Multi-sectoral tools for Community-led Response to HIV/AIDS

Tanzania Public Health Association
Annual Conference Presentation
Phyllis Craun-Selka, Pact Tanzania
Arusha, Tanzania
November 8, 2002

Thank you ladies and gentlemen of the Tanzania Public Health Association (TPHA) for accepting Pact's abstract to share its experience using multi-sectoral tools for community-led response to HIv/AIDS. Pact is an international civil society strengthening organization headquartered in Washington DC with offices in 14 countries in Africa, Asia and Latin America. In Tanzania, Pact is implementing USAID's almost 1 year old Tanzania Advocacy Partnership Program or TAPP. The goal of TAPP is to provide civil society organizations expert training in organizational development and advocacy. This will enable NGOs to participate in shaping people-centered development policies in partnership with the government. Pact is working with civil society organizations and NGO networks in the HIV/AIDS, natural resource management and private sectors.

I am speaking to you today as a newcomer to Tanzania with health experience as it relates to gender equity, women's access to and control over their reproductive health, women's roles in overall family and community health, and the pervasive devastation of HIV/AIDS. I hope that you will find Pact's experience and tools applicable and useful to Tanzanian organizations and the communities they serve.

In the past 2 years, Pact has been trying to contribute democracy and governance capacity-building approaches to community-led response to HIV/AIDS. We are acting on the following four assumptions-

1. Despite the best efforts of the past 20 years to cope with this pandemic, despite the great awakening of the past couple of years to acknowledge the seriousness and multi-sectoral pervasiveness of AIDS and leverage greater resources to stop it, the vast majority of citizens still do not have adequate access to:
   • HIV/AIDS information and education
   • Prevention methods
   • Care and treatment
   • Protection from stigma and discrimination
   • The right to negotiate safe sex
   • Livelihood without risking unsafe sex
2. The HIV/AIDS pandemic is far more than a health crisis -it ravages whole communities, deepens poverty and threatens the stability of nations.
3. The HIV/AIDS pandemic will only be brought under control through multi-sectoral approaches in the context of holistic economic and social development. That means understanding and responding accordingly to the relationship between HIV/AIDS and poverty, gender inequity, economic opportunity and stigma that is rooted in cultural traditions.
4. In order to effectively deal with the AIDS pandemic, we must overcome issues of turf, exponentially scale up and coordinate community-led multi-sectoral response.

Understandably, because of the horror and magnitude of AIDS, we tend to spend more energy trying to describe its nasty nature than taking action to cope with it. Add the rotting silence borne of fear and tradition and the deadly result has already been the loss of millions of innocent and precious lives. So, I will move directly to share what Pact is doing experimentally and urgently, combining research and action without repeating the statistics that rummage unfathomable and numbing in our minds.

Let us take ourselves to communities. Pact has produced this tool kit entitled 'Survival is the First Freedom' from its experience with partners in Ethiopia, Kenya, Madagascar, Nepal, Zambia and Zimbabwe. Imagine you are a community leader and speak out when one of the following ten priorities seems most important to you. The 16 tools in the Survival booklet can help you:

1. Make HIV/AIDS prevention and care a human right
2. Ensure PLWA are cared for and protected from stigma and discrimination
3. Guarantee children affected by AIDS are nutured and educated
4. Strengthen leaders' and groups' skills and capacities to cope with HIV/aIDS
5. Inspire hope and plan for the future
6. Network and coordinate HIV/AIDS activities in districts
7. Voice the unspeakable (challenge stigma).
8. Help women and youth generate income for more life-saving choices and control in their lives.
9. Advocate for prevention, care and treatment in partnership with government and the private sectors
10. Work with the media to get the word out and get people the information they need to cope.

Pact's approach is two-fold: linking capacity-building with allocation of resources. This approach can allay concerns about absorptive capacity by working closely with partners to provide technical assistance and help them ensure that resources are effectively used and accounted for. In our work, we have used these tools in:

1. Rural Zimbabwe to strengthen CBOs to link traditional leaders, educators, home care givers, youth and other stakeholders to cope with the pandemic.
2. Ethiopian households to help wives negotiate safe sex and counsel their children.
3. Kenya to facilitate community-led assessment of access to HIV/AIDS prevention and care.
4. Zambia convened multi-sectoral groups to practice community-based tools and coordination.

The list continues to grow. With support from USAID, Pact will facilitate a survival toolkit workshop here in early 2003 to strategize how to best disseminate and enrich these tools in Tanzania. Please let me know if you are interested in participating.

In August, 2002, Zambia reported to BBC radio its first decrease in HIV infection since the AIDS pandemic began 20 years ago. The Ministry of Health spokesperson attributed the decrease to multi-sectoral approaches. The first use of the Survival is the First Freedom tool kit was with diverse partners in Zambia in September, 2001.

In conclusion, let each of us think every day, "What am I risking to do and say in my bedroom, with my children and family, in the office, and in the community to challenge the terrible silence that keeps HIV/AIDS alive."

Thank you.