COMMUNITY CONVERSATIONS AT WORK

SWAZILANDCOMMUNITYCONVERSATIONSAT WORKCCE IMPLEMENTATION IN SWAZILAND

CONTENTS3Situational Analysis:Amidst the gloom,some hope4What is CCE: Helpingcommunities understandthe underlyingcauses ofHIV&AIDS5The CCE Methodology:facilitating acommunity-ledchange process6Leadership Developmentan importantpart of the UNDPsCorporate Responseto HIV7Enabling the environment:Workingwith chiefs and communityleaders8Community LeadersResponding: Thepath breaking actionof one chief9Working with themainstream and themarginalized101112131415Working with themedia to createicons, role modelsand championsOur key partnersand implementingorganizationsSome achievements:A communitydialogue thatrestored cleanwater.Map of SwazilandCCE partners, whatthey are doing andwhere.Lessons Learnt andChallengesFOREWORD2Key priority has to be preventionas the key to our national responseOver the past 15 years, the HIV infection rate in Swazilandhas continued to rise steadily, increasing from 3.9% ofpregnant women attending antenatal clinics in 1992 to Dr Derek von Wissell39.2% of pregnant women attending antenatal clinics in 2006.The HIV epidemic is ravaging the nation’s people, shaping the lives of not onlythose that are infected, but of their families, friends, neighbors and communities aswell. The disease has left in its wake tens of thousands of orphaned children whomust be cared for and educated. It has decimated national capacity, carving out ageneration of young, productive citizens that were once teachers, nurses and otherprofessionals. HIV has succeeded in ravaging the nation’s economy as well, reversingdecades of progress in our national economic objectives.The HIV epidemic in Swaziland has spread to all segments of society regardlessof age, sex, socio-economic status, education, marital status or religious affiliation.Consequently, the risk of getting infected has become a tangible reality forall sexually active persons in the country.In response to the devastation caused by HIV, the country has focused its attentionon prevention with renewed energy and commitment. An acceleration of HIV preventioninitiatives is vital to the future and survival of the nation. Behaviourchange is key in this and in reducing the number of new infections. This objective,along with others in the key areas of impact mitigation; treatment, care and support;and management of the response, are detailed in the second National MultisectoralStrategic Plan (NSP) on HIV and AIDS for 2006-2008. The NSP is theframework for the nation’s response to the epidemic and outlines the objectivesand strategies that will be used to stop the spread of this deadly disease.During the development of the NSP, the “drivers” of the epidemic were identified.This process was an extensive, participatory course of consultation that involvedall stakeholders from the grassroots level in communities to stakeholders and developmentpartners in the capital. The drivers were identified as: inadequate publicawareness of the epidemic; multiple concurrent sexual partners; inter-generationalsex; secrecy and denial of HIV infection; abuse of power by men in sexual relationships;low condom use; and stigma and discrimination. This country-wideconsultation was a major achievement and ensured that HIV and AIDS were discussedthroughout the nation.In this light, we welcome the UNDP’s Community Capacity Enhancement(CCEP) approach to promote community level dialogue focusing on the epidemic.We know that behaviour change takes time and effort. Indeed, successful preventionof HIV will occur when it is recognized that each of us has a personal responsibilityto prevent infection.We value this form of community conversation that promotes public knowledge ofHIV and addresses the attitudes and values that put individuals at risk for infection.We greatly appreciate the efforts and contribution of UNDP and the entire UNsystem.Derek von Wissell, DirectorNational Emergency Response Council on HIV and AIDS (NERCHA)CCE IMPLEMENTATION IN SWAZILAND

3Swaziland HIV&AIDS situational analysisAmidst the gloom, at least some ray of hope among the youthIn Swaziland the HIV&AIDS epidemic has touchedalmost every family with catastrophic effect on thepopulation of nearly one million people.The Southern Africa Kingdom is a small country ofjust over 17,000 square kilometers situated in theEast of South Africa with which it shares borders inthe South, West and North and with Mozambique inthe East.The Ministry of Health and Social Welfare’s 2004HIV sentinel surveillance report estimates that by2015 the population will have grown to 1.6 million,about 41% lower than it would have been withoutHIV&AIDS.Since 2004, the Kingdomhas emerged at the topamong countries with thehighest HIV prevalencerates. Infection ratesamong women attendingantenatal care have risenfrom 3.9% in 1992 to astaggering 42.6% in2004. Urban and ruralareas are almost equallyaffected with 40.6% infectionrates in the citiesand 35.9% in rural areas.As a result of the epidemic,Government estimatesthat the countrynow has nearly 70,000orphans. This represents7% of the population.The number of theseyoung orphans is growingdaily. The Ministryof Health estimates thatby 2010, the number oforphans will have grownto 120,000 or 10 percentof the population. Already, over 15,000 householdsin the country are headed by children who are tryingto raise their little brothers and sisters by themselves.The social and economic disruption caused by theepidemic is impossible to quantify with accuracy.Orphans and child headed families have become the face of theepidemic in Swaziland. Picture: Courtesy of Young HeroesBut poverty is increasing. Government estimatesshow the annual economic growth rate fell from2.6% in 2003 to 2.1% in 2004 (Budget Report2004). Almost 70% of the population is alreadyliving below $30 per month, a four percent increasefrom 2004, and the burden of looking afterthe sick and dying is driving many more peopleinto deeper poverty.HIV&AIDS has aggravated household food insecurity,which is already compounded by erraticweather patterns, decrease in arable land and thedeaths of productive members of society.The Swaziland Governmenthas intensifiedthe fight againstHIV&AIDS by rollingout free Antiretroviraltreatment. In2005, it exceeded theWHO 3x5 target byplacing 50% of thepeople needing treatmenton ARVs. TheMinistry of Educationhas respondedwith a policy of providingfree educationfor all orphaned children.A SwazilandHealth and DemographicSurvey to beconducted this yearwill replace the sentinelsurveillance ofpregnant womenwhich has been usedto determine the nationalHIV prevalencerate since1992.However, amidst the gloom, there is a small ray ofhope. After several years of effort to strengthenleadership capacity and knowledge about the epidemic,the 2004 HIV surveillance report noted anappreciable decrease in infection rates within thekey 15-19 year old age group.CCE IMPLEMENTATION IN SWAZILAND

WHAT IS THE COMMUNITY CAPACITY ENHANCEMENT (CCE) APPROACHGenerating understanding of underlying causes of epidemicWhat is CCE: The Community Capacity Enhancementapproach (CCE) is a methodology for addressingthe underlying causes of HIV&AIDS, be theypower relations, gender issues, stigma or discrimination.It focuses on the issues of testing, treatment andcare. Most community programmes dealing withHIV&AIDS rightly concentrates on awareness-raisngdiscussion. The CCE programme does this too, butgoes deeper, getting to the heart of why the epidemicis spreading and, through an interactive dialogueknown as Community Conversations, enables communitydecision-making and action. The CCE programmeis an integral part of the UNDP’s Leadershipfor Results Programm (L4R), which seeks to respondto the challenge of generatingleadership capacityagainst theHIV&AIDS epidemic.A lesson of the last decadeis that the lack of adynamic committedleadership may be responsiblesteady rise ofHIV infections. A strongleadership has beenidentified as a commonfeature among countriesthat have successfullystopped and reversed theonslaught of HIV.Strengthening leadership is also the first of eight corestrategic development areas articulated by the UN-GASS Declaration of Commitment signed by Headsof State in 2000. The Declaration stresses: “Strongleadership at all levels of society is essential for aneffective response to the epidemic. Leadership involvespersonal commitment and concrete action.”UNGASS requires that the full authority and powerof the state be brought to bear on this crisis by recognizingthat HIV&AIDS poses a major governancechallenge for developing countries.The UNDP’s mandate and status as a long timetrusted partner of governments in developing countriesuniquely positions it to promote action orientedinitiatives. This includes the mobilization of politicalcommitment and institutions beyond the health sector.In addition, UNDP supports the development ofleadership competencies to enable greater accountabilityand transparency.A community conversation in progress in a rural setting.4CCE IMPLEMENTATION IN SWAZILANDThe Millennium Development Goals (MDGs) campaignis one of UNDP’s most important advocacymeasures. Goal 6 aims at halting and reversing thespread of HIV&AIDS by 2015, and the UNDP isworking to create the enabling policy and resourceenvironment to achieve this. Furthermore, UNDP’sapproach to HIV &AIDS contributes to achievingother key MDG’s:• Reducing poverty and Hunger (Goal 1)• Empowering women (Goal 3)• Reducing maternal and child mortality (Goal4&5)• Developing a global partnership for development(Goal 8).CCE provides the vitallink between leadershipand action at the communitylevel. By facilitatinga series of communitylevel dialogues, CCE providescommunities with aplatform to think throughall the repercussions of asituation. This includesdiscussing how their individualvalues and behaviour,as well as those oftheir community affectother people’s lives. Themethodology is foundedon the understanding that communities have the capacityto prevent HIV, care for the affected andchange ways that fuel the epidemic. It is peoplefocusedand builds on their interactions, strengths andresources. It is an interactive process of observing,reflecting, questioning and making decisions forchanging together. At the same time, CCE workswithin the reality that communities can also holdfalse beliefs, be misinformed or act in bad faith.The CCE methodology is based on facilitation, inclusion,partnerships; and respect of communities’ insights,perspectives, interest and desire for change.Community Conversations are conducted by teams oftrained facilitators. Through inclusive interactionCCE achieves collective and social learning, shiftingpower relations, strengthening ownership and responsibilityfor change, and mobilizing local capacity andresources.

THE CCE METHODOLOGYFig 15Facilitating Community led Change to respond to HIV&AIDSCCE is a facilitated change process based on varioustheories and experiences of how individuals andcommunities change their values, attitudes and practices.This methodological framework (Fig 1) outlinesthe steps of the community conversation processand links the change process to facilitationskills, tools and competencies. It recognizes thatchange and transformation are often complex andrequire a supportive facilitation process. Facilitationmakes the process of change smoother and minimizesthe chances of repeating old practices andvalues—repetitionthat often accompaniesnon-facilitatedprocesses.Facilitators aretrained to observeand understand howchange occurs and tosupport the changeprocess at the communitylevel using aframework of skillsand tools.Objectives of CCE• To generate a deepand complex understandingof the natureof the epidemicwithin individualsand communities.• To support the developmentof selfesteem, self confidence,tolerance,trust, accountability,FReflection and ReviewImplementationof communitydecisionsrequiressupport fromvarious levelsof society aswell as accessto resources.Reflection and Reviewis a way of looking atwhat has transpired—shifts in practices thatachieved the objectivesof decisions.EAction (Implementation)introspection and self management.• To empower communities to examine and redefinesocial contracts between different groups in the community– for example between women and man, peopleliving with HIV&AIDS (PLWHAs) and those thatare uninfected or untested, the old and young, the richand poor.• To build a pool of resource persons with transformativeleadership competencies and facilitation skills incommunity conversations, to scale up community responsesto HIV and related developmental issues.ARelationship BuildingAmong the most importantfactors in building relationshipsare respect and acknowledgementof communityexperiences, norms,values and perspectives.This is usually the first pointof entry in a communitychange process.HOPE, TRANSFORMATION, RESULTSDDecision MakingCConcern ExplorationCommunities have the capacity to make theirown decisions based on identified concerns.BConcern IdentificationCommunity concernsare general issues thatdisturb the communityfrom within. They areusually not visible tooutsiders.Exploration seeks tobring out the interconnectednessofconcerns and otherfactors. It unravelsthe different manifestationsof thesame problem atindividual, organizationand collectivelevels.THE CCE IMPLEMENTATION EXPERT TEAM IN SWAZILANDModison Magagula Sebenzile Mtetwa Zelda NhlabatsiJabu Matsebula—co-ordinatorCCE IMPLEMENTATION IN SWAZILAND

THE UNDP CORPORATE STRATEGY FOR HIV AND AIDSUNDPs L4R Program: A Set of 4 Synergistic InitiativesArts &MediaCommunityCapacityEnhancementLeadershipDevelopmentProgramme6Leadership development part UNDP’S of response to HIV&AIDSCCE is part of the range of services UNDP providesunder its Global Cooperation Framework to governmentsand UNDP Country Offices in the battleagainst HIV&AIDS. It is part of the Leadership forResults Programme which focuses on:• Leadership and capacity development: Promotingleadership at all levels, and developing thecapacity of governments, civil society, developmentpartners,communitiesand individualsto effectivelyrespond to theepidemic.• Developmentplanning, implementationandHIV&AIDSresponses:Strengtheningdevelopmentplanning andsystems to comprehensivelyaddressBecause of its ability to reach communities at thegrassroots level, CCE is proving to be a valuabletool for strengthening the country’s ability to attainthe Millennium Development Goals.Swaziland is one of nine Southern African countriesthat are implementing the Southern Africa CapacityInitiative (SACI). SACI is a set of catalyticactions designed to deal with the interlocking challengesof HIV and AIDS, capacity erosion, povertyDevelopmentPlanning• Each program isintricately linkedto every otherprogram• The fourprograms workas a synergisticpackage and aremutuallyreinforcing• The program isseen as a longterm strategythat unfolds overtimeSTRENGTHENING THE NATIONAL CAPACITY FOR ACHIEVING MDGsCCE IMPLEMENTATION IN SWAZILANDHIV&AIDS at national, district and communitylevels.• Advocacy and communication: Generating asociety-wide response that is gender-sensitiveand respectful of the rights of people living withHIV&AIDS through advocacy and communicationThe Leadership for Results Programme (L4R) facilitatesimplementation of the areas outlined abovein partnership with other UN agencies and the UNTheme Group.Through L4R, UNDP supports the development oftransformational leadership at all levels, and thecapacity of governments, civil society and the privatesector – including development partners, communities,individuals, and the arts and media – toeffectively respond tothe epidemic.UNDP introduced L4Rsoon after the UN GeneralAssembly SpecialResolution (UNGASS)calling for renewedcommitment and supportfor countries worst affectedby HIV andAIDS.The Declaration recognizedthat strong andcommitted leadership atall levels of society wasessential for an effectiveresponse against HIV.The first of two nationalworkshops targeting middle-level to high levelleaders from civil society, Government, policymakers was conducted in 2002 and 2003. Participantsincluded Members of Parliament, chiefs,government executives as well as women and networksof People Living with HIV&AIDS(PLWHA). Some of the participants subsequentlybecame prominent national leaders and policymakers who influence national policy decisions.and disasters through the governance lens.In Swaziland, SACI has been adapted to meet thespecific needs of the country and renamed the SwazilandCapacity Initiative (SWACI).CCE has been extensively used in community sensitizationto assure the success of the initiative inthe communities of Matsanjeni and Ngwempisiwhich have been identified as SWACI demonstrationcommunities.

ENABLING ENVIRONMENT FOR AN EFFECTIVE RESPONSEMobilizing chiefs and other key community level leadersThe Leadership for Results Programme recognizes that astrong and committed leadership at all levels is critical inturning the tide against the epidemic. To introduce theprogramme in Swaziland, UNDP arranged for the trainingof trainers and facilitators from government and nongovernmentinstitutions involved in the HIV response.Once a base of skilled trainers and facilitators was built,it became to create anenabling environmentfor community level7CCE IMPLEMENTATION IN SWAZILANDimplementation. Forthat reason, communityleaders from keysectors were identifiedfor orientation andsensitization in CCE.The first group werechiefs from the ShiselweniRegion in SouthernSwaziland. In thesix years before theorientation, the regionconsistently recordedthe highest HIV infectiongrowth rates. Inresponse, United NationsCountry Team (UNCT) initiated a special Joint UNSupport to Develop Regional Capacity in Swaziland toCombat HIV & AIDS Among Youths under the age 24.Before implementation of the initiative, a special CCEsensitization programme in which the chiefs participatedin a series of community conversations to dialogue aboutthe challenges of HIV&AIDS. The dialogue helpedchiefs understand the underlying socio-cultural dynamicsthat helped fuel the spread of the epidemic and the rolethey could play in reversing the epidemic.During the dialogue, the HIV epidemic was compared toa fierce monster attacking their communities. Chiefswere asked to consider what action they would havetaken had HIV been a fierce animal that was killing theirsubjects. The dialogue helped chiefs make the linkagebetween the epidemic and the role they were expected toplay as leaders. The understanding resulted in importantcommitments by chiefs to take action to respond to theepidemic.When the results of the dialogue were shared with theDeputy Prime Minister’s Office and the National EmergencyResponse Council on HIV&AIDS (NERCHA),they requested UNDP support to scale up the programmeand hold dialogues for all chiefs in the country.Funded by the Government, a series of community dialogueswith Chiefs were conducted in all four administrativeregions in Manzini, Hhohho and Lubombo.Chiefs have a special place of respect in Swazi society.They are the political and administrative representativesof the King. In that context, they are responsible for allocationand management of communal land on behalf ofthe King as well as the final arbiters and custodians ofcustom and culture.During the dialogue, chiefswent through individual andcollective introspection oftheir beliefs and values. Oneof the issues raised was therole of power relations andsome cultural practices thatundermined human rights byamong others, condoning theabuse of girls. While Swazicultural values promote abstinenceand a safe environmentfor girls to grow to their fullestpotential, some customarypractices allowed men toforce young girls into marriage.The practice not onlyChiefs ponder the underlying factors fueling the epidemic. violated the rights of the girlsbut also promoted intergenerationalHIV transmission, but also set a poor examplefor the young, thereby contributing to poor moralstandards.During the dialogue, chiefs also understood that forcingunder-age girls into marriage was actually statutory rape,which is a criminal offence. They also discussed thepractice of co-habiting which has become common. Thepractice is blamed for abuse of women and contributingto orphans and vulnerable children (OVCs). This dialoguegenerated a shift in thinking. Many chiefs expresseda commitment to correct some of these practicesin their areas. For example, after they analyzed the impactof HIV on their communities, especially on vulnerablesectors of their communities, chiefs recognized thatby custom, they have the responsibility for mobilizingcommunity resources to provide care and protection,especially for orphans and other vulnerable sectors or thecommunity. All chiefs committed to initiate schemes forimpact mitigation and to support and partner with NER-CHA in the implementation of food security strategies.Chiefs agreed to release communal land and labour forfood production. After appreciating the impact of themethodology, the Government also requested training ofall local constituency level executive committees.

COMMUNITY LEADERS RESPONDINGOne Chief sets an important example of community actionThe community of Nkamazi in the Northern Hhohho hassuccessfully dealt with an untouchable subject – the protectionof girls and women. The chief of the area, PrinceGija returned from a CCE sensitization and called hiscommunity to a series of dialogues to discuss the underlyingcauses of HIV transmission in the area. He wassurprised to find that his community was concerned thatcommunity members aspiring to conform to modernculture had relaxed its moral standards and compromisedimportant cultural values that preventedsexual permissiveness. The communityalso found that low respect for the rightsof girls and women was one of the factorsfueling HIV transmission in the community.After the dialogue, the community acceptedthat unless the community focused on raisingthe moral standard and promoted a culture ofappreciation for the youth as the future of theAn important strength of CCE, is that it is empowering.Chiefs expressed concern that they felt various effortsin the fight against HIV totally ignored and marginalizedthem. As a result, they felt organizations worktheyhad lost the respect of their communities affecting theirleadership.•They found that CCE offered them an opportunity torespond to the epidemic with relevant initiatives.•Chiefs viewed responsibility of caring for orphans andvulnerable children to be an important part of theirduty.•They pledged to ensure that orphans were not strippedof their heritage, especially family fields and otherproperty left by parents. Chiefs committed to protect8IMPORTANT INSIGHTS GAINED FROM WORKING WITH CHIEFSthe assets until the orphans were of age to use the land.•Chiefs were against relocation of orphans from theircommunity. They particularly viewed the introductionof orphanages as detrimental to the future of the children.• Chiefs also understood the notion of stigma and discrimination.They agreed that the common reference tochildren as orphans was not only unSwazi but also aserious source of discrimination and stigma. Swazisociety regards all adults in the family to be parents.(In CCE, this form of social support for children is regardedas community capitalan important strength inthe fight against HIV to be promoted in society.)CCE IMPLEMENTATION IN SWAZILANDcountry, the community would be wiped outby HIV&AIDS. They accepted that this includedpromoting abstinence among young girls andboys, as well as protection of girls from forced marriageuntil they reached the age of consent.Together, the community took the decision to adopt anew code in which parents would actively promote abstinenceamong the youth, and to take action againstanyone who violated their chastity.The community has demonstrated that it is serious.When an elderly community member seduced his wife’sniece, community members reported him to the chief,who promptly called the police. The perpetrator wasarrested and charged with statutory rape. In deciding todeal with protection of girls, the community has fingeredone of the untouchables of national customs.The bold stand taken by the Nkamazi Community andthe publicity of the action through the media has promoteda resonance among neighbouring communities.There are increasing reports of community action to callthe police to deal with men who have forced under-agegirls into marriage or committed statutory rape.In the past, reports of young girls being pulled out ofschool were common and forced into marriage withoutany community response were common.Girls were vulnerable from abduction despite legal protectionunder the Women and Girls Protection Actwhich forbids any sexual contact with girls underthe age of 16, which is considered as statutoryrape. In all communities, statutory rape andteenage pregnancies are common and helplesslycondoned. Poverty increases vulnerability ofgirls to relations with older men who usuallyhave money. But custom also plays a role. It iscommon for girls to be removed from primaryschool and forced into marriage to much oldermen, often with the consent of their poor parents.Even those who saw the wrong felt power-Prince Gijaless to address this problem because it appeared deeplyingrained in the cultural values and practices of thecommunity.Girls visiting their married sisters or aunts are also exposedto being forcefully seduced by their brother inlaw. This and other customs are responsible for intergenerationaltransmission of HIV. Though aware of thisproblem, communities felt powerless because the practiceis commonly practices by leading members of thecommunity. By taking a stand, the chief has liberatedhis community to deal with an untouchable subject.What has become notable with this exercise is thatPrince Gija who is one of a crop of young chiefs, is oneof about 400 chiefs who were inspired in a nationalCCE programme for chiefs. His interventions showwhat is possible at the community level.

REACHING THE MAINSTREAM BUT ALSO MARGINALIZED COMMUNITIESChristians seek God’s intervention in National Prayer DayChurch leaders have resolved that their followers shouldnot continue to die because of lack of knowledge.To ensure that the message reaches every Christian in Swaziland,church leaders have arranged an annual national dayof prayer where the church will speak in one-voice in condemningHIV and urging their flock to address the underlyingfactors that fuel the spread of HIV infections.This is the outcome of a series of regional CCE trainingprogrammes for leaders of the largest Church network, theLeague of African Churches. Since a significant majorityof Swazis profess to be Christians, and the majority ofChristians are Zionists, this national day of prayer is expectedto become a valuable platform for communicatingbehaviour change.UNDP started working with the mainstream denominations,mostly under the Council of Swaziland Churches andthe Conference of Churches in 2003. These missions notonly minister to a large segment of the urban and ruralpopulations but also provide various social infrastructureand services ranging from education, health and social services.Indeed churches; both the established missions andthe relatively new ministries are important platforms withsignificant influence on the moral behaviour of a significantportion of the population. The Church however is asignificant late entrant in the response to the challenge ofHIV&AIDS. In conversations with religious leaders, it becomesclear that this is largely because of the link betweenthe main cause of HIV infections and sex, a subject that isclosely associated with sin. Since good Christians were notexpected to have HIV, for the best part of 20 years since9CCE IMPLEMENTATION IN SWAZILANDHIV was confirmed in Swaziland, the churches were indenial. As a result, the pulpit being one of the most importantsources of stigma and discrimination.As the rise in HIV infections increased and the death rateeven of Christians rose, AIDS was a factor that could nolonger be ignored, even in the church.What is significant is that most churches responded withprojects that focused on care and impact mitigation andsteered clear of the most controversial but important subjectof all—prevention.Yet this is the most important area where the Church’spotential for reversing the plague is strongest.The first CCE workshop for church leaders, which includedthe entire leadership of the Anglican Church inSwaziland was in 2003.Recognizing the importance of the role of faith based organizationsin its multi-sectoral response, the national HIVcouncil created the . As further support to the work of thissector and to provide focus for the sector’s interventions,UNDP arranged This was followed with a special Trainingof Trainers programme in 2005 to strengthen the capacityof the principal co-ordinating organization of faith basedorganizations, the Church Forum. However the most importantcapacity building programme so far, was capacitybuilding for the League of African Churches, mostly madeof the network of Zionist Apostolic Churches. The Zionistsare by far the largest church group. As they make over90% of the population and present in almost every community,Zionists are usually the implementing partners ofalmost local level intervention.Working with the stigmatized and marginalized communitiesThe rallying call in the national campaign against HIV :“AIDS Indzaba Yetfu Sonkhe (AIDS is everyone’s problem).”In practice however, “everyone” tends to relate to all the acceptedand acceptable population groups—the youth, women,men and workers in their various settings.Some groups however remain totally ignored by all interventions.Among these, are the communities of:-• Men who have sex with Men (MSM) and lesbian women• Sex workersIn most communities, these groups are part of the communitiesthat are not considered socially acceptable, and are thereforeoverlooked by most programmes.A recent Community Conversation which sought to engagewith the gay and lesbian community and separately with sexworkers highlighted the significance of engaging this underclasscommunity.The highlights of the interaction were:Same Sex Relationships: Because of the stigma associatedwith homosexuality,• most of the gay men and lesbian women live double lives.• Due to social pressure, they marry, and live double lives.• Due to lack of information that responds to the specificneeds of this community, there is limited knowledgeabout reducing possible HIV infection.• There are no products specific to the protection of gaymen (special condoms).• Lesbian women are prone to infection from the toyscommonly used in the community.Sex workers: This community considers itself as serviceproviders.• There is a large community of sex workers in Swaziland,growing largely because of poor economic opportunities.• They are both men and women• Condom use among both men and women was reportedlylow—and dictated mostly by clients who prefer sexwithout condoms.• Sex workers have limited negotiating power in advocatingfor safe sex.• Sex workers report their clients are members of the community.Sector response plans were developed for both communities.

ARTS AND MEDIAIn search of role models, icons and community championsThe Arts and Media sector are a special group that UNDPconsiders to be critical partners in the response againstHV&AIDS and an integral part of the Leadership for ResultsProgramme.The contribution of media has been significant in creatingawareness and disseminating information about HIV inmany countries. Experience has shown however that whileinformation is important, it is not sufficient in creating sustainablebehaviour change. Further, some of the earlynegative images and responses to the epidemic have hadnegative connotations that still impact the HIV&AIDS discourse.Arts and Media people were among the first group of participantschosen to participate in the Leadership for ResultsProgramme. They were represented by senior journalists,programme producers from both radio and TV as well asleading actors in the performing arts.UNDP engaged the Arts and Media sector in a series ofinitiatives. A special regional induction programme seekingto deepen understanding of the underlying causes fuelingthe spread of HIV and to generate personal commitmentand action was conducted in Johannesburg, whereartists and media people from Swaziland joined participantsfrom Southern Africa.Inspired by the workshop, Swaziland participants returnedto organize a unique two-day open air World AIDS Day10CCE IMPLEMENTATION IN SWAZILANDArts and Music festival in the center of the capital city.UNDP has also focused on the Arts and Media sector askey partners in ensuring an effective response toHIV&AIDS because artists and the media are in manyways the cultural mirrors of our times. They interpret theworld for us. Often the way the media reacts to issues determineshow society responds.Artists and media are capable of constructing a new socialreality and inspiring action, of shifting the public perceptionand help create new meanings and images. Becausethey can help change our attitudes and influence our behaviour,they are a valuable partner in creating an environmentthat influences perceptions and values of people toaddress the underlying causes of the epidemic.To promote sustainable behaviour change, media and professionalshave established a working arrangement withPLWHA to identify community role models whose contributionswill be showcased through the media through aseries of broadcast programmes and articles.To enroll the support of media owners and mangers, a specialeffort to promote development of institutional editorialpolicies to incorporate HIV concerns.UNDP used Community Conversations to engage the mediaon their role in creating public awareness, especially topromote accelerated HIV prevention and Anti RetroviralTreatment (ART).Using drama to reach the hard to get rural Swazi malesIn the face of a phenomenon that is so intricately woveninto the fabric of the society and as threatening asHIV&AIDS, only programmes that penetrate the soul cansucceed.A breakthrough initiative by CCE expert facilitator, ModisonMagagula is succeeding to reach men, who are noteasy to engage in HIV&AIDS initiatives. They are usuallyat work when awareness programmes are brought to theircommunities. Because of the subordinate status of women,the men refuse to take seriously the messages and informationwomen bring from meetings, clinics and hospitals. Asa result, they ignore important precautions and only seekhelp when they are very ill.Magagula and his Siphila Nje Drama Society have createdexclusive forums where they engage men on issues ofHIV&AIDS. Using culture as an entry point, the grouprecognized a social setting that provides an exclusive interactionbetween men. Custom dictates that all men in thecommunity must attend to eat the head of the beast whenevera community member slaughters a cow. During thesesocial interactions, men take the opportunity to hold deepdiscussions around important issues in the community.Only men are allowed in this meeting, during which theyprepare, cook and roast the meat themselves.The drama group uses this meeting to present theatre skitsto showing various scenarios of conduct that fuel the transmissionof HIV&AIDS. The range of discussions includewomen, male sexual preferences, polygamy, wife inheritance,illness and power dynamics in the family.The men are then engaged in a facilitated dialogue usingthe popular Community Conversations methodology—Story Telling. The facilitators document the perspectivesof the community showing the concerns of the men as wellas myths and misconceptions. The group discusses the issuescoming out during the dialogue and their implications.The group has used the natural relationship of art and mediato promote their work. The programme is advertised onnational TV and radio, which has created demand frommany communities.Once again, NERCHA who is one of the strongest partnersin the Leadership for Results Programme, is supporting thegroup, enabling them to visit communities throughout thecountry. The ongoing dialogues aim to cover all communitiesunder chiefs throughout the country.Magagula is one of the most developed transformationactivists who has used the power of theatre to promote socialchange. He has participated in three of the UNDPLeadership Development programmes—Emotional intelligence,Community Conversations and Arts and Mediatraining.

PARTNERS AND IMPLEMENTING ORGANIZATIONSThe original network of CCE implementation partnersThe CCE programme started off with a core of 10 organizationsthat were already committed to prevention andcare at national and decentralized levels. As a methodologythat builds on existing partnerships and aims tostrengthen the national response, it was critical that theNational Emergency Response Council on HIV& AIDS(NERCHA) was involved. Discussions with NERCHAand Government led to the first collaboration in the implementationof dialogues for youth and chiefs. Followingthe success of that programme, NERCHA and theDeputy Prime Ministers Office organized for a nationalprogramme of training chiefs and local constituency executivecouncil members (Bucopho) in all four regions.Key implementing partners in the programme were:1. AMICAALLTwo of the three CCE internationalexperts in Swazilandare managers of the Allianceof Mayors InterventionAgainst HIV&AIDS at theLocal Municipal Level(AMICAALL). The organizationwas the first of theoriginal partners to integrateCCE in the implementationof their programmes andmaintains a policy of continuousCCE training amongstaff and volunteer staff, especiallyMunicipal HealthTeams (MHTs).AMICAAL has also usedcommunity conversations to establish participatory planningthrough dialogues with urban community residents. The outcomesof the dialogues have been used to develop short tomedium term HIV response plans in all 13 municipalities.Community conversations have been conducted in Manzini,Piggs Peak, Mbabane, Ngwenya, Ezulwini, Mankayane,Hlathikulu, Nhlangano; Siteki, Vuvulane, Lavumisa.2. Baphalali Swaziland Red CrossBaphalali have used CCE to mobilize communities in theirproject areas to address issues of poverty reduction, disasterresponse and HIV& AIDS.In the Shisewleni Region, they are active in the drought affectedareas of Lavumisa, Matsanjeni and Somntongo as wellas the northern Hhohho community of Ntfonjeni.3. The AIDS Support Centre (TASC)The government AIDS Support Committee has used CCE tocreate community support groups and mobilize for VCT, especiallyin the Shiselweni areas of KaGodloza East of Hlathikhulu.4. Swaziland Action Group Against AbuseSWAGAA has used CCE to strengthen community awareness11CCE IMPLEMENTATION IN SWAZILANDof the link between HIV transmission and sexual abuse andviolence. AMICAALL has trained all its programme staff inCCE to integrate the programme in all their national and communitylevel interventions. SWAGAA originally used CCE atthree pilot areas at Dwalile, Mangcongco and Sandlane.5. Anglican ChurchThe Anglican Diocese of Southern Africa has trained all itspriests in CCE to strengthen their counseling services as well asappropriate sensitivity in addressing issues of HIV&AIDS intheir sernons. The church has also established HIV programmesto support home based care and to respond to the needs ofOVCs at parish level.6. Council of Swaziland ChurchesThe Council is a consortium of churches that believe in the theologyof social justice. Among their members are the establishedchurches organizations, includingthe Catholic, Anglicans, Lutherans andMethodist churches. The council hasused CCE to promote HIV awarenessacross denominational lines. They areactive in all parts of Swzailand.7. Siphila NjeThe group has adapted the CCE methodologyto develop stage acts promotingHIV awareness and transformation andfor MDG advocacy. Most recently thegroup has developed a series of skits tomobilized men’s participation in HIVinterventions. SNDS has taken CCEimplementation further than any groupby holding community conversations inAMICAALL volunteers build an NCP in Mankayane.all 55 national constituency regions(Tinkhundla) and intend to reach the sub-national chiefdomlevel.8. Lutsango Lwaka NgwaneLutsango is the national movement of traditional women. As itsmembers are in all communities, they have been assigned theresponsibility for psycho social care for OVCs. The movementhas trained all its local constituency leaders in CCE tostrengthen HIV responses among women.9. The Church ForumThe forum is a consortium of church organizations for coordinatingFBO HIV&AIDS interventions. Members of theconsortium have been trained as CCE Trainers to scale-upHIV&AIDS responses within the church. Leaders of the largestchurch group, the League of Churches is now responsible fororganizing a national prayer day to advocate for behaviourchange.10. Swaziland AIDS Support OrganizationSASO is the oldest network of people living with HIV andAIDS. It used its CCE capacity to advocate for the creating of anationwide network uniting 43 independent organizations underone banner. SASO has also used CCE to strengthen member’sresolve for positive prevention.

ACHIEVEMENTS OF CCE NATIONWIDE12Community dialogue results in clean water in MatsanjeniThe Community of Matsanjeni is one of two that were identifiedby the government and UNDP assuitable for demonstratingthe Swaziland Capacity Initiative (SWACI) development framework.A series of CCE dialogues were conducted to mobilize the communityand engage them in a process to identify communityconcerns. In all the dialogues which were conducted in all 7communities under the Matsanjeni Inkhundla water was identifiedas the most important community concern.Indeed, the Lavumisa area which lies on the Western foot of theLubombo Mountain range, is drought-prone Lowveld wherepoor harvests and food insecurity are common. Lack of waterhas affected community livelihood options leading to poverty, poor nutrition and poorhealth. CCE dialogues helped Community leaders realize that water was central to theirdevelopment needs, leading to serious discussions on how they could improve access toclean water in a sustainable way.Because of the frustration resulting fromdrought, community leaders could not appreciateany other development interventionif it did not address the shortage of water.Most frustratingly, various initiatives toaccess underground water through boreholeshad failed when the water leveldropped beyond the reach of water pumps.Water is an old problem that has grownprogressively worse during the past tenyears, affecting every facet of life in Matsanjeni.Drought had exacerbated poverty in the community. The death of large numbers of cattleroutinely accompany years of total crop failure.The community is fully aware of the link between HIV, poverty and nutritionand has responded by establishing several communityvegetable gardens and fish ponds. However the gardens andponds remain dry because of shortage of water. In takingstock of social capital that could be used to fight thedrought, and therefore improve the health of the community,the community identified water sources that could sustainthem even during hard times. After several community conversations,residents developed a work-plan for mobilizingthe community and securing partnerships and resources todeliver water. Leaders approached the Rural Water SupplyBoard with a proposal to revive an abandoned water-welland a request to the UNDP for equipment support and capacitybuilding.….and afterBefore….Daily life inMatsanjeni.Above, cartingwater home ona wheelbarrow,below, usingcars...and below,water atlastchildrencollect cleanwater from oneof severalstandpipes developedas partcommunitycollaboration.CCE IMPLEMENTATION IN SWAZILAND

13AREAS WHERE CCE HAS BEEN IMPLEMENTED1. Zibonele—Red Cross2. Piggs Peak—AMICAAL3. Community — Nkamazi4. Nkhaba—SASO5. Ngwenya—AMICAALL6. Mbabane—AMICAALL7. Manzini—AMICAALL8. Mankayane—AMICAALL9. Ngwempisi—Communities10. Hlathikhulu—AMICAALL11. Kwagodloza– Tasc12. Nhlangano—AMICAALL13. Matsanjeni—Communities14. Lavumisa—AMICAALL15. Big Bend—AMICAALL16. Siteki—AMICAALL17. Simunye—AMICAALL18. Mhlume—AMICAALL19. Mahlangatsha—SWAGAA20. Nationwide—SNDS12341856171671989151011121314CCE IMPLEMENTATION IN SWAZILAND

ACHIEVEMENTS OF CCE NATIONWIDETransformation and community level outcomes observedACTIONSAFTER leaders of the largest church network, the Zionistswent through a series of CCE dialogues, they realized justhow much their ignorance of the underlying factors fuellingthe spread of HIV had exposed their members to the dangersof infection. They then vowed:Our people shall not die for lackof knowledge.””As a result, the largest prayer servicededicated to HIV was organized.Christian Following a CCE Demandfor CCE training growing.New organizations, among themnetworks of Faith Based Organizations,Gay Men and LesbianWomen and Sex have requestedcapacity building to help themrespond to HIV.CCE has also been used to build acritical relationship betweenPLWHA and media personnel resulting in the formation of acollaboration strategy and joint work-plans.But more importantly, CCE partners involved in the initialrollout of CCE have requested capacity strengthening toscale-up their activities. Among these, is Lutsango, the networkof traditional women who are heavily involved in homebased care and psychosocial support for OVCs.The value of CCE as atransformational methodologyhas also beenincreased. At a workshopto strengthen capacityof the network ofZionist churches, 70% ofparticipants came outand tested. Many ofthose that did not testpromised to do so oncethey had consulted withtheir partners.Increased demandfor HIV & AIDS related services: Support groups for people living with HIV established. Establishment of mobile VCTs - Increased number of people going for VCT services - Information desks are held monthly and community dialogueson HIV/AIDS Increased condom uptake Communities identified concern and mobilized volunteers14A community member attends to a home-based patient.The Shiselweni business community started an OVC fund.CCE IMPLEMENTATION IN SWAZILANDfor community home based careCOMMUNITY RESPONSES Community projects initiated (Lavumisa, Nkamazi,Mankayane) Community level policies promoting prevention, leadershipsupport for protection of youngchildren, especially girls fromabuse, improved observation ofhigher standards of morality Increased capacity to influencepolicy and development plans(Urban HIV & AIDS action plansare based on community concernsraised during conversations) Ability to mobilize resources(a community fund forOVCs by the business community(Nhlangano) Increased community involvementin community basedHIV/AIDS interventions Community recreation facilitiescreated for youth (Netball and volleyball teams have beenestablished). Reduced fear, stigma and discrimination—increased confidencefor declaring HIV statusLANGUAGE Increased openness about HIV/AIDSand sexual reproductive health issues dueto improved comfort level. Increased education—people can differentiatebetween HIV and AIDS Increased acceptance of reality ofHIV/AIDS—reduced euphemisms inreference to virus (no longer called negativenames such as “that animal”)CHANGES AT INDIVIDUALLEVEL (as reported by participantsat community conversations) Raised awareness on HIV and AIDS Consistent use of condoms Protecting myself from HIV/AIDS Making condoms available and accessibleto all who use them Supporting those who are living with HIV/AIDS Promote positive living Encouraging PLWHA to honour appointment dates, adherenceand compliance with treatment Established and encouraged support groups Promoted sharing of information, ideas and experiences Assertiveness in demanding HIV testing before marriage (aCCE participant reported turning down marriage proposalafter partner refused to test before marriage.)

OBSERVATIONSLESSONS LEARNT AND CHALLENGES AT THE COMMUNITY LEVELTHOUGH the reality of HIV has taken a long to sink in, it isnow clear that communities are ready for action and hungryfor leadership and motivation to drive community levelHIV&AIDS.During a number of recent CCE training programmes, VCTservices were invited to be on hand. A large number of participantswent for counseling and more than 80% of participantstested.The fear as a result of stigmaand discrimination whichplayed a significant role indelaying initiatives for behavourchange and prevention,is slowly ebbing.NEED FOR GUID-ANCE: As a nationalemergency, there is insufficientnational level inspirationfor active communityled interventions to promoteprevention and reducetransmission of HIV.HIV prevention interventionsare perceived as optional.There is a need forstrong national level leadershipto inspire and supportdynamic communitylevel awareness and action.RESEARCH DATA: There is also a lack of research dataregarding the epidemic. Beside the bi-annual antenatal surveillancereport of the Ministry of Health, there is insufficientresearch information to inform initiatives.SUPPORT FOR COMMUNITY DIALOGUE: Nationally,local community leadership at key levels have been trainedeither as facilitators of Community Conversations or inceptedin the methodology as part of enabling the environment. CCEis a powerful tool that can effectively transform the battleagainst HIV.INSUFFICIENT EFFORT FOR COMMUNITY MOBILI-ZATION: Lack of informed dialogue at the national level is15The methodology has been adapted into drama and staged topromote awareness of abuse of girls and the spread of HIV.HOW TO BECOME A MEMBER OF THE CCE NATIONAL NETWORKOrganizations that are already committed to playinga role in the HIV&AIDS response in Swazilandwhether in prevention, care and impact mitigationare welcome to request training support.CCE seeks to strengthen the national response, fullyinvolving NERCHA, civil society, communitybased organizations, donors and UN agencies. TheUNDP provides the capacity building to organizationswho use the methodology to strengthen theirprogramme.CCE IMPLEMENTATION IN SWAZILANDreflected in the level of awareness and response at the communitylevel.OWNERSHIP OF THE EPIDEMIC: The success in generatinga national groundswell of community responses relieson the extent of a feeling of ownership of the crisis. Thissense of ownership is still low but growing. The League ofChurches has taken an important step to arrange a nationalprayer service to demonstrate national ownership of the epidemic.There is still the perception that those involved in theresponse may be motivated bythe opportunities for resourcemobilization. This has a stronginfluence on the extent towhich people are prepared tovolunteer personal time.ChallengesCCE participants have demonstrateda tangible shift inattitudes and commitment.To successfully sustain thiscommitment however requiresthat a number of challenges beaddressed. Among them are:-Lack of resources at the communitylevel for supportingfacilitators conduct effectivecommunity conversations.Limited commitment andownership of CCE by somepartners and stakeholders. Ownership and expectationsshould be emphasized to partners at enrollment to avoidthe tendency to depend on or expect UNDP resources supportwith.HIV is still not considered a priority at both national andcommunity level. HIV initiatives often loses out in competitionwith other community activities. This often compromisesattendance at conversationsLack of incentives discourage facilitators and limit interestedin conducting conversationsBrain drain: Ability to retain trained youth facilitators a ismajor challenge at community level.For further information on the UNDP contact:The Resident RepresentativeUnited Nations Development Programme5th Floor Lilunga HouseP O Box 261Mbabane, H100Phone: +268-404-2301 Fax: 404-5341Email: Registry.sz@undp.orgHttp://Www.undp.org/sz

16CCE IMPLEMENTATION IN SWAZILANDUNDP SWAZILAND5TH FLOOR, LILUNGA HOUSESOMHLOLO ROADP O BOX 261MBABANE H100REGISTRY.SZ@UNDP.ORGWEBSITE: WWW.UNDP.ORG.SZ