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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

    

 

 

African Microenterprise

AIDS Initiative 

Preventing the spread of HIV/AIDS by empowering women in Africa

 http://www.microcreditsummit.org/

Opportunity International

2122 York Road

Suite 340

Oak Brook, IL 60523

                                                                                                            630/645-4100

 

“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.” Henri Nouwen

"At the 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 Woman

"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) of Zimbabwe

 

Executive Summary

 

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.

Opportunity 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.         

 

The African 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 AIDS pandemic.

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 indefinitely. 

The focus 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.  

Opportunity 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 additional funding.

In seeking 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. 

An Overview of AIDS in the Developing World

The AIDS 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.[1]

 

If the 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.” [2]

With 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 surviving.[3]

  
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., M.P.H[4]

 

The worst 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. [5] 

In addition 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.[6]

 

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 countries?  

 

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 HIV virus.

 

Cultural Factors

Gender 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. 

In the traditional African family, the ideal feminine attributes include sexual innocence and motherhood with the expectation that the woman become a hard working household provider.[7]  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.

The 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 gender inequality.[8]

In the 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.”[9]

Economic Factors

 

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 virus.[10] 

 

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 infidelity.[11]

 

Another side effect of the migratory patterns is an increase in the number of households led by women (one third of all households worldwide).[12]  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.

Because 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 partner.[13]

One visual 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.[14]

The Opportunity Answer

"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[15]

 

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.

When women 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 Intervention

Public 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.[16]  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.      

The 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.

Trust Banks Empower Women

A Trust 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. 

Trust Banks 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 Operate

Members 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 Trust Bank.

Weekly 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. These include:

¨      Building confidence through leadership development

¨      Accountability with 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 business advice

¨      Learning to be assertive in family and social roles

Effective Partnership

Trust Bank 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.

The general 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.[17]  Projects utilizing group discussion in Mauritius and Thailand have been successful at increasing competencies to negotiate and communicate safe sex with partners.[18] [19]  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 and problems.[20]  Peer education within Trust Banks should prove to be an effective method of individual and community-wide HIV prevention.

For this 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 partnership(s).

At 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.

Beneficiaries

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 years

¨      Unemployed women (likely to become sex workers)

¨      Young girls

¨      AIDS widows

¨      AIDS orphans

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

Married 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.[21] A Senegal study revealed 50 percent of HIV infected women had monogamous relationships.[22]

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)

Many women 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.[23]  They are often single women or female head of households faced with no other income alternatives.

Trust Banks 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 healthier lifestyles. 

Young Girls

In Africa, 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.[24]

By 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.[25] 

AIDS Widows

Many AIDS 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.[26]  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.

Trust Banks 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 self-respect. 

AIDS Orphans

Eight 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.”[27]

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.[28]

A majority 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.

  

Basic Plan

The twin 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 intervention model.

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.[29] A lack of sustainability and proper management prohibits their scale-up potential.[30]  In contrast the Trust Bank lending technology is a proven sustainable model that harnesses the internal potential of female entrepreneurs.

Key Targets

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.       

 

Year One

Year Two

Year Three

Year Four

Year Five

Totals

 

New Trust Banks

315

540

1,220

2,290

3,450

7,815

Women empowered

10,500

18,000

40,667

76,333

115,000

260,500

Infections prevented*

3,045

5,220

11,793

22,137

33,350

75,545

Orphans supported**

9,187

15,750

35,583

66,792

100,625

227,937

Peer group meetings

7,245

19,665

44,103

90,563

154,071

315,646

Total beneficiaries***

63,000

108,000

244,000

458,000

690,000

1,563,000

Dollars loaned

$1,269,000

$5,417,000

$10,886,000

$20,485,000

$34,843,000

$72,900,000

   *  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 orphans supported).

 

Change is Possible

 

Dr. 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.”[31]  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.”[32]

 

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. 

 

If the 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 sources.   

This initiative will free millions of families in Africa from the threat of AIDS.  Thank you for your consideration. 

 [1]         UNAIDS.  Report on the Global HIV/AIDS Epidemic. April 1999.

[2]         UNAIDS.  Women and AIDS: Facts and Figures. October 1997.

[3]         UNAIDS.  1999 World AIDS Campaign: Facts and Figures.  February 1999.

[4]         Daulaire, Nils. National Council for International Health/Global Health Council. 16 Sept. 1998.

[5]         UNAIDS.  AIDS Epidemic Update.  December 1998

[6]         Rosenvard, C and Campbell, T.  A review of sexual behavior change studies from sub-Saharan Africa:

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[8]         Afonja, Simi. Changing patterns of gender stratification in West Africa in Persistent Inequalities,

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[13]     George A, Jaswal S.  Understanding sexuality: An ethnographic study of poor women in Bombay. 

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[14]     AIDS and Children: a family disease.  London, Panos Institute, 1989.

[15]  Brundland, G H. Commission on the Status of Women, United Nations. New York, 3 March 1999.

[16]     Gender and HIV/AIDS: Taking stock of research and programs. UNAIDS Best Practice Collection,

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[17]     Gender and HIV/AIDS: Taking stock of research and programs. UNAIDS Best Practice Collection,

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[18]     Cash K, Anasuchatkul B. Experimental educational interventions for AIDS prevention. Washington,

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[19]     Schensul S et al. Sexual intimacy and changing lifestyles in an era of AIDS. Reproductive Health

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[20]     Vasconcelos A et al. Sexuality and AIDS prevention among adolescents in Recife, Brazil.

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[21]     Allen, Susan et al. HIV Infection in Urban Rwanda, Journal of the American Medical Association,  25

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[22]     Hamblin J, Reid E. Women, the HIV epidemic and human rights, New York, UNDP (HIV and

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[23]     Heise L, Elias C. Transforming AIDS prevention to meet women's needs: a focus on developing

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[24]     Bassett M, Sherman J. Female sexual behavior and the risk of HIV infection: an ethnographic study

n  Harare, Zimbabwe.  Washington DC, International Center for Research on Women, 1994

[25]   Kahwa R et al. Peer education as a means of behavior change. Int Conf AIDS. 1996 Jul 7-12;11(2):473

[26]   Aseru DA; Candiru H; Candiu J. HIV positive women intervention in times of bereavement. Int Conf AIDS. 1998;12:166.

[27] Daley, Suzanne. In Zambia, the Abandoned Generation. New York Times, 09/18/98 P. A1

[28] The Orphans of AIDS: Breaking the Vicious Circle  Panos AIDS, October 1997

[29]     Ottenweller M. The Soweto Hope model for community based support. Int Conf AIDS. 1998;12:507

[30]     Jackson H et al. AIDS support and income generation. Harare, Zimbabwe, Int Conf AIDS. 1994

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[31] Collins, Huntly.  Epidemic Fueled by Wide Inequality in Relationships.  Philadelphia Inquirer,

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