INERELA+ promotes the ‘SAVE’ approach to HIV, a response that was originally formulated by the leaders of the African Network (ANERELA+) as a reaction to the shortcomings of the existing method known as ‘ABC.’ Long used as the foundation of comprehensive HIV prevention programmes around the world, ABC stands for ‘Abstinence; Be faithful; use Condoms.’ Unfortunately, the way in which it has been presented to far too many in the past is more like: ‘Abstain. If you can’t abstain, be faithful. And if you can’t be faithful, use a condom’.
The implication that the use of a condom automatically marks a person as unable to be faithful fuels stigma and acts as a disincentive to evidence-based prevention. Furthermore, ABC fails to consider a person’s HIV status. While abstinence may be appropriate at some stages of life, at others – within a faithful marriage, for instance – it is not; and yet an HIV-negative person whose spouse is positive is at risk even within a faithful marriage. The ABC doctrine is:
– Narrow – limiting itself to one mode of HIV transmission,
– Inaccurate – in assuming that people who are abstinent or faithful will completely avoid HIV, and by implying that those who are faithful do not need to use condoms as an added protective measure,
– Stigmatizing to PLHIV – by implying that people who are HIV positive have failed in abstinence and faithfulness,
– Inadequate – by leaving out messages for families, communities and nations, and placing the burden of prevention on the individual.
It ignores the role of HIV counselling, testing and treatment in prevention, and fails to highlight other possible means of HIV prevention, like safe blood transfusion, safe injections, safe circumcision, and prevention of mother-to-child transmission.The SAVE approach provides a more holistic way of preventing HIV by incorporating the principles of the ABC (Abstinence, Be faithful and Condom use) as well as providing additional information about HIV transmission and prevention, providing support and care for those already infected and actively challenging the denial, stigma and discrimination so commonly associated with HIV.
SAVE counters all these faults.
HIV is a virus, not a moral condition, and the response to it should be based on public health measures tempered by human rights principles. The SAVE model combines prevention and care components and provides messages to counter stigmatisation.
S refers to safer practices covering all the different modes of HIV transmission, like safe blood transfusions, and the use of condoms, or sterile needles for injecting. Abstinence remains the most reliable method of avoiding exposure to STIs, but it must not be taught in isolation. It emphasises PMTCT and PEP (Post Exposure Prophylaxis).
A refers to access to treatment– not just ART, but treatment for HIV-associated infections, and provision of good nutrition (particularly to help ensure adherence to ART) and clean water.
V refers to voluntary counselling and testing. Those who know their HIV status are in a better position to protect themselves and others.
E refers to empowerment. It is not possible to make informed decisions about any aspect of HIV or sexual behaviour without access to all the relevant facts on “S”, “A”, and “V”. Inaccurate information and ignorance are two of the greatest factors driving HIV-related stigma and discrimination. Empowerment also needs to addresses vulnerabilities caused by gender inequality, homophobia, illiteracy, poverty etc.
INERELA+ evidence-based policies, programmes, and interventions that support good practices and are not contrary to scientific evidence of effective HIV and AIDS interventions; including those that are based on cultural/religious beliefs and/or violate basic human rights principles.
INERELA+ developed the SAVE methodology through working in various community contexts across Africa. In particular, religious leaders were at the front line of the response in various ways:
– Many were dealing with their own HIV positive status in contexts with high levels of SSDDIM.
– Weekends were often occupied with an increasing number of funerals. One INERELA+ member stated: “he was burying upwards of fifty people a weekend.”
– Religious leaders were called on to provide counselling to people living with and affected by HIV and AIDS. This ran the gamut of pastoral interventions from bringing comfort to the dying, to counselling the bereaved, to counselling family and friends. Through the experiences of INERELA+ members, these religious leaders are able to bring hope and not condemnation, tackle the stigma related to HIV and provide crucial support to those who are suffering. In particular, many religious leaders provide their own experiences of positive living and are thus in a unique position to provide the necessary support to those vulnerable to HIV transmission.
– HIV prevention methodologies tend to possess narrowed focus on only certain issues. Commonly, they tend to focus solely on preventing transmission without also examining relative access to treatment, and analyse sexual transmission of HIV while neglecting vertical transmission. The SAVE methodology looks at HIV prevention in a holistic manner, and also exposes the underlying issues that have ensured the HIV virus’s continued existence. Thus INERERLA+ members are able to care for, themselves, as well as people infected and affected by HIV, and to assist the wider community without judgement, or without increasing SSDDIM. They are able to combine solid information with strategies that address underlying vulnerabilities. In particular, one of the key focuses of the SAVE Toolkit has been sex, sexuality, and gender. Religious leaders are enabled to challenge various cultural and religious traditions around these key topics that lead to increased vulnerability to HIV transmission. Within this INERELA+ is also able to highlight the vulnerabilities faced by most at risk populations and marginal groups such as the LGBT community.
– Many felt fearful and helpless in the face of the destruction caused by HIV and AIDS related death. Authorities, both locally and up, were unable to stem the tide, and important community leaders were stigmatising the infections for their own ends.”
– For a core group of religious leaders, all of whom are living with HIV, could not be silent as their communities were dying.
In working together with these affected groups, and by sharing their experiences these religious leaders realised that HIV was a virus and not a moral condition. As such, they developed a unique approach that is holistic and non-judgemental, and we use the following evidence-based approaches:
– We assist communities in examining their potential vulnerabilities to HIV transmission and infection within their given sphere of influence. Making these HIV interventions a complex, and considered response, rather than a superficial, or one-size-fits-all.”
– We monitor programmes, in terms of individual change, communal change, and structural change rather than a simple input-output approach. This allows communities power over the process, as well as the product. In implementing, and utilizing the process of SAVE implementation, which can be used to further strengthen the SAVE methodology.”
– To ensure that they do not further marginalise at risk individuals and communities.