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.     

A review of HIV testing strategies among MSM (2005–2015): Changes and continuities due to the biomedicalization of responses to AIDS

Global AIDS policy points to a new prevention rationale centred on the identification and treatment of people infected with HIV, particularly among the so-called key populations. This study analyses the continuities and changes in HIV testing strategies based on a meta-narrative review of academic output (2005–2015) focusing on men who have sex with men. We reviewed 65 articles based on their prevention approaches, testing strategies and the involvement of non-governmental organisations (NGOs) and community-based organisations. The analysis found continuities in HIV testing strategies in addition to changes. A new focus is reflected in the expansion and diversification of testing offered, the reduced importance of counselling, an emphasis on condom use associated with test results and on the absence of active participation of NGOs in implementing social responses to AIDS. Our findings indicate a systematic lack of problematising the potential ethical, political and cultural issues surrounding HIV testing as a strategy to control the epidemic. The findings of our study reinforce criticisms of the biomedicalization of current HIV-related policies, and reiterate the importance of combining progress achieved in increasing access to diagnosis and treatment with the historical achievements of social responses to AIDS.     

An ecological framing of HIV preventive intervention: a case study of non-government organizational work in the developing world

The work that non-governmental organizations (NGOs) perform in terms of HIV and AIDS is wide-ranging. Financial resources are available from government and other agencies if NGOs can frame their work in alignment with their interests. We take the particular case of Disha Foundation, an NGO working in Nasik, in the state of Maharashtra in India, whose clients are migrant workers. Drawing upon a broad notion of frame, we focus on the way in which activities such as 'intervention', 'prevention', 'empowerment' and 'community' in the HIV field can differ radically from articulation (at a government level) to practice (of NGOs). Disha's interventions can be described as ecological, in so far as they map and change root causes. Thus, Disha can be seen as doing HIV prevention. Further, we argue that framing HIV funding calls primarily in terms of 'quality of life' would facilitate the work of NGOs, especially of ecological interventions.     

Country watch: The Philippines

This article describes the efforts of local Philippine HIV/AIDS programs to widen their reach and sustain their efforts. The model assumes that the engagement of an ever larger number of institutions that understand HIV/AIDS issues and are committed to prevention and care will help foster safer sexual behavior. The Philippines HIV/AIDS Nongovernmental Organization (NGO) Support Program (PHANSuP), with the support of the International HIV/AIDS Alliance, developed skills and strategies workshop sessions. This pilot training program builds and strengthens local NGO capacity and partnerships between sectors. The Alliance in 1993 raised funds for PHANSuP, and PHANSuP supported local NGOs, including the Olangapo City AIDS Foundation (OCAFI). OCAFI was forced to stretch the new funding over a longer period and agreed to be a resource for a wide variety of local institutions rather than a single AIDS project. In this way, resources were complementary and more broadly distributed. OCAFI built partnerships with a variety of institutions ranging from the local Rotary Club to the casino. The result was wider financial, political, and practical support in Olangapo City, and improved access to vulnerable groups. The pilot program proved that local NGOs could reduce their dependency on PHANSuP financial support. The links between NGOs and government health services have led to a wider reach of the education programs and the use of mass media. PHANSuP has developed several initiatives to promote the view that partnerships between different sectors are possible and that sustainability is possible. Programs must sell themselves to the local community, which in turn will support the programs.     

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.     

Challenges to the meaningful involvement of HIV-positive people in the response to HIV/AIDS in Cambodia, India and Indonesia

This study examines challenges to HIV-positive people's involvement in AIDS policy making and project design and implementation in Asia. Forty-eight interviews were conducted with key players in the HIV sector in Cambodia, India and Indonesia. The major barrier to involvement is AIDS-related stigma. Most people are diagnosed late in infection and have poor access to antiretroviral drugs. The majority of positive people working in HIV/ AIDS have no training in public health or organisational management and few training opportunities are available. Respondents in all countries said NGOs exploit positive people in order to enhance funding opportunities. Representation on policy making bodies is low because the few people well enough to take on these roles often lack the confidence to assert their needs in front of doctors and government officials. Positive activists need advocacy skills to become more effective, encouragement and support to take on roles as educators and counsellors, sustainable incomes, and medication to stay alive.     

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。     

中国全球健康相关非政府组织的发展策略浅析

国际非政府组织在全球健康治理中发挥了重要作用,也是各国发挥国际影响力的重要渠道,但中国非政府组织目前参与全球健康治理甚少。本文旨在分析中国非政府组织发展的社会政策环境、健康类非政府组织的发展现状并借鉴国外新兴的全球健康相关非政府组织的经验,为中国扶持非政府组织参与全球健康治理提供策略建议。本文发现,中国参与全球健康治理有较好国际机遇;国内社会组织发展环境趋势向好,但具有依附行政体系、政策定向发展等特点。因为专业性、公共服务属性以及与公共治理相关性小,非政府组织参与全球健康可以得到政府的全力支持。健康类非政府组织数量较少、基础较差、参与国际合作少。不同类型健康类社会组织各有长短,国际经验提示新兴机构主要依靠政府力量扶持非政府组织参与全球健康。建议我国政府采取"重点扶持,整体改善"的策略,制定中国全球健康发展战略,以政府附属与社会精英创办的大型非营利机构为重点扶持对象,引导和资助健康类非营利机构走向国际舞台。     

HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation.

There are now a number of HIV/AIDS prevention programmes for migrant and ethnic minority communities throughout the world, both 'top down' programmes organised, for example, by governments and large NGOs, and 'bottom up' programmes, organised by migrant groups themselves. Evaluation of such programmes, however, is in most cases sorely lacking. The Swiss 'Migrants Project' is, to the authors' knowledge, the only such programme to have been systematically accompanied by evaluation throughout. This paper describes three phases of evaluation of the Migrants Project (exploratory studies, process, and outcome evaluations). The evaluations have highlighted the need for culturally and linguistically appropriate prevention efforts which use already-existing community structures, as well as the need to identify and train people from within communities to carry out local prevention efforts. Outcome evaluation has shown that: a government sponsored HIV/AIDS prevention programme can meet with acceptance by migrant communities; considerable engagement in prevention activities can be mobilised; and AIDS prevention among such communities can be effective. Such efforts can create levels of sensitivity to HIV issues and of protective behaviour that are equal to those of the host country population. The strategy adopted by the programme is thus supported. Key elements are to avoid potential for stigmatising by: (1) placing HIV/AIDS prevention efforts for migrant populations within an overall national HIV/AIDS prevention strategy; (2) informing and sensitising general populations within migrant communities before initiating more targeted prevention with migrant IDUs, MSM, and CSWs; (3) encouraging, facilitating and guiding health promotion efforts which emerge from within migrant communities themselves.     

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.     

Empowerment and sustainability -- whose responsibility?

Many different bodies are involved in ensuring empowerment and sustainability in the context of HIV/AIDS. International donor agencies and other funders can begin by helping the community groups which they support financially to build capacity and skills. Such action can be taken together with other community-based organizations or networks. Donors can also involve, support, and facilitate the involvement of people with HIV/AIDS (PWHA) in the community, organizations, and various structures. Rather than demanding to be involved simply because they are infected with HIV, PWHA need to demand assistance and expertise which will improve their effectiveness as collaborators in future strategies. Furthermore, nongovernmental organizations should stop trying to control PWHA by speaking on their behalf. Churches and religious bodies must stop using religion as an excuse to do nothing about HIV/AIDS, and the media needs to stop reporting that the epidemic has ended and stop using sensational reporting to sell publications.     

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.     

HIV and AIDS, stigma and AIDS support groups: Perspectives from women living with HIV and AIDS in central Thailand

In this paper, community attitudes toward women living with HIV and AIDS at the present time from the perspectives of women in Thailand are examined. We also look at strategies women use in order to deal with any stigma and discrimination that they may feel or experience in the community. The paper is based on our larger study of the experiences of women living with HIV and AIDS and their participation in clinical trials. In late 2007 and early 2008 we carried out a number of in-depth interviews with women living with HIV and AIDS in central Thailand. We find that women living with HIV and AIDS still deal with stigma and discrimination in their everyday life. However, from the women's narratives, we also find more positive attitudes from local communities. Some women deal with stigma and discrimination by joining and participating in HIV and AIDS support groups that have emerged in response to the AIDS epidemic in Thailand. We argue that women are not passive victims, but that they act in their own agencies to counteract any negativity they might encounter.     

Memisa and home care for AIDS patients in Zambia

Health care in Zambia has since long been receiving support from non-governmental organizations (NGOs) like Memisa. Church organizations bear responsibility for a considerable part of the national health services. During the last 15 years, growing attention has been given to improvement of basic services in the villages and to recruitment and organization of groups in the community active in the field of health care. The combat against AIDS is a major focus. Many NGOs give health education on HIV and AIDS, are coaching HIV-positive individuals and are trying to organize support for AIDS patients and their relatives and relief for women and children after the death of husband or father. The community home care projects established in the urban areas of Copperbelt province in Zambia provide a decent terminal phase for AIDS patients and assist the surviving families in maintaining a certain socioeconomic level of existence.     

Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: Opportunities and challenges

ABSTRACT: BACKGROUND: The implementation of collaborative TB/HIV activities requires interventions beyond facility fences in order to mitigate the impact of the dual epidemic on patients and communities at large. Engagement of Community Care Workers (CCWs) in delivery of integrated TB/HIV services is a potential avenue to enhance universal coverage and treatment outcomes and address human resource for health crisis in sub-Saharan Africa. In South Africa, CCWs are employed by nongovernmental organization (NGO) with Health Department contracts funded by government to provide various TB/ HIV community based activities. Using South Africa as a case, we report on engagement of NGOs and CCWs in the implementation of collaborative TB/HIV/PMTCT activities in rural South Africa, including extent of participation and constraints and opportunities to enhance effective participation. Our mixed method study in Sisonke district, KwaZulu-Natal included facility and NGO audits, a household survey (n=3867), 33 key informants with provincial, district and facility managers, NGOs managers and six CCW focus group discussions. Results: The findings indicate that most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of TB and HIV patients needing care and support at the community level were receiving support from CCWs, while 2% of pregnant women were counseled by CCWs on infant feeding options and HIV testing. Most facilities (83%) did not have referral mechanisms or any linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice, inadequate funding, and inconsistency in supplies and equipment. Individual and community factors such as lack of disclosure and stigma related to HIV; and cultural beliefs were also identified as constraints. Conclusions: We conclude that sub-optimal NGO/CCW engagement exists in implementation of collaborative TB/HIV/PMTCT activities, despite its potential benefits to enhance provision of integrated TB/HIV/PMTCT services at community level. Effective interventions that address contextual and health systems challenges are required and these interventions should combine systematic skills-building and consistent CCW supervision with a reliable referral and M&E system. Policy review to harmonise and expand the scope of CCW practice with task shifting to include home-based HIV counseling and testing is vital.     

Opening up their doors: perspectives on the involvement of the African American faith community in HIV prevention in four communities

In 1998, the U.S. government launched the Minority AIDS Initiative (MAI) to address growing ethnic and racial disparities in HIV/AIDS cases. The CDC performed an evaluation of its MAI-funded programs, including an assessment of community stakeholders' perspective on the involvement of the faith community in HIV prevention. Individual interviews (N = 113) were conducted annually over 3 years in four communities. The majority of participants described a change in faith community's attitudes toward HIV and a rise in HIV-related activities conducted by faith-based organizations. Participants attributed changes to faith-based funding, acknowledgment by African American community leadership that HIV is a serious health issue, and faith leaders' desire to become more educated on HIV/AIDS. Participants reported conservative faith doctrine and stigma as barriers to faith community involvement. The findings suggest that although barriers remain, there is an increased willingness to address HIV/AIDS, and the faith community serves as a vital resource in HIV prevention.     

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.     

Civic/sanctuary orientation and HIV involvement among Chinese immigrant religious institutions in New York City

Using data from a study of Chinese immigrant religious institutions in New York City (primarily Christian and Buddhist), this paper explores why some religious institutions are more inclined than others to be involved in HIV-related work. Although numerous factors are likely to play a role, we focus on organisations' differing views on social engagement as an explanatory factor. We hypothesise that religious institutions that value social engagement ('civic') will be more inclined towards HIV/AIDS involvement than those that are more inward focused ('sanctuary'). Given that many religious institutions are fundamentally defined by their stance on the appropriateness of social engagement, better understanding of this key characteristic may help to inform community and government organisations aiming to increase religious institutions' involvement in HIV/AIDS-related work. Our analysis suggests that some organisations may be less interested in taking on the challenges of working in HIV/AIDS because of their general view that churches or temples should not be socially engaged. On the other hand, religious institutions that have concerns about social acceptability, fear of infection or lack of capacity--but generally embrace social engagement--may be more open to partnering on HIV/AIDS-related work because of their overriding community service orientation.     

‘It’s in our veins’: caring natures and material motivations of community health workers in contexts of economic marginalisation

Khayelitsha, an economically marginal peri-urban settlement in Cape Town, is home to a number of ‘flagship’ public health interventions aimed at HIV/AIDS and TB. Alongside these high-profile, foreign donor-driven treatment and care programmes are a plethora of NGOs that provide a wide range of community-based carework. Some of these organisations are large, well funded and well connected globally, while others are run by a few unemployed women responding to care needs in their neighbourhoods. This article explores the ways that community health workers (CHWs) who work for these organisations understand and speak about their involvement in carework as volunteers, employees or managers of community-based care organisations. Many CHWs framed their work through discourses of gender, religion or culture (‘African-ness’). They also described forms of material or economic benefits of providing carework, but many were concerned that these might be seen as existing in tension with more socially accepted, altruistic motivations for care. We explore here how CHWs narrate and understand their roles and motivations as carers and members of a resource-constrained community.