THE LIFE CYCLE

The Life Cycle Chart

Horizontal table

Impact of Sectors listed vertically on other sect

The Community

In the community there have been many cases of AIDS. Generally the families known to have been infected were poor, but it is rumored that members of wealthy families have also been affected. In one case, two children, aged 5 and 7, are living with their grandparents since the deaths of their father (a trucker) and their mother. A local doctor is providing financial assistance. Their paternal uncle has occupied the house.

Some women have returned with their children after living in major cities. Rumors circulate about their return. They are depending on their families for support.

In the markets a stall-holder is experiencing a dramatic loss of business following rumors about the death of his new-born baby. Elsewhere in the market prices for goods and fuel transported from the city have been rising. Truckers say that city prices are rising steeply and that people should be grateful for regular supplies, as many truck drivers are too ill for consistent work. Business is thriving for bars, cafes and traditional healers.

Production has dropped at plantations because of frequent absence of female wage labourers. For management, this is compounded by difficulties in transporting products to markets.

At one tannery there is a strike with workers refusing to work with a cutter who has HIV. One of his fellow employees learnt this from a girlfriend who is a nurse at the hospital. The head office in the capital has stated there is no need to sack a good worker.

A few community organizations are becoming involved in HIV work. However, they are experiencing many difficulties.

The task is to develop a comprehensive and multisectoral programme using the cross matrix analysis.

Cross Impact Analysis - Situation Analysis

Critical data

1. Social (services) - Health / Education

Many AIDS cases

- Mainly among poor families
- But also in some wealthy families

Visible phase of the epidemic (AIDS)

- Substantial number of infections

Potential vectors

- Truck drivers
- Bars and cafes
- Women returning from cities to villages

2. Social (Institutions)

Solidarity and cohesion affected

- Increasing dependency ratio following return to community with their children, of women who lived in major cities
- Active community-based organisations but facing difficulties
- Orphans under care of strangers

3. Economy

Decreasing income

- Loss of transfers formerly remitted by women who return from major cities
- Difficulty in transporting goods from plantations

Decreasing production

- Plantations: frequent absences
- Manufacture: tannery, strikes

Inflation
- Increasing transport costs: truck drivers falling ill
- Rapid increase of prices in goods

Ethical issues and human rights
- Lack of confidentiality (hospital, nurses)

4. Analysis

AREAS	CONSEQUENCES OF THE EPIDEMIC ON THE AREA
1 ECONOMY 1.1 Agriculture 1.2 Manufacture 1.2 Commerce 1.4 Transportation 2.2 Energy
2. SOCIAL 2.1 Health/Education 2.2 Family/Community structures
3. POLITICAL 3.1 Human Rights 3.2 Government

Planning Exercise

1. The National Setting

The country is economically successful and has significantly raised the standard of living of most of its population. However, significant pockets of poverty exist.

A strong tradition of community organizations and activism does not exist but religious institutions have a significant influence in daily life. Military presence is not visible and there appears to be no problem regarding human rights.

The objectives of the National AIDS Control and Prevention Programme are:

· to prevent further infection and reinfection of people;
· to assist those affected by the epidemic to continue to live as productive, active members of society;
· to minimize the adverse impact of the epidemic on social and economic systems.

The country has a recent, growing epidemic which is still largely invisible. Some cases of HIV-related illness and death have been reported in urban areas.

Surveillance in larger towns indicates the following levels of infection:

· urban female sex workers 10-20%
· STD clinic patients, 10-15%;
· pregnant women, 1-3%;

There are concerns about working in the hospitality industry, including for example the effects on male sex workers. Donated blood comes mostly from volunteers. Where testing has been done (mainly in public hospitals in larger towns) infection rates in blood donors are 1%. Government is responsible for the formulation of laws and policies in all sectors.

2.The community

This is a tropical country renowned for its natural beauty and wonderful beaches. The population of 300,000 is scattered around the island. Long traditions of social support and solidarity have created closely-linked families and communities. The island receives hundreds of thousands of visitors each year. These visitors remain mostly in hotels by the beaches and have very limited in-depth contact with the local inhabitants. Most of these relationships occur through services provided in the tourist and commercial areas. Most islanders have regular contact with outsiders. A thriving, but discreet, sex industry involving women and men exists and while disapproved, is never acknowledged by officials for fear of damaging the tourism industry.

Literacy levels are high but fewer boys than girls graduate from high school. The health system is highly functional and includes a series of health care clinics around the island.

Most people are Christian and there is strong tradition of other local spiritual beliefs. The island, because of its natural beauty attracts many thousands of tourists and provides circumstances in which considerable sexual activity does occur between local people and foreigners. Because of the islands urbanised nature, young women and men move freely between the villages and the main centres for economic reasons. In addition, the country hosts a Jazz Festival early in the year, which attracts a considerable influx of people from North America and Europe. A communal festival held mid-year enjoys generous participation by a number of locals and visitors from other Caribbean territories.

Those who have become infected are mostly men and women who work in and around the tourist areas. Close social relations within the island communities have allowed their status to become known and this has led to social ostracism.

There have been highly visible prevention activities, however these have mostly been driven by the health sector. The media have addressed HIV sensitively. Hotel owners refuse to discuss the issue. Safer sex is rarely discussed and condom distribution is very limited.

3. The task

The government has limited funding for HIV and AIDS programmes. Develop a strategy for limiting the spread of the virus in the area.

Some Guiding Questions

¬ How can those infected be assisted to live meaningful and active lives, to continue their economic and productive activities and to raise their children and plan for their futures?

¬ How can we design and develop a strategy to minimise sexual transmission of the virus in this community and keep infections as low as possible?

¬ How can a country ensure that those infected be a central part of the national response and why should it want to?

¬ How can those affected directly assist others to change attitudes and behaviours?

¬ How can those affected assist communities to reflect on norms and values which may contribute to the spread of the virus: machismo, gender stereotypes, alcohol and drug use, lack of respect for others, prejudice, etc.?

¬ How can policies and programmes be developed and implemented in respect of tourism?

Personal and Family Plans of Action

Personal Action Plans

The facilitator should discuss with the group the strengths and weaknesses inherent in various strategies. Points for discussion include:

· no plan will work unless those implicated agree;

· plans require a degree of self knowledge and intimacy (freedom of communication) between sexual partners. The less intimacy, the less the trust, the more restrictive the personal action plan might have to be;

· celibacy may leave the person unprepared for the unexpected. Unsafe sex often results from not being prepared with a condom or being unpractised in negotiation;

· internal genital surfaces of young women mature slowly during their teens and are more easily damaged than those of women in their twenties, thirties and forties. This is another strong reason for delaying sexual debut;

· internal genital surfaces of women who have passed the menopause are more easily damaged than those of women in their childbearing years. Personal action plans should take this into account and should include the use of water-based lubricants if necessary;

· an undamaged genital area reduces the risk of HIV transmission. This is an essential part of any personal action plan. Keeping the genital area healthy is crucial for those who cannot use condoms or avoid unprotected penetrative sexual intercourse, or those unable to negotiate safer sex, and those who want to have children;

· effective male condom use requires consistent use of good quality condoms and that these be available, affordable and accessible. For women, condom use by men as a strategy is more complex since it requires the continued and consistent co-operation of a partner. The same is true for receptive partners of anal intercourse.

· female condoms allow women to have some degree of control. These are not yet widely available, affordable or accessible. Their use may still require negotiation.

· fidelity is an effective option when both partners are uninfected at the onset of the relationship and remain unfailingly faithful. Even in the context of mutually trusting relationship, couples may reach agreement on condom use with any other partner should this eventually occur.
· non-penetrative sex may be a possibility but needs to be perceived as a valid sexual option in its own right and not simply as a "preliminary" to intercourse;

· knowing one's own weaknesses and avoiding potential risk situations is a good feature of a personal action. It requires honesty and self knowledge;

· personal action plans should acknowledge the disinhibiting effects of alcohol, recreational drugs and loneliness;

· Strategies to avoid coerced sex should be part of every woman's and some men's personal action plans.

Family Action Plans

Family action plans should cover not only immediate prevention but also strategies to address issues relating to:

· changing the way children are raised and socialised as boys and girls;
· personality formation: self-esteem, self-confidence, autonomy, respect for others;
· moral and religious values formation;
· cultural factors;
· taboos, talking about sex, death, relationships.

Whilst the plan is for the family, the community and other external influences on family must be taken into account.

Workplace Action Plans

Workplace action plans are similar to family action plans in that they reveal the limit of the individual's ability to influence behaviour of others and the need to work collaboratively with others. Workplace action plans should include strategies for changing attitudes and values in the workplace as well as the behaviour of colleagues.

1.

Model for the development of an action plan

Workshop Assessment

1. Please describe in what ways the workshop did or did not meet your expectations.

2. In your opinion, the following topics or procedures were not covered and should be covered in future workshops.

3. In your opinon, the following topics or procedures should be covered in a better and different manner in future workshops.

4. Please share with us your comments on the workshop process.

5. Please share with us your comments on the performance of the facilitation team. What suggestions do you have to improve this performance?

6. What are your comments on the general content of the workshop?

7. How useful did you find the approach and the process used to deliver this approach?

8. Other comments on the workshop: organization, materials, logistics, ambiance...

Available online at http://www.undp.org/hiv

• Adolescent Sexuality, Gender and the HIV Epidemic, 1998


• Dying of Sadness: Gender, Sexual Violence and the HIV Epidemic, 1998


• Men and the HIV Epidemic, 1998


• Socio-Economic Causes and consequences of the HIV Epidemic in Southern Africa: A case study of Namibia, 1998


• The HIV Epidemic and Sustainable Human Development, 1998


• The Impact of HIV/AIDS on Children, Families and Communities: Risks and Realities of Childhood During the HIV Epidemic, 1998


• Strengthening National Capacity for HIV/AIDS Strategic Planning, 1998


• Poverty and HIV/AIDS in sub-Saharan Africa, 1998


• HIV Prevention in Multicultural Contexts, 1996


• The Impact of HIV on Families and Children, 1996


• The Vulnerability of Women: Is This Useful Construct for Policy and Programming, 1996


• HIV and the Challenges Facing Men, 1995


• Development Practice and the HIV Epidemic, 1995


• Living With HIV, 1994


• Children in Families Affected by the HIV Epidemic: A Strategic Approach, 1993


• Approaching the HIV Epidemic, 1993


• Young Women: Silence, Susceptibility and the HIV Epidemic, 1992


• The HIV Epidemic and Development: The Unfolding of the Epidemic, 1992


• The Economic Impact of the HIV Epidemic, 1992


• Gender, Knowledge and Responsibility, 1992


• People Living with HIV: The Law, Ethics and Discrimination, 1992


• Sharing the Challenge of the HIV Epidemic: Building Partnerships, 1992


• Female Genital Health and the Risk of HIV Transmission, 1991


• Behaviour Change in Response to the HIV Epidemic: Some Analogies and Lessons from the Experience of Gay Communities, 1991


• Women, the HIV Epidemic and Human Rights: A Tragic Imperative, 1991


• The Role of the Law in HIV and AIDS Policy, 1991


• Placing Women at the Centre of the Analysis, 1990

• The Implications of HIV/AIDS for Rural Development Policy and Programming, 1998


• From Single Parents to Child-Headed Households: The Case of Children Orphaned by AIDS in Kisumu and Siaya Districts in Kenya, 1998


• Riding the Roller Coaster: Experiencing Transitions from HIV to AIDS, 1997


• The Socio-Economic Impact of HIV and AIDS on Rural Families in Uganda, 1994


• Wheeling and Dealing: HIV and Development on the Shan State Borders of Myanmar, 1994


• The HIV Epidemic in Uganda: A Programme Approach, 1993

• The Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa, Summary Reports, Xth International Conference on HIV/AIDS and STDs in Africa, 1998


• Development and the HIV Epidemic: A Forward Looking Evaluation of the Approach of the UNDP HIV and Development Programme, UNDP, 1996 HIV & AIDS: The Global Inter-Connection, UNDP, 1995. Published by Kumarian Press, Inc