Author of the approach: Eva Neuhaus Peer reviewed by: Susan Leather, ILO, and Luise Lehmann, independent consultant Writer: Stuart Adams Published by the Secretariat of the German HIV Practice Collection
Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, December 2009
Officially launched in January 2004, the German-Burkinabe Sexual Health and Human Rights Programme (PROSAD) was chosen for write-up in the German HIV Practice Collection because, over the years, it has become a uniquely sustained, comprehensive and results-driven effort to protect and empower women, youth and children. It has helped raise their own and public awareness of their human rights, including their sexual and reproductive rights, and has provided them with a range of services and mechanisms that allow them to take advantage of those rights.
PROSAD has three components: The first focuses on youth and their needs for information and services in the areas of family planning, sexual and reproductive health, and prevention, care and treatment for HIV infection. The second focuses on women and girls and their needs for information about their basic rights and mechanisms they can turn to when their rights are violated, with special attention to stopping female genital mutilation (FGM) and to enrolling and retaining girls in school. The third focuses on children and their needs for protection from child trafficking and the worst forms of child labour.
Out of harm’s way - German support for countries reducing the harm of injecting drug use and HIV
Writer James Boothroyd Technical supervision: Patricia Kramarz Peer-reviewed by Jürgen Klee (LaStrada Drogenhilfe & Prävention) - [first version] and Susanne Schardt, independent consultant [final version] Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, October 2009
A key to HIV prevention and other social benefits is reducing the harms of drug use, a major mode of HIV transmission, accounting for about 30% of all new HIV infections outside sub-Saharan Africa. Harm reduction measures include providing easy (low-threshold) access to sterile drug paraphernalia and contact centres, drug consumption rooms and clinics for medically assisted substitution therapy (with methadone or buprenorphine) and they have helped Germany, and other countries, to control outbreaks of HIV and other infectious diseases.
This report gives an up to date overview of the controversial international debate on this issue and describes projects supported by German Development Cooperation (via German Technical Cooperation, GTZ) in five countries that are struggling to reduce the severe personal, social and economic harms of illicit drug use and HIV.
Whilst its Commission on Narcotic Drugs pleads for a balanced approach between drug-demand reduction and supply reduction, the UN does not speak with one voice on this matter: Many countries continue to emphasize law enforcement and the criminalization of drug use, above all. This position is at odds with a major body of evidence showing that repressive measures alone are ineffective, if not counter-productive - while they do not control either supply or demand in illicit drug markets, they do tend to drive drug users underground, undermining prevention efforts.
Germany has, therefore, been a leading voice amongst countries aiming to expand the role of drug-demand reduction, to recognize the importance of the harm reduction approach and to advance policies based on evidence rather than ideology.
Writer Stuart Adams Peer reviewed by Charlotte Frances Cole and Tim Manchester
An approach by KfW Entwicklungsbank (Development Bank, KfW), jointly published by KfW Entwicklungsbank and Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, July 2009
When we hear "social marketing" we think "selling condoms to prevent
HIV" but what does social marketing really mean? This report takes us
into the cities, towns and villages of Niger and shows us that it can
also be about family planning, gender equality, reducing poverty and
improving general health, not just sexual and reproductive health.
Social marketing can deliver a range of low-cost and reliable health
products (oral contraceptives, water purification tablets and mosquito
nets) to the smallest village and teach people how to use them. But,
more importantly, it can deliver inter-active communications to that
same small village and change attitudes and behaviour. It can get
across complex messages such as, for example, everyone benefits when
girls go to school, do not marry at age 15 to men twice their age, and
do not have far more babies than their families can afford, most of
them destined to be stunted and malnourished.
Evidence shows that social cash transfers (small, regular payments) are a cost-effective tool for helping needy households, promoting health and education and boosting local economies – at least, in middle- and high-income countries.
Would they work in a country with few resources? Beginning in 2004, Zambia’s Ministry of Community Development and Social Services (MCDSS), with technical support from German Technical Cooperation (GTZ), decided to find out, by pilot-testing a variety of social cash transfer (SCT) schemes in different parts of the country. These generated valuable information on impacts as well as the feasibility and costs and benefits of SCTs as a component of the country’s Social Protection Strategy.
Early results, together with findings of independent studies of the different pilot schemes, suggest that Zambia’s social cash transfer schemes are effective in targeting and helping HIV-affected households and that SCTs can be adequately administered despite the government’s low capacity.
Worldwide, soap operas are among the most popular of all TV programmes. They attract many times more viewers than purely educational programmes and yet they, too, have huge potential to educate. Given that they tell stories about the universal comedies and tragedies of daily life, they are perfect vehicles for shedding light on all of the issues surrounding HIV and causing people to reflect on the implications for them and the people they love.
As one of the world’s five biggest donors to Official Development Assistance (ODA), Germany is strongly committed to the drive towards universal access to HIV prevention, treatment and care. Much of Germany’s contribution comes in the form of financial and technical support for behaviour change communications (BCC), often associated with the social marketing of condoms. This publication looks closely at cases where Germany has supported the production and broadcast of television soap operas as key components of BCC in three very different countries with three very different HIV epidemics.
This publication describes method and results to date of the "Join-In Circuit on AIDS, Love, and Sexuality", an adaptable HIV prevention tool used in more than 18 countries. Initially developed by the German Federal Centre for Health Education (BZgA), it takes the form of a workshop with five or more stations, at which facilitators help participants to learn critical information about HIV through interactive problem-solving, games and conversation.
By the end of 2007, the Join-In Circuit had been adapted and used in HIV prevention in Bangladesh, Mongolia and Nepal; the Russian Federation and Ukraine; Mozambique, Zambia and Zimbabwe; and Ecuador and El Salvador. Cooperation with ministries of health and education often supported the quick uptake of the Circuit, as officials understood how it could be used to advance toward national prevention goals. The flexibility of the Circuit allowed it to address prevention among many different groups: young people aged 12-14 and up; young adults, including soldiers, prisoners, factory workers, sex workers, stock breeders, teachers and doctors in other countries. Wherever possible, organizers tailored the content and format to reflect the experience of the target group, in the most realistic, sensitive and explicit manner.
With this publication, German Development Cooperation (GDC) shares what it has learned about mainstreaming HIV in the course of doing it for seven years. It provides background on the history and logic of mainstreaming, describes GDC’s policies and practices, gives some examples, draws some lessons, and concludes with a German HIV Peer Review Group assessment.
Over the past four years, German Development Cooperation (GDC) has been developing and strengthening its methods for monitoring and evaluating its HIV mainstreaming efforts and, over the past few months, the BMZ HIV Task Team has been reviewing GDC's progress, drawing lessons and considering how GDC might strengthen or otherwise change its mainstreaming policies and practices. This publication describes the journey the Task Team took to reach its current understanding of what mainstreaming HIV can achieve and where it needs further focus and strengthening. It looks at the history and logic of the mainstreaming strategy, GDC's mainstreaming policies and practices, examples of GDC's mainstreaming experiences, and lessons GDC has drawn from those experiences.
Authors: Gundel Harms, Andrea Kunz, Stefanie Theuring, Geoffrey Kabagambe, Rose Kabasinguzi, Paulina Mbezi and John Odera
Peer-reviewed by Tin Tin Sint and Ehounou Ekpini, responsible for PMTCT at WHO, Geneva
Text: James Boothroyd
Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, November 2007
In 2001, the German government commissioned GTZ to partner with national ministries of health and local health authorities to implement a six-year project on prevention of mother-to-child transmission (PMTCT) and antiretroviral treatment (ART) of HIV in three east African countries: Kenya, the United Republic of Tanzania and Uganda. The PMTCT project provided pregnant women seeking antenatal care with HIV-test counselling and HIV-testing.
The project included efforts to raise public awareness of HIV; training of health workers; and upgrading of infrastructure, (building space for counselling and health education, and for antiretroviral and STD treatment, equipment for safe delivery and the renovation of maternity wards etc.). It also allowed for monitoring and evaluation of programme uptake, and extensive research on awareness and knowledge of PMTCT, infant-feeding practices, treatment outcomes, cost-effectiveness of interventions, drug administration strategies and factors influencing the effect of single-dose nevirapine.
by Annegret Spelleken, Ulrich Wagner, Ozzi Warwick and John Waters
Writer: Stuart Adams
Peer Review: Yvonne Schönemann, Henri van den Hombergh
Published by: Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH and KfW Entwicklungsbank, March 2008
The publication was approved by the Federal Ministry for Economic Cooperation and Development (BMZ) and the KfW Entwicklungsbank. A Spanish version is under preparation.
This publication looks at German-supported AIDS programmes in the Caribbean region. The first section describes initiatives supported by the German Technical Cooperation Agency (GTZ) beginning in 1995 and aimed at HIV prevention among youth. The second describes an initiative funded by the German Development Bank (KfW) beginning in 2005 and taking a regional approach to social marketing of condoms and behaviour change communications.
The publication differs from other publications in this Collection in that it describes the context of such initiatives in considerable detail. This is so because the Caribbean is a region of extraordinary diversity and complexity with unique characteristics that call for unique responses; and because the Caribbean has a complex set of national and regional mechanisms for coordinating its responses to the AIDS epidemic.
Approach developed by Flavien N’donko
Contributing Consultant Regina Görgen (evaplan Ltd.)
Documentation by Stuart Adams
Peer reviewed by the German HIV Peer Review Group (PRG)
Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH and InWEnt - Internationale Weiterbildung und Entwicklung gGmbH, first edition: July 2007, this edition: December 2007
The Aunties Programme empowers young mothers who got pregnant in their teens to reach into their villages or urban neighbourhoods in order to provide adolescents with sex education and counselling on sexual and reproductive health.
This publication concludes that the Aunties’ approach is transferable to other countries with traditions and contemporary situations not unlike those found in Cameroon. This approach is a good example of capacity development in that it enables young women at risk of marginalization to connect and support each other, locally and nationwide, and to shape their own futures. It has the potential to make significant contributions toward four of the eight inter-related Millennium Development Goals: gender equality and empowerment of women, reduction in child mortality, improvement of maternal health, and reduced infection and harm by HIV and other diseases.
The Medical Dialogue is a stepwise approach to bridging the gap between scientific thinking and cultural traditions, setting the stage for more effective prevention and treatment campaigns. Malawi is one of the countries hardest-hit by the AIDS epidemic. Nonetheless, the cooperation between the national health system and traditional practitioners that WHO recommends has not been realized to date. The Medical Dialogue approach described in this report shows how such a cooperation between traditional and the biomedical health care practitioners can be launched and established in a sustainable manner.
The method’s application began with training local moderators. They facilitated a series of focus group discussions in which traditional healers and biomedical practitioners talked about local sexual practices, beliefs and taboos and their ideas about illness, prevention, diagnosis and treatment. Both sides were encouraged to share their doubts and concerns about each other in ways in which both felt that their points of view were respected. The focus group discussions provided information on which to base three-day medical dialogue workshops. Participants included equal numbers of traditional healers and biomedical practitioners chosen for their knowledge and communication skills and in order to create a mix of genders, ages and fields of work within traditional medicine and biomedicine. On the first day, traditional healers and biomedical practitioners met separately to prepare themselves. On the second day, they met together to air and discuss their different ideas and opinions. On the third day, they worked together on producing a mutually agreed plan of action that divided responsibilities between the two groups.
Approach developed by Sepp Grimm, Julia Weinand, Michael Marx, Brigitte Jordan-Harder, Silvio Decurtins and Kirsten Roettcher
Documentation by Stuart Adams
Peer Review by Andrea Milkowski and Bob Verbruggen
Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, first edition: July 2006, this edition: December 2007
The report describes three approaches to supporting local, district and provincial governments in getting their local AIDS responses off the ground. Presenting methods and tools, outcomes and lessons learnt of GTZ-programmes in three different countries and contexts in Southern and Eastern Africa, the documentation focusses on the important interface between AIDS responses, governance and decentralisation. Like all publications of the GTZ HIV Practice Collection, it also includes a toolbox with a set of effective tools developed as part of each approach.
The report describes how, with GTZ’s technical support, the Kingdom of Lesotho, the United Republic of Tanzania and the Province of Mpumalanga in the Republic of South Africa have been empowering districts and localities to respond to AIDS. The approach, in all three cases, has been learn-as-you go. Methods and tools are developed and applied and, then, when they do not work as well as hoped, they are refined or replaced with new methods and tools. The processes of empowerment are ongoing. While it is too early to tell what the long-term results will be, the immediate results have been impressive. They include strategies and mechanisms that are streamlining the flow of available money to the front lines and putting it to work where it is most needed.
Approach developed by Ulla Tschoetschel (DED) and Stefan Erber (GTZ)
Documentation by Hansjörg Dilger
Peer Review by Peer Review Group
Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH and Deutscher Entwicklungsdienst (DED), November 2005 (this edition: December 2007)
The vocational training (VT) Sector has an important role to play in HIV/AIDS prevention and in impact mitigation.The young adults this sector works with not only represent the human capital that their country’s future economic growth depends upon, but also the age group most at risk of HIV/AIDS infection.The approach described in this report has the objective of mainstreaming HIV/AIDS in the VT system in Botswana, in order to help prevent further infections among teachers and learners.
In the course of this project, and with technical support provided by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) and German Development Service (DED), the Botswana Training Authority (BOTA) HIV/AIDS Division has developed a number of promising practices, including the mainstreaming of HIV/AIDS in the organisational structure of BOTA and the accreditation process for Vocational Training (VT) institutions, the development of unit standards and guidelines for curriculum development, as well as VT-specific approaches to promote behaviour change.
Involving PLWH is a crucial step towards addressing HIV/AIDS-related stigma and discrimination, two major hindering blocks for effective HIV/AIDS prevention and care. This report outlines how German development cooperation has helped build a large network of PLWH organisations in Cameroon.
For too long, the important role of people living with HIV or AIDS (PLWH) in the fight against the epidemic has not been sufficiently recognized by policy makers and programme managers. And yet, involving PLWH is a crucial step towards addressing HIV/AIDS-related stigma and discrimination, two major hindering blocks for effective HIV/AIDS prevention and care. In the context of the international initiative for Greater Involvement of PLWH (GIPA), the GTZ-supported health programme in Cameroon has aimed to empower PLWH and to ensure their participation in HIV/ AIDS-related political processes and programmes. With this support, 73 PLWH organisations have been established in Cameroon, comprising more than 5000 members. They share the goal to fight stigma and discrimination, to improve the quality of life of PLWH and to prevent the further spread of HIV/AIDS by providing psychosocial support, voluntary counselling and testing (VCT), Home Based Care, support to treatment programmes and prevention campaigns.
Approach developed by Manfred Wehrmann, Inge von der Ley, Brigitte Sodatonou
Documentation by Birgit Niebuhr and Tioulenta Témoré
Peer Review by Cornelius Oepen and Birgit Niebuhr
Published by Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, first edition: October 2006, this edition: December 2007
Many Sub-Saharan Africa countries are experiencing alarmingly high rates of HIV-infection, particularly among its youth, women, and girls. The impact of AIDS on the availability, quality, and demand for education poses an enormous problem. At the same time, it is known that education can act as a “social vaccine” against HIV by providing knowledge and life skills and by giving children basic information on gender relations, sexuality and reproductive health that will help them adopt responsible behaviours in these three domains later in life. This has led the three basic education projects of this publication to include AIDS prevention in their activities.
The projects in Chad, Mali and Guinea are based on a multisectoral approach that establishes close collaboration between the education and health sectors and involves the communities around the schools in a local AIDS response. The approaches developed by the projects focus on transmitting knowledge about sexuality and the prevention of sexually transmitted infections (STI), including HIV, as well as on developing communication capabilities among the different target groups, e.g. between parents and children and between teachers and pupils, thus facilitating dialogue and promoting self-help initiatives within the community. An essential goal of the education concerns the development of social and citizenship skills that lead to responsible behaviour. This occurs through active learning techniques centring on the learners themselves (role-playing, dialogue, etc.).
This report presents a stepwise approach to developing sex education material together with young people to ensure that it meets their informational needs. The concept was first developed in Tanzania and has in recent years been adapted in various other contexts in Africa and Asia.
The approach is new in so far as it follows in a rigorous and systematic manner a number of consecutive steps, involving young people and youth experts throughout the production process. This systematic approach lends itself to replication and adaptation in different socio-cultural settings. The outcome of the process is a set of question-answer-style booklets. So far this approach has been replicated or adapted in 17 countries in Africa and Asia. Reactions and evaluation results have shown high appreciation and further demand by young people, educators and parents alike. Lessons learnt are that it is essential and rewarding to involve young people throughout in the production of education material for them, that the material should take a broader perspective of young people’s concerns related to reproductive health and sexuality instead of an HIV perspective only; that particularly in the beginning a lead role by government structures is not necessarily appropriate and helpful, as they tend to avoid controversial issues such as youths' sexuality. Instead, creating alliances, with non-government and international organisations often contributes to making the process viable.
