Examination of Witnesses (Questions 234
TUESDAY 27 JUNE 2000
234. Thank you very much for being patient.
Welcome. I hope you will feel comfortable. We would like to go
straight into questions. Could I ask Mr Rowe to start us on the
question of prevention?
235. We would like very much to know what interventions
have been proved to work in giving children information on HIV/AIDS
and in changing behaviour. How can donors best support effective
(Dr Webb) This is a very difficult question. The question
of proving is a debate we could spend all day discussing. We have
not managed to prove that we can change behaviours according to
one single strategy. We are accumulating evidence on principles
of practice which are proving to be effective in terms of increasing
education levels, getting children to recognise that they are
at risk, getting them to understand what are the risk factors,
the protective factors, in their own environment. With Save the
Children, we encourage strategies such as peer education, child
to child education, linking in with teacher support and moving
beyond that into the community with community-based structures
such as peer counsellors, reaching the out of school youth. There
is no one, single strategy which is effective. It is a combination
of things and this is where the problem comes in. NGOs themselves
have specific competencies, specific areas where they have an
advantage and it is the combination of these different strategies
on any one particular scale which is proving to be most difficult
in effecting behaviour change.
236. When we were in Uganda, in particular,
we saw the remarkable work of an organisation whose name I have
forgotten, started by a Ugandan woman, where people were tested
for HIV and those who were positive remained with those who were
negative, as a supportive group. We also saw a similar organisation
sending people with HIV into the villages to talk particularly
to young people. It seemed very effective. Is that a good strategy
and, if so, how can donors encourage it around the world?
(Mr Gorman) Can I come in on that from the perspective
of the older age group? It is one concern that HelpAge International,
my organisation, has quite substantially that older people have
been completely excluded from nearly all programmes responding
to HIV/AIDS. We think that particularly around the issue of education
there are a great deal of old people who can contribute positively.
237. Do you mean grandparents?
(Mr Gorman) I mean grandparents. I am talking about
people over the age of 50 or 60 who are amongst the principal
care givers in the family for many orphans, grandchildren and
people with AIDS. In Thailand, 70 per cent of people with AIDS
are being cared for by older relatives, either their parents or
their grandparents or other relatives. Most of those older relatives
are over the age of 60. That is a very significant group in equation
but they are not being reached by education and awareness programmes.
They could contribute an enormous amount. People still do listen.
We have talked about how the extended family has been under threat
and stretched by HIV/AIDS but nevertheless there is still a strong
structure in Africa and Asia which we can use and part of that
structure is the older generation to whom people still defer.
It is very important that those people are reached appropriately.
Older people do not want to go on training sessions and education
programmes with younger people. They do not think that is appropriate.
We feel that is the case in this country too, but they do want
to know about what is happening and they want to be able to participating
in addressing the problem. They see it as a major issue, personally
and communally, in many countries.
(Ms Simms) I would like to point out that 8,500 children
and young people are being infected every day with HIV. Research
is suggesting that 37 per cent of young people do not know any
ways to protect themselves. There is obviously an enormous potential
for preventing AIDS with education, particularly of young people
and children and youth to youth programmes are particularly important.
You have to approach the whole community and the elderly have
a lot to say. Uganda has been particularly successful, partly
because the radio has been used for prevention programmes. Far
more use could be made of that, perhaps by donating transistor
radios to villages, to access people who do not have them. Have
transistors playing at food stores or in the meeting place. People
will go and listen to them if they do not have them. Put over
through the radio prevention messages and support programmes for
families suffering from AIDS. You can use the radio to dissipate
stigma. You can also educate children through the radio. Through
developing systematic radio programmes and donating radios, you
could do an enormous amount.
238. It is true though, is it not, that in this
country we are constantly surprised by the level of ignorance,
despite the fact that we talk about sex all the time, among children?
Is the incidence of ignorance in Africa a lot higher than the
incidence of ignorance among the same age group in this country?
(Ms Simms) I would not know but I think it might well
be. There have been campaigns here which have tried to advertise
(Dr Webb) I do not think absolute levels of knowledge
are the critical factor. It is the ability of people to internalise
the message and realise that they are themselves at risk. Your
point about using people living with HIV/AIDS is critical in this
respect, especially with younger people. I have been involved
with programmes where people living with HIV have gone to schools
and done open talks in communities. The ability of people to visualise
AIDS in people or people living healthily with HIV/AIDS is very
important. The problem is that there is a lot of stigma. The NGOs
which are involved in this kind of work are scattered. They are
stigmatised themselves and very often they will insist on doing
this kind of education well away from their home area so the costs
of this kind of work can be much greater. The importance at national
level is to recognise that they should be involved, particularly
at school and community level. If schools can be encouraged to
bring in these organisations so that there is some kind of structured
relationship between people living with AIDS and school visits,
that will have a massive impact on destigmatisation.
239. I know that studies have been done in the
United Kingdom that show that young people, if they have a particular
problem or an issue they want to clear up, will go first to a
best friend and secondly to a grand parent. That has been very
clearly researched. A grandparent is one stage removed from a
parent and it is somebody they trust. I would like to ask Save
the Children and others: why are you not following this up? Have
you looked at this issue? Is it something you could follow up?
(Dr Webb) In terms of communication networks, peers
are by far the closest to them. The link between grandparents
and children is more rhetorical than reality. That linkage between
the older generation and the younger generation is breaking down
in many main societies. We are finding horizontal linkages between
age groups in terms of information are much stronger in terms
of trust and support. We are finding out in our research coming
out now is that that connectedness intergenerationally is proving
to be very protective for young people. They feel part of a community;
they have prosocial attitudes towards their community, giving
them a sense of self-worth. That connectedness with significant
adults apart from their parents is proving to be very effective.
Within Save the Children, we are trying out projects to encourage
young people to not only increase their peer support through informed
education but also to seek out linkages with adults because that
is no doubt effective. How to do it is very difficult.
(Mr Gorman) I would agree with the latter part of
what Doug has said. I am not so convinced that there is a breakdown
intergenerationally in terms of advice and response. It is very
variable. Situations do vary and it depends on the degree of other
breakdown in the community as to how much the links between grandparents
and grandchildren are broken, but there is a kind of ambivalence
on the part of young people approaching grandparents. There is
still respect. It is to some extent rhetorical. Young people,
for example, say that one of the primary problems in the community
is older men. They are primary transmitters of the HIV/AIDS infection
because they use younger women. Nevertheless, the family and the
household has remained immensely strong. It has not existed for
hundreds or thousands of years in African and Asian communities
without being very strong. We should be careful not to write it
off too early, but what it needs above all is support from outside.
Family structures, older people, young people, cannot do without
that external support and that is where, for example, education
programmes can be immensely helpful and supportive if they are
sensitive and appropriate.
(Ms Simms) I would like to support that. There has
been research. People say the extended family is breaking down.
Research suggests the extended family is not breaking down. What
is happening is that there is less transmission of money within
the extended family, so you are getting an increasing number of
families without the means to support the basic needs of their
children, but the carers are still there and the relationships
are still there. There is a lack of money to provide for that
care and that is what is needed. Unless we provide that, under
the pressure of an AIDS orphan crisis we are going to see the
destruction of an extended family system which has gone on for
generations in Africa and has (considering the difficulties involved)
very successfully provided for the needs of all, children, elderly
people and disabled, in a very cost effective way. If it breaks
down, we are going to get enormous problems, which is why we must
put in the support now to enable people to have the means to support