Global Society's Response to HIV/AIDS: Botswana's Experience

Approximately 37% of Botswana's population was HIV-positive in 2005. This study examines Botswana's experience of the HIV/AIDS threat in order to assess the strengths and weaknesses of the response by global society. Botswana is particularly useful in evaluating the pandemic threat and national and global responses since it is considered a sub-Saharan leader in establishing a national infrastructure of HIV/AIDS governance—one closely coordinated with global society's infrastructure and culture of HIV/AIDS governance. This paper argues that a polyarchic notion of governance and authority has relevance to the sphere of HIV/AIDS governance and this is evident in Botswana's experience. This study analyses the key features of the global response to the pandemic. It then explains and evaluates Botswana's administrative, financial and operational responses to the pandemic. The paper concludes by identifying critical policy challenges for the further development of effective global–national HIV/AIDS governance.     

HIV/AIDS and governance along the corridors of conflict in West Africa

West Africa demonstrates a sub-regional pattern of violence and political instability that has engulfed Côte d'Ivoire, Liberia, Sierra Leone and Guinea, and now extends out from these states through corridors of violent conflict throughout the region; both physical and figurative. This article makes two arguments. That HIV/AIDS has developed a complex inter-relationship with violent conflict in the West African sub-region; and that the presence of HIV/AIDS in West Africa in zones of violent conflict is not given the recognition needed by the international policy community. The neglect of West Africa in the Pan-African response to HIV/AIDS, and the intractability of the region's Complex Political Emergencies, is creating an emerging phenomenon of Complex Human Emergency in the region. An acknowledged gap exists in social analyses of HIV/AIDS between policy speculations and the actual evidence base that these are built upon. Instead of speculative theorizing, this article presents seven key questions that need to be asked about HIV/AIDS and conflict in West Africa, in order to begin the process of serious policy research on the issue.     

Communication,choice and freedom with reference to risk in aspects of communication on HIV/AIDS

Abstract

Where analysis concludes that a context is characterised by high risk, as in thecase given HIV/AIDS in South Africa, individual choice and freedom are often negated, for instance, by social scientists when they resort to the statistical logic of large numbers. Ironically, given that knowledge and rationality are arguably related, the choice and freedom of the individual deemed not to have knowledge about a given issue, is questioned and soon negated. By focusing on the black people in South africa, as a key example, it is argued that such analyses and solutions deny the existential possibilities of the people. The aim of this article is to affirm an individual's possibilities. The situation of the individual who communicates is recalled to argue against approaches that variously seek to blame the individual.

In the time of HIV/AIDS, ideas such as those of Søren Kiekegaard should be engaged to advance understanding of the limitations and possibilities of the individual who communicates. In the trasition from understanding to acting on information on HIV/AIDS, the individual has the freedom to choose. This is humbling for communication scientists and practioners who seek to prevent the further spread of HIV/AIDS.     

Rhetoric and ethics: looking at the marks of our reading/speaking in society

ABSTRACT

This article follows aspects of the current debate on racism as embodied in the AIDS-HIV controversy. It discusses President Thabo Mbeki's AIDS letter to world leaders in terms of the religious reality it invokes and his reaction to opposition at home regarding his stance on the link between AIDS and HIV. His handling of opposition is analysed in terms of Emmanuel Levinas's concept of the Other and J Hillis Miller's concept of the law of the text. The article concludes that the debate on racism is still stifled by essentialist thinking on both sides of the racial spectrum, making it very difficult to transcend the situation.     

Handing over an operational project to community management in North Darfur,Sudan

The Kebkabiya project was the first of Oxfam's operational development projects instigated during the 1980s to initiate a handover to community management. It therefore offers a possible model to other operational projects considering their eventual future. This article analyses the processes of handover into those affecting the operational control of service delivery, management control, and the project's financial base. It argues that a handover, if it is to be successful and sustainable, must be treated as a complex set of activities requiring a long time framework, much like any other developmental process.     

Meeting the challenges to scaling up HIV/AIDS treatment in Africa

AIDS-related morbidity and mortality not only affects individuals and their families, but is rapidly undermining African states' capacity to develop. Stemming the impacts of the pandemic has therefore become a major concern. This calls for meeting the needs for care and support of those affected, and increasing the access of persons living with HIV/AIDS to effective treatment. Provision of such complex medication in resource-limited settings is a fairly recent phenomenon. In this context, the article builds on emerging experiences from the field in identifying issues and challenges that need to be addressed in order to facilitate the scaling-up of HIV/AIDS treatment in Africa.     

Who will guard the guardians? Amartya Sen's contribution to development evaluation

An Action Learning process integrated with Sen's Capability Approach can support development agencies to formulate interventions that enhance freedom. The authors show that putting this approach into practice has important implications for the manner in which ‘development’ is undertaken as an ideological project. It may help to examine and challenge those who hold power in development: the guardians. This finding is the result of an emergent Action Learning process that was initiated by applying Sen's principles to focus-group interviews with women who care for people affected by HIV and AIDS. One of the findings of these focus groups was that the participants valued the process because it opened a space for them to influence the work of the implementing NGO. Essentially, they could hold the implementing agency to account. Reflection on this outcome by the agency led to important shifts in processes that are more supportive of freedom.     

Measuring the success of HIV/AIDS NGOs among Nairobi's youth

NGOs receive praise and criticism for their international development efforts, but more work is needed to measure their contributions. This article lays out the contributions of local NGOs to HIV-prevention efforts. It draws on data from a survey of young people's experiences with NGOs to demonstrate the reach of several local HIV-prevention NGOs in Nairobi, Kenya. It argues that even small NGOs are capable of making measurable contributions to development in their fields. It also shows how factors such as education levels, religiosity, and discussions about HIV/AIDS can support NGO efforts by encouraging youth to participate in HIV-prevention programming.     

Stemming the HIV/AIDS epidemic in South Africa: Are our HIV/AIDS campaigns failing us?

Abstract

Media-based campaigns are critical tools in changing the behaviours that are fuelling the HIV/AIDS epidemic in South Africa. However, given the absence of an effective behaviour-change response in the face of the epidemic, many have come to doubt the efficacy of these campaigns. Campaign designers who profess to using best-practice principles in designing HIV/AIDS campaigns also report that although some of these campaigns book changes in beliefs and attitudes, they seldom have a significant effect on the behaviours that are fuelling the epidemic.

This situation raises a number of general questions with regard to South African HIV/AIDS campaigns: How effective are media-based campaigns in general in changing health-related behaviours? Are South African HIV/AIDS campaigns successful or not? If not, why not, what could be done to optimise their efficacy? What aspects of South African HIV/AIDS campaigns contribute to their efficacy and could be up-scaled in future campaigns?

This article provides a critical analysis of the processes followed in the design of the Living Positively Campaign and of the design features of the messaging of the booklet Living positively with HIV and AIDS. This analysis clearly indicates that despite claims by campaign designers of adherence to best-practice heuristics, very few of them are implemented in the design of HIV/AIDS campaigns.     

The dynamics of contemporary local-government policies and economic development in West Papua

There have been enormous political, economic, and social changes in West Papua. Every governor of West Papua has designed programmes to boost economic development and reduce poverty. The influx of migrant workers under the ‘transmigration programme’ into West Papua has limited the job opportunities for indigenous people in the labour market. This article concludes that the local government's strategies failed to deliver suitable development programmes to the local people, which resulted in increased poverty, the continuing poor development of the education system, and the deterioration of the population's health condition, with a rise in the number of Papuans infected with HIV and AIDS.     

Using art and everyday objects to fight HIV/AIDS in Uganda

This paper argues for the importance of enabling dialogue between women and men about taboo subjects of sex and sexuality in HIV/AIDS prevention. It reports the findings of a project that sought to use art (specifically sculpture) for creating dialogue between women and men in rural Uganda. It then provides suggestions for HIV/AIDS practitioners on how to use everyday objects to stimulate similar discussion about sex and disease prevention between women and men. We argue for the utility of art and everyday objects where literacy rates are low, or where modes of communication and information-sharing are predominantly orate.     

Managing and controlling HIV/AIDS talk among Ghanaians living with HIV/AIDS

Abstract

This study explored the meanings people attribute to talking about living with HIV/AIDS. Framed by interpersonal and health communication scholarship based on disclosure and the meanings of talk about illness, people living with HIV/AIDS are asked to describe how and why they discussed their health condition with others. Interviews (focus group and one-on-one) were conducted with 120 people living with HIV/AIDS. A grounded theory analysis of the interviews revealed how communication about HIV/AIDS may be particularly meaningful because it is something people feel they can control during what is already a highly stressful and turbulent time. However, attempts to manage communication are challenged by constraints imposed by others, such as unfavourable and unpredictable reactions to disclosure, which ultimately place limits on how people living with HIV/AIDS control information about them.     

The persuasive effect of Tsotsitaal in HIV/AIDS material

ABSTRACT

According to Statistics South Africa (2002) HIV infections were the leading cause of death for females between 15 and 39 years of age for the period 1997 to 2001. The South African Department of Health (2003) estimates that 3.1 million women (15–49 years) in South Africa are HIV-infected. The Human Sciences Research Council (HSRC) (2002) claimed that in the 15- to 24-year age group, 12 per cent of the women and 6.1 per cent of the males are HIV-infected. The high incidence of HIV/AIDS has resulted in a number of campaigns that seek to promote safe sex. According to the results that have been published, young people are seen as a high-risk group. However, of the campaigns that seek to address the issue of HIV/AIDS, the loveLife project is the only campaign aimed exclusively at young people. loveLife makes extensive use of the printed media in their campaigns. They claim to speak in a language with which young people will identify. Very little research into the effectiveness of the language use in these campaigns has been undertaken. Saal (2003) examined the effect of teenager slang as used by loveLife among learners in the Western Cape. This research is an extension of the research conducted by Saal (2003), looking in particular at the effect of Tsotsitaal among learners in the Eersterust area. Tsotsitaal is widely used in Eersterust, Gauteng Province, and its persuasive effect in HIV/AIDS material will be examined. Two brochures (written in Standard Afrikaans and Tsotsitaal) were tested in terms of their effect on source–receiver–similarity, source attraction and credibility (source expertise and trustworthiness) as well as persuasiveness. The findings of the study suggested, somewhat surprisingly, that speakers of Standard Afrikaans are rated more favourably than Tsotsitaal speakers in terms of source–receiver–similarity and credibility. The participants also viewed the brochure in Standard Afrikaans as significantly more persuasive than the Tsotsitaal brochure.     

VAWG mainstreaming in access to justice programmes: a framework for action

If we are finally to end violence against women and girls (VAWG), then this commitment needs to be embedded into all development programmes, regardless of sectorial focus. Women and girls are vulnerable across the board and recognition of this reality is the first step. This article proposes a VAWG mainstreaming framework that addresses how to centralise a VAWG lens into development programming, irrespective of programmatic priorities. The article outlines the need for such a lens and presents the approach through a number of stages. The model is then applied to two programme areas, microfinance and HIV/AIDS, demonstrating its applicability across development issues.     

Female volunteers: An asset to the reproductive health sector in rural Cambodia

The results of a field study examined in this article show the remarkable success of a reproductive health education and community outreach project in Cambodia that has been implemented by the Ministry of Women's and Veterans' Affairs since 1995, both in terms of levels of volunteer activity and in terms of the impact of the project on increased knowledge and practice in reproductive health issues among the target population. A key to the project's success appears to be its adherence to principles identified, but seldom practised, such as a strong commitment to capacity building at all levels.     

Evaluating HIV/AIDS education programmes in Ugandan secondary schools

Although not part of the national curriculum until 2004, HIV/AIDS education has been taught for some time in Ugandan secondary schools through a variety of extracurricular means, including the media, youth groups, drama, music, and Parent–Teacher Associations. This article identifies and evaluates the integration of HIV/AIDS information into the national curriculum in Ugandan secondary schools between 2002 and 2004, based on the viewpoints of administrators, teachers, and students from 76 schools. While most schools did not include HIV/AIDS as part of the formal national curriculum at this time, the information was disseminated through a range of alternative means. The authors identify the most effective of these, discuss the perceived reactions of various stakeholders regarding HIV/AIDS being taught in secondary schools, and make recommendations for curricular reform.     

Making aid effective at the community level: the AMREF experience

Effective use of donor aid is critical in achieving the sixth Millennium Development Goal –reversing the HIV/AIDS epidemic by 2015. The Paris Declaration of 2005 identified five key principles for aid effectiveness: ownership, alignment, harmonisation, mutual accountability and managing for results. As civil society organisations play a critical role in implementing HIV/AIDS interventions, it is important that they adhere to these principles. Often, however, they fail to implement interventions conforming with the principles, leading to duplication and inefficiency. Two case studies from AMREF in Kenya demonstrate how the principles of aid effectiveness can be applied to increase the impact of HIV/AIDS interventions.

Rendre l'aide efficace au niveau communautaire : l'expérience d'AMREF

L'utilisation efficace de l'aide apportée par les bailleurs de fonds est cruciale pour atteindre le sixième Objectif du Millénaire pour le développement – inverser l'épidémie du VIH/sida d'ici à 2015. La Déclaration de Paris de 2005 a identifié cinq principes clés pour l'efficacité de l'aide : l'appropriation, l'alignement, l'harmonisation, la redevabilité mutuelle et la gestion en vue de résultats. Comme les organisations de la société civile jouent un rôle crucial dans la mise en ?uvre des interventions en matière de VIH/sida, il est important qu'elles adhèrent à ces principes. Cependant, souvent, elles échouent à mettre en ?uvre des interventions conformes aux principes, ce qui aboutit à des doublons et à l'inefficacité. Deux études de cas d'AMREF au Kenya démontrent la manière dont les principes de l'efficacité de l'aide peuvent être appliqués pour accroître l'impact des interventions de lutte contre le VIH/sida.

Tornando a Ajuda Efetiva no Âmbito da Comunidade: A experiência da AMREF

O uso efetivo da ajuda dos doadores é crucial para se alcançar o sexto Objetivo de Desenvolvimento do Milênio – reverter a epidemia do HIV/AIDS até 2015. A Declaração de Paris de 2005 identificou cinco princípios-chave para a efetividade da ajuda: apropriação, alinhamento, harmonização, responsabilidade mútua e gerenciamento para resultados. Como as organizações da sociedade civil desempenham um papel crucial na implementação de intervenções relativas ao HIV/AIDS, é importante que elas tenham adesão a estes princípios. Frequentemente, porém, elas falham na implementação das intervenções de acordo com os princípios, levando à duplicação e ineficiência. Dois estudos de caso da AMREF no Quênia mostram como os princípios da efetividade da ajuda podem ser aplicados para aumentar o impacto das intervenções relativas ao HIV/AIDS.

Una ayuda más eficiente a nivel comunitario: la experiencia AMREF

Para alcanzar los Objetivos de Desarrollo del Milenio y conseguir que la epidemia del VIH/SIDA retroceda para el 2015, es de vital importancia que la ayuda de los donantes se utilice con más eficiencia. La Declaración de París de 2005 enunció cinco principios clave para que la ayuda sea eficaz: apropiación, alineación, armonización, rendición de cuentas mutua y gestión basada en los resultados. Debido a que las organizaciones de la sociedad civil desempeñan un papel fundamental en la lucha contra el VIH/SIDA, es necesario que éstas respeten los cinco principios. Sin embargo, a menudo éstos no se aplican en la práctica ocasionando duplicidades y falta de eficiencia. Dos estudios de caso de AMREF (siglas en inglés de la Fundación Africana de Medicina e Investigación) en Kenia muestran cómo estos principios de eficacia en la ayuda son útiles para aumentar el impacto de la lucha contra el VIH/SIDA.     

Democratic institutions,political representation and women's empowerment: The quota debate in India

This article reflects upon the debate on quotas for women in representative institutions of government. It poses the question whether current debates about quotas for women are relevant to debates on women's empowerment. In doing so, it points to the bases upon which the arguments for and against quotas have been presented within the Indian political system, taking into account the historical debates on caste, the emergence of coalition politics, the strength of the women's movement, and the engagement of women's groups with the politics of difference. The central argument of the article is that unless the issues of class‐based and caste‐based differences are taken seriously by women's groups in India, the wider question of empowerment cannot be satisfactorily answered. The conclusion assesses whether the Indian example is of relevance to wider debates on quotas as strategies of empowerment.     

From rhetoric to reality: an NGO’s challenge for reaching the furthest behind

The guiding principle of Agenda 2030 is the commitment to “leave no one behind”. However, as the Millennium Development Goals experience has demonstrated, there remains a “rhetoric-implementation gap” where local stakeholders struggle to realistically respond to policies formulated at the global level. This article proposes a way forward for NGOs seeking to translate the rhetoric of Agenda 2030 into reality. It presents an integrated and multi-sectoral approach to meet the challenges of an NGO working to ameliorate the basic needs of women who are affected by HIV/AIDS and limited WaSH provisions in the impoverished rural community of Lyantonde, Uganda.