In working to correct the fact that matters surrounding HIV and AIDS were shouldered since 1983 by a single unit of the diocese - the public health education programme (PHEP) unit, the policy document has introduced a multi-sectoral approach in response to the pandemic which will involve all organs of the diocese ranging from parishes to diocese departments and institutions.543 Since the involvement of parishes in this matter has already been discussed above, we will now look at the role of the departments and institutions of the diocese. According to the policy, these organs are required to do the following. 544 First, each organ is to develop its own departmental or institutional plan which will indicate its contribution in relation to the objectives of the HIV and AIDS policy.545 The second task of each organ is to prepare its annual activities and budget in relation to the objectives; and to secure funds to address them whenever possible. Each department and institution can therefore contribute to the objectives of the policy as illustrated on the table below.
543 KKKT-DK, “Sera ya Dayosisi ya Kupambana na Virusi vya UKIMWI na UKIMWI,” p. 17.
544 KKKT-DK, “Sera ya Dayosisi ya Kupambana na Virusi vya UKIMWI na UKIMWI,” p. 17.
545 The objectives of the HIV and AIDS draft policy are: a) to eliminate HIV infection; b) to encourage and enable Christians and non-Christians to undergo HIV testing; c) to provide humanitarian social support to PLWHA; d) to provide treatment to PLWHA; e) to ensure the continuum care of PLWHA; f) to provide guidelines for all projects geared to support PLWHA within the diocese.
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Table 7: The involvement of the departments and institutions in addressing HIV and AIDS pandemic
Department/
Institution
Prevention Medical care Social support Capacity building Medical Teach about
medical issues
Provide medical care for
PLWHA
Establish social medical fund
Train medical staff, provision of medical equipment, TOT PHEP unit Teach about
health care and HIV and AIDS
Home-based care (HBC)
Counselling and
psychological support
Train HBC providers
Diaconal Teach about diaconal ministry and caring for PLWHA
Social funds for diaconal work
Various forms of social support to the needy
Train
congregants on diaconal issues
Education Teach on prevention, behaviour change and Christian ethics
Teach
Christians about HBC
Teach about the role of a Christian with regard to his/her
neighbour
Training of trainers (TOT)
Women Teach women
how to prevent HIV infection and care for PLWHA
Train women on HBC
Train women on their responsibility to society (Diakonia)
Training of women leaders
Youth Teach young
people how to protect
Train young people on HBC
Train young people on their
Training of youth leaders
152 themselves from
HIV infection and to care for
PLWHA
responsibility to society (Diakonia)
Project Teach diocese workers how to protect
themselves from HIV infection
Encourage diocese employee to undertake HIV testing
Provide small income generating projects
Training on project
management
Tertiary/scho
ols and
others
Teach workers and students how to protect
themselves from HIV infection
Teach workers about HBC
Teach
workers about their
responsibility to society
Training of trainers (TOT)
Kindergarten /primary schools
Teach children how to protect themselves from HIV infection
Train children on HBC
Teach
children about their
responsibility to society (Diakonia)
Train teachers and children leaders
Hospitals and dispensaries
VCT and seminars about prevention
The package of HIV and AIDS treatment including HBC
Social
medical care
Train medical staff, HBC providers and conduct research
Source: Sera ya Dayosisi ya Kaskazini ya Kupambana na Virusi vya UKIMWI na UKIMWI
The above table shows that each department and institution has a role to play in prevention, medical care, social support and capacity building. As regards prevention, the Christian Education Department is responsible for bringing about behaviour change
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which has to do with sexual ethics, but the policy does not clarify the available resources that will be employed to facilitate this change of behaviour and adherence to Christian ethics. Since the majority of Chagga men indulge in multiple sexual partnerships, it is the task of this department to set up programmes to reach men of all age groups to discuss their risk taking behaviour and their responsibility to contain the pandemic. In other words, no behaviour change will take place in the absence of gender sensitive programmes which address the needs of each gender, and the root causes that prevent behaviour change from being possible.
Similarly, the Women Department is required to teach women on how to prevent HIV infection and to care for PLWHA. This implies that women can only be infected through providing care for people living with HIV and AIDS. While knowledge on how to protect themselves during the process of nursing is vital, it is marital relationships which are the main route through which women contract HIV infection, a fact that goes unmentioned.
This reveals the diocese‟s gender insensitivity since the need to empower women and girls is apparently beyond its concern or awareness.
Meanwhile, the Youth Department is given the task to educate young people on how to protect themselves from infection as well as to care for sick individuals. As discussed above, the policy insists on abstinence for young people as the only possible preventive strategy as regard HIV infection. Self-discipline in sexual matters can certainly protect individuals from HIV infection, but not all can comply with this because of the prevailing social and economical factors as well as due to peer pressure. For instance, the high rate of teenage pregnancies, as discussed in detail in chapter four, is an indication that boys and girls are sexually active at an early age. In view of this, proper sex education to guide young people to responsible sexual behaviour is a must. Furthermore, since a number of out-of-school young people are unemployed, the church needs to fund them to run small income generating projects to enable them to be self-sufficient, hence removing the need (especially among girls) to exchange sex for money. Generally, each department and institution has the task to impart prevention knowledge to its target groups, but resources to address this problem are not articulated adequately.
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With regard to medical care, home based care falls under this section. The table shows that home based care training is to be expanded to various groups in society but women and youth (obviously girls) are the main focus in this. The justification for this as outlined above, is based on the traditional gender roles and expectations of society which ascribe to women the role of caregiver for sick people in the family and society. In the era of HIV and AIDS, giving care to the sick calls for a joint effort from all categories of people in the family and society to share this responsibility as part of showing their Christian faith to people in need.
In terms of social support, the importance of teaching Christians about their responsibility to show Christ‟s love to the needy (diakonia) as is a fundamental part of the Christian faith is emphasized with regard to each category of people. Thus, the Project Department has the task of sponsoring individuals afflicted with the pandemic to allow them to embark on small income generating projects that will enable them to meet their basic needs. As discussed earlier, the income generating projects of the diocese are not linked with gender factors that reinforce the spread of HIV but rather serve as a coping mechanism for the individuals already living with and affected by HIV and AIDS.
Finally, the training of trainers, which is a strategy to equip more congregants with skills and knowledge to assume various tasks surrounding the pandemic, is according to the HIV and AIDS policy to be undertaken by all diocese organs. However, this task falls under the Women and Youth Departments and only women and youth leaders are thus singled out for training. After training the leaders, these individuals will in turn also impart their knowledge to members of their groups, enabling everyone to participate in ministering to those in need. What is problematic is that once again, men seem to have been excluded from this training process which focuses mainly on women and youth.
The fact that both the church and government are involved in responding to the HIV and AIDS pandemic requires a comparison of their respective programmes and policies in order to ascertain in particular how each responds to gender-related issues, which is my next discussion.
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5.5 Government and diocese: a comparison of HIV and AIDS policies/programmes As the diocese draft policy has not been implemented, it is hard to comment on its effectiveness. As stated earlier, the policy content reflects to a great extent the current diocese HIV and AIDS programmes. While some of the church programmes are similar to those of the government, the government is more aware of gender issues than the diocese. Both the church‟s and government‟s programmes/policies have prioritized HIV and AIDS education awareness as the main strategy in the prevention of the transmission of HIV. Similarly, for both, medical care, voluntary counselling and testing, the treatment of the opportunistic infections, the provision of antiretroviral drugs and home-based care are governed by the Ministry of Health. In addition, the provision of care and social support for people living with and affected by HIV and AIDS are stated as goals in both policies.
Despite these similarities however, there are differences between the diocese and the government HIV and AIDS policies. The government HIV and AIDS policy reveals a greater concern with regard to human rights and gender issues than that of the church.
Given that the main mode of HIV transmission is through heterosexual intercourse, the government policy states that women need to be empowered to negotiate for safer sex.546 It further states that men and women ought to be accorded equal status as well as equal opportunities for education, access to reproductive health education and access to health care services and leadership in all spheres of society. To translate these ideas into practice, the policy suggests five strategies.547 First, the unequal power relations which prevent women from protecting themselves from HIV infections will be addressed.
Second, cultural institutions and traditional practices that provide opportunities for education leading to increased public awareness will be utilized for empowerment and dissemination of information, education and communication (IEC) on reproductive health as well as HIV and AIDS. Third, community programmes will address the danger of multiple sexual partners, and the issue of reproductive rights in relation to the transmission of HIV. Fourth, all treatment related to reproductive health will be made
546 United Republic of Tanzania, National Policy on HIV/AIDS, p. 21.
547 United Republic of Tanzania, National Policy on HIV/AIDS, p. 21, 22.
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accessible for women, men and youth. Fifth, inheritance laws that prohibit women from owning property will be reviewed. In fact, if these suggestions have been implemented from the time the policy was launched in 2001, HIV and AIDS would not have reached such an alarming rate in Tanzania as it has today.
As discussed in chapter four, eighty five percent of societies in Tanzania are patriarchal in that males dominate all aspects of life in the social, cultural, religious and political sphere. This implies that women are at the receiving end and harder hit by the pandemic than men. Women are the main caregivers to PLWHA, and are besides, themselves infected with HIV. Although the government has tried to apply affirmative actions aiming to give more women access to formal education, wage employment and leadership positions in the civil and political arena, these have been little more than a token gestures until now, as discussed earlier. Likewise, property ownership for women is not secure, forcing them into positions of subordination: also inheritance law, including land tenure, is governed by patriarchal customary traditions which position women secondary to men in all spheres. This issue was elaborated on in chapter four. I therefore argue that the effectiveness of the constructive ideas on gender that have been outlined above will depend entirely on improving the mutual relationship between males and females.