Mainstreaming HIV/AIDS within Housing Cooperatives, Social Housing Institutions and NGOs That Provide Technical Assistance for Housing

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1 b Mainstreaming HIV/AIDS within Housing Cooperatives, Social Housing Institutions and NGOs That Provide Technical Assistance for Housing Report prepared on behalf of Rooftops Canada - Abri International January 2009 Report produced by Dennis Nduhura and Professor Richard Tomlinson Edited by Rooftops Canada

2 List of Acronyms HIV AIDS ASO NACHU HPZ SHI NGO CONGEH CBO FBO PHA Human Immunodeficiency Virus Acquired Immune Deficiency Syndrome AIDS service Organization National Co-operative Housing Union Housing People of Zimbabwe Social Housing Institution Non governmental Organization Coalition des Organisations Non-Gouvernementales et Organisations Communautaires de Base du Cameroun Oeuvrant dans le Domaine des Établissements Humains Community Based Organization Faith Based Organization People Having AIDS This assessment and reporting were carried out with assistance from the Government of Canada through the Canadian International Development Agency and Rooftops Canada-Abri international. The opinions expressed in this report are solely those of the authors and Rooftops Canada. 2

3 1. Introduction Since 2003, Rooftops Canada and its partners 1 in Kenya, Tanzania, Cameroon, Zimbabwe, South Africa, and Uganda have worked in responses to HIV/AIDS. The program has focused on mainstreaming HIV/ AIDS responses in a context of urban poverty and vulnerability - a context already challenged by insecure tenure, inadequate water and sanitation and poor housing. After five years of work, Rooftops Canada and its partners carried out a regional exercise to assess program outcomes and build strategies for replicating and scaling up. This report is based on country studies of Cameroon, Kenya, South Africa, Uganda, Tanzania and Zimbabwe. The questions concerned whether and to what extent Rooftops Canada s housing partners are mainstreaming HIV/AIDS within their housing and human settlements core business. Where this was being effectively done, the objectives were to develop best practice models, toolkits and benchmarks for housing sector actors to mainstream HIV/AIDS responses. The methodology included reviewing recent background materials on Rooftops Canada s work around housing and HIV/AIDS, working with local experts 2, interviewing the management of housing cooperatives, social housing institutions 3 (SHIs) and NGOs that provide technical assistance to both, and also interviewing other informed persons as well as members of housing cooperatives. Summaries of country studies are annexed to this report. The intention of this summary report is not merely to summarise these studies - it is deliberately more evaluative. What has been the experience to date? At a regional level - what are some of the common elements? Is the work relevant? Should it be taken further? What is or is not working? What are the gaps and challenges? Three major findings of this assessment: HIV/ AIDS accentuates the issues related to access to housing and living conditions in informal settlements. When seeking to mainstream HIV/AIDS one may, in effect, be seeking to mainstream understanding and responses to vulnerability, issues that are already embedded among the urban poor in Africa Mainstreaming HIV/AIDS should not necessarily mean adding HIV/AIDS to the core business of a housing cooperative or SHI, especially in contexts where there are quite a number of other actors directly addressing HIV/AIDS issues. Housing institutions, where possible, should not seek to mainstream HIV/AIDS on their own. Rather, they should integrate the perspective in their work, and make efforts to network and partner with other organizations that are better placed to deal with HIV/AIDS related issues. Three major findings are mentioned on a number of occasions below. The first is that many of the issues raised by HIV/AIDS are relevant as well in other circumstances, for example, inheritance rights, child welfare programs, urban food gardens, gendered roles for providing care, workplace programmes, housing groups cohesion, access to housing and living conditions in informal settlements. The impact of HIV/AIDS is to accentuate these issues. The result is that when seeking to mainstream HIV/AIDS one may, for example, in effect be seeking to mainstream understanding and responses to vulnerability, issues that are already embedded among the urban poor in Africa 1 Rooftops Canada s housing partners working on HIV and AIDS responses include the National Co-operative Housing Union (Kenya), WAT Human Settlements Trust (Tanzania), Coalition des Organisations Non- Gouvernementales et Organisations Communautaires de Base du Cameroun Oeuvrant dans le Domaine des Établissements Humains (CONGEH, Cameroon), Shelter and Settlement Alternatives (Uganda), Housing People of Zimbabwe, PlanAct (South Africa) and two Social Housing institutions Johannesburg Housing Company (JHC) and the Social Housing Company. 2 Philip Wambua in Kenya; Dr. Huruma Sigalla in Tanzania; Nathalie Nkoume in Cameroun; and Mercy Hatendi in Zimbabwe 3 Social Housing Institutions in the South African context are typically non-profit companies that own and manage mulit-unit, multi-storey flats for rent, targeting low income households. 1

4 The second is that mainstreaming HIV/AIDS should not necessarily mean adding HIV/AIDS to the core business of a housing cooperative or SHI, especially in contexts where there are quite a number of other actors directly addressing HIV/AIDS issues. Although these institutions may be under considerable pressure to address needs arising from HIV/AIDS, they should not attempt to become HIV/AIDS service organizations. The third is that housing institutions, where possible, should not seek to mainstream HIV/AIDS on their own. Rather, they should integrate the perspective in their work, and make efforts to network and partner with other organizations that are better placed to deal with HIV/AIDS related issues. Effective responses to many issues arising from HIV/AIDS can be outsourced or carried out in partnership with other NGOs, CBOs (Community Based Organizations) and FBOs (Faith Based Organizations) and government agencies. The housing cooperative, SHI or NGO can also be located within an integrated network of NGOs that provide housing, health care, child welfare, assistance with legal issues, food gardens and so on. The ability to outsource many HIV/AIDS issues enables the housing institution to concentrate on its core business and to scale up. In effect, mainstreaming HIV/AIDS includes the organization building its own understanding and capacity to respond where necessary and build networks. It also entails developing internal responses to deal with HIV/AIDS issues affecting its staff and the institution. 2. Relevance of the HIV/AIDS mainstreaming processes supported by Rooftops Canada The relevance of Rooftops Canada s work has to be viewed in terms of the partners and forms of housing in those countries as well as the country specific context. In South Africa, one set of partners considered by the study are Social Housing Institutions or SHIs. Rooftops Canada s assistance is considered to have been extremely worthwhile from the point of view of improving the overall capacity of the SHIs. The assistance in respect of HIV/AIDS has been less relevant because, while it triggered thinking about the matter, the impacts of HIV/AIDS have been less than those anticipated in the initial research funded by Rooftops Canada (2002). SHIs have, nevertheless, built partnerships with AIDS service organizations. The other partner, PlanAct 4, has had a quite significant proactive engagement on HIV/AIDS related issues. With the support of Rooftops Canada, it has provided on-going support to two organized groups - the Masisizane Women s Cooperative in Ivory Park and the Masizakhe Home Based Care (MHBC) Project in Vosloorus. One of the key achievements of this project is that MHBC has recently received official NPO registration from the Department of Social Development. It has set up a nutritional support component to assist families affected by HIV/AIDS. PlanAct has also built program partnerships with the City of Johannesburg. Rooftops Canada has also worked with a network of NGOs and other civil society actors to advocate for better reflection of HIV/AIDS and housing issues in the policies of the Departments of Housing, Health and Social Development. A Special Needs Housing Working Group has been set up and recognized by the Department of Housing. The Group intends to mainstream special needs in all of its housing delivery programs. HIV/AIDS is an essential component of special needs. In Zimbabwe, Housing People of Zimbabwe (HPZ), provides technical assistance to housing cooperatives. It is clear that HPZ has successfully informed housing cooperatives and 4 PlanAct is an NGO working with CBOs on human settlements issues. It is not a SHI. 2

5 District Unions (where there are more than five cooperatives) about HIV/AIDS, prevention and about how to respond to HIV/AIDS, and has tried to diminish stigma within the cooperatives. HPZ has set up support groups for people living with AIDS (PHAs). A major achievement of Rooftops Canada s support is that HPZ has received funds from the Stephen Lewis Foundation for intensifying work with PHAs on herb gardens, urban agriculture, and food packages to especially vulnerable members of support groups. The dismal political and economic conditions limit HPZ s ability to deliver at scale and threaten the viability of housing co-operatives. In Kenya, the program partner, NACHU, is an umbrella organization for housing cooperatives. Rooftops Canada has assisted NACHU to deepen its understanding of how HIV/AIDS impacts on the housing sector. NACHU has made significant progress in raising awareness within its membership on the linkages between HIV/AIDS and human settlements. These processes have already generated momentum within the housing cooperatives to initiate and implement community level interventions for educating members about HIV/AIDS. It has also created a supportive environment for the members affected and infected by HIV/AIDS. In Uganda, the program engaged with Shelter and Settlements Alternatives, an NGO created to lobby and advocate for inclusion of human settlements issues into the national and international development agenda. With Rooftops Canada support it has learned from the experiences of other partners and been inspired to recognize HIV/AIDS as issues that should be factored into its lobbying and advocacy work. Already, it has undertaken a study exploring the links between HIV/AIDS and human settlements, and is making efforts to create awareness to its wider constituency over the same issues. In Cameroon, CONGEH, a network of over twenty seven active organizations dealing with human settlements issues, has been supported by Rooftops Canada to develop capacity for responding to some of the HIV/AIDS related issues impacting on the housing sector. Consequently, CONGEH has taken the issue of HIV/AIDS seriously, linking it with housing and gender. Already, it has created social spaces as avenues to discuss these issues in an integrated manner so that they can have an institutionalized response. In Tanzania, the partner WAT Human Settlements Trust is an organization created to improve access to reasonable and affordable housing conditions, especially for marginalized people including women. It has recognized HIV/AIDS as issues that can impact on its staff and the institution, as well as its constituency (housing groups). It has initiated training for members of seven housing cooperatives on the links between HIV/AIDS and human settlements, and has initiated dialogue with a group of women living with HIV/AIDS. It has also strongly advocated on the land and inheritance rights of women as a way of reducing their vulnerability to HIV/AIDS. Internally, it has developed a workplace policy on HIV/AIDS, which is to some extent already being operationalized. To a significant extent, the work so far undertaken by the different partners is relevant especially in countries like Uganda, Kenya, Tanzania and Cameroon where there are mature epidemics. In these countries, Rooftops Canada partners are working in contexts where the impact of HIV/AIDS is already being felt, especially in the informal settlements. Also, the need to prevent further spread of HIV among members of housing cooperatives cannot be underestimated. Creating a supportive environment for those members that are already infected and or affected by HIV/AIDS remains critical for the survival of the cooperative movement. It is important to also reach outside the housing community for networking and reducing stigma. A fundamental constraint to Rooftops Canada s approach is its focus on concerns, responses and impact within cooperative / community-based housing constituencies. In 3

6 South Africa, some SHIs form part of networks of NGOs providing health care, emergency housing, social housing, education, and so on. In this model of networked NGOs, the SHI can stick to its core business and is better able to scale up. In some contexts, where the level of openness remains low, prevention messages and the destigmatization of HIV AIDS messages within housing groups or cooperatives may have limited impacts when the cooperative members who still hope to obtain housing or serviced sites live in the wider community and bear the full brunt of stigma and limited knowledge. However, in other contexts where HIV/AIDS have been openly accepted as issues, even by the political leadership, having an increased number of co-operative and housing group members who are aware and open has led to more discussion and de-stigmatization in the larger community. 2. HIV/AIDS methodology Rooftops Canada and its partners have been developing a HIV/AIDS methodology (annexed to the report). It includes the following aspects: How organizations reflect their perspective on HIV AIDS internally - staff development, organizational policies etc. How organizations situate themselves within a larger HIV/AIDS response through research and networking How organizations develop specific community based responses Facilitating regional exchange, consolidation and networking. In South Africa, Rooftops Canada has worked with SHIs and NGOs working in the informal sector. The HIV/AIDS methodology has had mixed results. The research on the impact of HIV/AIDS on SHIs (2002) came at a time when the country was in denial about HIV/AIDS and its impacts. It caused SHIs, which were fixated on institutional survival, to think more seriously about the impacts of HIV/AIDS and, perhaps also, to identify other institutions that they could work with to mitigate the impacts of HIV/AIDS. However, beyond including HIV/AIDS awareness and prevention messages within their community activities, and the development of a referral system for those who are ill, the anticipated consequences for orphans, adapting physical structures, bylaws and so on is not perceived as necessary due to the limited impact of HIV/AIDS. For PlanAct, an NGO, that works in urban informal settlements where the HIV prevalence rate is exceptionally high (25.8%), the methodology helped to test out and conceptualize a more organized approach to HIV and AIDS mainstreaming. In Zimbabwe, it is clear that many of the concerns included in the HIV/AIDS methodology have been taken on board. Early interventions of building awareness among co-operatives has led to the formation of support groups, development of herb gardens and promoting urban agriculture. HPZ is currently providing food and emergency shelter to some child headed and vulnerable households. However, given the circumstances prevailing in the country, many recommendations that cooperatives, for example, prepare detailed project plans have not proven practicable. Relevance of methodology The methodology is relevant and useful in guiding a systematic process of HIV/ AIDS mainstreaming. Organizations need minimum human and financial capacities to effectively use the methodology South to South exchanges expedite the learning and sharing process, especially when partners are operating in related contexts In contexts where stigma is high, articulating and addressing issues relating to overall vulnerability.e.g women s inheritance rights, helps at the same time address needs arising from HIV /AIDS. In Uganda, Kenya, Tanzania and Cameroon, there is consensus from partner organizations that the HIV/AIDS methodology is relevant and useful in guiding a systematic process of HIV/AIDS mainstreaming. Rooftops Canada s partners in Kenya and Uganda have used the 4

7 HIV/AIDS methodology to advance the mainstreaming process. However, it is also apparent that organizations need some minimum human and financial capacities to effectively use the methodology. It is not particularly meaningful if an NGO adopts the methodology but lacks the institutional capacity both to scale-up delivery and to provide an example for other cooperatives in the region. South-South exchanges are emphasized when it comes to expediting the learning and sharing process. Having dedicated resources would add value to these exchanges, especially given that partners are operating in related contexts, with some of the issues and complexities generic. While best practices have not yet emerged from the country research, the sharing of ideas and experience will contribute to the development of best practices. Partners in Southern Africa believe that the methodology would be more useful were it to be recast within a wider conception of a housing community and enhanced networks of NGOs, of which the housing community forms a part. This conception should also not focus solely on HIV/AIDS because if PHAs within a network of NGOs are provided with superior access to resources, this can exacerbate stigma. In other countries, however, there is more openness and commitment to provide extra support to PHAs, and families affected by HIV/AIDS to enhance their coping capacities. Part of the destigmatizing effort and awareness raising is that further stigma is not created. In contexts where there is still a lot of stigma and denial related to HIV/AIDS, the focus might be on networked NGOs serving vulnerable households, housing rights and legislation pertaining to, for example, the inheritance of property. Instead of articulating and addressing issues only within the context of HIV/AIDS, addressing them as issues within the broader context of vulnerability still addressing needs arising from HIV/AIDS without the attached stigma. Housing groups should also work with networks taking into account that housing institutions should probably not serve as HIV/AIDS service centres. In many instances, the best means through which they can focus on their core business, scale-up and mainstream HIV/AIDS is to outsource or network to other NGOs needs arising from HIV/AIDS. It should however be noted that housing groups can take on some of these functions especially if no other group is willing or able. 4. Regional level elements 4.1 What is working/ successes It is clear that the leadership and management of housing cooperatives, SHIs and technical assistance NGOs have a significantly improved understanding of HIV/AIDS, what causes it, the relevance of HIV/AIDS to their organizations, and the need to destigmatise HIV/AIDS. Many of the organisations now include prevention messages within the services they provide. This knowledge has been abetted by the HIV/AIDS research funded by Rooftops Canada (2002 and 2004), training manuals and information materials linking HIV/AIDS and human settlements, as well as the preparation of action plans. In addition, the international AIDS workshop and networking event at the World Urban Forum (2006) was an inspiration to many of Rooftops Canada s partners who participated. They emphasised the value of sharing experiences and ideas and how this has guided them in HIV/AIDS mainstreaming work. As before, one constraint to making use of this knowledge is the limits of existing institutional capacity and resources. To some extent, this also limits the value of technical assistance provided by Rooftops to its partners insofar as it is difficult to expand the impacts. Rooftops Canada has been very proactive in encouraging and assisting partners to develop new funding partnerships and basket funding arrangements, but there is always more to do than resources permit. Indeed, it is perhaps only in the case of SHIs that the institutions 5

8 have achieved the ability to be self-supporting, in part because South Africa which has substantial housing subsidies. 4.2 Best practices: It was noted that some partners started with internal HIV/AIDS mainstreaming before moving into external mainstreaming, which seemed to have enhanced the effectiveness of these organizations in dealing with the issues. This helps management and staff to better conceptualize and understand the key HIV/AIDS related issues, and relate with them at a personal level, which enhances their commitment to HIV/AIDS mainstreaming. This also reflects the organizational commitment to HIV/AIDS, and increases its legitimacy to undertake external mainstreaming. Working through established housing cooperative structures as an entry point for HIV/AIDS work seems to be more effective, and creates a firm ground for sustainability of the HIV/AIDS initiatives. In addition, training leaders of housing cooperative societies helps in building trust and commitment to the process. Best Practice Internal mainstreaming before external mainstreaming helps the organization better conceptualize, understand and better relate to key HIV/AIDS issues. Working through established community structures creates a firm ground for sustainable initiatives. Involving PHAs in the different processes helps to reduce stigma and gives HIV/ AIDS a human face Regional exchanges inspire action and shorten the learning curve. Involving people living with AIDS in the different processes helps to reduce stigma and gives HIV/AIDS a human face. For example, partners like NACHU that involved PLHA in the workshops and other subsequent processes significantly contributed to members acceptance and openness about HIV/AIDS, as well as reducing stigma and discrimination. Regional workshops and exchange programmes, such as that organized by Rooftops Canada in Vancouver helps to shorten the learning curve and acts as a source of inspiration for others to start on the process. 5. Gaps and Challenges As noted above, in the midst of high expectations for support from housing cooperatives and NGOs that provide technical assistance to cooperatives, the limited human and financial resources of these institutions limits the effectiveness of Rooftops Canada support and the ability to scale up. This is exacerbated by the limited experience on HIV/AIDS mainstreaming processes among the staff and management of partner organizations and their ability to concentrate on their core business, while transacting it using an HIV/AIDS lens. Instead, most partners have to a large extent developed and implemented interventions similar to those of AIDS service organizations. It should however be noted that, to some extent, this has happened because local ASO capacity is not enough to meet all the partners needs. In the absence of this, some of the partners have taken deliberate steps to engage in conventional HIV/AIDS work to help their partners cope with the impacts. Gaps and Challenges Limited financial and institutional capacity to transact core business using HIV / AIDS lens. Sometimes have to mimic ASO roles in the absence of local ASO capacity Need to prioritize internal mainstreaming in operational terms Limited networking and partnership building around HIV/AIDS and vulnerability Weak monitoring and evaluation systems In addition, some of the partners have not prioritized mainstreaming HIV/AIDS within the organization itself. Even in the case of SHIs and NGOs that have HIV/AIDS workplace policies, their operationalization may still be limited. 6

9 Further, networking and partnership building with other organizations that deal with HIV/AIDS and other issues related to vulnerability is still minimal, which limits the extent to which needs arising out of HIV/AIDS can be outsourced. Finally, the monitoring and evaluation system of HIV/AIDS mainstreaming processes is not well developed 6. What can Rooftops Canada and its partners do? Much of what Rooftops Canada and its partners are presently doing is of considerable value. Alerting housing institutions to the anticipated impacts of HIV/AIDS, explaining HIV/AIDS, leading to the institutions to adopt preventative messages and destigmatisation are valuable services. However, visiting the Kibera slum in Kenya, in the midst of vast housing and services needs, one appreciates the enormous challenges that organizations working on human settlements face as they embark on mainstreaming HIV/AIDS. A number of suggestions follow in terms of what Rooftops Canada can do to advance the HIV/AIDS mainstreaming process among its partners. The first is to obtain better projections for planning and programming purposes. In countries where the assessment was conducted, all the partners testified that HIV/AIDS is an issue they are already grappling with as it continues to impact on their constituencies. This is also true for PlanAct working in urban informal settlements in South Africa. However, the situations of South African SHIs may be somewhat different. It was asserted that HIV/AIDS has had little impact on the SHIs. The impacts were overestimated and misunderstood; or at least this is the case at this point in time. The impacts may be felt downstream. The second concerns locating housing institutions within networks that provide complimentary services: housing, health care, legal assistance, food gardens, home-based care (for all who are ill), and so on. The assumption might be that one has in mind NGOs, CBOs and FBOs, and this will certainly be true; but there is every reason to include government departments and agencies, whether because they provide clinical services or because they provide water. In effect, while Suggestions for next steps: Better projections for planning and programming purposes. Locating housing institutions within networks that provide complimentary services: health care, legal assistance, food gardens, home-based care (for all who are ill) etc. Increase resource support (human and financial) to strengthen and guide the mainstreaming process. Develop a clear agenda and strategy for lobbying and advocacy at national, regional and international levels so that more actors can be brought on board. Document and share lessons, and encourage the process through which these lessons are shared building the capacity of housing institutions is highly desirable, so to is building networks. Networks that enable the respective organisations to concentrate on their core businesses are highly desirable throughout the civil society sector. The third returns to the point that the impact of mainstreaming HIV/AIDS is constrained if the institution concerned has limited capacity. Rooftops Canada needs to continue working with its partners to increase financial support so they can hire technical people to strengthen the institution and who can at the same time coordinate and guide the mainstreaming process. Related to this is necessary support to develop monitoring and evaluation systems to measure progress, achievements and outcomes arising out of the HIV/AIDS mainstreaming process. 7

10 The fourth is that Rooftops Canada should continue to support the work of its partners to develop a clear agenda and strategy for lobbying and advocacy at national, regional and international levels so that more actors can be brought on board. This would include those working directly on HIV/AIDS so that they can factor human settlements issues into their programmes, and those working on human settlements issues so that they can also factor HIV/AIDS issues into their work. The role that Rooftops Canada and it partners can continue to play in advocating for inclusion of HIV/AIDS issues onto the international human settlements policy agenda cannot be overemphasised considering its strategic positioning. Already, Rooftops Canada has helped the SHIs and other NGOs in SA to lobby around special needs, including HIV/AIDS; CONGEH and SSA are also both active in lobbying; and Rooftops Canada is trying to influence UN Habitat 5. The research found increasing understanding of the impacts of HIV/AIDS, an evolution of experience and lessons, but limited institutional and/or financial capacity of housing cooperatives and NGOs that provide technical assistance. However, their interest in and their ability to continue to mainstream HIV/AIDS can serve as an example to other organisations. It is important to continue to document and share these experiences and lessons, and encourage the process through which they are shared. 5 The United Nations Human Settlements Programme, UN-HABITAT, is the United Nations agency for human settlements. It is mandated by the UN General Assembly to promote socially and environmentally sustainable towns and cities with the goal of providing adequate shelter for all. 8

11 Rooftops Canada HIV / AIDS and Housing Programming Methodology 1) Partner staff responsible for implementing HIV AIDS activity trained in relation to HIV / AIDS and management of project. 2) External scan for each partner / country to identify local resources, existing programs, key issues, lessons learned to date, best practise. 3) Initial sensitization of staff, boards, key constituency members (cooperative and community leaders, influential members / women) 4) Rapid participatory assessment of impact, existing responses and concerns within cooperative/ community based housing constituency. 5) Develop detailed project plan with each partner including two key areas: a) Information, education, communication - awareness, destigmatization, prevention within partner organization and constituent cooperatives and community based housing groups b) Community based planning to implement pilot activities in areas such as: - protection of children - inheritance of property, support, home care, education, exemption from rates, responsibilities for loans, rates, etc - adapting physical structures to cope with growing number of disabled, indigent persons and child-headed households - sanitation, water, design, etc. - adapting organizational / legal framework - bylaws, tenure, home ownership, savings and loans - community based support services - bereavement counselling, education, emotional support and medical services for children and adults. - community based support services - income generation, urban agriculture, social insurance schemes within cooperative - support in training and recognition of volunteers especially women & youth - training and support systems for peer educators especially women & youth - Monitoring and documentation of activities - Assessment of project activities 6) Regional sharing / lessons learned workshop involving direct project partners and other interested parties as relevant. Recommendations on revision / adoption of activities 7) Apply lessons learned in partner projects at country level - Monitoring and documentation of activities - Assessment of project activities 8) Regional sharing / lessons learned workshop involving direct project partners and other interested parties as relevant. Final report, best practises

12 CAMEROON: COALITION DES ONG ET DES OCB OEUVRANT DANS LE DOMAINE DES ETABLISSEMENTS HUMAINS ET DE L HABITAT (CONGEH) CONGEH is a coalition of 30 NGOs and grassroots groups in Cameroon working to improve human settlements. CONGEH began working on HIV/AIDS in 1998 in response to stories and observations from the field about mortality and morbidity related to HIV/AIDS, including stigma and discrimination. At the community level, women were particularly vulnerable to HIV/AIDS; and rural communities had less knowledge about HIV/AIDS than urban areas. It was also evident that people s housing conditions were greatly contributing to susceptibility and vulnerability to HIV/AIDS. Houses in slums lacked privacy and were overcrowded, exposing young children to sex life at an early age. Commercial sex work existed in these slums, with the young people watching. Poor sanitation and lack of water exposed HIV infected people to further opportunistic infections. CONGEH began with developing IEC material including a documentary, training tools, flyers and image boxes to sensitize rural communities. This was following by training coalition and community members as trainers to link Gender, Housing and HIV/AIDS. In 2003, CONGEH developed the GSH Model (Gender, AIDS and Habitat). CONGEH has facilitated the development of social spaces - forums created to discuss issues of HIV/AIDS, gender and habitat affecting communities. The social space is also an avenue for other programs aimed at women s economic The social spaces have contributed to create an enabling environment where people can openly talk about HIV and AIDS. empowerment, promoting rights to land and housing, and better living conditions. CONGEH is also developing housing for poor families and has recently acquired a large plot of land which can house 200 families. All of CONGEH s initiatives are aimed at empowering the most vulnerable people, especially women, to deal with HIV/AIDS, either directly or indirectly, through information, skills, legal support and economic empowerment. The micro credit scheme under the FOCAH project has assisted thirty women to access loans for income generating activities (IGAs); and sixteen women have been trained in how to manage IGAs. All these have contributed to increasing women s economic empowerment and autonomy, reducing their susceptibility and vulnerability to HIV/AIDS. Furthermore, the land consultation clinics under the CCF project have helped widows and orphans affected by HIV/AIDS to reclaim their rights to land, housing and property. The program conceptualization is a key achievement, for it links the gender, shelter and HIV/AIDS aspects making the concrete programmatic link between sustainable development and HIV/AIDS. CONGEH needs to prioritize internal mainstreaming by developing internal mechanisms, workplace policies and programs within its network. Sustainability of actions and interventions is challenged by limited human and financial resources. While there is a larger civil society response to AIDS, CONGEH needs to network and develop better links with this sector to build synergies and gain access to a wider spectrum of services and resources. While a cadre of trainers and community relays has been created, their skills need to be updated and a strategy for incentives to keep them engaged needs to be developed. Systems for monitoring and evaluation need to be developed to measure the impact of the cross-cutting GSH strategy. CONGEH is currently reviewing its organizational structure to reflect the cross cutting nature of GSH work. This summary is based on the report Mainstreaming Responses to HIV and AIDS: Lessons from the Human Settlements Sector in Africa Final report for CONGEH Cameroon by Dennis Nduhura and Nathalie Nkoume. For the full report on Cameroon and other country reports, or for more information on Housing, HIV and AIDS please contact info@rooftops.ca

13 KENYA: NATIONAL COOPERATIVE HOUSING UNION (NACHU) NACHU is an umbrella organization for housing co-operatives in Kenya with a membership of over 200,000 people. NACHU is committed to providing affordable shelter to low income groups and improving their quality of life. NACHU began responding to HIV and AIDS in 2002 when the impacts of HIV and AIDS were felt within the organization as well as its membership. Seven members with loans died and co-operative leadership had to care for orphaned children. Stigma and discrimination stemming from fear and ignorance was rampant. NACHU first response was to understand the impact of HIV and AIDS and NACHU was our closest develop a strategy to respond. NACHU focused on both internal partner and we had to run to them to share our organizational responses as well as developing responses within primary cooperatives. As part of the internal response, NACHU developed a policy challenges related to HIV and AIDS We kept stipulating key elements that would be supported to deal with HIV and AIDS asking NACHU as to as a workplace issue. NACHU developed linkages with AIDS sector who would stay in these organizations to understand and situate their work and identify partnerships. houses when members NACHU also developed training and awareness material on HIV, AIDS and were dying. housing for use by trainers, co-operatives and other stakeholders. Housing Microfinance for co-operative members is one of NACHU s core programs and NACHU has insured loans to minimize losses on default due to sickness or death. NACHU carried out a needs assessment to understand community perspectives, establish HIV/AIDS awareness and knowledge levels, attitudes and practices amongst respondents; and to identify effective intervention measures. The program titled Build and Live was started in Training of trainers (TOT) has been the primary strategy NACHU has trained 731 men and women members of housing co-operatives as community trainers. The work of trainers has helped reduced stigma, initiate community based responses such as support to PLHIV and rehabilitation and feeding of orphaned children. The TOT program has created a pool of community trainers that are instrumental in creating HIV and AIDS awareness among housing cooperatives, providing care and support to the infected and affected, as well as orphan care. The TOT is credited with creating increased knowledge and awareness, promoting preventive behaviour, encouraging positive living, initiating support groups for PLHIV and community support initiatives for OVCs. NACHU needs to institute regular follow ups to the trainers to keep abreast of progress and outcomes arising out of their interventions, but also keep the trainers motivated and equipped with updated knowledge on HIV and AIDS. NACHU has done some work on inheritance rights two members who were evicted regained their inheritance rights. NACHU should support housing cooperatives to review and adapt their by-laws such as writing wills to ensure property rights and inheritance, co-operative membership for child headed households. NACHU has the potential to achieve scale considering the level of commitment from the Board, management and staff, as well as the cooperative association members to further address HIV and AIDS related issues. NACHU needs dedicated financial and human resources to sustain and expand the program. This is critical to build and nurture relationships with the key AIDS networks. A monitoring and evaluation system is being developed and needs to be refined to systematically measure the progress, achievements, outcomes and impact of both internal and external mainstreaming work. NACHU s role in advocacy and lobbying has been limited but the potential is immense. NACHU has the experience and membership to proactively engage with key policy makers, Government and other CSOs, on the need to mainstream housing and shelter issues into the national HIV and AIDS response. This summary is based on the report Mainstreaming Responses to HIV and AIDS: Lessons from the Human Settlements Sector in Africa Final report for NACHU- Kenya by Dennis Nduhura. For the full report on Kenya and other country reports, or for more information on Housing, HIV and AIDS please contact info@rooftops.ca

14 SOUTH AFRICA: SOCIAL HOUSING INSTITUTIONS and PLANACT In South Africa, two set of Rooftops Canada partners were considered for the assessment. The first set are Social Housing Institutions or SHIs, which in the South African context are typically non-profit companies that own and manage mulit-unit, multi-storey flats for rent, targeting low income households. The second partner was PlanAct, an NGO working in informal settlements HIV prevalence in South Africa is 10.8% for the total population. There are marked racial differences in prevalence. Demographic projections do not preclude problems arising for SHIs, but do not suggest the likelihood of an insurmountable burden. In 2002, Rooftops Canada and the Social Housing Foundation undertook research on the possible impacts of HIV AIDS on SHIs. Some of the anticipated impacts included families unable to pay rent because of illness leading to evictions, and threatening the financial viability of SHIs; SHIS having to deal with orphaned children, illness and AIDS related death threatening institutional capacity and sustainability. The assessment discovers that the impact of HIV and AIDS on SHIs has not been to the extent perceived by earlier research. SHIs provide condoms and preventive information to tenants. They have not encountered a situation where orphans, arising from various causes of death, have not been cared for by the extended family. Some SHIs have HIV and AIDS workplace policies. Whiel the research triggered thinking about the matter; the impacts of HIV/AIDS have been less than those anticipated. SHIs have, nevertheless, built partnerships with AIDS service organizations. While SHIs have assumed responsibility for prevention messages and condom distribution, HIV/AIDS is treated as a community or social issue and the task of dealing with HIV/AIDS is outsourced via a referral system. Mainstreaming HIV/AIDS has been fundamentally affected by staff turnover and the absence of champions within organizations; and by the limited impact of HIV/AIDS. PlanAct however faces a different reality. HIV prevalence in urban informal settlements is 25.8% where 97% of the households are African an important statistic since all of PlanAct s work is in urban informal settlements. Planact s involvement in HIV and AIDS issues arose from its managing a Peoples Housing Process Project and finding persons in shacks that were to be replaced who were profoundly ill. Planact works with the Masizakhe home-based care NGO and the Rethabile food and herb garden cooperative. The home-based care service is based on donations of equipment such as gloves and disinfectants and voluntary services of a few and declining number of woman, and a man. The food cooperative has obtained a R700,000 grant but is having considerable difficulty obtaining land from the government and the food garden is presently less than a hectare. The food is distributed to the ill and needy, and not solely to persons with HIV/AIDS which, it was explained, would further stigmatise those having HIV/AIDS. Planact has also implemented the Joburg Connections Project: An Integrated Community Approach to Addressing HIV/AIDS in Informal Settlements. The main purpose of this project was to develop a community-based response to HIV/AIDS in partnership with the City of Johannesburg HIV/AIDS Unit (Jozi Ihlomile volunteer pilot project), the Medical Research Council (MRC) and informal settlement communities, geared towards reducing HIV/AIDS infections and improving the quality of life for those affected and infected. This summary is based on the report South Africa: Social Housing Institutions Mainstream HIV/ AIDS by Prof. Richard Tomlinson and Dennis Nduhura. For the full report on South Africa and other country reports, or for more information on Housing, HIV and AIDS please contact info@rooftops.ca

15 TANZANIA: WAT HUMAN SETTLEMENTS TRUST WAT Human Settlements Trust (WAT), formerly Women Advancement Trust is a national, NGO established in July 1989 to promote the advancement of women. Since its formation, WAT has promoted gender equality through training, education and advocacy. This includes equal rights in access to land, property ownership, adequate housing and inheritance. WAT started addressing HIV and AIDS issues in 1999, when they realized that there was no point in continuing to support people build houses that they were not going to live in because of HIV and AIDS related morbidity and mortality. Some of the impacts felt were reducing membership in housing groups, reduced savings and increased loan default. WAT has a workplace policy on HIV and AIDS. Staff have been trained and are provided opportunities to update their knowledge. Condoms are provided in all washrooms, but there is a need for regular information and discussion at staff meetings. Efforts have been made to integrate HIV and AIDS sessions into all workshop conducted for housing groups and so far 6 of the 8 housing groups have been reached. WAT has developed IEC materials as well as a video and role play. WAT has conducted sessions on positive living including nutrition to women s groups. As part of its efforts on ensuring women s housing rights, WAT has been advocating the repeal of the customary inheritance law that denies women the right to their husband s property. This has been intensified within the context of HIV and AIDS. WAT includes HIV and AIDS issues within its legal rights awareness and education sessions, training of para-legals and along with other partners drafted and submitted an alternative law to the Government. WAT recognizes that its core business housing development and improvement schemes, housing loans, regularizing security of tenure, getting government plots all service to reduce vulnerability and susceptibility to HIV AIDS. This has not as yet, been monitored empirically. WAT has recently commenced a pilot progam on Housing Microfinance with support of the Financial Services Deepening Trust. A reserve fund for HIV AIDS has been included within this program. This will ensure that affected families are not disadvantaged in the housing process while safeguarding financial viability of the loan program. While WAT has been nominated to the ward level Multi-Sectoral AIDS Committee, it has not built strategic partnerships with organizations within the AIDS sector, which could help fill gaps in existing service needs. WAT also needs to participate in local and national AIDS events and use its advocacy strength to highlight human settlements issues and the need for these to be integrated as part of the AIDS response. WAT needs to undertake research to better understand the dynamics of HIV and AIDS within the housing sector in Tanzania. This will enhance understanding and capacity of staff as well as housing groups to better understand and respond to the impact of HIV AIDS. While HIV AIDS is included in all training programs, there needs to be the space for on-going and in-depth discussion. WAT can work with PLHIV groups and involve them within workshops and training processes. WAT is developing a new strategic plan which presents an opportunity to intensify HIV and aids mainstreaming. This will also help identify and attract more resources human and financial, and help strengthen systems for planning, monitoring and evaluation. This summary is based on the report Mainstreaming Responses to HIV and AIDS: Lessons from the Human Settlements Sector in Africa Final report for WAT - Tanzania by Dennis Nduhura and Dr. Huruma Sigalla. For the full report on Tanzania and other country reports, or for more information on Housing, HIV and AIDS please contact info@rooftops.ca

16 UGANDA: SHELTER AND SETTLEMENTS ASSOCIATES Shelter and Settlements Alternatives (SSA) is a Ugandan NGO, registered in 1999, focused on advocating for the prioritization of human settlements issues in Uganda s national agenda. SSA does this by facilitating information sharing and implementing community outreach programs aimed to engage stakeholders in sustained dialogue and debate on important issues concerning human settlements. In 2006, the Executive Director of SSA participated in a workshop and networking event organized by Rooftops Canada on HIV AIDS within the context of Human Settlements Development, in Vancouver, where she met other African NGOs working on the issue. This workshop was the catalyst for SSA s engagement with the issue. The program was informed by the framework suggested by Rooftops Canada. As a first step, SSA worked with its board members, sharing feedback from the workshop and raised their awareness on the need to mainstream. They then undertook a a stakeholder analysis, mapping organizations working in the human settlements and the HIV and AIDS sectors respectively. This process helped SSA to identify some potential partners that they could work with at a strategic and operational level. SSA could no longer continue doing its core business without using an HIV and AIDS lens, and thus the need to proactively embark on HIV and AIDS mainstreaming In 2007, an action research project examining the links between HIV AIDS and housing was conducted. The study highlighted some of the dynamics and factors within the slum environment that increase susceptibility and vulnerability to HIV and AIDS. This was followed by a one-day workshop that drew multi-sectoral participation on issues relating to AIDS, housing and gender. The workshop has laid some foundations for future networking and partnership. SSA published a newsletter on HIV, AIDS and Housing as well as a position paper on the subject. Both were disseminated widely, but there is no mechanism in place to monitor the impact of these publications. SSA is till in the early stages of engaging in HIV and AIDS mainstreaming processes. SSA has contributed to raising awareness on the links between housing and HIV AIDS across many sectors. This needs to be translated into a concrete action, with measureable impact. SSA has initiated the formation of a network around HIV, AIDS, human settlements and gender issues in Uganda. SSA needs to overcome its resource and capacity limitations in order to sustain this network as a space for continuous dialogue and policy advocacy. SSA s strategic planning process, currently underway, presents an opportunity to strengthen HIV and AIDS mainstreaming within organizational development and develop appropriate systems for planning, monitoring and evaluation. SSA appears to be the only NGO in Uganda that is committed to promoting the challenges of human settlements on the national policy agenda, and could thus use this strategic positioning to put HIV and AIDS mainstreaming on the national housing agenda. SSA continues to focus on influencing other stakeholders to mainstream HIV and AIDS as they plan and implement projects, rather than going into direct service delivery at community level. SSA should play a more pivotal role in lobbying and policy advocacy, research and information sharing (evidence-based information). This summary is based on the report Mainstreaming Responses to HIV and AIDS: Lessons from the Human Settlements Sector in Africa Final report for SSA - Uganda by Dennis Nduhura. For the full report Uganda and other country reports, or for more information on Housing, HIV and AIDS please contact info@rooftops.ca