From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Monday, part 3
Note: non-commercial reproduction.
Archive-Number: 5735
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 20 Jul 92 20:30:06 GMT

CONFERENCE NEWSPAPER - MONDAY, PART 3

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How international cooperation should change in the face of 
AIDS

Every year, the world spends about $50 billion on 
international cooperation through official channels. In 
1991, about $250 million of this was spent on activities 
directly related to the HIV pandemic, just 0.5 per cent of 
the total.
Some would argue that the true amount is much greater. But 
the most visible funds for international cooperation 
related to HIV are designated as official development 
assistance or ODA: the WHO committees and technical 
advisers, the UNICEF four-wheel-drive vehicles, and so on.
Is $250 million enough? We expect a lot from official 
development assistance. The work of international 
cooperation agencies has been in the limelight ever since 
the promotion of the "worldwide effort to stop AIDS" in the 
1980s. But $250 million - $25 for each person who had been 
infected with HIV by 1991 - is a pittance. To make matters 
worse, it is often difficult to direct the available money 
to the programmes which most need it.
What is the solution? AIDS could take a bigger slice of the 
total official development assistance. I have no doubt that 
this will gradually happen. But the margin for growth is 
narrow. Additional money spent on AIDS has to be taken from 
some other sectors. The environment, population, children, 
drought relief - take your pick, where would you like to 
make the cut?
Official development assistance could increase - even 
double - if all industrialised countries met the target set 
by the United Nations to allocate 0.7 per cent of their 
gross national product to this type of assistance. But in 
the present economic and political climate this is 
unlikely. Just maintaining official development assistance 
at present levels will be a political achievement.
It is time to reexamine the unrealistic expectation that 
international cooperation agencies could or should shoulder 
most of the response to HIV. As in all other fields of 
development, mobilisation by affected individuals, 
communities and countries accounts for an overwhelming 
share of the response to HIV. So what should the role for 
international cooperation agencies be?
The agencies must also recognise that they cannot "control 
AIDS". They can only lend a small helping hand to the 
communities and countries who need to formulate and 
implement their own responses, and with whom the ultimate 
responsibility for an appropriate response to HIV rests. 
But let us not stop there. HIV, the agencies are telling 
their partner governments, is a "multi-sectorial" issue. 
How does that affect the delivery of official development 
assistance? What about the $49.75 billion spent on projects 
other than AIDS? To what extent is HIV considered when 
planning projects for other sectors? How often do the 
planners of agricultural develop-ment projects take the 
effect of their proposal on gender relations into account? 
What about the effect of housing thousands of male 
construction workers in camps and hostels? How many 
railroad projects have included strategies to prevent the 
spread of HIV along major transportation routes?
Maybe $250 million is not enough. But an adequate response 
by international cooperation agencies is not expressed in 
dollars alone. The response will be adequate when the 
agencies are ready to integrate the following question into 
their decision-making process: "Will this policy, programme 
or project contribute to a social environment that supports 
a decrease in the spread of HIV, and will it improve the 
capacity of the affected population to cope with the 
epidemic?"
The environmentalist lobby has imposed an environmental 
audit on the activities of international agencies. A 
similar social audit is not only justified in the face of 
the HIV pandemic, it is urgently needed.

Josef Decosas, AIDS specialist, Health and Population 
Directorate, Canadian International Develop-ment Agency

Reference
Miller N, Carballo M. AIDS: a disease of development. AIDS 
and Society, 1989; 
1 (1).

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Sex is now a Tvery open topic'
By Janis Kelly

Every nation must mobilize the resources it has to fight 
the AIDS pandemic, and in Zambia the most freely available 
resources are the natural kinship ties that exist 
throughout society, according to Elizabeth Mataka of the 
Family Health Trust in Lusaka, Zambia. The trust, founded 
by Mataka in 1987, runs five decentralized AIDS-related 
projects: care for orphans (many of whom have lost parents 
to AIDS); home-based care for people with AIDS; education 
for teachers; an AIDS education programme for school 
children and young adults; and an AIDS education caravan 
that parks in markets, car parks and other places where 
people gather.
Mataka is a social worker whose long involvement in child 
welfare projects led naturally to her present work when 
AIDS became a significant health problem in Zambia. 
According to a recent pilot study in the Matero area of 
Lusaka, more than one in 10 children under age 20 had lost 
one or both parents. Mataka believes many of these losses 
were due to AIDS, although the extent to which AIDS has 
orphaned children locally and nationwide is unknown.

Research
Mataka says: "We hope to convince the government and major 
funders that we need research to determine the true extent 
of this situation. The AIDS orphan problem does exist in 
Zambia, and it is a problem that must be addressed now."
The approach Mataka and the Family Health Trust have 
developed relies on kinship ties to provide care for 
orphaned children while keeping them in their usual 
neighbourhoods and schools.  "The problem in Zambia is so 
large that we cannot afford to remove all of these children 
from their homes to other places for foster care,"  says 
Mataka.  "We get other family members, teachers or other 
adults close to the family to be Tcaretakers' providing 
guidance and care for these young people.  Aid for orphaned 
children is funnelled through these caretakers."  The 
educational project targets primary school children and 
young adults through 1,500 anti-AIDS clubs in schools 
throughout Zambia.  "We are attempting to distribute AIDS 
education information through these club members to the 
wider community Q their parents, for example," Mataka says.  
However, although basic AIDS information is now dispersed 
fairly widely among these younger Zambians, the traditional 
hesitancy between generations about discussing sexual
matters, particularly between parents and children, appears 
to be inhibiting the spread of infor-mation.

Caravan
Mataka says that this became particularly clear in the 
caravan project.  Children are immediately attracted to the 
van with its audio and video equipment, but their presence 
inhibits the type of
frank discussion needed by adults.  Success with the 
caravan has been greatest in villages and market-places 
where the local residents can build a small enclosure for 
the visiting caravan, thus keeping children out from the 
adult discussions.
Like most non-governmental organizations, the Family Health 
Trust is always short of funds. Support has come from 
private foundations and from the Norwegian government 
(NORAD), the European Economic Com-munity and the Danish 
government, but Mataka is always dealing with the problem 
of finding money and how to develop and keep staff in such 
an insecure atmosphere.

Stressful
Providing HIV-related services has been more stressful than 
Mataka's previous work because AIDS is "so final". She 
says: "As a social worker, when you get involved in a 
problem, you usually expect to come up with a plan, to work 
with the person through the necessary stages and finally to 
see the client become their own person, independent of you. 
With AIDS, your focus has to be different.  You work out a 
plan for making the person and family as comfortable as 
possible, but you know that the ultimate outcome will not 
be what you would like it to be."

Taboos
Mataka is able to cope with this stress in part because her 
husband is also a social worker and understands the 
problems she faces every day. Her work in the AIDS crisis 
has caused personal changes: "Doing this work has changed 
me in one big way - some of the traditional attitudes and 
taboos have ceased to have meaning for me.  When I deal 
with my children, for example, I know that I am dealing 
with a matter of life and death where AIDS is concerned. 
This business of not being able to discuss sex is over. 
Before I became involved with AIDS education, I was part of 
that large group of parents who find it very difficult to 
discuss sex with their children. Now, it is a very open 
topic."

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How the 1992 Conference Got From Boston to Amsterdam 
By William Check

In 1986, when Max Essex, chairman of the Harvard AIDS 
Institute, was asked whether he would head the effort to 
organize the 1992 VIIIth International AIDS Conference in 
Boston, his first concern was to make sure he would have 
the support of his Harvard colleagues. Having satisfied 
himself on that point, he agreed. He had no inkling then 
that his real nemesis would be US immigration policy, which 
would ultimately force the meeting to be cancelled, then 
moved to Amsterdam. 
Nor could he have foreseen how personally torn he would be 
during the "week of decision" at the 1991 meeting in 
Florence. Looking back at those few days, he says: "There 
were no easy options. It was an extremely difficult 
decision." 
In 1986, Essex's colleagues at Harvard convinced him that 
it would be valuable for Harvard, and especially the 
Harvard AIDS Institute, to host the meeting. 
The first signs of trouble appeared around the time of the 
San Francisco meeting in 1990. Essex says: "There was a lot 
of unrest and confusion about holding the meeting there 
because of the discriminatory American laws". 

Restrictions
Some agencies decided to stay away. It was in San Francisco 
that Essex was first asked what he would do if, two years 
later, the same disciminatory legislation existed. His 
response was that he would not have the meeting in Boston, 
but have it somewhere else - anticipating that, by then, 
the legislation would be changed. 
In late November 1990, the US Congress decided to leave 
restrictions on the travel of HIV-infected people up to 
Louis Sullivan, the Secretary of Health and Human Services 
(HSS). People assumed that this move would solve the 
problem, as Sullivan could take HIV off the travel 
restriction list.
But in the late spring of 1991, the US government announced 
more studies of concerns about HIV, and that until they 
were completed, HIV would remain on the restricted list. 
The result was a severe problem for Essex, who was required 
to give the traditional talk at the last session of the 
Florence conference, inviting people to come to Boston the 
next year. What should he say? 

Rallying point
Most activists present at Florence were strongly against 
having the meeting in the US if the discriminatory 
legislation was still in effect. Yet, Essex says, there 
were many delegates, particularly from Third World 
countries, who were very upset by the idea of terminating 
the meeting, which would leave no forum for information 
exchange. 
Some activists later said the meeting should have been held 
in the US and used as a rallying point. But Essex questions 
whether it would have been right to take over the 
conference as a vehicle to protest against American 
discriminatory immigration policy. 
"I faced a very difficult dilemma at that time," he says. 
Visibly upset during his closing speech at Florence, he 
announced that the meeting would not go ahead in Boston. 
Harvard agreed with his recommendation.

Brilliant
The question remained of whether there would be a meeting 
at all. But Harvey Feinberg and Jonathan Mann decided the 
meeting should be held in another country. Together with 
Dutch experts, they arranged joint administration: each of 
the four Harvard track chairs would work as a co-chair with 
a Dutch counterpart. 
Essex calls the choice of Amsterdam "brilliant". He is, he 
says, delighted with the way it has come to fruition.

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Conference Newspaper 
VIII International Conference on AIDS/ 
III STD World Congress
Amsterdam, The Netherlands 
19-24 July 1992

Editor: 	Sharon Kingman
Deputy Editor:	Cindy Patton
Writers: 	William Check
	Janis Kelly
	Simon Rozendaal
	Wim Zeijlemaker
Translators:	Elena Hanselaar 
	Annette Eskenazi
Managing Editor:	Jackie Bailey
Production Manager: Karin Balster
Layout & Design: 	Kuiper & Company
Photography: 	Rob List 
	Fotografie BV

Published by: 	Medialert Projekten BV
Publisher:	Willem Korteling
Printing: 	Salland Rotatie 		Drukkerij, 
Deventer
Conference Directors 
of Communications: 	Hilary Rao
	Nono Landheer
Conference Com-
munications staff: 	John Willoughby
	Pien Witteveen

Supported by an educational grant from 
The opinions expressed are those solely of the authors.

The Conference Newspaper gratefully acknowledges the 
generous assistance of 
Van Beek Automatisering.

-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands