The Centre of the Analysis 1: Creating a Family - Demographic Silhouettes

Purpose and Rationale

The consequences of the impact of HIV for individuals, families and communities, and its implications for larger social and economic contexts need to be fully understood as a prerequisite for the formulation of appropriate policies and programmes.

This exercise is designed to enhance understanding of the causes and consequences of HIV infection in individuals, families and communities, the policy and programmatic implications of the epidemic and to assist in identifying examples of appropriate strategic responses.

Procedure

Divide participants into small groups. Provide each group with a set of silhouettes or cards which depict men, women (adults and elders), teenagers, boys and girls. Ask each group to create "a family" using these silhouettes. Families created may include those headed by the elderly; those reflecting more traditional structures (mother, father, 4-5 children); single-mother headed families or extended families. The settings may be urban or rural, may involve those middle or lower classes, land-owners or peasants.

Invite groups to discuss each family member and to develop social, economic, cultural, religious, psychological, etc. backgrounds for them which characterise the social and economic roles they play within the family and the wider community. Conclude this part of the exercise by asking them to project the well-being of the family 5 years hence. Each family story should then be shared in plenary.

Remind participants of the ways in which they have analysed the spread of the virus from person to person, place to place, and the silent and erratic nature of HIV infection. Ask participants to "infect" one, two or three members of a given family. This person may be the breadwinner (the father, mother or other head of the family); a young son or daughter who is starting a promising career; mother and or an infant.

Ask the small groups to discuss the new context for the family and its members and to review the prospects they had anticipated for "their" family in the next five years.

Materials: Silhouettes or cards with human figures, flipcharts, markers.
Time: 90 min.

The Centre of the Analysis 2: Unfolding the scenarios - Sectoral Impact

Purpose and Rationale

The nature of the impact of the epidemic is extremely complex. There are many levels of impact: upon individuals, families, communities, organisations, businesses, nations, regionally and globally. There are also many types of impact: psychological, physical, cultural, emotional, social, legal, strategic, moral, environmental, political and economical. Each contributes to the overall impact of the epidemic which cannot be reduced to a simplistic explanation.

This exercise allows participants to explore the causal chains of effects of the epidemic over time from different staring points or perspectives, at different levels and encompassing different aspects. In so doing, participants become better able to understand the potential of the impact for community and national development.

It is essential that the scenarios are locally relevant. The exercise provides participants with the opportunity to think through sequences of consequences associated with the epidemic. The capacity to think these through is essential for strategic planning and for timely identification of policies or interventions.

Procedure

Starting with a given scenario, the resource person requests participants to develop chains of causality, flowing over time. Causal chains must unfold to their ultimate, extreme consequences. As a consequence or likely outcome is identified by participants, they should explore the implications of the situation under analysis, until the chain comes to an or has reached a state where it is moving from analysis to the formulation of responses. Only then should participants pick up another thread of consequences and move through this sequence.

Encourage participants to formulate a series of strategic questions for each scenario:
C Who should respond?
C How and when?

C
C What can/must they do?
C What is the feasibility of responses?
C What are the policy and programmatic implications?
C Where and how can available or needed budgets and resources be identified and allocated?

Once the chains are completed, the various components of each can be colour coded to highlight the multisectoral nature of the impact.

Scenario Examples

Scenario 1

Imagine a 15 year-old girl. She has to assist her mother in caring for her father. He is dying of AIDS and her baby brother is already dead. Her father who had been a gold miner has passed the virus to her mother. She found out after her baby became ill repeatedly and was diagnosed as having AIDS.

Her father has chronic repeated diarrhoea, and she has been taken away from school to nurse her father. She knows her father has had many women and became infected this way. He has passed the virus to her mother and she is now always tired and often sick. The family found out when the baby started getting sick soon after birth and was diagnosed as having AIDS.

Because her mother is constantly tired and often sick, she has to assist with changing and washing her father's clothes. Her younger sister and brother have to collect water and as a result are always late for school. The 5 year girl old is so overwhelmed with work that at times she is unable to attend school.

Other relatives have abandoned this family and refuse to be associated with them. The children are worried as to the likely outcome for their future when their parents die. Their father can no longer work and their mother is often too weak to cook or to attend to the family shop.

Unfold this scenario...

Scenario 2

Recent studies undertaken in four of the main hospitals in the most highly populated islands indicate that 5-6% of pregnant women who are receiving antenatal care are HIV positive. Increasingly, men, women and their children are starting to show signs of opportunistic infections.

Gossip in small villages and towns has forced some of the women and their families to abandon their homes and income generating activities, for fear of what neighbours or close relatives may say or do. Some women, whose HIV status was disclosed by indiscreet health workers, have received anonymous threats and two have been publicly rejected.

Local social workers are saying that most women with HIV are monogamous and that their partners, some of whom are ill or have already died, refuse to acknowledge their own outside sexual activities.

Unfold this scenario...

Scenario 3

The capital of this small and beautiful island is thriving with tourists who come by the hundreds of thousands from all parts of the world. The island as a whole has a population of 400,000 and on average, five tourists per inhabitant arrive yearly.

The infrastructure of the country has greatly benefited from the tourist industry income flow: from water and sanitation, roads that lead to five-star hotels, schools for children and adolescents, health-care facilities, a key international airport for the region, etc. Numerous hotels, large and small, restaurants, gift shops, car rental businesses, import-export agencies, provide inhabitants with some of the best paid jobs in the region.

However, the enormous flow of foreigners, and the constant travel of native inhabitants to other islands and far away countries have visibly changed the social customs of islanders, especially those related with sexual norms. Many young women date tourists for money or pleasure or both. Likewise, local men do the same with female and male tourists. There is little visible activity in relation to prevention of sexually transmitted infections, including HIV, and condoms are rarely visible in places where tourists and local people meet.

HIV infection has already been detected among young men and women on the island and yet there is reluctance at all levels and sectors to implement extensive prevention activities for fear of the possible impact of the epidemic upon the vital tourism sector.

Unfold this scenario...

Chart: The centre of the Analysis

Levels of Impact:

• Individual


• Family


• Community


• Sector


• Region


• Nation

• Psychological


• Social


• Economic


• Services


• Political

The Economic Impact of the HIV Epidemic

Purpose and Rationale

Deeper understanding of the developmental dimensions of the epidemic can be developed through analysis of the links between the epidemic and social and economic factors in terms of:

The economic Impact of the HIV Epidemic - Presentation Summary

The HIV and AIDS epidemics have important socio-economic implications which have negative impact on development efforts.

The consequences of the impact will be felt:

1. At the level of the household

¬ loss of income
¬ changes in budget allocation with:

C
C increased health direct and indirect costs
C lower savings
C lower productive investments
C increased rates of dependency

2. At the level of businesses

¬ increased production costs
¬ lower investments
¬ lower production

3. At the level of the Government

¬ decreased tax revenues
¬ worsened budget balance
¬ increase in expenditures for certain social services
¬ reduction in expenditures for infrastructure
¬ decrease in foreign exchange

4. At the level of the national economy

¬ fall in GDP growth

The scope and severity of the impact will depend on several factors, namely:

C the development phase of the epidemic;
C the prevalence of HIV infection and its geographical distribution among various socio - professional groups and economic sectors;

C the structure of the economy and the relative vulnerability of sectors to the impact of the HIV epidemic;
C the development of policies and programmes which are appropriate, effective, relevant, and timely.

This requires:

¬ National awareness of the issue
¬ National co-ordinated response
¬ Commitment of leaders and communities
¬ Enabling ethical and legal environment
¬ Responsible participation of persons living with the virus and persons affected by HIV
Mobilisation of the private sector