This paper is a contribution to the debate on preventative education concerning HIV/AIDS. It relates to a programme in eastern Sudan, an area with a largely Muslim population and a wide variety of ethnicities and cultural practices.
The HIV/AIDS epidemic has now reached proportions almost unimaginable twenty years ago. It has killed over 20 million people in the past two decades and destroyed the lives of countless more. Some 40 million people are currently infected worldwide.
The current impact on Sudan of the epidemic is unclear. Figures exist, but they all come with significant caveats. More work has been done in parts of the south, which because of their proximity to countries with high infection rates, are assumed to be more vulnerable. However, in eastern Sudan little was known when Ockenden’s programme was in its development stages.
Ockenden International, with support from the UK government’s Department for International Development, has designed an innovative response to HIV/AIDS education in eastern Sudan. Although the programme is under one year old, we believe there are lessons to be shared at this stage.
The context is challenging. The region is multi ethnic, with displaced Sudanese, mainly from the west and the south, as well as refugees from Ethiopia and Eritrea. This impacts upon an already diverse cultural context in which there is a mixture of Muslims and Christians. Seasonal migration also means high numbers of people pass through both States. Additionally, poverty is severe in many parts of eastern Sudan. The World Food Programme has recently reported that malnutrition is worse in parts of the region than in Darfur.
High levels of mobility are a characteristic of this region, particularly in and around Kassala and Port Sudan, the capitals of Kassala and Red Sea States respectively. Positioned on main roads leading to Khartoum, they receive high volumes of traffic, particularly long-distance trucks, whose drivers are frequent visitors to sex workers and brothels along their routes. In such towns, the local population mingles freely with visitors. There are also high concentrations of what are internationally known as high-risk groups : military personnel ; sex workers ; street children ; nomadic, and other poor and vulnerable groups.
However, given that the further spread of HIV/AIDS is likely, and that current levels of infection are relatively low, preventative action could have a significant impact. There have been calls for this in the region as a whole from both UNAIDS and the World Bank, as well as other agencies.
Ockenden and its local partners began a large multi-sectoral project to fight HIV/AIDS in the eastern part of Sudan in early 2004. Focused on preventing the further increase of the disease in both Red Sea and Kassala States it has four main purposes :
1. To increase awareness and knowledge of HIV/AIDS
2. To build the institutional capacity of local and national organisations to fight the disease
3. To address the socio-economic factors that contribute to the spread of HIV/AIDS
4. To facilitate HIV/AIDS related research, knowledge management, training and policy development at national and State level.
The overall goal is to create a response to HIV/AIDS education that involves entire communities in an active learning experience and that enables preventative action. Instead of supplying information to beneficiaries in a one-way process, we are seeking to encourage a long-term interactive process of learning and awareness raising. We are focusing on creating an environment that will empower and encourage communities and individuals to fight the disease themselves and that will have a positive effect on other organisations and individuals.
Part of the goal is to create a network of actors and organisations fighting the disease that will link into those of the Sudan National AIDS Programme and the Government of Sudan’s Country Co-ordination Mechanism, ensuring that activities are not duplicated. We also want to make sure that the limited financial resources available for fighting the disease are used in the most efficient manner possible.
Fighting as complex a disease as HIV/AIDS is a difficult task, and there are many factors and elements that need to be tackled. We believe that effective responses are those that come from all sectors and parts of society, and that promote a co-operative approach to fighting the disease. Effective responses are also those that are co-ordinated and directed by political and religious leaders who recognise the dangers of HIV/AIDS and are prepared to take a stand.
However, effective responses must also aim to improve health services and infrastructure, to ensure the presence of fully trained expert health personnel and to provide protective devices, testing centres and counselling services. They must ensure that clean needles and blood screening are available, that those affected by the disease are supported, treated and counselled and are treated as equal members of society. They must also ensure that the most vulnerable groups are provided with socio-economic support. Thus effective responses must involve both prevention and treatment, and must take a holistic approach to fighting HIV/AIDS.
The first step in creating this kind of approach is using information, education and communication to raise awareness and educate people about the disease in exactly the way we are doing in eastern Sudan. Knowledge and understanding of HIV/AIDS empowers people and enables them to protect themselves, their families and other people : to demand and access treatment ; to mobilise and raise awareness of the disease ; and to influence and impact on the actions of governments and political leaders. Through this process, HIV/AIDS becomes recognised as, and in turn becomes, a problem needing a response, and concrete action to fight the disease can then be taken.
This paper does not examine the impact of the programme. This will be published later in the year, following an evaluation. It does, though, provide a series of recommendations :
? Poverty and the spread of HIV are closely linked. An enhanced move towards meeting the Millennium Development Goals will be an effective tool in fighting the spread of the epidemic.
? ’Developmental approaches’ are possible in areas of low-level conflict, within a context of a wider civil war.
? Ockenden International welcomes the involvement of other organisations in eastern Sudan who are concerned with HIV/AIDS. In particular we believe that the most effective approach also requires testing, counselling and the availability of a suitable drugs regime for those in need.
? Donors should increase their focus on displaced communities and HIV/AIDS. Such initiatives should always fully integrate host communities.
? Effective educative responses have to be based on and within the cultures covered by the intervention. It is important to recognise that there is often more than one cultural view within an area.
? Bringing religious leaders into the process of education improves access and the acceptability of the message.
? Holistic HIV/AIDS programmes, including life skills education, are an essential element in responding to the very significant population movements in Sudan that the peace agreement may cause.
? Understanding and analysis of gender relations is an essential component of any response.
? The Sudan National Aids Programme (SNAP) needs resources to enable it to provide a much wider coverage than is currently possible.
? Post-conflict funding needs to fully integrate local authorities, throughout the country, including developing their capacity to manage such interventions.
? Similar interventions, in places where there may be some resistance, need to be planned over time, with the communities, and be adapted to their needs and concerns.
? Monitoring and evaluating behavioural change is an area that requires additional collaborative research.
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