Preventing and Mitigating AIDS in Sub-Saharan Africa Research and Data Priorities for the Social and Behavioral Sciences (1996) / Chapter Skim
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APPENDIX A: PANEL VISITS TO THREE AFRICAN COUNTRIES, JANUARY 20-FEBRUARY 12, 1995
APPENDIX A: PANEL VISITS TO THREE AFRICAN COUNTRIES, JANUARY 20-FEBRUARY 12, 1995
Pages 315-339
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314 REFERENCES United States Department of Health and Human Services 1994 AIDS International Training and Research Programs: Fifth Year Progress Report and Cumulative Report for the First Five Years. Washington, D.C.: National Institutes of Health.
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The countries thus selected were Zambia, Tanzania, and Cameroon. Zambia is a country with a mature epidemic that is being countered with a coordinated response from a strong Ministry of Health, including innovative workplace and traditional healer prevention programs.
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The team met with the national AIDS control program managers in each of the three countries, as well as many other government officials, social and behavioral scientists, donors, university researchers, policy makers, caregivers, and employees of national and international nongovernmental organizations. This appendix presents findings from the team's visits to Zambia, Tanzania, and Cameroon.i For each, it presents an overview of the current HIV/AIDS situation, summarizes the history of AIDS-prevention efforts, describes ongoing prevention and mitigation initiatives, and reviews the state of social and behavioral research.
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Each donor organization has its own readily identifiable AIDS prevention or control activities, but these are integrated reasonably well into the overall national strategy. In addition, a large number of national and international nongovernmental organizations operate throughout the country.
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To ensure the broadest possible base for consensus, the Ministry of Health invited to the workshop over 60 participants from other government ministries and departments, local and international nongovernmental organizations and parastatal organizations operating in Zambia, and representatives from bilateral and multilateral donors. The consensus workshop was followed by technical workshops in the areas of youth, women, the workplace, defense, management, and behavioral change.
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Workplace Peer Education and Counseling The Morehouse project, together with the Institute of African Studies of the University of Zambia, has designed and started implementing a workplace peer education and counseling model intended to reach 30,000 workers at approximately 300 sites over 3 years. The project has been designed to provide a mechanism whereby Zambian public- and private-sector employers can assume responsibility for, and institutionalize, a continuing peer education program that will increase STD/AIDS awareness, promote safer sexual behavior, and reduce STD/HIV transmission among their employees.
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Additionally, some healers counsel patients whom they believe to be seropositive that repeated unsafe sex will make them sicker. These preliminary findings about the project encourage further exploration of the potential role of traditional healers in HIV prevention and care.
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The State of Social and Behavioral Research In general, AIDS-related research activities have been largely uncoordinated in Zambia. Currently, multiple research activities are being carried out, but as far as the team could ascertain, they are not being coordinated by the National AIDS/ STD/TB & Leprosy Control Programme or by any other organization.
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A good number of individuals in Zambia have conducted research related to HIV/AIDS. Most have at least masters degrees in the social sciences from universities abroad, coupled with relevant experience at various levels of governmental or nongovernmental organizations.
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In 1988, the Technical Advisory Committee assisted in the creation of the Tanzanian national AIDS control program, which is now in its second 5-year Medium-Term Plan.
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The Nongovernmental Organization Strategy Tanzania is unusual among the countries visited by the team in that USAIDfunded interventions are channeled exclusively through nongovernmental organizations. This strategy arose from concerns on the part of the USAID mission that there was a divergence between the mission goals and the GPA-linked national AIDS control program.
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The Nongovernmental Organization Strategy Tanzania is unusual among the countries visited by the team in that USAIDfunded interventions are channeled exclusively through nongovernmental organizations. This strategy arose from concerns on the part of the USAID mission that there was a divergence between the mission goals and the GPA-linked national AIDS control program.
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In sum, it remains to be seen whether this investment in nongovernmental organizations is effective, either in delivering appropriate services or in building sustainable programs. Social and Economic Mitigation of AIDS In addition to all the conventional components of USAID-funded AIDS Control and Prevention (AIDSCAP' projects, the Tanzania AIDS Project attempts to address directly the issue of social and economic mitigation of the impact of the epidemic, focusing especially on women and children.
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This table lists 12 research priorities and 7 data collection priorities and reviews the agendas of AIDS experts in Washington, the national AIDS control program, and the Tanzania AIDS Project. There is no agreement on any of the 12 research priorities among the three programs.
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The AIDS epidemic is at an earlier stage in Cameroon than in either Zambia or Tanzania, although it has experienced steady growth over the last decade. Currently, commercial sex workers in the large cities of Yaounde and Douala show infection rates of 20-35 percent.
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As discussed below, AIDSCAP has several specific interventions with commercial sex workers and university students and has a nationwide condom social marketing program (Population Services International)
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According to the director of the national AIDS control program, existing donor support funds about 50 to 60 percent of the current Medium-Term Plan, begun several years ago. The remainder of the plan is simply not being implemented.
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Commercial Sex Worker Project This project began as a pilot among Yaounde commercial sex workers and their clients in 1988; STD clinic patients were also added as a target group. The project began with only 15 peer educators.
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FOCAP The Cameroon Psychology Forum (FOCAP) is another local nongovernmental organization working in the area of social and behavioral research in Cameroon.
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Primary and secondary prevention programs are considerably more cost-effective than dealing with the costs of care and the indirect effects of the epidemic on the future of these countries. While government national AIDS control programs should be encouraged and helped to work toward sustainability, gradually reducing their dependency on foreign aid and introducing limited cost-recovery efforts, they are likely to need considerable financial and technical assistance for at least some 1020 years.
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5. There are some good examples of national AIDS control programs using HIV behavioral research results in program planning.
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These are crucial HIV-prevention areas about which we know very little. There is an urgent need for substantial research that goes beyond traditional health education for commercial sex workers and creatively reaches women and youth in a variety of venues.
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This means donor priorities may not match the priorities of national AIDS control programs. There is a need to consider introducing more flexibility into the process for directing funds to national AIDS control programs.
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There are certainly examples of excellent nongovernmental organizations that are doing good work, but not all these organizations are local or effective, and many have a need for technical training and assistance from the government national AIDS control programs. The optimal roles of government, nongovernmental organizations and donors in HIV prevention need further study.
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E.F. Ndyetabura, clinical AIDS/STDs, National AIDS Control Programme Justin Nguma, Tanzania AIDS Project I.S.
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