Addressing HIV in emergencies

Karine Garnier, FAO Regional Emergency Officer for Gender and HIV in Nairobi, manages a regional project supporting people affected by HIV and gender inequities, including gender-based violence, in six countries in East and Central Africa and was among the nearly 24,000 delegates from around the world attending the 2012 International AIDS Conference in Washington DC.

At the conference, Karine participated in a meeting on the importance and challenges of addressing HIV in humanitarian emergencies, giving a presentation, along with colleagues from the World Food Programme (WFP), on the integration of HIV into the crisis response in the Horn of Africa.

Karine Garnier, FAO Regional Emergency Officer for Gender and HIV, Nairobi.

What are some of the particular challenges related to HIV in emergencies?

In an emergency context, the risk factors for HIV infection increase. Displacement, transactional sex, which increases when people find themselves in desperate situations, sexual and gender-based violence, rape – all of these factors that put people at greater risk of infection tend to be more prevalent in emergency situations.

In addition, food insecurity and malnutrition can accelerate the development of the virus in those infected with HIV, and leave others, whose immune systems are weak due to malnutrition, more vulnerable to infection.

In emergencies, as in the general HIV response, we need to have all sectors integrating HIV concerns into their interventions. The global inter-agency task team of UN and non-UN agencies working on emergencies and HIV helps ensure that we act in an integrated, coordinated way to address the issue following guidelines on HIV  developed by the humanitarian community.

Can you talk a bit about the project you are managing to address some of these issues in East and Central Africa?

The project is funded by the Swedish International Development Agency and targets six countries in the region – Burundi, Central African Republic, Democratic Republic of the Congo, Kenya, Rwanda and Uganda.

We help rural populations affected by HIV and gender inequalities improve their livelihoods and their nutrition through training sessions and using the junior and adult Farmer Field and Life School methodology, where groups of male and female farmers learn through observation and experimentation in their own fields and communities.

So far, the project has reached 80,000 men, women and children with a curriculum aimed at increasing awareness of gender issues, reducing the stigma of HIV and improving nutrition levels and food security.

For people living with HIV, nutrition is a crucial element of living well.  Without good nutrition, even people receiving anti-retroviral treatment will do poorly. Often, eating well is a challenge due to economic constraints but also due to lack of knowledge of what is nutritionally good to eat. So we ensure that we provide training on good nutrition – what to eat, how to prepare it – focusing mainly on what they produce, what is available locally.

What are some of the impacts you’ve seen so far?

An important impact has been the empowerment of previously marginalized people. The beneficiaries of the project are being reintegrated into their communities because now, as a result of the training they have received, they are seen as productive members of the society. They are more active in the community, more inclined to assume leadership positions, and when it comes to young people, they are more keen to go back to school if they have dropped out, or to improve their school performance.

Field school participants receive agriculture know-how and inputs to improve the productivity of their farms. They have improved their incomes through the sale of surplus production and their nutrition through consumption of the food they have produced. They become self-reliant.

Also, because it's group based, we’ve seen a reduction in stigma related to HIV and in discrimination against victims of gender-based violence. This comes from their being perceived as productive members of society. As a result of the training we do on HIV, there is also greater understanding of what HIV is, which helps demystify some of the taboos.

We’ve even seen some successful examples of groups forming cooperatives. So the group-based approach is very important because it's what will help sustain the intervention in the future.

At national level there is much more recognition of the field school approach as a successful methodology for technology transfer. In some countries there has even been interest in incorporating the field school methodology into national curricula.

Are the men on board with the gender elements of the project?

Our approach helps empower women but in a manner that doesn't threaten men. Men are actively involved so they see the benefits and don’t feel disempowered. Men have an important role to play in achieving gender equality.

Focusing exclusively on women can, in some cases, create more harm than good. If the men in the community are excluded, they can feel disempowered and when the women go back to their households this can create tension. So it’s not only about women.

Any plans for expansion?

A recent external evaluation of the project recommended scaling up the intervention in the region, but in stronger partnership with other agencies. Discussion is under way within the regional network on gender and rural livelihoods, led by FAO, on how to do this.

There is a lot of interest around it and demand from surrounding communities to start this sort of program. Some of our partners are already expanding this approach to other areas, and we have trained around 40 master trainers and 260 facilitators who are now fully equipped to train others, facilitate field schools and address HIV and gender issues.  With these master trainers, we have created a wider capacity to do more.

Also, because it’s a regional project, it includes exchange between countries, where trainees from one country visit another to learn and share their experiences. This helps us collect lessons learned within region, but also to share these beyond the current project countries.

How did you get involved in working on HIV?

In 2003, I was living in South Africa and working in a local clinic, assisting with an administration system. In South Africa, particularly in Johannesburg, where I was working, HIV is very prevalent and we had many HIV-positive patients. So I became interested, and received training in HIV counseling. When my family and I moved to Kenya, I continued working on HIV programs and was eventually hired first by WFP and then by FAO when they started their emergency program on gender and HIV.

Does the project provide treatment to participants?

We don’t provide treatment, but we make sure that we link up with the health system in the countries where we work so we can target the most vulnerable and connect them with existing services, ensure beneficiaries go to the clinic, encourage those who don’t know their status to go for testing and so on, which is part of the whole multi-sectoral approach.

Some groups that we’ve worked with have actually gone as a group for testing. This happened in Kenya. A number of people tested positive, but when they told the group there was solidarity, not stigma.

Because of the sense of cohesion from working together?

Yes, because of the sense of trust within the group, the sense of empowerment. The project approach helps the farmers to be empowered in their fields, but also in their lives. In rural areas it’s not always easy to touch on subjects like HIV and gender inequity. A local official once told me, “When we call for a meeting on HIV, no one comes because there is so much stigma associated with it.”

But in these projects, it’s easier because the issues are brought into the group. The farmers are there for their own economic benefit, but the social outcome is also very good.