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close this bookAfrican Women and AIDS: Scope, Impact and Response (UNESCO, 1999, 59 p.)
View the document(introduction...)
View the documentACRONYMS
View the documentINTRODUCTION
View the documentCHAPTER 1: WOMEN AND AIDS: HIV INFECTION SCOPE AND EPIDEMIOLOGY IN AFRICA
View the documentCHAPTER 2: WOMEN AND AIDS: IMPACT AND RESPONSE
View the documentCHAPTER 3: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: SOME WOMEN ORGANISATIONS EXPERIENCE
View the documentCHAPTER 4: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: GENDER APPROACH
View the documentCHAPTER 5: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: ADAPTED TOOLS AND MESSAGES
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(introduction...)

The views expressed in this publication are entirely those of the authors, and do not represent the official position of UNESCO.

Published in 1999 by UNESCO/DAKAR
BP. 3311, Dakar, SENEGAL
ISBN 92-9091-075-5
©UNESCO, 1999

ACRONYMS

AIDS

Acquired Immune Deficiency Virus

AIDSCAP

AIDS Control and Prevention

AMPPF

Association Mondiale pour la Planification Familiale

HIV

Human Immune Deficiency Syndrome

IEC

Information Education Communication

INTRAH

International Training on Health

NGO

Non Governmental Organisation

PWA

Person Living with HIV/AIDS

SR

Reproductive Health

STD

Sexually Transmitted Diseases

UNAIDS

United Nations Common Programme on AIDS

UNDP

United Nations Development Programme

UNESCO

United Nations Educational, Scientific and Cultural Organisation

WHO

World Health Organisation

INTRODUCTION

Despite some two decades of concerted HIV/AIDS prevention activities, the pandemy continues to escalate. UNAIDS estimates that 16.000 new infections occur everyday throughout the world, 70% of which occur in Sub-saharan Africa.

Women are increasingly being affected by this pandemy, especially in Africa, where the situation is alarming. Actions taken up to now have had some set-backs mainly because of the channels of communication used. Other factors related to the vulnerability of women have been at play as well. These are among other factors: the low level of involvement of men, the influence of the mass-media on the education of the children, lack of dialogue on sex issues between couples and between parents and children, traditional practices which have negative effects on women's health and the economic dependence of women.

The vulnerability of women increases the impact of HIV on the family, the community and the society at large. The analysis of the chain of consequences leads to the conclusion that reducing the vulnerability of women will not be possible unless there is the political will to take serious steps to safeguard the fundamental rights and improve the economic autonomy and the legal status of the population in general and of women in particular.

We are here concerned with two main categories of women's organisations, those whose activities are exclusively linked to HIV/AIDS and those which have a wider area of interventions (health, environment, economy, advocacy and spiritual issues). The experience of these organisations in different countries confirms the need to readapt our messages, reinforcing the actions to be undertaken and involving men, policy makers, religious and traditional leaders in the HIV/AIDS prevention campaign.

In Africa, there has always been complementarity between men and women in handling a wide variety of societal problems, and specifically issues touching on the improvement of the autonomy of women and aimed at creating a system which seeks to empower women, making them more independent and better able to control their own earnings and manage their funds. It is therefore necessary to strike a balance between the roles of women in the family and in society. This should go along with their full involvement in decision-making and putting a stop to all women marginalisation tendencies.

Since HIV/AIDS prevention education is one sure strategy of raising awareness of the need to protect women, UNESCO in collaboration with UNAIDS and the UNDP regional project on HIV and Development organised 7-11 September 1998 a regional workshop for co-ordinators of women's grassroot organisations from 17 African countries.

This book is an attempt to bring the rich papers presented at the workshop to the attention of a wider audience of actors, especially those working with women's grassroot organisations. We hope that they will find in the book useful ideas and information to reinforce their programmes of HIV/AIDS preventive education.

CHAPTER 1: WOMEN AND AIDS: HIV INFECTION SCOPE AND EPIDEMIOLOGY IN AFRICA

by Lillian K. S. Chigwedere
(Psychologist Independent Consultant, Harare-Zimbabwe)

SUMMARY

The June, 1998 UNAIDS report highlights the following issues

· Over two thirds of all people now living with HIV in the world live in Africa south of the Sahara desert

· Eighty five percent of the world's aids deaths have been in the Sub-saharan region.

· Right from the start of the epidemic, HIV has spread mostly through sex between men and women

· An estimated 87% of children living with HIV in the world are in Africa

· No cure for aids has yet been found.

The facts listed above immediately justify organising a workshop for the women co-ordinators of grassroots women's organisations, to share experiences on how best we can help to stop the spread of the HIV virus. Why women and not men? Some might ask. As you will see later in the presentation, women seem to be the more vulnerable group. The objective is to highlight some of the pertinent issues regarding HIV and women and to induce the reflection on the problem of HIV/AIDS in much broader terms than before. To help grassroots women protect themselves against HIV/AIDS and help to prevent its spread, it is imperative to have up to date information on these issues in order to transmit efficiently and effectively accurate and culturally appropriate messages to the target groups. The issues to be covered in this segment include:

· The extent and epidemiology of HIV infection in Africa

· Factors that make women, particularly in Africa more vulnerable to HIV virus

· Problems regarding sexuality between men and women, particularly in Africa

· Cultural and traditional constraints and practices - the challenge

· Reduction of risk of infection in women especially in Africa.

To be able to deal with a problem, one should understand not just the problem but the magnitude of the problem. We will look first at the problem as it affects us at individual, country, regional and global level. By analysing the problem this way, we will then know how to attack it and produce the appropriate tools to use to induce behaviour change.

First of all, we will note that it is not always necessary to have scientifically drawn statistics to see the magnitude of the problem and how it is indeed a pandemic. However, formal statistics can help us to appreciate not only the magnitude of the epidemic but also to begin to think of appropriate ways and means of fighting the HIV virus.

Globally, the data show that the HIV knows or recognises only one totem and that is "HUMAN" and that women are not spared at all. By 1994, women represented 40% of all new AIDS cases and 50% of all new infections were women aged between 15 and 29 (SAFAIDS & WHO 1995). Sources including UNAIDS say that by the year 2000 an estimated 14 million women will have been infected with HIV and about 4 million will have died of AIDS. The question is " why are women so vulnerable to HIV infection?" The answer may not be so simple. It is possible to list the various reasons. These include physiological, social and cultural, economic, sexual, and sheer ignorance.

PHYSIOLOGICAL FACTORS

Knowing one's body can help individuals gain insight into the risks of contracting the HIV infection.

What is it about the female physiology that facilitates the transmission of HIV infection in women?

· Larger mucosal surface area exposed to the virus

· Greater viral load present in semen compared to vaginal secretions

· Young girls have immature cervix and relatively low vaginal mucus production - this present less of a barrier to HIV

· Older women use various herbs and powders to make if difficult for penetration thus increasing both men's and women's pleasure from intercourse - this increases friction and the risk of lacerations is high

· Vaginal wall is not well lined with protective cells

· The cervix may be easily eroded

· Potential bleeding through tearing of the hymen.

Young women and teenagers constitute the group that is at most risk. Teenagers are a highly sexually active group and the percentage of young women pregnant or who have had their first child by age 19 is quite high in most countries. Most of these young women are impregnated by older men who are mostly promiscuous and infected. The reasons for younger women involvement with older men brings us to the second category facilitating factors i.e. social and cultural factors.

SOCIAL AND CULTURAL FACTORS

These range from rape to beliefs about sex and women in general.

· RAPE - this seems to be increasing at such an alarming rate. In many Sub Saharan countries it seems no day passes by without a report on rape or child abuse, e.g.

The causes of rape and child abuse are many. In the different parts of Africa, beliefs, traditions and cultures as well as perceptions regarding sex are central to societal norms and behaviours.

The following are some of the beliefs and practices that may result in either rape or child abuse in the Zimbabwean society:

· Traditional healers' prescription - to rid yourself of the HIV virus, you have to have intercourse with a girl under 10 years old.

· Man must regularly release semen to avoid ill health - the release may be effected through forced sex.

· The father of the groom should be the first one to have intercourse with his daughter in law in order to ensure that everything is OK before the son takes over.

· A father should have sexual intercourse with his daughter to appease the spirits.

All of the above are likely to involve coerced sex which increases the likelihood of micro lesions in the vaginal mucosae thereby creating entry points for the HIV virus. Other pertinent factors include:

· POLYGAMY - women are perceived as man's property, therefore a man can acquire as many as he wants or as his purse can afford to purchase.

· BARENHOOD VS MOTHERHOOD - no marriage is permitted to be childless hence sharing of wife with a nephew, uncle or brother is perceived as normal.

· INHERITANCE OF WIDOWS - belief that a woman is not complete without a man, she is only a property of her husband's family who has to be repossessed by another member of the family.

· PERCEPTION OF MANLINESS AND WOMANLINESS - the African society condones male sexual freedom while emphasising female virginity. Even young boys are encouraged to experiment with sex before marriage- they must be experienced yet girls must be virgins. If this practice is condoned note the relevance and implications to married women of the message "stick to one partner".


All these beliefs and practices put the woman at risk of HIV infection. As if cultural and social factors are not enough in constraining a woman's ability to protect herself from HIV infection, economic factors have been found to be even most potent in the transmission of the HIV virus.

ECONOMIC FACTORS

· ESAP - with the introduction of structural adjustment programmes in most of our countries, the poor are getting poorer thus putting many women and children at risk: many kids on the street risk being raped and sodomised.

· PROSTITUTION - this has become a means of survival for many women in our countries thereby risking their lives.

· SUGAR DADDIES - many young girls are enticed by older men into sexual intercourse in return for various material goodies.

· JOB SEARCH AND PROMOTION - many couples are forced to split in search of jobs or promotion - this migration promotes multiplicity of sexual partners thereby increasing the risk of HIV infection e.g. executives, drivers, soldiers, miners, farm workers, business women, etc.

· SEXUAL FAVOURS - many women (men too) are trading sex for a job or just job promotion.

· KNOWINGLY INFECTING - HIV positives are marrying in order to get someone to look after them when they become sick.

SEXUALITY

Sex talk

The norm is that sex is not something that you talk about, just get on with it. Women are supposed to be silent partners who have no say in the marital affairs let alone sex matters. Hence with this state of affairs, a woman cannot insist on condom use, if she does the result can be "guilty of mistrust or infidelity".

Multiplicity of partners

This practice is condoned in men and not in women, women silently accept this practice, challenging it is unwomanly.

Ignorance

Women may not be very knowledgeable about their bodies particularly the reproductive system, because of this ignorance they might fail to recognise any symptoms of STDs or be forced into unprotected sex.

SHEER IGNORANCE

Many women may be ignorant or may not very well understand the basic facts on HIV/AIDS that they unknowingly and unwittingly put themselves at risk of infection e.g. young girls and women may be talked into accepting sex without a condom because they are told by the men that if they do it standing the virus will not affect them, etc. The ignorance might also be linked to their strong belief in cultural and traditional practices. The portrait of a good African woman or (womanliness) and a good African man (manliness) according to Chigwedere, a well known Zimbabwean historian is as outlined below:

PORTRAIT OF A "GOOD WOMAN"

· Patient
· Humble
· Pretend not to know
· Subservient
· Soft spoken
· Less knowledgeable than a man
· Receiver and not giver
· Incubator or producer of children
· Man's toy (hence use of herbs and extending of labia)
· Know that man is always right

"MANLINESS"

· Physical valour
· Sexual valour
· Ability to defend himself and his property women and children included
· Ones ability to resist domination by any woman
· Gives effective orders to juniors (women and children)
· Responsible for feeding his family
· Never to be treated like a woman - hence all the fights that erupted and continue to erupt.
· Never to admit that his wife is cleverer than him

(source: Chigwedere: The Abandoned Adolescents)

These values were taught and instilled in boys and girls from as early as six years of age. The question is: do these qualities of a good woman place a woman at risk of HIV infection or protect her? In what ways do they protect the woman? In what ways do they put her at risk?

CHALLENGE - Reduction of risk to HIV infection

Factors that put women at risk of infection seem to centre around the socialisation of woman as depicted in the above portrait. With a strong belief in these qualities that make a good African woman, and the African woman thoroughly socialised to accept and act in line with them, how best can we as people working with grassroots women help to empower them to make a difference in guarding their health and protecting themselves against HIV infection. With no cure in sight, what options do we have? These are questions to ponder seriously if we hope to design messages and tools that can effectively empower women to choose between sentencing themselves to death or to life.

It is true that old habits die hard and old patterns take long to break. It is also very true that nothing will ever change if no steps are taken to address the problem. Therefore the initial step to bring about change is awareness of and acceptance of patterns and behaviours that put women at risk. Therefore as we work through messages and tools of helping grassroots women to reduce risk of HIV infection, we must bear in mind an inevitable objective which is to touch a row nerve, "the belief system" in order to bring about meaningful change and appropriate behaviours.

True we can give many messages about how to avoid infection, but without the necessary tools to implement these messages, they will be like, if I may quote the Bible, 'seeds that fell on a rock that dried up and never generated'. So as we deliberate on messages and tools let us think seriously about the implications of the message that we give as well as the appropriate tools to make the seed germinate and bear fruit. One of the famous messages that has so far been widely used is " NO condom no sex". This is a very powerful message, but without first equipping women with appropriate skills to say and act it out, it is just as good as no message at all. The foundation to changing patterns is threefold, rights, boundaries and assertiveness. These are the issues that we shall discuss in the next session on messages and appropriate tools. For now let's start thinking: Realistically, Appropriately, Practically, Assertively; in short RAPA.

REFERENCES

1. Chigwedere A. S., The abandoned adolescents

2. Goodman M.S. et Fallon B.C., Pattern changing for abused women

3. SAFAIDS and WHO; Facing the challenge of HIV/AIDS/STDS: a gender response

4. UNAIDS, Report on the global HIV/AIDS epidemic, June 1998

5. WHO-global Programme on AIDS: report of a meeting 8-10 February 1995

6. Zimbabwe women's Research Centre and Network, Zimbabwe women's voices

CHAPTER 2: WOMEN AND AIDS: IMPACT AND RESPONSE

The Impact of HIV/AIDS on African Women as Socio-Economic Agents within the Communities

By Brigitte Quenum
(A Public Health Medical Doctor, Counsellor in Community Responses, Regional Project on HIV and Development for Sub-Saharan Africa, UNDP)

Even though prevention strategies are effective, the current high levels of HIV infection and the long incubation period prior to AIDS indicate that the economic impact of the disease will represent a major impediment to development for many years to come.

AIDS of course affects the population at large, but women are more specifically affected. This is due to a number of reasons which are biological and social, including the various roles that women play as mothers, wives, and providers.

WOMEN'S VULNERABILITY TO THE HIV INFECTION IS BIOLOGICAL, SOCIAL, AND ECONOMIC

· Biological vulnerability: women are at major risk of infection; they are more prone to HIV contamination than men. The risk of being infected during unprotected sexual intercourse is twice to four times higher among women than men. Women are also more vulnerable to other sexually transmitted diseases, which represent an important factor in the transmission of the virus. Those STDs cause serious or chronic genital lesions among women and represent an additional infection risk factor. Moreover, when women are infected with STDs, they generally are not aware of it or are poorly treated. Inadequate treatment is often due to lack of financial resources or a lack of understanding about the necessity to treat the disease. Anaemic conditions and complications related to pregnancy and childbirth often require blood transfusion, which are more likely to expose women rather than men to infection. Finally, it is easier for women than men to cause mother-fetus transmission due to the simple fact that the woman gives birth. This situation in turn, seriously affects women in their capacity as progenitors and mothers, which is quite valued in Africa.

Social and economic vulnerability: Women's condition aggravates their exposure to HIV/AIDS. Although the condition varies from one country to another within the continent, we generally notice that family and social systems place women in a subordinate role to their partners, in particular, and men in general. This is in view of the fact that men hold the economic and political power, be it at the family, lineage, or village levels. Some changes have of course occurred over the last several decades, especially with women attending school. However, female school attendance is still below males' although it has improved over the past few years. Increasingly more women are running households, namely in urban areas. This evolution may be perceived as some form of emancipation for women, yet it often places them in difficult situations. Many women are compelled to develop survival strategies because they often have to take care of their children's education, and sometimes meet the needs of parents. This leads them on a continuous search for jobs, particularly in the non-formal sector, which results in repeated home changes and in many instances prostitution.

The consequences of AIDS are all the more significant for women as they often attend to many duties in the family. The epidemic affects them disproportionately, not only as persons infected by the virus, but also as carers of other affected members of the family. Whether it is the woman or her husband who has AIDS, important changes occur in the distribution of roles within the family and in ways of caring for the children. When women fall sick or are overloaded with work due to the husband's sickness, they call upon other members of the family (especially grandparents) for care to the children and, sometimes, pay for their schooling. This is not new but AIDS has the capacity to boost the phenomenon.

Moreover, when a relative falls sick, women are the ones to extend care both at home and at the hospital. This task is all the more difficult when it comes to AIDS, as it may affect women's own productive capacities. Indeed, it is women's responsibility, especially in rural areas, to care for the family and take on related domestic chores such as fetching wood and water, cooking, etc., as well as providing most of the food for subsistence. With the advent of AIDS, task distribution within the household, where men used to produce cash crops for export (coffee, cotton, cocoa, etc.) changes. In fact, if the woman falls sick, she can no longer ensure production of subsistence crops. If in order to replace her affected husband, she is compelled to channel her activities more toward cash-generating ventures to meet family needs, in particular health expenses, the family may therefore be exposed to food shortages Other production arrangements will be necessary which, contrary to the first scenario, may cause the dropping off of cash crops in favor of subsistence production. However, those arrangements may also call for the use of additional labor, namely child labor. Finally, when the husband dies, many women who were already deprived of the right to land inheritance and are additionally stigmatised by the community, are compelled to adopt personal survival strategies that put them at risk of expanding the epidemic. Due to some traditional inheritance laws, a widow can find herself separated from her children and denied access to family resources.

WHAT STRATEGIES COULD POSSIBLY HELP REDUCE WOMEN'S VULNERABILITY TO THE HIV INFECTION?

A vulnerable woman has neither the means nor the power to control or reduce the risk of being HIV-infected. However, because she is biologically, socially, and economically vulnerable does not necessarily imply that she cannot be protected or provided with the means to protect herself.

Reducing vulnerability could be achieved through the following:

· improving girl's access to the formal school system;

· developing prevention methods that women can comprehend;

· Reinforcing women's financial independence, i.e., multiplying and strengthening training opportunities for women, credit programs, savings mechanisms and women's co-operatives, and combining such initiatives with AIDS prevention activities. For instance, UNAIDS is supporting an initiative of women fish sellers in Zambia which is about to set up a co-operative that will extend interest-free loans to the women. Thus, they will not need to offer sexual favours to fishermen or truckers to get their fish or transportation, as was previously the case.

· Developing prevention, counselling and appropriate care services: availability of condoms and STD care in places and in an environment that is comfortable and supportive to women.

In order to reduce vulnerability, policies have to change, i.e., there is a need for an environment that strengthens women's capacity to protect themselves and their communities from the virus. This presupposes some reforms at the community and national level, in order to safeguard women's basic rights and to improve their economic autonomy.

BIBLIOGRAPHICAL REFERENCES:

- African Populations and AIDS. Supervised by JACQUES VALLIN, Editions La Decouverte/CEPED, 1994, pages 195-198.

- Reducing Women's Vulnerability to the HI V infection. Viewpoints. UNAIDS.

- AIDS and the Development of Africa. World Bank publication, Africa Region.

CHAPTER 3: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: SOME WOMEN ORGANISATIONS EXPERIENCE

By Karim Seek
(Public Health Medical Doctor, Deputy Co-ordinator of the National HIV/AIDS Programme in Senegal)

As the HIV/AIDS epidemic evolves in the world, the protection of women is increasingly becoming a major concern. Indeed, from a men-women ratio of 7/1 in 1990, the rate of infection has inverted to 1.5/1 in certain countries. Four out of six new cases of infections occur among women aged between 16 and 24 years.

The vulnerability of women to HIV has been widely documented. The gravity has been more widespread in sub-Saharan Africa. The low level of literacy among the majority of women constitutes a major obstacle to efforts to educate them on the mode of transmission of the disease. The peculiar nature of AIDS, a deadly disease associated with sexual behaviour, imposes specific educational strategies which make it possible not only to create awareness on the risk but also to bring about a change in behaviour with the aim of protecting women through better control of their sex lives.

The HIV/AIDS prevention education is the responsibility of the national AIDS programmes. They are assisted in this task by associations and Non-Governmental Organisations that most often constitute the operational link in direct contact with the "beneficiaries". Their educational role and assistance often go beyond the domain of the HIV/AIDS, to include health care, and other sectors of development.

This paper is a summary of experiences on HIV/AIDS prevention education of the organisations invited to this workshop. It provides a basis for discussion on a variety of strategies that have been used so far to tackle the various aspects of women's vulnerability to HIV/AIDS, strategies which seek to integrate the social and cultural realities of the target group in question.

ORGANISATIONS

Areas of Intervention

Two main groups of organisations are directly concerned: those whose activities are exclusively concerned with HIV/AIDS and those whose field of intervention is wider. The main activities of the first group of organisations centre around sensitisation, training, back-up support for AIDS patients or those affected and advocacy.

The second group of the organisations invests in other health care programmes (family planning, reproductive health, maternal or child health), as well as in such other sectors as the environment, economy, the spiritual and more generally, in the promotion of the women's status. The field of interventions can be summarised as follows:

Health

· Education on STD/AIDS prevention
· Provision of medical and psycho-social care
· Reproductive Health IEC HIV/AIDS
· Family Health, Family Planning
· Maternal and Child Health

Environment/Development

· Education on the environment
· Literacy, health, economy
· Rehabilitation of slums, Reforestation
· Water resources

Rights, Citizenship and Advocacy

· Promotion of rights
· Education For Citizenship
· Program against violence on women
· IEC On the right of women
· Civic Rights and Responsibility

Economic Empowerment

· Training and education for development
· Training in Savings and credit management
· Handicraft, agriculture, cattle fattening
· Fight against poverty

Spiritual Approaches

· Facilitation and support for women in their religious and social endeavours.

Target Groups

Women, girls, the youth, whether in school or out-of school, constitute a common target of the two types of organisations. Organisations exclusively involved in HIV/AIDS have proposed a greater variety of targets based on their support activities for people living with HIV, as well as in the mobilisation of community leaders and other people in some social and professional categories.

With regard to illiterate and neo-literate women, the quasi-totality of the organisations already include them among their targets, in which they represent a proportion varying between 50% to 90%. The age brackets are very wide, most often ranging between the age of 15 and 70 years. However, particular attention is devoted to young people aged 15 to 25 years.

Target Groups of Specific Organisations:

· Women and girls in pen-urban and rural areas, either within organised groups or in high risk situations;
· Pupils and female Students;
· Young adolescent girls.
· Persons living with HIV/AIDS
· Prostitutes and their clients;
· Leaders and Policy makers;
· Men and women of the community;
· Organisations and individuals involved in projects;
· Police, social and judicial workers, traditional and political authorities.

Target Groups of non-specific organisations:
· Socio-professional female Groups (seamstresses, dyers), women's associations, village women organisations;
· Young female students, girls;
· Some men;
· Porters;
· Prostitutes.

Internal Structure (Organigramme)

It is generally composed of three to four levels: level of orientation/decision, level of execution and operational level.

For about 45% of the organisations, the level of orientation/decision is handled by a deliberating assembly (general assembly, Synod, Convention...) with decentralised membership based on areas of intervention (regional or provincial commissions). In the other organisations, the orientation/decision post is occupied by a chairwoman or a female co-ordinator.

The level of execution generally involves several units of intervention, led by the chief of programs. The number of units as well as their tasks vary according to the domains of intervention.

The operational level has to do with field operators. It is made up of either grassroot community groups (village groups, associations) or community relay teams, peer educators, or even active members of organisations (voluntary women, project assistants, field teams). Whatever the composition, this operational level has, in all organisations, benefited from basic training related to field activities. This training has more often been organised in batches (training of trainers, field training) generally by IEC experts of the National AIDS campaign Programs, as well as by those from some national or international NGOs (INTRAH, AMPPF, AIDSCAP).

In the field, 60% of the work of the supervisor in most cases consists of co-ordinating activities and implementing programs according to the established plan. In some cases, however, they directly play the roles of animators and facilitators on the occasion of awareness-raising meetings.

ACTIVITIES ON EDUCATION FOR HIV/AIDS PREVENTION

Areas of Activities

The activities of the HIV/AIDS prevention education are made up of training, sensitisation, support and care, advocacy and various other types of activities associated with the development of aids, research and networking.

Training

· Training of members;
· Training educational peers;
· Training in counselling, communication skills and self-assertion;
· Training of trainers (capacity building);
· Vocational training and post vocational support;
· Training of traditional birth attendants.

Sensitisation

· Educational discussion, conferences, round table meetings;
· Marketing of subsidised condoms;
· Advocacy and awareness campaigns on HIV/AIDS.

Support and Care

· Taking charge of infected people;
· Advocacy for infected women and the affected;
· Home care during terminal phase
· Assistance to people living with HIV through micro-projects;
· Income generating activities.

Advocacy for the protection of the rights of women

· Advocacy for women empowerment;
· Centre for women in distress;
· Legal support;
· Promotion of women.

Miscellaneous

· Designing materials/aids;
· Collection and dissemination of information;
· Catering for STD patients;
· SR for teenagers;
· Networking and partnership.

Teaching/learning support and channels of communication

Major types of support materials

The most commonly support materials used are the graphic ones (folders, picture books, and posters) and audiovisual materials (video films). The demonstration on the utilisation of the condom with the help of model penis seems very common. On the other hand, fewer space is devoted to the theatre and plays. Most of these aids are either produced by the organisations themselves or by the national partners (Ministry of Health, national HIV/AIDS Programs) with the financial support from international partners.

Traditional support systems

The quasi-totality of organisations think that some of the messages designed for HIV/AIDS prevention can be transmitted through objects in use in daily life (cloth/pottery, etc.) and by so doing induce discussion, ease taboos and help as constant reminder. Several suggestions have been made to this effect:

· Weaving of loincloth with drawings showing the modes of transmission or signifying death and captions in the national language;

· Illustration of an AIDS patient by using an art object (clay),

· Tee shirt, loincloth, caps, gadgets but also songs, sketches and theatre;

· Training in tie-dying, batik and sengraphy using educational images on AIDS;

· Pottery, arts, plates, hand bags and market bags

Channels of communication

In close to two-thirds of the cases, research has been conducted to identify the most appropriate channels of information for the various target groups. The main methods used were:

· The organisation of proximity awareness meetings, talks (focus group) with the various men and women age groups in the villages,

· Baseline surveys and evaluation of target groups' needs;

· Personal contacts, family visits,

· Seminars and group discussions,

· Peer education.

Peer education is often highlighted as one of the best channels of communication (women-to-women, youth-to-youth, men-to-men) Further-more, dramatic activities seem to be more appropriate for illiterate people, out-of-school young people and those in rural areas, while video and play activities are appreciated by young people in school. The media as well as the traditional communicators (griots) are sometimes cited.

Designing and developing programmes

Close to 90% of the organisations have carried out preliminary studies before the preparation of the educational programmes. The methods often used are:

· The MARP (Participative Rapid Appraisal);
· Baseline surveys of KAP in associations, in urban and rural schools;
· Hospital statistics;
· EDS research reports;
· Door-to-door.

Those who did not first carry out an initial assessment, prepared their program based on a community initiative which spontaneously highlighted the needs. Some organisations, however, conducted initial studies but in domains other than HIV/AIDS.

On the other hand, only 35% of the organisations conducted final or midterm assessment of their programs. In most cases, it was participatory self-assessment with leaders of focus groups to assess the impact of the messages. Some external evaluations were, however, undertaken by the research institutes, international NGOs and universities, the UNAIDS and co-operation agencies.

Evaluation

These assessments resulted in the adaptation of strategies and orientations, messages or the educational materials. The results of the surveys have also been used for the:

· rectification of sketches, based on the suggestions of resource persons in theatre and the target group.

· inclusion of women teachers in target groups of the project destined only for mothers and their girls.

· production of materials in vernacular language with reinforced graphics

· modification of the time chosen for intervention as well as the subjects discussed at meetings.

· developing more specific themes such as negotiations on the use of the condom, relationship between STD/HIV.

MESSAGES

General Features

There is a large predominance of the tripod of "abstinence - fidelity -condoms". These topics are however, arranged according to targets. Abstinence and fidelity are especially destined for young school children, with an orientation toward condom use for non-school going youths. Fidelity and use of male and female condoms are advocated for couples. For young girls, emphasis is placed on protective behaviour vis-a-vis premature sexuality. The wider pubic is especially provided with information of a general nature on AIDS, the modes of prevention, risky behaviour, family and sexual health and promotion of AIDS tests.

Teenagers

· Abstinence and fidelity for teenagers and young persons especially in school environments;
· Condoms for out-of-school youth;
· Stopping sexual exploitation of children.

Couples

· Reciprocal fidelity;
· Use of male and female condoms for married couples.

Young Girls

· Choice of a faithful partner;
· "I love my body";
· "Young girls you have the right to say no"

Persons Living with HIV

· Solidarity with persons suffering from HIV/AIDS;
· Adopting the right attitude towards infected people.

The Wider Public

· Adoption of risk-free attitude to sex;
· Definition of AIDS and modes of prevention,
· Family and sexual health;
· Sexually Transmitted Diseases;
· Promotion of AIDS testing and diagnosis.

More Specific Features

The gender approach

Close to the two-thirds of the organisations assert that they take Gender into account in the preparation and dissemination of educational messages. The biological and socio-economic vulnerability of women in addition to the fact that sexual intercourse is forced on women often justify this approach. But concern on the need to raise the level of risk awareness should also be taken into account so as to encourage men to show greater respect and protection toward women.

The approach goes beyond mere dissemination of the message. Some organisations are involved in overall promotion of women in order to achieve greater balance of power between men and women. Concretely, it can boil down to efficient management of homes by both men and women such that each and everyone has the opportunity to attain their full social, moral and economic potential. The most relevant strategy to achieve this objective consists in organising awareness workshops on Gender, to encourage women and men to first think separately then to discuss together.

The gender approach is not, however, universally applied. Some organisations believe that only women should be involved considering the fact that they are composed of women specifically. For others, men and women run the same risk of contamination. Promotion of methods of prevention familiar to women such as the use of female condoms is another reason adduced to reduce the emphasis placed on male condoms for too long.

Dialogue

The majority of organisations encourage couples, parents and/or children to discuss these issues related to sexual health. Two types of methods are used:

· peer education that encourages dialogue within the same age-group (IEC program "children-to-children" in schools, sensitisation "Parents-to-parents");

· the introduction of programs based on communication workshops which encourage dialogue between various age-groups (mother-to-daughter, parents-to-children).

Promotion of risk-free sex

Sexuality among the youth is a subject which has been widely integrated by the organisations. Starting from the notion that the youth are sexually active but immature, they have some specific needs in terms of prevention. The role of elders as models of good behaviour is also recommended. Some indications testify to this preoccupation, for example, the presence of young animators in the organisations, and the holding of public meetings without distinction of sex among youth organisations.

Issues associated with casual sexual relations outside marriage are also incorporated by organisations. Several types of strategies have been put in place, among others:

· Emphasis on spiritual precepts: "God and the Church condemn sexual relations before marriage known as fornication while the extra-marital sex is termed adultery";

· Sensitisation on the risk of social stigmatisation faced by women, a risk that does not weigh as much on men.

80% of the organisations hold the view that their program strengthens the capacity of women and men to negotiate in risk-free sexual relations. This opinion is based on the specific experiences of training in sexual relations negotiations especially with prostitutes. Furthermore, among couples, women are encouraged to discuss and use contraceptives. In a similar vein, women gain more confidence through specific training programs on self-affirmation and the capacity to communicate, and by strengthening their economic independence. Besides, some indicators give an idea on this change through the ability to convince husbands to use the condom, confidence and freedom to speak in public on these issues.

Rape and sexual harassment appear to get less attention from the organisations. Less than two-thirds of them tackle these problems, either by setting up specific programs (Program against violence on women, periodic seminars on the prevention of rape in homes and places of work), either through mobilisation and advocacy (support to young women victims of sexual harassment, wide-scale mobilisation against proven cases of rape and testimonies of victims). Sensitisation on the risks of AIDS associated with rape and on the rights of women, is among the applied strategies.

CONDOMS

Accessibility to male condoms is encouraged by almost all the programs without distinction of sex. Distribution at the community level, free distribution especially among target groups (prostitutes, young people), or the orientation of people toward sales outlets or distribution points promote easy access. On the other hand, femidon remains an object of curiosity or for experimentation in many countries, whereas it is available at affordable prices in certain regions of the continent.

The majority of organisations (83%) feel they provide answers to the problems associated with the use of condoms by both men and women. There is a wide variation in the methods employed: campaign against false notions on the use of condoms, sustained promotion of the condom, group discussions and workshops as well as forums attended by the two sexes are among the advocated methods.

Training on the use of the condom almost always concerns men and women. The latter often play the role of contact-person within homes and in their community and most educational sessions end with a demonstration on how to use condoms. The use of drawings and posters seems to be a good way of conveying messages on this topic. Some organisations, however, have complained about the difficulties they encounter when meetings are organised simultaneously for the two sexes.

SUPPORT FOR PERSONS LIVING WITH HIV/AIDS

Organisations working exclusively on HIV/AIDS say they provide support for persons who are HIV positive so that they can live positively with HIV/AIDS. They achieve this mainly through sensitisation on the need for solidarity and non-rejection of sick persons as well as by undertaking some psycho-social work (listening to persons, support, food and medical support, income generating activities).

The few organisations of this type that do not initiate support activities have said that they require improved training to meet the needs and that they collaborate with those more experience in the meantime. The formulation of messages seems in most cases to take into account the needs of infected people. Avoiding such words as "victim", dissociating HIV/AIDS from the mode of living, sessions on the needs of infected persons are some of the ways of reducing discrimination and creating an environment of solidarity and compassion around such persons.

PROSPECTS AND EXPECTATIONS

The organisations have expressed their needs regarding the improvement of their programmes and as regards the workshop.

Immediate Requirements for Improving Prevention Education Programmes

These can be classified as follows:

· Need of adapted materials/aids which can be used easily by the illiterate women while conveying the appropriate messages;

· Needed expertise for more judicious evaluation of needs, more adequate planning, better approach to new techniques and to the concept of gender;

· Material needs: audiovisual, teaching aids, logistics;

· Financial Needs.


Expectations from the workshop

Strategic and operational requirements/or:

· strengthening of prevention education activities among female groups;
· change of behaviour particularly at grassroots level;
· identifying key issues to be considered mainly for the youth;
· efficient communication strategies for women and the young.

The need for research on:

· the role of culture/tradition on HIV/AIDS prevention education;
· influences of social norms and especially the gender imbalance on the implementation of prevention programs;
· effectiveness of peer education within the programs;
· role of community educators in the anti-HIV/AIDS campaign.

Strategic needs associated with the status of women in order to:

· reinforce the power of women and the youth;
· protect women against risky-behaviour (prostitution);
· reinforce the rights of women (access to resources and inheritance),
· understand the relations between tradition, status of women and HIV/AIDS prevention,
· ensure the sustainability of activities led by women,
· promote education to self-help,
· promote the use of female condoms

Support to infected persons

· Setting up of monitoring and counselling centres,
· More positive support for the sick by the society

CONCLUSION

Female vulnerability to HIV/AIDS is no longer in doubt According to WHO, it even seems as if female seropositivity is likely to become one of the major challenges of public health in the coming years Numerous activities have been initiated for the benefit of women, to protect them against infection sensitisation, training, skills acquisition or more globally, promotion of the status of women, are among the responses provided to various degrees by the women's grassroot organisations At this stage of the evolution of the epidemic and knowledge about it, the objective has, in fact, gone beyond the mere dissemination of information to create a real perception of risk likely to lead to the change of behaviour To this effect, the recommendations of the UNAIDS are, among others, to support the development of prevention programs that provide the messages and the appropriate skills as well as support services destined for both men and women including the marginalised or those who are difficult to reach These programmes should lay emphasis on the importance of condom use and on the mutual responsibility of men and women to adopt safe sex practices It has also been recommended that these programmes be integrated in other community development activities such as literacy and income-generating activities.

CHAPTER 4: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: GENDER APPROACH

by Femi Nzegwu
(Doctor in Social Sciences, Counsellor in Gender and Networking, Regional Project on HIV and Development for Sub-Saharan Africa, UNDP)

HISTORICAL AND CONTEMPORARY UNDERSTANDING OF GENDER

The concept of gendensed roles in Africa is not new In every sphere of social activity, over the ages, across varying political economies on the continent, Africans have been conscious of ensuring the codification and operationalisation of clearly defined role patterns by sex. This is seen as a means of establishing a complementary social order in which all of society participate, and in which conflict is minimalised There is an acknowledgement of the differences in the range of abilities between the sexes, and the need to ensure that these abilities are appropriated and optimally utilised for the well-being, progress and development of society. This is evident within marriage and child rearing, in the selection of occupations, during periods of social crises, etc.

Just like other dominant features of African contemporary life (the State, Governance, the Economy), the understanding of gender relations has been informed primarily by intellectual and cultural traditions external to the African experience. Today what often characterises the discourse on gender roles in Africa is mis-information and unduly emotion, quite often equating gender roles with women's disempowerment and/or men's oppression of the latter. On the contrary, Africa's historical experience shows that genderised roles did not necessarily place women at a disadvantage in society, socioeconomically or politically. The marginalised position in which many African women find themselves presently, is in contrast to a historical experience and culture that recognised and valued the contributions of women to the development and advancement of their societies in pre-conquest times. The lack of equity and equality which the vast majority of women experience in contemporary Africa is a result of the marginalisation and loss of political power that has since occurred, and the resultant lack of control over decisions that directly impact on their lives, the lives of their families, and their communities as a whole. That the positive components of roles of women and men have become marginalised is a tragedy of Africa in the current age. This inhibits our capacity to understand both the evolution of what presents today as genderised roles as well as develop solutions to problems in which gender disparities are implicated. Nowhere is this problem more clearly demonstrated than with HIV/AIDS. Here, there is a crucial need to understand how gender roles and gender disparities, as they present in present day African society, affect women's and men's capacities to respond effectively to the impact of the epidemic - personally, within families and communities.

The greatest challenge confronting Africa today is that of meeting the basic socioeconomic needs of the people of this continent. Indeed, one of the primary factors which, if achieved, will minimise the spread of HIV/AIDS is economic independence. The capacity to cater for one's economic needs is crucial to any attempts at economic and health security. In contemporary Africa, the pattern of gender disparity is rooted firmly in economic disparity ostensibly supported by "culture". The fact is that the vast majority of Africans have limited, indeed minimal access to utilising the resources of society for their own development. However, given the central role of the African woman in providing for and supporting that essence of African existence - that is, the African family - deprivation for her has far reaching ramifications. Within the scenario of near-universal deprivation which exists across the continent, gender disparities do exist, making deprivation for women even more acutely and more widely felt. Faced with extremely limited options, many young women (and men) who lack the opportunities and means to employment needed to provide for their basic needs and those of their families, increasingly view sex work (including the "sugar-daddy" syndrome) as the most available means of readily generating desperately needed funds. This exposes women to a host of health problems, most notably HIV/AIDS. The process of gender and therefore economic disparity is traceable to early childhood. There is a tendency in African societies to discriminate against girls in the area of education, with regard to both access to education and the scope/variety made available to girls. Consequently, girls do not often benefit from the variety of specialist training and job opportunities for which they may be eligible. A number of contributing factors have been identified. These include:

· Parental and societal attitudes towards the education of children which favour financial investment in boys over girls;

· Early marriage by girls and pregnancy;

· Heavy reliance on girls for domestic duties;

· Gender biases in employment and training; and

· Limited visibility of educated women in influential positions.

Within the home setting, parents and the community need to be supported to play the central role in positive gender socialisation. This should include the promotion of mutual respect in boys and girls, greater understanding of their respective sexuality and the responsibilities as well as the rights which should fundamentally define the onset of sexual activity in both boys and girls. Furthermore, socialisation should promote the growth of non-violent modes of conflict resolution within relationships, and in the greater community as a whole. Out-of school youth strategies are also needed to develop schemes which promote equal access to vocational skills and employment opportunities for boys and girls.

THE HIV REALITY

The topic, as described above, invites us to interrogate, assess and understand the position of men and women within the evolution of HIV/AIDS epidemic - both in terms of how it has impacted upon them and how they have responded to it. It further compels us to examine how individuals, families, organisations and communities can assist the creation of an environment that supports the respective role that women and men, individually and collectively, have played and continue to play in ameliorating the impact of the epidemic on their families and communities. This allows us to examine practical and effective means of providing general public but also group-specific education and information on preventing the transmission of HIV/AIDS.

Two questions need to be posed? What are the current roles carried out by men and women which appear to facilitate the spread of HIV. Second, in response to the HIV crisis, what aspects of African traditional, seemingly marginalised gender roles can be drawn upon and strengthened to address this crisis. It is clear that any attempts to largely impact upon the debilitating spread of HIV across the continent will need to focus on the relationship between the family - the bedrock of African socioeconomic existence - and the community at large. This focus must centrally involve families in three respects:

· Frank discussion between husbands and wives, children and the supportive extended family about the prevention and/or in the presence of infection, short, medium and long-term emotional and financial support to family member(s).

· Open and informed discussion about those cultural/sociological practices which reinforce gender disparities and place women and by implication men and the society at large at incalculable risk.

· Strengthening the economic capacity of families to make provision for their needs and those of their families, in the immediate and long term.


Women comprise the largest group of those infected and affected by the HIV virus on the African continent. According to UNAIDS there are over 20 million people living with HIV/AIDS in Africa, over half of whom are women. Additionally, over half the infections take place in young women and men between the ages of 15 and 24 years. Women are disproportionately affected by this epidemic both as those infected by the virus and also as carers of those infected and affected by the virus. Yet, it is clear that attempts to optimise the health status of women and to minimise the spread of HIV/AIDS can only occur within the context of a committed and supportive male population. Without a male population that understands the issues, and thus directly contributes towards the creation of an environment which is supportive of women in their quest for greater control over their lives and destinies, success in limiting the spread of HIV will remain very limited.

Two critical factors require consideration. First, what are those social/cultural elements (which we recognise can vary greatly from one community to another) which put women, in particular at risk of exposure to, and infection by the virus, and what are those elements that strengthen their capacity to effectively protect themselves and their communities from the virus? Secondly, what activities have women and men undertaken, drawing on their respective biological and cultural heritage, to address the impact of the epidemic in their communities? How can these be strengthened?

Issues such as the rights of women within marriage, the complexities of polygynous relationships within the HIV/AIDS context, inheritance laws, sexually exploitative employment and business relationships, etc, immediately come to mind. What indigenous structures exist that address these issues? How can these be drawn upon/strengthened/modified to create a more protective and enabling environment for women? There are political and economic structures created by women and men (albeit less powerful in contemporary times) in many African societies which exist and operate independently of either sex, to ensure the preservation of their own unique interests. These entities have been known to undertake sociopolitical/economic action whenever it is perceived that the well-being of women is potentially threatened. Examples of these range from the more dramatic, ever inspiring "women's war" among Igbo women (eastern Nigeria) in the 1920s, to contemporary structures which oversee the affairs of women in their community, undertaking activities such as the institution of sanctions in cases of wife-beating and other irresponsible/detrimental behaviour by the men in their society, economic and psychological support to bereaved members of their society, initiating town/village meetings to discuss issues of particular importance to women and their children in the society, etc. To what extent have these structures or others which similarly provide support to women been explored as a very real avenue for presenting and discussing the issue of HIV/AIDS?

Women who are often at the forefront of remarkable communal activity know only too well the potentially disastrous impact which an unchecked/unaddressed emergency such as that of the HIV pandemic can have on their lives and that of their children. Women understand that the initiative to take some action to minimise, indeed halt the transmission of HIV by obtaining the full understanding and co-operation of their menfolk lies primarily with them. The extended family is one of Africa's greatest assets. It is predicated upon a mutually reinforcing network of individuals committed to the well-being of their families and communities. Out of these close-knit family systems that characterise local communities, flows a level of mutual support that will be crucial to any attempts at societal reconstruction in Africa. How these existing networks of people are transformed into vehicles of information dissemination and education, is one of the key challenges that faces HIV/AIDS service organisations in Africa today.

THE REQUIRED RESPONSE

It would appear then that the task for government and non-governmental organisations alike is to clearly articulate the needs of women, men and children within the context of HIV. Furthermore, it seems that both government and non-government bodies must tap into an existing indigenous base in order to ensure that any action is firmly rooted in the culture, always evolves locally, and always responds to a very specific and sociocultural identity. It seems that all of society needs to become a powerful advocate for the rights of women, raising, particularly in the wake of HIV, a number of pertinent issues:

· How can governmental and non-governmental organisations, place on the political agenda those issues (not necessarily HIV-related) that clearly violate the most fundamental of women's human rights -whether these women be persons living with HIV/AIDS or not?

· How can these groups become a vehicle, indeed spearhead the move (working in conjunction with other international bodies) to introduce into popular debate (e.g. African traditional socio-economic, political and legal structures/radio/TV/print media, women's and men's groups, the school system, etc.) the need to amend/revoke those situations or laws (whether western or African) which, singly and collectively, contribute to the creation of a disempowering, indeed debilitating environment for women, and by extension the entire society as a whole? At the same time how can these organisations use their forums to commend and publicise the tireless efforts of women and women's structures/organisations which admirably continue to create change and progress often under very difficult circumstances?

· How can we harness and build on African traditional systems to create an environment which empowers women and men to take greater control of the economic destinies of themselves and their children?

· What strategies can be used to promote the economic empowerment of women and young people to enhance their life opportunities while protecting their reproductive health and rights?

· In many African countries, community-based action is at the front-line of the struggle against HIV/AIDS. These respond to the specific needs of communities and, wherever possible, play an advocacy role for a re-evaluation of structures and systems that impede societal development and therefore facilitate the easy transmission of the disease. How can these community structures and efforts be strengthened?

· The vast majority of African ministries of education do not have in place and/or are not implementing policies which enhance gender equity and equality within and outside the classroom. Schools must be central in de-constructing the process of gender socialisation which restrict the academic/creative freedoms, life and health opportunities for girls and boys. How can ministries of education be made to become more accountable to creating gender-responsive situations in the entire educational system?

· What strategies should be developed to equip boys and girls with accurate information on sexual and reproductive health and life skills which will prevent early sexual activity, foster self esteem, positive gender relationships and shared responsibility?

· African countries currently allocate to the health and education sectors less than 5% of their GNP. How can society advocate for a reallocation of national resources to the health and education sectors to ensure maximum investment in society's human resource development and well-being?

The task of reconstructing society lies with harnessing the collective positive energies which define the socio-political and financial structures that characterise the society in question. These entities are existing channels of communication, wholly indigenous to the people which can serve to educate the vast majority of society on virtually every aspect of contemporary life, including HIV/AIDS and the collective (male and female) effort that must define any attempt to halt the spread of the epidemic.

REFERENCES

1. Herbert Ekwe-Ekwe and Femi Nzegwu, Operationalising Afrocentrism, (Reading: International Institute for African Research, 1994).

2. I. Amadiume, African Matriarchal Foundations: The Igbo Case (London: Karnak House, 1987).

3. J. Van Allen, 'Sitting on a Man: Colonialism and the Lost Political Institutions of Igbo women Canadian Journal of African Studies, Vol 6, No.2, 1972.

4. Adu Boahen 'Colonialism in Africa: Its impact and significance in Boahen, ed., UNESCO General History of Africa: Vol. VIII (Paris/London: Heinneman Education Books, 1985).

5. UNAIDS Web-site, unaids.org/unaids/ppt/report 97.ppt.

CHAPTER 5: PREVENTIVE EDUCATION WOMEN AND HIV/AIDS IN AFRICA: ADAPTED TOOLS AND MESSAGES

By Lillian K.S. Chigwedere
(Psychologist Independent Consultant, Harare, Zimbabwe)

The exchange of experience between the organisations show that the main messages deal with abstinence, fidelity and the use of condom. For the messages to induce among women, especially at the grassroot communities, the change in behaviour aimed, a favourable socio-cultural, economic and juridical environment is necessary. The mutations must also rest on the heritage of the leaders who are supposed to be role models for change even if the benefits of the African culture have been reduced with the introduction of exogenous factors resulting from the pseudo-development of the African countries.

Therefore, the objectives of this chapter are to:

1. critically analyse messages and tools that have been used so far in the HIV education programmes by the various organisations in relation to their sensitivity to gender and the needs of HIV positive people.

2. Suggest a list of messages and methods that are gender sensitive and appropriate to the needs of seropositive people.

3. Suggest appropriate materials for use at grassroots level.

It is therefore expected that the participants will be ready to develop appropriate messages and tools for use in their efforts to help grassroots women minimise the spread of the HIV virus and protect themselves against HIV infection.


Types of messages and target populations

Many of you asserted that you take gender and seropositivity into account in the preparation and dissemination of these messages.

GENDER

Gender refers to widely shared ideas and expectations (norms) about women and men. Ideas about feminine and masculine characteristics, abilities, expectations about how men and women should behave in various situations. These ideas and expectations are learned from families, friends, opinion leaders, religious leaders, workplace, media, cultural institutions and schools. They reflect and influence the different roles, social status, economic and political power of men and women in society (SAFAID & WHO, 1995).

SEROPOSITIVITY

Seropositive refers to people who are HIV positive i.e. they have the HIV virus in their body.

Summary of Gender and seropositivity

- Question: What are some of these norms and ideas as far as communities in your countries are concerned? List

- How appropriate are your messages? Are they gender sensitive?

- " Is it possible to have gender and seropositive sensitive messages and tools to reduce the vulnerability of both men and women to HIV infection? Yes/no. If yes HOW?

DESIGNING MESSAGES

Criteria

- Target group

- Objective/goal/purpose

- Appropnateness i.e. language, perceptions, connotation (discriminating, blaming, threatening, preaching, moralising)

- Enabling/empowering/realistic i e Does the message give the individual the skills to be assertive enough to act?

- Vehicle of the message - how is the message going to be presented to the target group.

The strategies

These may be short term or long term.

Short term - this is probably what your organisations are currently involved in. Indeed the process of change begins by awareness which includes provision of accurate information about HIV/AIDS, access to health education and access to means of protection. An analysis of responses to the pre-workshop questionnaire shows that most of your organisations' activities are designed to fulfill this short term objective.

Long term - However as has already been discussed, the vulnerability of women to HIV infection is closely linked to cultural and social factors. A study by Mwale & Burnard to gain insight into the perceptions of rural women in Zambia regarding HIV/AIDS confirmed this assertion as most women interviewed concurred that:

- There is a need for not only women but men as well to be taught the true facts about HIV.

- Cultural and traditional practices are a cause of concern regarding the spread of HIV.

If these issues are not addressed we may be chasing a dead horse. What organisations need to do now is to move a step further and embark on strategies that are directed at changing ideas and patterns that inhibit both men and women from acting and engaging in risk reduction in behaviours. The messages and tools that are used should therefore be realistic, practical, appropriate and enable an individual to act upon them (assertiveness).

Exercise 1

1. Let's examine some of the messages that your organisations have used so far. List all messages on flip chart and analyse each one for gender and seropositive sensitivity.

2. How can the messages be modified to make them sensitive?

3. What tools are best to effectively and appropriately make these messages work?

Stumbling blocks to assertiveness:

- Fear of retaliation
- Lack of knowledge of assertiveness
- Belief that 'I don't deserve to be in control'
- Fear of being labelled
- Fear of stirring up anger
- Fear of losing friendship.

These are genuine fears and unless one receives help in the form of training, it becomes difficult to even think about change. Thus as you work on various messages and tools bear in mind this very important element in the process of change. Perhaps future workshops need to focus on assertiveness training so that co-ordinators can effectively help grassroots women to protect themselves against HIV infection and other forms of abuse.

Exercise 2

Instructions:

1. ALL participants stand up.

2. Each participant take a position in the room which approximates the position of your country on the imaginary map of Africa in the room.

3. At the top of the card in front of you, write your country's name.

4. Draw a large square on the left comer of the card and a large circle on the right comer of the card.

5. In the square estimate the number of males known to you to have AIDS or have died of AIDS; similarly in the circle indicate the number of females known to you to have AIDS or have died of AIDS

6. Now bring your card and paste it on the appropriate position on the map of Africa on the chart.

Exercise 3

Discussion:

- What in your country do you see as making women vulnerable to HIV infection?

- Relevant elements on messages.

- Most commonly used materials: graphic ones as posters, picture books, T-shirts, caps; audio visuals ones as video films, models drama, also stories song, poems, games, puzzles.

- Target groups (youth, men, illiterate in rural areas, out of school youth).

Other tools suggested: Cloth, Pottery, art objects, T-shirts, caps, mugs, kitchen utensils, etc. Objective being mainly to link these with the ultimate goal of inducing behaviour change:

- Open channels of communication
- Bring about awareness of impact of tradition and beliefs.
- Present the pros and cons of the past
- Present the pros and cons of the present

Methodology

1. Presentation of objectives

2. Summary of messages currently used by various organisations

3. Analysis of these messages for gender sensitivity as well as sensitivity to the needs of people living with HIV

4. Brief summary of criteria for designing of messages

5. Listing of appropriate messages

6. Refinement of messages

7. Interpretation of selected messages into graphics and radio programme

8. Presentation of final product of the: (a) Graphic messages; (b) Radio programme.

Process of change

- Insight, awareness
- Self-analysis, analysis of situation
- Positives negatives
- Options
- Action (behaviour).

From a teaching point of view:

- Labelling bad behaviour entrenchment
Successive reinforcement, improved behaviour
Reverse psychology, improved psychology
Messages employing positive elements bring about more positive behaviours.

- Power to change lies within the individuals to make appropriate decisions that improve their situation.

I. Results of the workshop

An analysis of the experiences shared by participants at the workshop points to the need to focus on programmes more heavily on:

· Behaviour change activities - all organisations are and have been involved in intensive HIV/AIDS awareness and education programmes, but all concede that this has not been enough to bring about behaviour change

· Gender sensitisation programmes - the concept is vaguely understood by many, both men and women

· Research and documentation - there is always talk of positive and negative factors in the various communities, that impact on behaviour change, what are these and how can they be incorporated into HIV prevention programmes?

· Seminars and workshops for men - there seems to be very little focus on this group, yet their behaviour plays a major role in the success of HIV prevention programmes

· The family - the African family is in a state of crisis. Dialogue is needed to encourage openness among family members

· Politicians, religious and community leaders - whatever efforts grassroots women's organisations put into the fight against HIV, unless they are supported by community leaders, they are likely to fail

· Intensive training - women need assertiveness and communication skills to help them stand up for their rights and avoid risky behaviours

· Sensibilisation seminars - these are important in familiarising women and communities with human rights including women and children's rights

· Open dialogue - men and women need to have open discussions on pertinent social issues including sexual issues

· Media programmes - the media can be a powerful instrument for behaviour change. Assisting development of grassroots print or radio education programmes would facilitate the change process.

At the end of the workshop, the following recommendations were adopted:

1. To Decision-Makers

· Better involvement of political, religious and traditional decision-makers for reducing HIV/AIDS transmission in Africa

· Effective implementation of laws concerning the basic rights of women

· The involvement of women in decision-making for better gender balances in order to achieve harmonious and sustainable development.


2. To Grassroot Women Organisations

· the strengthening of the skills of women at grassroots level especially through promoting functional literacy programmes

· the intensification and dissemination of appropriate messages on HIV/AIDS Prevention Education in the different national languages

· the popularisation of the rights of women at grassroots level

· advocacy with governments, political decision-makers in order to implement the rights of women

· support and encouraging of open discussion on the impact of traditional practices on the health of the population, particularly women

· the setting up of a mechanism for co-ordination and exchange of information and experiences between NGOs working in the field of HIV/AIDS Prevention Education

· the promotion of the image, self-esteem and self-confidence of women in rural areas.

3. To Funding Agencies

· Support for income generating activities for women at grassroots level in order to alleviate poverty

· the funding of actions identified during this regional workshop in order to implement them in the short term and undertake monitoring and evaluation.

Developing communication programmes, using traditional channels and local radio stations for NGOs at grassroots level in order to convey prevention messages appropriate to illiterate and semi-literate women.

In order to ensure follow-up to the workshop, UNESCO Harare and UNESCO Dakar Offices, in co-operation with the consultants agreed to produce and disseminate the final report on the workshop and to design, produce and disseminate the guide on the graphic illustration and the radio programme.

II. List of participants/organizers/facilitators

Benin: M. Chidjou Taofickou, ONG Femme Initiative Dloppement. Botswana: Mandisa Segwagwe, AIDS Action Trust. Burkina Faso: Ouedraogo Clntine Rosalie, ONG Promo Femme/Dloppement Sport. Cameroun: Mofor Teugwa Clotilde, Association Fnine de Lutte contre le SIDA. Cap Vert: Maria Luisa Texeira. Cd'Ivoire: Kon Sanogo, Association de Soutien 'auto-promotion sanitaire urbaine; Dorothsso Toualy, ONG Renaissance SantConstance Yai, Dnse des Droits des Femmes; Odette Eiger, ONG Femme face au SIDA; Awa Sylla, Consultante IEC/Formation, Evaluation; Vale EkouRadiodiffusion, Mrs. Jeanne Kouame, personne ressource. Ghana: Margaret Osei, Woman's Ministries, Director Seventh Day Adventist Church. Guin Bintou Bamba, ONG ASFEGMASSI/SWAA. Malawi: Esther Munthali, Co-ordinator Ekvendini Mission hospital. Mali: Traoratou Diaw, Projet Association d'Aide et Appui aux Groupements; Youma W Diallo, coordonatrice des projets (3AG). Namibia: Monika Shikongo, AIDS Care Trust. Nigeria: Iwalola Onifade, Youth Empowerment Foundation; Hannatu Bororo Musa, Ministry of information, home affairs Sport and culture, Yakubu Gorson Way Casa-Campaign Against Spread of AIDS. Togo: Akouvi Fifonsi. S. Dossou, ONG Force Action pour le mieux e de la M et de l'Enfant. Sgal: N'D Dieumb Diagne, Association pour la Promotion de la Femme Sgalaise. Uganda: Brice Lubega, AIDS Widows Orphan Family Support. Zambia: Fcia Sakala, YWCA. Zimbabwe: Barbara Dembedza, Women and AIDS Support Network.

UNESCO-Dakar: Nathalie Barboza, Point Focal EPD; Zeynabou Gu, Interpr; Diomansi BombotOPI; Justin Adjanohoun, Assistant Administratif. UNESCO-Abidjan: Lucette de Andrade Diawara. UNESCO-Harare: Mina Koroma, Programme Specialist; Patricia Koster, associate Expert. PNLS Sgal: Karim Seck, Consultant/Spaliste. Lilian Chigwedere, Consultant/Preventive Education Training, Harare. Projet regional PNUD/VIH/SIDA/Dloppement: Brigitte Quenum, Conseiller en rnse communautaire; Femi Nzegwu, Responsable Genre ONUSIDA: Agathe Lawson, CPA.CO/ONUSIDA; Dr. Boni Nicole. Graphist: Mr. Dan Nguessan (Cd'Ivoire).