nicola-brennan

Irish Aid Responds

BY NICOLA BRENNAN

For Irish Aid, it was clearly evident that HIV and AIDS was having a huge impact on people's daily lives. There were many teachers, health workers and ordinary members of the community dying. People were phenomenally affected and very little was being done. This was the development challenge to which Irish Aid responded.

Irish Aid was among one of the first bilateral donor countries to develop an organisational strategy in response to this HIV and AIDS crisis. It was developed in 2000 as a direct response to the impact of HIV and AIDS on people in the areas where Irish Aid was working - particularly in Sub-Saharan Africa including Zambia. The strategy identified women and children as being disproportionately vulnerable to HIV and AIDS and also looked at the impact of the virus and its consequences on women and children in particular.

Women were identified as being more susceptible than men biologically but also culturally where in terms of sexual relations, women could not always demand protection, leaving them particularly vulnerable. Another area in which women were identified as being particularly vulnerable was in the burden of care. Women and particularly young girls take on the role as care-givers when someone becomes ill within the family.

Men, it is clear, are the decision makers in families and there is a lot of work to be done in working with both men and women to address unequal power relations especially in relation to sex. Irish Aid has a strong gender based approach in its work to reduce poverty and address the impact of the HIV and AIDS pandemic.

The prevention of further HIV infection is at the core of Irish Aid's approach which also addresses issues of treatment access and care for those living with HIV and AIDS. Prevention is still central to our work. There is no magic bullet when it comes to HIV prevention and Irish Aid looks to a range of strategies including Behaviour Change Communication.

Education and Prevention

Irish Aid invests a lot in education prevention campaigns and education for girls - in Zambia this is the largest component of the aid programme. Access to education for girls is vital and research has shown that education in itself is a preventative mechanism so it is critical that girls get access to education and the longer they stay in formal education the better - this is critical.

Irish Aid also supports direct HIV prevention education, working with teachers in terms of building their skills and capacity to teach about the virus etc. We also support peer education and youth groups as a method of educating young people about HIV and AIDS. In Zambia, Irish Aid has a particular focus on supporting community schools where education is accessed by the most vulnerable children, many of whom have been orphaned and whose vulnerability has increased as a result. Statistics would suggest that the majority of those orphaned are often as a result of HIV and AIDS. Irish Aid also supports schools through working with civil society organisations and government to reduce child abuse in schools and provides bursaries for very vulnerable children to ensure that they can go to school. In addition, we support country wide HIV campaign prevention campaigns, access to voluntary counselling and testing, and the prevention of HIV being transmitted from mother to child during and after birth.

Internationally

Irish Aid invests in long-term research and development with the objective of identifying a suitable HIV preventative vaccine. Some but slow progress is now being made in this area. The identification of such a vaccine could provide immediate protection against HIV infection. We need to continue this investment if we are going to have a long term impact on this pandemic. Irish Aid has also invested in the development of microbicides1 and was among the first bilateral donors to fund such which includes the public sector donors who provide the funding and the pharmaceutical industry who provide the science and research. There are different types of microbicides currently being tested in clinical trials with varying levels of progress. Trials are taking place in South Africa, West Africa, India etc. A fully effective result has not yet been discovered but when it is, the benefit to women will be great. It will mean they will be able to access microbicides as an individual and determine their use. Studies have shown that many women are excited because they will be able to take control themselves while others are less optimistic and a little concerned about the reaction by their male partners.

Nutrition and Care

Nutrition plays a key role in relation to HIV and AIDS. People who have adequate access to food can stave off infection initially and if HIV positive, can halt the spread of the disease to AIDS if their access to food is good and consistent. Irish Aid works to ensure that people infected and affected by HIV and AIDS have adequate and consistent access to a stable and nutritious diet. In the area of care, we work at a number of different levels.

As regards policy and advocacy, we support government to respond to the vulnerability of HIV and also provide advocacy support to civil society so that they can represent the voices and reality from community level in their dialogue with government and in influencing policy and programming. Irish Aid provides significant support to civil society organisations in their work on HIV and AIDS - both direct service delivery - particularly in relation to education on HIV, support to women's groups, support to children and people living with HIV and AIDS.

For example, in Northern Province in Zambia, there is a women's group outside Kasama who were given a small grant of about 10,000 euros. They developed a support group within the community and gave direct support and home based care kits to those affected by HIV and AIDS. They encouraged people to deal with opportunistic infections and supported people in terms of access voluntary counselling and testing and getting to the clinic. As a general strategy, Irish Aid supports civil society organisations to deliver services. Block grants are given to a number of community-based organisations.

Irish Aid also supports cash transfers given by the Zambian government to communities as a social protection measure in order to tackle vulnerability. While Zambia as an economy has being doing very well, the gap between rich and poor is ever increasing. Cash transfers and direct funding of food vouchers are for people who are extremely vulnerable. The child grants scheme covers children up to the age of 5 years old.

These transfers are provided in a number of districts - a small amount of money is given to the poorest people on a monthly basis. Among the criteria determining who receives the transfer is being chronically ill (TB, repetitive malaria, etc). Community groups come together and identify those most vulnerable in their community and they get cash in hand on a monthly basis. Irish Aid has contributed to this but we also monitor the programme to see what people do with the money they receive and how it affects their livelihoods such as building up household assets, seeding and planting, buying livestock, children in school, spending on local healthcare, etc. At the moment, the evidence is that this approach is producing considerable impact. Because HIV is a driver of vulnerability especially among the poor, anyone who is HIV infected has increased vulnerability. If they have resources then they have options. If they don't have resources, then their options are limited.

Throughout all of this work, the emphasis is on building the resilience of the people who are most vulnerable, especially women and children.

HIV Treatment

Irish Aid also does considerable work on access to HIV Treatment where the main approach has been to strengthen health systems overall. It is important that health workers are trained, laboratory services are functional and support services are in place for people to access HIV treatment. Irish Aid was one of the founding members of the Global Fund to fight AIDS, TB and Malaria in 2001/02 and I sat on the Board of the Fund for 6 years. Zambia is a key recipient of the Global Fund where they have been able to extend HIV treatment to all 72 districts and ensure that over 50% of people who need HIV treatment now get access to it.

Treatment is not just the delivery of drugs but also having systems in place, training health workers, providing laboratory support services, follow up, treatment education and support to people on treatment. Irish Aid also supports services relating to PMTCT.

Irish Aid has a specific focus on Northern Province in Zambia. Irish Aid supports four districts as well as the province itself where NGOs have over the years, been funded to provide a range of services as well as care and support in the community. In certain areas, Irish Aid has supported improved water and sanitation access. Through their work, Irish Aid has been monitoring the impact access to water has for care givers, vulnerable households as well as monitoring impact on water charges on female headed households.

Irish Aid has supported a home based care programme in Northern Province; originally we worked with a large number of NGOs and now we are working to ensure that the district council's strategic plans take into consideration the needs of people living with HIV and AIDS.

Work with National AIDS Council (NAC)

It is essential to develop and strengthen institutional structures in Zambia, building the government's capacity to deliver services to the people. In this regard, the National AIDS Council (NAC) is a critical body in the national response to HIV and AIDS and works across a wide range of sectors within government itself as well as in society more broadly. The Council is mandated to coordinate national HIV-related policy and strategy in Zambia and NAC also supports district level structures - Provincial AIDS Task Forces and District AIDS Task Forces to ensure planning at provincial and district level is taking HIV and AIDS adequately into account.

Research and analysis must be strong and accurate and this is a key determinant of HIV and AIDS approaches within the country, informing policy and planning. Irish Aid continues to engage directly with the Zambian Government in areas such as the Sixth National Development Plan (SNDP) to ensure that HIV was informing and shaping priorities.

Stigma

It is unacceptable that the disease is hidden as a result of stigma and discrimination. It is heartbreaking to think about what many people have gone through without being able to talk about being infected and the impact of the disease on them and their families. There is still too much silence around HIV and AIDS.

In 2006, Irish Aid launched a National HIV stigma campaign in Ireland. Known as Stamp Out Stigma the implementation of this campaign was linked into the overseas development programme to ensure that the reality of people's lives both in Ireland and in sub-Saharan Africa helped to inform and shape education about HIV and policy responses to HIV.

Irish Aid has a progressive HIV workplace policy; it supports its staff on prevention, treatment and care. We have regular discussions on HIV with staff in the workplace and we provide HIV treatment for staff and their dependents if they need it.

The legal dimension

Irish Aid is playing a role in trying to get a Gender Based Violence Bill in Zambia passed by Parliament and we support community and civil society organisations to assist in developing the Bill and in ensuring that it gets a hearing in Parliament. This is an important piece of legislation which is about protecting and empowering women.

1- Although there are many approaches to preventing sexually transmitted diseases in general and HIV in particular, current methods have not been sufficient to halt the spread of these diseases — particularly among women and people who live in less-developed nations. Sexual abstinence is not a realistic option for women who want to bear children or who are at risk of sexual violence. In such situations, use of microbicides could offer both primary protection in the absence of condoms and secondary protection if a condom breaks or slips off during intercourse. Microbicides may eventually prove to be safe and effective in reducing the risk of HIV transmission during sexual activity with an infected partner


Nicola Brennan is a Development Specialist currently working with Irish Aid in Zambia.