Let’s declare war on stigma

Replies to This Discussion

Permalink Reply by Francis Mwathi on February 24, 2009 at 2:05am

Tools for fighting HIV and AIDS stigma in Northern Uganda

Thank you Jackie for starting this group. Uganda has been successfully combating AIDS since 1987. The number of people infected has fallen from 35 per cent at the outset to around 6.5 per cent. This rapid decline merits respect, and not only on the African continent. The country which once had the highest rate of AIDS in the whole of Africa has demonstrated what it can achieve. It has become an exemplary model for the rest of Africa. In December 2007 the World Association of Christian Communication (WACC) and the Entebbe Women Association (EWA) embarked on a project to fight stigma among HIV/AIDS positive people in Gulu Municipal Council. Centrally located in Northern Uganda, Gulu serves as a hub of economic activity in the region, including Southern Sudan. While it is slowly recovering from years of instability caused by rebel insurgency, there remains a high HIV/AIDS prevalence rate of 8.2% among Northern Uganda’s adult population, as compared to the national rate of 6.4%. Poverty and prolonged insurgency has led to the degeneration of cultural values, making the population of Gulu extremely vulnerable to HIV/AIDS. High unemployment rates have also forced many to turn to commercial sex for income which, when coupled with the constant population movement common to the area, puts many people at risk. Other factors contributing to high prevalence are child defilement, gender-based violence, stigma, self-denial, and mother to child transmission. With so many factors feeding into the problem, only a multifaceted solution could have an impact.

EWA, a national non-governmental organization (NGO), sought such a solution through information, education and communication (IEC). The proposed solution was three-fold: 1) HIV/AIDS awareness campaigns through radio programs, IEC material dissemination, and public dance/drama performances. 2) Training and advocacy for people living with HIV/AIDS (PHAs). 3) Radio programs focusing on reducing stigmatization. Through these activities EWA hoped to encourage PHAs to adopt and maintain positive living practices, increase the disclosure of HIV status among sexual partners and improve community involvement in HIV/AIDS services. Through WACC funding, the project became a reality and 2008 saw many positive achievements, challenges and lessons learned.

When implementing any project at the grassroots level, an NGO must always form good relationships with local leaders and other NGOs active in the area. To this end EWA organized a consultative forum in which to discuss project strategies to avoid the duplication of services and hear recommendations for how to best implement project activities. Not only were new ideas gained but other NGOs saw the need to increase their activities in relation to HIV/AIDS and good working relationships were established with local leaders, whose support became invaluable to the project.

Soon after, HIV/AIDS sensitization was carried out through drama and music sessions – over ten sessions were conducted in four divisions of Gulu Municipality, reaching over 2000 people. These sessions aimed to increase HIV/AIDS awareness by highlighting issues surrounding stigma, the care and support for HIV/AIDS patients and the community role in HIV/AIDS prevention. Such performances were effective live performances have strong impacts. One indicator of this, for example, is that the Municipal HIV/AIDS Focal Point Officer received over 35 referral cases for integrated HIV/AIDS support through advocacy following the drama sessions.

In order to reach an even wider audience, EWA also used radio messages focusing on stigma and the care and support of PHAs. Over a period of seven days, two spot messages were run three times a day on Mega FM, one of Gulu’s radio stations. In total, six radio programs were conducted on Mega FM in 2008, reaching out to the populations of over five districts within Northern Uganda. These programs proved to be effective as people called in during the programs for more information and wrote letters and/or visited the local EWA office to request more information, posters and brochures.

A solution to the problem, however, is only possible when also specifically targeting and utilizing PHAs. Thus 328 PHAs were trained in positive living, positive prevention, drug adherence, reduced stigma and orphans/vulnerable children childcare. Of those trained, over 246 have now openly declared their HIV/AIDS status and some have even created drama groups in order to share their testimonies with others. Live testimonies coupled with drama presentations will become a powerful tool in the next phase of awareness campaigns for reduced stigma, safer sex practices and positive.

While the response to the training was encouraging, one must not forget that PHAs are often poor, weak and in need of care and support. In fulfilling its mission of empowering the vulnerable and providing them with increased self-esteem through sustainable development, EWA was able to solicit additional funding in order to provide two sewing machines and two carpentry kits to selected groups of PHAs. These income generating tools have provided the recipients with new confidence and a way of providing for their families. The PHA group that received the two sewing machines, for example, has opened a tailoring shop and is now filled with hope for the future.

Despite these successes, many challenges were faced. Most importantly, it was noted that NGOs often prefer to work in rural areas, leading to the neglect of the urban poor. Many people in Northern Uganda have been displaced due to the insurgency and have come to cities looking for work, making this a crucial service gap. Also, facing high population and poverty levels made it impossible for EWA to complete its strategic awareness campaign within one year. EWA also observed that more women than men attend sensitization meetings. It seems that men, due to their dominant social status within the culture and communities, fear to disclose their HIV/AIDS status. Lastly, a large percentage of the target population does not listen to the radio, rendering radio communication ineffective when considering the very poor.

Many lessons were learned during this project. First, drama presentations are the most effective communication tool in HIV/AIDS sensitization. Drama presentations leave deep impressions on the minds of the audience, as drama is difficult to forget. Second, sensitization is not only important in combating ignorance on HIV/AIDS and stigma, but also in providing PHAs with the confidence to openly disclose their status. Third, local officials are integral to project implementation. Partnering with local leaders builds confidence within the community and allows for the sustainability of the program.

Lessons for future projects were also learned. Mass communication is effective, but organizations should also visit the homes of PHAs to build relationships with them, encourage them and demonstrate that they are important community members. The confidence thus acquired will encourage PHAs to live positively. For more effective program execution, especially at the district level, the working relationship between local and municipal leaders needs to be strengthened. Also, HIV/AIDS prevention needs to start at a young age and therefore drama presentations should also target schools and tertiary institutions, creating a broader base of awareness. Lastly, the capacity of local volunteers needs to be increased so they can spearhead community-based communication for HIV/AIDS, positive prevention, reduced stigma and positive living, thus increasing project sustainability.

Communication is an important tool in combating HIV/AIDS. When adapted to local contexts and needs, it can indeed make a difference and save lives.

▶ Reply to This

Permalink Reply by Sandra Nassali on February 24, 2009 at 2:10am

When HIV & AIDS began to spread in Africa, Uganda was one of the worst affected countries. The disease was first reported in the country in 1982. By the late 1980s, the country had the highest rate of HIV & AIDS infection in the world.

During this time, many countries were still struggling to come to terms with the implications of the disease. But the Ugandan government took action and set up an AIDS Control Program in the Ministry of Health. It was one of the first countries to work with the World Health Organization to create a national HIV control plan.

The Uganda AIDS Commission was set up under the Office of the President. Involving the President directly has been a powerful way to get the message across to the Ugandan people. The strategy is to tackle HIV by working with a range of groups in the community – including people living with HIV.

The Ugandan government began a widespread campaign to raise awareness about HIV & AIDS (ABC_ A for abstaining form sex until marriage, B- for being faithful to your partner and C for using a condom during sexual intercourse). Everyone from government departments to churches have been involved. The campaign is headed by the first lady.

A range of other activities have also been promoted for instance HIV testing, sex education and condom distribution.

The results of this have been impressive. For example, between 1992 and 1997, rates of HIV infection among pregnant women fell by 50 percent.

Rates of condom use have increased and there is evidence that young people are delaying their first sexual experiences by up to two years. The overall infection rate has dropped to a low of about 7 percent of the adult population.

As regards fighting stigma, there is an on going campaign i.e ''It begins with you''. The media has also played a big role. People living with the disease are no longer discriminated but accepted because in the country today we look at HIV as any other disease.

Sandra

▶ Reply to This

Permalink Reply by Shipra Sharma on February 25, 2009 at 5:40am

Hi Jackie,
In India HIV AIDS is a grave concern with 2.4 million people living with this disease as per 2007 statistics. The stigma attached with this disease is even greater. So, lately the government agency, National AIDS Control Organisation (NACO) has focused more on creating awareness about the disease and alleviating the stigma attached to it. Since the film media is very popular in India and it is a country proud of its film industry and film stars, it has roped in famous film stars to spread across the message to the masses. It has been a very successful campaign. The film industry has also dealt with this subject through very popular and critically acclaimed films like My Brother Nikhil and Phir Milenge (shall meet again). So, this has been one popular way of creating more and more awareness about AIDS and dealing with the stigma attached to it.

▶ Reply to This

Permalink Reply by Jackie Mondi on February 26, 2009 at 8:33am

Thank you so much Shipra for sharing the experiences in your country! It is definitely a brilliant idea to use what people love and their 'idols' to spread the anti stigma messages. In South Africa there is also a group called Positive Heroes. These are HIV positive people who live to show that being HIV positive is not the end and that one can live a fruitful life and be a positive influence on others as well. They have started a group of HIV positive athletes who are running ultra-marathons. They are really an inspiration! Information on Positive Heroes can be found on Nike's Gamechangers Competition site, here is the link to their entry: http://sportforchange.changemakers.net/en-us/node/17136

▶ Reply to This

Permalink Reply by Shipra Sharma on March 5, 2009 at 11:24am

Dear Jackie,
Sorry for the late reply and thanks for sharing this wonderful Information. This is so inspiring and gives hope to others. I have forwarded this message to my group for wider circulation.

▶ Reply to This

Permalink Reply by Jacob Baiden Odame on February 25, 2009 at 6:09am

Great Jackie! You are an inspirer

▶ Reply to This

Permalink Reply by Alan Foo on March 18, 2009 at 10:08am

One area omitted by most NGOs is the use of education to schools children as a powerful weapon against the ills of the world .. be it against smoking, AIDs/HIVs , drugs etc.

This is one of the directions we at www.paperlesshomework.com is pursuing to fight these ills through education at school levels.

We have a good example at
http://www.youtube.com/watch?v=kuEq1o1z1Lg
which is one example of how we use Learning English to teach the child on the ills of smoking.
This way the child need not be told but rather they have to know why smoking is bad - they need to pass the test.

If this is doen nationally, the children would start to influence their parents who surely would listen to their little ones than all the advertisements and campaigns by all.

Education is the key.

If any NGO wishes to use such a method to do this kind of work , let us know. Contack us at www.paperlesshomework.com/Ycontact.htm

A good initiative to get grants ?

Regards
Alan
www.paperlesshomework.com

▶ Reply to This

Permalink Reply by Jackie Mondi on March 19, 2009 at 1:44am

Hey Alan,

Thank you for participating in the dicussion and sharing your resources. I will definitely check them out and encourage others to do so as well.

Jackie

▶ Reply to This