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The Synergy Project

Community, Care, Change and Hope: Local Responses to HIV in Zambia

Sue Lucas

July 2004

SARPN acknowledges the Development Experience Clearinghouse website as the source of this report: www.dec.org
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Summary

This case study documents a successful model for facilitating a strong community response to HIV/AIDS. The Salvation Army Change Program in Ndola and Choma Districts in Zambia illustrates the facilitation process stimulating an appropriate local response to HIV/AIDS an essential component of human capacity development. “Human capacity development means developing the will, skills, capacities and systems for an effective response to HIV.”

The model builds on local strengths and resources, stimulating ordinary people to address the barriers that prevent them from using HIV/AIDS information and services to prevent new infections, compassionately care for those who are infected, and mitigate the effects of the epidemic on families and the community. Only by addressing personal risk, stigma, and the potential for personal and societal change will the demand for and use of voluntary counseling and testing, prevention of mother-to-child transmission, and antiretroviral therapy services increase. Thus, building human capacity in the community to become “AIDS competent” and respond effectively to HIV/AIDS is an essential intervention alongside the strengthened and expanded health services that are being rolled out with the President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis and Malaria resources.

Evidence for the success of the facilitation process in Zambia includes:
  • Establishment of community gardens to provide food and some income from the sale of surplus food to orphans in 17 communities in one area


  • Demand from community members for voluntary counseling and testing, resulting in testing of 85 people in one community and requests that testing be provided in several nearby communities


  • Increase in the numbers of people reached in home-care programs and in the quality of support provided to them


  • Increase in the numbers of communities organizing themselves to respond actively to HIV


  • Change in risky activities—the local cultural practice of sexual cleansing of widows replaced by alternative rites that do not increase transmission of HIV, and sharp personal implements such as razors no longer being shared

Introduction

Early in the course of the HIV epidemic in Africa, people recognized that controlling the spread of the virus could not be achieved by health services alone. Human rights, community participation, multisectoral approaches, and the role of culture have all been accepted as essential parts of an effective response to the epidemic. But despite these calls, technology (in the form of condoms, antiretroviral therapy, antiretroviral drugs to prevent mother-to-child transmission, the use of clean syringes and needles, and vaccine research) is still the major element of most interventions and absorbs the majority of funds available to fight HIV and AIDS. Health services are still the main conduit for donor funding for HIV, and health ministries still control most government spending. Programs are often evaluated in terms of condoms distributed and reported condom use, number of people who hear or see messages about HIV, or number of vulnerable people provided with means of prevention. While all these responses are essential parts of an effective response to HIV/AIDS, it is clear from the experience of the last 20 years—and from the ever-increasing spread of the virus—that they are not sufficient.

The missing element is human capacity development—the ability of people to respond to the epidemic. In many places, people still have not acknowledged HIV or changed their beliefs and behaviors in response to a devastating epidemic. Without acknowledgment, communities have not been able to take control of how to use technology; hence, technical solutions have been imposed on them. Without developing the human capacity for change, communities are losing hope because their own strengths are not being taken into account, and organizations and institutions providing services and technological interventions are relying on external analysis without understanding the potential that lies within community leadership. As a result, not much significant, long-lasting change is taking place.

Human capacity development issues werediscussed and developed at a series of meetings (Brazil and Geneva in 2000, Ouagadougou in 2001, and Barcelona and London in 2002) that included participation from civil society, governments, donors, international organizations, the commercial sector, and people living with HIV in both resource-rich and resource-poor settings. As a result of the meetings and discussions, and the existing documentation on human capacity development in practice, a definition and framework were developed and core concepts and ways of working are being refined. The term was defined at the meeting in Barcelona in 2002 as follows: Human capacity development means developing the will, skills, capacities and systems for an effective response to HIV.

This case study describes The Salvation Army response to HIV in Zambia. It specifically examines a current partner, the Lusaka Change Programme, in order to portray the response in action, to assess its challenges and successes, and to depict the people and communities involved.




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