There has been a common tendency to perceive the HIV/AIDS epidemic primarily as a health problem and for responses to be designed and implemented within this paradigm. Hence many responses have tended to focus on the "technological" solutions of condoms and STD service provision. More recently attention has also included consideration of issues relating to access to anti-retroviral treatment and the possibility of vaccine development. Clearly these are, and will continue to be, critical issues.

Nonetheless, the epidemic is also a development issue: both in terms of differing levels of susceptibility and vulnerability to infection among different groups (and their capacity to prevent it) and in terms of the socio-economic impact of the epidemic.

Within any population, patterns of infection reflect underlying patterns of social and economic inequality: for example, in terms of distribution of wealth and power, gender relations and women's status, poverty and lack of sustainable livelihoods, civil disorder and unrest.

Moreover, probably because of the sexually transmitted nature of most instances of HIV infection, the social response to those who are infected has usually (at least initially) been characterised by blame, stigmatisation and the further marginalisation of already vulnerable populations.

Socio-Economic Implications of the HIV Epidemic

The sexually transmitted nature of the majority of HIV infections also means that those who contract infection are usually those who are sexually active, who tend also to be those who are in their most economically and socially productive years and to be those with most responsibility for the financial support and care of others. In many countries these also tend to be among the better educated and skilled. The implications of their incapacitation reach far beyond the level of the family and community and are demonstrated in the depletion of specific sectors together with a reduction in labour productivity and the savings which are necessary for capital investment in agriculture, industry and other sectors.

The epidemic is already undermining the development gains of recent decades. In heavily affected countries, life expectancy has been reduced and by the year 2010 the epidemic is expected to double child mortality and to wipe out the improvements in infant and child mortality achieved during the last ten years. Evidence exists from several countries to demonstrate impact upon households (and particularly upon women and children), farming systems, private business, formal and informal sector enterprise, public services such as health, education, public administration and industries such as water and communications and upon security, including the police and military.

Emotional, social and economic coping mechanisms of communities affected by the epidemic are already stretched to their limits in some countries as people struggle to shoulder the responsibilities of care and support for those who are infected and their survivors, including orphans.

Collectively, these impacts result in a cumulative loss of human resources, erosion of capacity for development, and ever-deepening personal and social distress.

HIV/AIDS and Sustainable Human Development

Nearly two decades of experience with the epidemic have clearly revealed that responses to the epidemic which focus narrowly upon behavioural or technological interventions, without addressing the structural and contextual factors which create or sustain vulnerability, will have limited impact.

Similarly, decades of experience of technical cooperation have resulted in the concept of Sustainable Human Development (SHD) defined as: - development that promotes growth along with an equitable distribution of its benefits - which embodies principles of participation, equity and sustainability.

The obstacles which stand in the way of this vision of development - poverty, gender inequality, environmental degradation, social conflict, lack of participation and civil unrest - are also the factors which fuel the epidemic. Thus, programmes designed to foster Sustainable Human Development - for example those designed to eradicate poverty, to promote gender equality and good governance - potentially can have significant impact both in reducing the spread of the HIV epidemic and in alleviating its effects.

The Response of the United Nations System to HIV/AIDS

The challenges posed by the epidemic to human well-being and development necessitate broad, collaborative action. Within the United Nations system, different agencies and organisations have complimentary roles to play.

In the first decade of the epidemic, the most visible UN response was the Global Programme on AIDS, based within the World Health Organisation. As the epidemic matured and the scale and scope of its impact were gradually recognised, it became clear that there was a need for improved coordination of the response to the epidemic among the different UN organisations, and for the nature of that response to be expanded to include multi-sectoral action designed to address the social, cultural and economic causes and consequences of the epidemic. In 1996 the new Joint United Nations Programme on HIV/AIDS (UNAIDS) came into existence.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) represents an innovative partnership among a group of UN agencies (the co-sponsors): UNDP, UNDCP, World Bank, World Health Organisation, UNICEF, UNFPA, and UNESCO. It brings together the expertise of a range of sectors including health, education, social development and economics.

As the main advocate for global action on HIV/AIDS, the mission of UNAIDS is to lead, strengthen and support an expanded response, aimed at preventing the transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities to HIV/AIDS, and alleviating the impact of the epidemic.

UNAIDS programmatic activity consists of the HIV/AIDS-related work of the co-sponsoring agencies at national, regional and global levels, supported by a Geneva-based Secretariat and a network of Country and Inter-Country Programme Advisers. Drawing upon and synthesising the experience of these diverse levels and actors, UNAIDS has responsibility for policy development and research, technical support, advocacy and coordination.

UNDP and the HIV/AIDS Epidemic

UNDP is the UN's largest provider of grants for economic and social development and is the main coordinator of UN operational activities for development at country level. UNDP works in 174 developing countries and territories (including those moving towards market economies) through a network of 132 offices worldwide.

The overall goal of UNDP is to build capacity for sustainable human development (SHD). In working towards this goal, top priority is given to the eradication of poverty. Other areas of focus include employment and sustainable livelihoods; the advancement of women; environmental protection and regeneration; and building an enabling environment for SHD which includes the promotion of good governance.

UNDP's involvement with the epidemic began in 1987 when it started to provide support to National HIV/AIDS Programmes. In 1988, a formal Alliance to Combat AIDS was signed between WHO and UNDP, providing for a complementary programme of action between the two organisations, building on their respective mandates and comparative advantages. Within this Alliance, UNDP supported the development and implementation of national, regional and global HIV/AIDS activities within the overall framework of the WHO Global Programme on AIDS (GPA). UNDP was also one of the most significant financial contributors to the GPA: between 1987 and 1995, UNDP provided approximately US $150 million in support of country, regional, inter-regional and global projects.

UNDP has implemented HIV/AIDS related activities through a number of mechanisms including country programming, regional and sub-regional projects in Africa, Asia and the Pacific, Latin America and the Caribbean, Europe and the Commonwealth of Independent States and at the global level through the HIV and Development Programme (HDP), charged with responsibility for coordination of UNDP's HIV-related activities in the areas of policy guidance and programme support. At country level UNDP's HIV/AIDS-related activities occur through a range of mechanisms including mainstreaming within other programmatic areas, through HIV/AIDS-specific projects and through the provision of financial, administrative and technical support to UNAIDS.

UNDP HIV and Development Programme

The UNDP HIV and Development Programme (HDP), located in the Social Development and Poverty Eradication Division (SEPED) within the Bureau for Development Policy (BDP) was established in January 1992 with responsibility for the following areas:

¬ to provide policy guidance to the organization on HIV-related substantive and personnel issues;

¬ to coordinate all activities undertaken by UNDP in this area and

¬ to provide policy and programme support to regional bureaux and country offices and other units to manage special programme and other resources for policy and programme development.

Within the context of UNDP's overall goal of building capacity for sustainable human development, the specific role of HDP is to increase understanding of the social and economic causes and consequences of the epidemic and to build the capacity to respond appropriately both within UNDP itself and at national and local levels. The Programme is supported by a small staff group in New York working in collaboration with UNDP Regional Bureaux, Projects and a large network of HIV and Development "focal points" including 22 National Programme Officers for HIV.

The focus of the Programme to date has been upon policy and programme development and advocacy to counter the prejudice and stigma which characterise initial responses to the epidemic and to create a favourable climate in which capacity building activities can occur. Innovative strategies are being adopted and new types of partnerships created which cross traditional boundaries of disciplines, sectors and spheres of activity and interest.

The HIV and Development Workshop

The epidemic poses considerable policy and programming challenges for governments, donors, NGOs and local communities. Effective action will depend upon:

¬ understanding of the social and economic causes and repercussions of the epidemic with specific attention paid to the different ways in which women and men, children, the elderly and the poor are affected
¬ recognition and harnessing of the critical role of individuals, families and communities in promoting and effecting change
¬ engagement of opinion-formers, decision-makers and local communities in responding to the epidemic in an informed and constructive manner in discussing and exploring possibilities for creative, multi-sectoral programming with particular emphasis on governance and civil society involvement, and on strengthening community- based responses.

To build capacity in these specific areas, the Programme has developed the HIV and Development Workshop: a tool designed specifically to increase awareness of the nature of the impact of the epidemic, to promote approaches to strengthening community coping and national responses, and to identify the associated policies and programmes which will be necessary.

To date, the materials have been used with UN staff and senior government officials, for example from Ministries of Planning, Labour, Tourism, Education and Finance; with staff of National HIV/AIDS Programmes, members of productive and social sectors; with members of the Armed Forces, religious organisations; and community members and their organisations. Meaningful participation of people living with HIV/AIDS is a fundamental feature of the workshop.

Specifically the workshop is designed to assist participants in:

¬ increasing awareness of the development implications of the epidemic
¬ strengthening national capacity to plan and conduct programmes in response to the development dimensions of the epidemic
¬ understanding the gendered nature of the epidemic and the implications of this for effective responses
¬ identifying and assisting specific sectors and programmes adversely affected by the epidemic
¬ strengthening and expanding HIV-related community responses to the epidemic
¬ assisting affected individuals, families and communities
¬ supporting NGOs involved in responding to the epidemic
¬ developing comprehensive, integrated and coordinated national and regional responses to the epidemic.

Numerous full-scale national and inter-country workshops have been conducted: for example in Kenya, Senegal, Uganda, Malawi, Zambia, Zimbabwe, Zaire and Ecuador. Shorter programmes on HIV and Development have been organized in several countries for politicians, community organizations and NGOs, for example in India, Australia, Austria, Nicaragua, Mexico, Morocco, Jamaica, Peru and Paraguay.

Working with Group Process

Each of us already has considerable experience about group processes. After all, we spend much, if not most, of our lives in them: within families, friendship groups, class groups at school and college, working groups, church and social groups etc.

Some of our group affiliations are elective (that is we may choose to belong or not) such as friendship networks, or teams at work or play. However in other groups, membership (or exclusion) is pre-determined for us: for example groups which are based on selection criteria of sex, skin or hair colour, nationality, or biological family etc.

Based upon this vast wealth of human experience of social groups, we can make a number of broad generalisations which have relevance to working with groups in the context of a workshop.

¬ In a newly formed group individuals need time to establish a sense of belonging to the group and to feel connected to other members.

¬ The clearer the purpose of the group and the extent to which this reflects the shared and common concerns and priorities of participants, the more likely it is that the group will work effectively towards this goal.

¬ The ultimate goal of the facilitator is to assist the participants to achieve the overall purpose of the workshop and to realise their specific individual learning needs within this overall context.

Origins of the Facilitation Approach Used in the Workshop

The facilitation approach used in the HIV and Development Workshop draws upon a number of elements. These include:

¬ experiential learning: so-called because it provides structured opportunities for experience, reflection and learning in a mutually reinforcing cyclical process

¬ social change theories: which draw for example upon the work of Paolo Friere in seeking to increase the capacity of local people to identify and address the structural determinants of many social and economic problems
¬ participatory approaches to development: PRA (participatory rural appraisal), PLA (participatory learning for action) and a number of other similarly titled approaches, share a fundamental appreciation of the critical importance of locally determined problem indentification, analysis and action. The methods in these processes are specifically designed to elicit and prioritise local experience and expertise and to be highly participatory.

¬ new insights in development thinking and practice: the workshop also draws upon the concepts of Sustainable Human Development (defined as development that promotes growth along with an equitable distribution of its benefits) and Social Capital, a concept which emphasises the critical importance of collaborative social relationships.

¬ importance of process: collectively these have led to an increasing understanding that how things are done may be just as important as what things are done. This relates to the changing role of the outsider from expert to facilitator.

The Role and Responsibilities of the Facilitator

These approaches share a common appreciation of the potential power which groups of people working together collaboratively can generate and use in pursuit of shared goals. The common perception across these approaches is of the worker primarily as someone who facilitates a process whereby the group can achieve its stated goals. Facilitation actually includes a number of discreet tasks and requires a range of skills and qualities.

There are certain core qualities required of a facilitator:

· fundamental respect for people
· awareness of one's own strengths and weaknesses
· some level of personal insight and ability to tolerate uncomfortable feeings (in oneself and participants)
· commitment to one's own continuing professional development
· appropriate sense of humour

The skills of the facilitator include basic communication and counselling skills such as active listening, strategic questioning, problem-solving, and the ability to explain things clearly.

The tasks of the facilitator depend upon the stage of the group as outlined in the table (p.9) but principally these include:

· providing support to the group to form itself and to function cohesively (through appropriate activities such as energisers and process activity) until the end of the workshop
· keeping the group focused on the task at hand
· monitoring the group to ensure that needs of individual participants are not allowed to dominate the group nor to be sacrificed to it.

Helping People Learn

There are several practical steps which will help participants to learn. These include attending to the physical environment (light, suitable seating, refreshments), responding to the need for regular breaks and opportunities for people to move around.

The emotional environment is also an important contributor or inhibitor of learning. Facilitators may wish to consider asking themselves regularly the following questions:

"To what extent does each participant appear to be participating?"

"What is the most dominant feeling in the group?" (does it feel tired? tense? angry? warm? friendly? relaxed?)

More complete participation can be promoted by small group work which requires full participation of each individual or through. the use of "rounds" in which every participant is required to speak sequentially. For reasons of time and monotony it is probably best to limit such rounds to very brief responses such as "one word describing how you feel about the last activity".

Basic Principles

One of the fundamental principles of the different strands of the origins of this approach is recognition of the need to start where people are (rather than where we think they are or should be). Most people come to the workshop with a lifetime of personal and professional experience and knowledge. The facilitator's task is to encourage them to share this appropriately in the achievement of the group's goals. Avoiding domination of the group by more experienced (or just more vocal) individuals is very important.

We may not be able to like all those with whom we work but we do, as facilitators, have a fundamental responsibility to respect participants - even those whom we and others find difficult. This does not mean having to allow offensive or unfounded remarks to go unchallenged, but the more we are able to treat participants with respect the more they will do the same with us and each other.