HIV/AIDS Nursing Education in Sub-Saharan Africa – O. Dibelius, S. Gwaze, N. Mbirintengerenji by Mabuse-Verlag

The Editors: Prof. Dr. Olivia Dibelius – Project leader and head of the Degree Programme Nursing Science/Nursing Management, Evangelische Hochschule Berlin. Simbirai Gwaze – lecturer of the Health Faculty, Africa University – Mutare, Simbabwe. Noel Mbirintengerenji – lecturer Medical Surgical Nursing Department, University of Malawi – Kamuzu College of Nursing, Lilongwe, Malawi.

Olivia Dibelius, Simbirai Gwaze, Noel Mbirintengerenji (Eds.)

HIV/AIDS Nursing Education in Sub-Saharan Africa A South-South-North HIV and AIDS Nursing Network

Mabuse-Verlag Frankfurt am Main

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Outline Figures .............................................................................................................. 8 Tables ............................................................................................................... 9 Introduction ................................................................................................... 10 1

Project Management and Outcomes ..................................................... 13

O. Dibelius, D. Preiss-Allesch, E. Feldhaus-Plumin, Y. Weidlich, Y. Scholz 1.1 1.2 1.3 1.4 1.5 2

Prior contacts and co-operations between African Universities and the EHB (O. Dibelius, D. Preiss-Allesch) ...................................... 13 The final project partners and project objectives (O. Dibelius, D. Preiss-Allesch) ..................................................... 15 Working Process and Outcomes (O. Dibelius, E. Feldhaus-Plumin, D. Preiss-Allesch) ................... 15 Needs-Assessments in Lilongwe and Berlin (O. Dibelius, Y. Weidlich, Y. Scholz) ............................................ 18 Viewing Programmes ..................................................................... 24

HIV and AIDS in a Global and Sub-Saharan Perspective ................. 33

P. Fasan 2.1 2.2 2.3 2.4 2.5 2.6

Magnitude of HIV/AIDS epidemic in Sub-Saharan Africa and its historical background ................................................................. 33 Overview of the epidemic in Southern Africa with particular reference to Zimbabwe ................................................................... 36 Country Responses from mid 1980â&#x20AC;&#x2122;s to the present ....................... 38 Otherstrategies ................................................................................ 41 Antiretroviral Therapy (ART) as a prevention strategy ................. 42 Training of human resources for HIV and AIDS prevention and control activities. ............................................................................. 43

2.7 2.8 2.9 2.10 2.11 2.12 2.13 3

Infection Risks, Conditions of Work and the Prevention of HIV Transmission among Healthcare Workers.............................. 44 Prevention Strategies ...................................................................... 45 Monitoring the effects of PEP. ....................................................... 46 The Future of the AIDS Epidemic in Sub-Saharan Africa. ............ 47 Annex .............................................................................................. 47 Research .......................................................................................... 49 References ....................................................................................... 50

Sub-Saharan perspective on nursing education and practice ............ 51

S. Gwaze, V. Chikanya 3.1 3.2 3.3 3.4 3.5 3.5.1 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19

A perspective on nursing education................................................ 52 Nursing practice perspective........................................................... 54 Zimbabwean Perspective on Nursing Education and Nursing Practice ............................................................................................ 57 Incidence and prevalence of HIV/AIDS ......................................... 60 Government strategies .................................................................... 62 Education ........................................................................................ 65 Results of prevention programmes ................................................. 67 Response of Africa University to the HIV and AIDS pandemic ... 69 Africa Universityâ&#x20AC;&#x2122;s HIV and AIDS Programmes ........................... 70 Networking with local/national/international organisations, institutions and communities in the fight against HIV and AIDS .. 70 Outreach Programme ...................................................................... 71 HIV and AIDS awareness programmes .......................................... 71 Voluntary Counseling and Testing (VCT) ..................................... 72 Impact of DAAD Modules at Africa University ............................ 72 Need for short courses .................................................................... 73 Possible short courses ..................................................................... 74 Benefits of the South-South, North-South Network....................... 75 Benefits of the curriculum .............................................................. 75 Results of the Implementation process ........................................... 76 References ....................................................................................... 77

The impact of DAAD HIV Module development in Malawi .............. 79

N. Mbirintengerenji 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21

The historical background of Malawi ............................................. 79 Background of HIV in Malawi ....................................................... 80 Response of the government to HIV and AIDS ............................. 83 Policy and programmatic response ................................................. 88 Men who have sex with men .......................................................... 91 Sex workers..................................................................................... 92 Youth............................................................................................... 92 Truck drivers ................................................................................... 93 Teachers .......................................................................................... 93 Orphans and vulnerable children .................................................... 93 Harmful cultural beliefs, attitudes and practices ............................ 95 Organizational impact of HOB and AIDS in Malawi .................... 96 History of the Kamuzu College of Nursing .................................... 97 HIV response by the college ........................................................... 98 The DAAD and Kamuzu College of Nursing (KCN) .................... 99 Impact of DAAD Modules at Kamuzu College of Nursing (KCN) ............................................................................. 100 Cultural practices .......................................................................... 102 Transactional sex .......................................................................... 102 Food insecurity in households affected by HIV/AIDS................. 103 Recommendation .......................................................................... 107 References ..................................................................................... 108

Authors and Contributors .......................................................................... 110

Figures Figure 1:

The interviewees field of work ................................................... 18

Figure 2:

Age distribution of the interviewees ........................................... 19

Figure 3:

Desired training contents ............................................................ 19

Figure 4:

Graph of life expectancy at Birth for some Sub-Saharan countries showing a decrease in the 1990s which was primarily due to the AIDS pandemic.......................................... 60

Figure 5:

Incidence (%) by risk category- Malawi 2007 Source: National Report, 2008 ................................................... 83

Figure 6:

Estimated and Projected HIV Prevalence from 19802012 (NSO, 2012) showing the national response status Source: National Report, 2012 ................................................... 87

Figure 7:

HIV Prevalence by Location: 1998-2007 Source: MDHS, 2010.................................................................. 89

Figure 8:

HIV Prevalence among population groups most at risk and vulnerable groups Source: National statistics Office, 2010 ..................................... 91

Figure 9:

Proximate determinants of HIV infection in Malawi Source: A 2000 National Report. ............................................... 94

Figure 10: Organizational impact of HOB and AIDS in Malawi Source: A 2002 National Report ................................................ 96

Tables Table 1:

Programmes ................................................................................ 25

Table 2:

2012 global and regional statistics Source: 2013 global fact sheet (UNAIDS 2013) ........................ 35

Table 3:

2012 global and regional statistics Source: 2013 global fact sheet (UNAIDS 2013) ........................ 36

Table 4:

The top ten HIV/AIDS countries of the world are in Sub-Saharan Africa (UNAIDS 2013) ......................................... 37

Table 5:

HIV and AIDS Status at a Glance (National HIV Estimates 2011) .......................................................................... 38

Table 6:

Strategies that have been developed by Zimbabwe in the 2011-2015 National AIDS prevention and control plan: Source: (Zimbabwe National HIV and AIDS Strategic Plan [ZNASPII] 2011-2015, October 2011) .............................. 40

Table 7:

The percentage of pregnant women receiving antiretroviral regimens (excluding single- dose nevirapine) for preventing mother-to-child transmission in Sub-Saharan African countries in 2011 Source: Global Report, UNAIDS 2013 ...................................... 43

O. Dibelius

Introduction The high prevalence and incidence of HIV/AIDS in Sub-Saharan countries has given nursing particular importance in these places. These countries are perceived to be losers of Globalisation. Ecological, social and financial inequality are constant themes and are primed to increase in the future. For this reason, Nurses are not only the largest professional group in the medical sector promoting health care in the population, but also raise an awareness of human rights and act as a go-between for people particularly in need. This publication is based on a nine-year cooperation (2002-2011) with Africa University’s Department of Health and a four-year cooperation with colleagues from the Universities of Malawi and Zambia (2008-2011).The four-year HIV/AIDS Programme has had the aim of discerning the specific educational and learning needs of Nurses, so that educational and learning modules suitable for the context they work in could be developed. The modules have been largely incorporated into the curricula of the three Universities (Zimbabwe, Malawi, Zambia) or else are on offer as part of their further education programme. This communal publication will be a cornerstone in Africa and Europe and contribute to the sustainability of the whole project. You will find the following chapters: In Chapter 1, the contents of the DAAD projects from 2002-2011 are introduced by the German team. This chapter’s emphasis is on the project “South-South-North HIV and AIDS Nursing Network” (2008-2011), whose goals and most significant results are presented and discussed. In Chapter 2, Peter Fasan looks at the urgent issue of a global and SubSaharan perspective on HIV/AIDS. The situation in Zimbabwe is compared with that of its neighbouring countries on the basis of epistemological HIV/AIDS data from the Sub-Saharan countries. The success of the preventative, therapeutic and large-scale heath system measures in Zimbabwe are

Introduction

discussed on the basis of this comparison. Subsequently, structural proposals which may lead to the sustainability of these measures in the future, are introduced. In Chapter 3, Simbirai Gwaze and Violet Chikanya portray a global perspective on Nursing Education. They problematise the difficult training situation of Nurses in Africa, the “Brain Drain” of Nurses educated in Africa and the resulting Nursing crisis in the African public health system. The situation of HIV/AIDS in public health in Zimbabwe is analysed here. The results of the state prevention programme are tallied up. In addition, Africa University’s (AU) strategies and concepts for dealing with the epidemic are thematised. In Chapter 4, Noel Mbirimtengerenji analyses the epidemiological situation of the HIV/AIDS epidemic in Malawi. He evaluates the results of the state prevention and therapy programme. The author identifies particular groups which are at risk, as well as components of cultural beliefs, habits and behaviourisms which may have contributed to the perpetuation of the epidemic. In this context, the psycho-social situation of students at the Kamuzu College of Nursing is examined. The precursory project and the four-year programme for developing modules (2008-2011) were both financed by the German Academic Exchange Programme (DAAD). We’d like to thank the employees of the DAAD, in particular Mrs. Katrin Winter, for their inspiring cooperation and constructive assistance. This project would also not have been possible without the assistance of Pastor Heinrich Meinhardt of the Protestant Methodist Lindenkirche in Berlin (former member of the Board of the AU), Prof. Dr. Peter Fasan, the founder of the Faculty of Health at Africa University (AU) in Mutare/Zimbabwe and co-author and former Chairman of the AU, Prof. Dr. Murapa. The success of this four-year project is, above all, due to the editors and authors of this book and the authors of the modules, who have displayed a strong motivation and perseverance in the course of this long-term cooperation. The modules can be found where they have been published on the Homepage of the EHB under www.eh-berlin.de/ forschung/forschungsprojekte-pflegemanagement/professionelle-pflege-von-

Introduction

hivaids-erkrankten-im-suedlichen-afrika.html. The need for low-threshold access for our African colleagues and their students was pivotal in determining this form of publication.

O. Dibelius, D. Preiss-Allesch, E. Feldhaus-Plumin, Y. Weidlich, Y. Scholz

Chapter 1 1 Project Management and Outcomes 1.1 Prior contacts and co-operations between African Universities and the EHB O. Dibelius, D. Preiss-Allesch The Evangelische Hochschule Berlin (EHB) and Africa University (AU) signed a contract ensuring co-operation in 2002. This covered the following points: - Exchange of staff and students - Common teaching and research projects Since the signing of the contract, there have been the following activities, which were financed by the DAAD: A curriculum workshop took place in 2003 at Africa University in Zimbabwe. During a visit from the German team to the UNAM in Namibia and the University of Cape Town, discussions on the present conditions of teaching and research in the field of health, the development of common modules, preparations for staff and student exchanges and the development of common research projects took place. Professor Dr. Olivia Dibelius was guest professor at Africa University (2004). She taught the module “Care of the Elderly”. Apart from the module being introduced, a research article (Pflege Aktuell, March, 2005, P. 162167) was completed and published on the theme of “Ageing in Zimbabwe”.

Projeect Managem ment and Outcomes O

E Excursion of the facculty of hhealth (stu udents and d Olivia D Dibelius on the riight side) to an eldeerly home (elderly men m on thee left sidee) in Zimbabwe (22004). F From Junee 2005 to Decembeer 2006, th he co-opeeration wit ith Africa Universiity became part of the t â&#x20AC;&#x153;Dialoogue on In nnovative Higher Edducation StratS egiess Program mâ&#x20AC;? (DIES-Program)) of the DAAD. D The T resultts of this program mme show wed that diialogue froom worksshops led to a mutuual undersstanding oof the similarities an nd differennces betw ween the education aand health h sectors in Zimbaabwe and Germany.. Mutual respect was w considdered to be b the f furtherr co-operaation. Un ntil now, tthe Faculty of mostt importannt basis for Heallth has had contactss at and ccooperation with thee Universsity of Maalawi. Thuss, the Vicee-Chancelllor of Afr frica Univeersity emp phasized tthe need to t developp an Sub-S Saharan Network N foor the acad demic heaalth professsion. T The Malaw wi and Zam mbian Unniversities were cho osen as coooperation partners because of: o - Geograpphical pro oximity

Project Management and Outcomes

- Cultural similarities - Similarities in the standards of the Universities - Similarities in the health system structures The Network aimed to improve the quality of teaching, best practice in the field and research.

1.2 The final project partners and project objectives O. Dibelius, D. Preiss-Allesch The South-South-North HIV and AIDS Nursing Network (2008-2011) consisted of the following College and University partners: -

Kamuzu College of Nursing, University of Malawi Faculty of Health Sciences, University of Zambia Faculty of Health, Africa University, Zimbabwe Faculty of Nursing Sciences and Nursing Management, Protestant University in Berlin

Through the measures planned for partnership and network formation, the following objectives were formulated: -

Development of HIV/AIDS modules Implementation of the modules Definition of research needs Promotion of student and lecturer exchanges Common publications

1.3 Working Process and Outcomes O. Dibelius, E. Feldhaus-Plumin, D. Preiss-Allesch Firstly, a country-specific analysis of existing educational offers was made and the results were presented and discussed. On the basis of this analysis, the need for further education in Zimbabwe was evaluated to be as follows: many courses are offered that are too short (approx. 5 days) and do not meet quality standards. Predominantly economic interests on the part of the provider may be assumed. The same can be said of Zambia, and the EU courses

Project Management and Outcomes

which are offered (for example in Great Britain) are too expensive and not specific enough for African nurses. Nurses in Africa should, on account of the high prevalence of HIV/AIDS in southern Africa, be specially supported and thus protected. The next step was to decide the occupational-political and structural level of the training and its contents in view of its African context: A “Short Course” and no more than a subsequent “Diploma” was planned, since they are not so bureaucratic and require the shortest implementation period. For “Short Courses” no accreditation should be necessary. These measures should strengthen the bedside Nurse and not contribute to the invasive “brain drain” trend. The students need to finance the modules themselves as the Universities can not subsidise costs. “Short courses” are thus very popular among Nurses, as they represent neither a financial burden nor a time problem. The “short course” should be held in a block and run for 6-8 weeks, containing 13 modules. Admission Criteria: The curriculum developed is suitable for registered nurses. The participating universities would prefer to offer this course in the Semester break (June-August). The learning targets of the modules should be designed to suit the particularities of the health system in Southern Africa. This specific profile should appeal to African Nurses in particular. The following modules were chosen and considered to be most important: Curriculum 1. 2. 3. 4. 5. 6. 7.

An Introduction to HIV/AIDS Leadership and Management in the context of HIV/AIDS Communication and Counselling HIV/AIDS Policies HIV Testing and Counselling Antiretroviral Therapy Caring/Nursing Care for HIV and AIDS

Project Management and Outcomes

8. 9. 10. 11. 12. 13.

Nutrition for HIV and AIDS Home Based Care Care of the carers PMTCT Opportunistic infections STIs

The network was characterised by great continuity in the participation of its members. The results of the four conferences contributed to the outcomes of its objectives. The most important objectives - finishing the modules and writing a book - were fulfilled. The implementation of the modules at the Universities in Malawi, Zambia and Zimbabwe is a process that will be continued on an individual level by the colleagues in their courses. The Universities are free to change or adapt the modules. The network will continue to promote the modules as a Certificate (one module) or a Diploma (13 modules). For the members of the group, the group process has proved an enrichment for the development of the modules. For the participants, the process of discussing modules and the curriculum of the short courses was democratic, good for the clarification of issues, liberal, constructive and intensive. Supervision by colleagues, networking and co-operation have already been fruits of the network.

Projeect Managem ment and Outcomes O

1.4 Needs-A Assessmeents in L Lilongwee and Beerlin O. Dibeliius, Y. Weidlich, Y. SScholz A grroup of exxperts deveeloped a pprocedure for assesssing the nneed for fu urther trainning in Maalawi. Inteerviews wiith Nursess should cllarify whiich experieences of fuurther eduucation an nd qualification in HIV/AID DS those N Nurses with w a basicc qualificaation of tw wo or threee years have had. They T shouuld also cllarify in whhich areass and undeer which cconditionss those Nu urses have cared forr people aafflicted with w HIV/A AIDS andd the subseequent req quirementss of the Nurses N for ffurther eduucation in n this areaa. This pro ocess wass put into action in Septembber of 20008 by E. Chilemba C of the Etthics Com mmission oof the Kam muzu Colleege in Lillongwe. Afterwards A s, a â&#x20AC;&#x153;Need ds Assessm mentâ&#x20AC;? of tten Nursess was carriied out in Kamuzu College w with the assistancee of Evelyyn and Winnie W owing Chileemba. Thhe intervieews and sstructured guidelinees createdd the follo resullts:

Figure 1: The intervieweees field off work

T The majority of professional N Nurses arre active in n the hom me, Gynaeecology, S Surgery annd the Paediatric deppartment of o the hospital.

Project Managemeent and Outccomes

Figure 2: Age distributio on of the in nterviewees

T The averagge age of the t Nursess was 41-5 50 years old. T The majoriity of the interviewe i ed Nurses (N=7) haad a basic ttraining of two to three years. Only onee person haas a speciffic qualification forr HIV/AID DS.

Figure 3: Desirred trainin ng contentts

T There is a very v greatt need for Nurses to o be schooled in HIV V/AIDS in n Malawi or other Sub-Sahar S ran countriies. Recom mmended training ccontents arre: – Basic knowledge k e of the HIIV/AIDS illness i – Hygiene guidelin nes – Psychollogical sch hooling

Project Management and Outcomes

– – – –

Particularities in caring for the HIV/AIDS afflicted Course of illness Secondary illnesses Pharmacological fundaments of specialist medication

Similar scenarios are suspected in the participating African partner countries. In Berlin, a Needs-Assessment was administered to find out the educational needs of Nurses in the field and to decide on the German contribution to the modules. An ambulant Care Unit focussing on the care and supervision of patients with HIV and AIDS, psychic and oncological illnesses, as well as two further ambulant Units without a specialisation were chosen. In conversations with the respective Care Units, the contents and the goals of the interviews were explained. Anonymity was guaranteed. The Nursing Care Services gave permission for the interviews to be carried out and selected the Nurses for them, although taking part had to be voluntary on the Nurses’ part. Six of the ten interviews took place with Nurses from the specialised ambulant Care Unit. Two further interviews took place in each of the other two kinds of Care Units. At these four interviews, the permission of the Nursing Care Services extended to telephone interviews, which is how the Nurses were then interviewed. It all began with appointments made over the phone for the individual telephone interviews. At the start of the interview, the interviewee was informed of the point of the interview and assured of their anonymity. The interviewee agreed to their conversation being recorded and a protocol being made of the recording. Five of the interview partners are woman and five are men. Three have a leadership function, although they are still active in the care and mentoring of patients. Seven of the Nurses are between 31 and 50 years of age. Two Nurses are younger than 31 and one is older than 50. All the interviewees possessed a Nursing qualification. Four of them had a religious denomination. All of the interviewees had accrued many years of work experience. There were differences only in the length they spent employed in different spheres of work. This varied between one and twenty years of employment in their current ambulant Nursing Unit.

Project Management and Outcomes

Four of the interviewees indicated that they had had no contact with HIV/AIDS afflicted patients in their current sphere of activity. These are the four Nurses serving in the non-specialist Care Unit. The six Nurses from the specialist Unit had daily contact with HIV and AIDS afflicted. They referred to therapy and the psychosocial mentoring of the afflicted and their relatives as special offers made by their Nursing Unit. Of the four Nurses from the non-specialised Care Unit, two classified the quality of Nursing for HIV/AIDS afflicted as poor. The other two, as well as the six Nurses from the specialist Care Unit found that the quality of care for this group of patients was good. There was a good supply of the necessary medication for HIV/AIDS afflicted by the specialist Care Unit. In addition, the Nurses reported special materials made available to them for use as nursing aids. These enable a secure handling of hollow needles etc. and offer a corresponding protection from being pricked and thus from contamination. The Nurses from the other Care Units couldnâ&#x20AC;&#x2122;t say anything about the supply of medication. Two Nurses classified the provision of hygiene as poor and two others made no comment. Five interviewees had further professional qualifications (e.g. leadership course and specialisation in Psychiatrics). All Nurses from the specialist Units were schooled in HIV/AIDS. This training is obligatory for the employer and accredited as working hours. Currently, four of the six interviewees classify their competence in the care and mentoring of HIV/AIDS afflicted as high. Two Nurses, who have been active in this Unit for a year, assessed their caring competence as average. For these two employees, their participation in further vocational training is already planned. The four Nurses from the other Care Unit possess no relevant vocational training. In spite of this, three assessed themselves as possessing a medium competence in the care and mentoring of the HIV/AIDS afflicted. One Nurse ranked herself as little competent. The management of these Care Units do not consider vocational training in the area of HIV/AIDS to be a priority. The management of both kinds of Care Units would train their workers when it is required by the patients - in other words, when they recognise the necessity for it.

Project Management and Outcomes

The Nurses who have attended no vocational training in this area to date, give the following contents priority: hygiene guidelines, protection from infection and pharmacological fundamentals. This is followed by the thematics of dealing with afflicted patients and their relatives. The type and method of educational programmes desired were widely varied and depended on subjective preferences such as the age, family situation and financial and personal resources of the interviewee, as well as the level of academic challenge offered. The Nurses with previous vocational training did not perceive medical knowledge as a priority. They emphasised the reduction of fear of contact and stigmatisation as part of a psychosocial approach to the illness. This does not, however, exclude regular updating of pharmacological and medical knowledge. In order to pave the way for an open reception of the topic HIV/AIDS and also to raise a consciousness of what a danger the illness is, learning should take place alongside practical everyday care - that is, where the Nurses work. Further conceptions about the type and method of training are dependent on the topics involved. Vocational training in hygiene, protection from infection, pharmacology and the illness itself seem viable in hourly evening or day seminars, whereas the specifics of dealing with the illnessâ&#x20AC;&#x2122; psychosocial aspects were preferred as weekend or intensive many day seminars. This was rationalised by the nature of the topic and a need for an intensive sharing of experience on the part of the participants. Except for one Nurse, all the interviewees indicated an interest in further schooling. This was attributed to personal interest, the wish to gain more knowledge and the practical need for it. Four of the interviewees would be prepared to attend a schooling in a foreign country, whereas two would prefer training which took place in German. The reasons for the rejection of training in another country reside in the language barrier, the lack of financial resources and time as well as the intervieweesâ&#x20AC;&#x2122; family situations. One Nurse saw no necessity for participating in a training in another country since Germany offers a comprehensive and suitable range of vocational trainings on HIV/AIDS.

Project Management and Outcomes

The aspects most often named as conducive for improving the quality of care for HIV and AIDS afflicted were openness in dealing with the illness and acceptance of it. A continuing instruction as to the path of the infection and the financing of preventative measures could be beneficial. Compulsory vocational trainings on the topic of HIV/AIDS were suggested as a measure against stigmatisation within the medical world. Furthermore the support of existing supply networks and the necessity of sponsorship for further specialist medical practices received mention. All interviewees from the specialist Care Unit indicated that their specialisation was important and necessary for the adequate care and mentoring of HIV/AIDS afflicted and their relatives. â&#x20AC;&#x153;This specialisation is very important ... a different way of dealing with things ... a different understanding for the lifestyle of these people and a greater competence.â&#x20AC;? Recommendations for the contents of vocational trainings: Basic knowledge on the topic of HIV/AIDS should already form part of the university/college curriculum studied by Nursing and Medical students. In the course of their later profession, in-service trainings in the form of day or evening seminars should offer the possibility of consolidating or actualising existing knowledge: -

basic knowledge of the HIV/AIDS illness the illness, the course of the illness, secondary infections hygiene the course of the infection, protection from infections, dealing with the weakened immune system of the afflicted particular care in the attendance on HIV/AIDS afflicted the pharmacological basics for the specialist medication needed Building on this basis, seminars on a weekend or successive days are then the suitable forum for: psychological schoolings care of the afflicted, mentoring of the relatives, conversation techniques

Project Management and Outcomes

In this way, the participants of these seminars would attain a more open and intensive way of sharing experiences when it comes to discussing the particularities of dealing with HIV/AIDS afflicted.

1.5 Viewing Programmes In the course of the project, projects and institutions with best-practice models in the areas prevention, counselling, treatment and dealing with the social and community consequences or attendant ills of the HIV/AIDS afflicted were visited. German Care Institutions were also incorporated into the viewing programme. The following list gives an overview of the institutions visited. The projects were organised into different categories. Initially, a short description of the institution or project was given and then the question was raised of how it might be categorised â&#x20AC;&#x201C; i.e. if it offered stationary or mobile care, or if it had measures to offer support to the environment of the HIV/AIDS afflicted. Of additional relevance was whether the project/institution made a contribution to the training of Nurses. This overview reveals a wide spectrum of initiatives, which must also be seen in the context of national developments in the corresponding health systems and politics. These issues are partly discussed in the specific publications of the countries involved. In this respect, the following questions are interesting: - Which insights about the promotion of health, counselling and care offered in the Sub-Saharan region could be inferred from our project viewings and - Which relevance do they or could they have for the development of the Module programme?