Mainstreaming HIV/AIDS in water, sanitation and hygiene projects A case study of WASH interventions by JESE and PROTOS in the fishing communities around Lake George MSc Thesis by Katia Leber Master International Land and water management January 2008 Foto: Tom D’Hayer Mainstreaming HIV/AIDS in water, sanitation and hygiene projects A case study of WASH interventions by JESE and PROTOS in the fishing communities around Lake George Master Thesis January 2008 Wageningen, The Netherlands By Katia Leber Study program: Master International Land and Water Management Major thesis Irrigation and Water management, submitted in fulfillment of the degree of Master of Science in International Land and Water Management at Wageningen University, The Netherlands Supervisors: Dr. Ir. Margreet Zwarteveen Dr. Rico Lie Irrigation and Water Engineering group Communication and Innovation Studies Examinators: Prof. Linden Vincent Irrigation and Water Engineering group Picture front: Taken by Tom d’Haeyer, Regional office PROTOS Uganda Summary The objective of this research is to understand the mainstreaming concept in the field of HIV/AIDS in the WASH projects of JESE/PROTOS within the fishing communities around Lake George in Western Uganda. Mainstreaming is defined as the alignment of project activities with the reality of HIV/AIDS, without changing the purpose of the development objectives. The starting point of the research is that HIV/AIDS is a problem that undermines development. HIV/AIDS affects communities, but also affects organisations working in these communities. PROTOS and JESE are two NGO’s involved in improving the water, sanitation and hygiene situation in the fishing communities around Lake George. Confronted with a high prevalence in the fishing communities, they are interested in mainstreaming HIV/AIDS in their projects. The research exists of three parts. The first part aims to understand the socio-cultural construction of the fishing communities and the drivers of susceptibility (i.e. the risk of infection) and vulnerability (i.e. the likelihood of being negatively impacted) to HIV/AIDS. Two fishing communities are compared: Kasenyi, a community inside Queen Elizabeth National Park and Mahyoro, a community outside the national park. The data is collected through interviews, observation and interaction and is analysed using the sustainable livelihood framework and a gender and power analysis. The vulnerability analysis shows that Kasenyi is more vulnerable to the impacts of HIV/AIDS due to its physical, political and economic isolation. The analysis also revealed that a livelihood approach helps to identify all vulnerable groups in the community and does not automatically assume that all women, female headed families or People Living With HIV/AIDS (PLWHA) are vulnerable. As Elsey at al. (2003) state: communities should be taken as starting point for mainstreaming instead of addressing issues like gender or HIV/AIDS. The susceptibility analysis shows that sexual relationships in the fishing community and are mostly money-oriented. Both men and women aim to maintain certain lifestyles and use sexual relationships as a means. However, poverty plays an important role. Women without an income may be forced to engage in unprotected sexual relationships in order to survive and provide for the household. Risk of infection is thus both related to poverty and culture. The first part also aims to identify the community needs in relation to HIV/AIDS. An important need is knowledge on healthy lifestyles, so that PLWHA can be healthy for longer and proceed with their economic activities. The second part exists of finding the comparative advantage of JESE. The comparative advantage of JESE and PROTOS is improved health through improved water, sanitation and hygiene. The research looks at JESE’s activities in the communities and identified that, if the overall health of the community improves, the project will contribute to the reduction in susceptibility and vulnerability of the community members. Data is gathered through participant observation. The activities of JESE are compared to the community characteristics and needs in order to identify the gaps in sustainable implementation. Looking at vulnerability and susceptibility in relation to the WASH project of JESE in the fishing communities, several observations are made. JESE uses a prefixed approach to development based on measurable outputs. To implement WASH projects in the community adoption strategies towards behavior change and take up of new technologies is used. Thereby they mainly work with the middle (socio –economic) classes and often vulnerable groups are excluded. The research shows that adoption depends of financial, physical and political capital a household has and not necessarily on the willingness to adopt. Local leaders are actively involved in the WASH project, but the involvement of other community members is limited. Participation depends on local mobilisation, time and willingness by the community members to participate. The third part looks at the concept of mainstreaming itself and discusses how different views on HIV/AIDS influence perceptions on mainstreaming opportunities. When HIV/AIDS is considered a health and/or behavioural issue only, a WATSAN organisation feels they can not bring a contribution to the reduction of susceptibility and vulnerability. When HIV/AIDS is understood as a development and underdevelopment problem, opportunities arise. It is important to understand all aspects of HIV/AIDS in a community. The HIV/AIDS issue belongs to all four conceptualisations. The research showed that it is a health, behavioural, development and underdevelopment issue. Depending to the social, economic or political class one belongs to, one is affected differently. Comparing these outcomes with a critical assessment of the organisations activites, mission, vision and values opportunities to contribute to reduced susceptibility and vulnerability to HIV/AIDS arise. Alignment of activities to the reality of HIV/AIDS can take place, without changing the purpose of development project. It is important to understand that this analysis has different outcomes in different intervention areas or communities. Acknowledgments This research is an answer to a question which I have been struggling with for long time. In 2003, I participated in a workshop in on HIV/AIDS in Turkana, Northern Kenya. Several NGO’s discussed how their projects were affected by HIV/AIDS and what could be done. It was my first realization that HIV/AIDS is a development problem. Last year I learned about the concept of mainstreaming and decided that this was a chance for me to find out how I, as a future irrigation engineer/water manager can include HIV/AIDS in my profession. PROTOS gave me the opportunity to fulfil this idea, by assisting me in the development of this research. Therefore, I would firstly like to thank PROTOS for this opportunity and the freedom, time and resources they have given me. I hope sincerely that they will benefit from the results of this research. Equally grateful I am towards the staff of JESE. They have been great colleagues and without them I would not have managed to carry out this research. I would like to thank them to allow me to look at their projects and organization critically. The heart of the organization is really oriented towards helping out their communities and they are doing a great job. I appreciate that they are open to learning and therefore they have also given me an opportunity to learn. When I presented the results here in the Netherlands someone remarked that JESE is an example to other organizations by addressing HIV/AIDS in their programmes. Hopefully, with the gained knowledge and expertise they are able to advise other organizations. I would like to thank all the communities I visited, the BMU members, the local leaders and all the people who were willing to give me time and information. The communities have been very open and provided me useful information. In addition, I would like to thank George and Grace for the feedback they have given me during my field work. My supervisors, Margreet and Rico have been very helpful and patient. Through discussions and advice they have helped me to organize and analyse my data at academic level. I appreciate the enthusiasm they have shown for my research. I also want to thank them for the opportunity to present my results in the form of a seminar. Last, but not least I would to thank my friends, in Uganda and in Wageningen, for moral support and advice during the field work and this writing process. Abbreviations ABC rule Abstinence, Be faithful, Correct Condom use AIDS Acquired Immuno deficiency Syndrome ARV Anti Retro Viral BMU Beach Management Unit CBO Community Based Organisation CDO Community Development Officer CSW Casual Sex Worker DFR Department of Fisheries Resources DFO District fisheries Officer HA Health Assistant HIV Human Immuno Deficiency Virus HH Household ILM Integrated Lake Management IRWM Integrated Water Resource Management JESE Joint Effort to Safe the Environment LAGBIMO Lake George Basin Integrated Management Organisation LC Local government; e.g. LC1 Local government at village level MAAIF Ministry of Agriculture, Animal Industry and Fisheries M&E Monitoring and Evaluation NAADS National Agricultural Advisory Services NGO Non Governmental Organisation STD Sexually Transmitted Disease O&M Operation and Maintenance PLWHA People Living With HIV/AIDS PRA Participatory Rural Appraisal