非政府组织(NGO)艾滋病防治工作在转型期的可持续发展

随着国际社会逐渐减少对中国的艾滋病防治工作提供经费支持,云南省防艾工作已逐步进入转型期。在转型期,非政府组织(NGO)防艾工作面临一系列挑战,如:如何继续获得参与的平台;如何促进NGO参与的管理方式、理念转化为政府的工作机制等。为使NGO防艾工作可持续发展,首先应开展一些独立的活动,如技术资料和人力资源及工作网络的整理与利用、经济资源投入促动行动、培训政府相关部门的艾滋病工作管理人员等,以推动目前NGO参与的产出进一步扩大、增值和继续发挥其作用;其次应创造条件,促进政府的认可,扩大NGO自己的生存空间;第三应从服务领域、服务层次、筹资渠道、志愿者发展、组织网络建设等方面努力提高自身专业能力的建构和财政的自主性,谋求长远发展。     

Country watch: Brazil

The National STD/AIDS Program (NSAP) of the Brazilian government believes that nongovernmental organizations (NGO) occupy a strategic position in mobilizing the human and financial resources needed to deal with the HIV/AIDS epidemic. NGOs are indeed partners with the state in planning and implementing a national HIV/AIDS strategy, organizations which are highly flexible and determined to deal directly with affected communities. It is especially regarding prevention among vulnerable groups and the implementation of alternative care/support strategies for people living with HIV/AIDS (PHIV) that the NSAP cooperates most directly with NGOs. This cooperation is clearly seen in NSAP funding for NGO projects conducted in 1993-94 in the following areas: the care and support of PHIV, IEC, institutional development and exchange, and behavioral interventions among the most vulnerable population groups. 102 organizations have thus far received financial aid for 170 projects. The funding of NGO projects occurs twice annually, supervised by an external committee. To help NGOs find partners for new proposals, the NSAP published a NGO directory and manual on the formulation and evaluation of community projects. NGOs receiving funding receive further orientation via an NSAP manual on administrative procedures and bookkeeping. Funds are released periodically to projects upon presentation of reports including technical, financial, and qualitative information, with monitoring taking place three times yearly by the projects in collaboration with external consultants.     

Retracted: Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai,Uganda

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross‐sectional study using face‐to‐face interviews in a mixed‐methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision‐making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement. Copyright © 2010 John Wiley & Sons, Ltd.     

HIV / AIDS control programme: lessons from the VHAI-EC joint initiative

The Voluntary Health Association of India (VHAI), with financial support and technical advice from the European Commission, developed the HIV/AIDS Control Programme. The program began in January 1995. Its overall goal was to strengthen the capacities of nongovernmental organizations (NGOs) in initiating and developing HIV/AIDS interventions at the grass-roots level. Program strategies include capacity building within NGOs for effective HIV/AIDS efforts, primary prevention of HIV/sexually transmitted disease (STD) transmission through information and education and promotion of safer sex, promotion of condom use, improvement of STD control in primary health care, and advocacy and social mobilization in support of persons affected by HIV/AIDS. VHAI first invited project proposals from NGOS in Manipur, Assam, West Bengal, Bihar, Kerala, and Andhra Pradesh. Then it held a workshop for interested NGOs on policy and funding criteria. 24 NGOs were selected in the first round from all the above states, except Andhra Pradesh. The intended audiences included youth, women, migrant workers, intravenous drug users, commercial sex workers, tribals, and students. The selected projects consisted of awareness generation, needle exchange, blood safety, condom promotion, and counseling. Training programs addressed project management, counseling, and training of health personnel (medical practitioners, health workers, peer educators, and paramedical workers). State-specific communication strategies involved traditional and folk media, a condom key chain, workshops for journalists, and meetings with members of the Legislative Assembly. VHAI is developing a comprehensive communication package for lobbying and advocacy activities. The May-June 1996 mid-term evaluation found that the program helped state VHAs to work more closely with member NGOS and non-member groups and that NGOs did become familiar with HIV/STD prevention and control. NGOS had inadequate experience in project management. NGOs were able to mobilize communities, to take on innovative interventions, and to network effectively.     

HIV Prevention in Africa: Programs and Populations Served by Non-Governmental Organizations

The AIDS epidemic in Africa remains an urgent health crisis. Non-governmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services and assistance to persons living with AIDS. African NGOs are conducting numerous HIV prevention programs with several at-risk populations, yet their efforts have only rarely been systematically documented. To address this gap in the literature, the authors surveyed one NGO in each of 29 African countries regarding their HIV prevention activities and populations served. This report provides details concerning HIV prevention activities across the continent and describes in detail innovative programs from Togo and South Africa. NGOs in the present sample operate with modest budgets and small staff sizes, yet conduct programs that reach large segments of their communities. NGOs were most likely to report community-level interventions such as peer-education or community outreach. Faced with an epidemic where the main transmission occurs via heterosexual activity, African NGOs were most likely to direct their attention to the general public and to youth. NGOs in Africa are struggling to implement sustainable, cost-effective programs with few resources. Strengthening the infrastructure and capacity of these key agencies is crucial to fighting the AIDS epidemic in Africa.     

湖北省相关非政府组织参与艾滋病防治工作调查研究

目的了解和掌握湖北省相关非政府组织（NGO）参与艾滋病防治工作的基本情况、活动能力与目前的需求，探索湖北省NGO参与艾滋病防治工作的策略、方法与能力建设模式。方法发放统一调查表格，由各市、州预防医学会组织相关NGO填报，并个别访谈NGO负责人或艾滋病防治专家，对全省资料进行统计分析。结果①全省56个相关NGO主要分布在武汉、襄樊、宜昌、孝感、黄冈、咸宁、随州等地；活动经费来源依次为34％国内NGO、22％政府、16％企业、14％国际NGO、10％会费、4％个人资助。②主要活动领域依次为学术交流、健康教育、技术培训、行为干预、关爱护理等。③主要目标人群依次为大众人群、艾滋病病毒感染者／病人、性乱人群、男男性接触者（MSM）、青少年和孤儿、吸毒人群、妇女和流动人口等。④主要需求依次为活动经费、人力资源、场所设备、政策支持、信息提供、技术支持等。结论全省相关NGO参与艾滋病防治活动体系已初步形成，并在艾滋病防治工作中起到了重要作用。建议加强对NGO人力资源的管理和自身建设，加强对NGO的政策、资金和技术支持，建立参与艾滋病工作的NGO联盟，探索适合湖北省NGO参与艾滋病防治的策略、方法与能力提高模式。     

Italian public and non-governmental organisations related to HIV/AIDS infection and migrant populations

This work is the result of two surveys carried out to obtain an overview of the specific types of activities conducted by public institutions and non-governmental organisations (NGO) with regard to HIV infection and AIDS among migrant populations in Italy. The results reveal that the types of services offered to migrant populations differ when comparing public institutions to NGOs. Public institutions mainly provide services related to medical-health issues, whereas NGOs focus on social assistance and acceptance. Both types of organisations report problems in communicating to migrant populations information on HIV infection, sexually transmitted diseases, prevention, and therapy, which is a critical issue in the relationship between the psycho-social-health operator and the foreigner.     

Providing support to caregivers and self-care

The evolution of HIV/AIDS care has resulted in a wide range of caregivers who work out of public and private hospital facilities, nongovernmental organizations (NGOs) and community-based facilities. Others are volunteers and community health and social workers based at facilities or community sites. Many caregivers are family members or part of a client's close social network. Additionally, people living with HIV/AIDS (PHA) themselves engage in self-care and provide support to other PHA through support groups. In the best-case scenario the services of these caregivers are sometimes provided free of charge at one site by a specialized NGO. In many cases, however, a person wishing to gain access to care and social services may need an understanding how the systems and procedures of various institutions operate. Many PHA are unprepared for the administrative, financial, and legal barriers that they may encounter. To cope with this need, a new type of support service called the "buddy" system has emerged. Buddies are individuals who are less directly involved with, but who know about HIV/AIDS, the services available and the rights of PHA. A buddy is close enough for the PHA to approach, has sufficient time to devote to him/her and can be asked almost everything. The article on the Rio de Janeiro Buddy Project provides an example of a project for gay men in Brazil. In other parts of the world where the buddy system is non-existent, the PHA must often rely on support provided by family and friends.     

HIV prevention programs of nongovernmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project.

OBJECTIVE: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. METHODS: One NGO undertaking HIV prevention programs was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most actively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. RESULTS: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD=4.45; range 1-18 years). Average annual program budget was US $205,393 (range: US $10,000 to US $1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD=4.7). Many relied on volunteers (median=10, mean=51, range 0-700, SD=150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6%), children and adolescents (34.8%) and men who have sex with men (30.4%). Activities conducted by NGOs included train-the-trainer activities (43.5%) and face-to-face prevention activities (34.8%). Obstacles cited included lack of funding (60.9%) and HIV-related stigma and discrimination (56.5%). CONCLUSION: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions.     

Country watch: Malawi

The Drought Network for information sharing eventually led to the establishment of the more formal Southern Region AIDS Network (SORAN) where representatives from government and nongovernmental organizations (NGOs) focused on awareness raising, lobbying, and advocacy. As an initial step towards networking on HIV/AIDS issues, a festival was organized in Blantyre on December 4, 1993, by NGOs, private companies, church groups, school children, and volunteers to bring about behavior change. About 2000 people gathered to listen to music, learn about HIV transmission through drama group presentations, watch videos with HIV/STD prevention messages, and learn about proper condom use. The participants officially established SORAN in February 1994 to act as a coordinating body for organizations working in prevention and care for HIV/STD-infected persons and their families. Network activities endeavored: to assist organizations interested in developing HIV/AIDS programs and activities; to encourage the business communities to participate in multisectoral coordination and to help channel funds from them to HIV/AIDS programs; to act as a resource center for information about HIV/AIDS; and to lobby among politicians as well as traditional local and religious leaders. When the first multi-party parliamentary election approached in May 1994, SORAN challenged representatives of 7 political parties and a women's organization to speak out publicly on what they envisioned doing about HIV/AIDS. The Grand Walk was also organized by SORAN members representing the Catholic Episcopal Conference of Malawi, the Protestant Blantyre Synod, a local brewery, and UNICEF. About 500 walkers received support from passersby. 70% were school children 10-18 years old who sang AIDS awareness songs and passed out flyers. Three months later the National AIDS Program's Big Walk for AIDS, following a National AIDS Crisis Conference, signaled the government's public recognition of the need for a multisectoral approach to combatting HIV/AIDS.     

Country watch: Peru

A Peruvian nongovernmental organization (NGO), the New Life Christian Community, works to promote human rights among homosexuals, pregnant teenagers, and children suffering from sex abuse. The NGO, which is not affiliated with any church hierarchy, also provides training in AIDS and sexuality counseling as well as personal development activities that promote health preservation. The NGO supports AIDS sufferers by providing family support and temporary hospice care. The Community plans to conduct research into adolescent pregnancy, the relationship of sexuality and AIDS, and ways to support people with HIV/AIDS. The Community's free newsletter geared for sexual minorities is distributed at social venues and government health institutions. The NGO promotes condom use as a resource for pleasure and is working to replace the prevailing reality of sex as power with the concept of sex as pleasure.     

Reorienting health and social services

The global HIV/AIDS epidemic poses the particular challenge of how to concentrate resources and bring about results without provoking stigmatization against those groups who are highly vulnerable. AIDS-based discrimination is increasing around the world and is manifested in the unwillingness to fund programs claiming that the victims are at fault. This means that sexually transmitted diseases (STDs) and AIDS programs are responsible for promoting nondiscriminatory approaches. STD treatment programs generally provide pre- and post-test counseling, but broader antistigmatization efforts have been carried out by AIDS service organizations and nongovernmental organizations. A well-developed response to HIV/AIDS and STDs involves service and program providers, community health workers, traditional health practitioners, general and private practitioners, pharmacists, traditional birth attendants, and social workers. Outreach staff need to link with community workers and volunteers close to the client groups. HIV/STD diagnosis and treatment programs need to be coupled also with intensive community-led prevention and support activities in order to influence sexual behaviors. Programs conducted in this spirit share information more easily, provide authoritative roles for nonbiomedical workers, and have clear goals that are supported by the clients. These programs forge alliances between clients, service providers, and community leaders. The underlying concept of human rights embraces a broader perspective looking for the determinants and remedies for vulnerability to HIV/STD. HIV/AIDS/STDs must be fought to defeat both the virus and social backlash. This two-pronged struggle requires the reorientation of health and social services centering on partnerships and a conducive management style. Health and social services can be constrained by a trend toward reduced funding, but HIV-affected communities induce them to change whereby new partnerships could be forged.     

Country watch: Mexico

"LETRA S. SIDA. Cultura y Vida Cotidiana" is a monthly 16-page supplement that appears in the Mexican national newspaper "La Jornada." The supplement is produced by a nongovernmental organization (NGO) of the same name, and advertisements pay for the costs of production. Each issue studies a different AIDS theme, including women, indigenous people, migration, safe sex, homophobia, religion, and education. Each theme is approached from various perspectives, including epidemiology, medicine, sexuality, human rights, social science research, culture, and the arts. Populations most at risk are targeted. The aim is to arouse cultural criticism of taboos, prejudice and discrimination, sexual inequality, and gender issues that facilitate the transmission of HIV. Official health policies and the activities of groups, conservative and religious, which reject prevention programs are scrutinized. Each issue of the supplement includes a journalistic investigation providing statistics, facts, and opinions; interviews with health and education officials, politicians, state governors, and NGO staff; background articles by intellectuals, researchers, and well-known persons in Mexican society; PHA testimonies; reports on research and conferences; letters to the editor; cultural reviews relating to the theme of the issue; and a directory of NGOs doing HIV/AIDS work and of health institutions serving PHAs. The supplement has gone from a print run of 25,000 copies, when it was published as part of "El Nacional" (another government newspaper), to 70,000 in "La Jornada." The NGO has recently won the "Francisco Estrada Valle" award for its work.     

A private organization and public agency partnership in community health education.

The authors address a unique partnership among private and public organizations, that of the American Red Cross and the Centers for Disease Control of the Public Health Service. The partnership stimulates an integrated community response to preventing and controlling human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) at the local level. The partnership channels information and provides education to local communities through the efforts of volunteers and staff members. Information is made available as well through other partnerships established under the cooperative agreement between the American Red Cross and the Centers for Disease Control. These partnerships include other national organizations, such as the National Leadership Coalition on AIDS, the National Association of People with AIDS, the National Urban League, and the National Council of La Raza. Education and information messages are designed to complement and be consistent with information and messages from the Public Health Service through the National AIDS Information and Education Program and the "America Responds to AIDS" public information campaign. The objectives are to mobilize local community support for efforts for HIV infection and AIDS prevention and services, as well as to heighten public awareness of the issues.     

Introducing operations research into management and policy practices of a non-governmental organization (NGO): a partnership between an Indian leprosy NGO and an international academic institution

This paper reports on a partnership between LEPRA, a non-governmental organization (NGO), and the London School of Hygiene and Tropical Medicine (LSHTM) to explore the feasibility and appropriateness of incorporating operations research into the management and decision-making of a leprosy NGO. A pilot study in Orissa was used to determine the advantages and disadvantages of introducing operations research to assist in decision-making and programme implementation within the organization. The results highlight the difficulty and complexity of the process, but point to several important themes: partnership, changing perspectives, use of time and priority-setting, identification of gaps in systems, and building institutional and personal capabilities. The results of the study provide support to encourage NGOs to become actively involved in research. Because of their work and service to local communities, NGOs have the opportunity to collect information about the perceptions, resources and constraints of individuals, families and the communities themselves in accessing appropriate care. Their proximity to communities gives them a feeling of responsibility for ensuring that this information is translated to the district, national and ultimately international level. This will help to ensure the creation of appropriate infectious disease control policies that support the needs of patients. 'Outside' academic institutions can help NGOs to facilitate this up-stream flow of information from the local to the national and international level, to help to ensure that international disease control policies are appropriately serving local communities.     

HIV-related stigma and NGO-isation in India: a historico-empirical analysis

In response to World Bank critiques in 2007, the Indian Ministry of Health and Family Welfare declared that human immunodeficiency virus (HIV)‐related stigma was a barrier to the participation of non‐governmental organisations (NGOs) in the implementation of HIV prevention targeted interventions. Taking a deeper view of HIV‐related stigma as a historically inflected process of devaluation, this article details the history and transformation of NGO involvement in the HIV epidemic from 1986 through economic liberalisation in the 1990s up to the Second National AIDS Control Programme (NACP II 1999–2006). It additionally examines findings from interviews and participant observation of NGO workers (N = 24) from four targeted intervention NGOs in Delhi funded under NACP II. Analysis reveals that a second wave of HIV‐related NGO involvement has mushroomed in the past two decades, affording NGO workers multiple pathways to credibility in the Indian response to the epidemic. Contradictions embedded in the overlap of these pathways produce stigma, reflecting ‘adverse incorporation’ of the NGO workers. Drawing upon noteworthy exceptions to this trend from the first wave of Indian HIV‐related NGOs, the article calls for NGO participation as an explicitly political project of addressing the social inequalities that shape stigma as well as vulnerability to illness writ large.     

Congregation-Based Programs to Address HIV/AIDS: Elements of Successful Implementation

Religious organizations may be uniquely positioned to address HIV by offering prevention, treatment, or support services to affected populations, but models of effective congregation-based HIV programs in the literature are scarce. This systematic review distils lessons on successfully implementing congregation HIV efforts. Peer-reviewed articles on congregation-based HIV efforts were reviewed against criteria measuring the extent of collaboration, tailoring to the local context, and use of community-based participatory research (CBPR) methods. The effectiveness of congregations’ efforts and their capacity to overcome barriers to addressing HIV is also assessed. We found that most congregational efforts focused primarily on HIV prevention, were developed in partnerships with outside organizations and tailored to target audiences, and used CBPR methods. A few more comprehensive programs also provided care and support to people with HIV and/or addressed substance use and mental health needs. We also found that congregational barriers such as HIV stigma and lack of understanding HIV’s importance were overcome using various strategies including tailoring programs to be respectful of church doctrine and campaigns to inform clergy and congregations. However, efforts to confront stigma directly were rare, suggesting a need for further research.     

Building capacity for AIDS NGOs in southern Africa: evaluation of a pilot initiative

In this paper, we present the evaluation results of an AIDS non-governmental organization (NGO) capacity building 20-month pilot initiative in five countries in southern Africa called the NGO Institute. A five-person international team conducted a 2 week evaluation of the pilot in 2004 to assess the strength of the model, designed and funded by Bristol-Myers Squibb Foundation. The NGO Institute functioned through a separate consortium in each country. Results of the pilot indicate variations in adaptation and implementation of the model in each of the five countries. Each consortium took considerable time to develop its own governance and management systems. There were examples of strengthened NGO capacity in each country although it was too soon to establish overall impact. The strengths and weaknesses of this NGO capacity building model are presented along with the implications for other funding agencies and NGOs.     

Process, rationale, and interventions of Pakistan's National Action Plan on Chronic Diseases

Most developing countries do not comprehensively address chronic diseases as part of their health agendas because of lack of resources, limited capacity within the health system, and the threat that the institution of national-level programs will weaken local health systems and compete with other health issues. An integrated partnership-based approach, however, could obviate some of these obstacles. In Pakistan, a tripartite public-private partnership was developed among the Ministry of Health, the nongovernmental organization (NGO) Heartfile, and World Health Organization. This was the first time an NGO participated in a national health program; NGOs typically assume a contractual role. The partnership developed a national integrated plan for health promotion and the prevention and control of noncommunicable diseases (NCDs), which as of January 2006 is in the first stage of implementation. This plan, called the National Action Plan on NCD Prevention, Control, and Health Promotion (NAP-NCD), was released on May 12, 2004, and attempts to obviate the challenges associated with addressing chronic diseases in countries with limited resources. By developing an integrated approach to chronic diseases at several levels, capitalizing on the strengths of partnerships, building on existing efforts, and focusing primary health care on chronic disease prevention, the NAP-NCD aims to mitigate the effects of national-level programs on local resources. The impact of the NAP-NCD on population outcomes can only be assessed over time. However, this article details the plan's process, its perceived merits, and its limitations in addition to discussing challenges with its implementation, highlighting the value of such partnerships in facilitating the missions and mandates of participating agencies, and suggesting options for generalizability.