THE NEED FOR THE NEED FOR COMMUNITY BASED COMMUNITY BASED RESEARCH AGAINST RESEARCH AGAINST

HIV/AIDSHIV/AIDSDavid Zakus, BSc, MES, MSc, PhDDavid Zakus, BSc, MES, MSc, PhD

Director, Centre for International HealthDirector, Centre for International HealthAssociate Professor, Department of Public Health Sciences andAssociate Professor, Department of Public Health Sciences and

Department of Health Policy, Management and EvaluationDepartment of Health Policy, Management and EvaluationFaculty of Medicine, University of TorontoFaculty of Medicine, University of Toronto

University of Toronto – McGill University Joint Satellite SymposiumUniversity of Toronto – McGill University Joint Satellite Symposium““Canada’s National and Global HIV Research: Where Have We Canada’s National and Global HIV Research: Where Have We

Been, Where Are We Going and How Do We Get There?”Been, Where Are We Going and How Do We Get There?”International AIDS ConferenceInternational AIDS Conference

Toronto, August 14, 2006Toronto, August 14, 2006

OVERVIEWOVERVIEW

Based on experience as lead Based on experience as lead evaluator of major African HIV/AIDS evaluator of major African HIV/AIDS program in 2005-06: Southern Africa program in 2005-06: Southern Africa AIDS Trust.AIDS Trust.

Community based responses to Community based responses to HIV/AIDS in southern Africa.HIV/AIDS in southern Africa.

Identification of major research Identification of major research needs.needs.

Southern Africa AIDS Trust Southern Africa AIDS Trust (SAT)(SAT)

• SAT operates in five African countries and is SAT operates in five African countries and is now headquartered in Johannesburg (moving now headquartered in Johannesburg (moving from Harare in late 2005 after about 15 years from Harare in late 2005 after about 15 years there).there).

• SAT partners with local community based SAT partners with local community based organizations to help them develop good: organizations to help them develop good: vision, mission, planning, financial vision, mission, planning, financial management, reporting, governance.management, reporting, governance.

• SAT is unique in providing dependable SAT is unique in providing dependable program/organizational funding (i.e. program/organizational funding (i.e. administration, salaries) as opposed to administration, salaries) as opposed to “project” or “activity” funding – in addition to “project” or “activity” funding – in addition to operational support.operational support.

• SAT is often the initial “donor”, helps build SAT is often the initial “donor”, helps build capacity, CBOs/NGOs able to diversity funding capacity, CBOs/NGOs able to diversity funding sources.sources.

BUILDING HIV BUILDING HIV COMMUNITY COMMUNITY COMPETENCYCOMPETENCY

SAT SAT capacity buildingcapacity building is a package: is a package: • skills building workshops; skills building workshops; • mentoring visits; mentoring visits; • exchange visits; exchange visits; • annual country and other meetings; annual country and other meetings; • publications; publications; • data bases; data bases; • other informal support.other informal support.

Malawi -Malawi -ContextContext

• 14.2 % of 14.2 % of adult adult population population HIV+HIV+

• 23,000 on 23,000 on ARTs (14% ARTs (14% of need)of need)

• 150,000 of 150,000 of ART need is ART need is unmetunmet

MozambiquMozambiquee

ContextContext•12.2% of adult 12.2% of adult population HIV+.population HIV+.• Highest Highest prevalence in the prevalence in the Beira Corridor – Beira Corridor – but nearing same but nearing same level in the level in the south.south.• 13,000 on ARTs 13,000 on ARTs (6% of need).(6% of need).• Unmet need Unmet need 204,000.204,000.

Zambia Zambia --

ContextContext• 16.5% of 16.5% of

adult adult population population is HIV+is HIV+

• 33,000 on 33,000 on ARTs (18% ARTs (18% of need)of need)

• Unmet ART Unmet ART need is need is 153,000153,000

TanzaniTanzania -a -

ContextContext• 8.8% of 8.8% of

adult adult populatiopopulation HIV+n HIV+

• 9,500 on 9,500 on ARTs (3 % ARTs (3 % of need)of need)

• Unmet Unmet ART need ART need is 307,000is 307,000

ZimbabwZimbabwe -e -

ContextContext• 24.6% of 24.6% of

adult adult population population is HIV+is HIV+

• 15,000 on 15,000 on ARTs (9,000 ARTs (9,000 public ARV)public ARV)

• 340,000 of 340,000 of ART need is ART need is unmetunmet

Current PlayersCurrent Players

Ususal institutions (multi/bi-lateral, public/private)

Hundreds/Thousands of new COMMUNITY BASED ORGANIZATIONS who are involved the battle, in scale up operations, their number is increasing every day…

BUT, they need assistance in really understanding the problems and their responses…especially at the community (and household) level.

CURRENT CBCURRENT CBRESEARCH ISSUESRESEARCH ISSUES

Current burning topics in SAT include: Current burning topics in SAT include: 1) Treatment Literacy; 2) Orphans and 1) Treatment Literacy; 2) Orphans and Vulnerable Groups; 3) Children Living Vulnerable Groups; 3) Children Living with HIV; 4) Stigma.with HIV; 4) Stigma.

Organization of CBOs: Staffing and HR Organization of CBOs: Staffing and HR Development; Organization Culture; Development; Organization Culture; Management and Leadership; Strategic Management and Leadership; Strategic Partering and Networking; Monitoring Partering and Networking; Monitoring and Evaluation…(thru Operations and Evaluation…(thru Operations Research).Research).

Gender: GENDER MAINSTREAMINGGender: GENDER MAINSTREAMING

CB Research Challenges (cont’d)CB Research Challenges (cont’d)

Care for the sick and dying (home-based and institutional…but community based)

Integration of traditional healers, including birth attendants.

New Treatment related issues: treatment adherence, drug supply, storage and resistance, post ARV care (side effects), regular check-up/follow up of those on treatment, rehabilitation of PLWAs back into the workforce … revival of community participation.

CB Research Challenges (cont’d)CB Research Challenges (cont’d)

Giving voice to PLWHA. Responding to unemployment, lack of

food, housing, and clean water, etc… Communications: How to effectively

communicate messages and influence behaviour change.

Scaling up…meeting the increased need for services and HIV programs as more people present for testing, test positive and need care and other services.

CONCLUSIONSCONCLUSIONS Huge need for community based Huge need for community based

research; research as capacity building.research; research as capacity building. Great opportunity for ‘researchers’ and Great opportunity for ‘researchers’ and

trained staff to make significant trained staff to make significant contributions.contributions.

Imperative to have multidisciplinary Imperative to have multidisciplinary research and research teams, research and research teams, community level training, and community level training, and participatory methodologies.participatory methodologies.