1. HOW COMMUNITY COUNSELING IN THE
1990’S TURNED THE TIDE AGAINST
HIV/AIDS IN AFRICA: WRITING HISTORY
TODAY.
MacDonald Chaava
Feb, 2014

2. How Community Counseling Turned the Tide
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In the darkness, a candle
• In the late 1980s and early 1990s the heart of Africa was
very dark because of HIV/AIDS
• In the most unlikely place, lessons from the most unlikely
programs began to turn the tide
• One community at a time, many communities
• Zambia, Uganda, Zimbabwe, Kenya, Nigeria, Ghana, Tan
zania…

3. How Community Counseling Turned the Tide
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What History Will Say
o The story of HIV/AIDS would have been written differently
because there was no cure, no hope
o More people died than necessary
o There was no short-cut; no easy path
o Community counseling turned the tide in the 1990s
o The credit goes to a small hospital in rural Africa for
thinking out-of-the-box

4. How Community Counseling Turned the Tide
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Testing and Counseling
• A snap survey of hospital inpatients HIV status concluded:
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We Have a Problem!!
Thinking out of the box: start to warn people through
counseling
Start Testing and spread the word
Testing and counseling for individuals was established
Train health workers and prepare counselors
Rotate counselors to handle increasing workloads

5. How Community Counseling Turned the Tide
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Testing and Counseling for Individuals
• Tens of health professionals including Clinical Officers,
nurses, para-medical staff trained as counselors in
hospital
• Local teachers from primary and secondary school trained
as HIV/AIDS counselors

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Increasing Workload
• Men, women, children of all ages diagnosed, many
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admitted to hospital
Some sick at home in the villages
Some are critical, come to hospital, are admitted, begin to
clog the system
More loved ones waiting on the sick
Hospital grounds become overcrowded

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Find out What People Want
• A simple survey determined where patients wanted to die:
At Home, NOT in the hospital
• Explains why people want to die at home
• Preparation for transfer of counseling model from case
management to community counseling
• Offer by donors to build a hospice turned down

8. How Community Counseling Turned the Tide
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Patients Want to Die At Home;
Not in Hospital!
• A simple Social worker’s survey determines where
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patients want to die, and Why
At home they are in familiar surroundings
At home they are surrounded by loved ones
At home the loved ones can watch over their sick ones
and also do field work
At home, all the extended family members can come at
any time

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Patients Don’t Want to Die in Hospital!
• A simple Social worker’s survey determines why patients
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don’t want to die in hospital
In hospital they are surrounded by strangers
In hospital it means all their loved ones must leave home
to watch over them
Loved ones cannot do their field work; there will be no
harvests
In hospital, only few of the extended family members can
come at any given time
“People go to hospital to get well, not to die”

10. How Community Counseling Turned the Tide
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Counseling for Communities!
• Practical lessons learned from ongoing leprosy
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rehabilitation are tried out in the HIV/AIDS work
Birth of Home Based Care: Transfer of care from Hospital
to Household
The problem with HIV/AIDS is defined as an intricate
social dynamic that can only be unraveled through an
equally sensitive culture-centric approach
Community counseling started
Integrated multi-sector approach to HIV/AIDS established
with Chikankata Hospital as the hub
AIDS Training for international participants took root at
Chikankata Hospital

11. How Community Counseling Turned the Tide
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Why Community Counseling Works
• Provides space for people to identify themselves as a
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community
Allows people of various tribes (ethnic groups), age, and
gender to think together
Provides safe spaces for community members to speak their
minds
Provides a place where people cannot be “wrong”
Provides a place where every voice counts
Provides a place where people can laugh at themselves
without feeling ashamed
Provides spaces for community to process what is going on
Creates space for community members to be accountable to
one another by mutual agreement
Helps community to look HIV/AIDS in the face: the stigma, the
loss, the orphans, the widows, the faith, and so on

12. How Community Counseling Turned the Tide
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How Community Counseling Works
• Counseling is based on relationship
• Trained facilitators enter relationship with community
• Facilitators help community to begin a journey together
• Entry of facilitators into community is by invitation,
recognizing role of community leadership
• Entry is preceded by enrollment of leaders, explaining
why this journey is important
• Facilitators use a strategic framework built solidly on
relationship
• The framework for community counseling begins with
relationship building, extends into problem identification,
exploration, action, and review

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What was apparent
• Anecdotal evidence showed that community counseling
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was well received
Communities were willing to do this
Faith groups did not separate people, instead
strengthened the bonds of community
Community counseling reduced the friction within
community
Community conversations were very well attended
Community conversations generated immense talk at
funerals, at school, in church, and around the fireplace
and in bedrooms
Community conversations brought hope of a new sun-rise

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The Facilitator
Is not a leadership, political, or religious position
• Has knowledge and skill-set necessary to drive the
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community counseling process
Knows to respect the relationship with community
A typical community counseling facilitator is a member of
the community
Is trusted by the community
Is recognized by the community as their voice
Is the conscious of the community, reminding of
commitments made by the community

15. How Community Counseling Turned the Tide
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Why History will look back at the 1990s as
the Turning Point
• Community counseling helped many across Africa to face
their fears and overcome their inhibitions
• Faith Based Organizations, Governments, NGOs, and
Community based organizations took up HBC and
components of counseling
• The Community counseling model was rapidly taken to
scale across Sub-Sahara Africa, Thanks to the Salvation
Army

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What I discovered about my African
heritage (1)
My first week in England I might have been at the
bus station waiting for a bus with the bus schedule
in my hand, and yet, I probably turned to the guy
standing near me and asked, “What time is the bus
coming?”

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What I discovered about my African
heritage (2)
• You see, it was not about the bus… or the schedule… it
was about relationship: I wanted the guy to know me, I
wanted to know him so that if we met again we would
greet and say, Hi! I know you! I am your friend.
• Generally the people I did this to, hated it. They probably
did not want to be known by me. They did not want to
know me except as the figure who stood near them.

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What I discovered about my African
heritage (2)
• In my African heritage, I tend to value
relationships, trust, care, love…
• I am always conscious of relationship. It is hard work not
to relate with people; it is hard work just standing there
with all the strangers without looking into each other’s
eyes and wondering or asking, “Do you have a mother
who loves you? Are you okay today? Can I be your
friend?”

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HIV/AIDS makes people lonely: Community
counseling counters by building relationships
Across Africa you heard sayings like these:
• You are my brother/sister; I may not know you, you may
not know me
• Ubuntu
• I am, because you are
• You are not alone; it will be okay
• No one should die alone
• No community should stand alone
• The Answer Lies Within
• You can build highways and freeways; people will
continue to walk the byways

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And the Verdict: History
We have to wait until history is born in 2028!
THE END