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Mozambique National Human Development Report 2007The concept of the Window of Hope, as seenabove, is strong and requires not only commitment, butabove all social responsibility, which should be borneand monitored by all sectors of society. Saving children,adolescents and youths from HIV infection is a key conditionfor the development of the country tomorrow.The prevention of infection, expressed in messages thatstrengthen abstinence at these ages, until the psychologicaland physical growth of the human organism isconsolidated, and young people, no longer children,feel they are able to formulate a correct decision ontheir sexuality, should be the banner of the campaign.Faithfulness should accompany the educationalmodels that seek to instil a moral approach to sexualityfrom a tender age. It will be difficult to controlHIV and AIDS with palliatives. Prevention mustalways be the battlefront. It should be consistent withthe values it is intended to instil in children from theearliest ages of their development.Putting these principles into practice will requirethe development of curricula on how to approachmatters connected with knowledge of healthy and balancedgrowth and respect for one’s body in anunashamed way in early childhood. Duly designed andstandardised programmes can be transmitted by radioor in simple brochures which give clear instructionson the role that parents and guardians or educationmonitors in infancy can play in this area. In line withthis, the Window of Hope Campaign coordinated bythe CNCS and implemented by two NGOs, the FDC andN´weti, are to be highlighted as relevant experiencesin the national response to HIV and AIDS inMozambique.Meanwhile, the pre-school curriculum and allsubsequent education should strengthen in stages thecontents on the sex education of children, dependingon their psychological and bodily development andthe association of these contents with other schoolmaterials, through placing them on the curriculum.In adolescence, specialised services should beset up with a strong impact on the personality,including personalised assistance to all adolescentsand young people who seek information about sexualand reproductive health.Strengthen ART throughprioritising preventionDespite the various questions that can be posed, andalthough the number of people undergoing treatmentis still insignificant, the growth in treatment means agreat qualitative and quantitative improvement incare for PLWA. In terms of individuals this means agreat advance for those benefiting from treatment,but in terms of public health the significance of thisintervention is minimal because it still excludes manypatients who require treatment.However great the commitment of the governmentfor all to gain access to treatment, the possibilitiesof success along this line will always be limited,if the costs implied are taken into account(Table 8.1).While it is the conviction of government and itsmain national and international partners that ARTshould be reinforced and made as widely accessibleas possible nationally, the truth is that treatment initself will never solve the problem.The success of HIV and AIDS control programmesin reducing the spread of the epidemic incountries such as Senegal, Uganda and Thailand wasnot achieved with treatment, but with prevention programmesthat deter the occurrence of new infections.Along these lines, the strategy implies certainundertakings. The state should make efforts to continueexpanding the opportunities for treatment toensure that every Mozambican has the same chancesof survival. For their part, the patients undergoingtreatment should comply strictly with the therapeuticrules and guarantee that they will infect nobody else.Critical analysis of the national responseThe prevention strategy:from the first PEN to 2005Using a similar approach to the one widely used bycountries that have experienced and are still experiencinga growing epidemic, Mozambique has, fromits First National Strategic Plan to the present, beenguided by interventions along the classic “ABC” line– that is, Abstinence, Be faithful and use Condoms.If the final goal to be achieved through thisthree-pronged approach is to reduce infection, themessages used to encourage behaviour aligned toeach of the targets of this approach have been frequentlyquestioned. The inadequate nature of themessages has been mentioned, in that they often donot respect certain principles of ethics and decency,and are thus referred to as competing in the promotionof promiscuity, particularly among the youth(Report of the National Debate on Prevention,CNCS, 2004).60
Planning for the Future: The Window of HopeBut it is not just the messages that have beenqueried. An entire communication strategy forchanging behaviour is considered as somehow aliento the way individuals navigate their social and sexuallives, and also to how they establish their identitieswithin communities.Instead of making a point of using a contextualisedapproach that exploits the socio-cultural variablesthat govern specific human relations fromplace to place, the interventions undertaken lapseinto information flows and audio-visual pieces in themedia that are saturated with contradictory and sensationalmessages on sex, love and relationships.It is a fact that in the traditional African, andspecifically the Mozambican, context, sexuality is asubject which, when approached within the community,is done so in a way where not only the sexes, butalso age groups are separated; and there are alsotimes that are considered appropriate for this. But theprevention programmes carried into the communityand domestic spheres for the purposes of consciousness-raisingintended to change sexual behaviourhave often not observed these criteria and requirements,bringing together, for the same purpose, oldpeople and children, parents and their sons ordaughters, without any age or sex discrimination.Messages drawn from the one-fits-all communicationapproaches, in disregard of the differentsocio-cultural contexts may slip into rejection by thetargeted groups (e.g. when young activists use awooden imitation penis to simulate how condomsare worn to elder people).This is also apparent in many of the interventionsexpressed through other conventional means of influencinga target group. (In fact, the leaflets and visualresources that seek to awaken awareness for a visiblechange in behaviour always reflect the stereotypicalvision and sentiment of what change means for theactivist communicator.) There is no fluid cognitivecommunication between them and the audience, sincethe language, the symbolism, the context and the idiosyncrasiescontain irreconcilable differences.That is why many studies on Knowledge, Attitudesand Practices (KAP) have shown that there has beenfor some time a considerable rise in the level ofknowledge about what HIV and AIDS is, how it istransmitted, and how it can be avoided, but withoutthis being reflected in visible changes of behaviour,since the same studies show that the attitudes andpractices remain at worrying levels.Rather than information, people need motivationand skills to begin a visible change in behaviour.They also need a welcoming environment that betterencourages the changes that it is urgent to make.This is what Catherine Campbell is referring to, in herwork on Why HIV/AIDS Intervention ProgrammesFail (2003), when she states that:“…giving people information about health risksis unlikely to change the behaviour of more than onein four people, and these are generally the moreaffluent and better-educated members of a socialgroup. This is because health-related behaviours(such as condom use) are determined not only byconscious rational choice by individuals, on the basisof good information, but also by the extent to whichbroader contextual factors support the performanceof such behaviours.”Indeed, when we compare the investment madeto date with the gains achieved in the prevention ofAIDS in Mozambique, we have good reason to saythat we are still rather a long way from finding theright approach for halting the damage that the pandemicimposes on us. In fact, in the absence of a sensitivityabout how to anchor these approaches withinthe context and social determinants that conditionthe acceptance and assimilation of outside contributions,intended to encourage behavioural changes,the investment in HIV and AIDS prevention, in theway that it has been taken to the communities, howeverwell-intentioned, brings marginal returns.It will be said that it is useful to bring in lessonsand good practices from other countries that havealready found instruments more or less able toreduce risk and provoke a relative change in behaviour.Such references should not be underestimated.However, it is useful to note that the few examples ofcountries which have experienced some success canoften be reduced to the specific context of the placeswhere they occur. It is difficult to recommend, in letterand spirit, their mechanical replication.Since HIV and AIDS is an epidemic that communitieswill live with for a long time, and since there isa need for care about its effects, it is useful to rethinkwhat looks like probable weaknesses in the currentstrategies.The allocation of financial resourcesThe growing level of HIV and AIDS infection, and thematuring of its evolution towards the state of illnessin the human organism, are beginning to bring to the61
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Preface“Mozambican men and women:
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Forewordby the UN Resident Coordina
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ContentsPrefaceForewordContentsList
Page 10 and 11:
Mozambique National Human Developme
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Page 14 and 15:
Page 16 and 17:
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6Mozambique National Human Developm
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Page 22 and 23: Mozambique National Human Developme
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 and 58: National Strategies against the Spr
Page 69 and 70: Chapter 8Planning for the Future: T
Page 71: Planning for the Future: The Window
Page 75 and 76: Planning for the Future: The Window
Page 77 and 78: 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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