31 May 2005

Bonn, Germany: Attending funerals was not in Tsholofelo Barei’s job description when she signed on as a United Nations Volunteer (UNV) in November 2004. Yet the 28-year-old Botswanan has developed an unconventional approach to grab people’s attention on HIV/AIDS. To educate youth, she uses every opportunity presented, and the untimely death of a village teenager by AIDS provided no better time than to discuss the reality of AIDS in her country.

To many people unfamiliar with AIDS in the southern Africa context, Tsholofelo’s actions may be considered absurd, but in Botswana, with a 37 percent adult infection rate and a life expectancy hovering at 40, extreme measures are necessary.

In fact, the combined number of people living with HIV/AIDS in southern Africa – Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – account for more than 30 percent of the 40 million people living with HIV/AIDS worldwide, according to statistics released at the end of 2004 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) . Representing only two percent of the world’s population, the region has the world’s highest levels of HIV infection.

In real terms, AIDS deaths affect key sectors such as agriculture, education, and health. The unprecedented loss of skilled and productive men and women from the workforce has placed an enormous strain on the southern Africa countries already facing development challenges before the epidemic peaked.

This dire situation led the United Nations Development Programme (UNDP) to launch the Southern Africa Capacity Initiative (SACI) in March 2004 to support the governments of the nine countries in developing innovative approaches to stop the erosion of human resources and strengthen HIV/AIDS awareness initiatives and support mechanisms.

Included in this response are 132 United Nations Volunteers who provide skills and expertise in a broad range of fields such as medical, planning, policy and technical support. Placed within ministries, specialized agencies and nongovernmental organizations, they are developing leadership capacity and skills, accelerating skills training in key sectors, and empowering institutions to continue functioning and delivering services. They are also strengthening volunteer capacity in communities where external assistance for carrying out HIV/AIDS education and support to those affected and infected is limited.

Strengthening communities
As a community capacity facilitator, Tsholofelo Barei conducts outreach activities in six communities in Botswana’s North East District. The district itself, with a population of 50,000, has one of the highest prevalence rates in all of Botswana – 40 percent according to 2002 estimates. “It is hard not to find someone affected by AIDS, so people here are very receptive and ready for change, and that’s where I come in,” says Tsholofelo.

Since her arrival late last year, she has worked hard on creating an open and comfortable relationship with the communities. During one of her first village meetings in January, residents of Tati-Siding voiced concern over the confidentially of HIV testing at the local clinic. “They don’t want to get tested because they fear their status will be revealed,” says Tsholofelo. “HIV is still very much stigmatized here.”

One recommendation by the group was to have a mobile HIV counselling and testing centre, or Tebelopele, a Setswana word meaning, “Look into the future,” come to the village once a month. With results available instantaneously, they agreed it would encourage people to get tested. With the guidance and support of her supervisor, the District AIDS Coordinator, Tsholofelo met with regional organizations to get Tati-Siding on the mobile testing unit’s route.

Much of Tsholofelo’s energy is spent on youth. She says the district’s teenagers are at high risk of contracting HIV due to idleness. “The youth have nothing to do in the villages, so they go to the local bar, drink, and a lot of the girls hang out near the truck stops. We all know what happens next,” she says.

Teaming up with Tati-Siding’s village chief, Tsholofelo brought together a group of concerned citizens to write a letter requesting the police commander to close the bars that stay open beyond two a.m. Realizing this is a stopgap measure, she meets with youth informally, on their turf, to get their views on what is needed to provide a long-term solution.

“Whenever meetings or workshops are held on AIDS in the villages, the youth don’t show up – they have no interest in hearing an adult talk down to them. My approach is to go where they go, like at the football field,” she says. “As a young person I can talk and they listen. I tell them, ‘Look, I’m part of your village and we are going to fight this together.”

Her relaxed style and persistence has paid off. A number of teenagers in several villages have volunteered to act as community facilitators to speak on HIV/AIDS awareness in their own communities and to encourage other youths to do the same. She supports their engagement through trainings on presentation skills and HIV/AIDS education exercises.

Enhancing structures
Working under the Swaziland Ministry of Health and Social Welfare, Gambian UNV Fatou Ceesay Jallow is sharing her expertise as a human resources specialist to address the many challenges facing this African kingdom of one million people.

With one of the highest HIV infection rates in the world – 38.8 percent – Swaziland’s health care system is struggling to cope. While the epidemic is not visible on the streets of the capital of Mbabane, Fatou says, one step into the Mbababe Government Hospital and it is evident that something is wrong. “The hospital’s outpatients clinic is so overcrowded. I’ve never seen anything like it before. People come a day earlier just to get a registration number,” she says. “The same goes for the [HIV/AIDS] counselling centre and especially the female ward.”

After months of intensive research and one-on-one interviews with staff, from department heads to frontline workers, she unearthed several problems. She says the main complaints were poor internal communications, low staff morale, stress, unclear reporting lines, lack of training opportunities, and a slow recruitment process. “Hospital workers are following guidelines that were suitable some ten years ago. The job description for nurses, for instance, is based on their role in the mid-1980s,” she adds. “A lot of the qualified nurses and doctors are also leaving the country to find work elsewhere because of the stress and absence of training opportunities – brain drain is a major concern.”

With this information, Fatou drafted proposals for the ministry’s administration to improve its human resources set-up. She revised its organization chart, created a staff list, established weekly inter-unit meetings, and provided support to a committee developing a human resources policy for the entire ministry. “Once the policy is finalized, the strategic plan will follow. We anticipate this will address some of the challenges… through training, recruitment of staff and volunteers, and implementation of policy guidelines,” she says.

Outside of the ministry, Fatou helped the government hospital revise the job description of its nurses to ensure they receive training that reflects their current working environment. “The nurses need to know how to counsel patients infected with HIV, they need education on ARV (anti-retroviral) medicines and health and safety on the job,” she says. “Overall, we need to know what is redundant and where improvements are urgently needed.”

Now that the job description proposal is finished, she hopes the public service ministry will approve the review and start implementing the necessary changes in the coming months. For the nurses, she says, this will increase their performance and ability to respond to the country’s health crisis.

Growing stronger
In Zambia’s Southern Province district of Kafue, a group of people living with HIV and AIDS has not let the disease take over their lives. Instead, they formed an association, the Pride Community Health Club, to fight stigma, support each other, and, in turn, live positively.

Set in motion in January 2004, the club has 35 members active in income generation activities and skills training to provide economic independence and self-empowerment. Standing behind the group is Zambian UNV Emmanuel Chama. As part of SACI’s support to the government’s District AIDS Task Force, he was requested to assist the group in April 2004 to enhance the members’ skills and the club’s overall operations.

Now one year on, Emmanuel’s advice and support is expanding the club’s presence within the district. Successful funding proposals he helped prepare enabled four members to receive certified training as counsellors, who now extend their reach to other individuals and associations in the district. The training Emmanuel conducted in home-based care is also having a positive impact on the lives of the members, their immediate families and others affected by the epidemic.

An equally successful venture of the club is its activities in income-generation, making it possible for members to earn a living and flow funds back to the club. “The members are making uniforms for the schools and tie-dye garments for sale at the market,” says Emmanuel. “They’re also rearing chickens and keeping a vegetable garden to supplement their own nutritional needs.”

Emmanuel says it is vital for the club to sustain its own operations, as many of the members have lost their jobs and do not have a formal education and other resources to fall back on. “The training of the members in technical skills has not only improved their health status, but it has also gone a long way in helping them stand up against the stigma associated with people living with HIV/AIDS – they’re role models for the entire district,” he says.

As for HIV/AIDS outreach in the district, the club hosts monthly seminars inviting on average some 100 people to discuss such issues as positive living, the Prevention of Mother-to-Child HIV Transmission (PMTCT), good nutrition practices for people living with HIV/AIDS, and ways to avoid life-threatening infections.

To ensure a much broader audience is kept on top of the club’s initiatives, one member attends the monthly District AIDS Task Force meetings to update others on the club’s progress, challenges and successes. Emmanuel says this participation ensures people living with HIV/AIDS are involved in all aspects of prevention programming.

The club’s next steps, he says, include having its own HIV testing centre on the premises, scaling up its income activities, and encouraging the formation of similar clubs in other communities throughout Zambia. “What the group is trying to get across is that HIV and AIDS isn’t the end of the world and that with support and guidance it is possible to continue contributing to the development of the country.”

Contributions by: Akua Dua Agyeman, SACI UNV Programme Manager, Shipra Bose, UNV Programme Officer - Zambia, Agnes Phiri, SACI Communications Advisor, and Andreas Sieren, UNV Programme Officer - Botswana.