by 'sugardaddies'
Reduces household
capacity to fund
medical treatment
and cope with the
impacts of AIDS
Direct and indirect
costs of schooling
born by the
household \
Pupils
Pupils
will not—
use
condoms
Anti-condom
policy in
schools (in
Ghana)
Low pay of junior
(often female)
teachers
Senior
teachers/managers
nay take advantage
and sexually harass
them
Pupils not equipped to
say no to unwanted sex
or have safer-sex
Lack of adequate sex
education in the school
curriculum, especially on
self-e|teem
How might the work of
the sector increase
vulnerability to HIV
infection or reduce the
capacity of
households/communities
to deal with the impacts
of HIV and AIDS?
Posting of teachers
far from home
susceptible to unsafe sex
with casual partners
can take advantage or
pupils, particularly girls,
particularly as virgins are
seen as HIV - free
Teachers are in a
position of power
Combining
primary and-
secondary
schools
exposes
younger
children to
sexually
active pupils
Late payment of salaries to
teachers
increases susceptibility
due to lack of money
e.g. female teachers
may seek other support
V/5
Koramangala
TK.bangalore -
//
9.1.2 What is the Impact of AIDS on Education?
fewer households
see the point in
sending their
children to school
What others
impacts are there
in your context?
children underachieve and
may not want to go back to
school
reduced quality in teaching
Children from AIDS
affected households/ or
living with HIV suffer
stigma at school
Increased pupil :teacher
ratio
What is the Impact of
AIDS on Education?
HIV positive teachers
may experience stigma
cases of teachers leaving
the profession due to
stigma (Ghana)
9.1.3 Mainstreaming
ideas___________________
Review teacher posting
policies to reduce
vulnerability (potential
problem: such a policy may
further undermine attempts
to post teachers to more
inaccessible rural areas)
Develop a policy to deal with
cases of abuse and fast-track
a disciplinary committee to
reduce sexual harassment
Increase the number of
teachers trained. Quota for
number of teachers trained
based on demand_________
Provide student grants so
students not likely to sell sex
Children involved in more work at home to
take care of sick relatives or younger
siblings/orphans (particularly in high impact
countries)
9.1.4 How can the sector do
this in practice________________
incentive package for teachers and
their families, so the families travel
with the teacher
• induction for young teachers to
include HIV and AIDS
awareness
• mentors to support new teacher
trainees within schools and
inspectors to go round and
provide support. For example in
Ghana, HIV/AIDS awareness
and issues has recently been
included in the training for
mentors and inspectors)_______
• teachers code of ethics in
existence, needs legislation and
monitoring
• Child rights clubs to increase
assertiveness to say no to abuse
• monitor number of teachers
who are sick/dying included in
EMIS
Negotiation with banks and MoE to
be guarantor for student grants
9.2.1. Does the Agriculture sector increase vulnerability?
children are not able to
get the most from school
9.1.5 Indicator
•
•
•
•
•
•
% of teachers posted
with their families
presence of HIV/AIDS
awareness training
within teacher induction
packages
presence of HIV/AIDS
awareness training
within training for
mentors and inspectors
number of cases
reported and
investigated and where
necessary, taken to
court and punished.
use existing pupil :
teacher data/quota
increase in tertiary
enrolments
Activities carried out by the sector that either increase
susceptibility to HIV or reduce or fail to improve the capacity
of households to respond to the impact of AIDS on their lives
and livelihoods.
Extension workers travel around
the villages and may/can take
advantage of female farmers
Do the points below
apply in your context?
Are there any others?
In Ghana, since the government stopped their
involvement in the distribution of produce
thousands of women have taken on the role
of ‘market mammies’ who spend long periods
away from families and this can make the
vulnerable to HIV/STIs, particularly as they
are often dependent on truck drivers to give
them lifts to market.
Loans aimed at helping farmers may
instead make them susceptible/vulnerable
as it is difficult to access and paying back
the loan.
Does the Agriculture sector
increase vulnerability?
v>orer and AIDS affected households
^ss likely to demand and receive
_.evant help from extension workers
Farming inputs are expensive and women
may pay for the inputs with their bodies
▼
Increased agricultural output, particularly for
cash crops can increase vulnerability as cash is
spent on drinking, entertainment which may
result in un-safe sex. Men's control of cash
exacerbates this situation and leaves women
vulnerable to exchanging sex for
commodities/services, as they don't have enough
cash themselves.
9.2.2. What Impact is HIV and AIDS having on Agriculture?
How true are these
in your context?
AIDS related illness and death
affects labour available for
agricultural production
Less produce
Lower inputs
AIDS related illness and death can lead to selling
off of assets, i.e. animals which impacts on
productivity and future livelihoods
What Impact is HIV and
AIDS having on Agriculture?
Orphan households face
particular problems in
knowledge gap
Fisher folk are particularly hard hit due to
their mobility to reduced capacity to fishing
and for passing on fishing expertise to future
generations
9.2.3. Mainstreaming ideas
Alternative technologies like
organic agricultural practices
as they have cheaper inputs
Labour saving technologies
Quick maturing crops more
suited to labour constrained
households, like elderly, very
young, sick______________
Weed/disease resistant crops
more suited to labour
constrained households, like
elderly, very young, sick
Work with youth to fill
knowledge gap left by AIDS
deaths
Broaden partnership between
government and traditional
and non-traditional NGO
partners
9.2.4. How can the sector
respond in practice__________
Research into crops, animal
industries, techniques and tools
appropriate for labour constrained
households (in Uganda (HASNET)
a research network of government
and NGOs has been formed to
prioritise and carry out this type of
research
•
•
9.2.5. Indicators
Learn from NGO experiences of •
working with youth
Allow NGOs, where they have a •
comparative advantage, to play
a leading role in the provision
of services to young people
•
Number of new
technologies/approaches
suitable for AIDS affected
and poor households
being pioneered
Number of youth groups
supported
Number of young people
headed households
supported by extension
workers______________
Number of collaborative
partnerships established
between government and
NGOs
What other indicators
would be useful to
measure progress in
mainstreaming? See
Section 10 for more ideas
The issues noted above for education and
agriculture are by no means a definitive list,
look at the examples and think how different
the situation and inter-linkages with HIV/AIDS
are in your country. If you work in another
sector, how would you fill out the framework
for your sector?
Section 10: Indicators for Mainstreaming
As most sectors are only just beginning to mainstream HIV/AIDS into the core of their sector work,
it may be too early to try to measure the impact of HIV/AIDS mainstreaming on the general
population. However, it is still a good idea to think through what the hoped-for future impacts
should be and to ensure these indicators are in sector plans early on. This is particularly true for
countries using sector-wide approaches as much emphasis is placed on the ability of the sector to
meet certain pre-defined targets, measured by specific indicators. The existence of indicators that
address HIV/AIDS mainstreaming in the overall sector strategies is vital if mainstreaming work is
to be properly institutionalised, and not just a one-off donor project.
Below are a few ideas of possible indicators to measure the process of mainstreaming within any
sector and then, the first table looks at possible indicators of the process of mainstreaming and
could be adapted for any sector. The last two tables take agriculture and education as examples
and give examples of possible indicators of impact.
10.1 Process Indicators
These tables give ideas on indicators - they are by no means
exhaustive! What indicators would be relevant in your sector
to measure process and impact of mainstreaming? How
would you collect the data needed to measure them and how
often - is this realistic? I.e. are your indicators SMART?
Specific
Measurable
Achievable
Realistic
Time-bound
Strategy
Issue
HIV/AIDS Focal
Points
While sector ministries/districts
may have HIV/AIDS focal points,
they often have HIV tagged onto
existing heavy workloads and have
had no training or support in what
is involved in HIV mainstreaming in
their sector
Getting high level
commitment
Focal Points alone can not make
much progress unless they have
support from the highest level
within the sector
Training of sector
staff on HIV/AIDS
HIV/AIDS mainstreaming training
may need to start 1. by addressing
HIV/AIDS on the personal level to
Possible Indicators to measure
real progress__________________
• How many trained HIV/AIDS Focal
points exist, (and in what
departments, district / national)
• The number of HIV/AIDS FPs with
HIV/AIDS mainstreaming as a
clear task in their job descriptions
The number of FP in receipt of
technical HIV/AIDS supervision______
• Existence of multi-sectoral
HIV/AIDS committees for top
management and their attendance
at meetings
• Attendance of top level managers
at HIV mainstreaming training
• Consideration of HIV/AIDS into
strategic decision-making and
reporting processes____________
• (Really needs an evaluation of the
training programme, an easy
indicator like number of training
help staff to become comfortable
even talking about HIV/AIDS.
But, it is important that it goes
beyond this to give staff the space
to think about 2:
a. what HIV/AIDS means for their
sector, i.e. how HIV/AIDS is
impacting on their work,
b. how their work may make
people more vulnerable to HIV or
undermine the coping mechanisms
c. how their work could potentially
support/reach PLHAs and reduce
vulnerability.
Staff policy on
HIV/AIDS and staff
access to HIV/AIDS
related services
HIV/AIDS in
department plans
Staff policy on HIV/AIDS
department/ministry staff access
to services (condom/awareness
creation/STI/TB and VCT)_______
• Existence of department/ministry
specific policy (or strategic
framework on HIV/AIDS)
• Department plans are based on
contextual analysis
• The number of times HIV/AIDS is
mentioned in sector/department
plans
•
Plans address a, b and c
• The department has received
support to develop quality work
plans (e.g. Plan to include:
Specific objectives, M&E
mechanisms, performance
indicators)
• Implementation of work plans
underway___________________
• % of the budget is available for
supporting the process of HIV
mainstreaming (training, part of
HIV FP's salary, materials etc)
• % of the department budget is
available for service delivery that
has been refocused to take into
consideration the inter-linkages
with HIV/AIDS.
How much of the money budgeted for
HIV/AIDS is actually spent.
•
•
If HIV/AIDS is mentioned in
sectoral department plans, it is
often covered in a very general
way and those implementing the
plan are not given many clues as
to what they should actually be
doing. Inevitably this leads to
complete inaction.
A
Budgets and
expenditure for
mainstreaming/ HIV
related activities
programmes conducted doesn't
really show much. The indicator
below on HIV in plans would show
more about the impact and value
of any training.)
• The number of training courses
that cover both 1 and 2 (a,b,c)
Clearly, there is a need for funds to
back up plans, used both for the
process of mainstreaming and the
actual HIV/aids related activities
within the sector's work are
needed.
However, if HIV has been really
mainstreamed within a sectors
work, it may be hard to pick out
from the budget. For example if
the whole design of an agricultural
project is intended at reaching the
most vulnerable - including
households infected/affected - it
becomes difficult to pull out a
precise HIV-related figure.
Even if money is budgeted for, it
doesn't mean it will be spent and
some kind of expenditure tracking
Intra & Inter
sectoral
communication and
collaboration
between line
ministries
is important to follow progress.
There is a need to maximise
information sharing and avoid
duplication efforts between
departments or ministries. For
instance in the development of IEC
materials. There is also a need to
understand the inter-linkages
between different sectors and to
develop a harmonised response.
Evidence of sharing and lesson
learning between departments
• Evidence of increased
understanding of the impact of
HIV/AIDS on different sectors and
the inter-linkages between these
different areas
(departments/ministries)
Evidence of appropriate collaboration
across ministries on HIV/AIDS related
activities
•
10.2 Impact Indicators: Education
Possible Strategy
Issue
Targeting vulnerable May take a while to see any impact,
also problems of increasing stigma if
children, including
orphans are singled out. May need
AIDS orphans (and
complete rethink of how education
particularly girls) to
programmes are delivered, in terms
increase their
of timing, location etc so that
access to education
vulnerable children, such as those
with caring responsibilities in the
household can still fit some education
in their lives.___________________
The problem here is that HIV
Creating a safer
mainstreaming programmes are
environment within
often interpreted as solely HIV
and around schools
prevention activities and may boil
to reduce
down
to the distribution of a few HIV
vulnerability of
leaflets and posters.
school children to
abuse (both sexual
abuse and
discrimination
because of
HIV/AIDS) and
promote safer sex
Preparedness for
future reductions in
teaching and
administrative staff
Due to the time lag between
infection and sickness and death, the
future impacts of AIDS' on the
teachers, managers and
administrators cannot be
underestimated, but must be
analysed now in order to prepare for
future staff shortages. ;The costs of
staff support policies, length of sick
leave etc all have to be calculated
given future high morbidity and
mortality rates._____ <__________
Possible Indicators to measure
real progress________________
• Existence of programmes and
plans that take target vulnerable
children.
• Drop out rate among orphans
reduced (disaggregated by
gender)
•
•
•
•
•
•
•
Clear legislation, education sector
policies and disciplinary
procedures in place to stop sexual
abuse and discrimination
Existence of programmes that
address behaviour change,
increase girls' and boys' selfesteem to start sex later/have
safer sex
Code of ethics/conduct developed
and implemented in every school
Policy of zero tolerance for
violence and sexual abuse in all
learning institutions___________
Existence of a regular data
collection system that includes
information on number of
teachers that are off sick or have
died and the amount of time
spent at funerals
Existence of realistic and costed
policies to support staff and
extent of their utilisation.
Evidence of multi-skilling
programmes for staff and
teachers in the education sector.
10.3 Impact indicators: Agriculture
Possible Strategies_______
Making sure current strategies
don't exclude household's
infected/affected by HIV/AIDS
E.g. Uganda is pursuing the idea
of setting up farmers groups that
form the starting point for
agricultural extension advisers
and support. However, AIDS
affected households are least
likely to be able to participate in
these groups (lack of time, as
sick/ lack of money for
contributions) and are unlikely to
be able to afford new
technologies or seed varieties,
even if subsidised. Hence they
remain excluded and unable to
benefit
Issues________________
This does also depend on
the whole thinking behind
the Agriculture policies, if
they have a stated aim of
reaching the poor, then
clearly this strategy applies.
But, if they have the aim of
modernising and increasing
revenue from the agricultural
sector, then targeting AIDS
affected households is not
going to be a top priority.
As most countries are now
working within PRSPs, there
certainly seems to be a
strong case for targeting
AIDS affected households but this shouldn't be taken
for granted and needs to be
pushed!
Designing programmes and
technologies that are suitable for
households with low labour
productivity and in need of good
nutrition.
E.g. promoting fast turn over
crops/ livestock, nutritious crops
that can be grown close to the
house and don't require much
weeding, marketing systems that
don't take up too much
time/money/energy.__________
Ensuring that programmes do
not increase vulnerability.
E.g. promoting cash crops where
most of the income goes to men
which they may spend on unsafe
sex.
Possible Indicators_______
• Evidence of analysis of who
are the poorest and AIDS
affected households at local
level
• Proportion vulnerable/AIDS
affected households
reached through agriculture
extension
•
•
•
This can be difficult to do as
it seems a very hypothetical
exercise, but is absolutely
vital. Full attention to the
gender aspects of strategies
and their implications may
enable the problem to be
reduced.
Where there seems no
alternative but to promote
strategies that may put
people in vulnerable
situations, then it is
important to recognise this
and to link up with behaviour
change programmes (maybe
by contracting NGOs or even
MoH). NB Min of Agriculture
and its staff are not best
•
•
Existence of technologies
suitable for low labour
intensity and improved
nutrition
Number of households
receiving agricultural advice
on low labour intensive
methods and improved
nutrition
Extent of take-up of
methods.
The recognition in policies
and plans of the potential to
increase vulnerability
The existence of alternative
strategies that minimise
vulnerability or the existence
of behaviour change
programmes that run
concurrently with agriculture
programmes.
placed to do BCI
programmes themselves.
Where this has been tried
they end up having the time
or capacity to do either their
agri work or the BCI work
__________ effectively._________________________________________
(These ideas were developed with the assistance of Katie Bigmore (ActionAid/IPPA))
Section 11: Useful Resources on Mainstreaming
Annotated Bibliography
Adeyi, O. Hecht, R. Njobvu, E. Soucat, A. (2001) AIDS, Poverty Reduction and Debt Relief: A
Toolkit for Mainstreaming HIV/AIDS Programmes into Development Instruments. Department of
Policy, Strategy and Research, UNAIDS, Geneva
http: / / www.unaids.org
This toolkit aims at adding to the knowledge base to support analysts and decision makers in their
work to mainstream HIV/AIDS as a major item on the development agenda and to mobilise
resources needed for intervention in the fight against the epidemic. As a resource for training at
the country and sub regional levels for country teams and their partners (NGOs and Donor
agencies), the toolkit will enable the country teams to develop useful materials on scaled up
HIV/AIDS programmes for inclusion in the Poverty Reduction Strategy Papers.
Barnett, T. and Whiteside, A. (2002) AIDS in the 21st Century: Disease and Globalisation,
Chapter. 13. Palgrave Macmillan.
This highly informative book looks in-depth at the forces driving the pandemic and gives a detailed
perspective on the impact of AIDS on all levels, from the household to the community, from macro
economic development to private companies. Chapter 13 is of particular interest as the focus is on
the need to plan for impact mitigation. In order to help readers to understand these challenges,
six concepts have been explored, (a) Timing and Targeting, which explains the importance of a
careful study of the six main stages of the evolution of the epidemic for each response and target,
(b) The three key elements of Information, Observation and Instruction- for successful prevention
and effective impact mitigation for individuals as well as planners, (c) Advocacy and Ownership
people should be aware of the problem and its implications for them and society and be able to
act on it. (d) Process and Product- although these two concepts may seem to have different
meanings, in some cases the process itself can be argued to be the product (e) Scaling up and
sustainability, (f) The myth of community coping mechanisms is explored. The chapter also
stresses the importance of learning from strategies and goals that have worked. For example,
National leadership and political commitment at all levels in Uganda, Thailand's concentration of
public information and condom campaign and good STD services.
Barnett, T. and Whiteside, A. (2000), Guidelines for the Studies of the Social and Economic
Impact of HIV/AIDS. UNAIDS, Geneva.
http: //www.unaids.org
This manual provides basic concepts that can assist in thinking critically about the social and
economic implications caused by HIV/AIDS as well as techniques for planning responses to the
medium and long-term impacts. It is also a source of ideas intended for senior researchers and
can be used in their own settings to meet their own needs. The manual can also be used by
anyone planning to do research work on the socio-economic impact of HIV/AIDS. The document is
divided into three parts; (a) Introductory section addresses why AIDS is unique and deserving
impact studies, (b) Provides guidelines on how to conduct an assessment of the social and
economic impact, (c) Gives a conceptual framework for such socio-economic impact studies.
Grant, K.B. Strode, A. Smart, R. (2002) Managing HIV/AIDS in the Workplace: A guide for
Government Departments.
Department of Public Service and Administration, South Africa, http://www.dpsa.gov.za
Baylies, C. (2002), The Impact of AIDS on Rural Households in Africa: A Shock Like Any Other?
In development and Change 33 (4): 611-632. Institute of Social Studies, Blackwell, Oxford
This article examines the reasons for the apparent under reaction to AIDS and looks at recent calls
to mitigate the effects of AIDS at household level. This is based on data collected from household
survey in Chipapa and Minga villages in Zambia. The article then moves on to consider the
appropriateness and feasibility of those interventions which have begun to be advocated for
mitigating the effects of AIDS at household level. Critical consideration is directed at proposals
relating to community safety nets, micro-finance and mainstreaming of AIDS within larger poverty
alleviation programmes. It further argues that effective initiatives must attend to the specific
features of AIDS, incorporating both an assault on those inequalities which drive the epidemic and
sensitivity to the staging of AIDS both across and within households. A multi-prolonged approach
is advocated which is addressed not just at mitigation or prevention, but also at emergency relief,
rehabilitation and development.
Bjorkman, H. (2002) HIV/AIDS and Poverty Reduction Strategies: Policy Note, UNDP, New York.
www.undp.orq
This policy note provides guidance on the important challenges of integrating HIV//AIDS priorities
into Poverty Reduction Strategies (PRSPs) to help create the necessary policy and planning
environment for a comprehensive, multi-sectoral and adequately funded responses to the
epidemic. It also provides a synthesis of thinking on the interface between poverty reduction
strategies and efforts to reverse the spread of HIV/AIDS. It identifies some areas that UNDP and
its partners must focus on as a matter of priority. At a core of the policy note is a checklist with
specific guidance on how to integrate HIV/AIDS into poverty reduction strategies relevant for both
high and low prevalence all countries. To conclude, the Policy Note addresses the global level by
recommending that UNDP places HIV/AIDS at the centre of the international development agenda,
particularly in the context of the Millennium Development Goals, and builds on its work at country
level.
CAFOD's simple A3 size leaflet The Silent Emergency: HIV/AIDS in Conflicts and
Disasters' outlines the AIDS-related consequences of emergencies, and key recommendations for
how humanitarian agencies can adapt their work. It is available to practitioners for free in small
quantities from CAFOD, Romero Close, Stockwell Road, London, SW9 9TY, or e-mail
hiv@cafod.org.uk, or order on line at www.cafod.org.uk/hivaids/silentemergform.shtml .
Cohen, D. (1999) HIV and Development Programme: Responding to the Socio-economic Impact
of the HIV Epidemic in Sub-Saharan Africa; Why a System Approach is Needed.
http://www.undp.orq/hiv/publicatiohs/issues/enqlish/issue34e.htm
Looking at the many development constraints facing Africa in light of the HIV/AIDS epidemic, this
article identifies some of the factors which need to be taken into account in order at achieve an
effective response. It is clear that there are differential impacts of the epidemic and not all sectors
of society feel these impacts equally. There are spatial, sectoral, class and gender differentiations
in the impact of the epidemic. This article suggests that for responses to be effective these
differences should be identified in an initial analysis and these socio-economic impacts of
HIV/AIDS should be addressed through policies and programmes, in a systemic and multi-sectoral
way.
Cohen, D. (2002) Human Capital and The HIV Epidemic in Sub-Saharan Africa. HIDEV
Consultant.
The impact of HIV/AIDS in Sub-Saharan Africa has undermined the possibilities of sustainable
development in most countries of sub-Saharan Africa. The capacity of families, communities and
nations to cope with the social, economical and political consequences has been severely reduced.
This paper provides some insights into effects of HIV/AIDS epidemic on human capital. Since the
high prevalence of HIV/AIDS is among the working population (15-49 year-olds) where morbidity
and mortality are concentrated, different skills and knowledge within the labour force in all sectors
and at different levels are eroded. Men and women with important economic and social roles are
prevented from their full contribution and participation to development due to morbidity and
mortality. These effects have much deeper implications for the structures of families, survival of
the communities and sustainability of productive capacities both in the formal and informal sectors
at all levels. The paper points out that though not measurable by standard economic costing, the
economic and social values of the losses of human capital in heterogeneous labour should not be
underestimated. It aims at providing an analytical framework for understanding the policy and
programming issues. Before any policy or programmes are designed and implemented it is
important to understand and analyse the situation and complexity of the impact HIV/AIDS on
different productive sectors. It is also important to see the inter-dependence of the social and
economic systems within the productive sectors. Therefore a systemic approach is needed in terms
of policies and programmes.. The paper is divided into four sections. Section 1 sets out the
framework and provides a background for the later discussion. Section 2 analyses the impact on
the public service in Malawi. Based on the study by the Malawi Institute of Management ( MIM)
the impact of the epidemic in sectors of water and development, health, education agriculture and
Malawi police services show high levels of mortality within the young age group who are more
skilled and professional. For example, in the Malawi police service two thirds of the reported
mortality was in the age range of 20- 30 years. The report estimates that in effect some 15-20
officers die every month from HIV-related illnesses. The paper suggests that in order to mitigate
the impact, there is need to support the planning department in all the ministries so as to increase
the planning capacities on how best to mitigate the impact A more detailed presentation of the
impact in the two sectors of education and health is discussed in section 3, a case study of the
effects of HIV/AIDS on the health sector in Botswana is given as an example. Finally, in section 4
issues relating to the measurement of the impact on different social partners such as employers,
employees and labour unions who should also be involved in the responses to AIDS in adjusting to
and managing the impact are discussed. In the conclusion, the paper suggests a rethinking of
many channels through which changes in the stock of human capital effects production and
livelihood.
Coombe, C. (2001) Rethinking Some of our Perceptions About HIV/AIDS and Education. Seminar
Paper, Pretoria.
The paper examines some of the evidence of the links between HIV/AIDS and the Education
sector. Common perceptions and how they are being adjusted in ways that can help in responding
more accurately to AIDS and education in Southern Africa are reviewed. The paper calls for a
move away from the narrow focus on sex education in school to a broader focus on protecting
education quality, which directly confronts the full challenge of the epidemic. It suggests that this
can only be achieved through stabilisation of education systems, mitigating the impact of
HIV/AIDS in schools and educational institutions, shifting from viewing the epidemic as " business
as usual/' to addressing all the complex inter-relationships of AIDS within the sector. Some of the
suggested responses include the importance of working in partnership at all levels, understanding
what teachers can and can not do, managing the disaster, creating a foundation for joint action
through committed and informed leadership, research and monitoring, effective management,
streamlined funding and the development of policy and regulatory frameworks.
Dennil, K. Pleaner, M. Smart, R. (2001) Planning the New Millennium: A Primary HIV/AIDS
Capacity Development Course For Government Planners; Facilitators Hand Book. Department of
Social Development, Pretoria.
HIV/AIDS is having a significant impact on population and development, all the evidence points to
an even more severe impact in the future. In recognition of the problem and its implications, the
South African Department of Social Development, in partnership with UNFPA, have developed this
facilitators hand book, which aims to support government and universities to run short courses for
government planners from national, provincial and local levels so as to enhance planning which
take into account of HIV/AIDS and its impact on population and development. The programme
was developed through collaboration among several government departments, South African
Universities and many leading HIV/AIDS researchers and trainers. The Manual provides work
sheets, handouts and presentation materials to help course participants and those using the
manual in the areas of Analysis, Planning, workplace policies and programmes.
Elsey, H. (2002) What Challenges and Opportunities Do SWAPS Offer for HIV/AIDS
Mainstreaming? A brief overview of research findings. Unpublished Liverpool School of Tropical
Medicine
This report consists of a review of recent literature addressing gender mainstreaming within the
health sector and mainstreaming HIV/AIDS with development sectors and presents findings of
recent research on mainstreaming gender and HIV/AIDS in Uganda. The paper looks specifically at
sectors currently using the sector-wide approach (SWAP) and identifies the opportunities and
challenges that these relatively new approaches offer for mainstreaming both gender and
HIV/AIDS. The paper provides definitions of both gender mainstreaming and HIV/AIDS
mainstreaming. To look in more depth at experiences of mainstreaming HIV/AIDS, the study takes
examples from the education and agriculture sectors. The Ugandan case study explores the real
challenges to mainstreaming facing those at ministry and district level in a number of sectors. Of
particular concern is the lack of clarity from all those involved - government sector, donor
partners NGOs - of the exact meaning of HIV/AIDS mainstreaming and what it involves.
Experiences from those working on mainstreaming gender highlight some of the problems of the
strategies employed for mainstreaming, such as the use of focal points and sensitisation training.
SWAps themselves raise new dilemmas, particularly concerning the funding of mainstreaming
activities and their prospects for institutional and financial sustainability.
Gould, B. and Huber, U. (2002), HIV/AIDS, Poverty and Schooling in Tanzania and Uganda,
Department of Geography, Liverpool University
This paper presents findings from demographic modelling of school age data from Tanzania and
Uganda. The paper is divided into two major sections; the first section discusses technical issues
of modelling school age cohort development in AIDS affected populations and presents and
compares the results of the demographic modelling for Tanzania and Uganda and how these can
be used in estimating actual and expected enrolment growth/ pattern of enrolment change in an
explicit policy framework. The second section examines the results of the demographic enrolment
modelling within the broader development context of the two countries. The paper concludes by
arguing that it is too simplistic to describe the HIV/AIDS epidemic as the biggest threat to the
continent's development and instead the inter-relationships with gender, environment, governance
which affect the nature of poverty and its alleviation are key to understanding the real
relationships between HIV/AIDS and schooling.
Grant, K.B. Smart, R. and Strode, A. (2000) Managing HIV/AIDS in The Workplace: A Guide
for Government Departments. The Department of Public Service and Administration, Pretoria,
South Africa.
This guide was developed to complement the South African government's "Minimum Standards on
HIV/AIDS" by providing guidance to departments on how best to implement HIV/AIDS workplace
policies and programmes within the minimum standards. As a practical guide and user friendly
resource, The guide aims to be practical and user-friendly in order to assist public sector staff to
oversee the development of HIV/AIDS policies, programmes at national and provincial levels in
order to plan, implement, monitor and evaluate appropriate and effective responses within the
public service working environment. It is also targeted at those involved in work place
management such as human resources officers and labour relations officers. It contains internal
workplace issues and how to manage the impact of AIDS on public services from an employment
perspective and gives some references to the external functions of government in relation to the
sectors ability to deliver services effectively and efficiently in a time of HIV/AIDS. The guide is
divided into four parts. The first part introduces the guide and describes the framework and
principles to guide workplace HIV/AIDS responses. The second part focuses on policy and planning
for an effective response. The third part looks at the development and implementation of effective
workplace responses, the final section addresses reporting, monitoring and evaluation issues.
HEARD at the University of Natal has produced a range of materials concerning responding to
AIDS, which include elements of both AIDS work and mainstreaming AIDS. They have 28 'AIDS
Briefs' serving different sectors and professions, 11 'Toolkits' written for government ministries and
departments, and another toolkit for local government. They can all be downloaded from
www.und.ac.za/und/heard, or e-mail freeman@nu.ac.za, or write to HEARD, University of Natal,
Durban, 4041, South Africa to get copies.
International Labour Organisation (2001) Code of Practice on HIV/AIDS and the World of
Work clearly sets out policies and practices on HIV/AIDS in the workplace and can be downloaded
from http://www.ilo.orq/public/enqlish/protection/trav/aids/. The site also has fact
sheets and statistics relating to AIDS and work.
Ministry of Education (2002) Workplace Manual: A Three Module Manual Concerning the
Implementation of Work place Programmes, Basic Facts on HIV/AIDS and Reporting. Ministry of
Education, Ghana.
With funding from the Ghana AIDS Commission, this manual was developed by the Ministry of
Education in recognition of the need to mitigate the impact of the HIV/AIDS epidemic on the
education sector. The manual was designed to be used by HIV/AIDS focal points at national,
regional and district levels. The aim is to guide focal points persons in planning and executing
awareness sessions in the work place, providing the focal points with the information they need for
peer group discussions and motivating the focal persons to improve their skills in organising peer
group activities. The manual is divided into three modules. The first module is a guide to the
implementation of the of workplace activities. It provides focal points with suggestions on the
abilities and skills they need to develop to enable them to carry out their roles effectively. The
second module provides facts and information about HIV/AIDS and other STIs. The last module
provides the focal points with the necessary information to carry out the collection of relevant data
on HIV and AIDS and to write the required reports. Bearing in mind that the job of focal point is
challenging and require special skilled person, the manual identifies specific criteria for the
selection of focal points and their roles and responsibilities once they have been identified.
Oxfam (2001) Lessons Learnt in Mainstreaming HIV/AIDS: Flyers 1,2,3,4,5,6,7 and S. Oxfam,
Malawi, www.oxfam.org.uk
These flyers provide some lessons and ideas from Malawi on how to mainstream HIV/AIDS without
changing the core business of an organisation. Flyer 1 outlines some of the key activities and
lessons in the systematic process that Oxfam have used to mainstream HIV/AIDS within their
Malawi programme. Flyer 2 illustrates what mainstreaming HIV/AIDS looks like in practice. Flyer 3
explores how to raise awareness of staff on how the epidemic affects them personally and
professionally. Flyer 4 discusses how staff and organisations are infected and affected by
HIV/AIDS and what constitutes good practice and the appropriate legal framework required for
realistic and just workplace policies. Flyer 5 outlines the importance of local qualitative research in
order to understand the effects on different groups within the community and on organisational
capacities. Flyer 6 presents the key lessons for the local level research carried out by Oxfam. Flyer
7 provides the basis for programme review and modification based on the new understanding of
HIV/AIDS on personal and professional levels, in the workplace and communities. And lastly, flyer
8 focuses on how to conduct an internal vulnerability audit. These flyers on the Oxfam website, or
you can write to Oxfam at Postnet Suite 183, Private Bag X15, Menlo Park 0102, Pretoria, Republic
of South Africa.
Rau, B. (2002) Workplace HIV/AIDS Programs: An Action Guide for Managers' This manual
outlines practical steps in developing a workplace programme of prevention and care, as part of
internal mainstreaming of AIDS. It can be downloaded from www.fhi.org, or ordered from the
Publications Coordinator, Family Health International, PO Box 13950, Research Triangle Park, NC
27709 USA. Fax: (919) 544-7261. Free copies are available to organisations in the South: send a
letter on headed paper explaining the work you do and how you intend to use the publication.
Smart, R. (2001) Revised HIV/AIDS Toolkit for Local Government. National Department of
Health and USAID, South Africa.
This toolkit recognises the need for collaboration of different sectors of the government at all
levels. This toolkit has been developed in order to assist the Local Government to define their role
in the partnership against AIDS and to initiate their responses to the epidemic. The instruments
within the pack were developed after interviews with various stakeholders in Kwazulu Natal on the
role of local government and what the local government would need in terms of resources,
partnership and technical assistance for an effective response. The toolkit is mainly targeted at
local government councillors and officials and their support structures. It consists of tools or
instruments, which can be used individually or collectively. These include a model HIV/AIDS
strategy for a city, a model HIV/AIDS workplace policy, guidelines for networking, guidelines and
tools for multi-sectoral planning, action checklists, advocacy guidelines and guidelines on
HIV/AIDS. Each tool has a brief introduction, which defines it and describes its purpose. Each tool
also identifies any process issues, which require special attention, and makes provision for
recording notes on the tool. The tool kit emphasises the need for anyone who wants to use it to
undergo training on HIV/AIDS.
Smart, R. (2001) State and Community Interventions to Prevent the Transmission of HIV. Paper
5 UNICEF, Global Impact and Policy Study
Smart, R. Dennill, K. and Pleaner, M. (2001) Planning in the New Millennium: A Primary
HIV/AIDS Capacity Development course for Government Planners: Facilitator's Handbook.
Department of Social Development, South Africa http://population.Dwv.gov.za
Topouzis, D. (2001) Addressing the Impact of HIV/AIDS on Ministries of Agriculture and their
work in Sub-Saharan Africa: Focus on Eastern and Southern Africa. Discussion Paper,
FAO/UNAIDS.
This paper examines the relevance of HIV/AIDS for Ministries of Agriculture (MoA) and their work
in Sub-Saharan Africa particularly Eastern and Southern Africa. The focus of analysis is smallholder
agriculture as this has been affected most severely by the HIV/AIDS epidemic. Given that the
mandate of most agricultural ministries is to enhance agricultural production and promote food
security, the impact of HIV/AIDS is of pivotal importance to their work. Although HIV/AIDS may
not appear to have a significant impact on agricultural production and productivity at national
level, its impact is felt at micro level where a combined loss of household labour, income, assets,
knowledge and skills results in a threat to household's livelihood, food and nutrition security. This
is changing the environment in which ministries of agriculture operate, intensifying a number of
structural changes in the smallholder sector in particular. The paper identifies significant, long
term changes in farming systems, as household cultivation shifts from cash crops to subsistence
crops and from labour intensive to labour extensive crops); and changes in the structure and
quality of the agricultural labour force as more elderly people and children assume a greater role
in farming. A detailed analysis of the impact of HIV/AIDS on Ministries of Agriculture is divided into
several areas; vulnerability of MoA staff to HIV infections and AIDS impact; the disruption of MoA
operations and the erosion of capacity to respond to the challenges being posed by HIV/AIDS
epidemic; the increased vulnerability of MoA clients to food and livelihood insecurity; and finally
the relevance of certain • policies, programmes and strategies in view of the conditions being
created by HIV/ AIDS. The paper also reviews selected examples of MoA responses and proposes
additional ways of creating capacity within MoA to ensure the sustainability of on-going
programmes to address the challenges posed by the epidemic.
UNAIDS 'HIV/AIDS and The Workplace' (1998) and 'Voluntary Counselling and
Testing' (2000) are both technical updates with relevance to internal mainstreaming. The Male
Latex Condom' (2001) comprises guidelines and fact sheets concerning procuring and
distributing condoms. All are available from www.unaids.org, your local UNAIDS office, or from
the Information Manager, UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
UNDP (1999) Mainstreaming the Policy and Programming Response to the HIV Epidemic. Issue
Paper No. 33
http://www.undp.org/hiv/publications/issue/English/issue33e.htm
This builds on the recent experiences of UNDP's HIV and development programme to offer a
guide to mainstreaming more effectively within policies and programmes. The paper outlines
some important points to take into consideration when addressing HIV/AIDS within policies and
programmes: a) There are no blue-prints for understanding 'how to' mainstreaming
b) Experiences of mainstreaming gender should be drawn on to avoid costly lessons.
c) Give the all-pervasive nature of the epidemic, effective responses require mainstreaming
throughout all development activities.
d) There are many innovative approaches to mainstreaming and these need to be explored,
expanded and used.
is crucial both for design of how to undertake
e) The process of mainstreaming
mainstreaming as well as in the implementation of the designed programmes - don't
understand is it:
The process of mainstreaming is as important as the outcome of mainstreaming activities
OR
It is important to design mainstreaming programmes carefully
f) The activities essential for mainstreaming need to be sustained over time and supported
and are not one-off events.
UNHCR has lots of guidelines and 'how to' documents relating to protection of women and
preventing and responding to sexual and gender based violence. It also has the Action for the
Rights of Children training resource packs (produced by UNHCR and SCF), which are aimed at
enhancing care and protection of boy and' girl children in emergency situations. All these
documents can be downloaded from www.unhcr.ch, or from your UNHCR office.
WHO's 'Reproductive Health During Conflict & Displacement: A Guide for Programme Managers'
(2000) gives a through overview of the phases of humanitarian response with regard to
reproductive health, including HIV and sexual violence: www.who.ch.
Information about AIDS
www.census.gov/ipc/www has country profiles which include surveillance data from HIV sentinel
testing in many countries. The site also has an HIV/AIDS surveillance data base.
UNAIDS provides an epidemiological fact sheet for each country in the world, along with its annual
AIDS Epidemic Update' which summarises the global situation, and a wide range of other
materials. Download from www.unaids.orgr or e-mail unaids@unaids.org or write to the
Information Manager, UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland for a complete
list of all UNAIDS publications (they are free of charge).
The AIDS Education Global Information System is at www.aegis.org and includes basic fact sheets,
as well as more detailed information for people who are HIV-positive, access to news and
publications about AIDS, and a glossary of AIDS terms.
Gender mainstreaming
http://www.un.org/womenwatch/resources/goodpractices/
Database of good practices in gender mainstreaming among UN agencies
http://www.genie.ids.ac.uk/
The Gender Information Exchange site allows users to search donor agencies' gender resources,
including policy documents, sectoral reports, guidelines, good practice cases, bibliographies,
background papers, research reports, and tools. The site also provides a searchable database of
gender country profiles, and of consultants specialising in gender issues. The GEM part of the site
(http://www.genie.ids.ac.uk/gem/) is about putting DfID's gender policy into practice. It contains
key texts, case studies, checklists, tools and methods, facts and figures. It also has a range of
thematic bibliographies, including bibliographies for gender mainstreaming, training, violence
against women, and conflicts and emergencies.
http://www.siyanda.org/
A searchable database of materials to support practitioners' efforts to mainstream gender.
http://www.liv.ac.uk follow links to the gender and health group for a range of materials on
gender mainstreaming in health.
Gender & SRH
The Stepping Stones training package by Alice Welbourn concerns gender, HIV, communication,
and relationship skills, and is designed for use with whole communities to challenge gender and
inter-generational inequalities. For more information about translations, how it has been used,
and with what results, visit www.steppingstonesfeedback.org. Stepping Stones is available from
TALC, PO Box 49, St Albans, Herts, AL1 5TX, UK, or visit www.talcuk.org.
'Gender or Sex: Who Cares?
Skills-building Resource Pack on Gender and
Reproductive Health for Adolescents and Youth Workers'is a training pack by Maria de
Bruyn and Nadine France (2001). It offers a series of participatory workshop activities, and
concentrates particularly on violence, STIs and HIV, unwanted pregnancy, and unsafe abortion.
Download from www.ipas.org/pdf/GenderBook.pdf and get the curriculum cards and overheads by
e-mailing wardk@ipas.orq.
Gender, HIV and Human Rights: A Training Manual, by M B Nath (2000), includes training
modules aimed at raising awareness of the gender dimensions of HIV/AIDS. Available from
www.unifem.undp.org/public/hivtraining
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Appendix 1: Informal Contributors
The following individuals were active participants in the HIV/AIDS Mainstreaming Workshop,
December 2002 and several also commented on drafts of the resource pack:
David Sam
Professor Bill Gould
Dr Uli Huber
Dr Sally Theobald
Rachel Tolhurst
HIV/AIDS Worker, Ghana
Department of Geography
Department of Geography
Gender and Health Group, LSTM
Gender and Health Group, LSTM
Thanks goes in particular to Adele Graham and Teresa Jackson of the HIV/AIDS Knowledge
Programme for their help and patience in the organisation of the workshop and support in the
development of the resource pack.
Appendix 2: Mainstreaming Ideas from Malawi
HIV/AIDS MAINSTREAMING: A PREREQUISITE TO ACHIEVING THE GOAS FOR THE
MINISTRY OF GENDER AND COMMUNITY SERVICES IN MALAWI
A think-piece by Prisca Joan Kutengule, Community Development Officer, Ministry of
Gender and Community Services
January 2003
This paper has been developed as a response to the contents of this resource pack and explores
the implications of the ideas within the pack for the Ministry of Gender and Community Services in
Malawi. While the ideas and suggestions within the paper have not been developed in
collaboration with other colleagues from the Ministry, they represent some initial, hypothetical
steps in thinking how the Ministry could respond to the development implications of HIV and AIDS.
Background Information
Malawi has one of the highest levels of HIV/AIDS prevalence in Sub-Saharan Africa with an
estimated adult rate of 13.4 %. The age group with the highest number of infections is those
between 15-49 years, with more women infected than men (UNDP Information Kit, 1997). This is
evident from recent figures of new infections, 60% of which are among girls and young women
(Cohen 2002). The problem of HIV/AIDS is worsening the already existing poverty situation in the
country with certain population groups such as girls and women more vulnerable than others.
Some of the contributing factors are socio-economic stratification, inequitable and oppressive
social relations and high levels of unemployment. Unless the problem of HIV/AIDS is addressed
through strategies that focus on equity and fairness, sustainable development can not be
achieved. In addition to this, the problem of HIV/AIDS should be understood as a development
problem, which affects the interconnected systems of society, environment and the economy.
Therefore tackling this problem in the country would require a framework that emphasises the
linkages with all dimensions of development.
1. The Ministry Of Gender And Community Services
It is the mission of the Ministry of (Render and Community Services to empower the vulnerable
women, men, boys and girls in the cbmmunities to enable them to become self-reliant and active
participants in the process of development. The ministry delivers its services to the communities
through programmes under the departments of Community development. Gender Affairs and
Social Welfare with structures at national, regional and district levels the functioning of each of
these departments is described below. The national level is responsible for policy formulation while
the implementation of programmes and activities is done at district level. The regions act as a
bridge between the national and districts.
1.1 Community Development Services
The department aims to improve the living standards of both rural and urban communities by
increasing levels of awareness of the various development programmes and encouraging local
initiatives and participation in the development process. It also aims to increase literacy levels
among adults and promote self-reliance in order to facilitate community members to be active
participants in the development process.
The main activities of the department include community mobilisation, sensitisation of
communities and building capacities of community leaders and various committees such as project
and community based water and sanitation committees in order to enhance community
participation in the identification, formulation, implementation and management of development
programmes and projects.
It is also the role of the department to facilitate funded community construction projects such as
those funded by the Malawi Social Action Fund ( MASAF), the European Union (EU) and the
International Development Agency (IDA) as well as self help projects, and to reduce illiteracy rates
in the country through establishment of functional literacy classes. Furthermore, the department
works in collaboration with Department of Water, Ministry of Health and Population in areas of
health and sanitation as well as the Ministry of education in social mobilisation campaigns on the
importance of girl's education and education quality. All these activities are largely carried out by
Community Development Assistants (CDAs) and are mostly in communities based under the
supervision of District Community Development Officers (DCDOs).
1.2 Gender Development Services
The Department of Gender Affairs aims to improve the living standards of communities through
socio-economic empowerment and gender mainstreaming in all development sectors and activities.
The main activities of the department are economic activities through organisation and training
women and men's groups in business, credit management and appropriate technologies. It is also
the duty of the department to link these groups to credit lending institutions. These activities are
largely done by Community Development Assistants and at a lesser extent by Social Welfare
Assistants under the supervision of District Community Development Officers and District Social
Welfare Officers respectively. Other activities conducted by the Department are gender
mainstreaming which include sensitisation of stakeholders at all levels. The Department also
carries out supervision and monitoring of gender related activities at these levels, social
mobilisation campaigns on prevention and eradication of gender-based violence, capacity building
on gender equity and equality and community based population education. The Department has
established the national gender policy and is responsible for its implementation in collaboration
with gender focal points in other ministries and organisations.
1.3 Social Welfare
The aim of the Department is to improve survival, protection and development of children and to
assist in the welfare of the needy and disadvantaged members of the population particularly
orphans, the destitute, disabled and abandoned children. Activities of the department include child
development through organisation of pre-school activities family and child welfare counselling
services, protection from child abuse and violence, reformatory activities through establishment of
rehabilitation centres, organisation of community based child centres for orphans and other
vulnerable groups. These activities are largely carried out by Social Welfare Assistants mostly
based at district level under the supervision of District Social Welfare Officers (DSWOs).
To conclude, for all these departments, fulfilling the mission and achieving the objectives of the
Ministry could be problematic if HIV/AIDS issues and concerns are not identified and addressed.
Although there have been no direct studies on the impact of HIV/AIDS on the ministry, studies
done by the Malawi Institute of Management (MIM) indicate high death rates in the public sector.
This is mainly from AIDS related diseases such as TB and pneumonia (Cohen 2002). It is likely that
the Ministry of Gender is no exception. Indeed the ministry is already experiencing a lot of deaths
of frontline staff in many districts. Some of the death causes could be due AIDS although no such
cases have been reported. This is contributing to the already existing shortage of staff at districts
and community levels resulting in services not reaching many communities especially in the
remotest parts of the country. These internal issues are dealt with in more depth in the following
sector.
2. The Impact of HIV/AIDS on the Ministry as an Organisation
The following points highlight some of the observed and potential impacts of HIV and AIDS on the
staff and functioning of the Ministry as an organisation:
• One area of particular concern is the possibility of increased vulnerability of HIV infections
amongst staff at lower levels within of the Ministry's hierarchy due to lack of incentives
such as low pay and the limited promotion opportunities. This may encourage low-level
women staff to use their bodies in exchange for various benefits.
• The ministry is experiencing a diminishing labour force due to high death rates among staff
at district and community levels. These staff play an important role in facilitating
•
•
•
development that can be sustainable at community level and will be a great loss to the
sector.
Increasingly the Ministry is experiencing low productivity due to absenteeism from work as
a result of staff's own illness and the need, (particularly among female staff) to care for the
sick and attend funerals of other staff members and relatives.
The ministry is spending a lot of funds, which could be used for implementing, monitoring
and supervising development programmes on funeral logistics. The problem of resources is
particularly acute in districts many of which are under-funded.
Increasing numbers of AIDS orphans are putting a lot of pressure on the services of the
Department of Social Welfare and increasing the workload of already over-burdened staff.
3. The Impact of HIV/AIDS on Community Services
The points below highlight just some of the impacts of HIV and AIDS on the external work of the
ministry:
• There is increased susceptibility to HIV infection and AIDS among some members cf the
community especially among women and girls. Some male Community Development
Assistants in the rural areas may take advantage of their position and bargaining power to
have affairs with women they work with, such as female literacy instructors and members
of economic activities groups. This type of behaviour does not only put the women they
serve at risk but they also put their own lives at risk, hence high death rates of the staff in
the ministry.
• AIDS related illnesses and death affect community development projects as communities
have to attend frequent funerals. As a result projects take much longer to complete and
communities fail to make the contributions they are supposed to make towards construction
projects.
• Increasing numbers of AIDS orphans are putting pressure on affected households to spend
more time looking for resources for their livelihoods rather than participating in
development programmes and activities.
• Social capital, which is an important element for sustainable development, is eroded among
the community in general and economic activities in particular due to illness or death of
some members of the community or groups who may influence solidarity and collaborative
efforts. Repayment of loans may be difficult due to the illness of some group members or
members of their family, who must opt to use their funds for seeking medical expenses
instead of repaying the loan. Many defaults may be experienced, leaving some group
members without access to loans.
• Illiteracy rates may increase due to pronged illnesses or death of literacy instructors, or
there may also be reduced periods of learning because people have to attend funerals.
Prolonged illnesses and deaths of Community Development Assistants may affect the
effectiveness and quality of teaching and learning among adult learners.
4, Ideas On Mainstreaming HIV/AIDS in the Ministry
To-date the Ministry has had limited success in mainstreaming gender; many of the strategies that
have been tried have not achieved what was hoped. As HIV/AIDS mainstreaming has many
similarities with gender mainstreaming, it seems likely similar challenges will arise. It would be
valuable if the Ministry could take stock of the experiences to date in mainstreaming gender and
think through the lessons which can be learnt from these experiences. These lessons could then
help to shape the strategies used by the Ministry to mainstream HIV/AIDS.
While the strategies to be used require more consideration, some ideas for approaches within both
the internal and external areas of the ministry that cover both HIV/AIDS specific work and
mainstreaming are given below:
4.1 Internal HIV/AIDS Work
4.1.1 Prevention of New Infections among staff
In order to prevent new infections among staff at all levels as well as in the outside communities
the ministry is serving, strategies and programmes that promote safe and responsible sexual
behaviours should be encouraged. Strategies could include intensive sensitisation on safe sex
education among all staff at all levels, making condoms available to those who would need them.
It is also important that incentives should be given to staff at all levels where and when it is
appropriate. This should be monitored in an open and accountable fashion and may help to
decrease any sexual abuse of vulnerable employees.
4.1.2 Care and Support for staff
There are, so far, no care and support services for staff within the ministry at all levels. There is
need to establish care and support services such as counselling centres and revolving funds, which
sick staff can access. For example:
• There are some social welfare officers who are based in hospitals who provide counselling
services to people at hospitals. These officers plus others could be used as counsellors to
other members of staff since they under go training on confidentiality and other things.
• Sensitisation among staff members to promote openness of status and to avoid
stigmatisation should be intensified.
• Focal persons at national level should be strong enough to push decision makers to include
the infected and affected staff especially those with low income to have access to credit
schemes under the Ministry since the status of HIV/AIDS normally means that they fall
under the category of" new poor."
4.2 Mainstreaming HIV/AIDS within the Ministry
4.2.1 Research, Monitoring and Evaluation
It is important to have baseline data so as to understand the effects the epidemic has on the
service delivery of the Ministry, and where interventions would be required.
• This requires strengthening capacities at all levels in strategic planning, research,
monitoring and evaluation skills and knowledge to help conduct regular impact assessment
and the effectiveness of interventions.
Monitoring and evaluation should be conducted on a regular basis. Therefore, there is need to
have monitoring systems at all levels with well defined indicators which are gender sensitive.
Although experience has shown that at times it is difficult to find concrete indicators for
mainstreaming, developing process indicators could as well be useful.
4.2.2 Implementation and Institutional Framework
There is need to strengthen the capacity for planning, implementing, co-ordinating and managing
in response to the inter-linkages between HIV/AIDS and the core work of the Ministry at all levels.
Some ideas to start this process include:
• Putting focal persons at all levels to liase with other stakeholders on how to carry out
mainstreaming activities especially at the district and community levels
• Facilitating a forum to co-ordinate community efforts by developing task forces for
HIV/AIDS mainstreaming especially in districts and community levels within the already
existing structures such as District Executive Committees (DECs) and Area Executive
Committees (AECs). The task forces could evaluate the existing work of the districts and
refocus the work to take HIV/AIDS into consideration. They should be able to develop co
ordinated plan of actions for all stake holders in the districts and community levels and
facilitate resource sharing between stakeholders.
• Communities should be viewed as actors and partners not just as beneficiaries; therefore
they should be involved in identifying HIV/AIDS impacts in the society and be able to find
solutions to the problem. This can only be possible by building capacities of the
communities so that they are able to identify the links between development and HIV/AIDS
and existing and future socio-economic implications for attaining sustainable development.
•
•
This could be done through needs assessment, sensitisation meeting during day-to-day
activities and during local leadership training courses.
Incorporating HIV/AIDS issues and how they relate to community development in training
programmes and manuals.
Resources should be available for district and field staff to carry out these refocused,
HIV/AIDS sensitive activities effectively. Many activities fail to be implemented effectively
because district offices have no resources and equipment
Priority Recommendations Of Activities For Mainstreaming
Some of the activities could be:
• Base line surveys to understand the magnitude of the impact of HIV/AIDS on the
communities and employees.
• Capacity building of members of staff at all levels in recognising the inter-linkages with
HIV/AIDS and their existing work and then planning, implementing and managing
refocused activities that have mainstreamed HIV/AIDS. In particular, the local level staff
should have enough training - in the case of gender mainstreaming the training has been
done in haste and proved ineffective. As district staff are the very ones responsible for
implementing activities it is vital that they understand the implications of HIV/AIDS
mainstreaming.
• Mobilise community coalitions to work for local solutions to the challenges caused by
HIV/AIDS
• Build capacities of community leaders to facilitate change in their communities.
• Conduct Social Mobilisation Campaign on the impact of HIV/AIDS on sustainable
development and measures of mitigation
• Creating more opportunities for income generating activities for AIDS orphans, unemployed
youths, poor men and women.
• Conducting study tours to countries that are doing well in mainstreaming HIV/AIDS in order
to share experiences
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