Preventing and Coping with HIV/AIDS in Post-Conflict Societies: Gender-Based Lessons from Sub-Saharan Africa

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Acrobat version available here

Symposium on:

Preventing and Coping with HIV/AIDS

In Post-Conflict Societies:

Gender-Based Lessons from Sub-Saharan Africa

Hosted by:

Tulane University Payson Center for
International Development and Technology Transfer

African Centre for the Constructive Resolution of Disputes (ACCORD)

Sponsored by:

United States Agency for International Development

In Association With:

Linking Complex Emergency Response and Transition Initiative (CERTI)

International Centre for Migration and Health - Geneva

World Bank – Pretoria

FINAL REPORT

Prepared for the

United States Agency for International Development (USAID)

Bureau for Africa (AFR)
Office of Sustainable Development (SD)
Crisis, Mitigation and Recovery Division (CMR)

By

Payson Conflict Study Group

October 2001

EXECUTIVE SUMMARY (ÝtopÝ)

There is an urgent need to address the formidable threats to human security posed by the twin crises of violent conflict and HIV/AIDS in Sub-Saharan Africa (SSA). It is now understood that conflict and HIV/AIDS can reinforce one another by deepening the conditions that breed violence and disease. Throughout, vulnerable populations such as women suffer the most.

There have been important gains made in preventing and coping with HIV/AIDS in some areas, and a rich body of research has emerged offering lessons from which to learn. Yet there are also gaps in knowledge and practice, one of which is limited understanding of the effective approaches to preventing and coping with HIV/AIDS in post-conflict environments. There are, however, many initiatives. Across Africa, women especially are engaged in efforts to prevent and cope with HIV/AIDS. Too often their voices are not heard, and their lessons are not learned by others. The overall objective of the Durban symposium was to provide a forum for African practitioners with diverse backgrounds to share and build upon their rich and complex, personal and professional experiences working on HIV/AIDS issues amongst conflict-affected populations. The specific goals were:

1. to strengthen networking among Africans drawn from government and PVOs who work in this field,

2. build and augment African capacity for further work, and

3. to draw any lessons and best practices that the participants are able to describe so that these may be utilized both by Africans as well as the international donor community to design and implement future programs.

In order to achieve the overall objective, participants authored narratives of their work and made oral presentations and discussed issues during the symposium. The symposium culminated with a consensus declaration.

Several common themes emerged from the discussion led by the African practitioners assembled in Durban.

• The need for a multi-sector, integrated, and gendered approach to HIV/AIDS prevention and psychosocial and economic rehabilitation in post conflict societies is the most powerful message that emerged from the symposium. The critical role of poverty reduction and developmental component of such programs was repeatedly stressed.

• In conflict situations women are the principal victims of violence and HIV/AIDS. Thus programs for conflict-affected populations must be designed with cultural sensitivity and gender sensitivity to overcome the disadvantages suffered by women.

• Stigma (HIV/AIDS) and shame (rape), the twin psycho-social scourges that afflict many women in post-conflict societies, can be overcome with collective action by women.

• A “Health as a Bridge to Peace” component that helps resolve or mitigate conflict and promotes peace building can be incorporated into both HIV/AIDS programs that are specially tailored to women as well as to more general programs in post-conflict societies.

• HIV/AIDS programs for the military would be more successful if they took gender into account and incorporated women.

INTRODUCTION (ÝtopÝ)

“The HIV epidemic rages in situations where power is exercised without regard of others, whether that power be economic, social, sexual, psychological or the power of force. It spreads where there is a disregard for life, an intolerance of difference, a devaluing of women, a lack of a will to live, and a breakdown of community values, violence and conflict. (…) What is required to respond to it is a way of perceiving and constructing social reality in its interconnectedness.”
Ever more Effective Responses to HIV/AIDS Discussion: HIV in Situations of Conflict¹

Background

There is an urgent need to develop an integrated approach to address the formidable threats to human security posed by the twin crises of violent conflict and HIV/AIDS in Sub-Saharan Africa (SSA). There is a rich and growing body of research on HIV/AIDS prevention/mitigation in humanitarian emergencies, particularly in refugee camp settings. Resources on best practices to guide policy and programming addressing HIV/AIDS in populations affected by violent conflict and other crisis/transition settings are less available. There are, however, many initiatives. All across Africa, people from all walks of life, women especially, are engaged in formal and informal initiatives that not only confront the scourge of HIV/AIDS in the context of crisis and reconstruction, but also contribute to environments that enhance human security in all its dimensions.

To tap into this experience, Tulane University’s Payson Center for International Development and Technology Transfer and the African Center for the Constructive Resolution of Disputes (ACCORD), in collaboration with USAID's Africa Bureau Conflict, Mitigation and Recovery Division organized the symposium “Preventing and Coping with HIV/AIDS in Post Conflict Situations: Gender-Based Lessons,” held March 26 – 28, 2001 in Durban, South Africa. Tulane University’s Linking Complex Emergency Response and Transition Initiative (CERTI), the International Centre for Migration and Health-Geneva (ICMH), and World Bank – Pretoria also extended support. This report briefly outlines the background that led to this initiative and describes the principal findings of the symposium.

Conflict

Violent conflict in some part of Sub Saharan Africa is protracted and almost endemic. Many countries and regions move in and out of conflict, making it hard to define precisely those which are in a stable post-conflict setting. Thus, it is more accurate to say that the focus of the Durban symposium and this report is on populations affected by conflict. This broader definition of populations permits us to include refugee populations in otherwise peaceful and stable countries such as Tanzania.

The number and nature of violent conflicts and related complex emergencies, coupled with the HIV/AIDS pandemic are now setting development in SSA back and negating many of the gains achieved over the last 50 years. Half of all the world’s conflicts in 1999 were located in SSA, involving two-thirds of the countries in the region. Six high-intensity conflicts (causing over a thousand deaths per year) were still raging there in late 2000. Africa is also the part of the globe that has been hardest hit by HIV/AIDS. Nearly 70% of the world’s infections (over 25 million infected people), and 90% of deaths from AIDS are to be found in a region that is home to just 10% of the world’s population.²

Although little cross-country epidemiological data is available, there is evidence to suggest that conflicts increase the risk and impact of HIV/AIDS in several ways. Conflicts dislocate communities, create flows of refugees and internally displaced persons (IDPs), and seriously disrupt family life. They also bring soldiers and fighters into contact with civilians in situations where women and youths are highly vulnerable to sexual violence and sexual exploitation, and combatants, especially child soldiers, may have experienced intense traumas that make them particularly susceptible to violent and other high-risk behavior. Breakdown of basic services and psychosocial stress compound the situation. The magnitude of these problems has prompted efforts among national and international actors to mainstream HIV/AIDS prevention and control into humanitarian response, development efforts, and post-conflict reconstruction.

Despite the persistence of violent conflict, it is important to recognize that in the past ten years, some intra-state and regional wars have come to an end in Africa, and progress towards transitions have been made in others. Some post-conflict countries, like Mozambique, have gone on to sustained economic growth. A few others such as Uganda are considered to have achieved some success in preventing growth of HIV/AIDS rates. These experiences beg several questions:

• What are the factors driving the pandemic in post-conflict countries?

• What interventions make a difference in such countries?

• What conditions favor action?

• What hinders success in building the capacity of people affected by conflict, to prevent HIV infections and provide essential services to those who are directly affected by HIV/AIDS?

• Most importantly, what are the special considerations that must be taken into account in designing HIV/AIDS programs in post-conflict countries and conflict-affected populations that are confronted with problems such as demobilization of ex-combatants and single-parent families mostly headed by women?

These were some of the principal questions that were addressed at the Durban symposium.

Why Gender-Based Lessons in Post-Conflict Societies?

The importance of exploring gender-sensitive approaches to the HIV/AIDS pandemic is widely recognized, for in SSA, HIV/AIDS especially impacts women. Over 50% of new HIV infections in SSA occur in women; their vulnerability is compounded by lack of control over their own sexual health. At the same time, women also carry the main burden of care of family members with HIV/AIDS. In conflict and post-conflict contexts, the burdens on women escalate at the same time that their coping capacities are diminished. For these reasons, it is especially important that any HIV/AIDS prevention or mitigation approach for conflict-affected populations address not only the clinical health aspects of the disease, but the underlying social and economic determinants of vulnerability, of which gender is among the most significant.

There is also a need to understand better the impact of conflict and HIV/AIDS on African men, as they too are suffering and dying. Countries with a population “youth bulge,” especially concentrations of young males who are out of school, also have higher risk of violent political conflict. Anecdotal accounts suggest that during high intensity conflicts boys and men are vulnerable to sexual violence as much as women. Furthermore, overall rates of infection among the military -- traditionally an almost exclusive male domain -- are significantly above the average rate of the general population. The needs of these young men are too often overlooked, to the detriment and danger of themselves and their communities. Sometimes they are even demonized, rather than having their needs respected or their suffering acknowledged.

In sum the symposium sought to identify the crosscutting issues and solutions in the HIV/AIDS-conflict-gender nexus through the eyes of African practitioners and to propose a set of “lessons learned” and “best practices” as guidance for policy makers, practitioners and others. In the next section we describe five major lessons learned and connected best practices identified by the participants with supporting case examples. The report ends with several appendices that provide additional information to the reader who wishes to know more about the symposium and follow up work.

CROSSCUTTING LESSONS LEARNED AND BEST PRACTICES:

KEY THEMES OF THE DURBAN SYMPOSIUM (ÝtopÝ)

Table 1 is a summary of the country projects that were presented to the symposium. Inevitably, a significant number of the lessons learned and best practices were of a generic nature. They ranged from using schools as an effective point of intervention for HIV/AIDS awareness programs for youth to the importance of closer cooperation between NGOs, host country governments and donors. The importance of these should not be underestimated. However, they are not unique to HIV/AIDS programs in the context of conflict and gender. Many are common issues concerning all HIV/AIDS programs, if not development aid in general. Some of the more important generic issues have been included in the Durban Declaration that is annexed (Appendix A) to this report. A summary of the symposium discussion is also included in Appendix D. We shall not repeat the more generic issues in the main body of this report that would dilute the principal message we wish to convey. Here we focus exclusively on the interrelated dimension of HIV/AIDS, Gender and Conflict. In what follows we report on the lessons learned and best practices that crosscut those three themes.

A few key issues emerged that were emphasized by participants throughout the symposium. Despite tremendous differences in the backgrounds of the participants and countries they work in, these common themes were returned to time and again. These have been presented below under five “Lessons Learned,” with appropriate illustrations from case studies. It should be noted that the five lessons are not mutually exclusive. Some are closely connected to one another. For example, income-generating programs for women lead to women’s empowerment while enhancing their choice and confidence in dealing with men. On the other hand literacy programs and skills development programs that empower women also create more economic opportunities for them.

Lesson 1 – Multi-sector, integrated and gendered programs are the best.

The need for a multi-sector, integrated and gendered approach to HIV/AIDS prevention and psychosocial and economic rehabilitation in post conflict societies is the most powerful message that emerged from the symposium.

This underscores the close link between HIV/AIDS prevention and poverty reduction. It also confirms the validity of the current thinking on the conflict to transition to sustainable development continuum that also emphasizes the importance of starting the developmental component from the very beginning of the process.

Participants cited successful examples from Rwanda (Box 1), Tanzania (Box 2), Ethiopia (Box 3) and Kenya (Box 7) among others.

Lesson 2: In conflict situations women are the principal victims of violence and HIV/AIDS. Thus programs for conflict-affected populations must be designed with cultural sensitivity and gender sensitivity to overcome the disadvantages suffered by women.

In the African family and the African community, the power of patriarchy is especially strong and places women at a disadvantage. Male domination over women is accentuated in the dynamic context of war and its aftermath through commercial sex, rape, and sexual violence and demobilized soldiers returning home with hardened and aggressive attitudes, and with HIV/AIDS. War is also a situation in which traditional coping and protection mechanisms for women breakdown. As the quotes from Burundi, South Africa and Tanzania (Box 4) indicate, several participants were very frank in their assessment of the second-class status of women in many parts of Africa, which they noted has worsened in the context of conflict. Thus they placed a great deal of emphasis on the importance of empowering women who have been either victims of HIV/AIDS and rape or belonged to vulnerable groups that required assistance to avoid being victims of the disease. However, as section (d) listed below shows the empowerment programs were of a more general nature and not necessarily confined to HIV/AIDS and conflict situations.

3. The third, which the Burundi military adopted (See Box 7), was when possible “not to separate husbands and wives.” This, it is worth noting, was possible because the Burundi program was a “Fight against HIV/AIDS within the military community” that was subject to military discipline. A similar program for civilians that encouraged “partnerships with husbands” in HIV/AIDS awareness education was reported from Uganda at the symposium.

4. The fourth were a limited number of women empowerment programs such as a legal aid program in Burundi, a program in DRC to enhance women’s rights to inheritance of property, and literacy programs in the same two countries.

Lesson 3: Stigma (HIV/AIDS) and shame (rape), the twin psycho-social scourges that afflict many women in post-conflict societies, could be overcome with collective action by women.

Lesson 4: A “Health as a Bridge to Peace” component that resolves conflict and promotes peace building can be incorporated into both HIV/AIDS programs that are specially tailored to women as well as to more general programs in post-conflict societies.

Almost all the HIV/AIDS programs that were reported to the symposium explicitly recognized that conflict aggravated and compounded the HIV/AIDS problem. In response, many of the programs explicitly incorporated a peace-building/conflict-resolution component in them, underscoring the concept of “health as a bridge to peace”

In Zambia, the “Community Responses to Refugee Crisis” project designed primarily to enhance the capacity of the refugee host community to cope with the refugees has a peace-enhancing component to help communities understand the “nature, causes and effects of war.” This has been done primarily to avert a conflict between the host community and the refugees.

The Polyclinic project in Rwanda (Box 1) encouraged the participating women to express their opposition to “war and brutality in society; the right to condemn all forms of violence (and) discrimination in society; the right to build solidarity of women for women as women, and the right to political freedom and participation.”

In the Trauma Healing and Reconciliation Project of Rwanda “a larger aim was to reach the people at the grassroots level …… with the message of peace, and reconciliation. This was to be achieved through training of trainers at the prefecture (provincial) level in trauma counseling/trauma healing so that they could carry on the work within their own prefectures.”

The AMREF project in Tanzania (Box 2) has a strong “community conflict resolution” component.

Lesson 5: HIV/AIDS programs for the military would be more successful if they took gender into account and incorporated women.

CONCLUSION (ÝtopÝ)

In this brief conclusion we want to highlight a few salient issues that synthesize some of the Lessons Learned and Best Practices that have been cited in the report. First, the discussion in Durban placed a great deal of stress on the value of what the participants called the “intangible qualities” of programs such as compassion and commitment that made a crucial contribution to success. These, they noted, were essential because of the very nature of the issues – HIV/AIDS, rape, stigma, shame, psycho-social illness etc. - that the programs addressed

Second, the participants stressed the importance of community involvement for success, again taking into account the peculiar characteristics of the problem. They noted that in Africa the sense of community, especially in rural areas, still remains strong and should be viewed as an asset to fight HIV/AIDS in the context post-conflict transition. Many of the best practices that have been cited in the report have successfully used the community as a resource.

Third, every participant stressed the importance of a multi-sector and integrated approach to HIV/AIDS prevention in conflict-affected populations, placing special emphasis on poverty reduction and income generation.

Fourth, as one would expect, different countries and different regions within countries often adopted different strategies and programs that best suited their needs and resource endowments. For example, in South Africa and Zimbabwe street dramas were used as a medium to promote HIV/AIDS awareness, whereas in DRC and Burundi radio was being used to spread the message. In Rwanda a polyclinic also became a “political” platform to advocate women’s rights. The implication of this is that strategies and programs have to be very situation specific to ensure success.

FOLLOWUP (ÝtopÝ)

The participants emphasized the importance of networking within Sub-Saharan Africa and declared that the symposium was useful for that purpose alone. They appealed to the donors to finance continuing dialogue among such inter-sectoral groups. Several of the participants have written back to the organizers of the symposium indicating how they are making use of the information they gathered and the networking they did in Durban in their work at home. For example, Mary Balikungeri of Rwanda reported that she found the symposium useful for her network planning. Barbara Jaeggi of the ICRC, Geneva reported that she shared the symposium findings with her colleagues working on HIV/AIDS in Sub-Saharan Africa.

The participants also requested a list serve that Tulane/CERTI has now provided. To subscribe to the listserv please send a message to listserv@tulane.edu and in the body of the message type: SUBSCRIBE AIDS_SYMP-L

Tulane/CERTI is disseminating the Durban Declaration, Symposium Report and related documents through the website www.certi.org. The website also contains full audio and limited video record of the symposium. Hard copies of the report together with the Durban Declaration will be forwarded to relevant donors and humanitarian/development agencies. The full report also can be downloaded from the CERTI website from the following URL: www.certi.org. An announcement of the availability of the report, website and list serve will be made through several humanitarian electronic communities.

A State Department unclassified cable drafted by USAID/AFR/SD/CMR was sent out to all USAID missions in Sub Saharan Africa as well as Washington-based staff working in projects related to the symposium in order to ensure maximum dissemination.

TABLE 1: A Summary of the Country Projects Presented to the Symposium (ÝtopÝ)

Note: This table is limited to projects that have been implemented. It excludes projects that have been planned but not yet implemented, as well as papers presented on the general HIV/AIDS country situation.

Appendix A: Durban Declaration (ÝtopÝ)

Preventing and Coping with HIV/AIDS in Post Conflict Societies: Gender-Based Lessons from Sub-Saharan Africa

WHEREAS Sub-Saharan Africa is home to 630 million people of diverse racial and ethnic groups with a long and proud history and culture and has one of the richest natural resource bases in the world, with potential to be one of the most prosperous regions, nevertheless: 

Appendix B: Cable Summary of the Symposium (ÝtopÝ)

UNCLASSIFIED

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SUMMARY

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1. SUMMARY: A THREE DAY SYMPOSIUM ON PREVENTING AND COPING WITH HIV/AIDS IN POST-CONFLICT SOCIETIES: GENDER-BASED LESSONS FROM SUB-SAHARAN AFRICA WAS HELD FROM 26-28 MARCH 2001 IN DURBAN, SOUTH AFRICA. 26 AFRICAN PARTICIPANTS FROM EAST AND SOUTHERN AFRICA ATTENDED. COUNTRIES INCLUDED WERE BURUNDI, DEMOCRATIC REPUBLIC OF THE CONGO, ETHIOPIA, KENYA, MOZAMBIQUE, NAMIBIA, REPUBLIC OF THE CONGO, RWANDA, SOUTH AFRICA, TANZANIA, UGANDA, AND ZAMBIA. THESE HIV/AIDS PRACTITIONERS, LARGELY INDIGENOUS AND NON-GOVERNMENTAL

WITH SOME GOVERNMENTAL PARTICIPATION, DEVELOPED A #DURBAN DECLARATION# STATING THAT CONFLICT, HIV/AIDS AND GENDER INEQUALITIES ARE INEXTRICABLY RELATED. SOLUTIONS TO THESE PROBLEMS REQUIRE MULTI-SECTORAL, CROSS-SECTORAL AND SYNERGISTIC APPROACHES. PARTICIPANTS PLAN TO DEVELOP A STRATEGIC PLAN THAT LINKS HIV/AIDS, CONFLICT, AND GENDER FOR THE NATIONAL AND REGIONAL LEVELS BY DEVELOPING AN EFFECTIVE DIALOGUE WITH GOVERNMENT AT COMMITTEE AND CABINET LEVELS, CIVIL SOCIETY ACTORS, THE PRESS, AND OTHER SALIENT ACTORS SUCH AS FIRST LADIES. THE SYMPOSIUM DEMONSTRATED THAT WE LIVE IN AN ERA WHERE AIDS IS NOT SIMPLY A DISEASE OR AN EPIDEMIC, BUT A FACT OF LIFE AND A COMPLEX SOCIAL DYNAMIC THAT IS INTRICATELY TIED TO ISSUES OF GENDER AND CONFLICT. THE DURBAN DECLARATION TEXT IS REPORTED IN PARAGRAPHS 23-31.

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WORKSHOP METHODOLOGY

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2. METHODOLOGY OF SYMPOSIUM: OVER THE THREE DAYS, PARTICIPANTS SHARED THEIR STORIES FROM THE TRENCHES THAT ELUCIDATED THE LINKS AMONG HIV/AIDS, CONFLICT, AND GENDER. PRIOR TO THE SYMPOSIUM, EACH PARTICIPANT PREPARED A PAPER ILLUSTRATING THEIR ORGANIZATION'S OR COUNTRY'S EXPERIENCES. PARTICIPANTS SHARED THESE STORIES IN A SERIES OF PANEL PRESENTATIONS AND SMALL WORKING GROUPS. THESE LESSONS LEARNED WILL BE PART OF A BEST PRACTICES DOCUMENT THAT WILL BE PREPARED BY TULANE UNIVERSITY OVER THE NEXT FEW MONTHS. PARTICIPANTS SHARED THESE IDEAS WITH INTERNATIONAL AND USAID COLLEAGUES FOR CREATING AN EFFECTIVE AND COGENT PLATFORM FOR ACTION AND ADVOCACY.

3. STRATEGIC FRAMEWORK SETTING: PARTICIPANTS PLAN TO BEGIN THEIR STRATEGIC ANALYSIS BY MEETING WITH USAID MISSIONS IN AFRICA TO BRIEF MISSIONS ON THE WORKSHOP. THEY THEN PLAN TO DEVELOP A STRATEGIC PLAN THAT LINKS HIV, GENDER, AND CONFLICT FOR THE NATIONAL AND

REGIONAL LEVELS FOR EFFECTIVE DIALOGUE WITH GOVERNMENT AT COMMITTEE AND CABINET LEVELS, OTHER CIVIL SOCIETY ACTORS, THE PRESS, AND OTHER SALIENT ACTORS SUCH AS FIRST LADIES.

4. WORKSHOP GOALS: (A) TO PROVIDE A QUICK OVERVIEW OF GENDER-SENSITIVE PRACTICES AND KNOWLEDGE IN PREVENTING AND COPING WITH HIV/AIDS IN THE AFTERMATH OF VIOLENT CONFLICT; (B) TO EXPAND THIS KNOWLEDGE BASE BY SHARING AND DISSEMINATING THE EXPERIENCES OF AFRICANS WHO ARE CONFRONTING THESE ISSUES IN THEIR COUNTRIES; AND, (C) TO IDENTIFY RECOMMENDATIONS AND STRATEGIES FOR PRACTITIONERS, POLICYMAKERS, AND DONORS ON HOW THESE EFFORTS CAN BE BEST SUPPORTED. THEMATIC AREAS INCLUDED: (A) DEMOBILIZATION AND REINTEGRATION OF ARMED FORCES, (B) GIRLS' EMPOWERMENT, (C) CARING FOR ORPHANS AND PEOPLE LIVING WITH HIV/AIDS, (D) REHABILITATING OR REBUILDING HEALTH SERVICES, (E) HEALTH AS A BRIDGE TO PEACE, (F) LOCAL, NATIONAL, AND REGIONAL RESPONSES, AND (G) GRASS ROOTS LESSONS LEARNED AND RECOMMENDATIONS FOR PRACTITIONERS, AFRICAN GOVERNMENTS, AND DONORS.

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BACKGROUND TO WORKSHOP

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5. BACKGROUND: STATISTICS ON HIV/CONFLICT/GENDER: PARTICIPANTS AGREED WITH THE INITIAL OBSERVATIONS OF USAID/AFR/SD/CMR (REF. CABLE STATE 044234): VIOLENT CONFLICT AND HIV/AIDS POSE FORMIDABLE THREATS TO HUMAN SECURITY IN AFRICA. THE NUMBER AND NATURE OF VIOLENT CONFLICTS AND RELATED COMPLEX EMERGENCIES, COUPLED WITH THE HIV/AIDS PANDEMIC IS NOW IMPEDING DEVELOPMENT IN AFRICA, AND NEGATING MANY OF THE GAINS ACHIEVED. HALF OF ALL THE WORLD'S CONFLICTS IN 1999 WERE LOCATED IN SUB-SAHARAN AFRICA (SSA), INVOLVING TWO THIRDS OF THE COUNTRIES IN THE REGION. SIX HIGH INTENSITY CONFLICTS (CAUSING OVER A THOUSAND DEATHS PER YEAR) WERE STILL RAGING IN THE REGION IN LATE 2000. AS OF JANUARY 2001, AFRICA HAD 3.5 MILLION REFUGEES AND 1.7 MILLION INTERNALLY DISPLACED PEOPLE (IDPS). AFRICA IS ALSO THE PART OF THE GLOBE THAT HAS BEEN HARDEST HIT BY HIV/AIDS. OVER 25 MILLION PEOPLE, OR NEARLY 70 PERCENT OF THE WORLD'S 34.5 MILLION AFFLICTED WITH HIV/AIDS, AND 90 PERCENT OF DEATHS FROM AIDS ARE TO BE FOUND IN A REGION THAT IS HOME TO JUST 10 PERCENT OF THE WORLD'S POPULATION. OVER HALF OF THE AFRICANS AFFLICTED BY HIV/AIDS PEOPLE ARE WOMEN.

6. BACKGROUND: LINKS AMONG HIV/CONFLICT/GENDER: ALTHOUGH THERE IS LITTLE CROSS-COUNTRY EPIDEMIOLOGICAL DATA AVAILABLE, THERE IS EVIDENCE TO SUGGEST THAT CONFLICTS INCREASE THE RISK AND IMPACT OF HIV/AIDS IN SEVERAL WAYS. CONFLICTS DISLOCATE COMMUNITIES, CREATE

FLOWS OF REFUGEES AND INTERNALLY DISPLACED PERSONS, AND SERIOUSLY DISRUPT FAMILY LIFE. THERE IS AN INCREASE IN THE NUMBER OF WOMEN HEADED HOUSEHOLDS. SOLDIERS AND FIGHTERS COME INTO GREATER CONTACT WITH CIVILIANS IN SITUATIONS WHERE WOMEN, YOUNG GIRLS AND BOYS ARE HIGHLY VULNERABLE TO SEXUAL AND GENDER-BASED VIOLENCE, SEXUAL EXPLOITATION, AND RISKY SEXUAL BEHAVIOR DUE TO INCREASED PSYCHOSOCIAL TRAUMA AND BREAKDOWN OF BASIC SERVICES. THE MAGNITUDE OF THESE PROBLEMS HAS PROMPTED CONSIDERABLE WORK AMONG NATIONAL AND INTERNATIONAL ACTORS TO MAINSTREAM HIV/AIDS PREVENTION, SCREENING, EDUCATION, TREATMENT, AND CONTROL INTO HUMANITARIAN RESPONSE AND POST-CONFLICT RECONSTRUCTION. GENDER SENSITIVE APPROACHES THAT AFFECT THE EFFECTIVENESS OF RESPONSES TO THE AIDS PANDEMIC ARE KEY IN AFRICA, GIVEN WOMEN'S DUAL ROLE AS CARE GIVERS AND HOUSEHOLD INCOME EARNERS. NOTING THAT OVER 50 PERCENT OF NEW HIV INFECTIONS IN AFRICA OCCUR IN WOMEN, YOUNG WOMEN SEEM TO BE PARTICULARLY VULNERABLE. FOR EXAMPLE, ONE IN FOUR SOUTH AFRICAN WOMEN IN THE 20-29 AGE GROUP CARRY THE VIRUS TODAY. THE NUMBER ONE FORM OF TRANSMISSION OF HIV AMONG WOMEN IN AFRICA IS SEXUAL INTERCOURSE. WOMEN'S INCREASED RISK FOR HIV HAS BEEN ASSOCIATED WITH PROSTITUTION, TRAFFICKING OF WOMEN AND CHILDREN, DOMESTIC VIOLENCE, FORCED MARRIAGES, RAPE AND INCEST, POOR HEALTH,

(PARTICULARLY ACCESS TO QUALITY REPRODUCTIVE HEALTH SERVICES) AND LIMITED POWER TO AFFECT THESE RISKS. WOMEN ALSO CARRY THE MAIN BURDEN OF CARE OF FAMILY MEMBERS WITH HIV/AIDS. IN SITUATIONS OF CONFLICT AND POST-CONFLICT, WOMEN ARE NOT ONLY MORE EXPOSED AND

VULNERABLE TO HIV/AIDS, THEY ALSO HAVE LESS COPING CAPACITY, NOT LEAST BECAUSE THEY ARE NOT USUALLY INVOLVED IN PLANNING THE ALLOCATION OF RESOURCES FOR RECONSTRUCTION, INCLUDING THOSE FOR HIV/AIDS PREVENTION AND MANAGEMENT. AT PRESENT, NO ESTABLISHED SET OF BEST PRACTICES TO GUIDE POLICY AND PROGRAMMING FOR ADDRESSING HIV/AIDS IN POST-CONFLICT COUNTRIES EXISTS. THERE ARE HOWEVER, MANY INITIATIVES. ALL ACROSS AFRICA, PEOPLE FROM ALL WALKS OF LIFE, AND ESPECIALLY WOMEN, ARE ENGAGED IN FORMAL AND INFORMAL INITIATIVES THAT NOT ONLY STRENGTHEN THE COPING CAPACITIES OF FAMILIES, COMMUNITIES, AND COUNTRIES IN THE FACE OF THESE CRISES, BUT ALSO CONTRIBUTE TO CREATE ENVIRONMENTS THAT ENHANCE HUMAN SECURITY IN ALL ITS DIMENSIONS. WOMEN HAVE WORKED ON BOTH DIPLOMATIC AND DEVELOPMENT EFFORTS, AT THE NATIONAL/INTERNATIONAL LEVEL, AND AT THE GRASSROOTS LEVEL.

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SUMMARY OF WORKSHOP SESSIONS

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7. DURING THE OPENING SESSION OF THE WORKSHOP, STATISTICS (SEE PARAGRAPHS FIVE AND SIX ABOVE) WERE PRESENTED AND LINKAGES EXPLORED WITH QUESTIONS THAT HAVE BEEN RAISED ON HIV AND CONFLICT. SUCH QUESTIONS INCLUDE WHETHER KNOWINGLY HIV POSITIVE SOLDIERS DELIBERATELY RAPE WOMEN IN CONFLICT SITUATIONS. THE LINK AMONG THE THREE AREAS WAS SET IN THE CONTEXT OF PUBLIC INTERNATIONAL HUMAN RIGHTS LAW AND PRACTICAL EXAMPLES FROM THE FIELD.

8. SESSION ONE OVERVIEW: WORKSHOP PARTICIPANTS HAD PREPARED SUMMARY PAPERS PRIOR TO THE WORKSHOP. KEY THEMES WERE THE FOLLOWING: (1) NEED FOR A SOLUTION BEYOND A NARROW TECHNICAL APPROACH, (2) AGREEMENT THAT HIV HAS BEEN IDENTIFIED AS AN EXPLICIT WEAPON OF WAR, (3) THE EXTRAORDINARY URGENCY OF THE VULNERABILITY OF WOMEN, CHILDREN, REFUGEES, AND IDPS, (4) CONNECTION WITH LOCAL CULTURE THAT CAN BE EITHER HARNESSED OR DETRIMENTAL TO PROGRESS, (5) NEED FOR FOCUSING ON PSYCHOSOCIAL AND SOCIO-ECONOMIC DETERMINANTS, AND (6) RECOGNIZING THAT WOMEN AND MEN HAVE DIFFERENT ACCESS AND POWER OVER RESOURCES. CHALLENGES ARE INTANGIBLES SUCH AS FEAR, IGNORANCE, LACK OF POWER TO MAKE INDIVIDUAL SEXUAL HEALTH DECISIONS, AND COMMUNITY-LEVEL COMMITMENT.

9. MILLICENT MALAZA-DEBOSE OF SAVE AFRICA ESTABLISHED THAT GENDER ROLES AND EXPECTATIONS TAKE DIFFERENT FORMS IN CONFLICT SITUATIONS. TRADITIONALLY, WOMEN HAVE BEEN SEEN AS CARETAKERS AND MEN AS PROVIDERS AND PROTECTORS; IN CONFLICT THESE ROLES ARE HEIGHTENED. THE GROUP QUESTIONED HOW SECURITY, GOVERNANCE, AND DEEP-ROOTED POVERTY CAN BE ADDRESSED TO MITIGATE THE POTENTIAL FOR WEAKENED GENDER ROLES AND INCREASED HIV TRANSMISSION. GROUP CONCURRED THAT THERE IS A NEED FOR BEHAVIORAL CHANGE, INCLUDING MEN AS PARTNERS IN THE HEALTH PROCESS. GLOBALIZATION WAS RAISED AS BOTH A POSITIVE AND NEGATIVE IN PROVIDING INFORMATION TO STEM HIV TRANSMISSION. THERE WAS AN AGREEMENT THAT THE MILITARY NEEDS TO BE PART OF A BROADER HIV STRATEGY, RATHER THAN AS A TARGET GROUP.

10. SESSION TWO - LIVING WITH HIV/AIDS: ASUNTA WAGURA, AN HIV POSITIVE KENYAN WHO IS THE EXECUTIVE DIRECTOR OF KENYA NETWORK OF WOMEN WITH AIDS, GROUNDED THE WORKSHOP BY PRESENTING HER PERSONAL LIFE HISTORY WITH AIDS. HER GRIPPING PRESENTATION REMINDED PARTICIPANTS THAT HIV POSITIVE PEOPLE CANNOT BE CONSIDERED AS VICTIMS; VICTIMS ARE CONSIDERED WEAK AND POWERLESS; HIV POSITIVE PEOPLE HAVE CAPABILITIES DESPITE THEIR STATUS. CLAUDINE MUYALA TAYAYE BIBI OF THE UNIVERSITY OF KINSHASA AND THE NGO PLATFORM PAAF FOLLOWED WAGURA'S PRESENTATION, ARGUING THAT WITHOUT PEACE IN THE DRC, THERE WILL BE NO SECURITY IN CENTRAL AND SOUTHERN AFRICA AND THE AFRICAN RENAISSANCE WILL REMAIN A DREAM, FORESTALLING FUTURE PROGRESS ON HIV. NZAMA CHIKWANKA OF THE SOCIETY FOR WOMEN AND AIDS IN ZAMBIA ARGUED THAT AFRICAN CULTURE ENCOURAGES SILENCE; YET EFFECTIVE HIV EDUCATION CALLS FOR A HEALTHY DISCUSSION OF AN INDIVIDUAL'S RESPONSIBILITY FOR MAKING HEALTHY SEXUAL DECISIONS.

11. SESSION THREE - WOMEN'S STRUGGLES AGAINST HIV/AIDS AND VIOLENCE: SMALL GROUP DISCUSSIONS CRITIQUED THE DUAL EXPECTATIONS OF WOMEN AS CAREGIVERS (PILLARS OF CULTURE AND CUSTODIANS OF COMMUNITY) AND AS BREAD-WINNERS. PARTICIPANTS ARGUED THAT WOMEN CANNOT AUTOMATICALLY BE CONSIDERED AS PROGRESSIVE INDIVIDUALS; WOMEN, LIKE MEN, ARE REPRESENTATIVE OF BROADER SOCIETAL ISSUES. HOWEVER, PARTICIPANTS CONCURRED THAT HIV, VIOLENT CONFLICT, AND POVERTY DISPROPORTIONATELY AFFECT WOMEN. NGO PARTICIPANTS SHARED PRACTICAL CHALLENGES OF DESIGNING EFFECTIVE EDUCATIONAL CAMPAIGNS WHILE BEING RIDICULED FOR PROMOTING HIV. PARTICIPANTS STATED THAT CRISIS CHANGES THE NATURE OF PERSONAL RELATIONSHIPS AND WOMEN TAKE ON NEW ROLES. WOMEN CANNOT ESCAPE THE CYCLE OF MALE DOMINATION AS THE LOSS OF ONE MAN USUALLY MEANS THE REPLACEMENT WITH ANOTHER. NGOS STRESSED THAT THEY HAVE A CHALLENGE OF BRINGING WOMEN'S GROUPS TOGETHER TO ACHIEVE A COMMON PLATFORM, ESPECIALLY WHEN SOME OF THEIR AGENDAS ARE DRIVEN BY DONOR INTERESTS.

12. SESSION FOUR - HIV/AIDS, VULNERABLE POPULATIONS, AND THE MILITARY: NSAMA CHIKWANKA OF THE SOCIETY FOR WOMEN AND AIDS IN ZAMBIA DISCUSSED THE ROLE OF POST TRAUMATIC STRESS DISORDER AND THE PARTICULAR REACTIONS OF HYPERACTIVITY AND DEPRESSION THAT ARE LINKED TO VIOLENCE AND RISKY SEXUAL BEHAVIOR. DOROTHY GATERA WIBABARA OF THE PRESBYTERIAN CHURCH OF RWANDA ARGUED THAT FAITH-BASED HIV/AIDS INITIATIVES NEED TO WORK WITH AN ON-THE-GROUND FAMILY SUPPORT NETWORK TO ENCOURAGE CAPACITY BUILDING IN FAMILIES AND COMMUNITIES SO THAT INDIVIDUALS CAN MAKE HEALTHY CHOICES ON SEXUAL BEHAVIOR. TRAUMA COUNSELING IS SEEN AS AN EFFECTIVE INTERVENTION POINT. ANNE-MARY SHIGWEDHA OF THE NAMIBIAN MINISTRY OF DEFENSE REMINDED THE GROUP OF SECURITY COUNCIL RESOLUTION 1308 THAT STATED THAT HIV IS A HUMAN SECURITY ISSUE. UGANDAN PARTICIPANT CAROLINE ODONGO TURYATEMBA NOTED THAT UGANDAN VETERANS HAVE NOT UNIFORMLY ENJOYED ACROSS THE BOARD SUCCESS IN ECONOMIC REINTEGRATION. PARTICIPANTS ITERATED THE NEED FOR EFFECTIVE INTEGRATION OF HIV PROGRAMMING IN CONFLICT SETTINGS OF DEMOBILIZATION (DDRR) ACTIVITIES AND HIV/AIDS EDUCATION FOR EX-COMBATANTS

13. SESSION FIVE - THE SECURITY SECTOR AND GOVERNANCE: THIS SESSION FOCUSED ON THE ISSUE THAT DEVELOPMENT IS IMPOSSIBLE WITHOUT SECURITY AND JUSTICE. SECURITY AND GOVERNANCE ARE SEEN AS THE UNDERPINNINGS OF ECONOMIC GROWTH.

14. SESSION SIX - HEALTH CARE IN POST CONFLICT ENVIRONMENTS: DARAUS BUKENYA OF THE TANZANIA-BASED AFRICAN MEDICAL AND RESEARCH FOUNDATION (AMREF) STATED THAT PRESERVATION OF HEALTH SYSTEMS INCLUDES BUILDING SELF-RELIANCE AND REHABILITATING HEALTH INFRASTRUCTURE, YET BEING AWARE OF THE POTENTIAL TO RECREATE DETRIMENTAL GENDER AND HEALTH ROLES. BEATRICE MURUNGA OF MAP INTERNATIONAL SPOKE ABOUT PSYCHOSOCIAL SERVICES FOR SURVIVORS OF VIOLENCE. SHE NOTED THAT SEXUAL VIOLENCE RESULTING IN POSITIVE HIV STATUS CREATES LOW SELF-ESTEEM AND SELF HATRED IN WOMEN. THIS PSYCHOLOGICAL TRAUMA IS TIED TO LOSS OF ECONOMIC STATUS AND SELF-ESTEEM. CULTURALLY, RAPE CONTINUES TO HAVE A NEGATIVE STIGMA ATTACHED TO IT. FOR THIS REASON, IN AFRICAN CULTURE, THERE IS A GREAT DEAL OF SILENCE AROUND RAPE, ESPECIALLY AMONG WOMEN; PARTICIPANTS WANT TO BREAK THIS SILENCE TO MORE EFFECTIVELY ADDRESS THE INTERSECTION AMONG HIV/AIDS, CONFLICT, AND GENDER. PROGRAMS IN TANZANIA THAT HAVE USED A TRAINING OF TRAINERS MODEL IN WHICH SURVIVORS WHO THEN RETURN TO THEIR COMMUNITIES AND WORK WITH CLIENTS.

15. SESSION SEVEN - PREVENTING HIV/AIDS IN POST CONFLICT AFRICAN SOCIETIES: PRACTICAL APPROACHES TO DEALING WITH HIV PREVENTION WERE DISCUSSED. AN EAST AFRICA GROUP SUGGESTED THAT THE MAIN ENTRY POINT

SHOULD BE DEMOBILIZED SOLDIERS AND THE HIV EDUCATION ENTRY POINT SHOULD BE COORDINATED AT THE NATIONAL LEVEL AND INCLUDED IN THAT LEVEL OF POLICY. THE CENTRAL AFRICA GROUP FOCUSED ON DEVELOPING RADIO PROGRAMS THAT ARE TARGETED FOR ADULT AND ILLITERATE WOMEN SO THAT THEY ARE BETTER INFORMED. THIS GROUP ALSO FOCUSED ON DEVELOPING WOMEN'S ECONOMIC CAPACITIES. THE SOUTHERN AFRICA GROUP DISCUSSED THE TOOL OF DRAMA FOR DISSEMINATING HIV/AIDS EDUCATION IN A SAFE WAY THAT USES LOCAL LANGUAGE AND CULTURE. IT WAS CLEAR FROM THIS SESSION THAT EACH AFRICAN SUB-REGION REQUIRES A LOCALLY GENERATED AND RELEVANT APPROACH THAT MEETS THE MOST CRITICAL NEEDS IDENTIFIED. THESE INTERVENTIONS MUST WORK WITH THE LOCAL POPULATION.

16. ONE SIDE GROUP DISCUSSED NETWORKING AND POSSIBLE FOLLOW ON ACTIONS FOR THIS WORKSHOP. IT WAS ENVISAGED THAT THE GROUP RECONVENES IN TWO YEARS TO SEE HOW THEY HAVE IMPLEMENTED THE HIV/CONFLICT/GENDER APPROACH INTO NATIONAL-LEVEL POLICY. SECONDLY, THE GROUP SUGGESTED THAT THEY CONVENE QUARTERLY DISCUSSIONS TO SHARE LESSONS LEARNED. THIRD, SPECIFIC THEMES WERE RAISED INCLUDING RAPE, DONOR COMMUNICATION WITH COMMUNITY-BASED ORGANIZATIONS, PSYCHOSOCIAL ISSUES, THE ROLE OF MEN IN PREVENTING HIV/AIDS, LITERACY AND HIV/AIDS, AND THE CONNECTION BETWEEN DONORS AND HIV/AIDS POLICY.

17. SESSION EIGHT - COPING WITH HIV/AIDS IN POST CONFLICT AFRICA: THIS SESSION FOCUSED ON INCREASING ACCESS TO RESOURCES (ECONOMIC, EDUCATIONAL, AGRICULTURAL, HEALTH, FINANCIAL) IN EAST AFRICA, PSYCHOSOCIAL SERVICES AND HEALTH CLINICS IN CENTRAL AFRICA, AND ORPHANS IN WEST AFRICA. IN EAST AFRICA, THE EMPHASIS IS AT THE GRASS ROOTS LEVEL, ADULT EDUCATION PROGRAMS, AND INCLUDING WOMEN'S GROUPS IN ALL STAGES OF PLANNING AND IMPLEMENTATION DESIGN. TWO APPROACHES SUGGESTED WERE FOCUSING ON WOMEN'S INHERITANCE AND ENSURING WOMEN'S EQUAL RIGHTS IN A COUNTRY. THERE WAS A CLEAR FOCUS ON IDENTIFYING TALENTED WOMEN IN THE SUB-REGION AND DRAWING ON THEIR SKILLS TO DESIGN EFFECTIVE PROGRAMS. THE CENTRAL AFRICA GROUP FOCUSED NOT ONLY ON PSYCHOSOCIAL AND HEALTH CLINICS, BUT LEGAL CLINICS WHERE WOMEN ARE ABLE TO HAVE ACCESS TO LEGAL REMEDIES. THE SOUTHERN AFRICA GROUP FOCUSED ON COMMUNITY-BASED RESPONSES TO ORPHANS GIVEN DIFFERENT COMMUNITIES' LEVELS OF RECEPTIVITY TO ORPHANS.

18. SESSION NINE - HEALTH AS A BRIDGE FOR PEACE: MARY BALIKUNGERI OF THE RWANDA WOMEN COMMUNITY GROUP ARGUED THAT STORY TELLING AND SHARING OF STORIES IN A TRUSTING ENVIRONMENT ASSIST WOMEN IN DEALING WITH ISSUES OF DOMESTIC VIOLENCE. BALIKUNGERI DESCRIBED THE POLYCLINIC THAT SHE RUNS WHICH INCLUDES PSYCHOSOCIAL SUPPORT, LEGAL SUPPORT AND WITNESS PROTECTION, MICRO FINANCE, AND POLITICAL EMPOWERMENT. THE CLINIC IS AN EXAMPLE OF AN MULTI-SECTORAL APPROACH TO ADDRESSING HIV/AIDS. CAROLINE ODONGO TURYATEMBA OF REACH UGANDA DISCUSSED HOW HER PROGRAM EMERGED FROM LOCALLY GROWN FOCUS ON FEMALE GENITAL MUTILATION (FGM). AS THE CLINIC STARTED TO TACKLE FGM WITHOUT THREATENING LOCAL CULTURE, THE KEY LESSON LEARNED WAS DEVELOPING A PROGRAM IN CONJUNCTION WITH THE COMMUNITY THROUGH SENSITIZATION AND DEVELOPING RAPPORT WITH EACH PATIENT SO THAT S/HE IS COMMITTED TO CHANGE. SUSTAINABILITY HAS BEEN A FUNCTION OF FAMILY AND COMMUNITY LEVEL INPUT. A SECOND LESSON FOR THE SUCCESS OF THE CLINIC WAS COORDINATION WITH THE MILITARY. THE MILITARY WAS SEEN AS AN ORGANIZATION THAT COULD PROVIDE SERVICES AND ALSO PROTECT A BENEFICIARY GROUP.

19. SESSION TEN - EMPOWERING WOMEN: PROVIDING SEX WORKERS WITH INCOME GENERATING SKILLS AND LEGAL KNOWLEDGE HAS BEEN SUCCESSFUL IN ONE COMMUNITY IN ETHIOPIA AND HAD A SPILLOVER EFFECT THAT HAS WORKED IN OTHER COMMUNITIES. THE ETHIOPIAN FEDERAL GOVERNMENT BACKED THIS PROGRAM, WHICH ENSURED ITS SUCCESS. GIVEN THE SENSITIVE NATURE OF WOMEN'S PROGRAMS, PARTICIPANTS QUESTIONED WHETHER HOST GOVERNMENTS WOULD SUSTAIN ACTIVITIES IN THE LONG TERM. BULIKUNGERI STATED THAT THE USG-FUNDED WOMEN AS PARTNERS FOR PEACE IN AFRICA HAS BEEN A SUCCESSFUL NETWORKING MODEL FOR AFRICAN WOMEN. WHILE THESE EFFORTS HAVE BEEN SUCCESSFUL INTERNATIONALLY, PARTICIPANTS QUESTIONED THE SUSTAINABILITY OF LOCAL LEVEL INVOLVEMENT AND SUPPORT.

20. SESSION ELEVEN - LESSONS LEARNED AND ISSUES FOR CONSIDERATION BY PRACTITIONERS: PARTICIPANTS NOTED THAT LOCAL NEEDS AND COMMUNITY EMPOWERMENT ARE CRITICAL TO ADDRESSING ISSUES. EXAMPLES INCLUDE USE OF LOCAL LANGUAGE AND THE MEN-AS-PARTNERS HEALTH APPROACH. PRACTITIONERS ARE CHALLENGED BY LACK OF STAFF COMMITMENT TO KEEPING THE MESSAGES ON HIV/AIDS SERIOUS, AND NOT REDUCED TO JOKES OR INAPPROPRIATE/INSENSITIVE COMMENTS. PARTICIPANTS DISCUSSED THE EMERGENCE OF HIV/AIDS IN THE UNITED STATES LARGELY IN THE GAY MALE COMMUNITY AND DREW A PARALLEL THAT HOMOPHOBIA IS PREVALENT IN SUB-SAHARAN AFRICA. IN DISCUSSING GENDER ROLES BETWEEN MEN AND WOMEN, PARTICIPANTS NOTED THAT THE PARADIGM SHOULD BE BROADENED TO NON-TRADITIONAL ROLES. AGE IS A CRITICAL FACTOR IN GENDER ROLES AND PRACTITIONER SUCCESS; ACTIVITIES NEED TO BE SENSITIVE TO YOUTH. BESIDES GENDER ROLES, ANOTHER ISSUE IDENTIFIED WAS THE LACK OF COMMITMENT ON THE PART OF THE STATE TO ADDRESS THE ROOT CAUSES OF GENDER INEQUALITY AND CONFLICT WHICH CAN LEAD TO HIGHER HIV/AIDS TRANSMISSION (E.G. INHERITANCE AND LAND RIGHTS). COUNTRIES' CONSTITUTIONS DO NOT REFLECT THE GROUND LEVEL REALITY IN COMMUNITIES AND IN THE PERIPHERY. INTERNATIONAL COVENANTS, E.G. THE CONVENTION TO ELIMINATE ALL FORMS OF DISCRIMINATION AGAINST WOMEN (CEDAW) OR THE CONVENTION ON THE RIGHTS OF THE CHILD (CRC), OR OTHER HUMAN RIGHTS CONVENTIONS, ARE EITHER NOT SIGNED AND RATIFIED BY HOST GOVERNMENTS, POORLY IMPLEMENTED, OR THE EDUCATION DOES NOT TAKE PLACE IN THE FIELD SO COMMUNITIES ARE EMPOWERED TO MAKE DECISIONS.

21. SESSION TWELVE - LESSONS LEARNED AND ISSUES FOR CONSIDERATION BY POLICYMAKERS: THIS SESSION RAISED DIFFERENCES AMONG DONORS, DONOR INTERESTS, AND APPROACHES. SOME PARTICIPANTS SUGGESTED THAT EUROPEAN DONORS ARE MORE CONSULTATIVE THAN AMERICAN DONORS ARE. ISSUES WERE RAISED REGARDING HOW BEST TO IMPLEMENT DECENTRALIZATION ACTIVITIES TO MITIGATE CORRUPTION AND OTHER PROBLEMS IN LOCAL GOVERNMENTS. PARTICIPANTS CALLED FOR AN EFFECTIVE PARTNERSHIP WITH DONORS AND FOR TRANSPARENT NATIONAL-LEVEL UMBRELLA ORGANIZATIONS THAT COORDINATE EFFECTIVELY. SOME PRACTITIONERS RAISED MANAGEMENT CHALLENGES SUCH AS THEIR DIFFICULTIES WITH HAVING DIFFERENT FINANCIAL SYSTEMS FOR DIFFERENT DONORS AND FULFILLING A MYRIAD OF REPORTING REQUIREMENTS FOR EACH DONOR. THERE WAS UNANIMOUS AGREEMENT THAT DONORS NEED TO REDUCE REPORTING REQUIREMENTS SO THAT GRANTEES CAN DEVOTE MORE TIME AND RESOURCES TO IMPLEMENTATION. DONORS COULD ALSO CONSIDER PROVIDING MORE INSTITUTIONAL SUPPORT SO THAT NGOS ARE BETTER EQUIPPED TO ADDRESS ISSUES IN THE LONG TERM, AND HAVE THE FINANCIAL, ADMINISTRATIVE, AND MANAGEMENT CAPACITY TO DEAL WITH DIFFERENT DONORS' AGENDAS, REQUIREMENTS, AND ACTIVITIES. LINKING THE THREE AREAS OF HIV/AIDS, CONFLICT, AND GENDER, PARTICIPANTS AGREED THAT WOMEN'S EMPOWERMENT, FOCUS ON CROSS-CUTTING APPROACHES, CONSULTATION, OUTREACH, AND PARTNERSHIP ARE ALL CRITICAL, WHILE TAKING ACCOUNT OF LOCAL CONDITIONS, CULTURE, AND LANGUAGE.

22. PARTICIPANTS CONCLUDED WITH A CONSENSUS ON A #DURBAN DECLARATION#THAT STATED THEIR VIEWS, AND COMMITTED THE GROUP TO CONTINUE THEIR NETWORKING AND NATIONAL LEVEL ADVOCACY.

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DURBAN DECLARATION

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23. DURBAN DECLARATION BEGIN TEXT: WHEREAS SUB-SAHARAN AFRICA IS HOME TO 630 MILLION PEOPLE OF DIVERSE RACIAL AND ETHNIC GROUPS WITH A LONG AND PROUD HISTORY AND CULTURE AND HAS ONE OF THE RICHEST NATURAL RESOURCE BASES IN THE WORLD, WITH POTENTIAL TO BE ONE OF THE MOST PROSPEROUS REGIONS, NEVERTHELESS:

 A. THE TWIN SCOURGES OF VIOLENT CONFLICT AND HIV/AIDS HAVE MUTUALLY REINFORCED EACH OTHER THOUGH A MULTIPLICITY OF MECHANISMS INCLUDING LARGE-SCALE POPULATION DISLOCATION, THE DESTRUCTION OF THE PUBLIC HEALTH INFRASTRUCTURE AND THE WEAKENING OF GOVERNANCE AND ECONOMY. THESE TWIN SCOURGES ARE DESTROYING FAMILIES, COMMUNITIES, NATIONS AND THE AFRICAN CONTINENT AS A WHOLE.

B. MORE THAN 50 PERCENT OF THE WORLD'S ACTIVE VIOLENT INTERNAL AND REGIONAL CONFLICTS ARE IN AFRICA. THESE CONFLICTS HAVE DIRECTLY OR INDIRECTLY AFFECTED OVER 75 PERCENT OF THE REGION'S COUNTRIES AND POPULATIONS, CONSCRIPTED OVER 300,000 CHILD SOLDIERS, DISPLACED OVER 30 MILLION PEOPLE FROM THEIR HOMES, CAUSED THE DEATHS OF OVER ONE MILLION PEOPLE, DESTROYED SOCIAL AND ECONOMIC INFRASTRUCTURE, DAMAGED THE ENVIRONMENT, WEAKENED INSTITUTIONS OF GOVERNANCE AND GENERALLY RETARDED EQUITABLE, SUSTAINED AND SUSTAINABLE DEVELOPMENT.

C. MORE THAN 75 PERCENT OF THE WORLD'S HIV/AIDS CASES ARE FOUND IN AFRICA. MORE THAN 11 MILLION AFRICANS HAVE SUCCUMBED TO AIDS OVER THE PAST DECADE AND THE SOCIAL AND ECONOMIC CONSEQUENCES ARE PROFOUND.

D. GENDER ROLES PLAY A CRUCIAL ROLE IN BOTH THE EVOLUTION OF THE PROBLEM AND IN THE WAY FORWARD TO SOLUTIONS. THE PHYSICAL AND PSYCHOLOGICAL CONSEQUENCES OF CONFLICT AND HIV DISPROPORTIONATELY AFFECT WOMEN.

E. POVERTY IS A KEY CONTRIBUTING FACTOR TO THE SPREAD OF HIV/AIDS.

F. WHILE THERE IS RECOGNITION OF THESE PROBLEMS, AND RESOURCES HAVE BEEN DEVOTED TO THEIR SOLUTIONS, CURRENT APPROACHES ARE INADEQUATE IN BOTH MAGNITUDE AND SCOPE. HIV, CONFLICT AND GENDER ROLES CROSSCUT ALL DEVELOPMENT CONCERNS AND SHOULD BE MAINSTREAMED INTO ALL SECTORS.

G. CURRENT FINANCIAL RESOURCES ARE ALSO INADEQUATE TO ADDRESS THE SCOPE AND MAGNITUDE OF THESE COMPLEX SOCIAL PROBLEMS.

24. NOTING THAT THROUGHOUT THE CONTINENT, EVERY SINGLE DAY, WOMEN AND MEN ARE ACTIVELY PREVENTING AND COPING WITH HIV/AIDS, CONFLICT, AND GENDER-BASED VIOLENCE AND THAT THERE ARE PARTICULARLY REMARKABLE LESSONS TO BE LEARNED FROM AFRICAN WOMEN WHO THROUGH A SERIES OF GRASS-ROOTS EFFORTS HAVE EVOLVED UNIQUE APPROACHES TOWARDS THESE CHALLENGES;

25. FURTHER NOTING THAT, THERE ARE GROWING NETWORKS, INITIATIVES, AND PARTNERSHIPS TO ADDRESS THESE INTERTWINED CHALLENGES IN AFRICA AND THAT THESE EFFORTS, ALREADY GENERATING MOMENTUM TOWARDS CREATIVE SOLUTIONS, NEED TO BE RECOGNIZED AND SUPPORTED;

26. NOW THEREFORE, WE THE UNDERSIGNED AFRICAN MEMBERS OF THE INTERNATIONAL DEVELOPMENT AND HEALTH COMMUNITY WHO ASSEMBLED IN DURBAN SOUTH AFRICA AND DELIBERATED FOR THREE FULL DAYS, AT THE INVITATION OF THE AFRICAN CENTRE FOR THE CONSTRUCTIVE RESOLUTION OF DISPUTES (ACCORD) AND THE TULANE UNIVERSITY PAYSON CENTER FOR INTERNATIONAL DEVELOPMENT AND TECHNOLOGY TRANSFER AND SPONSORED BY THE UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) IN ASSOCIATION WITH THE LINKING COMPLEX EMERGENCY RESPONSE AND TRANSITION INITIATIVE (CERTI), THE INTERNATIONAL CENTRE FOR MIGRATION AND HEALTH (ICMH-GENEVA) AND THE WORLD BANK (PRETORIA),

27. TAKING SPECIAL ACCOUNT OF THE COMMUNITY, NATIONAL AND REGIONAL EXPERIENCE AND LESSONS LEARNED OF AFRICAN STRATEGISTS AND IMPLEMENTERS OF PROGRAMS AND PROJECTS, ESPECIALLY AT THE SUB-NATIONAL AND COMMUNITY LEVEL, TO COPE WITH AND COMBAT HIV/AIDS IN CONFLICT AFFECTED COUNTRIES;

28. ACKNOWLEDGING THAT CONFLICT, HIV/AIDS AND GENDER INEQUALITIES ARE INEXTRICABLY RELATED AND THEREFORE SOLUTIONS TO THESE PROBLEMS MUST TAKE IN TO ACCOUNT THIS COMPLEX INTERRELATIONSHIP WHICH REQUIRES INTERDISCIPLINARY AND INTERSECTORAL APPROACHES.

29. REQUEST THAT NATIONAL GOVERNMENTS, NATIONAL NGOS, AND THE INTERNATIONAL COMMUNITY, INCLUDING ALL BILATERAL AND MULTILATERAL DONORS AND INTERNATIONAL NGOS, MUST REVISIT THEIR POLICIES, STRATEGIES AND PROGRAMS TO FIGHT THE TWIN SCOURGES OF VIOLENT CONFLICT AND HIV-AIDS AND ACHIEVE SUSTAINABLE PEACE

BASED ON:

A. MAINSTREAMING INTERVENTIONS TO ADDRESS HIV/AIDS, CONFLICT PREVENTION, MITIGATION AND RESOLUTION/RECONCILIATION AND WOMEN'S EMPOWERMENT INTO ALL SECTORAL PROGRAMS;

B. EMPOWERING WOMEN AS KEY ACTORS AND COMMUNITY MOBILIZERS TO BOTH ADDRESS BOTH HIV/AIDS AND CONFLICT RESOLUTION/PEACE BUILDING. EMPOWERMENT REQUIRES ACTION AT THE POLICY (INCLUDING LEGAL FRAMEWORK), STRATEGY AND PROGRAM LEVELS AT LOCAL, SUB-NATIONAL, NATIONAL AND INTERNATIONAL LEGAL LEVELS;

C. DEVISING A CONCEPTUAL FRAMEWORK THAT:

• IS HOLISTIC, INTEGRATED, AND GENDERED;

• TAKES INTO ACCOUNT THE NEEDS OF BOTH WOMEN AND MEN;

• TAKES INTO ACCOUNT IMPORTANT DETERMINANTS AT THE INDIVIDUAL, COMMUNITY, NATIONAL AND INTERNATIONAL/GLOBAL LEVELS;

• INCORPORATES THE IMPORTANCE OF POVERTY AS A DETERMINANT OF HIGH-RISK BEHAVIORS RELATED TO HIV AND CONFLICT.

• TAKES INTO ACCOUNT THE IMPORTANCE OF SECURITY, GOVERNANCE AND SOCIOECONOMIC DEVELOPMENT;

• CONTEXTUALIZES THE PANDEMIC WITHIN DETERMINANTS INCLUDING POVERTY, GENDER SOCIALIZATION AND ACCESS TO RESOURCES.

D. RECOGNIZING THAT CONFLICT AND HIV/AIDS WILL REQUIRE BEHAVIORAL CHANGE AT THE INDIVIDUAL, INSTITUTIONAL, COMMUNITY, NATIONAL AND INTERNATIONAL LEVELS;

E. NECESSITATING THAT APPROACHES MUST ADDRESS THE PROBLEMS OF STIGMA AND SHAME, WHICH ARE UNDERLINED BY FEAR ON THE PARTS OF BOTH, INFECTED AND AFFECTED. THERE IS ALSO A NEED TO PROMOTE SELF-ESTEEM AND HEALTHY RELATIONSHIPS AND HOPE, INCLUDING HOPE FOR A CURE;

F. INCLUDING AS A PRIORITY PSYCHOSOCIAL CARE FOR THOSE AFFECTED BY CONFLICT AND HIV/AIDS, WITH SPECIAL ATTENTION GIVEN TO TRAUMA MANAGEMENT AND REINTEGRATION INTO COMMUNITIES FOR EX-COMBATANTS, ESPECIALLY FORMER CHILD SOLDIERS;

G. GIVING SPECIAL CONSIDERATION TO VULNERABLE GROUPS SUCH AS WOMEN, CHILDREN, YOUNG ADULTS, PEOPLE WITH DISABILITIES, ORPHANS, REFUGEES AND INTERNALLY DISPLACED PERSONS, CHILD SOLDIERS AND EX-COMBATANTS;

H. REQUIRING BROAD AND STRATEGIC PARTNERSHIPS, INCLUDING THE MILITARY SECTOR, WOMEN'S GROUPS, CIVIL SOCIETY GROUPS, SPIRITUAL INSTITUTIONS AND THE PRIVATE SECTOR;

I. EMBRACING THE IMPORTANCE OF REGIONAL AND LOCALLY-TAILORED SOLUTIONS THAT ARE BASED ON THE COMMON PRINCIPALS OF WOMEN'S EMPOWERMENT, INTERSECTORAL APPROACHES, ANALYSIS OF THE NEEDS OF VULNERABLE GROUPS, GENDER ANALYSIS, AND PEACE;

J. PROMOTING NATIONAL, REGIONAL, AND INTERNATIONAL NETWORKING, DIALOGUE AND COOPERATION;

K. MAINSTREAMING CONFLICT, GENDER AND HIV/AIDS STRATEGIES AND PROGRAMS IN THE BROADER POST-CONFLICT DEVELOPMENT AND DEMOCRACY AND GOVERNANCE FRAMEWORK;

L. ENHANCING PRESENT PROGRAMMES IN AREAS OF CARE AND SUPPORT FOR PEOPLE LIVING WITH HIV/AIDS, PARTICULARLY IN MAKING MEDICAL TREATMENT AFFORDABLE AND ACCESSIBLE AND PROVIDING SERVICES THAT ALLEVIATE THEIR SUFFERING AND PROTECT THEIR HUMAN RIGHTS.

30. WE THEREFORE RECOMMEND THAT:

A. AS CONFLICT, HIV/AIDS AND GENDER ARE NOW INEXTRICABLY LINKED IN SUB-SAHARAN AFRICA, ALL CONFLICT PROGRAMS MUST ADEQUATELY ADDRESS THE ISSUES OF HIV/AIDS, POVERTY AND GENDER.

B. THE PROCEEDINGS OF THIS FORUM BE WIDELY DISSEMINATED TO THE PRACTITIONERS AND POLICY COMMUNITY, INCLUDING DONORS, INTERNATIONAL ORGANIZATIONS, NON-GOVERNMENTAL ORGANIZATIONS (NGOS), INCLUDING RELIGIOUS ORGANIZATIONS, AND GOVERNMENTAL SECTORS, INCLUDING THE MILITARY;

C. PRACTICAL TOOLS BE DEVELOPED TO SUPPORT THE PROGRAMMING APPROACHES ARTICULATED ABOVE FOR ADDRESSING THE PROBLEMS OF HIV/AIDS AND CONFLICT/CRISIS THROUGH GENDER-BASED STRATEGIES

D. DONORS INCREASE RESOURCE LEVELS IN SUPPORT OF PROGRAMS TO ADDRESS THESE CRITICAL PROBLEMS THROUGH A PROCESS OF REGULAR CONSULTATION THAT FACILITATES STRATEGIC PARTNERSHIPS, COMMUNITY OWNERSHIP AND MUTUAL ACCOUNTABILITY;

E. THERE BE INCREASED DONOR COORDINATION AND PROGRAMMING AND STREAMLINED REQUIREMENTS;

F. ALL OF THE ACTORS INVOLVED IN ADDRESSING THESE PROBLEMS UTILIZE INTERSECTORAL APPROACHES THAT ADDRESS THE COMPLEX INTER-RELATIONSHIP BETWEEN CONFLICT, HIV/AIDS, POVERTY AND GENDER ROLES; 

G. MECHANISMS BE PUT IN PLACE TO BUILD A LEARNING NETWORK OF PROFESSIONALS AND WORKERS IN ORDER TO IMPROVE THE QUALITY AND EFFICACY OF PROGRAMS AS WELL AS TO INCREASE ADVOCACY FOR THESE ISSUES;

H. EMPOWERING WOMEN AND ADDRESSING THE ROOT CAUSES OF THEIR VULNERABILITY IS KEY TO PREVENTING AND COPING WITH HIV/AIDS.

31. IN WITNESS, WHEREOF, WE THE UNDERSIGNED, BEING DULY REPRESENTATIVE OF AFRICAN MEMBERS OF THE INTERNATIONAL DEVELOPMENT AND HEALTH COMMUNITY HAVE ASSENTED TO THE DECLARATION HERE IN, CONCLUDED IN DURBAN, REPUBLIC OF SOUTH AFRICA ON THE 28TH DAY OF MARCH 2001.

DURBAN DECLARATION END TEXT.

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WORKSHOP PARTICIPANTS

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 32. PARTICIPANTS: (1) YENE ASSEGID OF EVERYONE ADVANCED HEALTH COMMUNICATION TRAINING AND TECHNICAL SUPPORT IN ETHIOPIA, (2) MARY BALIKUNGERI OF RWANDAN WOMEN COMMUNITY DEVELOPMENT NETWORK, (3) CALUDINE MUYALA TAYAYE BIBI OF THE UNIVERSITY OF KINSHASA AND THE NGO PLATFORM PAAF IN THE DRC, (4) CAROL POWER OF RAPCAN IN SOUTH AFRICA, (5) DARAUS BUKENYA OF THE AFRICAN MEDICAL AND RESEARCH FOUNDATION IN TANZANIA, (6) NSAMA CHIKWANKA OF THE SOCIETY FOR WOMEN AND AIDS IN ZAMBIA, (7) ANNA VANESCH OF THE FUTURES GROUP IN SOUTH AFRICA, (8) EMMANUEL GASAKURE OF THE FACULTY OF MEDICINE OF THE NATIONAL UNIVERSITY OF RWANDA, (9) BOGALETCH GEBRE OF THE KEMBETTA WOMEN'S SELF HELP CENTER IN ETHIOPIA, (10) SUSAN KAJURA OF WORLD LEARNING IN UGANDA, (11) BEN KATAMILA OF THE COMMUNITY BASED AIDS PROGRAM AND THE AIDS CARE TRUST OF NAMIBIA, (12) SERAPHINE MANIRAMBONA OF THE SUPPORT TO RURAL WOMAN ADVANCEMENT PROJECT IN BURUNDI, (13) GUILHERMINA LANGA MILICE OF THE MULEIDE STD/HIV/AIDS PROJECT IN MOZAMBIQUE, (14) NESTOR MOUSSOKI OF THE INFORMATION, EDUCATION, AND COMMUNICATION BRANCH OF THE NATIONAL PROGRAM FOR THE CAMPAIGN AGAINST AIDS (PROGRAMME NATIONAL DE LUTE CONTRA LE SIDA  PNLS) IN THE REPUBLIC OF THE CONGO, (15) BEATRICE MURUNGA OF MAP INTERNATIONAL FOR EAST AND SOUTHERN AFRICA IN KENYA, (16) SOPHONIE NIYONDAVYI OF THE BURUNDI MINISTRY OF NATIONAL HEALTH SERVICES, (17) JOSEPH NTAGANIRA OF THE DEPARTMENT OF PUBLIC HEALTH OF THE NATIONAL UNIVERSITY OF RWANDA, (18) PATIENCE NELISIWE NTULI OF THE SOUTH AFRICA MEDICAL RESEARCH COUNCIL, (19) AIRAH SCHIKWAMBI OF THE COMMUNITY BASED HEALTH CARE PROGRAM IN THE NAMIBIA MINISTRY OF HEALTH AND SOCIAL SERVICES, (20) ANNE-MARY SHIGWEDHHA OF THE PRIMARY HEALTH CARE STD/HIV/AIDS PROGRAMME IN THE NAMIBIA MINISTRY OF DEFENSE, (21) EMMANUEL B. SSEMPA OF THE HIV/AIDS PREVENTION AND POVERTY ERADICATION PROGRAM IN UGANDA, (22) JOHN TESHA OF THE INTERNATIONAL ORGANIZATION FOR MIGRATION IN PRETORIA, (23) CAROLINE ODONGO TURYATEMBA OF THE JOOINT CLINICAL RESEARCH CENTRE IN UGANDA, (24) ASUNTA WAGURA OF THE KENYA NETWORK OF WOMEN WITH AIDS, (25) DOROTHY GATERA WIBABARA OF THE AIDS PROJECT OF THE PRESBYTERIAN CHURCH OF RWANDA, AND (26) GLADNESS LINDIWE XABA OF THE RELIGIOUS AIDS PROGRAM IN SOUTH AFRICA.

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CONCLUSION

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33. COMMENT: USAID/AFR/SD THANKS USAID/SOUTH AFRICA FOR ENCOURAGING THIS WORKSHOP TO TAKE PLACE IN SOUTH AFRICA. THE OFFICE APPRECIATES THE COLLABORATIVE WORKING RELATIONSHIP ESTABLISHED AMONG ITS GRANTEES, TULANE UNIVERSITY AND ACCORD, FOR THEIR PERSEVERANCE IN DESIGNING AND IMPLEMENTING THIS WORKSHOP. THE OFFICE ALSO APPRECIATES USAID AFRICA FIELD MISSIONS AND USAID WASHINGTON OPERATIONAL UNITS IN THEIR ASSISTANCE IN THE THINKING AND PLANNING OF THIS SYMPOSIUM. FULL WORKSHOP PROCEEDINGS WILL BE AVAILABLE THROUGH THE FOLLOWING WEBSITE: HTTP://WWW.USAID.GOV/REGIONS/AFR/CONFLICTWEB/WHATSNEW.TML. END COMMENT.

UNCLASSIFIED

Appendix C: Agenda (ÝtopÝ)

Day 1:  Monday March 26, 2001