|A Strategic Approach Towards an AIDS-competent Society (Technical Note no.1) (UNAIDS, 2000, 9 p.)|
Local Responses to HIV/AIDS
From the experiences of local responses to HIV/AIDS that have been documented in a range of countries, it emerges that those strategies that have been successful have all employed a combination of at least some of the steps described in this Technical Note. The sequence in which they are performed is not critical, and - depending on local circumstances - any of the steps can be the starting point. The recommended steps are the following.
In order to develop "AIDS competence" - whereby people are able to assess accurately the factors that may put them or their communities at risk of infection, and act so as to reduce those risks - a conducive political environment is essential, as are the availability of and accessibility to a range of services.
For a society to be AIDS competent, every sector and its institutions must also be AIDS competent. To achieve this, sectors need to assess the impact that HIV/AIDS has - or is likely to have - on their activities, resources and organization, and adapt to the new situation. Competence is not a single act, but needs rather to be continuously refined and redefined through the experiences that are learnt.
The key elements in developing a national strategy based on local responses are:
The most appropriate decentralized planning unit, close to the communities, should be chosen to implement interventions. A basic package of interventions - cutting across all sectors - should be formulated, which is flexible and can respond dynamically to changing conditions. An initial evaluation of the various communities should be undertaken to help determine how best to reach decentralized groups. Communities should always be regarded as both partners and important actors in interventions.
· A multisectoral approach
The approach adopted should be both multisectoral and participatory. Responses will be greatly enhanced if highly-placed officials in a given sector commit their support. All interventions in a particular community should take into account the social, cultural and legal aspects of that community.
Partners - from a range of social, cultural and religious groups - should be involved in programmes at the local level and in analysing the results of interventions. The ideal is a common goal and a plan of action with clearly defined tasks between the various partners.
The main task of a facilitator is to encourage feedback from lessons stemming from activities at the local level and to set up ways to exchange experiences between communities, sectors and policy makers. The facilitator will also be responsible for helping to implement the remaining steps of the strategy listed below.
A local responses support team should be set up at the decentralized level , whether urban or rural, with support from the facilitator. The team should be technically well-equipped and have the moral support of local communities. A team may develop out of existing structures, or may be created by the communities themselves. Its members may include people such as district officials, religious and traditional leaders, representatives of NGOs, community-based organizations and the private sector, and people living with HIV or AIDS. A team needs to be self-confident, with the ability to define priorities, develop a plan of action and implement the plan.
A team's working style should be participatory, interactive and based on consensus. It will take on situation analyses and analyse the outcome of interventions, and it will identify and set priorities, determine strategies, and plan, coordinate and monitor activities.
A team will seek to expand local partnerships against HIV/AIDS and enhance the resources of local communities.
Documenting and building on the experiences of community projects are core functions for every team.
An early task of the local responses support team will be to identify key social groups. These are groups of people who - because of their occupation or life style - may be particularly at risk of HIV infection. For their own sakes and the sake of the local society as a whole, it is vitally important that these groups are AIDS competent and that their vulnerability to HIV infection is sharply reduced. Key social groups might, for instance, involve groups of men - in particular, vulnerable groups such as truck drivers, fishermen on long-distance trawlers, and miners - women, and out-of-school or unemployed young people. The social groups themselves should participate in the exercise of mapping risk and vulnerability across the local society. Through such participation, they will become aware of the range of factors that create added risk.
Some of the techniques that can be used in this step include:
· local strategic planning
· mapping individual and group vulnerability
· selecting key groups and individuals for partnerships
· analysing the basic needs of the local society
· assessing the role of gender in the local society
· reviewing sectoral policies to check they pass the "HIV test" - enabling society to deal effectively with HIV/AIDS - and if they do not, then recommending reforms.
An important task of the local responses support team is to facilitate the development of local partnerships, with a view to attaining a high level of AIDS competence. These partnerships will include members of the key social groups and front-line workers from the different sectors at the sub-district level, and they should be supported in their work by a facilitator. Using a common starting definition of AIDS competence, the partners should develop an action plan for achieving it - working out their specific contributions to the process and the means of evaluating the results. They should also document and exchange experiences from the very beginning.
The feedback process of learning from direct action will help local partners adjust the criteria for what determines AIDS competence, and the means by which it can be achieved. At the same time, the local response support team should collect the various lessons from around the district and, using these, refine the definition of AIDS competence and the means of attaining it.
As an example, in November 1999, the Provincial Multisectoral AIDS Committee of Gaoua, Burkina Faso, reached a definition of AIDS competence that included the following criteria:
· a change in individual sexual behaviour
· a reduction in the stigmatization of HIV-positive individuals
· a spontaneous willingness to come forward to be tested for HIV
· improvement in the quality of hospital care
· increased mobilization of people against AIDS
· a reduction or stability in HIV prevalence.
The formulation of criteria for AIDS competence at local and district levels and efforts to attain it will help groups in the field identify constraints and opportunities. This, in turn, will help the various sectors to develop their own AIDS competence. In each sector, units should review - with regard to HIV/AIDS - the amount and quality of the services they are providing, their internal organizational structures, their interaction with others, and the planning and development of their human resources. The implementation of sectoral reforms is intended to create a suitable environment in which AIDS competence can flourish.
A checklist on sectoral AIDS competence
Have we taken into account how AIDS affects:
· the quality and quantity of our services
· our ability to supply the required services
· the organisation of our sector
· the role of our service providers
· our human resource policy and management practices
· the planning and management of our sector resources
· the availability of public and private resources for our sector
· donor support to our sector?
(adapted from Kelly MJ, The impact of HIV/AIDS on schooling in Zambia. ICASA, September 1999)
Communities should share their experiences with other communities, knowing that success is possible and that the threat of HIV/AIDS can be controlled. Front-line workers should share their experiences with their peers, who face similar problems under different conditions. The local response support teams should encourage these exchanges, structuring the process so that political decision makers also have access to the documented experiences. This should lead to greater political commitment and a more vigorous and coherent national response.
From these interactions at local, district and national levels, some universal lessons will be derived, which in turn can be shared on a global level with those working to develop AIDS competence in other societies.