Mozambique

Some of the 200 orphans who daily come to the support centre in Dondo, on the Beira Corridor, Mozambique © 2004 Gideon Mendel for International HIV/AIDS Alliance

The epidemic has now advanced significantly in Mozambique, fuelled by nearly 30 years of war, labour migration, rapid urbanisation, high levels of poverty, insufficient health infrastructures and significant rates of sexually transmitted infections.

By 2002, 13.6% of the population were living with HIV. The majority are from the central provinces, but new cases are occurring now most rapidly along the major transportation and commercial routes in the southern and central region. Of all new infections, 43% are among 15–24 year-olds, with the highest rate of 16% being among 15–19 year-old girls compared to 9% of boys in the same age group.

The Government of Mozambique has taken a robust stance, matched by significant international efforts to combat the epidemic. None of these have so far incorporated large-scale treatment programmes for people living with HIV/AIDS. The emphasis has been on prevention, awareness-raising, voluntary counselling and testing (VCT) and palliative care.

What we do

The Alliance has been working in Mozambique since 2001 and established a country office in 2003. It offers programmatic and organisational support to local non-governmental and community-based organisations, faith-based organisations, organisations of people living with HIV and governmental institutions in the central provinces to respond effectively to HIV.

The Alliance also enables orphans, vulnerable children and people living with HIV to access quality care and support services through partner programmes in central Mozambique. It works with local communities and vulnerable populations, such as sex workers and their clients, in order to raise awareness of sexually transmitted infections and HIV prevention, as well as promoting VCT.

To do this work, the Alliance collaborates with three organisations in Manica province: the Associação Nacional de Desenvolvimento Auto-Sustentável (ANDA), Kubatsirana and the Organização da Mulher Educadora do SIDA (OMES).

The Alliance supports ANDA’s work with community volunteers to provide home-based care to orphans and vulnerable children and their families. ANDA has also built a day care centre for 430 children, to provide them with schooling, basic health care and daily meals. A psychologist will offer psychosocial support, and older children (aged 10–16) will be able to access vocational training. The children will also receive prevention education from centre staff and volunteers from their own communities.

The faith-based organisation Kubatsirana receives Alliance support for three of its programmes. In the first, Kubatsirana builds the capacity of local organisations to initiate community support programmes for orphans and vulnerable children, and to integrate services for these children into existing prevention and care activities. Secondly, the youth education programme provides information in its churches’ youth groups on HIV prevention. And lastly, Kubatsirana also trains and supervises church volunteers to provide quality home-based care and support to orphans, other vulnerable children, people living with HIV and their families.

Through its women peer educators, OMES empowers sex workers and their clients to practice safer sex, and trains them as community educators in HIV prevention. The organisation’s walk-in counselling centres also target young people, sex workers and truck drivers with educational activities, whilst offering counselling services and referrals to VCT centres.

What we will achieve

Alliance programming continues to develop alongside the government's HIV strategy, and will prioritise the high numbers of orphans and other children affected by HIV in the region. Given the very high rate of new infections among 15–24 year-olds, this group will also remain a priority.

Information, education and communication will focus on behaviour change, delayed sexual debut and increased contraceptive use. Home-based care for people living with HIV needs a major scale-up, due to the high numbers of positive people living in a resource-poor setting where few care and support initiatives are available.

Promotion of VCT has tended to focus on social marketing and, while successful, now needs to focus more on community-based VCT mobilisation activities to increase the numbers of people tested. And lastly, capacity building is a priority, since non-governmental and community-based organisations in the region generally lack the technical and organisational capacity to scale up their work – and there are few non-governmental organisation support programmes available to provide technical assistance.