Wednesday, August 17, 2011

Public Opinion of Behavior Change

I try really hard to keep up with current events while I am here in Uganda. Sometimes I feel so displaced from what is going on in the rest of the world because when I am out in my community it is not the easiest to access current world news unless spending an arm and leg for internet time. Frankly, what it boils down to is I need to invest in a radio so I can listen to BBC, but until that day I will continue to get my news from the internet. One place I like to read periodically is the World Policy Journal's blog. A couple of weeks back there was an interesting editorial post by an RPCV writer entitled "The U.S.'s Failed HIV Policy". She was a volunteer that served in Botswana which is a country that has had a comparably large HIV infection rate since epidemiological data has been recorded. This is vastly different from Uganda's story mostly due to the Ugandan people being more open to helping themselves and changing risky behaviors to safer solutions when it comes to their sexual behavior. Though in no way am I saying Uganda is perfect and/or not still facing challenges.

This particular article was frustrating for me to read because as a current PCV who is a PEPFAR funded PCV (PEPFAR gives so much money to fund certain community health volunteer spots per Peace Corps Program) as well as a PCV who is working for an organization that is funded by PEPFAR and U.S. Military HIV Research Program I disagree with her stance on U.S. involvement in international communities regarding HIV/AIDS interventions. The author stated that Botswana has failed to decrease their infection rate due to lack of behavior change within the local community. She attributes this to the fact that PEPFAR, which is the program that supplies most of the HIV/AIDS program money to African countries (Uganda receives $300 million annually), has behavior change messages focusing around abstinence, being faithful and use of a condom (ABC's) that were never tested in the U.S. community or international community before being put into practice. She attributes these beliefs to be American and that trying to change the morals and values of a traditional African society is the wrong way to insure development. However, the ABC's model I would argue is not placing American morals and values on this society more so giving people a model of safe sexual behavior to follow for a better chance at a healthy sexual lifestyle. It is said that the ABC's model stems from Christian ideals about safe sex and perhaps I have less frustration with this model here in Uganda than the writer did in Botswana because Uganda is a predominately Christian society at 85.2% of it's population following the religion.

During her Peace Corps service the writer spoke of seeing the issues with U.S. funded HIV/AIDS work in her host country and so to try and help her community more she started to focus on women's empowerment. This is because it is a male dominated society in Botswana and when it comes to sexual practices and behaviors the men hold all the cards. Her project and many more of it's kind aims to be sustainable long term though the end result of the empowerment takes a very long time to reach. This is because the main goal is behavior change and that takes time. However, what the author did not mention is that PEPFAR allots part of it's annual Abstinence and Being Faithful (A/B) budget as well as Other Prevention Activities (O/P) budget to incorporating gender and development activities related to HIV/AIDS as well as creating empowerment projects in local communities. If a current PCV were to write a grant being funded by PEPFAR they now have to included both gender and development life skills and women empowerment into their project or they will not receive funding. Personally, the Youth Center where I work is funded out of the A/B and O/P budget and part of my job is to insure that those programs are being implemented in my community as it relates to HIV/AIDS and gender. Quite frankly I think in a male dominated society you can empower the women as much as possible, but if the men do not accept their new lease on life than the work will not improve the lives of the women involved. More effort needs to be placed on educating men on how to be a better member of the community, friend, lover and husband while also working with women in the same community to greet the goal of behavior change and a lower infection rate.

I think if you look at any development model long enough you can say that their mission and implementation is not the best for the community at large because it disagrees with local cultural beliefs and practices, but I think something important to remember is that prevention strategies are set by the funders and not implemented by them. Workers on the ground level are having the impact on the community: they know what the community responds best to, what they need and what they want as far as education, VCT and condom distribution. I believe that if you have an effective way of teaching health education while implementing the goals of the funding organization then the sustainable behavior change impact can happen.

Though I guess it all boils down to the authors first point: that you can not help people who do not want to help themselves. This is a challenge in any development work and present on anyone's mind who is working abroad. Overall the intentions of development organizations are good even if their models are not up to par with everyone's public opinion.

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