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Areas of action
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Prevention:
Developing sustainable strategies
Because no vaccine is yet available against the HI virus and an HIV infection still cannot be cured, avoiding new infections is still the most important goal of measures to contain the HIV epidemic.
The focus is on raising awareness and providing information. Someone who knows how they can become infected and how to prevent that happening can protect themselves and others. Using condoms can prevent HIV infection – unless there are social factors stopping people using condoms. Such factors include gender inequality, stigmatisation of those living with HIV, discrimination against disadvantaged population groups, criminalisation, violence, drug and alcohol abuse, sex work, flight, displacement and cultural dislocation.
Because the above factors have a significant impact on how successful awareness-raising campaigns will be, it is not enough to merely provide people with facts: prevention programmes also need to address cultural aspects; they should promote a social environment in which people can protect themselves against infection.
Together with organisations in its partner countries, German development cooperation supports prevention programmes in many different areas. They include a wealth of different approaches, ranging from setting up advice centres that offer voluntary and free HIV testing to developing teaching materials for schools.
Social marketing
The social marketing of contraceptives has proven a very effective form of prevention. It involves using commercial marketing methods to promote the use of condoms. The goal is to promote behaviour that is conducive to health. The price of condoms is generally subsidised so as to ensure that the products are distributed as widely as possible – including to poorer social strata. 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. Social marketing thus does not primarily serve to sell products, but rather helps in the dissemination of ideas and values.
Working on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ), the KfW Entwicklungsbank is very successfully promoting social marketing projects. It is currently supporting projects in 28 countries with a total volume of some 350 million euros. Funding committed in this area has nearly doubled since 2001. One focus of its cooperation is on sub-Saharan Africa. In addition, it now has four regional projects, two in Latin America and two in Africa.
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 control at local level
Some German development cooperation applies a number of successful approaches to HIV prevention. Two examples are:
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Comprehensive HIV measures at local level:
The German government has been supporting programmes of this kind for more than 15 years 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. -
Giving risk groups access to health services:
One key element of HIV prevention is harm reduction in relation to drug abuse. Needle-sharing between injecting drug users is responsible for 30 per cent of new HIV infections outside of sub-Saharan Africa. Up to three million out of an estimated 15.9 million injecting drug users worldwide are HIV-positive. 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 as well as new HIV and hepatitis-C infections and the rate at which sufferers discontinue treatment.
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