Memorandum submitted by Students Partnership
HIV/AIDS AND SOCIAL
In conjunction with the Governments of Uganda,
Tanzania, South Africa and Zimbabwe, SPW is currently working
on peer-education models which use trained local and overseas
volunteers, based in rural schools, to address reproductive health
and other threats to young people's livelihoods.
Introductiona wasted decade
In the Great Lakes region of Central Africa,
the capacity of HIV/AIDS to devastate whole societies was painfully
evident by the late 80s. In 1992, at the Earth Summit in Rio de
Janeiro, the world's governments pledged to "mobilise and
unify national and international efforts against AIDS to prevent
infection and reduce the personal and social impact of HIV infection".
Since 1992, while costly and effective measures
have been taken to protect high-risk groups in the North, HIV/AIDS
has been making horrifying inroads into the impoverished youth
population of sub-Saharan Africa, leading to growing exclusion
and unemployment, and the exponential rise of HIV infection.
The commitment by governments at Rio was not
simply a rhetorical call to arms; it was part of a carefully thought
out and comprehensive strategy for sustainable living in the face
of unprecedented threats to human health and the environment.
This strategy took particular account of the demography of countries
in the South, where already young people under 25 constituted
a disproportionately large element in societyand insisted
that young people must be central to sustainable development policy:
"It is imperative that youth from all parts
of the world participate actively in all relevant levels of decision-making
processes because it affects their lives today and has implications
for the future. In addition to their intellectual contribution
and their ability to mobilise support, they bring unique perspectives
that need to be taken into account."
Agenda 21 made it clear that formal teaching
was inadequate if long-term changes in young people's attitude
and behaviour were to be effected; alternative learning approaches
and methodologies were strongly recommended. The point repeatedly
made in chapters 25 and 36 was that, in both the North and South,
young people must participate in the design and implementation
of programmes which raise awareness and stimulate action.
The humane and enlightened global stance adopted
in Rio has been reaffirmed annually at the Commission for Sustainable
Development meetings in New York, and the component relating to
youth has been reiterated in a succession of youth-focused global
conferences sponsored by the UN agencies and yet it is only now,
against a background of public indifference in the North, that
co-ordinated global action on behalf of the world's most disenfranchised
communities appears at last a real possibility.
During this period of inaction, SPW has been
recruiting and training hundreds of young Africans, alongside
counterparts from the North, to work as peer leaders addressing
reproductive health and other life issues in rural communities
in Uganda, Tanzania, South Africa and Zimbabwe. By the nature
of its work, SPW has been made all too aware of the gap between
rhetoric and reality. Five years ago, SPW received the official
endorsement of the UNDP and UNEP, acknowledging that its aims
and methodology were entirely consistent with Agenda 21 and notifying
all UNDP country offices; since then, apart for one isolated grant,
these agencies have failed to provide anything more than moral
support. SPW and other youth-focused agencies working in the South
hope that this year's high-profile exposure of the HIV/AIDS calamity
will not be seen in retrospect as part of the same pattern of
rhetoric and inaction.
DFID's two recent strategy papers, Fighting
Back and Better Health for Poor People, are encouraging
evidence of a profound shift in thinking. The strategic objectives
of Fighting Back in particular bring policy back in line
with Agenda 21: its commitment to regard youth as the primary
target group, and the need for young people to take a pro-active
role in the drive to control HIV/AIDS is especially to be welcomed.
The challenge remains to find an effective means of implementation.
DFID's policy in this regard is much less convincing.
It presupposes a superstructure made up of governmental and multilateral
agencies which would direct national strategy through inter-departmental
groups, via local education and health authorities, into civil
society and community-based organisations. The intention is that
decentralised strategies would be reinforced, and responsibility
devolved to local level. Attractive though this sounds, it simply
will not work on the ground. The same powerful inhibiting mechanisms
which have prevented co-ordinated and purposeful intervention
in the past, will continue to do so.
The following analysis of these inhibitors is
based on SPW's experience in four sub-Saharan African countries
of operating at the interface between government and multilateral
bodies on the one hand, and schools and rural communities on the
Both DFID papers assume that under the new "crisis"
dispensation that there will be an increased role for the multilateral
agencies. Given their track record, this assumption is difficult
to justify. During the '90s, the primary role of these bodies
should have been to instil urgency in each national government
to co-ordinate its efforts against AIDSthis they have failed
to do. In the countries where SPW operates there are no active
cross-sectoral groups targeting AIDS at any level, and no effective
liaison between the two lead ministries: health and education.
No strategic ideas for tackling AIDS on a regional basis have
emerged from these organisations.
A root cause of this disjunction is that that
the agencies themselves do not work together. In Kampala, all
five relevant UN agencies (UNAIDS, UNICEF, UNDP, UNESCO and UNFPA)
have separate offices, with no established lines of communication
between them. In Dar-es-Salaam, despite the presence of a UNAIDS
co-ordinator, there is another AIDS co-ordinator within UNDP.
In the face of increasing need for co-ordinated
intervention, the response of these multi-tiered bureaucracies
has been reactive; their habit of mind, at best, academic and
detached. They have been more interested in circulating research
papers than, offering advice to and facilitating the activities
of disparate groups than co-ordinating practical action on the
ground. Highly visible at conferences, seminars and workshops,
they are rarely to be seen at the grassroots where HIV/AIDS is
Furthermore, multilateral agencies deal almost
exclusively with government, reinforcing central control at a
time when what is urgently needed is decentralisation, local capacity
building and community mobilisation. They are not designed to
interact with civil society organisations, let alone community
groups in the rural areas. Funding application procedures are
generally arcane, and the result is that such money as is set
aside for micro-project work in rural communities is frequently
unspent. More than a year ago, UNESCO expressed whole-hearted
support for SPW's work in Africait is still trying to find
a mechanism for funding SPW within its inflexible parameters.
Besides, the amount spent on sustaining these
elaborate structures is already profligatemoney which is
desperately needed for practical intervention. In Better Health
for Poor People, section 2.2.2, the point is bluntly made
with reference to these agencies:
The financial leverage of donor agencies in recipient
countries, coupled with low levels of political profile and scrutiny
"at home", combine to create a hazardous vacuum of accountability.
The report also notes that there has been a
"proliferation of the actors responding to global health
needs over the last 20 years", and that "mandates and
responses have become blurred, resulting in overlap and confusion".
If this is an accurate judgement of the performance of these agencies,
they are entirely unsuited to the implementation of grassroots
strategies. As the report suggests, "The challenge facing
the international health community is to mould these key actorseach
pursuing often radically different agendasinto an integrated
whole". The crisis management required cannot wait for these
inflexible agencies to achieve the desired co-operation. While
they try to become a genuine "international health community",
millions more will contract HIV.
Civil society organisations
Both DFID strategy papers rightly stress the
need to work closely with civil society organisations if a genuinely
national prevention strategy is to be put in placebut they
do not make clear which organisations they have in mind. If they
mean schools, churches and other religious institutions, rather
than NGOs and community groups, then it has to be recognised that
progress has been seriously retarded during the 90s by their damaging
chauvinist and conservative attitudes. Given as they are to moralistic
judgement and prescriptive advice for young people, they have
shown themselves not to be natural allies in a campaign for community
mobilisation in the fight against AIDS. While the school system
must remain central in any strategy, it has so far failed in its
responsibilities. Teachers are now one of the worst hit groups
in society, and as such are not appropriate role modelsto
the point where girls are now at risk at school.
In rural Africa, the AIDS epidemic has produced
a plethora of AIDS service and community-based organisations.
These paid and voluntary groups, which form the front line in
the grassroots battle against AIDS, generally lack funding and
administrative skills. Because they work largely in isolation,
they cannot provide a reliable infrastructure for systematic AIDS
prevention work. But if there were rurally-focussed umbrella organisations
offering small-scale funding, training and advice, they could
collectively become a force for change.
Undermining any plans for implementation is
the shortage of skilled people at all levels of African society.
The strategy documents talk repeatedly of the activities that
must be undertaken if its strategic objectives are to be met;
but the human resource implications are not mentioned. In countries
where few proceed to secondary education, and where training facilities
are minimal, who will fill these vital roles?
Given these fundamental systemic weaknesses,
there must be a strong case for taking an entirely different linewhich
is the subject of the accompanying summary paper, "HIV/AIDSa
youth-led approach". This paper was recently circulated in
advance to a range of organisations in Kampala and Dar-es-Salaam.
Discussions followed with over 30 senior people in the relevant
UN agencies, government ministries and key players in the donor
community: DFID, USAID, GTZ, CIDA and others. There was unanimous
support for its underlying principles. The papers and accompanying
material have also been sent to the HIV/AIDS section of the World
Bank by the London Director, who in his letter of recommendation
called it "a fresh catalytic approach". SPW is currently
in discussion with DFID, and is hopeful that it will support this
In the countries most afflicted by HIV/AIDS
there are no coherent nation-wide strategies for reaching the
young generation. As a result millions of childrenespecially
those living in the rural areasare contracting the disease
because of ignorance or because they fail to understand the full
implications of their own behaviour. Already the high incidence
of HIV infection among teenagers has staggering medium-term human
and economic implications.
Given that there is no vaccine nor cure for
AIDS, the strategic emphasis must be on educationeducation
which is powerful enough to overcome the inhibitors working against
changes in attitude and behaviour. It must focus on children and
young people because they are especially vulnerable, and because
they are increasingly bearing the brunt of the epidemic.
To achieve this, two conditions must be met.
National campaigns must be integrated into the heart of civil
society, and sufficient numbers of trained educators must be made
available to implement them. These basic requirements are within
the capacity of even the poorest countries. All have primary and
secondary schools educational systems which give access to the
great majority of children; these form a natural infrastructure
for national coverage. Less obviously, all these countries have
the potential to mobilise such educators in abundance.
What form, then, should the educational campaign
take? Evidence from UNICEF and other agencies shows that curriculum-based
and teacher-led programmes have so far failed significantly to
change young people's behaviour. Alternative strategies for HIV/AIDS
education are urgently needed, which take into account the understandable
reluctance of young people to listen and respond to the advice
of their elders in sexual matters. The natural urge to explore
sexuality, the risks and excitement involved are heightened in
the young person's mind by the different risks and excitement
of ignoring adult advice, and defying their rules. Approaches
based on adult prescription must therefore be sparingly used.
What then is the alternative? It is widely recognised
that the strongest single determinant of sexual conduct is peer
influence. The adolescent defines his or her sexual nature in
ways which subtly conform to the standards and expectations of
their group. Children are therefore more likely to be persuaded
to review or change their behaviour by others close to their own
age whom they look up to. This truth is borne out by a range of
projects which show that clinics staffed with trained young volunteers
attract more response, and are valued more highly by the young
people involved, than those staffed solely by adults. Other projects
confirm the power of peer influenceand yet young people
have not so far been given a leading role in the HIV/AIDS offensive.
All across Africa the secondary school and university
systems are producing large numbers of graduates, who frequently
remain unemployed for long periods. It is precisely these educated
and confident young people who must spearhead national campaigns
to change attitudes and behaviour among rural children. Attaching
these young people to rural schools would add a dynamic peer education
element to HIV/AIDS education. Their presence in rural communities
would challenge the damaging reluctance of the older generation
to openly discuss HIV/AIDS.
At the same time this new focal point for youth
and community action could grow organically into a sustainable
community-based care system for AIDS sufferers in rural areas,
surely preferable to the building of homes and hospices with no
roots in the local society. A coherent response to the HIV/AIDS
epidemic must seek to link prevention and care.
For some time now SPW, a youth development agency,
has been working along these lines in four of the worst hit counties
in sub-Saharan Africa. SPW trains and attaches local and overseas
volunteers to rural schools as peer educators for up to a year.
The volunteers set up and run Youth Groups, which raise awareness
of key social and environmental problems children face in their
everyday livesin particular, reproductive health. Through
non-formal teaching methods they bring home the deadly immediacy
of AIDS, and enable Youth Group members to acquire the self-confidence
and life-skills necessary to translate information into behavioural
changeespecially amongst girls. They also gain the support
of peer leaders, teachers and other community members to continue
these activities after they leave. These clubs impact throughout
the school and into the wider community.
In co-operation with the Governments of South
Africa, Uganda, Tanzania and Zimbabwe, SPW is currently developing
a Demonstration Model, which uses task forces of approximately
50 volunteers in each country, based in 25 rural schools. Its
purpose is to trial and test components for a comprehensive HIV/AIDS
prevention programme, which would:
use schools as access points to rural
youth and their communities;
be delivered by trained young adults;
target specific age groups with appropriate
draw on existing materials and best
practice from other agencies;
design effective strategies, materials
and methodologiescapable of local and national replication;
use local culture and language to
reinforce standard approaches.
SPW's programmes have already produced a wealth
of youth-friendly materials, training strategies and practical
methodologiesdrawn from first hand experienceand
designed to make the threat of HIV/AIDS more real to rural children
than formal classroom teaching ever could.
To provide the necessary resources and expertise
to sustain activities in the schools initiated by volunteers,
SPW is piloting Youth Development Centres (YDCs) in each of its
working districts. These interactive district centres would link
young people in the rural areas to the providers of expertise
and resources in the urban centresincluding private sector
partners. This model, if properly supported, has the potential
to develop into national networks of linked, multi-purpose youth
and community development centres.
The South African Government's recent radical
reforms confirm that this is a viable approach. Facing a desperate
AIDS crisis, it has initiated two major social reforms. Firstly,
it is advocating stronger links between rural schools and their
local communities so that they can together engage with AIDS and
primary development issues. Secondly, it is setting up a National
Youth Service, which would encourage and enable young people to
contribute through voluntary activity to community and national
There is no time to lose, Initiatives to date
have only had local and limited effect, failing even to stem the
acceleration of HIV infection. Within a decade, a whole generation
of young Africans could be lost. Rather than being dismissed as
the helpless victims of the disease, they must be given the support
and funding to take the lead in the next stage of the campaign.