ase. In Uganda, for example, songs about the disease, nationally distributed posters, and public awareness campaigns starting as early as kindergarten have all helped to stem the spread of AIDS. Prostitutes in Senegal are licensed and regularly tested for HIV, and the clergy, including Islamic religious leaders, work to inform the public about the disease. Other parts of Africa, however, have experienced little progress. For example, the practice of sexually violating very young girls has developed among some HIV-positive African men because of the misguided belief that such acts would somehow cure them of the disease. Better education and advocacy of safer practices, as encouraged and directed by NGOs working in conjunction with the United Nations system, and community leaders and members, can battle the damaging stereotypes, misinformation, and disturbing practices associated with AIDS (Mach 2000; UNAIDS 2002; WHO/ GPA 1989).
Laws concerning HIV and AIDS typically fall into four categories: (1) mandatory reporting, (2) mandatory testing, (3) laws against transmission, and (4) immigration. The mandatory reporting of newly discovered HIV infections is meant to encourage early treatment. Canada, Switzerland, Denmark, and Germany, among other countries have enacted mandatory screening laws for HIV. Countries like Estonia require mandatory testing of prison populations (in response to explosive rates of infection among the incarcerated). The United States requires some form of testing for convicted sex offenders. Other legal and international issues concern the criminalization of knowing or unknowing transmission (more prevalent in the United States and Canada) and the rights of HIV-positive individuals to immigrate to or even enter foreign countries (Encyclopaedia Britannica 2003; Arnold 1997; Jonsson and Soderholm 1995; UNAIDS 2002).
In the United States, communities have fought the opening of AIDS clinics or the right of HIV-positive children to attend public schools. Countries like Thailand, India, and Brazil challenge international drug patent laws, arguing that the societal need for up-to-date treatments supersedes the rights of pharmaceutical companies protected by international patent laws. At the start of the 21st century, Western countries were also battling the reluctance of the Vatican, some Muslim nations, and other countries such as China to single out homosexuals, prostitutes, and drug dealers for special attention out of fear of appearing to condone their lifestyles. These are all only some of the examples of the obstacles HIV/ AIDS related NGOs all over the globe must face and surmount regularly (Encyclopaedia Britannica 2003; Arnold 1997; Jonsson and Soderholm 1995; Mercer et al. 1991; Nayak 2000; Tielman et al., eds. 1991; UNAIDS 2002).
Less developed countries (LDCs) have made impressive progress in human development since the Second World War. However, those achievements are being undermined as countries lose young, productive people to HIV/ AIDS. Households fall into deeper poverty, economies stumble and the impact of the epidemic is felt across society (UNAIDS 2002).
The demographic impact:
More than 60 million people have been infected with HIV since the beginning of the epidemic almost 20 years ago. In 2001 alone, the HIV/ AIDS epidemic claimed an estimated 3 million lives. In the 45 most affected countries, between 2000 and 2020 an estimated 68 million people will die due to AIDS. In many countries, AIDS is erasing decades of progress in human development by drastically reducing life expectancy (UNAIDS 2002).
The impact on households:
AIDS pushes people deeper into poverty as households lose breadwinners, livelihoods are compromised and savings are consumed by the cost of health care and funerals. Women are left bearing bigger burdens as workers, care givers, educators and mothers. Yet, their legal, social and political status leaves them more vulnerable to HIV/ AIDS (UNAIDS 2002).
The impact on the health sector:
In all affected countries, the HIV/ AIDS epidemic is putting the health sector under strain. Overall quality of health care dropped. There is a shortage of hospital beds. While demand for health services is expanding, more health care personnel are affected by HIV/ AIDS. Home-care initiatives are a key coping mechanism for mitigating impact (UNAIDS 2002).
The impact on education:
A noticeable decline in school enrolment occurs as AIDS hampers the ability of education systems to fulfil basic social mandates as teachers succumb to the disease. How well educational institutions adapt and function will influence how well societies recover from the epidemic (UNAIDS 2002).
The impact on enterprises and workplaces:
The vast majority of people living with AIDS worldwide are in the prime of their working lives. AIDS weakens economic activity by squeezing productivity, adding costs, diverting resources, and depleting skills. The epidemic hits productivity through absenteeism, organisational disruption, and the loss of skills and organisational memory. Production cycles are disrupted, equipment stands idle, and temporary staff need to be recruited and trained. Loss of know-how is the most often-cited cost factor (UNAIDS 2002).
AIDS has a profound impact on growth, income and poverty. For countries with HIV/ AIDS prevalence rates of 20% or more, the GDP growth has been estimated to drop by an average of 2.6% annually (UNAIDS 2002).
The factors listed above are common to the impact of HIV/ AIDS globally (UNAIDS 2002). On the one hand, they trigger solidarity to combat government, community and individual denial, and offer support and care to people living with HIV and AIDS. On the other hand, individuals suffering from HIV/ AIDS are stigmatised and ostracised by their loved ones, their family and their communities, and discriminated against individually as well as institutionally (UNAIDS 2002).
HIV/ AIDS-related stigma and discrimination builds upon, and reinforces, existing prejudices. They play into and strengthen existing social inequalities, especially those of gender, sexuality and race. They also play a key role in producing and reproducing relations of power and control. They cause some groups to be devalued and others to feel that they are superior. Ultimately, stigma creates and is reinforced by social inequality. HIV/ AIDS victims are denied health services and education, or may lose employment on the grounds of their HIV status. This is another issue that NGOs tackling the AIDS crisis must deal with on a regular basis. To overcome such stigma, these NGOs collaborate with UNAIDS and the UN Commission on Human Rights (Disclosure of HIV status and Human Rights 2000; ACORD and ACTIONAID 1997; Crane and Carswell 1990; Mercer et al. 1991; Shreedhar and Colaco 1996; UNAIDS 2002; Wiseman 1992).
Recent UN Commission on Human Rights resolutions have unequivocally stated that “the term ‘or other status’ in non-discrimination provisions in international human rights texts should be interpreted to cover health status, including HIV/ AIDS”, and has confirmed that “discrimination on the basis of HIV/ AIDS status, actual or presumed, is prohibited by existing human rights standards” (UNAIDS 2002). The human rights framework provides access to existing procedural, institutional and other monitoring mechanisms for enforcing the rights of people living with HIV/ AIDS, and for countering and redressing discriminatory action. Two complementary kinds of alleviation strategies are necessary to address stigma and discrimination: (1) strategies that prevent stigma or prejudicial thoughts being formed, and (2) strategies that address or redress the situation when stigma persists and is acted upon through discriminatory action, leading to negative consequences or the denial of entitlements or services. Ultimately, it is at the community and national levels that HIV/ AIDS-related stigma and discrimination are most effectively combated. Communities and community leaders must advocate for inclusiveness and equality irrespective of HIV status (ACORD and ACTIONAID 1997; Crane and Carswell 1990; Mercer et al. 1991; Shreedhar and Colaco 1996; UNAIDS 2002; Wiseman 1992).
In its role as the leading advocate for worldwide action against HIV/ AIDS, UNAIDS – the Joint United Nations Programme on HIV/ AIDS – along with its eight cosponsors – United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations International Drug Control Programme (UNDCP), International Labour Organisation (ILO), United Nations Educational, Scientific and Cultural Organisation (UNESCO), World Health Organisation (WHO), and World Bank (WB) – states as its mission to “lead, strengthen, and support an expanded response to the HIV/ AIDS epidemic aimed at preventing the transmission of HIV, providing care and support for those infected and affected by the disease, reducing vulnerability of individuals and communities to the HIV/ AIDS epidemic aimed at preventing the transmission of HIV, providing care and support for those infected by the disease, reducing the vulnerability of individuals and communities to HIV/ AIDS, and alleviating the socioeconomic and human impact of the epidemic” (UNAIDS 2002). In order to achieve this, the Global Fund to Fight AIDS, TB and Malaria was set up. The Global Fund complements the work by UNAIDS by providing finance to meet these aims (UNAIDS 2002).
HIV/ AIDS programmes in developing countries and countries in transition need to spend US $10 billion annually for an adequate AIDS response. Current funds are less than a quarter of that. To reach the goal of US $10 billion annual spending on AIDS in developing countries, there must be major increases in national government allocations, greater support from the private sector and increases in international assistance through the Global Fund, bilateral funding programmes and international organisations. Two-thirds of the funding is met by international assistance (Brodhead and O’Malley 1989; Mercer et al. 1991; UNAIDS 2002).
As the epidemic of HIV/ AIDS continues to expand to all corners of the globe, it is clear that every sector of society must respond. AIDS is no longer a concern just of health authorities. The potential impact of AIDS makes it a challenge in economic, political, social and religious spheres as well. Among organisations responding to the crisis, non-governmental organisations (NGOs) are emerging as a powerful force in the effort to contain the epidemic. Diverse groups at risk of HIV infection have been reached by NGOs in a wide variety of innovative programmes (Mercer, et al. 1991).
The role of NGOs in HIV/ AIDS prevention and care
Widespread pressure for popular participation and a declining faith in the capacities of governments to solve the interrelated problems of social welfare, development, and the environment, lead to the global upsurge of organised private activity through a new non-profit sector. The non-profit sector has grown increasingly important in its efforts to provide alleviation of societal problems and injustices and the promotion of democratic values throughout the world in recent years. This sector has also become a major economic force with sizeable expenditures and multiple levels of paid and volunteer employment. Non-governmental organisations make up the subset of the non-profit sector involved in development work (Salamon 1997).
According to Brodhead and O’Malley, the term ‘non-governmental organisations’ applies to diverse organisations that “work together outside of government to address a need, advance a cause or defend an interest” (Brodhead and O’Malley 1989). However, the World Bank defines NGOs as “private organisations that pursue activities to relieve suffering, promote the interests of the poor, protect the environment or undertake community development” (World Bank 1988; Mercer et al. 1991). Brown and Korten further differentiate nongovernmental groups into the commercial and voluntary sectors. According to them, “the voluntary sector is seen as a distinct class of organisations that are held together by common beliefs and shared values, rather than by political imperatives (government) or economic incentives (the commercial sector)” (Brown and Korten 1989). They include locally-based groups as well as international organisations having local offices in project countries. Many are single-focus, narrowly targeted organisations while others attempt to meet broader needs in mainstream communities. All are characterised by their dedication to a set of shared social values that guides their organisational mission (Brown and Korten 1989; Mercer, et al. 1991).
NGOs have in increasing numbers voiced their concerns in international discourse about numerous problems of international scope. Human rights activists, gender activists, development agencies, groups of indigenous peoples and representatives of other defined interests have become active in the international community. Since their inception, the United Nations and its various organisations have felt the direct and indirect impact of NGOs. NGOs are omnipresent in many aspects of international relations, and have become critical to the UN’s future. NGOs have assumed a central role in activities involving human rights, complex humanitarian emergencies, the United Nations relationship, the global environment, the international women’s movement, operational coalitions and state relations, and AIDS. They also bring local experience to bear on international decision making (Gordenker and Weiss 1996).
The NGO expansion, dubbed the “barefoot revolution”, can be attributed to several external and internal factors to produce what has become a significant event in international policy making and execution (Gordenker and Weiss 1996). Three of the more important factors include: the end of the cold war, technological developments, and growing resources. The end of the Cold War was the first, and perhaps most important influence on NGO expansion. The demise of the Cold War brought with it the end of ideological and social orthodoxy. UN practitioners and diplomats became less reluctant to interact with nongovernmental staff, opening up new avenues of communication and cooperation within the decision making process. The UN became a forum for discussions between governments and NGOs. When politics and security, especially over nuclear proliferation, dominated the international agenda, NGOs were at a comparative disadvantage. They had no weapons, and only limited access to people wielding decision-making power. Since the end of the Cold War, NGOs have had the capacity for direct action. They also contribute advanced knowledge on issues such as gender, environment, AIDS, relief assistance, human rights, and community development (Gordenker and Weiss 1996).
The development of new technology is widely considered a second factor in influencing the prominence of NGOs in UN activity. Governments hostile to NGOs often fail in their efforts to prevent information flow, interaction and networking through the Internet and telecommunications. Electronic media have made it possible to ignore national borders, and create communities based on common values and objectives that were once the exclusive privilege of nationalism (Gordenker and Weiss 1996).
A third factor is the growing resources and professionalism of NGOs. Indigenous and trans-national NGOs have attracted additional resources from individual donors, governments and the UN. Western governments, for example, have increasingly turned towards NGO projects on the basis of reputation and cost-effectiveness. This trend matches the progressively declining funding for foreign assistance and with domestic pressures in donor countries to cut back on overseas commitments. New communications technologies are also helping foster the kinds of interaction and relationships that were once possible only through air travel. Scaling up certain kinds of trans-national efforts from neighbourhoods and regions to the global level, and scaling down to involve local grassroots organisations are no longer logistically impossible (Gordenker and Weiss 1996).
NGOs facilitate the formation of international institutions and reinforce the standards promoted by these institutions through public education, organised attempts to hold states accountable to these, and enhance institutional effectiveness by reducing the implementation costs associated with international institutions. Increased networking capabilities also allows for improved capacity to monitor states’ compliance with international agreements, promote institutional adaptation and innovation, and challenge failed institutions or projects. NGOs employ a variety of inter-organisational devices ranging from formal structures, to informal interpersonal ties to increase their persuasiveness and efficiency. Four types of inter-organisational devices can be identified: formal bridging groups, federations, UN coordinating bureaus, and connections to governments (Gordenker and Weiss 1996).
Based on a close scrutiny of goals, relationships among various organisations, and operational methods, it was deduced that NGOs play two broad roles in society: (1) operational roles, and (2) educational and advocacy roles. Operational NGOs are more central to international responses in the post-Cold War world. They have the responsibility of fundraising. The rendering of services is central to most NGO budgets, and the source for support from donors. Services rendered could include technical advice, tangible resources for disaster relief, development, etc. (Gordenker and Weiss 1996).
While the target of organisational NGOs is beneficiaries (or victims in case of emergencies), educational and advocacy NGOs seek to influence citizens, and through public opinion, bear fruit in the form of additional resources for their activities, as well as new policies, better decisions and enhanced international regimes. These NGOs help to reinforce various norms promoted through public education campaigns. This heightened awareness among public audiences in turn helps hold the state accountable for their international commitments (Gordenker and Weiss 1996).
Categorising NGOs, their trans-national relationships, and their impact on the community marks an initial step toward understanding non-governmental organisations. NGO interactions with the UN system and the global community forms part of a larger set of challenges as the international community copes with changing political trends towards decentralisation and democratisation of global governance. NGOs have played a key role in this global progression (Gordenker and Weiss 1996).
The role of NGOs in society cannot be ignored. This is true also in the field of prevention and treatment of HIV/ AIDS. In areas of the industrialised world hardest-hit by AIDS, NGOs helped set trends that have now been institutionalised within AIDS prevention:
In the developing world, the NGO response to AIDS emerged somewhat more slowly, reflecting both a lack of resources and experience, and a widespread reluctance to recognise publicly or acknowledge the threat. As the epidemic has progressed however, both well-established and newly organised NGOs have been among the first to respond, promoting the need for persons with AIDS and HIV to have access to counselling, support and health care. They have mobilised impressive efforts for training, education, and other supportive services while official declarations denied the existence of the problem (Morna and PANOS 1991; Haslegrave 1988; and Mercer et al. 1991).
The importance of NGOs in the national AIDS control programmes of developing countries has also evolved over time. When the World Health Organisation’s Global Programme on AIDS (GPA) first began to assist countries to draw up national plans for AIDS control, NGOs were not regularly consulted during planning, nor represented on national AIDS committees. Over time, GPA developed extensive links with a wide range of NGOs, and now supports their efforts to combat AIDS at global, national and local levels (Grose 1989). A 1989 resolution from the World Health Assembly supported the importance of NGOs in the global strategy for the prevention and control of AIDS, acknowledging that “their commitment and versatility, and their knowledge and experience… can make a special impact on individuals and society regarding AIDS and the needs of HIV-infected people and those with AIDS” (World Health Organisation/ Global Programme on AIDS 1989).
There is a growing list of NGO projects for AIDS prevention and care that are providing critically needed services in many different settings (Mercer et al. 1991):
The AIDS Support Organisation (TASO) - Uganda:
TASO was organised in response to the urgent need in Uganda for medical, emotional and practical support for people with HIV/ AIDS and their immediate families (Mercer et al. 1991).
Bombay Dost – India:
In response to violence against the gay community and a lack of information about AIDS and other STDs, the newsletter Bombay Dost was started to reach out to people with alternate sexuality in the city of Bombay (Mumbai) (Mercer et al. 1991).
Rio de Janeiro Prostitutes Association (APRJ) – Brazil:
APRJ has worked out agreements with the local medical establishment for regular medical check-ups, and with BEMFAM, Brazil’s largest private family planning agency to provide condoms (Mercer et al. 1991).
Project Hope/ Family Life Association (FLAS) – Swaziland:
FLAS, a local NGO is collaborating with Project HOPE, an international NGO for an AIDS awareness and prevention programme. FLAS staff develop training programmes and educational materials for non-literate adults, out-of-school youth, staff of FLAS family planning clinics, and traditional healers, train 60 HIV/ AIDS counsellors in Swaziland, and organise nationwide networks of regional counselling support groups (Mercer et al. 1991).
Education Means Protection Of Women Engaged in Recreation (EMPOWER) – Thailand:
EMPOWER offers support, assistance and access to education for women workers in Patpong, the entertainment district of Bangkok, Thailand. EMPOWER also provides referrals and health counselling on sexually transmitted diseases, nutrition, exercise, safe drug use and family planning (Mercer et al. 1991).
Copperbelt Health Education Project (CHEP) - Zambia:
CHEP offers street children a five-day survival skills course directly responding to immediate needs and long-term concerns including job training, small business management, staying within the law, avoiding drug and alcohol abuse, and preventing STD and AIDS. CHEP also runs training workshops for health workers and community leaders (Mercer et al. 1991).
NGO Consortium – Kenya:
NGOs formed a national consortium of organisations concerned with improving HIV/AIDS prevention and care, ensuring regular dialogue between NGOs and the AIDS Programme Secretariat, a government supported national AIDS committee. The sharing of information skills between NGOs leads to recognition for the role of NGOs played in the AIDS programme (Mercer et al. 1991).
To identify the most effective roles for NGOs in HIV/ AIDS prevention and care, it is imperative to recognise the strengths and weaknesses of NGOs. While not all NGOs share the same strong points, some strengths are common to most. For example, NGOs, being smaller and having more flexible administrative systems, and less cumbersome bureaucracies than governmental organisation, can devise and implement programmes faster. This allows NGOs to deal more openly with sensitive issues like sexuality and condom use (Arnold 1997; Brown and Korten 1989; Mercer et al. 1991).
NGOs are often created and staffed by community members. This gives them credibility with and understanding of the communities they serve. Thus, NGOs are more likely to attract community participation for HIV/ AIDS prevention and care efforts. They are also more likely to recognise what will be appropriate and effective for their constituencies, and in so doing, increase the potential for transforming community attitudes, beliefs and behaviours from within the community. This is a much-needed and valuable approach to HIV/ AIDS prevention. Also, volunteers provide the energy and resources to staff many NGOs, and even paid staff often work at lower salaries because of personal commitment to the goals of the organisation (Mercer et al. 1991; NORAD 1991).
NGOs are also willing to involve in their programmes those individuals who are poor and marginalised, and thereby, they succeed in reaching groups such as prostitutes or intravenous drug users, who are outside the mainstream society, and may be suspicious of public institutions. However, NGOs also have certain constraints and limitations that must also be considered in identifying their most effective roles in HIV/ AIDS prevention and care (Mercer et al. 1991; NORAD 1991).
Newer, smaller NGOs with small administrative staffs are not properly designed for large-scale budgeting or technical reporting. This leaves some organisations at a disadvantage when competing for AIDS-related funding from large international donors. Also, smaller NGOs are limited by their in-house technical capacity for complex projects. This prevents such organisations from meeting the requirements of outside funders for monetary and curriculum reporting, including evaluation of project efforts (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996).
Since NGOs often operate with volunteer or modestly paid staff, they risk the likelihood of erosion due to burn-out. They need to maintain a balance between paid and volunteer staff in order to maintain project continuity, while preventing attrition which is especially common in the emotionally demanding field of combating HIV and AIDS (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996). Also, it has often been the case that NGOs work in isolation, reluctant to collaborate with each other or with the government. This leads to limited sustainability, which does not focus on developing local capacities to carry on without NGO or other external support. This problem obscures NGO projects which are highly successful on a small scale. Early successes of a project are often found to be related to unique characteristics within the community or the NGO and may not be replicable on a large scale (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996).
There is enormous potential for NGOs to play a major role in the effort to combat HIV and AIDS. In order for NGOs to perform at their full potential, Mercer et al. suggested several approaches supporting the role of NGOs in their response to the challenges of HIV/ AIDS (Crane and Carswell 1990; Mercer et al. 1991).
NGOs must be included in the design, implementation, and review of national AIDS programme plans. Also, the efforts of AIDS-related NGOs to form national and regional consortia, in order to strengthen their abilities to collaborate with each other and with their respective national AIDS control programmes, must be supported and strengthened (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996).
Mercer et al. called for seed money and technical assistance to be provided to strengthen the administrative and organisational capacities of AIDS-related NGOs, especially in areas of great need. They argued the need for research about the best ways that this can be accomplished, even if it requires more funding for longer periods of time (1991). Collaboration has also been recommended, between larger, more established NGOs and their newer counterparts in a mentorship programme designed to strengthen capacity of small, indigenous NGOs. This would enable the newer organisations gain organisational skills more rapidly. International and indigenous NGOs need to collaborate on projects, and the success of such collaborations carefully evaluated (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996).
NGOs should be funded based on their strengths. They should be encouraged to build on their strengths. In the area of HIV and AIDS, this requires recognition of NGOs’ desire to provide support and care to persons with AIDS, as an integral part of their prevention activities (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Shreedhar and Colaco 1996).
By developing links with local universities, NGOs can substantially increase their technical capacities. Technical assistance in the field in key aspects of NGO programme interventions, provided by consultants or staff who have experience in working successfully with NGOs is a great asset, often preventing needless expenditure of misguided energy, and will assist NGO projects meet the needs of the people they serve. NGOs also need to analyse the roles played by television, radio and the press. These media act as agents of information, education or sensationalism. Their influence in creating public opinion can be monumental with regard to educational activities (ACORD and ACTIONAID 1997; Brodhead and O’Malley 1989; Brown and Korten 1989; Crane and Carswell 1990; Jonsson and Soderholm 1994; Mercer et al. 1991; NORAD 1991; Rodriguez 1994; Shreedhar and Colaco 1996). Despite current literature concerning the work of NGOs, more research analysing ways to improve their efficacy is necessary.
Developing and evaluating the effectiveness of an interactive Internet programme or HIV prevention intervention models from the research arena to nongovernmental organisations in developing countries with high HIV incidence will highlight areas of improvement (Kelly 2000). The study will incorporate Internet-based dissemination methods to establish a technology transfer approach that is rapid, widely applicable and cost-effective for national and international public health organisations including networks of NGOs. According to Kelly, previous research, found that technology transfer methods that provide intervention manuals, face-to-face staff training, and individualised consultation for implementing research-based HIV prevention interventions facilitate their adoption by service providers. This framework is now being expanded to test the use of Internet technologies to transfer an HIV prevention approach to NGOs in developing countries. Each NGO will be assessed to determine its organisational characteristics, and the full repertoire of HIV prevention services it had offered. The assessment of the efficacy of the NGOs will determine maintenance of intervention use, tailoring or adaptations made to it, staff attitudes and satisfaction with the intervention, and implementation costs. According to Kelly, this study “will add to our scientific knowledge concerning approaches for transferring effective research-based HIV prevention approaches to community-based service providers; will test and develop a prototype model for using advanced Internet-based approaches for technology transfer; and will allow HIV prevention research advances to better benefit the global fight against HIV/ AIDS” (Kelly 2000).
While NGOs and international agencies have set up specific programmes to stem the spread of HIV/ AIDS, some of the consequences of wider development policies, such as increased mobility or migration or increased income to spend on recreation, can counteract these programmes and contribute to the spread of the virus. Unless HIV/ AIDS prevention programmes adopt an integrated gender perspective addressing power relations within relevant social and economic context they are likely to fail. Many HIV/ AIDS prevention programmes for youth in school fail because HIV/ AIDS education is seen as irrelevant to their social and cultural circumstances. Youth education must therefore begin with an analysis of the needs and roles of young people in their particular community in order to respond appropriately to their needs (ACORD AND ACTIONAID, 1997).
After over a decade of research, it is recognised by NGOs and many governments that long-term solutions are needed to address the power imbalances. To date, solutions have been incomplete or inadequate and future strategies need to concentrate on power relations. There need to be changes in these relations and appropriate programme responses must be developed on this basis. Long-term solutions are needed so that women and young girls have equal access to employment, education and income generating opportunities (ACORD AND ACTIONAID, 1997).
International agencies and local NGOs need to recognise the link between development, gender relations and roles and the spread of HIV/ AIDS and to promote awareness in a broad context with staff and within projects. Existing programmes should be modified to ensure they are gender sensitive (ACORD AND ACTIONAID, 1997).
Information and services must be provided to support people who are affected or infected with HIV/ AIDS or other sexually transmitted diseases and infections (STDs and STIs). For example, confidential counselling and testing, information about safer sex and different control methods. The wider community must also be encouraged to use information services and consequently NGOs should produce accessible material and widely publicise these different services. NGOs are in a strong position to support advocacy and campaigns that can battle the spread of HIV/ AIDS (ACORD AND ACTIONAID, 1997).
Mercer et al. (1991) suggested that “… the need to adopt multiple approaches and involve diverse organisations in bringing about attitudinal and behavioural change at the community level,” will prevent further destruction by HIV/ AIDS. This review demonstrates how NGOs have embodied diverse objectives while maintaining effective local, national and international campaigns to combat the HIV/ AIDS epidemic. Further development of NGO-governmental ties and research defining efficient strategies to affect social change at the individual level will determine the course of HIV/ AIDS. Clearly, NGOs will play a role as the epidemic progresses.
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 English (UK) spellings and grammar have been used throughout this document.