The Power of Community the 'Resilience Effect'

Spring 2017

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The return of resilience to the communities in which our partner organizations work in sub-Saharan Africa is one of the great untold stories of the HIV&AIDS response.
In our Spring 2015 Spotlight on Grassroots we shared that we had begun working with our partners to find a way to substantively measure something as elusive as resilience. The Stephen Lewis Foundation’s (SLF) Impact Assessment Framework (IAF), developed collaboratively with our community-based partners over a period of two years, has led to documentation and tracking of a critical dimension of their work—one which is pivotal to their success. Organizations have found a way to document and discuss the emotional roadmap to resurrecting resilience in families and communities devastated by the AIDS pandemic. Instead of being relegated to sidebar stories of heartwarming examples that illustrate results we already recognize as important (i.e. how many children have graduated from elementary school, how many grandmothers are participating in income-generation projects etc.), it emerges that these stories are actually central to understanding how real change and improvement in the quality of life unfolds. They reflect the reality and complexity of lived lives, but are also measureable.  
This is work that breaks new ground. The initial reports from our community partners, using the IAF, show that it is possible to measure change in critical areas of life that seem to defy measurement—for instance, emotional well-being, community connections, and whether or not people are able to recapture hope for the future and have a renewed sense of purpose and direction. Our newly published 2016 Year in Review reflects what we have heard and learned from our partners in 2016—amongst all of their successes and innovations around income-generation, food security, access to education, protection from violence, housing security for people living with HIV&AIDS, and grandmothers raising orphaned children, there is a wealth of powerful information about, and evidence of, improved emotional well-being and the re-establishing of bonds that connect people to one another—what we are calling ‘the resilience effect’. 
"Over the past two years, our grassroots partners have used their perceptiveness, understanding and expertise to ‘crack the code’, developing new and different markers for gauging signs of emotional and psychological improvement. Nothing quite like this has been done before."
It is not new work for our grassroots partners but, over the past two years, they have used their perceptiveness, understanding and expertise to ‘crack the code’, developing and identifying new and different markers for gauging signs of emotional and psychological improvement. Nothing quite like this has been done before. 
That’s why we have chosen to highlight psychosocial change in this Spotlight on Grassroots, although it is but one of the seven areas covered in our annual Year in Review. Psychosocial support is often presented in anecdotes and stories about grand-mothers and grandchildren who have been supported to overcome challenges and express their relief and happiness. Here, you’ll find that our African grassroots partners have truly elevated the impact of emotional support and well-being to its proper place—and documented it—as a powerful and critical component of ‘the resilience effect’. 
Psychological and Emotional Support


Grandmothers at PEFO in Uganda support each other through their grief.
HIV&AIDS inflicts emotional and psychological devastation, and for people with limited access to healthcare and limited information about the virus, a positive diagnosis can arrive like a death sentence. People struggling with the illness often lose their ability to support themselves and their families, are stigmatized and ostracized by their communities, and despair of ever finding a way forward again. Women who test positive can be thrown out of their homes, abandoned by their families, and left to fend for themselves. Women and girls who have contracted HIV through rape have to deal with the massive psychic double blow of both the violation and its life-threatening consequences. Teenagers often start spinning out of emotional control when their HIV status is disclosed to them, quitting school and engaging in risky behaviour with drugs, alcohol or unprotected sex. Children who have lost their parents to AIDS are overwhelmed with grief and, without caregivers, their very survival is in question. The grandmothers, pressed by necessity, are taking multiple orphans into their homes, without any idea of how they will be able to feed so many mouths or heal so many broken hearts. Grassroots organizations who are working to turn the tide of AIDS have seen very clearly that the people in their communities need more than supplies of ARV med-ication. They need to feel hope again.
The Expertise of Community-Based Organizations
The support and validation that comes from group therapy or mutual support groups can play a very significant role in the healing process.
These examples, while overwhelming, are not exhaustive—there are hundreds more that could be listed. The community-based organizations with whom the SLF works have always understood the many ways the need for psychosocial support manifests in a community, and from the earliest days have been developing tailor-made programmes to address them. Our partners are on the cutting edge of innovation at all times and their work in psychosocial support over the past decade and beyond offers the gold standard in restoration of the emotional resilience that people must have in order to succeed in reclaiming their lives from HIV&AIDS. 
For instance, the SLF’s partners are providing one-on-one counselling within their clinics and through home-based care, hosting group therapy sessions and mutual support groups, providing therapy that’s focused on play, music, art and drama, and operating summer camps. Special therapeutic approaches are targeted to meet the different needs of people living with HIV&AIDS, women and girl survivors of violence, young mothers, men, teenaged girls and boys, orphaned children, and grandmothers. They attend to a host of different problems, but with the common aim of restoring a person’s ability to cope. 
As Kimara Peer Educators & Health Promoters in Tanzania explains: We help the individual accept what has happened as a reality that will not change, and impart the skills that will help them focus on the future—redirecting the pain of loss to possible successes to come. We help them understand that ‘life goes on’ and that, despite hardships, there is always life after the hardship.
Working with Children
Community-based organizations have an especially deft hand with children. One of the counsellors at Ripples International in Kenya speaks about their work with a boy she calls Jimmy:
When I first met Jimmy he looked sickly, dull and withdrawn. His father had passed on a month before, and Jimmy told me that his father was living with HIV but refused to accept his status, and thus did not take medication. The boy watched him get worse every day until he passed on. Jimmy knew that he was HIV positive himself, and felt that he would soon die like his father did. He felt that life had come to an end because his father, who was not only the bread winner but also his best friend, had died.
Jimmy was missing most of his classes at school because he was always sick. He’d lost his appetite and hardly ate, and shared with me that one day he collapsed on his way to school and had to be carried back home because he was so weak. He was irritable and hardly smiled at anyone. He told me he didn’t want to talk to anyone and just wanted to be alone in his bedroom.
We brought Jimmy in for individual counselling sessions, and he made some important decisions. He learnt from us that he didn’t have to follow the pattern of dying like his father, and that by taking ARVs his body’s immunity would improve and he wouldn’t fall sick, so he decided to adhere to his drugs. He also mourned and grieved his father, and by accepting his death he made the decision to move on. Jimmy even came up with goals he wanted to meet in life and made the decision to work hard in school. Jimmy is now 12 years old, healthy and strong, in class six, and he doesn’t miss his school lessons. He’s a happy boy—no longer withdrawn.
The Importance of Peer Support
Community-based organizations like Siyaphambili HIV and AIDS Support Group in South Africa are opening up new worlds of possibility for the people and communities hardest hit by the pandemic.
Because of the intense stigma that surrounds it, HIV&AIDS can be tremendously isolating. People so often lose their families and friends, connection to their communities, and any sense of having a place in this world. Our partners report, again and again, that one of the most important benefits their therapy programmes provide is reassuring clients that they are not alone in whatever they are going through, and that someone cares for them. The support and validation that comes from group therapy or belonging to a mutual support group can play a very significant role in the healing process.
Kiambu People Living with HIV/AIDS, Kenya: At our PLWHA meetings, people share their challenges and achievements, personal testimonies, and stories of their journey with HIV, advising and encouraging one another. The common factor is the personal touch that is experienced during these sessions. People get to meet, and talk, and feel that they actually belong. The sense of belonging is the first step towards healing of the mind.
Mamelani Projects, South Africa: One of the most important aspects of the psychological support we provide is that it enables people to find their inner resources and feel better about themselves. The women who join our groups say that by sharing their experiences with the others they feel heard and valued, and they feel like they have more information and more power—this makes them feel lighter and happier and more motivated. 
In our 2016 Year in Review, you will find more examples from our African grassroots partners of struggle, perseverance and resilience in the areas of Healthcare, Income Generation, Food Security, Access to Education, Protection from Violence, and Community Mobilization. Time and time again, they prove the SLF’s conviction that support to grassroots work is the most important, effective and transformative investment that can be made in the struggle to turn the tide of HIV&AIDS. Their holistic programmes are life-saving, and have life-changing impact. Community-based organizations are opening up whole new worlds of possibility for the people and communities who have been hit hardest by the pandemic—and the global HIV&AIDS response has much to learn from them.

Thanks to your generous support, the Foundation has invested over $97 million through partnerships with more than 300 grassroots organizations in 15 countries—responsively, without needless bureaucracy, directly at the community level. Now that’s undeniable success. A grassroots-to-grassroots movement. Let us continue.


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