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Using participatory approaches to mitigate the impacts of HIV/AIDS

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Sam L J Page Consultant

Using Participatory Approaches to Mitigate the Impacts of HIV/AIDS Sam L J Page The impacts of HIV/AIDS on African households in terms of increasing poverty and labour constraints in the absence of a national social welfare system... MODERATE Two adults caring for orphans Two adults caring for a sick relative Widow caring for orphans

Moderate Impact of HIV/AIDS Mr & Mrs Muketsi with the youngest of their 7 orphaned grand children.

SEVERE One adult nursing a sick relative Grandmother caring for orphans Breadwinner suffering from AIDS-related infections

Severe Impact of HIV/AIDS Margaret Shambara with her HIV+ son and 3 of her 5 orphaned grandchildren.

VERY SEVERE HIV+ widow caring for orphans HIV+ wife nursing her sick husband/relative Children caring for a sick parent/relative Orphans fending for themselves

Very Severe Impact of HIV/AIDS HIV+ widow spraying her cotton crop accompanied by her two small children

19 year old Louis Gobede with 3 of his 5 orphaned brothers and sisters

The impacts of HIV/AIDs are not just measured in terms of loss of labour and income but in terms of a phenomenon called “short-termism” due to hopelessness and despair. Short-termism encourages selfishness and greed rather than community action and innovation. Many donors are guilty of promoting short-termism when they with-draw support from crucial development projects after only 3 years or less. How do we know when we have mitigated the impacts of HIV/AIDS? Community support groups arise spontaneously. Vulnerable people are motivated to join in project activities. Vulnerable people benefit from the activities. Orphans are cared for within the community. The number of vulnerable people within the community declines. Long-term planning becomes possible. Looking at Best Practise

Effects of the Zambezi Valley Organic Cotton Project on Mitigating the Impacts of HIV/AIDS This project promoted the formation of support groups and motivated vulnerable people, especially widows from AIDS, to join in the learning activities. The widows said they liked growing organic cotton because it provided a cash income and increased food security. This project was cut by the donor and the organic farmers were later attacked by ZANU PF militia.

Effects of CBNRM Projects on Mitigating the Impacts of HIV/AIDS in Malawi 13 CBOs were promoting CBNRM activities such as; tree planting fish farming fruit tree production fruit processing herb gardening mushroom growing briquette making improved stove making Out of 13 CBNRM projects investigated: 2 were promoting activities that were directly benefiting vulnerable people. 3 had given rise to community support groups. 8 were unwittingly excluding vulnerable people. Involving Vulnerable People The Ndirande Women’s Briquette Making Group, The Songai Sawdust Briquette Making Group & Bwanje Environmental Rural Development Organisation were involving widows in their activities. Vulnerable people benefiting from the activities Sick people were receiving remedies from herb gardens being supported by Hope Humana. Vulnerable people were receiving food in return for planting trees and making compost in Bwanje Valley. Fostering Community Support The Ndirande Women’s Briquette-Making Group was providing financial and spiritual support to members caring for orphans or nursing the sick. Tsogolo La Ana was providing training for orphans within the community. The Bwanje Environmental Rural Development Organisation was providing material support for orphans within the community. Excluding Vulnerable People Kalino Fish Farming Group was selling only big fish, at a price that could not be afforded by the poorest people. Mwanza East CBNRM project was failing to involve vulnerable people in baobab fruit harvesting. Lake Chilwa Boat Co-Management project was improving fish stocks for fishermen without supporting destitute widows in their locality.

58 year old Agnes Chipanga was caring for 4 orphaned grandchildren. When asked about harvesting the malambe she said that the “owners” of the trees had threatened to beat her. Lucy Wyman outside her rented shack, seeking to make money from local fishermen to support her 3 children and 6 orphaned nieces and nephews.

Rural people need more information on reducing vulnerability to HIV improving health and preventing disease in order to build hope and prevent despair Reducing Vulnerability to HIV/AIDS through Positive Living For improved health and longevity for farming families in HIV/AIDS-affected areas of Africa. A practical training manual for community workers What is Positive Living? Assessing risk and encouraging behaviour change Preventing disease by cleaning up the environment Promoting good health through improved nutrition Assessing risk and encouraging behaviour change

Looking at the underlying causes of HIV These are; unequal access to wealth unequal gender relations Women looked at their vulnerability to HIV They said their vulnerability was due to poverty and tradition Women looked at their ability to protect themselves from HIV They said they were too powerless to take responsibility for protecting themselves from HIV. Analysing the causes and effects of female powerlessness The causes are religious and traditional, enforced by abuse of power and poor education. The effects are poverty, lack of human rights and low self esteem. These effects make women and girls vulnerable to HIV. Men looked at their vulnerability to HIV They said that abuse of power, comparative wealth and the enjoyment of risk-taking makes them vulnerable to HIV. Men looked at their ability to protect themselves from HIV/AIDS They realised that they are free to take responsibility for their own lives through “behaviour change”.

Taking responsibility Men have the power to address the root causes of female powerlessness. Men should be given the opportunity to negotiate power-sharing with women to reduce their vulnerability to HIV Preventing disease by cleaning up the environment Demonstrating how microbes are spread...

Can you spot the health hazards? Inspecting local homesteads for health hazards

Infectious diseases identified in 3 households included; 1 case of malaria 1 suspected case of cholera several cases of severe scabies. Health hazards identified pit latrines without facilities for washing hands. no kitchen doors, allowing free access to dogs. small, unventilated kitchens, exposing women to smoke toilet cover kept in the kitchen. pigs and other animals kept alongside the bedroom. 6 children, 1 with severe diarrhoea, sharing the same dirty blanket in a bedroom measuring 6 sq.m. no mosquito nets. child’s potty, full of fermenting excrement under dish rack. floors unswept with refuse strewn about. Promoting good health through improved nutrition

What makes us healthy?

The Impact of Declining T-cells on Vulnerability to Infection and Life Expectancy No. of T-cells per ml of blood Vulnerability to infection Life expectancy (years) More than 900 Low More than 15 More than 500 Moderate More than 5 Less than 200 High Less than 5

The best local sources of nutrients Avocado, baobab, bambara, banana, dark green leafy vegetables, eggs, fish, guava, insects, mango, pumpkin, small grains. Who gets the most nutritious food? Father Mother (who is pregnant) Auntie (who is sick) Grandmother 15 year old girl 5 year old boy

The impact of power relations on food distribution within the family The women gave the most food to the father and the least to the children and the sick auntie Planning a nutrition orchard Fruit trees provide the best low-risk source of nutrition

Fruit Trees for Positive Living   Tree/vine Important nutrients No. of years to first fruits   Banana Vitamin B 1 Mulberry Vitamin C 1 Oyster nut Protein 1 Paw-paw Vitamin A 1 Pigeon pea Protein, iron 1 Tree tomato Vitamin C 2 West Indian cherry Vitamin C 2 Guava Vitamin C 2 – 3 Citrus Vitamin C 4 – 6 Mango Vitamin A 5 – 7 Avocado Vitamin A, oil 7 – 10

Planning a nutrition garden

Choose indigenous crops Eliminate pesticides

Community Action Mr & Mrs Sibanda sharing their garden with the community in order to feed orphans Community Action Using traditional methods in Mr & Mrs Sibanda’s collective nutrition garden Community Support Groups Mrs Mudzipurwa receiving emotional and material support from the community Providing hope... Mrs Mudzipurwa demonstrating that her friends can still help her stand on her own two feet!

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