HIV

Building resilience to adverse childhood experiences

Sue Holden Publications - English , , ,
HEJ article

HEJ article - Building resilience to adverse childhood experiences An assessment of the effects of the Stepping Stones with Children training programme on Tanzanian children affected by HIV and their caregivers

In this article, published in the Health Education Journal, my colleagues and I presented the effects of the Stepping Stones with Children programme on children aged 5–14  years affected by HIV and their caregivers.  The findings are from the community workshops conducted by PASADA in four communities in Tanzania.

Although we intentionally excluded ‘disclosure’ of HIV sero-status to children as an indicator, the proportion who knew their sero-status increased from 27% to 93%. Assessment of clinical data before and after the workshops showed a statistically significant increase (p-value of <.01) in the CD4 count among the child participants living with HIV (n = 85, mean CD4 change + 317; from 530 to 847) compared with the control group (n = 91, mean CD4 change + 133; from 557 to 690). The mean weight gain was 3.51 kg for child participants and 1.33 kg for controls. Other benefits included improved relationships and reduced violence against the children, greater confidence, more willingness to use HIV services and better networks of support.  We concluded that the Stepping Stones with Children programme can achieve multiple outcomes, including disclosure and better adherence to treatment, to reduce the impact of the adverse childhood experience of being affected by HIV. The work also demonstrated that it is possible and acceptable to include children aged five and over in learning about HIV, sexual health and skills to improve their resilience.

Stepping Stones with Children

Sue Holden Publications - English , ,
StStwC front cover

StStwC front cover A transformative training for children affected by HIV and their caregivers

Children living with HIV can live normal, healthy lives if they have love, care, and treatment when they need it. Yet they and their caregivers face many challenges, including stigma and self-stigma, discrimination, violence and abuse, and services that may not serve children well. While we would all prefer to experience relationships of love, appreciation, and compassion, challenges including grief, bereavement, stress, and poverty can get in the way. The result is that children suffer in many ways, and some die because they have not received treatment, and the care and support needed to take it, in time. Stepping Stones with Children is a response to this, enabling children and their caregivers to explore and change norms, learn and practise skills, and develop healthier and happier ways of living.

Please note, Gill Gordon is the author of Stepping Stones with Children; as manager of the project I played a role in shaping the materials by editing them and contributing some exercises, so am listed as a co-creator.  The manuals are available for purchase from Practical Action Publishing; if your organisation cannot afford to buy them please apply for free copies.

Stepping Stones with Children Counselling Guide

Sue Holden Publications - English , , , , ,
Stepping Stones Counselling

Stepping Stones with Children Counselling Guide

This guide accompanies the Stepping Stones with Children manuals.  I wrote it with Jovin Riziki, focussing on the additional knowledge and skills that HIV counsellors need to work with both children who are affected by or living with HIV and their caregivers. We explore the differences between counselling adults and children, and outline the key steps to follow in different counselling situations involving children and caregivers. You can download the guide for free here (scroll down the page); you may need to register with the Salamander Trust’s website to access the document. Also available in KiSwahili.

Extract

We’ve written this guide for people who already have the knowledge, skills and experience needed to counsel adults about HIV and related issues. We haven’t included basic information, such as what counselling is or key skills for counselling. Instead we’ve focused on the additional knowledge and skills that counsellors need to work both with children who are affected by or living with HIV, and with their caregivers. We also outline the key steps to follow in different counselling situations involving children and caregivers. This guide accompanies the Stepping Stones with Children manuals. Children and caregivers who attend Stepping Stones with Children workshops learn to appreciate their abilities, and to find ways of using these to improve their lives. For example: caregivers learn how to discipline children rather than hitting or otherwise punishing them, while children learn how to set boundaries regarding sexual intimacy, and how to protect themselves and others from sexual abuse. Basics of counselling children HIV counselling with children, as with adults, aims to help them cope with emotions and challenges relating to HIV and its effects, and to make informed choices that will improve their quality of life. Though the focus may be on HIV, counsellors need to see and work with the whole child: all the things that affect their life. Counselling children includes:

  • helping them tell their story;
  • listening carefully;
  • giving them correct and appropriate information;
  • helping them make informed decisions;
  • helping them recognize and build on their strengths;
  • helping them develop a positive attitude to life.

Counselling children does not include:

  • making decisions for them;
  • judging or blaming them;
  • interrogating or arguing with them;
  • making promises you cannot keep;
  • preaching to or lecturing them;
  • imposing your own beliefs on them.

Our key tasks during counselling sessions with children and caregivers include:

  • helping them understand their situation and how they are feeling by reflecting back what they have told us, both verbally and non-verbally;
  • helping them explore their regrets and feelings of blame and anger;
  • supporting them in seeing what they may be able to do to improve their situation, even though many factors are beyond their control;
  • supporting them in making informed decisions;
  • sharing useful information with them;
  • supporting them in developing the courage and confidence to come up with their own strategies and hopes and plans for their future.

What’s different about counselling children? There are four key differences when counselling children as opposed to adults.

  1. We must adjust what we say and do to suit the age and development stage of each child. There should be a big difference between the way we work with a five-year-old who may not yet be able to write, and a 15-year-old who may already be emotionally mature.
  2. We usually work not with a single client, but with a child and their caregiver(s). We must attend to their different hopes and needs, and support them in working together.
  3. We have to be willing and able to talk with children about sex and sexuality, and we may find this difficult.
  4. We need to be mindful of local rules and laws regarding children, for example, knowing at what age and under what circumstances a child can get an HIV test without a caregiver’s consent.

¡Logrando que suceda! Formando jóvenes para la incidencia política por la salud y los derechos sexuales y reproductivos

Sue Holden Publications - Spanish , , ,
¡Logrando que suceda! Formando jóvenes para la incidencia política por la salud y los derechos sexuales y reproductivos

iLogrando que suceda!¡Logrando que suceda! Formando jóvenes para la incidencia política por la salud y los derechos sexuales y reproductivos

Desarrollé este manual de capacitación sobre defensa para dance4life, basado en las actividades que habían desarrollado.  Está acompañado de folletos y un diario de los facilitadores, y fue escrito originalmente en inglés.

(The Spanish translation of Making It Happen!)

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Algunos cambios sencillamente ocurren. el suelo se moja porque está lloviendo. Sin embargo, la mayoría de los cambios viene de alguien. la idea de construir un refugio para no mojarse en la lluvia, luego el trabajo para construirlo. Esta formación es acerca de permitir a los jóvenes que creen cambios, utilicen sus ideas y sus voces de manera efectiva para influir en otros y logren que las cosas sucedan.

dance4life está convencida que la incidencia política es esencial si queremos alcanzar cambios a largo plazo que beneficien a gran cantidad de jóvenes y la comunidad en general. El impulso para esos cambios debe venir de los mismos jóvenes. Ellos conocen mejor los temas que enfrentan y los cambios que se requieren. Con el apoyo de organizaciones relevantes, los jóvenes son los mejores representantes de los temas de la propia gente joven.

¿Cuál es el propósito de este manual de capacitación?

Este manual está escrito para facilitar al personal (de incidencia política) y los facilitadors de dance4life National Concept Owners (NCO – Propietarios de Concepto Nacionales) para capacitar a los jóvenes en la promoción e incidencia política nacional. Es una herramienta que puede utilizar para: Reforzar el conocimiento y la capacidad de los jóvenes a través del aprendizaje acerca de la incidencia política. Ayudar a los activistas jóvenes en averiguar qué quieren cambiar más con respecto a su salud y derechos sexuales y reproductivos (SDSR). Ofrecerles una participación significativa en la refinación, finalización e implementación de sus planes de incidencia política (NCO).

Crear un contexto de aprendizaje positivo

¿Recuerda lo aburrido que puede ser, recibir clases? ¿Cómo la voz del/de la profesor(a) sigue y su mente se distrae – lo frustrado que se siente porque no hay posibilidad de hablar? ¿O sentirse preocupado de que entendería algo ‘mal’? Esta capacitación no debería ser así ¡PARA NADA! Será divertida y creativa e involucrará a todos sin miedo o ansiedad.

¡Su papel no es ser profesor(a) o expert! En cambio usted es un(a) facilitador(a): alguien que hace un proceso de aprendizaje y descubrimiento más fácil. Los métodos en las sesiones de capacitación ayudan a que esto suceda. permiten a los participantes a descubrir las cosas por sí mismos, en lugar de que ser contadas. Su tarea es crear un contexto positivo para su aprendizaje, de las siguientes maneras:

  • Guíe por el ejemplo, con un enfoque positivo, con voluntad de escuchar y una actitud respetuosa.
  • Dele estructura a las sesiones siguiendo el plan de capacitación, explicando qué hay que hacer y controlando el tiempo.
  • Apoye a los grupos en concentrarse en la tarea que están haciendo, en lugar de desviarse del tema.
  • Esté abierto a las discusiones inesperadas pero importantes y sea flexible para adaptar el plan y explicar cambios si es necesario.
  • Gestione las manera de interactuar de las personas si se requiere, de modo que todos tengan la oportunidad de añadir su voz y nadie domine.
  • Responda a cualquier problema que surja, tal vez preguntando al grupo qué hacer.
  • Proporcione a cada persona la oportunidad de dar retroalimentación acerca de la capacitación y de mejorar el proceso.
  • Elogie a los participantes por sus esfuerzos y por las virtudes y el liderazgo que han mostrado.
  • Utilice el humor y el enfoque diplomático para hacer frente a conflictos dentro del grupo.

Know Much More About HIV: Staying positive and healthy in the workplace

Sue Holden Publications - English , ,
Know Much More About HIV

Know Much More About HIVKnow Much More About HIV: Staying positive and healthy in the workplace

SAfAIDS asked me to write a booklet for employees, as part of a toolkit to support workplace responses to HIV. I wanted to give readers more options and more detail than the usual HIV prevention messages, and so set out 26 ways in which individuals can reduce their risk of acquiring HIV.

The booklet also outlines the steps which individuals can take to create a supportive and healthier workplace, and is available in Portuguese.

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Extract

What has HIV got to do with your workplace?

There are many different things which affect how well you and your colleagues work, and how productive your organisation is. Among those many factors, the impact of the HIV epidemic is likely to be significant. The effects of HIV in the workplace include:

  • If employees become infected with HIV and do not access treatment, then HIV will, in time, badly affect their health and productivity, leading to severe illness and their eventual death;
  • Increased staff absenteeism and higher staff turnover cause problems. These include stalled projects, missed targets, colleagues becoming overworked, managers spending too much time sorting out problems related to health issues, and lower morale in the workforce;
  • Staff costs tend to rise. This is due to higher medical costs, more funeral expenses and death benefits, and increased recruitment and training costs;
  • Efficiency is also undermined when staff are indirectly affected by HIV. For example, caring for sick relatives, or taking on responsibility for relatives’ children, takes time and causes stress.

However, we are not powerless against HIV. We can manage HIV in the workplace in three ways:

  1. Support staff and their family members to protect themselves from HIV infection
  2. Support staff (and sometimes their family members) who are HIV infected to maintain their health and their ability to work.
  3. By advocating for and creating a supportive working environment that implements its HIV policy and operates a wellness programme, with peer educators, educational awareness campaigns and programmes for staff.

What’s in this booklet?

Section 2 covers basic information on HIV transmission, progression to AIDS, and treatments for HIV and the opportunistic infections that arise from it. It may be a useful reminder for you, even though you already know a lot. You can use the information there to work out for yourself if a certain situation has potential for HIV transmission.

Section 3 deals with ways of preventing HIV transmission. This means both protecting yourself from getting infected, and stopping transmission of HIV to others.

Section 3.1 goes beyond the usual ABC of HIV prevention, and gives you 14 different options for reducing the chance of HIV transmission through sex! You may find new options there that you can use.

Section 3.2 concentrates on reducing HIV transmission from mother to child. It includes options for couples who want to get pregnant where one or both of them are infected with HIV.

Section 3.3 looks at ways of maintaining health and preventing opportunistic infections

Section 3.4 looks at ways of reducing HIV transmission through medical, cutting and injecting procedures. This section should also give you food for thought.

In Section 4 we move on to the more general topic of valuing our health. HIV is not the only threat we face, and there is a lot we can do to increase our chances of enjoying good health and productive lives.

Lastly, in Section 5 we set out the key ways in which we can create a supportive workplace for the benefit of all staff.

Saiba Muito Mais sobre o HIV: Mantendo-se seropositivo e saudável no local de trabalho

Sue Holden Publications - Portguese , ,
Saiba Muito Mais sobre o HIV: Mantendo-se seropositivo e saudável no local de trabalho

Saiba Muito Mais Sobre o HIVSaiba Muito Mais sobre o HIV: Mantendo-se seropositivo e saudável no local de trabalho

A SAfAIDS me pediu para escrever um livreto para os funcionários, como parte de um kit de ferramentas para apoiar as respostas do local de trabalho ao HIV. Eu queria dar aos leitores mais opções e mais detalhes do que as mensagens habituais de prevenção ao HIV, e assim estabelecer 26 maneiras pelas quais os indivíduos podem reduzir o risco de contrair o HIV.

O livreto também descreve as etapas que os indivíduos podem seguir para criar um ambiente de trabalho mais saudável e de apoio, e foi originalmente escrito em inglês.

(The Portuguese translation of Know Much More About HIV)

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O que é que o HIV e SIDA têm a ver com o teu local de trabalho?

Há muitas coisas que afectam o teu trabalho e dos teus colegas e quão produtivo é a tua organização. Dentre tantos factores o impacto da epidemia do HIV e SIDA é o mais provável de ser significativo (importante). Os efeitos do HIV e SIDA no local de trabalho incluem:

  • Se os trabalhadores ficarem infectados pelo HIV e não acederem ao tratamento, então o HIV por sua vez irá afectar negativamente a sua saúde e produtividade, levando a doenças graves e eventual morte;
  • absentismo do pessoal acrescido e a uma maior mudança de trabalhadores causam problemas, tais incluem projectos não terminados, metas não cumpridas, colegas sobrecarregados de trabalho, gestores que desperdiçam demasiado tempo na resolução de problemas relacionados com questões de saúde e uma baixa moral na força laboral;
  • As despesas do pessoal tendem a aumentar. Isso ocorre devido aos mais elevados custos médicos, mais despesas com funerais e subsídios de morte, e custos acrescidos de recrutamento e treinamento;
  • A eficiência é também posta em causa quando o pessoal está indirectamente afectado pelo HIV. Por exemplo, cuidar dos familiares doentes ou assumir responsabilidades pelos filhos dos familiares, leva tempo e causa stress.

No entanto, não estamos sem poder em relação ao HIV. Nós podemos gerir o HIV no local de trabalho de três formas:

  1. Apoiar o pessoal (e algumas vezes os membros da sua família) que estejam infectados pelo HIV para manterem a sua saúde e a sua capacidade de trabalho.
  2. Apoiar o pessoal e os membros da sua família para se protegerem das infecções do HIV.
  3. Advocar e criar um ambiente de trabalho de apoio que implemente a sua política de HIV e implementar um programa de bem-estar, com educadores de pares, campanhas de programas de sensibilização educativos para o pessoal.

Qual é o conteúdo do livro?

A secção 2, aborda informação básica sobre a transmissão do HIV, a sua evolução e transformação em SIDA e os tratamentos para o HIV, e para as infecções oportunistas que surgem como resultado do virus. Pode ser útil fazer lembrar, embora mesmo tu saibas muito sobre o assunto. Podes usar a informação aí existente para resolver por ti próprio, caso uma certa situação aponte para a possibilidade de transmissão do HIV.

A secção 3, aborda as formas de prevenção da transmissão do HIV, isso significa tanto protegeres-te para não ficares infectado, como evitar a transmissão do HIV para outras pessoas.

A secção 3.1, vai para além do ABC do costume da prevenção do HIV e dá-te 14 diferentes opções para reduzir a hipótese de transmissão do HIV através do sexo! Podes encontrar novas opções aí existentes que podes empregar.

A secção 3.2, focaliza-se na redução da transmissão do HIV de mãe para filho. Ela inclui opções para casais que queiram ter um filho, onde um deles ou ambos estejam infectados pelo HIV.

A secção 3.3, olha para as formas de se manter saudável e de prevenir as infecções oportunistas.

A secção 3.4, aborda as formas de redução da transmissão do HIV através de procedimentos médicos, cortes e infecção, esta secção também dá-te ideias para reflexão.

Na secção 4, passamos o tema mais geral de valorização da nossa saúde. O HIV não constitui a única ameaça que nós enfrentamos e há muitas coisas que nós podemos fazer para aumentar as nossas hipóteses de desfrutar de uma boa saúde e de levar uma vida produtiva.

Por último, na secção 5, nós apresentaremos as formas chaves através das quais nós podemos criar um local de trabalho e de apoio favorável para todos os trabalhadores.

The Big Picture: A guide for implementing HIV prevention that empowers women and girls

Sue Holden Publications - English , , , , ,
The Big Picture - Implementing HIV prevention

The Big Picture - A guide for Implementing HIV prevention that empowers women and girlsThe Big Picture: A guide for implementing HIV prevention that empowers women and girls

From 2006 to 2010 STOP AIDS NOW! supported an innovative project in Kenya and Indonesia which gave equal weight to HIV prevention, gender equity and human rights. At the end of the project they asked me to set out the theory and practice of their partners’ efforts in a ‘how to’ guide. This is the result, which I co-authored with the project’s manager, Jennifer Bushee.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

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Extract

This guide provides ‘how-to’ information for developing a ‘transformative approach’ to HIV prevention for women and girls. Such an approach addresses key root causes of vulnerability to HIV and seeks to reshape the beliefs, attitudes and behaviours of individuals and communities in favour of women and girls and gender equality. It also aims to empower women and girls to protect themselves from HIV infection and from the negative impact of living with HIV.

It sets out the rationale for working on HIV prevention using a transformative approach. It also shares experiences and promising practices from the Gender Development Project. It then provides 5 steps based on these for developing HIV prevention work aimed at reducing the HIV risk of women and girl through promotion of gender equality and women’s rights.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

We note that the advice in this guide is not fixed and definite; please read it as providing suggestions based on the experiences of the partners in the Gender Development Project. The advice should be adapted to fit local needs and the relevant social, political and cultural context.

We also note that this guide is not comprehensive and is not written to support the development of a whole project cycle. It gives guidance about how to think from a ‘gender transformative’ perspective, but it does not, for example, give step-by-step instructions for doing a needs assessment.

Finally, we note that this guide encourages readers to think differently about how to respond to HIV, using a holistic perspective, the so-called ‘big picture’. This approach gives you wider scope for doing HIV prevention work. It allows you to integrate HIV prevention in other work on gender and rights. It also allows you to respond more closely to the felt needs of girls and women. Crucially, the ‘big picture’ approach, over time, allows you to work in a ‘transformative’ way. This means it helps supports people to transform or change gender relations in ways that are beneficial to all, including—but by no means limited to—by reducing vulnerability to HIV transmission.

Managing HIV in the Workplace: A Guide for CSOs

Sue Holden Publications - English ,
Managing HIV in the Workplace

Managing HIV in the WorkplaceManaging HIV in the Workplace: A Guide for CSOs

STOP AIDS NOW! commissioned me to research and write this handbook (which they translated into French) to help organisations reduce the effects of HIV on their staff and their work. Other terms for this include ‘internal mainstreaming’ or ‘mainstreaming HIV at the organisational level’ or ‘addressing HIV in the workplace’.

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The costs and benefits of managing HIV

Of course, managing HIV in the workplace is not free of cost.

One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff.

The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial.

We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three.

It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future.

So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs.

CSOs that have chosen to manage HIV report various benefits. These include:

  • Staff are better informed, and more able to talk about HIV and sexuality issues;
  • There is less stigma and discrimination in the workplace;
  • Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;
  • More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);
  • Staff report safer sexual behaviour, so are less likely to get infected with HIV;
  • More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;
  • Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;
  • Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;
  • Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;
  • The positive effects spill over to family members and the wider community.

La gestion du VIH sur le lieu de travail: Un guide pour les OSC

Sue Holden Publications - French , ,
The costs and benefits of managing HIV Of course, managing HIV in the workplace is not free of cost. One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff. The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial. We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three. It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future. So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs. CSOs that have chosen to manage HIV report various benefits. These include:  Staff are better informed, and more able to talk about HIV and sexuality issues;  There is less stigma and discrimination in the workplace;  Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;  More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);  Staff report safer sexual behaviour, so are less likely to get infected with HIV;  More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;  Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;  Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;  Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;  The positive effects spill over to family members and the wider community.

Prévention du VIHLa gestion du VIH sur le lieu de travail: Un guide pour les OSC

STOP AIDS NOW! m’a chargé de rédiger ce manuel pour aider les organisations à réduire les effets du VIH sur leur personnel et leur travail. Originellement écrit en anglais.

(This is the French translation of Managing HIV in the Workplace.)

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Les coûts et les avantages de la gestion du VIH

Bien entendu, la gestion du VIH sur le lieu de travail n’est pas dépourvue de coûts.

L’un des coûts est le temps de travail dont le personnel de votre OSC aura besoin pour établir des plans et pour traduire ceux-ci dans des actions. Peut-être aurez-vous également besoin d’argent supplémentaire, par exemple si votre OSC engage des formateurs pour la tenue d’ateliers, ou bien si elle contribue à l’assurance maladie ou aux frais médicaux du personnel.

Les coûts réels, exprimés en temps et en argent, sont très différentes d’une OSC et d’un pays à l’autre. Mais quels qu’ils soient, on pourrait croire que le déni de l’existence du VIH est la solution la plus avantageuse, parce qu’elle ne coûte rien. Cependant, l’étude de cas à la page 7 montre que lorsqu’une OSC ne tient pas compte du VIH, les conséquences s’enchaînent: absentéisme du personnel; échec du projet; décès d’un membre du personnel apprécié; utilisation abusive des ressources; stress pour la direction; renvoi d’un membre du personnel; perte d’un donateur; sous-performance du personnel; et des tensions entre les membres du personnel. Les coûts de l’inaction peuvent être élevés.

Nous n’avons guère d’information sur les coûts et les avantages de la gestion du VIH dans le secteur des OSC. De nombreuses OSC n’enregistrent pas les congés de maladie, et les résultats des OSC sont souvent difficiles à mesurer. Mais une enquête récente auprès d’entreprises en Zambie a montré qu’en moyenne, les avantages de la gestion du VIH étaient trois fois supérieurs au coût5 . Donc, pour chaque kwacha (ou dollar) dépensé, ces entreprises en ont économisé trois.

Ce n’est donc pas par hasard que les entreprises ont été les premières à gérer le VIH. En effet, elles sont très sensibles à des coûts en hausse et à une productivité en baisse, car ces phénomènes s’accompagnent d’une perte de bénéfices. De nombreuses entreprises ont admis qu’il est moins cher de gérer le VIH que d’ignorer son existence. C’est également l’expérience de nombreux projets d’OSC soutenus par STOP AIDS NOW! en Ouganda, en Éthiopie et en Inde. Ces OSC ont compris qu’en investissant du temps et de d’argent maintenant, elles en tirent des avantages aujourd’hui et réduisent les coûts à l’avenir.

Par conséquent, la gestion du VIH au sein des organisations est une activité rentable. Elle est également nécessaire, particulièrement aux endroits à forte prévalence du VIH, si votre organisation doit protéger sa capacité à fournir des résultats.

Les OSC qui ont décidé de gérer le VIH signalent divers avantages:

  • Les membres du personnel sont mieux informés, plus disposés à parler du VIH et de questions de sexualité;
  • La stigmatisation et la discrimination sur le lieu de travail diminuent;
  • Les membres du personnel sont plus sûrs de garder leur emploi s’ils sont séropositifs à VIH et plus prêts à révéler leur statut;
  • Plus de membres du personnel, et plus de membres de leur famille, passent des tests VIH (dans le projet STOP AIDS NOW! en Ouganda, 65 % du personnel de l’OSC avaient passé un test contre 13 % dans la population);
  • Le personnel a un comportement sexuel plus sûr et a donc moins de chances d’être infecté par le VIH;
  • Plus de membres du personnel séropositifs au VIH se relient à des réseaux de vie positive, préviennent les infections opportunistes et suivent un TAR; ils sont donc en meilleure santé et vivent plus longtemps;
  • Le personnel est plus sensibles aux questions de genre, ce qui réduit la discrimination à l’encontre des femmes et des membres du personnel transsexuels;
  • Les membres du personnel se sentent plus appréciés et, par des approches participatives, ont plus le sens de l’étroitesse des liens;
  • La capacité du personnel augmente. L’organisation est incitée à améliorer son travail en ajustant sesprogrammes de telle sorte qu’ils tiennent compte du VIH, ou bien en travaillant dans le sida;
  • Les effets positifs se répandent aux membres de la famille et à la communauté générale.

Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

Sue Holden Publications - English , , ,
internal mainstreaming HIV

HIV in the workplace
Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

These guildlines were the outcome of an interesting process of research and negotiation with five Dutch donors.

In them I set out the sponsoring donors’ commitments to support their partners’ efforts to manage HIV in their workplaces in pilot projects in Uganda and India. I also presented the rationale and basic steps for organisations to do this.

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Extract

Why have we developed these guidelines?

Breaking the silence: in many partnerships between Northern and Southern NGOs, HIV/AIDS is not discussed, or is discussed only in terms of the effects at community level. We want HIV/AIDS to be part of our dialogue with partners, and hope that these guidelines will lead to it being on the agenda, for both donors and partners. The guidelines may also help stimulate discussion within partner organizations.

Acting in solidarity: we are now in the late stages of developing and implementing workplace programs for our own staff, but are funding local partners which lack such programs. We believe we should actively open up dialogue and provide support to our partners, rather than be ‘concerned bystanders’, watching the impacts of HIV/AIDS on our partners but doing little to assist.

Getting our ‘heads out of the sand’: a recent CARE survey3 of 42 NGOs in Southern Africa found that, despite a HIV prevalence rate of around 25%, two thirds of the respondents said they did not think they had any HIV-positive employees! This vividly illustrates how managers may act like ostriches by ignoring difficult realities, a costly habit in the case of HIV/AIDS. These guidelines are about raising our heads, stating our commitments, communicating them to our partners, and helping them also to raise their heads.

Responding to demands from local NGOs: some donors expect better results from NGOs in high prevalence settings, or lower costs, as if HIV/AIDS does not exist. Research with local NGOs shows that instead of that lack of understanding, they want more openness, more support, and more clarity from their donors with regard to managing HIV/AIDS4 . These guidelines should go some way to meeting those demands.

Responding to demands from Program Officers: our Program Officers sometimes get requests from partners to fund their workplace policies. Some of them feel ill-equipped to deal with this new topic, and have asked for guidance. These guidelines should help them make decisions, and should ensure that partners’ requests are dealt with consistently within each of the Dutch donor NGOs.

Influencing others: other NGOs who work through partnership with organizations in the South are facing the same issues, but none have ‘grasped the nettle’ and developed guidelines on good donorship in a time of AIDS. We can share these guidelines with those development agencies, and so use them to stimulate their response. We expect that partners may also use these guidelines to influence their other donors towards ‘good donorship’ with regard to HIV/ AIDS.

Greater accountability: where local NGOs do not have budgets to cover employees’ health care costs, managers may cover the costs with money from other parts of their budgets. They are unlikely to tell their donors about this. These guidelines should increase communication and so accountability between us by providing clarity on what costs we are willing to fund, and by initiating dialogue between donors and partners, so that we can agree budgets to cover the financial costs of HIV/AIDS and other chronic diseases.