AIDS action Issue 7 Page 1 2
Issue 7 June 1989
Cooperation and coordination
As this newsletter goes to print, over ten thousand people will be attending the Fifth International Conference on AIDS/HIV infection, held this year in Montreal, Canada. Over the past few years, the number of individuals, community organisations and governments working on AIDS has increased almost as rapidly as the spread of the disease itself. But until the results of our collective efforts can be seen - that is, until HIV transmission is reduced to a minimum and better health and health care have been achieved for all - there is much to be done.
Much of this work lies in promoting effective cooperation and coordination between the thousands of community, national and international organisations involved. No one group can fight this disease alone: government policy-makers need local activists, and local activists need government grants. All of us need to ensure that scarce resources are not wasted, tasks are not duplicated and that health messages are complementary, not contradictory. Most important of all, national and international programmes need an "Early Warning System" when things go wrong or could be done better. In many cases, non-government organisations (NGO's) working at the community level are best placed to sound the alarm.
Such organisations are beginning to coordinate their efforts to ensure that warnings or concerns about the effectiveness of programmes are acted upon. Governments, too, are recognising the vital role of NGOs, particularly those with long standing community based experience, in national care and prevention programmes. Many have acknowledged the need for greater cooperation with NGOs, expressed through recent resolutions at the World Health Assembly.
In this edition of WHO Report (centre insert) Bob Grose, External Relations Officer for the Global Programme on AIDS, stresses that government cooperation with NGOs does not mean control of NGOs. But if this is to remain true, NGOs need effective ways of voicing their demands. How can this be achieved amongst many different, and sometimes small, organisations? Quite simply, by getting together and discussing the issues concern - both with each other, with the WHO/Global Programme on AIDS and with National AIDS Committees. This is happening, for example, at international meetings (such as the NGO forum Opportunities for Solidarity held in Montreal (see page 7); greater NGO representation on National AIDS Committees and the formation of NGO AIDS consortia (such as the UK consortium of development agencies reviewed on page 7).
As a result, NGOs are able to ask key questions from a stronger standpoint: 'Where is our promised supply of HIV testing kits? Does the National AIDS Committee have effective community representation? Why can't we publish statistics? Why are infected people losing their jobs and what can we do to stop it?' Community based NGOs are now becoming strong enough to ensure that their questions are answered.
In this issue
Diarrhoea and AIDS your questions answered Community core the Northwest AIDS Foundation (USA) Counselling an African experience WHO Report the role of non-government organisations in National AIDS Programmes
The international newsletter for information exchange on AIDS prevention and control
Diarrhoea and AIDS
Long-term (chronic) diarrhoea, often accompanied by significant weight loss, is a common symptom of AIDS. However, diarrhoea and the dehydration and malnutrition associated with it, can be successfully treated and, in many cases, prevented.
What is diarrhoea?
This is when the water content and, usually, the number and volume of the stools (faeces) increase. The colour and smell may also change. The term 'acute' diarrhoea is used to describe diarrhoea that starts suddenly and lasts only a few days. 'Chronic' diarrhoea lasts for much longer-months, or even years.
What causes diarrhoea?
Diarrhoea occurs when the exchange of fluids in the gut is not functioning correctly, i.e. too much fluid is secreted into the gut and/or too little fluid is absorbed back into the body through the lining of the gut during or after digestion. Infection with harmful parasites, bacteria or viruses prevents the normal exchange of fluids in the gut, causing diarrhoea. Food or water contaminated by the harmful pathogens (germs) present in human and animal faeces can cause intestinal infection in humans, resulting in diarrhoea. Good hygiene and sanitation are vital in preventing the spread of germs in this way.
Is diarrhoea dangerous?
Yes. The most serious consequence of diarrhoea is dehydration - the body's loss of essential water and salts. Symptoms of dehydration include: thirst, faster heartbeat, dryness of mouth, sunken dry eyes, reduced skin elasticity.
The dehydration caused by severe diarrhoea can cause patients to lose their appetite and may lead to vomiting, causing reduced food intake and weight loss. Some of the infections that cause diarrhoea in AIDS also reduce appetite and cause nausea and vomiting; some can also cause the loss of proteins from the gut or reduce the absorption of food.
The combined effects of weight loss, dehydration, and decreased appetite can further weaken the body and its immune system, making the patient more vulnerable to infections, contributing to further disease and sometimes death. The multiplication (growth) of some bowel pathogens (germs) causing diarrhoea can lead to permanent damage of the gut. This is common in AIDS patients.
Why do people with AIDS often suffer from diarrhoea?
People with AIDS (PWAs) are infected with the human immunodeficiency virus (HIV) which damages the body's natural ability to fight off infections. As a result, they are more vulnerable to infections of the gut (as well as infections elsewhere in the body).
Food and drink can be contaminated with dangerous diarrhoea-causing organisms. Normally, the body is protected by acid juices in the stomach and by the gut's immune defence system which destroys invading pathogens. However, if this system has been weakened or destroyed by HIV, these pathogens can survive and grow, causing diarrhoea. In addition, HIV itself can damage the gut, causing diarrhoea and malabsorption of food.
What are the common causes of AIDS-related diarrhoea?
PWAs may get all the normal causes of diarrhoea but in some cases the symptoms are more severe and prolonged. PWAs are especially vulnerable to Salmonella and Shigella bacteria. In addition, the damage to their immune defence system makes them susceptible to the parasites Cryptosporidium and Isospora belli (which cause very severe watery diarrhoea and malabsorption of food, often with crampy abdominal pain, nausea and vomiting) and to the virus Cytomegalovirus (which causes abdominal pain and less severe diarrhoea). Tuberculosis (TB) can sometimes affect the gut and lead to chronic diarrhoea (though easily treatable with anti-diarrhoeal agents) and malabsorption. People with HIV infection/AIDS often have diarrhoea and malabsorption due to the damaging effects of HIV itself on the gut lining.
What is the treatment for AIDS-related diarrhoea?
For dehydration: Whatever the cause of the diarrhoea, replacement of lost water and salts is always the first priority. Prevent dehydration by oral rehydration therapy (ORT) using oral rehydration salts (ORS) dissolved in clean water, as well as drinking additional fluids such as tea, soups, rice water and fruit juices. ORT is not a cure for diarrhoea, but it does effectively treat and prevent dehydration and replace salts lost from the body during diarrhoea.'
The formula for ORS solution recommended by WHO and UNICEF contains:
3.5 gms sodium chloride (or 2.5 gms sodium bicarbonate)
1.5 gms potassium chloride
20 gms glucose (anhydrous)
Dissolved in a litre of clean water.
Oral Rehydration Salts - ORS
ORS is distributed and sold in small packets. A simple sugar and salt solution can be made up at home as follows:
Mix one level teaspoon (5ml) of salt (ordinary cooking salt will do) with eight level teaspoons of sugar in a litre of clean drinking water. Do not add too much salt. Molasses and other forms of raw sugar can be used instead of white sugar. Raw sugar contains more potassium than white sugar.
Different countries and communities use different methods for measuring the salt and sugar depending on the most commonly available utensils, e. g. teaspoon, bottle-top, finger pinch, etc. Whatever method is used, the patient and his/her carer should be told how to measure and mix the correct proportions (further information on ORT can be obtained from AHRTAG).
For the infection: Some infections may need antibiotic treatment, including Salmonella, which may need long-term treatment to prevent relapse. Isopora belli can be treated with co-trimoxazole (960mg twice a day for 10-21 days); maintenance treatment at lower doses is often needed. Anti-tuberculosis treatment should be used for gut TB. For most other infections, notably Cryptosporidiosis, there is no specific drug treatment. Antibiotics should never be used to treat diarrhoea of unknown cause, since these drugs can worsen the patient's condition by killing 'helpful' bacteria naturally occurring in the gut (i.e. bacteria which control the growth of more dangerous germs). PWAs can also develop serious adverse effects to these drugs. In all cases, oral rehydration therapy remains the most important treatment.
Can better nutrition help treat the effects of diarrhoea?
Yes. Eating frequent amounts of high energy foods helps to replace lost nutrients and energy. A little vegetable oil can be added to millet or rice to increase energy content. Foods high in potassium are important as they replace the potassium lost through diarrhoea. Such foods include bananas, lentils, mangoes, pineapples, paw paw, coconut milk and citrus. In general, people with chronic should eat normal foods as frequently as possible although high fiber and spicy food should be avoided.
Why is diarrhoea more of a problem in developing countries?
Chronic diarrhoea is one of the major symptoms of AIDS in developing countries, and is probably a more predominant symptom than in wealthier nations. This is because the conditions necessary for good sanitation, personal hygiene and safe food preparation are often not available. As a result, gut pathogens are significantly more prevalent, putting people at higher risk of acquiring diarrhoeal disease. In hot, tropical regions, increased loss of water through sweating may make it harder to tolerate the effects of extra water loss through diarrhoea. Restricted water supply can be an additional problem.
How can diarrhoea be prevented?
Hygiene, access to safe water supplies and good sanitation and living conditions are all essential to the prevention of diarrhoea. Hygienic preparation and storage of food is also particularly important. Uncooked food should be washed carefully in clean, or disinfected water. All foods should be covered by a clean cloth or stored in clean, animal-proof containers in a cool place. Cooked food should not be stored for long periods before eating. Hands should be washed thoroughly (with soap wherever possible) before preparing food, fruits. and especially after going to the toilet. Properly maintained latrines should used or urine and faeces should be covered by earth. Although these measures are important for all people, they are particularly important for PWAs.
Soiled bed linen and underclothes should be washed in very hot water and soap or disposed of carefully, and handled as little as possible. This is important to prevent the spread of diarrhoea. Wherever possible, home-care kits should be provided for patients and their families who may not be able to afford to buy the necessary items. A useful kit could contain:
bleach (keep away from children and give instructions on different strengths used for disinfection of soiled clothes, washing food stuffs, etc.) .
ORS packets or instructions for making salt/sugar solution
extra undergarments and sheets
sanitary padding for incontinence (strips of cloth, absorbent paper or cotton wool), with instructions for safe disposal
fuel and utensils for boiling water if necessary
petroleum jelly or antiseptic cream to be applied to the anal region after washing, to prevent soreness.
Further information can be obtained from Dialogue on Diarrhoea, published by Healthlink Worldwide, issue 19 (on ORT), 31 (water and sanitation) and 36 (practical hygiene and preventing food borne infections). Copies available from Healthlink Worldwide
A family commitment
Mrs. Noerine Kaleeba, founder member of The AIDS Support Organisation (TASO) in Uganda, discusses the wider role of counselling in AIDS prevention and control.
'In many countries, when someone is diagnosed HIV antibody positive, that's usually the end of the story - nobody wants to help. Before the creation of TASO, there was nowhere for a young man or woman to go and find out more, to get answers to their questions, to talk about their illness. TASO's work is based on promoting hope and compassion for people with AIDS and their families. At present, we work largely in the urban areas in Kampala and Masaka, providing medical, emotional and practical support to families affected by AIDS.
Many of TASO's volunteers are themselves HIV antibody positive, or have lost relatives with AIDS. My work is also based on personal experience - my husband died of AIDS in 1987 after receiving an infected blood transfusion following a road accident. While my husband was dying I started looking at the problem as a whole - looking at other families and how they were coping. I had an advantage - I had a good education, and was able to read about the disease. But I saw other women who don't go out to work, whose husband is the sole breadwinner. When the husband suddenly develops full-blown AIDS and dies, and the mother doesn't know whether she'll develop AIDS or not, or which one of her children may have been born with the disease, she is faced with overwhelming problems. And to make matters worse, society shuts her out because of the stigma.
Material and medical support
includes the provision of oral rehydration salts to alleviate the effects of
chronic diarrhoea (see page 3), and
home care kits containing. soap, Time should be spent explaining to the
antiseptic cream and protective rubber gloves. These kits help family of a sick relative how the disease
her gloves. These kits help families take care of patients and avoid
cross-infection through careless handling of
body fluids. It is no good telling a
patient's family to wash him or her
carefully and change bed linen often,
if they cannot afford soap or plastic
gloves, or even a pair of sheets.
A lot to say and a little time to say it
In Africa, many people came from miles away for treatment and counselling, and have problems with transport. This puts quite a pressure on the counsellor - you don't know when you'll see the patient again and you have five or six very important things you want them to understand and act on. Very often, the person has only just found out about their infection, and they are in shock. In general, patients are not very communicative - you have to talk and talk to get a patient to respond. There is too much information for them to take in at once, but you know that this might be your only chance to counsel them. The most difficult counselling situation is when a client refuses to tell their partner about the nature of their illness, and yet there is still a possibility that the partner is not infected. The role of the counsellor is to stress the fatality of the disease and the importance of protecting another life. Usually, clients eventually bring their partner in. Some men and women, for example, are in polygamous marriages. If one partner develops AIDS, and the husband/co-wives do not know, there are many crucial problems to be dealt with: knowledge about safer sex, keeping well, confidentiality, and so on. If a woman is discovered to be HIV positive before her husband, then the situation is more difficult than if the man's illness is discovered first. Some women - in trying to avoid telling their partner - say: "I'll keep away from him (sexually)." But this is virtually impossible. In this country it is men who decide when they want to make love - it often doesn't matter how the woman feels!
Understanding symptomless infection
We live in a male-dominated society. Often relatives will encourage a man who appears fit and well to leave his wife with AIDS and find another one, with no understanding that he may pass the infection on to another woman. We have some clients who have lost a number of wives - and yet their relatives are still persuading the man to find a new one. People start to ask them: "Why are you still alone?" The social pressure to remarry after a previous sexual partner has died of AIDS, stems from a lack of understanding of asymptomatic infection, i.e. people do not understand that you can be infected with the virus that causes AIDS and still look and feel healthy. local people recognise the symptoms of the illness AIDS, but they do not understand how a healthy-looking infected person could infect their sexual partners, probably causing them to die. For example, people say: "look at that man - he has four wives, but only two of them have AIDS; he and the other wives look fine." People always try to prove you wrong about the spread of AIDS.
In Uganda, safer sex(1) is not considered to be proper sex. Advising clients about their future sex life is not easy - especially since condoms are unpopular. We have to advise our clients either to use a condom or to "stay away" from further sexual relationships. We also try to advise HIV antibody positive women not to have more babies.
Such advice is difficult to accept. The majority of our female clients are quite young, often between 20 and 25 years old, an age when women are normally having a number of children. We have one girl who has only one child and whose husband has just died of AIDS. She doesn't want to have the HIV antibody test (in fact, we don't advise people to take tests unless knowing the answer will definitely help them). So what does a woman in her position do? It is safest never to remarry - both for future partners, and for one's self. I tell them: "If you escaped the virus this time - will you next time? And if you are already infected, you must consider the risks of passing on the virus to someone else."
TASO is also developing a widow's project, which will enable women who have lost their husbands to become economically independent, so that they have no financial reasons for finding another husband. An organisation in Germany has donated sewing machines and materials to help women make items for sale.
Some women, and men, hope to run away from AIDS - to start up a new life in a new place with a new family. This is why the advice and support offered by counselling organisations like TASO is so important to the prevention and control of AIDS - because you can never run away from this disease.
For further information, please write to: The AIDS Support Organisation, PO Box 676, Kampala, Uganda.
(1) that is, using a condom or avoiding putting the penis into the vagina or anus.
TASO is a non-government organisation formed in 1987 to provide support for people with HIV infection or AIDS and their immediate families. It provides:
a counselling service offered by trained volunteers at offices and AIDS clinics in Kampala and Masaka, and an outreach service covering ten zones through-out Kampala. Home visits are made daily to facilitate family counselling and to provide friendly support for the AIDS sufferer.
basic material support for AIDS patients and their families where possible, e. g. eggs and milk to provide protein, a home-care pack (see text) and selected low cost medicines, including herbal remedies. Understanding symptomless infection
support for the development of social projects, such as income generating programmes for widows and grandparents, and support for orphans, e. g. money for schooling.
on-going training in basic counselling skills. Counselling courses have been held for health workers, social workers, volunteers and religious leaders. A counsellor-trainer recently joined TASO full time, recruited through Voluntary Service Overseas (UK).
The Northwest AIDS Foundation, Seattle, USA
Since 1982, over 800 cases of AIDS have been reported in the Seattle-King County area, in the Northwest of the United States of America. Of these people, nearly half are still alive, and most receive practical, emotional and financial help coordinated and supported by the Northwest AIDS Foundation (NWAF). This Foundation is one of hundreds of voluntary AIDS service organisations worldwide, formed as a community response the AIDS. Jane Mortell, Case Management Coordinator, describes its activities.
WALKATHON - an annual fund raising and educational marathon organised by NWAF. Last year (1988) over 4,000 sponsored walkers raised US$544,740 for health education and community care programmes.
Five or six years ago, AIDS was known here as the Gay Related Immune Deficiency Disease (GRID), because at first it primarily affected the gay (homosexual) community. As people became sick and began to die, and it was clear that the government was not responding quickly enough to the crisis, members of this community and the medical profession took up the challenge themselves. NWAF was formed in 1983 to care for people living with AIDS and to provide information about the disease and its prevention.
Although it started largely as the gay community's response to AIDS, its activities and focus have broadened greatly since then, now working to support all people who practice high-risk behaviour. From a staff of four, NWAF now has 30 staff and coordinates the work of over 600 volunteers. The Foundation provides a wide range of services (see right) to its clients, i.e. people living with AIDS who apply for assistance. Clients are referred to staff either by the hospital, a friend, relative, or by the client him/herself. The Case Manager (staff member who takes responsibility for coordinating services and support) then meets the client either at the client's home or the hospital to work out what services are needed and what are available.
John, for example, had lost an incredible amount of weight and had only recently found out that he had AIDS. His major worry was money. He had worked as long as possible before becoming too ill to continue, but he had no savings and no pension plan (post-employment income). The Case Manager helped John to apply for state Income support. He then looked at John's other needs. As John became more ill, the Chicken Soup Brigade (another voluntary organisation providing meals, and home help) was able to give him enough practical assistance to enable him to continue living at home, instead of moving to a nursing home or hospital. For emotional support, NWAF put John in contact with Shanti Seattle, a group of trained volunteers who provided one-to-one counselling.
In spite of his worsening health, John also wanted to help others, and often spoke about his disease in health promotion and publicity campaigns. Sometime before his death, he told NWAF: 'without the support of all these community organisations, I probably would have never come out of hospital.'
NWAF provides the following services to clients
Information and Referral
clients can call in or telephone for information about available services, e. g. housing, medical advice, home help.
coordinates a wide range of services for clients during their illness. The Case Manager works with an average of 35 clients, and is a highly trained professional with an excellent knowledge of the services available, including financial, legal, emotional and home care.
some clients only need short-term, or one-off assistance, rather than continual support. The Client Advocate assists the person living with AIDS in applying for financial or legal help, e. g. filling out application forms for state income support and accompanying clients to interviews.
nearly half of NWAF's clients need low-cost housing or housing assistance. Help is provided in finding cheap but comfortable accommodation, and information provided about nursing homes and hospices.
Emergency grant programme
limited funds are available to help with financial emergencies.
...as well as financial support to:
The Chicken Soup Brigade
offers practical support to house-bound people living with AIDS, including home-cooked meals, transport to the shops, domestic help (cleaning etc.) and friendship.
trained volunteers provide one-to-one emotional support and friendship to clients and their loved ones.
Seattle AIDS support group
provides a daily drop-in centre, a community living room for people living with AIDS, emotional support groups, social events.
In touch volunteer massage therapists offer weekly massages to clients in homes and hospitals.
For further information contact: NWAF, 1818 East Madison Street, Seattle, WA 98122, USA.
The UK NGO AIDS Consortium
The UK NGO AIDS Consortium for the Third World is a highly successful umbrella group of over 30 UK-based development agencies. The Consortium was set up in 1986 to organise an interagency response to the AIDS problem. Sue Lucas, the Consortium's Coordinator, and Dr Peter Poore, of the member agency Save the Children Fund, discuss the special role of the consortium.
The Consortium was formed to lend support to its members, each of which has its own characteristics and scope of activities: it does not aim to duplicate the roles of individual members or vice versa.
What the consortium does
Information gathering and exchange - through quarterly meetings, attended by up to 45 member representatives, a regular newsletter and circulation to all members of information and briefing documents, from a range of sources, including the member organisations themselves.
Identifying and responding to information needs - drawing on the expertise of individuals within the member agencies and external expert advice.
Lobbying on AIDS policy issues - the large membership of the Consortium, consisting of nearly all the major development and health charities in the UK, can act as a powerful pressure group. For example, the Consortium has successfully opposed the publication and/or continued circulation of inaccurate material, and has provided valuable advice on the wording of government recommendations.
Representation at, and circulation of, reports from international and national conferences and meetings, so that smaller NGOs can keep in touch with developments.
A Central Secretariat acts as a focal point for communication with other networks, those seeking funds, and with official bodies such as the WHO Global Programme on AIDS and government departments.
The Consortium enables NGOs to draw attention to gaps in official provision of services, especially as they often have closer links with health workers and facilities at grass roots level - a network can speak out more effectively than a single NGO.
United but still independent
The Consortium has not detracted from the independence and unique identities of individual member organisations, and being part of a network has not meant external control or additional administration. In spite of the wide range of organisations and views represented within the Consortium, much common ground exists, and all member agencies see AIDS as an extension of their existing activities rather than as a separate programme area. Such networks can draw attention to the underlying problems of ill-health, enhance recognition of the contribution which NGOs can make, and help to ensure that there is effective coordination and cooperation between NGOs
For further information please con-tact: Sue Lucas, UK NGO AIDS Consortium for the Third World, 1 London Bridge St, London SE1 9SG, UK.
International NGO meeting
Opportunities for solidarity: an international meeting of NGOs involved in Community AIDS Service was held recently on 2-4 June at McGill University, in Montreal, organised by a wide range of Canadian NGOs. The meeting aimed to:
improve the ability of organisations working with AIDS to identify and deal with problems affecting their performance, especially relating to management and communications
establish clearer network connections among participating NGOs, including better links between AIDS-specific organisations and development NGOs
identify opportunities for inter-agency cooperation
prepare and orientate participants
for the Vth International AIDS Conference held in Montreal, 4-9 June.
Over 300 participants attended the meeting and reports and background papers are available from the Canadian Council for International Cooperation, 1 Rue Nicholas St., Suite 300, Ottawa, Ontario, Canada K1N 7B7.
for street children:
An animated (cartoon) film partly based an the real-life adventures of street children in Mexico and Guatemala City.
This special AIDS education video aims to reach same of the estimated 40 million children and adolescents living on the streets of the world's cities. Many are forced into prostitution and theft out of economic necessity and are increasingly vulnerable to AIDS. Messages about safer sex are clear and nonjudgmental. It tells the story of two boys who juggle in the streets further livelihood. A smiling stronger offers one of the boys money in exchange for sex and the child becomes infected with HIV and eventually dies. The karate hero of the film uses the language of self defence to explain why his friend died and how condoms protect against HIV - when having sex with strangers or friends.
The video was pre-tested extensively with street children in a number of developing countries. To be released in October 1989 and initially distribute for a nominal fee in Brazil, Mozambique (Portuguese), Kenya, Uganda (English), Senegal, Haiti, Zaire (French), and Mexico, Peru, Colombia (Spanish), Produced by Street Kids International and the National Film Board of Canada with technical collaboration of the World Health Organisation.
'Its a film about me and my friends. I like Dingo Dog because he doesn't have a home and neither do we. The characters have choices and we learn these choices have consequences... I learned a lot about AIDS. '
Further information and copies from: Peter Dalglish, Street Kids International, 221 Front Street East, Toronto, Canada, M5A 1 E8.
for health workers and health planners:
AIDS: Frankly Speaking and Young People Talking
Two films produced by the International Broadcasting Trust (IBT). Both are aimed at decision-makers in developing countries, and encourage the broadcasting of direct and clear sexual information, by analysing the British campaign experience. They are introduced by Dr Kihumbu Thairu, Medical Adviser to the Commonwealth Secretary General.
The first film contains extracts from factual programmes broadcast in the UK, the second concentrates on the reactions of young people in AIDS discussion programmes. There are several examples of how campaigners demonstrated the correct use of condoms. Suitable for all those responsible for informing young people about AIDS/HIV.
Available free to developing countries from: Action Aid, HamIyn House, Archway, London N19 5PG Action Aid offices in Africa.
AIDS: Action now
Information, prevention and support in Zimbabwe
An excellent paperback, full of facts and suitable for all those working in the field of AIDS/HIV infection, as well as the interested public. Written from an African perspective, it includes general information about the virus, the disease, its spread, testing for HIV, counselling, support and self help, public awareness and policy. It contains a very useful glossary of terms and an annotated bibliography.
By Helen Jackson, Lecturer at the School of Social Work in Harare.
153pp Zim$5.00 plus postage from: AIDS Counselling Trust (ACT), PO Box 7225, Harare, Zimbabwe.
Colour Slide Sets
Three sets of 24 slides available from TALC (Teaching Aids at Low Cost) UK. Suitable for doctors, nurses, medical students and health educators working in Africa. These sets include teaching notes and questions and answers for discussion.
The first in the series, Virology and transmission, should be used before the other two sets. Covers epidemiology, virology, immunology and transmission of HIV.
Clinical manifestations covers all the major clinical signs and symptoms of AIDS in African patients.
Prevention and counselling discusses HIV prevention and control, including strengthening health care practices, safer sex promotion and reaching target groups with appropriate education.
Price: self-mount, with instructions, £2.75 (Seamail to developing countries) £0.60 extra for airmail. From: TALC, PO Box 49, St Albans, Herts. AL1 4AX, UK.
WHO Report - Global Programme on AIDS
WHO Report - Special Programme on AIDS
Four our mutual benefit
This is the first of two articles on the role of non-government organisations (NGOs) in national and international AIDS prevention and control strategies, written from the perspective of the World Health Organisation's Global Programme on AIDS( GPA). Bob Grose, GPA External Relations Officer for NGOs, argues that cooperation between NGOs, WHO and national AIDS committees is of vital mutual benefit in promoting effective programmes.
Apart from individuals, there are three main forces in confronting AIDS - governments, intergovernment organisations, and non-government organisations. While it is important to look at what organisations and governments have in common in their approach to AIDS, it is equally useful to look at the differences. It is through differing strengths and weaknesses that governments and NGOs can combine their resources to confront the AIDS crisis successfully; because no one sector - government or non-government - can face this problem alone.
What role can NGOs play in AIDS control programmes?
The most important collective resource that NGOs can bring to any AIDS control programme is their experience of working at community level. Such a community focus can help to bridge the gap between a national policy and local action. In general, NGOs can respond more immediately than governments to the local needs of those who are ill and their families, and often have access to sectors of the population not always reached by campaigns initiated at a national level, for example, rural populations and illiterate or marginalised groups. In addition, NGOs with experience in working for community development have expertise in promoting primary health care in developing countries and are able to adapt this for AIDS health education. Collectively, NGOs can contribute a wealth of community based experience to any national or international AIDS care and control strategy.
What is the relevance of WHO's Global AIDS Strategy to the work of local NGOs?
WHO's Strategy is founded on three basic objectives - shared both by its member governments and by NGOs:
prevention of HIV infection and AIDS
limiting the personal and social impact
unifying national and international responses.
NGOs share at least the first two of these objectives and thus have a common interest in combining resources with WHO. NGO/WHO cooperation is based on one fundamental objective - mutual benefit in a common fight for effective care and prevention strategies.
Endorsed by every country of the world, the Global AIDS Strategy is founded on basic principles arising from knowledge of HIV and its spread, and on worldwide experience of infectious disease control. This makes the strategy acceptable in all countries and provides an international framework within which governments can set their own policies and programmes. It is broad enough for every organisation wishing to work effectively on AIDS to find a place within it.
NGOs can often respond more immediately than governments to local needs, and have access to sectors of the population not always reached by national campaigns
At country level, the Strategy includes establishing National AIDS Committees and planning three to five year medium term plans (MTPs) (see WHO Report, issue 2). A country's MTP provides a reference framework for all participating organisations, including NGOs. This framework is not intended to control the activities of NGOs - simply to guide and coordinate, thus avoiding wasteful duplication of work and the production of contradictory health messages, while ensuring that plans are consistent and resources are made available and used to their best advantage.
WHO Report - AIDS: a worldwide effort will stop it
What are the main elements of cooperation between WHO and NGOs?
provision by WHO to NGOs of relevant up-to-date information when requested, for example, on scientific developments, epidemiological information or country programme development
provision of information from NGOs to WHO based on project experience, for example, evaluation, planning
and project implementation. WHO then tries to ensure
that similar organisations have access to this information
cooperation at an international level, for example, in the planning and implementation of counselling work-shops, development of health education materials, human rights, condom quality control, and NGO-NGO liaison
pooling international resources and contacts. Working through NGOs with international and national networks, WHO can more effectively disseminate and receive information and advice from an extensive collection of NGO contacts. Such NGOs include the International Council for Voluntary Associations, The League of Red Cross and Red Crescent Societies, the UN NGO Committee on Narcotics and Substance Abuse, Caritas, the UK NGO AIDS Consortium for the Third World (see page 7), and the International Federation of Free Teachers Unions.
What sort of NGOs does the GPA work with?
There are three main categories of NGOs that the WHO, Global Programme on AIDS is working with:
AIDS service organisations - NGOs that predominantly work on AIDS, including responding to the needs of people with HIV infection/AIDS in areas such as housing, counselling, home care, political or legal help, as well as public education and information
NGOs working in developing countries who already have a wealth of experience, particularly in the areas of primary health care and community development, on which to base new work on AIDS. Many have integrated AIDS work into existing activities such as mother and child health, clinical care, health education and training. These may be national NGOs or they may have headquarters in other countries
NGOs working in developed countries which are increasingly becoming involved with AIDS issues, such as haemophilia societies, ethnic organisations, prostitutes' associations and labour unions.
What kind of activities is WHO/GPA planning with NGOs?
WHO/GPA is involved in the following activities at the international level:
promoting NGO participation at major international meetings
developing the efficient exchange of information between WHO and NGO umbrella organisations or consortia
developing a directory that is accessible and kept up to date, of international and national NGOs active in the prevention of HIV infection/AIDS.
At the national level:
furthering consultation between NGOs and national AIDS programmes. This can be done individually, or through meetings of NGO groups and the national programmes. Such cooperation can be initiated either by the authorities or by NGOs. In countries where WHO/GPA field staff are in place, they support both governments and NGOs in the development of coordinated programmes within the medium term plan. For example, in Uganda, over 25 NGO projects have been included in the MTP, in areas including counsellor training and blood donor recruitment. In Kenya, over 11 NGOs are working within the national programme on production of health education materials from magazines to teachers' manuals, and the training of counsellors, clinic staff and youth workers
promoting a simplified system for funding of NGO projects in line with the national medium term plans. This has already happened in Zambia, for example. A contract was set up at the end of 1988 through an exchange of letters between the WHO representative and the Church Medical Association of Zambia, who are now carrying out a major health promotion and community care project
encouraging national AIDS committees to include representatives of appropriate NGOs among their members, and to include NGOs in review teams for medium term plans.
The balance between cooperation and maintaining independence for NGOs working within medium term plans is an important one. While ensuring that their projects fit into the overall framework of national programmes, NGOs still remain autonomous, keeping their financial and political independence; many NGOs are independently funded and their projects have been self-generated, reflecting their own capabilities and assessment of needs.
It is important to remember that the Global AIDS Strategy is about cooperation rather than control: that is, the coordination of efforts to achieve maximum impact. This cooperation is the only mechanism that will be far-reaching enough to stop AIDS.
WHO Report - AIDS: a worldwide effort will stop it
Youth and AIDS
By April 1989, 148 countries had reported a total of more than 145,000 cases of AIDS. WHO estimates that the real total is closer to 450,000 and that worldwide between five and ten million people are infected. By 1991, about one million new cases of AIDS could occur in people already infected with HIV.
Why focus on youth?
At least half of those infected with HIV are under the age of 25, making AIDS a major concern affecting youth today. About 20 per cent of all people who have AIDS are in their twenties. A large proportion of them became infected during adolescence. In the examples given in the graph opposite (Belgium, Brazil, Uganda, United States of America), the high proportion of cases in the 20 to 29-year-old age group indicates that infection probably occurred when they were 15-19 years of age.
The rate of increase of HIV infection among young people in many countries, even in places where the prevalence of AIDS or HIV infection is not yet high, is disturbing. In Bangkok, where many people who use injectable drugs are under the age of 25, the rate of HIV infection among such drug users seeking treatment has increased from zero two years ago to over 40 per cent today.
The risk of HIV transmission among young people may not be fully recognised, or there may be insufficient programmes providing young people with information, skills or the means they can use to protect themselves. Young people need to be aware of the possible consequences of unprotected sexual intercourse and experimentation with drugs. They may also become infected if they lack the means or ability to act on the knowledge they have. HIV infection and its consequences are changing the world in which young people find themselves, and rapidly altering the context in which they have to make decisions about behaviour. Many young people are not yet aware of the effect HIV infection may have on their lives. Throughout the world, sexual intercourse is the most frequent and important mode of transmission in HIV infection. Because of the social taboos and sensitivity associated with sexual behaviour and communication about it, public health officials and educators often face major problems in their prevention and control efforts, especially if they are dealing with young people between the ages of 10 and 24 years.
What are the consequences of HIV infection?
The diagnosis of HIV infection in a young person (who may feel well for years) can be disruptive not only because of fears about future illness and death: life choices about sexuality, marriage or partnership, pregnancy and work take on an added dimension of difficulty, uncertainty and hardship.
There is no reason to fear people who are infected with HIV. However, young people who are infected with HIV have been forbidden to attend school and take part in sports, or have lost their employment or housing. They have been prevented from travelling or living in some areas. HIV infected young people have sometimes been refused scholarship places at university, or jobs. Although feeling well, they may be irrationally treated as severely ill, and forbidden to participate in normal activities because they are regarded as somehow disabled.
Young people can prevent the spread of the virus that causes AIDS
What are the consequences of HIV infection? They can do this by learning the facts about AIDS in order to protect themselves and those they love and teach others how to stop the transmission of HIV Young people who do not have sexual intercourse or use injectable drugs or do not share needles greatly reduce the risk of infection. If a young person does have a sexual partner and both are uninfected and faithful, and are not using injectable drugs or sharing needles, they are at little risk of HIV infection in the United States of America and many European countries. In other countries, they may still be at risk from outside sources such as infected blood transfusions. The number of sexual partners should be kept to a minimum, and for the entire duration of sexual intercourse a condom should be properly used. Sexual intercourse should be avoided with people who have many sexual partners, such as male or female prostitutes, or with persons who may be using injectable drugs.
AIDS action Issue 7 11 Page 12
WHO Report - AIDS: a worldwide effort will stop it
Why don't more young people protect themselves against HIV infection?
traditions, beliefs, fears or other inhibitions may
prevent young people from learning about sexual transmission
of HIV and methods of prevention, or from acting
on the knowledge they have.
What is being done to prevent HIV infection among young people?
Over 150 countries now have National AIDS Committees to advise on the development of AIDS prevention and control programmes. Of these, over 50 have medium term plans with a large education and health promotion component. Most of them concentrate on young people in and out of school.
Health promotion should be aimed at changing behaviour within the broader context of young people's lives and needs.
UNICEF estimates that over 40 million young people in the world are currently living 'on the street'; for many of these, unprotected sexual intercourse with many partners is a way of making a living, despite the risks it brings. In Sao Paulo, Brazil, for instance, Fundacao do Bem Estar do Menor found that in 1988, nearly 9 per cent of over 2,000 children living on the street were HIV infected.
Schools are a common focus for educational activities
In the Netherlands, for example, videos, pamphlets, and comics for the prevention of HIV transmission are available to every school in the country. Broad applications of the WHO/UNESCO guide for school health education to prevent AIDS* and other sexually transmitted diseases is expected to help make similar material available in every country.
Student-to-student communication can broaden the effect of school programmes. In the Eastern Province of Sierra Leone, a peer teaching programme featuring a photo story book and music has been associated with both an increase in the percentage of young people who plan to delay sexual intercourse until marriage, and the percentage of young people who are registering for condoms.
Programmes for young people not at school are also being developed; an anti-AIDS cartoon video by Street Kids International of Canada (see Resources, p. 8) has prompted intense discussion about HIV among workers and young people on the streets during pre-tests in Latin America, Africa, the Philippines, and New York. A peer teaching programme in Kenya for prostitutes, many as young as fifteen, has been associated with an increase in the use of condoms from less than 10 per cent of the group to over 60 per cent.
This text is an excerpt from the leaflet 'AIDS and youth' prepared for the 1989 WHO World Health Assembly. Full text available from WHO/GPA.
*available from WHO/GPA
Any questions about the content of the WHO Report should be sent to WHO/GPA/HPR, 20 Avenue Appia, 1211 Geneva 27; Switzerland.
Managing editor: Kathy Attawell
Executive editor: Hilary Hughes
Production: Katherine Miles
Editorial advisory group: Professor EM Essien (Nigeria), Dr K Fleischer (FRG), Dr P Kataaha (Uganda), Professor K McAdam (UK), Professor L Mata (Costa Rica), Dr A Meyer (WHO), Dr D Nabarro (UK), Dr P Nunn (Kenya), Dr A Pinching (UK), Dr P Poore (UK), Dr W Almeida (Brazil), Dr T K Sinyangwe (Zambia), Dr M Wolff (FRG).
Produced and distributed (free of charge to developing countries) by Healthlink Worldwide
With support from Misereor, ODA, Oxfam, Save the Children Fund, SIDA and WHO/GPA.
The International Newsletter on AIDS Prevention and Care
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