Private and Community-based HIV/AIDS Approaches in Burkina Faso
by Marie Rose Sawadogo
The first recognized cases of AIDS were declared in 1986 in Burkina Faso, and since then the virus has continued to spread. The country’s population is vulnerable to HIV/AIDS because of poverty, high internal and external migration, weak health services, low levels of school enrolment, and certain traditional practices and beliefs regarding women. Burkina Faso is the third most affected country in West Africa with an adult prevalence rate of 6.5%, and there is no sign the epidemic has stopped its spread. The impact of HIV/AIDS is increasingly visible in all sectors of society and in the daily life of each citizen.
Initial response to HIV/AIDS in the country came essentially from the government, which set up a national control programme to tackle the epidemic in 1987, with development partners readily providing assistance. Civil society was slower in responding, and the first AIDS control associations came into being only in the early 1990s.
One of these earlier groups is the Private and Community-based HIV/AIDS Control Initiative (IPC), set up in December 1994 under the legal responsibility of Plan International as a liaison agency for the London-based International Alliance Against HIV/AIDS. The IPC is now an autonomous NGO in Burkina Faso.
A cornerstone of its work was a campaign in 1996 to raise public awareness about HIV/AIDS. Early awareness efforts in the country had centred on information, education and communications (IEC) campaigns. While providing those involved with practical experience about the impact of AIDS campaigns on the general public, this approach was considered inadequate in bringing about changes in attitudes and behaviour.
Experiences and data collected to date in the country show that more men (94%) than women (84%) have heard of HIV/AIDS. The level of knowledge—whether accurate or not—is high but varies with socio-economic status, and especially location and education. Given this information and the fact that levels of behaviour change have been low, the IPC adopted an approach to prevention based on gradually changing behaviour through participative, peer-directed discussion groups in communities.
Constraints and Lessons Learned
Although it is difficult to evaluate the actual impact of associations working on HIV/AIDS issues in Burkina Faso, a number of lessons have been learned. Sustained investment in associations and additional financial resources are needed to consolidate them and broaden responses to the disease. New approaches have helped improve participation in activities and boost capacity building and self-confidence, although a new strategy for providing technical support in the field is required. Other needs include developing “relay associations” to increase responses to HIV/AIDS; building the training capacity of NGOs; improving administrative procedures; instigating leadership training sessions; intensifying resource mobilization efforts; improving impact evaluations; increasing the profile of AIDS and of people living with the disease; and better sharing of experiences among community-based associations and organizations to improve skills and involve a community’s leading actors.
Partnerships Against AIDS
In Burkina Faso attitudes toward HIV/AIDS seem to be marked by greater acceptance and openness; an increasing number of initiatives to fight the disease have also been launched.
HIV/AIDS must be fought by a broad front, and everyone in society has a stake in halting its spread. It is the role of the government to design and implement AIDS control programmes, coordinate all actors engaged in HIV/AIDS control and mobilize the forces required, disseminate information, and to facilitate access to drugs. In Burkina Faso, a decentralized multi-sector response in the Gaoua district has proved so successful that it is being extended to the rest of the country.
Given the scale of the challenge posed by coordination of the national response, and in the interests of an appropriate community response, NGOs are important actors in this national effort to strengthen the partnership for AIDS control. Consequently, mobilization and deep community involvement are essential if society is to prove capable of tackling the disease. NGOs are legally recognized in Burkina Faso and all have signed an agreement with the government. IPC believes that the closer the link between association members and the communities they target, the greater their ability will be to identify needs and appropriate responses. Since NGOs are far less cumbersome administrative structures than the state, they can act swiftly and produce immediate results, which enhances their credibility and effectiveness.
People living with HIV/AIDS (PWAs) are crucial to prevention efforts. Their visible presence and participation are important factors in providing care and changing attitudes toward the disease. One IPC-funded group, REVS+ (Responsibility-Hope-Solidarity with Seropositive People), is managed by PWAs who provide support in a number of areas. These include psychosocial services, home or hospital visits to patients, self-help initiatives, counselling, and advocacy for rights.
In Burkina Faso there is a tradition of communal action to combat a variety of afflictions such as desertification or drought, and the community sector has developed enormously in recent years. This may be attributed to the numerous training programmes and local technical support available, as well as to increased participation and mobilization by women. Being a woman is frequently synonymous with a low level of education, weak purchasing power, a dependent position within the couple, and a limited ability to impose herself. Through increased participation in HIV/AIDS prevention activities, women in the country have been successful in designing and preparing projects, as well as in trying innovative methods of community leadership. New approaches, such as group discussions, have been received with enthusiasm and have helped enhance the status of women in their communities. Thanks to peer group discussions, many women have been able to discuss issues about sexuality with their partners. For the first time, in these groups they have had the opportunity to handle condoms for men, and to voice their apprehension about using condoms during sexual relations with their husbands. Currently women make up about 60% of the membership of most associations in the country and contribute to both theory and decision making. And whether in women’s associations or mixed groups, they often occupy positions of responsibility.
Finally, the high media profile adopted by IPC and other associations has helped sensitize communities to the importance of HIV/AIDS through numerous television, radio and press interviews.
The main hurdle to active participation by association members is the voluntary nature of the work. Few people have the financial means to undertake such work, and most members are unemployed. In addition, the failure of donors to provide institutional support to community-based organizations and the lack of access to funds, materials, and technical and human resources poses many problems. IPC is calling for institutional support to such associations and for a re-examination of the notion of “volunteer” in poor countries, where most of the population is destitute.
Voices from Africa no. 10