INTERNATIONAL: Money in Her Hands: Funding Survivors of HIV/AIDS, Violence Against Women and Conflict

What if funding was given directly to women survivors of HIV/AIDS, violence against women and conflict? A two year project undertaken by Isis-WICCE and the Urgent Action Fund-Africa seeks to answer this question.

Algeria, Burundi, Chad, the Democratic Republic of Congo, Eritrea, Kenya, Guinea Conakry, Liberia, Nigeria, Morocco, Rwanda, Sierra Leone, Somalia, Sudan, Uganda, Western Sahara, Zimbabwe. These are all countries on the continent of Africa that are on the brink of conflict, in the midst of full-blown conflict or have just emerged from conflict.

The need to address the intersection between HIV/AIDS and violence against women is gaining more and more currency. Violence or the threat of violence affects women's ability to negotiate for safe sex. Violent sex or rape can increase the chances of contracting HIV because of the greater likelihood of lacerations which are entry sites for the virus. Some women fear getting tested for the virus or disclosing their status if they are HIV+ for fear of abandonment or violence, and this affects their chances of getting vital treatment and psychosocial care early.

Responding to the three dimensions
A recently concluded project implemented by Isis-WICCE and the Urgent Action Fund-Africa (UAF-Africa) with the support of the Ford Foundation sought to address – and provide funding for - the intersection between HIV/AIDS, violence against women and conflict. They decided to undertake an experiment to see what would happen if money was put directly into the hands of survivors of what UAF-Africa Executive Director Jessica Nkuuhe, calls the “three ugly heads.” The project focussed on three countries: Liberia, Uganda and Zimbabwe, and the beneficiaries, donors and women's organisations recently gathered in Nairobi to reflect on the project.

Multiple obstacles
Conflict fuels these so-called twin pandemics of HIV/AIDS and violence against women. In situations of conflict, there is a general breakdown of law and order. Incidences of rape multiply as women's bodies are treated as battle sites where rape is employed as a weapon of war or genocide. It is not only combatants who rape; civilians do so as well, and since no one has any recourse to formal justice, rapists know they can get away with it.

Insecurity affects people's mobility which means that many people living with HIV/AIDS cannot travel to health centres where antiretroviral therapy is administered. In some post-conflict situations where there is relative calm, poor road infrastructure and lack of money for bus or taxi fares can make it difficult for people to go to health centres to get their drugs. This is the case in much of Liberia and conflict-affected parts of Uganda. In Liberia the government provides free and sufficient quantities of antiretroviral drugs to people living with HIV/AIDS. Stigma and fear of ostracization prevents many people from getting tested for HIV or going to health centres to get drugs. In rural areas, poor roads and lack of means of transport are also a barrier. Levels of awareness about the disease and how to prevent and treat it are generally low.

In Uganda on the whole awareness levels about HIV/AIDS are high, but in conflict-affected areas of northern and north-eastern Uganda, there is less knowledge about how to prevent and live with HIV/AIDS.

In Zimbabwe, many qualified medical doctors, nurses and other medical workers have fled the politically and economically volatile environment to seek better opportunities abroad. This means that the ailing health system has a huge shortage of medical personnel which in turn means that the overall quality of responses to HIV/AIDS is compromised.

Women make their own decisions
The project by Isis-WICCE and UAF-Africa put women at the centre of the analysis of their problems, and the identification of solutions to address HIV/AIDS, violence against women and conflict. In each of the three countries where the project was undertaken, women were given money to do what they saw as most important in addressing these intersecting issues. In Liberia, the money went to individual grants for women living with HIV/AIDS and to training for income generating activities such as manufacturing soap which enabled some women to start small businesses. The improved financial status of women enabled them to disclose their status, join support groups and conduct awareness raising and advocacy work around HIV/AIDS. It gave them back a level of esteem that had been taken away. The HIV/AIDS pandemic is relatively young in Liberia and typical of a young pandemic, there is much denial, ignorance and stigma about the disease.

In Uganda, during the conflict cattle, which were a livelihood for many women, had been stolen during raids leaving families destitute. The funds from the project were used to buy more cattle for women, and for individual grants. Women formed revolving funds and eventually a village bank which loans money to women at a modest interest rate. The money that they got has enabled them to have enough food to eat and money for transport to health centres where antiretroviral therapy is available.

In Zimbabwe, the money was used to start a mobile clinic that goes round administering antiretroviral therapy to women who have challenges accessing it. The pandemic is at a mature stage in Zimbabwe and there is political will to address it, and a lot of knowledge about its dimensions and prevention and cure. The problem is that the national health system has more or less broken down and many people cannot access the few services still available.

Money for survivors vs. money to survivors: Is there a difference?
Lots of money has been made available to combat HIV/AIDS, violence against women, peace, reconstruction and transitional justice work. Money that goes to African governments from PEPFAR and the Global Fund and other donorshas been instrumental in ensuring that antiretroviral therapy is available free of charge to many people living with HIV and AIDS. The problem is that while the vital drugs are widely available, they are not always accessible. People often have to travel long distances to get them, which is not something that those who are weak are able to do. For antiretroviral therapy to work, a patient needs adequate amounts of nutritional food. In Zimbabwe there has been extreme food scarcity. In rural areas, women have had to resort to gathering wild fruits to feed their families. In Uganda and Liberia, poverty has compromised the ability of people living with HIV and AIDS to get nutritional food in sufficient quantities.

The major trickle down effect that money to governments has is making much needed drugs available. There is no money for people living with HIV and AIDS to get treatment for opportunistic infections, to get money for transport to health facilities, or to buy food. The money does not cater sufficiently for psycho-social support for people living with HIV and AIDS. Nor are the beneficiaries directly involved in analysing their problems, or planning and implementing interventions. Lack of knowledge and financial means makes it difficult for them to track the money that is given for their benefit, something that is very important given the notoriously corrupt reputation of most governments. Bureaucracy is another limiting factor characterising large funding for HIV/AIDS
This project gave small amounts of money directly to women affected by the triple pandemic and allowed them to design their own interventions without the imposition of ideas or conditionalities from their donors. The women reported an increased sense of power over their situations and immediate results. The model demonstrates that small and large grants, and top-down and bottom-up approaches are all necessary in redressing HIV/AIDS, violence against women and conflict.