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Works of ART

By Angela Savage and Geoffrey Goddard

A worst-case scenario sees HIV cases in Asia outnumbering all those on the rest of the planet. Pooling knowledge and resources to contain the threat, Red Cross and Red Crescent National Societies are fighting on a regional front. Young people throughout Asia are being reached by a border-crossing strategy.

Her nickname is Joy and she promotes safe sex. In conservative corners of Laos that isn’t always appreciated. Sex isn’t something you talk about openly, particularly if you are female. A decent girl can acquire a reputation.

Joy – real name Phuenchit Chantamaly – isn’t discouraged. At 22, the volunteer Red Cross educator considers breaking taboos is all part of the job. “Sometimes”, she says, “people think I’m crazy to talk as I do but they don’t realise how serious the problem is.”

The problem is HIV infection and AIDS. The virus is spreading more rapidly in Asia than in any other part of the world and by mid-1996, the UNAIDS agency estimates, some 5 million Asian adults had been infected since the onset of the pandemic. This is 18 per cent of the global total in an area which is home to 60 per cent of the world’s population. It is now feared that the people infected in Asia may, in the end, outnumber those in the rest of the world combined.

Joy’s challenge in Laos is getting the message over. It isn’t just the taboos. While HIV/AIDS has caused widespread suffering in neighbouring countries, so far in Laos it hasn’t hit hard. While Thailand has an estimated 850,000 HIV cases and 40,000 people with AIDS, the problem in Laos is still largely invisible. People are reluctant to accept the size of the threat they are facing. So using Joy, and a growing team of peer group educators, the Lao Red Cross is raising awareness as fast as it can. Supported by the Australian Red Cross and funded by the Australian overseas aid agency AusAID, a nationwide programme is under way.


Regional strategy

The response is the stronger for belonging to a regional strategy. Since HIV knows no boundaries, and borders cannot contain or exclude the virus, Asia’s National Societies are pooling knowledge and resources. Set up by the Federation in 1994, the Asian Red Cross and Red Crescent AIDS Task Force (ART) has brought together China, India, Indonesia, Laos, Malaysia, Myanmar, Nepal, the Philippines, Thailand, Viet Nam and, since last year, Cambodia and South Korea. “The ART”, says Patrick Couteau, its former secretary, and previously health delegate at the Federation’s regional delegation in Kuala Lumpur, “is for sure among the best examples of networking the Movement has seen.”

Region-wide it is backing programmes to prevent the spread of HIV, and to care for those infected, protecting their rights and combating discrimination. Underlying the ART’s efforts is a workplan developed with health professionals and volunteers from all 12 countries. Its focus for now is on a youth peer education programme, and young people throughout Asia are being mobilised to meet the challenge of the frightening worst-case scenario.

By the end of last year most ART countries were busily training young core trainers. They in turn are training district facilitators to run grassroots education workshops. If all goes to plan, within 18 months each country will have 1,000 youth educators, and some are well on the way. Myanmar, one of the pioneers of youth-to-youth awareness, was reporting last autumn that close to 300 young facilitators from 27 townships had reached over 13,000 young people.

While the strategy – the target groups, the methods, the educational approach – is common to every country, cultural and socioeconomic differences are being taken into account. The training manual that is key to the programme is fine-tuned to each country’s profile, and to its sensitivities. But, say the National Societies, it is the young themselves, involved at every stage of the programme, who ultimately enhance its relevance. Says Nguyen Thi Y Duyen, programme officer in Viet Nam, “It is developed for young people by young people and is using the language of the young. We understand why we train our friends because we care about their well-being. We want them to talk to each other and spread role models widely in our society.”

Peer education

In Laos, Joy goes along with that. She is typical of the people the ART is encouraging. Since becoming a volunteer with the Lao Red Cross in 1994, she has gone through a number of courses and workshops, among them a course which the ART conducted in Malaysia on HIV and women, and one in Indonesia on peer education.

The five-day gathering in Indonesia was crucial, for it brought together key youngsters from all ART countries to report on the development and pre-testing of the manual in their national languages. They pored over vital sections on the causes of infection and AIDS, on contraception and birth control, on community-based counselling, on abstinence and pre-marital sex, and on drug abuse. They examined language, content and methodology through role play and presentations.

The bottom line was to agree on a programme that tells young people, clearly and accurately, how to protect themselves and their friends from the virus and its consequences. For that they need to understand and avoid risk behaviour, develop the social skills for good decision-making, learn to support one another and to provide care and compassion for those affected. Having had the last say, the youngsters returned home from Indonesia to finalise manual production and launch the ART’s training programme.

Just how much it is needed in Laos can be judged by Joy’s concerns as she educates friends, and friends of friends. One is a widespread ignorance of condoms. “Some people”, she says, “don’t know what they are; they have never even seen one.” Those who have can be embarrassed by them, and overcoming the shyness is difficult. “Sometimes I take people to the pharmacy to buy condoms,” Joy says, “to show them there’s no need to be embarrassed.”


Global precedent

She has mountains to climb but the ART is helping her climb them faster. With support from the British, Norwegian and Swedish Red Cross Societies, as well as from the Australians, the sharing of decisions, concerns, experience, resources and technical expertise is developing the capacity of National Societies in the region.

Before the ART there was little collaboration on any front. Dr Win Win Aye of the Myanmar Red Cross says her National Society had been working more or less in isolation for a quarter of a century.

Like Laos, Myanmar did not have a problem on the scale of some neighbours but knew it could have if no action was taken. “The official figures”, says Win Win Aye, “were about 7,000 HIV positive cases and about 200 known AIDS patients. These we realised could grow at an alarming rate if concerted efforts were not made in time, as rapid urbanisation and increased economic development are an inducement to high-risk behaviour among young people.” With chapters in 308 of the country’s 320 townships, the Red Cross was well placed to respond but knew it had to break out of isolation. Contacts across borders were essential.

Former ART secretary Patrick Couteau says Thai Red Cross collaboration with Myanmar to some degree inspired the Task Force. Today cooperation runs to the development of collective fund-raising strategies, and region-wide partnerships with UNICEF and UNAIDS to support programme implementation. Those National Societies with most experience are passing it on to those with the least. When ART members presented The Benefits of a Regional Network to the XIth International Conference on AIDS in Vancouver last summer, enhanced commitment and productivity were high on the list.

Clearly it is a precedent, and in many ways an exciting one for Federation-supported programmes glo-bally. But with the growing threat to Asia of HIV/AIDS, no one is resting on their laurels. Dr Anis Ahmad, ART chairman and a Malaysian Red Crescent volunteer, insists, “We have just begun serious work. We still have a long way to go. We have many other aspects of the problem to tackle. We need to mobilise our energies, skills and knowledge to greater heights, produce better results and become the leading non-governmental organisation in the battle against HIV and AIDS.”

Writing in Work of ART, the Task Force newsletter, he called for more National Societies to be involved. There was, he said, still a need to help sister Societies elsewhere in the region face the pandemic effectively.

Compiled from reports by Angela Savage and by Geoffrey Goddard. Angela Savage is the current ART Secretary and Coordinator of the Australian Red Cross Sub-regional HIV/AIDS Network, based in Hanoi. Geoffrey Goddard worked as an Australian Red Cross volunteer.

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