40654 HIV/AIDS in Africa- Getting Results These reports describe activities, challenges and lessons learned during the World Bank Global HIV/AIDS World Bank's HI/AIDS work with countries and other partners. Program and ACTafrica Uganda MAP ­ the power of community HIV and AIDS initiatives Some of the people and local organizations empowered treat opportunistic infections and ARVs; increased support by the Uganda AIDS Control Project ­ one of the first for AIDS orphans and widows, home-based care services, projects under the Africa Multi-Country AIDS Program and income-generating activities that benefit the (MAP) ­ tell their stories. A comprehensive system of community. Groups of people living with HIV have support provided funding, training and guidance to civil demonstrated their ability to manage funds and provide society organizations operating at community, district useful services, enhancing their own and the community's and national level -- to expand services, build local perception of their potential to contribute to the national capacity and reduce stigma and discrimination. Grants response, and helping reduce stigma. for 3,629 community-led HIV/AIDS Initiatives (CHAIs) were a key feature of this innovative support for local Nonetheless, with increased numbers of needy orphans, HIV and AIDS responses. With strong decentralized elderly guardians, child-headed households and people support from District AIDS Committees, communities living with HIV ­ along with poverty and the lack of long- have used the grants to save and change lives, improve term, reliable funding ­ the challenge to respond to health, provide care, and give new hope to people community needs remains enormous. infected and affected by HIV across Uganda. Helping People to Live Positively with HIV and MAP community grants for HIV initiatives prevent new infections ­ Mukono AIDS Support Association (MASA) When the IDA-funded Uganda AIDS Control Project began in 2001, it took a new approach by directly funding communities ­ defined as groups with common interests or needs ­ to develop and implement their own initiatives, instead of continuing to rely on NGOs to do things for communities (which was not having the desired impact). These Community-led HIV/AIDS Initiatives (CHAIs) funded by the Uganda MAP have strengthened and expanded the local response to AIDS in a remarkable way. A chain of support -- from the District AIDS Committees (DACs) and district-based NGOs and community-based organizations (CBOs) -- has trained community groups to plan, implement, monitor and report, and built capacity to procure goods and manage funds. Procedures for community participation in the project were clear, simple, and well publicized, and improved over time with experience on the Government's side and flexibility on the Bank's side. Group accountability led to good use of the funds ­ everyone knew how much was received and how much was spent, which helped ensure that most projects were implemented as planned. MASA Director, Ruth Kaweesa, in front of the Post-Test Club hen-house Communities have identified and been empowered to meet their priority needs. Results include increased use In 1992, a group of six infected and affected people began of condoms, and of voluntary counseling and testing; trying to respond to HIV in their community. From this wider access to treatment, through referrals for drugs to small and tentative beginning, the Mukono AIDS Support Association (MASA) has grown to become a major provider of services in Mukono District. One of its "We shall overcome AIDS, let HIV stop with me". founders, Ruth Kaweesa, is a trained nurse and medical clinical officer who was widowed by AIDS and now runs the organization. MASA sees an average of 50 clients a day. In the early years MASA relied on volunteers and small in-kind inputs such as benches and food from a few donors and the District Government. Later, drugs for opportunistic infections came through the IDA-funded Uganda Sexually Transmitted Infections Project. In recent years an important share of the organization's financial backing has come through the IDA-funded Uganda AIDS Control Project (Uganda MAP). Working with the AIDS Information Center (a national NGO), MASA offers pre- and post-test counseling, undertakes HIV testing in their `mini-lab', and provides drugs for the treatment of opportunistic infections. (Of those tested at MASA, 33% are HIV positive.) In addition, MASA has organized 120 partners (no longer considered clients or The MASA Post-Test Club Music Group spreading key patients) into `post-test' clubs that offer group support to messages on prevention, treatment, and hope those who have tested positive. Another of the group's songs is all about ARVs ­ how they With a combination of the services these clients receive used to be too expensive but now are freely available in directly from MASA and the anti-retroviral treatment the community, how before people were dying of malaria provided through the Department of Health, 40 members or diarrhea but now they have a future, and that the MASA of the MASA Post-Test Club have organized themselves group members hope to live until the day that a cure is into a powerful instrument to communicate key AIDS found. The group members touch their wrist watches in messages. Through their strong, melodic and upbeat time with the beat as the lyric goes on to give clear songs, they transmit critical information to the community instructions about the importance of taking the drugs twice about how, where and why to get services. They are daily at regular times. extraordinary examples of how to live positively with the virus. A third musical message is about the need to avoid rumors and misinformation. It explains that HIV is a virus, is The technical information that infuses their messages transmitted by sex and not by witchcraft, and that it does comes directly from the Community Education Charts not discriminate (nor does it come only from businessmen produced and supplied by the Uganda MAP IEC office, who have traveled to Tanzania!). The song urges those in which also provided training on how best to pass on the the audience to come to MASA for screening ­ "If you're messages. With the support of the MAP, the MASA positive, be strong, you are not the first to live with HIV". It group of singers, dancers and drummers ­ dressed in closes by singing the praises of MASA. identical vibrant red outfits ­ sing of their confidence in themselves and hope for the future. Indeed, the work of this MAP-supported district NGO is worthy of praise. Beyond the counseling, clinical and In one of their songs, with an irrepressible beat and the communications services that MASA provides, it is also refrain "We are people of HIV", group members tell their helping members to organize themselves into groups to personal stories. A woman named Mary ­ whose generate additional income for themselves and their enthusiasm is palpable ­ sings out that she is a widow families. At present this includes a small piggery project. It with seven children, that she's on ARVs, and that's why has started with a few pigs, and the litters will be given to we see her strong, that's why she sings and dances! other members until eventually each member gets a female pig to continue breeding. The profits from selling The next verse is sung by Richard, the group's leader pork are to be used for the upkeep of AIDS orphans. and father of a little boy, born HIV-negative thanks to MASA has also begun a poultry project, using the profits medication to prevent mother-to-child transmission from selling eggs to support sick patients, as contributions (PMTCT). Richard's message is that HIV is not the end, to funerals and other emergencies. and that people need to get tested and start taking drugs if they are positive. As for prevention, he urges young Through MAP funding, MASA has nurtured five remotely- people to abstain, and others to use condoms or be located groups of people living with HIV, providing them faithful. He ends his verse by singing out strongly that with skills in organizational development, community 2 mobilization, counseling and home-based care. In the "Hadijah came from rich to the ground; she bent low and areas where these groups live, MASA has also started associating with the low. She is now in a new life, undertaken out-reach HIV screening, an essential with the members of her community-based organization service for those unable to travel to Mukono town. as her partners." Finally, through monitoring and evaluation (M&E) training provided by the Uganda MAP, MASA's Director Her work started unintentionally, after she came from the Ruth Kaweesa has become an M&E Technical Resource village (where she had to move after her property was person in other districts, sharing her experience and taken by her husband's family) to the district capital to knowledge widely. receive food for herself and her family from MASA. Soon From Ruth's perspective: she began collecting food not only for herself, but for other women in her area who were bedridden ­ first three, then "The MAP has helped the Ugandan response to five, and soon the numbers of hungry widows and others HIV/AIDS to move to communities, which has made it she was helping grew. When MASA began to provide possible for people to come out with their HIV status drugs for HIV opportunistic infections (OIs) the and live positively. This has allowed positive people to organization decided to open an outreach center at the join together and has opened our eyes on how to sub-county level, so that the women coming to Hadijah for support ourselves. While before they used to beg, now food could be tested for HIV and treated for OIs. they are strong." Over time, Hadijah began counseling the women of her All of this success notwithstanding, MASA notes that the area, and later obtained a certificate from TASO (The growing number of people living with HIV is making it AIDS Service Organization) as a Community Volunteer difficult to provide the required drugs for HIV-related Worker. With this, she began home visiting, with the help infections, and orphans need food and health care as of a bicycle provided by the Sub-County Chief in 2000. well as payment of school fees. In addition, funds are needed to continue to make home visits, conduct When the Uganda MAP started the concept of community- outreach screening, and support new groups of positive led HIV/AIDS initiatives (CHAI), Hadijah's group of widows, people, services that have had to be suspended due to widowers and orphans produced "a traditional proposal, lack of funds. what they had on their fingertips", and sent it to the district for approval and submission for MAP funding. This Community-led Work for Widows and Orphans secured a grant for orphan support (including school fees, ­ Hadijah Hajati Nabukenya and the books, blankets, mattresses and bednets) and for widows Agali Awamu (Coming Together to Overcome) (especially seedlings and gardening implements). One result of the gardening effort is that the members are able HIV/AIDS Support Project to produce beans to improve their own nutrition, some of which have been kept so they can be planted during the Hadijah Hajati Nabukenya was once the rich and next rainy season when MAP support will have ended. beautiful young wife of a successful businessman, living They are also trying to grow passion fruit. in a large flat in the district capital of Mukono. Today Hadijah is an AIDS widow, living as an HIV-positive woman in rural Uganda. Along the way, she has lost all her worldly goods. At the same time, this remarkable woman has gained the love and respect of other HIV- positive widows and many others as a result of the work she is doing in her community and beyond. She coordinates HIV/AIDS work throughout her sub-county of Nnama, and the organization she chairs ­ Agali Awamu (Coming Together to Overcome) HIV/AIDS Support Project ­ is one of the 3,629 Community-led HIV/AIDS Initiatives (CHAIs) supported by the Uganda AIDS Control Project (Uganda MAP). Hadijah's story really started in 1988, the year in which her husband died, she learned her own positive HIV status, and came to MASA (Mukono AIDS Support Association) for counseling. From that point on, she decided to care for her two young daughters on her own, "Coming Together to Overcome" ­ members of Agali and to live openly and positively with the virus. In the Awamu meeting outside Hadijah's home. words of her MASA counselor, Ruth Kaweesa: 3 The work of this successful community-led organization The Role of Districts in Supporting a Multi-Sector has been strengthened by the technical support provided Response in Uganda ­ by Margaret Nakityo, a Technical Resource Person from MASA and herself an AIDS widow and woman living with Views from Mukono, Rakai and Soroti HIV. Some of the critical skills Margaret was able to transfer to Hadijah included how to approach the To encourage a multi-sector response at the district level community in the early days, to get members to agree to and below, the Uganda AIDS Control Project (Uganda HIV testing, and to sensitize the Sub-County Chief. With MAP) enabled the country's District AIDS Committees funding from the Uganda MAP, Margaret visited the (DAC) to put in place a chain of support that has given group to discuss nutrition, how to plant the garden, and local civil society organizations and 3,651 community-led how to share and store their beans. She also connected initiatives (CHAIs) funds and technical know-how to the members to the local agriculture extension officer for contribute to the national response to HIV and AIDS. further advice. Understandably, Margaret feels very happy about the support she's been able to offer Hadijah The Role of the District AIDS Committees and her members. DACs are the first link in the chain. They coordinate planning, appraisal, financing, implementation and Both women believe that MAP support empowered the management, including accounting and monitoring of all group members to be open about their HIV status, to HIV and AIDS activities for government departments, share information, support each other and live positively. district-based NGOs, Community Based Organizations As a result, the members say that HIV is no longer a (CBOs), and CHAIs. Each DAC is chaired by the District cause for discrimination in their community. Further, by Chief Administrative Officer. DAC members are heads of caring for orphans, the group acts as a good example to epartments and representatives of all eight government the community, helping them to understand that HIV is directorates, district NGOs and CBOs selected by local not the end and that positive people can be productive civil society organizations, and representatives of people and strong. living with HIV (PLWH). The DAC's work is coordinated by a District HIV/AIDS Focal Point, over and above his or her The children of the group members are now all in school, other responsibilities. including Hadijah's two daughters who are completing their secondary studies. Beyond staying in school, these Because the DAC brings in partners from the whole district young people have been trained and deployed as a administrative structure, Mukono District HIV/AIDS Focal group to spread key messages about HIV prevention, Point Dr. Khonde Anthony notes that colleagues from all care and support in song. departments have begun to understand that HIV/AIDS is not only a health problem and that they all have a role to With her "voluntary heart", Hadijah and her members play. His counterpart from Rakai District, Mugisha Ereazer, have demonstrated strong results and the success of the also underlines the importance of "integrating communities MAP initiative to transfer resources to communities. with other service providers to increase the impact of their activities". With financial backing from the Uganda MAP, the districts have provided finance for the following tasks: · Training DAC members to help local civil society organizations and communities mobilize and prepare proposals and manage their funds; · Field assessments of CHAI proposals by district- level NGOs and CBOs; · Ongoing support for procurement, implementation, record keeping, reporting and financial management; · Facilitating networking with technical colleagues (e.g., from the Departments of Agriculture, Community Development and Health), and with Technical Resource Persons from district-based CBOs); · Regular monitoring. Hadijah Hajati Nabukenya and Margaret Nakityo The HIV/AIDS Focal Point for Soroti District, Godfrey Eretu, explains that "the technocrats' job was to see if the 4 work was done, and how well". The Focal Points from of their own experiences, undertake first stage health care these three districts note that the provision of funds and referral. This was done initially at community level, but technical capacity building to district-based civil society later the DAC helped them to come together as a network organizations (the second link in the chain) to assist the at county level. In addition, the responsibility of managing CHAIs (the third link) represented a change of strategy. a grant has also boosted people's confidence. One AIDS Rather than supporting NGOs to come in and do things widow, for example, gained the strength to stand up to her for communities (defined as a group with a common brothers-in-law to keep her land. This was done with the interest or need related to HIV), this time the money support of her CHAI group, which has helped to resolve went directly to the communities themselves, and others other community disagreements too. It has also led local only assisted. According to Godfrey Eretu, this allowed authorities to enforce land and property laws for PLWH communities "to address their aspirations" and and other widows. undertake the activities that best responded to their needs. Dr. Khonde Anthony also emphasizes the importance of community identification of their own priorities, to ensure that funds received go for "the right activities and to the right individuals". Community-led HIV/AIDS Initiatives With the recognition that AIDS was overwhelming the ability of individual families and, especially, child-headed households to cope, communities came together to see how best they could help mitigate the impact of AIDS on the most vulnerable groups. In most districts these included PLWH, widows, orphans and elderly guardians. It also included youth groups, people with disabilities, taxi drivers, women's and men's groups, farmers and teachers, among others. In Soroti District, migrant fishermen and their partners are an especially vulnerable group. Though it was difficult to work with them due to their frequent movement, the Soroti DAC provided special support by mapping their settlement patterns and helping them to come up with a CHAI proposal to address their basic needs for knowledge and medical services. And in light Soroti District HIV/AIDS Focal Point, Godfrey Eretu of their frequent movement in and out of the district, the Soroti Focal Point collaborated with neighboring districts Strengthened capacity and accountable by radio to ensure ongoing provision of HIV prevention community leadership information and services for fishermen. In addition to providing services, CHAIs have benefited from DAC support to build their capacity to write proposals, The effect on people living with HIV/AIDS implement projects and report on progress, and financial These three Focal Points believe that CHAI activities management skills and accountable leadership. An have had a strong and positive effect on PLWH in their example of accountability comes from Soroti District: districts. In Rakai, for example, Mugisha Ereazer says CHAI members went together to the market to buy oxen CHAIs have encouraged health seeking behavior, so with project money, so that the transaction was public and that those living with HIV are now getting better medical transparent. Each member of the group knows exactly how care and access to condoms. In Mukono District, Dr. the project money is spent. Such accountability within the Khonde Anthony explains that PLWH are helping each group (not only to those above) is now a way of operating other to get information and go for services, and that that will continue and be used for other activities in the healthy HIV-positive people are reaching out to support CHAI communities. others in the community. Improving HIV knowledge and reducing stigma Similarly in Soroti, Godfrey Eretu notes that when a Moreover, the Focal Points (and many others) believe that member of a PWHA CHAI does not show up for a by supporting "post-test clubs" to organize themselves into meeting, the group will contact the local health worker to musical and drama groups that give personal testimonies follow up with the missing member. HIV-positive CHAI and communicate messages about services and the members are also playing an important role in referring benefits of ART, CHAI has helped to spread critical families of their members to get tested and, on the basis prevention and care information and motivate people to 5 access services. In addition, the growing involvement of of those that received only one payment is in question. communities has helped to reduce the stigma and And in a small number of districts there have been some discrimination experienced by people living with the accounting problems. Further, the turnover of District virus. The work done by PLWH has made a special HIV/AIDS Focal Points has caused some delays as new contribution in this effort, by demonstrating that they can people need to be trained to coordinate and support the carry out activities themselves, and do them well. work. And lastly, the fact that the Focal Points have had to undertake their DAC responsibilities in addition to their Fighting poverty other full-time jobs has not been ideal. In Godfrey Eretu's view, CHAI has also directly fought poverty by helping communities to "shock absorb Positive assessment of the DAC chain of support problems beyond AIDS ". Through the purchase of ox for community-led initiatives plows, oxen, goats and cows, or bee keeping and small- Nonetheless, when asked what the HIV/AIDS response scale farming with disease-resistant seeds, CHAIs have would be like in their districts without the interventions earned the funds needed to pay for school fees, supported by the Uganda MAP, the District Focal Points uniforms, and scholastic materials, improve nutrition or were unanimous in their positive assessments. rehabilitate shelter for orphans, and provide basic household inputs for widows and PLWH. In areas where In Mukono, Dr. Khonde Anthony says he "cannot even AIDS orphans have benefited from a one-year vocational imagine" where his district would be today without the training course, some are now able to pay their own MAP. Awareness would be lower, stigma would be higher, school fees and support themselves by working as fewer people would know their status and decide to get tailors, carpenters and bricklayers. And today, even drugs, there would be less use of PMTCT without the though Uganda MAP funds have stopped, Soroti information communicated by the post-test clubs, and community groups still come to the DAC to show what there would be lower demand for condoms. Through the they are doing to contribute to the well-being of their work of the DAC and its decentralized partners supported members. by the MAP, there is now stronger multi-sectoral involvement, and a strategic plan to guide interventions CHAIs have grown into CBOs over the next five years. Indeed, some groups have become sufficiently institutionalized that they have registered as CBOs. This is confirmed by the Executive Director of the Uganda Network of AIDS Service Organizations (UNASO), Syakula Hannigton, who says that while his organization had 600 members prior to the Uganda MAP, today it has 1,000. This is an important development as it expands the linkages between the grass roots and the national level, helping transmit correct information both up and down the line, ensuring that communities know about the latest research findings and funding opportunities, and that national level advocates can base their messages on ground-level needs and realities. DAC Strategic Planning Finally, the Uganda MAP has supported DACs to develop five-year strategic plans, produced with the involvement of all stakeholders. In Mukono District, for example, the strategic planning workshop included local businesses that want to put condoms in their washrooms. It also attracted the participation of a "lodge" proprietor, who came to learn how he could help to protect the people who use his premises for casual sex. According to the District HIV/AIDS Focal Point, before the MAP, these people would not even have spoken about work-place interventions. Dr. Khonde Anthony, Mukono District HIV/AIDS Focal Point outside his office Challenges However, the DACs and the CHAI approach have had In Rakai District, Mugishu Ereazar notes that without the their challenges. The most stable CHAI groups are those MAP, orphans would not be in school or as well cared for, that were funded more than once, and the sustainability there would be less knowledge about the virus, more 6 stigma in communities and less health-seeking behavior providing service to neighboring districts, and has created among PLWH. The capacity of communities to write five `mini-TASOs' around the country. proposals, liaise with other service providers to improve On the basis of its track record and experience, TASO was the quality of interventions, to budget, report and selected by the World Bank-financed Uganda AIDS account would also not be where it is today. Finally, he Control Project (Uganda MAP) to work at district level as a points to the enhanced social cohesion that now exists, member of the District AIDS Committees (DACs) in the which is "the way to go to ensure wider participation". following areas: And in Soroti, Godfrey Eretu states strongly that without · Sensitizing groups at high risk of infection (e.g., the MAP, nothing would be going on at the community commercial sex workers, fishermen and motorcycle level; there would have been no technical support groups of out-of-school youth); provided; and communities would not have an · Expanding home-based care, including provi ding appreciation of their own ability to manage and drugs, counseling and training for those caring for contribute to the response. CHAI allowed communities to people living with HIV, in collaboration with discover that they had resources to address social and community nurses; health needs and to move forward on their own. On the basis of their proven track record in financial · Working with local legal experts to sensitize management, some PLWH CHAIs in Soroti have gone communities on the rights of people living with or on to get funding from the European Union, affected by HIV (e.g., the right of an AIDS widow to USAID/PEPFAR and other sources. Others with CHAI keep her property). experience in agriculture projects are now receiving grants through the National Agricultural Advisory In addition, as members of DACs, TASO staff supported Services (NAADS). local CBOs and community-led HIV/AIDS initiatives (CHAIs) to plan, implement, monitor and report on the He further notes that the relationship between the activities undertaken with support from the MAP. Sophie authorities and communities in his district has become Nantume, the TASO DAC representative for Masaka one of mutual respect, which has helped operations to District (and currently ART Counseling Coordinator at be carried out as planned and reporting to be done: TASO headquarters), received training from the district to help communities apply for CHAI resources. She then sat "The MAP was the first of its kind to give communities with community groups to help them identify their problems the chance to write their own reports, on their own. All and plan their responses. She points out that she did not the shillings reached the communities, and have plan for them, but rather facilitated their own process of stimulated them to believe `yes, you can do this'. The discussion, analysis and planning. Many of the CHAIs she benefit has been big, as once the money has reached worked with faced a huge orphan burden, and needed to the community it stays within ­ no one will take away provide scholastic materials, uniforms, food, bedding and ­ an ox plow." in some cases ­ shelter. Sophie asked the communities with which she worked Strengthening and Expanding Decentralized what else they might do to make their support sustainable. Support by Uganda's Premier AIDS Service This led to the initiation of a range of income-generating Organization ­ activities, including keeping heifer cows to provide milk, The story of TASO planting maize to provide flour for porridge to give to orphans who had no food, and providing sewing machines to girls so that they might learn and practice a useful skill. From a small initiative founded in 1987 by a group of Other CHAI groups made herbal medicines for distribution volunteers, including people living with HIV, TASO (The to the bedridden during home visits, and started fish pond AIDS Service Organization) has grown into one of the harvesting, again for distribution to the needy. Groups of leading partners in the response to HIV/AIDS in Uganda people living with HIV undertook the same types of and the region. It is known as a pioneer in the areas of activities as non-PLWH groups, and were empowered by HIV counseling, medical care, provision of home-based being able to show they were still useful to the community. care, and medical outreach to communities. Recently TASO began a phased introduction of anti-retroviral With respect to the impact of the Uganda MAP support for therapy (ART) and home-based testing and counseling. community-led initiatives, Sophie Nantume says "the It also offers social support services to enhance positive burden is so big, it can't be left to one entity to handle" ­ living, skills building, educational music, dance and everyone must be involved, including communities. From drama, and fellowship among clients in the day care her perspective as a member of the Masaka District AIDS center. With its 840 staff and 142 volunteers, TASO Committee, CHAIs contributed to the national response by operates service centers in ten districts, each of them 7 spreading knowledge of how HIV is spread and how clients it was able to cover through their ongoing outreach people can protect themselves. activities. It also enhanced the communities' appreciation of the role of civil society organizations. Finally, while she points out that supporting the communities was a challenge with just a single vehicle to cover over 150 CHAIs in her district, Sophie says that the "chain of support" from the DACs, to district NGOs and other district-based partners, down to community-led initiatives made a difference. "You can see that life had changed, the communities really benefited a lot." Flexible MAP funding spreads new knowledge about traditional herbal approaches in HIV treatment ­ THETA (Traditional and Modern Health Practitioners Together Against AIDS) With 80% of Uganda's population located in rural areas with limited access to modern health care it is not surprising that when people fall sick the first place many go for treatment is to traditional healers. THETA (Traditional and Modern Health Practitioners Together Against AIDS and Other Diseases) was started in 1992 in response to the fact that communities needed to cope with HIV/AIDS, but at the time, the bio-medical sector Sophie Nantume at TASO headquarters had little to offer. THETA aims to improve and make health care more accessible to the population by respecting the Moreover, she believes that CHAIs made it possible to knowledge of traditional health practitioners and linking provide money to the grassroots, where it was used to them to the modern health sector. improve the quality of life of orphans and the bedridden. As for the capacity of CHAIs, on the basis of her twice Seeing the success traditional health practitioners were monthly visits to the groups, Sophie concludes that having in treating opportunistic infections such as rashes capacity building has been "a big achievement ­ (which are especially stigmatizing) and alleviating appetite communities learned how to write in a cashbook, keep and weight loss, THETA undertook research into herbal ledger books, and manage their money. They learned products that appeared to be effective and compared them tendering and bidding, and were very appreciative of the to first-line medications used in the conventional sector. funds they received. They did whatever they had The herbal products were clearly helpful in alleviating planned, and did it the right way." Although at the outset common symptoms of HIV and related opportunistic she and others feared that some of the funds might be infections. stolen by communities, in the end she says "they did not steal, they used the money well." With funding from the Rockefeller Foundation, THETA worked with traditional practitioners to document their Sophie Nantume also believes that TASO's own work findings. And with support from the Uganda AIDS Control has been supported by the CHAIs. Before the MAP, Project (Uganda MAP), findings about the medicinal plants TASO did not have the funds to respond to the needs of most commonly used to treat and manage HIV-related orphans and vulnerable children or to motivate people to conditions were published in a practical booklet called work. Providing tee-shirts and a bicycle was not "Herbs Commonly Used for the Treatment of HIV/AIDS, sufficient. And although the TASO communities had Related Infections and Other Common Illnesses." work plans, they had no money to implement them. The MAP, through support to CHAIs, helped fill these gaps. After working together with THETA on this research, the Further, through providing funds for the fuel and lunch healers asked for education on HIV and AIDS, to improve allowances for TASO home visits, the MAP made it their practices. From this, THETA services have expanded possible for TASO Masaka to double the number of to include: 8 · Training and capacity building ­ to build supported some of THETA's key activities without partnerships through joint training of traditional restriction. and modern practitioners, encourage collaboration at the community level, and assist the two systems to work together for better health care; · Holistic care ­ to look into products and practices, and undertake observational research to improve hygiene, safety, dosage and efficacy of herbal preparations, in collaboration with Makerere University Department of Pharmacology; · Community initiative program ­ this work has grown out of THETA's training and capacity building efforts, leading healers to take actions on their own or with their communities in the areas of orphan care, widow support, animal and agriculture projects, and using dance and drama to educate the community; · Information/documentation/sensitization ­ to document the work of African traditional healers and disseminate lessons across the continent. The organization has established a regional initiative (with support from the Rockefeller Foundation, WHO-Afro and UNAIDS) to attract international attention and to fight the confusion around traditional practice and witchcraft. The organization also advocates for official recognition of traditional health practitioners and for policies to regulate their practices. Dr. Dorothy Balaba, MD, MPH, Executive Director of THETA, is working to strengthen the HIV response by With support from the MAP, THETA has also supported linking traditional and bio-medical practitioners groups across Uganda to produce culturally appropriate IEC messages for HIV prevention and traditional treatment and care, through instrumental music and Dr. Balaba also notes that by avoiding competition among drama. Although MAP funding was provided for just one CBOs and NGOs, the MAP allowed good community work year, the messages developed and the instruments used to be undertaken by those who were less able to compete to deliver them are still very much in use today, two on the basis of good proposal writing skills. And through its years after the end of the support. THETA Executive support to community-led HIV/AIDS organizations Director Dr. Dorothy Balaba (MD, MPH) says that the (CHAIs), Balaba believes that even with limited funding, MAP funds were also important to the organization as "the effect the MAP has had, and the lives it has they allowed THETA to do the work they believed touched, have been tremendous." needed to be done, in line with what communities wanted. Unlike donors that decline to finance research or development of traditional medicine, the Uganda MAP 9 About the MAP and Uganda AIDS Control Project: The Africa Multi-Country AIDS Program (MAP) was designed to help countries intensify and expand their multi-sectoral national responses to the HIV epidemic, to dramatically increase access to HIV prevention, care, and treatment. To qualify for MAP funding, countries were asked to: (i) develop HIV-AIDS prevention, care, treatment and mitigation strategies and implementation plans through a participatory process; (ii) have a national multi-sector coordinating authority with broad stakeholder representation from public and private sector and civil society, with access to high levels of decision-making; (iii) empower and mobilize stakeholders from village to national level with funds and decision-making authority within a multi-sectoral framework; and (iv) agree to use exceptional implementation arrangements such as channeling money directly to communities and civil society organizations, and contracting services for administrative functions like financial management, procurement, monitoring and evaluation, IEC etc as needed. The Uganda AIDS Control Project (Uganda MAP) was the fifth of 39 MAP projects approved, and provided an IDA Credit of US$47.50 million to the Government of Uganda. Approved on January 15, 2001, the project was fully disbursed and closed on December 31st, 2006. Out of a total project financing envelope of $55.2 million, 38 percent was channeled directly support the local response; $8.5 million to 233 district-based departments, NGOs and community-based organizations, and $12.5 million to 3,629 Community-led HIV and AIDS Initiatives (CHAIs), including those described in this note. CHAI communities contributed 5% of the total sub-project cost themselves, in cash or in kind. More information on the project can be found on the World Bank website, www.worldbank.org, search within projects, using the project number: P072482. Acknowledgments: We sincerely thank all the people who shared their stories, and gave us permission to publish their stories and photographs. About the author: Janet Leno works with the World Bank Global HIV/AIDS Program and ACTafrica. From 2001 to mid-2002 she was National HIV/AIDS Coordinator for ActionAID/Ghana, and then until mid-2006 worked as UNAIDS Country Coordinator for Sri Lanka and Maldives, under World Bank secondments. Janet met the people whose stories are told in this note during December 2006, while visiting Uganda to assess the local response component of the Uganda MAP project, as part of a broader assessment of community support initiatives being undertaken by ACTafrica. For further information, or feed-back, please contact: Elizabeth Lule, ACTafrica (for more on the World Bank Multi-Country AIDS Program ­ MAP), elule@worldbank.org Peter Okwero (for more information on the Uganda AIDS Control Project) pokwero@worldbank.org Joy de Beyer, Global HIV/AIDS Program (for additional copies of this note), jdebeyer@worldbank.org January 2007 10