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Techniques and Practices for
Local Responses to HIV/AIDS
Part 2: Practices
Techniques and Practices for
Local Responses to HIV/AIDS
Part 2: Practices
This Toolkit is a joint publication between the Joint
United Nations Programme on HIV/AIDS (UNAIDS)
and the Royal Tropical Institute.
Information
Royal Tropical Institute (KIT)
KIT Development Policy and Practice
Mauritskade 63
1092 AD Amsterdam, The Netherlands
T: +31 (0)20 5688 8332
F: +31 (0)20 5688 8444
E-mail: m.wegelin@kit.nl
Website: www.kit.nl/health/html/aids
UNAIDS
20 Avenue Appia
1211 Geneva 27, Switserland
T: +41 (0)22 791 4651
F: +41 (0)22 791 4187
E-mail: unaids@unaids.org
Website: www.unaids.org
KIT Publishers
P.O. Box 95001
1090 HA Amsterdam, The Netherlands
T: +31 (0)20 5688 272
F: +31 (0)20 5688 286
E-mail: publishers@kit.nl
Website: www.kit.nl/publishers
© 2004 Joint United Nations Programme on HIV/AIDS
(UNAIDS) – KIT Publishers, Amsterdam, The Netherlands
All rights reserved. This document, which is not a
formal publication of UNAIDS, may be freely reviewed,
quoted, reproduced or translated, in part or in full,
provided the source is acknowledged. The views
expressed in documents by named authors are solely
the responsibility of those authors. The designations
employed and the presentation of the material in this
work do not imply the expression of any opinion
whatsoever on the part of UNAIDS concerning the
legal status of any country, territory, city or area or of
its authorities, or concerning the delimitation of its
frontiers and boundaries.
Editing
Madeleen Wegelin-Schuringa and
Georges Tiendrebéogo
Cover illustrations
Barbara van Amelsfoort
Cover and graphic design
Grafisch Ontwerpbureau Agaatsz BNO, Meppel,
The Netherlands
Printing
Meester & de Jonge, Lochem,
The Netherlands
ISBN 90 6832 639 2
Contents
Preface
Acknowledgements
Introduction
Practices
1 A Buddhist approach to HIV /AIDS prevention and care, Thailand
2 Club Cool Project, Haiti
3 Community Art versus AIDS project, Togo
4 Community Centre for IDUs, Ukraine
5 The Condom ‘Krew’, Trinidad and Tobago
6 Outreach Program targeting Hong Kong China cross-border Travellers
7 ‘De Living Room’, Trinidad and Tobago
8 A drop-in centre for sex workers, Thailand
9 Each one Teach one, Hong Kong
10 Jus’ Once, an interactive HIV/AIDS awareness production
11 Life skills education in a poor suburb in São Paulo, Brazil
12 Peer education among youth in a rural district in Thailand
13 Prevention and care for migrant workers, Brazil
14 Mobile VCT clinic, India
15 Prison AIDS prevention and care programme, Zambia
16 Protection of young male prostitutes against HIV infection, Brazil
17 The ‘Rap against Silence’ project, Togo
18 Resource centre for youth, Kumi, Uganda
19 HIV/AIDS awareness raising by youth group
20 Sex industry outreach program in Hong Kong
21 The Toco Youth Sexuality Project, Trinidad and Tobago
22 Outreach voluntary counselling and testing (VCT) targeting MSM in
Hong Kong saunas
23 Voucher scheme for S&RH health services, Nicaragua
24 The ‘Wear to Care’ project, Togo
25 Young people’s movement in Jhapa, Morang and Illam districts in response
to HIV/AIDS, Nepal
26 Youth learning to take care in a poor neighbourhood in São Paulo, Brazil
27 ‘Choice or Chance’: Video documentary of HIV/AIDS Projects, Trinidad
28 Group therapy, ‘Show you care, take care of yourself and others’
29 Care and prevention teams in rural Zambia
30 Care and prevention by community volonteers, Zambia
31 Pilot project on free ARV provision in resource poor setting, Uganda
32 Mpigi district home based care
33 Nursery for orphans and children affected by AIDS, Trinidad
34 Psycho-social and home care for PLWHA, Ukraine
35 Management of ARV treatment by PLWHA group, Thailand
36 Integrated support for children infected and affected by HIV/AIDS, Thailand
37 Balcão de Direitos (Rights Corner), Brazil
38 The ‘Child is Life’ project
39 Gaining community acceptance of PLWHA through awareness raising and
income generating activities, Thailand
40 Co-operative of PLWHA for producing school uniforms, Brazil
41 Farm school for orphans, Uganda
42 Combining counselling and skills training for PLWHA, Zambia
43 Support and vocational training for orphaned girls, Zambia
44 Sipho Eshile (beautiful gift) feeding scheme, South Africa
45 Support from monks to a HIV positive women group, Thailand
46 NGO and Local Government co-operation in a rural district in Uganda
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HealthNeed Uganda
47 People living with HIV/AIDS coming together in the Caribbean
48 Transforming local experiences into national learning: Project Somos, Brazil
49 SEPO Centre coordination of multi-sectoral aids prevention and care at district
level, Zambia
50 Soroti Network of AIDS Service Organisations (SONASO)
Annex 1: Guideline on how to write a practice
Annex 2: Index by category of practice
Annex 3: Index by domains of the Self Assessment Framework
Annex 4: Index per country
Annex 5: List of abbreviations
157
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Preface
It is people who must respond to HIV/AIDS. For their responses to be effective, they need
commodities, information and money. However, these can only support — and not substitute
for — a people-driven response. Individuals, households and communities that respond
effectively to HIV/AIDS take ownership both of the issue and of its solution. To progress
towards AIDS competence, they forge partnerships with local sources of support, with individual
and peers and also with local government, social service departments, community-based and
non-governmental organizations or the private sector. This is, briefly, what we have learned
from effective local responses, the responses by people where they live and work. How can
one foster such effective responses at large scale?
This toolkit represents a new and excellent resource for the many committed to this goal.
The techniques and practices presented here have been “distilled” from local responses
around the globe. This toolkit offers the techniques and practices for others to adapt to their
own context. To the extent possible, it includes a contact address so that various actors can
contact each other to share their experience with the various techniques and practices, and
make a synthesis of lessons learnt from their use.
We wish that the publication of their Toolkit would stimulate new connections for more effective
Local Responses. UNAIDS is looking forward to learn more from those new connections.
Michel Sidibé
Director of Country and Regional Support Division
UNAIDS, Geneva
7
Acknowledgements
We like to express our appreciation and gratitude to the partner organisations for the warm
reception during the visits of the KIT consultants, for the discussions on strategies for learning
and sharing knowledge and for the arrangement of the meetings with NGOs active in Local
Responses in their respective countries. These partner organisations are AIDSNet and AIDS
Education Project of the University of Chiangmai in Thailand, Christian Health Association
Zambia (CHAZ) in Zambia, UNASO in Uganda, ABIA in Brasil, Programme d’Appui au Programme
Multisectoriel de Lutte contre le SIDA et les IST / World Bank in Burkina Faso and The Caribbean
Regional Epidemiology Centre (CAREC) in Trinidad and Tobago. We are also thankful to the
UNAIDS Country Coordinators in these countries and the UNAIDS Caribbean Team for their
insight in programmes on Local Responses and their valuable advice in clarifying specific
aspects of the institutional arrangements and regulatory framework for HIV/AIDS in these
countries.
Madeleen Wegelin and Georges Tiendrebéogo from KIT brought together the techniques and
practices contributed and adapted them to the framework, initially assisted by Carolien
Aantjes. After sending them back to the various sources for comments, they were reviewed
by a group of colleagues from KIT. We like to thank the many individuals and organisations
for taking time to talk and write to the KIT consultants about their programmes and for the
frank analysis of the impact and challenges of these programmes. We are also grateful for
suggestions from many people working in HIV/AIDS around the world on organisations that
could contribute to the documentation of techniques and practices for Local Responses.
A special word of thanks goes to Luc Barriere-Constantin of the Africa Division of the Country
and Regional Support Department, UNAIDS and Jean Louis Lamboray of the UNAIDS/UNITAR
AIDS Competence Team for their continuous guidance, advice and support as well as their
comments on the draft practices and techniques and the links with the Self Assessment for
AIDS Competence.
Finally, without financial support, the toolkit would never have been possible. For this, we
therefore thank the Japanese government, the government of The Netherlands and the UNAIDS
departments of Technical Network Development (TND) and Information Centre (IRC).
9
Introduction
In 2001 UNAIDS initiated the development of a toolkit with techniques and practices for Local
Responses to HIV and AIDS in consultation with the UNAIDS Secretariat, with the UN Theme
Groups in different countries and members of the UNAIDS Technical Network on Local Responses
to HIV/AIDS. The toolkit aims to further strengthen the capacity and competence of different
actors to address HIV/AIDS at local level. Experiences worldwide contributed to the identification
and selection of practices and techniques for the toolkit and they are meant for all with an
interest in furthering local responses to HIV/AIDS. The Royal Tropical Institute (KIT) in the
Netherlands manages the project for UNAIDS.
This document presents the practices that have been contributed to the toolkit. They are
available in hard copy in English and on CD-rom. In addition, they are posted on the Local
Response e-workspace (LR_toolkit@ews.unaids.org) for further discussion and are available
on the UNAIDS website (www.unaids.org) and the KIT website www.kit.nl/health/html/aids.asp.
A practice describes a process that has been carried out by an organisation/ institution/
community to address one or more specific problems, indicating in a practical way the whole
process of implementation as it has taken place. The techniques, that also form a part of the
toolkit, are presented in a separate document and are available in English, French and Portugese
in hard copy, on the CD-rom, the e-workspace and the websites. Techniques help a facilitator
to support an audience to analyse their own situation and to establish their needs and
priorities, in order to plan interventions.
In this document we first describe the reasons for developing the toolkit and the process that
was followed for the collection of techniques and practices. It continues with a description of
how you can contribute and/or access the practices and techniques and how to use them.
The last part of the introduction describes the link with the framework for Self Assessment of
AIDS Competence and concludes with an overview of the practices. The rest of the document
consists of fifty practices. Annex 1 provides guidelines on how to write a practice enabling
readers to contribute to the toolkit and expand the common knowledge base. Annexes 2, 3
and 4 respectively give the index of the practices by category of practice, by domains of the
Self Assessment Framework and by country. A list of abbreviations is given in annex 5.
Local Responses to HIV/AIDS imply the involvement of people where they live - in their homes,
their neighbourhoods and their work places. For HIV/AIDS prevention and impact mitigation,
each individual, family, community and organisation needs to deal effectively with HIV/AIDS,
in other words, needs to become “AIDS-competent”. AIDS competent societies acknowledge
the reality of HIV/AIDS and assess how HIV/AIDS affects different aspects of life and
organisations. Based on this assessment, AIDS-competent societies build their capacity to
respond and take concrete measures to reduce vulnerability and risk. Learning and sharing
experiences with others is an important aspect of building capacity and avoids time and
energy spent on re-inventing the wheel.
Crucial in a strategy for learning and sharing across communities, organisations and countries,
is the documentation of experiences that have proven to work in a specific context. Often,
such experiences tend to remain local and are rarely documented. Even if they are, these are
often lengthy case studies and not very accessible. The toolkit and the discussion on the
e-workspace provides a platform where experiences are available in a short, concise format
in which the source for further information is given to facilitate practical application and
adaptation to another local context. The development and implementation of a strategy for
learning and sharing in each country will help to get the experiences to those that can use
them best.
Partners that already collaborated in the UNAIDS local response network, developed a format
for the practices and techniques that form the backbone of the toolkit, during a start-up
workshop (held in Uganda in May 2002). In addition, the strategy for the project was discussed
as well as approaches for a knowledge exchange strategy within and between countries.
Why a toolkit for local
responses
The process followed to
collect the practices and
techniques
11
Subsequently, KIT finalised guidelines for writing practices and techniques (see annex 1).
Organisations in the local response network, partners that participated in the workshop and
contacts made at international conferences, played an important role in identifying practices
and techniques for the toolkit. In addition, KIT staff visited six countries (Brazil, Burkina Faso,
Trinidad and Tobago, Thailand, Uganda and Zambia) to document practices and techniques.
In the countries, practices and techniques already available in the toolkit were shared and in-
country knowledge exchange strategies were discussed. In three countries this was also
linked to workshops on self-assessment.
A total of 50 practices are included in the toolkit, taken from twelve countries across the world.
The majority of the practices are documented as a result of visits by KIT staff to the organisations
implementing the practice. Usually interviews were conducted following the format of the
practice. KIT prepared the document and sent it back for comments and approval. In Burkina
Faso and Trinidad and Tobago, a workshop was held after which the participants wrote their
own practices, to be commented and reviewed by KIT. The same approach was used for the
practices that were contributed by organisations through email. The practices of some of the
organisations visited, turned out to be impossible to capture in the practice format for a
variety of reasons. For instance, in Brazil and Kenya, the operation of the Documentation and
Resource Centres of ABIA and KANCO is too specialised and complicated to describe in a
short document. The same applies to the orphanages Viva Cazuza in Brazil and Mercy Centre
in Bangkok, Thailand. Other practices, such as the approach for mobilisation of communities
in Bangkok (BMA) and the newsletter for MSM communities in Trinidad (Free Forum), are still
evolving and too new to properly analyse the impact and sustainability. Some practices that
were documented are not included because we never received feed-back and comments from
the organisations. All practices documented, were assessed on clarity, consistency, focus and
practical use by a team of external reviewers.
The organisations that contributed to the toolkit are diverse, some of these organisations
function as umbrella organisations for local NGOs, such as AIDSNet in Thailand, UNASO in
Uganda, CHAZ in Zambia and ABIA in Brazil. They helped to contact their participating NGOs
to share their practices and techniques and will also be instrumental in disseminating and
using the tools. Other inputs result from NGOs implementing the Local Responses agenda in
the six selected countries with the support of the World Bank (MAP) and other UNAIDS co-
sponsors, such as UNICEF, UNDP and WHO or from NGOs that are linked to international
NGOs such as Save the Children, Action AID, International HIV/AIDS Alliance, Oxfam and
international faith based organisations.
National facilitators for Local Responses, district support teams or umbrella organisations are
a key audience for the use and further development of the toolkit because their task it is to
motivate, facilitate and support communities in planning their own responses. They make use
of participatory techniques in this work and the tools in the toolkit give them additional options.
The practices describe what (often common) problems are addressed, what the purpose of
the intervention is and what steps the organisation has taken to implement the practice. In
addition, an analysis is given on the impact of the intervention and on the critical issues and
lessons learnt. This is meant to facilitate adaptation by other organisations and to build on
both positive and negative aspects of the practice. It is hoped that by making these practices
available on a wide scale, both within countries and internationally, effective responses can
be fed back to the policy level (National AIDS Councils or Programmes), to sector ministries
for possible integration in national policies and to national and international NGOs.
The practices and techniques in the toolkit, are presented and discussed in the Technical
Network on Local Responses to HIV/AIDS with about 700 members working in all continents
and at all levels of the response. The members of this network meet virtually in the Local
Responses to HIV/AIDS e-Workspace. They exchange lessons with regard to their work in
e-mail discussions and contribute to the collective learning on responses to HIV/AIDS.
The Local Responses e-Workspace hosts three e-mail discussion forums. One on the City-Aids
programme (LR_City-Aids@ews.unaids.org) focussing on responses to HIV/AIDS in cities, one
on the Toolkit for Local Responses (LR_Toolkit@ews.unaids.org) where new practices and
techniques related to Local Responses are discussed, and one on general information related
to Local Responses (Localresponse@ews.unaids.org). The Local Responses e-workspace
further accommodates document libraries, an event calendar, a contact list and links to
related websites.
Who contributes to the
toolkit, who uses it and
how can it be accessed
Techniques and Practices for Local Responses to HIV/AIDS
12
It is expected that with a substantive initial collection of practices and techniques in the toolkit,
organisations are motivated to share their experiences in using and adapting the practices
and techniques and thus enhance global learning. We ask the users of the toolkit to contribute
to this discussion by sending a response to the e-workspace on the following questions:
• For what purpose have you used the practice/technique
• What adaptations have you made
• What is the outcome of the use of the practice/technique
In addition all users are invited to contribute new practices and techniques so the content
can evolve continuously and a platform for exchange is established on the website and in the
e-workspace. The facilitator of the toolkit will give support in documenting the practices and
techniques in the common framework.
A practice describes a process that is carried out by an organisation/ institution/ community
to address one or more specific problems. It can serve as an example and/or inspiration for
others that are confronted with a similar problem. The practice describes in a practical way
the whole process of implementation as it has taken place and gives an analysis of critical
issues and lessons learnt. The source of information is included to ensure that more details
of the process can be obtained if necessary. A practice usually has a longer time frame and it
must be sustainable in the context in which it is applied.
A technique is a procedure that is used for a specific purpose at a certain stage during a
process of intervention, described in a practical step-by-step fashion. Many of the techniques
are applied in development programmes that aim at community mobilisation and empowerment
and are adapted for use in HIV/AIDS programming. Although some techniques and practices
are for use specifically at community level, others are applied at sub-district, district, regional
and international levels by government staff and by NGOs. Because most organisations have
experience with participatory techniques, the toolkit does not include a specific training
manual but is a collection of techniques that can be adopted in an existing approach.
Since the formulation of the toolkit project, UNAIDS has formed a partnership with UNITAR to
create and share knowledge from effective responses to the HIV/AIDS epidemic. As a starting
point, a self-assessment process is designed in which people (groups and organisations at
various levels) assess where they are already performing good practice, where they might
improve, what gaps in knowledge and experience exist and how these can be overcome.
This process helps to guide sharing of knowledge and interaction between organisations and
groups of people and can be seen as a technique in itself. The self-assessment framework is
described in annex 2 of the Techniques of the toolkit. The toolkit is complementary to the
self-assessment process as it provides a framework for documenting practices and techniques
and a common source of practical examples that can help organisations to advance from one
level of competence to another. In annex 3, the practices are listed for each ‘domain’ of the
self-assessment framework. Some of the practices are listed in more than one domain. The
listing has to be regarded as an indication and illustration of interventions that can help
people and organisations to improve their AIDS competence.
There are 50 practices in this document. We have divided these in four categories: Prevention,
Care and treatment, Support and mitigation, and Partnerships and coordination and within
these categories have listed them in alphabetical order. The categories are not mutually
exclusive, but the key words indicate the activities, target group and location of the practice.
In the table below, an overview is given of the practices by category of intervention. In annex 2
the same table is given, but including key words. Annexes 3 and 4, give the index by domains
of the Self Assessment Framework and by country.
What are practices and
techniques
The framework for Self
Assessment of AIDS
competence
Overview of the practices
presented in this document
Introduction
13
No. Practice
Prevention
1 Buddhist approach to prevention and care
2 Club Cool
3 Community Art vs. AIDS
4 Community Centre for IDUs
5 Condom ‘Krew’
6 Cross Border project
7 ‘De Living Room’
8 Drop-in centre for sex workers
9 Each one, teach one
10 ‘Jus Once’, an interactive HIV/AIDS awareness production
11 Life skills education in a poor suburb in São Paulo
12 Meakaotom Youth Group
13 Migrant workers prevention and care
14 Mobile VCT clinic
15 Prison setting prevention and care
16 Protection of young male prostitutes against HIV/AIDS
17 Rap against silence
18 Resource centre for youth
19 Sang Phan Wan Mai Youth Group
20 Sex industry outreach
21 Toco Youth Sexuality Project
22 VCT at MSM saunas
23 Voucher scheme
24 Wear to care
25 Young people’s movement
26 Youth learning to take care in a poor neighbourhood in São Paulo
27 Video Documentary of HIV/AIDS Projects, ‘Choice or Chance’
Care and Treatment
28 Group Therapy, ‘Show you care, Take care of yourself and others’
29 Macha mission home based care and prevention
30 Maramba home based care and prevention
31 Masaka ARV provision
32 Mpigi home based care
33 Nursery for Orphans and Children affected by AIDS
34 Psycho-social and home care for PLWHA
35 Sai Samphan management of ARV treatment by PLWHA group
Support and mitigation
36 Access integrated child support
37 Balcão de direitos (Rights Corner)
38 ‘Child is Life’ project
39 PLWHA Health and Income generating activities
40 Co-operative of PLWHA for producing school uniforms
41 Farm school for orphans
42 Counselling and skills training in Kara Hope House
43 Support to orphan girls in Kara Umoyo
44 Orphan feeding scheme
45 Support from monks to HIV positive women group
Partnership and coordination
46 NGO and Local Government cooperation
47 People Living with HIV/AIDS Coming Together in the Caribbean
48 Networking and training of MSM NGOs: Projeto Somos
49 SEPO Centre, district coordination
50 Soroti Network of AIDS Service Organisations (SONASO)
Techniques and Practices for Local Responses to HIV/AIDS
14
15
Content
A programme that trains and supports monks to expand their traditional role to include
HIV/AIDS education, prevention, care and outreach
Community level for implementation, local, national and regional level for training
Faith based organisations, NGOs, communities
• PLWHA face stigma and discrimination in their communities
• PLWHA and their families need spiritual, social and economic support from the communities
in which they live
• Monks are traditionally teaching communities but do not have the knowledge to include
HIV/AIDS in their teaching; they support communities in their development activities, but
not do not address HIV/AIDS in a structured way
1 To provide Buddhist monks with an opportunity to take part in HIV/AIDS prevention and care
2 To establish a network of Buddhist monks capable of working in HIV/AIDS prevention and
care
3 To help Buddhist monks identify roles they can play in HIV/AIDS prevention and care
4 To provide Buddhist monks with accurate and up-to-date information on HIV/AIDS
prevention, transmission and care
5 To organize seminars, workshops and training programs for Buddhist monks, nuns and
novices
6 To equip Buddhist monks, nuns and novices with participatory social management skills
to enable them to work more effectively in HIV/AIDS prevention and care
7 To serve as a resource centre providing information and materials on HIV/AIDS
8 To promote and support the role of Buddhist monks, nuns and novices in HIV/AIDS
prevention and care
9 To cooperate and coordinate with other organizations working in HIV/AIDS prevention
and care
94% of the Thai population is Buddhist. The temple and the monks, nuns and novices who
live in the temple are the centre of spiritual and social well being in all communities. Because
of their faith in Buddhism and the respect that they have for monks, community members
listen to what monks have to say and uphold their teachings as truth. At the end of 2001
there were more than 1 million PLWHA in Thailand and there is hardly a community in Thailand
that has not been affected by HIV/AIDS, in one way or another. A multi-sectoral approach
that involves government, religious organisations, NGOs and the community is needed to
address impacts and develop effective approaches for prevention. If the HIV/AIDS problem is
to be solved it should be dealt with locally. To enable this to happen, all communities need to
be made aware of the problem, its impact on their community and the need for their cooperation
in solving it. Once awareness has been raised, the community has to be given assistance in
identifying ways to solve the problem and in developing plans and strategies.
The Sanga-metta project was initiated by monks themselves in 1997 in response to the need
for monks to have a more active role in HIV/AIDS prevention and care. Taking the Buddhist
teachings as their inspiration, they concluded that a core aspect of HIV/AIDS was ignorance
about the condition both among those infected and the general public. In line with their
traditional role as teachers, they decided they could teach both groups about its realities.
Within this basic framework, the project teaches monks, nuns and novices about HIV/AIDS,
taking as a starting point the Four Noble Truths of Buddhism – Dukkha (Suffering); Samudaya
(the origin of suffering); Nirodha (the cessation of suffering); and Magga (the path leading to
the cessation of suffering) and replacing dukkha (suffering) with HIV/AIDS. The Buddhist way
to overcome suffering is by following the Noble Eight-fold Path that includes right understanding,
right thought, right speech, right action, right livelihood, right effort, right mindfulness, right
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
1 A Buddhist approach to HIV/AIDS prevention
and care, Thailand
Developed by: Sangha Metta Project, Chiangmai, Thailand
Key words: Faith based organisations, community, training, prevention, care, Thailand
concentration. These can also be applied to HIV/AIDS. It also equips the monks with modern
participatory social management skills and tools so that they can in turn work effectively in
their communities both to prevent further HIV transmission and to help people living with
HIV/AIDS and their families. One of the most important developments is that, in contrast with
their traditional formal roles (where the monks wait for the community to come to them), the
project trains monks to have a more active role in community work. Using Buddhist ethics as
their guideline, they now teach villagers how to avoid high-risk behaviour, help to set up
support groups, train people with HIV/AIDS in handicrafts, donate their alms and take care of
AIDS orphans. Because local people are accustomed to telling monks their troubles, the
latter have become a conduit for identifying many secret HIV+ people who, once identified,
can be referred to support groups and public assistance programs. ‘HIV-friendly’ temples
encourage these people to participate in community activities. They also provide training in
meditation as well as grow and dispense herbal medicines in collaboration with local hospitals.
This more active role among monks is strengthening trust between them and the people. It is
also developing community potential and encouraging greater grass roots participation in
solving problem at the local level. Because the project has given monks a way to become
actively involved in their communities, something they have always wanted, it is spreading
rapidly into other regions of Thailand and in neighbouring countries such as Cambodia, Laos,
Myanmar, Vietnam, Bhutan, Mongolia and China.
1 Conduct training seminars with monks, nuns and novices. Topics covered are basic
knowledge on HIV/AIDS, the impact on the community and development and its socio-
economic impacts. This is then applied to Buddhist teachings to increase understanding.
Monks and lay people engaged in community development work are invited to talk and
also this is applied to Buddhist teachings. Also PLWHA are invited to talk about their
experiences, their needs and wants from the monks and the community. In addition, the
training covers participatory skills, life skills education and social management skills. At
the end of the seminar they realise that HIV/AIDS prevention and care are an integral part
of community development work
2 Trainees return to their temples and conduct 3-5 day seminars similar to those they
attended for other monks and lay community leaders ( including village headmen,
members of the village development committees and representatives of the local
government council) to ensure participation of people responsible for the development
and well being of the community. The monks and lay community leaders work in groups
to draft action plans and devise strategies for managing HIV/AIDS related problems at
the community level. They also identify potential problems and obstacles and work out
ways to solve or avoid them
3 In the community HIV/AIDS action groups are set up and community members are
collaborating with the monks, existing NGOs and local government staff to develop their
work
4 As an ongoing activity, monks carry out home visits for advice and spiritual support, give
counselling, give health care and refer to health services
5 They give seminars on HIV/AIDS related topics and especially prevention topics
(awareness raising, narcotics and substance abuse, Buddhist values and the five precepts
of Buddhism) to special target groups such as youth, orphans, schools, PLWHA. In this
they make use of participatory and life skills approaches
6 They promote and support community initiatives such as income generating activities,
orphan care, herbal gardens and network with supporting organisations
7 The Sangha Metta project organises specialised seminars on topics such as child and
adult counselling, facilitation skills, media at different levels (district, provincial, regional)
to further train the monks. It also gives technical advice for projects set up by monks in
the communities
8 The project is involved in other activities such as youth camps, vocational training, an
information resource centre, education fund, a milk bank, a medicine bank, an alms
offering bank, a funeral robes bank
From 1997 onwards and expanding to neighbouring Buddhist countries
• Staff (5)
• Skilled facilitators to conduct the seminars
• Resource persons for the seminars (doctors, public health officials, PLWHA)
• Transport
• Office equipment
8 Steps in
implementation
9 Duration
10 Resources required
Techniques and Practices for Local Responses to HIV/AIDS
16
Section Content
• Funds for rent of space for the seminars, food and accommodation
• Funds to support special activities (see under 8)
• Number of monks trained (over 5000)
• Evaluations at the end of the training seminars
• Number of seminars conducted at local level by trained monks
• Number of communities that have initiated action plans with support of the monks
• Activities carried out in the communities
• Raised awareness with monks, nuns and novices on HIV/AIDS and its impact and ability
to teach this in the community
• Ability with the monks to integrate HIV/AIDS in their Buddhist teachings and to have a
greater and more influential role in community development and social welfare
• Greater cooperation between monks, communities, local government administration,
public health sector, schools and other relevant sectors
• Monks promote and support many activities in the communities, resulting in increased
awareness, decreased stigma, greater solidarity and hence increased care and support
for PLWHA and their families
• Behaviour changes are taking place in the communities where monks are active and
people are involved less in risk behaviour (visiting sex workers, substance abuse)
• PLWHA receive counselling, spiritual guidance, care and support from the temple
• Organisation of resource persons for the seminars is not very easy as they are paid only a
small incentive
• Often monks ask for support of their community activities, but the project feels quite
strongly that such activities need to be financed from the temple donations in order to be
sustainable
• Initially the attitude of the higher Buddhist officials was not very supportive, but this has
changed with the success of the project
Through this approach, those trained have become aware that HIV/AIDS is a serious socio-
economic issue with potentially devastating impacts on future development. It is something
that affects everyone and everyone must unite to respond to the crisis if they are to ensure a
peaceful, happy future. Participants recognize that all the resources needed to confront this
crisis are already available in their own community. They learn how to identify those
resources and how to mobilize them in the fight against AIDS. When people unite, it is the
community working together for the benefit of the community. When they don’t unite, it is
the community who suffers.
Sangha Metta Project (Project manager: Laurie Maund), Wat Sri Suphan, 100 Wualai Road, Soi 2
Tambon Haiya, Muang District, Chiang Mai, Thailand 50100 laurie@cm.ksc.co.th
www.buddhanet.net/sangha-metta/project.html
This is an exceptional good project because it builds capacity in a target group that reaches
the majority of the population in Thailand (or any Buddhist country). It not only enables the
monks, nuns and novices to integrate HIV/AIDS in their Buddhist teaching, but also equips
them with methods to reach out effectively to different groups in the community through
participatory approaches and life skills. The approach moreover is highly sustainable because
the trained monks in turn train others and community initiatives are funded by temple donations,
private donations and by linking to funded government activities.
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
A Buddhist approach to HIV/AIDS prevention and care, Thailand
17
Section Content
Picture: Monks give meditation instruction
to people living with HIV/AIDS
Techniques and Practices for Local Responses to HIV/AIDS
18
Content
A total of 24 youth clubs, called Club Cools, were set up to run educational and
entertainment activities in schools and communities. A magazine was developed, Journal
Jenn Yo, to reach Haitian youth with entertaining information on reproductive and sexual
health issues.
Community level
NGO’s, local government authorities who want to start up initiatives to reach youth
• Young people in Haiti are at high risk of contracting HIV but harbour many misconceptions
about their personal risk
• Half of all youth aged 15-24 reports they have never used condoms with their regular
partners. Lots of rumours and misconceptions circulate about HIV/STI prevention through
condom use
• To educate and train Haitian youth in HIV/AIDS and STI prevention, family planning,
sexual awareness, condom negotiation and other skills
• To provide entertainment and income generating opportunities for adolescents through
local community organisations (Club Cools)
• Haiti has the highest rate of HIV/AIDS in the Americas. In addition, it is estimated that 48%
of all Haitians has at least one STI
• Young people in Haiti begin sexual activity at a very early age: a national survey found that
67% of adolescents interviewed had sex before they were 15 years old, and 43% said they
had had more than four partners
• Ninety percent of Haitians who are HIV positive acquired the infection during adolescence
or early adulthood
• Due to the socio-economic situation, and security problems, there is a lack of parks, sport
fields and other places for adolescents to meet and entertain themselves
• Unemployment rates in young people are high. This places young people at a particular
risk for early sexual activity. At the same time, Haitian adolescents are looking for ways to
entertain themselves and become involved in community activities
• The first Club Cool was developed in Port-au-Prince out of a focus group organised by
PSI/Haiti to test messages for a youth magazine Journal Jenn Yo. Adolescents in the focus
group came from various parts of Port-au-Prince, and represented diverse socio-economic
backgrounds. There was a general sense of excitement to become part of AIDS prevention
work, and after a second focus group, the participants decided to form a youth club
• They approached PSI/Haiti for training in peer education, and to help them become involved
in community HIV/AIDS prevention work. This group became the first Club Cool
• Subsequently, interested adolescents in each of Haiti’s nine regions were identified by PSI
to form their own local Club Cool. They proved their commitment and motivation by identifying
and securing the facilities. PSI/Haiti then assisted in developing the organisational
structure of each Club Cool
1 Membership and recruitment: Club Cools are initiated when a core group of young people
is able to identity 25 potential club members and petitions PSI/Haiti to establish a club in
their area. PSI/Haiti then provides assistance with the development of goals, objectives
and implementation strategies including income generation activities
2 Club Cool development: Each Club Cool elects a board, comprised of a President, Vice
President, Secretary, and Treasurer, and develops a management structure based on an
established Club Cool constitution. The Board is responsible for identifying a facility adequate
for meetings and activities, supervising the implementation of the strategies and for
meeting the Club mandate. Club members are responsible for implementing the activities
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
19
2 Club Cool Project, Haiti
Developed by: Population Service International (PSI), Haiti
Key words: Youth, sexual and reproductive health, income generating activities, Haiti
3 Peer Education Training: Board members receive training to assist them with management
and leadership responsibilities. PSI/Haiti staff also provide training and technical assistance
in HIV/AIDS and STI prevention, sexual and reproductive health, peer education techniques,
and counselling skills
4 Further Technical Training: Adolescents who are interested in learning sales skills are trained
as Club Cool vendors that sell condoms directly to consumers. The three-day training
includes information on reproductive health, social marketing goals and strategies,
interpersonal communication, sales techniques, condom use and demonstration, and
field practice
Activities of Club Cool members:
1 Peer Education: Club Cool members organise various educational and entertainment
activities designed to convey messages about reproductive and sexual health. A wide
variety of activities, such as theatre and dance presentations, movies and sporting events,
are used to capture the attention of youth and provide a medium for conveying information
in an exciting and interactive manner
2 Contribution to the Journal Jenn Yo: Ideas and contributions from Club Cools are featured
in PSI/Haiti’s monthly youth magazine, Journal Jenn Yo, which serves as a forum to
advertise Club Cool activities and to present entertaining information on reproductive
health to youth. Each Club Cool sells Journal Jenn Yo, which enables wide dissemination
of the magazine across Haiti and also provides a source of income generation for the
Clubs, thereby improving overall sustainability
3 National Club Cool Festival: PSI/Haiti organises an annual workshop to exchange ideas
amongst the various Club Cools. The workshops also serve to bring together peer educators
who provide training and presentations to young people and show locally produced videos
that feature youth celebrities
The Club Cool program began in 1997. Now in its 5th year of operation, the network has
expanded from the initial ten clubs to 24 clubs throughout the country in 2002
To get started, the Club Cool program secured $ 75,000 in funding from UNFPA and the Dutch
Embassy in Haiti. Considerable investments were needed for the training of peer educators.
Additional resources went to club sponsorship, the development of educational materials,
promotional activities and AIDS day and Carnival workshops. Monthly sales from the Journal
Jenn Yo also provide local Club Cools with revenues
• Number of Clubs established
• Type of activities initiated
• Number of members
• Achieved outputs
• Type of training completed, with number of participants, achieved training plans and
follow up of trainees
• Revenue, sales and distribution data are collected monthly and compared with objectives.
Data include the number of male and female condoms sold by Club, by sales outlet, by
geographic location, by sales agent, and the rates of re-stocking
• Distribution of the Journal Jenn Yo is monitored for each Club and geographic location
• As a result of the Club Cools, hundreds of peer educators have been trained and provide
ongoing community education on HIV/AIDS prevention
• Myths and rumours about HIV/AIDS prevention have been dispelled
• Entertainment and educational activities, using innovative techniques including a local
mobile van with video equipment, are likely to have reached thousands of Haitian
adolescents
• Through their involvement as members of Club Cool, numerous youth have developed
important leadership skills as well as gained valuable experience in project planning,
budgeting and organisation
• Five issues of Journal Jenn Yo are produced each year, with 25,000 copies of each issue
being printed and distributed around the country. Over 90% of all issues are sold via Club
Cools and other partner organisations
• Over 50% of Haitians are under the age of 18. Due to these demographics, every year, a
number of new Club Cool members arrive and older members depart. This rapid turnover
of the youth in the various clubs causes occasional disruptions in specific club operations
due to lack of consistent leadership. Therefore Club Cools require frequent refresher
training’s as new leaders are identified and new members are incorporated
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
Techniques and Practices for Local Responses to HIV/AIDS
20
Section Content
• Income generating activities afford a measure of cost recovery, but the Club Cools are not
fully sustainable and require continued, albeit minimal, outside financial support
• Adolescents must be empowered to train and educate each other on reproductive and
sexual health issues. To this end, peer educators from each club were involved and
encouraged to take the lead in message development, to ensure that activities are
entertaining and appealing to their peers. Club Cools have their own elected Board and
self established goals and objectives
• Club Cools, while primarily designed to convey messages on adolescent sexual and
reproductive health, also provide youth with experience in other areas such as
democratic governance, micro-credit management and community mobilisation. It would
therefore be important to have these Clubs tap into the expertise of other local
institutions that could provide expertise and training in these fields
Moussa Abbo, Country Representative PSI/Haiti
C/o USAID/PSI
Rue Theodule # 1, Bourdon, Port-au-Prince, Haiti
Email: mabbo@hainet.net
Jim Malster or Julie Fine at PSI/Washington:
1120 19th St. N.W., Suite 600
Washington, DC 20036, USA
E-mail: jmalster@psi.org or jfine@psi.org
www.psi.org
Similar programmes could be initiated in many countries. PSI has many offices or affiliations
in the world and can be approached for funding. The management and leadership training
and sales skills training are useful to manage the club cools, and may at the same time
enhance future perspectives for employment for the trained youth
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Club Cool Project, Haiti
2121
Section Content
Content
Youth are involved in the creation of a mural which carries a message on HIV/AIDS to their
own community and serves as a discussion starter among youth and other community
members
Community level
NGOs, Youth organisations, villages, workplaces, any community
• Lack of targeted information on HIV/AIDS for rural youth on specific issues such as living
positively with HIV/AIDS and prevention of mother to child transmission
• Insufficient opportunities for rural youth to express their creativity
• To create open and creative ways of expression and communication for rural youth
• Provision of information on risk behavior leading to an understanding of the relationship
between behavior and transmission of HIV/AIDS
• To create 40 messages on positive living with HIV/AIDS targeting rural youth in a public
space
• To promote the rights of people living with HIV/AIDS and their families
• Creation of awareness on vertical transmission as one of the three modes of transmission
of HIV
• Prevalence of HIV in Togo according to latest surveillance in 1999 is 6%
• A national multi-sectoral institutional framework, Conseil National de Lutte contre le SIDA
(CNLS) was created by presidential decree in October 2001 and there is an increasing
awareness and interest HIV/AIDS issues among governmental and non-governmental
organisations
• Information and awareness campaigns on HIV/AIDS have been carried out throughout
Togo, but have mostly been concentrated in the urban areas, in particular in Lomé and
the Maritime region
• The prevalence of HIV is high amongst young people; however, their perception of risk is
still relatively low
• Youth in rural communities are more difficult to reach due to a number of factors,
including low school attendance rates, and relative geographic isolation of villages
The project is a collaboration between UNDP, UNICEF, and the Peace Corps Volunteers and
the communities in which the Peace Corps Volunteers are located.
Peace Corps volunteers facilitate a public discussion within their communities on a specific
AIDS-related theme, assist in the creation and selection of a drawn message for the community,
and organize the painted visualization of this message in a public space.
A jury of representatives from various organizations, including people living with HIV/AIDS,
selects the village with the most effective and powerful message answering one of the
following questions:
• How can we support persons living with HIV/AIDS and their families, both emotionally
and practically?
• How will our community support HIV-positive pregnant women, their newborns, and their
partners?
• How can we prevent HIV/AIDS as individuals and as members of our community?
On the World AIDS Day, an award ceremony with festivities is held in the winning village
1 Identify and assemble a team. Think about youth groups and out of school youth, take
gender balance into account. Start with a large enough groups to allow for the normal drop-
out rates, core team of 8-15 people. It may be a good idea to establish some group
membership rules, especially in communication and attendance
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
22
3 Community Art versus AIDS project, Togo
Developed by: Focal Point HIV/AIDS, UNDP Office, Lomé, Togo
Key words: Youth, community, contest, awareness raising, prevention, care and support, arts, Togo
2 Assess knowledge and attitudes. This has to be the basis of the messages and also provides
an indicator to assess change as a result of the murals. The project used a questionnaire that
measures knowledge and attitudes about HIV/AIDS among the participants
3 Identify topic. The mural can answer any of the questions mentioned in section 7. Help the
group brainstorm their ideas and their visualisation through art. Give the team members a
few days to come up with designs, and then reassemble to collectively choose a design for
the wall (anonymous voting is encouraged). At this time also discussions can take place on
HIV modes of transmission, and on myths and facts, to make sure that everyone is on the
same knowledge level
4 Identify an appropriate wall with the group and seek permission from the appropriate
authority. Identify a wall with little direct sunlight and rain. If the mural is to be painted on a
school wall, ensure permission of school and village authorities. Show the final project design
for approval
5 Choose approach. Decide if other types of behaviour change interventions should also be
developed during the process or an exclusive focus on awareness raising. Factors to take into
consideration include: the level of knowledge of HIV/AIDS transmission and prevention among
target population, time available for team meetings, and the possibilities for linking it with
other ongoing work
6 Set a timeline. Set up a schedule with the team for the prevention/behaviour change activities,
as well as the drawing and painting. Painting usually takes three days for paid professionals-
it may take longer for the team, depending on the motivation and organization of the group
7 Sketch designs and lesson plan. Individual members of the group make a sketch of the
mural based on the theme identified. There are certain basic art skills such as colour mixing,
line, and proportion that may need to be covered to help the team better express their ideas.
Create an encouraging atmosphere to allow expression of creativity and feelings. Display all
the drawings at the end of the session and talk about art skills, and then use the themes of
the drawings in the next session to talk about the topic
8 Select a design. A team can either select one drawing democratically, or combine elements
of the separate drawings into one group mural painting. The mural has to have an overall coherent
style that can be understood by its audience. Make a group draft before the final painting;
test the design on target group members to see if they understand the basic message
9 Paint the mural. Keep an overview of the whole mural- to ensure coherence. Ensure equal
participation in creating the mural by creating alternative tasks to keep dominant members
occupied
10 Village opening ceremony. Mobilize the whole community and let the youth speak out
and present themselves in a positive manner as a vital asset in the fight against HIV/AIDS
Optional:
11 Jury visit & Village celebrations. A jury composed of representatives from various
organizations working on HIV/AIDS visits each completed mural site and selects one mural as
the winner. The winning village holds celebrations, hereby press can be invited, as well as
high level representatives of the government and donor community
12 Evaluation with the group on the process. Assess and compare knowledge and attitudes
on HIV/AIDS with assessment at the start
The duration of the activity depends on the amount of awareness raising that is taking place
in the process, on the size of the group and the size of the wall
• Paint, brushes
• Preparatory drawing materials
• Transport
• Finances for village party
• Per diem jury
• Total budget for 40 village murals U$ 4900 (UNDP/UNICEF)
• Number of murals created
• % of participants who can list the three modes of transmission of HIV/AIDS
• % of participants who can list the three methods of HIV/AIDS prevention
• Art versus AIDS has elicited a tremendous response from the Togolese public – As one
market woman put it: ‘You can bring your boy or girl here to teach them how to stay
healthy, how to live longer’
• While the activity takes place at community level, the scope of the project was regional and
national. The nation wide competitive element stimulated local youth to do their very best
• Nationwide and local visibility of key problems of the HIV/AIDS epidemic
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
Community Art versus AIDS project, Togo
23
Section Content
• For host villages and their volunteers this project left a concrete memory of the volunteer
after his/her departure
• Mobilisation of a wide range of village leaders and youth
• Mobilisation of regional AIDS activists as they work together as jury members
• Facilitation of networking between regional experts and rural youth
• It is crucial to assure the logistics are well taken care of. Every village, even the most
remote one, should receive information, paint and tools at the same time The Peace
Corps has a weekly mail delivery system by road, which was used to reach volunteers
• All jury’s should use the same criteria for which this project used a standardized jury form
• A coordinating and facilitating body is crucial and needs people experienced in art and
with basic understanding of the issues surrounding HIV/AIDS
• Even though murals are visual, it remains difficult to reach illiterate unorganised poor
people. One stops to watch the murals but needs strong encouragement to ask questions
about the themes
• More follow up activities, such as informative talks and sketches could be undertaken at
these new murals to keep the discussion on HIV/AIDS going
Focal Point HIV/AIDS, UNDP Office, Lomé, Togo. fo.tgo@undp.org or
For pictures see http://www.pnud.tg/artvsaids/
• This approach is a very interesting way to raise HIV/AIDS in a manner that is accessible
not only for youth, but for communities as a whole. It would be interesting to find out the
impact of the murals on the general public: does it lead to a more open discussion on
HIV/AIDS, does it increase levels of knowledge and can it be used to mobilize youth on
further AIDS awareness activities or as the start of a process of making action plans to
address the topic of the mural (e.g. organizing care and support activities)
• The questions that are raised in section 7 can be adapted to any other problem to be
addressed
• This type of intervention could also be used in a workplace environment
Picture: An example of a mural
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
24
Section Content
Content
A community centre for Intravenous Drug Users (IDU) provides counselling, referral to other
services, syringe exchange, self-help as well as information and preventive messages to IDUs
in Kiev
Community/municipal level
Active groups of IDUs, AIDS service organisations, health care providers, governments and
NGOs/CBOs
• The risk for HIV infection in IDUs is very high
• IDUs need information on HIV prevention and on support mechanisms to IDUs with HIV
• IDUs need peer psychological support
• IDUs have poor understanding and knowledge of Ukrainian legislature on drug use and
human rights
• IDUs face numerous social problems
• To provide support to active and former IDUs and PLWHA by conducting self-help groups
every other day
• To identify and involve new IDUs into the programme of ‘Eney’ Club
• To minimise the risk of HIV transmission and to dispel myths and misconceptions about
HIV/AIDS in the community of IDUs of this district of Kiev through syringe exchange,
counselling on medical issues and referral to relevant services
• To improve the life of IDUs and to help them solve legal, medical and social problems via
counselling on legal issues, referral to relevant medical and social services
• HIV epidemic in Ukraine is IDU-driven with 72% of adults with HIV having been infected
via injecting drug use (official data as for October 1, 2003)
• There are about 75 thousand officially registered IDUs in Ukraine; recent research by the
Centre ‘Social Monitoring’ estimate there are about 560 thousand IDUs in the country;
the same research says that about 15% of IDUs in Ukraine are being reached by the work
of HIV-service NGOs
• Total population of Kiev is 2.6 million
• Official data for IDUs in Kiev is 7300; estimated number is about 30 thousand, with
average age of 26-30 years
• Services for IDUs are provided by government services such as substance abuse clinics,
STI clinics, TB clinics and other medical institutions, centres for AIDS prevention, centres
of social services for youths and rehabilitation centres. Services are also provided by
NGOs and these are most friendly and most efficient
• Free of charge condoms and syringes remain to be the most efficient mode of HIV
prevention among IDUs
• There still remains great need in information on HIV/AIDS, various legal and social
aspects in IDUs in the country
• Drug use is indirectly criminalized in Ukraine (there is no punishment for using drugs, but
it is prohibited to carry certain doses of drug substances, to cook drugs and to sell them),
nevertheless harm reduction is recognised as an effective measure of HIV prevention and
supported by the relevant ministry decree
• Club ‘Eney’ started as a self-help group for IDUs in 1993 in Kiev but they didn’t get
officially registered until 2000. They had 7 members at that time
• In 2001 they developed with members and with the support of the International HIV/AIDS
Alliance in Ukraine, a proposal for a HIV prevention project among IDUs of Kiev and
suburbs. This proposal entailed a needle exchange programme, self-help groups,
provision of counselling on HIV/AIDS, legal counselling, solving questions in dealing with
police, and referrals to other relevant services
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
25
4 Community Centre for IDUs, Ukraine
Developed by: ‘Eney’ Club with the support of the International HIV/AIDS Alliance in Ukraine and International
Renaissance Foundation, Ukraine
Key words: IDU, self-help, syringe exchange, counselling, Ukraine
• From the very beginning of its activity ‘Eney’ managed to establish friendly relations with
local authorities of Kiev
• In 2002 ‘Eney’ concluded a 3-side agreement with Centre for Social Services for Youth and
AIDS-Centre in Kiev on mutual support of activities
• In the Autumn of 2002 they started needle exchange in one of the buildings on the
grounds of the city AIDS-Centre and Hepatitis Hospital. This is actually the place where
many IDUs from all around Kiev gather to have their diseases treated. There is a drug
dealing spot located right near the hospital and it was especially important to organise a
needle exchange right beside the drug selling and using point
• ‘Eney’ started repairs of this building by the efforts of their own members and finished
the work in the spring of 2003
• Since this time they are carrying out all activities as proposed in the plan from this centre.
Self-help groups follow the 12 steps programme using the method of group therapy. The
main task of a self-help group is to help those who want to quit using drugs. Therefore it
gathers former and active drug users to discuss problems under the facilitation of one of
the group’s members. The group elects the facilitator for 6 months or a year to facilitate once
a week. So there are several facilitators every week and a different facilitator every day
• Every month 25 new IDUs and about 4 newcomers are entering self-help groups
• Within a year of operation Eney reaches about 15% of the IDUs of the district of Kiev in
which they are working
11 Getting registered as an HIV-service organisation
12 Establish among the members priorities for activities
13 Establish good working relations with local authorities (possibly concluding an agreement
on mutual assistance)
14 Identify partners to support a community centre and write a project proposal
15 Carry out a situation analysis and assess the most appropriate place for such a centre
taking into account the local drug scene
16 Organise all the agreements and permissions needed for operation
17 Find an organisation to manage disposal of used syringes and make up a contract
18 Get the premises and arrange the necessary renovation
19 Buy syringes and start the syringe exchange, meanwhile give information about the
future programs of the centre
10 Acquire, develop, print booklets on HIV and other social issues to distribute in the centre
11 Identify staff members to work in the centre. All ‘Eney’ staff are former drug users and
have no problem getting access to IDUs (self-help can hardly be organised by an
outsider) and specialists to counsel on relevant topics, and identifying friendly services
for drug users for referrals
12 Implementation of syringe exchange, outreach work to attract more people into the ‘Eney’
programme and facilitation of self-help group and counselling
13 Implementation of needle disposal
The project started in October 2002 and is ongoing
• Syringes, condoms, containers for the used syringes
• Premises and some minimal furniture for the centre
• Tea, coffee supply for the visitors of the centre
• Leaflets on HIV, legal questions and other relevant issues with information on other
activities of the organisation
• Funds for staff salaries and operational management
• Trained staff and counsellors for relevant issues
• Number of people making use of the syringe exchange (newcomers and regular visitors)
• Number of consultations and people served
• Number of self-help group members (newcomers and regular visitors)
• Number of casual visitors
• Documentation distributed
• Number of syringes and condoms distributed and syringes exchanged
• Number of people that visit the head office of ‘Eney’ and become involved in the main
activities of the club
• Number of people starting to volunteer for the club
• Feedback book for the visitors of the community centre
• Reports of consultants and facilitators of the self-help groups
8 Steps in
implementation
9 Duration
10 Resources required
11 Indicators for monitoring
Techniques and Practices for Local Responses to HIV/AIDS
26
Section Content
• IDUs have access to clean syringes and condoms, information, education, communication,
counselling and referral
• IDUs provide peer support in self-help groups
• ‘Eney’ is organising disposal of the used needles that used to lie all around the place so
now the place is clean and is less dangerous for passers-by
• Doctors in the hospital and AIDS-Centre are aware of the programme, highly appreciate
its work and refer their patient IDUs to ‘Eney’
• The centre facilitated behaviour change in many IDUs, several of them have quitted using
drugs and started volunteering for ‘Eney’, taking pride in managing to live without drugs
• The programme was accepted by the authorities in the country’s capital which serves as
an example for other regions
• Problems exist because drugs are sold and used right besides where the centre is located
and many syringes may lie around the place causing negative reaction to the centre’s
activity. This problem is easily sold via organisation of utilization of the disposed syringes
• As drugs are used right besides the point, staff working in the centre have to be very
familiar with and ready to work with people being high
• Syringe exchange has to be regular as breach for even a day’s functioning can lead to
dangerous outcomes for the clients. So there have to be at least 2 staff members
responsible for the exchange
• It is difficult to motivate IDUs for safer behaviour
• It is extremely important to establish good working relations with local authorities,
including the police, and the organisation providing the premises. Drawing up a written
agreement is a good idea
• The syringe exchange point should be located near the places of drug use
• It is very important to continuously involve new and young IDUs in the programme
• Self-help group should be carried out as often as possible (ideally every day)
• Members have to develop a sense of ownership and collective responsibility to make the
programme work
International HIV/AIDS Alliance in Ukraine
Victor Isakov, NGO Support Officer
Dimitrova 5, building 10 A, 6th floor
Kiev 03150
Tel: +38 044 490 54 86, 490 54 87, 490 54 88
E-mail: deshko@aidsalliance.kiev.ua, isakov@aidsalliance.kiev.ua
Website: www.aidsalliance.kiev.ua
At the present stage of the HIV/AIDS epidemic in Ukraine it is necessary to reach large
numbers of IDUs. Although needles and syringes are freely available in Ukraine and not very
expensive, it is the change in attitude that is most important. By offering comprehensive
services in the community centre, catering for various needs of various groups of clients,
more drug users are attracted and can eventually be motivated for safer behaviour
Picture: Participants of a self-help group at the Eney club
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Community Centre for IDUs, Ukraine
27
Section Content
Content
‘The Condom Krew’ is an intervention focussing on the provision of condoms and information
on their procurement, storage and use. The ‘krew’ has as its main strategy the infiltration of
social events such as parties and public premises where people socialize. The bulk of its
work is done during the carnival season, a time when it has been shown that there is an
increase in sexual activity
National and community levels
NGO’s, CBO’s and Peer education groups who target especially urban youth
• Increased sexual activities during the carnival season
• The spread of sexually transmitted infections (STI) and HIV through unprotected sexual
contact
• Inaccurate information about condoms
Inform and provide condoms to sexually active groups especially in places / events where sex
is negotiated.
Trinidad is well known for its annual carnival that gathers the population and tourists from
different parts of the country and the world. National statistics and the Caribbean
Epidemiology Centre (CAREC) year 2000 record of people living with HIV/AIDS in Trinidad and
Tobago indicate that:
• Rate of pregnancies increases during the post carnival period.
• Young people between the ages of 15 –24 are engaging in unsafe sexual practices, noting
a 45% increase in the rate of HIV infection amongst youth
• An increase in the number of persons aged 15-27 treated for sexually transmitted infections
• Noticing these trends, YMCA worked with a group of key young people (the ‘Krew’)
representing various agencies working on HIV/AIDS awareness in Trinidad and Tobago to
come together to provide and promote the use of condoms. Different stakeholders such
as condom promoters, condom manufacturers, UNAIDS, CAREC and the National AIDS
Programme (NAP) each saw the advantage of the intervention (for instance manufacturers
saw the potential to have their brand marketed without them spending large sums on an
advertisement campaign)
• The Carnival season was selected as the point of introduction for this activity, Carnival
being the most sexually charged cultural season in Trinidad and Tobago
• The ‘Krew’ is now focused on expanding its outreach to include a community-based
approach throughout the year during other cultural and entertainment events, and
sporting events
1 Planning: YMCA contacted organisations and groups involved in HIV/AIDS related work
or in the field of sexual and reproductive health and rights. On the basis of existing
activities of the organisations, relevance, comparative advantage and barriers to
cooperation were discussed
2 Organisation: The ‘Krew’ secured storage space for condoms at the store rooms of the
Rapport/NAP. Main sources of condoms were the NAP and condom manufacturers and
distributors. In addition procurement of cloth for the making of the condom ‘krew’ flag
and plain t-shirts for printing; identification of a printer for the flag and t-shirts for the
‘krew’; transport for the conveyance of the ‘krew’ members, condoms and flag; planning
for ‘krew’ members attendance at events
3 Advocacy: Contacts with party promoters to secure entrance to their events and with
possible sponsors to bear the cost of entrance fees to parties, t-shirt and flag cost, transport
cost and condoms if they have to be bought. Coordination with ongoing awareness
raising activities on condom promotion and on promotion of the event
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
28
5 The Condom ‘Krew’, Trinidad and Tobago
Developed by: YMCA, Outreach Department. Trinidad
Key words: Youth, sexual and reproductive health, STI/HIV, condom promotion, Carnival, Trinidad, The Caribbean
4 Implementation: The locations are selected for their attendance of young people and
their history as a meeting place (incidence of sexual activity during or after parties)
2000 to present (every carnival season)
• Crew members (at least 10 members per event)
• Condoms (from Rapport/NAP, the NGO ASPIRE, Durex and was approached by the
manufacturers of SLAM condoms)
• T-shirts, flags
• Transport
• Condom pamphlets
• Entrance fees to parties
• Storage space for condoms
• The number of condoms distributed at one event
• The number of condoms (intact) seen strewn on the floor of the event. This is done by
surveying the premises after the event is over to get a brief account of what lies intact or
used in and around the premises
• The number of condoms (used) seen strewn in and around the premises of the event
assessed in the same way as above
• The number of condoms distributed over a stated period
• Number of cases of STI’s post season and in general. The Krew acquired results of treated
and reported STI cases from the Queens park clinic and the Monitoring department of the
Ministry of Health public labs
• Number of people seeking condoms at the various organizations from which they are
available
• The duplication of the condom ‘Krews’ methodology of distribution at parties and other
social hot spots
• The Condom Krew has successfully distributed approximately 5,000 condoms per carnival
event for the year 2000. Over the past 3 years the ‘krew’ has successfully sustained its
efforts without funding, distributing an average of 30,000 condoms per carnival season
• An increase in condom use among the youth population aged 15 – 25. The evidence for
this is the increase in distribution at the Rapport and Family Planning Association drop in
centres. The Krew has also done its on-the-spot surveys at the events and has detected
an increase in the number of people who would say yes rather than no. In addition the
Krew keeps track of distribution figures from its own stock of condoms
• The popularity of the phenomenon of the Party Krew and heightened awareness of condoms
by the public as evidenced by an increase in the number of public condom debates
(television and radio segments, symposia on contraception). Attribution to the Krew’s
activities are ascertained during these public debates by questions in relation to the
Krew’s activities or distribution material and often involve Krew members as panellists.
One of the Krew member groups AYSHR (Advocates for Youth Sexual and Reproductive
Health and Rights) has been responsible for sparking a great deal of debate
• Stimulation of research to ascertain patterns of condom use by sex, age, sexual
orientation etc. in Trinidad and Tobago
• Securing a consistent supply of condoms
• Condoms provided by the NAP, which were close to expiration on one occasion
• Securing access to a brand of condoms trusted by the public
• The willingness of some promoters to allow only small numbers of the ‘krew’ into the
party free of charge
• No consistent sponsorship to help defer operational costs
• Cultural association of condoms with infidelity, which made some people self-conscious
about the idea of taking condoms publicly
• Limited human resource i.e. the same people having to attend all events every night
during the carnival period and then work by day can be very exhausting
• Access to a brand of condoms trusted by the public is key to a good starting response
• The maintenance of good relationships with promotional organizations rather than just
individuals is important
• Membership should consist of individuals capable of answering any question asked and
able to do a proper condom use demonstration
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
The Condom ‘Krew’, Trinidad and Tobago
29
Section Content
• The securing of a sponsor for a long-term period like 3 years will eliminate the need to be
constantly searching for means of covering of operational costs
• If the Condom ‘Krew’ is to consist of several groups, there should be intermittent
meetings to assess needs and issues arising
• While there may be members who work tirelessly in the field of HIV/AIDS, there may be
religious and value related issues to hinder participation in the activities of the intervention
YMCA, Outreach Department
Benbow Road, Off Wrightson Road,
Pot-Of-Spain
Trinidad, W.I.
Contact – Gregory Sloane-Seale, Outreach Director, sloaneseale@yahoo.com; Svenn Grant,
Community Outreach Coordinator, svenngrant@hotmail.com,
Tel: +1 (868) 627-7835, Fax-1 (868) 627-8764
• It is not clear if distributing condoms will enhance their actual and consistent use. However,
this rather ‘aggressive’ way of condom demonstration and promotion does provide
condoms – in a timely manner – to those in need, especially during carnival seasons and
in places where sexual activities are known to be negotiated and performed
• The practice highlights collaboration rather than competition of several organizations in
an attempt to spread information on condoms in places where sexual activities are negotiated
and to promote the use of condoms. At present the Krew membership includes ASPIRE,
YMCA, THE RAPPORT, AYSHR, with support of UNAIDS
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
30
Section Content
Content
A community-based outreach programme targeting cross-border drivers and other frequent
Hong Kong-China travellers
Community level
NGOs, government services
The number of cross-border drivers who pass through the busiest border access points range
from 7,000 to 25,000 round trips per day. Local research has shown that many of these
drivers visit sex workers in China often without using condoms
This project aims to increase HIV/AIDS and safer sex knowledge and condom use among
cross-border travellers and drivers through outreach efforts at border access points
• The Hong Kong Department of Health STD/AIDS statistics revealed that for the period
April 2001 to March 2002, HIV transmission through heterosexual contact comprises over
50% of all new cases. Cumulative HIV cases in Hong Kong now stand at 1798 persons
• A report recently released by UNAIDS (2002), estimates that mainland China now has
approximately 850,000 to 1,500,000 cases of HIV infection, which could rise to 10 million
by the year 2010
• As the volume of travel between Hong Kong and its neighbouring cities such as Shenzhen
and Guangzhou increases, a low prevalence zone (Hong Kong) becomes connected to a
high prevalence (mainland) area, and HIV can spread further and faster
• The building of transport and other infrastructure brings about mobility of workers and
communities, and people’s vulnerability to HIV transmission in turn rises. Prevention
efforts to target a highly mobile population is therefore important
• A safe-sex kit distribution campaign and survey on HIV/AIDS knowledge targeting cross-
border travelers was conducted in 1996
• This was followed by the design of a strategic plan to conduct a mass continuous
promotion and education program targeting not only cross-border drivers but other cross-
border travelers who travel to China by public transportation (i.e. bus and train) as well
• Outreach workers for this project were recruited from the target population of current or
ex-cross border drivers. At present, half of the staff members for this project are enlisted
from this community
• In 1999, a large-scale distribution of safe sex kits and leaflets was carried out at two
locations including a train station and a bus station
• Contact was established with truck drivers’ unions, police, cafe owners, and other border
access points administrators to ensure support of the project and to obtain permits to
operate safer sex booths at the border access points
• After travelers became familiar with AIDS Concern’s presence, safer sex booths were
established for enquiries and direct dialogue with the travelers in order to further
influence their safer sex practices
1 The Project coordinator consults with respective authorities (e.g. vehicle terminal
administrators, police) and schedules weekly outreach sessions at border access points
2 Development of materials for distribution
3 The primary outreach activities involve activities-booths set up at Hong Kong-China
border locations with a high volume of vehicle traffic (‘border access points’). These
‘access points’ include bus and train stations, vehicle holding areas, container terminals
and cafes where cross-border travellers congregate
4 Each outreach session involves 2 workers who interact with cross-border travellers
through condom demonstrations, giving out safer sex materials, and answering STD or
HIV/AIDS questions raised by the contacts
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
31
6 Outreach Program targeting Hong Kong
China cross-border travellers
Developed by: AIDS Concern, Hong Kong
Key words: Truck drivers, awareness raising, prevention, condoms, Hong Kong
5 During each outreach occasion, cross-border travellers are invited to take part in the condom
demonstration activity and if correctly demonstrating the necessary steps to accurate condom
use, a small souvenir will be given to them as a token of appreciation and encouragement
6 Following each session, workers record on report forms safer sex items that were handed
out and issues being raised during their conversations with the travellers
7 An educational safer-sex video is also shown once a week at border access points to drive
home HIV prevention messages
Ongoing, the project formally started in 1999
1 Human Resources: The project requires one full-time coordinator to plan, coordinate, and
implement program as well as oversee the design and production of safer sex materials.
The project coordinator conducts weekly outreach visits with three additional workers
(one full-time and two part-time). Since the project’s main focus is on-site outreach,
which requires that workers travel to border access points far away from the city centre
and interact with a large mobile population, a large labour pool is necessary to prevent
worker fatigue and burn out
2 Safer sex kits, condom instruction cards, HIV/AIDS and STD booklets: large quantities
are produced each year to meet the high border traffic
3 Volunteers: their primary responsibility is to pack the high number of safer sex kits
4 Funding: Funding came mainly from the government trust fund (The Hong Kong AIDS
Trust Fund), and international donors (Levi Strauss Foundation and Japanese Foundation
of AIDS Prevention). The cost last year was HKD 600,000 (app USD 77,120)
• Number of outreach sessions
• Number of cross border travellers and drivers approached
• % of cross border travellers who show correct knowledge of HIV prevention methods
• Number of safer sex material (condoms, leaflets, booklets and video showings) distributed
• % of cross border drivers who demonstrate correct condom use
• Two surveys, conducted by the Chinese University of Hong Kong for the cross-border prevention
program, show that knowledge about HIV/AIDS has increased with the target group (through
leaflets) and so has the willingness to use condoms while having commercial sex
• In another survey AIDS Concern conducted, 97% respondents claimed that they
understood more about safer sex after watching the safer sex film
• Of the number of drivers who participated in our HIV oral-fluid antibody test pilot project,
95% of drivers who filled out the post-service evaluation questionnaire felt that the
counselling provided increased their understanding of HIV/AIDS, their knowledge on
safer sex and of the testing
• Building a trustful relationship with a highly mobile population is very difficult as they
have little time to stay at one location and to interact with outreach workers
• It is difficult to discuss safer sex with commercial sex workers clients if people are not
willing to admit that they visit these workers
• Since they are an extremely diverse group of people, counselling styles and messages
have to be tailored to the different types of people who constitute the target group
• The success of this project is highly dependent on the receptiveness and support of
administrators and other gatekeepers who manage the bus and train stations, vehicle
holding areas, as well as legal authorities. For AIDS Concern, maintaining a trusting
relationship with these people, can at times be quite a challenge
• Persistence, regularity and the establishment of trust are crucial. Clients are more
inclined to disclose personal details such as their safer sex practices if a trusting
relationship has been built. Behavioural and attitudinal changes among the target groups
increase with regular communication
• Trusted relationships lead drivers to offer help with outreach activities, such as recruiting
other drivers to participate in the condom demonstrations. This may lead to recruitment
of peer educators from among the target group
• Condom demonstration activities have shown that a lot of drivers could not properly put
on a condom. There was a general assumption among drivers that since they were male,
they should naturally know these things
• It is important to use different channels of communication. AIDS Concern produced a
safer sex video specifically with cross-border drivers in mind. This is shown weekly at
border vehicle terminals, where drivers have to wait for instructions. The response to this
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
Techniques and Practices for Local Responses to HIV/AIDS
32
Section Content
video has been very positive because the drivers can easily identify with the video’s
characters (truck drivers) and language used
• A pilot HIV oral-fluid antibody test was provided to cross-border drivers during ten weeks.
The high response rate for testing showed demand, but many did not return to get their
results. This may in part be due to the intensely mobile nature of this population and their
highly unpredictable work schedules that make returning after a week for test results
difficult. Therefore, other testing processes that may be more suitable such as rapid
testing methods will be assessed
AIDS Concern
Margaret Pang, Prevention Officer
17B, Block F, 3 Lok Man Road, Chai Wan, Hong Kong.
Tel: +852 2898 4411
Fax: +852 2505 1682
E-mail: Margaretpang@aidsconcern.org.hk
Website: www.aidsconcern.org.hk
• This is a highly relevant project because truck drivers are at high risk
• Because they usually have to wait for a long time at border crossings, they may be more
inclined to spend some time on information activities relating to HIV/AIDS
• It is also conceivable that sex workers could be reached with information, as they often
operate at these crossings
Picture 1: An enquiry booth set up in Lo Wu KCR station. Outreach worker (right) talking to a
cross border traveller, giving him a safer sex almanac
Picture 2: Outreach worker discusses HIV/AIDS with some cross border truck drivers in a
café in Lok Ma Chau
15 Source of practice
and dialogue
16 Editor’s note for learning
Outreach Program targeting Hong Kong China cross-border travellers
33
Section Content
Content
Provision of comprehensive sexual and reproductive health services (SRH) in a Multipurpose
Youth Centre. ‘De Living Room’ is a youth-friendly clinic in which young people 25 and under
access SRH clinical, educational and counselling services
Community level with focus on Trinidad’s capital Port of Spain and its environs
Youth organizations, NGOs, CBOs, Governmental and International agencies
Low use of SRH services among young people
To reduce physical and psychological barriers to access of SRH services faced by young
people by creating a separate facility, that provides services in a non-threatening
environment, with non-judgmental staff, enhanced comfort, privacy and confidentiality
• Despite the existence of SRH services, the unmet need among young people is high. This
is evidenced by teenage live birth rate (14.1%), extensive HIV/AIDS and STI transmission
rates among youth
• The fastest growing rate of HIV transmission has been reported among young women
between the ages of 14 and 19
• The percentage of females infected with HIV rose from 0% in 1983, to 42% in 1999.
Females between the ages of 15 and 45 represent 82% of those cases (UNAIDS, 2000)
• Both Ministry of Health and PAHO/WHO are interested in the establishment of a model
centre for young people
• FPATT participated in the Adolescent Wellness Initiative, a programme spearheaded by
Ministry of Health in collaboration with PAHO/WHO and joined the national delegation on
a trip to the Bahamas to learn from their best practices
• FPATT conducted Operations Research funded by International Planned Parenthood
Federation’s I3 (Innovate, Indicate and Inform) Project to identify barriers to the use of its
services by youth and to implement interventions to increase the use of these services
among males and females under 25 years old
• The research involved young people recruited to administer a Client Satisfaction survey to
young clients of FPATTs existing Port of Spain clinic and Community surveys to youth who
lived within communities in the catchment’s area of the clinic. Focus groups with the
target population were also conducted
• Findings were translated into practical strategies by FPATT and young people involved in
the process, and with support of various stakeholders working with youth, such as the
YMCA and RAPPORT
1 Operations Research - Diagnostic Phase: Tested the service delivery systems of FPATT
with respect to its youth friendliness as well as socio-cultural and economic barriers to
utilization. To test the hypothesis that utilisation of the sexual and reproductive health
services (i.e. the number of young people 15-24 who seek and receive information,
counselling, contraceptives, condoms, pap smears, pregnancy tests from the FPATT)
varies with the quality of its service delivery system. Quality is assessed against the
variable included in section 11 below
2 Operations Research – Intervention Phase: To empower young people to take greater
responsibility for their sexual and reproductive health. ‘De Living Room’ Multipurpose
Youth Centre is established. Youth were called upon to assist in the design of the planned
dedicated multi-purpose centre, in relation to layout and structure as well as development
of the services offered. They were also involved in the naming of the clinic and the official
launch, and continue to be involved to this day with regard to the general running of the
clinic and other activities of the FPATT, which are youth-centric. A doctor, two nurses and
a social worker assist the core group of young people
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
34
7 ‘De Living Room’, Trinidad and Tobago
Developed by: Family Planning Association of Trinidad and Tobago (FPATT)
Key words: Youth friendly clinic, sexual and reproductive health, Trinidad, The Caribbean
3 Programme Evaluation – ‘De Living Room’ is monitored by a team comprising the Youth
Co-ordinator, the Director of Operations and the Programme and Evaluation Officer. The
YMCA also have a role to play in the ongoing monitoring of the Centre for they provide the
critical youth perspective which helps the Association to gauge its performance with
respect to standards for the delivery of youth friendly services
The diagnostic phase of the intervention lasted approximately one month. ‘De Living’ room
was established based on the findings in May 2001 and continues to operate
Personnel, cost per Year in US$
• 1 Centre Manager/Youth Co-ordinator - 10,400
• 1 Social Worker (part time) - 3,466
• 1 Doctor (part time) - 4,333
• 2 Nurses (part time) -17,333
• 1 Clinic Clerk - 4,333
• Benefits 12% - 4,983
Total: US$ 44,848
Material resources:
Corporate citizens donated furniture with a total value of US$ 10,333 to ‘De Living Room’.
These items included: three computers, three computer desks and chairs, VCR, television,
refrigerator, two coffee tables, one Living Room Set and one Dining Room set. Other material
resources such as medical equipment and filing cabinets valued at US$ 6,450, were
purchased with designated project funding
Qualitative Indicators
• Provider-client interpersonal relations
• The youth friendliness of the physical set-up of the service areas
• Client comfort with the level of privacy and confidentiality and the competence of the
providers
• Client satisfaction with the range of services provided
• The extent to which FPATT reaches out to youth in marketing its services
Quantitative indicators
• The number of young people who see and receive a) information b) counselling
c) contraceptives d) condoms e) pap smears f) pregnancy tests from the FPATT
• ‘De Living Room’ – first of its kind in Trinidad and Tobago to offer comprehensive sexual
and reproductive health services to young people 15-24
• Phenomenal increase in client visits. In the month before its opening in May 2001
approximately 80 visits were recorded. In the first twelve months since the Centre has
been in operation, young people have visited the Centre on average 355 times per month
– with the highest – 561 – in April, 2002
• Sustainability: As a model-programme it has the potential to attract long-term government
support as it demonstrates ongoing success in addressing the unmet sexual and reproductive
health needs of young people. FPATT will continue to seek corporate sponsorship. FPATT’s
Healthlink programme for corporate clients will help to subsidize ‘De Living Room’.
FPATT’s standardized clinic fees are charged. 86% of clients who attended the clinic
between January and March 2002 were employed and are in the 19-25 age range
• Initial defensiveness of older staff on the need to institutionalise youth-friendly services
• Some pre-existing youth organizations felt threatened by the opening of ‘De Living Room’
despite their involvement in the designing of it
• The Operations Research has acted as a catalyst for institutional change within FPATT,
which has had an impact upon all FPATT programmes and staff
• There is a need for the continual management of these internal processes of change to
ensure continuity of quality and approaches to serving young people across FPATT’s
services
• There is a need for continual management of relations and networking with youth
advocacy and community groups to strengthen collaboration and referral networks
• As demand increases, there will be a need to manage the disjunction between the quality
of FPATT’s youth services and the quality of its existing clinical services
• Efforts to encourage the corporate sector and others to support Centres such as ‘De
Living Room’ should be ongoing
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
‘De Living Room’, Trinidad and Tobago
35
Section Content
• It is imperative that mechanisms be put in place to ensure the youth involved as clients
and as providers (with respect to the YAM members) are encouraged to form an integral
role in the monitoring and continued development of the programme
• It is important to engage in ongoing staff sensitisation workshops on the issue of youth
friendly service and to ensure that there is enough opportunity for staff to engage in
frank and open dialogue re any fears, questions and suggestions they might have about
the process
Family Planning Association of Trinidad and Tobago
79 Oxford Street, Port of Spain, Trinidad W.I.
Contact: Donna Da Costa Martinez, Executive Director
Tel: +1 (868) 623 5169
E-mail: fpattrep@ttfpa.org
Website: www.ttfpa.org
• Sexual and Reproductive Health services are not meeting the needs of young people due
to unfriendly attitudes of service providers. Some are rather entertainment centres or at
best, information centres. Staff is criticised on the lack of confidentiality particularly in
relation to STIs
• This practice addresses the use of a research and systematic approach to project
development. FPATT’s approach is characterised by strong client orientation, cost
efficiency and high quality standards combined with innovation. The systematic approach
to project design, implementation and evaluation ensures that the project meets the
needs of beneficiaries (access, affordability, confidentiality, quality services, non-
judgemental attitudes, etc)
• In a similar way, in Ivory Coast, the Santé Familiale Prevention du SIDA / USAID has
designed a youth friendly approach ‘Just Smile’ following a study, which identified
unwelcoming attitudes of staff as the main barrier to use of services
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
36
Section Content
Content
A drop-in centre that supports commercial sex workers (CSW) by offering counselling services
and different types of skills training in a home where they can also come to meet and relax.
By being united, the group is able to fight for the rights of sex workers and to advocate for
improved policies at different levels.
Community, municipality
Organisations of commercial sex workers, women’s rights organisations, NGOs
• CSW have insufficient access to information that enables them to protect themselves
physically and to defend their rights
• Poverty and lack of education keeps the women trapped in a situation they find difficult
to control and from which it is hard to escape
• CSW are being discriminated by employers, public services and legal policies, lacking
social security provisions that apply to other types of employment
• To increase access to information on general health, sexually transmitted diseases
including HIV/AIDS, and safer sex methods for CSW
• To increase self confidence and self esteem through counselling and to give CSW
opportunities to improve their living conditions through education and skills training
• To provide a place where CSW can meet for friendship and to share their daily
experiences and ideas about working and improving their living conditions
• To unite CSW to strive for better working conditions, improved health sector services,
improved legal status and adherence to human rights principles
• Prostitution is still illegal in Thailand, but this is not enforced for women over 18. An Act
that will give prostitution a legal status including social benefits is being drawn up at
present
• The economic situation in Thailand has been difficult over the past years after the Asian
financial crisis and this has increased poverty and migration from rural areas, including
from ethnic communities. The more difficult economic situation in neighbouring countries
has resulted in a large number of sex workers from these countries
• CSWs work for employers such as bars, karaoke clubs and bar-brothels for a regular
salary. If they engage in sex work with clients picked up in the bar, they have to hand over
a percentage of their earnings. As part of this agreement they have to have medical
check-ups, including a test for HIV, every three months. There is only post test
counselling if found HIV positive
• There is a government drive for 100% condom use for sex workers, but not all sex workers
are adequately informed and educated to adhere to this all the time or in all their sexual
contacts
• Discrimination and harassment of sex workers is common
• When HIV prevalence started to increase in Thailand, the sex workers were the first to be
blamed. In 1990 women activists came together with sex workers and decided to
establish the organisation Empower (stands for: education means protection of women
engaged in recreation) to protect their human rights and to enable sex workers to meet
and to have better access to social counselling, education and skills training
• Subsequently, the group developed plans, wrote proposals for funding and obtained funding
• The drop-in centre in Chiangmai was established in 1990. All staff in the centre are ex
CWS, trained in social and health counselling. The centre provides documentation on
sexual and reproductive health and on other topics of interest. There are a number of
computers that members can use
• Classes are offered in Thai language, English language, typing and computer skills, non-
formal adult education, sewing, batik, art and martial art. It is possible for the women to
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
37
8 A drop-in centre for sex workers, Thailand
Developed by: Empower, Chiangmai, Thailand
Key words: Commercial sex workers, information and education, skills training, social and legal protection
obtain a certificate (primary and high school) of the non-formal education programme
(community school) that is accredited by the Thai Ministry of Education. The classes are
conducted by the staff of Empower or by someone from outside if staff does not have the
required skills. The selection of subjects for training is based on demand from the
members
• Empower staff has established relations with social workers, health centres and
organisations relevant for support to CSWs with regard to social security and legal
aspects of their profession
11 Establishment of a drop in centre that is open daily with at least 20 visitors a day
12 Ongoing health and social counselling, referral if needed
13 Ongoing networking with social workers, the public health system and NGOs active in
related fields
14 Regular visits to the health centre with new members to ensure proper treatment by
health workers
15 Ongoing membership registration (0.5 $ fee for life) with about 300-500 new members a
year and fluctuating active members
16 Selection of subjects for training by members, subjects change over time. Recruitment of
teachers if needed
17 Registration for subject classes by payment of a 1$ fee for 20 lessons (signed off by the
teacher)
18 Twice a month a meeting with feed back on general issues (such as the development of
the Act on prostitution) and a special focus, topic decided on demand or issues of
importance (trafficking of women, women’s rights, PLWHA networks, STIs and HIV, rights of
children, abuse and violence). Resource persons for the topic are identified from the network
19 Once a year a three day camp with 40-60 members organised by different community
based organisations with the objective to: 1) have fun, learn to give and take and unite as
a group 2) to get special knowledge from resource persons and to visit other community
based organisations
10 The staff conducts daily awareness raising activities in different institutions in the
community (on invitation from schools, temples) and visits places where sex workers are
for awareness raising and education and to invite sex workers to visit the centre
11 Ongoing advocacy and liaison with women activists in Bangkok with feed back from and
to members
The centre in Chiangmai opened in 1990 and is ongoing
• Human resources: 3 full time staff (education, information, health) trained in counselling
who are ex sex workers, 2 part time staff, 2 volunteers, one consultant advisor (nurse)
• House (rented), 3 computers, gasoline for transport (own motorbikes)
• Total funding for two centres (Chiangmai and Mae Sai) 1.3 million baht/year
(1 Thai Baht = 0.03 US$)
• Number of members (active and inactive)
• Number of visitors (members) at the drop-in centre
• Type of information and counselling given
• Referral and liaison with health centres
• Number of classes held, number of participants
• Number of certificates obtained by members
• Special sessions organised and attendance at these sessions
• Number of visits to schools and other institutions for awareness raising activities
• Number of liaison visits to employers of CSW
• Sex workers feel supported and more protected
• Increased self esteem and determination
• Increased income (by speaking English, they can get foreign clients who pay more)
• Increased possibilities to start up their own business and quit working as sex workers
• Better treatment by health workers (attitude and medical) and employers (less exploitation)
• Some employers are not co-operative because they expect Empower to motivate sex
workers for other employment, which will affect their business
• Other sectors that are involved with sex workers always want them to stop their work and
do not agree with the support given by Empower which does not question the type of
employment
8 Steps in
implementation
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
Techniques and Practices for Local Responses to HIV/AIDS
38
Section Content
• It is important to consider all women related issues and not to focus only on the health
aspects of sex work
• Respect for/by staff and members is critical in order to enhance confidence and self
esteem and to be able to unite as an organisation
Empower Chiangmai (Ms. Pornpit Puckmai)
72/2 Raming Nives Village, Tippanet Hiya district, Chiangmai 50100, Thailand.
Tel: 66-53-282504
E-mail: empower@cm.ksc.co.th
• Commercial sex workers are subjected to continuous discrimination. The drop-in centre
functions as a home where the CSWs give each other mutual support and at the same
time can get information and skills to improve their life, be it as sex worker or in another
profession
• The fact that Empower staff has also worked as CSW makes counselling much more effective
• Operating as a group enables the CSW to promote their rights better, to influence the
attitudes of health workers, to better avoid exploitation and to strive for a better legal
position.
Picture: Members of Empower in the drop-in centre
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
A drop-in centre for sex workers, Thailand
39
Section Content
Content
Peer HIV and STI education project, targeting younger men who have sex with men (MSM) in
public places, where men pick up sexual partners
Community level
NGOs targeting young MSM, Public Health services
HIV disproportionately affects gay men, with gay and bisexual men comprising close to one
fourth of new cases of HIV infection through sexual contact
• To increase HIV and STI knowledge among MSM who frequent PCE.
• To increase their condom use
The MSM population in Hong Kong remains a highly stigmatised and invisible community.
They are invisible because of a complete absence of public policies that protect their personal
and working lives and because of the cultural values that favour Confucian ideology and
emphasise family over individual rights. As a result, there is a proliferation of ‘underground’
venues where MSM find each other. Public Cruising Environments (PCE) such as gay saunas,
health clubs, beaches, and public toilets become popular meeting places where MSM find sex
partners. AIDS Concern’s MSM outreach project is developed in reaction to this phenomenon. It
seeks to bring HIV and STI information to MSM who are unconnected to existing gay
resources and untouched by general public HIV education.
• Recruitment of Project Staff: 6 peer educators are recruited from the MSM community to
conduct weekly outreach sessions at PCE. They are recruited with diversity in age, occupation
and personalities to maximize opportunities to reach out to an equally diverse population
of MSM. In addition, peer guides – volunteers are recruited for PCE to assist in expanding
the coverage of the program. They affect change when and where paid workers leave off,
given the limited work hours and clearly defined work boundaries that workers have to
abide by
• Geographical and Social Mapping: to uncover and document a variety of public cruising
venues where MSM congregate, MSM publications, electronic message bulletin boards on
gay websites, anecdotal information provided by outreach contacts are used
• Scheduled outreach visits: based on data gathered from the geographical and social
mapping, outreach visits are scheduled at sites where there is a high MSM traffic
• Annual revisions and updates: Due to the dynamic nature of PCE (mobility of MSM,
closure of public cruising sites, gang influences, etc.), the PCE geographical mapping is
revised each year so that the outreach team can maximize its contact rate
• Design and production of outreach materials: safer sex kits (each containing a condom
and lubricant sachet as well as a condom instruction card) and pamphlets designed
specifically with MSM in mind (and especially younger MSM) are produced to support the
contacts’ safer sex practice. These pamphlets focus on topics such as sexually transmitted
diseases, ways to negotiate safer sex with partners and community resources (i.e. gay
information/crisis lines, social groups, HIV/STD clinics)
• Police Liaison: Meetings with the police were conducted to discuss the programme and
its objectives with the police and gain their support. Monthly outreach schedules are
faxed to police stations to inform them of the outreach activities. This is to protect our
staff from being apprehended by police during their outreach work
• Pre and Post Intervention Assessment of Selected PCE baseline and follow-up studies are
conducted at selected outreach sites to monitor the effectiveness of this programme
1 Three outreach sessions are scheduled per week; two outreach workers will partner at
each outreach site
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
40
9 Each one Teach one, Hong Kong
Developed by: AIDS Concern, Hong Kong
Key words: MSM, awareness raising, safer sex practices, Hong Kong
2 Direct face-to-face dialogue at PCE. Each contact with an individual is approximately 30 to
45 minutes long, involving a risk assessment of contact’s sexual behaviour, exchange of
safer sex and HIV transmission information, and referrals (e.g. HIV antibody testing or gay
community groups). Safer sex kits and STD booklets are also given out
3 After face-to-face conversations in which contacts are made, workers will fill in contact
reports and debrief with each other after they have left the outreach venue
The project commenced since 1999 and still ongoing
1 Human Resources: One project coordinator to manage a public cruising environment
outreach team of four part time team members and volunteers
2 Equipment: Target population specific safer sex kits (condoms, lubricant, and condom
instruction cards), safer sex pamphlets
3 Transport: vehicles
4 Funding: HKD350,000 (appr. USD 44,987) per year (includes salary, condoms, lubricant,
production of other safer sex materials, stationary and travel costs)
(1 Hong Kong Dollar (HKD) = 0.13 USD)
• Number of MSM contacted in PCE outreach sites
• Number of MSM contacted who are within the ages of late teens and twenties
• Number of MSM counselled on HIV and STIs
• % of MSM who show correct knowledge of HIV prevention methods
• Number of MSM who report unprotected anal sex in the last 12 months
• % of MSM who used a condom for last episode of anal sex
• Number of peer educators
• Number of MSM reached through contact with volunteer peer guides
• Outreach workers now have opportunities for direct face-to-face dialogue with MSM. This
allows for greater influence on behavioural change, i.e. more accurate risks assessment,
correction of misconceptions on how HIV is transmitted, as well as peer role modelling to
encourage and support contacts in adopting safer sex practices
• The outreach prevention program that targets MSM in PCE brings information to a highly
closeted population that may have no knowledge of MSM community resources, i.e. gay
information/crisis lines, social groups, HIV/STD clinics
• A variety of positive changes have been witnessed among the target population. Repeated
contacts with whom we have built a solid rapport would voluntarily approach our workers
to report increases in condom use. Younger MSM we have counselled also report greater
usage of community resources (e.g. access to gay groups) as well as successes in safer
sex negotiation. Even contacts we have approached years ago would later recall our name
and select our HIV antibody testing service as their first experience in testing
• The closure/renovation of toilets: the layout of older toilets has been conducive of MSM
cruising. As the police become more aware of sexual activities at these venues and as
traditional toilets deteriorate and become run down, complete renovation of such toilets
forces regular users to disperse to other PCE
• Gangs, who might pose as MSM, extort money from innocent victims who fell prey to
their sham and this stops many MSM from visiting these sites. There is no legal recourse
for victims to strike back
• There has been a diversification of PCE environment in the last few years, making traditional
PCE sites such as toilets no longer the only way MSM meet their sexual partners. MSM sex
is now common at certain beaches, health clubs, and gay saunas. With the popularisation
of ICQ and gay specific bulletin board systems (BBS), finding sex partners has become
increasingly instant and easier with less opportunity for outreach
• Under current Hong Kong law, the age of consent for homosexual sex is 21. This contrasts
with the age of consent for heterosexual sex set at 16. To complicate things further, sex
with multiple partners at one time or at public places such public toilets, bathhouses is
considered illegal activity. However, staff in fiduciary relationships such as that of social
workers and their clients, are not required by law to report if they suspect any illegal or
dangerous activities. To avoid staff from getting apprehended by the police, monthly
outreach schedules to public toilets are faxed to the relevant police stations
• Mainstream funding sources usually reflect the public moral climate, and in Hong Kong
public sex in saunas or toilets is considered immoral. At times our program proposals are
rejected because funders side with public sentiment
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
Each one Teach one, Hong Kong
41
Section Content
• Who the Messenger is Matters: Mainstream HIV prevention services either avoids the
issue of sexual diversity altogether or assumes everyone is heterosexual. This situation
keeps many MSM from seeking services from such service providers (e.g. STD clinics that
show a discriminatory attitude towards MSM). AIDS Concern ensures that the peer
educators it employs are not only recruited from the MSM population but that they hold
non-judgmental attitudes towards the community they serve. This promotes the
likelihood that rapport is built between worker and client and that trust is established
• Worker versus Participant approaches: This project utilizes two outreach approaches:
Worker Approach and Participant-Observer Approach. The former approach requires that
the outreach worker introduce himself as an AIDS Concern staff. This method clarifies the
role of the worker. However, under this approach, honest conversations about sexual
behaviours may not always be possible. Contacts may feel that they are being scrutinized
and are more likely to exaggerate their safer sex behaviours. As for the latter method
(Participant-observer approach), outreach workers are not required to immediately
disclose their agency affiliation. Instead, they act as one of the participants, with the
apparent exception that they do not take part in any sexual acts. This approach places
the worker and client on more equal footing and an accurate risk assessment of the
contact behaviour can be achieved
• Repeat Contacts: It has been formerly assumed that the high mobility of our target
population would make it difficult for any follow-up contact to occur. At the initial stage of
the project, AIDS Concern mainly focused on new contacts and reached out to as many
individuals as possible. But with regular visits to the venues, it became apparent to all of
our workers that there are a good number of toilet users who are regular users. The
project then took on the emphasis of building up a stronger relationship with these users
in order to establish a greater influence on their sexual behaviour. Our outreach workers
have repeatedly reported how the quality of their conversations with contacts have
greatly improved and risk assessments have become more complete and in-depth
AIDS Concern, Paul Louey
17B, Block F, 3 Lok Man Road, Chai Wan, Hong Kong.
Tel: +852 2898 4411
Fax: +852 2505 1682
E-mail: paul@aidsconcern.org.hk
Website: www.aidsconcern.org.hk
• This is a very strategic approach to reach a population that is almost impossible to reach.
The fact that the outreach workers themselves are MSM clearly facilitates the work. The
cooperation of the police is crucial but this may be quite difficult to obtain in other countries
• We wonder about actual adoption of safer sex practices. Research has shown that knowledge
in itself does not lead to behaviour change, as this is an individual asset while the social
environment in which the behaviour occurs largely determines behaviour. The self reported
change by repeated contacts may be biased
• It would be good to develop indicators for behaviour change resulting from the intervention,
but we do realise it will be quite difficult with this target group
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
42
Section Content
Picture: MSM outreach - Safer sex kits distributed during outreach work in public
cruising environment
Content
Jus’ Once is an interactive participatory HIV/AIDS programme for young people and the
community, which invites the participating audience to address the concerns in their
community in order to alleviate the spread and stigmas surrounding HIV/AIDS epidemic
Community, schools, Government ministries, corporate bodies, NGOs throughout Trinidad &
Tobago, and the wider Caribbean
Government’s institutions, youth organisations, NGOs, communities, schools
Misinformation, stigma and denial associated with HIV/AIDS prevention, care, and support
found in the Caribbean
The Centre for Creative and Festival Arts and Arts-in-Action (Theatre-in-Education outreach unit),
a group of artists working within the Centre at The University of the West Indies aims to:
• Present interactive and participative performances which seek to explore the reasons and
the forces behind the continuing growth of HIV/AIDS (especially in the Caribbean)
• Encourage people of different age groups in the community to look inside themselves and
their environment for answers and strategies to reduce and control the growth of all
sexually transmitted diseases
• Form links and support with the community as an effective means of disseminating
ongoing information on HIV and AIDS
• The Caribbean Epidemiology Centre (CAREC) reported that young girls and women are
among the highest numbers of persons infected with HIV in Trinidad & Tobago
• Research in Trinidad & Tobago has revealed that there are number of myths associated
with the disease
• National statistics suggest a continuing and increasing problem of HIV/AIDS, and the
need to explore the societal impact of this situation is critical
• Education through lectures and brochures has been shown not to be especially effective
due to the educational levels of certain sectors (i.e., low income areas) of the society
• Interactive productions which encourage participants to openly address the situation and
‘practice’ informed responses within hypothetical dramatic situations, is now statistically
proven to be highly effective in curtailing the forces behind the growth of HIV/AIDS
• The Centre for Creative and Festival Arts has established its outreach programme, ‘Arts-
in-Action’, since 1994. The basis of the work of Arts-in-Action is that art has an
indispensable role to play in the process of social and attitudinal change and
development. Arts-in-Action is the most experienced and professionally trained group of
actor-teachers/facilitators in the Caribbean. In 1998, HIV/AIDS was identified as the main
issue to be dealt with
• Working together with its Director, Arts-in-Action actors/facilitators researched, devised,
rehearsed and prepared a series of interactive scenarios/monologues for interactive
performance-workshops. The scenarios all focus on HIV/AIDS prevention amongst young
adults (see Section 8 below)
• Specific venues and areas are chosen in order to reach groups of young adults (approximately
50 to 150 at any given time) in easily accessible locations where they ‘lime’ and/or
congregate in their free or formal time (i.e. in and outside of school /office hours)
• Links are established with and in the proposed local areas or venues where the productions
are being offered. These include the community elders, mentors, shop keepers, etc.
and/or school administrations, as well as NGOs associated with HIV/AIDS dissemination
and awareness programmes (e.g. AIDS Foundations, community hospitals, clinics,
resource persons)
• The actor-facilitators perform Jus’ Once. The issues of the production, based on seven or
eight monologues and linked by original Caribbean music and song, are then opened up
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
43
10 Jus’ Once, an interactive HIV/AIDS awareness
production
Developed by: Arts-in-Action/Centre for Creative & Festival Arts. University of the West Indies
Key words: Community, awareness raising, prevention, myths, sexuality, drama and arts, Trinidad, The Caribbean
for discussion from the participating audience by facilitators who hot seat and role-play
the characters. This causes the participating audience to empathize, question, condone,
or support the actions and experiences they witness. They face their own perceptions and
experience actual feelings about their sense of self and how to deal with, for example,
their own sexuality, gender issues, and peer relationships (male and female), thereby
raising their awareness of self and others and their self-esteem to maximize their
potential. The interactive facilitation techniques cause the viewers to offer and try out
alternative solutions and options, empowering and evoking a positive change in attitude
and behaviour, as well as a heightened sensibility to be more highly attuned to their
surroundings
1 Training: Five to eight actors are trained in interactive techniques by the actor-facilitator.
(i.e. Forum Theatre, facilitation, etc.)
2 Research: Research and rehearsals for the process-drama are carried out by the group
and the Director
3 Planning: Administrative personnel locate venues, educative links and transportation facilities
4 Performance Preparation: Production staff (director, designer) design and identify
costume and set requirements. These minimalist elements include stock ‘uniforms’ for
the performers, colour coordinated, symbolic costume pieces and props, black cubes or
blocks for the set, a heavy-duty circular carpet (for the performing arena), and an advertising
sandwich board
5 Implementation: Performances-workshops are performed. At each venue, ‘an ambassador’
is identified to monitor local needs and distribute further educative materials. Characters
used in workshops:
• Cassandra: Vengeance is the solution to getting rid of all promiscuous men; life ends with
an HIV/AIDS diagnosis; class, education level, professional status aid in determining
who would be infected
• Stanton: Only skinny people are HIV/AIDS infected; once a person looks healthy they
are not infected; a good ‘sweat’ (workout) could solve any illness; selective use of
condoms only with new clients
• Susan: Pulling out of the penis before ejaculation is safe sex; sleeping with only one
person is a guarantee that safe sex is being practiced; the need to be tested only once
if sexually active
• Taye: The denial of a loss of a friend to an AIDS related death (renal failure); the
unsafe practice of ‘parrying’ otherwise known as orgies; the need for testing for HIV
once sexually active; the risk of promiscuity
• Derek: Pleasure vs. safety; decision to break up the relationship because lack of condom
use is an issue; stigmas attached to condom use
• Judy: How it feels to be an AIDS patient; what you REALLY can and cannot do with
someone who has AIDS; the world does not end with a positive HIV result
• Simon: immediate reactions to being tested HIV positive; risky sexual behaviours
coming back to haunt a person living with HIV/AIDS; best way to deal with being
tested HIV positive
6 Evaluation: Evaluations before and after each intervention are assessed and where
necessary adjustments are made to the interactive performance
Ongoing. In Trinidad & Tobago, the first productions began in 1998
• 5 to 8 actor-facilitators, one who can drive
• Funding for performers, facilitator, and director’s stipends/fees
• Transportation & fuel
• An administrative base and person to arrange production timetable, dates, and venues;
fund-raising and payments
• Research assistant to document pre and post questionnaires and/or videotape
interventions for record keeping purposes and assessment
• Pre and post performance evaluation forms are developed, distributed to audiences and
collected by the actor-facilitators at each venue
• On site, the actor-facilitators record oral questions and their answers, or comments and
further suggestions after each performance-workshop
• Links with local ‘ambassadors’ are identified and contact maintained
• Follow-up productions are created and community awareness is assessed
• Quarterly reports are written and disseminated to sponsors
8 Steps in
implementation
9 Duration
10 Resources required
11 Indicators for monitoring
Techniques and Practices for Local Responses to HIV/AIDS
44
Section Content
• Reports are available to show the positive impact of this intervention (Canada Fund
Reports May 2001, November 2002, March 2003)
• The project reaches and speaks to the youth and the community on their own turf/ground
through animated interactive presentations and increases the number of youths with
first-hand knowledge as to how to prevent sexual transmission of HIV/AIDS
• Involvement of the participating community directly with options and ways to protect
themselves from HIV/AIDS
• Requests for training youth organisations in Trinidad and Tobago and from other
countries in the Caribbean
• Challenges and pitfalls Weather conditions may prevent consistent outdoor performances
• Large venues may require amplification
• Sponsorship for performers, and transportation to and from venues is essential in order
to facilitate the process
• A home base with administrative & rehearsals facilities is necessary
• A well-trained and committed team is essential
• Monetary reimbursements for the hours of preparation and performance times are necessary
to maintain a high level of professionalism
• Participating audiences are generally aware of the HIV/AIDS epidemic, and consequently
affirm their commitments to adjust their lifestyles, remove the stigmas and understand
the myths surrounding the disease. But the need to continually re-educate, remind,
reinforce this information to the ever-growing younger generations is never-ending, even
in a population of only 1.3 million people
Arts-in-Action
c/o Centre for Creative & Festival Arts
The University of the West Indies
St. Augustine, Trinidad (West Indies)
Contact person: Dani Lyndersay
Tel: +1(868) 663 0327 or 662 2002 ext 2510, 3539
dlyndersay@fhe.uwi.tt, artsinaction@tstt.net.tt, festival@tstt.net.tt, www.festival.uwi.tt
Arts-in-Action is also involved in training NGO and CBO members and teachers in Trinidad and
Tobago. The institution hosts students from various countries and has the potential for
becoming the Regional/International Training and Resource Centre for promoting the use of
participatory approaches to social problems, especially for HIV/AIDS
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Jus’ Once, an interactive HIV/AIDS awareness production
45
Section Content
Content
A Training of Teachers project to strengthen life skills amongst adolescents to handle the
danger of AIDS and drugs in a marginalized suburb of São Paulo
Secondary schools in marginalized suburbs
Secondary school teachers
• High vulnerability for HIV infection of adolescents through high risk sexual behaviour in
which male adolescents are afraid not to be able to give up to their macho role and
female adolescents are afraid to be rejected
• Both attitudes provoke fear to negotiate or even to suggest the use of condoms
• Inadequate attitudes and lack of skills to negotiate for safer sex with sexual partners
contribute to this problem
To promote a ‘natural attitude’ in the communication and negotiation between adolescent
partners in the use of condoms by emphasising sexual pleasure
The Project is situated in Vila Brasilândia, one of the poorest suburbs of São Paulo. The suburb
has the following characteristics:
• Low level of income
• High level of male unemployment
• High consumption of alcohol, resulting in violence en sexual abuse
• High level of use and traffic of drugs
• Social vulnerability
• Limited access to public education
• Concerned with the problem of HIV/AIDS in this marginalised suburb of São Paulo, the
National AIDS programme wrote out a tender that was won by ECOS, an NGO with a strong
reputation in communication projects with adolescents
• ECOS is an NGO, based in São Paulo with a focus on sexual and reproductive rights of
women and adolescents but covers also areas like participation of youngsters, prevention
of drug use and violation against women. For that purpose it developed participatory
communication techniques in workshops and by involving target groups in the publication
of their own newsletters / bulletins
1 Curriculum development
Elaboration of intervention strategies and educational materials. The intervention is aimed to
develop skills for safe sexual behaviour of adolescents. Central in its approach is the
empowerment of the adolescent that are vulnerable because of lack of natural
communication skills in negotiating the use of condoms. The approach emphasises the
pleasure of sex, in which distinguishes itself from other programmes that usually emphasise
the mandatory use of condoms.
The program forms a series of workshops that have the following components:
• Information on STI/AIDS
• Social and physiological aspects of adolescent sexuality
• Skills training to empower adolescents to decide, to communicate, to be more assertive,
and to negotiate using condoms.
Note: The three components above are not based on gender equality but on role and skills
differentiation
2 Manual
The manual produced for the Project has the following content:
• Initial considerations (methodology of training, self esteem, empowerment and the
acquisition of abilities, gender perspectives)
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
46
11 Life skills education in a poor suburb in
São Paulo, Brazil
Developed by: ECOS – Communication and Sexuality, Brazil
Key words: Life skills education, teacher training, Brazil
• Workshops (after and pre tests, games, videos, case studies, information about STI/AIDS
and drugs)
• Supporting texts
• Bibliography / Sources of info
3 Identification of the teachers
The teachers that participate in the project are identified through visits at the schools in the
neighbourhood. Teachers make themselves available on a voluntary basis
4 Implementation Phase
The implementation of the training of teachers and the organisation of the workshops at school
lasted eight months, during which workshops were held of 4 hours, 3 days per month, covering
in this way about 300 children per school in different classes. Instead of first completing the
training in total, the teachers started to implement the course in their schools, after each
workshop. In this way the teachers could exchange the experiences between themselves and
the trainers.
In order to stimulate the participation of the adolescents and to increase motivation during
the process, the following activities were included:
• The publication of Transa Legal (Save Sex), a bulletin of ECOS Institute for adolescents,
produced with contribution of teachers about sexuality, violence and drugs (six editions
in total)
• A design contest for a poster about AIDS prevention
8 months
Infrastructure:
• Room with a capacity of 20-30 persons
• Chairs
• TV /video set
• Flipchart
• Other materials
Human resources:
Skills: Competency in relation to contents (Aids, reproductive health), in attitude (didactic
methods) and being a good performer on stage
Preparation of the course: 2 persons x 100 hours
Course: 120 hours x 2 persons
Bulletins: 40 hours each x 6 bulletins
Budget:
US$ 10-15 thousand, including the production of bulletins and poster
Process indicators:
• Number of teachers trained (38)
• Number of adolescents reached (8.750)
• Number of schools visited (30)
Impact and Quality indicators:
• Quality of training: Pre and after testing of teachers
• Demand for condoms from distribution outlets in the neighbourhood
• Research about changes in skills and attitude of adolescents (not yet implemented)
• Communication between adolescents about sexuality and violence improved
• Violence in the schools decreased
• Solidarity between students increased
• Demand for condoms increased
• Communication about sexuality within the family improved
(Source: personal observations of trained teachers to ECOS)
• One of the major challenges is the establishment of good operational relations with the
public (health) services for health (that not necessarily exist in these suburbs)
• The continuity of the project depends on the awareness of the director of the school. This
requires that the project is carried out as a school activity and not just as a project of one
of the teachers
• There is a risk that the project is not regarded as an integrated part of the standard
curriculum of the school, which could threaten its continuity
• The social position and low salaries of the teachers affects their motivation in general negatively
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
Life skills education in a poor suburb in São Paulo, Brazil
47
Section Content
• The project also meets opposition in these suburbs from religious and cultural groups,
and from the families of adolescents
What to do:
• Keep always a professional attitude (which means always a certain distance towards local
context)
• Focus always on the professional capacity in training of teacher, which implicates to
always actualise the knowledge and attitude in relation to reproductive health and AIDS
• Establish partnerships with public health services and community leaders and get sponsors
What not to do:
• Do not mix age groups (i.e. join young people of 13 years with adults of 20 years)
• Do not mix adolescent and parents
• Do not keep on with the theory, but discuss the day to day reality
ECOS – Communication and Sexuality
Rua Araújo, 124, 2º andar – Vila Buarque
01220-020 – São Paulo – SP, Brasil
José Roberto Simonetti (Director)
E-mail: zeroberto.ecos@uol.com.br
Sylvia Cavasin (Director)
ECOS has a highly professional approach towards involving adolescents in these
underprivileged suburban areas
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
48
Section Content
Content
Education by trained youth volunteers among in and out of school youth and other groups in
the community for HIV/AIDS awareness, acceptance and prevention
Community
Youth groups, community based organisations
• HIV/AIDS is not perceived to be a problem that affects everyone in the community
• People in the community do not have the knowledge and skills to avoid becoming infected
• Discrimination of PLWHA and their families, especially children
• To enhance knowledge on HIV/AIDS prevention in the community at large
• To increase acceptance and community involvement of PLWHA and their families so they
can be part of community development efforts, happy and with dignity like the others
• To enhance the capacity of children and youth that are affected by HIV/AIDS to come to
terms with HIV/AIDS with concern for their physical, social and emotional development in
a creative way and facilitate them to develop their own plans for prevention
• To enhance the capacity of youth volunteers to effectively work with youth and other
groups at community level and to improve adult understanding and appreciation of the
potential of youth
• Communities in the North saw the incidence of AIDS grow in the early 90s, but apart from
the general government information and awareness raising campaign, no targeted activities
were taking place to enable people to deal with HIV/AIDS in their own environment and
to develop their own plans. Discrimination of PLWHA and their families was high in all
sectors of society
• Most villagers are poor and male and female migration is common. Girls/women often
end up working in the entertainment sector as sex workers in the large cities. Youth who
want to continue their studies also have to leave the village for their education, often
staying in dormitories, which increases their vulnerability to infection
• In 1994 a teacher in the village realised that her pupils and other youth in the village did
not understand that they were vulnerable to become infected with HIV. With another
teacher and a number of young people, she decided to launch a campaign for HIV/AIDS
awareness raising. This led to the establishment of the Maekaotom AIDS Co-ordinating
Centre, based in the house of the teacher
• She trained the youth volunteers in PRA activities (mapping, AIDS trend appraisal, ranking
of risk behaviour, Venn diagramme – see techniques in the toolkit) and these volunteers
started to work with different youth groups in the village. This was so successful that the
volunteers were asked to organise PRA in schools, at festivals etc. and also with groups
other than youth. This then expanded to other villages
• Because not all people like PRA activities, other methods of awareness raising were
developed such as puppet shows, drama, a painting exhibition, sports events, music
• The awareness raising activities are followed by AIC (Appreciate, influence, control)
workshops in which during 2-3 days community groups are facilitated to develop a
common vision, explore interventions to reach this vision, prioritise interventions and
develop an action plan. The process is documented and after three months a review
workshop is organised
• The activities of the Coordinating Centre have now reached over 20 communities in the
district and outside and also include saving and loan schemes in the communities
1 Identification and training of youth volunteers (10 in total, but changing over time,
presently 8 girls and 2 boys, age 14 and up – most are still schooling) in HIV/AIDS
knowledge, in PRA, and in counselling
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
49
12 Peer education among youth in a rural district
in Thailand
Developed by: Maekaotom AIDS Coordinating Centre, Chiangrai, Thailand
Key words: Youth, peer education, awareness raising, prevention, Thailand
12 Identification of youth group leaders to work with (there are ‘gangs’ in most communities
and to get these interested it is important to persuade the gang leader first)
13 Identification of other groups such as migrants going away for work, children whose
parents are away, children in- and affected by HIV/AIDS and their guardians
14 Mobilizing interest in these different groups to participate in the HIV/AIDS awareness
activities by talking to the leaders first, by showing them the PRA activities and by
discussing the vulnerability of all to HIV infection
15 Division and coordination of activities between group members (each has their own
target group, but due to shortage of volunteers, often events cannot take place on the
same day)
16 Planning for activities to be done – this depends on the type of target group that is being
addressed (activities such as working/playing with the children and counselling support
to PLWHA are ongoing) and is done in a meeting once or twice per week
17 Implementation of activities (one member responsible, others may assist) followed by
evaluation
18 Networking with community level institutions (schools, health centre, local government
administration, community leaders, PLWHA groups) to promote involvement and support
of the activities – expansion to 27 other communities
19 AIC workshops have led to the establishment of PLWHA networks, counselling services,
development of alternative care systems, interventions for community development
issues and the establishment of a community saving and loan scheme that incorporates a
welfare fund (part of the interest). Such saving and loan funds are being promoted by the
Thai government in rural areas (Social Investment Fund)
10 Training of health volunteers and PLWHA family members and guardians in counselling
Since 1994 and ongoing
• A skilled PRA and AIC facilitator and trainer
• Trained and motivated volunteers
• Pick-up truck (donation)
• Computer
• Funding from variety of donors (including UNICEF, Aidsnet, Save the Children) for different
activities (when there is no funding, the groups savings fund is used and activities further
away may be scaled down)
• Volunteers are paid if they are involved in a funded activity
• Number of youth volunteers in a community
• Number of plans for activities developed and implemented
• Recognition in the community that youth are capable/able to play a key part in working
on HIV/AIDS by involving them in the development of HIV/AIDS action planning
• Linkages for collaboration/coordination developed by youth groups with other community
sectors
• Community understands AIDS facts and problems of PLWHA and their families and
discrimination has reduced
• PLWHA have been integrated in community development work and live with dignity
• Care in the community for PLWHA and their families has increased
• The saving funds (24 with a total of 208 members) that have been started in the
community give part (25%)of the profit for a fund for Orphans and Other Vulnerable
Children that is being organised by a CBO
• The (ex) volunteers have acquired skills to work with groups, have increased self
confidence and are recognised in the community
• Youth is highly mobile and not interested for a very long time so turnover of volunteers is high
• School teachers do not understand the value of the involvement of their pupils as
volunteers and do not support the empowerment that is taken place as it clashes with
their approach to learning
• Since most volunteers are still in school, most activities have to take place in the
weekends. This reduces the number of activities that can be carried out
• The development of the saving and loan groups was a slow process because much time
was needed to raise understanding of the concept. The amounts saved are small and
hence contribution to the Fund for OVC is also small
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
Techniques and Practices for Local Responses to HIV/AIDS
50
Section Content
• It is more difficult to get male volunteers than female volunteers: boys can spend time
away from home easily while girls are expected to do household chores. For them the
youth group activities provide a chance to be outside the house
• The volunteers who are being empowered in their volunteer work, making use of participatory
methods of learning find it difficult to get motivated in school where the traditional way of
teaching is adopted. Ways have to be found how the volunteers can combine what they
learn in school with what they learn as volunteers
• AIDS is a problem that challenges the moral, ethical, economic and social responsibilities
of people in the community. To make people in the community feel the problem is theirs,
the power of traditional culture needs to be combined with the power of thinking and
analysing using new (participatory) techniques that give equal importance to all involved
• Youth have to be supported to become change agents as they are open to combine new
approaches with traditional wisdom
• The saving groups have become the motor for community development
Ms. Sumalee Wanarat, Maekaotom AIDS coordinating Centre, 138 Moo2, Tambon
Maekaotom, Muang district, Chaingrai 57100, Thailand. Tel. 66-53-607026 Fax. 66-53-742143
E-mail: s_wanarat@hotmail.com
• The enthusiasm with which the peer educators work, has a very positive impact on the
youth who enjoy the PRA activities. The peer educators do not suggest youth to change
their activities but rather discuss how to avoid taking risks (like always having a condom
with you when you go out to a party). Not being told what to do, but being facilitated to
develop their own plans is much more effective than ‘lecturing’
• This empowerment however, clashes with the traditional education system and the
traditional social environment of Thai rural society where adults instruct youth how to
behave and do not recognise the strength of youth themselves. It will take longer to
develop this recognition, but in the end it will be one of the positive spin-offs of the
programmes. The same experience is described in the practice of the Sang Fan Wan Mai
youth group
• The high turnover of volunteers affects both these programmes and requires a constant
identification and training of new volunteers
Picture: A Venn diagramme made by youth to list places of recreation and the relative risks
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Peer education among youth in a rural district in Thailand
51
Section Content
Content
Prevention, care and support activities for Brazilian migrant workers in Japan are organized in
a cooperation between a Brazilian and a Japanese NGO
Community of migrant workers
Organizations of migrant workers
• Migrant workers as such usually form a high-risk group for becoming infected with HIV/AIDS
• Brazilians in Japan are faced with all kind of cultural and other barriers to integrate in the
Japanese society. This makes them even more vulnerable
• Once infected with HIV/AIDS, they don’t know as foreigners how to find their way to get
treatment, due to language problems and misunderstanding / discrimination by Japanese
society
• To promote safe sex practices with migrant workers prior to departure
• To reduce problems of access once they become infected in Japan
• To assist them to return to Brazil to receive antiretroviral treatment
• About 80 thousand Brazilians come for temporary migrant work to Japan and 250 thousand
Brazilians (dekasseguis) are resident in Japan (women and men) Many of the migrant
workers are in the age group of 25-40 years (predominantly male adults). They are
working in the big industries in the provinces of Shizuoka (30.000 Brazilian residents),
Kanagawa (20.000 Brazilian residents), Aichi (35.000 Brazilian residents) and some in
Tokyo, where the main Brazilian representations are located
• The migrant workers usually come for two years to Japan and do in such a short period
not integrate in the closed Japanese society with strong cultural identity. They do not
speak the language and Portuguese is not understood in Japan
• The migrant workers, many of them from Japanese origin, feel discriminated. Once they
suspect being infected, they get insecure because of fear of being expulsed from work
• In many cases the workers are illegal and do not receive information about the health
system in Japan and therefore stay outside the system
• GIV was founded on the 8 of February 1990 by a group of seropositive people, lead by the
psychologist José Roberto Peruzzo, and is the first NGO in Brazil functioning as a self-help
group and a centre of care, managed by people infected with HIV/AIDS. GIV organizes
meetings with people newly infected with HIV/AIDS, psychotherapeutic workshops,
discussions on sexuality, attending infected children, activism, professional courses,
discussions with the community and social services
• In 1994, José Araújo Lima, a Brazilian HIV/AIDS activist and third president of GIV in São Paulo,
met a Japanese who invited him to a Global Conference on AIDS in Yokohama. There he saw
the enormous problems that Brazilian migrant workers had when becoming infected with
HIV/AIDS, because of cultural barriers and lack of information on where to look for help
• Back in Brazil, GIV made contacts with CRIATIVOS, a Japanese NGO that promotes
Brazilian culture and sports in Japan to try to set-up a partnership to provide information
on prevention of HIV/AIDS and to support Brazilian migrant infected with the virus. This
partnership was established in 1996
• Two years later in 1998, the National AIDS programme of the Ministry of Health in Brazil
also established contacts with various institutions in Japan, trying to promote preventive
practices and assistance for the migrant workers
• Because of the lobby of GIV and CRIATIVOS, the two governments signed in the year 2000
an agreement for co-operation in policies regarding HIV/AIDS that aims to improve the
lives of Brazilians that are affected by HIV/AIDS in Japan
• All was formalized in the year 2001 in a direct partnership between GIV / CRIATIVOS and
the National HIV/AIDS programme
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
52
13 Prevention and care for migrant workers, Brazil
Developed by: GRUPO GIV – Grupo de Incentivo à Vida
Key words: Migrant workers, prevention, care, Brazil
Prior to departure to Japan:
Activities in Brazil by GIV:
1 Contact recruitment agencies for migrant workers
2 Conduct workshops on prevention of HIV/AIDS in general and information on cultural
aspects in Japan with regard to HIV/AIDS (culture of shame!)
3 Develop and distribute educational materials through the recruitment agencies to migrant
workers to Japan, including information whom how to get condoms in Japan and how to
get access to the health system in Japan and Brazil
While in Japan:
Activities in Japan by CRIATIVOS
1 Identification of concentration areas of Latin American migrant workers in Japan
2 Distribute condoms
3 Develop and conduct periodically (through the general network CRIATIVOS) workshops on
prevention of HIV/AIDS, how HIV/AIDS can be recognized and what to do in case of
suspecting HIV/AIDS
4 Seven days a week counseling and support in Portuguese and Spanish (to Brazilians and
other Latino’s) by telephone (roughly 1500 persons are attended every year)
When infected:
5 Assistance to infected persons and their families by organizing meetings, support to form
self-help groups, translation services (interpreters) in hospitals and other institutions
6 Support to repatriation of Brazilian PLWHA
Back in Brazil:
Activities at return by GIV:
1 Facilitation of arrangement of places for home-based care of PLWHA
The migrant worker project started in 1996 and is ongoing
In Brazil:
• Funds for office costs of GIV
• Input by volunteers of GIV
• Funds for conducting workshops in Brazil
• Funds for producing and distribution of educational materials
• Funds for repatriation of PLWHA (Tickets covered by VARIG)
• Funds for home-based care
• Funds for medical services of PLWHA (including HAART)
In Japan:
• Input from volunteers of CRIATIVOS
• Funds for production and distribution of educational materials
• Funds for covering telephone costs for counseling
• Funds for organizing coordination meetings and self-help groups
• Number of direct beneficiaries (different categories)
• Number of workshops conducted in Brazil and Japan
• Number of self help groups established
• Number of educational materials distributed
• Number of condoms distributed (CRIATIVOS)
• Number of migrant workers returned to Brazil and put on treatment
• Access problems to counseling and testing reduced by telephonic VCT services
• Lives saved of many migrant workers by assisting them to return to Brazil and receive
treatment
The level of discrimination of HIV/AIDS victims, particularly of ethnic Japanese migrant
workers from Brazil remains still very high
• This case shows the important role NGOs play in identifying issues affecting people living
with HIV/AIDS. In this case, support of the Brazilian victims in Japan is in fact the
responsibility of both governments, but the NGOs took the lead in the process
• In Japan, the approach to HIV/AIDS is totally different from that in Brazil. In ‘a culture
of shame’ people are very afraid to talk about AIDS. Initially Japan did not want take
responsibility for the Brazilian victims, which however radically changed during the process
8 Steps in
implementation
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
Prevention and care for migrant workers, Brazil
53
Section Content
GRUPO GIV
Rua Capitão Cavalcanti, 145 (Vila Mariana, São Paulo - SP) Brasil
Gilvane Casimiro da Silva Presidente
CEP 04017-000
Phone/Fax (55 11) 5084-0255 / 5084-6397
Website: www.giv.org.br / www.aids.gov.br
E-mail: giv@giv.org.br / edugiv@ig.com.br / araujo.l@uol.com.br
Connected sites:
www.forumaidssp.org.br
forumongsp@uol.com.br
www.criativos.org
araujo.l@uol.com.br / www.araujo.hpg.com.br
This practice describes a relevant response to the problem of migrant workers, a group that
usually is not first mentioned as a core group for HIV/AIDS prevention or care. The isolated
position, in which (illegal) migrant workers operate, makes them vulnerable and the extent of
the problem is grossly underestimated. The ILO estimates that worldwide there are roughly
130 million people working as migrants, up from 75 million in 1965. The number of
undocumented migrants is estimated at 10 million to 15 million. Economic migrants are
seeking work in roughly 67 countries, up from 39 in 1970, and fleeing 55 countries, compared
to 29 previously. But in a sign of the complexity of immigration patterns, 15 countries such as
Thailand and Malaysia both receive and send a major number of migrant workers
The press release summarizing the ILO report is on line at:
http://www.ilo.org
15 Source of practice
and dialogue
16 Editor’s note for learning
Techniques and Practices for Local Responses to HIV/AIDS
54
Section Content
Content
A mobile VCT centre provides same day voluntary counselling and rapid HIV testing as well as
information and preventive messages to the population of Mumbai
Community level/District level
AIDS service organisations, health care providers, governments and NGOs/CBOs
• Ignorance, lack of time and fear of breach in confidentiality reduce the use of facility-based
HIV testing
• Delay in providing test results is common in most facilities (from days to weeks)
• Lack of appropriate HIV/AIDS information understandable for illiterate people
• To minimise the risk of HIV transmission and dispel myths and misconceptions about
HIV/AIDS in the community of Mumbai
• To provide information and education on HIV/AIDS through exhibitions, a public address
system, participatory group meetings, condom demonstration and distribution
• To provide HIV testing using rapid test kits and provide same day results to VCT clients
• To provide quality counselling and appropriate referral for people with HIV/AIDS
• To identify and network with HIV friendly health care facilities
• There are an estimated 250,000 HIV infections and 50,000 AIDS cases in Mumbai (2001).
Among the medical in-patients of public hospitals 15% are HIV positive; among the TB
patients 35%; in STD patients over 30% are HIV positive. Among healthy blood donors
and pregnant women HIV rate is between 1.5 to 2%
• Total population of Mumbai 12.4 million
• Total of VCT centres in Mumbai: 15 + 1 mobile VCT clinic
• The 15 VCTs have been started within the mandate of National AIDS Control Organisation,
rather than based on specific needs. While some VCTs exist only on paper, others do provide
free services to clients
• High stigma attached to HIV/AIDS: This is due to the stigma attached to sex outside
marriage and the fact that sexual transmission is the main mode in India. Stigma leads to
discrimination at societal, medical and workplace level. Most medical caregivers are
apprehensive about caring for HIV/AIDS patients and if they do, they use extra-ordinary
precautions that are discriminatory to the patients
• Government funding for HIV/AIDS prevention and control is limited, the national annual
budget is 45 million US dollars (0.05 of the total annual government budget) for a total
population of over a billion people. But this amount is already a 25% increase over the
previous year
• People’s Health Organisation (PHO) started a Mobile Clinic catering for sex workers in
Mumbai in 1989 and in Pune in 1991. With the support of the Rajiv Gandhi Foundation
(RGF) this developed into a partnership project to initiate a Mobile HIV Counselling and
Testing clinic, incorporating rapid HIV testing and results. Capillus HIV test kits were
chosen as they are sensitive and user-friendly and only need one drop of blood
• The mobile clinic is manned by medical officer, health educator, peer counsellor, helper
and driver to carry out counselling and testing as well as public information and condom
demonstrations
• Every week the clinic covers ten pre-determined locations on rotation basis in South &
Central Mumbai, reaching a population of 3 million
• Locations selected are in busy strategic places like railway stations, markets, over-crowded
slums
• Non-reactive results are given instantly with post-test counselling
• The link with the formal health care system is maintained through referrals for
confirmation of initial reactive tests and for follow-up of people living with HIV/AIDS
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
55
14 Mobile VCT Clinic, India
Developed by: Peoples Health Organisation, Mumbai, India and Rajiv Gandhi Foundation, New Delhi, India
Key words: Voluntary counselling and testing, awareness raising, India
• The Rajiv Gandhi Foundation sponsored the project from November 1999 to October 2000
and again for one year from April 2002. From Nov.2000 till March 2002, PHO continued
the project without any regular grants and thrived on financial assistance collected
through small donations, selling IEC material, membership subscription, publication of
AIDS ASIA (a bimonthly newsletter) and training fee collected from those trained by and
at PHO facilities. PHO pays all the mobile clinic staff salaries from the above funds
11 Identification of Private Medical Practitioners (PMP) to be responsible for the prevention
and control of AIDS and care for PLWHA’s
12 Identification of other staff members, like social workers, counsellors and NGO activists
to be responsible for raising awareness and the prevention of HIV/AIDS and to carry out
intervention programs to halt the spread of HIV/AIDS
13 The staff is trained in sensitively handling HIV/AIDS patients and those at risk of
HIV/STDs and this created a mutual understanding and a common goal
14 Proper spots for the locations of Mobile clinic are selected and a time schedule is
developed so that adequate follow-up can be maintained
15 Necessary permissions are obtained from Police and local authorities for parking of the
vehicle at the scheduled stops, using public-address system, arranging mobile exhibition
and for having group meetings
16 A protocol is designed to enable a proper risk assessment done by the staff for each
visitor of the clinic and to give appropriate advise for or against taking an HIV test,
depending on the risk assessment by the staff
17 The van is covered with slogans in Hindi and English and a public address system is used to
air short speeches and important messages. Mobile exhibits on different aspects of HIV are
hung on the mobile van once it is parked, hundreds of passer-by come and see the exhibits
18 Group meetings are held outside the van and among other things demonstration on
proper condom usage is held, followed by distribution of AIDS leaflets and condoms
19 Visitors are received in the van (one by one) and a proper risk assessment is done by the
staff according to a protocol to counsel patients on taking a HIV test or not, this takes
about 10-15 minutes
10 For those who wish, the test is done, this takes about 5 minutes
11 The result is given in a post-test counselling session of about 10-15 minutes. For those
who have tested positive, referral is given to clinics for confirmation of initial test results
and for follow-up (care and support). The clinic serves on an average 10-12 persons per
session of 3 hours. Most of them come for counselling. A few take a HIV test. There is not
much waiting usually. When one takes to testing enclosure, the other can be taken for
counselling. Some times, they do come back after a while. Most people coming for the
test come after calling the AIDSLINE run by PHO, which informs the callers the exact
location of the Mobile clinic. People from one part of town may go to the Mobile Clinic
location in the other part, where they cannot be recognised
The project started in October 1999 and is still ongoing
• Vehicle, large enough to have facility for counselling enclosure, testing enclosure,
carrying literature, exhibition and condoms. It should be preferably with high roof
• Public Address system
• Mobile Exhibits
• Ice-box to carry HIV test kit in the vehicle and refrigerator to preserve the kits in
organisation’s office
• Good-quality spot HIV test kits; which can be used on one drop of blood
• Gloves, needles for prick (lancets), spirit swabs etc.
• Consent forms, reporting forms, receipt-book, referral forms, information booklets
• Condoms
• Funds for staff salaries and operational management (like fuel, repairs etc)
• Trained staff
• Number of people attending the mobile exhibition, public meetings, counselling, testing,
literature distributed, number of condoms distributed
• Number of revisits of persons found to be HIV positive who come for supportive
counselling, crisis counselling, or reasserting the results from referral centre. They come
back to Mobile clinic because of personalised care and excellent rapport that the clinic
staff enjoys. In most referral places, they do not get adequate attention as the hospitals
are usually busy and there is discrimination from staff of public hospitals
• Suggestion book
8 Steps in
implementation
9 Duration
10 Resources required
11 Indicators for monitoring
Techniques and Practices for Local Responses to HIV/AIDS
56
Section Content
• Feedback on Hotline, where people can anonymously provide feedback, critic,
suggestions etc.
• The project provides access to information, education, communication, counselling and
HIV testing at the doorstep of the people in Mumbai. Information is given in own
language and questions can be answered on the spot
• Medical consultation is available to people at risk of HIV/AIDS without appointments or
queues in private clinics/public hospitals, saving time, money and energy and therefore
people feel more free to go for HIV testing
• People get an HIV test without much fuss at a reasonable cost: Rs. 100/- (US$ 2/-) with
full anonymity and confidentiality
• Test reports are given instantly to those who test negative, thus most of them don’t have
to wait for hours or days for reports and save time to visit to seek a report
• The project helped in reducing the stigma about HIV/AIDS, has increased initiative in seeking
help and making infected people feel confident in coping up with such a serious problem
• Resistance of shopkeepers and traffic police when the van operates near them as it affects
their work, sometimes forcing to relocating of the clinic
• Residents have complained to the police about the ‘noise pollution’. However, looking at
the laudable goals of the mobile clinic, no action was taken. The project now has official
permission to use the public address system till a certain decibel level
• When the van breaks down, the staff takes leave or during heavy down pour, the service
comes to a halt. Thus the mobile van was grounded almost half the time affecting the
regularity of the service. There is no back-up vehicle or back-up staff. Implementation of
strategies to overcome this aspect are necessary
• Hesitance of people to be seen entering the van is not a big problem because of the
anonymity of the large city and the possibility to visit the van in a different part of the city
away from the normal living environment
• Confirmation of positive results is not possible in the mobile HIV clinic
• Strategies to enhance acceptance of counselling and testing among women need to be
devised and implemented, as very few women attend this service
• There is a need for three or four mobile clinics, with one spare vehicle for back-up in the
event of break-down
• Most of the clients tested were not tested for HIV before, indicating that this approach is
useful in out-reach and creating a need of testing among the persons practising ‘risk’
behaviour
• Mobile clinic offering voluntary counselling and HIV test are well accepted in a
metropolitan city, but may not be suitable in smaller towns
Peoples Health Organisation (India)
Dr. I.S.Gilada, Secretary General
Municipal School Building, J.J. Hospital Compound
Mumbai-400008
Tel. No. +91-22-23061616; 23719020
E-mail: ihoaids@vsnl.com
Website: www.aidsasia.info; www.aidsindia.info
• The mobile van is an interesting concept in situations where uptake of VCT in clinics is
low for a variety of reasons (staff, equipment, access). But the confidentiality aspects will
prevent people to go to the van in their own neighbourhood
• In Dakar a different system of mobile service is established by SIDA service. Here the van
brings counsellors and equipment to a clinic and service is given in the clinic itself ensuring
confidentiality and privacy
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
15 Source of practice
and dialogue
16 Editor’s note for learning
Mobile VCT Clinic, India
57
Section Content
Picture: HIV testing in the van
Techniques and Practices for Local Responses to HIV/AIDS
58
Content
A prison based aids care and prevention programme that aims to contain the spread of HIV in
prisons and to give care and support to chronically ill prisoners
Prisons
Any individual or organisation that works in prisons
• Prevalence and spread of HIV/AIDS and STIs in prisons is high (20% up to 60%) and
access to VCT is lacking
• Health care and treatment is not available
• Knowledge and awareness on HIV/AIDS basic facts is insufficient
• Stigma and discrimination is very high
• Mitigate the impact of HIV/AIDS
• Create awareness on HIV/AIDS
• Promote safe behaviour
• Prisons in Zambia are overcrowded and accommodate 10-15 times more people than
intended. The conditions in the prisons are terrible with poor hygiene, poor water and
sanitation services, poor ventilation, inadequate quantity and quality of food leading to a
very bad health status among the inmates (diarrhoea, TB, respiratory diseases, malnutrition,
scabies)
• The Prisons Act stems from 1959 and sentences people to prison for all offences, including
minor ones such as theft of food. Procedures take a long time; so all inmates are in prison
for long terms
• The Prison Fellowship Zambia Programme, a faith based interdominational para-church
organisation, carried out an assessment on the health conditions of prisoners. Subsequently,
consultations were held with prison authorities, government departments such as the
judiciary and the high court registrar and prisoners, and a request for intervention was
approved
• A strategic plan was developed on the basis of experiences with interventions in HIV/AIDS
and STI prevention and treatment and peer education in other settings. This plan was
successfully used to raise funds from donors. The strategy includes awareness raising
and health education, peer education, pre- and post test counselling, STI syndromic
treatment, care giving, stigma reduction
1 Selection of prisons in the programme based on proximity to Prison Fellowship Offices,
the gravity of the problems, the (non) availability of health services, interest of prison
authorities in the programme and availability of resources such as transport
2 Recruitment of local volunteers from the church community around the prisons
3 The volunteers are male and female (to help male and female prisoners) and have a medical
profession (doctors, nurses, para-medics) or are unemployed high school graduates that
are trained in health education and counselling
4 The volunteers are not paid but receive training in coordination and decision making
processes with a future possibility of promotion into a paid system
5 Development of a training programme, training and orientation of volunteers on HIV/AIDS
and STIs, health care and roles and responsibilities
6 Development of an action plan for each prison
7 Development of leaflets and brochures
8 Health education and AIDS awareness training of prisoners in large groups (up to 250
prisoners) with use of participatory methods such as role plays, song and dance, picture
codes and story telling. Weekly sessions of two hours following a health education syllabus
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
8 Steps in
implementation
59
15 Prison Aids prevention and care programme, Zambia
Developed by: HIV/AIDS Project, Prison Fellowship Zambia, Ndola, Zambia
Key words: Prison, care, prevention, Zambia
19 Art competition on specific subjects selected with the prisoners (rape, battering) resulting
in calendars with art made by prisoners. This years’ topic is women’s rights and
prevention of HIV/AIDS among women and the role of men in this. Country-wide
dissemination through churches and shops
10 Peer education. For each cell of about 40 people, 5 peer educators, selected by their cell
mates, are trained to do peer counselling in their cells and to refer prisoners for
treatment. They receive a kit with stories, a HIV training manual, games and leaflets. As
an incentive they get soap and sugar and regular training. They also encourage
improvements in hygiene in the cell as many prisoners suffer from water and sanitation
related diseases
11 Counselling, pre- and post test counselling carried out by trained volunteers. The blood
samples are taken to the nearest testing centre. Demand for testing is high
12 Training of prisoners in care and treatment of common STIs. They give drugs and refer for
diagnosis and treatment that they cannot do
13 AIDS care is now piloted in two prisons with 40 clients. Initially trained volunteers from
outside did this care, now volunteer inmates are trained and provided with drugs and
gloves. There is a referral possibility to the hospital, but possibilities for treatment are not
much better there
14 Stigma reduction with the help of PLWHA who visit the prison and give testimonies. They
help create support groups for PLWHA in the prisons. In addition, there is a programme in
HIV/AIDS awareness raising for prison officials and their families that helps them to
become peer educators in their own communities
Started in 1998 and ongoing programme in 11 prisons
• 3 full time staff trained in counselling and peer education training
• 50 outside professional volunteers trained in counselling and HIV/AIDS prevention and care
• Trained peer educators in prison
• 1 car, public transport
• Funding needed is about $ 100.000 per year (last year only $ 41.000 was available)
• Weekly team meeting with volunteers in which lesson plans are assessed and discussed
• Weekly assessment of counselling monitoring forms Monitoring of drug use for STI
treatment, cure rate
• Monitoring of time spent on specific subjects by peer educators and volunteers
• Tracing of contacts of prisoners with STIs
• Behaviour change after treatment and counselling
• Consistent and correct use of condoms
• More openness on HIV/AIDS in the prisons
• STIs are being cured and incidence is going down
• Self reported behaviour change
• A more caring environment in the prisons
• Increasing interest in testing
• Stigma is still an issue, inmates leaving the prison do not disclose
• Chronic shortages of drugs and basic health care
• No proper link to the health system that is very weak
• Access to testing facilities was difficult, but now the programme has received their own
testing equipment
• Attracting funding is very difficult
• Basic environmental hygiene is lacking and very difficult to improve without funding
• The hierarchy among prisoners is strict with inmate ‘bosses’ and ‘judges’ enforcing
security, but also abusing their fellow inmates. The problem of sodomy is often raised
during counselling sessions, but it is difficult to address the bosses effectively in a
special programme
• An attempt was made to train prison wardens as counsellors but this did not work
because of confidentiality issues and unequal power relations
• Prison wardens are mobile and therefore at risk, there is a high HIV prevalence among
them. Thus programmes need to be developed that target them as well
• Prisoners are very receptive to HIV/AIDS interventions both in prevention and care. It is
possible to empower them as peer educators and assist their peers to make informed choices
9 Duration
10 Resources required
11 Indicators for monitoring
12 Impact
13 Challenges and pitfalls
14 Critical issues and
lessons learnt
Techniques and Practices for Local Responses to HIV/AIDS
60
Section Content
• A recent behavioural survey showed that the level of awareness has increased, but
behaviour change needs to be facilitated not only by the prison management, but also
through better training, through activities, recreation and rehabilitation programmes
Maurice Shakwamba, project manager HIV/AIDS Project. Prison Fellowship Zambia.
P.O.Box 240070, Ndola, Zambia.
E-mail: prisonf@coppernet.zm or mshakwamba@yahoo.com.
Tel: 096-781996
• This programme requires a high degree of motivation on the part of staff and volunteers
• A major problem is the inability of the programme to change anything about the unhygienic
conditions in the prisons – this can easily discourage inmates to become involved
• If the programme would get more funding it is also conceivable to that follow-up activities
are developed with inmates that leave the prison and could become active in peer
education outside the prison
15 Source of practice
and dialogue
16 Editor’s note for learning
Prison Aids prevention and care programme, Zambia
61
Section Content
Content
Awareness raising, mobilisation and life skills training to reduce the risk of HIV/AIDS
infection in street boys who prostitute themselves
Community level
NGO’s working with street boys
• Within the macho culture in Brazil most boy prostitutes will not admit that they have sex
with men. Therefore these boys have to offer their services in dark, remote places, where
they can’t be recognised and where they stay anonymous, but where they run an increased
risk of being raped. They do not have the skills to negotiate condom use with their clients,
particularly if they are put in the passive role
• Lack of knowledge on STI/HIV/AIDS and other health issues
• Intravenous drug use and sharing of needles in an effort to build up courage for prostitution
To empower street boys from urban slums to survive in a very high risk environment
• In Rio de Janeiro about 600 street and slum boys try to survive by male prostitution
activities, but they don’t consider themselves prostitutes. The knowledge about STI’s
/AIDS and other health issues is low among the boys. Moreover they are not open to
information, because they are afraid to give the impression that they have something to
do with prostitution or homosexuality (among peers homosexuality is not accepted) and
because the usual information material doesn’t fit their strategies to survive, their culture
and their language of communication
• There is an enormous lack of special information material, adapted to the street life of
this population, but even elaboration of useful ‘special material’ will only have partial
effect. From experiences with other marginalised groups, the only way to approach them
is by face-to-face contacts. A study by IBISS on sexual exposure among 300 street boys
gave the following results:
• 28% had anal intercourse before the age of 7 years
• 63% had anal intercourse between the age of 7 and 12
• 57% of these kids were anally (ab)used by older kids on the streets
• Having anal intercourse among each other is a public secret, but the kids do not like to
talk about it as a problem. They qualified anal (ab)use by older ‘friends’ as:
• It happens, what can I do: 68%
• Its a training for my friend, to become a macho-lover: 16%
• It is really a form of abuse: 4%
• I was total drugged at the time: 12%
• For them admitting anal intercourse and talking about it in the own group meant:
• You are homosexual: 61%
• You have an illness (AIDS): 34%
• You are crazy: 5%
• Ways to break this ‘public secret’ require innovative approaches, while poverty and lack of
social perspective increases the phenomenon of prostitution and exploitation of youngsters
• IBISS is an NGO with its headquarters in Rio de Janeiro, Brazil. IBISS aims to develop new
forms of preventive social health-care aimed at the poorest part of society, especially at
marginalised groups such as physically, mentally and socially and/or economically
disadvantaged youngsters (street and favela kids). In this way IBISS tries to contribute to
the development of a ‘Healthy Society’ in which Human Rights are respected, access to
public services (for example education and health care) is guaranteed for each citizen,
where social injustice is eliminated and in which citizens are entitled to free cultural and
mental development
Section
1 Summary of
the practice
2 Level of intervention
3 Prospective users
of the practice
4 Problem addressed
5 Purpose of intervention
6 Context
7 History and process
62
16 Protection of young male prostitutes against
HIV infection, Brazil
Developed by: IBISS (Projeto Programa), Rio de Janeiro, Brazil
Key words: Street boys, prevention, Brazil
• While working with marginalised street boys who were collecting waste from the streets,
IBISS staff observed that these street boys sometimes disappeared for short periods to