The Social Context of HIV in Africa AIDS and Religion, 17 March

1. The Social Context of HIV in Africa AIDS and Religion, 17 March

2. Programme • Introduction – also to DCA, Danish Church Aid • CHAZ - Introduction and HIV/AIDS strategic plan 2006-10 • Break • Patriarchal Sins - Japhet Ndlovu • Analysis of situation in 10 West/Central African countries

3. Questions for Ice breaker session Do you agree or disagree on the following statements: • 1. Sex education may encourage early sexual activity. • 2. Faith Based Organisation’s should promote condoms as a HIV preventive measure

4. DCA HIV/AIDS Focus areas • Advocacy for increased commitment to scale up the HIV and AIDS response • A rights based and gender equality perspective • Focus on multi dimensional prevention • Sexual and reproductive health and rights • Fighting stigma and discrimination

5. Overall objective of DCA’s HIV/AIDS policy • The poor, especially girls, young women, vulnerable children and PLWHA, can Access their rights to reduce their vulnerability to HIV and AIDS, and communities are empowered to alleviate the negative consequences of HIV and AIDS.

6. DCA’s HIV/AIDS policy • Human rights and gender equality • Focus on prevention • Changing the legal, social, cultural and economic conditions, that make sexual exploitation and violence possible • The faith-based partners and churches play a central role. • Focus on youth, OVCs and their rights

7. Why focus on youth? • They are the most exposed • They lack information and support • Greater chance of achieving behavior change and of changing sexual practice with younger people

8. CHAZ HIV/AIDS strategic plan 2006-10 • CHAZ is an association of health institutions belonging to any one of the founding church mother bodies and which are recognized as health providers by the Ministry of Health, Global Fund (GFATM) and major donors.

9. CHAZ HIV/AIDS strategic plan 2006-10 • CHAZ is presenting this strategic plan for the period 2006 -2010, to coincide with the National Development Plan 2006 – 2010, the Health Sector Strategic Plan 2006 – 2010 and the National HIV/AIDS Strategic Framework 2006-2010.

10. Background • HIV/AIDS IN ZAMBIA Zambia, with a population of over 10.3 million and an annual growth rate of 2.9 percent - is one of the Sub Saharan African countries worst affected by the HIV and AIDS pandemic. The Zambia demographic survey 2005-2006 reports an adult HIV prevalence of 16% in 2002 (23% in urban areas, 11% rural (ZDHS 2002). Zambia is experiencing a generalised epidemic.

11. Background • Women are overall 1.4 times more likely to be HIV-infected than men (18% for women and 13% for men). • Among young people, 15-24 year age group, the HIV prevalence is 7.7 %. The infection rate is 4 times higher in the young women than those for young men in the same age group. • 40% of infants born to HIV infected parents are HIV infected. • More than 50 per cent of the population is less than 20 years of age.

12. Background • The estimates for orphans in Zambia range from 600,000 to 1.6 million, 64% of orphans are paternal orphans, 22% maternal and 14% double.

13. Background • The political climate in Zambia is generally peaceful, stable and conducive for smooth delivery of services throughout the country. • In 2003, the Government launched the National Decentralisation Policy, which will be implemented over a period of 10 years, starting from 2003. • The Zambian economy registered positive real growth at an average rate of 4.6% per year for the last 8 years. Despite the improvement in GDP growth rate, it is still inadequate to have significant changes on the standard of living and health status of Zambians.

14. Orphans and vulnerable children HIV transmission to own children, early death No education, child labor, sexual abuse Increased risk of HIV/AIDS Background • High levels of poverty directly or indirectly promote behaviours which create vulnerability to HIV and AIDS. Vicious circle. • The average national literacy rate in 2001-02 was estimated at 65.1% (ZDHS 2001-02). In all the age groups, literacy levels for men were higher than for women.

15. CHAZ HIV/AIDS strategic plan 2006-10 • The National AIDS Council (NAC), established through an Act of Parliament in 2002, is a broad-based corporate body with government, private sector and civil society representation. The NAC is the Multi-Sectoral national response to HIV and AIDS

16. CHAZ HIV/AIDS strategic plan 2006-10 • Grant making: Zambia is now making considerable progress in strengthening its grant administration systems for CSOs, especially those in non-metropolitan areas. For example, the Church Health Association of Zambia (CHAZ) now have well-established systems for supporting grant-making to FBOs. CHAZ has been able to win finance from other donors for HIV/AIDS activities, most notably from the EU to scale up the model by starting it 5 new sites, and from the Global Fund.

17. CHAZ HIV/AIDS strategic plan 2006-10 • The CHAZ HIV/AIDS intervention The key feature is that, apart from the project leader, it is a volunteer based intervention. Both health personnel and community members volunteer for training and carrying out prevention and care activities. It is community-based, depending on early engagement of and leadership by community leaders.

18. CHAZ HIV/AIDS strategic plan 2006-10 CHAZ multisectoral approach: • Training and support by CHAZ secretariat to a local project officer at the CHAZ facility • Training and supervision of community leaders • Home based care for people with HIV/AIDS • HIV/AIDS prevention education, including drama groups, school teachers, and youth aids clubs, • Orphan assistance • Micro-credit schemes, to provide resources for volunteers • Supplies and materials

19. CHAZ HIV/AIDS strategic plan 2006-10 • I Intensifying Prevention • II Expanding Treatment, Care and Support • III Mitigating the Socio-economic impact • IV Strengthening the Decentralized Response and Mainstreaming HIV and AIDS • V. Improving the monitoring of the Response • VI. Integrating Advocacy and Coordination of the Multi-Sectoral Response

20. CHAZ HIV/AIDS strategic plan 2006-10 Regarding I, Outcome: 1People in the targeted sites have access to HIV/AIDS Education and Behavior Change information ABC approach: The life skills are a set of psychological competencies that empower young people to deal with the challenges in their life and helps young people to develop their self awareness. Life skills education aims to develop coping strategies, communication strategies, problem analysis and problem solving, interpersonal relationships.

21. CHAZ HIV/AIDS strategic plan 2006-10 • Regarding II – PLWHA – and Outcome 2: PLWHA have access to treatment including ART • The Zambian Government has made a conscient decision to make Anti Retroviral Therapy (ART) available to all its citizens requiring this service. By the end of 2006, 100,000 people were accessing ART through the Church supported institutions.

22. CHAZ HIV/AIDS strategic plan 2006-10 Thematic area V: PromoteHuman Rights ,Gender and Advocacy For instance: • Prevent non-discrimination and equality through assistance to all, independent of race, sex, religion, etc. • Encourage participatory decision-making whereby all stakeholders must have a say in activities performed in their interest and must increasingly direct decision making themselves.

23. Break

24. Patriarchal Sins • Theological and practical reflections on sexuality, gender and HIV/AIDS – by Japhet Ndlovu • The churches in Zambia are the guardians of patriarchal power and other unequal relationships. As long as men and women are defined as unequal, the control of HIV/AIDS will prove to be a challenge. • Sexual behaviour in Zambia, including inside marriage, is very much influenced by the social-cultural-religious norms.

25. Patriarchal Sins • “The belief that having sex with a virgin girl can cure HIV positive men has also increased the vulnerability of young girls and increased cases of incest. “ • “These practices amplify the risks of contracting HIV by both women and men but place women in a much more complicated position and renders them more vulnerable to HIV because they are not able to control their own bodies.”

26. Patriarchal Sins • “The insistence of preachers in most churches that women should submit to men is completely out of context and erroneous.” • “Not only does such interpretation enhance the power of husbands over their wives in all spheres of life including sexual relations, but it also demeans the position of all women in the country, relegates them to subordinate positions and renders them powerless in taking control of their sexuality. “

27. Patriarchal Sins • “Need to positively influence men as the chief and powerful decision-makers in the family, especially in the patriarchal Zambian society.” • “Men usually make decisions with whom, where and how to have sex. Men tend to have more sexual partners than women and men often do not use condoms consistently. Why do men behave that way? Mostly because society tells them that is how they should behave. “ • Such attitudes were reinforced by traditional polygamy, where a man could have more than one wife.

28. Gender inequalities drive the AIDS pandemic • Increased feminisation of the HIV and AIDS pandemic • Globally 50% male and 50% female HIV+. • In Sub-Saharan Africa the ratio is 26% male to 74 % female among the young girls (15-24 years). • Women are more vulnerable because of biology, discriminatory practices and lack of basic sexual and reproductive health rights.

29. Churches and FBO’s must connect gender equality and HIV prevention • For FBO’s to participate and contribute to the prevention of HIV, the issue of gender justice must be taken seriously • To reflect the God given value of each human being, churches must work for an equal and respectful relationship between men and women.

30. Women’s social, political and economical empowerment • Empower women, in particular young girls, to be more assertive in determining their own gender roles and claiming their sexual and reproductive rights • Protect children, young people and women against sexual abuse and harmful cultural practices • Empower young girls and women economically • Increase women's decision making power

31. Involvement of men • Men’s sexual behaviour is influenced by prevalent gender norms and men often have to appear to be in control to maintain their status. • Involving men as partners in social change, can contribute to challenge gender stereotypes that disempower women and keep both men and women in fixed roles. • Important to encourage men to behave in ways to reduce their own risk of HIV transmission – and to promote men as fellow leaders in finding solutions

32. Challenging patriarchal structures There is a call for leadership in faith based organisations to: • Challenge the social norms and values that give an inferior status to women. • Promote equal power relations between men and women • Clearly speak out against gender-based violence and gender discrimination

33. Life skills education and Condom promotion are keys to prevention • Life skills education to facilitate non risk taking sexual behaviour is essential part of prevention • Condom promotion is still viewed as controversial by many FBO’s. • A constructive evidence based dialogue on all preventive methods including condom use with FBO’s is essential

35. Group work questions • 1. What do you think are the challenges for faith-based organisations and churches in addressing gender stereotypes in HIV prevention? • 2. How can churches and other faith-based organisations promote equal rights for men and women? • 3. How do gender norms contribute to increased risk for HIV infection? • 4. Behaviour change is said to be the most difficult part of HIV/AIDS efforts. Why do you think this is?

36. WCC Analysis – 10 countries • Study of experiences gained by churches in Benin, Burkina Faso, Ghana, Guinea, Ivory Coast, Liberia, Mali, Nigeria, Senegal and Togo • World Council of Churches an ecumenical organisation • Religious leaders interviewed: Catholic, Methodist, Baptist, Anglica, Presbyterian, Lutheran, Adventist – among others • Church responses criticized – and here we have idea of organisational insight of strengths and weaknesses – also of historic interest

37. WCC Analysis – 10 countries • General lack of a formal framework of collaboration between the National Programmes to Combat AIDS – problematic • Reason – not everywhere seen as key agents to combat AIDS – even though recognized as important

38. WCC Analysis – 10 countries • The churches position converge when it comes to means of prevention – especially Catholics, Adventists and Muslims in the name of religious morality. • ARVs beyond the financial means of churches – yes, but no longer so. • The church and ecumenical leaders are grasping the problem of being connected to poverty but the relation of human rights had not been given any thought. • Catholic leaders in the field may sometimes be flexible regarding the use of condoms. • Volontary testing before marriage –not main concern of churches. Today taken up – Ethiopia is a case.

39. WCC Analysis – 10 countries • Churches must be able to enter into permanent dialogue with the governments and where necessary, take part in negotiations with the international financial institutions. (CHAZ organisation in Zambia is a good example of a FBO being able to do so)

40. THANK YOU!