The Growth of KIWAKKUKI

Background to KIWAKKUKI:
KIWAKKUKI is a Kiswahili acronym (Kikundi cha Wanawake Kilimanjaro Kupambana na UKIMWI)Funded in 1990 and around the theme of Women and AIDS; formally registered as an NGO in1995.Fundamental goal is to accelerate Women’s access to Information on HIV and empower them with skills needed to fight HIV/AIDS in their Community. After empowerment, these women have made a big difference in the war against HIV/AIDS in Kilimanjaro region Tanzania. KIWAKKUKI was conceived as a result of the December 1990 World AIDS Day Theme of “Women and AIDS.” This theme inspired women from all walks of life in Moshi town who saw the need to join hands to engage in the campaign against HIV and AIDS in Kilimanjaro in order to mitigate the impact AIDS was bringing in the community. Women and girl children as traditional managers of domestic unpaid labour were the most impacted. “Let’s give women the awareness to become drivers of their own lives their own protection and that of their children. Many women see the need for giving assistance and support to those families impacted by AIDS. They have to bear pressure on those whose lifestyles endanger other families and that of their children. Women are educators of family and community life. They are potentially powerful leaders for change” wrote the late Juliet Howlet.

KIWAKKUKI works in all 6 Districts of Kilimanjaro, where it now considered the leading HIV/AIDS service organization Work started in Moshi town and gradually spiraled out to the grassroots approach whereby 20 sensitized women or more built synergies through group formation to extend services in their areas. Currently there are >150 such groups. These women have since then become brigades for service provision and indicators of KIWAKKUKI’s visibility.
Today the number has risen from 44 at the fist Annual General Meeting on 25th February 1992 to more than 6,000 from virtually all corners of Kilimanjaro region. Formal registration was in July 1995. After the initial meetings held at the Cooperative College, by then and the YMCA the venue moved to the Catholic Bishop’s Chancery with Sr Mary Lauda, then to the ELCT Women’s Department under Veronica Swai and later to the Primary health Department under Dr Janet Lefroy. In 1994 KIWAKKUKI offices were moved to the 1st Floor Rooms 109 + 110 of the THB building.
3.1 Vision:

A community taking appropriate measures to eradicate HIV while contributing efforts to mitigate the impact of AIDS.

3.2. Mission:

To integrate programs that focus on HIV/AIDS information and to increase community participation in providing services to those infected and affected by HIV/AIDS.

3.3. Core Purpose:

To unite women and help them harness the skills and talents needed in order to face challenges and restore dignity, self - respect and purpose to lives on individual and their families mainly AIDS patients and children.

3.4. Core Values:

Voluntarism, Unity, respect, sharing recognition of talents, love, transparency, Accountability to each other, Collaborating and Team culture.

The major commitments of KIWAKKUKI are in harmony with those of the Tanzanian government and also address some of the Millennium Development Goals and so cover 16 out of 18 Strategies streamlined by (TACAIDS) which is a significant contribution to the National Efforts and also touches on 7 out of 8 MDG, a contribution to the UN Efforts.
1995 was a turning point:
2-1- 1995 – The late Ms. Juliet Hardy Howlet the leading Founder died in the UK. May the Almighty God rest her soul in eternal peace.

30-1 – 1995 Annual General Meeting at Kahawa House Membership stood at 371

3 – 7- 1995 Obtained a Certificate of Registration No. SO 8488.

20- 9 – 1995 Moved from THB to Manking 'a Street, Mawenzi Ward

29 - 11 -1995 PLHA's meeting centre moved from Rainbow Centre to KIWAKKUKI and established as "Centre of Hope".

1996-1997: Two External Evaluations Conducted.

2000 was a celebrating year for 10 years of KIWAKKUKI whereby several events were organized for fundraising, PLHIV’s, Roundtable discussion, grassroots groups display for their work and the climax was the World AIDS Day at the YMCA where the World AIDS Day Event focusing “Women and AIDS was held in 1990.

2001 -2002: Conducted Organizational Development Intervention with EASUN, Qualitative Evaluation with FOKUS and ECD Evaluation with BvLF.

2002 purchased a plot of land for constructing an orphans’ Vocational Training Centre.

2003: A VCT Facility and research opened at the centre with the support of Duke University

2004, 2006 and 2008 KIWAKKUKI’s Best Practices presented at the International and National AIDS Conferences International.

2005: 1st Strategic Business Plan launched along Lindi Street for erecting an office building.

2007: 2nd Strategic Business Plan (2007-2011) launched.

December 2007: Construction started with a strong back up or Action Medeor Pharmaceutical Organisation based in Germany and a few other donors.

31st of August 2008 – Moved into our own Office Building along Lindi Street, Korongoni Ward.

1st October: Foundation Stone placed at building by the leader of the Uhuru Torch

7th October: Official Launching of the building and celebrations.


3.6. KIWAKKUKI major HIV/AIDS Strategies:

· HIV/AIDS Prevention through Awareness Raising for community behaviour change.
· Home Based Care and Post test Clubs as an aspect of the Continuum of Support, Care and positive prevention.
· VCT, an Entry point to Treatment, Support, Care and Positive living
· Orphans’ Support as an aspect of the Continuum of Support and Care.
· Impact Mitigation through Community Development Projects and Micro credit.

. KIWAKKUKI in a Nutshell Strategies Approach programmes

KIWAKKUKI’s work is centered on addressing AIDS as a development Challenge by Lobbying and Advocating for Access to basic rights for the beneficiaries as follows:
The right to Accurate Information on HIV and AIDS: Means of transmission, non transmission, Prevention, Behaviour change strategies leading to making informed choices, life skills. This also addresses cultural taboos such as talking about sex in the families between parents themselves and also between parents and children as well as between teachers or instructors and pupils or students in order to sustain family lives and promote an AIDS free generation. Coverage include women members, school children, out of school children, men and the community at large. These are reached in either KIWAKKUKI organized forums or in most cases in community or institutional organized forums. The KIWAKKUKI peer educators reach > 10.000 community members with HIV and AIDS awareness and behavior change messages every year. This has promoted openness and free discussion on HIV and AIDS in the community.


A. Awareness Raising
Activities
· Information centre-daily education
· School health programmes
i. Parents/break the silence
ii. Income Generating Activities under school health clubs
· Work place education programme
· Outreaches (in risk area, church places, mosque, WDC etc.)
Approaches:
· Community theatre in high risk
· Youth Talk to Youth In school & out school youth
o Songs, Role plays,
· The Fleet of Hope (focuses on behaviour change)
· Sensitizing Community Forum
Using Research as a Strategic Approach to inform Service:
• Identifying service provision gaps in HIV/AIDS Policy on Prevention, Support & Care..
• Generating data on prevailing HIV risk factors among people presenting for VCT, school children, common OI’s and clinical characteristics of patients in the HBC, KAP
• Presenting scientific findings.
KAP STUDY RESULTS
• Results to 4 primary schools in Moshi Municipal: Fe:116 and Male: 117
• School children already engaged in sexual matters were- F: 62 and M:41
• Community’s views on persistent cultural misconception habits which lead to spread of HIV & AIDS were Widows’ inheritance, Female Genital Mutilation and Witch craft/Superstition
Conclusion: More girls start sexual debut earlier than boys.

4.2 .HOME BASED CARE
The right to access basic needs and care by women donating their time, energy and small resources to conduct home based care and support on the African neighbourly basis. The





KIWAKKUKI volunteers follow up > 3,000 patients every year in their homes and they have revived hope to several of them and reduced stigma in the families and community at large. Some of the patients are referred by the grassroots women and the KIWAKKUKI medical staff for further examination, CD4 count, treatment and legal aid and other social support. > 500 referrals are made per year.

Activities:
· Home visits-Normal Visits & Special Needs Team.
· Referrals –External (KCMC & Mawenzi)
· Providing Treatment for Treatment of opportunistic Infections (OI)
· Follow up on adherence for who are on ARV.
· Research along side HBC (THIRST & ISAAC.)
· Income Generating Activities to PLHAs.
· School Health Club

4.3. Voluntary counseling and testing (VCT)

The right to health care and early access to treatment. The grassroots women have mobilized and escorted several individuals and families from their villages to access VCT services at KIWAKKUKI and other centres. >11,000 clients have been reached since 2003. Consequently, those who have been found HIV positive have accesses early treatment and care. Normally they get referrals from the VCT centres.
Activities:
· Free same day results VCT services
· Internal referrals
· External referrals
· Quarterly VCT committee meeting
· Quarterly PLHAs meeting in their respective Districts/Wards
· Mobile VCT (MVCT)

Research along side VCT on:
· Social demographic characteristics
· Risk sexual behaviour
· Reasons for Testing
· Health Status
· Effects of consequences of Testing
· Coping Health AIDS in Tanzania(CHAT)
Effects of consequences of Testing
We have been able to see that those HIV Negative clients who have come to KIWAKKUKI for repeat testing has largely been able to retain their sero negative Status. VCT has been a tool for their behaviour change.1st Time Testers were 12,082 (85.43%) and 2nd Time Testers were 2,448 (17.31%).In 2003/2004:We Tested 5,269 (prevalence rate:16.6%) while in 2005:We Tested 2,778 (479+ve prevalence rate:17.24%).In 2006:We Tested 2,610 (prevalence rate: 13%) while in 2007: 11% and 2008: 9%
Conclusion: Not all clients turn up for 2nd test
• Prevalence rate is high but going down.
• Male Tested were 213 (5+Ve and 208-Ve)
• Female Tested were 214 (16+Ve and 198-Ve)
• Prevalence rate at the community during Mobile VCT is 4.9%
Conclusion: HIV prevalence is lower with MVCT but still higher for women than men


4.4: ORPHANS’ SUPPORT: OVC who have access to education, skills training, shelter, recreation, good nutrition health and succession plans through memory work

The right to education and equal opportunities for education. The grassroots women do identify needy orphaned girls and boys for school sponsorship and facilitate their placement into various levels of education. Some of these have made it to University level and many to diploma level and many others have acquired vocational skills. Some of these children are heading families and have assumed roles of parenting by supporting their siblings. >12,000 orphans have been supported since 1998. In 2008 sponsored children: Primary school: 1,182, Secondary school: 716Vocational Skills: 43 which make total to be 1,941


These women have also organized the provision of the right to shelter for the child headed homesteads and other very desperate households. The grassroots women have linked these households with the head office for the construction of shelter. The women have worked with the community leaders to contribute towards the construction of such houses which legally belong to the children. >than 35 houses have been constructed up to December 2007.

The right to social wellbeing (of the beneficiaries): The grassroots women are also supervisors of another form of informal micro enterprise conducted by PLHIV and OVC surviving parents and caregivers. These get a loan of an equivalent of 95 USD each to run Income Generation Activities (IGA’s), the profit of which is used to support children to access their rights of education, health, food and nutrition as well as psychosocial support. AIDS has made surviving parents and caregivers more destitute as grandparents have to be parents again!
The right to identity and protection: KIWAKKUKI has discovered that many orphans have no birth certificates. They have been linked with the human rights organization, KWIECO which facilitates access to this basic right. Moreover, the children’s protection has been enhanced through the Memory Project which facilitates the surviving parents to disclose their sero status to their children. This has lead to joint planning of the children’s care and family property as a future protection for the children. 180 wills have been written as added value towards protection of the children and widows and 288 birth certificates are in process.


The right to social wellbeing (of the care providers): The grassroots women have also been sensitized to seek economic livelihood and be able to shift from ill being to well being. This helps to minimize their dependence on men and controls the spread of HIV. In groups of 3 up to 5, women have formed a mutual support system whereby they inject money as a saving and take loans after a minimum of 6 months. The team is its own collateral and they get new funding every time they complete a cycle of loan fund. The members are obliged to run small businesses and use the profit to increase their income and provide material support to the orphans and PLHIV.
KIWAKKUKI STRATEGIC APPROACH OF BUILDING PARTNERSHIPS

KIWAKKUKI works in partnership with other HIV/AIDS partners in Kilimanjaro as follows:
• Clinical Referrals at KCMC Hospital. HAART Clinic, Dermatology, Paediatric and Majengo Health Centre for Sexually Transmitted Infections Clinic, PMTCT.
• Kibong’oto hospital for TB chest clinic, Mawenzi hospital provides Exemptions and free medicine, Early management of opportunistic infections and free ART.The Government: Good collaboration with the Reg. Commissioner’s office, The RMO’s, The Social Welfare Office , The 5 Distr. Comm.’ offices, The 6 Distr. Exec. directors’ Offices, the 6 DMO’s Offices, ward and village offices. - Collaborators: KWIECO a Human Rights support org. Others: Amani Str. Children Centre, Mkombozi Str. Children Centre, TACAIDS, Mildmay International. Network membership: TAF,TANGO.KIGEN
Training and Research Partnerships
• The University of Dar es Salaam- ICDP
• Tumaini University – Patients based Researches
• Moshi University of Cooperative and Business Studies – KAP Studies
• Duke University- Patients & Children Researches.
• Oslo Deaconic Nursing College -Nursing
• Bergen University- Social Work

PLHAHow they survive

How the people live here

KIWAKKUKI September 4, 2009

I promised to continue the stories of the brave people who are part of the KIWAKKUKI family. In morning meeting today, we heard two students from the capitol city of Dodoma express their appreciation for all that they had learned from KIWAKKUKI. One of the things they told us was that when they came to their field placement, they thought that people living with HIV only had to deal with the disease. They didn’t realize that they also suffer from the other problems that people living in a poor country also have, but in addition, they deal with their illness and the STIGMA connected to it. As they said, “Shidas mbali mbali”! Translated, all different sorts of problems. As if to underscore what they said, a lovely lady who is HIV-infected reported that a thief came last night and stole everything she had. She had a shy smile on her face as she said, Thank God, that she wasn’t hurt. But, the man had taken advantage of her because of her HIV. The two students said that they learned that people with HIV had to find ways to speak up for themselves, and they now realized that this was very hard. They appreciated the work that KIWAKKUKI does in trying to help HIV+ persons to accept their illness and go about the other difficult things in life.

Cecelia and Ndosi (Ndosi is a KIWAKKUKI driver)

Blandi and John

My second story is about Blandina. Blandi is a young woman who became infected with HIV many years ago. At first, her husband wanted to leave her and treated her very badly. She found out about her HIV when she had her first child. This child died. She was incorporated into the memory project and worked with her husband on her story. They built a family tree together so that other family members would know and appreciate her story. This memory work has been healing for the couple and he is treating her better now. They had another child who is not infected. But, her struggles do not end there. Blandina spoke no English when I first met her 5 ½ years ago, but she has worked very hard to improve. As she learned English, she also learned the importance of standing up for herself, and not being ashamed. She volunteered with the memory project, working with children’s clubs, listening to their stories, helping them to express their sadness over being orphans and living with HIV. In one of these clubs, she heard the story of a young boy who talked to his sister about learning that both his parents had HIV, and how they died, and then learning that both he and his sister were also HIV-infected. These two acted out their story as if they were on a telephone. The children were crying before their story was over. She helped to comfort them and to give them hope for the future. Since that time, with her help, these children have acted out their story for schools, meetings, and businesses. Because of her skill with young people, she was hired for one of the mobile Voluntary Counseling and Testing (MVCT) counselors, and was found to be very good at this job. She had unusual compassion for people entering the system through counseling and testing. As her comfort level with people continued to grow, she was then hired to be part of the CHAT, Children with HIV/AIDS project in Tanzania. She carries herself with pride and honor.

Blandi has friends everywhere because she does not shrink from others. She joined an internet group of women with HIV, and in particular found a friend who visited from the US and they found a common bond.

The KIWAKKUKI folks are amazing. Some of them will appear in pictures. The woman who was robbed last night, John who has lived with HIV for 20 years and continues to thrive and others. John’s first born son died from AIDS two years ago at the age of around 24 and John himself suffered an accident in which his arm had to be amputated. Yet, each day he rides his bicycle about 10 kilometers from his home to KIWAKKUKI to work with the VCT program. A huge smile covers his face as he works. He married an HIV-negative woman who has accepted him with all her heart, and though there were problems from neighbors who thought that they should not marry, they rose above these critics and persuaded them that they had the right to live a full life regardless of John’s HIV status. Now he is one of the leaders of the community.

Their stories are unique only because they have conquered many of the fears and discrimination that haunt others. As peer educators, they serve to be the voice of the voiceless and it is precisely because of KIWAKKUKI that they have been able to do this.

Here are some of the heroes, Verynice, Theresia, Rayline, Ellie.....Every day they come to work with smiles amidst the angst.

The New KIWAKKUKI

Here we are at KIWAKKUKI at its new location in Moshi. The building is shiny, and the staff are enthusiastic. But, the needs are grave. With the economic crisis globally, there is little money to go around. Although, KIWAKKUKI proudly believes that it has helped the national HIV+ prevalence rates to decrease by at least 1% through their counseling, testing and education programs, they are still burdened by the orphans left behind in the first wave of the epidemic, and by the positive persons who are striving to maintain a quality of life.

Let me highlight a survivor of this epidemic:
Melkizedik is an 18 year old young man who has no parents. He has some distant relatives who for years shuttled him back and forth. Melki never knew that he was HIV-infected until he got quite ill and was admitted to KCMC Hospital. A fabulous Assistant Medical Officer, Rehema Kiwera, cared for him there, and helped him adjust to his new diagnosis. She helped him to find a place to live with a "small" sister. (This means the daughter of a different wife of Melki's father-both of whom are dead). This living situation was hardly acceptable but for over a year Melki remained in this home. His "small" sister sold used clothes for a living, and had her two small children to care for in addition to Melki. There was no electricity in the house, and the family barely survived on her income.
Melkizediki was so popular at KIWAKKUKI that he earned a place on the Community Advisory Board (CAB) for the Duke researches. During this time, he participated in the Memory Project, which allowed him to make a Memory Book and trace his family roots. These books have served young people in many ways and have allowed them to find some family members, to locate their tribe, and to help them find closure on the deaths of their parents. One advantage of belonging to the Memory Project is that young people are also registered as orphans, and this helps them to be eligible for discounts for school fees and for other services. But, one thing for Melki was that he wanted to attend school more than anything else, and he had not been in school for some years as he had been sent back and forth from Moshi to Dar Es Salaam.
Melkizediki was lucky. During the time that he was attending the CAB meetings and attending Memory Project work, some wonderful volunteers were spending time at KIWAKKUKI. Just some of them, Jennifer L., Tone A., Jennifer A., Caitlin H., Kimberly W., were so touched by his desire to return to school, to make a better life, and to try very hard to improve; and, at the same time to take every one of his pills every day, to attend the clinic at KCMC on a regular basis, and to be able to speak publically about his HIV, that they agreed to help to support him. Jennifer L. paid his school fees while the others began support. They and their parents, as well as the Weiss family has made Melkizediks dream begin to be a reality.
Melkizediki has a long way to go. He had to leave the "small" sister's house and has moved into a place of his own. The cost is overwhelming, and in this room, though he has electricity and quiet, he has no mentoring for school, and his chances of making his grades all the way through secondary are questionnable. Supporting him for this period of time will be difficult, especially in these tough economic times. His only hope is his support from KIWAKKUKI and from these wonderful friends who have sacrificed much to help him remain in school.
Melkizediki tells me-Say a big "Asenteni Sana" for all who have helped. (Thank you very much). I know who you are, remember you all, and want to see you again!

Stay tuned for a picture of Melkizediki and for more stories from KIWAKKUKI

In Washington DC

In Washington DC at a national meeting, I ponder the diversity of humanity. My job as an outreach coordinator and liaison means that I find some common thread, some linkage to such a wide breadth of humanity, that even I at my late stage in life am baffled as my father used to say. I am first baffled at the way that US citizens simply believe that everything is so available to them that surely it is available to the world at large. Here I am, mentoring a person whose English speaking skills are minimal, but who is trying really hard. He is in the midst of 200 (small group) 5,000 (large group) folks who speak very quickly, and who expect that he can find his way oh so easily. He is reading everything but ever so pole pole. The crowd has moved on. At each turn a person whom I sit next to says, "wow" I have learned so much from you. Why? well because I mention that computers at home where there is no electricity, running water or hard floor, might not be the best use of resources, but don't mean that the person cannot be a good community person. He and I wend our way through the crowd. He is given a check and we have to find the bank to cash it. We get to the bank. He has not endorsed a check before! And today, they required a finger print from him. Thumb. Right. What is the kiswahili? thumb? I don't know...right...Kulia. What is the money for he asks and wants to wire it to Tanzania..... No I say. You have to buy your food with this money. Oh. All this money? Yes. Save what you can and you can carry it back. Oh, he says.

We find that Obama has read about our program in Tanzania. Does he love it like we do? Does he care? Does he know that this man is here, in a new country, without a clue, trying so hard to understand what is going on around him. A man whose wife deserted him, who won't let him see his two children, who was fired from his job, who is trying soo hard. I don't know. Obama cannot care about everyone. But surely says Thomas, he cares about us. Oh I hope so.

Donations welcome

Chrissy's well researched articles brought immediately to mind many many stories that I could tell about KIWAKKUKI.  I cannot wait until the web site is fully activated and anyone can find the site to see the wonderful work that this organization comprised primarily of women accomplishes each and ever year.  But, the web page will not tell you about the day to day stories, and they are the ones that make your heart weep or your heart soar.

So I will tell one story that was heart soaring.  One of our great volunteers to KIWAKKUKI is named Sarah.  She stepped into the world of Moshi from Yale University with absolutely no concept of what she would do when she arrived.  "Volunteering for AIDS in Africa" is the buzz word that I now understand is on nearly every college and graduate school application, so just to say this is not to be very unique.  Fortunately, we have had some very unique volunteers, and Sarah is one of them.

Sarah spent 3 months with KIWAKKUKI, basically starting the process of putting a web site that Chrissy has finally completed and just needs to get the final details to post, she also developed an avid following of KIWAKKUKI employees and volunteers who were desperate to learn English so that their skills would be more marketable to help KIWAKKUKI (writing, editing, reading grants, and learning to speak to visitors in English so that they could understand the KIWAKKUKI mission and work in a more accurate way).  I remember seeing little groups clustered not far from the latrine of young people reading phrases, newspapers, and quizzing Sarah back on her knowledge of Kiswahili, the National Language.  Sarah was a natural with this group and they loved her.

When Sarah left KIWAKKUKI and Moshi, we all wished her well, and thought, "Well, she was certainly a nice volunter."  But Sarah went home, talked to her family, her friends, and relatives, and they decided that they wanted to help.  Sarah's mother is a teacher and she and her students collected materials that the children's groups could use.  Sarah's uncle collected things that he thought all children should have!  And Sarah's family agreed to sponsor several children in school.

We were impatient I must say.  The boxes were mailed in April and still had not arrived by the end of September.  But then, the post office notified us that there were some boxes waiting for us, and beloved Ellie, our tea maker and just about everything else, went down to the post office and hauled everything back.  Chrissy and I set to work identifying everything and putting them together in clusters.  Some things were missing (oops TRA needs their cut) but most things were there.  Some were funny--stuff little kids love, some were vastly needed for school and just about everything else.  It was fantastic.

I went to Lui's office (head of orphan department) and reported what Sarah had provided.  WOW!  what luck, there were to be orphan support groups in all the districts for the next month.  What started like an avalanche of materials for children for the next year, turned out to be devoutly divided for these children's groups so that each child would get something.  In one fell swoop, huge boxes of donations were delivered to Moshi Municipality, Moshi Rural, Mwanga, Same, Machame, Hai, and Saa Hii.  Never enough, never enough.  But, what made my heart soar were the stories that came back from these club meetings.

"Wow" some mzungus (European  --also American--Canadian etc) cared about us and sent these boxes on ships?  Wow, how did they find these pens, the papers.  These were the type of words that were used.  And though the boxes went quickly, they did not go without great love and care.

So Sarah, whenever you think of your time in Moshi, know that the children of Kilimanjaro are thinking of you.  And for anyone else out there-even if it seems "trite" now to volunteer in Africa, there are sustainable programs out there, and they are started by Africans, maintained by Africans, and supported by the community.  You can reach out and you can give.

Patricia Bartlett, LCSW, volunteer and Community Advisory Board Liaison for the Kilimanjaro Christian Medical Center's Collaborative Research efforts with KIWAKKUKI, KCMC and Duke University.

Report from The Citizen

Tanzania: Caring for the Sick Carefully

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The Citizen (Dar es Salaam)

29 December 2007
Posted to the web 31 December 2007

Eric Kalunga
Marangu

In 2000, When Anna was in standard five she had to take care of her parents who fell sick. She was 12 years old and was the oldest female child so it was her duty to take care of the parents. In 2001 the parents died.

Then Anna fell ill herself. At this time she was about to receive confirmation at the church. Reverend Winfred Joseph Mosha of the Lutheran Church there saw that the child was in trouble and thought he recognized her symptoms as of a person suffering from HIV/Aids.

"I talked to her and suggested that she goes to a testing centre," recalls rev. Mosha.

With the little girl they set off for Moshi town to Kiwakkuki, Kilimanjaro women's group against Aids. The NGO offers testing and counselling services as well as information on HIV/Aids accumulated through research.

Anna stayed at the centre and they tested her blood. The results came back positive. she was devastated and could not stop crying.

The counsellor asked her which people she would like to inform of her condition.

Anna said she would like her grandmother and the father to know as well as her elder brother who was at the Serengeti National Park at the time.

"When I went to pick her up at Kiwakkuki," says Rev Mosha, "she told me 'father, I have tested and I am infected'".

The ride back home was hard for the two. Anna was grappling with the new reality of her HIV status and resorting to tears while Rev Mosha was thinking of the best way of helping the little girl cope.

Eventually Anna continued with her education. She completed primary school and reverend Mosha took her to his sister in Moshi who was a librarian at Moshi Technical Secondary School. His sister took the girl to the clinic regularly.

The church supplied her with clothes and money for food. She also got help from Kiwakkuki. Anna now lives in Arusha with her grandparents.

Rev Mosha says Anna is just one of the thousands of orphans that are a result of parents who died of HIV/Aids. Aids is a big problem in this area.

"We are in a tourist corridor," he says.

The road that leads up to Mount Kilimanjaro passes through their town. Many tourists pass through here annually.

To cater for these hotels and lodges have sprouted all over Marangu.

Beautiful houses with satellite dishes on their roof tops and signs in front advertising rooms are numerous.

As you walk on this road you are bound to bump into a toutist or two making their way to the mountain or the waterfalls, Kinukamori, also in the same direction.

"People make money from the tourists, from tour guides. So you get a lot of people from other parts of the country coming here to make money," says Rev Mosha. These people come on their own as single men and women to do business.

The money and the availability of alcohol and guest houses combine to make the area conducive for unsafe sex and the spread of HIV/Aids. Ultimately local children suffer indirectly as orphans or directly as people living with the Aids virus. It is not clear how Anna contacted HIV/Aids.

While it might be easy to point a finger at her deceased parents and say that she got the disease while taking care of them, experts disagree.

The leading cause of HIV/Aids is sex taking up more than 90 percent of the cases. Then comes mother to child transimission and then the last category includes blood transfusion, sharing of objects and nursing.

Negligible as it is, nursing of the the Aids victim can lead to an infection. Dafiosa Itemba is the executive coordinator of Kiwakkuki and deals with Aids cases on a day to day basis at the centre.

She vaguely recalls the case of Anna, more than five years ago, but cannot give a lot of details. "We deal with a lot of children here," she says.

However she says that it is possible that the child might have gotten infected through washing and generally taking care of her sick parents.

"It is possible that she did not know that her parents had Aids. If that is so then her grandparents who live with her could be in danger of getting infected as well," she says.

According to data from HelpAge International, 90% of Aids related care is provided at home, often by older women.

Up to two-thirds of people living with Aids are cared for by their parents in their 60s and 70s and over 60% of orphaned children live in households headed by their grandparents in severely affected countries.

"This area is important to study. There is a research gap in this and great care will be needed because we wouldn't like to advocate stigma which we are fighting now," says Itemba.

"Telling people to be careful in their homes could lead to stigma. They will be afraid of touching someone who has diarrhoea for instance," she says.

Antipas Mtalo, a counsellor, agrees that informing people about the full extent of the risks needs to be handled with delicacy to avoid stigma.

He himself has witnessed what can happen when people are misinformed or given too little information and make decions based on that information.

"I was in church once when someone stood up at the pew and told us a story," he says.

The story was of a person who was HIV+. When this person was given food he would not finish all of it and children used to eat what he left. Then the children got infected.

"I was shocked," says Mtalo, "there were about 500 people in the church and they all heard this outrageous claim. Some of the people were doctors that I know but you couldn't go up there and argue with the man. It was in a church."

He says it is this kind of misinformed conclusions that institutions need to be aware of when stepping into area of Aids related care provided at home.

"It is the same case with barber shops. There is a risk involved. If they use razor blades go there with one of your own," he says.