spread of HIV/AIDS by empowering women in Africa
2122 York Road
Oak Brook, IL 60523
“Compassion asks us to go where it hurts, to enter into places
of pain, to share in brokenness, fear, confusion, and anguish.
Compassion requires us to be weak with the weak, vulnerable with
the vulnerable, and powerless with the powerless. Compassion
means full immersion in the condition of being human.”
age of 19, a wealthy man who took advantage of poverty in my
family promised to pay my school fees, if I could love him. He
used my relatives to persuade me. Because of my ignorance of
HIV/AIDS, I didn't know that the man was infected." Ugandan
"Women are getting poorer and
poorer, and women continue to be socially and economically
dependent on men. What all this means is that women have less
control over when and whether they have sex." Priscilla
Misihairabwi, Director of the Women and AIDS, Support Network (WASN)
Disadvantaged African women
require both economic empowerment and HIV/AIDS education to
significantly reduce their susceptibility to the HIV virus.
Their lack of resources and understanding constrains them to
high-risk sexual behavior.
International and its seven African Partners are prepared to
launch the African Microenterprise AIDS Initiative, which will
provide women and their families with the resources and skills
necessary to combat the spread of the virus. The project will
directly benefit one and a half million people in its first five
years, five million over the next ten years, and millions into
the future. The initiative's innovative and sustainable model
will address the myriad complexities of the AIDS problem in
Africa and provide a blueprint for other groups fighting to
eliminate the disease from the continent.
Microenterprise AIDS Initiative will give women the choice to
say no or negotiate safer sex. "Trust Banks", a group lending
program, combined with peer education will increase income,
widen personal choice, and provide HIV/AIDS education within
targeted African communities. This African initiative will not
only reduce the rate of infections among formerly impoverished
women and provide economic support to AIDS widows and orphans,
but will also impede the spiraling economic consequences of the
foundation for this new program will be "Trust Banks", which
were pioneered by Grameen Bank in Bangladesh almost 15 years
ago. This appropriate lending technology works by organizing
small groups of 25-40 women into informal business networks – or
Trust Banks – which cross-guarantee small loans made to each of
the bank members. These loans are then utilized by each
individual to strengthen her personal microentrepreneurial
efforts. Loan interest covers the low amount of overhead,
making the program sustainable. The corpus of the loan fund
itself gets recycled and reused, perpetuating the program
is loans plus education. Within peer groups, women will be
taught essential AIDS knowledge and wrestle with difficult
issues, which will lead them to make positive decisions. To
facilitate this, Opportunity will partner with expert AIDS
organizations based in Africa.
International will take this combined intervention model, which
was pioneered by others, to a new level. Phase One, which is
ready to commence in 1999, will develop and test a sustainable
intervention model that combines peer education, economic
empowerment, and personal choice through pilot programs in
Ghana, Zimbabwe, and Uganda. Phase Two, which will begin at the
end of year two, involves the expansion of the pilot programs
into 50 new areas of high HIV-prevalence. At this stage, the
initiative will broaden to involve several countries and will
attract the attention of the global community, leveraging
to launch this innovative program on behalf of the millions of
vulnerable women living in Sub-Saharan Africa, Opportunity is
looking to partner with globally concerned citizens who are
interested in leading the fight against HIV/AIDS.
of AIDS in the Developing World
pandemic continues to sweep largely unchecked across continents
containing the Developing countries. While Western societies
benefit from radical new medical advancements, studies indicate
that the majority of new HIV infections occur outside the
Developed World. In fact, according to The AIDS Control and
Prevention (AIDSCAP) Project of Family Health International,
over 93 percent of HIV infections thus far have occurred in
Developing countries. And among these countries, no region has
been hit harder by this epidemic than Sub-Saharan Africa, which
now accounts for 67 percent -- or 22.5 million -- of the total
number of infections worldwide.
picture being painted is grim for the continent’s population as
a whole, it is even worse for its women and children. A report
dated October 1997 reveals that 6 out of every 11 people newly
infected are women, up from 1 in every 14 in 1985. Even worse
is the rate at which infections are climbing among younger
women. The same study also shows that “in countries where
youngsters account for 60 percent of the new infections, young
women outnumber their male peers by a ratio of 2 to 1.”
regards to children, the UNAIDS Report on the Global HIV/AIDS
epidemic reveals that 83 percent (or 1 million) of the 1.2
million children currently infected by this epidemic now live in
Sub-Saharan Africa. More tragic yet is the rate at which
infections among these children are climbing. Of the
approximately 4 million Africans exposed to the virus in 1998,
530,000 (13 percent) of them were children. With no access to
sophisticated medical care, these children have little chance of
The Road Ahead
“Within the next decade, the
cumulative number of infections is projected to exceed 100
million. Unless something dramatic happens to change the
dynamics, by early in the 21st century more people will have
died of AIDS since it emerged on the world stage than died in
all of the 20th century's devastating wars.”
Nils Daulaire, M.D.,
may be yet to come. As the HIV virus continues to ravage the
Sub-Saharan region, studies show that in the nine countries
where the HIV-prevalence is greater than 10 percent, AIDS will,
on average, cost that population 17 years of life expectancy.
Instead of life expectancy rising to 64 years by 2010-2015, a
gain that would be expected in the absence of AIDS, it will
regress on average to 47 years. Deaths of young children will
account for much of this decrease. The US Bureau of the Census
has predicted by the year 2010, if the spread of HIV is not
contained, AIDS will increase infant mortality by as much as 75
percent and under-five mortality by more than 100 percent in
those regions most affected by the disease.
to those who die from the disease, many children and even adult
survivors will experience the human trauma as it claims the
lives of their parents and relatives. Nils Daulaire, in his
address to the United States Congress stated, “Within the next
two decades, there will be an estimated 40 million children
orphaned by AIDS.”
AIDS Hidden Vectors
When grappling with the issue of
AIDS in Sub-Saharan Africa, it is important to look beyond
individual behavior patterns that lead to high-risk activity.
While personal freedom and choice have certainly played a role
in the rapid spread of this disease, current research suggests
that there may be far more complex factors that are contributing
to the explosion of this epidemic.
In the early 1980s, as AIDS was
just beginning to trickle into the global consciousness, medical
doctors and social scientists began an aggressive campaign to
combat the HIV virus. Their strategy of preventative knowledge
was widely viewed as the best weapon readily available in our
admittedly limited arsenal. Seventeen years later, social
scientists report that this campaign has largely failed. While
studies debate the actual figures, most experts now agree that
HIV/AIDS awareness is fairly common among African citizens. In
their report on sexual behavioral changes, C. Rosenvard and T.
Campbell state, “ . . . public information campaigns about HIV
have occurred in many Sub-Saharan African countries with high
HIV prevalence. While knowledge about HIV/AIDS has resulted in
higher levels of awareness, this has not generally been
reflected in a consistent reduction of incidence of HIV.”
If awareness has not reduced the
rate of infection, the question that must still be answered is
this: what other factors, apart from HIV-ignorance, are
contributing to the high rates of HIV in certain African
In answering this question,
global health experts have shifted away from the traditional
behaviorist model and have sought to find solutions within
socio-economics. It is their contention (after years of
observation) that poverty, working together with certain gender
norms, has created an atmosphere conducive to the spread of the
norms pervade all aspects of society and must be examined in
relation to the roles of women and men to gain a valid cultural
point of view. The status of women within the African context
should not be seen as an insurmountable barrier to reducing HIV
risk. Although gender norms significantly increase the woman's
risk of HIV/AIDS, it is important to recognize the diverse
factors influencing these norms.
traditional African family, the ideal feminine attributes
include sexual innocence and motherhood with the expectation
that the woman become a hard working household provider. In the rural setting, she cared for her children
and worked the fields. Her status depended on her ability to
influence the size and strength of her family. Traditionally,
she had little access to such key resources as information,
education, employment, income, land, or property.
breakdown of this traditional African family has been influenced
by several factors. The decline of the rural subsistence
agrarian economy has resulted in a new urban-centered monetary
economy. As a result, the social fabric is fragmented, and
traditional gender roles are changing. Colonialism, racism,
merchant capitalism, and export commodity production are
redefining African society in recent years, leading to greater
traditional model, the African woman's status was unrelated to
income and resources, but her lack of economic clout now
undermines her position in the culture. Her dependency still
exists, but now it betrays her. "Where women perceive no
alternatives to living by these norms, they may see no other way
to assure a good life for their children than by continuing to
enforce inequality. Breaking the cycle of complicity then
requires a change in the circumstances of adult women as well as
a change in their ideas.”
The twentieth century has
brought many changes to Sub-Saharan Africa. While much of the
world has experienced a period of economic growth unparalleled
in history, Africa continues to labor under a harsh climate and
extreme poverty. As the scarcity of resources has grown more
acute over the years, sociologists have observed new trends
within the society as parents have sought to find new ways to
provide for their families.
One of the most damaging of
these trends is a pattern of migration that has developed as
Africa has become increasingly urbanized. As men have left
their small communities to seek employment in the urban centers,
social relationships and familial ties have been weakened. New
sexual networks are formed in the city and men find themselves
exposed to a variety of STDs, including the highly prevalent HIV
African women’s vulnerability to
HIV/AIDS is also affected by these migration patterns. Studies
show that as men move home to their rural communities, they
often return with the HIV virus and end up infecting their
wives, who are usually unaware of their husband’s urban
Another side effect of the
migratory patterns is an increase in the number of households
led by women (one third of all households worldwide).
Often unable to meet the economic needs of their families, many
of these women are turning to transactional sex in exchange for
goods and money.
many women are economically dependent on men, the degree to
which they are able to express their own will is often limited.
This lack of choice – or lack of power –leads some women to
engage in high-risk behaviors, which increase their chance of
contracting the HIV virus. Many women believe the negative
economic consequences of leaving the high-risk relationship
outweigh the possible repercussions of staying with an infected
demonstration of this lack of choice is the “sugar daddy”
phenomenon currently being reported in Uganda, Zimbabwe and
other countries in the Sub-Saharan region. According to social
scientists who have examined this trend, young women are
increasingly engaging in high-risk sexual activity with older
men in exchange for gifts, money and promises of future
provision. Although many of these girls are familiar with the
AIDS epidemic, the allure of economic security is strong,
regardless of the risk to their personal health.
"We must incorporate into our
thinking the concepts of women's rights and empowerment in
conception, childbearing, and prevention and care of sexually
transmitted diseases including HIV/AIDS."
Gro Harlem Brundland
As a premier microfinance
network operating in Sub-Saharan Africa, Opportunity
International is in a unique position to address the problem of
AIDS among the impoverished women of this region. Since most
experts now agree that the lack of cultural and economic power
is a key factor in the transmission of the HIV virus among
women, such women are helpless to defend themselves against the
advances of HIV-infected men.
By design, Trust Banks are
intended to empower those who have lost the ability to provide
for themselves. By offering small cross-guaranteed loans to
previously marginalized women, Opportunity is able to increase
cultural and economic power, and enhance personal dignity.
In the beginning of the loan
cycle, the potential applicant is assessed on the strength of
her character. Because she lacks traditional collateral, the
Trust Bank must decide if her loan will be cross-guaranteed
solely on the basis of her personal integrity. Although this
may seem a risky proposition, Opportunity has found that this is
the first step in building the woman’s dignity. By providing a
loan, the Trust Bank says, “We believe in you,” and places a
measure of responsibility upon her shoulders.
Because the money given is a
loan and not a handout, the woman’s sense of self-worth is
further strengthened. As she continues to build community with
the other women who have cross-guaranteed her loan, she finds
herself in an accountable support network.
The woman accepts the money and
invests it into her own micro-business. As she begins to
experience newfound financial independence, her sense of
self-worth and empowerment grows. She is no longer constrained
by economic forces to participate in sexual relationships, which
are dangerous and degrading. With each loan she receives and
repays, the woman becomes increasingly stable financially and
better equipped to negotiate her roles within her community.
Sexual encounters become a matter of choice instead of
obligation or necessity.
know what choices to exercise, their empowerment is complete.
By adding HIV/AIDS education and services, Trust Banks become an
effective combined intervention program targeting poor women in
Africa. The pretext of the required weekly loan repayments at
business meetings provides a forum to deliver information,
education, and skills for prevention. Meeting often with peers
will influence women to adopt risk reduction behaviors through
interactions and accountability.
Program Description: Combined
health organizations with extensive experience in HIV prevention
and methods of intervention have tested and perfected HIV/AIDS
peer education programs, but have concluded that they are ill
equipped to adequately address gender-related economic and
social factors. Opportunity Trust Banks in
partnership with such programs will therefore be able to respond
effectively to each aspect of the HIV/AIDS situation as it
affects women in Sub-Saharan Africa.
partnership will equip women with the knowledge that change is
possible and empower them to make that change. Combined
intervention, which is defined as peer education within Trust
Banks, will empower African women. An understanding of what
Trust Banks are and how they operate will be helpful to
understand how this partnership will work.
Bank is an innovative and appropriate lending technology that
provides microloans, thereby creating jobs and economic
empowerment primarily for women in poor communities. Loans,
averaging $50 to $300, are given to entrepreneurs-in-the-rough
who run variety stores, dressmaking shops, beauty salons, market
vending stalls, and other microenterprises. Members of each
group of 25-40 cross guarantee each other’s loans and meet
weekly for administrative, training and consulting purposes,
which help to maintain the 98 percent repayment rate.
holistically transform a person through economic empowerment,
social interaction, confidence building, and political
participation. As grassroots community networks, Trust Banks
provide learning through shared experiences.
How Trust Banks
build relationships with one another and form a democracy during
the Trust Bank's eight-week formation period. They organize
themselves into sub-groups of 5-8 and elect representatives.
These representatives then become candidates for the offices of
Chairperson, Vice-Chair, Treasurer, Secretary, and Auditor. As
officers, they manage both their own sub-groups and the overall
meetings are the operating system of the Trust Bank technology.
These interactions provide the context for financial activities,
training, conflict resolution, and community activities.
Important non-financial aspects of life are dealt with as well.
through leadership development
fellow members when making lifestyle changes
Training topics such as
health (AIDS prevention), literacy and numeracy
Enhancing values through
discussion and reflection
Increasing awareness of
social and environmental issues
Networking and sharing
Learning to be assertive
in family and social roles
weekly meetings are ideally structured to incorporate an
HIV/AIDS peer education program. Meetings last for 1 to 1.5
hours and typically include a discussion or activity session.
AIDS educators will facilitate discussions at weekly meetings on
a regular basis. These discussions will address gender-related
risk factors and provide a forum where the women will gain
counsel for their real life problems.
consensus among health officials acknowledges that face-to-face
communication and peer education are the most effective ways of
influencing individual behavior and risk reduction. Projects utilizing group discussion in Mauritius
and Thailand have been successful at increasing competencies to
negotiate and communicate safe sex with partners. Another study concluded that a broader
discussion of local gender norms had a significant impact on the
target group and the desire of participants to become involved
in community mobilization to challenge wider social inequalities
Peer education within Trust Banks should prove to be an
effective method of individual and community-wide HIV
initiative, partnerships with AIDS educators will be determined
on a country-by-country basis because most countries have
capable non-governmental organizations specializing in HIV/AIDS
education and skills training. Organizations like The AIDS
Support Organization (TASO) in Uganda and the Women and AIDS
Support Network (WASN) in Zimbabwe are excellent examples. The
Society for Women and AIDS in Africa (SWAA) has branches in 26
countries and might be a candidate for region-wide partnership.
Opportunity's Africa regional office will coordinate the
micro or Trust Bank level, the Vice-Chair will facilitate the
partnership as an officer level responsibility. The Vice-Chair
of the Trust Bank will coordinate with HIV/AIDS organizations.
Leadership development and sustainability are the advantages of
training the Vice-Chair to accomplish the task instead of
driving the process from the outside. If the Trust Bank
disbands, the community will still have this capable leader.
The Trust Banks will assist
women at risk of contracting HIV/AIDS, their children, and those
who have been widowed or orphaned by AIDS in Africa.
Participants will be the poorest of the economically active poor
living in geographic areas with high prevalence of the disease.
The five main target groups will include:
Women in childbearing
Unemployed women (likely
to become sex workers)
Note: According to
the 1997 United Nations Worlds AIDS day report, officials
estimate that 90 percent of those infected with HIV in Africa
are unaware of it.
Women in childbearing years
women living in poverty are at risk. A study of 1,458
childbearing women from Rwanda, found an infection rate of 20
percent among women in monogamous relationships. A Senegal study revealed 50 percent of HIV
infected women had monogamous relationships.
Participation in a Trust Bank will help a married woman in
several ways. Her improved income generating capacity will keep
her man at home instead of seeking work elsewhere. The practice
of seeking occasional sexual partners to make economic ends meet
will no longer be necessary. As the Trust Bank gives her
economic leverage and knowledge, she will be able to negotiate
safer sex or leave a high-risk sexual relationship.
Unemployed Women (likely to
become sex workers)
become sex workers or rely on transactional sex (sex in exchange
for goods or services not necessarily on a professional basis)
to make ends meet.
They are often single women or female head of households faced
with no other income alternatives.
will provide these women with financial alternatives to selling
or bartering their bodies. The peer support structure and AIDS
prevention skills will help them make the transition to
the risk for girls aged 15-24 is two to one, compared with boys.
This is because older men are seeking out ever-younger girls in
the belief that, as virgins, they are free from HIV. Girls from
low-income families are vulnerable to the enticements of these
older men known as "sugar daddies" who offer money or gifts for
sex. A study conducted with high school girls in Zimbabwe found
that "sugar daddies" paid for school fees and books.
increasing the mother's income, the "sugar daddy" effect will be
negated because the family's needs will be met. In addition, a
targeted education and sexual behavior modification strategy
focused on children will be part of the peer education program.
The 200 women who participate in the Nalwewuba Zone Women's
Clubs in rural Uganda have demonstrated that peer education
programs can successfully pass on the skills and knowledge to
children. Before, customary taboo prevented the women from
discussing sex with their children.
impoverished widows fall victims to quarrels with their
husbands' family and are deprived of assets leaving them with no
hope to begin a life of widowhood.
Customarily the deceased's brothers care for the widow and
inherit the remaining assets. But the high probability that she
is infected and her limited assets lead to complications and
often mistreatment in the new family arrangement. With
unfavorable laws, no assets, a large number of dependents, and
few marketable skills, AIDS widows have few options.
will give these women hope. An income generating activity
secures economic status, and the Trust Bank meetings provide the
necessary support structure to begin a new life. These outcomes
are paralleled by near-total transformation of their
million children have lost their mother to AIDS in Africa. In
Uganda, there are 1.2 million children under the age of 18 who
have lost at least one parent to AIDS out of a total population
of 21 million (4.7 percent). “Last year, AIDS orphaned 1.7
million children, the overwhelming majority of whom were in
Sub-Saharan Africa. The United Nations reports Zambia has the
highest proportion of orphaned children in the world with 23
percent of children under 15 missing one or both parents.”
Many of the
children are taken in by extended families, with about
three-quarters of households taking care of one or more orphans
in Zambia. The extended family kinship system is being
stretched, creating a desperate situation. Many extended
families that have accepted orphans cannot afford to send all
their children to school, and orphans are often the first to be
denied education. "My foster mother wants to stop me from going
to school. She wants me to work as a maid so I can earn money to
buy food", says 16-year-old Beatrice from Kenya.
of current Trust Bank clients care for one or more orphans.
Mushrooming infection rates ensure this problem will get worse.
If mothers cannot support their own families, they will be
incapable of supporting their extended families. A large
network of Trust Banks in Africa may be the best way to address
the orphan support problem.
objectives of the African AIDS Microenterprise Initiative are to
prevent the spread of the disease and reduce its negative
economic and social impact. This will involve increasing the
current number of Trust Banks ten-fold over the next five
years. An HIV/AIDS peer education module will be integrated
with the lending technology, creating a dynamic combined
At the 12th
International Conference on AIDS held in Geneva last year, a
dozen combined intervention programs utilizing peer education
and microenterprise development reported improved women's social
and economic status (see Appendix A for details). Such projects
have yet to be evaluated in terms of specific vulnerability
reduction. However, these programs have demonstrated many
positive non-financial results such as increased awareness of
HIV/AIDS transmission, prevention skills, self-worth, hope for
the future, and community unity. A lack of sustainability and proper management
prohibits their scale-up potential.
In contrast the Trust Bank lending technology is a proven
sustainable model that harnesses the internal potential of
The projected outputs for this proposal and the ability of
Opportunity in Africa to achieve them are based on the
collective performance of the region as a whole. Trust Bank
programs can be quickly scaled up as has been clearly
demonstrated in Ghana and most recently in Zambia. Ghana had
zero Trust Banks in 1995, 8 Trust Banks in 1996, 33 in 1997, and
110 by the end of 1998 (over a 300% increase each year). In
less than one year since commencement of its operations, Zambia
has opened 50 Trust Banks. Note: the outputs below correlate to
the specific funding for this project.
* Based on the assumption
that 9.67 HIV infections will be prevented over the lifetime of
each Trust Bank (likely scenario: four members plus six through
outreach). No empirical data supports this.
** Based on the assumption that
.875 orphans per member will be supported.
***Each member's increased
income will have a downstream impact on six beneficiaries as
each supports an average of six children and adults (including
Change is Possible
Jonathan Mann, the ex-UNAIDS chief who died on Swissair Flight
111, was the first to link the spread of HIV/AIDS with poverty
and gender inequality. He said, “… vulnerability to HIV and
AIDS is directly linked with the inequality of women and the
lack of respect for their rights.” In arguing that
widespread discrimination against women limited their freedom to
leave men who refused to practice safe sex, he wrote:
. . Vulnerability is the converse of empowerment. By
vulnerability we mean the extent to which individuals are
capable of making and effecting free and informed decisions
about their life. A person who is genuinely able to make free
and informed decisions is least vulnerable (empowered); the
person who is ill-informed, or whose inability to make informed
decisions freely and carry them out is most vulnerable . . .
Empowerment occurs when people realize that some important
aspect of their lives can be different . . . A second
element in empowerment is a sense of self-efficacy, the idea
that change is possible.”
Opportunity International and
the African Microenterprise AIDS Initiative will bring dignity
to disadvantaged women and families. It will help them see that
their lives can be different and that change is possible. By
joining together with one another in Trust Banks, women in
thousands of communities will transform desperate societies,
illustrating the African saying, "the power of many hands and
minds is unequalled."
To help us
prove our concept and lay the foundation for our campaign
against this lethal pandemic, Opportunity International is
seeking to identify $6,974,000 over two years from the key
supporters. The grant funds will launch phase one of the
African Microenterprise AIDS Initiative.
project meets its key targets and proves successful in phase
one, Opportunity will need an additional $28,650,000 to complete
phase two. The key supporters would be invited to take the lead
in the second phase, but it is our hope and expectation that the
project will have gained the attention of the international
donor community and attract additional funding from other
initiative will free millions of families in Africa from the
threat of AIDS. Thank you for your consideration.
HIV/AIDS: Taking stock of research and
programs. UNAIDS Best Practice
Key Material, March 1999.
Kahwa R et al. Peer
education as a means of behavior change.
Int Conf AIDS. 1996 Jul 7-12;11(2):473
Aseru DA; Candiru H; Candiu J.
HIV positive women intervention
in times of bereavement.
Int Conf AIDS. 1998;12:166.
In Zambia, the Abandoned
New York Times, 09/18/98 P. A1
Ottenweller M. The Soweto Hope model for community based
support. Int Conf AIDS.
Jackson H et al.
AIDS support and income
generation. Harare, Zimbabwe,
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