Vulnerable Populations (Ghana Social Marketing Firm)

"Vulnerable Populations" is a hot phrase in development work. It is particularly useful for securing funding and creating a sense of urgency. As a term, it is fairly self-explanatory. A vulnerable population is a distinct group of people with a distinct susceptibility to something awful. In the fight against HIV/AIDS, considerable resources are spent in the effort to discover where these vulnerable populations are and how they can be most effectively reached.

When AIDS first rose to prominence in the 1980s, everyone was vulnerable in so much as they were clueless about the disease and its transmission. As massive sensitization campaigns at the national level increased overall awareness and enabled most people to make intelligent choices that safeguard their bodies, some groups of people remained unreached or unconvinced. This is especially so in the developing world, where some communities lack the technological means to receive widespread messages, where others receive it in a language or at a level of complexity that they do not understand, where still others are misinformed by trusted and influential figures, and where some groups feel so desperate that the notion of modifying their essential behavior to "protect" themselves seems ridiculous.

Vulnerable populations are vulnerable for good reason. They are typically young and destitute or separated from their family structure and very poor. Generally they have received little or no schooling; often they do not receive the care and guidance of stable communities. They typically speak African languages, rely on African medicines, and have, at most, passing contact with the parts of their countries that have modernized. Since the great sparkling progress of their nations has generally left them behind, vulnerable populations can also resent or distrust intrusions and instructions that originate in the wealthy Western segment of their society—especially if the messages are not tailored with great care.

All of this makes it difficult to share information about HIV/AIDS and other health-related issues. A similar difficulty is discovering in the first place which people are not receiving or absorbing the information. This task involves considerable research; it requires that marginalized and ignored groups of people be visited, tested and spoken with.

Some vulnerable populations are easy to recognize. Every country in West Africa is aware that its long haul drivers and its sex workers are especially vulnerable to HIV/AIDS. Most of these countries target such people with special materials, special events and regular attention. A few other countries have recognized the vulnerability of those who work in temporary unregulated mines—such people often move away from their families in order to work in unthinkable conditions for unhealthy lengths of time; they tend not to complicate the small comfort of sex with prophylactics.

Ghana is ahead of some of its neighbors in discovering and communicating with vulnerable populations. National and independent initiatives do focus on the groups mentioned above, and their initiatives seem very well planned and implemented. However, it is interesting to note the other populations that Ghana has singled out for special mentoring and assistance.

Ghana Social Marketing Firm (GSMF) is Ghana’s equivalent of Population Services International, a group discussed in our Mali and Burkina Faso sections. They have been working in a coordinated fashion to educate the Ghanaian populace about HIV/AIDS for five years and they are supported by the Department for International Development (DFID), the UK’s equivalent to USAID.

They have spearheaded the initiative to discover and assist the vulnerable populations within Ghana. Mabel Tsibu-Nyarko, Technical Manager of HIV/AIDS Special Programs, outlined the focuses of GSMF for the African AIDS Awareness Campaign.

Under her guidance, an initiative called "Tool Guard" is flourishing. GSMF noticed that young apprentices prove especially vulnerable to sexual advances and the spread of sexual disease. Young women who relocate to larger cities seeking work frequently apprentice themselves to tailors, dressmakers, hairdressers and beauticians. During the time of their apprenticeship, which can last upwards of a year, the young women earn little or no money for their efforts. It is not uncommon for them to exchange sexual favors for their accommodation and sustenance.

Initially, this group proved difficult to reach. Attempts to communicate with them directly and to invite them to small functions met with little success. This changed when GSMF began to work through their teachers and masters. These experienced workers proved willing and even eager to offer additional guidance and instruction to their apprentices. Through the formal associations of women operating in these trades, GSMF organizes events and instructional sessions during the training period. As much as possible, GSMF trains the teachers and masters to convey messages about sexual health and responsibility in their own words and languages. These associations take the matter so seriously that they have even begun to include formal questions about HIV/AIDS in the final exam that the apprentices much pass in order to receive their practicing licenses. The success of GSMF’s sensitizations can be deduced from the happenings on their "Health and Fun Days." These events, thrown for the benefit of the women, include voluntary testing and counseling at temporary laboratories. GSMF have been consistently surprised by the sheer number of voluntary participants; on the last two occasions, they ran out of testing kits with hundreds still standing in line. In other countries, there can be too much shame attached to the idea of being tested to attract even the scantest participation.

Traditionally male-dominated trades like carpentry and metalworking also involve periods of apprenticeship, and the young men in training are considered to be at risk for contracting HIV/AIDS. This derives from their poverty, their lack of education, and the pressures to which they are subjected in their all-male work places. There is a tendency to make foolish decisions with regards to sexual health amongst these men, and GSMF is working with their supervisors much as they are coordinating with the tradeswomen.

A "Hawkers Empowerment Program" works with young people in similar circumstances. Those who attempt to make small business by selling wares in transit stations or on the street often have backgrounds much like the apprentices. They are frequently isolated, poorly educated and under-resourced. Ms. Tsibu-Nyarko has been overseeing the Hawkers Empowerment Program for several years. Her workers revealed that behavior change was high in the young men they had spoken with, but low amongst the young women. She said that young women "are the most desperate"; that "they knew but didn’t change." She helped to revamp the Empowerment Program to "give them some economic power." They are working to build the self-worth of the girls, to reduce their number of partners, to increase their independence, and to strengthen the foundations of their businesses with a micro-credit loan scheme. Local banks are cooperating with the initiative and providing small loans (typically below two hundred dollars) that can jump-start or solidify the investment of a young hawker. In areas without banks, GSMF is providing the money out of budget. Ms. Tsibu-Nyarko said these efforts are coming along nicely. They do not have problems recuperating money from such women; rather, banks regard them as the most reliable debtors.

A final and unrelated vulnerable population receiving the attentions of GSMF is the young male workers in Ghana’s ports. According to Ms. Tsibu-Nyarko, those who work at loading and unloading massive boats "feel endangered and live dangerously." Their job is not a safe one; serious injuries and death are a known risk. Some young men compensate with a recklessness that is only strengthened by the fact that they are paid every week. Sex workers can be found all around the ports, and they are an obvious outlet for the young men. The attitude in this workplace is not conducive to GSMF’s usual methods. This is not skilled labor; there is not an organization through which they can deliver their messages, and peer education has proven ineffective. The program called "Ports Shield" is in its infancy. For the time being, a major facet of this program is making cheap condoms widely available throughout the ports and encouraging sexually active workers to use them. This is obviously a stop-gap solution, but the relevant vendors have accepted it and safer sexual practices are on the rise. Ports Shield is currently developing training sessions for these men. They will need to work against the fatalistic attitude of poorly disadvantaged and exploited grunt laborers.

The very fact that these diverse populations are attracting the attention of Ghanaian social marketers is a hopeful sign. In nearby countries, men and women in equally bleak circumstances can fall between the cracks in national initiatives to combat HIV/AIDS. The activities of Ghana Social Marketing Firm are notable for their clear focus and their persistence. Visits to vulnerable populations occur with a frequency that is often unmatched by other West African nations, and GSMF have proven willing to expand their understanding of vulnerability whenever new populations are brought to their attention. Ideally, countries that have not already taken steps in this direction will take inspiration from the activities here.


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