|Enhancing the Greater Involvement of People Living or affected by HIV/AIDS (GIPA) in sub-Saharan Africa (UNAIDS, 2000, 28 p.)|
South Africa has one of the fastest-growing epidemics in the world. Over three million people are currently infected with HIV, yet the epidemic remains almost silent and faceless. The levels of discrimination and social stigma are unacceptably high and people continue to live under a conspiracy of silence. The National AIDS Review of 1997 recommended that greater involvement of PWHA was crucial for effective HIV prevention and management. On the basis of this, the National AIDS Plan identifies GIPA as one of the key components for managing the epidemic in South Africa. The need for capacity building to enable PWHA to fulfil this role efficiently has been identified and training programmes, such as those included in GIPA, are crucial in addressing this.
In January 1997, the UNAIDS Inter-country Team, together with UNV South Africa, convened a meeting with partners from the Department of Health and the National Association of People Living with HIV/AIDS (NAPWA) to explore the scope of developing a National UNV project similar to the pilot projects in Zambia and Malawi. Following this meeting, it was agreed that, in order to get a better and deeper understanding of the issues around GIPA and to avoid replicating existing efforts, a rapid assessment should be undertaken. Two independent consultants (one a PWHA) participated in the National AIDS Review in July 1 997. They also visited and interviewed representatives from a range of public and private sector organizations to assess the need for such a project and inform the design and modality of the project management. As a strategy for expanding the response, the consultants were required to actively explore the role and interest of private sector organizations to participate in such a project.
The rapid assessment confirmed that while some progress has been made in the involvement of PWHA, the epidemic remains largely invisible in South Africa. The environment is not conducive to people disclosing their HIV status because of the fear of rejection. NGOs that do work with PWHA find that their contributions are not sustained because of a high 'burn-out' factor. Workplace HIV/AIDS programmes have not always been effective because people do not see the epidemic as real if they have never seen an infected person.
Following the three-month rapid assessment, the UN hosted a one-day planning/consultative meeting. The purpose of the meeting was to flesh out issues pertaining to roles and responsibilities of the project partners, criteria for recruitment and selection of GIPA Field Workers (GFWs), and operational and management issues. The meeting was attended by representatives from government (Department of Health), NGOs (AIDS Consortium, NAPWA, Wolanani, NACOSA), partner organizations (Lifeline, South African National Defence Force (SANDF), Religious AIDS Project) and UNAIDS (WHO, UNDP, United Nations Population Fund, UNV).
Following the planning/consultative meeting, a project document was drafted for funding and approval. The purpose of the project was then defined as being that of: (1) mobilizing the private sector to put in place effective, non-discriminatory HIV/AIDS workplace programmes and policies; and (2) strengthening existing national programmes that involve PWHA.
To fulfil this purpose, the project is placing people living openly and positively with HIV/AIDS in partner organizations to assist with work-based HIV/AIDS policies and programmes.
A National Project Manager was recruited in March 1 998 and a Steering Committee and Advisory Board were established.
Recruitment and selection of GFWs
One of the essential criteria for the GFWs agreed to by the Advisory Board was the need and importance of all candidates to be HIV-positive and willing to be open about their status. Other requirements included having good organizational, verbal and non-verbal communication skills, willingness to be trained, minimum educational qualification of Standard 1 0 and ability to work as a member of a team. The advertisement for the recruitment of the GFWs was placed in two national newspapers and circulated widely to partners. Following the receipt of approximately 100 application forms, 20 candidates were invited to an intensive two-day Selection Workshop.
The workshop was structured to determine whether the individuals fulfilled the stated requirements, as well as to promote self-growth and personal development. A highly participatory and experiential methodology was selected instead of straight interviews, since a workshop provides more time for assessing applicants' strengths and weaknesses. It also provides a better insight into how applicants handle themselves in different situations. The various activities were selected with the aim of being informative, educational and personally empowering.
At the end of the weekend, a total of 12 candidates were selected as GFWs. In addition to the selection process for GFWs, the workshop was attended by guest participants from Mozambique and Swaziland who used the opportunity to become sensitized to the GIPA principle and to get motivated to kick-start similar processes in their own countries.
Placement of GFWs in partner organizations
Since the selection workshop, GFWs have been placed in partner organizations. These include our government partner the Ministry of Health, private organizations (Eskom Electricity Commission, Super Group Pty Ltd, Imperial Transport Holdings, Sowetan Newspaper, Lonrho Platinum Mines and Transnet), and NGOs (Lifeline and A.M.E. Church) (see Box 8 for an example of GFW placement in a partner organization).
Box 8: Example of placement of a GFW in a partner organization
Martin VOFLOO (Eskom South Africa)
Liz THEBE, Manager, AIDS Programme, Eskom, said:
"I have been working with Martin since October 1 998. We have held presentations and given talks to more than 700 Eskom employees.
What I have experienced with him is that he does not blame anybody for being HIV-positive except himself, and that is why most people are listening to him and they invite him to come back again. Most of the people have reported seriously considering taking responsibility for their behaviour and health after listening to him. He has an ability to read his audience and is a powerful and straight-to-the-point speaker.
To have Martin as a white person living openly with HIV has made a big impact on many of the people in our company. Most of the whites we re thinking of it as a 'black' thing. Some of the whites were surprised to see him, and now they support our AIDS programmes.
Some of the construction camps, where they did not believe that AIDS existed, have changed because of Martin. Most of the blacks were asking, "Why don't you bring a white person who is HIV-positive?" Our training programme has gained credibility and we seem to be reaching more HIV-negative people with prevention messages, as well as HIV-positive ones with messages of hope and health. Thanks to the GIPA Project for bringing Martin to Eskom; it has boosted our AIDS programme and made a tremendous impact so far."
Training and development
In order for the GFWs to perform their duties effectively and professionally, a comprehensive training and development programme has been formulated. The goal is to ensure that, with support and encouragement, each GFW can develop his or her own potential, on a personal and professional level. The GFWs have so far received the following training: basic computer skills; personal empowerment and guidelines to living positively with HIV, modelled on the field of psycho-neuroimmunology; communication and presentation skills; HIV and development; and HIV/AIDS policy and programme development. Further training in counselling and advanced computer skills is planned to follow soon.
GFWs also participate in various HIV/AIDS projects aimed at raising visibility and championing the cause of current issues affecting PWHA in South Africa. They have been involved in the UNDP Human Development Report for South Africa, the Ster Kinekor movie project, Stepping Stones Gender and HIV/AIDS training, UNV workshops, and activities with the South African Broadcasting Cooperation (SABC). GFWs have also assisted with regional workshops organized by UNAIDS to help kick-start GIPA activities in the region.
Many of the GFWs have been interviewed by local and international print and electronic media. Examples of situations where GFWs have spoken publicly about their HIV status include: World AIDS Day press conference with Dr Peter Piot; South African Business Council dinner attended by the then Deputy President, Thabo Mbeki; SABC prime-time slots including the news; and interviews with various newspapers including the New York Times, Los Angeles Times, and The Sunday Independent. Participation in radio programmes has been extensive, with most national radios having had interviews with GFWs.
The main challenge is to sustain the project by continuing to provide on-going training as well as support for the GFWs in order for them to fulfil their expected roles. This depends largely on availability of resources.
The South African Business Council is currently being established and it is hoped that the links with the GIPA project will go from strength to strength. The training and development programme for 1 999 included: on-going skills building; development of a support system for the GFWs; electronic connectivity; an advocacy programme; developing participatory monitoring tools; and extending international opportunities to the GFWs (e.g. the International Conference on AIDS and STD in Africa, ICASA, and the Global Network of People Living with HIV/AIDS and International Community of Women Living with HIV/AIDS (GNP+/ICW+) Conference in Poland.
Selection of partner organizations
The rapid assessment process was important as it determined the direction of the project. One of the difficult aspects of the process was the selection of partner organizations. In hindsight, more time should have been devoted to screening the suitability of the organizations identified and interviewed. At least four-out-of-six original organizations have been considered unprepared or unsuitable to host a GFW. The intention of expanding the response was not fully realized and the choice of organizations was very limited in scope. These setbacks have delayed the implementation and the placement process of the GFWs. More effort had to be spent finding new partner organizations - a process that is both very slow and labour-intensive.
Selection of GFWs
A much more intensive reference check is probably necessary to ensure that the selected GFWs have acceptable records with the communities in which they have to serve. This might have to be backed up with preparing the community for the GFW and for talking about HIV/AIDS openly. This should help prevent the sort of unnecessary hostilities experienced in the past.
Motivation of the GFWs
It is important to find strategies that can sustain the interest of the GFWs and provide a certain financial security at the same time. On-going training and support are crucial for the GFWs to continue operating at the energy levels required.
Following a visit of the UNAIDS Executive Director to UNV Headquarters in Bonn in September 1997, and a discussion that took place in New York, in July 1 998, with the Director of the UNDP Regional Bureau for Africa, agreement was reached on a number of follow-up actions on future collaborative activities. One of the follow-up actions was the possible expansion of the pilot project to other countries in Africa and to other regions. During the Joint UNAIDS/UNDP/UNV Meeting that took place in Bonn, in April 1998, participants agreed to expand the project, particularly to French-speaking African countries, using a similar approach and building on the lessons learnt.
As a result, a new project was designed to further develop appropriate approaches and mechanisms for enhancing the involvement of individuals living with or affected by HIV and AIDS in the response to the HIV epidemic. The proposal outlines an approach based on two separate but related strategies. The first strategy aims at ensuring, through an appropriate volunteer modality, the meaningful representation of individuals living with or affected by HIV and AIDS in key organizations and institutions engaged in the response to the HIV epidemic at community, district and national levels. The other strategy aims to strengthen the capacity of organizations and networks to participate at all levels in the formulation and implementation of policies and programmes that will create a supportive ethical, legal and social environment for an expanded response to the epidemic.
The NUNV modality, as currently being developed and implemented in Malawi and Zambia, provides an appropriate delivery mechanism for GIPA. Through this expansion, the NUNV modality and any other appropriate volunteer modalities will be further tested - this time in countries that are characterized by a lower HIV prevalence and poorly functioning national organizations and networks of PWHA. These various volunteer modalities will be considered in terms of the following questions: a) As currently developed, can they provide the appropriate space for individuals living with or affected by HIV and AIDS to influence policy and programming in host institutions, and at national level? b) Are these different volunteer modalities an appropriate delivery mechanism for economically empowering individuals living with or affected by HIV and AIDS, and for strengthening their organizations and networks? c) Is the NUNV modality, or any other volunteer modality, a feasible delivery mechanism for promoting GIPA?
Activities to initiate the expansion in two French-speaking countries were started in February-March 1999. UNAIDS and the UNDP HIV and Development Regional Project will be involved in the implementation of this expansion, to an even greater extent than for the pilot phase in Malawi and Zambia.
The formal 'project' approach of placing individuals living with or affected by HIV and AIDS is only one approach to GIPA. The projects currently implemented in Malawi, South Africa and Zambia should provide an opportunity to review different approaches for enhancing GIPA. To that end, a round table discussion was held during the XIth ICASA in Zambia, in September 1999, with the following theme: "Promoting GIPA in sub-Saharan Africa: what does it mean? What are the alternatives? Lessons learnt from Malawi, South Africa and Zambia".
This round table was to create space for the sharing of experiences and lessons learnt from the different approaches to enhancing GIPA, particularly in sub-Saharan Africa. It was also intended to provide a venue for examining the following prioritization issues: a) Given the current trends of the HIV epidemic, should GIPA be considered a key element in the national response to HIV in sub-Saharan Africa? b) Which mechanism is the most appropriate for promoting GIPA, given the different political, economic, cultural and social contexts?
UNAIDS has made the GIPA principles a part of its policy because it has now been demonstrated that GIPA is a key strategy in the response at all levels. A technical consultation on GIPA has taken place and key areas for action have been determined.
Sources: Project document RAF/96/VO1, UNV, Sept. 96; Monitoring & Evaluation Mission Report, UNDP, Oct. 97; Self-reflection and Selection Workshops Trip Report, UNAIDS/UNDP/UNV, Feb. 98; Trip Report on Joint UNAIDS/UNDP/UNV Meeting, Apr. 98; UNV SVF and SIDA Project Proposals, UNDP, Jun. 98 and Aug. 98; Malawi-Zambia Travel Report, UNAIDS, Sept. 98.