Jasmine Owens, HIV/AIDS in Africa: NGOs in the Battle Against the Epidemic

HIV/AIDS in Africa: NGOs in the Battle Against the Epidemic

By Jasmine Owens

The beginning of what is now the HIV/AIDS epidemic began to emerge in the US during the early 1980s, with the first cases being reported among homosexual men. Almost simultaneously, cases appeared on a global scale in places such as Uganda, Tanzania, the Congo, and Rwanda (Barnett & Whiteside 28). Africa is the continent bearing the major burden of the disease. According to the UNAIDS report on the global AIDS epidemic in 2010, of the 33.3 million people living with HIV/AIDS in 2009, 22.5 million are living in Sub-Saharan Africa, with a further 460,000 in the Middle East and North Africa (22-23). No other region in the world even comes close to that number. Why is it that Africa is so severely affected by HIV/AIDS? This is a complex question that involves many factors. These may include the high levels of poverty throughout Africa, its ongoing history of conflict and political strife, and the stereotypes and perceptions associated with the disease.

Therefore, what is being done to combat the spread of HIV/AIDS in Africa, and who are the actors at the front lines? Many are international NGOs who partner or work closely with African community based organizations and governments. These include the African Medical and Research Foundation (AMREF), the Canada Africa Partnership on AIDS (CAP AIDS), and AVERT. These are just a few of the countless organizations that are constantly engaging in the difficult battle against HIV/AIDS in Africa. The work of these NGOs is similar in that they emphasize the importance of local and community based initiatives regarding the HIV/AIDS epidemic; however, they each portray distinct path towards that goal. Whether it be, forging partnerships, promoting gender equality, or advocating for education and cooperation, these organizations owe much of their success to their local, community, and grassroots strategies towards HIV/AIDS elimination.

There is a distinct relationship between how levels of poverty contribute to epidemics, just as there is a connection between epidemics and an increase in poverty (Whiteside 316). Studies have shown that “HIV prevalence is highly correlated with falling calorie consumption, falling protein consumption, unequal distribution of income and other variables conventionally associated with susceptibility to infectious disease, however transmitted” (qtd. in Whiteside 316). There has also been work done in cell biology that shows that mechanisms connected with malnutrition and parasite infestation depress immune responses by weakening the effectiveness of cells in the immune system (Whiteside 316-317). 


However, there is not a simple answer to the question of HIV/AIDS and poverty. For example, Botswana, which has one of the highest per capita incomes in Africa, also has some of the highest levels of infection (Whiteside 317). This could be because Botswana has a better developed healthcare system, leading to higher reported rates of infection; however, one would assume that higher income translates into lower levels of poverty. Although this may be the case sometimes, the success or failure of rapid economic growth brings its own problems such as disruption of traditional norms and cultures, and the unequal distribution of income and resources. On the other hand, economic decline can also lead to increased outbreaks of HIV/AIDS. 


Regarding South Africa, there was little growth between 1994 and 1999 which led to fundamental changes in the economy such as shrinking primary and secondary sectors and a growing tertiary sector (Whiteside 319). Ultimately, this meant a drastic decline in formal employment, from 5,576,000 in 1991 to 4,864,000 in 1999, leading to a surplus of unskilled workers (qtd. in Whiteside 319). As Alan Whiteside states, it is now widely accepted that HIV/AIDS impoverishes people, households, and communities, but what is not well known, is how these units affect and interact with one another (320).

Conflict and political strife are also responsible for the spread of HIV/AIDS throughout Africa. Rape has long been used as a weapon of war, and many war torn regions even promote a sexual culture among soldiers. Robert L. Ostergard describes two ways in which war benefits HIV/AIDS. First, the presence of the military attracts sex trade workers, and if these workers are infected then the virus can be spread to soldiers and their families (Ostergard 342). Second, HIV/AIDS is spread through terror, as mass rape, torture, and sexual slavery are used as war tactics (Ostergard 343). Some of the most infamous incidents of rape as a weapon of war are reported in the Democratic Republic of the Congo, where it is estimated that 50 percent of military personnel are HIV positive, and that the ongoing conflict has resulted in thousands of rapes and new infections (Ostergard 343). The lethal effects of HIV/AIDS are also used psychologically to gain strategic advances over enemies. During the transition from apartheid to democracy in South Africa, Mike Odendaal reported that he was ordered by the head of Roodeplaat Research Laboratories to freeze a sample of infected blood to allegedly be used by a chemical warfare specialist “against a political opponent” (Elbe 170). Such appropriations of HIV/AIDS by armed forces in Africa reflect its increasing significance as a tool of war (Elbe 171). For this reason, a response to the epidemic can only be successful if security plays an important role (Elbe 171).

Overcoming the communicative challenges presented by HIV/AIDS is crucial in dealing with the epidemic. The fear of infection, discrimination, and stigmatization, leads to silence, denial, and “othering” of the issue (Petros et al. 67-68). Both silence and denial about HIV/AIDS are very dangerous as they prevent people from fully understanding the risks of the disease (qtd. in Petros et al. 68). This is why stigma and blame have been cited as two of the biggest obstacles to combating HIV/AIDS (UN/WHO 2000). Some scholars have argued that HIV/AIDS related stigma is more strongly expressed against women than men. Frequently, when HIV/AIDS shames women and men in gender-specific ways, it reinforces the view that HIV/AIDS is a “woman’s disease” or a “prostitute’s disease” (UN/WHO 13). Women who are HIV positive, or are suspected of having the virus, are more likely to be abandoned by their families and labelled as promiscuous or unworthy by society (UN/WHO 13). This can lead to greater personal stress, social isolation, and limited access to healthcare, education, and employment (UN/WHO 13).

In Africa and much of the Global South, women are typically the caregivers of a household; whereas, men are the symbol of financial security. As more women are abandoned or die, children and orphans are left behind to care for themselves. Without any experience, education, or resources, these children are uncertain on how to move forward with their lives (Nemapare & Tang 52). In addition, they may be caring for younger siblings or aging family members. As a result, the number of infections in HIV/AIDS orphans is on the rise due to increased participation in activities such as prostitution, theft, begging, and drug use (Patterson 23). 


Homophobia is another type of stigmatization that is generally associated with men rather than women. In South Africa, homosexuality continues to be seen as one of the defining characteristics of HIV/AIDS transmission (Petros et al. 73). As one man from the region stated, “it [HIV/AIDS] took root in the Gay community...Now it seems like the Gays have started to become even more promiscuous than they were” (Petros et al. 73). Therefore, inequality among genders and different groups are critical factors affecting HIV/AIDS transmission in Africa and around the world.

With all of these aspects contributing to the spread of HIV/AIDS in Africa, who and what is counteracting it? One example stems from 1957 when three surgeons founded the Flying Doctors of East Africa to provide mobile health services and surgical support to areas in the region (AMREF 2011a). Headquartered in Nairobi, Kenya, this laid the foundation for what later became AMREF, one of the leading health development and research organizations in Africa (2011a). By the 1970s and 1980s, AMREF was providing education for rural health workers and engaging in closer collaboration with the ministries of health and international aid agencies (2011a). This set the course for the organization’s future, leading to an increased focus on research, capacity building, and advocacy relating to HIV/AIDS, other sexually transmitted diseases, tuberculosis, malaria, basic hygiene, family health, clinical services, and training (AMREF 2011a). More recently, AMREF launched a new 10 year strategy (2007 to 2017) that concentrates on linking health services to the people in need and tailoring responses to specific community concerns (2011a). The overarching goal of the plan is “to advance Africa’s health by catalysing an evidence-based movement aimed at reducing the gap between communities and the rest of the health system” (AMREF 2007). To achieve this goal, AMREF plans to build on its previous strategy while placing a stronger emphasis on community empowerment and engagement (2007).

The basis of AMREF’s program involves three themes: partnerships with communities for better health, building capacity for strengthened communities and health system responsiveness, and health systems research for policy and practice (2007). The first program theme revolves around health as a human right, meaning that health systems must make people and communities a top priority (AMREF 2007). Within this, AMREF wants to target its HIV/AIDS and general health promotion and prevention to children, adolescents, women, and the workforce (2007). In addressing the health needs of children under five years old, AMREF will explore the prevention and treatment of HIV/AIDS and common childhood illnesses, the present levels of malaria, HIV/AIDS, and other diseases, and the reduction of mother to child transmission of HIV (2007). With pre-teens, adolescents, and youth ages five to twenty-four, attention will be on sex education, family lifestyles, and protection against gender-based violence (AMREF 2007). For women of reproductive age, AMREF’s health response team will focus on maternal health, reducing HIV/AIDS transmission before, during, and after pregnancy, family planning, promotion of reproductive rights, and protection against gender-based and domestic violence (2007). Lastly, the AMREF community health focus on the workforce will consider health promotion to combat HIV/AIDS in the workplace, as well as forging links between workplace programs and communities (2007). Through all of this, AMREF anticipates that new community and health system partnerships will develop, existing relationships will become stronger, and communities will be able to better identify their own health needs and threats (2007).

The second component of AMREF’s ten year strategy is to enhance the capacity of health systems and civil society organizations (CSOs), and to improve the quality of healthcare in communities (2007). The specifics include improving health management information systems (HMIS) at the local level, human resource development, organizational development in health related organizations, and the incorporation of institutional and legal frameworks to these organizations (AMREF 2007). The hope is that the outcomes will include things such as poor and rural community based health planning, better resource allocation and monitoring by health ministries, improved diagnostic skills and treatment for HIV/AIDS patients, and strengthened support systems for HIV/AIDS orphans and vulnerable children (AMREF 2007).

The third element acknowledges that in order to sustain adequate response to healthcare challenges, there needs to be continuous research on influential policy and practice (AMREF 2007). These policies should then be circulated and effectively advertized throughout communities, the health system, and partnering organizations (AMREF 2007). As AMREF continues this research, it will work with national governments and development partners at all levels to ensure community driven health planning in Africa (2007). Generating strong answers to health related questions will contribute to a better understanding of the gap between African communities and the health system, and allow AMREF to identify the policies and practices that have had a positive effect on individuals, families, and communities (2007).

Although this ten year plan incorporates other diseases along with HIV/AIDS, AMREF does run projects throughout Africa that focus specifically on HIV/AIDS. For instance, the Community Focused Initiative to Control HIV & AIDS project in Kenya aims to reduce the spread of HIV and improve the quality of life of those already affected (AMREF 2011b). The project objectives are to build the capacity of CSOs to implement quality HIV/AIDS interventions, to promote safe sex practices, to improve coordination between CSOs and the Government of Kenya, to improve quality of healthcare to persons living with HIV/AIDS, and to strengthen policy and practices (AMREF 2011b). Through this program, AMREF has celebrated multiple achievements. By the end of 2009, AMREF had provided grants to 540 CSOs, reached 85, 079 people living with HIV/AIDS, supported 34,314 orphans, and trained thousands of care givers and counsellors (2011b).

Another AMREF program is the Luwero Orphans and Vulnerable Children Project in Uganda. The objectives of this project are to strengthen community based support for orphans, lobby for the rights of HIV/AIDS orphans, raise awareness around HIV/AIDS transmission, and provide employment training to orphans and vulnerable children (AMREF 2011c). The key achievements of this program so far include hosting radio broadcasts and showing films to raise awareness and promote testing, training children as school health club leaders and Village Orphan Representatives, and strengthening Parish Orphans Committees (AMREF 2011c). This project as well as the other one mentioned above are just two of the many AMREF projects in Africa that target HIV/AIDS.

CAP AIDS is another example of an NGO focusing on the HIV/AIDS epidemic. In partnership with community based organizations in Africa, CAP AIDS is able to learn about and respond to the needs and priorities in various communities (2010a). Similar to AMREF, CAP AIDS main goals are to reduce the spread of HIV/AIDS, provide relief, treatment, and comfort to those living with the disease, help orphans, families, and communities cope with the devastating consequences of HIV/AIDS, and promote and protect the human rights of HIV positive people (2010a). Knowing that gender inequality is a major factor in regards to HIV/AIDS, CAP AIDS is committed to promoting gender equality as an integral part of its efforts to help other organizations fight, resist, and overcome HIV/AIDS (2010b). Its policy on gender and HIV/AIDS addresses the different needs of women and men regarding HIV/AIDS, promotes female participation in identifying problems, and developing solutions for CAP AIDS programs, and encourages shared responsibility for men and women when it comes to the prevention and treatment of HIV/AIDS (CAP AIDS 2010b). In order to sustain respect of this policy, CAP AIDS conducts regular monitoring and progress evaluation.

AVERT is an international charity “working to avert HIV and AIDS worldwide, through education, treatment, and care” (2011a). Based in the United Kingdom (UK), AVERT was created in 1986 and was previously known as the AIDS Education & Research Trust (2011a). AVERT’s programs throughout Africa emphasize sustainable, cost effective community responses to HIV/AIDS, and each project addresses the unique needs of the local situation (2011b). Sisonke, one of AVERT’s projects in the poor Eastern Cape province of South Africa, reaches out to and meets the needs of 800 orphans and vulnerable children living in the community (2011b). For the people looking after these children, training is provided in terms of HIV/AIDS prevention and treatment, income generation, and psychological support (AVERT 2011b). As a result, some local people have been able to establish gardens and larger scale community feeding programs (AVERT 2011b).

AVERT also supports Dar es Salaam based WAMATA; the first registered HIV/AIDS NGO in Tanzania. WAMATA is the Swahili acronym for “People in the Fight Against AIDS in Tanzania,” and runs several different activities in local communities to support people affected by AIDS (AVERT 2011b). WAMATA also has seven support groups categorized into four sections: adult, women, youth, and grandparents (AVERT 2011b). The HIV/AIDS related topics covered in these groups are based primarily on members' interests (AVERT 2011b). AVERT is currently helping WAMATA re-establish its home based care service which works in cooperation with volunteers, doctors, nurses, and counsellors (2011b). In the hope that HIV/AIDS will become completely preventable one day, WAMATA runs HIV testing clinics and offers test facilities at major public gatherings throughout Tanzania (AVERT 2011b). AVERT’s support to WAMATA portrays the links between an international NGO and an African community based NGO. With financial support, AVERT has enabled WAMATA to continue its work as a grassroots organization that focuses on client and community interests. As international NGOs work with African NGOs and advocate for change on a global scale, the issues of legitimacy, accountability, and control inevitably arise. In the case of AVERT and WAMATA, the relationship seems to be relatively equal. AVERT emphasizes that it develops, runs, and aids projects according to the specific needs of each area and its people (AVERT 2011b). There is not much information on whether or not AVERT maintains a powerful influence on WAMATA or any of its other supported projects, but the overall impression is that it tries to allow each project to retain its local and community based aims.

In comparing the NGOs of AMREF, CAP AIDS, and AVERT, it is evident that the basis of their work focuses on community based, local initiatives to treat and combat the spread of HIV/AIDS. Even so, each of the organizations has its specific objectives to reach this goal. For example, AMREF revolves around reducing the gap between communities and the rest of the healthcare system in Africa; CAP AIDS promotes gender inequality as an integral part of its work on HIV/AIDS; and AVERT focuses on specific projects throughout Africa that foster sustainable solutions to the prevention and treatment of HIV/AIDS. With different paths to a similar goal, one theme remains consistent: in order to prevent, treat, and stop the spread of HIV/AIDS in Africa there needs to be education, training, cooperation, community, regional, and international partnerships, support networks, and a focus on local control.

Clearly, the HIV/AIDS epidemic that is rampantly sweeping the globe is much more complex than anyone would have imagined it would become when it began in the 1980s. HIV/AIDS is so intricately connected with every element of life from economic and social to psychological, that one specific cause and solution cannot be pinpointed. The work that NGOs like AMREF, CAP AIDS, and AVERT do is essential to ensure that the HIV/AIDS epidemic can be prevented, treated, and eventually, eradicated altogether. Without the efforts of these self-less organizations, the HIV/AIDS epidemic would be even more tragic and devastating than it is currently.

Bibliography

AMREF. “Enhancing Capacity and Participation to Close the Gap in the Health Systems: Strategy 2007 to 2017.” 2007. March 2011. .

AMREF. “Our History.” 2011a. March 2011. < http://www.amref.org/who-we-are/our-history/>.

AMREF. “Community Focused Initiatives to Control HIV & AIDS in Kenya.” 2011b. March 2011. < http://www.amref.org/what-we-do/maanisha--community-focused-initiatives-to-control-hiv--aids-in-kenya/>.

AMREF. “Luwero Orphans and Vulnerable Children Project.” 2011c. March 2011. .

AVERT. “How is AVERT Organised?” 2011a. March 2011. < http://www.avert.org/aids-hiv-charity-avert.htm>.

AVERT. “AIDS Projects.” 2011b. March 2011. < http://www.avert.org/aids-projects.htm>.

Barnett, Tony & Alan Whiteside. AIDS in the Twenty-First Century: Disease and Globalization. New York: Palgrave Macmillan, 2002.

CAP AIDS. “About CAP AIDS.” 2010a. March 2011. .

CAP AIDS. “CAP AIDS Policy on Gender & HIV/AIDS.” 2010b. March 2011. .

Elbe, Stefan. “HIV/AIDS and the Changing Landscape of War in Africa.” International Security Vol. 27, No. 2 (2002): 159-177. JSTOR. March 2011. .

Nemapare, Prisca N. & D. Dow Tang. “The Vulnerability of Children and Orphaned Youth in Zimbabwe.” The Children of Africa Confront AIDS: From Vulnerability to Possibility. Eds. Arvind Singhal & W. Stephen Howard. Athens, OH: Ohio University Press, 2003. 51-58.

Ostergard, Robert L. “Politics in the Hot Zone: AIDS and National Security in Africa.” Third World Quarterly Vol. 23, No. 2 (2002): 333-350. JSTOR. March 2011. .

Patterson, Amy S. “AIDS, Orphans, and the Future of Democracy in Africa.” In The Children of Africa Confront AIDS: From Vulnerability to Possibility.

Petros, George et al. “HIV/AIDS and “Othering” in South Africa: The Blame Goes On.” Culture, Health, and Sexuality Vol. 8, No. 1 (2006): 67-77. JSTOR. March 2011. .

UNAIDS. “Report on the Global AIDS Epidemic.” 2010. March 2011. .

UN & WHO. “The HIV/AIDS Pandemic and its Gender Implications.” 2000. March 2011. < http://www.un.org/womenwatch/daw/csw/hivaids/report.pdf>.

Whiteside, Alan. “Poverty and HIV/AIDS in Africa.” Third World Quarterly Vol. 23, No. 2 (2002): 313-332. JSTOR. March 2011. .