The Good Practice Guidelines for HIV outline the role of the church, areas which Tearfund will and will not support, principles of good practice and considers HIV alongside Tearfund's other cross-cutting issues.
Introduction
Definition
HIV is the acronym for Human Immunodeficiency Virus. The virus is transmitted from one person to another through exchange of bodily fluids like blood, semen, vaginal fluids and breast milk. HIV is therefore not transmitted through casual contact. This virus leads to a syndrome called AIDS, the Acquired Immune Deficiency Syndrome. AIDS is a collection of infections that the body is unable to fight. Without access to antiretroviral therapy, it can take between 6 to 10 years for a person infected with HIV to develop AIDS, with large variations depending on the prevailing local health situation. The condition can be treated with antiretroviral therapy which can significantly prolong the lifespan of a person living with HIV, but there is no cure.
HIV is increasing poverty and vulnerability and dramatically reducing life expectancy and increasing child mortality across the world. Demographic profiles of countries are being altered by HIV undermining every area of development. Around 33.2 million people are living with HIV around the world and over 2 million people were newly infected with HIV in 2007. At least 2.1 million people died due to AIDS-related illnesses in 2007 (UNAIDS). The impact of HIV is greatest on poor people.
HIV is a strategic priority for Tearfund for several reasons:
• it is a major cause of poverty
• poor people are more vulnerable to the spread and impact of HIV
• development progress is being halted or even reversed by HIV
• The church is in a good place to enable restoration and transformation of communities where people are living with and affected by HIV
These guidelines are developed to guide overall program content in the following five focus areas of Tearfund HIV work:
- Prevention of mother to child transmission
- Impact mitigation through support services for widows and children
- Promoting access to treatment for opportunistic infections and ART
- Ending stigma and discrimination of people living with or affected by HIV and AIDS
- Behaviour change among children and young people.
It is not expected that any one Tearfund partner will be active in all these areas, or in all activities within each focus area, but together will form a comprehensive and integrated response. Tearfund partners have work planned and underway in each of the above focus areas in each of the regions in which they operate.
These guidelines are intended to be used across a wide variety of geographic, economic, ethnic, social and religious contexts, which requires each Tearfund partner to implement their particular programs using methodology based on local experience, field research and local best practice. Resources provided by government and other agencies; for HIV education, support for orphans and vulnerable children, treatment of HIV with antiretroviral drugs, treatment of opportunistic infections and drugs available for the prevention of transmission of HIV from parents to children will vary widely between countries and influence what Tearfund partners will be able to offer, and what is appropriate in any particular context.
Each focus area emphasises the need for Tearfund partners to collaborate with Christian, secular and government groups and particularly to work in collaboration with the national AIDS plan.
Suggested indicators for each focus area are given in an attempt to standardize baseline measurements, project monitoring and outcomes. As well as being of assistance to partner implementation, this will allow greater ease of Tearfund in making objective measurements of program activities and impact, to demonstrate their activity to donors and to allow comparison within and between countries to inform good practice.
Tearfund is scaling up its own and partner organisations’ response to the spread of HIV to match the scale and speed of the pandemic.
Tearfund is committed to Greater Involvement of People Living with HIV and AIDS (GIPA) in all areas of programmes.
Biblical and developmental justification
Tearfund’s response to HIV is shaped by biblical principles of compassion, justice, accountability, leadership and participation. The good news of Jesus Christ brings hope of sustainable solutions to the spread of HIV because it impacts the way that people behave with one another. Jesus Christ showed compassion and justice, especially towards those that were broken and rejected. People living with, and affected by, HIV are often marginalised in society. It is our Christian privilege to serve such people so that they may discover their value to God in Christ and be able to live meaningful lives despite their HIV status.
HIV and poverty are inextricably linked. Poverty and income inequality, gender inequality, poor public services (health care and education), crises and disasters make people more vulnerable. HIV affects the most productive age group (15-50 years) and as a result economic growth has plummeted in many countries. The AIDS pandemic has reversed developmental gains, increased levels of poverty in communities, and heightened the vulnerability of women and children. AIDS has claimed more lives than any conflict.
Millennium Development Goal 6 target 7 commits the international community to halt and begin to reverse the spread of HIV by 2015.
Role of the church
In many communities churches have been at the frontline in responding to HIV by providing care and support. The church is caring for hundreds of thousands of orphans, especially in Africa. Often churches have been forced to respond to the AIDS crisis simply because of the devastating impact on their own members. Although providing care and support has been the natural first step, many churches are beginning to engage with the complex areas of prevention and education.
Strategies and policies of governments, donors and bilateral agencies are increasingly recognising the capacity and potential of churches in responding to HIV because of their access to the local community, and the work they are already doing in caring for people affected by HIV. Our task is to build the capacity of churches so that their vital contribution is recognised and supported.
Governments are best placed to provide certain essential services like testing, blood safety, and antiretroviral drugs to extend life expectancy so Tearfund would not normally support projects providing services of this nature.
Principles of good practice
• Consider the spectrum of responses in strategy and project design, spanning the five niche areas.
• Address the underlying causes of HIV such as gender and culture. As HIV transmission is a behavioural issue, understanding knowledge, attitudes, behaviour and practice will be useful.
• Involve people living with HIV in all stages of the project cycle. Projects should empower the most vulnerable groups such as women, elderly and children.
• Ensure that awareness-raising and education projects aim to change behaviour.
• In care and support projects, consider the range of needs of people living with HIV. People with HIV can live a long time. Strategies should empower them and help them live fruitful lives.
• Always maintain confidentiality.
• Ensure that carers and other service providers are cared for to prevent burnout, share strategies and ensure sustainability.
• Tackle stigma and discrimination in all projects.
• Empower and support people to advocate for rights and services that should be provided by government and policy-makers.
• HIV scenarios change rapidly. Keep up-to-date with new developments and the latest examples of good practice and share these through training with project staff.
• HIV is not just a health issue - it is a developmental issue. It is important to mainstream HIV and AIDS in all areas of work.
Cross-cutting issues
Gender sensitivity
Women are more vulnerable physiologically, culturally, socially and economically to HIV infection. In addition, women are disproportionately impacted by HIV because they have fewer opportunities to access treatment, rights and other essential services, and are almost always the carers for people with HIV.
• Is the project influenced by, or considerate of, women’s views and situations?
• Does the project attempt to influence men’s attitudes towards women and vice versa?
• Is the project challenging gender stereotypes and harmful practices (such as female circumcision) towards women and girls?
• How will men be targeted in prevention and education projects?
• How will men be mobilised in care projects?
Conflict sensitivity
HIV has become a new weapon used in war. War exposes people to exploitation, insecurity and abuse as social order and systems collapse. Women and children are particularly vulnerable.
• Is enough being done to protect women and children from sexual abuse?
• If rape and sexual abuse is prevalent, are there processes in place to provide support to the victims?
• After conflict, what support is given to men who were forced to abuse women and children?
Conflict can be caused as a result of HIV, including conflict among family members over inheritance when a member dies, loss of rights and respect for those affected by HIV due to stigma, and conflict within a community when resources are diminishing because those who are sick are not working.
• Is support given to widows and children when the head of the household dies?
• Are efforts made to ensure that people affected by HIV are not excluded from community life?
Environmental sensitivity
People affected by HIV are amongst the most vulnerable to natural hazards. For example, during floods, people living with HIV may be too weak to leave the area without assistance.
• What are the environmental risks facing people affected by HIV and how can these be minimised?
• What are the positive and negative impacts of the project on the environment?
• What steps are taken to reduce the negative impacts on the environment?
• What are the positive and negative impacts of the environment on the project?
Child sensitivity
Children are often badly affected by HIV. Children who are orphaned have fewer opportunities and are often exploited and discriminated against. They may be forced to drop out of school, work to support the family, sent to other homes where they could be abused and sometimes they live on the streets where they are coerced into sex. Girls are more vulnerable than boys. However, children sometimes show great resilience in the way they cope by heading up households when parents have died.
• How are children coping?
• Is enough being done to prevent children from getting infected with HIV?
• What level of care is being provided by the church and community for orphans and vulnerable children?
• Is there any provision to prevent transmission of HIV from a mother to the child?
• Are the rights of children upheld, especially with respect to inheritance rights and protection?