1. The HIV/AIDS Epidemic
A Guiding Snapshot
Rouzeh Eghtessadi
Public Health Specialist- Gender & Human Rights
Southern Africa HIV/AIDS Information Dissemination
Service (SAfAIDS)
17 Beveridge Rd, Avondale, Harare, Zimbabwe
Tel: +263 33 61 93/4
Fax:
Website:
+263 33 61 95
http:// www.safaids.org.zw

SAfAIDS

2. Summary
• Epidemiological Overview
• Key Determinant Factors : risk, vulnerability,
susceptibility
• The Commitments : promises honored vs
dishonored
• HIV/AIDS Response Spheres : what we should
be concerting efforts in unison
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SAfAIDS

3. Epidemiological Overview
(1)
• Southern Africa remains the global epicentre of the
epidemic (1 in 3 people infected/globally live in SA)
• About 43% of all children (under 15 years) living with HIV
are in southern Africa
• Approximately 52% of all women (15 years and older)
living with HIV, live in s.Africa
• Abundant statistics around affected and infected groups
call for joint developmental responses
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4. Epidemiological Overview
(2)
Source: UNAIDS 2006 Report on the Global AIDS Epidemic ,
May 2006
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5. Source: UNAIDS 2006 Report on the Global AIDS Epidemic ,
May 2006
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6. Feminization of HIV/AIDS in selected
Sub-Saharan Countries, 2005
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7. 
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8. Key Determinant Factors
………..that fuel HIV/AIDS related Risks,
Vulnerability & Susceptibility
• Gender Relations
• Poverty
• Migration
• Civil & Political Unrest
• Natural Disasters
• Human Rights Violations –vulnerable/ marginalised
populations
• Access to Resources & Services
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9. Affected versus Infected…….
Impact cannot be ignored
• Children
• Women
• Elderly
• Interrelationship of AIDS with other problems of human
development has become clearer
• MDGs- reversed
“ In countries , AIDS is undermining progress towards the MDGs particularly
those related with poverty reduction, achieving universal primary education,
promoting gender equality, reducing child mortality and improving health of
mothers” UNFPA, 2005

10. Key Impact Areas…
• Population structure
• Poverty and inequality (Bots,2005)
• Governance- PRSP, NSP (Mozambique, 2006)
• Social and Traditional Structures & Networks
• Households – “coping”- (Zambia, 2005, FAO, 2004)
• Stigma & Discrimination (Bots & SA, 2003)
• World of Work
• Agriculture, Transport, Mining, Education,
Fisheries, Health Systems (ILO, 2004)

11. HIV/AIDS Related
Commitments (1)
• U nited Nations General Assembly Special Summit
on HIV/AIDS (U NGASS ) Declaration (2001/2006)-
Achieve Universal Access by 2010
• UNAIDS GIPA Principles (2001)
• UN Millennium De claration/MDGs (2000) – Goal
6 , linked closely with all other goals: child mortality, education, gender,
poverty, environmental sustainability [IWRM], maternal health, partnerships)
• International Labour Organisation –HIV/AIDS
Employment Code ( 2001 )
• C onvention on the Elimination of All Forms of
Discrimination Against Women (C EDAW ) & Beijing
Declaration & Platform for Action (1995)
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12. HIV/AIDS Related
Commitments (2)
• International Guidelines on HIV/AIDS & Human
Rights
• SADC Code on E mpl o yme nt and HIV/AIDS
• Abuja Declaration : AU Special Summit on HIV/AIDS, TB and
Malaria (2001/2006)
• COMESA Gender Policy (2002)
• Maseru Declaration – SADC (2003)
• A U Protocol on Rights of Women in Africa (2003)
• C ountry Strategies/Policies and Programmes
• Jo’burg Summit (2002) recognized HIV/AIDS
• World Water Forum, Mexico (2006) did not ! 
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13. HIV/AIDS Response Spheres
Response is developmental, not HEALTH
SECTOR responsibility only :
• Prevention - ABC, gender based violence, PEP, VCT
• Care – home based care, positive living, health system monitoring,
nutrition & food security
• Support – access to resources & services, peer support networks &
groups, capacity building
• Treatment – ART, opportunistic infections
• Advocacy – awareness raising, combat stigma & discrimination,
community and policy maker mobilisation
• Research
• Mitigation & Litigation – legal aid for human rights violations,
willful transmission
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14. So where do we
penetrate ?
• Global level
• Regional level- developmental, multisectoral concerted
efforts’ policy making
• National level- policy making, resource mobilisation
• Sector level – Water and Sanitation Sector
• Sub-sector level – IWRM
• Organisational level – lobbying, researching,
implementing, mitigating IWRM Managers
• Community level – IWRM field workers
• Individual level – IWRM Practitioners, behaviour &
attitudinal change, support systems
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15. How do we Penetrate ?
• Policy and Law Making Level
• Organisational Culture- Strategy and Plan
development
• Community based intervention

16. Knowledge Management :
A Strategy to Manage Mainstreaming
HIV/AIDS
Identification Key Issues
•Research
Monitoring, •Focus Groups/ Workshops
Evaluation, Building Capacity
Documentation •Partner/donor Identification
• Sit-in Sensitisation
•Monitoring, Trainings
Utilisation of Information
evaluation •ICT (www) , Workplace
•Advocacy Campaigns Policies and Programs
•Documentation
•Peer education, buddy systems,
•Dissemination Production of
support groups, discussion forums
towards
Materials
empowerment • Organisational events and
and informed culture shift (Programing, • Awareness Publications
decision making

policy/legal reform)
• Curriculum adjustment
•GIPA/MIPA/MIWA
•Document ammendments
R.Eghtessadi – MPH(2006)

17. Mainstreaming HIV/AIDS in
Practice : A Developmental
Response
Rouzeh Eghtessadi
Public Health Specialist- Gender & Human
Rights
Southern Africa HIV/AIDS Information
Dissemination Service (SAfAIDS)
17 Beveridge Rd, Avondale, Harare, Zimbabwe
Tel: +263 33 61 93/4
Fax: +263 33 61 95
Website: http:// www.safaids.org.zw

SAfAIDS

18. IWRM & Mainstreaming
HIV/AIDS have one
important element in
common = both are fairly
new and rapidly evolving
concepts
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19. Summary
• HIV/AIDS & Knowledge Management Cycles
• Defining Mainstreaming
• Mainstreaming is not…….
• Mainstreaming HIV/AIDS : The Basic Steps
• Essential Principles HIV/AIDS
Mainstreaming
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SAfAIDS

20. Knowledge Management :
A Strategy to Manage Mainstreaming
HIV/AIDS
Identification Key Issues
•Research
Monitoring, •Focus Groups/ Workshops
Evaluation, Building Capacity
Documentation •Partner/donor Identification
• Sit-in Sensitisation
•Monitoring, Trainings
Utilisation of Information
evaluation •ICT (www) , Workplace
•Advocacy Campaigns Policies and Programs
•Documentation
•Peer education, buddy systems,
•Dissemination Production of
support groups, discussion forums
towards
Materials
empowerment • Organisational events and
and informed culture shift (Programing, • Awareness Publications
decision making

policy/legal reform)
• Curriculum adjustment
•GIPA/MIPA/MIWA
•Document ammendments
R.Eghtessadi – MPH(2006)

21. Defining Mainstreaming (1)
• How many of us are SINCERELY &
URGENTLY concerned?
• Mainstreaming is a process that enables
development actors to address the causes
and effects of HIV/AIDS in an effective and
sustained manner, both through their usual
work and within their workplace (UNAIDS)
across all sectors 
It means ‘wearing HIV/AIDS glasses” while working in all levels
SAfAIDS

22. Reciprocal Relationship: HIV/AIDS & Development
Specific
Mainstreaming
AIDS-focused
HIV/AIDS & interventions

23. Defining Mainstreaming (2)
• Internal Mainstreaming IM pre-requisite for EM effectiveness)
(
involves changing organisational policy and practice., to
reduce the susceptibility to HIV infection and its vulnerability
to the impact of AIDS. The focus is on HIV/AIDS and the
organisation
• External Mainstreaming (EM) refers to adapting
programme work to take into account susceptibility to HIV
transmission and vulnerability to the impact of AIDS. The
focus is on core programme work in the changing context.
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24. Mainstreaming
Assumes Internal sphere
(workplace, your
organisation)
•multi-disciplinary Mainstreaming
HIV/AIDS
•multi-level and &
•multi-sector approaches
External sphere
(your cooperation
activities)

25. Mainstreaming HIV/AIDS
is not …….
• Changing core functions and responsibilities
in order to turn all org. activities into
HIV/AIDS programmes
• Simply introducing HIV/AIDS awareness
raising in all activities - should be more to it
• All staff having to become HIV/AIDS
specialists
• Business as usual …………
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26. We need to be “Turning the Tide”
of our organisations – let
HIV/AIDS responses slip into our
business ‘main’ stream…
HIV/AIDS Reponses
… automatic flow into all core
business offshoots… ‘process’
not ‘event’
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SAfAIDS

27. Mainstreaming HIV/AIDS (1)
• Basic Steps in Mainstreaming HIV/AIDS :
– Context & Organisational Profile (HIV/AIDS
Audit/Situational Analysis) - How is HIV/AIDS affecting your
organisation? Your work?
– Impact of HIV/AIDS on IWRM – activity map tracking
HIV/AIDS influence
– Impact of IWRM on HIV/AIDS – risk, vulnerability,
responses & entry point identification
– HIV/AIDS Transformative Strategy/Policy/Program:
awareness raising-reflection-action, advocacy, S&D combated,
universal access, policy and support mechanism establishment, budget
review, M&E plan, research & documentation, knowledge sharing
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28. Mainstreaming HIV/AIDS (2)
• Simply : let’s ask ourselves Four Key
questions:
– How does HIV/AIDS affect my organisation ?
– How does HIV/AIDS affect my work?
– How can harm due to HIV/AIDS be avoided?
– How can I contribute to fighting HIV/AIDS by
limiting the spread and mitigating the impact of
the epidemic?
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29. Step 1: Baseline Analysis
Internal sphere Extern
al sph
Conte ere
Organisational analysis : xt ana
 Gen lysis:
– How are staff and their eral HI
V/AIDS
families affected? situatio
n?
– Impact of HIV/AIDS on  Imp
acts of
human resources in the HIV/AI
on the DS
sector?
sector?  Poli
cies an
– What institutional d majo
respon r
instruments are available ses?
 Stak
to respond? eholde
r
analys
– What resources are is?
Reso
available to respond? urce an
alysis?
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30. Step 2: Use Baseline Analysis Results
to answer how HIV/AIDS affects your
organisation and your work
Assess the impact of HIV/AIDS on:
• The workplace and your organisation
• The beneficiaries of your programme
• What you want to do (including whether your
objectives are relevant and feasible in this
context)
Then discuss how vulnerable your cooperation activity is to
HIV/AIDS and what changes need to be made.
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31. Step 3: Analysis of Potential negative
implications of what you do on
HIV/AIDS
How to do no harm? Do your cooperation
activities increase:
• Population mobility
• Gender inequalities
• Exclusion of people living with HIV/AIDS or other
vulnerable groups
• Risk situations for gender based violence/ sex work
• Etc?
Then anticipate by planning corrective actions.
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32. Step 4a: Develop an HIV/AIDS
workplace policy and programme
Source: ILO
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33. Step 4b: Plan and implement your
contribution to fighting HIV/AIDS
Assess, where your comparative advantage is
highest for making a difference, in terms of:
• Risk : helping people to behave safer and avoid
risk situations
• Vulnerability : acting on developmental factors
that increase the vulnerability of population groups
to HIV/AIDS
• Impact mitigation : help affected people and
communities to cope with the effects of HIV/AIDS
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34. Step 4c: Monitoring - how to develop
indicators
– Outcome: Has the behaviour of beneficiaries and/or
the way of working of staff/partners changed in the
intended way
– Impact: What impact did this make in terms of
changing the HIV/AIDS epidemic and its context? (BUT:
avoid the pitfall HIV prevalence or mortality!)
– Process: Which process did you use with what effect?
What works and what doesn't?
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35. Essential Principles in
HIV/AIDS Mainstreaming (1)
• Adapt to your context- No standard approach (varied
combinations of organisational, sociology, logframe elements)
• Relevant at all stages of the epidemic, also in low
prevalence contexts
• Continuous and integrated
• Gender sensitive approach
• MIPA - Involve people living with HIV/AIDS
• Networking & coordination
• Advocacy
• Share good practices and lessons learnt
• Generate evidence through continuous monitoring
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36. Essential Principles in
HIV/AIDS Mainstreaming (2)
To be successful :
• Consider HIV/AIDS as a development issue
• Commitment and support of decision makers
• Clearly defined objectives for mainstreaming
• Knowledgeable, compassionate and skilled staff
• Document and share experiences through
knowledge sharing systems
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37. Essential Principles in
HIV/AIDS Mainstreaming (3)
To be successful (cont) :
• Expertise and support available and made
use of
• Sufficient allocation of resources (human,
financial, technical)
• Willingness to learn, reflect and share
Linking Theory to Practice
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38. Source: UNAIDS

39. References
• UNAIDS (2006) Global AIDS Epidemic Report
• IRC International Water & Sanitation Centre
website http://www.irc.nl
• UNAIDS(2004), Support to Mainstreaming AIDS
in Development
• Swiss Agency for Development and Cooperation
(SDC) (2004), Mainstreaming HIV/AIDS in
Practice
• Oxfam International (2003), Tools to Support the
Mainstreaming of HIV/AIDS
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40. Thank you…
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Lets translate these concepts into
excitingly effective IWRM practice
………………
SAfAIDS