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Public Health Promotion

Briefing Paper

Mainstreaming HIV and AIDS in Humanitarian programmes

What is it? Promoting prevention of HIV

transmission within a program
Mainstreaming is thinking and acting about Care and support of both infected and
HIV and AIDS in all programmes (and affected people
considering both staff and beneficiaries). Mitigation of impact of the emergency
The term refers to adjusting humanitarian on the HIV and AIDS infected and
programmes to ensure they take into affected peoples well being
consideration causes of vulnerability that
Working with existing stakeholders in
are or may be related to HIV infection and
HIV and AIDS when carrying out
the consequences of AIDS during such
livelihoods or PH program e.g. Red
Cross, Ministry of Health etc
The focus of such programmes (water,
sanitation and hygiene promotion as well What mainstreaming is not
as livelihoods), however remains the Working only with HIV positive men
original goal. But consideration, taken to and women
address needs of HIV and AIDS infected Doing mass condom distribution in
and affected people as well as reducing isolation
potential means of transmitting the HIV Changing the focus of the
virus through sensitively planned activities. humanitarian response to HIV
There are two ways to mainstream:

Internal When considering any response you should

ask yourself two key questions:
It is about addressing HIV and AIDS with 1) How will HIV and AIDS affect the
staff through training on both self programme?
awareness and community 2) How will the programme affect HIV and
mainstreaming, adapting and changing AIDS prevalence?
policy to promote staff welfare e.g part of For instance
Oxfams policy on HIV/AIDS states that In Turkana district in Kenya, a team of field
employees with HIV or AIDS staff were visiting a village during a routine
Will not be discriminated against monitoring trip. Whilst walking around and
Have the right to confidentiality on observing, they talked to several women who,
medical status when asked what sickness there was in the
Will be treated the same as an village, replied that some houses had very thin
employee with any other illness etc sick people. It turned out that these houses
In event of rape, all staff is entitled to were the homes of men who had left the village
Post exposure prophylaxis (PEP), to work in a nearby town. Away from their
contraception and counselling. families and with money in their pockets, they
paid for sex and subsequently contracted HIV.
External The team realised that their cash for work
Is about reducing the risk or impact of HIV programme, where village men were paid to do
and AIDS through the way we interact with bush clearance near the town, could expose
the communities and deliver our these men to an increased risk of contracting
programmes. Especially by the virus.

Foyeke Tolani (Health Adviser & HIV and AIDS focal point, Humanitarian Dept.)
Zimbabwean woman said: It is
Why mainstream HIV and AIDS better to get AIDS than to watch
your kids starving.
in rapid or slow onset - Some men/boys may engage in
emergencies? work that can entail mobility and
1. In some emergencies, there is the family disruption (migrant labour,
potential for increased vulnerability to truck driving, fishing etc).
infection with HIV and to the impacts - Loss of labour due to illness or
of the HIV and AIDS epidemic, due to increased caring and it may lead to
the following factors selling of productive assets.
- Breakdown of family and social - Disruption and displacement may
values and networks, with lead to separation of the infected
increased vulnerability and person and their carer
susceptibility especially of women - Lack of medical services,
and children; especially access to antibiotics and
- Increase in rape cases/sexual anti-retrovirals, will seriously
violence often by military or
paramilitary or due to poor siting of
affect the health of HIV positive
water and sanitation facilities e.g. people.
in dark unlit areas
- Breakdown in supply chain for
Essentially, consider the needs of both
condoms leading to more
people infected by HIV and those
unprotected sex
affected by it!
- Population movement/ increased
mixing of populations with different
HIV prevalence
- Decreased availability/ utilisation Who should mainstream HIV and
of reproductive health and other AIDS?
services/means to prevent Every staff member is expected to
transmission etc mainstream HIV and AIDS both internally
and externally in programmes. HR
2. HIV can worsen the emergency together with the programme manager
situation (depending on the should ensure internal mainstreaming e.g.
prevalence in the country before the initial assessment, rolling out HIV work
emergency) by: place policy, and providing staff with
- Undermining existing positive information and an enabling supportive
coping strategies in HIV-affected environment to prevent HIV and AIDS.
households, and over-burdening
carers On external mainstreaming, it is expected
- Causing the host community or that all programme technical and support
other cultures and ethnic groups to staff should mainstream HIV and AIDS
discriminate against people living and the programme manager should
with HIV and AIDS (PLWHA) in the delegate and make this happen. Some
new environment health promoters may have background
- Increasing the vulnerability of information on HIV and AIDS prevention
orphans and other vulnerable and they may be useful resource person in
children affected by HIV, old the process but the responsibility lies with
people and child headed everyone. Nominating a focal point will
households etc ensure adequate dissemination of relevant
information, monitoring and feedback on
3. Increased vulnerability of potential progress made.
vulnerable groups (women, men,
children, older people, disabled Where do we mainstream HIV
people, PLWHA, ethnic minorities etc) and AIDS? (Slow/rapid onset or
to HIV transmission. For example: high/low HIV prevalent areas?)
- Women may turn to commercial
sex work or sex for subsistence as There have been different arguments on
a coping mechanism, or because whether it is necessary or not to
their lives have been disrupted by mainstream HIV and AIDS in rapid onset
war, widowhood etc. As one emergency especially when there are lots
of life saving activities to do; or why bother

Foyeke Tolani (Health Adviser & HIV and AIDS focal point, Humanitarian Dept.)
to mainstream in areas with low For details, see section 3: How to
prevalence? Based on the importance of mainstream HIV and AIDS in
how an emergency may: emergencies in Humanitarian
Impact negatively on vulnerable programmes and HIV and AIDS by
groups, increase transmission of the Walden et al (2007).
virus from high prevalence to low
prevalence areas, Things to consider for minimum
Make PLWHA (if they exist) more response
vulnerable to opportunistic diseases
due to lack of water, food, clean water, Keep the focus of your humanitarian
general hygienic facilities etc. programme
It is worth taking the first step in Avoid stigmatisation during
mainstreaming which is assessment assessment (especially in the way
and analysis of possible risk to information is collected), program
increase in transmission of HIV (to staff analysis, implementation, monitoring
and beneficiaries) and how the and evaluation
emergency has impacted on those Find out about the HIV situation in the
infected and affected by the virus. This emergency affected country and
will ensure that the most vulnerable are amongst the affected population
heard, represented and their needs met Based on assessment and analysis:
accordingly. It will also contribute to - Use vulnerable households or
meeting Sphere standards, promote chronically ill as a criteria in order
Oxfams right-based approach and the aim to avoid stigmatisation
of Do no harm in addition to fulfilling our - In water and sanitation work,
corporate objective. consider the safety and protection
of vulnerable groups as well as
need for closeness of water and
Oxfam has a mandatory objective to sanitation facilities to persons with
mainstream HIV and AIDS in all disability/long chronic illness
programmes by 2010 and in the year - Livelihoods work should be suited
2007/8 it is expected that 40% of all to the special needs of both those
emergency responses mainstream HIV affected and infected
and AIDS effectively into their Consider issues of gender and
programmes protection
Make sure your staff are informed
about HIV facts
How do we mainstream HIV and Make sure that there is good two
AIDS? way communication and flow of
Like gender it is expected that programs information between the emergency
mainstream HIV and AIDS throughout the affected community and your
emergency project cycle. i.e. organization. Use participatory ways to
Pre emergency: Collect specific also involve PLWA in discreet non-
information to map susceptibility and threatening ways.
vulnerability of population to HIV and
AIDS, create enabling and supportive Some practical examples
workplace environment. Uganda IDP and flood responses
Assessment: Integrate with PH/EFSL Trying to ensure vulnerable (including
assessment (determine predisposing families with a chronically ill member)
factors to HIV transmission, needs of people are exempt from water user
people with long chronic illness, fees as well as avoid the queue
access to health services, condoms Training to community outreach
etc) workers and awareness raising with
Implementation Minimum response contractors on HIV.
Do no harm e.g reducing Protection in shelter special
opportunities for sexual and gender provision for girls and young women
based violence (SGBV), mainstream as well as HIV education
gender, raise staff awareness, During the 2007 flood response,
coordinate with others Oxfam distributed Jerry cans (white
Monitoring and evaluation and wide mouth) that were similar to

Foyeke Tolani (Health Adviser & HIV and AIDS focal point, Humanitarian Dept.)
the ones MOH was providing to
families with PLHA. The blanket
distribution helped to de-stigmatise
those who already had but could not
use them due to the government
targeted distribution to PLHA

Sri Lanka Tsunami response

When transitional houses were being
built, the community asked for the
units to be joined so that people would
feel more secure.
Locks were provided for the doors of
houses. This is an ideal situation for
single women and children headed
households as well as those nursing
chronically ill people

Zimbabwe Drought response

Helping women to find other sources
of income so they are not dependent
on sex for subsistence, vegetable
gardens were successful here
Planting of traditional herbs to provide
essential micronutrients for beneficiary
populations (including vulnerable

Zambia Floods Response

Mobilizing and sensitising children
about HIV and AIDS as part of water
sanitation activities
Using female hygiene packs
distribution sessions for sensitising
women on HIV transmission and
Integration of existing home based
care team into community Mobilizers
Distribution of additional hygiene kits
to families living with AIDS patient.

Holden, S. (2004) Mainstreaming HIV/AIDS in

Development and Humanitarian Programmes,
Walden, V. M., OReilly, M. and Yetter, M. (2007)
Humanitarian Programmes and HIV and AIDS. A
Practical Approach to Mainstreaming. Oxfam.
Oxfam workplace policy

Foyeke Tolani (Health Adviser & HIV and AIDS focal point, Humanitarian Dept.)