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 HIV/AIDS.