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2. A challenge for NGOs: Moving beyond awareness raising
   Last updated: 29.06.02
 
There is an emerging consensus around the world about the conceptual under-pinnings of a more effective response to the HIV epidemic. Many similar ideas are reflected in the “Best Practice” collection of UNAIDS, advocacy positions of networks like ICASO and GNP+, and evaluations from large multi-year programmes like the European Union’s AIDS Task Force and Family Health International’s AIDSCAP project. One key message is that programmes must do more than raise people’s awareness of HIV and AIDS. In many countries around the world, high levels of reported awareness of the basic facts of HIV and AIDS co-exist with an increasing incidence of HIV transmission, a worsening epidemic and inadequate care and support for people living with HIV and AIDS.

Despite this broad consensus, large numbers of NGO programmes on HIV/AIDS continue to depend on simple information dissemination, perhaps accompanied by condom distribution. An external evaluation conducted in 1996 of the Alliance’s first two years found that this was the case for most of the Alliance’s partner NGOs as well. It stated that: “IEC activities have been the main feature of NGO interventions to date... An increase in enabling rather than persuasive strategies is required” . The Alliance and its partners took up this challenge, focusing energies through 1997 and into 1998 on helping NGOs to “move beyond awareness raising”. This then became the theme of the first year of country seminars for “Community Lessons, Global Learning”. The key questions being addressed were: What does it mean to put “best practice” into practice? In the real world of complex community needs and organisational challenges, how do we actually promote effective behaviour change and care? And what processes help NGOs to get there?

The “Community Lessons, Global Learning” programme - and, therefore, this report - draws lessons from the Alliance’s experience in supporting HIV/AIDS prevention and care strategies which build on but move beyond the provision of information and the raising of awareness. It is based on the work of the Alliance’s linking organisations and their partner NGOs in developing countries in Africa, Asia and Latin America. For the sake of brevity, this ‘family’ (comprising the international secretariat, linking organisations and partner NGOs) will be collectively referred to as the Alliance.

To date, the Alliance has supported over 600 care and prevention initiatives with over 400 NGOs and community groups. The number of these initiatives moving beyond awareness raising has increased considerably since 1996. For example, in 1995, only 3% of projects in Burkina Faso were “moving beyond awareness.” By 1998, this figure stood at 93%.

This report describes the Alliance’s work toward the goal of HIV prevention. Its starting point is the recognition by Linking Organisations and their partner NGOs that this goal is not being, and cannot be, achieved by awareness-raising strategies alone. The report looks at the Alliance’s search for a richer understanding of the epidemic, one which permits a greater clarity about the meanings of risk and vulnerability in relation to community, and about the meaning of community in response, in HIV prevention.

Drawing lessons from the Alliance’s Linking Organisations and their partner NGOs, the report acknowledges that these lessons constitute a work in progress. The projects from which they are drawn are relatively young and there is a lack of impact evaluation data on which to base firm conclusions. However there is an emerging consensus within the Alliance ‘family’ about the concepts and practices of a more effective response to the HIV epidemic, one which works with communities and with the experience of community. The report articulates this consensus and its implications for achieving the goal of HIV prevention and care.

What does the Alliance mean by “moving beyond awareness raising”?

The Alliance uses the phrase “moving beyond awareness raising” to describe HIV/AIDS programmes that go beyond general information, education and communication (IEC), and focus on reducing vulnerability and ensuring behaviour change. Programmes which “move beyond awareness raising” often involve initiatives to address contextual issues - such as empowering women to address cultural barriers to discussing sex with their husbands and to develop negotiation skills for condom use. They may also combine community outreach work with the provision of practical services to enable people to reduce their vulnerability - such as STD treatment and counselling, and condom information and distribution.

Strategies for “moving beyond awareness raising”

The following are examples of the types of “moving beyond awareness raising” initiatives shared at Partners’ Meetings during the first year of “Community Lessons, Global Learning”:

....... through providing services

In Bangladesh, HASAB has supported JTS to integrate STD advice and treatment into community outreach, health information and counselling with a marginalised “sweeper” colony in Dhaka.

....... through participatory prevention activities

In Morocco, PASA/SIDA has supported Association Oued Srou, to use group discussions within socio-economic activities with poor young urban women in Khenifra.

....... through addressing contextual issues

In Cambodia, KHANA has supported IDA to develop strategies to address gender and power relations and to involve the local police and military, in their project with sex workers in Phnom Penh.

....... through mobilising marginalised groups

In the Philippines, PHANSuP has worked with IWAG to mobilise action and peer support within their programme with gay men in Davao City.

........ through harm reduction

In Bangladesh, HASAB has supported SHEASS to develop a harm reduction approach - including a needle exchange programme - with injecting drug users in Rajshahi.

...... through linking prevention and care

In the Philippines, PHANSuP has supported OCAFI to combine counselling and self-help services with integrating people living with HIV/AIDS into community prevention work in Olongapo City.

....... through community based care

In Burkina Faso, IPC/BF have supported La Bergerie in Ougadougou, to build on their prevention activities by combining out-patient and home-care, including providing basic drugs and training family members as care givers.

...... through self-help for people living with HIV/AIDS

In the Philippines, PHANSuP have supported Pinoy Plus, a self-help group for people living with HIV/AIDS, based in Metro Manila, to carry out peer counselling, income generation, advocacy and network building.

........ through the involvement of people living with HIV/AIDS

In Senegal, ANCS have involved people living with HIV/AIDS in its own priority setting and programme planning, including incorporating two members within their management committee.

...... through networks of people living with HIV/AIDS

In Ecuador, COMUNIDEC have supported the nascent National Network of People Living with HIV/AIDS to build their skills in organisational development and strategic planning.

Source: Beyond Awareness Raising
This is an extract from Beyond Awareness Raising: Community lessons about improving responses to HIV/AIDS, published by the International HIV/AIDS
Alliance in 1998.

To view the whole report follow this link

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 465 Kbytes).