Implementation of the HIV/AIDS intervention programs in Botswana : strengthening the management and programming capacity of the district multi sectoral AIDS committees

Abstract

This study sets out a detailed approach to responding to the HIV/AIDS situation in the Districts. The priority areas or targets of the response are derived from what has been learnt from the situation and the elements of the response to date. This study could be used by the management District Multi-Sectoral AIDS committees (DMSACS) to develop specific intervention programs and ensure effective implementation. The priority areas for the response to HIV/AIDS in the districts are deemed to be: (1) behaviour change communication (BCC); (2) condom promotion and distribution; (3) sexual health education for the different social groups; (4) community mobilization and participation; and (5) training of personnel/community members at district level in the following areas: community counselling, peer education and project management. These priority areas can be regarded as the macro planning framework. Following from the priority areas, there are some key elements in need of response. These constitute the micro planning framework and for each there are a set of initiatives to meet their respective objective. The first key element in need of response is men. The objective is to both increase awareness and improve the sexual knowledge of men so that they can be channeled in a positive manner toward behaviour which reduces the risk of HIV infection. Men deserve to be targeted for their own sake, for women's sake and for the health of their families and communities. The two initiatives proposed to meet the objective in this element are behaviour change communication campaigns, using traditional structures, non-governmental organisations and churches as the primary forums. The second key element of the response pertains to women. Women are at greater risk than men in becoming infected with the HIV or sexually transmitted infections (STis). At the same time, they have little or no control over how and when they have sex with their partners. They are perhaps the most vulnerable group in society. The objective here is to empower men while at the same time promoting gender awareness in behaviour change communication activities. Three initiatives are to be pursued in the context of this objective:

(I) behaviour change communication campaigns to combat risk behaviour about HIV/AIDS, and other STis, and to build safer norms through the specific gender awareness elements of those campaigns; (2) counselling services related to HIV/AIDS and other STis as well as the associated promotion and distribution of condoms including the female condom; (3) development of income-generating schemes or the creation of opportunities for women to participate in such schemes. The next key element relates to the youth. The youth, like women are also a very vulnerable group. They have high rates of teenage pregnancy and STis infections as a result of unprotected sex. They face serious health risks due to limited factual information, too little guidance about social responsibility, and insufficient access to relevant health care. The objective is to reach out to young people to educate them about sexual health and their role in promoting safer sexual behaviour for themselves and their peers. The three initiatives for achieving this objective are: (1) design and implementation of in school and out of school sexual health education programmes (2) delivery of HIV and other STD health care services and counselling specifically for young people (3) promotion and distributions of male and female condoms in convenient places other than clinics and health posts. The fourth key element in the response deals with orphans. The extended family system can no longer be seen as guaranteeing assistance to, orphans due, primarily, to the cost implications and some residual fear of the disease. The objective here is to develop cooperative efforts by all levels of government CBOs, NGOs and churches to provide assistance for subsistence health care, counseling, shelter, education and training and property inheritance. The fifth key element in the response is the community at large. Since the contacting and spread of HIV/AIDS has interdependent impacts which have multiplier effects on the community at large, it is necessary that steps be taken to involve and assist the community as a whole to mitigate the spread and impact of the disease. The objective is to both mobilize and empower the wider community to take actions to control the spread of HIV/AIDS and improve the quality of life of those affected. The only initiative required here is to facilitate grassroots participation in the development and implementation of appropriate elements of the response.

The other key elements pertain to develop human capital required to respond to this epidemic effectively. The human resources and equipment necessary to mount a credible response to the HIV/AIDS epidemic in districts is most inadequate. There does not exist a sufficient number of community counselors, peer educators and project managers nor staff at district level required for sustaining response activities. Consequently, the objective in this area is to both acquire and train personnel within the district councils and at community level. The final element is ensuring that DAMSACs have a strengthened capacity for management and programming, which can only happen if District authorities develop specific project management, cost effective analysis tools and community counsellors in each District.