(June 2002) The impact of the HIV/AIDS epidemic in sub-Saharan Africa has been enormous and far-reaching, especially in the urban areas. In one city, the public hospital and nearby health centers are overwhelmed with sick patients; in another, the problem of street children has reached crisis stage; and in a third, absenteeism has increased dramatically for municipal employees and mine workers.
The epidemic has become far more than a health issue in this region, where an estimated 28.1 million people are living with HIV or AIDS. Some 3.4 million people were infected with the virus in 2001, and AIDS-related illnesses killed 2.3 million that same year, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). By the end of 1999, an estimated 1.7 million children had lost a mother or both parents to the epidemic. With Uganda and Senegal as rare “success” stories in efforts to counter the effects of the epidemic, the importance of leadership at the local and national levels in addressing the epidemic has emerged as a critical component of the response.
“We must give full attention to the needs and wishes of our citizens in formulating our policies,” said Ernest N’Koumo Mobio, mayor of Abidjan, Côte d’Ivoire. “We must be humble enough to listen and understand, and courageous enough to guide and lead.”
To this end, many African countries have created national strategies that seek to channel the expertise and resources of local and national government departments and ministries, private companies, community-based groups, nongovernmental bodies, and other sectors of the society into a holistic, national response. In 2000, African governments joined the United Nations, donors, and private and community sectors in what is known as the International Partnership against AIDS in Africa (IPAA) in a bid to strengthen countries’ responses to the epidemic over the next decade. In June 2001, countries attending the UN General Assembly Special Session on HIV/AIDS specifically agreed that by 2003 they would “develop multi-sectoral strategies to address the impact of the HIV/AIDS epidemic at the individual, family, community and national levels.”
With national strategies in place, countries face the challenge of moving to the next step: actually making the plans work. This process is being facilitated by a coalition of African leaders at the municipal level.
Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa
With the support of the United Nations and other public and private sector partners, an initiative has emerged that is aiming to translate the vision for an all-inclusive, community-focused approach into concrete actions. The Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa, formed in 1998, aims to limit the spread of HIV/AIDS and reduce the social and economic impact of the epidemic on communities in and around the region’s towns and cities.
To achieve its goals, the Alliance envisions working in partnership with governments, civil society organizations, the private sector, and local communities. Countries that have launched national chapters of the Alliance include Burkina Faso, Côte d’Ivoire, Mali, Namibia, South Africa, Swaziland, Tanzania, and Uganda. Several others are preparing to launch chapters.
AMICAALL Strategy and Country Programs
As a key part of its plan, the Alliance has adopted a strategy known as the Alliance of Mayors’ Initiative for Community Action on AIDS at the Local Level (AMICAALL). The initiative, which aims to be inclusive, responsive, gender-sensitive, and dynamic, is designed to increase the ability of communities to access funds and other support needed to combat HIV/AIDS, result in key partnerships across sectors and among a variety of groups, and create an environment in which communities and individuals can move beyond the denial and stigma associated with the epidemic.
The main activities involved in establishing this initiative in a country include:
- launching a National Chapter of the Alliance
- developing an AMICAALL National Plan of Action
- kicking off the plan with a workshop and recruiting a national coordinator
- establishing AMICAALL municipal teams
- building the capacity of elected leaders, municipal staff, community members, and others to undertake anti-HIV/AIDS activities
- organizing community-based projects, such as HIV testing and counseling services as well as support for a youth association against AIDS
- creating partnerships among cities and groups within the country, and beyond
- engaging local and national leaders in dialogue on instituting effective policies
- monitoring and evaluating progress
- scaling up and disseminating the experience from initial pilot sites to all municipalities
Program activities must fit into existing national frameworks to support and improve on policies and activities that are already in place, while increasing community-level action. Getting local leaders on board is critical for creating an “enabling environment” that overcomes the denial and stigma that exists in many communities. Part of the strategy is to move local authorities from viewing HIV/AIDS as a problem “out there” to one they must own and incorporate as part of their service agendas.
With support from UNAIDS, the UN-AMICAALL partnership program was launched in 2001 to support the activities of the Alliance and AMICAALL country programs. Based in Geneva, Switzerland, the program focuses on promoting the AMICAALL strategy; providing national programs with technical assistance; supporting the Alliance Secretariat; promoting public/private-sector partnerships; mobilizing resources, and documenting and sharing lessons learned.
To date, AMICAALL programs have been initiated in Burkina Faso, Namibia, Swaziland, and Uganda.
Local Leaders Take Action in Namibia
Namibia launched its national chapter of the Alliance of Mayors and Municipal Leaders on HIV/AIDS in December 2001. Elected mayors and municipal leaders met to sign the declaration, and a public rally highlighted the development and the crisis nature of the epidemic in the country.
“The AMICAALL initiative promises to be an appropriate response to the HIV/AIDS epidemic,” said Mathew Shikongo, mayor of Windhoek. “It involves a broad range of stakeholders; it is responsive to locally articulated needs, and increases dialogue among local people, municipalities and decision makers at all levels.”
Countries with small populations, like Namibia, are especially hard hit by the HIV/AIDS epidemic. They have limited human resources to draw upon to replace caregivers and those who die. Namibia, with only 1.8 million people across vast area of 318,261 square miles (824,300 km2), ranks as one of the top five affected countries in the world. An estimated 150,000 adults — or about 20 percent of people 15 to 49 years old — are living with the virus, according to UNAIDS. The effect on the labor force is expected to be devastating. The International Labour Organization estimates that by 2020 the country could lose a quarter to a third of its workers.
Namibia became independent from South Africa in 1990 after 20 years of civil conflict. This culturally diverse country with nine indigenous ethnic groups covering 13 regions is still emerging from the effects of the apartheid laws enforced on its population under South African rule.
Although Namibia qualifies as a middle-income country with a per capita income of US$2,000 a year, there are extreme inequities: 65 percent of the population survives on less than US$150 a year, according to the Government of Namibia/United Nations Children’s Fund Country Programme of Cooperation (2002-2005). The indigenous populations are much poorer and bear the brunt of the HIV/AIDS epidemic. This kind of inequity has contributed to a strong denial and stigmatization about HIV/AIDS. An organization of people living with HIV/AIDS, called Lironga Eparu, was formed in November 2001. However, few people have publicly stated they are living with the virus.
A leader and innovator in the battle against HIV/AIDS is Theresia Samaria, mayor of Walvis Bay, a small port town of 25,000 people. The town has an estimated HIV adult prevalence rate of 28 percent, according to the Namibian Ministry of Health and Social Services.
The mayor helped secure funding to establish a multi-purpose center that provides HIV/AIDS prevention, education, and legal aid services, particularly for young people. The municipality donated the land for the center, which has been so successful that the director of the center, Beverley Figaji, anticipates there will soon be a need for more space.
In addition to establishing an HIV/AIDS committee with representatives from each of their departments, the municipality and city council have approved an HIV/AIDS policy for their 600-plus employees, calling for coordination as well as prevention and care services and other support. Mayor Samaria has also set up a regional forum to assist other mayors in developing their own municipal HIV/AIDS policies and programs.
To replicate this kind of success, the Alliance of Mayors and Municipal Leaders is now working with UN partners, the Association for Local Authorities in Namibia, the Ministry of Regional and Local Government and Housing, and other local partners to establish a national AMICAALL program. In March 2002, a workplan was developed that outlines a preparatory phase, highlights gaps and needs, and identifies budgetary needs.
Efforts are underway to establish an AMICAALL program that enhances the capacity of mayors and municipal leaders to secure a place for HIV/AIDS on the institutional agenda, initiate or expand activities in their communities, and mobilize resources in support of local action.
Mayors and municipal leaders may prove to be key leaders, and local authorities a desirable entry point, for implementing a broad-based approach to addressing HIV/AIDS. These leaders can involve a wide range of constituents, including nongovernmental organizations, traditional and religious leaders, the private sector, and communities to mobilize and coordinate an effective and efficient response to the epidemic. In the past few years, the Alliance of Mayors and Municipal Leaders and AMICAALL national programs have taken root to build local capacity and engage local leaders to step forward and address the consequences and effects of HIV/AIDS.
With infection rates climbing, officials in other regions have also expressed interest in the Alliance and AMICAALL program. UN partners are undertaking some exploratory efforts to bring similar activities to several Eastern Europe countries.
International Partnership against AIDS in Africa, A Framework for Action (May 2000).
UNAIDS, AIDS Epidemic Update, December 2001 (Geneva: UNAIDS, 2001).
Republic of Namibia Ministry of Health and Social Services, Report of the 2000 HIV Sentinel Sero-Survey (Windhoek, Namibia: April 2001).
United Nations Office for Project Services, Alliance of Mayors and Municipal Leaders on HIV/AIDS, brochure (April 2002).
Margo M. Kelly is a program development specialist and freelance writer based in the Washington, D.C. area.
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