Ingvild Singsaas

ESST - Maastricht University - MaESST - Maastricht University - March 2004rch 2004

WhatWhat kinds of technologies does a kinds of technologies does a development agency/organisation development agency/organisation

apply under specific social conditions apply under specific social conditions to prevent and treat HIV/AIDS? to prevent and treat HIV/AIDS?


One has to create a context for One has to create a context for the technology to workthe technology to work

Health education

Antiretroviral treatment

condoms


Prevention, treatment and care Prevention, treatment and care of HIV infected people includes of HIV infected people includes interventions such asinterventions such as

BiomedicalBiomedical NutritionalNutritional PsychosocialPsychosocial BehaviouralBehavioural


All interventions (technologies) must All interventions (technologies) must be guided by local socio-economic be guided by local socio-economic

conditions and epidemiological conditions and epidemiological conditionsconditions

One technology may One technology may be successful in one be successful in one particular setting…..particular setting…..

…….and a failure in .and a failure in anotheranother


Social conditionsSocial conditions

PovertyPoverty Political situation Political situation Culture as a barrier or a resource for Culture as a barrier or a resource for

HIV/AIDS prevention and treatmentHIV/AIDS prevention and treatment Individual behaviour Individual behaviour Increased knowledge on HIV/AIDS does Increased knowledge on HIV/AIDS does

not reduce high risk behaviournot reduce high risk behaviour


Which technologies?Which technologies?

Condom distributionCondom distribution Test centresTest centres Treatment of opportunistic diseasesTreatment of opportunistic diseases Diagnosis and treatment of STDDiagnosis and treatment of STD Antiretroviral treatmentAntiretroviral treatment Distribution of clean needles and syringesDistribution of clean needles and syringes Mass media campaignsMass media campaigns Blood safetyBlood safety


Additionally…Additionally…

Development of national programs Development of national programs Health education and counselling Health education and counselling Social welfareSocial welfare Poverty alliviationPoverty alliviation Reduce the impact of sexual ineqalityReduce the impact of sexual ineqality Stigmatization of PLWHA Stigmatization of PLWHA


Important!!!Important!!!

Investigate where new infections are Investigate where new infections are occurring!!!occurring!!!


Patterns of transmission of HIV varies Patterns of transmission of HIV varies between countries and within between countries and within

countriescountries Commercial sex Commercial sex

workersworkers Homosexual Homosexual

relationshipsrelationships Heterosexual Heterosexual

relationshipsrelationships Injecting drug usersInjecting drug users Blood transfersBlood transfers Mother-to-child Mother-to-child

transmissionstransmissions

Which development Which development agency/organisation? agency/organisation?

1. Norwegian Church Aid1. Norwegian Church Aid 2. Haydom Lutheran Hospital, 2. Haydom Lutheran Hospital,

TanzaniaTanzania


Norwegian Church AidNorwegian Church Aid

Experience with HIV/AIDS since the late Experience with HIV/AIDS since the late 1980s1980s

NCAs policy:NCAs policy: The poor will be the main focusThe poor will be the main focus Gender sensitivityGender sensitivity Activities must reflect the cultural situationActivities must reflect the cultural situation Promote human rightsPromote human rights


What will NCA do?What will NCA do?

Testing for HIVTesting for HIV Education and information in relation Education and information in relation

to sexuality (incl. condom promotion)to sexuality (incl. condom promotion) Access to medicines and treatmentAccess to medicines and treatment Advocacy and lobbying for the rights Advocacy and lobbying for the rights

of HIV infected peopleof HIV infected people


Haydom Lutheran Hospital, Haydom Lutheran Hospital, TanzaniaTanzania


Haydom Lutheran Hospital, Haydom Lutheran Hospital, TanzaniaTanzania

Risk, Vulnerability, ImpactRisk, Vulnerability, Impact

HIV/AIDS policyHIV/AIDS policy Increase awarenessIncrease awareness Reduce transmissionReduce transmission Reduce the impact of the diseaseReduce the impact of the disease

The program is supported by NORAD with The program is supported by NORAD with 13 millions NOK.13 millions NOK.


How?How?

The target groups will have a deciding role in the The target groups will have a deciding role in the implementation of the strategies implementation of the strategies

The official Tanzanian policy ABC (Abstinence, Be faithful, The official Tanzanian policy ABC (Abstinence, Be faithful, Condom) in a culturally adapted contextCondom) in a culturally adapted context

Traditional culture vs modern cultureTraditional culture vs modern culture Treatment of diseasesTreatment of diseases Social welfare and poverty alliviationSocial welfare and poverty alliviation A pilot project with antiretroviral treatment for pregnant A pilot project with antiretroviral treatment for pregnant

womenwomen CampaignsCampaigns Counselling activitiesCounselling activities Multisectoral cooperationMultisectoral cooperation


ESST - Maastricht University - March 2004

CONDOMCONDOM

►Condom use is often associated with Condom use is often associated with higher educationhigher education


The increasing distribution/use The increasing distribution/use of condoms will have little of condoms will have little

impact on the transmission of impact on the transmission of HIV, if condoms are not used in HIV, if condoms are not used in sexual high risk partnershipssexual high risk partnerships


Lower the costs of condom Lower the costs of condom useuse

►Costs are not only the price of a Costs are not only the price of a condom but alsocondom but also

►The humiliation of obtaining oneThe humiliation of obtaining one►The humiliation of using oneThe humiliation of using one►The experience of reduced sexual The experience of reduced sexual

pleasurepleasure


ABCABC

AbstinenceAbstinence Be faithfulBe faithful CondomCondom

Does it work in all cultural contexts?Does it work in all cultural contexts?


Haydom Lutheran Hospital in Haydom Lutheran Hospital in Tanzania applies ABC in its HIV/AIDS Tanzania applies ABC in its HIV/AIDS policypolicy

Field work from 4 ethnic groups in Field work from 4 ethnic groups in Botswana shows a cultural resistance Botswana shows a cultural resistance towards the use of condom (and towards the use of condom (and hand gloves when caring for the hand gloves when caring for the sick). sick).

Many groups regard and Many groups regard and

respect their culture highly, respect their culture highly,

and expect the solution of and expect the solution of HIV/AIDS to come from within HIV/AIDS to come from within

the culturethe culture


MethodMethod

interviews

analysis

Literatureresearch


Time tableTime table

End of March – interview appointmentsEnd of March – interview appointments April – do research and prepare thesis April – do research and prepare thesis

outlineoutline May – do research, prepaire for May – do research, prepaire for

interviews, do and analyse interviews interviews, do and analyse interviews June – interviews and writingJune – interviews and writing July etc. writingJuly etc. writing

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Ingvild Singsaas

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