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Mozambique National Human Development Report 2007Box 7.2approaching the country’s development over the nexttwo decades, which are contained in Agenda 2025.Likewise, PARPA II, approved by the Council ofMinisters on 2 May 2006, stresses the need forgreater strengthening and coordination of multi-sectoractivities in response to the deadly disease (Box7.2). The relationship between and relative weight ofprevention and treatment has been placed at the centreof the strategic lines of PARPA II in this specificfield.HIV and AIDS in PARPA IIThe central objective towards HIV and AIDS is to halt and begin to reversethe spread of the disease. Based on PEN II, 2005-2009, it is intended tofocus on some selected results in the following five areas: prevention,stigma and discrimination, treatment, impact mitigation, and coordinationof the national response.The PEN stakeholders are the Ministry of Health, the entire privatesector, and the NGOs that work for a reduction in the spread of the pandemic,and who work with the directly or indirectly affected population,under the coordination of the National AIDS Council.The fundamental goals in this area are:• reducing the number of new infections from the current level of 500per day, to less than 350 in five years, and less than 150 in 10 years;• transforming the response to HIV and AIDS into a nationalemergency;• reducing the stigma and discrimination linked to HIV and AIDS;• prolonging and improving the quality of life of people infected withHIV and of AIDS patients;• reducing the consequences of HIV and AIDS for individuals, families,communities, companies and also the overall impacts;• increasing the level of scientific knowledge about HIV and AIDS, theirconsequences and the best practices for fighting against them;• strengthening the planning, coordination and decentralisationcapacity of the decision taking and resource managementmechanisms;• promoting actions that reduce the weight of home care on women;and,• taking action to prevent the feminisation of the epidemic.An increase is envisaged in the proportion of the State Budget allocatedto specific areas of the HIV and AIDS programme that will implementactivities in the thematic areas mentioned above.In the final analysis, the degree of political commitmentwill be assessed in accordance with achievingthe Millennium Development Goals, particularlythe struggle against absolute poverty and hunger,success in which is strongly dependent on the level ofcontrol achieved against the spread of HIV and AIDSand the combined effects of other associated diseases,such as malaria and tuberculosis.Community leadership andtraditional normative systemsThe socio-economic and political transformationsthe country has been undergoing in recent years,with the civil war, and with the economic opening toa regional and world liberalization, have dictatednew ways of being which tend to generate a conflictof values between the old and the new.This new form is sharpened by the growing deteriorationin household living standards, which isexpressed in weakening the traditional normativeand organizational systems, and in the consequentweakening of their role in responding to the generalchallenges of survival, such as that which HIV andAIDS represents today.This is the social reality, which has been markingincreasingly visibly the distinction between the oldand new generations, as well as between the urbanand rural worlds.Gender relations, the traditional rights of menand of women, the norms about what can be spokenof and what is forbidden, questions of a religiousnature and other human sensitivities, can find treatmentat community level through a complex web cultural,social and political questions that influence thepandemic.The prestige, respect and obedience that generallysurround traditional leaders in their respectiveterritories of jurisdiction and influence, as depositoriesof the local historical consciousness and respectivesocio-cultural values, form a privileged space, aneffective starting point, for community actionsresponding to the challenges that HIV and AIDS representat local level.The relevance of such an approach lies in thefact that the responses communities find locally, veryoften headed by these traditional leaders, are basedon a solid knowledge of the local beliefs and practicesin response to serious crises, such as diseaseand death, over time.The coordinated nationalresponse against HIV and AIDSThe overall national response against this pandemic,in the multi-sector perspective, has been underimplementation since the approval of the firstNational Strategic Plan (PEN) 2000-2002. This documentwas written at a critical moment in the courseof the epidemic in the country and in the world,characterised by discussions, not only about strategicoptions (Prevention vs Treatment), but above allabout the evolution of the question of anti-retroviraldrugs, their manufacture and availability on the mar-46
National Strategies against the Spread and Impact of HIV and AIDSProvince by DANIDA, three years later (2004) whichcontinued to show relatively high levels of knowledgeabout HIV and AIDS — “the majority of the populationhave already heard of HIV and AIDS, and individuals,families and community groups are broadlyaware that AIDS is a lethal disease that has no cure.A large part of the population recognises that peoplewho look healthy may be infected. There is also abroad awareness that ‘the AIDS creature’ is in theblood and cannot be seen,” the final report mentions.However, as regards specific preventive attitudesand practices, the situation remains very worrying, asthe level of condom acceptance in Maputo Cityshows. (Box 5.1, Chapter 5)Various programmes were implementedthroughout the country, combining prevention, careand treatment and impact mitigation. Some deserveattention because they have become reference pointsfor good practices.In the southern zone, for example, among manyother interventions, the Kulhuvuka Project of theCommunity Development Foundation (FDC), was theone with the largest audience, through its social marketingstrategy, and through the involvement andempowerment of grassroots community organisations,among other national NGOs.As regards the treatment, the experiences of thepartnership between MISAU and the Sant’ EgidioCommunity (focusing on prevention of vertical transmissionof the HIV virus from parent to child), wellas between MISAU and Médicins Sans Frontiers, HAI,USAID, the Clinton Foundation, among others, areworth mentioning, and it was through these initiativesthat ART started becoming more encompassing andto cause some impact throughout the country.In the sphere of impact mitigation efforts, theexperience to note is the partnership that Kindlimuka– the first national NGO of people living with the HIVvirus (PLWA) and sympathisers – developed withTotal, an international fuel company. Through anaccord between the two, it was possible to set up aviable income-generating project run by PLWA, consistingof making and supplying uniforms for Totalworkers.In Manica province, an experience should berecorded in the area of home care and psychologicalsupport for AIDS patients and their relatives, undertakenby Kubatsirana, an organisation with a religiousbase, as well as community mobilisation activket,accessibility and conditions for their expandedadministration, and particularly their cost per yearper patient.In the framework of the strategic options definedby the PEN 2000-2002, primacy was given to preventinginfection, recommending the development ofexpanded awareness activities through means ofcommunication, information and education in general;peer education, theatre and dramatization,among others, at the same time as other, importantinterventions.These interventions included:• the care and treatment of sexually transmittedinfections;• the expansion of the Counselling and VoluntaryTesting Offices;• the observance of biosecurity;• actions to mitigate impact; and• the incorporation of material on sexual andreproductive health and HIV and AIDS into theschool curricula, providing it with contents thatexplore knowledge about the disease by teachersand students.During the implementation of the first NationalStrategic Plan 2000-2002, a notable dynamism waswitnessed on the part of the actors most directlyinvolved, whether within the government, or in theprivate sector and civil society organisations in general.However, notorious fragility in coordination andweaknesses noted in the prior assessment of theexpected impacts, as a result of the cost-effectivenessrelation, left the overall final results below the levelsgenerally hoped for.It should be stressed that the activities undertaken,albeit in an isolated, sporadic form, lacking coordinationon the ground, to some extent helped raisethe level of awareness and general knowledge aboutHIV and AIDS infection, although this awakening ofminds did not have objective reflections in changingbehaviour through suitable attitudes and practices.The National Survey of Youths and Adolescents(INJAD), undertaken by the INE in 2001, for example,showed above average levels of knowledge aboutHIV and AIDS in both urban and rural areas. Over70% of the adolescents and young people surveyedhad already heard of HIV and AIDS. But there wassubstantial variation between men and women intheir knowledge about this epidemic.This fact was confirmed by a study on Behaviour,Attitudes and Practices (BAP) carried out in Tete47
Page 3 and 4:
Preface“Mozambican men and women:
Page 5 and 6:
Forewordby the UN Resident Coordina
Page 7: ContentsPrefaceForewordContentsList
Page 10 and 11: Mozambique National Human Developme
Page 18 and 19: 6Mozambique National Human Developm
Page 42 and 43: 30Mozambique National Human Develop
Page 48: Mozambique National Human Developme
Page 51 and 52: The General Threat posed by HIV and
Page 53 and 54: The General Threat posed by HIV and
Page 55 and 56: Chapter 7National Strategies agains
Page 57: National Strategies against the Spr
Page 61 and 62: National Strategies against the Spr
Page 69 and 70: Chapter 8Planning for the Future: T
Page 71 and 72: Planning for the Future: The Window
Page 79 and 80: Technical NotesTechnical Note 1Calc
Page 81 and 82: Technical NotesConclusionsIn this w
Page 83 and 84: Technical Notesmaximum and minimum
Page 85 and 86: References and BibliographyADEPESE
Page 87: Statistical Annex75
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