Mainstreaming HIV into Water, Sanitation and Hygiene (WASH)

Southern AfricaHIV/AIDS Information Dissemination Service

HIV/AIDS INFORMATION : the power to make a differenceSAfAIDS - P O Box A509,Avondale, Harare, Zimbabwe, Tel: 263 4 336193/4, Fax: 263 4 336195, E-mail: [email protected], Website: www.safaids.org.zw Southern Africa

HIV/AIDS Information Dissemination Service

SAfAIDS - P O Box A509,Avondale, Harare, Zimbabwe, Tel: 263 4 336193/4, Fax: 263 4 336195, E-mail: [email protected], Website: www.safaids.org.zw

On the Road to HIV & On the Road to HIV & WASH Integration WASH Integration

Regional Management Regional Management Team MeetingTeam Meeting

22ndnd November 2012 November 2012 Siavonga, Zambia Siavonga, Zambia

Rouzeh Eghtessadi (MPH)

Southern Africa HIV and AIDS InformationDissemination Service (SAfAIDS)479 Sappers Contour, Lynnwood, Pretoria, South AfricaTel: +27 76 381 2425Website: http://www.safaids.net Email: [email protected]


HIV/AIDS INFORMATION : the power to make a differenceSAfAIDS - P O Box A509,Avondale, Harare, Zimbabwe, Tel: 263 4 336193/4, Fax: 263 4 336195, E-mail: [email protected], Website: www.safaids.org.zw

Activity A: Quiz & Gallery Wall

Together:Who has been affected by HIV ?Who has taken an HIV test?Who has disclosed their HIV status to another person ?Who has integrated some aspect of HIV into their work?

Individual: Hesitations, Aspirations & Experiences GalleryOn yellow card share an experience you have had, either in the WASH environment or in your personal life, related to HIV

On pink card share your hesitations, IF you have any, to linking HIV and WASH for programmes (externally) and workforce (internally)

On blue card share your aspirations (positive), IF you have any, to linking HIV and WASH integration



Intended Vision……

WaterAid to emerge as pioneer and role model in sustainable integration of HIV into WASH in the SADC region and beyond



Building the Case……. Building the Case……. • Main objective of comprehensive water, sanitation and hygiene

(WASH) interventions is to improve quality of life for individuals, families and the community. With advent of HIV (WaterAid positioned in epicentre of global epidemic) this becomes paramount

• WaterAid (Ethiopia, India, Nepal, Tanzania), early 2004/recent 2011, shown evidence of benefits of mainstreaming HIV into WASH

• Integration (multi-disciplinary/sectoral) vs Silo practice is direction the development sector/funding priorities is shifting – unavoidable!

• Like all sectors, WASH sector is susceptible to HIV – reality check !– HIV can reverse gains made externally

– Capacity to delivery can be compromised internally



HIV Response Spheres Response is developmental, not Health Sector

responsibility only : • Prevention - ABC, gender based violence, VCT

• Care – home based care, positive living, health system monitoring, nutrition & food security, access to water/sanitation

• Support – access to resources & services, peer support networks & groups, capacity building

• Treatment – ART, opportunistic infections

• Advocacy – awareness raising, combat stigma & discrimination, community and policy maker mobilisation, correct messaging

• Research – build body of evidence

• Mitigation & Litigation – legal aid for human rights violations, willful transmission, building conducive environment



Links to Wateraid SA Strategy 2013-2015

• Principles– Equity and Inclusion (prioritise beyond disability, eg OVC, child and female

headed & PLHIV affected households etc)

– Community participation (strategic partnerships, advocate involvement of community to represent those with greatest need eg women, PLHIV)

• Influence 3 levels through 5 Aims– Organisational (culture, funding, development)

– Policy (legislative)

– Programme (service delivery, advocacy)

• Key shifts– Cross-sector working & synergy building

– Systematic learning and documentation of BPs

– Collaboration & partnerships with SADC PF, SADC Sec Water Division

– Deepening learning (esp water security, disaster risk reduction)



Specific HIV and WASH Specific HIV and WASH Linkages Linkages

Perspectives categorizing linkages between HIV and WASH include:

• Consumer• Health• Human Rights• Gender • Community-driven development• Poverty Alleviation

Institutional: internal capacity for WASH at community and higher levels being lost, compromising delivery



Critical Consumer Links with HIV

• HIV affected households impoverished unable to pay user fees forfeit right to quality water & sanitation

• Indigenous knowledge in water and other natural resource management lost leading inappropriate ways of utilisation

• Households sink further into poverty exploitation of natural resources as alternative, result in water exploitation

• Shift in “care-economy” from institution to home-base care (influenced by cultural pref); lack of skills on recycling and multi-water use techniques excessive water usage during home-based care; limited knowledge in hygiene practices lead to opportunistic infections (OIs)



Critical Health Links with HIV (1)

• Quality, Quantity, Affordability, Access:– Successful adherence to antiretroviral treatment

regimens , TB treatment etc– Mixing powdered formula for infant feeding as well as

nutrition boosting for ill adults, need safe & ample water

• Technological design & infrastructural access – Facilitate fetching water by children from HIV-affected

households or people living with HIV (pump handles too low, too heavy, walls of the well too low etc)

– Distance and mobility capacity need regauging



Critical Health Links with HIV (2)• Poor water handling, storage & sanitation practices:

– Personal hygiene, domestic hygiene (ARVs, OIs), food

hygiene (TB, diahorrea) and environmental hygiene – Safe waste water disposal and drainage increase water

and sanitation related diseases- OIs

• Poor access to sanitation:– Stds on closing distance gaps for fetching water by care-

givers or PLHIV who are weak; and disposal facilities and access – revise to suit the population need

– Risk of rape while fetching water or relieving oneself in remote places, thus increasing vulnerability to HIV



Mr. Singh’s Life Changing Experience A driver in India, diagnosed with HIV, whose wife and 3 children also

have HIV. Wife passes (2009), leaving him alone to care for children. His health deteriorates rapidly, with frequent episodes of diarrhoea.

WaterAid India, in partnership with AIDS Control Society in Uttar Pradesh State, rolled out a project for PLHIV. Through the project Mr.Singh and other PLHIV received-Key hygiene messages and counseling, including information on hand-washing, safe water handling, diarrhoea management and use of boiled water for taking ARVs-Hygiene kit containing soap, chlorine tablets, Dettol, a towel & pamphlet

“Before I was very ill, and now I suffer from diarrhoea less, can manage on my own, and look forward to working and earning money I need to care for my family” - testifies Mr. Singh



Critical Health Links with HIV(3)

• Burial issue and safety of transmission myths can be strategically addressed by WaterAid

• Reverse erroneous beliefs that contribute to HIV related stigma and discrimination (via advocacy) eg: – “people can become infected with HIV due to groundwater

pollution near burial sites”

– “people (playing children) can become HIV infected through

poor waste disposal practices: condoms and sanitary pads”



Critical Gender Links with HIV

• Women burdened with care roles, once “labelled” they face double-stigma and exclusion from community WASH participatory activities – omitted from equitable access

• School enrolment rates for girls decrease in communities with high HIV prevalence rates; they are required to take on a wider range of household and domestic responsibilities (fetching water and using it for domestic/agriculture/HBC)

• Water collection is time consuming – done by women/girls, thus WLHIV’s health deteriorate - less time for self-care, and gender practical needs. Often due to gender biases in access to information, they don’t have hygiene knowledge



Critical Community-driven Links with HIV• HIV related stigma and discrimination compromises

participation of PLHIV and affected households , social cohesion is weakened and traditional participatory channels become dysfunctional . Community empowerment fails!

• What in WASH sector is known as “community management” can be compared to “community HIV competence” environmental sustainability – Placing communities in the driver's seat– Requires government & civil society to be demand-

responsive, to build capacities and to create an enabling environment by providing technical support, formation of partnerships and supportive policy frameworks



Critical Human Rights Links with HIV (1)

• Stigma & discrimination of HIV affected/infected families becomes exclusion factor for participation in community-based WASH related decision- making

• Access to safe water and sanitation is considered not only a basic need but also a human right – For ALL! (advocacy)

At the Johannesburg World Summit for Sustainable Development, delegates of the "The Civil Society Action Programme on Water" launched a statement

saying that secure access to sufficient safe water and sanitation to meet basic human needs, including water for small-scale productive use to support

livelihoods strategies, must be considered a human right



Critical Human Rights Links with HIV (2)

• Actively involving people affected by HIV (PLHIV) proven – To be an effective strategy to tackle S&D and create

more openness, in all sectors including WASH– That PLHIV can also be employed as effective &

productive workers eg as WASH community mobilisers/peer educators (supermarket house-to-house approach sharing HIV and WASH information)

• Promoting MIPA necessary to ensure that the voices of people living with HIV are heard within WASH circles



Critical Poverty Alleviation Links with HIV

• Poor access to basic services such as education, health care and water and sanitation, are the same factors that are driving vulnerability to HIV infection

• Adequate water supply, and access to sanitation and hygiene service and technologies – saves labour and energy;

– contributes to diversification of income;

– generates nutritional value;

– reduces expenditure on health

……… thus implicating sustainable livelihoods



“Having no proper sanitation means that there is a vicious cycle of poverty, diseases and bad hygiene…… The cycle of epidemic is at a stage where many people are falling sick. Through home based and palliative care, people are looked and cared for. One of the important ingredients of care is water…”

Nkululko Nxesi (Director, South African National Association of People living with AIDS (NAPWA)



Activity B: Mainstreaming HIV into WaterAid Regional Strategic Aims (2012-2015)

Group Guide: •How is HIV related to the programme objectives under this Strategic Aim?•Would addressing HIV contribute to meeting targets of each objective under the Aim?

Group 1 = Aims 1 and 2

Group 2 = Aims 2 and 3

Group 3 = Aim 5 and ideas on penetrating HIV sector



Defining Mainstreaming (1)

Mainstreaming is a process that enables development actors to address the causes and

effects of HIV in an effective and sustained manner, both through their usual work and

within their workplace (UNAIDS)



Defining Mainstreaming (2)

• Internal Mainstreaming (IM pre-requisite for EM effectiveness) involves – Changing organisational culture - policy and practice - to reduce the

susceptibility to HIV infection and vulnerability to the impact of AIDS– Preserving workforce well-being and organisational productivity– Building synergy with HIV expertise for capacity building internally

• External Mainstreaming (EM) refers to – Adapting programme work to take into account susceptibility to HIV

transmission and vulnerability to the impact of AIDS– Keeping HIV on the agenda of core programme work in the

changing context of WASH needs and gaps– Advocating WASH into HIV interventions



Internal sphere (workplace, your

organisation)

External sphere (your

cooperation activities)

&

Mainstreaming Mainstreaming HIVHIV

Mainstreaming Assumes

•multi-disciplinary

•multi-level and

•multi-sector approaches



Mainstreaming HIV is not …….

• Changing core functions and responsibilities in order to turn all organisational activities into HIV programmes

• Simply introducing HIV awareness raising in all activities - should be more systematic

• All staff having to become HIV specialists

• Business as usual …………



“Turning the Tide” of WASH Organisational Culture ‘main’

stream’

… automatic flow into all core business offshoots… ‘process’ not ‘event’

INTERNALINTERNAL

EXTERNALEXTERNAL



Mainstreaming HIV (1) – Context & Organisational Profile (HIV

Audit/Situational Analysis) - How is HIV affecting your

organisation? Your work?

– Impact of HIV on WASH– activity map tracking HIV influence

– Impact of WASH on HIV – risk, vulnerability, responses & entry point identification

– HIV Transformative Strategy/Policy/ Costed Program: awareness raising-reflection-action, advocacy, S&D combated, universal access, policy and support mechanism establishment, budget review, M&E plan, research & documentation, knowledge sharing ; synergy building with HIV sector actors



Mainstreaming HIV (2)• Simply : let’s ask ourselves Four Key questions:

– How does HIV affect my organisation ?

– How does HIV affect my work?

– How can harm due to HIV be avoided?

– How can I contribute to responding to HIV by limiting the spread, and mitigating the impact of the epidemic?

– What HIV sector activity can I showcase WASH at?



Step 1: Baseline Analysis

INTERNAL SPHERE

Organisational analysis:

– How are staff and their families affected?

– Impact of HIV on human resources in the sector?

– What institutional instruments are available to respond?

– What resources are available to respond?

EXTERNAL SPHEREContext analysis: What is general HIV

What is general HIV situation in community ?

situation in community ? Impacts of HIV

Impacts of HIV on the WASH sector?

on the WASH sector? Policies and major

Policies and major responses?responses? Stakeholder

Stakeholder analysis?analysis? Resource analysis?

Resource analysis?



Step 2: Use Baseline Analysis Results to answer how HIV affects your organisation and your work

Assess the impact of HIV on:• The workplace and your organisation

• The beneficiaries of your programme

• What you want to do (including whether your objectives and activities are relevant and feasible in the HIV context)

Then discuss how vulnerable your cooperation activity is to HIV and what changes need to be made?



Step 3: Analysis of Potential Negative Implications of “ignoring

the HIV agenda” How to do “no harm”? Do your cooperation

activities increase:• Population mobility

• Gender inequalities

• Exclusion of PLHIV or other vulnerable groups

• Risk situations for gender based violence/ sex work/unsafe sexual practices/compromised access to services

Then plan corrective actions



Step 4a: Develop an HIV Workplace policy & programme

Source: ILO



Step 4b: Plan and implement your contribution to responding to HIV

Assess, where your comparative advantage is highest for making a difference, and design costed plans in terms of:

• Risk: helping people to behave safer and avoid risk situations

• Vulnerability: acting on developmental factors that increase the vulnerability of population groups to HIV

• Impact mitigation: help affected people and communities to cope with the effects of HIV



Step 4c: Monitoring - develop indicators to measure change

– Outcome: Has behaviour of beneficiaries and/or way of working of staff/partners changed in the intended way

– Impact: What impact did this make in terms of changing the HIV epidemic and its context? (BUT: avoid the pitfall HIV prevalence or mortality!)

– Process: Which process did you use - with what effect? What works and what doesn't? what has been learnt ?



Essential Principles in HIV Mainstreaming (1)

• Adapted to your context- no standard approach (varied combinations of organisational, sociology, logframe elements)

• Relevant at all stages of the epidemic, also in low prevalence contexts

• Continuous and integrated• Gender sensitive approach• MIPA involving people living with HIV • Networking & coordination• Advocating• Sharing of good practices and lessons learnt • Generating evidence through continuous monitoring




To be successful :• Consider HIV as a development issue

• Commitment and support of decision makers

• Clearly defined objectives for mainstreaming

• Knowledgeable, compassionate and skilled staff

• Document and share experiences through knowledge sharing systems, appropriate messaging and packaging




To be successful (cont) :• Expertise and support available and made use of; explore

penetrating HIV sector events (International AIDS Conferences, ICASA, National HIV Strategic Planning Forums, etc)

• Sufficient allocation of resources (human, financial, technical)

• Willingness to learn, reflect and share



Activity C: Back to Our Gallery Wall

-How do we feel about the - Hesitations?- Aspirations- Building on our experiences?

-Roadmap: reaching the HIV & WASH Integration “destination”



Thank Thank you …..you …..

Zikomo Zikomo

Documents

Mainstreaming HIV into Water, Sanitation and Hygiene (WASH)