D+C Development and Cooperation (No. 5, September/October 1999,
p. 15-17)

The ever more threatening extent of the HIV/AIDS epidemic has shown that the disease cannot be combated at the medical level alone. Medical measures such as vaccination and medication cannot be applied. The negative impacts in a number of developing countries are affecting the heart of the development process, above all because the economically active age groups are dying. For development cooperation, that means that combating AIDS must no longer be seen as a task solely for the health specialists, but as one that must be integrated in all projects.

The development experts' conception of the HIV/AIDS epidemic has changed fundamentally in recent years. Whereas at first the phenomenon was assigned to the health sector, the perception that it far exceeds this boundary has gained more and more ground. The current view is that, rather, it is a matter of a newly-emerged, general obstacle to development. Newly-emerged means something that was not there before, and thus was not taken into account in earlier development strategies.

This view of HIV/AIDS as a general development obstacle obviously applies to the most heavily affected countries of Africa. But apart from those countries, it is also correct and appropriate when developing concepts to adopt this way of thinking for the (still) less affected regions as well.

The economic impacts of HIV/AIDS

A phenomenon that directly and inevitably threatens the life, limb and assets of large sections of the population can no longer be seen as an issue that can be limited to the health sector. Depending on the country and region, often more than 10 per cent of the total population and more than half of certain groups, such as pregnant women, are infected. Sooner or later the infected will fall ill, and sooner or later almost all the sick will die. Teachers, nurses, farmers and project employees are affected.

If one counts families, workmates, salaried employees and other dependent people as also involved in human, economic and social terms, it is clear that the well-being of an entire society is seriously affected and its substance must, in fact, be seen as endangered.

The threat becomes particularly clear when one considers that it is precisely the age groups that are economically active and in responsible positions that are affected by the epidemic. In many countries, such persons, mostly men whose families have invested a great deal in their education in both financial and human terms, are infected disproportionately to the rest of the population.

The consequences of the epidemic at the economic and social levels are equally clear and drastic for both the individual persons and their families.

For all types of business enterprises and for development projects, this means that trained employees fall ill and die, that tasks therefore cannot be carried out, that promoting the younger generation must be given a quite different status from that which was planned, and that heavy costs in treating the sick, lost earnings, burials and support of dependants arise. Thus, the epidemic will by no means take its course without cost to the economy. In Zimbabwe, some companies have calculated that AIDS is costing them about one-fifth of their profits, and in Tanzania and Zambia some firms even put their losses at 50 per cent of their profits.

What influences the spread of AIDS?

The epidemic is developing differently from country to country and from region to region, depending on local morals, customs and other prerequisites for its propagation and the resources available to stem it, including the necessary knowledge and awareness. These differences are - obviously - still to be attributed least of all to biological or medical reasons. The vast difference between the industrialised nations and the developing countries in the speed with which the epidemic is spreading has increased awareness that the main cause of its rapid spread in the developing countries is under-development itself. Some examples:

• In the political sector: suppression or minimisation of the HIV/AIDS problem by opinion leaders and decision-takers, with the result that appropriate countermeasures are delayed or hindered; and flight and expulsion due to wars and unrest that make access to medical resources difficult and favour frequent changes of partners and unsafe sexual contacts, including the use of compulsion and violence.

• In the economic sector: migration in search of jobs and urbanisation resulting in the break-up of families, loosening of social networks, and promotion of prostitution.

• In the cultural and social sector: the subordinate role of women, which favours sexual exploitation and dependence; the discussion of sexuality as a taboo, which prevents open communication; the resistance of conservative and religious groups, which prevents timely and appropriate sexual education; and the discrimination of people with certain sexual orientations, which impedes their access to information and treatment.

AIDS will remain a central and global subject of the 21st century. It will become more relevant for:

• Global structural policy: AIDS is a worldwide phenomenon. It is true that at present it affects primarily individual countries and regions (Southern Africa, Southeast Asia, the Caribbean), but its dynamics and way of spreading mean it has a potential global impact. The virus knows no borders. In the final analysis, to be successful the solution can only be global.

• Crisis prevention: the dramatic effects on the social network of countries and local communities, the huge death rate among young adults, and the loss of economic and social productive power have negative impacts that stand comparison with local and regional wars.

In general, the public health system plays no outstanding role in the process of controlling the spread of the HIV/AIDS epidemic. Its most effective weapons, usually vaccination and medication, are blunt against this infection. The focal point remains the prevention or at least reduction of new infections. In the fight against the epidemic, the successful measures are information, building awareness, and creating social conditions that do not allow sexual communication to degenerate into a fatal risk. These are often best left to education both in and out of school, enlightenment of the people, public relations work, the news media, or the development of social services. By this means they also reach more people, and above all those (still) healthy.

How must development
cooperation react?

Therefore if the view begins to take hold that the HIV/AIDS epidemic is a general obstacle to development and that the competence for it does not lie primarily, and certainly not solely, in the health sector, then in assigning competence to all development efforts it cannot be mainly a question of, for example, finding new target groups (beyond the clients of the public health system) or recruiting new actors, such as teachers and agricultural advisors, for defensive measures, and otherwise leaving responsibility to the health sector.

Rather, it is about anchoring preventive activities and alleviating the impacts of infection in every development project as its genuine task. It is a question of strengthening those development factors in the respective task sector, and remedying under-development factors that favour the spread of HIV/AIDS or counter the alleviation of consequences.

If this is accepted as a principle, the next question is that of implementation. How can Technical Cooperation (TC) cope with this new development task? For this, one must differentiate between tasks at the political and implementation levels.

The Federal Ministry for Economic Cooperation and Development (BMZ) has presented the guidelines for development cooperation in a number of statements of principles. These differentiate between trans-sectoral and sectoral concepts. The seven trans-sectoral concepts are binding for all development projects, and are oriented on the following subjects: promotion of women, self-help, poverty alleviation, socio-cultural criteria, target group orientation, the role of the private sector, and employment of local experts.

At the end of 1998 the BMZ published a position paper on combating HIV/AIDS. The paper contains a subject-specific deepening of the relevant sector-related and trans-sectoral papers and presents a generally applicable guideline. Even if the position paper does not have the great binding nature of a trans-sectoral concept, it is an official instrument of development cooperation policy and equips all development projects with a mandate to combat HIV/AIDS. The latest statement of the BMZ minister underlines once again in all clarity the dimension her ministry ascribes the AIDS problem.

The measures of GTZ

At the implementation level of TC, the German Agency for Technical Cooperation (GTZ) has identified three approaches, which are currently being pursued further within the organisation.

The first one deals with information and advanced training. It is a matter of winning over to the subject interested and committed TC employees, both local and international. One should consider here that these persons' professional orientation is a major part of their self-perception, and that in this respect they may at first feel they are not competent to deal with the special subject of HIV/AIDS. This is where, beginning with their preparation, professional and above all communicative competencies must be be imparted on a sensible scale and in a manageable way. For later project work, an easily accessible backstopping and other service offers must be held in readiness.

This will be the task of the existing trans-sectoral GTZ project on combating AIDS in developing countries. The GTZ is thinking of an introductory module which will be conveyed to all employees as part of their preparation, and a deepening module for alternative advanced training events. An analogue offer can be made to local employees, with the mandate for it being given to GTZ country offices. The objective is that every employee, particularly those working abroad, will besides their other specialist and managerial qualifications, pass the "HIV test" for themselves and their project or programme.

Second, in cooperation with the current sectoral project of combating AIDS, a GTZ staff office will be charged with developing a strategy. In cooperation with the sectoral approaches, such as regional rural development, primary education, economic and social policy consultancy, and so on, this strategy will aim at anchoring specific measures of prevention and alleviating the impacts of infection all relevant TC sectors. The strategy will be applied in particular where TC has a multiplier function, such as in consultancy and education, and where special aspects of under-development, such as legal and social general conditions, are a substantial breeding ground for the spread of the epidemic.

The significance of the epidemic for development prospects must also be brought out at the level of country working papers or a regional concept for Africa and included in the dialogue with the partners.

Third, the strategy will be implemented as a model in some selected countries in order to gain and systematically evaluate experience and use it as a basis for improving the strategies and concepts. The GTZ country offices will also assume the leading role here and fall back on the professional support of the AIDS project. Two to four countries in each continent will be selected for the trials, each with different epidemiological situations and economic-social general conditions. The GTZ is thinking not only of the sub-Saharan African countries, but also of others that so far have been little affected. It has been seen that prevention is precisely most effective where infection rates are still low.

Although the details of the country strategies are still to be developed, it is not only and not primarily about classic interventions such as information campaigns and enabling access to condoms. It is about continually making the problem a discussion point, combating silence and false shame, increasing awareness, enhancing communicative and subject-related competence, learning from models, co-shaping general conditions, and systematic and continual inclusion of the subject in the portfolio analyses at sector and country level. If the fight against HIV/AIDS is to be successful, every development cooperation project can and must do its bit towards it.