|HIV, AIDS and Advocacy|
Bulletin of Medicus Mundi Switzerland No. 125, September 2012
Advocacy for the change of practices, customs and traditions
Bringing about change in the policies and practices in Tanzania
The Geita District in Northwestern Tanzania is one of the areas with the highest prevalence of HIV and AIDS. This influenced NELICO to take action in HIV, AIDS and advocacy, using a wide range of strategies in order to respond to the priority needs of orphans and most vulnerable resulting from the AIDS pandemic.
By Paulina Alex *
NELICO started its operations in Geita District in March 2004 as a small non-governmental organization focusing on support to orphans and most vulnerable children. Starting of the organization was motivated with the desire to address the issues of HIV/AIDS and orphans in the District.
The government appeal for support from NGOs followed the official announcement by the Tanzania Government that Geita is the leading District for HIV Transmission in the Lake Victoria Regions of Tanzania and that the impact of HIV and AIDS has serious detrimental effects on the lives of women and children in Geita District.
Following this announcement and the diverse effects of HIV and AIDS on the lives of children in Geita District, in 2004, four committed women, specialized in sociology came up together with a motto of “Live to serve” and agreed to start the organization in the name of NELICO. Since inception to date NELICO is implementing programmes related to: Psychosocial support, legal aid and “Voices of youth” as part of its strategies in HIV, AIDS and advocacy.
As an active participating stakeholder in HIV/AIDS, NELICO works to mitigate the impact on an increasing number of orphans and most vulnerable children that are a consequence of the AIDS epidemic and on people living with HIV, preferably youth groups. In order to help marginalized women and children and fill in the gap left by the government NELICO engages in HIV/AIDS advocacy to reduce the spread of HIV/AIDS, utilizing a wide spectrum of strategies.
Community awareness creation
NELICO engages the community to understand the preventive measures and get rid of practices, customs and traditions that speed up HIV/AIDS spread. The awareness creation is done through structured and unstructured community meetings where NELICO social workers knowledgeable on issues of HIV/AIDS discuss and share preventive measures that the community members have to take to reduce new HIV infections. This involves the issues of eliminating practices, customs and traditions that promulgate to the spread of HIV.
The practices that expose community members especially youth to new HIV infections are traced from both small and scale mining and in fishing places. The common features found in mining places and which can lead to new infections are excessive use of alcohol leading to unsafe sex. Many sex commercial workers do their business in mining places in consideration of substantial amount of money from the miners. The miners have a thinking of sex and alcohol as their primary leisure. The worse thing is a tendency of some miners, most of them young, bidding to take a lady for a date. They often ignore the use of condoms with the impression of fully utilization of money paid to the lady.
Similar features characterize fishing places. However, one notable difference in fishing places especially in islands is that the fishermen consider every woman belongs to every man in the island. The situation rarely accommodates the woman in terms of marital status - that is wife and husband or one to one relationship. So both men and women have multiple sexual relationships in such places which multiply the possibilities of acquiring new HIV infections.
NELICO organizes awareness creation meetings, dialogues and campaigns and discusses with community members and other stakeholders like local community leaders and police force on how to get rid of such practices. The efforts are fruitful for local leaders and police forces do ban sex commercial workers in such areas. However, the challenge remains in the islands where the fishermen consider themselves as people with no government and rarely government initiative is observed.
In addition, NELICO has established HIV/AIDS youth clubs. The clubs involve young people, both male and female. The main goal of these clubs is to discuss preventive measures against HIV and AIDS. There is a tendency of adult male to get young girls as their sexual partners. And so many young girls have fallen prey to adults. Therefore, these groups in and out of schools give an opportunity to young people to decide their fate by suggesting solutions for themselves to prevent new infections.
The clubs hold individual and joint meetings in discussing these matters. In the beginning of this year (2012), NELICO conducted a joint dialogue involving youth on the effects of premarital sex of which the spread of new HIV infections is one of them.
Psychosocial support of People Living with HIV/AIDS
Psychosocial support is an integral programme undertaken by NELICO for years now and has been used by NELICO in HIV/AIDS and advocacy in three parts. One is conducting trainings on memory book to people living with HIV (PLWH). The aim of the memory book trainings is to equip people living with HIV with the fundamental knowledge of preparing memory books on their life histories. This is a kind of therapy which enables people living with HIV even to disclose their status and to tell openly how they were infected. This is for their own benefit as well as for the benefit of their children and the community members at large. On this issue, NELICO was able to work closely with people living with HIV who formed a Vumilia Group.
The second part is psychological counseling of PLWH. A considerable number of people who are HIV positive approach the organization for support while not revealing their status. Psychological counselling has been provided so as to assist them to accept their situation, to consult a medical doctor for diagnosis and to start medication if possible. There many scenarios encountered, it suffices to note one:
A woman approached NELICO seeking support. She had two babies, one was two years old and the other almost eight months. However, before she could tell what kind of support she wanted, she was lamenting and feeling uncomfortable to the extent of saying that she wanted to commit suicide.
After a long discussion, the woman revealed that her husband died of AIDS a year before and she was unable to provide for the family. When she was asked to tell what she really wanted instead of committing suicide, she requested transport fare to visit a healing doctor, Pastor Amibilike Mwasapile who was thought to cure AIDS in Loliondo, near Arusha.
Having said so, she was asked first of all to visit the Geita District hospital before going to that healing doctor. This made her say openly that she was taking ARV but stopped. As a result of counseling, she agreed to go back to medication at the Geita District Hospital, HIV and AIDS Department.
Hence, NELICO has been working with people who do not want to disclose their status and do not want to start medication either for ignorance or shyness. The positive results that have been achieved to date is the involvement of some Vumilia group members to work with NELICO as community counselors.
The third part is the provision of a start capital to PLWH to establish income
generating activities. A main challenge is that PLWH have an insufficient balanced
diet in support of the ARVs they take. It is the policy of the country that
ARVs are freely provided to PLWH but the issue of food remains to be an individual
Noting this gap, NELICO provides income to these people to start business. One good example is the support given to a Vumilia group to start a business of crushing gold ores.
Solution focused approach
This is a tool used to facilitate solutions to different problems that youth are faced within the society. One of the areas that solution focused approach is applied is HIV/AIDS Advocacy. The solution focused approach brings youth together and supports them to find solutions for themselves, how to deal with a HIV infection and how to handle their status. It appears that youth do not want to take the test and know their status. This is to the detriment of their health. Hence the solution focused approach gives them a chance to suggest solutions themselves towards stabling or keeping their health.
However, those who test and happen to be HIV positive often travel away from their locality for medication just to hide their status. The solution focused approach has been used to discuss these issues and concerns.
Lobbying government and politicians
NELICO takes part in the development issues of Geita Region and participates in many development meetings, workshops and seminars organized at the district and regional level. Such meetings are attended by politicians ranging from District commissioner, Councilors and Parliamentarians who have a say in law making processes. Having this platform, NELICO shares its experiences and contribute to the change of some of the practices and policies that involve HIV/AIDS.
One of the issues that NELICO has contributed and demanded the government to change is the employment of girl children as barmaids. The girl children working as barmaids fall prey to customers who sexually exploit them. These children are unable to bargain safe sex. Another area that NELICO is advocating is the elimination of employment of girl children in small scale mining activities. These places expose girl children to be used sexually by the miners. If left undone, these situation leads to new HIV infections.
With these efforts, the local government authority was able to pass a law banning young girls to work and unreasonably live in mining places. This is the response to the Child Development Policy of 2008, the Law of the Child Act No. 21 of 2009, National HIV/AIDS Policy of 2007 and the HIV/AIDS (Prevention and Control) Act of 2008. NELICO is armed with these policies and pieces of legislation in advocating for change with government and politicians in order to avoid new HIV/AIDS infections.
Provision of legal aid
Through its legal aid department, NELICO has been providing legal aid to people living with HIV/AIDS and other community members. The provision of legal aid involves awareness creation on legal literacy with particular focus to the Child Development Policy of 2008, the Law of the Child Act No. 21 of 2009, the National HIV/AIDS Policy of 2007 and the HIV/AIDS (Prevention and Control) Act of 2008.
People living with HIV/AIDS are sensitized to know their rights and obligations under the National HIV/AIDS Policy of 2007 and the HIV/AIDS (Prevention and Control) Act of 2008. Both the policy and the law require that PLWH should not be discriminated and stigmatized. And under the Employment and Labour Relations Act of 2004, PLWH have equal employment opportunities regardless of their status. Therefore, when they feel that such rights are violated they have to demand and get redress.
However, the PLWH are also obliged by the policy and the law to make sure they value their health and avoid deliberate transmission of HIV to other community members.
Advocating the implementation of this policy and law comes from the fact that some employers do not offer job opportunities to people living with HIV due to their status. Meanwhile there are PLWH who are alleged to deliberate transmit HIV to other community members with the view have a long queue of people infected. This seems to be a matter of retribution. Retribution in the sense that some of the married women and men who exercise fidelity in the matrimonial relationship but at the end of the day they find themselves infected, knowing that they are not the source. This creates hatred which sometimes leads to engaging heavily in unsafe extra marital relationships. In this situation, NELICO engages in awareness campaigns as noted before to alert the PLWH on the effects of having unsafe sex with another person while knowing that are their infected.
Another issue is that female spouses are thrown out of their family house for reason that they are HIV positive. The chase involves infringement of the spouse’s property rights. Under these circumstances NELICO works to reconcile the situation so as to make the spouse not discriminated because of her status. When reconciliation and mediation fail, NELICO helps the client with court procedures that will assist in getting her rights.
Consultative meetings with key stakeholders
In making sure it fully involves in HIV/AIDS advocacy, NELICO participates in and conducts consultative meetings with key stakeholders such as the government, non-governmental organizations, community based organization, faith based organization, local leaders, activists, politicians, community members and elders.
The consultative meetings are organized by NELICO and others scheduled by ward development committees and district council. NELICO uses these meetings to share with these stakeholders issues pertaining to HIV/AIDS in the region. Thus they are responding to the government policy that in every meeting regardless of the planned agenda the issue of HIV/AIDS should be considered.
Engagement of Media
NELICO engages media (radio and TV series) in awareness raising campaigns. The use of media is a reason that many people will get the information, including policy makers and law enforcers. NELICO has severally used the media in HIV/AIDS advocacy. One is the incidence of Kibaha Primary school of Coastal Region which labeled pupils who were infected by HIV by putting a red badge on their school shirts so as to make the rest of the students and teachers to identify them.
Considering that stigmatization and discrimination is against the national policies and laws, NELICO declared its position by condemning such situation which was alleged to be endorsed by some of the community members to media people. The story was covered by different newspapers.
Improvement of monitoring and evaluation practices
Since 2005 the NELICO has been implementing HIV/AIDS activities with different tools, techniques and approaches, including peer education and social agents at community level. The different stakeholders were not using the national adopted tool for monitoring and evaluation that was coordinated by the government and as being developed by the stakeholders and Tanzania Commission of Aids (TCAIDS).
The new tool which is in place and functional now is the Tanzania Output Monitoring and System for non–medical HIV and AIDS Interventions (TOMSHA). The tool is well detailed and clear to monitor HIV/AIDS interventions in the field. NELICO was engaged in the final stage of introduction of TOMSHA to the stakeholders. The tool was introduced to stakeholders in a workshop conducted in Mwanza for the Lake Zone Regions. NELICO was one of the stakeholders participating.
Before such a tool was developed it was quite difficulty to capture the clear and reality outputs being achieved. NELICO has been appointed by TACAIDS as a national stakeholder to use the tool and train new organization. The appointment of NELICO was preceded by training NELICO staffs on this tool by TACAIDS. In addition, NELICO’s appointment to report on issues of HIV/AIDS to TACAIDS was not a coincidence since NELICO has long experience and good track in managing HIV/AIDS projects and working with orphans and vulnerable children (OVC) and PLWH. Therefore, the tangible results that have been achieved by NELICO in implementing HIV/AIDS project activities are among the sources of its asset in networking and working with the government in Geita region and nation as well.
With the limited resources that NELICO has, it has managed to advocate for change in practices, customs, traditions as well as policies that impair the rights and obligations of PLWH. NELICO’s advocacy strategies are formulated to respond to the priority needs of orphans and most vulnerable resulting from HIV/AIDS pandemic.
However, the challenges that need much more effort to eliminate include stigma and discrimination, which still exists in rural and hard to reach areas due to inadequate awareness on HIV/AIDS and social and cultural barriers that promote unsafe sex.
*Paulina Alex is a sociologist (BA in Sociology) with more than eight years working experience in the area of HIV/AIDS and Advocacy in Tanzania. She is currently working with New Light Children Center Organization (NELICO) as an Executive Director. NELICO is a partner of terre des hommes Schweiz, partner of aidsfocus.ch, http://nelicotz.org. Contact: email@example.com