Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 234 - 239)




  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?

Mr Rowe

  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 work?
  (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 this.
  (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.

Ms Kingham

  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 their children.

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