NetNews Usenet Archive 1992 #16/NN_1992_16.iso/spool/sci/med/aids/1502

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Subject: Conference newspaper - Monday, part 3
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CONFERENCE NEWSPAPER - MONDAY, PART 3

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How international cooperation should change in the face of
AIDS

Every year, the world spends about $50 billion on
international cooperation through official channels. In
1991, about $250 million of this was spent on activities
directly related to the HIV pandemic, just 0.5 per cent of
the total.
Some would argue that the true amount is much greater. But
the most visible funds for international cooperation
related to HIV are designated as official development
assistance or ODA: the WHO committees and technical
advisers, the UNICEF four-wheel-drive vehicles, and so on.
Is $250 million enough? We expect a lot from official
development assistance. The work of international
cooperation agencies has been in the limelight ever since
the promotion of the "worldwide effort to stop AIDS" in the
1980s. But $250 million - $25 for each person who had been
infected with HIV by 1991 - is a pittance. To make matters
worse, it is often difficult to direct the available money
to the programmes which most need it.
What is the solution? AIDS could take a bigger slice of the
total official development assistance. I have no doubt that
this will gradually happen. But the margin for growth is
narrow. Additional money spent on AIDS has to be taken from
some other sectors. The environment, population, children,
drought relief - take your pick, where would you like to
make the cut?
Official development assistance could increase - even
double - if all industrialised countries met the target set
by the United Nations to allocate 0.7 per cent of their
gross national product to this type of assistance. But in
the present economic and political climate this is
unlikely. Just maintaining official development assistance
at present levels will be a political achievement.
It is time to reexamine the unrealistic expectation that
international cooperation agencies could or should shoulder
most of the response to HIV. As in all other fields of
development, mobilisation by affected individuals,
communities and countries accounts for an overwhelming
share of the response to HIV. So what should the role for
international cooperation agencies be?
The agencies must also recognise that they cannot "control
AIDS". They can only lend a small helping hand to the
communities and countries who need to formulate and
implement their own responses, and with whom the ultimate
responsibility for an appropriate response to HIV rests.
But let us not stop there. HIV, the agencies are telling
their partner governments, is a "multi-sectorial" issue.
How does that affect the delivery of official development
assistance? What about the $49.75 billion spent on projects
other than AIDS? To what extent is HIV considered when
planning projects for other sectors? How often do the
planners of agricultural develop-ment projects take the
effect of their proposal on gender relations into account?
What about the effect of housing thousands of male
construction workers in camps and hostels? How many
railroad projects have included strategies to prevent the
spread of HIV along major transportation routes?
Maybe $250 million is not enough. But an adequate response
by international cooperation agencies is not expressed in
dollars alone. The response will be adequate when the
agencies are ready to integrate the following question into
their decision-making process: "Will this policy, programme
or project contribute to a social environment that supports
a decrease in the spread of HIV, and will it improve the
capacity of the affected population to cope with the
epidemic?"
The environmentalist lobby has imposed an environmental
audit on the activities of international agencies. A
similar social audit is not only justified in the face of
the HIV pandemic, it is urgently needed.

Josef Decosas, AIDS specialist, Health and Population
Directorate, Canadian International Develop-ment Agency

Reference
Miller N, Carballo M. AIDS: a disease of development. AIDS
and Society, 1989;
1 (1).

*********************************************************
Sex is now a Tvery open topic'
By Janis Kelly

Every nation must mobilize the resources it has to fight
the AIDS pandemic, and in Zambia the most freely available
resources are the natural kinship ties that exist
throughout society, according to Elizabeth Mataka of the
Family Health Trust in Lusaka, Zambia. The trust, founded
by Mataka in 1987, runs five decentralized AIDS-related
projects: care for orphans (many of whom have lost parents
to AIDS); home-based care for people with AIDS; education
for teachers; an AIDS education programme for school
children and young adults; and an AIDS education caravan
that parks in markets, car parks and other places where
people gather.
Mataka is a social worker whose long involvement in child
welfare projects led naturally to her present work when
AIDS became a significant health problem in Zambia.
According to a recent pilot study in the Matero area of
Lusaka, more than one in 10 children under age 20 had lost
one or both parents. Mataka believes many of these losses
were due to AIDS, although the extent to which AIDS has
orphaned children locally and nationwide is unknown.

Research
Mataka says: "We hope to convince the government and major
funders that we need research to determine the true extent
of this situation. The AIDS orphan problem does exist in
Zambia, and it is a problem that must be addressed now."
The approach Mataka and the Family Health Trust have
developed relies on kinship ties to provide care for
orphaned children while keeping them in their usual
neighbourhoods and schools.  "The problem in Zambia is so
large that we cannot afford to remove all of these children
from their homes to other places for foster care,"  says
Mataka.  "We get other family members, teachers or other
adults close to the family to be Tcaretakers' providing
guidance and care for these young people.  Aid for orphaned
children is funnelled through these caretakers."  The
educational project targets primary school children and
young adults through 1,500 anti-AIDS clubs in schools
throughout Zambia.  "We are attempting to distribute AIDS
education information through these club members to the
wider community Q their parents, for example," Mataka says.
However, although basic AIDS information is now dispersed
fairly widely among these younger Zambians, the traditional
hesitancy between generations about discussing sexual
matters, particularly between parents and children, appears
to be inhibiting the spread of infor-mation.

Caravan
Mataka says that this became particularly clear in the
caravan project.  Children are immediately attracted to the
van with its audio and video equipment, but their presence
inhibits the type of
frank discussion needed by adults.  Success with the
caravan has been greatest in villages and market-places
where the local residents can build a small enclosure for
the visiting caravan, thus keeping children out from the
adult discussions.
Like most non-governmental organizations, the Family Health
Trust is always short of funds. Support has come from
private foundations and from the Norwegian government
(NORAD), the European Economic Com-munity and the Danish
government, but Mataka is always dealing with the problem
of finding money and how to develop and keep staff in such
an insecure atmosphere.

Stressful
Providing HIV-related services has been more stressful than
Mataka's previous work because AIDS is "so final". She
says: "As a social worker, when you get involved in a
problem, you usually expect to come up with a plan, to work
with the person through the necessary stages and finally to
see the client become their own person, independent of you.
With AIDS, your focus has to be different.  You work out a
plan for making the person and family as comfortable as
possible, but you know that the ultimate outcome will not
be what you would like it to be."

Taboos
Mataka is able to cope with this stress in part because her
husband is also a social worker and understands the
problems she faces every day. Her work in the AIDS crisis
has caused personal changes: "Doing this work has changed
me in one big way - some of the traditional attitudes and
taboos have ceased to have meaning for me.  When I deal
with my children, for example, I know that I am dealing
with a matter of life and death where AIDS is concerned.
This business of not being able to discuss sex is over.
Before I became involved with AIDS education, I was part of
that large group of parents who find it very difficult to
discuss sex with their children. Now, it is a very open
topic."

*********************************************************
How the 1992 Conference Got From Boston to Amsterdam
By William Check

In 1986, when Max Essex, chairman of the Harvard AIDS
Institute, was asked whether he would head the effort to
organize the 1992 VIIIth International AIDS Conference in
Boston, his first concern was to make sure he would have
the support of his Harvard colleagues. Having satisfied
himself on that point, he agreed. He had no inkling then
that his real nemesis would be US immigration policy, which
would ultimately force the meeting to be cancelled, then
moved to Amsterdam.
Nor could he have foreseen how personally torn he would be
during the "week of decision" at the 1991 meeting in
Florence. Looking back at those few days, he says: "There
were no easy options. It was an extremely difficult
decision."
In 1986, Essex's colleagues at Harvard convinced him that
it would be valuable for Harvard, and especially the
Harvard AIDS Institute, to host the meeting.
The first signs of trouble appeared around the time of the
San Francisco meeting in 1990. Essex says: "There was a lot
of unrest and confusion about holding the meeting there
because of the discriminatory American laws".

Restrictions
Some agencies decided to stay away. It was in San Francisco
that Essex was first asked what he would do if, two years
later, the same disciminatory legislation existed. His
response was that he would not have the meeting in Boston,
but have it somewhere else - anticipating that, by then,
the legislation would be changed.
In late November 1990, the US Congress decided to leave
restrictions on the travel of HIV-infected people up to
Louis Sullivan, the Secretary of Health and Human Services
(HSS). People assumed that this move would solve the
problem, as Sullivan could take HIV off the travel
restriction list.
But in the late spring of 1991, the US government announced
more studies of concerns about HIV, and that until they
were completed, HIV would remain on the restricted list.
The result was a severe problem for Essex, who was required
to give the traditional talk at the last session of the
Florence conference, inviting people to come to Boston the
next year. What should he say?

Rallying point
Most activists present at Florence were strongly against
having the meeting in the US if the discriminatory
legislation was still in effect. Yet, Essex says, there
were many delegates, particularly from Third World
countries, who were very upset by the idea of terminating
the meeting, which would leave no forum for information
exchange.
Some activists later said the meeting should have been held
in the US and used as a rallying point. But Essex questions
whether it would have been right to take over the
conference as a vehicle to protest against American
discriminatory immigration policy.
"I faced a very difficult dilemma at that time," he says.
Visibly upset during his closing speech at Florence, he
announced that the meeting would not go ahead in Boston.
Harvard agreed with his recommendation.

Brilliant
The question remained of whether there would be a meeting
at all. But Harvey Feinberg and Jonathan Mann decided the
meeting should be held in another country. Together with
Dutch experts, they arranged joint administration: each of
the four Harvard track chairs would work as a co-chair with
a Dutch counterpart.
Essex calls the choice of Amsterdam "brilliant". He is, he
says, delighted with the way it has come to fruition.

*********************************************************
Conference Newspaper
VIII International Conference on AIDS/
III STD World Congress
Amsterdam, The Netherlands
19-24 July 1992

Editor:     Sharon Kingman
Deputy Editor:    Cindy Patton
Writers:     William Check
    Janis Kelly
    Simon Rozendaal
    Wim Zeijlemaker
Translators:    Elena Hanselaar
    Annette Eskenazi
Managing Editor:    Jackie Bailey
Production Manager: Karin Balster
Layout & Design:     Kuiper & Company
Photography:     Rob List
    Fotografie BV

Published by:     Medialert Projekten BV
Publisher:    Willem Korteling
Printing:     Salland Rotatie         Drukkerij,
Deventer
Conference Directors
of Communications:     Hilary Rao
    Nono Landheer
Conference Com-
munications staff:     John Willoughby
    Pien Witteveen

Supported by an educational grant from
The opinions expressed are those solely of the authors.

The Conference Newspaper gratefully acknowledges the
generous assistance of
Van Beek Automatisering.

--
Matthew Lewis, University of Amsterdam        Grote Bickersstraat 72
[phone]                1013 KS  Amsterdam
Internet: [e-mail]            The Netherlands