In the past few years, the growing recognition that the impact HIV/AIDS has on development work has necessitated an analysis of its impact and how project outcomes, like those of ActionAid (AA), might in turn affect the local epidemic. Development organisations like AA need to integrate HIV/AIDS into their programmes and develop specific strategies to deal with the epidemic, not least because their own staff are also dying from the epidemic and will need support.

The impact of HIV/AIDS on ActionAid's development work

As an international development agency, AA works on poverty alleviation in defined geographical development areas (DAs), which vary in size from populations of 10,000 to 100,000 people, in over 24 countries in Africa, Asia and Latin America. The impact of the epidemic on AA's development work is evident in DAs where AA has been working for more than 10 years and was in the phase out stage. These areas have experienced an increase in the numbers of orphans, households classified as "extremely poor," child- and women-headed households and ill health and death.
On the other hand, AA's development work may unwittingly have created conditions that facilitated the spread of HIV. For instance, road building in a DA increases mobility and migration; income-generating activities create disposable income; non-formal education encourages greater social interaction and mobility as well as new needs; adult literacy programmes empower people, which can creating tensions between spouses. Also, the presence of development workers has created a new "social caste" in communities that has disposable income throughout the year unlike those in the community who may depend on harvest seasons and separation of AA staff from spouses may lead to extramarital affairs.

AA's role in fighting HIV/AIDS

In many countries, districts and provinces with development NGOs have better social welfare services than those provided by local governments. In addition, the presence of such NGOs may block the entrance of other NGOs who may have a sharper sexual and reproductive health focus. This puts a moral obligation on lead NGOs like AA.
Communities whose most basic needs are not being met are difficult to mobilise around HIV/AIDS. AA has an advantage in the development process by helping communities to address HIV/AIDS issues. Planning and integration can mitigate impact; for example, the training of community cadres may result in their forming CBOs, home-based care and orphan support programmes. The ongoing process of community mobilisation around development issues helps institutionalise HIV/AIDS into community structures.

AA's response

AA takes an integrated approach to HIV/AIDS, identifying the factors that increase vulnerability to HIV infection and the impact of AIDS, and considering the possible impact that HIV/AIDS can have on the development process, and how the outcomes of the projects might in turn affect the local epidemic. Workplace initiatives are important and are included in planning procedures. For instance, out of a staff of 1500, between 150 and 300 people are likely to be HIV positive. This will result in a high sick leave rate. AA encourages responsible behaviour among colleagues by promoting condom use (provides condoms in toilets), by offering professional counselling services and by discussing issues such as gender, human rights and mother-to-child transmission and taboo issues like traditional sex education, how to achieve sexual pleasure, risk-taking, aphrodisiacs and responsible behaviour. Other activities include:

• AIDS terminal illness policies within each country to take care of health care needs of HIV-positive staff.
• Workshops on AIDS and development that address the determinants of the epidemic and its socio-economic impact and analyse and plans for the practical implications of HIV/AIDS. AIDS and development training are integrated into community capacity building.
• Planning guidelines for country programmes and development areas.
• Building capacity of community structures to respond to HIV/AIDS through training at village level and NGO networking and coordination at local government level. AA also trains counsellor aides in most DAs.
• AA recognises that HIV transmission takes place within the broader context of gender and sexual and reproductive health issues. SPELL OUT - PRA and sexual health studies have been conducted in situation analysis and vulnerability maps are used in raising communities' awareness. Basic factual education is being overtaken by empowering behaviour change models like Stepping Stones.
• Development of Reflect, a structured participatory adult literacy tool. This tool helps people make a critical analysis of their environment and take appropriate action on key issues. It has been used as an entry point for integrating HIV/AIDS into development programming by two AA country programmes and will be the focus of an action research project to assess its potential in improving household and community coping with HIV/AIDS implemented by AAUganda.
• Integration of HIV/AIDS into thematic projects and sectors, including emergency training and response, conflict analysis and advocacy, savings and credit, institution building and support to local NGOs, mainstreaming of gender, corporate advocacy campaigns on education and food rights, child sponsorship and fund raising.

Some differences AA's work has made

Multisectoral mobilisation: the development process creates access to a wide range of partners critical in the implementation of projects. These partners are again allies once HIV/AIDS is on the agenda. Because the range of partners is wide, AA does not have to do everything itself, for it can tap into existing resources within the district.
Increasingly, information about other districts' experiences around HIV/AIDS circulates, opening up access to donor funding.
HIV/AIDS dovetails onto advocacy initiatives and other processes to raise profile and action. Communities are developing greater openness about HIV/AIDS issues. As the response to HIV/AIDS is set within the context of community development and empowerment, greater sustainability is achieved. Through in interviews and induction of country directors, HIV/AIDS is integrated into the recruitment process.

Key recommendations

Development organisations must integrate HIV/AIDS into their programmes. Based on AA's experiences so far, the following recommendations can be made:

• provide ongoing support and training, using resource persons from AIDS organisations
• include PLWHAs in the process and explain the impact of HIV/AIDS on their livelihood
• change the way organisations view HIV/AIDS, i.e., that it is a sex-related problem
• use participatory rural appraisal (PRA) methods
• strengthen peer education programmes, especially during peak times such as the planting season in agricultural areas
• involve NGOs that specialise in development work in rural areas
• know who to target, document ideas and share this information through meetings at country level.