Health and HIV/AIDS prevention
WHO, like UNICEF and other organisations such as UNFPA, has
espoused a community-based approach to the problem of low-income urban groups
for many years. Its principal strategy for this work is emphasis on Urban
Primary Health Care (PHC), which draws upon many of the same features as the
regular rural PHC approach. The principles for community participation are
similar to the ones described above. Aside from the difficulty of securing
community participation in health-related work, there is a further issue which
complicates this work, and the lives of low-income urban groups: the epidemic
spread of the HIV/AIDS virus in developing countries. Awareness of the magnitude
and socioeconomic impact of this pandemic has grown only recently.
According to WHO estimates of the 20 million people worldwide
infected by the human immuno-deficiency virus (HIV), about half of them are
expected to develop AIDS within the next few years. Almost 85% of these people
live in urban areas. Studies show that low-income urban groups are particularly
vulnerable to this virus.
While women and men are affected in almost equal numbers, HIV
prevalence is higher among women in the high fertility 15-20 age-bracket. Infant
mortality rates rise sharply through infected mothers and foetal transmission.
The impact of HIV/AIDS on low-income groups is disastrous. The most productive
adult members are the first to disappear, and the economic burden on survivors -
particularly orphaned children and the elderly - becomes untenable. In one small
African city, it is estimated that the epidemic will have produced
120,000-160,000 orphans by 1995. Even community support arrangements will be
unable to provide for such a large number of destitute children.
An associated problem is the spread of AIDS-related diseases, such
as tuberculosis. Unsanitary and overcrowded conditions in low-income urban
settlements create a conducive environment for the rapid spread of
highly-infectious diseases. Estimates show that communicable diseases have
quadrupled in some cities with the onset of HIV infection.
Another indirect impact of HIV/AIDS is the burden it presents on
the provision of general health services. Persons with AIDS continue to absorb a
greater proportion of the total health care resources available. The pandemic
has also seriously affected the outreach of child immunization, nutrition
programmes and diarrhoea and TB prevention.
The strain on the maintenance of community-based social welfare
structures in low-income urban settlements will soon become intolerable. It is
with concern for these individuals and others that UNV, in cooperation with UNDP
and WHO, developed its community-oriented programme for using UN Volunteers in
HIV/AIDs-related work. Based on a mixed-team approach which uses UNV
Specialists, DDS field workers and local community workers, UNV has found that
VDWs can play a substantial role in strengthening NGO and community-based
activities through training, coordination and resource mobilisation, focusing on
social aspects and prevention measures to deal with the epidemic. In Zaire, for
example, various church groups such as the Eglise du Christ au Zaire and the Red
Cross, small women's groups such as Mamans Catholiques and Maman Kambangiste,
and even farmer cooperatives and youth groups -are all working to address
counselling needs, develop group information sessions, and find ways of
alleviating poverty and extending family incomes beyond extremely low levels.
VDWs can play a key role in further extending these "self-help" efforts in
addressing concerns related to