The human tragedy of the HIV/AIDS epidemic was captured this week in a moving exhibition Positive Negatives, hosted by Christian Aid in Dublin. The collection of photographs represents six HIV positive women's personal accounts of living with HIV in the Democratic Republic of the Congo. The images reflect the stark reality facing millions of people who are living with HIV/AIDS worldwide, and the enormity of the task faced by Irish and international aid agencies.
DOCHAS, the Irish Association of non-governmental organisations (NGOs) represents 31 development bodies. Their work spans the worst affected areas in sub-Saharan Africa, where 28 million people are living with HIV/AIDS, to the less affected but, equally daunting, emerging epidemics in Asia and the Caribbean, where a similar tragedy is unfolding.
Irish agencies are responding to the epidemic by co-operating more closely with one another and with the government, to deal with what Kofi Annan calls "a global problem of catastrophic proportions".
Charles Businge of Action Aid Uganda sums up why the involvement of NGOs is important. He believes that "the resources of the NGOs go where they are most needed. They build trust in the communities in which they work, and they have the ability to reach down to the people through bottom-up planning. Their expertise of working with local organisations and communities means that they can reach people in a way that governments cannot".
Irish agencies are attempting to remain true to this vision by supporting good quality community initiatives, without losing sight of the broader global issues that affect people's vulnerability and their ability to respond.
Almost all of the Irish agencies are reorienting the way they respond to HIV/AIDS.
Mainstreaming HIV/AIDS involves looking at programmes through an 'HIV lens', recognising that certain activities are less relevant because of HIV/AIDS.
Fumakazi Munthali from Oxfam explains how an agricultural programme in Malawi was changed to accommodate families who are affected by HIV/AIDS, and whose time and energy is diverted to caring for the sick.
"The programme was revised to include small livestock such as rabbits and chickens to replace goats, which are more time consuming and kept further from the home.
We are also experimenting with hardy crops that need little maintenance, or give higher returns of nutritious foods, to help build people's nutritional status, without overburdening them with labour intensive methods".
Women constitute 55% of all HIV/AIDS cases in sub-Saharan Africa, and teenage girls are infected at a rate of five or six times greater than young men in the region.
Their risks are increased by pervasive concepts of masculinity and power that prevent women from negotiating safe sexual practices. "The Men in Soccer Programme" works with forty soccer teams in Kwa Zulu Natal in South Africa and challenges men's attitudes and behaviour that put themselves and their partners at risk. Gethwana Makhaye explained that men are beginning to change both the way they behave and how they communicate with women. They are more willing to discuss their relationship with their partners and to practise safe sex.
Agencies recognise that changes will not happen overnight. Mashambanzou, a trust run by the Presentation Sisters in Zimbabwe, receives support from Trocaire to assist people to freely discuss sexuality, risk behaviour and practices and to seek testing, counselling and treatment.
Losing a young productive adult population has many repercussions. Over 12 million children have been orphaned by AIDS in sub-Saharan Africa and AIDS is expected to claim the lives of around one third of today's 15 year olds in Africa.
Many remain vulnerable without the safety of secure households and are forced onto the streets to live in high-risk environments. A baseline study on street children by GOAL found that 50% of girls living on the streets say that sex is "always" or "sometimes" forced on them.
Agencies such as GOAL are responding by supporting a life-skills approach that includes HIV prevention, as well as addressing issues such as drug abuse and gang rape, and by training children to become educators for their peers.
Young people and adults living with AIDS are often the best advisors. Studies have shown that stigma is reduced if people living with HIV/AIDS are involved in the response.
Concern explains how they worked successfully in Ethiopia through a local organisation, Mekdim, whose membership is drawn from people living with HIV and AIDS and children who are orphaned by AIDS. The organisation provides counselling, home care, prevention, education and some financial support for those who are HIV positive or living with AIDS.
Metshiet Temene was barely 15 when both parents died of AIDS. Today, at 23, she works for Mekdim and is committed to "raise awareness so that people with HIV/AIDS are not ostracised, and to use this awareness to prevent other people from becoming infected".
As the numbers affected increases, communities become overstretched. The challenge is to learn from the rich experiences at a community level and to support these on a scale that will truly make a difference. Ultimately, real change will only come about if the underlying social and economic inequalities are tackled alongside disease prevention and care.
The arithmetic at the moment simply doesn't add up. Sub-Saharan Africa pays $13.5 billion in debt repayments every year and only $300 million on prevention and basic health care. Until we tackle the social and structural inequalities that ensure that 1.2 billion of the world's population have no access to modern health services and that 600,000 women die of pregnancy related causes each year, we will continue to grapple with this enormous tragedy.