JOHAP Evaluation (External) (2005) by The Power Is In People

Evaluation

2005

External Evaluation Executive Summary

Moira Campbell, Mary Crewe, Rakgadi Mohlahlane, Easter Kunene, Tiny Mdlalose, Jimmy Pieterse Centre for the Study of AIDS University of Pretoria April 2005

JOHAP The Joint Oxfam HIV/AIDS Program in South Africa seeks to strengthen the civil society response to HIV/AIDS through supporting integrated communitybased services for HIV prevention and care, including a focus on gender and sexuality and the rights of people living with, and affected by, HIV/AIDS.

Deutschland ISBN XXXXXXXXX

Ireland

A series of reports on the Joint Oxfam HIV/AIDS Program (JOHAP) 2005

Contents Photos Front cover: The children are playing one of their favourite games organised by the CHoiCE Volunteer Care Givers during their Scout meetings. What the Volunteers try to do is allow the children time to play for the first part of their afternoon meetings so as to get rid of their energy then to come together afterwards for more serious meetings of teaching and guidance. Matthew Willman/OxfamAUS.

Acknowledgements

JOHAP would like to acknowledge the participation of partner organisations who gave input into this evaluation.

Summary

Overview

Evaluation objective one

3.1

HIV/STI prevention work addressing gender and sexuality with focus on youth

3.1.1 Recommendations

Top left: Mary Maluleke walks her orphaned grandson, Tumi, to creche. Paul Weinberg/OxfamAUS

3.2

Top centre:Elias Mabuza ia a PLWHA (person living with HIV and AIDS) who has disclosed his status to the community. Paul Weinberg/OxfamAUS

3.3

Create a more enabling environment for HIV programming with a focus on the rights of PLWHA 14

Evaluation objective two

4.1

Assess and make recommendations on whether the strategies engaged by JOHAP have contributed to the overall program response. 18

Top right: Project coordinator for the KwaZulu-Natal Progressive Primary Health Care (PPHC) Musa Nglovo speaking with the pupils of KwaMvimbela High School. Matthew Willman/OxfamAUS Middle left: Beauty (Nkhangweleni) Magala was part of a case study of HIV and AIDS with Rainbow Youth Developement Organisation. Matthew Willman/OxfamAUS

Strengthen models of linking HIV prevention and care in integrated community services

8 9

Emergent Themes

Acronyms

Middle centre: PPHC run the annual Soccer Festival. The trophy shown here is last years winner from Stepmore. Matthew Willman/OxfamAUS Middle right: Mary Maluleke at church on Sunday. Paul Weinberg/OxfamAUS Bottom left: During a school lunchtime break boys gather to relax, kick a ball and talk openly between each other. Matthew Willman/OxfamAUS Bottom centre: Themi Dlamini: Project Coordinator for the Home Based Care Givers from the Highway Hospice, supported by the Kwamakhuta Resource Centre. Matthew Willman/OxfamAUS Bottom right: Mary Maluleke walks her orphaned grandson, Tumi, to creche. Matthew Willman/OxfamAUS

Acknowledgements

JOHAP would like to acknowledge the participation of partner organisations who gave input into this evaluation.

Summary

Overview

Evaluation objective one

3.1

HIV/STI prevention work addressing gender and sexuality with focus on youth

3.1.1 Recommendations

Top left: Mary Maluleke walks her orphaned grandson, Tumi, to creche. Paul Weinberg/OxfamAUS

3.2

Top centre:Elias Mabuza ia a PLWHA (person living with HIV and AIDS) who has disclosed his status to the community. Paul Weinberg/OxfamAUS

3.3

Create a more enabling environment for HIV programming with a focus on the rights of PLWHA 14

Evaluation objective two

4.1

Assess and make recommendations on whether the strategies engaged by JOHAP have contributed to the overall program response. 18

Strengthen models of linking HIV prevention and care in integrated community services

8 9

Emergent Themes

Acronyms

1. Summary Summary of recommendations The external evaluation recommendations encompass the major areas for growth that exist in the HIV and AIDS sector for JOHAP. While there are certainly many other areas to be addressed in the current environment, the scope and ability of JOHAP to address issues needs to be located within the capacity of its specific partners and their contribution to strengthening the civil society response to HIV and AIDS in South Africa, with a focus on human rights, gender equity and development. • JOHAP needs to institutionalise approaches to incorporate gender issues across all programs, increasing capacity and training around gender, intensifying workshops that focus on gender and HIV and AIDS, and profiling successes of partners that have successfully mainstreamed gender into their programs. This is a matter of great priority for all partners moving into the next phase. • JOHAP should provide support and training to its partners around advocacy, because partners have established themselves well in their communities. Partners are ready to take on an advocacy role; and need to be encouraged to move to another level of influence. It is recommended that JOHAP make use of the proven expertise of current JOHAP partners in capacity building around advocacy. • JOHAP should identify areas to increase its investment in youth institutions, and to focus on capacity building of youth, in order for them to set their own agenda and drive programs based on their own initiative.

• Partners, with the assistance of JOHAP, should strengthen and formalize links with other civil society organisations in order to create a more cohesive network of partners beyond the JOHAP fold, and in this way increase the range of services they can offer through a broader referral process. • JOHAP should focus on more investment in partner staff development to disperse expertise and transfer skills throughout partner organisations, so that they are not dependent on the leadership, profile and guidance of key individuals alone. • Partner organisations should keep their focus on the core activities and areas of expertise, and avoid over-ambitious programming in response to requests for additional services that can be provided by other partners.

• Stronger links with government need to be forged across all partner programs, in order to not only position themselves as supportive partners in their efforts to address HIV and AIDS, but also to apply more pressure on government to increase its own activities around poverty alleviation and providing relief to impoverished communities and areas. • JOHAP needs to find ways to raise its profile in terms of the important contribution its partners are making to the civil society response to HIV and AIDS in South Africa. It needs to position itself as a key player in civil society in the sector, and to increase its visibility and its links with other large well-established donors and contributors.

• All partner programs need to focus on innovative ways of including men and young boys in their activities, and of encouraging their participation in a way that will challenge their own roles, and break down gender stereotyping about what tasks women and men perform in support of these organisations. • Partners need to be assisted in developing better tools for measuring and evaluating the impact of their programs from a qualitative perspective.

Photo left: Sophie Maeokela ia a PLWHA, a HIV and AIDS activist and the major breadwinner for her extended family. Pictured with her children, Maria (left) and Ephenia, who live with their grandparents. Paul Weinberg/OxfamAUS

2. Overview Overview Oxfam Australia manages the Joint Oxfam HIV and AIDS Program in South Africa, which seeks to strengthen the civil society response to HIV and AIDS through supporting integrated community-based services for HIV prevention and care, including a focus on gender and sexuality and the rights of people living with, and affected by, HIV and AIDS. JOHAP was established as a pilot program in 1998 by a group of Oxfam affiliates, in response to the worsening HIV and AIDS epidemic in the region. The program was based on a three-year strategic plan focussing on human rights, gender equity, and development, with the aim of strengthening the civil society response to HIV and AIDS in South Africa. It became evident that there was a need for all Oxfam agencies working in southern Africa to develop their own responses to the increasingly complex HIV and AIDS epidemics. Coordination of these various responses, including JOHAP, is now achieved through the adoption of an Oxfam Regional HIV and AIDS Strategic Framework. During its first phase, JOHAP focused on service delivery, capacity building and advocacy, working through its CBO & NGO1 partners in the provinces of KwaZulu-Natal and Limpopo2. The emphasis of the JOHAP program during its second phase was on consolidating the impact of the civil society response to HIV and AIDS by strengthening the quality and cohesion of that response. In support of this mission, JOHAP encouraged the development, 1 2 3

documentation, evaluation and dissemination of good practice in HIV and AIDS work through its CBO and NGO partners. Since JOHAP’s inception, it was decided that a series of formal evaluations would take place to assess the strengths, weaknesses and lessons learned, and that these processes would inform the future direction of the program. This Phase Two impact evaluation is part of this process, and follows an earlier external evaluation of JOHAP’s partnership, management and governance arrangements. Completed in May 2001 toward the end of Phase One of its operations, the conclusions of the earlier evaluation were overwhelmingly positive, recommending that the program proceed into its second phase with confidence and commitment. JOHAP completed its strategic planning process for Phase Two at the beginning of 2002, committing the program to its focus on quality and cohesion of the civil society response to HIV and AIDS, by way of increasing the impact of its work. The specific details laid out in the Strategic Plan appear in the section on JOHAP in the full report3. The Centre for the Study of AIDS (CSA) at the University of Pretoria was contracted to conduct an Impact Evaluation of the JOHAP program, which currently funds 21 partner organisations, of which 11 were selected for evaluation by JOHAP and the Oxfam affiliates. The primary function of this evaluation was to measure the impact of the JOHAP program by examining the

quality and impact of partners’ work on beneficiaries, and how this has contributed to the civil society response to HIV and AIDS in South Africa. This evaluation took place between October 2004 and February 2005, and was carried out by a six-person team, namely Mary Crewe, Rakgadi Mohlahlane, Jimmy Pieterse, Tiny Mdlalose and Easter Kunene under the direction of Moira Campbell. Rakgadi, Easter, Moira and Jimmy conducted the interviews with partners, beneficiaries, program committee members, advisory board members, and external stakeholders, largely in-person but also via telephone and e-mail.

Beneficiary Viewpoint “I couldn’t believe that I was treated with such great respect by this organisation, as this was something I had never experienced at government departments – in fact, sometimes they were so harsh that they made me cry. I am fortunate to have also had a lot of support from my community, as there are so many grandmothers in the same situation as I am. Many of them have come to ask me about this program that has helped me so much.”

Community Based Organisations & Non-Governmental Organisations Limpopo and KwaZulu-Natal are the two provinces where JOHAP is operational, have high incidence of HIV and AIDS The full report is available at www.oxfam.org.au/world/africa/index.html

The purpose of this evaluation was twofold: • to review and assess JOHAP’s partner organisations in the context of the three programmatic objectives established by JOHAP; and • to assess and make recommendations on whether the strategies engaged by JOHAP have contributed to the overall program response. This evaluation: • documents the accomplishments of the program, • examines the contextual constraints and facilitating factors that have influenced the implementation and effectiveness of program activities, and • verifies whether existing program strategies are suitable for partners to achieve the impact at the beneficiary level. The three priority areas of the JOHAP program are as follows: • Approaches to HIV and STI prevention work that effectively address gender and sexuality with a focus on young people have been strengthened • Models of linking HIV prevention and care in integrated community services have been strengthened • A more enabling environment for HIV programming was created with a focus on the rights of people infected and affected by HIV.

Photo right: There are a few nurses who sit at different portable table, each attending to specific needs of the community. The two main sections are the elderly and the mothers with young children. Matthew Willman/OxfamAUS

3. Evaluation objective one 3.1 HIV and STI prevention work addressing gender and sexuality with focus on youth This evaluation found that partners in this group are involved in innovative prevention work with youth, and in particular young men and boys, through awareness and education campaigns around HIV and STI prevention. Their success can be attributed to a targeted approach that is focused on reaching young people in the areas where they congregate, and through recreational and sporting activities that involve young people on a regular basis. Peer educators are equipped with skills and knowledge to protect themselves against HIV and STIs involving exercises that personalise the risk of infection. They are exposed to a wide range of issues including sexuality, the gender dimension of HIV and AIDS, rape and violence, and the danger of many partners, and become strong motivators with their peers around these and related topics. These partners also demonstrated a welldeveloped grasp of gender issues, and are committed to mainstreaming the link between gender and HIV in all of their activities. A strong component to this has been the sharing of expertise and capacity building from other JOHAP partners around adopting a gendered approach to prevention work, as well as the ardent gender advocates heading up these two programs. The evaluators heard from both the partners and their beneficiaries about the progress being made in schools towards creating a more open environment for discussion around sexuality and gender issues, in particular with those organisations that have involved school administrators, teachers and principals in gender awareness workshops, who are now working towards

including HIV education in curriculum development, as well as creating Gender and HIV Forums in schools. It appeared to the evaluators that young women are more empowered to protect themselves against infection and to make decisions regarding their own sexual rights. However, partners and beneficiaries alike acknowledged the ongoing vulnerability of married women, as although they themselves are better informed about risk, their partners are not. Partners continue to look for new ways to involve men in their activities, in order to influence and challenge their behaviour and attitudes around HIV and gender. Both partner organisations have a strong presence in the community, and their awareness campaigns have helped to reduce stigma and create wider acceptance of and support for People Living with HIV and AIDS (PLWHA). The prevalence of HIV and AIDS in communities, to the point where everyone is somehow affected, has also contributed to a greater understanding of and familiarity with the epidemic. The

involvement of key community stakeholders in their activities has also ensured a level of sustainability, as buy-in to program activities is crucial for their survival and ongoing support from communities. The added benefit is the influence that the partner organisations bring to bear on many community structures, and the opportunity for them to become involved in formulating policy around HIV and AIDS, gender etc.

Photo above: Pupils from KwaMvimbela High School being educated on HIV and AIDS Awareness. Matthew Willman/OxfamAUS

3.1.1 Recommendations It is recommended that JOHAP assist these partners in strengthening their lobbying and advocacy capacity, in order to affect more fundamental change in the societies in which they operate. These organisations are well-placed to take on this role, and have the potential to exert considerable power and influence over institutions, and to contribute to policy work in a meaningful way, given their status and reputation in their communities. The evaluation also identified a gap in the capacity building of staff members of these organisations, resulting in the primary responsibility for programs often resting on one person alone, with whom the drive and expertise would disappear if they were to leave. In order to ensure more long-term sustainability of the program and stronger internal structures, there needs to be transference of skills and capacity

development to several members of the team. The partners acknowledged that there is sometimes the tendency for overambitious programming, largely as a result of overwhelming demand for services in their communities. The evaluation recommended that partners stay focused on their core activities which are yielding results, but that they strengthen their links with other organisations and government institutions working in their areas, to create a much more effective system of referral, and to work towards building a more cohesive network of interconnected organisations with different skills and services, working together to address HIV and AIDS in a cohesive way. It is also recommended, and this applies to partners under all three program objectives, that in spite of inputs and advances among young people, much more capacity building with and investment in youth organisations

and structures is required, as well as more effort in fully mainstreaming gender and sexuality issues into HIV and AIDS education as directed at young people. Additionally, approaches to prevention work among youth should look at ways for young people to set their own agendas in this context.

Photo: Twice a month the Government Health Department travels to the surrounding Districts of the Southern Drakensberg in Mobile Clinics. These mobile clinics are the only medical treatment centers that almost all of the rural villages are able to get. Here nurses administer treatment and medicine to patients who have sat waiting often whole days to get a chance to be attended to. Matthew Willman/OxfamAUS

Photo above: Pupils from KwaMvimbela High School being educated on HIV and AIDS Awareness. Matthew Willman/OxfamAUS

3.2 Strengthen models of linking HIV prevention and care in integrated community services

the volunteers become agents of change, and a strong motivating force within the community.

In the view of the evaluators, what makes the programs in this group successful and sustainable is that they are communitydriven, involving key community stakeholders at a central level, and often introducing new services at the request of the communities in which they serve. As the focus of this group is on prevention and care, the strong networks that they have established with local clinics, hospitals, other health structures, schools, churches and local municipalities ensures an effective and mutually beneficial referral system, and a sense that organisations are working in partnership against HIV and AIDS.

The Evaluation found that in terms of methodologies for improving the quality of care and support for PLWHA, one on one counselling has been highly effective, not only because in many cases the counsellors are positive themselves, but also because it provides a safe and confidential environment for people to disclose their status, express their concerns, and request advice and support from a counsellor that they have chosen, often according to gender. Partners also reported on significant progress in other areas impacting on the rights of PLWHA, for example in the workplace, where partners have been instrumental in helping to formulate workplace policies; and at home, where families and communities have been mobilized around providing quality care and services to the infected, with family members becoming caregivers.

The evaluation team witnessed the key role that peer educators play in these programs and how they assist in reducing stigma, particularly the stigma around women, given that the majority of peer educators are women, often PLWHA themselves, and in some cases, sex workers. The evaluators observed that they encourage greater openness about HIV through their dramatisation of real life scenarios, and their frankness in discussing all aspects of HIV and AIDS, which encourages participation from their target audiences who engage and participate in these scenarios. There has also been success in reaching marginalized and other targeted sectors, including sex workers, farm workers, truck drivers and the unemployed. Once individuals from these groups are selected as peer educators, it is assumed that there will be a level of behaviour change, and 4

Prevention of Mother to Child Transmission

The active participation of families in providing home-based care services has helped to reduce the stigma and isolation previously experienced by PLWHA in some communities. Regarding the impact of JOHAP programming on policies, practices, attitudes and beliefs, beneficiaries of and participants in these partner organisations confirmed that this has been significant. Many beneficiaries spoke first about the influence of the programs on their own lives, how to access information about HIV and AIDS has helped to change their views, expose prejudices, end the feeling of isolation, and above all, provide support through their staff and services.

Beneficiary Viewpoint “I have seen a change in my own ability to exercise power, especially where this concerns male domination. I have tried to tackle this at home, and things are better, but now there is the fear of me being strong, as a woman. I don’t cry any more, and I am in control and able to discuss things without anger, so I am getting stronger. I used to be very ashamed to ask for things, but I now handle conflict in a much calmer and more authoritative way. Of course, they liked me more when I was more dependent! We do need men, but if they don’t listen, or respond to what we need or want, then we will leave them behind. But the fact is that we do want to work with them” Strategic awareness campaigns have helped to improve attitudes towards PLWHA and have stimulated dialogue around HIV, an example being the intensive campaigns around PMTCT4 programs that helped shift attitudes towards breastfeeding. The evaluators found that the partner organisations are well-established and have earned respect in their communities, to the

extent that they are automatically accepted as valued contributors and participants in any HIV and AIDS related work that takes place in their communities. Some partners now also receive requests for assistance from government structures, as government has come to realize that it can’t deal with this problem alone. Due to the standing of these organisations in communities, employers have also involved partners in devising workplace programs around HIV and AIDS, and so they have been able to shift policies in that way. As men are still lagging behind in terms of testing, condom use and general information about HIV and AIDS, most of these partners are struggling to increase the ratio of men to women in their programs, as experience has shown that the gender dynamic improves and it is easier to shift attitudes when both men and women are involved on a broader scale. In all cases, women participate, volunteer, and become advocates of these programs in far greater numbers than do men for a variety of reasons – men are often away from the rural areas seeking jobs elsewhere, women are more willing to share and to seek information, and women are infected at a much higher rate than men, although they are also the ones to come for testing and to disclose their status.

Photo: Mrs. Sbongile Khumalo, working in one of the vegetable gardens organized and sponsored by a Community Resource Centre. Matthew Willman/OxfamAUS

3.2 Strengthen models of linking HIV prevention and care in integrated community services

the volunteers become agents of change, and a strong motivating force within the community.

Prevention of Mother to Child Transmission

Photo: Mrs. Sbongile Khumalo, working in one of the vegetable gardens organized and sponsored by a Community Resource Centre. Matthew Willman/OxfamAUS

In spite of ongoing efforts among these partners to raise consciousness about gender issues, the evaluators determined that much more needs to be done by way of focused activities or training on gender, gender-based violence and its link to HIV, in order to more fully integrate the concept of gender and reproductive and sexual rights into programs to influence the communities in which they operate. It is clear that as attitudes around gender roles are still so entrenched in many of these areas, there should be ongoing emphasis placed on the need to create a more equitable environment for women to exercise power alongside men.

Attempts are being made to bring forward high profile men willing to disclose their status in public fora and it is hoped that over time this will encourage other men to be as open and participatory. There is also a push to develop more male caregivers to break down gender stereotyping and to challenge prevailing attitudes around gender.

Recommendations concerning this group of partners centre on some areas that apply to other partners across all three

programmatic objectives. The first point concerns the question of gender, which receives much attention in this report â&#x20AC;&#x201C; it should be noted here that the understanding of the gender dimension of HIV and AIDS, or rather the capacity to insert this into every process, varied from program to program across all three objectives. The evaluators received the impression that this issue is less fully mainstreamed into processes in some rural areas than in urban areas, with

some exceptions, although a contributing factor is the overloading of staff to address the overwhelming needs of communities, with little resources and energy in reserve.

Photo: During a school lunchtime break boys gather to relax, kick a ball and talk openly between each other. Soccer is a favourite game for the young men and one can often see them gathering to play friendly matches between each other. Matthew Willman/OxfamAUS

The skewing of programs towards far greater involvement of women, based on the high prevalence, while supportive of the need to empower women, has led to the concern that men and boys are not being actively targeted for inclusion in program activities to the same extent. The evaluators, and the partners themselves, consider this an important area of focus, to attempt to find ways to reach boys and men, to make information about HIV and AIDS available to them, and to encourage their participation, as a way to challenge prevailing attitudes about the disease and gender stereotyping. The recommendation for advocacy training for partners applies to this group as well, many of whom lack adequate skills in advocacy, but for which they are poised, given the influence that they carry and the fact that they have sufficient power and

alliances to fulfil this role. The most practical solution would be for JOHAP to allocate funds specifically for advocacy training across the program, and to deploy the services of one of its advocacy partners in support of this, as this could also lead to a more unified approach to advocacy throughout the JOHAP partnership. The evaluation team also noted the need for improved tools for measuring impact, particularly with regard to the Peer Education awareness campaigns, as most data collected so far seems to focus on numbers reached, and not the quality of the message and its impact, or the extent to which it is able to reach sectors of the community, and effect behavioural and attitudinal change on a meaningful level. Overwhelmingly in this group, poverty is identified as a major contributing factor to the spread of HIV, the difficulty in containing it, and to the ongoing pain and suffering of PLWHA, who battle to cope with the impact of HIV and AIDS without proper nutrition, treatment and support. The evaluation recommends that much more be done in forging links with government structures, to motivate for their involvement in poverty alleviation and income-generating projects, as the partners themselves are unable to address alone social problems of that nature. By creating stronger relationships with government, the partners will be in a better position to provide support and increase pressure regarding service delivery.

The social implications of poverty in areas of high unemployment are obvious, hence the need for partners to insert themselves into all forums looking to address those needs, so that they are freed up to concentrate their energies on activities around prevention and care that target their communities and marginalized groups trying to survive under adverse conditions.

Photo: Mrs. An elderly woman attending the Seminar. The elderly are taking upon themselves to lead the initiative in teaching and supporting younger people the effects of HIV and AIDS. Matthew Willman/OxfamAUS

Recommendations concerning this group of partners centre on some areas that apply to other partners across all three

some exceptions, although a contributing factor is the overloading of staff to address the overwhelming needs of communities, with little resources and energy in reserve.

3.3 Create a more enabling environment for HIV programming with a focus on the rights of PLWHA The evaluation established that partner organisations falling into this group represent the strongest gendered approach and have excellent advocacy credentials, particularly those in the KwaZulu-Natal (KZN) region, given that this group comprises most of JOHAP’s advocacy and capacity building partners. Many of these organisations deserve credit for the key role they have played in strengthening the civil society response to HIV and AIDS, for raising awareness and making contributions around issues such as the effect of HIV and AIDS on women and girls, marginalisation in the context of HIV and AIDS, diversity, sexual orientation, gender roles, children’s rights and the rights of PLWHA and how

Quote from Beneficiary “Now even the children understand issues around gender and HIV. For example, I have trained my older Grade IV kids to be peer counsellors to the younger kids, as they talk the same language. I am shocked at what good communicators some of them are turning out to be, how confident they are at public speaking, and how they link what they have seen on TV with lessons about HIV and gender.”

stigma breeds vulnerability, to name just a few. Additionally, several organisations in this group have effectively contributed to policy changes particularly where this concerns the legal and human rights of PLWHA. JOHAP partners have forged strategic partnerships with local, regional, and international partners, and have earned respect from a variety of these alliances. An outcome of this type of collaboration is the inclusion in a network of highly effective referral systems, creating a more cohesive civil society response to HIV and AIDS, and another is the influence some partners have brought to bear through their advocacy work on issues of global debate, for instance around microbicides. The links with government and other institutions have grown stronger over time, and many JOHAP partners are now consulted to provide expertise and guidance in matters relating to HIV prevention, treatment, gender equity, violence against women, the legal and human rights of PLWHA, and behavioural change. One partner organisation is part of a key strategic initiative in the KZN Provincial HIV Dialogue, for which they will be convening a series of meetings between the Department of Health, the corporate sector and civil society, which is the kind of activity that the evaluators would envisage more of in the next phase of the program. The programs dealing specifically with the law and HIV have seen a sharp rise in the number of referrals of patients and clients seeking to protect and access their rights. Beneficiaries interviewed for the purposes

of this evaluation demonstrated a greater confidence in the legal process; having experienced personally, through the services of these organisations, that access to justice also exists for poor people like themselves. Those organisations running workshops pointed to pre and post-workshop evaluations which indicated the changes people had undergone as a result of their participation, and gave valuable feedback for the structuring of future workshops. Participants in programs have demonstrated a clearer understanding of the socioeconomic drivers of HIV, have shifted their attitudes towards diversity, and have shown progress in terms of analysis and interpretation over time. The evaluation also found that with most of these programs, the primary beneficiaries are women and young people, without being specifically targeted, as in reality it is these groups that are coming forward to receive services and to participate in the programs. However, partners in this group also recognize that they need to try to integrate men to bring about real change. Attempts are being made to actively include men in a range of forums, for instance the work being done in Limpopo with men from the South African National Defence Force, and traditional leaders, in which gender issues are incorporated into outreach activities. However, the question of gender equity has to be handled sensitively in these areas, and approached within the cultural context, which is by nature more traditional and conservative.

As far as the empowerment of women is concerned, there is much strategic work being done by these JOHAP partners – for example, the advocacy work of two organisations around microbicides5, given that this is a women-controlled technology that does not require negotiation of condom use, as well as contributions to a wellcirculated paper on the effects of HIV and AIDS on women and girls6. Several JOHAP partners are very seriously exploring what gender transformation means, believing strongly that change 5

needs to happen on an intensely personal and intimate level, in order to transform power relations from the ground up. For some partners there is also a focus on working with diversity as well as marginalized groups, in order to increase the impact of program work to incorporate all those who are affected by stigma and isolation. Related to this is the recognition by two of the partners that efforts must be made to draw in older women on whom the burden of care is placed increasingly, but who are also marginalized.

For many of these partners and beneficiaries, drama and role-playing are powerful tools with regard to reaching the youth, as well as new workshop methodologies.

Photo above: Elias Mabuza ia a PLWHA who has disclosed his status to the community. Here he is reunited with his mother, after he returned from Zimbabwe. Paul Weinberg/OxfamAUS

The Gender AIDS Forum (GAF) has been instrumental in establishment of the African Microbicides Advocacy Group (AMAG), a network of over 180 African researchers and advocates involved in microbicides-related work in Africa. Campus Law Clinic (CLC) also participates in this initiative UN SG Report on The Effect of HIV and AIDS on Women and Young Girls, to which GAF contributed

For many of these partners and beneficiaries, drama and role-playing are powerful tools with regard to reaching the youth, as well as new workshop methodologies.

Photo above: Elias Mabuza ia a PLWHA who has disclosed his status to the community. Here he is reunited with his mother, after he returned from Zimbabwe. Paul Weinberg/OxfamAUS

These methods take young people and participants through a process of confronting and coming to terms with their own sexuality and attitudes, teaching them to turn this insight outwards, to understand others and what makes people vulnerable to HIV infection. In Limpopo province, the main activity of community peer educators is to empower women on sexual and reproductive rights, where they have seen marked improvements. The greater involvement of PLWHA has also helped to mobilise communities and instil a sense of ownership in the program. The extensive involvement of PLWHA in each of the partner programs is a defining principle throughout JOHAP, and is recognized as central to the effectiveness of the programs and their ability to have increased impact.

Many of the beneficiaries interviewed have HIV very close in their lives, personally or through family members, and their increased access to information through the partners has changed the way they approach the disease, and how they manage it in their own lives and their communities. While some of these programs are not directly involved in the communities, but act more as intermediaries between workshop participants and the communities in which they operate, the assumption is that the experience gained by their participants will ultimately reach a wider audience through the lessons they have learned. Individuals confirmed to the evaluation team that they feel far more empowered to respond to gender discrimination in their personal lives,

places of work, and communities, have a new understanding of issues like diversity and sexual practices, and see the added benefit of having acquired valuable skills in terms of how to address HIV and AIDS in their communities. Additionally, beneficiaries displayed far greater confidence in the legal process, and spoke of reduced stigma in their communities once they were made aware of how to tackle discrimination and access their rights. The recommendations made by the evaluation team for this group include greater investment and capacity building in youth institutions, as many partners raised this issue, and the problem of older people targeting younger people, when the youth should be setting their own agenda

and driving initiatives. The suggestion is that JOHAP consider at funding youthcentred organisations, as the issue here is not lack of involvement of young people, who participate as a matter of course, but more a lack of concerted investment in youth structures and of new and relevant conceptual frameworks that effective capacity building of the youth. The second recommendation arises from the fact that many JOHAP partners are engaging in relief work and taking on the work of government institutions, to the detriment of their prevention work. This is compounded by an often difficult or combative relationship with the Department of Health and other government structures, and the fact that many organisations have not been adequately inserted into processes, for example government ARV rollouts, where they could provide valuable back up by way of information and referrals. Some JOHAP organisations are focusing on establishing communication at a basic level between government and civil society, in order to ramp up delivery of essential services. In this context, the evaluators recommended that the links with both local and national government structures be strengthened, to address the problem of relief response and service delivery. Linked to this is the suggestion that JOHAP, on behalf of its partners, embarks on a targeted campaign to profile its organisations and the valuable work they are doing, not only to civil society but to government institutions as well, and to highlight the fact that these organisations and their activities are complementary,

Photo left: A young boy plays while his mother is being attended to by the nurses behind. Matthew Willman/OxfamAUS

that they are supportive and enabling centres that are well-placed to support government and other institutions in their task of providing basic services and access to treatment. An obvious factor in this strategy of raising the profile of JOHAP partners and the work they are doing, is the contribution this can make externally in the response to HIV and AIDS. Related to this point is the need for JOHAP to back and recommend the kinds of methodologies created and used effectively by JOHAP partners to a wider audience, so that the benefits of their services and practices can permeate outwards, and to also facilitate more regular transfer of expertise that exists in the JOHAP fold. Other recommendations from the evaluation team include the need to find innovative ways to involve men in programs, to create forums that will motivate men to participate in an environment that they consider safe, but still appropriate for challenging existing perceptions of gender and HIV. Also, there needs to be a better system of tracking clients once they have been referred to other organisations, to measure the impact of these programs in association with others, and their ability to provide services as a collective. Better evaluation tools are also needed to measure behaviour and qualitative change in peopleâ&#x20AC;&#x2122;s lives, and the degree of progress partners made by partners toward their objectives. There needs to be ongoing profiling of success stories, either through the use of case studies or stories to highlight individual

contributions to creating a more enabling environment for PLWHA. Partners pointed to lack of time and additional resources to facilitate this, and it is suggested that JOHAP assist with finding avenues and resources for publishing material to a broader audience.

Photo above: Women often carry umbrellas to protect themselves from the sunâ&#x20AC;&#x2122;s rays whilst walking long distances. Matthew Willman/OxfamAUS

Photo left: A young boy plays while his mother is being attended to by the nurses behind. Matthew Willman/OxfamAUS

Photo above: Women often carry umbrellas to protect themselves from the sunâ&#x20AC;&#x2122;s rays whilst walking long distances. Matthew Willman/OxfamAUS

4. Evaluation objective two issue of sustainability of programs is of concern to most partners, and a range of strategies are being deployed with this in mind, including community support and empowerment, and targeting of other donor organisations. They have also found that if government officials are involved in, or aware of programs, it is easier to market them, and to get funding. JOHAP partners are at various stages of putting systems in place for sharing information, and for the most part, they are active in all forums in their communities, attending a variety of events and NGO forums as a way of sharing experiences and avoiding duplication of services.

4.1 Assess and make recommendations on whether the strategies engaged by JOHAP have contributed to the overall program response. As part of its strategic plan, JOHAP outlined its strategies for providing support to its partners, including managing financial disbursements, assisting them to identify their technical support needs, linking them with organisations and resources to meet those needs, and monitoring and evaluating the implementation of projects. The level of support would vary from partner to partner based on the stage of the organisation’s development. Those partners with less formalized expertise have relied extensively on the capacity JOHAP has provided in terms of technical support on program management, organisational development,

documentation, and financial management. The Evaluators found that partners felt their capacity and knowledge had increased around these issues, and as a result many are actively building external relationships and submitting funding proposals to other organisations in response to JOHAP’s encouragement that partners look for ways to diversify their funding. By fortifying the skills base of its partners, JOHAP is contributing to good practice and the development of tools, manuals and methodologies that can have wider relevance in the HIV and AIDS sector. The Evaluators found that partners are more focused now on the need to share information, to improve documentation and dissemination of lessons learned and good practice to a wider audience, and the

benefit of stronger relationships with the external environment. Partners understand that sharing and documenting information presents a vehicle for getting their services more widely known, and the exchange it facilitates informs them of other practice areas that complement or could add value to their own activities. Access to and sharing of information also assists in future planning and structuring of programs, in re-evaluating their own programs and impact, identifying gaps in terms of training or services, highlighting areas for collaboration with other organisations, and positioning partner programs to other potential donors. The

Photo above: Seminar at the Kwamakhuta Library. Matthew Willman/OxfamAUS

JOHAP’s quarterly monitoring visits and reporting and the annual partner platforms were praised as helpful forums to discuss their technical support needs, to provide and exchange mutual support, to learn from others experiences in program development, to monitor their own progress against those of their peers, and to look for innovative strategies that could enhance the effectiveness of their own programs. The partner platforms also provide opportunities for linking and learning between partners which many found very beneficial. In terms of other linking and learning strategies, the evaluators recommended that more could be done by JOHAP to facilitate the linking of organisations within and across sectors to encourage an exchange of lessons learned. Several JOHAP partners are in a strong position to assist in this initiative, due to their own links with regional and international bodies. Interviews with partners revealed that many

Targeted AIDS Intervention

are not aware of the range of documented lessons, models and tools being used outside of the JOHAP network, which indicates that relationships with other organisations need to be strengthened at a strategic level. These organisations should include national and international NGOs, government bodies, academic institutions, UN organisations and other donors, with whom JOHAP should institute a mutual sharing and exchange of lessons learned, thereby ensuring that JOHAP’s own good practice will reach a wider network. The challenge still remains for JOHAP to be more effective in documenting valuable lessons learned and sharing them with a wider audience. Most partners spoke of a wish to improve their documentation, and to include pamphlets and posters on current and pertinent issues, for example information on men’s issues6. While most partners had instituted basic monitoring systems, the results of this evaluation show that more qualitative data is still lacking from many reporting systems. More support needs to be given to partners in compiling case studies of their projects, and to distribute these to appropriate audiences and stakeholders. Additionally, there needs to be more attention given to ongoing publishing and distribution of documents, manuals, case studies, profiles and expertise that resides within these partner organisations, through printed materials, websites, e-mail, media campaigns and distribution at conferences and large events focused on HIV and AIDS. Many of the partners themselves are involved in publishing pamphlets, newsletters, training manuals, profiles and case studies, as well as participating in radio programs and

media campaigns, but the evaluators heard repeatedly that the primary obstacles for sustaining this momentum are time and resources. The costs of publishing materials over and above partners’ mandated activities are often prohibitive. The task of creating a more public profile for JOHAP and its partner organisations is related to the external relations work in which JOHAP is engaged. In order to improve the cohesion of the civil society response to HIV and AIDS, it is important to continue focusing on building strategic alliances at a program management level, and to maintain JOHAP’s visibility in conferences, seminars and forums that are contributing to this cohesion, and are actively building consensus and cooperation around programming and policy. Some work has undoubtedly been done in this regard, but the poor response received from external stakeholders approached for feedback on JOHAP for the purposes of this evaluation points to a lack of recognition of the combined work and contribution being made by JOHAP partners to the overall quality and cohesion of the civil society response to HIV and AIDS. As suggested by program committee members, JOHAP needs to be positioned much more visibly within the broader South African response, it needs to be seen to be stimulating dialogue, and creating stronger links with other structures within and outside of civil society. By putting the program on the map, JOHAP fulfils its mission of improving the quality and cohesion of the civil society response to HIV and AIDS, but also enhances the prospects of sustainability of its programs.

Photo above: Seminar at the Kwamakhuta Library. Matthew Willman/OxfamAUS

Targeted AIDS Intervention

Emergent themes The evaluators highlighted some important emergent themes during the evaluation process, which place the recommendations at the beginning of this executive summary into a broader perspective. These factors define a larger landscape as it affects partners and other organisations conducting work in the HIV and AIDS arena. • While JOHAP is small, it is considered to be influential and progressive by its partners, and the staff members in the Durban office are well respected and accessible, and have succeeded in building relationships that are healthy, constructive, and consultative. • The issue of women and stigma is an ongoing concern, and taps into the fact that attitudes around gender, gender roles, sexual and reproductive rights and violence against women are still entrenched, and contribute to this pervasive problem. Linked to this is the lack of participation of men in program activities, not through deliberate exclusion, but more as a result of a reluctance on the part of men to fully enter into efforts being made to understand what underscores the prevalence of HIV and AIDS, how their own behaviour is a major contributory factor, and how their attitudes perpetuate the inability to stem the rate of infection.

with providing relief services to fill in the gaps left by a government unable to fulfil its role in this regard. • Issues concerning professional and economic power also came to the fore, with many poor people failing to exercise their rights due to a lack of status or employment, and women not feeling empowered to do so as a result of economic dependence. • It also emerged from the work of several partners that older women as a group have been excluded from many debates around HIV, and are marginalized in spite of the increasingly large burden of care that they are carrying in terms of caring for infected and affected children left behind.

• It was also clear that there needs to be more investment in youth structures, in order to transfer the ownership of programs to young people, who are most at risk, along with women, and who need to be empowered into the future. • The importance of strengthening partnerships with government also came through strongly as organisations struggle

Photo: Martha Maeokela, a PLWHA and HIV and AIDS activist, at home with her son, Mogomotsi and her new partner. Paul Weinberg/OxfamAUS

Acronyms ARV CBO GBV HBC JOHAP NGO OCAA OVC PLWHA PMTCT STI TAC VCT

Anti-Retroviral Community Based Organisation Gender-Based Violence Home-Based Care Joint Oxfam HIV/AIDS Program Non Governmental Organisation Oxfam Community Aid Abroad Orphans and Vulnerable Children People Living With HIV/AIDS Prevention of Mother to Child Transmission Sexually Transmitted Infection Treatment Action Campaign Voluntary Counselling and Testing

HIV and HIV denotes the nonAIDS symptomatic stage of HIV infection and AIDS the end stages of infection with symptoms – in line with the UNAIDS usage HIV and AIDS is used throughout rather than the more common HIV/AIDS. CSA Centre for the Study of AIDS

Oxfam Australia, 156 George Street, Fitzroy Victoria, Australia 3065 Telephone +61 3 9289 9444 www.oxfam.org.au

Photos

“Personally, I used to depend on my counsellor to take action on my behalf, even within my family. But since this course, I am more able to handle my own affairs, to be myself, to be proud of my body when I look in the mirror, so it has given me so much more confidence, as a woman.” Beneficiary 22

Right: Volunteer Care organisers from RYDO go out into the community to promote HIV awareness amongst youth. Depicted in this series of images is a scene where the Volunteers demonstrate how they use a busy informal trading post and Taxi Rank to build awareness of HIV and AIDS by singing and dancing. The music is loud and the movements are bold with much clapping and rhythmic dance. Through singing they tell a story of HIV and AIDS usually centered around an individual. As most of the people around them are illiterate who have either never been to school or only got to a certain level of education can understand the song and dance the massage that is being promoted by the Volunteers helpers from RYDO. The community have grown to respect these young adults and how they have pledged to being more pro-active in their community. The volunteers work in and around the Mbaleni Village which lies a few kilometers East of the larger town of Thohoyandou. Matthew Willman/OxfamAUS Back cover: Small children on their way home from nursery school in Stepmore village. Matthew Willman/OxfamAUS