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Income-generating activities for young peoplein southern Africa: Exploring AIDS andother constraints

02 Jun 2017 03:34:11 GMT

This paper reports on a study with rural young people (aged 10–24 years) in Malawi and Lesotho, focusing on their opportunities to learn skills and access capital and assets to engage in income-generating activities (IGAs). Participatory group exercises and individual interviews provide many examples of how young people learn skills and start small businesses, as well as an insight into their strategic thinking about engaging in these livelihood options. Various factors, including the effects of AIDS, are shown to affect young people's prospects of succeeding in their ventures. Young people are very keen on starting IGAs, and are supported by adult members of their communities in asking for interventions to help them. We argue that expanded vocational and business training, focusing on locally appropriate types and scale of businesses, coupled with help to raise start-up capital has the potential to improve the chances of young people who are poor and/or AIDS-affected securing sustainable rural livelihoods in their futures. Since AIDS is intertwined with many other issues affecting young people's livelihoods, it is problematic to single out and target only AIDS-affected young people with interventions on skills building and IGAs. Policymakers' attitudes to vocational skills training and support for IGAs in Malawi and Lesotho are also explored, and policy recommendations made to support vulnerable rural young people in their attempts to build sustainable livelihoods.

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Ending child marriage and stopping the spread of HIV ...opportunities and challenges for action

10 Feb 2017 04:14:39 GMT

AIDS is now the number-one killer of adolescents in Africa. What is more worrying is that seven of every 10 new infections of HIV among adolescents are girls, which shows how vulnerable girls are to acquiring HIV. Similar socioeconomic factors drive both HIV and child marriage, but very few studies have shown the causal effects and links between the two.
This desk review examines some of the existing literature to highlight what is known about the links between child marriage and HIV, and spotlights opportunities for further action. Very few studies have explicitly explored the two phenomena. Given recent increases in the number of adolescent girls who are HIV-positive and the high numbers and rates of child marriage in countries with high HIV prevalence, the data do suggest a correlation between ending child marriage and stopping the spread of HIV/AIDS.
This review argues that gender, gender relations and women’s empowerment play a significant role in linking child marriage and HIV. When girls marry young, usually to older men, they are vulnerable to gender-based disadvantages. The imbalance of power in a child marriage significantly erodes a girl’s control of her body and her social and economic potential.

Transmission, spread and control of HIV hinges on improving gender relations, and this may be even truer with child marriage. Fundamentally, child marriage is a construct and a result of gender imbalances.

Averting 'New Variant Famine' in Southern Africa: building food-secure livelihoods with AIDS-affected young people

06 Dec 2016 12:19:41 GMT

Numerous reports have linked AIDS’ impacts on young people and their long term food insecurity, through, for instance, orphans’ failure to inherit property and resources; inability to retain rights to land which they are too young or inexperienced to farm; or interruption of intergenerational knowledge transfer following parental deaths. Hitherto, however, reports have only addressed isolated aspects of young people’s livelihood prospects, and most lack substantive evidence. Impacts of AIDS on young people’s attitudes and dispositions remain neglected.  responds to the clear need to understand better how AIDS affects young people’s livelihood participation in varying geographical/livelihood contexts.

The research covered in this report aimed to generate new, in- depth understanding of how AIDS, in interaction with other factors, is impacting on the livelihood activities, opportunities and choices of young people in rural southern Africa. This was intended to support the development of policies and interventions that enhance AIDS- affected young people’s prospects of achieving sustainable, food -secure livelihoods throughout the region.

Averting ‘New Variant Famine’ in Southern Africa: building food-secure rural livelihoods with AIDS-affected young people

02 Dec 2016 04:51:34 GMT

Southern Africa is experiencing the world’s highest HIV prevalence rates alongside recurrent food crises. This has prompted scholars to hypothesise a 'New Variant Famine' in which inability to access food is driven by the effects of AIDS. In line with this, it has been suggested that the impacts of AIDS on young people today is likely to diminish their prospects of food security in adult life. In particular, children whose parents die of AIDS may fail to inherit land or other productive assets, and transmission of knowledge and skills between the generations may be disrupted, leaving young people ill-prepared to build food-secure livelihoods for themselves. However, prior to this research, those propositions were largely untested.

The ‘Averting New Variant Famine’ research project was therefore undertaken to generate new, in-depth understanding of how AIDS, in interaction with other factors, is impacting on the livelihood activities, opportunities and choices of young people in rural southern Africa.

The research was conducted in two villages in Malawi and Lesotho, two of the worst affected countries. The fieldwork comprised four elements:

  • community and household profiling to provide a contextual understanding of livelihood responses to sickness and death, and in particular how young people are incorporated in livelihood strategies
  • participatory research with more than thirty 10-24-year-olds in each community (around half of whom were affected by AIDS) to explore their aspirations, means of accessing livelihood opportunities, obstacles faced and decision-making processes
  • semi-structured interviews with policy makers and other key informants to explore the linkages with macro-level policies and processes
  • life history interviews with more than twenty 18-24 year olds in each village to explore the factors shaping their lifecourses and livelihoods

There are a number of policy recommendations arising from the research:

  • focusing on increasing school attendance (which has hitherto been the main response to the impacts of AIDS on young people) is an inadequate response. Education needs to be much more relevant to the livelihood options available to the majority of rural youth
  • rural young people would benefit particularly from opportunities for vocational skills training, but also business education and the identification of opportunities that rely not only on the local market, if they are to engage successfully in rural enterprise
  • although fertiliser subsidies, food aid and food for work programmes are aimed principally at securing immediate subsistence rather than buildingassets for the future, they can free young people’s time and energy to devote to activities with secure long term prospects
  • equally, cash transfers, including those directed at elderly people, can help young people do business and find employment by putting more cash into local circulation
  • significantly, however, the project findings do not support the targeting of interventions specifically at AIDS-affected young people

Learning from young people about their lives: using participatory methods to research the impacts of AIDS in southern Africa

15 Nov 2016 12:52:36 GMT

Methods of participatory research have become popular among children’s geographers as they are believed to enable young people to speak openly about their lives in unthreatening contexts. In this paper the authors reflect on their experience of using participatory methods to explore the sensitive topic of (indirect) impacts of AIDS on young people’s livelihoods in Malawi and Lesotho.
The paper examines how different methodological approaches generate varying knowledges of children’s lived realities; challenges of using ‘insider’ and ‘outsider’ research assistants, place of group-based approaches in participatory research and ethical issues. The authors suggest that researchers of young people’s lives should take full account of the relationship between epistemology and methodology in selecting and employing methods appropriate to particular research questions.

Averting ‘New Variant Famine’ in Southern Africa: building food secure rural livelihoods with AIDS-affected young people

15 Nov 2016 04:22:34 GMT

Southern Africa is experi-encing the world’s highest HIV prevalence rates alongside recurrent food crises. This has prompted scholars to hypothesise a 'New Variant Famine' in which inability to access food is driven by the ef-fects of AIDS. In line with this, it has been suggested that the impacts of AIDS on young people today is likely to diminish their prospects of food security in adult life. In particular, children whose parents die of AIDS may fail to inherit land or other pro-ductive assets, and trans-mission of knowledge and skills between the genera-tions may be disrupted, leaving young people ill-prepared to build food-secure livelihoods for themselves. However, prior to this research, those propositions were largely untested.

The ‘Averting New Vari-ant Famine’ research pro-ject was therefore under-taken to generate new, in-depth understanding of how AIDS, in interaction with other factors, is im-pacting on the livelihood activities, opportunities and choices of young peo-ple in rural southern Africa.

Research was conducted in two villages in Malawi and Lesotho, two of the worst affected countries, and fieldwork included participatory research with 10-24-year-olds in each community (around half of whom were affected by AIDS) to explore their aspirations, means of accessing livelihood oppor-tunities, obstacles faced and decision-making processes.

Policy recommendations:

  • focusing on increasing school attendance is an inadequate response
  • rural young people would benefit particularly from opportunities for vocational training and development of market opportunities
  • measures to improve access to productive assets such as land
  • social protection measures that allow young people to devote their energies to accruing livelihood assets to depend on in the long term
  • however, targeting of AIDS-affected youth is not advocated

Income generating activities as components of sustainable rural livelihoods for young southern Africans - AIDS and other constraints

15 Nov 2016 01:33:36 GMT

The literature dedicated to exploring rural livelihoods in southern Africa has devoted comparatively little attention to non-agricultural livelihoods, as several authors have pointed out. This gap in knowledge about non-agricultural livelihoods is also reflected in the literature looking at the effects of AIDS on rural livelihoods in Southern Africa. In general, research focusing on the effects of AIDS on livelihoods has also tended to neglect effects on young people’s abilities to create sustainable livelihoods for themselves in the future, and consequently, AIDS-affected young people’s abilities to engage in non-agricultural livelihoods have been even less explored.

This paper reports on a study with rural young people (aged 10-24 years) in Malawi and Lesotho, focusing on their opportunities to learn skills and access capital and assets to engage in income generating activities (IGAs). Participatory group exercises and individual interviews provide many examples of how young people learn skills and start small businesses, as well as insight into their strategic thinking around engaging in these livelihood options.

Various factors, including the effects of AIDS, are shown to affect young people’s prospects of succeeding in their ventures. Young people are themselves very keen on starting IGAs, and are supported by adult members of their communities in asking for interventions to help them do so. The paper argues that expanded vocational and business training, focusing on locally appropriate types and scale of businesses, coupled with help to raise start-up capital has the potential to improve poor and/or AIDS-affected young people’s chances of securing sustainable rural livelihoods in their futures.

Since AIDS is intertwined with many other issues affecting young people’s livelihoods, it is however problematic to single out and target only AIDS-affected young people with interventions on skills building and IGAs. Policy makers’ attitudes to vocational skills training and support for IGAs in Malawi and Lesotho are also explored, and policy recommendations made in relation to supporting vulnerable rural young people in their attempts to build sustainable livelihoods for themselves.

Young people are themselves very keen to learn various skills and to try running small businesses, and often mention IGAs when asked about future plans and aspirations. Adult community members also talk about wishing that vocational skills training and loans for businesses were available to young people locally, and in participatory dissemination activities with the communities, these issues were mentioned repeatedly when generating recommendations for governments and NGOs.

Factors shaping the HIV-competence of two primary schools in rural Zimbabwe

04 Nov 2016 04:36:05 GMT

School attendance often has positive impacts on the well-being of HIV-affected and HIV-vulnerable children in sub-Saharan Africa. In the context of the growing emphasis on the need for schools to go ‘beyond education’, international policy accords schools and teachers a central role in the care and protection of such children, particularly in relation to facilitating their school access and their health and well-being. However, much remains to be learned about (i) the readiness and ability of schools to take on these roles, and (ii) the impacts of wider contextual factors on school efforts.

This paper explores these issues through a multi-method study of two primary schools in a rural Zimbabwean province, one in a rural area and one in a small town. The rural school is located in a relatively settled rural farming settlement, and small-town primary school is located in a small roadside town. Compared to the small-town school, the rural school is associated with

  • higher levels of school attendance by HIV-affected children in its catchment area; and
  • higher well-being scores among HIV-affected children

The authors use the method of dichotomous case comparison, involving comparisons of very different cases, to flag up factors facilitating or hindering each school in providing support and care for HIV-affected children.

The role of schools in supporting HIV-affected children in sub-Saharan Africa: a systematic review

04 Nov 2016 02:35:18 GMT

HIV-affected children (themselves sick/with sick parents/orphaned) are particularly vulnerable to poor nutrition, mental and physical health, sexual abuse and poverty - which consequently tend to have a negative impact on their school enrolment and academic progress.

Reviewing existing literature on schools and the health and well-being of vulnerable children, this literature review aims to address the following question:

What interventions have been made to improve school environments to facilitate support for the health and well-being of vulnerable children in Zimbabwe and similar socio-economic contexts in sub-Saharan Africa?

Establishing an overview of existing literature on this topic is essential to learn from previous experiences and identify what supplementary research is needed in order to fully understand the potential possibilities of school capacities to facilitate contexts of care and support for HIV-affected children.

This review has demonstrated positive correlations between school enrolment and the health of children, as well as acknowledged the potential of school-based interventions to support the health of children and promote their health knowledge. However, there is a need for schools to go beyond knowledge and provide more comprehensive support for HIV-affected and orphaned children, particularly in light of the dwindling capacity of struggling households to provide adequate care and support for children in their care. Rather than relying on the implementation of external resources to do this, there is a need to supplement existing research exploring the pathways through which some schools in challenging socio-economic contexts manage to support HIV-affected learners by drawing on already available resources and by involving local communities.

Furthermore, there is a need to explore the interface between schools and external organizations in order to strengthen supportive school environments. This should be done by developing the existing literature with more in-depth qualitative research focusing on children’s perspectives, allowing HIV-affected children to express how they experience the school environment and cope with adversity in their everyday lives.

AIDS-affected young people’s access to livelihood assets: Exploring 'new variant famine' in rural southern Africa

03 Nov 2016 05:02:37 GMT

The ‘new variant famine’ hypothesis suggests AIDS is contributing to food insecurity in southern Africa. Proposed causal mechanisms include a loss of livelihood assets and skills, brought about through AIDS′ impacts on children’s access to inherited property and intergenerationally-transferred knowledge. This paper employs a sustainable livelihoods framework to examine how AIDS is impacting on young people’s access to assets and skills in two southern African countries: Malawi and Lesotho. Drawing on qualitative research with rural youth, the paper shows that AIDS affects some young people’s access to some livelihood assets, but does not do so in a systematic or predictable way, nor are its impacts invariably negative. The broader cultural and institutional context is of key importance. The paper also demonstrates the need for the sustainable livelihoods framework to take greater account of the temporalities of livelihoods, and in particular the significance of lifecourse and generation.


  • the New Variant Famine hypothesis attributes southern Africa’s food crises to AIDSq

  • it suggests AIDS reduces young people’s access to livelihood assets

  • qualitative research with rural youth in Malawi and Lesotho reveals greater complexity
  • AIDS has some impact on youth access to livelihood assets but this is not systematic

  • the Sustainable Livelihoods Framework should incorporate lifecourse and generation

Review and synthesis - ten years of research evidence in health and development: ESRC-DFID Joint Fund for Poverty Alleviation Research

16 Aug 2016 03:25:07 GMT

The ESRC–DFID Joint Fund for Poverty Alleviation Research was established in 2005 in order to ‘provide a robust conceptual and empirical basis for development and enhance the quality and impact of social science research which contributes to the achievement of the Millennium Development Goals (MDGs)’. The scheme has provided funding to a range of research projects examining how poverty may be tackled in a broad range of economic and social contexts.

This report describes how studies funded by the Joint Fund have Direct and Indirect implications for health/ health services and how they can help to understand the links and pathways between poverty and health. It is an analysis based on the screening of all available documentation and outputs from 121 research projects funded by the Joint Scheme, and a subset of 69 studies that were identified as health related. The screening and review of documents was supplemented by discussions and interviews with current grant-holders who are only just beginning to produce outputs.

Chapter 2 presents the research methodology in more detail. Chapter 3 presents the contextual background for health development research starting at the new millennium. Chapter 4 presents a detailed analysis of 69 projects which had a health dimension. It uses basic descriptive statistics to highlight key trends across the projects as well contextualizes the observations. Chapter 5 discusses key gaps in the studies and methodologies used and provides suggestions for further research and future. The Appendices contain an annotated bibliography of outputs from all the health related studies. This is meant to be a resource that makes the research outputs of funded projects accessible to a wider audience.

Using provider performance incentives to increase HIV testing and counseling services in Rwanda

12 Aug 2016 02:01:05 GMT

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilisation and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme’s impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design.

The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.

How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa

12 Aug 2016 01:36:01 GMT

This paper seeks to characterise the social environments in which community-led health programmes are most likely to facilitate effective and sustainable health improvements, using three dimensions to characterise social contexts: material, symbolic and relational. 

Drawing on secondary sources, the authors compare two well-documented case studies of HIV/AIDS management projects. Both sought to use technical communication about HIV/AIDS as a springboard for developing transformative communication skills amongst marginalised women. The Entabeni Project in South Africa sought to empower impoverished women to deliver home-based nursing to people with AIDS. Whilst it performed a vital shortterm welfare function, it did not achieve its goals of leadership by local participants and long-term sustainability. By contrast, the Sonagachi Project in India, which started as an HIV-prevention programme targeting female sex workers, has achieved both these outcomes. 

The authors examine the way in which pre-existing social contexts in West Bengal and rural KwaZulu Natal impacted on the possibility of effective mobilisation of excluded women in each case. They also highlight the strategies through which Sonagachi, but not Entabeni, was able to alter aspects of the material, symbolic and relational contexts of participants’ communities in ways that opened up significant opportunities for project participants to articulate and assert their needs, and motivated powerful actors and groups to heed these demands.

Prevention gap report 2016

12 Jul 2016 02:45:22 GMT

Tremendous progress against AIDS over the last 15 years have inspired a global commitment to end the epidemic by 2030. The United Nations General Assembly agreed in June 2016 that ending AIDS by 2030 requires a Fast–Track response to reach three milestones by 2020:

  • reduce new HIV infections to fewer than 500 000 globally by 2020
  • reduce AIDS-related deaths to fewer than 500 000 globally by 2020
  • eliminate HIV-related stigma and discrimination by 2020

Remarkable scale up of antiretroviral therapy has put the world on track to reach the target on AIDS-related deaths. Intensive efforts to eliminate mother-to-child transmission of HIV have achieved steep declines in the annual number of new HIV infections among children, from 290 000 [250 000-€“350 000] in 2010 to 150 000 [110 000-€“190 000] in 2015. However, problems remain with HIV prevention. Declines in new HIV infections among adults have slowed, threatening further progress towards the end of the AIDS epidemic. Since 2010, the annual number of new infections among adults (15+) has remained static at an estimated 1.9 million [2015 range of 1.7 million-€“2.2 million].

Efforts to reach fewer than 500 000 new HIV infections by 2020 are off track. This simple conclusion sits atop a complex and diverse global tapestry. Data from 146 countries show that some have achieved declines in new HIV infections among adults of 50% or more over the last 10 years, while many others have not made measurable progress, and yet others have experienced worrying increases in new HIV infections.

Evaluation of the television drama series, Intersexions: Episodes 1 – 26

24 Jun 2016 12:59:44 GMT

This summary shares the findings of a qualitative evaluation of the first series of Intersexions, a 26-part South African entertainment-education television drama series to communicate health- and HIV-related messages, with a focus on sexual networks. This report presents qualitative research findings about audience responses to the first 26 episodes and discusses how viewers engaged with and responded to the drama series, which was produced by Curious Pictures, Antz Media, and Johns Hopkins Health and Education in South Africa. Based on focus groups and interviews, it was found that "the compelling drama, identifiable and realistic storylines, and the focal content of the drama series - the sexual network - attracted and intrigued viewers."

The series set out to portray the lives of ordinary South Africans and demonstrate different contexts that put people at risk of HIV infection, emphasising sexual networks and multiple concurrent partnerships. "Using well-researched case studies and numerous dramatic devices, the series intended to show how the moment people become sexually active they become part of a sexual network of people who are connected even though they may never have met." The interrelated episodes mapped out a sexual network, and the series closed with a one-hour 'docudrama' that explicitly revealed the sexual network and the virus's movement between characters

Alcohol use: summary of the findings from the Third National HIV Communication Survey

24 Jun 2016 12:50:24 GMT

Alcohol use and abuse is an important risk factor for HIV infection in southern Africa. A number of studies have found a relationship between alcohol and HIV seropositivity. Alcohol is increasingly being recognised as an indirect contributor to the transmission of HIV in sub-Saharan Africa as it is a key determinant of risky sexual behaviour.

Based on findings from the Third National HIV Communication Survey, this document looks at behaviour related to alcohol abuse. The intention of this paper is to assist policymakers and planners in the design of future HIV communication strategies and programmes.

The summary offers a number of different recommendations for health communication programmes. These include countering perceptions of drinking as an accepted social norm, while also promoting safer drinking practices and awareness about HIV risk while drinking, particularly to address binge drinking. Strategies to consider include using gender specific approaches, implementing interventions in drinking establishments, and advocating for policies such as warning labels and banning alcohol advertising.

Gender matters: overcoming gender-related barriers to prevent new HIV infections among children and keep their mothers alive

24 Jun 2016 12:30:51 GMT

Studies indicate that harmful gender norms and practices, cultural perceptions and beliefs surrounding pregnancy and childbirth, and a distrust of health-care services all can pose barriers to HIV prevention and treatment. In particular, women face difficulties related to unequal gender power relations and stigma.

This Joint United Nations Programme on HIV/AIDS (UNAIDS) document presents evidence that timely and continued access to antiretroviral medicines would reduce new infections in children and give HIV-infected women access to HIV treatment and care for their own health and well-being. Because 1) women's lack of autonomy, 2) mistrust of health services, particularly due to a lack of cultural sensitivity and confidentiality among health-service providers, and 3) fear of stigma and related abuse can affect women's access to treatment, key gender-related barriers stand in the way of preventing new HIV infections among children and keeping their mothers alive.

The following recommendations, based upon discussions in Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Uganda, are proposed to overcome gender-related and cultural barriers to services.

  • address stigma and discrimination against women living with HIV to increase utilization of and adherence to services", by, for example, building awareness and sensitivity in communities, including through the use of local media and local language(s), and engaging community leaders at all levels, including religious leaders, in dialogue on stigma
  • address violence against women as part of programmes to prevent new HIV infections among children and keep mothers alive and healthy", by integrating services for survivors of violence in all health-care settings and training health services to work in a non-judgmental manner with the complexities around violence against women and the underlying gender inequalities, using confidentiality and promoting the right to respect
  • support transformation of traditional gender roles related to maternal health, providing correct information on HIV by using culturally-appropriate, gender-sensitive and rights-based approaches" by, for example, creating opportunities for voluntary attendance, counselling, and testing for couples
  • address lack of awareness and mistrust of existing services to prevent new HIV infections among children and keep mothers alive and healthy", by, for example, reaching communities, beyond individual clients and healthcare providers, as part of "decentralized approaches and awareness campaigns. For consistency in messaging and the effective use of expertise, both women living with HIV and traditional birth attendants must be engaged in community mobilization efforts

Adolescents' HIV Prevention and Treatment Literacy Toolkit for Eastern and Southern Africa

24 Jun 2016 11:41:44 GMT

The Adolescents' HIV Prevention and Treatment Toolkit for Eastern and Southern Africa is made up of 10 publications which are designed to help young people better understand HIV and what it means in their lives. The Toolkit, also known as Young Champions (YC) Support Pack, includes resources for facilitators or Young Champions working on HIV issues, as well as workbooks for different age groups. Together, the resources are intended to support the facilitators (teachers, social workers, youth leaders, or health workers who have undergone training) and young people themselves. They are intended to create more awareness about HIV, including increasing knowledge and skills related to prevention, testing, disclosing, being a young person living with HIV (YPLHIV), and treatment.

The Toolkit resulted from collaboration between the United Nations Educational, Scientific and Cultural Organization (UNESCO) Regional Support Team for Eastern and Southern Africa and SAfAIDS and was produced as part of the Young Champions (YC) initiative. It is intended primarily for use in schools, though can also be used in other settings. "Ideally, the Young Champions Support Pack helps you 'bridge the gap' between school, home and community efforts to support young people as a high risk group in the response to HIV and help create an HIV free generation."

The publications in the Toolkit include the following:

  • Facilitator's Guide: developed for teachers, school staff, and counsellors, this guide uses a training of trainers approach so that those introduced to the pack can teach others how to use it. It also includes advocacy support to help build a Young Champions Circle at community level
  • Reference Handbook for Young Champions Facilitators: for trained facilitators to use as a go-to resource for facts and other information on HIV prevention and treatment relating to adolescents.Reference Handbook for Young Champions Facilitators
  • Workbooks: the three workbooks - for ages 10 to 12, 13 to 15, and 16 to 19 - take young people (individually and in groups) through age appropriate activities on each learning topic
  • Educator Cards: because it is school-based, these 11 educator cards are designed to help prompt discussion at appropriate times in the classroom. They allow the YC materials to be more mobile
  • Board Game Quiz Cards: designed to encourage open discussion among young people about HIV and sexual rights and health-related services

The role of community conversations in facilitating local HIV competence: case study from rural Zimbabwe

24 Jun 2016 11:28:45 GMT

This journal article examines the potential of using community conversations to strengthen positive responses to HIV in resource-poor environments. Guided by a facilitator, community members collectively identify local strengths and challenges and brainstorm potential strategies for solving local problems. Researchers conducted a series of such community conversations in Zimbabwe to promote critical thinking and action planning in response to HIV/AIDS and to test the strategy using the concept of community-level HIV/AIDS competence as a lens for analysis. The study found that community conversations hold great potential to help communities recognise their potential strengths and capacities for responding more effectively to HIV, but contextual factors, such as availability of treatment, poverty, poor harvests, and political instability, can help or hinder communities' response plans.

Researchers conducted 18 community conversations (CCs) in two locations, with 6 groups participating in 3 conversations each. During the sessions, participants were asked to "reflect on how they were responding to the challenges of HIV, both as individuals and in community groups, and to think of ways to better support openness about HIV, kindness towards people living with HIV and greater community uptake of HIV prevention and treatment."

The article concludes that "findings suggest that conversations may create social space for people to reflect on the possibility of more effective responses to HIV, but a host of other factors will intervene in shaping whether such reflection leads to concrete behaviour change." However, despite these challenges, the researchers "remain confident that our conversations were successful in the modest aims which we set them - to create spaces in which people might 'break the silence', think critically about obstacles to effective responses and brainstorm action plans. Such dialogue is a vital, if not a sufficient, precondition for health-enhancing behaviour change."

Group dialogue and critical reflection of HIV prevention: an evaluation of the C-Change Community Conversation Toolkit

24 Jun 2016 11:08:36 GMT

Communication for Change (C-Change) set out to develop support tools that would foster interactive communication among low-literacy adults and prompt engagement on HIV prevention issues, including encouraging individual and group-oriented problem solving. The Community Conversation Toolkit (CCT) was developed using participatory approaches with lower literacy audiences and was extensively pre-tested in southern and eastern Africa. The CCT is a social and behavior change communication (SBCC) resource that comprises a set of interactive communication components including role play cards, throw cubes, playing cards, dialogue buttons, finger puppets, and guides for facilitation and community mobilization. The CCT has been adapted for use in seven countries and is available in ten languages.

This evaluation report looked at whether this toolkit elicited changes in behaviour and practices by participants around HIV prevention, and whether the processes of reflection and problem solving led to community-level action for HIV-prevention-related change.

The evaluation study found that "participants were able to recognise their own risks and felt empowered to change their behaviour, for example, insisting on using a condom or increasing dialogue with their partners and within their families and communities. The group dialogues encouraged critical reflection about contextual risks, enabling both community members and leaders to analyse risk factors in their communities."



  • the CCT is a well developed SBCC resource that fosters dialogue and critical reflection processes that contribute to the empowerment of HIV-vulnerable participants. As such, the CCT is suitable for replication in its current format
  • the CCT is a versatile resource that can be utilized with literate adults as well as adults with lower literacy skills. Potential use with youth audiences should be explored, noting that the content of the present toolkit would need to take into account age-appropriateness in relation to content regarding sexuality
  • the CCT complements existing HIV prevention activities and bolsters such activities by serving as a catalyst for spurring problem solving and action at individual, relationship, family, and community levels. It should thus be considered as a complementary resource to the work of organizations in facilitated or spontaneous situations
  • the CCT is available in a range of languages and includes context-relevant adaptations in the form of localized proverbs and questions. These are suitable for reproduction for use in a wide range of communities in the countries for which they were developed. Demand for such upscaling has already been voiced in study countries
  • the durability of the CCT was not assessed as part of this evaluation, and CCT components were only used four to five times by the dialogue groups. Reproducing the CCT would require additional research to determine durablity for more intensive use
  • while the broad curriculum and facilitation style attached to the CCT dialogues is appropriate and leads to action outcomes, it is unclear whether there is an optimal number of ‘sessions’ or how participants could continue independently using the toolkits. Four sessions appear to be a suitable minimum. Strategies for expanding use within communities, and determining optimal intensity of use and ‘saturation’ per community, would need to be considered


Inside Story - film and discussion guide

24 Jun 2016 10:31:15 GMT

Inside Story is a 98-minute African film that tells the story of the science of HIV transmission by combining the story of a rising soccer star with an animated journey of HIV infection through the human body.

The film follows the life experiences, relationships, and career of Kalu Kaminju as he comes to terms with his HIV status. Interwoven into the story are animation sequences which show HIV inside the body so that audiences can better understand how HIV works. The film also addresses myths and misunderstandings about HIV. "It shows how getting tested for HIV and knowing one's status gives people power to make informed decisions about their health and helps them live better lives."

Inside Story was produced in 2011 by Curious Pictures (now Quizzical Pictures), a production company in South Africa, for the Discovery Channel Global Education Partnership (now Discovery Learning Alliance) with the support of United States Agency for International Development (USAID), U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Chevron, Discovery Communications, Access Bank, the South African Department of Trade and Industry, SEACOM, and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This accompanying discussion guide can be used to facilitate a screening and discussion of the film, and can be used by teachers, health workers, community mobilisers, and others.

The film (available in English, French, Portuguese, and Swahili) can be downloaded for free from the Inside Story website

External evaluation of the Southern African Regional Social and Behavior Change Communication Program, as implemented in Lesotho

24 Jun 2016 01:07:12 GMT

This report discusses the Lesotho findings of an external evaluation of the Southern African Regional Social and Behaviour Change Communication Programme, an initiative implemented in 8 countries in Southern Africa from 2007 to 2011 to reduce HIV infection by increasing health awareness and facilitating social and behavioural change through both mass media and community-based activities. This evaluation assesses the impact of exposure to interventions on key indicators of HIV knowledge, attitudes, and behaviours. The report outlines how impact varied among the intervention components and demonstrates that some different forms of media may be best used based on gender or desired outcome.

The critical role of communities in reaching global targets to end the AIDS epidemic

23 Jun 2016 12:17:33 GMT

This report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Stop AIDS Alliance draws on multiple sources to document the many ways in which communities are advancing the response to AIDS and to explore evidence for the effectiveness of these responses. Four core areas of community-based responses to HIV include: (i) advocacy, campaigning, and participation in accountability; (ii) community-based service delivery; (iii) participatory community-based research; and (iv) financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other funders. Each of these areas is illustrated in the report by examples of community-based actions from various countries and contexts around the world. Network Contact: UNAIDS SecretariatJanuary 26, 2016Categories:GlobalStrategic ThinkingAdvocacyEliminate Stigma and DiscriminationImpact Evaluation DataCommunity ParticipationEmpower MSM Sex Workers TransgenderEnhance Social ProtectionEvaluation MethodologiesPerson-to-PersonInterpersonalEliminate Gender InequalitiesMDG 6. Combat DiseasesIncrease antiretroviral accessResearchAvoid TB DeathsHIV AIDSNGOsPrevent HIV amongst Drug UsersReduce Sexual TransmissionRemove Punitive Laws and PoliciesTreatment, Care and SupportUnited NationsRightsFeaturedUNAIDSHealth Communication - AfricaGlobalHIV/AIDS - AfricaHealth, Rights and MediaHealthHIV / AIDSAfricaGive it 1/5Give it 2/5Give it 3/5Give it 4/5Give it 5/5No votes yet0 Publication DateAugust 18, 2015"Communities were the first responders to HIV three decades ago, and they remain essential in advocating for a robust response to the epidemic, delivering services that can reach everyone in need and tackling HIV-related stigma and discrimination."This report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Stop AIDS Alliance draws on multiple sources to document the many ways in which communities are advancing the response to AIDS and to explore evidence for the effectiveness of these responses. Four core areas of community-based responses to HIV include: (i) advocacy, campaigning, and participation in accountability; (ii) community-based service delivery; (iii) participatory community-based research; and (iv) financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other funders. Each of these areas is illustrated in the report by examples of community-based actions from various countries and contexts around the world.Despite what the report characterises as "substantial achievement" over 30 years of response to HIV - with communities at the forefront of action - challenges remain. For example, gender inequalities faced by young women in sub-Saharan Africa - and stigma and discrimination faced by people living with HIV in other key populations globally - can lead to denial of access to, or deterrence of people from seeking, vital services. In addition, legal and sociopolitical environments such as punitive laws or abusive law enforcement can obstruct effective access to and delivery of services. Because "communities give a voice to those who need services, provide feedback as to whether policies and programmes are working and suggest how they can be improved", they are key participants in responses that: generate positive health and development outcomes and strengthen health systems; safeguard the rights of those they reach and serve; mobilise communities, including marginalised, socially excluded, and crimina[...]

Empower young women and adolescent girls: fast-track the end of the AIDS epidemic in Africa

23 Jun 2016 12:04:44 GMT

"To be effective, any health and development agenda needs to focus on the root causes of the gender gap, and the AIDS response is no different."This report was produced to guide regional and global advocacy and inform political dialogue, particularly within discussions and planning being shaped as part of the African Union Agenda 2063 and the post-2015 sustainable development agenda, in order to consider actions needed to achieve the goal of ending the AIDS epidemic as a public health threat by 2030. The report centres on the understanding that this requires taking action to target the root causes of young women and girls' vulnerability, largely arising from harmful gender norms and inequality.The report offers five key recommendations:Women's agency, participation and leadership: By empowering women as political and social actors, institutions and policies can become more representative of diverse voices, including those young women and girls. This should include young women living with and affected by HIV being part of policy and decision-making bodies and ensuring women's participation in humanitarian situations.Strategies to reduce intimate partner violence and reduce vulnerability to HIV: "Strategies and action implemented at the community level to address intimate partner violence are critical to reducing young women's and adolescent girls' vulnerability to HIV." One example given is the Raising Voices SASA! kit, which was designed to inspire and guide community mobilisation to prevent violence against women and HIV. "Community activists spearheaded a wide range of activities in their own neighbourhoods designed to decrease the social acceptability of violence by influencing knowledge, attitudes, skills and behaviours on gender, power and violence."Scaling up social protection and cash transfers to reduce poverty and girls' vulnerability to HIV: According to the report, in the context of comprehensive social policies and programmes, "households affected by HIV are an appropriate target for cash transfer programmes that aim to alleviate poverty. Cash transfers can achieve multiple simultaneous outcomes, including declines in early marriage and teenage pregnancy."Strategies to keep girls in school and comprehensive sexuality education: Evidence shows that education contributes to a higher level of knowledge about HIV and sexual and reproductive health and rights, lowers exposure to gender-based violence, and increases women's and girls' chances of being financially secure and independent. As well, "when young women and adolescent girls have access to comprehensive age-appropriate sexuality education before becoming sexually active, they are more likely to make informed decisions about their sexuality and approach relationships with more self-confidence."Scaling up and integrating HIV with sexual and reproductive health services: "A massive scale-up of comprehensive and youth-friendly sexual and reproductive health and HIV services for young women and adolescent girls should be planned and rolled out, taking into consideration rapid population growth. " This would include condom programming designed to reach young people, removing barriers around reproductive health services such as parental and spousal consent, and ensuring access to youth-friendly sexual and reproductive health services.The report concludes that "Fast-tracking the end of the AIDS epidemic by 2030 requires strong political leadership[...]

Access, Services and Knowledge (ASK) Programme - essential packages manual

23 Jun 2016 11:53:46 GMT

The Essential Packages Manual was produced as part of the "Access, Services and Knowledge" (ASK) programme of the Youth Empowerment Alliance, which seeks to improve the sexual and reproductive health rights (SRHR) of young people (15-24 years) by increasing their uptake of SRH services in Kenya, Uganda, Ethiopia, Ghana, Senegal, Pakistan, and Indonesia.

The manual is designed to help partners understand the main concepts, principles, and values of the ASK programme, and provides information and practical tools designed to assist partners to reach programme objectives. This includes information about SRHR and related services for young people, as well as guidance in creating an enabling environment and integrating SRHR, HIV/AIDS, and meaningful youth participation into programming.

The publication includes tools for self-assessment to help identify partners’ own progress and areas requiring support. It also includes roadmaps with practical steps to move towards desired project results, and outlines available tools, guidelines, protocols, and standards.

The manual includes the following contents, organised around key result areas:

  • Values and Principles
  • Result area 1: Direct SRHR information for young people
  • Result area 2 & 3: SRH services for young people
  • Result area 4: Creating an enabling environment
  • Cross-Cutting Strategies: Integrating SRHR and HIV, meaningful youth participation

Empowering each other: young people who sell sex in Ethiopia

23 Jun 2016 11:31:28 GMT

This 12-page case study discusses the experience of a peer education project in Ethiopia, which trained young people who sell sex to reach out to their peers and lead sexual and reproductive health and rights sessions, supported by trained nurses and a referral system for services. The project was led by the Organisation for Support Services for AIDS (OSSA) as part of Link Up, a five-country programme working to improve the sexual and reproductive health and rights (SRHR) of one million young people most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda. The Ethiopian initiative was created to fill both knowledge and service gaps to ensure that young people who sell sex have access to both adequate information and services about their SRHR in order to stay healthy.The case study outlines a number of challenges faced by the peer educators and nurse counsellors. This includes group dynamics in which some groups did not bond and in other cases group members did not always respect their peer educator. Group members also sometimes requested additional refreshments (beyond the coffee and bread already provided) to come to sessions. In addition, the priorities of young people who sell sex are often not SRHR-related, but rather the need to provide housing, food, and clothing for themselves and their families, plus the need to attend school or start a business.The case study offers a number of lessons learned:Role of peer educators -“ Peer educators speak the same language as their peers, are good at facilitating conversation, can answer questions clearly, and talk openly about sensitive issues. They play an important role in identifying session participants as well as setting appropriate times and locations for sessions. They are often seen as role models by their peers"Role of nurse counsellors - "The nurse counsellors are critical to this intervention. They provide peer educators with support, enhance their knowledge and instil confidence in them. Nurse counsellors provide a critical service by assisting young people who sell sex to health facilities"Locations and times of peer education sessions - “It is important to hold sessions at times convenient to, and agreed by, group members otherwise this may become a barrier to participation"SRHR and HIV must be integrated - “During the project, a significant number of young people who sell sex reported experiences of unplanned pregnancy and STIs as well as living with HIV. These stories remind us of the importance of integrating SRHR and HIV information and services. This means addressing a range of SRHR and HIV issues in the peer education sessions and ensuring that information, education and communication materials speak about dual protection and the use of condoms for protecting against both pregnancy and HIV and other STIs. It also means ensuring young people who sell sex know they can access a range of services at health facilities"Recognising the priorities of young people who sell sex - “It is important to recognise that young people who sell sex may share a range of experiences and needs during peer education sessions including the need for housing, food, employment opportunities and education plus psychosocial support to respond to violence, stigma, discrimination and other issues"Promoting good experiences - "When young people who sell sex have experienced sensitised and sup[...]

Breaking down barriers: empowering young people living with HIV in Uganda

23 Jun 2016 11:18:54 GMT

"Link Up’s experience in Uganda demonstrates the success empowered young people living with HIV can have in achieving greater access to SRHR and HIV services for their peers. Building a strong team of peer educators who were visible and proud of their work proved the foundation for service provision in the project.”

This is a key outcome outlined in this 16-page case study discussing the experience of the Link Up Project in Uganda, which was designed to increase access to integrated and quality sexual and reproductive health and rights and HIV information, as well as commodities and services, for young people living with and most affected by HIV. Between October 2013 and March 2015 the Link Up Project used peer educators, along with improving youth-friendly health services, to address barriers facing young people in accessing reproductive health services, such as lack of knowledge, skills, and youth-friendly services.

The case study first explains the context of the programme and then goes on to describe the main component of the programme - the use of peer educators.

According to the case study, through the project young people who are normally hard-to-reach were brought closer to SRHR and HIV services, and many were referred for antiretroviral therapy enrolment. Between 2013 and 2015 the project:

  • "Reached 5980 young people living with HIV with SRHR information, counselling and services in their own communities
  • Reached 3794 young people living with HIV with SRHR information, counselling and services in health facilities and through clinical outreach
  • Made 224 completed referrals of young people living with HIV to health facilities"

Tsima community mobilisation materials

23 Jun 2016 11:01:43 GMT

This three part package of materials comprising of a handbook, workshop manual, and toolkit, are designed to support community mobilisation activities around the issue of treatment as prevention. The materials were produced to support the Tsima Community Mobilisation Programme, which aims to "mobilise communities to "Activate HIV Treatment as Prevention"by dramatically increasing community uptake of HIV testing and antiretroviral treatment (ART)."

As stated in the materials, "research shows that ART protects the health of someone living with HIV and greatly reduces the chance that that person will transmit HIV to an uninfected partner. When taken correctly and consistently, ART reduces the amount of virus (or the "viral load") in a person's body so much that it becomes undetectable (i.e. very small numbers of the virus), so there is little virus that can be passed on to an uninfected partner. If a large enough proportion of people get tested, start treatment as soon as they are eligible, and stay on treatment for HIV in our communities, very few people will become infected."

The three Tsima booklets are:

  • Tsima Booklet 1: Community Mobiliser's Handbook - This handbook is intended to be a resource for community mobilisers working with Sonke's community action teams (CAT) to engage men and women on issues of gender, HIV prevention, care and treatment, violence, and human rights.
  • Tsima Booklet 2: Community Mobilisation Workshop Manual - This manual is intended as a resource for community mobilisers and CAT members to guide a series of five two-day workshops. Each workshop has a different set of activities, but many of the same themes around social justice, gender equality, and engaged citizen activism are addressed in all of the workshops.
  • Tsima Booklet 3: Community Mobilisation Toolkit - This toolkit is intended to be used by community mobilisers and CAT members to undertake community-based activities such as street soccer, community theatre, digital stories and engaging community leaders. Some activities may be undertaken in teams or as a group, understanding that the widest input leads to the best result. Mobilisers/CATs can implement only one activity at a time, or combine them to form a larger campaign.

One youth can: facilitator's guide and workbook

23 Jun 2016 10:39:14 GMT

South Africa has amongst the highest levels of domestic violence and rape of any country in the world. Research conducted by the Medical Research Council in 2004 shows that every six hours, a woman is killed by her intimate partner. This is the highest rate recorded anywhere in the world.

This Manual is intended to be a resource for those working with youth on issues of citizenship, human rights, gender, health, sexuality and violence. The content is informed by a commitment to social justice, gender equality and engaged citizen activism. The activities encourage all youth to reflect on their own experiences, attitudes and values regarding sexuality; gender; what it means to be a boy/man or girl/woman; domestic and sexual violence; HIV/AIDS, democracy and human rights. They encourage all youth to take action to help prevent domestic and sexual violence, reduce the spread and impact of HIV and AIDS, and promote gender equality.

There is an accompanying Participants' Manual.


Tiyani Vavasati: empowerment and financial education intervention

23 Jun 2016 10:25:49 GMT

Specifically aimed at females between the ages of 18-24 years-old, this training manual was produced to guide a series of training sessions which were designed to empower young women. Part of a Sonke Gender Justice project implemented in South Africa, the four one-day long training sessions, are meant to:

  • "empower young women to set goals for their lives
  • increase young women's knowledge of correct reproductive health and HIV information, as well as promote HIV testing
  • help young women learn to recognise and address gender-based violence
  • teach young women how to make sound financial decisions; and
  • reinforce and promote attitudes and behaviours that will lead to a better quality of life for the young women"

Hosted over the course of a month, each training day consists of a morning classroom-based session where young women engage in both informative learning and interactive exercises, and then an afternoon session where they participate in a field trip. These morning sessions "are designed to be engaging, interactive, and make use of best practice young adult learning principles - that is games, small group work, etc., while focusing on pertinent topics to the lives of the young women." The afternoon sessions build on information learned in the morning and give the young women a chance to visit a local resource in the community, such as a clinic.

This manual is divided into four modules:

  • Module 1: Introduction, Self-Esteem, and Goal Setting
  • Module 2: Reproductive Health, HIV
  • Module 3: Gender-Based Violence
  • Module 4: Financial Education

According to Sonke Gender Justice, "young, rural, South African women are faced with many challenges that can impede a healthy transition from young person to adult. These include age-specific social pressures, lack of correct health knowledge, and lack of safe, economic opportunity." Tiyani Vavasati aims to intervene on some of these root issues, instilling useable assets into the young women. This manual was adapted, in part, from the 2013 Adolescent Girls Empowerment Program, Health and Life Skills and Financial Education Curricula published by Zambia YMCA, UKAID, and Population Council. Additional materials come from Sonke Gender Justice, South Africa.


Vunja Ukimya, Zungumza na Mwenzio: a mass media campaign to motivate couples to communicate effectively for HIV-free households

23 Jun 2016 10:15:33 GMT

Vunja Ukimya, Zungumza na Mwenzio: A Mass Media Campaign to Motivate Couples to Communicate Effectively for HIV-Free Households

"As a result of the campaign, couples were motivated to communicate about health, and men and women were more likely to seek reproductive health services together."

This was one of the key results of the Vunja Ukimya. Zungumza na Mwenzio (Break the Silence. Talk to your partner) campaign in Tanzania. The campaign was launched in 2010 as part of the CHAMPION project, a six-year initiative (2008-2014) to increase men's positive involvement in preventing the spread of HIV in Tanzania. The 5-month national social and behaviour change communication (SBCC) campaign was designed to encourage couples to communicate more effectively for healthier, more equitable relationships and to prevent the spread of HIV. "Campaign messages focused on the role of gender equity in ensuring health, and targeted individuals, couples, and communities in promoting dialogue around HIV, gender equality, and positive health-seeking behavior." The brief forms part of a series of CHAMPION briefs to highlight some of the project's achievements.

The brief explains the campaign approach, which used radio, television, national newspapers, billboards, and outreach events and activities to reach audiences of adult men and women over the age of 25 and in established, longer-term relationships. The roll-out occurred in phases, beginning with a teaser phase, followed by a two month "problem phase" that also incorporated a World Cup sub-campaign, and then a "how to" phase, highlighting and demonstrating the health benefits of effective communication between partners. The messages focused on positive couple communication and used food as a metaphor for relationships, "indicating that both (dinner and happiness) require preparation and care to achieve the desired results."

The following are a selection of lessons learned:

  • campaign slogans need to be specific, should not reinforce gender inequality, and should use language not specific to particular regions within a country;
  • large events, public gatherings, holidays, and international events are key opportunities to increase awareness about gender and health;
  • combining entertainment with community dialogue (as used in the Vunja Ukimya Activation Tour) is an effective way to communicate campaign messages.

Overall, the assessment of the Vunja Ukimya campaign was that it was widely well received, with community members responding positively to the promotion of couples being close and the concept of "transparency" within relationships.

Engaging local media in VMMC scale-up: a case study from Kenya

23 Jun 2016 04:54:09 GMT

This case study discusses how media can play a positive role in promoting voluntary medical male circumcision (VMMC) as part of HIV prevention efforts, or can fuel fears and discourage VMMC through sensationalist, inaccurate, or negative coverage. Content analysis conducted in 2012 by the United States Agency for International Development (USAID) and AVAC (a global advocacy group for HIV prevention) found that Kenya's successes in VMMC roll-out were coupled with strong media coverage. This case study documents the experience of engaging with the media during VMMC rollout to Kenya's traditionally non-circumcising communities, highlighting the lessons learned, to assist other countries in their VMMC scale-up efforts.

The case study notes that "early and ongoing engagement of all relevant stakeholders has been critical to the successful rollout of Kenya's VMMC program". Government, non-governmental organisations, and media organisations all collaborated to support media outreach activities such as conducting roundtables, briefings, and media tours, as well as providing experts and training spokespersons in strategic communications. As stated in the report, "Such collaboration helped ensure that the stories were based on real field experience and expert analysis of communication gaps in the community." It also helped ensure that stories complemented public service announcement (PSA) campaigns and other communication efforts.

In terms of outcomes, the case study states that "early and ongoing engagement with journalists in Kenya has paid off with frequent, accurate media coverage of VMMC, which has helped to create a supportive environment for scale-up."

The document highlights the following as key lessons learned:

  • strong partnerships among the MOH [Ministry of Health], donor, and implementing partners are essential to effectively address misunderstandings and controversy around VMMC
  • when all elements of the 'communications ecology' are connected and each plays its distinct part, their impact is magnified
  • frequent, accurate coverage of VMMC requires ongoing engagement with a cadre of journalists who already know the basic science of HIV and can be nurtured as specialist health reporters
  • engaging journalists at the beginning of a programme sets a positive tone for ongoing collaboration between project staff and journalists during the life if the project
  • consistent attention to interpersonal relations between journalists and government officials helps prevent the escalation of issues - allowing for rapid outreach to allies who can provide correct information when necessary
  • monitoring media coverage is critical to identify and correct inaccuracies quickly

Findings from the SASA! Study: A Cluster Randomized Controlled Trial To Assess the Impact of a Community Mobilization Intervention To Prevent Violence Against Women and Reduce HIV risk in Kampala, Uganda

23 Jun 2016 04:03:39 GMT

The need for HIV prevention efforts to more explicitly incorporate program elements to address gender inequality and violence has been repeatedly articulated, and the elimination of sexual and gender-based violence has been identified by the Joint United Nations Program on HIV/AIDS (UNAIDS) as being one of the core pillars of HIV prevention.

Recognising that intimate partner violence (IPV) is an independent risk factor for HIV infection, researchers in this SASA! study sought to assess the community-level impact of SASA!, a community mobilisation intervention to prevent violence and reduce HIV-risk behaviors.

This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved
important community impacts, and is now being delivered in control communities and replicated in 15 countries.

A Kenyan newspaper analysis of the limitations of voluntary medical male circumcision and the importance of sustained condom use

23 Jun 2016 03:53:51 GMT

This analysis of Kenyan media treatment of condom use has the objectives of: (1) investigating promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gaining insight into popular understandings of the limitations of this new procedure through newspaper reader comments.

Because the results of three clinical trials in sub-Saharan Africa indicate that male circumcision may provide a protective effect of approximately 60% against the acquisition of HIV in heterosexual males, voluntary medical male circumcision (VMMC), has been promoted in Kenya.

This study searched the independent East and Central African newspaper the Daily Nation, using as a qualitative thematic analysis. "Following this sampling framework, a total of 34 online media articles published during a two-year period between January 1, 2008 and December 31, 2010 were selected for final coding and analysis. This period coincided with the launch and expansion of the Kenyan VMMC programme." The study utilised the newspaper's website for both news and Op/Ed articles and included reader comments in the analysis. Researchers included a placement analysis on the assumption that more readers scan the beginning of articles than finish them.

Among the recommendations:

  • the government could provide regular news releases or information sessions to the media, which communicate the procedures’ partial protection
  • continued monitoring is needed to ensure media messaging concerning VMMC includes discussion of limitations and encourages condom use following circumcision
  • further research should be conducted to investigate whether the general public understands that VMMC does not completely protect them from HIV infection and the importance of sustained condom use whether or not they are circumcised. This research could involve surveys of people’s attitudes or employ more qualitative methods of focus group discussions and interviews

Visions, voices and priorities of young people living with and most affected by HIV

23 Jun 2016 03:44:53 GMT

This 30-page report shares perspectives and insights from young people from around the world living with and affected by HIV, who share their visions for realising and claiming their sexual and reproductive health and rights (SRHR) and for setting priorities for HIV and SRHR integration. The publication was produced by the Link Up project, as part of discussions held to help advocate for young people to be a priority when setting development agendas, particularly within the emerging post-2015 framework.

The Link Up project is being implemented by a consortium of global and national partners, working with young people aged 10 to 24 years old, with a specific focus on young men who have sex with men, young people who do sex work, young people who use drugs, young transgender people, and young women and men living with HIV. Two consortium partners, the Global Youth Coalition on HIV/AIDS (GYCA) and the ATHENA Network led consultations with young people, which involved nearly 800 people from around the world who responded to a global online survey, and over 400 young people who participated in a series of community dialogues and focus groups with national partners in Ethiopia, Uganda, Burundi, Bangladesh, and Myanmar.

The report discusses five "vision areas for positive change" that emerged from the consultations, and outlines the related recommendations that emerged, which speak to young peoples’ shared perspectives on what is needed to achieve real progress. For each vision area, a case study of a Link Up best practice that could be replicated is profiled, to help inspire implementation of the recommendations.

HIV/AIDS vulnerabilities, discrimination, and service accessibility of Nigeria's youth

23 Jun 2016 03:30:21 GMT

Nigerian youth continue to be a vulnerable group. The imbalance between high-risk sex, condom use in high-risk sex, and uptake of HIV testing raises concern for HIV prevention. This young population should have access to comprehensive SRH services and youth-focused sexuality education that goes beyond abstinence-only messages.

This is the key conclusion outlined in this report which discuss findings of a study conducted between August 2011 and July 2012 to: provide a comprehensive, evidence-based picture of HIV and sexual health and rights (SHR) related issues facing Nigerian youth; as well as explore legal, policy, and programmatic responses. The study was designed to inform a more focused approach for youth within the national response to HIV, particularly around responding to youth needs and vulnerabilities, including stigma and discrimination, especially for the most vulnerable populations such as men who have sex with men, the lesbian, gay, bisexual, transgender and intersex (LGBTI) community, female sex workers, married adolescents, orphans, prisoners, and migrants.

Based on the results of the study, the following recommendations are made:

  • improving sexual health-seeking behaviors, especially uptake of HCT and condom use by all youth, through a combination of youth-accessible communication channels, is imperative
  • evidence-based advocacy needs to be targeted at policymakers and donors to bring greater attention to the youth dimensions of the HIV epidemic, especially in relation to neglected vulnerable youth
  • innovative operational research is called for to better understand how to increase the meaningful involvement of young people in the conception, planning, and implementation of SRH and HIV/AIDS policies and programs
  • efforts to promote the mainstreaming of youth-friendly SRH and HIV services are required given the challenges of scaling up and sustaining the few model stand-alone services provided largely by nongovernmental organizations (NGOs)
  • a strong case exists for systematic domestication of key international regional protocols.
  • alignment of national and subnational laws and of civil, customary, and religious laws need to be advocated for strongly to ensure that laws and policies are not contradictory, and implementation of existing youth-specific laws and policies need to be improved
  • the National Agency for the Control of AIDS (NACA) must live up to its oversight function of ensuring that young people are not neglected in national HIV policies and programs
  • the government needs to increase funding and demonstrate ownership and sustainability of youth-based HIV programs

Shuga: engaging Tanzanian young people in HIV prevention through edutainment radio

23 Jun 2016 03:07:04 GMT

The Shuga radio serial drama is an evidence-based and participatory behaviour change communication edutainment drama designed to increase demand for HIV testing and counselling (HTC) and condom use among sexually active youth aged 15-24 years. The 12-episode drama series was developed in collaboration with UNICEF, MTV and HIV and AIDS Free Generation, together with government representatives and young people from six participating countries - Tanzania, Kenya, the Democratic Republic of the Congo (DRC), Lesotho, South Africa and Cameroon.

This report highlights key results and lessons learned from implementation of the first phase of Shuga radio, initiated by UNICEF Tanzania in a partnership with UNESCO and in collaboration with TACAIDS, MOHSW and key partners including JHU-CCP, PSI, T-MARC, PASADA, Baylor, Restless Development and SUMASESU and broadcast partners Tanzania Network of Community Radios and Clouds FM.

Lessons learned:

Multisectoral support is needed to design successful behavior change communication programs. Much of the success of Shuga radio is because of the support obtained from key partners at community level, the Shuga Advisory Committee, partnership with UNESCO. Moreover, within UNICEF planning, monitoring and evaluation colleagues played a big role in supporting the M&E design and data analysis, and communication advocacy and partnership colleagues supported in Facebook posts and linking Shuga radio serial drama to Radio 5.

Although there is a challenge of attribution of a particular social behaviour change communication activities to HTC outcomes, use of multiple M&E approaches generated the assertion that radio was among the top three sources of information for young people about HTC (along with health workers and teachers) and suggested that more efforts should focus on adolescents, who were less likely than young adults to be aware about HTC and to report being HIV tested.

Building the assets to thrive: addressing the HIV-related vulnerabilities of adolescent girls in Ethiopia

23 Jun 2016 02:51:22 GMT

When HIV prevention programs are shaped by evidence and designed for replication and scale-up, they can reach large numbers of the girls and young women at greatest risk and increase their ability to avoid infection.

In Eastern and Southern Africa, HIV is the leading cause of death among girls aged 15–19. Despite decades of investment and substantial progress against HIV, adolescent girls remain at disproportionate risk of infection.

Few programs have sought to take a “whole girl” approach to addressing the multiple vulnerabilities to HIV infection—social isolation, economic insecurity, lack of access to services, and sexual and gender-based violence—experienced by the most marginalized adolescent girls in the poorest communities in Africa.

Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia is a comprehensive review of three programs implemented and evaluated by the Population Council and the Ethiopian government beginning in 2007: Biruh Tesfa, Meseret Hiwott, and Addis Birhan. These
programs seek to reduce Ethiopian girls’ HIV risk by using similar methods to engage girls—and, in the case of one program, the males who play a role in their health and well-being.

This policy brief summarizes Building the Assets to Thrive to provide policymakers and program planners with a road map for creating and supporting evidence-based, locally responsive, simple, effective, scalable, and sustainable programs that produce positive outcomes for girls and their communities.

On the fast-track to end AIDS: UNAIDS 2016 - 2021 strategy

23 Jun 2016 02:37:14 GMT

This document outlines the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2016-2021 strategy to end the AIDS epidemic as a public health threat by 2030. The strategy maps out the UNAIDS Fast-Track approach to accelerating the AIDS response over the next five years with the aim of reaching the following goals or milestones by 2020: fewer than 500,000 people newly infected with HIV, fewer than 500,000 people dying from AIDS-related causes, and elimination of HIV-related discrimination. By reaching these targets, the strategy hopes to be on track towards ending the epidemic by 2030, when the target is Zero new HIV infections, Zero discimination, and Zero AIDS-related deaths.

Gender considerations along the HIV treatment cascade: an evidence review with priority actions

23 Jun 2016 02:25:33 GMT

This brief provides policymakers and programme implementers with evidence about the impact of gender dynamics on treatment access and adherence and the gender-related gaps in treatment research and programming. It also raises questions for implementation science in order, by 2020, to achieve the global goals set out by the Joint United Nations Programme on HIV/AIDS (UNAIDS): 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy (ART) will have viral suppression. The brief draws from What Works For Women and Girls: Evidence for HIV Interventions and uses the World Health Organization (WHO) treatment cascade framework to identify and analyse major gender considerations in providing ART to those living with HIV in low- and middle-income countries.

The brief concludes with an argument that all ART programming must include respect for human rights. For example: "Requiring people living with HIV to disclose their serostatus to sexual partners and/or community members in order to receive treatment, care or support is a human rights violation. Similarly, coercing women to accept contraception in order to access treatment violates women's rights to make their own fertility choices." The authors note that there are few evaluated interventions demonstrating what works to overcome gender-related barrier to ART treatment. Future studies should ask questions such as "how can ART availability and accessibility be partnered with informed consent about the risks and benefits of treatment so that all people living with HIV may decide for themselves how best to stay healthy and live full, productive lives?"

Mobilising a response to HIV, gender, youth and gender-based violence in South Africa: a toolkit for trainers and programme implementers

21 Jun 2016 04:42:54 GMT

This toolkit was produced as part of the Sexual HIV Prevention Project (SHIPP) to support in-house training on gender, HIV, youth, and community mobilisation for programme implementers working on HIV and gender-based violence (GBV) prevention at the district and community levels. The toolkit modules cover a range of topics and can be selected based on organisational needs and specific knowledge gaps among staff and volunteers. According to the toolkit, "an advantage of the modular arrangement is that rather than having to set aside large blocks of time for training workshops, exercises and modules can be conducted on a stand-alone basis through sessions as short as two to three hours, or, if time permits, over a day or several days, or intermittently over a number of weeks or months." The toolkit also provides a detailed outline of the key principles and techniques of participatory learning.

The following topic areas are covered:

  • Module 1: Gender concepts and definitions
  • Module 2: Gender roles and change
  • Module 3: GBV: intimate partner and non-partner domestic violence
  • Module 4: Links between GBV and HIV
  • Module 5: Gender and HIV policies
  • Module 6: Gender analysis and engaging men and boys
  • Module 7: Mobilising community action teams through community facilitators
  • Module 8: Youth vulnerability, HIV and GBV

Community matters: fostering community-level champions in addressing HIV and gender-based violence in Tanzania

21 Jun 2016 04:08:08 GMT

Local activists, leaders, and experts are best positioned to challenge the harmful social and gender norms within their communities that contribute to HIV transmission, gender-based violence (GBV), and other poor health outcomes.This brief discusses the experience of the CHAMPION Project in Tanzania, which trained and supported community partners in 14 urban districts in 10 regions of Tanzania to plan and implement gender transformative HIV and gender-based violence (GBV) prevention activities in their communities. The project used community-level 'champions' to lead local actions to raise awareness about HIV and GBV, champion equitable gender norms to promote long term behaviour and social change related to sexual and reproductive health (SRH), and encourage community members to test for HIV. These community champions were found to be critical allies within Tanzania's HIV prevention efforts, a "promising approach to engendering social change and improving sexual and reproductive health outcomes." This brief forms part of a series of CHAMPION briefs to highlight some of the project's achievements.The brief discusses the importance of partnerships across various levels of intervention, including working with local partners to identify champions to serve as change agents; building partners' capacity around in-depth understanding of gender norms; and building leadership, communication, and community mobilisation skills. These community-level partners "planned and led a variety of activities in their communities to create awareness, promote behaviour change, and stimulate community dialogue about gender norms, HIV, SRH, and GBV." Their activities included community dialogues, discussions, video shows, street dialogues and theatre, health fairs, sporting events, and rallies, all of which are briefly explained in the publication.Based on learning from the project, the brief outlines a number of recommendations:Go local: " interventions and related capacity building must be tailored to specific communities and to the partners who are working to lead social change. Efforts should be made to identify audio-visual materials that resonate with community members. The more 'foreign' the messenger, the less likely the message is to resonate."Creativity matters: Messages should be "clever, catchy, persuasive, compelling, and tailored to the local context." They should provoke discussion and reflection, rather than reiterate facts people already know."Avoid the blame game: Positive approaches can best contribute to a more constructive dialogue about gender norms, why inequities exist, how they are harmful, why challenging them is important, and how they can be transformed.Programme holistically: Programmes should ensure that community capacity building and engagement is accompanied by the availability and accessibility of health services. "Service providers must also have the capacity, resources, and commodities available that[...]

CoupleConnect: a gender-transformative approach to HIV prevention for Tanzanian couples

21 Jun 2016 03:38:44 GMT

Couple connectedness is defined as the quality of the emotional bond between partners that is both mutual and sustained over time. For couple connectedness to exist, it must be experienced by both partners in the relationship who are committed to practicing these behaviors..."This was the core principle underlying CoupleConnect, a gender-transformative curriculum developed by the CHAMPION Project in Tanzania to help couples communicate more effectively about relationship challenges as a way to foster improved sexual and reproductive health and prevent HIV. Created in 2011, the CoupleConnect curriculum was used to guide group education workshops designed to provide couples with insights, information, and skills needed to increase their "connectedness," considered an important determinant of healthy sexual and reproductive health (SRH) behaviour.The brief explains that "couple connectedness is operationalized by nine determinants of sexual behavior focused on mutual trust and support, communication, financial planning and management, shared goals, love and affection, joint decision making, achievement and maintenance of RH, and conflict resolution." The 15-session CoupleConnect curriculum was designed specifically for Tanzania through a process that included stakeholder meetings and key informant interviews, followed by a pilot project in nine districts. Couples participated in sessions using interactive teaching methodologies, such as large-group and knee-to-knee couple discussions, fishbowls, and other adult learning games. Workshop results were assessed through a comparison of questionnaires to assess attitudes, beliefs, and knowledge related to "couple connectedness."The brief offers a number of recommendations:Tailor Interventions to Meet Couples' Needs: Workshops should consider education and literacy and group similar sets of couples. The implementation should also respond to identified needs. For example, during the pilot the intervention was adapted from a two-month intervention to an intensive three-day course, which improved attendance and participation by both partnersInvolve Community Leaders in Implementation: Implementation and recruitments should happen at ward level, as participants then have greater connection to the facilitators who come from the community. Likewise, obtaining intervention buy-in from local authorities and leaders (e.g., community, religious) is criticalEnsure Strong Facilitator Capacity and Equitable Interaction: CoupleConnect is facilitated by married co-facilitators. "The manner in which married co-facilitators communicate, negotiate, resolve conflict, and support each other is critical to the success of interactive, mixed-sex, gender-transformative programs like CoupleConnect. Cofacilitators must mirror the positive and gender-equitable communication skills that the curriculum promotes"Collect More In-Depth Data: In order to better understand how post-worksho[...]

The informal economy and decent work: a policy resource guide supporting transitions to formality

19 Mar 2016 02:42:09 GMT

This is a policy resource guide developed to build the capacities of ILO constituents in approaches that facilitate transitions to formality. Previous work has shown that the move out of informality requires approaches that are targeted, comprehensive and inter-disciplinary. Country experience shows that policies that are ad-hoc, piece-meal and in isolation from each other rarely have a sustained impact. The objective of this tool is thus to bring together a range of technical fields in order to enable an integrated policy approach. 

The Guide brings together selected examples both from within the ILO and from external sources; it highlights conceptual issues and practical experience in a range of technical fields, including ‘organisation, representation and dialogue’, ‘promoting equality and addressing discrimination’ and ‘entrepreneurship, skills development and finance’. The brief also provides a review of good practices and innovative approaches from different regions, and assesses lessons learned. Additionally, there is a section that provides a list of resources, which can be used to shape more effective strategies. 

Adapted from available summary.

Social protection programmes contribute to HIV prevention

18 Mar 2016 11:53:52 GMT

This brief describes the pathways through which social protection contributes to HIV prevention, particularly in addressing the social, economic and structural drivers of HIV in adolescents. Drawing on evidence from various studies of cash transfer programmes in Africa this brief finds that cash transfers contribute to preventing HIV by reducing risky sexual behaviour, reducing economic insecurity and improving access to healthcare. 

On the basis of the findings the brief provides a range of policy recommendations and considers the ethical considerations of conditioning cash transfers on HIV status. It also points to evidence gaps and makes research suggestions, which include understanding ‘transmission mechanisms’, the role of design features and accounting for the costs of implementing social protection. 

Adapted from authors' summary.

Cash transfers for HIV prevention: considering their potential

18 Mar 2016 11:49:53 GMT

Cash transfers programmes are increasingly being recognised for their potential to reduce poverty and achieve other social goals, such as improved health and education. Evidence from Malawi and Tanzania suggests that cash transfers can impact HIV-related behaviours and outcomes and, therefore, could serve as an important component of HIV prevention efforts. 

This paper reviews existing evidence on cash transfers for HIV prevention and provides suggestions for future research. The identified gaps include (1) understanding more about the mechanisms and pathways through which cash transfers affect HIV-related outcomes; (2) addressing key operational questions, including the potential feasibility and the costs and benefits of different models of transfers and conditionality; and (3) evaluating and enhancing the wider impacts of cash transfers on health and development. 

The author concludes that future studies should build on current findings to close the identified knowledge gaps and to collect additional evidence on the impacts of transfers in different settings. Finally, the author argues that in order for cash transfer programmes to be sustainable they need to be integrated with other sectors and programmes that address structural factors such as education and programming to promote gender equality and address HIV. 

Adapted from authors' summary.

How does a national poverty programme influence sexual debut among Kenyan adolescents?

18 Mar 2016 11:35:05 GMT

Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the precise mechanisms through which risk reduction occurs are not well understood. This report seeks to better understand the relationship between cash transfer and HIV risk by exploring three pathways through which cash transfer could affect sexual debut: schooling, socio-economic status and psycho-social status. Sexual debut is argued to be an appropriate measure since it has shown to have important implications for HIV risk. 

The study examines data on 1459 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, a programme which has shown to have an effect on postponing sexual debut among young people aged 15-25. However, none of the hypothesised mediators were found to greatly alter the main effect. 

The results show gendered patterns of effects, which the authors argue may explain why no mediating effects of cash transfer were observed. Further, the authors argue that overall results suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours. 

Adapted from authors' summary.

Is Violence against Women Preventable? Findings from the SASA! Study summarized for general audiences

01 Mar 2016 02:15:26 GMT

This report showcases the findings from the SASA! study, a cluster randomized control trial (RCT) of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda.

It summarizes the SASA! intervention’s comprehensive impact on intimate partner violence and HIV prevention, including effects on relevant attitudes and behaviors. The study compares two groups – communities that received SASA! programming (intervention communities) and those where no programming took place (control communities).  

SASA! An Activist Kit for Preventing Violence against Women and HIV

01 Mar 2016 01:12:25 GMT

SASA! is a comprehensive and user-friendly program tool to help organizations, institutions, and groups interested in mobilizing communities to prevent violence against women and HIV

An Assessment of the Outpatient HIV/AIDS Treatment Package Provided by the Philippine Health Insurance Corporation

24 Feb 2016 03:37:23 GMT

The Philippines is one of the few countries where the prevalence of HIV/AIDS remains relatively small. However, recent data show that while other countries have shown a decrease in the incidence rate for this disease, the Philippines has experienced a 25 percent increase in incidence rate for HIV infection. While the proportion of people living with HIV/AIDS accounts for less than 1 percent of the population, the country is clearly falling behind in attaining the Millennium Development Goal for this disease. Moreover, it is still evident that Filipinos continue to experience inequity and unequal access to health services for HIV/AIDS even with different interventions already in place.

The Philippine Health Insurance Corporation (PHIC) launched the Outpatient HIV/AIDS Treatment (OHAT) package in 2010 to improve accessibility and affordability of HIV/AIDS treatment. With already three years underway and continued growth in people infected with HIV/AIDS, an assessment of this benefit package looked into issues that hinder the utilization of this package. The benefit coverage, support value, and utilization rate for this benefit package were evaluated through a review of literature, costing analysis, and key informant interviews.

The results of this study show that there is a need to enhance the OHAT package, as this is not fully utilized despite the increasing number of people living with HIV/AIDS who are in need of treatment. Addressing underutilization and retention among PHIC members will involve expanding coverage benefits to patients at different stages of the disease, increasing patient awareness, and improving claims processes. However, expanding access to treatment must also be coupled with preventive programs for HIV at the primary care level to maximize the benefits of this intervention and minimize financial out-of-pocket.