Areas of action

Developing sustainable strategies

Mobile HIV testing in Sao Tomé and Principe.

No vaccine is yet available against the HI virus. Because there is as yet no cure, avoiding infection is still the most im­por­tant goal of measures to contain the HIV epidemic. The focus is on raising aware­ness and providing information.

However, there are various reasons why it is proving difficult to contain the HIV epidemic. They include a lack of gender equality, traditional role models, religious taboos, stigma­tisa­tion of those living with HIV, dis­crimi­na­tion against dis­advantaged popu­la­tion groups, crimi­nali­sa­tion, violence, drug and alcohol abuse, economic dependence and sex work, flight, dis­place­ment and cultural dis­location.

Together with organisations in partner coun­tries, German de­vel­op­ment co­op­er­a­tion supports prevention programmes with a variety of different approaches, ranging from setting up advice centres that also offer voluntary and free HIV testing, to de­vel­op­ing teaching materials for schools.

Social marketing

Different brands of condoms in a shop in Mombasa, Kenya. Copyright: Julius Mwelu/IRINThe social marketing of contra­ceptives has proven a very effective form of pre­ven­tion. It involves using commer­cial mar­ket­ing methods to promote health-promoting be­hav­iour and the use of con­doms. People are made aware of condoms through tele­vision and radio advertising, posters, leaf­lets and street theatre. They are also informed about their correct usage and about HIV and AIDS.

Working on behalf of the BMZ, KfW Entwicklungsbank is very success­fully promoting social marketing projects. HIV prevention is closely linked to other aspects of sexual health in the context of these measures, such as for example family planning and female genital mutilation (FGM). In some coun­tries in Asia social marketing agencies are already able to cover their own costs and are no longer reliant on German support.

Comprehensive HIV programmes at local level

The German gov­ern­ment has been supporting local programmes for more than 15 years, for example in Tanzania. Studies in the Mbeya region show that in the period from 1994 to 2000 intensive prevention programmes led to more fre­quent condom use and better treat­ment of sexually trans­mitted diseases. The HIV infection rate among women between the ages of 15 and 24 fell from 21 per cent to 15 per cent.

Situation analyses at local level are a key element of such programmes. Based on these analyses over­arching, locally adapted measures are developed that address both prevention and treatment.

Giving risk groups access to health services

Preparing a tranquilizer-type substance for injection with a safe injection kit. Copyright: Sean Kimmons/IRINOne key element of HIV prevention is harm reduction in relation to drug abuse. Increased high-risk behaviour , such as needle sharing between injecting drug users, is the reason behind numerous new HIV infections. Harm reduction approaches include, for example, providing access to sterile needles, drop-in centres, counselling services and drug substitution. Germany supports partner coun­tries in applying these approaches, which it also had a key role in de­vel­op­ing.

In Nepal, for example, the quality, safety and cost-effectiveness of the national methadone programme was considerably increased through a public-private partnership (PPP), a joint project between German de­vel­op­ment co­op­er­a­tion and the private sector. Drug substitution therapy can drastically reduce both high-risk behaviour that leads to new HIV and hepatitis-C infections and the rate at which sufferers discontinue treatment.

Sexual minorities and HIV

In many societies, people whose sexual orientation or gender identity does not conform to the majority norms face dis­crimi­na­tion, persecution and crimi­nali­sa­tion. In numerous coun­tries same-sex sexual relations are a criminal offence, sometimes even punishable by death.

German de­vel­op­ment co­op­er­a­tion there­fore places particular emphasis on homo­sexual, bisexual, trans­gender and inter­sexual men and women. In several of its partner coun­tries the BMZ promotes targeted HIV prevention measures for these minority groups. Other programmes receiving German support are also designed to benefit everyone – regardless of sexual orientation or gender identity.

Detailed information is available in the leaflet ​Sexual minorities and HIV.

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