5. Progress, lessons and the way forward

There is little evidence so far that the WSH sector is responding coherently or effectively to the challenges of HIV/AIDS. Research for this TOP found few examples of sector agencies with systematic ways of addressing the impact of the epidemic, either internally or in terms of service delivery. It urges organisations to overcome the stigma and fears associated with the disease and recognise that investment now in strategies to combat HIV/AIDS internally will mean better performance and less expense later. It also points to the duty of all service organisations to support the fight against AIDS, and to adapt principles and approaches to the changing needs and capacities to pay.

By comparison, the agriculture, education and transport sectors are seen to be responding well to the costs and other implications of HIV/AIDS. The TOP cites four helpful papers with guidelines on best practices to adapt to the HIV/AIDS agenda.

There is also more specific advice on technology choice that is appropriate for people living with HIV/AIDS. So-called Safe Water Systems, consisting of water treatment with locally produced bleach, safe water storage and promotion of behaviour change, have been shown to reduce the number of episodes of diarrhoea and the duration of the disease among people living with AIDS in rural areas. Local handpumps, spring water protection, rainwater harvesting, solar disinfection, and household latrines are also seen as appropriate and cheap technologies. In assessing demand, agencies are encouraged to look at the increased demand for water to provide basic WSH services, but also to recognise that for HIV/AIDS sufferers, water for small-scale productive use can have a highly beneficial impact on their daily lives. Weakened individuals can still be involved in growing vegetables, tending animals or home-based businesses, provided that they do not need to haul water from a distance. So, water for productive use is being seen as a big livelihood benefit, which may also enable infected consumers to contribute to society.

Political commitment and a multi-disciplinary, multi-sectoral approach are seen as prerequisites for combating HIV/AIDS. Decentralisation facilitates local integrated action, and the moves to decentralise WSH services over the years provide a platform for wider community and local government action in the fight against HIV/AIDS. More detailed guidance for district level frameworks comes in a document published by the Royal Tropical Institute (KIT), World Bank, TANESA and UNAIDS, entitled Rural workers’ contribution to the fight against HIV/AIDS: a framework for district and community action.

The hope is that HIV/AIDS can be mainstreamed into institutions and programmes for future WSH services. This has not happened to date, but lessons from other more progressive sectors and from the mainstreaming of gender into the WSH sector suggest these guidelines:

A basic principle in mainstreaming is that the sector keeps to its core business. Too often, mainstreaming means that sector staff are expected to carry out information, education or communication activities in communities in the field of HIV/AIDS and/or to serve as condom providers in communities. This assumes that such staff are willing and able to do this, and have the necessary training (which is often not the case), and it takes time away from core functions. It is not what mainstreaming is all about.

For instance, using agricultural extension staff for AIDS awareness raising and condom promotion diverts staff from effective mainstreaming. Examples of useful mainstreaming include: promotion of less labour-intensive crops and collective forms of production; assistance to child- and women-headed households that lack the technical knowledge and skills associated with adult male household members; and assisting co-operatives in developing a strategy for inclusion of whole households rather than individual persons etc.

Mainstreaming requires, first of all, a commitment from the management of the organisation. Secondly it requires time, funds and training for the staff responsible for HIV/AIDS mainstreaming. Such staff, furthermore, should have sufficient influence to impact effectively within all sections of the organisation.

Section 8.6 of this TOP amplifies the way that WSH programmes that stimulate empowerment and poverty alleviation also address key issues for HIV/AIDS prevention and mitigation. It says:

Empowerment

A combination of empowerment of key actors and multi-sectoral support to their interventions can be effective in developing capacities of local communities to tackle development issues in their own environment. This has been demonstrated in community management in WS&S, and in poverty alleviation programmes aimed at community empowerment. The same has been demonstrated in HIV/AIDS in local response programmes that focus on the way in which individuals, families and communities behave, and then use this as a basis for strategy development.

Partnership

Models used in earlier HIV/AIDS prevention programmes assumed that people would modify their practices and beliefs once they had access to adequate information and technology. It is now recognised that information and technology are necessary, but not sufficient for an effective and sustained response. There are limits to what people can do as individuals and therefore it is necessary to create an enabling environment through partnerships among key social groups and service providers, mediated by facilitators or catalysts.

Key social groups, service providers and facilities

Key social ‘groups’ at community level can be women’s organisations, development committees (water, sanitation, health etc.), people affected by HIV/AIDS and/or traditional leaders. Service providers at district and local level include not only the health sector but also other sectors such as water supply, education (schools), agriculture and local government. They may be NGOs, faith-based organisations or the private sector. Finally, facilitators or catalysts facilitate the process in which partnerships are formed effectively. Such facilitators may come from any of the key social groups or from outside. They can assist in social mobilisation, people organising themselves, develop “voice”, obtain entitlements (e.g. minimum standards) and claim their rights.

Roles

The activities of service providers should be seen as complementary to and supportive of activities initiated at community-level. The role of the facilitators is to help empower communities to address HIV/AIDS issues and to mobilise communities to formulate their own HIV/AIDS action plans. They can play an important role in mobilising and empowering service providers as well.

Tools

For this to happen, service providers need appropriate approaches and tools. In the WS&S sector such tools have been developed over the past fifteen years and have been effective in stimulating ownership and ensuring sustainability. Many of these tools are adapted for use in HIV/AIDS and although their application is not yet widespread, it is gaining ground. UNAIDS developed a toolbox for local responses that includes techniques used in the water sector adapted for use in HIV/AIDS.

IEC channels and materials

The use of information, education and communication (IEC) channels and materials to combine hygiene promotion with HIV/AIDS education could be advantageous to both sectors, depending on the local context. Examples are the use of a historical profile (discussion on when HIV/AIDS became an issue), seasonal calendar (discussing the impact of seasonal migration), community mapping (discussing places that facilitate sexual encounters), or wealth ranking.

Involvement of people affected by HIV/AIDS

At community and district level, it is essential to involve people living with or affected by HIV/AIDS, in planning and implementing all development activities. They themselves can best judge how programmes affect them and which approaches work to avoid discrimination and social or economic exclusion. It is also important to show that people infected with the HIV virus can continue to live a productive life, continue to care for their families and contribute to community activities. Such courageous people have an important function in breaking the silence that surrounds HIV/AIDS and contribute to a reduction in discrimination and stigma.

The step-by-step conversion of these lessons and principles into policies and strategies for WSH agencies is described in Section 9 of the TOP.