“The problem that many people living with HIV have is stigmatisation. People point their fingers at you and discriminate against you wherever you go. Some HIV-positive persons have been thrown out of their homes; some have lost their jobs. People even refuse to eat with you. Such treatment kills. The disease does not.”
These were the complaints of an HIV-positive person at a programme organised at Techiman in the Brong Ahafo Region recently.
His concern sums up the humiliation, injustice and unfair treatment that confront people living with HIV and AIDS in Ghana, immediately they go public with their status.
Public attitude towards people living with HIV and AIDS, especially the responses when the disease started, created the impression that the disease was an illness visited on immoral and sinful persons. It was such a perception that caused society to stigmatise the patients and eventually isolate them, causing them to feel unwanted in society.
The result has been frustration in efforts to combat the disease. This is because people who know their status do not only refuse to come out publicly to declare it, but also consciously ignore safety measures that can prevent or curb the spread of the disease.
In Ghana, only a few HIV-positive persons have been bold enough to openly declare their status, but records show that no public figure has declared his or her status.
With such an attitude, stigmatisation has become a big problem to HIV prevention and control in the country - a situation that raises a number of concerns.
The question is, how can we as a nation control the disease effectively and efficiently to prevent future generations from being infected?
How do we as a nation, prevent new infections, especially when it is perceived that due to the stigmatisation, HIV-positive persons do not only refuse to come out publicly, but go underground or refuse to go for anti-retroviral therapy to help them manage the disease more meaningfully?
One organisation which is making a lot of impact in the management of the disease is Care Ghana.
This organisation is now making a headway in implementing a project dubbed ‘Prevent’ to encourage HIV-positive persons not only to feel at home, but also to socialise more meaningfully.
Started about two-and-a-half years ago with funding from the Danish International Development Agency (DANIDA) and support from Care Denmark, the project is showing the way by approaching HIV and AIDS prevention, as well as support and care in a humane and non-stigmatising manner.
So far, as many as 36 communities in six districts of Ashanti, Brong Ahafo and Western Regions of Ghana are benefiting from the project.
Among the beneficiary communities are Asafo, Amafie and Bibiani in the Western Region; Hansua, Menji and Nsawkaw in the Brong Ahafo Region, as well as Kensere, Kokofu and Ejura in the Ashanti Region.
One of the primary objectives of the project is to make the beneficiary communities appreciate the need to sympathise with persons living with HIV and AIDS, as well as care for and support them in a competent and non-stigmatising manner.
With such positive attitudes towards them, the beneficiary communities are emerging not only as strong and resourceful people, but are also tailoring their activities to serve as examples for replication to other communities across the country.
Care Ghana is collaborating with traditional authorities in all the participating communities, the National Association of HIV-Positive People (NAP), that is the national network of people living with HIV and AIDS, as well as the Centre for Indigenous Knowledge and Organisational Development (CIKOD), in this initiative .
What is important is that two-and-a half years of active work on the field is yielding positive results which could be attributed to the best practices packaged by Care Ghana.
Among the significant achievement of Care Ghana is enhancing the capacity of traditional authorities through various training workshops in HIV and AIDS management.
With such capacity building, traditional rulers in the beneficiary communities now have the skills to interact positively with members of their communities and devise mechanisms and strategies that would put control and preventive measures in place to ensure that they lead healthy lifestyles.
This is very significant because if the crusade against HIV and AIDS will yield positive results, traditional authorities have a big role to play.
They have been bestowed with the ability not only to mobilise people in their respective communities at a short notice, but also have the skills to ginger them to support development initiatives, including appreciating the essence of living healthily.
Trained queens have visited and learnt lessons from their counterparts at Manya Krobo in the Eastern Region and Techiman in the Brong Ahafo Region.
Traditional authorities and their community members have also been trained to develop their own stigmatisation and HIV and AIDS prevention plans.
The plans, which identified key HIV prevention activities including anti-stigmatisation campaigns, condom distribution, counselling and testing, were supported with available community resources and budget.
The efforts of the Prevent Project in promoting the integration of HIV and AIDS prevention into cultural activities and traditional practices in the project communities is also yielding fruitful results .
Another remarkable achievement of the Care Project is the practice where between 10 and 30 minutes is allocated for HIV and AIDS education at weekly traditional council sittings of paramount chiefs, sub-chiefs and queens of the project communities.
During such important meetings, resource persons trained by the project are invited to have positive interaction with the traditional authorities and opinion leaders as part of the strategy to make the project more sustainable.
In order to reach a wide audience, the traditional leaders also use customary and traditional ceremonies such as festivals and funerals as platforms for HIV and AIDS education.
Of equal importance is the fact that puberty rites have been reintroduced in some of the participating communities, and during the performance of such rites, HIV and AIDS education are integrated to make the youth appreciate the need to lead productive lifestyles.
The Prevent Project is also using existing traditional and community-based behavioural change communication channels in the project areas to provide HIV and AIDS information.
This is very significant because the application of these channels do not require any extensive training , beside the fact that community members are used. A typical example is the use of the gong-gong, which is a traditional means of mass communication, to mobilise community members for HIV and AIDS activities including counselling and testing services.
The project also uses community durbars to provide HIV and AIDS information to a large audience, and as advocacy tools, they are used to rally support and create the enabling environment for effective HIV and AIDS prevention activities.
In addition, support group members contact individuals through home visits and provide them comprehensive HIV and AIDS information on one-on-one basis. Consequently, knowledge about HIV and AIDS has increased tremendously among the participating community members.
An innovative strategy (“Know Your Status” Campaign) of the Ghana Health Service has also been adapted by the Prevent Project to make HIV counselling and testing more decentralised and affordable to rural communities.
The project is part of the strategies used by the Prevent Project and a collaborative effort between the beneficiary communities, the Information Services Department and the Ghana Health Service to galvanise members of the respective communities to undertake voluntary testing to determine their status, so as to lead more responsible lifestyle.
This particular project is spearheaded by the traditional authorities, while the District Health Management Teams provide nurses and counsellors for the exercise.
The Prevent Project has also lived up to its original billing as a collaborative effort among diverse stakeholders. The municipal and district and assemblies (MDAs) provide the needed political leadership and create the necessary platform for education, while the Ghana Health Service provides the technical expertise and products to support community-based services including counselling and testing, as well as condom distribution.
Similarly, the traditional authorities, community members and HIV and AIDS support groups have also been formed to develop and implement their HIV and AIDS prevention plans. To make the project more effective and sustainable, a monitoring mechanism has been put in place to ensure that the project is effectively implemented.
At the district level, monitoring teams involving Prevent Project staff, District HIV Focal Persons, CIKOD and NAP members undertake regular monitoring visits to the communities.
They also organise review meetings at the community and district levels, where they discuss project implementation issues.
Two Paramount Chiefs, Nana Karikari Apau of Bekwai, and Barima Ofei Akwasi Okogyeasuo II of Kokofu, have shown their commitment to the implementation of the HIV and AIDS prevention programmes.
They are not only leading the crusade to fight HIV and AIDS related stigma, but have also mandated all sub-chiefs under their paramountcy to take concrete steps to replicate the project in their respective communities.
The idea is to prevent HIV infection by discouraging the keeping of multiple partners and promotion of stable marriages. In the same vein, the Chief of Kensere in the Ashanti Region, Nana Fosu Kwabi, is championing HIV and AIDS prevention in his community. It is reassuring to witness how Nana Kwabi has personally led condom distribution and been demonstrating their proper use during anti HIV and AIDS campaigns in the area.
The dynamism of the queen of the Sefwi Wiaso Traditional Council, Nana Afia Korama, is also an example of what traditional authorities can do to move the HIV and AIDS prevention programme forward.
She discusses HIV and sexuality issues with children and regularly provides HIV education to her community, especially women and young people. Her activities were extended to schools, churches and other traditional leaders in her community.
Furthermore, the queen is promoting girl-child education and campaigning to prevent teenage pregnancy and school dropouts in her traditional area.
Through her efforts, the Sefwi Wiawso Traditional Council has passed a bye-law to check people who impregnate girls under 18 years. The district assembly has approved the bye-law, and people who flout it are fined GH¢100.
The efforts of the queen of Hansua in the Brong Ahafo Region, Nana Afia Bema, in organising women and youth forums on HIV and AIDS and Voluntary Counselling and Testing (VCT) programmes for her people to support the sustenance of the project is also paying off.
The Prevent Project has also built the capacities of groups of people living 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, many people living with HIV were reluctant to come out publicly to support HIV activities.
However, through training and other support from the project, they have now become more assertive, confident and more resilient in supporting each other in the management of their conditions.
The NAP Ghana was established with the primary purpose of mobilising all HIV-positive persons under one umbrella to promote their welfare.
This noble intention is far from being realised, as many PLHIV, especially those in the rural areas, are reluctant to join the association.
The reality now is NAP-Ghana is gradually but surely becoming a household name for PLHIV Groups in the project districts.
Members of the PLHIV Groups in the project districts have registered, thus making the public sympathise with them and reduce the stigma associated with the disease.
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 seems to be on the decline in the 36 project communities.
The various strategies have worked together to change the attitude of community members who are demonstrating acceptable attitudes towards people infected and affected by HIV.
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