Hiv & aids continuum traditional leaders role

TOPIC
HIV and AIDS Prevention, Treatment,
Care, and Support Continuum: The
Neglected Power of Traditional
Leaders.
11-Jun-16
AN AMUNGWA CREATION/TRADI-LEADERS & HIV AND AIDS
/JUNE 2016
1

welcome
to this
Slideshare
presentation
By Amungwa Athanasius Nche (PHD.DS, MPH, MBA,
MScTL)

11-Jun-16
AN AMUNGWA CREATION/TRADI-LEADERS & HIV AND AIDS /JUNE 2016
3
Albert EinsteinBruce LeeBob Marley
John LennonDesmond Tutu
Wole Soyinke
Ludwig-van-Beethoven
Malcolm-X
W-E-B-Du-Bois
Mother-Teresa
Nelson-Mandela
Charlie Chaplain
Michael-Jackson
John Travolta
Martin Luther King
Traditional leaders ,Influential leaders in the community could be
very instrumental in enhancing AIDS action Like these people have
done so during their time. They commanded peoples’ mind- sets
and moved them into purposive action beneficial to the people
Themselves. These days our leaders, traditional ones in particular
Fon of Mankon

ABSTRACT
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Introduction
This paper is a retrospective document
survey of traditional chief’s role in AIDS
control. Traditional Leaders are very useful
people that could be utilized in scaling
down HIV infection but such utilization is
inadequate.
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5

Objectives
The researcher seeks to find out how traditional
leaders can be more involved in national AIDS Control
Response.
The researcher will make some proposals on how to
Integrate traditional leaders in AIDS control
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Rationale
If traditional leaders are used
appropriately in national AIDS control
response, the achievements of such
programmes would apparently be
multiplied.
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Study Question
Why are traditional leaders not
adequately used in national
AIDS Control response?
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Methodology
This survey is a convenient sample of 30 articles and
documents from 1999-2008 targeting traditional leaders
gleaned from the internet and other sources. If any article
was read and found to treat traditional leader’s role and
aspects of the concept of traditional leadership in AIDS
control and suggestions for their better utilization, it was
included in the study.
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Findings1
Traditional leaders command much respect and authority
and are models to be emulated by their subjects in HIV
control efforts but are not fully engaged the HIV/AIDS
national response.
2
This scenario has to be reversed say (Katongo,L,2005
Harries P,2005). This means that these leaders must be used
in HIV & Strategies
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3
The centrality of culture must be addressed
rigorously in (all) countries and cultural
transformation engaged if the HIV pandemic is to
be halted.
4
The consensus is that community-based education
which includes cultural leaders, is the only means
to secure sustained and cost-effective behavioural
change at the grassroots level in favour of AIDS
response
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5
Leadership and its local governance structures
have to be empowered to offset the scenario
otherwise more and more people will be getting
new infections every day(IRINEWS, 2003; Greg H,
2004; Katongo C, 2005; Times of Zambia,1999;
UNDP Burkina Faso, 2003; UNDP, 2003, S.A.,
2008,Akoi J,2008;IFRC,2008;SARPN Event
papers,2002, The Ethiopian Herald,2005;
BAI,2008,MwendaKK, 2008)
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..12

6
To do this well organized and empowered
traditional leadership structures can be used
to change vulnerable norms including gender
insensitive norms which reinforce women’s
vulnerability to HIV evidenced by practices
such as sexual violence and coercion,
unshakable patriarchy, female poverty,
economic dependency, access to condoms,
ignorance and poor traditional governance
and sexual cleansing.11-Jun-16
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7
While the Global Fund for
AIDS/Tuberculosis/Malaria and other
international NGOs have been funding HIV/AIDS
projects, significant focus is yet to be put on
the role of traditional structures to reverse HIV
spread within grassroots communities.
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8
Stakeholders should be more determined
and reoriented to coordinate, empower and
support HIV and AIDS programmes focusing
more on local chiefs, village councils and
Queen Mothers.
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9
The door-to-door HIV and AIDS strategy is
seen as the best way to reinforce HIV
prevention, treatment and care and rolling
out stigma and discrimination. This can only
be best done by the proper empowerment
and use of traditional leaders and their local
governance structures
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INTRODUCTION
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Two Meaningful Quotations
“AIDS is the multi-facetted twenty century tragedy. This tragedy is not for
Only those who die, but those who are left behind, the children caring for
their parents, the grannies left to cope with a hut full of hungry mouths,
the poverty, the suffering, hopelessness, the countless abandoned
orphans.
For caught by the disease, its hell on earth” Stephanie(Canadian Author
Of the award winning ‘28 Stories of AIDS in Africa’)
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/JUNE 2016
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1

Two Meaningful Quotations
“AIDS is the multi-facetted twenty century tragedy. This tragedy is not for
Only those who die, but those who are left behind, the children caring for
their parents, the grannies left to cope with a hut full of hungry mouths,
the poverty, the suffering, hopelessness, the countless abandoned
orphans.
For caught by the disease, its hell on earth” Stephanie(Canadian Author
Of the award winning ‘28 Stories of AIDS in Africa’
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/JUNE 2016
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1

“Villagers do not testify in public [that they have HIV
and AIDS] either because of guilt [feelings], fear of
being discriminated against or do not know what the
benefits would be [if they testify]…our traditional
council has not been equipped[empowered] to
respond to HIV and AIDS …[so] increased witchcraft
tendencies and conflicts exist within families” ( An
opinion from a chief in Bamenda who withheld his
names)
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2

The above two quotations urgently request for reorientation of
HIV and AIDS control programmes to reflect village contexts
which should mirror the empowering and effectively using
traditional leaders and their traditional councils in national AIDS
Control programmes in collaboration with best practice UN-
Programmes and International NGOs
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Traditional leaders descend from laid down traditional arithmetic,
Are made by kingmakers and sit on power throne and wield power
Stick and this has been on since colonial times.
Rule in developing countries which bear the impact of the HIV and
AIDS pandemic(BBC News Mbeki Angers
Kings, http://www.news.bbc.co.uk/2/hi/africa/966015.stm
Should partner with national governments and departments of
education for scarce and critical skill development(OAU,1992)
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Conceptual Review of Traditional Leaders & Control-1

TLs should be empowered and used in AIDS
Control, http://www.medguide.org.zm/aidszam20.htm
TLs may be paternalistic, work alone[without an inner council], or
influenced by external politics which may reduce their subjects
allegiance with them. This breeds low participation in village
politics, Community Development Library, www.infocooperation.org
TLs rule and command their subjects and command power and
authority and are able to dialogue with the people and advice on
culture and traditional(Gurtong Report, no date)
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TLs live with the people, know them, understand their problems and
their people listen to them when they talk to them. TLs know how to
mobilize their people using cultural means and the people respect
them and act as dictated. Government sees TLs as the in-betweens
of the civil society and public governance (Gurtong Report).
Traditional leadership is not a constitutional affair, people are
brought up knowing who their TL is, they carry their problems to
him who consults them in the village and some of the problems
could be HIV and AIDS. TLs’ charisma works on the mindset of
subjects(ibid)
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220 TLs in Cameroon, Chad, Central African Republic were trained as
advocates of female genital cutting(FGC) or female genital
mutilation(FGM)(IFRC & RCS,2008) including other cultural practices
that fan HIV infection so that they could be able to use their throne
or power stick to cause change in their villages.
In Sierra Leone, 200 TLs, paramount chiefs, NGIs, CBOs, Clubs and
associations were trained in grant management, proposal writing,
implementation in order that they may mainstream HIV AND AIDS
in local governance(PowerPoint Presentation, Sierra Leone National
AIDS Response)
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Grassroots response HIV and AIDS depends on synergy so that they
could be able to use their throne or power between internal and
external stakeholders and actors during AIDS action on the ground.
Adequate village responses also depend on community
mobilization, TLs leadership skills and on how external stakeholders’
initiatives are Received(The ‘Social vaccine’ concept against HIV and
AIDS, PPT, Sierra Leone NAC, no year)
Some training of TLs has happened in Cameroon but transfer of KAP
studies have apparently never been done.
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Ghanaian Chiefs, queen-mothers and other traditional authority
figures believe that while we await the medical vaccine against HIV or
the cure for AIDS we should work towards the social vaccine against
stigma and discrimination so the queen mothers talk AIDS issues with
their people and raise funds to support children affected by AIDS
during public
campaigns(http://www.ucalgary.ca/oncampus/weekly/nov24-04/aids
in-africa.html) accessed 2008.
Some training of TLs has happened in Cameroon but transfer of KAP
studies have apparently never been done.
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/JUNE 2016
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A Problem Tree Analysis of the factors underlying the utilization of traditional rulers in AIDS Control Interventions
Support
& mitigation
Treatment
& Care
Culture &
Norms
Social Support Groups
Clubs /Credits
Associations, Self-help
Groups, Community-based
Organizations.
Income-generating groups
Voluntary Laborb
Psychological and
Spiritual Support
Patient Care
& mitigation
Child Care Changes in funeral Practices
Changes in Traditional Practices with HIV Risk
Shortening of Mourning Period
Savings Right
Protection of Property
Reduction of Risky Sexual Practices
Gender-related Change
Community Responses to HIV and AIDS
Fig. 1: Community Responses to HIV & AIDS
Community Development Library CD-ROM: A Cooperative Project to provide
sustainable Development and Basic Needs Information for all, 21st August, 2002,
found at www.infocooperation.org

Community-based education, including cultural leaders and traditional
leaders, is the only means to secure behavioral change Oxfam, in its
Ngorongoro Comprehensive HIV & AIDS Project(
http://.oxfamireland.org/yourcompany/projects/wheeldrive_tanzania.ht
m-17/06/2008) carried out 40 projects in a remote district in Arusha,
Tanzania, among pastoralists , hunter gatherers, trained traditional
birth attendants, traditional healers, community counselors, traditional
leaders and elders in HIV & AIDS and found out that Community responses are
the most cost-effective for supporting people living with HIV & AIDS and people
affected by HIV & AIDS, who access help principally from the family, neighbors,
community distributors, and local informal organizations, all under the
governance if TLs.
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Men have the right to beat their spouses.
Obligation for a woman to have sex with her spouse on demand even if she is
Not interested.
Because of no poverty alleviation schemes, women often engage in
transactional sexual activities including occasional or professional commercial
sex work.
Myths and beliefs plus those on HIV and AIDS impede the acceptance and
application of information about the pandemic.
Lethargy and denial among leaders sometimes including TLs: Mbeki,
http://web.cortland.edu/wagadu/Vvolume%202/articles/wodi.htm, accessed
10 September,2008
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Harmful Traditional Practices Justifying TL Role in AIDS Control-1

Some cultural conservative and prohibitive ideologies prescribe no debate or
public discussion of certain aspects of the culture including sex and sexuality
which on the hand can be discussed only in dark corners and behind closed
doors.
Women cannot own property.
Levirate marriages (system of remarrying within family: the practice by which a
man may be required to marry his brother's widow(Microsoft Encarta , 2007)
and Polygamy.
Sexual cleansing(purification sex)( demands that the surviving spouse of a death
man exorcise her husband’s spirit by having sex with his
relative(http://www.gonzagajil.org/view/168/26/27/02/2008
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“[during the act], I cried , remembering my husband…and when he finished, I went
outside and washed myself because I was afraid . I was worried I could contract
AIDS and die and leave my children to suffer”. There is no research that supports
the fact post-coital vaginal douching or washing prevents HIV so Fany was exposed
and could have been infected.
Fany, 23- year old wife[widow]. Fany was hunted out of her hiding place to have
sex with her husband's cousin without a condom(condoms are prohibited during
purification sex) . She had to do this to break the bond with her dead husband’s
spirit, according to cultural norm. These practices are common in Zambia, Kenya
and many areas in Sub-Saharan Africa.
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Change is happening slowly: be faster if TLs fully involved in
AIDS control(http://www.gonzagajil.org/view/168/26/27/02/2008). Zambian
TLs in a seminar(ibid[Abolition of negative cultural practices that make women
vulnerable to HIV], resolved to ban sexual cleansing, spouse inheritance and
Other cultural practices promoting HIV and pledged to help uphold fidelity
among couples in their chiefdoms as a weapon to fight the infection. The
question here would be whether other villages know what cultural practices
are harmful to whom. In one county in Zambia still, chiefs met together and
formed a council of elders through which chiefs submitted a petition to make
voluntary HIV counseling and testing compulsory with reason that social order
and good discipline in the family are important in AIDS control.
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Harmful Traditional Practices: Justifying TL Role in AIDS Control-5

Chiefs can be organized into national, regional as a medium of HIV and AIDS
mainstreaming to the grassroots because research shows that good and organized
governance is essential to sustained social and economic development and the
Africa House of Chiefs provides a governance model built on the principles of
inclusion, equality and responsibility, exploitable in AIDS control. Queen mothers
in South Ghana are useful advisors of
chiefs(http://www.niichro.com.hiv/hiv_6html). The Zambian House of Chiefs is
very functional in the fight against malaria into which
however they failed to integrate HIV and AIDS. Burkina
Faso and Mali chiefs were committed to fighting HIV and AIDS in their
communities(http://www.zambia.jhuccp.org/news/digest/digest.php?id=11,
http://undp.org/community/event_CA.htm)
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Harmful Traditional Practices: Justifying TL Role in AIDS Control-6

Traditional councils advice local and national governments on local custom and
tradition(Harries P, 2005) but is important to research on how they can help to
improve on customs and traditions that favor HIV and STI spread. Cameroons 2006-
2010’s development plan(MOH,2006) had targeted leaders including TLs for AIDS
control but it appears this target was not quite met.
The 2006-2010 plan dedicated a full chapter to target TLS based on the
assumptions that:
HIV and AIDS are a result of punishment from sexual transgression;
HIV and AIDS results from rejecting sexual taboos;
HIV and persons are objects of shame and discrimination because they have gone
against
The village’s cultural sex norms;
HIV and ADIDS originate from sorcery and focuses on immortality with other’s wives.
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Deeply rooted beliefs & traditions render biological & other approaches to AIDS control
difficult & further thought that TLs fully respected by their subjects could dislodge such
beliefs and practices. The US Department of Health and Human Sciences(2008) firmly
states that to help traditional communities(ruled by TLs) find alternatives to harmful
norms, stakeholders would have to assure that their HIV and AIDS Control Actors are
Culturally competent enough to integrate cultural sensitivity in their programmes.
Villages or communities could be organized properly for AIDS control whether it means a
Village organization, an informal grassroots community organization, social support
groups, indigenous saving associations, indigenous emergency assistance associations,
self-help groups, formal community-based organizations, all are answerable to
TLs(Mademo,1997; Rugalema,1998; Lwihula,1998; Ncube,1988; Barnet and Blaikie,1992;
CDL CD-ROM,2002. FHI Nigeria(www.fhi.org).
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“the best hope for the future is not in huge government programmes, in
presidential promises, and complicated bureaucracies ----But in the grassroots,
where enthusiasm and commitment are strongest; the new solution is to emerge”
Imihaly Csikszentmihalyi (www.fhi.org)
The following problem tree( next slide) depicts what is making it difficult to
maximally utilize traditional leaders.
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38
Fig.2. Conceptual Framework of the Factors
AIDS deaths
Increased Funeral DeathsSocial Support Groups Clubs /Credits
Levirate
PLWA Frustration
AIDS in the villages
Low Productivity
Shortening of Mourning Period
Savings Loss
Declining productivityb
HIV and AIDS is ravaging villages as traditional leaders are ill-prepared and underutilized in scaling down its spread
Inbcreased health expenses
Tattooing
No internal actions
Less focus on Traditional leaders
Sexual Cleansing
Genital cutting
Cure Sex with virgin
Manhood testing On virgins
Poor external action
Non respect of the “3 Ones”
Commercial Sex Work
Condom Use Refusal
Duplicated AIDS Action
Disordered AIDS Action
Idleness
Indiscriminate Sex
Skills lack
Knowledge lack
Medicinal Scarification
Traditional Sex Surgery
Declining moral in the village
Ignorance
Unemployment
Low income
Increased LWA Frustration
Increased Ignorance about HIV & AIDS
Low Morale
Increased Number of Orphans Stigma and Discrimination

THE WAY FORWARD
There is a need for Traditional Leaders to be
harnessed in AIDS Control.
Following slide shows a venn diagramme of
proper action
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39

Venn Diagram for Chiefs action in AIDS Control
11-Jun-16
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IEC/BCC
Social Mobilization
Community
Interest
Availability of
Funds
Monitoring and
evaluation skills
External
Stakeholders
External
Synergy and
inputs
Traditional
Council Team
Building
Integral Synergy
and inputs
Access to & idea for
HIV/AIDS Funds
Quality of CB HIV
And AIDS
Services
Working
EnvironmentTL as
harnesser of
AIDS action
Villages AIDS
capacity strength
[knowledge,
skills,
communication &
management
Capacity
Building,
Supervision &
Tech. Support
Data Collection
Village
HIV/AIDS
Info.
System
key

Way Forward-1
Proper identification and replication of best practices achieved by
community based organizations, local and international organizations,
healthcare workers.
Policy on the national use of traditional leaders in the AIDS response.
Empowering Traditional leaders to encourage poverty alleviation
smallholder business activities.
Improvement of traditional media in HIV and AIDS awareness
activities in their communities.
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41

Way Forward-2
Identification and use of villages stars(musicians, sculptors, artists,
professional oral historians) for HIV and AIDS sensitization.
Empowering TLs making HIV and AIDS an open secret to fight against
stigma and discrimination.
Empower TLs to study their cultural norms to tailor them to not
favour the spread of HIV.
TLs should be encouraged and empowered to create HIV and AIDS
fund for PHIV/PHA in their villages.
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42

Way Forward-3
TLs should a consortium of HIV and AODS associations to encourage
worker together better for optimal lifestyles in the village to scale up
collective development.
TLs should harness all opinion leaders(parliamentarians, senators, ace
business people, mayors, traditional healers) to help scale down
stigma and discrimination.
TLs should be helped in the M & B of HIV and AIDS actions in order to
make evidence-based decisions in favour of better(best) AIDS action.
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43

Way Forward-4
National legal frameworks should be revamped to trickle down to the
village grassroots to enable AIDS action to be universally carried out
in the nation and in all villages in a standardized manner.
Ministry and collaborating partners to organize regular and
continuous ADIS campaigns in the villages.
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Conclusion
• TLs, custodians of culture, customs and traditions play significant roles
in heritage preservation. TLs uphold and promote sound morals and
ethical practices that assist governance to raise social awareness
including for HIV and AIDS. Well handled, TLs continue to support moral
regeneration programmes including looking for acceptable alternatives
to HIV risky practices. Well empowered, TLs can ignite and maintain a
spirit of mass mobilization in their subjects to work together to kick HIV
out of their villages. Most importantly, TLs can act as agents of social
cohesion and change through sharing common good moral values and a
common agenda for HIV and AIDS, all within an environment of internal
and external synergies.
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45

Modified Venn Diagram for TLs in AIDS Control
11-Jun-16
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Educational
institutions
Family and
clan heads
Monitoring and
evaluation of
activities
Internal and
External
Stakeholders
External
Synergy and
inputs
Integral Synergy
and inputs
State/local
governance
structures
Traditional
councilTLs, Queen
mothers/Village
AIDS Committee
Village
HIV/AIDS
Info.
System
Religious
leaders
LNGOs, INGs
CBOs
Religious
leaders
HIV and AIDS
stakeholders=
better
framework of
action

References-1
http://www.unaids.org/en.knowledgeCentre/FeatureStories/2007/2008
Alliance of Mayors and Municipal Leaders on HV/AIDS in Africa(2006), Electronic Bulletin Issue, Issue 20.
March-May
RIPPLUS(2008), Histoire, Vision, members, activities et perspectives : presentation handout during the
ceremony of handing over PEPFAR cheques to RIP+ National NGOs
XV International AIDS Conference(2004) National AIDS Control Programme
managers Leadership Statement
http://ghanaaids.gov.gh/gac/publications/nshowet.php?recordID=56/20/08/2008
UNAIDS(2008) Report on Global AIDS Epidemic
Cameroon Health Digest(2005) HIV/AIDS- Top Killer, Better Health Foundation, Cameroon
11-Jun-16
/JUNE 2016
47

References-2
BBC News/Africa/Mbeki angers kings with election date: http://newbbc.co.uk/2/hi/africa/966015.stm
The University of Zambia School of Medicine, HIV/AIDS in Zambia: September 17-30. Times of Zambia, September 29,1999:
http://www.medguide.org.zm/aidszam20.htm
Gurtong report, Conference of traditional authority Leaders, Yambio, Capital of Western Equatorial State, March 26-28, South
Sudan
International Federation of Red cross and Red Crescent Societies(2008), Linking HIV and AIDS with action against sociocultural practices harmful to health,
New York
Community Development Library CD-ROM: A Cooperative Project to Provide Sustainable development and basic needs information for all (2002
XV International AIDS Conference(2004) National AIDS Control Programme
managers Leadership Statement
OXFAM(2008) Ngorongoro Comprehensive HIV/AIDS Project.
11-Jun-16
/JUNE 2016
48

References-3
http://www.gonzagajil.org/content/view/168/26/27/02/2008
U.S. Department of Health and Human Sciences(2008): Promoting Cultural Sensitivity: A Practical Guide for TB programmes That
PROVIDE
Services to human persons, Lagos
International Federation of Red cross and Red Crescent Societies(2008), Linking HIV and AIDS with action against sociocultural practices
harmful to health, New York
TASO, United against AIDS: The Story of TASo: sfh@stratshope.org
www.fhi.org
Doctors without Borders(2001) MSF Basic Information
UNIADS(1999)Review of Household and community Responses to the HIV/AIDS Epidemic in the Rural areas of Sub-Saharan Africa
11-Jun-16
/JUNE 2016
49

THANKS FOR FEEDBACK
5011-Jun-16
/JUNE 2016

Hiv & aids continuum traditional leaders role

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