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Mainstreaming of HIV/AIDS is not just about adapting NGO programmes, but involves adapting partnerships. Working in a context of high HIV/AIDS prevalence has a considerable organisational impact on implementing NGOs. As staff, or relatives of staff, fall sick there is more time off work, declining work performance, increased medical costs, and extra training and recruitment costs. Simply to maintain capacity, NGOs will have to invest in changes to their staff planning, training and awareness programmes, health policies, and financial management. It will necessarily cost more money to achieve the same work output and these activities will have less impact (as a proportion of beneficiaries may also be sick and dying). Providing effective support for NGO partners affected by HIV/AIDS therefore has major and difficult implications for donors, particularly at a time when their own back-donors are demanding visible `value-for-money’. Mainstreaming into partnerships requires that both partners change – can we rise to this professional and moral challenge?

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