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A world without AIDS: Bangladesh to Zimbabwe |
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Written by Amanda Atwood
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Tuesday, 08 April 2008 |
The spread of HIV has meant personal and national health crises in many countries. The disease has strained many poorer countries’ health care budgets and has challenged scientists, medical professionals and those in social services affected by it.
But despite the devastation it leaves in its wake, some activists confronting HIV also appreciate the opportunities it provides to rethink, reimagine and revision a host of social, political, and medical engagements.
In two vastly different countries, Bangladesh and Zimbabwe, HIV advocates are taking advantage of these opportunities, and using them to inspire proactive engagement and positive attitudes. The approach and analysis in each country is surprisingly similar, one more reminder of the many ways in which HIV/AIDS is a global problem in need of local solutions.
Zimbabwean Lynde Francis contracted HIV 21 years ago when little was known about the disease, and people were not expected to live more than five years. She founded The Centre at the back of her house in 1991, with the vision “to give hope to the hopeless.” 16 years later, Francis is still determined to demonstrate the power of hope and advocates a proactive, holistic approach to health.
The Centre’s Wellness Philosophy promotes a change towards health-seeking behaviour. It urges both individuals and the health care system to change their approach towards both wellness and disease. Francis has a dream of ‘wellness clinics,’ instead of illness clinics where “people could go to learn to be and stay healthy and could celebrate their health.”
Similarly, Francis believes a holistic approach to the AIDS epidemic is essential. “HIV rights are human rights,” she says. “Women’s rights are human rights, children’s rights are human rights, and you cannot deal with this pandemic unless you look at all of these areas.” Francis has come to value the ways in which the reality of AIDS is transforming perspectives on gender, sexuality, health and development. She believes AIDS is forcing people to look at the interconnectedness of different issues, and to confront topics which were previously difficult to tackle.
“My name for HIV is the great revealer,” says Francis. “It is a vehicle that is enabling us to put onto the table things which were taboo, the things that were there but nobody talked about. It is enabling us to find a platform for moving those issues.”
Because of this perspective, The Centre engages in a broad array of activities which reach out to a cross-spectrum of society. It believes in the meaningful involvement of people living with HIV/AIDS – not only as recipients of projects, but in the design, implementation and decision making elements of these projects. The Centre’s youth programmes target both students and school leavers, creating spaces where HIV-positive young people can take charge of their future. They focus on living positively, not only in one’s attitude towards HIV, but also in life generally. They support youth to take leadership positions in their communities and in society, and develop youth health advocates. The Centre engages businesses to take a holistic approach towards health, providing welfare support for staff, nutritional and herb gardens, counselling and training to management, staff and family members, and overhauling company canteens so that they offer healthy food to all staff members. At an international level, Francis engages with health workers, women’s rights organisations, environmental justice activists, housing advocates, development workers, and others.
A world away from Zimbabwe, Bangladesh reports low instances of HIV, despite the spread of the disease in neighbouring countries. The CARE-Bangladesh programme was developed with the intention of handing it over to its participants, and consciously involved primary stakeholders from the inception of the programme onwards. Union members have become implementers of health care services, including the prevention and care for HIV and Sexually Transmitted Infections (STIs).
This active involvement of union members enabled the programme to quickly take on a national character. It involves some 300,000 transport workers, with 45 Drop-In centres across the country, with 300 outreach workers and 25,000 peer educators. Approximately 4,000 transport workers receive care at the Drop-In Centres each month.
The programme is rooted in its holistic approach to HIV/AIDS education, prevention and treatment. But its success is also due to its deliberate identification of key stakeholders – such as transport workers – and its conscious involvement of these sectors at decision making levels from the very beginning of the programme. This stakeholder involvement meant the creation of educational programmes and strategies targeted specifically at these sectors.
In the case of the transport workers union, CARE-Bangladesh devoted a great deal of time to nurturing trusting relationships with the union leaders, through discussion, advocacy and sharing information. They held their meetings at the union offices to demonstrate their commitment to building partnership. During this initial process, they conducted a baseline survey to inform the foundation of the project, and made a note of areas that the union already wanted to strengthen – such as leadership and participation.
As CARE-Bangladesh deepened its relationship with the transport workers, they gained respect and trust from the union membership and leadership. They helped the union build roles in providing quality, affordable and accessible health care services for its members. This assured members that the union was concerned about their welfare, but was actively committed to doing something to improve it.
The involvement of the transport workers enabled CARE-Bangladesh to make greater inroads in taking on socially challenging issues, such as promoting condom use. Despite initial resistance, condoms are now available at tea stalls and mechanic shops frequented by truck drivers.
The union established Drop-In Centres in the union offices to build a sense of ownership over the centres. Peer counsellors and educators were recruited and trained from the union membership, so that workers would be able to go to people who readily understood them. The programme has a national standard where all service providers receive the same training, so that they can easily interpret the confidential, coded information each client receives. This means that a transport worker can receive continuing care on a daily or weekly basis – even if their transporting schedule means that they are never in the same town for more than a day. The union charges a nominal fee for the services it provides, in order to build ownership of the programme, and also so that it can move towards self sustainability in time.
Zimbabwe has been hard hit by HIV. As much as a quarter of the population is infected, and the disease has a national character with everyone affected across social and economic lines. In Bangladesh, infection rates are much lower and isolated. But despite the differences in how HIV has manifested itself, the two countries’ response to HIV has much in common. A holistic approach to health, the involvement of key stakeholders, the active engagement at decision-making levels, and the selection and implementation of relevant, targeted tactics are essential elements of successful programmes in both countries.
For more information read the tactical notebook “Engaging Key Stakeholders: Ensuring the right to HIV/AIDS education and health care services” on New Tactics in Human Rights here. |
Amanda Atwood |
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