A Different Way: Young women, their sexual orientations and their sexual rights

Sexual Orientation and sexual rights

A different way - International Programme on SexualityA Different Way: Young women, their sexual orientations and their sexual rights

Rutgers WPF asked gay and straight young people from around the world about what information would help girls and young women who have questions about their sexual orientation.  I used their ideas and queries to write A Different Way, which was also translated into French as Vivre Sa Difference.

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All around the world, people’s ideas of sex, love and marriage focus on men and women. But this is not the whole story! There are different ways to be, including relationships between women, and relationships between men. But there is not much information available to help young women find their way.

We have written this booklet for young women who:

  • may be feeling different;
  • want to know more;
  • have questions about their sexuality;
  • and want to do what is best for themselves.

We want to give young women information about different sexual orientations. We hope it will help them to understand the issues better, and to make good choices, particularly if they are feeling unsure. This booklet should also be useful for people who work with young women, such as teachers and health workers.

Our values

We believe in human rights. They are things which everyone should have. Among them are sexual rights. Everyone should be able to choose their sexual partner, to decide whether or not to have sex, and be free to try and have a satisfying and safe sexual life.

Too often these sexual rights are abused. For example, young women are forced or pressurised into having sex, or required to marry a certain man. The situation is usually worse for women who are attracted to other women.

Sometimes information can help. In many cultures young people get a confusing mix of messages from films, magazines, friends, family members, and religious leaders. Some of this information is incorrect. Some of it is used to try and control them. Many adults think telling young people information about sex will lead to them having sex. This is not true! Many studies have shown that getting information about sex and healthy relationships helps young people to make better decisions.

What’s in this booklet

Chapter 2 is about sex and healthy relationships. It should be useful to all young women.

Chapter 3 explains what gender identity is, and outlines the different kinds of attraction or sexual orientation that are normal for humans.

Chapter 4 has a lot of questions and answers about women who are attracted to other women. They should be interesting to young people in general, and particularly to young women who are trying to figure out their sexual orientation.

Vivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Vivre sa Difference sexualite

Les Jeunes femmes, leurs orientations sexuellesVivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Rutgers WPF a demandé aux jeunes homosexuels et hétérosexuels du monde entier quelles informations aideraient les filles et les jeunes femmes qui ont des questions sur leur orientation sexuelle.  J’ai utilisé leurs idées et leurs requêtes pour écrire Vivre sa différence. Originellement écrit en anglais.

(French translation of the publication A Different Way.)

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Partout dans le monde, les idées que l’on se fait de la sexualité, de l’amour et du mariage se limitent aux relations entre hommes et femmes. Et pourtant, ce n’est pas tout ! Il existe différents types de relations, y compris des relations entre femmes ou entre hommes. Cependant, il n’y a que très peu d’informations disponibles pour aider les jeunes femmes à trouver leur voie. Nous avons rédigé ce livret pour les jeunes femmes qui :

  • se sentent peut-être différentes ;
  • veulent en savoir plus ;
  • se posent des questions sur leur sexualité ;
  • et veulent faire ce qui est le mieux pour elle.

Nous voulons donner aux jeunes femmes des informations sur les différentes orientations sexuelles. Nous espérons que cela les aidera à mieux comprendre ces questions et à faire les bons choix, en particulier si elles ne se sentent pas sûr d’elles. Ce livret pourra également être utile aux personnes qui travaillent avec des jeunes femmes, comme par exemples les enseignants ou le personnel soignant.

Nos valeurs

Nous croyons aux droits humains. Chacun devrait pouvoir en profiter. Les droits sexuels en font partie. Chacun devrait pouvoir choisir son partenaire sexuel, décider si oui ou non il souhaite avoir une relation sexuelle et être libre d’essayer et d’avoir une vie sexuelle à la fois satisfaisante et sûre.

Ces droits sexuels sont trop souvent bafoués. Par exemple, des jeunes femmes sont forcées ou poussées à avoir des relations sexuelles, ou sont obligées de se marier avec un certain homme. Pour les femmes qui se sentent attirées par d’autres femmes, la situation est souvent encore pire.

Parfois, les informations peuvent aider. Dans de nombreuses cultures, les jeunes reçoivent de nombreux messages prêtant à confusion de la part des films, des magazines, de leurs amis, des membres de leur famille et des responsables religieux. Certaines de ces informations sont correctes. D’autres sont utilisées pour essayer d’exercer un contrôle sur les jeunes. De nombreux adultes pensent que fournir des informations aux jeunes sur la sexualité va les encourager à multiplier les relations sexuelles. C’est faux ! De nombreuses études ont montré que le fait d’obtenir des informations sur la sexualité et sur des relations saines aide les jeunes à faire de meilleurs choix.

Qu’allez-vous trouver dans ce livret ?

Le chapitre 2 est consacré à la sexualité et aux relations saines. Il peut être utile à toutes les jeunes femmes.

Le chapitre 3 explique ce qu’est l’identité de genre et souligne les différents types d’attirances ou d’orientations sexuelles qui existent chez l’être humain.

Le chapitre 4 contient de nombreuses questions et réponses sur les femmes qui se sentent attirées par d’autres femmes. Ce chapitre intéressera les jeunes en général et les jeunes femmes qui essaient de mieux comprendre leur propre orientation sexuelle en particulier.

Managing HIV in the Workplace: A Guide for CSOs

Managing HIV in the Workplace

Managing HIV in the WorkplaceManaging HIV in the Workplace: A Guide for CSOs

STOP AIDS NOW! commissioned me to research and write this handbook (which they translated into French) to help organisations reduce the effects of HIV on their staff and their work. Other terms for this include ‘internal mainstreaming’ or ‘mainstreaming HIV at the organisational level’ or ‘addressing HIV in the workplace’.

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The costs and benefits of managing HIV

Of course, managing HIV in the workplace is not free of cost.

One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff.

The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial.

We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three.

It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future.

So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs.

CSOs that have chosen to manage HIV report various benefits. These include:

  • Staff are better informed, and more able to talk about HIV and sexuality issues;
  • There is less stigma and discrimination in the workplace;
  • Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;
  • More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);
  • Staff report safer sexual behaviour, so are less likely to get infected with HIV;
  • More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;
  • Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;
  • Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;
  • Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;
  • The positive effects spill over to family members and the wider community.

La gestion du VIH sur le lieu de travail: Un guide pour les OSC

The costs and benefits of managing HIV Of course, managing HIV in the workplace is not free of cost. One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff. The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial. We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three. It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future. So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs. CSOs that have chosen to manage HIV report various benefits. These include:  Staff are better informed, and more able to talk about HIV and sexuality issues;  There is less stigma and discrimination in the workplace;  Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;  More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);  Staff report safer sexual behaviour, so are less likely to get infected with HIV;  More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;  Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;  Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;  Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;  The positive effects spill over to family members and the wider community.

Prévention du VIHLa gestion du VIH sur le lieu de travail: Un guide pour les OSC

STOP AIDS NOW! m’a chargé de rédiger ce manuel pour aider les organisations à réduire les effets du VIH sur leur personnel et leur travail. Originellement écrit en anglais.

(This is the French translation of Managing HIV in the Workplace.)

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Les coûts et les avantages de la gestion du VIH

Bien entendu, la gestion du VIH sur le lieu de travail n’est pas dépourvue de coûts.

L’un des coûts est le temps de travail dont le personnel de votre OSC aura besoin pour établir des plans et pour traduire ceux-ci dans des actions. Peut-être aurez-vous également besoin d’argent supplémentaire, par exemple si votre OSC engage des formateurs pour la tenue d’ateliers, ou bien si elle contribue à l’assurance maladie ou aux frais médicaux du personnel.

Les coûts réels, exprimés en temps et en argent, sont très différentes d’une OSC et d’un pays à l’autre. Mais quels qu’ils soient, on pourrait croire que le déni de l’existence du VIH est la solution la plus avantageuse, parce qu’elle ne coûte rien. Cependant, l’étude de cas à la page 7 montre que lorsqu’une OSC ne tient pas compte du VIH, les conséquences s’enchaînent: absentéisme du personnel; échec du projet; décès d’un membre du personnel apprécié; utilisation abusive des ressources; stress pour la direction; renvoi d’un membre du personnel; perte d’un donateur; sous-performance du personnel; et des tensions entre les membres du personnel. Les coûts de l’inaction peuvent être élevés.

Nous n’avons guère d’information sur les coûts et les avantages de la gestion du VIH dans le secteur des OSC. De nombreuses OSC n’enregistrent pas les congés de maladie, et les résultats des OSC sont souvent difficiles à mesurer. Mais une enquête récente auprès d’entreprises en Zambie a montré qu’en moyenne, les avantages de la gestion du VIH étaient trois fois supérieurs au coût5 . Donc, pour chaque kwacha (ou dollar) dépensé, ces entreprises en ont économisé trois.

Ce n’est donc pas par hasard que les entreprises ont été les premières à gérer le VIH. En effet, elles sont très sensibles à des coûts en hausse et à une productivité en baisse, car ces phénomènes s’accompagnent d’une perte de bénéfices. De nombreuses entreprises ont admis qu’il est moins cher de gérer le VIH que d’ignorer son existence. C’est également l’expérience de nombreux projets d’OSC soutenus par STOP AIDS NOW! en Ouganda, en Éthiopie et en Inde. Ces OSC ont compris qu’en investissant du temps et de d’argent maintenant, elles en tirent des avantages aujourd’hui et réduisent les coûts à l’avenir.

Par conséquent, la gestion du VIH au sein des organisations est une activité rentable. Elle est également nécessaire, particulièrement aux endroits à forte prévalence du VIH, si votre organisation doit protéger sa capacité à fournir des résultats.

Les OSC qui ont décidé de gérer le VIH signalent divers avantages:

  • Les membres du personnel sont mieux informés, plus disposés à parler du VIH et de questions de sexualité;
  • La stigmatisation et la discrimination sur le lieu de travail diminuent;
  • Les membres du personnel sont plus sûrs de garder leur emploi s’ils sont séropositifs à VIH et plus prêts à révéler leur statut;
  • Plus de membres du personnel, et plus de membres de leur famille, passent des tests VIH (dans le projet STOP AIDS NOW! en Ouganda, 65 % du personnel de l’OSC avaient passé un test contre 13 % dans la population);
  • Le personnel a un comportement sexuel plus sûr et a donc moins de chances d’être infecté par le VIH;
  • Plus de membres du personnel séropositifs au VIH se relient à des réseaux de vie positive, préviennent les infections opportunistes et suivent un TAR; ils sont donc en meilleure santé et vivent plus longtemps;
  • Le personnel est plus sensibles aux questions de genre, ce qui réduit la discrimination à l’encontre des femmes et des membres du personnel transsexuels;
  • Les membres du personnel se sentent plus appréciés et, par des approches participatives, ont plus le sens de l’étroitesse des liens;
  • La capacité du personnel augmente. L’organisation est incitée à améliorer son travail en ajustant sesprogrammes de telle sorte qu’ils tiennent compte du VIH, ou bien en travaillant dans le sida;
  • Les effets positifs se répandent aux membres de la famille et à la communauté générale.

Break Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

understanding sexual minorities in Africa

Sexual Minorities and rights in AfricaBreak Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

This booklet is about marginalised sexualities and human rights and is also available in French.

In a context of widespread homophobia and misinformation, it aims to give Oxfam’s and other NGOs’ staff both facts and food for thought about alternative sexualities.  It’s written for people working in civil society and government organisations, with a focus on Africa, particularly the Horn, East, and Central Africa.

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The idea for this booklet came from an HIV and AIDS forum, held in the Horn, East & Central Africa region, for Civil Society Organisation (CSO) staff working on HIV. The forum focussed on learning about linkages between gender, HIV & AIDS, and sexual rights. Two East African activists from a sexual minorities network spoke about how badly sexual minorities are treated, the violence and discrimination they experience, and the difficulties they face in accessing HIV and AIDS prevention, treatment & care services. Their testimonials stirred the participants’ interest. Some felt that they needed to know more. Many were surprised; they were working on HIV, and yet had not given much thought to sexual minorities. Some, perhaps, felt negative towards the two activists, a common reaction in African cultural settings. Others wondered how they and their organisations might support sexual minorities to claim their rights.

This booklet is to encourage staff in civil society and government organisations to: understand sexual rights as human rights; to become aware of the ongoing abuses of sexual minorities’ human rights including lack of access to essential services; and to take action to protect rights for all, including minority groups.

Chapter 1 focuses on basic information and key debates. Chapter 2 looks at reactions to sexual minorities and their sexual rights. The linkage between sexual minorities, human rights and HIV programming is explored in Chapter 3, while Chapter 4 deals with why most NGOs have been silent on the issue. The concluding chapter suggests ways to break that silence.

Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Sexualité, homosexualité

Sexualité, homosexualité Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Cette brochure traite des sexualités marginalisées et des droits de l’homme et a été écrite en anglais.

Dans le contexte de l’homophobie généralisée et de la désinformation, il vise à donner au personnel d’Oxfam et d’autres ONG à la fois des faits et des éléments de réflexion sur les sexualités alternatives. Il est écrit pour les personnes travaillant dans la société civile et les organisations gouvernementales, en mettant l’accent sur l’Afrique, en particulier la Corne, l’Afrique de l’Est et l’Afrique centrale.

(The French translation of Break Another Silence)

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L’idée à l’origine de ce livret est venue d’un forum sur le VIH et le SIDA tenu dans la région de la Corne, l’Est et le Centre de l’Afrique à l’intention du personnel des Organisations de la Société Civile (OSC) travaillant sur le VIH. Le forum portait sur l’apprentissage au sujet des liens existant entre : Genre, VIH, SIDA et droits sexuels. Deux activistes est-africains provenant d’un réseau de minorités sexuelles se sont exprimés au sujet de la manière dont les minorités sexuelles sont maltraitées. Ils ont parlé de la violence et de la discrimination que ces minorités subissent et des difficultés auxquelles elles font face pour accéder aux services de prévention du VIH et du SIDA, de traitement et de prise en charge. Leurs témoignages ont suscité l’intérêt des participants. Certains ont eu le sentiment qu’ils avaient besoin d’apprendre davantage. Certains d’entre eux étaient étonnés ; ils travaillaient sur le SIDA mais, hélas, ils n’avaient pas beaucoup pensé aux minorités sexuelles. Certains, peut-être, ont eu le sentiment de désapprouver les deux activistes; une réaction considérée comme ordinaire dans un contexte culturel africain. D’autres se demandaient comment eux-mêmes et leurs organisations pourraient aider les minorités sexuelles à revendiquer leurs droits.

Ce livret est destiné à encourager le personnel des organisations gouvernementales et de la société civile à : Comprendre les droits sexuels comme des droits humains ; Prendre conscience de l’abus des droits humains dont sont victimes au quotidien les minorités sexuelles, dont le manque d’accès aux services essentiels ; et entreprendre une action pour protéger les droits de tous, y compris pour les groupes minoritaires.

Le premier chapitre porte sur une information de base et sur les grands sujets de débats. Le chapitre 2 analyse les réactions courantes face aux minorités sexuelles et à leurs droits sexuels. Le lien entre minorités sexuelles, droits humains et programmation sur le VIH est explorée dans le chapitre 3, pendant que le chapitre 4 traite de la manière dont la plupart des ONG sont restées silencieuses sur la question. Le chapitre de conclusion suggère des voies de sortie pour briser ce silence.

Failing Women, Withholding Protection

HIV prevention with female condom

female condom to prevent HIV15 lost years in making the female condom accessible.

Oxfam Novib has been one of few organisations in the world investing in allowing the female condom to serve its purpose. I was fortunate to have the job of researching and writing this briefing paper for them.

They and the World Population Fund used it in their advocacy push at the 2008 International AIDS Conference. Find out more about their Universal Access to Female Condoms campaign here.

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2008 marks 15 years since the female condom was invented, and, disgracefully, 15 years of failing to make them accessible to the women who need them. Despite the absence of any other female-initated form of protection, and unprecedented rises in funding for the response to HIV, female condoms remain inaccessible, and their contribution remains untapped.

The urgent need for access to female condoms is evident in the feminisation of the HIV pandemic, the large unmet need for contraception, and the pitiful progress towards meeting Millennium Development Goals 5 and 6 on maternal health and halting and reversing the spread of HIV.

Why provide female condoms, when male condoms are readily available, much cheaper, and provide a comparable level of protection?

  • Female condoms are a tool to assist women’s empowerment. Women who use female condoms report an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex. It will be many years until women have any alternative femaleinitiated means of protecting themselves.
  • Providing both female and male condoms leads to more instances of protected sex and reductions in the incidence of sexually transmitted infections (STIs). Their additive effect, providing protection in instances which would not be protected by male condoms, makes them a costeffective form of HIV prevention.

Studies have repeatedly shown high levels of acceptability for female condoms. Some users prefer them over male condoms, as they offer more flexibility regarding the timing of putting them on and taking them off, and have a more natural feel. However, many donors and policy-makers remain sceptical that sufficient demand for them exists. Yet examination of femalecondom projects reveals significant demand, even though it is often deliberately suppressed and unintentionally undermined by stigmatisation and running out of stock. What is perceived as an issue of demand is actually one of supply. Expanding access to female condoms is held up not at the users’ end, but at the start of the chain: how much money donors and governments are willing to invest in buying female condoms, supporting female-condom programmes, and developing low-cost female condoms.

What is behind the failure to act comprehensively to create access to female condoms? Responses from donors and policy-makers to the female condom mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.

Of course, some efforts have been been made in the past 15 years, which have accelerated since the launch of the United Nations Population Fund’s (UNFPA) global Female Condom Initiative in 2005. The rapid expansion of sales and free distribution in the few countries at the forefront of female condom programming demonstrates the massive unmet demand for female condoms. But there is so much more to be done. Worldwide, in 2007, roughly 423 male condoms were produced for just one female condom. Female condoms currently have a unit cost about 18 times higher than male condoms.

The levels of investment and programming needed to increase the choice of available female condoms, to lower prices and to expand production are highly feasible. Through collaborative action, donors, governments, civil society organisations and the private sector can begin the progress of achieving universal access to female condoms. Female condoms exist now, and concerted efforts to make them accessible must begin now.

Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

internal mainstreaming HIV

HIV in the workplace
Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

These guildlines were the outcome of an interesting process of research and negotiation with five Dutch donors.

In them I set out the sponsoring donors’ commitments to support their partners’ efforts to manage HIV in their workplaces in pilot projects in Uganda and India. I also presented the rationale and basic steps for organisations to do this.

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Why have we developed these guidelines?

Breaking the silence: in many partnerships between Northern and Southern NGOs, HIV/AIDS is not discussed, or is discussed only in terms of the effects at community level. We want HIV/AIDS to be part of our dialogue with partners, and hope that these guidelines will lead to it being on the agenda, for both donors and partners. The guidelines may also help stimulate discussion within partner organizations.

Acting in solidarity: we are now in the late stages of developing and implementing workplace programs for our own staff, but are funding local partners which lack such programs. We believe we should actively open up dialogue and provide support to our partners, rather than be ‘concerned bystanders’, watching the impacts of HIV/AIDS on our partners but doing little to assist.

Getting our ‘heads out of the sand’: a recent CARE survey3 of 42 NGOs in Southern Africa found that, despite a HIV prevalence rate of around 25%, two thirds of the respondents said they did not think they had any HIV-positive employees! This vividly illustrates how managers may act like ostriches by ignoring difficult realities, a costly habit in the case of HIV/AIDS. These guidelines are about raising our heads, stating our commitments, communicating them to our partners, and helping them also to raise their heads.

Responding to demands from local NGOs: some donors expect better results from NGOs in high prevalence settings, or lower costs, as if HIV/AIDS does not exist. Research with local NGOs shows that instead of that lack of understanding, they want more openness, more support, and more clarity from their donors with regard to managing HIV/AIDS4 . These guidelines should go some way to meeting those demands.

Responding to demands from Program Officers: our Program Officers sometimes get requests from partners to fund their workplace policies. Some of them feel ill-equipped to deal with this new topic, and have asked for guidance. These guidelines should help them make decisions, and should ensure that partners’ requests are dealt with consistently within each of the Dutch donor NGOs.

Influencing others: other NGOs who work through partnership with organizations in the South are facing the same issues, but none have ‘grasped the nettle’ and developed guidelines on good donorship in a time of AIDS. We can share these guidelines with those development agencies, and so use them to stimulate their response. We expect that partners may also use these guidelines to influence their other donors towards ‘good donorship’ with regard to HIV/ AIDS.

Greater accountability: where local NGOs do not have budgets to cover employees’ health care costs, managers may cover the costs with money from other parts of their budgets. They are unlikely to tell their donors about this. These guidelines should increase communication and so accountability between us by providing clarity on what costs we are willing to fund, and by initiating dialogue between donors and partners, so that we can agree budgets to cover the financial costs of HIV/AIDS and other chronic diseases.

Support to Mainstreaming AIDS in Development

internal and external mainstreaming HIV

Support to Mainstreaming AIDS in DevelopmentSupport to Mainstreaming AIDS in Development: UNAIDS Strategy Note and Action Framework

Mainstreaming AIDS is a process that enables development actors to address the causes and effects of AIDS in an effective and sustained manner, both through their usual work and within their workplace.

Although not credited as such, I co-wrote this Strategy Note (minus the Action Framework) with Bob Verbruggen of UNAIDS.

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Twenty years into the pandemic, there is now ample evidence for the complex linkages between AIDS and development: development gaps increase people’s susceptibility to HIV transmission and their vulnerability to the impact of AIDS; inversely, the epidemic itself hampers or even reverses development progress so as to pose a major obstacle to the achievement of the Millennium Development Goals.

The growing understanding of this two-way relationship between AIDS and development has led to the insight that, in addition to developing programmes that specifically address AIDS, there is a need to strengthen the way in which existing development programmes address both the causes and effects of the epidemic in each country-specific setting. The process through which to achieve this is called ‘Mainstreaming AIDS’.

The Rationale for Mainstreaming AIDS in Development

1) Mainstreaming aims at improving development practice so as to enhance its contribution to the response to AIDS:

  • By having development actors attend to both the immediate and the underlying determinants of people’s susceptibility to HIV infection:

HIV spreads “along the fault lines of failing development”, such as poverty, gender inequality, poor social services. Mainstreaming enables development actors to strengthen the way in which they help reduce the susceptibility to HIV infection of the people they serve. This implies that they also try to identify and minimize unintended negative effects of their own work, such as increasing gender inequality.

  • By having development actors take into account the impact of AIDS and adjust their work accordingly:

AIDS disproportionately hits the most vulnerable groups, and affects the capacity of development actors themselves: it thus deepens existing development problems. Through the process of mainstreaming, development actors analyse and address the impact of AIDS both on their own capacity and on the people they serve, now and in the future.

2) Conversely, mainstreaming is about gradually incorporating national responses into national development processes in order to ultimately equip countries with the capacity to reverse and contain the epidemic. Through the process of mainstreaming, national responses are being institutionalized within national development instruments and processes: this will ensure the sustainability of AIDS programmes and strengthen national coping capacity, thus allowing them to achieve lasting results.

Mainstreaming and the National Response

Considering the above, mainstreaming and national responses are inseparable:

  • While all development actors, including international development agencies, need to mainstream AIDS in their work, it is not possible for any of them to respond to the complexity of the causes and effects of AIDS by itself. The intended system-wide impact of mainstreaming can only be achieved if the respective efforts complement and reinforce each other.
  • Inversely, for national responses to achieve their ultimate goal of containing the epidemic, they need to address the development-related causes and effects which fuel it through effective mainstreaming processes. Indeed, while HIV prevention work is necessary to inform and motivate people to protect themselves, it cannot overcome deeply-rooted societal causes of susceptibility; similarly, treatment, care and support programmes can reduce the impact of AIDS on affected households, but cannot address the underlying reasons for their vulnerability.

From the above, it is clear that putting in place “specific” AIDS programmes and mainstreaming AIDS in development is not a matter of “either/or”. One of the facets of the exceptionality of AIDS is indeed its character of long-term emergency, which commands a response representing a continuum, from a response attempting immediate relief to a more in-depth developmental response, addressing the societal factors of susceptibility and vulnerability.

Mainstreaming HIV/AIDS in Development and Humanitarian Programmes

mainstreaming hiv aids in development programmes

Mainstreaming HIV /ADIS in Development and Humanitarian Programmes

Aids on the Agenda – lite

AIDS on the Agenda is quite a long book, so in 2004 Oxfam produced this cut down version of it.

You can download it for free or buy a hard copy from Oxfam publications.

Extract

AIDS depends for its success on the failures of development. If the world was a fairer place, if opportunities for men and women were equal, if everyone was well nourished, good public services were the norm, and conflict was a rarity, then HIV (Human Immunodeficiency Virus) would not have spread to its current extent, nor would the impacts of AIDS (Acquired Immune Deficiency Syndrome) be as great. We now know that the spread of HIV and the effects of AIDS are closely linked to development problems such as poverty and gender inequality. Development and humanitarian agencies should be doing more to respond to the challenges posed by HIV/AIDS. This book suggests a way in which they can do so through their existing work without necessarily establishing special programmes of HIV prevention or AIDS care.

This book is a shorter, simplified version of AIDS on the Agenda (Holden 2003), a book which can be ordered from Oxfam GB, or downloaded for free from here. The ideas in the two books are the same; but this version, we hope, is accessible to a wider range of readers: those who actually do development and humanitarian work, in addition to those who manage it and fund it. Unlike AIDS on the Agenda, this book does not feature quotations and case studies; instead it presents general lessons learned – mainly from the experiences of non-government and community-based organisations (NGOs and CBOs) working in the parts of Africa that are worst affected by HIV/AIDS. AIDS has changed the world. This book is about the changes that we need to make in order to do effective development and humanitarian work in a world of AIDS.

Part 1: The case for mainstreaming HIV/AIDS

Chapter 2 considers the two-way relationship between under-development and the causes and consequences of HIV/AIDS. It shows how the disease can make gender inequality worse, and claims that HIV/AIDS is a long-term development problem with no obvious solution.

Chapter 3 explores what mainstreaming means, by setting out the four main terms used in this book: • AIDS work • integrated AIDS work • external (programmatic) mainstreaming of AIDS • and internal (organisational) mainstreaming of AIDS. It identifies similarities and differences between them, and gives practical examples of what the terms mean for development and humanitarian organisations.

Chapter 4 addresses the question ‘Why mainstream HIV/AIDS?’. It considers some of the problems that may arise if development and humanitarian organisations fail to take AIDS into account in their ordinary work. It also responds to some objections to the idea of mainstreaming HIV/AIDS, and describes two problems which development organisations may meet when they do AIDS work.

Chapter 5 draws together all the elements of Part 1. It presents a ‘web’, showing four levels of influence on HIV transmission, and different kinds of response, both direct and indirect.

Part 2: Ideas for mainstreaming HIV/AIDS

Chapter 6 provides some general strategies for initiating and sustaining mainstreaming, and proposes some guiding principles. Chapter 7 offers ideas for mainstreaming HIV/AIDS within the internal operations of development and humanitarian agencies, and Chapters 8 and 9 offer suggestions for external mainstreaming in development and humanitarian programmes respectively. Chapter 10 presents an overview of the issues and challenges involved in promoting and adopting the strategy of mainstreaming, and the book concludes with Chapter 11.