HIV/AIDS has become the leading cause of death in several African countries. Over the last two decades, different approaches have been adopted to check the spread of HIV/AIDS and to mitigate its impact on affected persons. Initially, most organisations adopted a vertical approach to fight the HIV/AIDS epidemic, implementing specific AIDS projects; this approach, however, was not successful in checking the spread of HIV/AIDS. New approaches focused on the integration of HIV/AIDS activities into existing primary healthcare systems.

Soon, it became evident that the health sector alone could neither stem the rapid spread of HIV/AIDS nor cope with the huge numbers of affected persons. HIV/AIDS is not only a health problem but has socio-cultural and economic dimensions, cutting across all segments of society and affecting a wide range of sectors from agriculture to industry, commerce, tourism and education. It is a challenge to development, whose solution requires a multi-sectoral approach. Only a few governments, NGOs and donor organisations are prepared to adopt this new approach. For instance, the German Technical Co-operation (GTZ) took a long time convincing other divisions of GTZ and project managers of the relevance of a multi-sectoral approach to their development projects. Fortunately, the German Federal Ministry of Co-operation (BMZ) was firmly committed to the multi-sectoral approach and instructed all its agencies to integrate HIV/AIDS into their development activities. In line with this directive, GTZ adopted the multi-sectoral approach as official policy in its programme responding to the HIV/AIDS epidemic. It is mandatory for all its divisions not only to undertake HIV prevention activities but also to ultimately integrate HIV/AIDS into its development programmes and projects.

The multi-sectoral approach in Ghana GTZ's Regional AIDS Programme for Africa (RAPA) introduced the multi-sectoral approach with a series of preparatory meetings and activities to sensitise the various GTZ offices and field projects. All the heads of GTZ projects in Ghana met in Accra to assess their preparedness to integrate HIV/AIDS activities in their programmes. A few projects were identified to take the lead in introducing the multi-sectoral approach. GTZ/RAPA also supported the activities of several local and international NGOs, providing an opportunity to introduce a multi-sectoral approach to HIV/AIDS.
RAPA also looked at the experiences of the Swiss Development Co-operation with integrating HIV/AIDS activities into non-health sectors in Mali. This enabled the RAPA team to assess the key conditions for integrating HIV prevention activities into on-going development projects/programmes, and it looked at the basic requirements for implementing a multi-sectoral approach at project level. Finally, RAPA conducted a number of studies on HIV/AIDS-related issues like migration and prostitution in several West African countries.
Regional follow-up activitiesGTZ's policies encouraged the RAPA team to assess the conditions under which GTZ non-health projects in other West African countries could be supported in implementing a multi-sectoral approach. As a result of visits to projects in the areas of agriculture, education, youth, urban development and district administration in Mali, Ghana, Côte d'Ivoire and Togo, GTZ offices have become promoters of integrating HIV/AIDS. As part of its capacity building programme in the sub-region, RAPA also provided technical and financial support to local initiatives of five NGOs working in the area of HIV/STIs in Ghana and Togo. In Togo, the support was on capacity building and peer education programme for sex workers. In Ghana, RAPA supported the following initiatives:

• youth peer education on HIV/AIDS in the Eastern Region
• HIV/AIIDS training programme for pastors as educators in Accra and Tema
• HIV prevention in the Muslim community
• health outreach for PLWHAs using theatre for development documentary
• promotion of condom use
• awareness activities in the workplace
• youth training programme on HIV/AIDS in the context of World AIDS Day
• international conference on HIV/AIDS and agriculture in Ghana, as  part of   awareness raising on the impact of HIV/AIDS on the agricultural sector.

Main outcomesSome of the main outcomes of GTZ/RAPA activities included a biannual assessment of AIDS activities in all GTZ-supported projects. Each project in Ghana, Mali, Togo and Côte d'Ivoire is expected to present detailed reports on its HIV/AIDS activities during the team leaders meetings. In addition, relevant educational materials have been distributed  to all GTZ supported projects in Ghana.
Specific projects in education and decentralisation sectors were examined for the integration of HIV/AIDS activities. These included:

• The Assistance to Teacher Education Project (ASTEP), which has been recognised as a vehicle for disseminating HIV/AIDS information to pupils and teachers. The project also provides opportunities at different levels for the integration of HIV/AIDS through capacity building. Teacher guides have been used to educate and inform students and teachers on HIV/AIDS. A reader on AIDS for children has been developed and will be distributed to schools in Ghana and other countries in Africa.
• The Programme for Rural Action (PRA) is ideal for incorporating HIV prevention into its development programmes at district level. HIV/AIDS was selected as a crosscutting issue to be included in all project activities, at all levels.
• Takoradi Technical Institute's large student body and staff, the institute's close links with the community and its association with public and private sector organisation offers several opportunities for the integration of HIV/AIDS.

Following up on RAPA's discussions, the GTZ-supported projects in Côte d'Ivoire  recruited a consultant for the assessment of AIDS activities in 16 GTZ projects in several sectors. A plan of action was drawn up, which includes training of project personnel as focal points for peer education.
Lessons learnedInstitutional support is essential for successful integration of HIV/AIDS activities. The need to integrate HIV/AIDS activities must be seen as relevant and beneficial by all levels of staff, including the management. Integration means that HIV/AIDS becomes part and parcel of the project's long-term planning process and plan of action. This is likely to be successful only in well-established and functional projects.
Integration of HIV prevention should be considered in all projects, especially where HIV might have an impact on the project objectives. Projects with an extension or training component are the most appropriate. In addition, in order to create active participation and support, the entire project staff must be sensitised about the relevance of integrating HIV/AIDS. Integration cannot be achieved overnight: it is a gradual process, requiring careful planning.
Integration should take the project's working structures into account; HIV/AIDS activities should not be undertaken as parallel activities to existing ones; rather, it should use existing projects to integrate HIV prevention. The integration process requires regular supervision. Follow-up activities should also be organised to ensure the continued integration of AIDS prevention activities.