4.4.2.1. Effectiveness
All generalist organisations (n=14) visited have responded to the HIV/AIDS epidemic adopting or modifying their programmes to the needs of the beneficiaries. They all take into account the specific needs of PLWHA and affected households though not based on a systematic needs assessment but on daily practice. Hence one could question whether they target the most vulnerable people and households. From two counterparts (Arise and Samuha/Samraksha) the evaluators have evidence that they took specific efforts to reach out child headed households or female headed households.
As these mainstreaming efforts are of a recent date, not much information is available yet on the way these generalist organisations have strengthened the coping mechanisms of affected households and communities19. It will be interesting to conduct specific research on this the coming years.
The main focus of the generalist organisations is on HIV/AIDS awareness building and prevention, including in particular the rights of PLWHA, denial and discrimination:
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A change in attitude of targeted constituencies towards PLWHA has been reported in the focus group discussions: PLWHA started to speak out in public (case BERDO), reduced stigma and discrimination was reported in focus groups discussions held at Jekesa Pfungwa (Zimbabwe) and in India, relatives started to take care for PLWHA (more information in the country reports which are available on request).
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Increased understanding of HIV/AIDS was reported by illiterate and marginalised groups in India like the Dalits and the Adivasi as they had been excluded from official HIV/AIDS prevention activities.
Generalist organisations can address factors that cause vulnerability to HIV/AIDS by linking it to their core business. The evaluators noticed a considerable understanding of the susceptibility to HIV and vulnerability to the impact of HIV/AIDS of the beneficiaries and an increased capacity of beneficiaries to deal with this vulnerability:
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Gender based violence was discussed at community gatherings and in schools resulting in smooth discussions and reflections (SWEAT, NISAA),
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Women learned and dared to speak at community gatherings (NISAA, PCRD, Jekesa Pfungwa),
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Constituencies were informed on the importance of a well balanced diet and they learned how to improve their nutrition situation (Jekesa Pfungwa),
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Economical situation was addressed through the set up of income generating programmes (Jekesa Pfungwa, BERDO) or by discussing access to micro credits for PLWHA (SEF),
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Harmful traditional practices have been discussed (such as widow inheritance and traditional cleansing - BERDO),
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The link with sustainable livelihood and access to land and natural resources has been discussed (SCLC),
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Structural problems such as accessing social grants has been addressed (The Black Sash)
Generalist organisations are faced with tackling one after the other all dimensions of the continuum – even if they are not prepared to do so- and they have prioritized on one or several elements in the fight against HIV/AIDS. Additional HIV/AIDS specific services have been integrated in the programmes but only when these services could be seen as an extension of the core activities:
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a hospital including VCT, ARV and palliative care (Mulanje hospital);
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an organisation experienced in training of health care workers includes HBC in their training (INSA); organisations experienced in income generating projects do include PLWHA in these income generating activities (Jekesa Pfungwa, BERDO, SCLC),
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organisations that build up capacity of CBOs include HBC groups in their programme (ASHA, INSA, CRD, SCLC, Mulanje hosptial).
Only in one case (BERDO) additional HIV/AIDS activities were not in the line of the current activities and hence other service providers were engaged to deliver these services (a good example of complementary partnerships).
Due to these mainstreaming efforts the generalist organisations enabled an increased access of PLWHA to HIV/AIDS specific services and five of them (NISAA, APSA, Berdo, SEF and NESA) secured the participation of PLWHA or affected families in research and pilot projects. More uptake of VCT services was reported and many organisations were no longer able to cope with the increasing demand for care and counselling. These data show that the generalist organisations were successful in their work on HIV/AIDS but it also provided them with new challenges e.g. human resource and funding capacity. Overall, the challenge to improve accessibility of all programme activities for PLWHA and affected families remains.
These mainstreaming processes mostly were initiated by the counterparts themselves but enhanced by the interventions of the CFAs (through –sometimes additional - funding or through the set up of research).
The evaluators see following advantages of the involvement of generalist organisations in HIV/AIDS related activities. These factors could explain their impact on strengthened coping mechanisms of affected households and communities, which have to be documented in the near future:
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As most of the generalist organisations are community based and community rooted they have a relatively easy access to infected and affected individuals and households within the communities they work. They might well be the best placed to address a sensitive issue such as HIV/AIDS as a result of the trust that has been build up between them and the beneficiaries and because they have the ability to incorporate the HIV/AIDS message into ongoing discussions with their beneficiaries making it more acceptable.
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These generalist organisations are involved in community building activities, working with village committees, community representatives or CBOs. Hence they easily can reach out CBOs and support groups dealing with HBC and/or counselling.
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Counterparts validated their comparative advantage. One could say there is a mutual enhancement between the HIV/AIDS activities and the core activities of these generalist organisations. Some of them have experience in peer education, in addressing gender based violence, with the set up of income generating project or development of farming or garden projects. These activities are very relevant to reduce vulnerability to the impact of HIV/AIDS of people and were carried out in a professional way, having considerable success (nutrition status of beneficiaries has improved, successful income generating projects, motivated peer educators, etc.)
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Counterparts remained close to their own core business. Additional activities were in the line of the current business, hence expertise and professionalism was secured. When there was no in house expertise, complementary partnerships were established to bring HIV/AIDS services to the communities.
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Research and pilot project enhance the link between different sectors and HIV/AIDS. Through this research and pilot projects appropriate tools and methodologies have been developed that can be used in all programme components of the organisations leading to the implementation of appropriate prevention and mitigation programmes.
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In South Africa, four generalist organisations fight gender based violence. The other organisations just address gender and HIV/AIDS in a rather classical way, with a few of them (6) working on the economic and strategic position of women in society. One could question to what extent prevention and awareness activities are effective when not all factors that influence women’s vulnerability to HIV/AIDS are taken into account (for example by linking female beneficiaries to women organisations (giving them a voice), by linking programmes to programmes of women organisation that address structural injustice towards women, by supporting advocacy groups promoting gender equity and human rights20)
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Most of the generalist counterparts are in an early stage of HIV/AIDS mainstreaming although some successes can already be reported. Some of the counterparts, for example, were not adapting all programme activities to the HIV/AIDS context, due to a lack of knowledge but predominantly due to lack of additional funding (e.g. The Black Sash, NESA, APSA)
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