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ROLE OF THE COMMUNITY (CBOs, NGOS/YMCA) http://www.ymca.int/programs/New_Hiv/aids.htm
STDs, which are a major public health problem, are largely neglected until the appearance of HIV/ AIDS. Now, more attention is focused on conventional STDs (such as gonorrhoea, syphilis, chlamydia, etc.). They are among the most common, although undiagnosed, causes of illness in the world; and they have far-reaching health, social and economic consequences. STDs substantially increase the risk of HIV infection. Preventing and controlling STDs are key strategies in controlling the spread of HIV/AIDS. In refugee situations, it is essential to ensure that all blood for transfusion is tested and that universal precautions are enforced. Where interaction between refugee and local populations occurs, it is vital to liaise with host countries to ensure that comparable services are provided to local populations. Failure to do so would not only be counterproductive in the effort to prevent the spread of STDs and HIV; it could also result in conflict between the two populations. Mandatory HIV testing of refugees is sometimes requested in the mistaken belief that this will help prevent HIV transmission. Under no circumstances should mandatory testing be pursued. Mandatory testing for HIV represents a violation of human rights and has no public health justification. Better Life Options (BLO)- South African
YMCA. Learning by doing -Kenya YMCA At the YMCA theatre including puppetry has been used as an educational and awareness tool. Through theatre, the community has become aware that HIV/AIDS has not only a health dimension but also an economic one linked to poverty. YMCAs like the Busia YMCA and Shaurimoyo YMCA use the down-up approach in communicating the HIV/AIDs situation and also learning from the community as they identify their immediate needs to help YMCA design relevant community friendly initiatives. The acting is done by young YMCA volunteers who create a common purpose by trying to turn information gathered from the community into dramatic scenes where people see their dilemmas and conflicts as a result of a major problem. For example prostitution due to socio-economic insecurity. This approach has enabled the Busia YMCA to address the food insecurity situation that yields responses that lead to the feminisation of the epidemic. Busia YMCA with its strong network of youth and women groups ,works in collaboration with OXFAM on organic farming as a poverty alleviation strategic - poverty which is a major factor to the progression of the HIV epidemic. 4. CRITICAL ANALYSIS OF FINDINGS FROM
THE THREE REGION. The predominant pattern of unequal distribution of public resources for health in developing countries is no mere accident. On the contrary, it is predictable, given the related distributions of economic resources and political power in these countries. The explanation for this inequity can be understood in the context of public choice theory, which provides a positive model of what the government will do, under the assumption that the chief agents act to maximise individual utility rather than social welfare. According to the theory, politicians and bureaucrats do not seek to optimise economic efficiency but rather to maximise their own chances of getting re-elected and staying employed; similarly, individuals use governments to maximise their own income by creating and protecting market positions and capturing publicly-financed services and transfers. Politicians and political parties have some discretionary power because of barriers to entry and because they are in a position to shape as well as respond to people's tastes and preferences. At the same time, they must act in a way that deters threats from potential competitors, and this limits the scope of their monopoly power. Where democracy does not exist in developing countries, a similar process can occur with even fewer political checks on the use of government resources to benefit the already powerful. · The extremes of poverty and socio-economic immobility may raise
fears of crime or revolution, which will ultimately hurt the rich;
historically, the provision of basic education, employment or medical
insurance have been ways of combating these problems. The social services sectors, including health and education, are arenas in which many of these forces play themselves out, as they involve a variety of public goods with different mixes of public and private benefits. The fact that health and education services generate social as well as private benefits, and their frequent designation as "merit" goods provides justification for government intervention along welfare theory lines. Yet once this intervention begins, apparently to correct for market failures and to benefit poor consumers, it is often seized by producer groups and the allocation of resources diverted to a more private service mix that predominantly benefits the rich. Three politically influential groups often work actively to protect the flow of government funds toward health services that benefit them directly, and resisting efforts to reallocate public resources for health to the poor. · First, government officials and politicians stand to gain from
construction projects for large hospitals. · Second, various middle-income consumer groups object strongly to any erosion of their public subsidies for health services. These groups include professionals from the private sector and labour organisations. British colonial policies in Ghana and Zambia, for example, dictated that public hospitals in Accra and Lusaka, respectively, should provide free or heavily subsidised medical care to the colonial elite. Once established, it has been extremely difficult for policy-makers in those countries to shift this demand for medical care to private hospitals or to charge full costs to the wealthy for care in the government teaching hospitals. Labour unions seek to protect public subsidies in the middle-income countries of Latin America, where governments extend financial support to social security-based health care through some combination of tax relief, public contributions to insurance premiums, and direct budgetary transfers to social security agencies · Third, the health workers and their respective labour organisations themselves are a major source of resistance to change. A shift in public funding to basic care would require that doctors and nurses be re-deployed from large urban-based hospitals to smaller outer facilities in poor urban neighbourhoods and rural areas. Living and working conditions in these may well be more difficult than in the central hospitals; it is thus not surprising that health workers oppose these changes. Similarly, a reallocation of government spending for health would reduce the demand for publicly financed services from medical specialists. The specialists, through their professional associations, can be vocal and influential lobbyists for continued spending on sophisticated equipment (such as diagnostic imaging machines) and hospital facilities.
For the above pattern of public subsidies to dominate, it is not necessary that all politicians and officials pursue only their own individual interests, nor that service providers and middle-class consumers have complete control of public revenue and expenditure patterns. It is only necessary that these tendencies occur widely enough and often enough to minimise countervailing efforts to reach the poor. The more equal the overall distribution of income and the stronger the political voice of the poor, the easier it should be to design and implement pro-poor programs. Malaysia and Costa Rica, as well as Sri Lanka, Korea, and the Indian
State of Kerala, are examples of economies with relatively low income
inequality and histories of broad-based social programs to reach the
poor. Communist countries, including China and Cuba, are examples of
economies in which the political legitimacy of the ruling party has
relied heavily on support of the working and peasant classes. The IMF Debt cancellation still provides an opportunity for real progress in development and the eradication of poverty - if it is organised specifically to benefit poor people. But debt cancellation can also enhance local control and involvement by ordinary people in how these resources are used. In this way, it can help build the open, accountable and participatory democracies for which people in poor countries are calling. Current terms and conditions demanded by institutions such as the IMF in return for aid and debt relief are making corruption worse; the money released through the HIPC debt relief initiative should be used in the interests of the poor. These resources should be earmarked for poverty eradication, social development, and for building participatory democracy; new mechanisms suggested by local organisations to ensure that the money is used properly can be put in place. In several countries this is already being done in striking examples of debt relief which can work. Money from debt cancellation can also help build greater accountability and transparency by governments. Coping with IMF policies While creditors, the World Bank and IMF talk loudly about the problem
of corruption, their policies, particularly in the ESAF programmes, have
exacerbated rather than helped stop corruption. Forcing cut backs in public spending, meanwhile, has led to poor pay of civil servants, doctors and nurses, greatly increasing the risk of petty corruption. Teachers who are underpaid or not paid at all have every temptation to take parental contributions in exchange for good exam marks. But paying all teachers a living wage, on time, would break many of the African treasuries that, on the World Bank's advice, are desperately trying to cut their budgets. In many cases corruption begins closer to home than many creditors would like to admit. As puts it: Corruption is the explicit product of multinational corporations, headquartered in leading industrialised countries, using massive bribery and kick-backs to buy contracts in the developing countries and countries in transition. Externally imposed conditions have not worked - not least because they were imposed from outside. Many NGOs including the YMCA believe that it would be inappropriate for the creditor community to impose more conditions on debt relief. They believe rather that conditions on governments should be set by local people, and civil society. In Latin America, they refer to this as 'positive' or 'reverse' conditionality. Conditions imposed by the donor countries, monitored by them, and not owned by the government and people themselves will never work. The answer is not ever more conditions but to empower local people to set and enforce the conditions. Necessary arrangements have to be made not to impose conditions by the creditors because those in most cases proved inappropriate, irrelevant and in many cases antidevelopment The civil society also worries that corruption is being used as an excuse to slow down debt relief. We do not have to wait until all safeguards have been set in place before debt relief should take place. No human community is corruption free. Waiting until societies are completely corruption-free is unrealistic. But, most importantly, it ignores the principle that debt cancellation, if done sensitively and with local control, can help countries that have a problem with corruption become less corrupt. What is needed is to put pressure especially on democratic governance, while at the same time relief is worked on. The international community still has a role. There is need for international monitoring to help back up local monitoring. External monitoring alone would not be necessary. But what is needed is 'joint monitoring' which includes the external and internal monitors. This is the arrangement that is currently being followed in Tanzania. Many organisations prefer a collaborative approach, not one driven primarily by creditors. They want to see a greater role for international NGOs and, in some cases, the United Nations working together with, and helping build the capacity of, civil society in the country concerned. External monitoring would work jointly with local partner monitors, with the aim of building the capacities to eventually take over full-time local monitoring. An educated public and a strong public lobby are perhaps the most effective safeguards against misuse of debt relief funds. In order that maximum benefits are derived, both local and international monitoring are necessary. At the local level, already existing structures would have to be strengthened to improve their monitoring roles. The depth of involvement of international public service institutions and other international private concerns or quasi-governments (like the World Bank) with national governments in the past do not put them in the best position to monitor the processes. It is only in extreme cases of misuse of funds or lack of political will, that it is necessary for creditors to suspend debt relief or apply sanctions. Here again, the preferred action should be in consultation with local civil society. If a government fails or a new regime comes to power and refuses to abide by the triple agreement, tough sanctions may be the solution. There is also a high possibility that debt relief would ultimately hurt those who are already vulnerable. More genuine methods should be sort to ensure that debt relief money reaches its target, rather than waiting until sanctions are needed. Halting debt relief would cause deprivation for communities. Phased allocation of debt relief, conditioned on performance, may also provide another disincentive for corruption or misappropriation. Clear indication of the objectives of debt relief allocation will help to make it easier to identify misuse, and thereby discourage it. Conclusion In 1996 German companies were paying more than $3 billion a year in bribes to win contracts abroad. Independent audits of 54 World Bank projects found 40 contracts worth some $40 million had been 'misprocured'. In one country alone, Indonesia, it is estimated that 20-30 per cent of World Bank loans were lost to corruption. All these examples suggest that people based in rich countries and concerned about corruption should focus their energy on cleaning their own houses before looking to problems in poor countries. Ensuring that Western companies are not involved in bribery, money laundering or tax evasion through offshore accounts should be our first target. Returning money stolen by corrupt dictators such as the millions taken by former President Marcos of the Philippines and Mobutu of Zaire is another important step. Debt cancellation - based on real participation of the poor and in consultation with local civil society is an opportunity to tackle poverty and help democracy, accountability and transparency to flourish in their countries. But creditors and international financial institutions need to show their willingness to create a fairer global economic system for poorer countries, and in doing so, demonstrate their commitment to a less corrupt, more just world. Debt cancellation along the lines would be a first step towards showing this commitment and making debt relief work. Then, also, the final excuses of the creditors for delaying debt cancellation would evaporate. One way in which the problem of corruption and political will could be achieved is to ensure a fair global economic system which would guarantee " fair and equal trade opportunities for all players in the global economic game"
These high levels of foreign indebtedness have worsened lack of funds for an expanded response to AIDS. Across Africa, national governments pay out four times more in debt service than they spend on health and education. In order to mount effective national AIDS prevention programmes, third world countries will need to spend at least US$ 1.2 billion a year, far more than is currently being invested. Sources that might be tapped for these additional resources include increased donations from the private sector and foundations, expansion and redirection of development assistance, and reallocations within countries own public budgets. Relieving countries debt burden is one of the more promising new approaches that could increase the funds flowing into programmes to roll back the AIDS epidemic in the third world. By relieving debt in the poorest countries which, often, are the ones with the highest HIV and AIDS figures , money now exported to service debt could be reinvested into AIDS prevention and care. A major initiative to reduce debt over the next few years will take place under the Highly Indebted Poor Country initiative (HIPC), supported by all the major creditor governments from the OECD countries and implemented by the World Bank and International Monetary Fund. In a typical debt relief agreement, portions of a country's debt will be cancelled in exchange for the debtor government's commitment to mobilise domestic resources for specific purposes, such as a Poverty Eradication Scheme (PRS) or an intensified national AIDS effort. Such transactions have succeeded since the 1980s in the field of
environmental conservation, for instance, by protecting rainforests from
logging. At the heart of debt reduction deals under HIPC lies the
challenge of agreeing on significant goals in poverty reduction and on
measurable indicators of progress towards these goals. Lending countries
will have greater incentives to reduce debt if there are clear and
measurable ways of assessing the benefits. For example, a medium-term
AIDS-related target might be to provide low-cost treatments to a
specific percent-age of the population suffering from the most common
opportunistic infections. Measurable indicators for monitoring progress
would likely include the availability of specific generic medicines in
primary health care centres. 6.1 KENYA'S POVERTY REDUCTION STRATEGY PAPER (PRSP) Kenya's socio-economic conditions have deteriorated since the early 1990s, mainly because of a failure to: · Sustain prudent macroeconomic policies What influences this trend should be the challenge to be faced head-on. As a result, economic growth has dwindled and unemployment has risen, which combined with decline in access to essential services by the poor has contributed to a significant increase in poverty. A recent survey (1997) shows that half the population of Kenya lives in poverty (52%) . There are two indicators for this deterioration in living standards. · Decline in the gross primary enrolment from 94% in 1993 to 83% in
1998. The deterioration is also compounded by the heavy toll taken by the HIV/AIDs epidemic, which in part is reflected in the estimated decline of life expectancy from 60 years in 1993 to 57 years in 1998. From 1998 the Kenyan government has been taking steps to address some of the socio-economic ills confronting the country thus maintaining the totalitarian macro-economic policies at the expense of: · Weak revenue performance Key structural reforms have been initiated in the areas of privatisation and public services (including civil service retrenchment) alongside governance problems.
To intensify the reforms mentioned, an interim poverty reduction strategy paper PRSP has been prepared which outlines a policy framework, which will be fully developed in context and finalised by May 2001. The production of the paper has been through a consultative process, with contributions from: · Representatives of the poor The implementation of these policies, as well as those to be developed in the subsequent full PRSP, will help achieve the objectives of the National Poverty Eradication Plan (NPEP) for the period 1999 - 2015. The plan, prepared in the context of a participatory poverty assessment, aims at reducing the number of the poor by one-half by the year 2015 and stresses the need to provide better coverage of basic services, particularly: · Education ECONOMIC PROGRAMME FOR 2000/2001 (A) Governance (B) Macroeconomic Policies Fiscal policies To this end, the fiscal inflation programme for 2000/01 envisages an overall deficit of K.Sh 12,266 Billion, or 1.5 percent of GDP, compared with 0.6 percent in 1999/2000. The programme also allows for a maximum of K.Sh 4 Billion (0.5% of GDP) in additional outlays in the priority areas of: · health , External Sector Policies Pressing Issues Structural Reform · Public service reforms Health Sector (HIV/AIDS) Comments: Countries have lost 10 to 20 years of life expectancy due to a single disease - an enormous setback in individual welfare, reversing years of investments in human capital, GDP per capita or GDP growth do not capture this dimension of welfare loss, especially the lost welfare to those who die. Moreover, as the epidemic has worsened, so have estimations of its effect on African economies, even without taking into account the broader human welfare issues. The scope of the epidemic is now so large now that numbers are no longer necessary to make the argument for the epidemic's economic consequences. For those who live and work in Africa, the impact on individual,
family, and community economies is obvious. Sickness, death, and the
loss of productive capacity in communities where as many as one-third of
the women in their reproductive years are HIV infected hardly needs to
be supported by data. Because it is difficult to measure the macroeconomic impact of an epidemic directly, economists have generally depended on economic models, which are built on a set of assumptions. Naturally, different assumptions yield different numbers. In "Confronting AIDS," the World Bank factored in labour supply issues and the amount to which health care would be financed out of savings to come up with a "rough estimate" of a 0.5 percent reduction in per capita GDP growth. One-half of 1 percent may not seem like much. Indeed, for countries with high growth rates such as Kenya but this has a cumulative effect. If Kenya for example had a growth rate of 2 percent a year in the absence of AIDS, its GNP [gross national product] per capita will increase by 81 percent in one generation, which is about 30 years. Now suppose that AIDS reduces growth to just 1.5 percent per year. Kenya will increase its GNP per capita by only 56 percent in the same period. Figures such as these are mere signposts on a larger landscape of
human suffering and tragedy. They fail to measure the grief of the
survivors and totally disregard the loss of the dead and dying. (a) Snap View of the HIV/AIDS situation
In Uganda · Alcohol brewing/distilling is a major economic activity for many young rural women in Uganda. It is also a major economic activity, which creates a high-risk environment for the spread of HIV, as women's homes often become makeshift bars. While the link between heavy drinking and the spread of HIV is apparent and needs to be addressed, what is even more critical is the need to create alternative income-generating opportunities for rural women. · Bride wealth, which has become unaffordable for many young men these days, and the breakdown of the institution of marriage are contributing to a growing number of informal unions between men and women, which deprive women of legal and socio-economic rights and status that marriage bestows upon them. Changes in legislation, legal literacy and social mobilisation to promote women's legal rights also need to be part of effective HIV and AIDS interventions. · Ritual cleansing and wife inheritance can greatly facilitate the spread of the HIV virus to the extended family. Even though these are sensitive and difficult issues to address, they are often issues, which may determine the economic and social status of an AIDS widow and her family. Young men and women are vulnerable to HIV infection because they begin to be sexually active at an increasingly young age; they tend to have multiple sexual partners and have restricted access to information on safer sexual practices. In addition, the interplay of a wide range of factors, such as war and instability, the loss of appeal in agriculture as a gainful profession, economic hardship and the absence of income-generating opportunities, the increase in drop-out school rates and alcohol/drug abuse, have contributed to the creation of a high risk environment for rural young men and women. The resulting increase in poverty and illiteracy, the lack of employment opportunities, and the erosion of social values and family life education act as catalysts to high risk sexual behaviour. The Uganda National Operational Plan for STD/HIV and AIDS Prevention,
Care and Support 1994-1998 has proposed that HIV and AIDS education
should aim at behaviour change with a priority on children and youth and
that "prevention activities should be integrated into mainstream health
programmes and other programmes dealing with community, women and youth
development. A critical point about youth is that childhood and adolescence, and marriage and parenthood, are often very close together, particularly for girls/young women. Effective behaviour change strategies need to involve the youth itself in the generation of appropriate messages and should address youth-specific socio-economic and cultural realities that influence sexual behaviour. Creating a forum for discussion and for interactive learning, where respect for HIV and AIDS as well as for young people's social and sexual needs co-exist, can help create an enabling environment for the generation of appropriate messages. The socio-cultural norms to be addressed include: - early uptake of sexual activity, If behaviour change is measured in part in terms of changing patterns
of alcohol/drug use, frequency of bar visits, etc., a more accurate
picture of behaviour change would emerge. Many young men and women, want to be tested for HIV (sometimes along with their children), but they do not have access to information and facilities. Pre-testing counselling and practical advice on how to persuade a partner to take the HIV test are key components. A major issue to be addressed, however, is transport cost, which is often prohibitively high, especially for women.
Youth programmes aiming at increasing opportunities for young men and women in rural areas through income-generating activities, leadership and management training, recreation, health education, and communication/negotiation skills are in themselves a strategy against HIV and AIDS and need to be targeted as such. Youth development activities can help prevent the spread of HIV and AIDS by informing young men and women about HIV and AIDS, empowering them to make choices and change their social and sexual behaviour and their lifestyles in general. When planning HIV and AIDS education components (prevention and impact alleviation) for youth programmes in rural areas, the following issues need to be addressed: · The integration of HIV and AIDS education within a Health Promotion package which will include primary health care (safe water, water-borne diseases, Oral Rehydration Salts, etc.), nutrition, first aid, family planning, and sexually transmitted diseases. This primary health care component, including HIV and AIDS, should be targeted to both women and men. · Sensitising youth to HIV, AIDS and STD issues does not mean "teaching" and/or "preaching". A top-down approach may alienate youths and/or generate inappropriate messages. Rural women show concern, for instance, that health workers usually talk in general terms and do not address concrete situations and problems, such as wife inheritance. Participatory training addressing group dynamics, gender relations, social norms, etc., may be more effective in generating appropriate messages. The objective should be not simply to disseminate information but to stimulate discussion and debate that will allow boys/young men and girls/young women to internalise the information and messages generated during the discussion. AIDS activities can and should be creative, entertaining, educational and relevant to young men and women's lives. Some of these activities could be initiated by the youths themselves -- the more involved they are in the design and implementation process, the more effective the message is likely to be.
- Where did AIDS come from? ( c) Key areas to guide intended initiatives I. The importance of training male as well as female trainers to deliver HIV and AIDS messages. These can be youth leaders, RC youth officers, youth leader office
bearers, health workers, and/or youths afflicted or affected by HIV and
AIDS, or a combination of the above. Ways of ensuring that trainers, in
this case male and female youth leaders, will disseminate the imparted
information and messages to young men and women need to be built into
the training curricula. It has been observed that trainers often do not
disseminate the imparted information to the villagers, particularly to
women. Social interaction habits like alcohol and drug abuse that
facilitate casual sexual contacts also needs to be addressed. II. Basic legal literacy for youths and widows Informing widows and young women of their rights before the law, especially with regard to inheritance/property rights and sexual abuse, should be part of every HIV and AIDS prevention component. For instance, in 1990, the government of Uganda passed a bill rendering sexual abuse of children below 18 years punishable by up to 10 years imprisonment. Such progressive legislation should be disseminated as widely as possible in rural areas. Women are usually not aware of their legal rights, nor of ongoing revisions of statutes affecting them and their children. Sensitisation of women's rights should not only be undertaken for the
women but also for the men who need to be informed of women's rights
before the law. It is also important to refer women to places where they
can get legal assistance. Information on the benefits of opening bank
accounts (why, how and where) may also be of assistance, particularly to
women who have only girl children. Young widows/ widowers whose families have been affected by AIDS could be involved in HIV and AIDS education and related activities and possibly given some incentives. They can also be assisted with information on how to live positively with AIDS within the community, and instructed how to make wills. IV. Training and working with young
PLWAs to reinforce HIV and AIDS Local NGOs have sponsored training for PLWAs in order to make its AIDS sensitisation more effective. Working with PLWAs is proving to be more successful than costly and impractical video shows, most of which are in English, and it provides income to AIDS afflicted families. Uganda's youth programme could introduce the concept of organising STD/HIV/AIDS education with assistance from youths who are afflicted or affected by HIV and AIDS. This will ensure that youths and their families affected by HIV and AIDS will not be marginalised, that PLWAs will have a new purpose and positive role in life while also supplementing their income. Finally, it will also enhance interactive delivery of HIV and AIDS messages and make behaviour change more effective.
VI. Linkages between rural youth programmes and related Ministries, international organisations and NGOs involved in HIV and AIDS interventions. Collaboration between the above-mentioned agencies may be uneven at the district level, given the fact that resources are unequally distributed between the districts. Rakai has more than 30 NGOs working on AIDS while Tororo and Gulu have only a handful. In Kabarole, GTZ and ACP have launched a comprehensive programme on HIV and AIDS (though mostly focusing on urban and peri-urban areas) and there are several other NGOs working there. GTZ-ACP have considerable resources and linkages which could be established with the youth programme to tap these resources. The issue of district co-ordination of AIDS activities also needs to be addressed. District co-ordination of AIDS activities is poor in Kabarole and Tororo Districts. District AIDS Committees should be created. VII. HIV/AIDS and Agricultural Extension HIV and AIDS are having an adverse effect on the already overburdened and under-resourced agricultural extension service. Highly qualified civil servants and technocrats are increasingly dying of AIDS and are not being replaced. In some districts, it is becoming difficult to implement agricultural programmes as a result of HIV and AIDS: extension staff are frequently attending burials. Every time there is a burial, the work week is reduced from six to three days (Tuesday, Wednesday and Thursday) as civil servants have to take Saturday, Sunday and Monday off (Friday is the official day of rest) to travel to villages and attend burials. HIV and AIDS interventions targeting rural youths through the agricultural extension service may be ineffective without appropriate measures to strengthen extension services. Training for agricultural extension workers could: a) raise awareness of groups vulnerable to AIDS (youths, including
widows/widowers and orphans) and address the needs of each of these
groups; Conclusion The Museveni government took the HIV-AIDS problem seriously and incorporated their AIDS prevention initiative into their overall development program. Uganda has taken development very seriously. It is the first African HIPC country to qualify for debt relief, which it rolled into their HIV-AIDS program. Uganda's success in coping with the AIDS crisis could be a model for other sub-Saharan countries to use in developing HIV-AIDS programs of their own. Uganda's success follows after debt relief and this should be the next step for World Bank to take in combating the disease in Africa. But many advocates of debt relief, as well as advocates for HIV-AIDS control, caution that Western nations must be respectful of African nations and listen to their ideas for what will work to combat AIDS. In the past, Western nations have just rushed in like a firehouse crew and attacked the AIDS emergency in Africa. While it is good to have the awareness that there is a crisis in Africa in HIV-AIDS infection and death, each country should have its own best solution for what will work there. Preventative education, new drug treatments, support for orphans and caregivers-all these take money, money that debt relief could help provide. Many Jubilee 2000 advocates have been frustrated with the slow pace of funding debt relief, especially in light of such deep human needs: Look at the year 2000 computer problem-billions were found instantly to fix that problem. What about the people in the highly indebted countries? Actions in the immediate future by the sub-Saharan governments as well as by creditor nations will have an enormous impact on the lives of millions in Africa. In the West, people of faith can answer the call in the Book of Leviticus for a Jubilee of debt cancellation with rollovers to be directed toward controlling HIV-AIDS, health, and education in sub-Saharan Africa. 7. STRATEGIES FOR THE YMCA The YMCA is a world-wide Christian Ecumenical Voluntary movement for women and men with special emphasis on the genuine involvement of young people , which seeks to share the Christian ideal of building a human community of justice with love, peace and reconciliation for the fullness of life for all creation. Member YMCAs are therefore, called to focus on certain challenges which will be prioritised according to their own context. This means that YMCAs should be involved in programmes that are relevant to their environments and communities they exist in and work for. However, we should remember the gospel words in John 17:21 " That all may be one". Our unity in Christ should be bridged by partnering in as many issues as possible. Our World today inevitably experiences violence, conflicts, poverty, natural disasters and epidemics. These need not only be addressed by individual YMCAs, but through a concerted effort and as in one body with Christ. HIV/AIDs a cold war annihilates myriad lives devoid of warning. It is the biggest challenge in the world today. Whose responsibility is it to develop intervention programmes? What is our argument about HIV/AIDs in religious terms? Is AIDs a health, social, religious or economic issue? From what angle do we address it? As part of the World - Wide ecumenical movement, what's our opinion on the stereotypes projected by some religious beliefs? Many Christian institutions believe Aids is a curse and therefore a punishment from God. Some protest on condom distribution. One of the YMCA's challenge 21 principles clearly states that the YMCA should be defend ant of God's creation against all that would destroy it, preserving and protecting the earth's resources for coming generations. Looking at the direct impacts of HIV/AIDS on God's people, it should be realised that the YMCA has a big load on its shoulders: · In defending God's creation by protecting and preventing those at
risk of HIV/AIDs infection, giving spiritual comfort, and rehabilitation
to those already dying hence leading them into reconciliation with
Christ. The YMCA s position on HIV/AIDs should be clearly stated. We should
be at the forefront in providing the love of Christ to the sick and
oppressed. We should follow Christ's example. Jesus came for the suffering, the poor, sick and oppressed. He left us as His disciples (those who share the good news of Jesus and striving for spiritual, intellectual and physical well - being of individuals and wholeness of communities) to tread His path follow His example and help those in need. PLWHA are a suffering lot, they are the sick, the oppressed and stigmatised people of the 21st century, those Jesus charges us to care for. Then does God cause suffering? Then why do people suffer? All religious movements like the YMCA have to address this question. The World is full of human suffering caused by hunger, disease, poverty and multiple forms of oppression and injustice, if these things are happening, does this mean it is all God's will and therefore God wills us to suffer? Evil is a very real force in the world, a force not of God's making (Mark 1:32-24). And HIV/AIDs is certainly a devastating evil not of God's will. It is not just a "snack" for gaymen, lesbians, haemophiliacs, babies born with HIV/AIDs, intravenous drug users, or any other persons living with HIV/AIDs. Jesus never punished the sick, He instead healed them. HIV/AIDS is a tragedy, but God suffers with all that are victimised by it or who lose loved ones because of it. Bad things happen, we suffer many times through no fault of our own, but because the world can be an unfair, unjust place. God does not create chaos or injustice. God brings order out of chaos, and demands justice where there is injustice. God does not cause tragedy, but God does respond to suffering with healing. God heals sometimes through physical restoration, and other times with grace sufficient to grow amidst suffering, even in the face of death (1 Corinthians 12; 9). Is God punishing those with HIV/AIDs? Each time some mysterious malady or disaster befalls an identified community, there has always been a claim that God has caused the disasters as a judgement against the affected people. If indeed HIV/AIDs is a plague sent by God to those that are vulnerable to infection and at high risk (you and me), then there is a flaw in the plan. Clearly there is no justification that God has unfavourably judged those at risk of infection, nor that God has created HIV/AIDs as a punishment. Are all the women with breast cancer victims of God's wrath? Are people in Sub-Saharan Africa punished with sickle cell anaemia? It is known that HIV/Aids is disproportionately affecting communities of colours in the United States. Does this mean that God has made judgement against people of colours?. The YMCAs Role A faithful response to HIV/AIDs, then, must be a group response. Love to those affected, teaching them the truth and dynamics of infection. It is our earnest duty as the YMCA to educate people who we can reach. Many people have fears about the risks of contracting HIV, that fear can be overcome with facts. As a Christian movement, we should be able to openly discuss about HIV/AIDs, amongst our membership and even our homes and the churches we belong. And in following Christ's example, we are called to eat with PLWHA, to share their homes with them (Mathew 25:6); to touch people with HIV/AIDs and give them intimacy (Mathew 8: 2-4); and to heal people with HIV/AIDs (Luke 17: 11 -19). Combating HIV requires bold, steadfast leadership. To stop the escalating slaughter of peoples by HIV, we must seek and receive leadership in ecumenical movements like the YMCA. The YMCA exists in 123 countries and with a population of over 30 million men, women and youth, this gives it the ability to mobilise masses and disseminate appropriate information. We should not also forget that within the membership of 30 million we have those affected, infected and those at risk of infection. The YMCA can be effective in doing so because it enjoys the respect and the support of people. In the face of a disease that is 100% preventable, our movement must begin to provide prevention education and to support those persons who are affected and infected by HIV. Only when the religious community will be willing to admit people living with AIDs (diminish the stigma) , then can they make a breakthrough. Take for instance those who are displaced by military conflict or even natural disaster; the homeless children; orphans, vulnerable teens for lack of information who will not live to be 25; mothers suffering from abuse and obligated to have unprotected sex with their husbands who are known to be infected. Yet there is no care, no love, no vaccine, nor a cure. Our unity and oneness in Christ makes us one body. And in solidarity,
we fight a good course. The YMCA needs to take appropriate steps to organise, mobilise
educate and reach out to those communities that are infected, affected
and those at risk. Most importantly, in the strategies, there should be
a guarantee for a breakthrough. We should be able to come up with doable
interventions/practises to help us pull down the wall When discussing issues at international, regional, national and at the grassroots levels, it should be borne in mind that policies realised and decisions made have had a colossal impact on family units. Many documents have been produced, many conferences organised, databases established and lots of resources pumped into research work. What is the significance of all this in the active lives of PLWAs? How best can we restrategise, make new moves and work not only within, but also with communities in alleviation of the existing dysfunctional psychosocial and economic strains? Where does the YMCA fit in the jigsaw puzzle? How do we diminish the pyramidal / hierachial approaches in strategizing for community development? Through out the paper, we realise the impact of policies made by IFIs and the strategies taken by NGOs in what we could call conformity to globalisation. These have continued to influence household coping responses against HIV/AIDS. For example Some of the coping responses and impacts discussed in section 1.3- increased CSW in India, section 2.2 -household impacts in Jamaica and section 4.0 - poor governance and corruption by governments and quasi-governments etc, could be addressed under: 1. Strategies aimed at improving food security The above responses have been cultured by households that have direct contact with problems resulting from HIV/AIDS. A good number of the affected persons need to be made aware that their responses are influenced by decisions made for them. It is the humble duty of community based organisations to create awareness on global economics that affect and have repercussions on household economies. This approach would garner the support and justify the need for partnership with the local community in community development. This is the principle of 'social capital'. In so doing, areas that would indirectly ease the coping strains of households will be addressed. For the YMCA this means strategizing with the aim of working more closely with and within the community to establish the social capital system. A system geared to partnership within civil society, governments, NGOs, decision-makers, well wishers and stakeholders. For lobbying and advocacy purposes and empowering the affected both economically and with knowledge and skill. The coalition should be able to come up with doable practises that will soften the effects of the NEPs for example by: 1. Shifting emphasis from production of commodities to diversified
agricultural production. The YMCA needs to broaden its scope in addressing the HIV/AIDs issue. In its operations/processes and dissemination of ideals, not only members but also the community for which it is purposed for should be made aware the multifacetedness of the epidemic. This means that the YMCA in its intervention should make vivid the scourge as stirred by 'global prudent conduct' and the repercussions to the infected, affected and the individuals at risk. As mentioned previously in the paper, factors influencing progression of the infection, vary from region to another. It is therefore rational to zero in and focus our research work to 'culture populations'. This should be our first step before we embark on interventions. The YMCA staff/Volunteers need be prepared by training to perceive the economic aspect of the epidemic. However long it takes, 'the pith cause' of the scourge should be addressed - factors that transfigure the enormity of HIV/AIDs and lead to survival responses that make people vulnerable to infection. This horn of dilemma is the challenge of the 21st century! Acronyms Epidemic Seropositivity
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