A GNA Feature by Kwaku Owusu-Yeboah

Kumasi, Nov. 23, GNA - "The problem of most of us living with HIV an= d AIDS is stigma. People point their fingers at you and discriminate agains= t you wherever you go. Some of our colleagues have been thrown out of their=

homes. Some have lost their jobs. People even refuse to eat with you. Suc= h treatments kill. The infection does not." These words of a member of the Brong Ahafo National Association of Positive People (NAP+) at Techiman sum up the humiliation, injustice and unfair treatment faced by people living with HIV and AIDS in Ghana immediately they go public with their status. In Ghana, people living with HIV and AIDS have not been treated well= at all. Early responses to the disease, borne mostly out of ignorance, are partly responsible for this. HIV and AIDS was presented as a monstrous illness visited on the immoral, a just retribution for the sinful. The result has been frustration in efforts to combat the disease. People who know their status refuse to come out publicly to declare it. O= nly a few have been bold enough to do so. No public figure has yet gone publi= c with his or her HIV+ status.

With such attitudes, stigma has become the bane of HIV and AIDS prevention and control in the country - a situation that raises a number of concerns. How can we effectively control the infection if we cannot prevent ne= w ones from occurring? How can we prevent new ones from occurring when many=

who have contracted it are in denial and refuse to come out publicly, or choose to go underground, or refuse to go for anti-retroviral therapy because of stigma and rejection?

This is where the "Prevent Project" comes in!

Started about two-and-a-half years ago by Care-Ghana with funding fr= om DANIDA and support from Care Denmark, the project is showing the way by i= ts approach to HIV and AIDS prevention, support and care in a humane and non-stigmatizing manner. The project is being piloted in 36 communities in six districts of Ashanti, Brong Ahafo and the Western Regions. Some of the communities are Asafo, Amafie and Bibiani in the Western=

Region; Hansua, Menji and Nsawkaw in the Brong Ahafo Region; and Kensere,=

Kokofu and Ejura in the Ashanti Region. The goal is to make the communities HIV and AIDS competent, to serve= as examples for replication. The communities are engaged in activities on th= e disease control, from prevention to care and support in a competent and non-stigmatizing manner and transform stakeholders into a strong resource= .. Care-Ghana is working together with the traditional authorities in t= he participating communities, National Association of Positive People (NAP+)=

i.e. the national network of people living with HIV and AIDS, and Centre for Indigenous Knowledge and Organizational Development (CIKOD) in the implementation of this initiative. Two-and-a-half years down the road, the following best practices hav= e been packaged and Care Ghana is ready to share them with the larger HIV a= nd AIDS social sector. First, the capacity of traditional authorities has been built throug= h various training workshops on HIV and AIDS management, community mobilization and presentation skills. Today, the beneficiary traditional leaders have become competent and=

extended their authorities to cover HIV and AIDS activities. HIV and AIDS= is a priority in these communities. Trained queens have visited and learned lessons from their counterparts at Manya Krobo in the Eastern Region and Techiman in the Brong Ahafo Region. Second, the traditional authorities and their community members have=

been trained to develop their own HIV/AIDS stigma prevention plans. The plans identify key prevention activities including anti-stigma campaigns, condom distribution, counselling and testing. These are inform= ed by available community resources and budgeted for accordingly.

PREVENT project's efforts at promoting the integration of HIV and AIDS prevention into cultural activities and traditional practices in the communities have paid off. It is now the norm in the project communities for time to be allocated for education on the disease by resource persons trained by the project at weekly traditional council sittings of paramount chiefs, chiefs and queens in the project communities. The normal time allocated is between 10 and 30 minutes.

In order to reach a wide range of audience, the traditional leaders also use customary and traditional ceremonies including festivals and funerals as platforms for HIV and AIDS education. Puberty rites and HIV and AIDS education have been re-introduced in some of the participating communities. PREVENT project is using existing traditional and community-based acceptable behavioural change communication channels to provide informati= on about the disease. The application of these channels does not require any extensive training because community members are used to them. An example is the use of gong-gong, a traditional a means of mass communication, to mobilize community members for HIV and AIDS activities including counselling and testing services. The project also uses community durbars to provide information to a large audience and as advocacy tools to rally support and create an enabl= ing environment for effective HIV and AIDS prevention activities. Support group members contact individuals through home visits and provide them with comprehensive HIV and AIDS information on one-to-one basis. Consequently, knowledge about the virus has increased among the participating community members.

The innovative strategy (Know Your Status Campaign) of the Ghana Hea= lth Service (GHS) has been adapted by the PREVENT project to make HIV counselling and testing more decentralized and affordable to rural communities. The community-based "Know Your Status" Campaign of the PREVENT proje= ct is a collaborative effort between the project communities, the Informatio= n Services Department and the GHS. It is spearheaded by the traditional authorities with the District Health Management Teams providing nurses and counsellors for the exercise= .. Municipal and District and Assemblies (MDAs) are also supporting the=

project with the needed political leadership. A monitoring mechanism is also in place to ensure that the project i= s effectively implemented.

At the district level, monitoring teams made up of the Prevent proje= ct staff, District HIV Focal Persons, CIKOD and Nap+ undertake regular monitoring visits to the communities. They also hold review meetings at the community and district levels to discuss project implementation issues. The various HIV and AIDS prevention teams submit monthly reports to their respective traditional authorities, which also include these in the= ir reports presented during their meetings of the Regional Houses of Chiefs. Two Paramount Chiefs, Nana Kaakari Apau, Omanhene of Bekwai, and Bar= ima Ofei Akwasi Okogyeasuo II, Kokofumanhene, have shown extraordinary leadership, leading the crusade to prevent the spread of the infection an= d stigmatization of the infected.

They have mandated all chiefs under their jurisdiction to take concr= ete steps to prevent HIV and AIDS and instituted fines as a deterrent against=

multiple sexual partners among married men. Since the institution of the fines, marital cases related to multipl= e partners have decreased significantly in the two traditional areas. It is re-assuring to see the Chief of Kensere Nana Fosu Kwabi, leadi= ng condom distribution and demonstrating their proper use during anti HIV an= d AIDS campaigns in the area.

In Amafie and Twafo, the queen of the Sefwi Wiaso Traditional area, Nana Afia Korama, is an example of what traditional authorities can do to=

move the HIV and AIDS prevention programme forward. She discusses HIV and sexuality issues with young people. Her activities are extended to schools, churches and other traditional leader= s in her community.

It is to her credit that the Sefwi Wiaso Traditional Council has pas= sed a bye-law against people who impregnate girls under 18 years. This has received the backing of the District Assembly has approved the bye-law an= d people who flout it are fined one hundred Ghana Cedis (GH¢100). Mention could also be made of the Queen of Hansua, near Techiman, Na= na Afia Bema, who is in the driver's seat, organizing women and youth forums= on HIV and AIDS and Voluntary Counselling and Testing (VCT) for her people. Nana Bema has also integrated HIV prevention education into the annual ya= m festival of her people.

PREVENT project has additionally, built the capacities of people liv= ing with HIV in the six project districts. They have been empowered and are serving as resource persons to support community level HIV prevention activities. Before the project, most of them were reluctant to come out publicly. However, through training and other support from the project they ha= ve now become more assertive and confident. They are now more resilient and supportive of each other in the management of their conditions. NAP+ Ghana was established with the primary intention to mobilize H= IV positive persons under one umbrella and seek their welfare. The reality now is NAP+ Ghana is gradually but surely becoming a household name for People Living with HIV Groups in the project districts= ..

Members of the PLHIV Groups in the project districts have registered= to join it. The visibility of NAP+ in the project districts has also helped to reduce HIV and AIDS related stigma.

A baseline survey conducted under the PREVENT project revealed that HIV and AIDS related stigma and discrimination in the project districts is widespread and pervasive. However, recent studies show that HIV and AIDS related stigma and discrimination seem to be on the decline in the 36 project communities. The various strategies have worked together to change the attitude o= f community members who are demonstrating acceptable attitudes towards peop= le infected and affected by HIV.

To conclude, the PREVENT project has empowered the participating 36 communities through training and support. Its efforts are gradually paying off by reducing ignorance and allay= ing fears that festered stigma and discrimination in the participating communities. It also has many lessons and that needs to be shared to bring down t= he infection rate.