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Contributions from
the Column
Focus
Combating HIV/AIDS – the German input
US study warns of dramatic rise in the HIV infection rate
People living with HIV as target group counsellors in Argentina
Empowerment of girls in Africa
Russia's underrated epidemic
Big sales, little education
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Work on the development of vaccines
02/2003
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Solidarity, medications and safer sex
People living with HIV as target group counsellors in Argentina
Peter Weis
The GTZ's HIV projects in Buenos Aires focus on people living with HIV/AIDS not only as a target group, but also as counsellors in the work.
As in other parts of the world, the people affected by the AIDS epidemic in Argentina are more and more younger, poorer and women. Almost 1 per cent, or about 15,000, of the country's young adults are now living with the HIV virus. That 80 per cent of the people affected know nothing about their infection is part of the problem. The minority that are aware of it are exposed even more to the risk of stigma and discrimination because of that knowledge. Also, most of the current victims are still among the so-called vulnerable groups: gay men, drug users and women sex workers.
A project supported by the GTZ since 1999 promotes alternative ways of HIV work. Important aspects of the intervention models are developed, accompanied and evaluated by people living with HIV. They have also assumed a central task: peer counselling. This means the advising of young people by young people, of women sex workers by women sex workers, of gays by gays, and of people living with HIV by fellow-victims.
That is not always without problems in a society whose middle and upper class has a conservative mentality, in which machismo is accepted, gender perspectives are still a rare exception, and talking openly about sexuality is largely taboo.
Two examples of the collaboration of people living with HIV:
Alejandro Freyre is gay, has lived with HIV since 1989, and now has AIDS. He is a founding member of the NGO Fundación Buenos Aires Sida, which is managed by committed young people, focuses on promoting safer sex, and stands up for the rights of sexual minorities. He has been a GTZ counsellor since 2000.
Maria Eugenia Gilligan has lived with AIDS since 1996. She promotes NGO work in the area of the multisectoral answer to the epidemic in various communities on the city's outskirts. As a former drug addict, she knows from personal experience the risks for the young target groups stemming from the project's three core subjects: sex, violence and drugs.
The direct participation of people living with HIV in the planning, implementation and steering of the project has considerable impacts. Whereas from the classic Technical Cooperation (TC) viewpoint pure prevention work has the highest priority (if due only to cost-benefit arguments based on scare TC resources), other subjects often are more important for the people directly affected. These include the defence of their human rights and dignity, access to anti-HIV medications for all, and the building of self-help group networks. Rightly, the people affected want first and foremost to stay alive - and live a life befitting a human being. This is a learning process for our entire project, including our government partners. They sometimes still find it difficult to live with activist Alex Freyre, who comes across well in the media, or with demonstrations outside the Health Ministry calling for a better policy on medications or for free access to HIV tests. The project also occasionally runs up against the borderline of conflicts of loyalty between civil society and target group orientation on the one hand, and cooperation with government partners in the ministerial bureaucracy on the other.
The collaboration of people living with HIV in advisory functions enables in particular the following lines of work to be developed or deepened more easily:
- human rights work, such as professional secrecy and the confidentiality of laboratory tests results, and media relations;
- peer counselling of vulnerable groups, such as on anti-retroviral therapies, reducing risks (covering sexual practices, use of condoms, needle exchange);
- the multisectoral answer to AIDS and 'demedicalising' of HIV programmes;
- street work with young people (in discos, sports clubs, leisure pursuits, schools);
- participatory models of cooperation between the government and civil society;
- access to work with vulnerable groups, in sub-cultures and 'scene' cultures (gays, transvestites, street prostitutes, among others).
The teamwork with people who are living with HIV also leads to new challenges. Young people who are infected have a different attitude to their life and work. This has to be tolerated and accepted. Despite the progress of HIV therapies (in Argentina, all patients have access to them by law) the disease is continuing to spread. True, the fear of early death is not omnipresent, but it also cannot always be suppressed. The daily life of the project must also allow for that. Disease, stays in clinics and the death of friends in hospital infection wards are an inseparable part of project experiences, which need time and understanding in the routine running of a project.
During the last two years, Alex, our 32 year-old colleague, was hospitalised twice with immunodeficiency problems, in a critical condition in each case. To work in a project together with people who are living with AIDS at first-hand from day to day demands a realistic approach to the epidemic. It gives AIDS a very meaningful human dimension in addition to the epidemiological and social sciences one. If only for that reason, the experience is very important for us. It enriches not only the project work, but also our entire professional and private lives.
Dr. Peter Weis, GTZ staff member, is the government advisor on public health in the Argentine Federal Health Ministry in Buenos Aires. saludgtz@datamarkets.com.ar
This article was written with the collaboration of Maria Eugenia Gilligan and Alejandro Freyre.
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