Impact of the HIV/AIDS & Gender Inequality Workshop in Africa

By Dr. Fitigu Tadesse, Vice President for Africa and
Jennifer Thomson, Senior Program Officer for the African Woman Food Farmer Initiative

As of the end of the Second Quarter 2004

Since the inception of the HIV/AIDS & Gender Inequality Workshop in 2003, the workshop has been conducted by THP in six countries in Africa in cooperation with various NGOs in all of THP’s Epicenters and Sub-Epicenters. The impact of this workshop is very important and the impact from country to country has varied.

As of the end of the Second Quarter 2004, almost 250,000 men and women in the rural villages have participated in the HIV/AIDS & Gender Inequality Workshop!  55% were women.  This has taken place in over 60 Epicenters and Sub-Epicenters in six countries in Africa.  Also, most of the people that attended the workshop did so in their own villages in workshops conducted by the 1,790 HIV/AIDS Animators, of which slightly over half (56%) are women, who attended special training to be able to offer the workshop in their own villages.

The impacts of the workshop are numerous. Below we have outlined the most important impacts in detail.

1. Greatly increased demand for condoms in the rural areas to protect against HIV transmission

One of the most important impacts has been that the demand for condoms to protect against HIV transmission has grown tremendously. For example:

• THP-Malawi has a partnership with UNFPA (the United Nations Population Fund) to provide condoms, especially the female condom, but the supplies are exhausted immediately. This shows that the use of condoms in the rural areas has become the norm. 8,000 female condoms have been acquired by the partners in the Epicenters.
• In Senegal, Dr. Mboup, the government health official working closely with THP-Senegal, said that use of condoms has dramatically increased in the rural areas as a result of the workshops.
• In Ghana, pharmacists in the Epicenter areas have reported to the HIV/AIDS Animators that purchases of condoms surged suddenly immediately after the Animators’ workshop sessions in their communities. The HIV/AIDS Animators and other THP women leaders also sell condoms directly. In the Second Quarter of 2004 alone, they sold over 2,000 male condoms. Another important outcome is that the stigma associated with the use of condoms is now virtually non-existent, and more women now purchase condoms themselves.
• Also in Ghana, in addition to the above impacts, some areas are also reporting a positive impact of condom usage on birth spacing. For example, one traditional birth attendant reported only 4 deliveries this year as opposed to 20 last year.

2. Increased knowledge of proper condom use

• THP-Malawi reports: “Despite the confession by almost 90% of the men to have used a male condom, only 16% of those involved knew and were able to demonstrate correct use of the male condom. No woman was able to stand and demonstrate how to correctly use a male condom because it was regarded as a men’s issue and any woman seen with a male condom was considered a prostitute. In our workshops today, above 90% of both men & women are able to demonstrate correct use of the male condoms. The taboo of ‘male condoms are men’s issue only’ has now been completely wiped out in our epicenters & sub-epicenters.”

• Chief Malikebu in Jali epicenter speaking before the commencement of one of the workshops in his village said ‘there is one thing important with these workshops – we are able to see the condoms we talk about and we are given an opportunity to practice their correct use using toys: this is a very effective practical approach than just to hear about them on the radio: that’s why most of us had heard a lot about the male condom but we couldn’t correctly use them before The Hunger Project Malawi came in our village with these village level workshops – We thank you Hunger Project Malawi.’”

3. Successful introduction of FEMALE condom in Malawi

THP-Malawi has introduced a unique initiative to provide female condoms in the villages of the Epicenters, in partnership with UNFPA, in order to help women protect themselves from HIV/AIDS and other sexually transmitted diseases. In fact, when THP-Malawi first introduced the female condom, they had no idea how the partners would react. They were very surprised and pleased when the female partners demanded to know how to access the female condoms because they saw it as something they would have control over more than the male condom, which is considered in Malawi as something the man should provide. THP-Malawi reports:

• A total of 8,000 female condoms have been acquired by our partners in our Epicenters, with the highest consumption levels in the 19 – 30 years age group. This age group is believed to be the most sexually active age group. About 57.7 % of the people that came to collect these female condoms from the specialized HIV/AIDS Animators were repeated users. The higher number of repeated users shows that female condoms have been generally accepted. THP-Malawi is the only organization working with partners on use of female condoms. This is because these female condoms are not locally available but The Hunger Project Malawi gets them from UNFPA free and distributed free.
• Some AWFFI partners in Nchalo said: “In the past, men used to cheat us saying that they have forgotten their condoms and that used to make us just go for unsafe sex: BUT today if a man says that he has forgotten his male condom, we just produce ours and we can’t be cheated anymore. Thank you, Hunger Project. At first we couldn’t hold a male condom in our hands and could not talk issues on sex & sexuality – we were being considered prostitutes – BUT MEN COULD TALK FREELY AND IT WAS BEING CONSIDERED NORMAL. THE FIRST TIME we talked freely about sex & sexuality in the presence of men was when The Hunger Project came to our village to conduct an AIDS workshop – today we are free to discuss these issues – we are no longer considered as prostitutes”
• About 40 % of the people that collected the female condoms are men. So, female condoms are not a female issue only. Men also are realizing their responsibility in practicing safe sex.

4. Men committed to take responsibility for stopping the spread of AIDS

One of the most common commitments to come out of the HIV/AIDS & Gender Inequality Workshop among men is to commit to take responsibility for stopping the spread of AIDS. This responsibility includes respecting their wives and other women and behaving in ways consistent with that respect. For example:

• In Senegal, the local program of Planned Parenthood International (“ASBEF”) which also works in partnership with THP-Senegal to train people in the HIV/AIDS & Gender Inequality Workshop, reported that men have started respecting their wives and other women more and are practicing safe sex in order to stop the spread of HIV/AIDS.

5. Participants of the workshops are now addressing gender inequality directly for the first time, and learning how it causes the spread of HIV/AIDS

Men and women that have attended the workshops reported gaining understanding of what gender inequality is, and how it is causing the spread of AIDS. Male dominance rooted in cultural practices that contribute to the spread of HIV/AIDS - such as forced and early marriage and female genital mutilation among others - are being addressed directly. In addition, practices like tattooing and male circumcision are being conducted using methods to protect from HIV/AIDS. For example,

• In Malawi, three harmful cultural practices were discovered to exist in the epicenters & sub-epicenters namely,

(i) “Kulowa Kufa” - It is believed in Nchalo epicenter area that when a husband passes away, the widow has to sleep with another man (usually selected by the elders) within two days of mourning. This practice is believed to disconnect the family from the spirits of death. If this ritual is not observed, it is believed that the family will keep on loosing people until the spirit is disconnected through observation of the ritual. Widows have for a longtime been victims of this practice suffering silently.

This practice is very prevalent in the Lower Shire of Malawi (this is where Nchalo epicenter is). THP-Malawi discovered that chiefs and elderly people are the main custodians of this practice and that even though the younger generation has been made aware of the dangers of HIV/AIDS and how it is spread, they couldn’t speak out against the practice. THP-Malawi therefore organized various village level workshops for the elders & chiefs in the epicenter where one person who was HIV positive and was suffering from AIDS (we took this person from Blantyre NAPHAM – National Association of People Living with HIV/AIDS in Malawi) spoke to the elders on the reality of HIV/AIDS. Further to that THP-Malawi showed the elders & chiefs that this is a sign of gender inequality since this practice was only observed when a husband dies and not when the opposite happens. At the end of the training, all partner village heads made a commitment to completely eradicate this practice or come up with an alternative safe practice to replace this harmful practice. Today, some villages have completely stopped the practice of “kulowa kufa” while other villages have come up with an alternative of chasing away the spirits of death. The alternative is this: Instead of the widow having sex with a man chosen by the elders, now they say one married couple within the same family tree should have sex in their family within the first two days of mourning BUT now doing it on behalf of the widow. This is a safe alternative because the people doing it on behalf of the widow are a family (couple).

(ii) “Kuchotsa mafuta” Removing oil - When a young lady reaches puberty, the elderly women are invited to counsel the young lady. It was discovered that among the many advices given to the young ladies was this harmful advice which was encouraging the young ladies to have sex with a man (usually chosen by the elders – usually older than her age). The young ladies were being advised that the man will remove oil from the inside of the vagina or else if this is not done the oil gets into the womb and this will make her barren. The young girl would be put in her own house at night and then a man (usually called a hyena to hide his true name) would sneak into the house and have sex with her believing that they are removing oil of bareness. The elderly women who are usually known as “Anankungwi - meaning counselors of young girls when they reach puberty” - were found to be main custodians of this practice. THP-Malawi targeted these women and brought them together for a discussion on the dangers of the practice. Most of the elderly women have now stopped this practice.

(iii) “Jando or Mdulidwe” Circumcision - This practice was observed in Jali Epicenter, Nsondole & Mpingo sub-epicenters. Most of the times the elders were using one cutting instrument to circumcise many young boys without knowing of the possibility of passing the virus from one person to the other. After their training, the HIV/AIDS specialized Animators from each of these three epicenters committed to conduct the workshop to the elders who facilitate and initiate the young boys through circumcision when they returned to their epicenters. Today even though the circumcision practice is still being done BUT now a modification has been done to the practice – each of the boys who come to be circumcised brings his own cutting instrument and they use it only on one boy and dispose it off. Besides that, the people doing the circumcision are now putting on gloves when they are conducting the practice. This is now happening in all our partner villages in Jali epicenter, Nsondole & Mpingo sub-epicenters where this practice is very prevalent.

• THP-Ghana reported the following impacts:

i. After the educational sessions on the impact of current gender relations on the spread of HIV/AIDS in one of the Epicenters, the Queen mother of Kofi Nyinah community passed a by-law abolishing violence against women and children.

ii. Improvement in girl-child education in Kwahu Atwedie as a result of sensitisation on Gender issues and discrimination against girls has led to reduction in teenage pregnancies from 20 in 2003 to only 4 as at July 2004.

iii. Retention of young girls in school has appreciated after community level discussions on gender relations in Atuobikrom. No girl has dropped out of school in 2004, compared with 5 girls who abandoned their education in 2003.

iv. Improved gender relations have led to men providing support to women in household chores and, and have resulted in the promotion of better marriages.

v. One Animator in the Tokome Epicenter, who is also a member of the community’s Unit Committee (the local political body) that handles local disputes, has witnessed a reduction in the number of adultery cases from 20 in 2003 to none in 2004.

vi. Major community based organisations in Kwahu Nsaba such as water and sanitation committees have increased women’s representation on their Executive Boards as a result of discussions on the benefits of gender equality.

vii. The Grunshie ethnic group in Kofi Nyinah which on a previous occasion prevented their women from attending a mass meeting called by the HIV/AIDS Animator, now allows the women to participate and contribute to discussions, following sensitisation on the importance of women’s involvement in community affairs

• THP-Burkina has found a reduction in the practice of two kinds of forced marriages: one in which widows are forced to marry their deceased husband’s brother, and the other in which the sister of a deceased woman is forced to marry the widower.
• Youth drama clubs have been formed in many countries. In Ghana, they assist the Animators in their HIV/AIDS campaigns by acting out role-plays on HIV/AIDS during the workshops.
• Women as well as men in all countries have said that their safe sex negotiating abilities have improved.
• People in all countries report reducing the number of sexual partners.

6. Decrease in the occurrence of sexually transmitted infections.

Health clinics near the Epicenters have noticed an observable decrease in the occurrence of sexually transmitted infections.

7. HIV/AIDS & Gender Inequality Workshop mainstreamed into other THP programs in each country

• In Malawi, all partners (men and women) in the Epicenters must attend the HIV/AIDS & Gender Inequality Workshop before accessing credit. In addition, the HIV/AIDS Animators teach the workshop once per quarter in the Functional Adult Literacy (FAL) classes.
• In each Epicenter in Burkina, key leaders in health - namely the village health officers, village mid-wives and members of the Epicenter Committee – have all become specialized HIV/AIDS Animators.

8. THP-Uganda reports that men & women are now starting to go for free testing and counseling services and demanding for those services where they do not exist.

9. The message of the HIV/AIDS & Gender Inequality Workshop is being picked up by other media:

• At an Epicenter in Benin, the HIV/AIDS & Gender Inequality Workshop was aired on the local radio in two local languages (Fon and Idasha). The THP-Benin staff and the Animators collaborated to produce the recording for the radio station. In addition, coverage of the workshop has appeared on two TV stations.
• At an Epicenter in Ghana, the team of Animators made a video recording of their HIV/AIDS campaign in one of their communities at their own expense, and which they intend to use in subsequent sensitization programs. They brought a copy with photographs to present to THP during the review workshop. The educational activity which brought other communities together was supported with funds by the local chief.
• The Government of Senegal gave about $6,800 to train 24 HIV/AIDS Animators in one Epicenter (2 men and 22 women). This partnership had the effect of reinforcing, to the district health official and others, the importance of The Hunger Project’s approach to HIV/AIDS.

Conclusions

• General awareness is widespread among the rural populations about the fatal danger posed by HIV/AIDS.
• As a result, there is a clear change of attitude by the population in practicing safe sex and condom use is now a fact of life.
• Men now increasingly respect their wives and women in general and do not to force unsafe sex; while women are more empowered to engage only in safe sex. Women express a feeling of pride and self-esteem.