Self Assessment framework for HIV/AIDs

This is an attempt to define a model Self Assessment framework for HIV/AIDS.

In my mind, there are 3 main challenges in the definition.

1. What are the practices?
2. Can we define them in a way that they are based around actions?
3. What are the levels?
4. Can we define a set of levels that we will apply to the practices?
5. Application of these levels to the practices?
6. Can we apply these levels consistently to the practices?

The intention is that this framework will be relevant beyond HIV/AIDs. We hope that it can be used as a model for ANY framework that we build in the Community Life Competence process.

1. The practices

1. We accept the reality and the nature of HIV/AIDS I find the old one to cover more depth. How about: We acknowledge and recognize that HIV/ AIDS is part of reality in this community. I am not clear about 'nature' in this sentence. Can you explain this further for me?
2. (This is the practice of 'Acknowledgement and recognition'. The practice describes an acceptance that HIV/AIDS is a reality and that it has an impact on ourselves, our family and our community.) I would use the words of the description: We accept that HIV/AIDS has an impact on ourselves, our family and our community. (Lau) Marlou likes Laurences suggestion
3. We include
4. (This is the practice of 'Inclusion'. The practice describes the acceptance of the humanity of all with regard to HIV/AIDS.) We include everyone (Lau)
5. We show care and thus stimulate prevention
6. (This is the practice of 'Linking care with prevention'. This tries to make explicit what is not self-evident to many of us. It asserts that a culture of care will lead automatically to environment of prevention.) Can we say 'therefore stimulate prevention'. (Lau) For me, this is just one (significant) explanation of this practice. There are more significant ones. People like Usa and Ian would be better at articulating this than me....
7. We access treatment
8. (This is the practice of 'Access to treatment'.)
9. We identify and address the risks to the infection by HIV that we face
10. (This is the practice of 'Identify and address vulnerability'.) We know and address the risks we take to be infected with HIV. (Lau)
11. We recognise that gender is an issue in HIV/AIDS
12. (This is the practice 'Gender') Not sure about this one. I have a problem with the word 'issue'. 'We recognize the importance of positive gender relations to respond to HIV/AIDS (Lau)
13. We check on our progress and adapt our response
14. (This is the practice 'Measuring change and adapting our response')
15. We learn-and-share with our peers
16. (This is the practice of 'Learning and transfer')
17. We work together on all issues concerned with HIV/AIDS
18. (This is the practice of 'Ways of working') I think here the emphasize is on 'work together' and 'working together in an appreciative way' (Lau)
19. We mobilise our resources. I think this is important to add, so that they first look at their own resources. Else people quickly go into 'we need to ask this organization for this and that...'
20. (This is the practice of 'Mobilising resources')

2. The 5 levels

I would keep the usual level descriptions, except for level 2 (not react but the other one). Level 4 doesn't work for me because we start planning as soon as we do the self-assessment, even when we are at level 1. (Lau)

The first 2 levels are about knowledge.

Level 1 indicates a recognition that the issue is important. But we do not know enough to take effective action.

Level 2 indicates an appreciation of the cause of the issue so that effective action is possible. This sounds very Buddhist - the four noble truths!

The next 2 levels are about action.

Level 3 indicates an uncoordinated response. Level 4 indicates a coordinated response.

I think level 3 can be a coordinated response but not widespread. Level 4 is it is widespread and systematic (not once in a while but almost all the time)

So level 3 is once in a while, level 4 is almost all the time, level 5 is always.

Level 5 indicates that the response has become routine.

3. The framework

The current model framework is on this page in Google docs

4. Problems, concerns and thinking

• Practice 1: We accept the reality and the nature of HIV/AIDS
• With the (old) practice of 'Acknowledgement and recognition', I remember a long discussion within the Knowledge Assets groups that struggled to understand what precisely this meant. Here is the definition of Level 5 for the practice that surfaced from the discussion:
• 'HIV/AIDS is an issue that affects us all. Together, we share concerns and hopes. We are honest to ourselves and our community and face the good and less good issues together. We naturally and openly discuss HIV/ AIDS as a normal disease, as well as our vulnerabilities, without taboo or prejudice. Our response to AIDS is part of our daily life. We know our own status and act from strength. There is no need for people to disclose their status because everyone shares the same knowledge and responsibility.'
• Practice 3: We show care and thus stimulate prevention
• I am afraid that for people like me it took a long time to see this link. For many people, it is not intuitive. I think that we have to be specific. Once again the Level 5 definition in the Knowledge Asset study helped me:
• 'Care and prevention are not separated. They are used in an integrative way. Care is used in the wider sense of the word and includes emotional, spiritual and psycho-social care. Care strengthens relationships and helps to change our behaviour.' One idea: Because we care for ourselves, our family and our community, we prevent the spread of HIV. (Lau) Gaston: This forum of Ricardo explains it just remarkably well! http://aidscompetence.ning.com/forum/topics/care-the-missing-link-in
• Practice 4: We access treatment
• In our current definition, the progression is essentially about the kind of medicine that we access. So Level 1 is access to basic medicines and Level 5 is full access to HIVs. I remember listening to Mary Kitau at the Aga Khan Hospital in Nairobi talk about this practice in a way that health needs were addressed in a much broader way as the levels progressed. But the progression was still based around levels of care rather than our current model of levels. Is this an exception? I often go hypothetical here as well especially in case there are no PLHIV in the community (that they know of). Same for UN teams etc. I would say: Imagine, there are people that get infected, would you have the access, would you know where to go and do you have the means to get it (economically for example)?
• Practice 5: We identify and address the risks to HIV that we face.
• I found this difficult to get this one down on paper. Is there a problem with the word 'risk'? We seem to want to use a phrase like 'the factors that make us vulnerable' Is that different from a risk? Yes, a quite significant risk. See the Knowledge Asset from Chiang Mai IKF. JL can share more, but there is a significant difference and I strongly suggest we use vulnerabilities.
• Practice 6: We recognise that gender is an issue in HIV/AIDS
• I am struggling to find the right words here, both for the practice and the levels Marlou trying: we are conscious of gender relations in our response to HIV/AIDS
• Practice 7: We check on our response and adapt our response
• I know that the correct phrase is 'measure change'. But I don't see that as what people do. They look to see what has happened and adapt accordingly. Love it.
• Practice 8: We learn-and-share with our peers
• This is the process of transfer. Perhaps we should just use that word. Yes!
• Practice 9: We work together from strength (marlou: like) to deal with HIV/AIDS Gaston: based on our individual and collective strengths. Normally we say the WOW is SALT and I would use the essence of SALT here.
• This is the old practice of 'Ways of working'. I have heard lots of interpretations of this. And now that we use the phrase 'Our way of working' in the Constellation it is even more confusing for people. I have taken it to mean the extent that we are able to integrate all of the different efforts made by the community to produce a better result.