Note: Page added to electronic version by USAID Development Experience Clearinghouse Mid-term Review of the High Risk Corridor Initiative Save the Chil dren USA Lead Reviewer Teigist Lemma Co-reviewer Michael Tamiru (MD) April 2004 Addis Ababa, Ethiopia >++ Table of Content Acknowledgement . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ,. . . . . . . . . . ... . .. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .; . . . . . . .3 Executive Summary . .. . . . . . . . . . . . . .. . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . , , . . . . i.. . . .;. ,. . . . ... . . . . . . . :. .. . . . . . . . .6 Major findings. .. . . . ....... . . . . . .. . . . . ... . ........ ... . . ... . .. . . . ... . . . .. . .. . . . . . . . . . . . . .. . .. . . . . . . . . . . . .... .... . . .. . . .. . . .6 1 Introduction ..... .... ....... . ................................................ ....................... . ....... 11 1.1 Background ..... ........................... ........ ........... . . . ...... . ................ . . 1 1 1.2 Overall goal and purpose . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 12 1.3 Objective of the Mid-term Review.. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 12 1.4 Mid-term Review method and approach . . . . . . . . . . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.4.1 Team formation . ... . .. . . . .. . . . . . . . . . . . .. . .. . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . 13 1.4.2 Data collection tools . . . . . . . . .. . . . . .. .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 I1 Processes, Progress, and Achievement.. . . . . . . . . . . . . .. . . . . . . . . . ... . . . . . . . , . . . , . . . . . . . . . . . . . . . , . . . . . . . . . , . . 15 2.1 General . . . . . . . . . . . . .. . . . ........ .. ... .. . . . . .. . .. . . . . . ..... . . . ... .. . .... . . .. . ..... . . . . . , , . .. . . . . . ...... . . . . . . . . . 15 2.2 Project com~onents/Intermediate Results.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.2.1 HTV/ADIS Prevention Practices and Demand creation for services . . . . . . . I 7 2.2.2 Access and availability of preventive services ..... . . . . . . . . .. . . . .. . .. . . .. . . . . . . . . . . . .22 2.2.3 Accessibility to care and support by PLWHA and OVC ......... ..... .. ....... 25 2.2.4 1,ivelihood security for PLWHA and OVC . .. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 2.2.5. Community defined quality of services (CDQ) ..... . ..... ........................... 33 3. Project management .. . ... . . . ....... . .. . . ... . .. ..... ........ . . . .... .... . .. . ... . . .... . . .. ... ... . . . ......... ... ;. .., . ... 34 3.1 Implementation arrangement ............................................... ................ , 34 3.2 Coordination offices ..................................................................................... 34 3.3. Sub-granted partners.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6 3.3.1 ISMS0 ................................................................................................ 36 3.3.2. Population Meida Center (PMC) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . ... . . . . ............ .......... - ....... 3.3.3. International Office of Migration (IOM) . .: .......................................... 37 I ,, . . ~, 4. Financial Management ........................................................................................... .3 7 5 Monitoring and Reporting ........................................................ , ............................... ;.37 6. Conclusion and recommendation ............................................................................. 38 6.1 Conclusion ............................................................ .:................................... .3 8 . ,, ~, ' , 6.2 Recommendations ......................................................................... ;. ................. .,3 8 _ . __,. ,- - ...... References ........................... ,.... , .,.,... . , ...... .;. . , .",. ... ,,. .... ;. ....... ,.. . .: ...... r;.;:.:.:. ..:2.,:K... .::. .: :.+,+;~&r;.i-i"3q-:2g42 Annexes ......................................................................................... > ...... .*r4.;.h*;-z-,, :-;~Ti-..~~43s~ez~,+42 -, Annex 1 : Tables generated from Mid-term Review survey ................................... 42 Annex 2: Performance of the initiative based on PMP .......................................... 42 Annex 3: Tasks of Team members ........................................................ ,.............. 50 Annex 4: List of people and Institutions contacted ............................................... 5 1 . , Annex 5: Data collection Instruments. ................................. .. ....,........... ,.,, ..... ,,,,,,,..456 ...... ....... . ............ ..... ....ax ..... ......... . , .", <* <. -.,.- -*~. ,$d-2s3,a" :.>- .* >. , i , - :.)"(.,.*C:l@:- ,.* :, " *, , ",. ',. .,?..m,>q-, .",:.*:?, .,".%.*.,-:&*A,&>.:;S f?, %: . 3 . , ........ ..?,*,<*. ./..*-.*.. .:.. " .-- ... - . ..... . ~ " .- ,* - , 2,' - ......... ; ... %....-.a ~*a%"*v#"*r***-&:M*'J* . . >! *.,..: . . Annex 6: Assessment .. of ............. VCT/STI: services'. ........................,,,..., .. , .......... ,,w--ss->..,,...-.-Yi,i . 78 .. .....*2#w..--..... ~---:-=~--*w* r.x.",a *ipj.." r -,,.-..- rru .*.>ce,z& - e:,,,**-T-,s&- ":." %&&&: *..'%..2w. - 4/,&+ *:sik&i':* ,"'. . =m ........................................................... ............. e "' ,%.-.<,*<,. *+*~.@:**;gs$*~g+~;:->:&-;":.:&. . : . *+^., .. . Annex 7:- ' -- *T*r..n-" $' .. *:-;r;..; ;,:. .&a*.. ..&. *<;:+,. 2 $*J&* iv&&&>A2**yg$$,:3s L&g;8v*4,.h<<- %"%, \ > . >. .<., epth Interview of service provider ,, , . - ...... ', . . ; ,, .-,, , ,," " * \ . -, -.,- G" ","T<'P.* ,++ *~*a &%&&*. A".; ,., ., , . ._,.. -....._ ".." ,,.,>. - ,,+,, , . ................ Annex 8: rans script ion df the fn-depth Interview and ~6cus ~roup discussion with serv~ce users ....................................................................................:............. .,.; .-: *:::.-. 42.1. . , , . Acknowledgement A number of people and institutions have contributed to the successfUl completion of this mid term review. Members of the evaluation teanwishto :re-cord~ tk-irappreciation for the support received from every individuals and institutions. We ~ould~~first of all like to thank all respondents the in-depth interview and focus group discussions (community, government staff and officials) who gave us their time in providing vital information, advice and share their experiences with utmost sincerity. Their contributions to the success of the review team are ~~aluabke~Secondly we are very gratefbl for the SC staff that helped us in organizing and facilitating the mission. Special thanks go to all SC coordination offices in Nazreth, Awasha and Dire Dawa and the coordination team in Addis Ababa. Finally the team is honored to have the privilege of taking this assignment. It had an opportunity to study the process and progress that HRCI undergone and learned a great deal from the experiences of the diverse activities of the comprehensive HIV/AIDS prevention program. ARV BCC CBCCC CPP CHBC CRM D.D FGA F19 FGD FHI FSW HAPCO ID1 IEC IG IOM OSSA ovc PLA PMC Acronyms I Anti retro-Viral Behavioral Change and Communication Community Based Child Care Center Community Defined Quality Community Planning Process , . '~ """ Community Home Based Care *." , Community Resource Mobilizqtion -," ,,.,..,. %~ , . Dire Dawa Family Guidance Association Focus Group discussion Family Health International Female Sex WorMers HIVIAIDS ?reventi~~.a!~,,C,4n_tr,~~~~rC>,rganization . . ,... *.,.. :" , -7 ,~ ,,.,+ 4<.;L:,,.. ,, ..*j-:i;l."~:"~2~~~.*~*.-~>=*~I:I:I:I:,cc-~.~i>?..~L2*%.~ . .,?.+ ,*:--. 2% - "- - - -,-'lar..&*%..Lw-- *: ~ < :* s-:~*c\ b- ... .&.. --, --. +, High Risk ~~o~idK~nlt~atl.ve-,~ .. - ,-.*2..n..,- ', -.,- . , . ., S%, ?&:: " :-;. " .*a *.r ;: .. ., .. , ..,,&,' -"*<'.- --,... .. ;,.; . : i:.. .<:.i !".;&>-<:.:iv..; , ... ,' ~ . :,. ., . __ . , V ~ . ,.,, .-. ', . , , .;. 5,. , , ." ..,~,. TCt, . , .+ .* - . , , ,.*> i -i -, ri *i . " " " " ,. , , , : . , - -- . ._. ,,, l. -_ .__~.,~p__". "I , ,% ,. ," . . ". . ,.- . ,. . ." ( _ .I. _" .. . Information center . , In Depth Interview Information Education and C,~mmunjcation Income Generatinglion .. "., . International Office of Migration Intermediate Result Integrated service Aids Prevention & Support Organization Opportunistic Infection Organization for Social Orphaned and Vulnerable Children Participatory Learning Approach Population Media Center PMP PLWHA QoC SC SCIUSA ST1 TOR VCT Performance Monitoring Plan People Living With HN/AIDS Quality of Care Save the Children Save the Childredunited States" of ,&neri,ca .*-. . Sexually Transmitted Infection Terms of Reference Voluntary Counseling and Testing Executive Summary 1 '. . , ! I ,I , - The High Risk Cbrridor Initiative (E[RCI) has an overall goal of reducing HIVJAIDS' transmission along the major trade route with a distance of-about 2000 -' .** ipe kilometer -;I Y ."-,~ -*. .,* from ..,.,. -. . , . , ., , , Ethiopia to Djibouti through the Afar NRS and Dire Dawa ~dministration. The"initiaiiye . ., . -,A , , , is planned for three years (2001-2003) and the project agreement was signed on July 2001 although the implementation started, in, December 2001 due to the , "" delay ", in administrative arrangements. The initiative targets to reach 10,570female sex workers (FSW); 956 hotels and bars owners; 5000 truckers, mechanics and truckers assistants; rn 5000 Dockers and port workers through its comprehensive HIV/AJDS prevention program. It also targets those associ&~.wi~h+thee$rgsp~ sector, particularly related to transport of relief/food aid commodities. -. ,'=I .--i-4-ir .-. -.*--i;r;~+w4e Its comprehensive ,.. . ..., . ,_.,,~~,.d~,+ program ..~-, .,, , is inclusive of a ~ .. 8s -"-A.m, ,,. ~m comprehensive prevention, care and support, and impact mitigation of HlViAIDS. An Evaluation team was,.fielded ‘- ,$. to -" review .- V4-xae..-+ ,,-- the appropriateness . .. , ; ,*+a ,%. of the ,- , project + planning in relation to the intermediate,r~lts ...,et -, in b.. the ,,.., planning Gcument and the implementation process. The evaluation focus~ed on assessing the project in'terms of its appropriateness (strategies, activities, inputs and intended outcomes); level of collaboration betyeen ,..~ " the ...,., ~-A different stakeholders and programs; its role in mobilizing the communities and their structures; and the progress made towards achieving the intermediate results A range of qualitative and quantitative informat.ion gathering and methods of analysis were used to compile this report. On-site visits* and, rev~g~~~~~of~~s~c~nda~y information were also used. to acquire adeguate insight on the ,"project's ~erformance and. , - - -- effectiveness. ~c~~rdin~l;, the following . .~ are &major findings of the evaluation;, ,- , . -,d. ~ ,,"a,. . -*-*',,,, ,~ ~ -,. ?+ +~,*.i~.;~?'~-..;?l15:5:5:~t*~P~+'$~~".Vii9i4J~jj , ... . jjjj ,.- -. . . .: .; a , , - .;, . ,. ",.. ,>. . ,: , , ".* ~<,< - , -- - . - .- - -. -. . . *z %.. z%*&-Az~~&~?~<*":;~..< ,.&-*>+ .'*> +: *,% * ,\,w ::;pz~;&yq.&pg~:@&$:;;;i,&;* ,-+.!- L - ,* . ..- .- ....wx -A" ~*&," %:. 4; ?+- ".*->*++w&.*"$~r . . Major . ~ :\> ~~$$+&~7~~$~*$2$>55j;?~~~~~~$~;.~~~p~q.~~+3.;5~*7~~>5*~3;;3* findings , . ,.,, $+-. -., . , . .: re% ~. . - --l..C- I,.., ' .,. ~ .,... , ,.... " :_._ .,_ I . -< , , .. " . ". I '/' " , :.l ".+__ . . ~. , < . .-,, ,,".. ,.,,, ' . .. ,* "*; ..>',," .... j. s,;& . . i* The project has made remarkable achievements in ter.ms,:ofplacing the'appropriate'and necessary structures to achieve the, expected results from the implementation of the project. This was particularly significant given the short period (18 months) of project implementation and limited- human. respu~e,, availrtG:,>~.:~"$; both in its coordination "h offices and partner institutions. The accomplishments of the project realized thus far are indeed exemplary although there are some more challenges that require fine-tuning of the already adopted strategies and initiated activities,, Commit,mentwrand motivation of ,. ': - . > "~,:,,!,t$;>- "..? .,>,:;.*- *. , , , . ,&&! :,,, project staff at the various levels.was~,~a~,major contributing factor for the extraordinary . , accomplishment recorded by the project. , , . ' . . Good Practices Among the wide range of achievements made- by the project, the following were prominent: The revision of the project based on its initial experiences enabled an appropriate shift from both planning and strategic point of view. Laying the ground for a comprehensive and integrated KIV/AIDS program along the corridor, s'kttingup of the necessary coordination structuresand smooth operation for the implementation of the-diverse care, support and accomplishments registered in the preventive services in the short project implementation period is exemplary. Linkages established. with different .sector ofices and~~socia1,organization has helped to create a sense of responsibility among officials of line offi,qes, committee members and the community towards supporting the People Livinb With HIV/AIDS (PLWHA) and Orphan and Vulnerable Children (OVC). Facilitating and/or developing local systems (instituting and/or organizing committees and establishing integrating Voluntary CounseIing and Testing -VCT in government managed health providers) for sustaining the initiative make it most appropriate and relevant program. Regarding the targeting, involving the street based FSW in the preventive aspect and street OVCs in the care and support program in some of the sites visited is appropriate. IR1 HIV/AIDS Prevention Practice andDemand . , c, :,%,,.. ;$ Creation r*.-w,2*,.+.,~ .z.yji~~m for z,"d.h-.*w->. Services % . , .-A,G . , " -,,. . In addition, to its expected services, the Information Center(IC) has been considered as a referral point -fir the community not only for VCT services but also for. medical information and coordination center for vac~ination,-~in,~~Mojo and sexual harassment reporting center in Mille. In addition, it has been serving the residents of the rural areas in the vicinity of the towns the ICs are located. Users and stakeholders have received very well the cassette serial drama and the recent IEC material published in the different languages. The messages in the drama were easily understood and taken up by listeners and disseminated among the community In addition, volunteers and counselors of IC are able to initiate socialization forums to reach the communities and disseminate information regarding HIV/AIDS preventicn Although their outreach is limited due to their capacity to finance these events, the icitiative is sound outreach strategy FSW contacted in every site visited sic well aware about the HIVIAIDS prevention and control practices and are effectively using the services of the IC. The inception of the FSW association with 186 paid up members and its sibling (girls' HIV/AIDS clubs with 80 members) in Mille is one of the best out come from the thrust of the project. The Association has developed an effective network with local administration and police to address the sexual harassments that FSWs are currently facing. IR2 Access and Availability of Preventive Services The VCT services have been given high priority by political/administrative officials as all Regional Health and HIVIAIDS Preventior, and Control, Organization (HAPCO) officials expressed that there is high level of political commitment to VCT as part of the overall prevention and care. Its benefits are well understood. qll sites have conducted .,. -, advocacy/advertisement activities to promote 'the VCT services. The promotional campaigns that are carried out through various medias have contributed to the ,increased demand for services. The availability of VCT services in all the sites is considered as one the strengths of the HRCI project. All visited VCT centers use uniform referral counseling and testing procedures. They have operational guidelines/manuals, training handbooks and other relevant forms and formats inline with the nat.iona!e~ecgion .... .$ ...... guideline .... This is one of the strong aspects of the programs that place systematic approach and standardized procedure. In addition, the centers have well-trai,ned and motjvated ... huma~~res,ource,who .;.'?. ........ *. . adequately recognize their role in the community: The HRCI'program has done a commendable job in building the required institutional capacity at project level. The referral system adopted in Mojo has great potential of ,reduci.ng the possible fraud that might arise from overusing the care and support of the comm,ittee,. (Fraud in over consuming by PLWHA has been identified i.n Dire ,,c,r33-,%s, Dawa,--D.D) *~-.. ..,%,;:. ..... VCT _. ._.. services were developed and accompanied by appropriate supportive HIV preventlo!? services .for. . .., clients tested sero positive. This has contributed . . ...* n, to .-.. r-*~*ibl~.-,ew;,*i~~s~a~~~,~~~~~~~+~~ make the community LLiii.i,i %.-, attitudes -=-,$ .z . , .. - ........ favorable and their ,in JrCT tp, be high.^, ........... - .............. ,.... , ,, 1* . * ~. . IR3 Accessibility to Care and Support by PLWHA and OVC ........... Although the committees have not yet gained from longer period of experience and skill development exercises, their ability to raise the 10%. matching hnd through various ways provides indication of the potential for furthering the approach for acquiringensuring sustainability. The introduction of an organized community care and support for OVC is very likely to contribute to the development and strengthening of the new and existing mutual support systems. Although mutual support systems are weld..practiced. in ~ many communities, adopting the objective of care..anA,,suppoft 'in the area%~.f.+~Y~Gd,u&%dL~~caP,k~~3.~has; .~.,,v~.,u.a~D~~w,, given ..... " ................. .......................... . promising . insight to the community. . . ...... ........ .,.- ,.' , . . . ""b"> , ~ ,> ** .. ,-,, , , ........ . . ., (*. &- *:~-;7a-&~+-&~~+h7*$&~*-w:x&*zm ::c-*- >, - -. . - ,<, . '***,-z ".pp-rifl*"?n?r,. An 1ddir.allows~pait of its plot for the set up o (CBCCC) and takes the, responsibility of ensuring appropriate 2are~~o~Q~Cs Lfeedjng and follow up of children under 6 years of age). Thelddi'ralso fiusthe gaps created due to late financial transfers.. . The selgctioq, of, such..l%& $gc$ge.s_-g ,,.$ $?e,%!v:. and% .. ... sustainable management is vejrelevant and appropriate for the success ofthe initiative, The Community Home Based Care (CHBC) has offered a range of positive effects in terms of reducing stigma and discrimination as ~ell,.~as,,in~creating a positive reception of the issue of HIV/AIDS among the residents of,. the .-". ......... visited ..'. . c.-..u.- towns. rw.,l.~.c, .. I.,~LL-d&h All *>A. contacted rx:-(i;.._ :.,+ ....I.... :I.............. : community members 'and PLWHA? .are Xefy grateful to CHB.Cs' commitment in venturing in an activity that is socially not yet accepted. Issues seeking more attenti,on ....... , . , ,,. , . , . Despite the remarkable achievements recorded by the project, its effectiveness has been constrained by factors presented below and some may require alteration 13x1 HIVIAID S Prevention practice and ?eman$ Creatiy4.$0r Se.,c$es, . ; ;, ....... . . The IC staff and volunteers have been attempting to live up to the challenges of huge information gap. The attempts made to fill this gap by collecting publications from passer-bys, locally produced scripts havenot been.~~@%~~~Landsomesit~s~~~T~g~~~~,fo lL9. ,%" r4,:t",d.aq,q transmit music to fill their. ai-time In addition_tp_a~b~~r~~a~~k~i~~oftp~As~~~:!~?~. gc materials, the need for variety serial drama and..o~~~~.,~~~~~s.suchasvideoca~~~,f.:~~i~~~he . . , , Amharic, Oromiffa and Afar languages is high. In the use of local!^ produced IEC materials, the services of the IC have ' sufferkd from "+~o,w,. capacity of its staff and volunteers in the design of IEC materials, write up and editing scripts. Potential users including PLWHA in some sites did. not~.knowv~~~a~fl,i~~s,~y~~le.di~~ the IC. The outreach service has_not been~sufficieap~,to,ade~quately inform the residents of the various sites. In addition, the absence of advertisement (posted on the ICs) contributed to inadequate recognition. In addition, the IC services at the mainlobligatory truck stops, for example, Galfi, Awash, Dewele, are not efficient. to adequately contact TW who could have ample time for counseling. The IC staff did not feel responsible to network with &t,i:.W.v!WS chubs "!!9i3!!E:.A,!0~~." ,, _ .. a ,,, , , ~ the Youth- and Prevention sub committee while it is vital_for,sha$g information. While it is relevant too promote non-IC based services, all ICs contacted have weak linkages. Although this is an area currently taken up, unavailability of the necessary funding for the IC to participate as well as to coordinate the public events to work with the clubs may partly impair its progress. Potential adverse effects of- rec.s~iting volunteers from Anti Aids Clubs have been observed. The pulling out of active club memb.ers,in Chle.nko (by recruiting them as IC volunteers) had resulted in the disintegration of a school Anti Aids Club. Had.therebeen appropriate linkage developed between the IC and clubs, the program would have benefited from managing attrition of volunteers easily. The project intends strengthening the link with local community structures and one potential area is linking through the IC. Although there are some attempts in Mille, the IC had played inadequate role in promoting local partnership in most of the sites visited. Its link with local institutions such,as Iddir and Mahzber-is not yet adequately attended. The IC counselors and volunteers are attempting to educate community members adopting un-institutionalized activities such as the c.offeecere,mony and participation in public events. Expenses involved in these activities are bop by the IC staff as it was not budgeted. Its continuity is very doubtkl in the face of absence of any other budget allocated for operational costs of the IC. IW Access and Availability of Preventive Services Although the heath workers (VTC counselors) in all sites surveyed understood the benefits of VCT and perceive it as a priority service area, health service mangers in Mojo and Mille were reported to have inadequate commitment (provide additional room, poor attention to VCT and STI, and scheduling of service for few days/week in some sites) to integrate and promote VCT as a priority program area and major part of their job. This has repercussion on the commitment of staff in the centers as appropriate administrative arrangement to reduce workload is lacking. . " I -. 1 ' , , ,,'.. , . ' . , ,. .,, ,. .. - ...,,,. ,.\ The VCT and IOM have been ,,-, linable , ~ to , .- &ond<"~ , . *,,,>,**, ,<\>. j$+,L~,. : ,\., -,,)., , ,- - . .( . . * ,- _... * _ ^.. , ",...\ ^, . 1- . . ,. "_ ^ , ~ ..z -a .. "',v,~m. . , * . 1333 ~ccessibilit~o 'Care: and :Support by PLWHA and 0xc+~ *.~ *,,..A,,. . .,. . , ~".,-. ., - . - . . , :, ; . , - . , , ,.. .,,. . " - .- ,> '." . . - , . ,... ; . L-- *"..i*&-*,-y.>:,,:* ;-*~~r-bb~i-*+xri*~*\iz,iz,~,iz,x-.j~jjr,;~ &-.- I,;.*>; ,*,., , , ., , , .: , , .' '." ,.; , _ -I -- i , i, *,,, :. Recruitment of the iom'mittee ;members ~.. .;..T.,q:,a2" upon appointment by their-,respective institution . . (due to the tendency to maintain H4PC 0'" s .st,-uc&;e) Kas'.n5gativ,ely , ., *-, . ,.:- -,,<**. contrib.uted, e,s-.v~.." t.- ,+-,. ,-. -. to the expected outCpmesL _Except for Mille, all contacted '~&m@~ttees~~,&ad,"~,operat~d sub optimally due'to lack of genuine commitment by the committee membg,-1n addition, most committee members represent formal institutions and,:theirtr,ansfer a$~qr,$ttriti?n,, has affected the progress of the committees (for example Nazreth, Mille and D.D) arid this is very likely to create an operaiional gap unless corrective measures are taken. .. . In addition to involving in overlapping responsibilities, all IC counselors and ,volunteers, in Logia and some in Mille .are.me?;nbers of the.H_Il/M@eSprevention committeevvlit!! a"?. "", . ,, excuse that there-are,no,lite~a!e people in the town. O.n, t!~~...otl~!%l~g$, members reported that there is a *,work160.@. The deminafion few,inPj~j&~&g&~~ blocking of dthers 'from the"exposure and participation may effectiveness ~. of the initiated activities. -. ". , .,' - , . , , ,.,,~ . ,,*,,t- .., , *~ . , . , ., ,', ~ ,, The sub committees responsible for the care and support for PLWA, OVC and fund raising members seem to lack understanding as to how they could discharge their responsibility. Lack of clarity and inadequate skill in the process of project implementation, financial management and supervision, and monitoring has created uneasiness (and led to unintentional personal fiictioq,in_ the,~ca~e~.~of .,Logia) among committee members. The fUnd raising committee limits itself with cpntact,@ ~m~mb~~.~~~i~~~~,t.*~~~o~~PP~~~rI,4~~S, ~a *, , -. ., . ,. . not yet developed linkage with community to mobilize .cowunity resources except in Mille. Members understanding and recognition on the relevance of.,involving the community rather than the local formal institutions in the fund (raising as well as in participating in all the efforts of the HIV/AIDS is nqt,sgisfac~. Members of particularly the youth and prevention sub committee could not think of an activity that doesn't require external fbnding support with an assumption that fhnding is imperative. Out of all contacted committees in D.D attempted to link with the HIVfAIDS club and Logia linking with school recently. Lack of direction and technical backing for the Youth and Prevention sub committee in their perceived activities has made them inactive. 1. Introduction 7.7 Background The High Risk Corridor Initiative (HRCI) has an overall goal of reducing HIVIAIDS transmission along the major trade route that has total distance of about 2000 kilometer fiom Ethiopia to Djibouti through Afar NRS and Dire Dawa Administration The initiative is planned for three years (2001-2003) and the project agreement was signed on July 2001 although the implementation started in December 2001 due to the delay in administrative arrangements The initiative targets to reach 10,570 female sex workers (FSW), 956 hotels and bars owners; 5000 truckers, mechanics and truckers assistants, 5000 Dockers and port workers through its comprehensive HIVIAIDS prevention program It also targets the transport sector, related to the transport of relieflfood aid commodities. The initial project document considered Behavior Change Communication as its major focus. However, the need for broadening the scope of the program to a more comprehensive prevention, care and suppc.~, and impact mitigation activities became more evident in the course, of the" first year of the project implementation. This has necessitated the redefining of the project strategies and activities to offer wrvices that are complementary and inclusive of counseling, establishment of VCT centers, support services such as capacity building, psychosocial support by community members as well as mitigation of the economic problems of PLWHA and OVC. To inhance complementarity and effectively address the divers and .complex componentslintermediate results designed in the intiative, SC/USA intended to continue and expand the existing preventin activities along the corridor. This had called for identifying and recruiting capable local NGOs and other implementing partners in the target area. In this connection a local NGO, ISAPSO, and IOM were sub granted to implement the discemination of IEC materials in 21 towns. and setting up of the VCT centers in 7 sites. , . .. . . , . , , . - ., - , ,. ., \ .,." . \ .. . " - -, , .<%. . ,,,. , , . ,, "". ,".> ,& ... &, ,.,%<,.+" "~.% ,,~, ,:,, This arrangement together with the r&viaion..of.the project to include th6,.c,%& ..a$ ,"".. ~,. :. . .. support, and impact mitigation component (approved in August 2002) enabled the initative to involve in community-based activities that has positively contributed to its i increased de~el6~rnenfaI ik@t This has bken,,acc.p~mpanied by positive response from the donor, USAID, to provided the necessary additional hnds for undertaking , .. the current care and support, and impact mitigation components. 1.2 Overall goal and purpose The current HRCI program included five major strategic objectives that leato the ,*,".," ,.,%. . , following five intermediate. res.ul&congluent to the national WVi.+=S ~ofic~, national strategic frame~work and program guidelines for 2001 I-s>.,2$25,&a&ingl~, the HRCI targeted the following major Xermediate results to pe,~~~~~~k~~~~~&.&~;,pro~ect. , , , , , . . ""....- , period. 1 Increased HIVIAIDS prevention practices and demand for seryjlces; 2. Increased accessibility to and availability of prevention services; 3 Increased accessibility to Care and Support by PLWA a'nd OVCs; 4. Facilitation of the livelihood security of PLWHA, OVCs, care givers and affected families. 5. Improved Community Defined Quality (CDQ) of services; ~ ~.. . 1.3 Objective of the Mid-fedrn peeview , a. -.. , ,*. -*. .."" ,. ,,., ~, >. ~>,.,, sb , . , .., .+,,- ,"~ ,,*-.,*, %., ., .. ,-, . . , , , ,. " ..>>, . ,," ,, . . . " , " ... ." ..i'i- , .,.., "'.,,,..*;,.I:..'.: .-. ".. . . . , , .c The overall . .. -. objective I - - , _ of _. the " __ _~~.i_._,__ eva~atipn~~istomakea~omprehensive _ *-_ a$~~?%%f-~@..th?, ~., .. - progress-of the . . .. . mCI -~~~~biri.5:c,~...n,iarhei'pI.~r~.~ program and xlAuw.af to --, chart .** - the,succega&operatibnal li&t-atk?ns.thatG**s ... + ,..,* ,d.%dd~,wi-~~n~.,- -#~.,,* ,,+&.dA--+,: , ;:- <+, , contriGute to the ...~~~~~~~G~IS~~~~~~S~:~~~ ~.~nte:~e$jd~~&@&$~L*~~~~~~$x,th~ng~g~:ry;m ,am ,, .. ,< , ,,. , alterations to improve the quality of the services established by the proe~ct humg . .. tfie . remaining implementation period and forseable future. &is specifically intended To assess the level of-achievements per intermediate result, using the HRCI performance monitoring plan (I'm) To identify gaps and successes in the implementation of the prevention activities against the original plan To assess the level of participation and involvement. fro.m~,thesst~~&~&:~per component or intermediate. resdts at -the respective project implementat.0-n ~ltes. along the corridor route To assess whether the implementation strategies were carried out as planned and to identify and explain obstacles, if any To document best practices and challenges for organizational learning as well as to share with relevant stakeholders including the donor. A review of the planning documents of the project and progress reports fiom sub granted partners as well as the three coordipation o@ces* was *, -,,.2,-$-vq, undertaker_l.*dung e .. .-- 7 -,,\ ~/, .,.- a,.c4. q the review period. The team has attempted to acquire a good grasp of the goal and objectives of the project, and the operational principles utilized during the implementation process. The review of the implementation process has included the assessment *,.+*'. ",,. .,.. of , ,- , targeting, ~* *s setting up partnership and facilities for HIV/rliDI)S, linkages with national policies and programs on HTV/AIDS and STI, and other relevant national programs and mobilization of communities. In addition, the progress made particularly in terms of its programmatic directions, outputs and placing the necessary networks with communities sincehe implementation of the project in 2001 are also assessed. In both . nationaL~ancJ / _ ___ ..*_ ,local,. ,. . . , contexts, the relevance, effectiveness, appropriateness and sustainability of the project components are also reviewed,..,The,.implementation arrangement, financial Management and the monitoring and reporting systems are also included in this report. In addition, the lessons learnt and reflection".o,neach project component and strategic issues are assessed, This considers .the as~ssm~~~c,,~~4e~~~~v.~~stems , *- developed for sustainability (adaptability, replicability and appropriateness) with a particular emphasis on the ccmmunity-based HIVIAIDS and STIs preventive mechanisms introduced by the initiative. A review of community and stakeholders participation and integration of the project activities and the efforts made to mainstream, gender are also conducted. 7.4 Mid-term Review method and approach Consistent to the objectives and directions stated in the Term~..of,~Reference, the following methodology is adopted to conduct the review and compile the report. . . .. 1.4.1 Team for~nation The initial plan to include stakeholders inthe review team fail,ed> due to,, administrative . . - ,.,. mi,,.*,-> -,, .*,. , rf . . . *. reasons. Therefore, the review team consited of two professionals and was accompanied by a staff from the coordination offices for the w coordination , -~- + ,:,. of . thereview ,,....,. *..A- ; . .. activities. j..r5 +~;, .*rl"f..~" The -a< . -, lead consultant take the re~~onsibilit'y of ensuring that the terms detailed in the TQ& are , discharged appropriately. The regional HA-PC0 and Health Bereaus in Oromiya, D.D and Afar are contacted %ng the review period. 1.4.2 Data collection tools , . . . . ~ Desk review The desk review task includes an assessment of available , .%a .-,$ ,". ..,,> from ',, **,, A~:*T:a"- the x,.,, ,existing ,.,: h~ > planning documents of the project, the memorandum of understanding signed between SC/USA and sub granted partners, progress reports and other relevant docume,nts such as baseline survey and assessments reports. This exercise has helped the team to develop appropriate guides/protocols'and checklist and design other data collection tool. Data collection tools . . . ., . .", ., . ~ i , ",,.." , , The evaluation benefited from drawing ,.*, . an exhaustive data from *he gfe,ryigk~.i~sin~ of tape recorder, as interviewers get a chance of concentrating on probing and spacing questions. .' , An interview guides for both the in-depth interview an&,fo.cus group discussion that includes list of generic, target and issue/ Intermediate,. Rgsubs (IR) specific questions were developed to make the interview" comprehensive and systematic (refer Annex 5). The guides are designed to include the, participants and stakehold~~o~look,and,fee~ings about the project and the various stakeholders, their experience in the project, their knowledge "about the project activities, the process, quality ..... ...,- of 'service .~ ". s - 'delivery and outcomes, participants expectations, salient features of,tine,iroject and their perception on the changes they have madelacquired due to. the project. The interviews were conducted with Information Center counselors .>a and . 4. &%.- volunteers .r,'.%>Jxw.++2~ .? ~. VCT .~ ',,, ,. Counselors, ,- . ., ,. ?. CHBC volunteers, FSWs, PLWHAs, OVCs, truck drivers, youth and committee me.mbers: . In-depth interview (IDI) In-depth interview is designed to capture detailed information from clients and stakeholders for the team to exhaustively assess the relevant issues In addition to the above respondents, the in-depth interviews with key informants from the public sector (Administrative structures, Health Bureaus) and private sector (hotel .. , . .., , ,, ;.~2,.<2..a. ";,<..; :-:">.-",. ,,? *,.* :. ' . ~ Focus group discussion (FGD): The objective of the focus group discussion . -.-..,. -. wasto ,. *.h. . adapt and facilitate participatory impact evaluation methods~.and,tap relevant information about the feelings of target groups in terms of accepting the services, systems and strategies introducedlenhanced by the project, assess the commitment of _stakeh.olde,rsw=andddthe ., ~.,, , ., ,,, ,, , available potential for sustaining project components. ' Each group included 6- 12 participants and , their transportation costs was covered b'ased ,on the-.gar!@- practice of SC/USA. This discussion provides a social. context (group dynamics) and helped the team to capture information from the, interactive,,, ~i~~~,s,~~,n,~~,rl/g~~~2f,erpersonal interaction in the group. Due to the availability of limited number of people the FGD with youth in Chelenko, Committee in Mojo & Nazreth were conducted with,,!e% &an,,8-; A,, ,,- , participants. . . ~ ~ ",. ' Structured questionnaire: Structured questionnaire is used to genefate basic and some qualitative data on relevant issues~,r.elated,.to kn-owledge, attitude and practice (KAP) to assess the possible changes in behavior that have beeq brought by the project in the last couple of years. The questionnaire was ad.mi-ni.stsr& ~i~.~,t~e,..;s~~u,randoml~ selected sites for the review. Tk respondents are selected based on their income status , and direct and indirect contact with the services, offered, by the project. A sample of 50- 180 respondents were contacted in each site . , . ,, Data management and analysis The ID1 and FDG are reco~ded~on 60qassette~ and , transcribed , . (ref& .. Annex . -: ,7 . - & - Annex =a .. . . . . I 8) and analyzed in conjunction with the results from the'data generated by the ~stGdtured questionnaire. Report writing and feedback The outline of the report was discussed with the SC/US prior to its adoption. Team members review the draft, report before submission to the SCRJS, The ._.,, data .,,_ _l.C. from _,, the _,b___. structured questionnaire is processed ahd analyzed using SPSS and Excel. The team has reviewed the draft repot before submission to the SCNSA. The", revolving fund and school quiz competition afci ~~~~$.g~,@g~t.i.~~,,~~~h~~~anges have , ~ imposed further challenges that reiuirefl additional. efforts.. andresourcesinthe -Ti process I . ., of implementation. -, Compared to the plans in the planning document, it may seem that some of the activities planned in the document are over ..or under. .$tended. . ?$,!,:$l)*anges made to track the outcomes in the various processes of facilitation and" m+ilization, .~ .<. . nonetheless, was instrumental for improving the effectiveness and appropriateness of the project components. Some examplksare to train the VCT co:u,n&qrs.,~ per the agreement with health bureaus and mqveinto fulfilling the facility in order to avail the.servic,e,by filling the gap created by commitment failure by the government stakehdders. .."., ~ . ., ~ . , . ... -. . , . " . ' ., - -.., ,. .ti i. , , ,, . untrained counselors. The average daily intake of ICS ranges from 2-4 persons per day in one-to-one counseling although estimating the number of people contacted through group counseling was difficult. ~lthou~h they have a clear picture of the goal of the IC, those who did not received the counseling training ....,.<, expr6sse"d. .%. ><., they ,. z~,a*.,.AJ did , not have the full , . ,...,,.~. . ,.," . confidence in their ability to conduct counseling. All counselors and volunteers 'are wels;. [,,. , ..- ,*<,... , ,..~. ., , aware about ,the, need for.respecting the confide&i,ality .priiiciplei, Kowever, against the . .- .-. , . . .- .. . accepted procedure; however, some ICs receive ~c&v~nte~~~ef$r:$~~f~o~Y,~~~:~~~t~~$,~,.: .: :;"-,:" . .. . ..- ..;.. ) :. '. . . , *$..; i*.ur..\i- + .., -. ~ ", . .~ ,,-, * ,.,. ~ . ' . ...., I:> ."i..j,..--$;,;$f:,-!: z .. .; . .. , "V " ~ ""&i"... -,.: ,......- .,. ,, . . , ," ,"L,..\,.-:>,~~.:=,,*\A~-Az~~. a- ;*,? .>>~ .~-, - - '. . ,, , ,, -. .... . .,~ , ,~ ," -. . .*,- ~ ,. The IC staff plays a very important role-$ th.g,15fgigf systems. For m&t;nC..,,... ,.. for ~ the HIV/AIDS prevention services-IC servi-ces, VCT counseling and condom- (Table 7). . .. , . Users and stakeholders have received very well the cassette serial drama and the recent . . ," IEC material published in the different languages. The cassette serial drama has been very influential in terms of arosing interests of users , .. in: ,, the issues of m.VtAQS. The , , sound system mini media also uses the currently available serial drama. The demand for.^ more and other varity of'seriaT4rama FhighIy"incr&sed. 1n"addgiontGe @slatjonnof ,,.., ,. - the existing IEC materials, the n&d for other varieties oftserial' drama, a@;.gherP;media_.. such as videocassettes in the Amharic, Oromiffa and Afq 1-anguages is very high. The .. k sound system has been very effective particularly in towns where the IC is lqc~d, 3 % :. central places. The team is informed that the.loca1 c,o+m$pynity events on HIV/AIDS is A.* .a*P been video recorded, for example in Chelenko are available., It ,might be of interest to -. ii . review such materials fq development and publication of IEC materials,in future., In addition to the very low capacity of staff and volunteers in the design of IEC materials, write up and editing scripts, the IC did not have any other source of audio inputs for its sound mini media. The staff, counselors and volunteers, have been attempting to live up to the challenges of the huge information gap by collecting publications from passer-bys, locally produced scripts (fiom individuals, anti-AIDS clubs in few cases) and this is very far from being sufficient. Most sites are forced to transmit music to fill their airtime. Users have al~o~expressed the need for more audio and visual electronic inputs to the IC in this regard. Clients of the IC, community members and almost all FSWs, have been using the condom distribution sewices very effectively. They also have indicated that the IC service has contributed to bring change and increased use -of condo^^ in, the community has improved in the last two years. Respondents also indicated this achievement (Table 8). The IC staff are very committed not only to discharge their responsibility but go beyond to educate community members adopting un-institutionalized activities such as the coffee ceremony, school competition and participation in public events as part of their out reach program. Although the outreach is limited due to the.capacity of volunteers and counselors to finance these events, the approach is found effective to adequately inform communities. Expenses involved in these activities are not~budgeted and most are conducted at the expense of counselors and volunteers. Potential users including PLMXA in some sites did not know the services availed by the IC. The outreach service has nat been sufficient yet to adequately inform the residents of the various sites. In addition, the absence of advertisement posted on the ICs contributed has contributed to inadeq~mte recognition of IC and dissemination of information In addition, the IC services at the maintobligatory truck stops, for example Galfi, Awash, Dewele, are not sufficient to adequately address the needs of the TW who have ample time for counseling. The involvement of the IC staff in educating the community on HIVIAJDS was not limited to hlfilling the information needs alone but the IC served as a center for accessing andlor facilitation point for VCT, harassment issues (Mille) and other medical services such as immunization (Mojo & Nazereth). In addition to inspiring the community by their various activities, the IC can serve as centers of dissemination and coordination points for various developmental activities. Supporting and strengthening IC in such initiatives would have a multiple benefrt - m sustaining - its services as well as broaden it sdope I The ICs in Dire Dawa and.Mjl.~~..~+~v~6~:~~~:&~~~~2-~bbI~j11~~~i~ in information This is encouraging and needto be strengthened in fiiturey On the other" hand, only few 1Cs have been able todevelop contact with Anti, A??S,Cl@,in operating , ,~ in the vicinity. Only ICs in Nazr~th, D.D. and Mojo started with very few clubs. pulling out of active volunteers due, to ,rhg~~$vo$emegin;th~~~bf:~:~:~~a~,~j~~integrati0n an Anti AIDS Club in ~h,eJenko. .-& ..> .,. Although ,-* .*.- *..-?". . this is an area currently planned taken up, unavailability of the necessary b~d~et'for'ih<~Ctq,~adicipate as well as to .coqrdjnate, . ,, , , >k7 , . their activities along this line and participate in public events ".,. , to.,work -.- with -a -~-.--~+.>,:~=A.~.~~~.~~~IIII. the clubs, may ,. . ", .,,-,. . ..,., . . . . ,". ,~ . , impair the necessary progress. . " , . RI . . - " The IC staff did not feel responsible to ~et~~~~~.:~~~+the&c&~&~$$~~~$g~;~~$~~~~~~~~~ jiLLL,i re:iIs., - and Prevention sub committee ,~h,&$~is, vj:afgdshg:(ngbinfo~rmatlon and pafilclpatlon in non-1C based services. The linkage with local institutionssuch'as .. A- .,.,., Iddir ",". -. and Mahiber . ", is not yet attended and ICs had played inadequate role in promoting local pa%lersh;p. Despite the unique and relevant services, problems such as absence of,,teaching aid models, suggestion box, counselors support group, assessment of clients' information .. . needs are outliving the IC. It was also reported that. unclearchain of com.&and .,',, ,,.%.~ ~ .-&.,;-,. ~ SCiLTSA has been affecting the working environment of the IC staff. I. dl Id, ,,, .. A ,. -. ..,,,.. - , " , ". Service us-ers , , .. .. ~.' . CI . ,A+ ,.r" .. ( / ' , . _ a. _ / ^,__ li ,I ' I." . -,- ..",, ...Il."'".I' .s* *,,"" cTT&* -,.- ,,,- : *..I. - ,/.#/ ,JX1 L --I \ , *, . . * . *. _ \. ,." ". .. - " - ' . . ., , . ,, . . -,.. .. ,". ,.. ,>, :- +, .. .>.> - .~., .. . . . .. ii' ... ,. " ,' -> .*, . .^"... ~ ' . .. , - , - . : ,. :. " ..-, ,,, ..>A,.+ <. - .- . . - , Female __,. Sex Workers (FSW) - . -. , ..... .~ -.n as-.--rw-ax-.ra*w~ws;t .b . .,,. , :..,... ..- a#j,,, .-,.,+* it,iu iuiuiuiurlZ" -*-.- --.-. . . . .,. ~ .,... . -~ .,.< . , ,, , ,,." .,, .,,*~*+ak?pa- -.-- 1*-*+&& ,.,; i%L;:&:C.+-$.; itttt:iiii,:r"r r&rrid,dd *$-*!.j.j*si;7&7X . - --->*\"*** %'A" .-+~.",,*%a?., . ., . ~>.-:A.,: .,. *, ,. e:&,'e,;;:., .., &",:: .. >., . *-: ,:a" - ~ . ' .~ :, ,- - -,* , * \ L, .* -, +, .,",-=&'w+w-,". ' - " ' ,- - .", *, , , \#%'*,,y*.sn - - me The contacted peer educators.for~$.~~~ ~$e&&s&ofthg~~A~~p ,saqsi s:+,2 transmission and, prevention mechanisms,APeer,:~~~~$g~e~~~~~s,ed,that they provide education to new entrants particularly those who are brought by middlemen without being informed about the job (sex work). New entrants c~ntacted,~dqlng the focus group discussion also express that their peers and volunteer~.i,nf!!~m~~tt?~n?,~!*abo$the~use~~~~d, ,;,; , .. ,. ,, management of condom and. the,anqedl.for prevention of WI&!?2SL"FSW+? Pass their leisure time by discussing about their partners and HIVIAID'S in addition to ,what they are informed through various Medias. They also expressed that the cassette serial drama was effective in providing them information.?~,.cpp&m~~,.~?~~g~.~,ept (some have learned , from this ,drama:g~~y+~~&g$~y~~~~g.aswell as informing others) and deeper understanding of peoples' behaviors fi~m~he~~~L~cf%ii~~i~;zdi~~e:~g~iF1~r~~L ~~ptx,3~ L32:x,h_ew ,;_ ;,_ ,;< :, ,.,-,, ,.*.,,,,-' ~ The team has underst~od th~~i.3~l~~st,s~t~~F2Em~e~~~~w~~:~fzi~g*~u,sing the services offered by the IC (EC materials, cassette serlal.drama ar?d:cp,~~~p~.-,~up~l~) in the tOwns visited. Apart from ad-hoc shortages of supply of condom observed during this year, they are provided with adequate condom both, the.i:-sworkplace and IC. Although the level of their understsmding on the issue of HIVIAIDS is high, FSWs expressed that those who have regular partner do not use condom cons&te$y (Mojo,'Mille, Logia and Chelenko). .,. ,, . . FSWs' involvemept in,other project activities is ,minimal.-.They have indicated the..need, for having a forum for FSWs to;get'~ogeter 'an3 discuss on; nece$sar)i issues regarding HIVIAIDS. Although almost all FSW agree that their job invoIves in high risk of health and well-being (harassment), their use of the"VCT services-is very low. Many FSWs' are not empowered enough to follow up their syro status as well as to think of other possible areas of work. In addition, they expressed that they are facing sexual harassments d,ue to their request for the use of condom.(and when client is nqli%interested) and only few hotel owners cooperate (if it happens only in the premises of the FSW's work place). The HIVIAIDS committee, neither local admini~tration.~or police are yet ready to adequately address this issue. This gap needs to be filled in the remaining project period in order to solve the problems of sexual harassment andthe experience of FSWs in Millecould be one promising option for designing intervention , . in this . regard. ~.. ,- ~ . .. , . . .. ' . , , The inception of the FSW associationFith, 18kpaid up members and its sibling 'ih~ille is one of the best out come fjrom,,the.,thnst,~ofthev project that effectively address the problems of FSWs. Members cqntribute, E3r 2.00 per month and have. regular monthly meetings to discuss their problems and future directions. The association ,,is,,,able, to include as well as assist about 80 young girls (in and out of school) to establish HIVIAIDS club. The association has the *,objective of educating members and n"ew entrants about HW/AIDS, assisting FSW who contracted HIV/m$S, discuss problems of FSW and find solutions.. The Associat,ion has ..- . s> developed 2m *A%. .& an effective network with local administration, police and other institutions such-as the,Milittay Administration to address the sexual harassments. and,ST.? ,cases ,t~~~+~S,Ws$~;;~~~ly are facing. It has also designed three projects and submitted to HAPGO andHRC1 for;~f~$&~ but has not yet acquired the support. The association has a plan to involve in activities that would help FSWs to do more decent work, involve in community activities and protect their right. Most contacted FSWs express that a discussion on the launching of the IG has been going on with HRCI since last year. As all are aware about the risks igtrolved.,in the sex work, most want to start other activities that are m'01-f: yel:!ab!eG,inr5ite:m~,of$du$ing risks. The tendency of depending on external support, however, is observed to be very high among a11 contacted FSWs. No one, among contacted, has the intention to start other activity by herself. This is an area that rcquiies revisiting. Trnnsport Workers Promotion of the HIV/AIQS preventive services among the TW through involving Federal Transport Authority is one of the sound achievements,,re,cor@ed-by HRCI. In partnership with ISAPSO, HRCI was able to integrate the HIV/AIDS education in the national driving licensees lessons in A.A. and this is one of the exemplary achievements in the promotion of the HIV/AIDS preventive practices. The team was able to discuss with truck drivers in Logia and Nazreth towns. One out of 4 drivers contacted in Logia was willing to discuss with the team and he is well informed as well as takes personal actions to protect himself and his partner fi-om contracting HIVIAIDS. In addition, a representative of a trucking agency in LO& expressed that volunfeersin his institutions are attempting to do their .b"et to keep truck workers infori?ed.,.Qf"t!!ea￾necessary precautionary rneas6-es they could adopt"to protect themselvesand-the.soc+ty at large. However, most of the time his office,.~s~sholtof~~~~.,F~,G~~~~$~~~~.~i*2~*~~~~nuous~ supply of IEC materials and condomfor the drivers . // . . to ~. access . a-.. it.easily ~*.,,, . . in -.. their . , work > ,. place , . is suggested. The truck drivers met i?! ?%?%h . ~~~~~~~~k,~~~~~:~~~~~~~~~A~~~~~,~~~'~~P:~~~d~~f e. .a. >". ~ .- , keen to discuss about V/AIDS. . -.- In~tq~d-of .- ., . ,. .-xiis,, discussing i-mi(-.+. about tie project, the team ended up providing information and answers, to ques$ons, raised by the drivers. Feeling excluded, the drivers expressed the need for having the IC services in the other routes %. . of . . , ,, the country as well. rn 2.2.2 Access and avxzjlability of preventive services One of the objectives of SCIUS cqmprehensive HIV/AIDS prevention and control project is to increase the accessib-ility to and availability of VCT for KIV, treatment of ST1 and opportunistic infecti.ons" The preventivekreatment seryices are <,$.,,, the ,.. central ,.--.",.,. \v ,, , elements of the HRCI I-q[V/@uSe program. According to project plan, the services are considered by SC-US as important sector ofthe BCI program with critical ahantage for being an entry point for the comprehensive KIV/AIDS prevention and care program. The responsibilities of planning, implementation and te~hnic~al" support for the VCT and ST1 centers have been entrusted and sub granted to IOM- and "Q,SS*A%,,z~&ly in government health facilities. IOM has been ,: earlier ., b.,,,t a"c,, ,. experience .*", of managing mobile VCT/STI services in Dissie and Nazreth, OSSA centers. 'The SCcoordipation .%-. team in -, . A.A and coordination offices in the field have involved in'the . 40-ordination , and implementation of technical capacity building aspects. IOM signed an agreement with SC/US - HRCI program in September 2002 and started establishing VCT and strengthening ST1 centers in government health facilities and OSSA (Nazerth) respectively in February 2003 (as securing agreement with Ministry of health took 6 months). As per the agreement, IOM conducted institutional,.assess.meg,,qf &a&h,,,sefyic:s; ':2,c ,.. .., ..,. the target areas and identified seven sites (4 sites ,in afar, and 3 sites in Oromiya) for setting up the VCT and ST1 services. Subsequently, it provided training to VCT ' counselors in which both IOM and SC hav-q , support program in all targeted towns. The failure,of the public health providers to set up the VCT centers forced SC a.nd.I,OM,, tq strategocally consider the setting up of ten additional VCT centers the sta* the ,care.,and,,support activiti,es in dl the @rgetd towns. HRCI, eventually, was able to increase its"YCTsites e~~A~:!QA?7."'&.: ,;a,d" ; ~ ;, <,.a ,,~ . . The scaling up of the VCT services, however, was not accompanied by increasing the supply of the Cappilus kits and other necessary supplies. Thining out of formerly procured resources was indeispensable. On the one hand, the bulk purchase enabled meeting the newly emerged needs of the additional VCT centers as well as efficient.% utilisation of the already procured supplies. On the other hand, the thining out of kits and other supplies had imposed shortage of same particularly in the face of inadequate preparations made to procure supplies for replenishment early on. .., . ~, Regarding HRCI's comprehensives, the VCT service is availed in, conjunction with capacity building of the public providers for sustainability, HIV education ad information through the IC and,' care and support services for thoz .w~o...test,,sero ," ,. . , positive; an arrangement that markdly contributed to making the target ..-, --ass ..,*... community ,+'.".,.,.....,A. . . A -. attitudes favorable and their interest in the VCT s-evices high. The servlces m the visited sites are carried out based on operational guidelines/manuals, ,*.., " . , . . training a" . . handbooks, , , . . . .. .. . national execution guidelines and other relkvant fo.rms and form,ats;, These ,-manuals, ,, . .,. ,. , assists the staff to carry out their duties to the standard and effectively. As a result, there seems to be no significant problem in the implementation of VCTISTI services due to lack of in-house capacity. This is one of the strong aspects of the component as it had placed a systematic and standardized procedure on its day-to-day operation. All visited project offices have conducted advocacy/advertisement activities to promote the VCT services of the program to the community. Although not coordinated, the promotional campaigns , .. ",, .,,.. carried , ., *,- .- out through various media have significaritly'contributed : .,,. ~* , .~ase*>*,~t."~**~"*,~c~m*a' +-e""+*->"-,,e~'s S*,'" %-.- . ,.a. ,% , "' . in increasing the demand foF"'%?~F?eil.'~ m-addition, tlig community in ab s~tes. have received educat,ion.,a.nd inf~r-mit{on+~.o,ri ,$JJVl,&.QS, ST1 and . VCT ,., , ., %-., 66: .-,,. regular .> . .- .. ,. . basis: 2 \, .~., ' Political/administrati& , officiials 6.a.v- &lo 'given the s&ic-es :of VCThigh pr~ority --A. .*..~.--A.\~~e m7.-,w-7 vp-, m~*:?*;~*~~+~~~;z+~$:-~~.~&& ;- ,*.*.. - .>3% -.z:+si*;-.< :";*"s*~~*a-~:*~~~~,~*;*,* .*.. ww *<* ,-- ~~~*~szs>>r~7Tbs political amd pollt~ca~ c&nmarnerif 6y Reglonal ,. ,, - ., ~, Health and Rapco * - .. ovc~~ais~.-Be +h*.-h., . , .'.- ,", .- -, ,.- - respondents of the va~u~~~~~~i~ns..~have~~hi~hl~ appreciatedVt.fie effo,rts o.~c~~ l.n.,' . .- " , advocating the concept, a;ja-iii9g'taht; s,krvke and- ctyempts-'made to-mitigiie t& ;ffectes ,. .l^_' I*/^a,, I"I",.X"--W-." -.., I of HIVIAIDS. It was reported that there was a high demand and clients flow following the promotion conducted. In all areas except Nazareth and cheleko, lack of adequate preparation or absence of a medium-term plan for the service, the supply couldn't meet ;he-demand and counselors reported that-a lot of clients were not able to access the service and take appointment as the system is not in palce. I , ,< . ~ ' . ,-.. , , ~,- . ,". . - \- Althugh counselors attempted to guarantee and respect confidentiality in .. all .-. the -, sites, briches have been observed in some areas due to revealing oneself for the care and ' . ' support. Most clients feel more..comfortable about attending VCT services if they can give a pseudonym and have' aridnymous testing. As indicated in the previous section, the VCT centers and/or th.e whoIe..ref~al,.~ system did not have policy'*to -guarantee confidentiality and avoiding breaches of confidentiality at all stages. 1n addition,' other medical and administrative staff did not receive specific guidance about the. role of counseling and confidentiality.The' polcy on confidentiality is relevant in terms of promoting acceptability and Crediljlility of the service. Although, Heath workers (VTC counselors) in all sites surveyed have understood the benefits of VCT and perceive it as a priority service area, health service mangers were reported to have inadequate commitment to promote VCT services as a priority and major part of their job. The reluctance of the Mojo Heath Center management to provide additional room for VCT to handle the increasing flow of clients, poor attention given to ma VCTISTI (fknctioningfor 2 days per week despite high and growing demand) in Mille +. r and Logia are some examples to site. The VCT sites have mostly well-trained and 0, motivated manpower who felt to have got good recognition and given high value by the 21) Pa! community and staff. the HRCI program has done a commendable job in building the required institutional capacity at project level. ma Although, there are well-ventilated waiting areas, thre are no separate private space in Dire Dawa health center and separate room in mille and logia. In addition, the absence of signposts in all sites to indicate the VCT rooms has brought challenges for ensuring %811 r .- privacy. In addition, counselors have mentioned work load because' of involvement in - .* , other departments, lack of adequate~counselo'rs support, procur"ement oftest'kits fbr,VCT activities have been a major problem. awn The overall figures from sentinel surveillance survey in Dire Dawa and VCT reports of other 5 areas evaluated indicate the high HIV sero-prevalence in the community (refer Annex 6 for details). This has brought a high level of understanding among health service managerdplanners on the services' effectiveness for targeting and identify appropriate strategies to develop services. The services in all areas were found to be affordable for the majority of people as they get the service'free of charge (and provided at low cost in Nazareth, OSSA and Dire Dawa hospital). - The quality of the VCT service was supposed to be crosschecked and samples have been collected and some centers are currently facing shortage of NUNC tubes. Although HIV testing methods have become much more sensitive and'specific, evaluations have shown that without rigorous quality control high numbers of false positive and negative results are common. Not only can this be harmful for clients, but it can undermine the credibility of the service. Although supply of the testing tubes are planned by IOM, the quality control need to be taken up as soon as possible. In addition, cappillus test l6t was found to have expired as of 8 March'2004 in all the sites surveyed the. According to the guideline the services should have been shut until the test kit is made available but counseloss were referring clients to other services and this negatively may contribute to the credibility of the services. Although Counselors are aware of the special medical needs of people living with HIV or AIDS, absence of free treatment at public health facilities (except in logia) and inadequate availability of drugs for opportunistic infections were reported to be the major challenges. Assessment of the diagnosis and treatment of STIs by providers revealed that patients m f with STIs or ST1 symptoms at all sites are appropriately diagnosed and treated according * I i, to national guidelines. This could be the result of provider training in ST1 case I*r, management and the adequacy of the history taking, assessment and treatment of patients reporting to facilities with specific STIs. All providers make satisfactory efforts treat as well as prevent the recurrence of STIs by promoting condom use and encouraging the treatment of partners to avoid reinfection: Howevef'STl6aiie i%is4hot given adequate attention as an entry point for referral for VCT in all the sites visited. This indicates the need to improve the extent 'to which . these' - aspects ., , .o~'STI &dice provisions are fknctioning. Although ST1 drugs are due to expire in two months time, all services except Mojo health center have the supply of essential ST1 drugs and reported no stock-outs lasting longer than one week in the preceding 12 months. Drugs int Mojo health center are kept in the drug store and the store keeper is not always available making drug and other 8ml necessary materials availability short. . . This poses . . . a t~ negative ~. .,A' . .) ..,>. impact ~ ..,.,-,--- ... ", on ,.'..*,,-,." ensuring .*, -..-,-. ~ ,.,.> adequate .$ " . ,.. :, provisiori.of service difficult' '- 2.2.3 Accessibility to care and support by PL U'HA and 0 VC ~ ~ .. . .,, This is one of the intermediate results implemented after the approval of the revised project in September 2002. This result is expected to be achieved through Strengthening of family and home based care, and support networks, F@ Increased attention to orphan care and . . Increased awareness and responsibilities of communities for protection against violence, social and gender discrimination and'reduction of stigma for PLWHA. a,*- . . "- .a- .. :,,,, ., , , .- . % - .. ,,. .&.',2~+-,; ,*..',.i.~, ..;>r., ,--,. T.".. It is also expected that especial effort are made to link HIV/~~dS,Fommittees, task %II forces and local iinStitutions (Mihiber,'"Iddir) witKpublicand prili;ate sect* business. . . " - . ,.%~ , , .. , , . ., , -.. . ."/ , .- ,w.r-.-.-rl.- ." ,;, 5*.? ,.. "3,. .... .. , ',. ., I..<. , .. *. -: ,*l-"l-;i.,ir.a.nr -..u-*++'Si*i,~,ii? ." ;>;*Tc -.. -i. .. -- . " . ..- . . -. -. - ; , " ->;. .~ , . iii ..'. i..." "..iii.ii :A?>.: --.' " .i<.- ** ec*;, *;+;: :+* .;".ly;-. . ,:.; "? C;" .-L s*.2.>~* ..*:% *,+ ;.-:%-,a &~~;*"s;~&*~e&~:~:~s?~%:t.~ <&=c* *=?& =*.;A -l... -.,*..ll -.-- I- .WL. . .,-**, ,.-.. .. ,--' L. -. - ., i^.,."-"".r^, . .. il- ... ' ., . .. ^ - <. ^. .-; ;r..",.. ..--"-" -..-.\ .> _-,..- ,"-~",'L:L..L~L~,::,&~ . ,,. *&* .,-.% ,;-.:;,!; z~*:, -,$?T:! :;- i.2.3.i ~/AIDS Committees . . . ", ,.. . ... . . *.~" -. ,- - ~. . -. ,,, '~. . .& -, ,.. .,-" , $.' .., .,. ,,,,,", . ., *~ .,,. , <-.- ... , - , - " ., .,' . .. . , .-..i :I-%~++*; "%."."--">"*" .Yi i.il' &,.. ,,., ,.. ,.. .,." ~. . .." . , * -.*., ,,<<# \ .' .->,. -..- %,**-> ".* , ., ,". 2" &<;;.* :4. .,\ :+ :,. . :. . . , , , ).. . , " ^i_-',"Y.* ,,,1 *> -J. .",.tl_il-n._l*i** -^, .:.. ,, . .. ' _. - . ~, In line with the intension of the projects,~eieda and KGbkli HIO AIDS cdmmittees that include sub-committees for 1) Prevention .2) Care and Suppori for PLWHA 3) =? Community Resource Mobilization and 4) Care for Orphan and Vulnerable Children are established in all the sites visited. -'The linkage's with the health facilities and schools have been arranged through the sub committees for care and support for PLWHA and OVCs respectively. The program is exemplary in its expansive coverage along the route and particularly the mobilization of the HIV/AIDS committees in all the targeted towns. The team has u.e ;-;. th,at""the-riked."'f;ii'poolin effo.rts by ssaEe,holdGFi ;c65 **-the pr6j'ect activity is recognized by both the residents and, loci1 and regional ofi"cia1s. According to the discussion with committee members, the workshop organized by SCfUSA on '". ?..<.....*.%<,.>.,,, -, .* ,",%."*.. . . , >. ,, . "Community Planning Process" 'ha'i 'beeninstiiimentd in equipping the members of the committee with the appropriate need idnetification and planning skills. The need assessment and the designing of project documents by the trained committee members was one of the best accomplishments accepted and appreciated. committee members have expressed that they are capable of designing a pr6jkct document for submission to other hnding agencies. In addition, the formation of both the committee and sub "r committees along with the capacity building training on planning is found most appropriate and effective. U The committee was organized in line with the national guideline for the establishment of HJY/AIDS committee. This intention limited the office to contact and delegate the Wereda Administration offices to identify and select committee members and members represent their respective institutions (government, religious and community based institutions). Such process had eliminated the chance of ensuring the interest and commitment of the members of the committees. In addition to omiting/excluding the paricipation of the community, the process did not allow assessment of the skill and knowledge of members in project planning, management and monitoring as well. In the initial set up, there were on average 30 members in each committee that made the committee activities cumbersome particularly having the right quorum for making decisions in the face of members' poor commitment. Almost all committees faced serious challenges that require revisiting the constituency in the sites visited during execution of their respective activities. This called for reorganizing of the committees that was conducted since September 2003 The re-organization of the committees provided opportunities for members to reduce the size of membership to about 20, include relatively committed individuals and try out the effective implementation of the committee owned projects. Although inadequate commitment of members is still a challenge, the commitment of few individuals (about 3-6 members) had enabled the implementation of the caqe and support to PLWHA and OVC and Community Resource Mobilization since the approval of the fund for their projects by SCAJSA in November 2003. Contacted committee members express committee objective same as project objective submitted to SC and it gives an impression that the committee did not have its own broader goal(s) and vision. Sn'addition, they believe that only those sub committees with knding from the currently approved project can remain active while the youth and prevention and fund raising sub committees, for example, are left inactive in almost all the sites visited. The inclination to stick to the project objective (and not developing committee vision and goal) as well as the miss conception on the role of sub-committees needs to be looked i~to inthe future. If the activities presented in the project are choices and priorities of the communities based on community needs assessment, the committee needs to learn how to address it by going beyond the project with SCAJSA Committees can develop more projects, submitted to other donors and/or look a means of hnd raising. Committee members in Mille, Logia and D.D., indicated that the SC staff both fiom the coordination offices as well as the coordinatin team in A.A need to spend more time with them for technical support. This will give opportunity for SC to forward the community/committee dynamics and provide transparent information regarding its and HRIC's vision and goals, which is found to be very low among committee members. Although the HRCI staff exerted their effort to facilitate and organize committees along the whole route in the last 6 ,. months ~, , . ., (in a very short period), the process of setting up and .. , _ " functions of the committee has revealed the absence of timely designing of appropriate guidelines, weak management skill of committee members, lack of close technical backing dn the part of SCRiS The-absence of procedural guideline has also created a loophole for staff to provide untimely and sometimes conflicting directions that is taken as false promise by committees and communities Lack of skill managing committee activities and procedure for project implementation and management, and fund raising are the major gaps in the knctions of the committees. . .. ( - ' , ', Financial procedures, for example, are not clear for any of the committees contacted. ,. .". ~ The finance department of SC made a visit recently and committees indicate that they did not get any technical support in this regard. For a community structure particularly where skills are scarce-are low, it is necessary 'to adjust modern financial systems to accepted lower levels of record keepi@.&nd reporting. Looking for skills may crate . . * . .%"" ,*-* *..wv-w* *.+V" :,&&"-><,., 'd:6( marginalizing potential volu~teeiB . fiom , .. belng , ~nvolved and exposed to societal activities as the case is in Logia. SC has acquired and adopted a guideline from is Mali program and this was sent to the coordination offices to discuss it with the various committees in their areas. The coordination ofice in Awash was able to provide its.feedback while others are planning to do so in the near future. While the team likes to propose the speeding up of the finalization of the guideline, it would like to express that the setting up of the committee was not accompanied by a genuine com$$me&of'the . -, local ,F .,,,> stakeholders and/or . members and in part by pre-defined/pilotid . I,. I' guidelines that can effectively direct the efforts of the local communit&s _ . .. and /_ _._~.-_._11.,~..-1_.-l-lj1~3 networkwith local systems (Iddir, Mahiber, etc) to . , I ' .. "d, .,- / _.. ( , . contribute to developing-a sustainable mechanism for the reduction of the transmissim. ; .. . . As the. communities are 'not yet adequately exposed to such systems the need' for " - , +*C.ce c,>. ?* ,. '"...,, -i, . - - - I I _: .. . . .. .- - -. technical backing is high. ~ce-team fo.~n&,-m~easg$ng the effectiveneSs of the project in . :--:-.--: terms of creating and/or developing i a .. kstairiable, ,-,. -. ., A- .. .-6L-f system - as premature in;sgch a context., " ") .. ; _ ". ._ . .~-. >. ~ -. --. --- - . . ..* ". -..,. , . ... ~.. ,- ~., - , , ---, ," ; .-,: ;,,.>T,7:-. ' ;?.* '" .' ',.: ..:. ." ,.",. >. . ".. , I' ,. .'A '"' ;..-. -."ST r--.:--t. The care and support as well as _ , the i ,~.,_., CRM -. sub *a- comm$tees .-. were able to meet the 10% requirements of mobilizing corn.munity resources for their projects. Community resource. mobilization is the most . " ..,," relevant ..-- ,.,..av"cw- in promoting ownership of the care and support for PLWHA and" OVC and appropriate intervention for $eveloping a sustainable prevention program. It is observed that pnly the committee in Mille had involved in real CRM by contacting and soliciting fhnds ~ from . - ,.. the residents of the town. The CRM in most Gases was acquired mainly from goverdm'ent institutions and kebele structures. Committee . ." members need to be appropriately skilled'andmotivaf+d to move beyond their respective offices and link with their commTnity at large. All contacted committees had developed a selection criterion for the care and support in ,.' ,..' diicusiion with SCRTSA. he process involved in the' identification, compiCng of the family and personal background, acquisition of testimony from the social courts in .,,. ~ -, ~ - ~ ., -. Kebeles and key informants, and home visits. The review,team has not encountered any complaint on the selection process. The availed care and support package for both PLWHA and OVC are uniform. The contacted PLWHAs indicated that they have been receiving Br. 100 for food, bed sheets; sanitary materials and detergents, financial coverage for house rent and palliative care supplies from CHBC. Contacted OVC express their gratefulness to the SCIUSK'"foi its assistance and have testifieb by showing what they' recei .frc;'g -K;,-,cbm# giGkk'-nd/or'.Mei'"Whiie the interaction of the street based OVCs in the support program ,. is .. appreciable, . , the ' .. exclusion of the support for basic needs'such Ksh'elter and 'rood for those living' inthe' ., . .~ . \ $, *,, ~". , - street made the effort incomplktk: With'a'dbeS'-regard for the general'LteAdency .of communities andlor OVCs towards food.iellief, the"teaii 6eliGes that the project 'needs to address these special needs of OVCs living in the .street. Provision of educational, material for contacted street boys under the care and support is encouraging them to attend their classes but does not ensure its continuity. They perform well in schooling and could do much better if they are provided with Shelter in which they can study, do their assignments and, if any in the future, entitlement to the support package could be upon fulfilling certain condition'such as good school performance. The community in Nazieth, D.D: and Mille (visited by t'he.team) give highvalue to the establishment of CBCCC for the care and support to "the OVC under age of 6 years. The team has been able to visit and talk to OVCs in the CBCCC in these towns. The sanitation at the CBCCCs are very good, the children are . ., cleaKandpr0videdKith .~ 2l3" meals a day. The team believes that there are issues of OW'S integration with their guardians and communities afier CBCCC. According to the current program, a child has to graduate at the age of 6 and when joining the 'elementary school. All the support package will automatically be changed to schooling support. Although identified/planned by the committee, the variety and quality of the meals provided by the CBCCC need assessment if it is differerii from the staple d'i'et in the area. The committee ,",. '. _ ., .( ,,,. ",.-_I,., *_ >. ,., . > ." needs to be well aware about the potential problem of integrating ~V~s'into the faiily' norms. .. - It might be relevant to look into the need for having a transition period for a child to normalize the food habits in the family norm. - 8 2.2.3.2 Home Based Care Service Provision CHBC volunteers are working in close contact and under supervision of the HIVIATDS " * , S," . . , .~ , ,..h ,. .,, . .". ~ ,.* d,-,r.>. . 4. , 7.. ,'. committees. Thelr major aci-ivities are c~llzcting referrals from the VCT centers, llalson with the committee for approval' and provision of palliative and psychosocial support to PLWHA. The selection of HBC volunteers was undertaken'tjased on recommendatibns . , ~,~~* .,- - ". ,,- , of committee, kebele. The criterion' includes previous performance, interest in the intervention area and motivation to help people. Although the committee recommends all CHBC volunteers were self initiated and applied ioliiitad,..,:~a ,"L, -~: . ,a,A <-5:z..",;,z-.,, <- .. ,. discussion with stakeholders and key informants that " CrnC, .voIunte.ers have , ,*. . , ,, . .* . , -.. . . . . , . , i. . . . . - ... . .-." 1. ,'-,-I substantially contributed s to . .$ ,, :- rncreasing . , s, ..~.?z5.-: atvarenesFof communities on care and support to PLWHA, changing communities attitude towards PLWHA;~(~VC'~<~~~''~~?~~;; :' -' %, ,. .--.?.. ,.,.,< -*. ..". ." .-* ' .""."". - - .*.. ** t. ' ~."". 5~- ~->r+ 2t.- ,:.c ".'* Furthermore, almost all indicated thelr determined move to provide care for the PLWH^A-- '' have aroused the enthusiasm of many. PLWHAs also noted thatl'the ~~'B"e'i&"ft>' ' ' accompanied care and support as the most efficient therapy for revitalizing their social toucNrelationships and filling their economic resource gap in the most fraught time of their life. The volunteers also regard the project as strong in increasing the understanding of the , , _ /, , 1 -,1 %'l,,- .-4, .. community on issues of HTViAIDS and "concluded that this component of the project is . , *. ,.**, ., " *,.., .*#* <;&~"**~'Z~&~~~:,A*. <%?,, *,-,.-,-,-.' ',,,?";<* , . . ,-*' -. .,, ,: -.*:\* ,,*..,> '--34>i1\1\'1\ ..i. 2..;' -.:-?--.--- - community participation. Apparently, availing HBC is one of ihe most rem-input " >,. :. - - .. - - ---- - - .- ." .". ."..-a" -.*.- =4&-aa.um*%&*w ... . . - of HRCI in terms ,__ . _ __,.l__l_l, of pr~v~~p':f~ate,relevant ___._. -_/l._.. - and . . . effective ;>. >:L.~~~~&~~~ ., z..-z"eG,+~ service k~~~Ta~x~-wxawM~e~!eh~~ to the needy .. and by and large ....# to ,. .*,+ reduce - .... ii &.+,- *.. stigma ... .. and discrimination. Contentedly, -. however, they indicated that their ability to cover the costs of health services is extremely low in the #,. . .,., -.. face of their high vulnerability to opportunist~c infections and repeated ihesses. . . , " 54- .: __. j,. -. .. . j,\(, , . ,,' . . .., , - The available public heath providers are backing the HBC services 'and CHBC volunteers refer to the public heaIth providers; however, the existing links/referrais for ' ,,. ~, ., ",. , PLWHAS for specialized care services is- inadequate. In addition, patients don't get adequate treatment immediately particularly treatment for opportunisstive infection (01) and access to medicines/drugs at the public health providers. ,. .- One of the challenges of the volunteers is their inability to creating conditions for family to discuss with patients if the PLWHA is resistant Bringing an open dialogue environment in the family, they believe, is relevant for training family care givers. Based on the interest of PLWHA, volufkeers are providing training family care grivers by ensuring confidentiality, and conduct follow ups CHBCs in Logia have been providing care and support for any bed ridden patient and there are patients who have not visited the VCT but under the care and support for the last 3-4 months. The patients need to be motivated and to visit the VCT and know their syro status and the committee need to revisit its appoach, in this regard The problems created by landlords/homeowners to evacuate PLWAs have adversely affected the activities of volunteers, as they have to track PLWHAand provide the care and support. However, the general attitude of the community is good and Community based organizations such as Iddir and Mahiber has positive views on volunteers' interventions. Volunteers andlor the committee receive referrals from the various VCT centers (such as OSSA, FGA, public health providers and other VCTs). Committees are required to conduct close supervision, approve support to PLWHA as fast as possible and network with other institutions to reduce over consumption of the available scarce financial resources by PLWHA. Although Wogen Lewogen and religious organizations in Nazreth, OSSSA and MMM in D.D are involved in home-based care, there is no coordination to standardize and control over consumption of the support and care resources and this requires networking. The networking may also include the assignment of focal persons for referrals in the public service providers. according^ to the CHE3C volunteers, the areas that need fbrther consideration are training on post mortal/terminal care as communities are currently requesting for the service, timely financial support to PLWHA and adequate and regular supply of HBC materials. In addition, the prediction of shortages of supplies and protective materials for HBC such as aprons, plastic sheets, and shoes, due to the currently increasing demand for care and support of HBC seems to raise concerns of the volunteers and the committee. The currently available resources would not be sufficient to meet the potential demand in the hture. Committees in D.D and coordination offices in Nazreth and Mojo manage the IiBC material supply. Differences in the efficiency of replenishing HBC have been observed where the committee shows a bit of delay due to the timely unavailability of the responsible members. 2.2.3.3 Users of Care and Support PLWHA The team contacted PLWHAs most of whom are living with children of age 1-30, some live with syro positive children ar,d have received either diagnostic or referral VCT and HBC counseling and palliative care before they visited the VCT centers (before they discover their syto status). Some are still under on-going counseling by the volunteers, VCT counselors, and other institutions such as OSSA, FGA and Tesfa Goh (in ~azreth, D.D. and.'~ojo). Few of the contacted PLWHAs visited the VCT by their own inclination/reasoningwithout refenal. Most have expressed that they are motivated to visit VCT due to the care and support component of the HRCI. In addition, participants have received one week training .on positive living in D.D, Nazreth, Mojo, Mlle and Logia. The services offered by the VCT and ST1 centers is reckoned to be of good quality because of the existence of staff that are supportive of PLWHA. StafYprovides adequate " . . , .. ' L., . - ...: ?. ,"-i.ri~:( - l:" ) ". , . ; . " . . ,, . . . ,. . . . - , , time and information , .., , . during , . . . .. , se and post counseling and give priority for PLWHAS. Mistreatment of specific counselors and use of abusive" terrn"6y other health-"workers in facilities of Mojo and D.D, absences of free medical treatments, lack of diagnostic services such as X-ray and bed for inpatient ireatments 'are'.sq-me--of the observed . ~ <.-, a"w'*,'*" 'i-ro.",x-w..'", ~- . .',,%:,:.<: ", ".,,~."* information on positive living. ~lthough'hdme-bas%dcare . -. y:.,:p" is %,.:.-" %..,:-, the p\-."x.>t,.".. most .- efficient . .*,' ~. therputic service they received to date, it is inadequate due ... to :nsuEGent ~. ,.. ., . supply ofsanitary materials, first aid materials andbed sheets.' The service is ell recognized as need based and, appropriate, relevant and effective support, however. The institutional support is believed to have impacted on improving access to VCT services, attitude of communities towards ~~W~~s'd~"to~education on HIVIAIDS and workshops and acceptance and use of condom in the community. The HRCI project is also strong in securing the means of subsistence for " PLWHAs and ,, placing access to home-based palliative . __ _. care __ . __ and . jj A, ... facilitating . -.- . .. .. support from health care providers. The limitations identified, in this regard, are inadequate commitment by committee members, inadequate support to organize PLWHAs' association, lack of income generation activity, absence of 01 management and ARV supply,--the need to register PLWHA .~,. , -. children for care and support after their termination.' . . ,< \ - . -.. .. ., ar* * " ..,-" .,-. , ,, . ,,.z ,~ . . , _,._I,I">I"U" -* .(,% .SII.+C..,I ^ ^,I-- ,. " . ^ --' - -'- -.-- ,' , ."*. , , , . " .;IXYQ;**,*J,.*& deg*t &: I,.s;. &:,.;-[ ...*. r~i:iu-~~~~~i**--'*~~'.'9.:55~>.". . - . . . - - .T.7 Regarding preventive practices, most PLWHA inaicaf~8'that they have either abstained ,, r-.jd-4a."Arri&d&LL'>. kYI;"W".' '**'?: .. .." .- , ---framSex--oy-~yg~~~*ndoM co+,$sfently," strictly- ;iiqold ,~fiarar~~~..pler&idgg'~z,materials with , . . I _ _ _ _ __ _ ^, ?. .".../- .- , .. \ - -. -ru; ..-...,*, -~-%%.i*%*** , ~. F, ... . . , . othershmily members. Few inform their status to -pairriers'"who , ,..... ,S ,..- aE .syro negative (in D.D) and casual partners who did not want to' use~~cbtldom.~~ost,,are interested to be ~. . C >_ - _ Gil ,.," productive and independent of the support they are currently receiving. ,- ." - . .- , . Although few of them disclose their status, PLWHAs who have healthy children express ,. ~ , .- that they inform and discuss with their children ab,out the prevention and control of HIVIAIDS. Those who have not disclosed did . not .... have.the . . intension in thenear fbture. ,,, . ,. .. On other hand, there are PLWI;IA8 who are interested to participate in the project I *I, activities particularly in providing public and informareducation on HIVIADIS and few participate at their workplace , ....,.. and v. '~,., , in ,.,, ~a communities. ". : s,s?: $: . =, .* z.,d 9 k' with'and es*~.p.r,-,.~:eb: ,\with-out ,, . . disclosing their status. A PLWHAAin D.'D has recently acqulfeda support letter r-s ,i.i $... from , the -...- government to educate the community on HIVIAIDS by tra+elilEgid'different . . . . , A - . places. . . Apart from Mojo where some Iddirs have stopped penalizing members who are syro positive when they fail to pay the monthly contributions, the support form community organizations is reported to be very minimal. There are private clinics (Mojo and Nazreth) that provide support for PLWHA and soo,me community members in the neighborhood of the PLWHA provide good support. However, PLWHA indicated that they and their children face high degree of stigma and discrimination and stressed the need for reducing self-stigmatization by PLWHA. Some of the other challenges faced by PLWHA are unsordable medical services, poor ongoing counseling, and psychosocial !-- and emotional support. All PLWHAs indicated that the economic support is inadequate m,, and irregular (in Nazreth, Mille, Logia). - E-. ovc The OVCs considered for the FGD yerqqldii than 8 years of age and are attending their schooling. All contacted OVCs are thankkl for the support they received from the committee, SC/USA and their guardians. The OVCs under the care and support are living with their guardians and some are from single PLWHA. Some are also living in the'street without guardian and almost all are living in very poor environment and/or guardians/families. Even though they feel the support is very essential for continuing their schooling (for those living with guardians), they indicated that they need food supplies. Some OVCs (in Mille) have experience of receiving food aid and they tend to look for same support. On the other hand, street boys who are under the support program express that shelter is what they need most. With due regard to the originality of the intervention in the target areas, the team conquers the need for addressing the special needs of OVC such as shelter for those living in the street is very crucial. However, future supports packages need to consider the appropriateness of the current and other supports provided by SC and other institutions. In spite of their demands, ail OVC has received uniform support package that contains education and sanitary materials and uniforms since October 2003. The support they received, according to OVCs in Nazreth, Mojo, Chelenko and Logia, has helped them to feel less discriminated as they used to feel dirty and shameful before the support In addition, they feel much more integrated in school because of the sanitation as well as good attention given by their teachers. Teachers, they say, have been very helphl in advising us to pursue our education. This change has been attributed to the increased feeling of responsibility of teachers due to the influence of the committee in the locality (exampie Mille, Logia, Mojo, Chelenko). As care and support to OVC is &lly managed by the committee, in most of the sites visited, an attempt was made to discuss the problems and living situation OVCs usually during the distribution of the support materials This has not been taken up as a regular activity though. Other than the support package, OVCs indicated that they are concerned about the rape idaround schools and sexual and ethnic harassments (in Afar). They have revealed their insecure feelings and this probably is due to absence of psychosocial support as well as inadequate committee and stakeholders' intervention along this line. The team, for instance, encountered a girl of about 12 years of age who has been harassed by her ankle and forced to leave her grand mothers' house (her guardian). Such issues can be addressed if the committee is able to mobilize the community to act in support of the OVCs under the support program. The OVCs in Mojo requested that it would be helphl for OVCs to get together and discuss problems either among themselves or with committee. Mille. A shop owner's assistance to OVC in providing them credit whenever they need and counsel on behavior can be taken as exemplary action. , ," ,_, * ____ ." .^ *._**. .. .' , -... ' . ,.. OVCs are kncihledgeable .,,,. about ,.,,,. .;l.,,.,,. SCRISA-HR& A*.uer ..-..,i.* P Ai .?-rz .. 1 and pairticiIaiIy about the education (IEC) on HNIAIDS *andcondom distribution and, care and supion for PLWHA: They have suggested that if grown up OVCs are provided with ski1l"training they would be ~ ,, ~. able to support their families~sibl~ngs. isn 2.2.4 Livelihood security for PLWHA and OVC This intermediate result is planned to be achieved through mobilization of community am organizations for the setting up of the income generation schemes, strengthening social - safety nets, nutrition interventions and support for accessing health and education services. As the process of setting up the committee and running the care and support activities have been given priority from the point of view availing the basic comprehensive HIVIAIDS preventionpackage, activities for this intermediate result has been planned to be taken up gradually and as second stages. To start full implementation of this activity, strong committee and community awareness and commitment to mobilize and manage the resources of the IG is crucial. currently, SC has prepared the guidelines at the coordination team level (in Addis Ababa). The committees in Mojo has also formed a , .- group (of PLWHAs and OVCs) and secured a plot for the IG, and is in the process of launching it. It is expected that this component will be taken up in the remaining project period. 6- 2.2.5. Community defined qualify of services (CDQ) . .~ This intermediate result is plannd to involve in identification of community and service providers perception of quality of care (QoC) indicators through participatory learning approach (PLA), bringing community and service providers in a forum to prioritize QoC indicators that needs to be improved, specify roles of community and service providers for QoC improvement and introducing a joint monitoring system by community and service providers This component has only been taken up very recently and training on partnership￾defined quality was provided in Mojo. Community members and service providers had a forum to prioritise the indicatorsand set up the monitoring system. Participants from service providers indicated that the training and setting up the monitoring system is relevant. HRCI need to continue to provide trainings and definitions of quality indicators need to be taken up in other target areas. 3. Project management I I 3.1 lmplemenfation arrangement __.,_^ ,,,_ ..-. . ._."^ " ": The initial project envisages that SC hill' 6e 'GfIjfL'responsible for the monitoring and' ' evaluation of the results of the program based on the baseline survey that would be '._,I_X ,* , -,, .,.e 2 . .' ,. conducted on component specific and regular basis throughout ihe'li'fe of the project. "AX., -,,- "l.,.," -- i .-- The revised project document stipulates that 'SC 'win -'sub grant some of tk'care and support, and impact mitigation components to one or more demonstrated local NGOs by sub granting. The sub grantees take responsibility for social mo6iliiation, capacity building and advocacy activities. , . . .. ' Significant in the management arrangement is the establishment of the HIVIIAIDS - ,, ...,., ., '<," U-i--' i-,."d^*" -.,'.', .a ' .- ".. --2 ..,..-,-."-I-.;. *- - - --- . * -1 committee in line with the HAPCO guideline. The establishment of the committees at i ;.~ . .j ;,4.., .-,i*,*s*,.~r,l- >, 1. 6 , .,*,*A > 8,. . ''? 4.d .",-:;-,,. -* i ,. ." 2.. r *, r . ; i Wereda levels has contributed to' the successfbl beginning of the care and support activities, created a sense of ownership and responsibility 'and'Zrong"'link'betw&n the . . - ~" ,. .. , ', .., "" -.-,l-\'rp<. , adminiitfation and' the beneficiaries/targit .. ., giiupis. The reorganization of the committee . ,- , .." had been one of the appropriate measures.taken to ensure eMiciency of the services although it may require additional assessment as committee members are still expressing that there are work load on few members and, lack of cornmitmmt, clarity on duties 'and responsibilities of the committee and sub committees". ~lthou~h committee would like to '. *~ ~,,2 -.>, *&,*.'A*.,'~ ,-*, ",, " ,*.%,, #~, ,#, ..., ,.?. .,, , . .*, , .-" ,', P have more time with staff, all have revorted the consistent close follow-u~s made on *,. ..,"" ,~, ,..,,,"A ,. l."~ L.4 ,, . ,. ". .. activities at grassroots level. +, e Considering -.~",~- ,.. >,*+,,- .,... .\a , " the .~,*,',& w~-*~+ huge +~,~p~~.~~~~~~,w+~3.~~~d.~w~.~~..-.~ task entrusted on the -.- coordination ...,. ,.<- ~-.:, -.: .. ..- $--. -,.. ,:- ,<.. -.,:, >&-.: % offices, remarkable accomplishments have 6eennegrstered .., In the v~srted areas. -. , .. _/ . ___. ;. "._._ _, . . --, *. _.. . - . . " , .. ,> i.. ,", :-(l :ti :ci- - - -. -_ . . , -. ".. . . -, .~., , ~ ... . . ~ . b=- . . .-. ~ . ,. . .. .... - ., %. ... , .; .X- .L>,,i"-:ji-!$".." , . - -. --.--.- 3.2 -- , Coordination %,-~".xt ..p:i;~=ij:9i1Ti~~2FS~L_~k..~A:s6-az~++w offjces , .+. , -.be, -., . .." . .- _,1 ____.-".l ._ j,_ ._/, , . ,. ) J.*~L'~.." . *".' ., .:a ' '.-':'. "' , ".-A--. &<-- .&&%%e-h*~$$, . . .. _ . ., . - .' - . . ,."-.,:,*..rr.Z. 'a,. r 2., r %~ . -. , . .. -. ?: .%.;;r :t;,;;*"$~~."~;&~@r*+*~-c;gzZaI :~?;:,U,uus,~:,~ ::. - .~ .-. , ' ;. 'i ~.>*,~ &.... .,.. .$.", **,$ am . . . The progress of the project was realized througfi -,"* -:"": thk -Z,:~G~~~~-~V;;-,-~~,. est%shment . s r of % r:. .- the t= 3 , . . .,_ _. and coordination systems at regional level4 with three coordination offices.in ~izkth *., ,,*,,*,,,-, ,.:, -.,~ :,.,~- ,* ,,*,&, ; .-, "we-. *. " . . ,. . Awash and Dire Dawa SCIUSA , recruited . . . , . .. . ., - tecfiinicar . --..,..,. -,-.. 2b .. - staff?rhree-four *, + ". technical stam at ., . .". ,, . , . . +' . . * . . , '. - , . gn, the field office that are responsible for providiG tedhnical backstopping and follow up , . . * , . . . . . ... . , r of the various activities of the HRCI'activities. Thew technrcal support was relevant in ,Xi _ ,( _ _jL."~_+,,.,",_".,. (,,., . ... _',. .*' - I, ;n .. - . ' , streamlining, standardizing, mobilizing and .fa'cilitating ,.,, ,.." ,for creating a good working *.I environment. Their input in ensuring the integration of activities and liaison with partner . . ,, , . , " . ' , " > . " '. . -,. ti institutions at higher levels had significantly contributed to the active involvement ofthe concerned line ofices and smooth ~impl'ementation'process. kna ."". " , z7:+; s *<,>*ad~w<&@d;{*q{t&<~3$F:.$*-.*+-.&&>",:*d, ,*s",x, ,, . ,* ' ,.",.." .,,* ~ ."<., . , , ;,, >,. :, . ,. 5. .. a. .A&-, s The coordination- offices estab1i~'hed'~rovide full assrstance in terms of following up the , ,- - ,-,. . *- ."- " -. r,... .-"w -.-.**-4***,4. w,**-a*"'-.""a. r"+ea!:**Ar.. 2 " .'. .w-. . .... ,..a -- .*.A. -.. daily activities related to the HIV/AIDS'committee, the facilities (the VCT centers, IC) , ,__. ( *;",,I . " .,^. .Y .... '" mel and provide close technical support to the care and support activities of the cbmmittees, . . , *. . ~- . . .. r: front-line successfully health operate workers, referrals service- ,. ,ddnna...cd;lnterye~ee*ii; users .-.and. community s-~or-rp'j&;WHIA~ leaders ,~: I. to adhit.ion, define and th.e. . . a ., -. .. " ~ . ".'..,. < .. . . . !ma coordination office is .reponsible to manage the finance and'& gays a crucial role in ".- ii . ~ '. ,-~. . &, " ". -. , . , < , . ,, . s . ,, - . - . ,,,. ". ", ,. L "providing 'feedbadk to the coordrnation team in A.A. The coordination offices have set up a regular monthly meeting with stakeholders and contact every 2 ' weeks? ~he';kgiilG. joint 'meeting is attended the IC staff, VCT nn :' .< l.,'. . . , . . .i. _ _ ,y;; .,-,,...' ..," ; . .';:. . .__ ,... , 3 ;;,(.y.': ., * ~?,7?S2*:-...+w" ,. . .~' -. "w:,-- ,... :?7-~i:wt5~~,~~~.~-;~;q~;~;~::?,! . . ,<-; ;;2,;Yj$~~:;7,x:;y. , :K,T,<, ;i>,, . ; I ,., -.: . - ,,< ,, " .>, :... . . . .., . , . <. . . ,. , . .. , ., !. , $+. ..:- . : ;.':=, , .. . . > . . .. . ,, ., , . .: : . ' . . . . . ' \ ..'."' ). - ,I. ~ . .. .. . , $.. ' ; . . ., \. , . . - . ,. :%I ' _ . . ,:. /. . .,: . . . , -. . , ,: ., , , ." ,,,, >~ .. . -.,. ., - -. - .. ..'..... c'. ' . . . ' - \ -- gna .. ,* counselors, CHBC and committee representative. This has contributed to strengthen the linkage of the var-io~ stakeh&f86~~~~d'a&~ of thk activities of =I. 'In kdaftiiiiin; v**.ae,*A,, ,.** eb&.*-,*. "*:-:-*2*.,A*a,,?T+?**,~*,-'%*,s' kc"* -, .+' quarterly reports are discussed at head ofTice~~16vel:~~his has helped the coordination offices to exhaustively -, , address their conct:rfi~-asd find soIutions for their operational problems. Regarding planning of activities, the coordination offices in,the field have a problem of maintaining schedules due to the incongruent and frequent visits (often not planned by the coordination office) by the SC staff in A.A. All offices reported that this renders a minimum of 5 days delay (per month) in their planned activities and negatively influenced the quality of their service/job In addition, inadequate prior in-house preparation on technical issues, for instance on the new procurement procedure, CPP, CDQ had created an apprehension by the staff as they believe that they should have 'made adequate preparation to address technical issues and back up the local structures (committees). The closing of the dropping center was done without adequate consultation of the coordination offices and such activities hamper the effectiveness at lower levels. On the other hand, some activities are placed without proper assessment of the local needs. Some cases reported are the setting up of inactive care and support programs in Karamile (no PLWRA reported due to inadequate advocacy), missing of refrigerator in setting up VCTs, providing refrigerator operating by electricity to town without electricity supply. The project is well received by its flexibility, however, it also opens up for more challenges in terms of achieving the desired result in the short project period. The D.D office reported that it was difficult to facilitate the mobilization and the activities of the committee in the absence of clear strategic direction. The networking with stakeholders and institutions working on HIV/AIDS and in the same area of intervention is very weak. Although institutions such as (HAPCO, OSSA, Health Bureaus, Health providers) have a forum to exchange,information and experiences, other stakeholders such as FSWs and own of Hope are not represented. In addition, the HRCI has no clear guideline to receive and provide support to joukalists and network with HIV/AIDS clubs. changes made to financial and other formats without guidelines coupled with inadequate follow up from the coordination team in A.A needs to be revisited. , .. . .. In view of the planned income generating activity, the D.D office has a concern that ,,..., <" .., without additional stag it might be difficult for 'the ofice to effectively involve in promoting it. Delay of the financial reports of the committee affects the timely processing of the transfers to the committees. All ofices have reported that all activities are executed, through voluntary activity and this has largely affected the performance of both the office and HRCI. In addition, the oEces were providing office space and transportation facility to the IC supervisors (ISAPSO'S~~~~~: ~cc&din~ to the field officers, this has been effective support to accomplish their activities in the face of the existing resource limitation. A , . ., . > . . . - ,., . - ., , ,. . " - " -,,. ..<.~~..< ,. -...., ., . " n --- - , "\-, . I. 1, ;- .., - ,. , . ~, . ,, s. . . , . ,, . .. ,,$.; ;!: .:.,. .> .;.,. ,. .,, , ,-, . - .,-, .i.- %* ;, *.\.;.,Li."i' ," ,~~,:~~~.z,;,~,,,~L~a , '. :.-;~,'"v,~;;,~~,:;~ :, .:a:.:,:;: :"' p:?;p,.;.:v.' '\" Y .. - .. - >., "".->-*",,~.. . . . :. . : *- I. .- - . , '35 field supervisor in D.D, however, indicated that his activity is highly constrained by budget limitations as well as lack of transportation facilities. I I 3.3. Sub-gran fed partners " . I ,'I -' 3.3.1 ISAPSO ISAPSO is currently managing the 21 IC in the high-risk corridor. Due to the difficulty for the 2 project officers to monitor 21 sites by shuttling fi-om A.A., ISAPSO recruited 3 field offices stationed at the SC/USA coordination offices to strengthen its supervision. The IC started with 42 trained IC counselors in 2002. Through its information dissemination activities, ISAPSO has been able to include a one hour HV/AIDS prevention session in the National Drivers Training Manual. . . * + "' <,,, ':~. , ., ,. , -,,+ ,,.. ,*. - ". , '- -' : ', ."* -" ~, The management in ISAPSO believes that counselors are not capable of producing IEC materials for the consumption of the sound mini media although theywere provided with light training on designing. For the prevailing increasing demand for information, HRCI cannot rely on the IC staff and other sources of information should be identified. The need for increased networking with and establishing MVlAIDS clubs in the target areas recognized by ISAPSO Some concerns, however, include the need for more training on management of sound mini media, promoting the involvement of stakeholder from the government, designing IG for the IC as phasing out strategy and clarifying the administrative and operational linkages of IC with SC. ." . , . -. . - .. > " ." ~ 3.3.2. Population Meida Cenjer (PMc) . . ,.,, ,., ~.,2!-'.,c.;v . ,,.% , .,". . t . ,.>.'.<. ,..'" ...- "' - ,,_.,.. ( - . . , , ,, ',~ .,,. ' .. . , ." . . , , ,. _ ,.^. . m .. . ., , ~, . .-.PMC . is sub granted for the prepMtion of the c&isetieskrial drama for dissemination to. . - - - - .---;-.*il;i-. . .. .. . *.*~ .,... -,, &- *>..%A~+=-+--.~ --' reduce -- A"~ . , - .- I. ~ their vulnerability to and risks of fIIv/AI'bS. . , A.j, . . Toihi; effect PMC Signed a rnemdnRdym . . , ,. *. of understanding with- SC in arch 2003:'Iii this agreement, " PI& 'ti~ii. the . responsibility of conducting rapid assessment and pre testing of the initial two episodes, share the results and keep SC infoimid ofthe process as well as the scripts, conduct F* third party evaluation to exzmine whether the objective is achieved and finally conduct a workshop to disseminate the findings of the evaluation. C'‘ b. , " . ,,.. . - In line with its agreement, PMC has produced rapid assessment and shared the results of the pre testing oFthe initial two episodes to SC. The scripts were prepared by conducting m+ focus group discussion, 'tiviewing literature.'and dispatching script plotters to target areas. A post evaluation report was also discussed with Sc. one thousand copies . ._ of ._ _A* the." , . . , ,,. , . , :- cassette drama was submitted to SC which SC @ribbted through ISAPSO-IC and its , ,." *.. ~.. {.:, . h coordination offices. - ". > ' .' ..,&..~ , The coordination offices distributed the copies-of the cassette serial dramas to peer educators, truck companies while ISAPSO also distribute to truck companies. The team could not find clear picture of the distributi-on methodology and this was also expressed by the PMC managment. In addition, PMC is concerned about the acquisition of the information on the dissemination of the cassette serial drama as it will be used for the dissemination workshop planned for June 2004. .". . -. 3.3.3. &tern*tionrrl Ofjie of Migratio~ @OM)', , ~. - . ..-, - - IOM is an international organization sub granted in September 2002 to undegake the establishment of t'he VC,T, centers, and strengthening of ST1 treatment mainly in government health facilities. IOM has earlier experience in running mobile VCT centers and availing STI treatment in Dessie and Nazreth. IOM has taken responsibilities of conducting facility assessment of public health care providers survey in all the targeted towns, training of staff, setting up the VCT centers ind strengthening of ST1 treatment by providing the necessary equipment and supplies, as well as integrate these facilities in the public health service system. Due to the long process involved in placing the appropriat~~administrative arrangement with Ministry of Health, Regional and Zonal Health Bureaus, the actual implementation of the HRCI did not start until February 2003. According to the agreement, IOM conducted the facility assessment in all the targeted towns and identified 7 sites for setting up the VCT centers: As discussed in the preceding chapters, IOM in consultation with SC revised the initially allocated budget and established a total of 17 VCt centers along the corridor. In addition, the team has briefly looked the electronic database created by 10M from information generated by the VCT/STI centers. Lack of cooperation in the public health care providers in the provision of space for office and drug store, inadequate integration of the VCT as regular activities of providers, absence of uniform schedule for the commitment of the public health providersibureaus, inadequate reception of the 'staff for effective use of the treatment cards for ST1 management are some ofthe observed institutional problems. In addition, IOM has considered the delay of procurement of VCT kits and shortage of sample NUNC tubes as issues to be taken up by the office soon . . ., s ~. . ~ 4. Financial ~anagernent 5. Monitoring and Reporting Project monitoring is undertaken at various stages. The HIVIAIDS committees do the lower level monitoring Most of the committees have regular monthly meetings to follows up the activities of various sub committees as well as making decisions. The monitoring emphasizes on specific activities, own procedural guidelines and financial utilization report. The coordination office conducts the second lower local level monitoring and this takes detailed account of the achievements of the committee as well , as the sub grantee activities such as the IC and VCT. The project monitoring has provided feedback from the target areas and concerned parties and, served as a means of information exchange and track records the actual practices. Although there is a general satisfaction in the quality of the progress reporting particularly achievement and financial reports, the analytical part seems lacking. The progress reports have not so far provided information on follow-ups of decisions, technical challenges, gaps, overlaps and synergy with other donor activities and collaborations. It is equally possible that the learning and empowerment process of the - - ___Y_,.'^ ,,-. ~, _il".",' ...,il,,"...., _..'^~n'._f(_.C.~"~..I.~."~~-.~~~ ' .. t-" 7 community could be documented -., ., .-.,,u . far . c.i,.... fUitli'er"$ev'elopment/refining ..-,.. i.r,r q-.q ( . L"l.i_,l.- . of approaches such as . < for development of sustainable community ,. . based systems;~ 6. Conclusion and recommendation gJF 6. I Conclusion . , -, The WRCI program has registered remaikable achievements by demonstrating results . % . ,11-1-11 1 from the scaling up and adoption of newly introduced gbpibaihes and systems for HIV/AIDS prevention and impact mitigation in the country. The achievements . . registered . , . . . , to date are voluminous considering the-'16 months of the actual implementation " . . , , . . , , a. - I ^. , , .- period and its limited human as-well as financial resources. evelo lop in^ partnership with. ' - those who have the relevant experience, the adoption of a comprehensive strategy by including the care and support as an en& to increase demand for HIVIAIDS preventive .d - _" _^_-_.,_I ">&* &/^"' I..*_ _ ~ _._.^._ .,.A,,_,~ i,,l^"C ,-. -*,. .;.. %, - 1 _'.,". --.,- ..&I services and mobilization'of the local structures to support the community based . . , . , , - . . . , . activities are the most ~, exemplary . ,". acc~m~li~h~e~ts. . , Among the prominent achievements of the program, the HRCI is able to create and .~"a strengthen linkages among the different sector ofI3ce.s and social organization and * - ". developing local systems. These efforts have helped to create a sense, of responsibility, . . ,. , . ." ownership and leadership commitment on the part of public institutions to the issue of >.,,d8,, d. ,.* < ,,a #..,& ,,*. e;:. %**.;*'&":~", L -" a- " %-. ~., , ", ." , *a HIVIAIDS. Most of the initiated activitres sucli'as the I"C,"VC'11' and S~rservices, care￾and support, livelihood security 'and 'CDQ are showing promising-.indications for ,",."'.>-'" r..v,. *..l)"" )".)")")")"." ,)")")")".)" ,-.*.Ur* I ir%'*i i-i.iVI . -,> **a> , .," ,.^ *..". ,.. \ -- .-,.,--* :-.**,-r .,." a , i . - - . . , ,. - bringing change although the , initiative A . . has .,I yet to confirm its'repl~cability as a package in . - , - an. . . the future. .. ,.. ,* . .,," ,,,\.*v*,.,,* . " . .~ , . . . .;: ~..%<'.:.",.,,A'~ 2,. ,.. : 4% ,- - ." . ,<" a".'",-.:*. ' ..., *,* . %~ , . . . ,. . , .* . - .. ,- ." , . .. >~. -, ~. .. , ..~ ,,...,,,,. .a. ,.*.* .+-< Ch",'.. ,-. >, , ., .-' . ,- ~. - ,,. ' ..p,s,<~~,>A.,*,*~,,,~~*s." ,*,..,. .,'"".v***.*,d>>.,**\,L *" , > x,; .", .".', . . : ,. -.. , , ,",. " .,..,. ,,*",, --,-. --7 -, . . - -.-. .--.+--& %A- ~h~ set up as well as the mana"smgdt th-&. placed expedient enviroa<~to:~~n~i~~~~~~.~~,-~ '.-- ,." -. . " , - " . ..\ ,.- , " . , ". ,. ,. , . .,, &::- L<*<-~>&&L.~;*,:~" ;-~" >.,> ,% , anr emerging local needs 'in tfiF:Gex , ~, ,.,, ::tLx>*<-r2f,>- ,>.k.ka':8,, the . %,, , implemintatiori; .%..* ' This ~ -#-. has ,. , provided . ~.. . . the * ,. initiative to be the most appropriate and' ,,,., effective .-. -.,I.,.,-.- in ~--.: trying'out ,, ." ,*,~ new , strategies and mobilizing stakeholders to achieve th"ecobjectives of each of the components. In addition, ., '". ." ,<. -., .. . ,, .A,-& I.*i,<*k:*,,*b..ll,l!h;* .a . , ii.c. _.rlr.'r\,*-rrir_ ..ii,"i:i ",.L:-.?~~.~>>"C" % .. , . .' + IR2 Access and Availaliifity to Preventive Services - Promote dialogue and commitment for the integration of the VCT'activities 'in the management system of the public health providers and for their proactive action in fulfilling the necessary budget and supplies requirements in the future is crucial for its sustainability. - Taking urgent steps for supplying the VCT and ST1 centers with the necessary ,, +,,p:, ..",-, :,: ~S>.,,..... <. -. supplies (such . as . testing . kits), '. conducting .-. j the quality control-and, to strictly and .%-.,rL--~hsJ,Ps.':'. < ..,...... '. , . , . . - uniformly follow appropriate .**. .*-. ',,".'*. technical iX,e.,, .. A and I ..,... refkral &. .I-.-,-.',.Y for referral ('such as . - " " . . , . . , " -. in the absence Cappilbskii) arecrucial to maintain, the credibility oftfie serv~ce. -- , - Improving attention given to ST1 care in all the sites is necessary to achieve the objective of increasitiggthe demand and access to VCT services. , . , ," . , .. , , . ." .., , ,. . . ", '. *, - , - HRCI needs to promote the availability of 01 treatment which is highly demanded by PLWHA. . ,. , " , , . ::',+A-. : a .i '- - IR3 Accessibility t6 Care and Support by PLWHA and OVd . ., , , . , , .,; . .., .. . ." -, ., "... . *,, , . - .\, 2, *'.%,s"* -"I ..- j'': . . ' " ."-' - Capacity building ofthe'lIIV/&h's committee'iii managing the care and support, knd raising, financial.&d administrative managemeit'is crucial for their effective services' In addition, strengthening the linkage with iommunities (by having adequate representation) is imperative for sustainability. Genuine commupity . . ,:,; ,..#A -7.. ,.-:. .;*.. .-, . .'. participation, needs to be adequately exercised in all .of the activlt~es and target . . areas. - The recently circulated TOR for the committee needs to be discussed, reiterated and adopted by all the committees as soon as possible. Ail the necessary guidelines ^U"Xw** "-- -. Y￾and procedures (administrative and financial) need to be placed for committees' effectiveness and empowering them to run all activities by their own. It is also necessary to encourage the committees to develop their own vision, mission and goals in the process for enhancing their efficiency and sustainability. - Encouraging the direct involvement of communities and local social networks such as Iddir and Mahiber in the activities of the committee is vital for effectively managing as well as sustaining the care and support component of HRCI. - Committee members with an overlapping responsibility need to revisit their roles and give space for other potential volunteers fi-om the community to take part in the initiative. - For sustaining the voluntarism in HBC requires rewarding volunteers for their free services through promoting dialogue and riobiliziig stakeholders for availing opportunities for them and providing them formal certificate for their service. - It is necessary to adopt a uniformlstandard procedure for the provision of HI3C to ,_,I/_.., -.>.. i" sickhed-ridden people as an entry to increasing demand for VCT; - In bigger towns such as Nazreth and Dire Dawa, HBC activities have to be standardized as there are other NGOs working. on care and support. HRCI should make special effort to mobiliz'e and assist eithkr HAPCO or any-other appropriate institution that could take responsibility of coordinating, streamlining and standardizing the care and support activities. Tolerating the currently observed frauds for instance in Dire Dawa would create a situation that is morally inconsistent io the objective of the program. - HRCI need to design a mechanism for addressing the special needs and psychosocial support for OVC. Networking with teachers, community members, and religious leaders for psychosociai counseling has shown positive indications . . . , and HRCI need to technically support such efforts. The committee needs to be encouraged to set a regular schedule to have a discussion with OVCs. lR4 Livelihood Security for PLWEtA and OVC! - The currently initiated activities need to continue being implemented at full scale as the target group have been informed early on and are expecting to start the schemes. IR5 Community Defined Quality of Service - This intermediate result also has only been started very recently and need to be strengthening in the reaming project period. Annex 1 Tables generated frbm Mid-term Review Survey I .,,. ._. . _I.r -**, ire..c-" r.,"xr..b . I".r -.."..",.n-.(.- ....'-l,\ ,i X *,<..i - ". . i --*-... .X^ ' - " Table 1. Kno~~ledge'a6out possible ways of transmission (~557) ", . . ,",.. ,. , , .*".". . ,' ,., Y.. .,. , Table 2 Knowledge about preventive measuri~fi~r'~W~X1fis'~(~=~57)~"' '- 4".* ,-,,.....- "..>,,",, 2,. ,, -*-..-- ,.--.a ,, , . , . , ,- - Table 3 Five major diseases and perceived as symptoms of ~~IAnbS'5y~respondents (n=557) ; , .,-..**a, $-h"=e+%-ae?-we+,>,q Limiting sexual'partner' -""-..~,* , , ~. ,. ..., VCT (know ,gfaiiis &. 6GTcfw..im"g~"d~i Avoid unsafe sex ,, ,. ,-. Wait until god protect us Type of diseases and symptoms Common illness flue/cold HIV\AIDS TB and Repeated TB Chronic cough Herpis ST I Long lived diarrhea Thinness of hair Visible infection -- 37 3 5 6.6 0.5 0.9 - m 5 Major diseases 462 279 243 133 87 27 1 - Loss of weight Frequent sickness ,. 51 4 385 -, -, ---* - - - Symptoms of HIV 92.3 69.1 n 38 - 321 376 18 473 35 73 (%> 6.8 0.0 57.6 67.5 3.2 0.0 84.9 6.3 13.1 .* .- <*"."rci,,." =)"" -=,. .-&_ %ill . ,:_- *- - .:, '-i, XI^^.,^^-- .. . , ,. ..= .. il <-. , , L. - , * " ' . . -. Table 4 Benefits of HRCI as perceived by respondents (n=557) . . Table 5 Respondents views on HRCI Strength and weakness by type of intervedion - " .. .....-.., #-i . .... ..... " .. . ..* i ..-. . '. . . . ." > ..,I? .,,- ---.a -r.&,-rs.i i,r , - i . - , ii ~ Type of services Care & support to OVC ., ', .". Care & support for PLWHA Counseling service lnformati.on,and education on HIVIAIDS VCT services Distribution of condom Lack of behavioral change Other , . , . - -. . .. .. , , . . ,...,, " . *,. .,...ii.. &..I.."~-.--,:xI*.Y.-CI iiii Irrr4.;.r* rr ,li... >,"i.*ii" i .^".., ?", ,:I;' l?. , '22' ' ' trength of HRCI project I . . heaknesses t,',.",. n 197 151 81 67 37 10 1 10 ",.in.~:',.*l.~P~:,,r-:,-.i.B,,"-BI",A % 35.4 27.1 14.5 12.0 6.6 1.8 0.2 1.8 Type of interventions Care & support to OVC Information, education & distribution of IEC materials Care & support for PLWHA Distribution of condom Created demand for condom HIV\AIDS committee Table G Media through which responpents k~ow zbout HRCI by source of information .,. ,..~. Among those who know about ~RCI (n472) Availability of VCT to rural people n 236 224 159 45 16 1 1 1 Type of interventions Inadequate IC activity Inadequate support for PLWHA Inadequate support to institutions Inadequate behavioral change observed Distribution of condom Poor ethics n 13 1 104 49 20 16 12 bnavailability of ARV drugs ' 14 Inadequate representation of communities bo confidentiality No free VCT service 9 6 5 4- ** - b Table 8 Examples observed changes as a result of HRCI Table 7 HRCI interventions that has brought change as perceived'by respondents & current users of I the services(n=542) A I ".***. . .. ... .-- -.--.------.--.-. ^-l- ---- .--- -- ..--.i- ~cii^-~+*t.-i;i -' . . .. 2". *25.?;*:~.?,%5%e:::: . - .. . , . .,.. -". , ^-.-".: -..*. ^-. "?. -. - . - -;*,. -,.* A .. '+. -,,: , .. L., * .,> *., , , .*"--a. -.~<"* --v-.'.-,.."Ysr.', *%*, -*. s ,. . t$p*+:" ,&w~-*+k6+*t&+s&mdpn 4*A*%t:&4*,,~, -,~".': A:?':~: .;":* .. , ,: . :,- .s>:: *"% ,&:. :f-i" - BA - . . . . . Ta61e9" Xeasns Tor not using the available v@ . preveiitive .,,,: -,,, ,, ~. sewices , . . ,. (n=s"t,' . .. ,. Reduction of stigma & discrimination : ' ::--: , , Use VCT (for personal benefit & before.,mariiage)". ,,.. " ,I.-_ ? : Did not believe on the sewice provided 1 I ( 0.21 ** , ( " ' .,. ,I.* I - 5.'-',.. -.,, *. ' .. ,, ' . . . .,.. ~ " , . *. *. . , " ::" .1..\.' .- , .,.:,I;,., ,... ..- I .- . , , . ., . *. s ,, -.. ,-'d'-.**-, " A',?, ,<."*.LAA<.~,:,': .*..., < >. > . , . ., m",,:~> < ..,- ~,?,... , , ,", - ; :,.,:,;~::s>.:*?\.+:;'. ,,.,\,, . ,, , . ~\,Z" ' 17 1 19 Have stopped sharing blades, needles and sharp object that Did not take injections . ,,,,,.,*,, 3.1 21.4 6 1, 7 1 .I 0.2- , " Table 10. . ,. Intended participation of &spondents in the Preventive -..... measures at personal, family'and community'leve1~~~ -'-'--"- Table 11. Possible action recommended by respondents for the future a,%;** ,,, , ., . . . , ,*_ ../ - . _A ; . . .. . - :I , . ~ ., -x#-& ,,"&w.v*:#'****~ . .- ,', ** m '~.uins*~~**~*~~~~rfi~~~~"yr~~'i'*i~m.*Is~~~.~D~%~+ "w*,*l~~v~.~s**~~~~*ia*r,% Table 12. 'Piotentlal threats (\?a ent%e% by respondents . . , . _ ,..: . ., . . . .,. .,,,,,.-,,,.A, "*."",.& .A'* , :-: ".. \<~?.d,* - .- .-J , , . Table 13 Knowledge of HRCI activities by type of services offered (n=545) Annex IL , . ," ~~ : a vl, 4 ~ . I." 4 i Total Achie v. % StrategyIResult IR 2 Increase accessibility to & availability of preventive services - No of VCT counselors trained - No of health staff trained on HIV testing & 01 - No of health staff trained on ST1 management - Clinic & health post (KP) staff trained on ST1 management - Cllmc & HP staff trained on VCT - Climc & HP staff trained on 01s - Climc & HP staff trained on HIV testing - No of VCT centers established - No of ST1 centers strengthened - No VCT kits hstributed - No ST1 kits distributed - No VCT & ST1 with suffic~ent guidel~nc/protocol IR 3 Accessibility to care & support by PLWHA & OVC Year Plan 16 26 - Planned and Achievement of IR I Achiev N B * = revised plan, ** = figure after /represent data for TW, *** = ~ncludes determine (scrccmng 123, Capillus (confirmatory) 37 and Umgoid (tie-breaker) 33 Plan Year Plan 4 4 Plan 12 20 20 18 8 17 2 16* 26* 26 Serv~ces Offered --- 7 Total Achiev - I11 Achiev 18 25 193*** 68 Year 11 Achiev 44 44 44 8 8 8 18 25 50 50 660" 26 3 2 300 660* 300 - No. of HBC Volunteers trained - No. of HBC kits distributed - No. of PLWHA received HBC service - No of HBC protocols ava~led - No. of PLWHA received positive llving tratning - No. of PLWHA referred to VCT by HBC volunteers - No of PLWHA received spiritual counseling by religous leaders - No of PLWHA received to health facllit~es for 01 & other treatment 70 70 200 200 pF- -B I 52 100 456 84 32 496 450 ,.. ., , , ." .- .. - ~ I Terms of Reference for the ~ib-term Review Tasks accomplished by Team Members - Michael Tamiru All All Naz, Mojo, D.D, Logia, Mille Mojo, Mille Naz, Mojo, Celenko, D D , Mllle, Logla Naz, Mojo, D D, Logra - - D.D D.D Mojo, D.D D.D Discussion Discussion & report Discussion Discussion - Survey VCT IC counselors IC volunteers CHBC PLWHA FSW Committee - - TW Youth OVC Hotel Owners Bureau of Health HAPCO Off. Activity Data collection, verification, analysis Transcribing Report Transcribing Report Transcribing Report Transcribing Report Transcribing Report Transcribing Report Transcribing Report Report Report Report Report Teigist Lemma All Mojo All Logia, Mille, Chelelnko All All D D, All All All All All All Chelenko All Mojo Vice President of the Afar Regional Administration Kebele Leader D.D Hoter Owners D.D Coor Off (Naz, Awash & D.D) BCC & Social Mob Care & Support ISASO, PMC, IOM FHI US AID CDC Discussion Discuss~on Discussion & report Discussion Discussion Discussion & report Discussion Annex V: " . .," . 5 .\ ~ .~ , - - List of persons and institutions contacted I. List of Institutions and people contacted 1 I Ms. Franchisca I FHI I List of Respondents for FGD OVC ~ ,. ,,- Name Gend Age Education - " Grade - -.-.- - Dire Dawa er Mahlet Terecha Deka Ken Mahlet Abebe Bedlu Nigusse Tamiru Yecime Ayne Rabi Michel Hufanta Habtamu Itafa Mati~vos Mesfin Grade Gen Name der F F F M M F M M M Age Chelenko, Logia (To be included) 1 I I Nazreth Education 14 13 21 16 14 14 14 11 10 Israel Sebsibe Yonas Hailu Ysln Abdla Atekalay Solomon Yared Zewdu Daniel Madu Tigist Begeta Helen Getu SenatayehuDerje Bezawit Shegaw TomanDechasa 7 6 7 6 5 5 6 1 1 9 Henok Tesfaye Yigeremu Haile Hiyvot Aseneghe Fire Hailu Feven Hilu Mahelt Gebehu Rosa Jafare Hana Weletaw Abi mamo Helen Amare 8 6 6 7 7 8 7 5 3 M M F F F F M F M F MilIe (To be included) 2 7 3 4 2 1 10 6 6 7 7 M M M M M M F F F F F 13 13 15 15 11 12 12 6 7 16 7 14 12 10 10 9 16 14 12 14 15 Mojo Shibre Amare Woubit gemechu Mihret Belda Goshu Tadesse Abdul Kasshun Bertukan Legesse Ellen takele Hanna Belda Dej ene teshome Messeret Hagos Maheder Genene 11 11 8 9 12 12 12 17 12 15 14 F F F M M F F F M F F 3 4 1 2 2 2 2 -7 * --- A* 7 5 8 8 List of Respondents for FGD --Peer Educators . . ,, ,. ... List of Respondents for Focus ~G?oup''Disciissi'OnnPKtiwftA . , .._^ _ C 1. . -. . , . I I I ........ ,.. /._ I I . . . , I ... 2 3- .. '. ... , . - ., _ . . ., T_li_--c '. - , . $.,. \ , ,". ' " ' . ...... ,^ _ ,-,; - _..-. ..--- - -------- .- hd-." +, iT&"*&&-+-+ G.. % _ _ (<.i....*".. Th*$&-& . -. ...._... <.. . . . .. .~. " .... -.: .,.x.. .. .t,~ ;:,:.. j.:*!#..:,:Lrr;: ....... ."~~ >?...%*. -7 .... *+.*,. =&:9 5*:*$?"%*;:: ........... , "" -. , . ................... ~ -- . .... - - ,- ,->. ' ............ ..... .... .~ , ". ., ."~". , ;y+&~.$%;.~4".A,~i$'**;~*?$~ ,, ..: , ", ,, 2 " ,,.~ , . .- *-**:-. ,.+.x: j+:.;.,; ,,J..~~.,j,, :. . . , . ..." ...... .. .. . .. . . . ~&~,~;;~~g;&$;:a&.~~b~~&~g~;~$s;g?~;j.:t$,~.'".~ii ;:)::.i:~. 2, 2,. .$ .:A .r::z;t.g' >. ,"; . , <,;-.., , 3 . , ;;.-:;%$ . ;;r*:~i~;;~q:~f~.;~~:,~;g,~.";-"-"-;i*:.r>: -. ., , .,*fjj$;? , - 5 -?; :+ .a . .: 1.. 5":,2- .": : ......... .,?. --- -.-.......-.. .... .r-i. .."...... ........".. List of Respondents for 'HIV/A:'IDS an3 Committee (& sub committees) m Annex 5: I I i I I. Guide for in-depth intW!!/@-~ . ,- .... , ., , . , ,. ,""7 G, , Introducing self and complement the respondent for agreeing to be inteXY~?w!?d!!.??!~~~~~ herihis t i,me.".st= *t&i2&:%&L&&&,f$5m5f0n+ skzirtf :pdes will be kept under strict , . ?- confidentiality and value andano~appreclate ~Tat respondent is..w?rking. Ask about herself, her work ..,aa~B._ dent,, that---&&-?, &%+Mb-t+ ~.,. 9z#bia ~ ..~G~.b2s..~a~...a~sa... *. understandandl , - le . , . " ,, , , , , , " \ . . m " 1- 1 ( . ".. ...... . , Ggmg&cquestions (applicable to. all %ce.t VCT and ~c~~~%~L~E~~~ -,+*-a ,. .............. -,. ........... @%a How are you contacted first to.invol,veiin this project? What .~.Qt~~~L!?~ You to accept the offer and provide service? ,At- whi*"stage of the processes did you participate (in the selection ide,ntific$ion of peers, training, etc.)? ,m other th,~ being volunt&er/peer educator what other ,&~!c.gs;,.$&n ".you ,oEr ,.(< to the, , , , , , , community you live in? 5% , ., Have you ever been to theIC'?If you do, with whom did ,you go and what do You get in IC (BCC materials, condoms, counseling service, etc.)? - .......... .... *"* ......... >.,* ........a. :". ..2;-..; .- ,,, . ., .... ... ..* .... .> Eaa .~ , .......... .._.....-. - _-What d.0 you know.. qb-~gt ,.th,vb~~& . . 2- . .." *.. .i,. .xi".," .. -; OVC care? Can you tel! us-~y of your con.qern$ ..... .... -. --- ... .---d+, . . -.I-__ . ," , . ':% ,,~:~,>g~d*~z~:*4;,9:;,*~:+~~Gy*-&&~c!">& "\,a; ,.;*. .,> ,, , . , , rn .............. ,~.-- r Generic questions (appiicable to FSW, TW, Youth, PL~HA)'. ,- ," , ,, . ma When and how do you contact.the ~~~.and,;~~~,+~~~:~~;~~~~~~~~&g$$~ept$? Did you r get the service (treatm~*t,~,g~d*,d+pgs) at all times? Is there an~klng that can be done - .,. . ~ , ~.. k. " better? t4n* , ~ What do you know about. the .sg--i:e~,offged by FdC? What do you know about. the. OVC care? Can you tell us any of your concerns about ,@C ..... ,@dG,ovc.,:if ,! any? . , . , .. m can you tell what you know about ,H?.~J4i2& %&S=g$. do ,z,o*e.to know about it (through radio, colleagues, health workers, project stacff%rchimosque, HRCI,. . ~ m etc.)? i e. , .. .,. .............. - .a.d...., . , . , Which insti&tio@ infour ittea &working on HIV/aS?-. .. ,...- ........... .*........ em Skip for FSW: Whatdo you know about the cond9pls supply in the hote1s in the town? - .. ~ .," .,..- I I Are there kircumsta~~~~.~~&~g;g&~&~~~~$~ please explain? %%~b***w*%~?~%~~%~&+,*~bas. +.a.?t&*~< w,*:<~r~.+.%, ,:x> *h, : ,*z\;. 2%. ~, >, e?sa r. Can you tell us about the practice in condomusejn your vicinity? If you think it is low, L s what are the ways to improve use of cond~~..~~~~~~~~~~~~~~~~&~~~~,~~~~~,~~~~~~, I ...... use" y , . . > , . . . # . . . ,-> ... l" - -- '., ,, ..a"- , ~ . ,,b '.. , ' "..I .- . :. .:. i.* .-a , . , . , What do you know about mI'm~ c6mmiitees ands sub-committees, care add supPoit i. "7r ?$ . . for PLWHq care for OVC ?.-E<-c..y.G< *'ever.' pi&cipai";d"'ii ' resource ,. . bca mobilization and sat was your &nt&ution? If not, what is your reason? t,' How do you spend you pass time? What islare the major topics you discuss with your i m. peers when you meet to pass time, get acquainted and some rest? Can you enumerate other possible activities that might be conducted in that special place and will benefit your peers? What are the goals that the HRCI project coordinator has set with you? In your opinion, . . what should we do to help you reach those goals? II, c: - -- a , ,, , . ." -..- *." ..,* .%,a-,. e$m-.,,*.i , .-' a'-.%, ." ?XS' . . Do FSW/TW/Youth/PLWRA have IddirMahber? If yes what is its objective? Can you include HIVIAIDS issues init? If FSW do not have ~ddir/Mahber,"can you and your E? colleagues organize such networks of solidarity along the Northern and Southern trading routes? What can you contribute for the formation? ", w Interview with Female S& Workers In your opinion, what are the benefits, and the risks of the sex work? What do you and do not like from sex work and why? Does your employer encourage you to get services of STI? What about protecting you from sexual harassment? What are you doing to reduce the transmission of HIV/AIDS in your area? What would you like to do in the future in this area? Do you have adequate supply of condom with you right now? What do you know about ,>., . , , the condoms supply in the hotels in'the town? If you; have a preference, what is your favorite brand? Why do you choose this brand? If you da not mind, can you show us how to use a condom? How often do you use condom? If there were circumstances that you were unable to use condom, can you tell us about ir? Do you have children of your own? If yes, are they living with you right now? How old are they? Are they in good health7~ow wouldyou 'helptliem become what they want to be? Thanks again for this confidential interview and for sharing your experiences and possible ideas for' strengthening our intervention. We will do our best to take the .. .." information to concerned experts for their action. We wish you good luck for everything. Interview with Truck Drivers Do you have children of your own? If yes, are they living with you right now? How old are they? Are they in good health? How would you help them become what they want to be? 1 ... .,..*: .......... ;.~ .... .:,, . '"i ..' -. .., .. +. ,-i.ut-,..c., ............ ,.r2i,.. ,-. ......... .-.. . ,-.. , ..',,. " .'. . , , . ' . ~ . - .. , , , 1 ', ^ ,. .... ,: ..X..*", ................ .-...i . ,,...- rrr -*r l.-,wi "*+. M ..... '..I.*....... ..................... If you had close friend/relative/family member. who is interested to become a truck ........................ driver, what would you pdvice him? In your opinion; ...................... truck driver and in the context of I%V/AIDS? -' " '" ' . ~ Does your employer encourage you to get services of HIV/mS and'S~~7'Havej;ou ever ," ..... ,>.,>>.L -\ . .".....>....t *, <"T... .... .3.-,;.d&<". ... . ,. .,- - - . visited VCT and IC along the corridor? If yes, for'wfiat purpose and/or servlce did you . - . - . , . , < . , , , -. ., . seek? How did the councilors and volunteers recelve youTxlSi~d you get what you want - from the centers, pleas explain? Do you have adequate suppiy of condom along the corridor? Do you travel with supply ........ "... ,-, ..... , .. .*. .. ... '. ... : ................ of condom or buy it wherever and when&& you need ~tTThink of the towns and hotels ......................... , "% ........................ .- . along the corridor, what do you knowabout~th~~'condoms suppf; In the hotels along tfie - - ........... >*--'*,"'.A "-*"*. . b-<,wvm*\, -MM"B""A,?",*-*%,%,?.-, -i U ;rr ...........A. -2bS .-:.. * ... corridor?'If you have a preference, what IS your 6vonte?kan you choose this brand? How often do-you use condom? If there were circumstances t'at you were unable to use condom, can you tell us about it? What are you doing to reduce the transmission of HIV/AIDS' in your area?What would you like to do in the kture in this area? ............. "*, .*\."-,G*x.'" .-A< -S,.A*..%- ... a~..~3~'.~~....~.~..>~.~..~~.:.~.~.?'~..~<~ -,.,. s,-x,<." .,srw,:.<,. .a,.* ..... Thanks again for this confidential interview and For sharing --your experiences and possible ideas for strengthening our intervention.' 'We w~l'1'"'~~'~r'tjest to "take 'the ~.+ information to concerned experts for their action.'We'wisE ....... y&gOod .......... luck'for everything. .. " .:,- ................ .... .;. , - .: '< -, ..~> ;. ! ,&. . ;c'>d,.:u:<2,,, :. ~, ' . ' . . , . < , :*'.,&' , .' BL .... .-- .... ..-.; --.--c-,%----. ,-. ...*.. -.A,.-., . .,,.= --, .$<> .... a &, -..+aF~.d- I;..,: . , . .%+ :~+~~-+i,<:.-~ ;~:~ZCL;z.:.:~~d~Tr$zl+A~:.I-:.I k?i>!,':;$j-. Do you have children of your own? If yes, are they [wing with you r~ght now? How oId . * , - " 4- A". , " . . , ' % s " , . 1- " -- ;. '. - i < are they? Are they in good health?'~How~wou~d youhelp &em become what~they want to be,7 ........... . ....................... .... "" .'^ ,. . -.*- m , . ................ .. I-"'. ,r..,".-. ,\*riii.*i .... x' ..rx<.... a *.:*..a 9 ".+.--" .^. ... ", ,.1: .. ,i . Have you ever visited VCT' and IC?'Zf yG,"Why&a you vlsit VCT and IC? How d~d the'. :, .,. ">~ councilors and volunteers receive you? ~, id you get what you want from' the'centers, .......... please explain?" . , Have ever used and/or intend to use condom? Ifyou ......... pfan ~.%* . e~ or :.*-*~~ a& .,z~-,< .-~..~a,a.a+-~+-,.~ currently .......... using condom, . ~ , ' from where do you get it? How often dijr you iiitend to keep condom with you7 ,,, __ i"., %_ ,._. .,. _. . . , ., . . . . . . . *, , , .",.!., . , ,".' , , , : . . < . -, . , . DO thinkihat there are iiriumstances that would be unable to use condom, can . ................ you tell us about it? .\ ." ,.". . , ,, .-. , . - , .._I.."- ",..CCIeI A..i .. L. ........ ;ir ._......"............... If you know someone who is HIV positive, what do you tGnk are major challenges that , , person is facing? In your opinion; what can he do to solve hislher IjiobSem's?;What can ..,~ < .......... \ . other people do to help this person? . , ,. , ,~ , . , I _ ,-I ,:_" , ' . : . ., . . ', .., 2,. f : '2 " - -- .- , ' . . , , ~ .. \. ' what are you doing to reduce the transmission of HIV/AIDS:in your area? What ~obl-d ~ ,. ,' .............. *. . you like to do in the f%ture in this area? " ......... , -, ~" F Thanks again for this confidential interview-. and for sharing your expgriences and 4. : possible ideas for strengthening our intervention. ' We iYill. 'do ' Our'6est~totakG thk information to concerned expertsfor their action. we wish you goodluck for everything. EA"a .. , , .. . , " ,. . -, , ,- , , .. , . . -. . , .. htehietu with PL'FW~A~ * Do you have children of your own? If yes, are they living with you rigfit nG? How old ._ _ .mu* jl_".l."" .+.. .~ ." ," , , . . /. ; .- .. . are they? Are they in goo3 health? Wli'at do 'you advice them to 'become what they want to be? Do you discuss.about HWfAIDS and ST1 ivith'you family'mem6~'?' ' ' ' "' '"~ ' " During your visit to VCT how was the reception of the stam "What'kin8"Of Griricedid the councilors and volunteers provide you? Did you get what you want from the centers, please explain? What is the difference between the sei+ice"at VCT.aiid'healt6 stGiodciyiiic3 'COu1h"~bu *.,'. ", -.. ,. ..~. ,,~, .?, - ., . ". explain about your satisfaction by the services'of health stati'odclinic? What kinds of protection from transmission do you use at home? Are you using condom? Since when did you start using condom? From where do you get it? Think all possible ways, do you think that there are circumstances that you would be unable to use condom, can you tell us about it? What are the major challenges that people living with the virus are facing? In your opinion, what can slhe do to solve these problems?' What ~another'~eop1edo tdhelp this .. . person? What kind of support have you received by people residing in' your vicinity? How do you value this support (are you comfortable with it, should it continue same way)? rn What are you doing to reduce the transmission of HIVIAIDS in your area? What would b you like to do in the hture in this area? Thanks again for this confidential interview and for sharing your experiences and possible ideas for strengthening our rntervention: We will do our best to take the information to concerned experts for their action. We wish you good luck for everything 1""3 ,, * . IC Counselors (from Michael) IC Volunteers (from Michael) (sr r , r - C. .* 11. Guide for a focused group'discussion' with FS W f? Warm up: Make sure that 50% of the participants are female. Fill the brief registration L'? , form while participants are arriving. During the meeting, the review team will start by introducing themselves and this will be ..folPo * -i.,z.Eyi*K;.-i nfr i6;i dp;*:p.in;sbf *<"'*-~.."Y, ,>*"., , *. .- -"".," .,*% .-,. .-=. ~ - . , ~ .:. + $:.; 1 FGD. Request participants if they allow the recording"of t6e ii~scussion by tapes, set it on , " - .. . ., . .". ,. .-a . . . . ,, %..*I 4 , . and move on to asking the questions below: Generic questions I 1 . . How are you contacted first to involve in this project? What motivates you to accept the offer and provide service? At which stage of the processes did you participate (in the selection identification of peers, training, etc.)? Can you briefly explain your responsibility as committee memberlpeer educator/volunteer? What was your' objective to become so? What is your current objective in terms of your active participation in service you are currently offering? other than being so what services can you offer to the community you live in? When and how do you contact the VCT and ST1 centers? Describe your working relationship? Do you think that the centers are well supplied (for treatment and drugs) at all times? Is there anything that can be done better? Except for FGD of HBC & OVC: What do you know about the services offered by HBC? What do you know about the OVC care? Can you tell us any 'of your concerns about HBC and OVC if any? -, . Have you ever been to the IC? How often'did you visit SCZ) If you do, with whom"i%d you' ~" go and what do you get in IC (BCC materials, condoms, counseling service, etc.)?' ama In your opinion, what does volunteer and peer educator mean? What does it require to - ,~ ~. become apeer educator? What does it require to become a volunteer?' :- ..,": ".' . :s.-,, , , , " .. , .......... a, , ..... ,."~'," . . ,&~. :- -, ,.. _r . . , ' ." - .- .,"~ . ann ............ ..%A ^...> ......... , -.. ........... .. , . - ~. " -, ., .. , .**.. 2. -* u;,, r ,,*r.-;, ,. . ,' Discussion with FS W , .I".b ,-*,, ,r_~.*w_./ . ' -,., . . ......*.. ......... . . % c* .,.. -'-~--.-i---" ,-p--l..-- .. .- -. "-., .-_-.- +-- -.*,-a ... --. ...a*-...-., ".+" ........ --'M-*>-c.,r;; ", -,: *.c,. .... .: .,, ..,... ... ..>."... ~,q*:+.s/.".- ,", d .%.. *:><.&f.a.s6~.:~5"-<;:,,>"L**#fi.,* -.,* ..>6"*. + ~.*z~;ab&mU.,& 2" -.-- *- *-"-" .--. ", **?A- ".-. .\ .>-. ~+,;'..*. ~ %*v-w7 ...... ' - . -. .' "&"+-*u+ In your opinion, .......... what &e theti&K6Ets, . and ..-.... thi'iiski, .. 6f 6Gi1ig i sex worker? W? w - -.,- , ...... .. .‘............... *.-..- ~"- ?.... +*, -.. ." ..:..; your plans in terms of either continuing your position or changing to "*ariotlier?*Whatttt '- '." "". - ,l. ,C..i_- , - " . , *^ - . . ' .- . .-..- **.i., . -.a. .a' :<,.l:l . .'. .*:.^..: i would you advice a lady who is a new entrant?'"'- An On average, how many one-on-one sessions do you conduct every week? How long does it take? . , ,., .,.. ~ ..... . - * ., .' What do you know about the HORCI project? 'Abo~t,SaVk the Children? Dbes'it bring,, anything new to the people residing in the area? What do you suggest to sustain the " , . newly introduced schemes? What are the goals'that you believe that HRCT'has yet'to work on? .,-,. .>. .. .-> ........... What is your opinion on the current use of Condompra&tice?.~hat are the waysdr'means . ., that you suggest to improvethe use of 'condoms 'among your peers and reach. f 00% '' condom use? dm Does your employers encourage you to get services of STI? What about protecting you from sexual harassment? What are you doing to reduce the transmission of HIVIAIDS as .--' .... ..-...- .-.. . ..-.--. ........... .;. .,n.** .-,.. +a\.r.-- ..w-. ..*.. &... ~~~h\~~~~'~,~.-L~VI~I*lir,i~i"~~~~.~"~.y.~ "r;i -*.irir; lrrr*!" ,%is*\ r <*'.51 -il"ar.ri i r.i_ .j_._. , ,_., - % _ , . , . , , ,, . . . . t , - -..,.... -: >-- .,+.",< ",a.,? +;. , .... ...,.-.., , . . ,, .. -.: %...--, . ..:' i , . :. _ , . . ! ,. . ,, . . . .. ,-:<: :.?,:.%)*--,: :+.:.;*"$*: ,$%<.* .,: ;;";*;*;:..; ,: <,:,.:., > ::. -,"I .,*. .,: ;t~ +.~ ,., , "- . -, . . , . - ( . ,' , .*. . Interview with Youth . , ."" . , . . .. , . . ,."."" ' , . . 5 ' . , . . , I .. . , ' .' . ,o.., , . .- ~ -.. > How many of you are' living with your parentsfguardians? If there are more'ithan 3, ask - .- " . . .'. .&, , , ;, =* .. . +. - . " how open and often the family' discuss about HIV?AIDS;ana STI. , ,. ,, How many of you have children of your own? If there are more than 3, ask if they are living with them, their age and health. How would you help them become what they want to be? Have you ever visited VCT and IC? If yes, why did youvisit~&iiiid'f~? Howdid the- . ' .-.., ' . .." .,..., " ..,." *.,,,, .~ .... ', ,.,., ,,,, , , councilors and volunteers receive you? Did you get what you want from the centers, -. please explain? Did ybur peer comment on your visit, please explaiii?"'.' -. . . .. . ., . , . . ~ ..;,; . v.' .,'* .J,-,h.d,: . : ... Lir.'.>. i.. .. . ., . ., , .,, Have you ever used andlor intend to use dondom?--If you plan or are currently using .- . condom, from where do you get it? How often do you i'nt%d'to'-geep condomwith' you? . ., ". .. . .. -. . . . Do you think that there are circumstances that you would be unable to use condom, can you tell us about it? Did you know a person living with HIV? If yes, what do you think are major challenges that person is facing? In your opinion, what can he do to solve hislher problems? Who should help this person to solve hidher problem? What other things can be done to help this person? . . L , . ., . . *, "A ***?"",#,:4* '""I ~::~-Oj'w''"L~~V~Ir.Ir~iiiri"~-" i*";,,, -V<.,<,.', ."^.@.. \"..,'a .,:",. .%.;.-...i*,..k. What are you doing to reduce the transmission of I-~~v/AID$~~I your area? what would .,;.:$$ ;>*.~:~;f~:::;#~~,3p$:<". *'% : .' .: , , . ,,you 1,ike to do in the hture in this area? --- ,. . . ,, , __-I/_ ,,** ~,,*, ,.,,..-,, - \' '__ - ., , , , * *'~ . A L . ' ' , : - , . ' , : . .- % " -. .* . -- -. . < ,&~~$&$$.G .A& >:,t2~~;3-;:3:~c,,;:*>~$,>~:,a~f*~~~*&:<2 .: - Thanks again for *'this --cbnfi possible ideas for strengthe information to concerned experts for their binq Interview with PL WHA Do you have children of your own? If yes, are they living with "you iighthbG?-~ow'old are they? Are they in good health? What do you advice them to become what they want to be? Do you discuss about ~1~/''~and,'3~1~with your'chi~drefind family members? How are they receiving and treating you? ' I; .," - .i*>'-*v*?~-.*t;.~bi.: ; Siiii ii:.*. - ... > ,,, .. . During your visit to VCT how was the receptrb'n ofthe staffr, What kind of service di& the councilors and volunteers provide you? Did you get what you'want fromthe centers, please explain? . ~ ,ill, - . . .' What is the difference between the service at VCT and hk~lth8t&,. ,i" .. i.'.)- , . r . . .,- r,.. .""' i .. . .. ,...ai. : .. a ;r.; * Are related services available for living with HIV . ., or . ," AIDS? ...,- am Ongoing medical care Yes In preparation No￾Ongoing social support Yes In preparation No ism Support group for people living with HIV or AIDS Yes- In preparati0,n * ,-ti0 -. . . *.",,.". . -. . ~ ... ,,<. ". . , . , , , . " Ongoing counseling support Yes - In preparation . No . -. . . , .,. . . . , .. . . -, m Liaison with NGOs Yes -. Iipieparation No Family planning Yes In preparation No . - -* MTCT interventions Yes In - meoaration No I' - - TBPT Yes- In preparation No ARV interventions Yes - In preparation - "No - - Other preventive therapies Yes-In preparidon ' No- (please specify) .. . . .. Are HIV preventive services available? Condom supplies Yes- District wide program Yes- some sites- No￾Ongoing counseling Yes- District wide program Yes- some sites- No- .. Other (please specify) Yes, country-wide program Yes ',some sites "No - m. . ,.. . . -> , .. " . ,. . . ,,~, , " . . ', . , . , , ,% . . +.&! , . . "...." " " .-... -, i -- r . .-. ,. . ..~ *: ,,,. Are st&c;licaf data. about the counsel~ng servlce regularly compiled? Yes . No . .. .. . If YES, by whom . . ,, ., , - For VCT site evaluation: logistic considerations and coverage Respondents = VCT managers ., Which services do you offer? Pre-test counseling Post-test counseling Ongoing counseling - HIV testing HIV diagnostic counseling ^(Gthout testing)" If pre- and post-test counseling are undertaken, do carefblly defined procedures exist? Yes No - Please describe these Opening hours Are you open at any of the following times? Early evening (afier 17:OO) No - Yes q (specify how many evenings) Lunch hour No - Yes Weekends No - Yes - (specify Sat. or Sun. or both) Do you have an appointment system? Yes No - If YES, what happens if someone comes without an appointment? They are asked to make a fbture appointment Yes - No - They will always be seen the same day Yes - No￾They will usually be seen the same day Yes No - Privacy Do you have adequate space to ensure counseling sessions can be private? Yes, there is adequate space - There is some private space, but not enough - No Specify, private office - cubicle curtained-off area other (describe) . . For example, do written policies, checklists, data management systems, etc., exist? Waiting area Describe the waiting area , ,, '., ,. . .,*., . . , -, _ _ . /, ,* , .,^".." .-*.., 1 , .1- I. ,, I I * , :".-. - ' . 'V . , . - .- ,. . Confidentiality Does the site have a written policy on confidentiality? Yes No - Describe the steps that have been taken to ensure confidentiality .. . . .. ., ,,% ., - ..., " * . . - . ,. L, . : $.. . " . " - - .'- - ,.- ,.,., - , , , . " Have any of the following staff received specific training about the role of counseling and confidentiality? Counselors Yes No - Laboratory staff Yes No - Non-counseling medical staff Yes - No - Ward attendants Yes No - Receptionists Yes No-, 4-ncillary staff (e.g. cleaners) Yes No Others (specify) Yes -~ No - Linkages Do you receive referrals from any of the following? CHBC Volunteers Yes Occasionally - No Information center Yes - Occasionally - No - FSW Yes OccasionaIly - No - HBC volunteers Yes OccasionaIIy - No Medical services (e.g. clinics/hospital) Yes Occasionally - No - Social services Yes Occasionally - No Other counseling services Yes - Occasionally - No NGOs Yes - Odcasionally No. - Family planning services Yes Occasionally - No MCH services Yes .- Occasionally - No ,." , ,. ,. , ... ' ~. .. ' ., ". . . "" , . . , * - ~ ,~ "3 ,S . ., ,.-. ~. .. .. ., ,.~, , , _ _ .__",._ ,_ .. , . . ' , . . 1 - . . 65 , . * "* . -+ " I. _ _. - ,,_:, _ *__ I i TB/chest clinic Yes - O+asio@illy - No ST1 services', Yes ~ccasionall~~o'" ', Siccasionasl'f' - ., ,Nb/ , , , .,, ,+ ~ " ~ .' . , - ,?I" Traditional healers Yes':‘‘ ' . - ../. I Occas'ionalbly " NGw*>*.., 9;. SpirituaVreligious groups Yes - ,, . :. -. s. ' Others (specify) ,' ma From Where do you receive,maximum referrals? . ' Do you refer to any of the following? , ,. . . 1 ,,*1 1 Medical services (e.g. clinics/hospiial) Yes - O'ccasionally No. ' . . Social services Yes ' ~ccasionall~ No -. Other counseling services Yes Occasionally - No NGOs . . Yes ~.ccasi~all~ - No . . . . Family planning services Yes - ~ccas~o-~ally 'No ., . , . . ., MCH services Yes - 0,ccasionally - No. ' . -. TBIchest clinic Yes '~ccas~onall~ No ST1 services Yes Occasionally - No Traditional healers Yes Occasionally - No' Spiritual/religious groups Yes - Occasionally ~ .- , No - Others (specify) Are files kept in a locked filing cabinet, is a system in place to protect confidential --,..,.,;. :". ,. c ,..- - ;-., ., . . -" , Computerized information? ^Yes - No..- -: . , ;>, ;.. , .". + <:."*;><. t ,,;.,:c -., , ..'. . " , . . . .. . . . ~escribe how the referral systems work' and any problems and .~". successes , .. ,.. , ,"." - ,," -, ,. , - >.. , .) ., . . ,<, .:.,,:e ,.< :, > .~. *,. a"",, *, ".".d,,*". . - . - . >, . ., :",. 3.. ,--,, : : -', , , * '" ,. , , " ,", .. . , ' ., - -, *.,- .,- .-~ %-.,w,***~* &q*$i;~;,i2";,:<:.~>~ ! :,-:- ~... :',: .. \ ' , . < " ,*.-. , , - .- ,., ' ,."," ..* .' ,,~. .*'..'*.. v. ,,**.,** 2 ~$:~,$:cu.:.s:,,*,;~t>$~:;~., ,- : <,<, + . -, ,, . . ., , . . ~.,."% -**i**-*~ ,& z,ae*r<... *.A s.-. .\2 *aM-f'-3~# .,.,"sL.~*.-W* ,- -a ~, ',*I,, > - .-. . , ,: .. , i..?:,:.. 5 , ; . . ., ..,, ,.,.~.<.", ."*, . --.Do you. feel there are adequate referral' se~~~ges~~ajl~a;ble, --particularly for the'ieeds of -- .- . . . "..,~.,*...&~ ..-"-".‘<~,":.‘,.*~-"+wed*-*-"->~~*."‘<- ",,-.*-"."- V~.,,. . - ...*.",*, , ,-~ .,.. .,Z"~>.&,~".S+,L+ ,*,c..,*.*,~ -pe6ple who test positive?' + .. . . &,-- , ... ._ ,..*. ....,., &.-," ".,." A.A. ,% .--L..d :,.-,.., .,+zhA,,-<-. -;-,-,,,..~,",' . %~, , *; .*,~. u ,. ~ ,, . . ., , . ,I _. , ._ -n; * . - ."a* .#,A. bsr~a#"-,*ei* a"... >,r ... , ~ -, -, , . ". . , ~ 4 .,,~<,&",,>* *-... z-;,? ;..3,.:, ,., .-... ., . G ".- - ~. >", ,., .,,., . , --.-. HN testing methods . ., Where do you carry out HIV tests? . ~ All testing done on site , , .. " .+ ." ..>. , .. . . Preliminary tests done on site, confirmations sent to other 'laboratory . , , , , -*." .,,. ,, - -,.- ". , .~ .* . . . ... , ~ . .,, ." All testing carried out in other laboratory What is the time interval between taking blood'-and results being available? -.'" ., ..,,,-. *.r-,+'..<.?. -.-,<-..-a Ir -... i . . ..1 A. . - , ,... , .,,.\- " . ., "'.,.." ,', :> ; , . .~ ... -. , ". . ., ,. x . .. ' " '." , " " ..'.C.';: ..,. .% - " , . , . , . ,'. ,~, a. ~ . . * ~ .,. . , . .. , .. ,+, .. " . .,-- ,, .". - ." Do you have external quality' control for HIV testis-Yes-'No-.- -' - .'- ' . ' . . . , ,"., If YES, describe .. . ,. .... ~ .,..,... , a" ,, .,. / ', . ' % ,. *L * . .,.,. , . ,. . , Cost and sustainability . .". . , ,. DO you charge for services? , . .. .,* "&, . .* ~'W.~ ,..,a ., . ," Counseling only 'No ' Yes '-- amount Testing No - Yes - amount , . Ongoing counseling No - Yes - amount If YES: Are there any people who do not pay? Yes No - % that do not pay Level of service provision and utilization In the last 3 months: How many people have presented at the site? What % of people have had pre-test counseling? What % of people have been tested for HIV? What % of people have returned for their result? What % of people have been given post-test counseling? What % of people have received ongoing counseling? What % of people have been referred to other services? List the services to which most referrals have been made: -, . .~-. , ," , Describe any problems and successes you have observed in people returning for test results , . ~.-. . , Outreach counseling (counseling in non-clinical settings) Is outreach counseling carried out? Yes No'- If YES, How many people, on average, per group? How many outreach sessions in the past 3 months? Where are outreach sessions held? ..z, < .~<' Advertising- and promotion of the'VCT service Do you advertise or promote your service in any way? Yes -No If YES, describe Does HRCT advertise? If yes How Group counseling Is pre-test counseling carried out? Yes - No If YES, How many people, on average, per group? How many group counseling sessions in the past 3 months? ,> . ., How long, on average is each session? How do you see SCNSA or HkCI rile 'in mitigating KSV/ATDS? Give Examples SECTION 3 Counselors' requirements and satisfaction For evaluation of counselor selection, training and support Respondents = counselors What is your background? Nurse Clinical officer , - "wi"t.h ' " Social worker , HIV" ' or '. Person living other (specify) , .-. . .. ..~ Selection , ~ How were you selected to be a counselor? .. < Proposed by senior colleague Self-motivated (expand] . .- ';. ;., -,,. ,>, **2" i.: .us? Do you feel that you have been'pressurized into doing counseling? (Explain) ". ,, - . , '> : ,, . \ -. ." .. . . . . " . ,. -.. .< .. .' . ,,, . , .r,,',.' . . z,:-.---. ".*a I,, '. .- A'* - "%*6 - "'.:'");",:-i ,*~u.7;:*.,+"i? +'.%.4 '":,G;?:,.$,& Training I . " '* ,....... 3 -,._Y&^ <,;":+p;i\ : +:P-..d . . How would you rate your counseling training? - very good good - adequate - . ..,*. ~ .." inade.guat e Give reasons why you decided to.train as a counselor, e.g. "concerned about the impact of HIV in the community", "following personal experience" - e.g. have fiiend, relative .. . with HIV, etc. . .~ . . .- ., .. -, ,* ., i .... ii .;atirr.ui*.i- *, ..b~.:.~+.,r...d+VI~iri.ri.~~X~~~~~8,nii~,~i-i-i-ii~~~jjj n-.d13n. - . . ..~ . . For example, is counseling something you feel comfortable' d~in~,'~or'do'~ou'feeS it 'is a - b ",.^.i__,. '. ,." . I' - . strain, or that you have to do it as part of your job? .. . .. . ...,. . -. . . . , . ,. - "* , .. ~ .,, " +," " . ~ . . -. * , .. . ,,*. -.:.s ,,."., ~~,~~~..~-..,~*~~:~ab"~<+-~~?~*~<~*dwP~*~*&+*w"s~: LSA..,. ' % *.*,,,, . ' ' ,~ ". ,. - . .., . ." , ., , . . . What were the good things and poor-things in your training? ~, - -~,- . . . , , ,,; .. :,;. . ."": ,.'**,,,,.. ., ;',,%.,. .., 2:. "."'"" %' . -, .. . . - - 1 : - .. - . , 2 - . . - .. .-. ,. - . .., , ". _I_L."# Vl lll,.z. <-.". ,C *. ,,:_iijl,*%lbi Xrl?.'*><,,il-2 <+-,>= 5- .,*\.;*4i**:4p,d",., 73" ,&.< *.%r.:,;,i-). ..'..; ' , . ., '" .,. ' .*<>i'*.,l .*" '.'* '" . ~.' ' ",'" ..,,., ~ ,," ..<*, . "- -.." ,,,~ , ...,* ~', .. . , , ~ Are there any areas in which you feel' vou Zed more traln~na? , . "-.>. ~-, , , . . . . ". .-. . , r %..i--.. ,"a- ,-,, i ,,.- .. , .,,m,&..'l~"r.,.:..r~~d,i"~~-i'"~,~~~~~~ A, ... * Have you had follow-up or ongoing training? Yes No If YES, describe it. . , ,- , .. . a? >..- , . ~ , ' , - " . .- .. \ - - .- . . . ', i , . , * . . ,.:.,*; , , . - % *,.~. , If NO, do you think ongoing training would be a good idea?Yes ' - " " No If YES, describe how it might, or might not, help ... ,- . ." .."i -.> .-...., - .: , . . . \<, <- 3q,>*", r., - .-,,, .,-; ~"~a~~~.~~,2~:~~~3~~..&~"~..+~,+:<~i~~,~~:~~~~d,-~ +* >*y<7s**;v*,?,"s#$* %.$? d, %,*.>"A:.: ,,,*, . - ,. . ..,,. " . ~, Support and supervision >,, '? 7 -A, -" 3,. .,,, > -*,, ,.;, , . . , .+,.-.--, .<.,.,n s... ..,, .,,-& :sa.:..q.,i -.~-.--M,..,s .v~s~,7,~~~99k'~;#:;i&:&;r>:g~q~ddi:S;j,;;d,-: .-"; . ; i How many hours a week do you spend in counsefing activities? , . _ , . . . . .- .., .,. , ." .. ,, $ >, . ,, ~ ~ .*'$,".;.::" . ~;-: !.--.z? --.,,, ,:,.' ,.:; '! A,' ,> ,, .&, a?, . , -,- . . . . .. , ,. , , .,., ,-.. :_ ~~k.~cr~~,~~~.~~~~$~~~~~&&-~&$~&~~~&~~ie;:~~~~~~::~~:-.": .-, . , - .,.. . ~+,,,~<,* ....- e,.,d-.-.N..,':*.,m ;4*~7.,.;., ,,.*..a *dP#. ., S~t .,,, d-e,*s.,<*<";.* ,.*<&:R**s*.:4eL~,*L-, *,.-.*I., . ,,% "." ,.. +~#. ,~,<.** *-> ,.,~. .".. + .. . " . .*~VI*>;.A~,. ~ .. , ,.,", ,,. "<. ,.<. -,,-,> . .~. , ~. ..-. +S,"*W.*.* -",*.k\v.$.~ *,*-".*.d"m* *,w.* <%,~%."#"&<** .E..'-J~., .a, * -, ~. , . , What proportion of your . - working .,.." ... 11fe is spent counseling? .. ..~ ....... .* --.. ., - nF ., . ,- ~ . " ' y.~ - ' , ' .%" ' ..w*~*mG'.*. ,,~+,..x. -. . ., . . . &. >. .,' ~ , . ' .._.._;.. ,_~..,_~.^".._."_, . , , , . . . . . . . c ;..,, %.,, .-%. ,j,&'-,,r.~; rr'rzx,-, rc,i 4': ' - . . -. . . .., ,,.," - ,. ,.. '. , . , - . ,. , .; .,.- ,- - . ."_', A %L *+". "*..ax- ..-rhi,rilax>*-,'h-. .. .i If YES, in what way is the group helpfhlor'not helpfhi? '"" . " . , -- -. .- " ..,- .,, ..". - .~. ,..- , ..,.,, 4 ..,", .,.. .. .. .-i* .*.. ' >..a,.*'., 7,"- ,~,~~~~.~?u;i"~~~~~~~~.*"~~.~-~bl1*,e~~~.~*~~~bbtdpP~~-~3CCC;:i-i-i-i-p11 3 ;La-. ,. . If NO, in what ways do you think you would 'benefit '(or not' benefit) frdm' & support -. group? , . ,, . - .." . ". . ;-"'."- . ...,.. .r, *,,=-.., -r..-**<,e.,+d&;&,4i ~": .;ir.,:.:.",. .. ; ,., ,, . ,,, ' . . -. . . , ,. . ! 4.. , ,. < ./ h.,",b *v,- bt. "~~."~~~~~-~.~~~~~~**~~~..,~>~.~*~~:..~: . . Do you have support for your cou~seling from other sources? Yes No - If YES, explain whom and how does it help , . . ,a ..,, . .,=,.* s-d ",&."., ... v *>. , ..~, ~<. %--, ,, , -, . . - , . . - . -.. ,- :.. . , , .-..*. ., , ..- . .- rd.." .- , , . . . &. .. .~+~~+:~~+:~-i::~~-it~:id?>~ ~.54.?,;irf~&~~.~~,r%:i~X" ;,;:r~~,,d~~~,~'~ii;irr&~,~?, i. ... :, * Do you have access to a designated . . ... . -- counseling .- - , .. .&. ,., supervisor to provide you with support ~, and technical back up? Yes No -, ." . .- , . .... - - ~ " . , .' ?,... ., , If YES, who provides: ~, Support . , . supervision . .*-,. , . ,. .., ". , )/ , ,," ^. _ .'*. - ".. ", .^.._,.l_i ./ " How do you feel about your jo68 , . Do you feel valued or undervalued by clients (explain in what ways)? , . , .... .-. . . .. - .. ... ;,. ,+ . , ..,.. r.,,a...,. *.1a..~.e:.rc~,+i-.x-ira,r-ih.~-,-ri*. ---~ilXIIt~,~*i:l?,'i~'rX*~I., .''K*'. Fi-1' i, ,".a -",,."v .<. ., . . Do you feel valued or undervalued by otlier staff (explain In what ways)? - . . % . ' * ,,.,, . .<, . &.' *+" ,\x.s~.. :"$< . -.a, *.,,, , 2.e~~" -s. \.a %<*,A,.,.*.,-. , ,.- ~ ,. .*, ,. ~ .d Do you feel valued &-"uddg%lLiii by 'ybui'super~ors (expla~n in what way$? - _ I ,* - , . . . , , , ~ ,, ,<, -, ", , ., -8% . ,.~~- ,>...". .*"* ,'~ , ,~ , :- ~, .., ." . - -*: Are you given adequate time in your job to carry out your counseling duties? - Please indicate how you feel about the following statements "I feel emotionally drained by my work" Always often - occasionally - never "My work is very stressful" Always often occasionally - never "My work is very rewarding" Always often - occasionally - never "My work environment is very stresskl" Always often - occasionally - never "I learn something new in my work every day" Always often - occasionally - never "I feel isolated in my work" Always - often - occasionally - never - "I have problems communicating with my colleagues" Always often - occasionally never .,. - "I can help my clients" - ~ Always often occasionally - never "I have no confidence in my clinical skills" Always often - occasionally - never Please elaborate on any of the above statements , . -. How many years have you been counseling? How many hours per day do you do counseling? , ,. If your daily schedule varies, please give an approximate indicationof the number of hours you spend, for each day of the week: Counseling about HIV-related'problems hours Counseling about other issues hours ." Other work (specify) hours -, How many days per week do you do counseling? How many clients do you see per day? . . If your daily schedule varies, please give an approximate-'indication of the number of clients you see for each day of the week: Clients with HIV-related problems Clients with other problems How do you see your hture in counseling? LTg,p A c~I~,~~~~y,~,.~..,..~~.~ : "..,, .$. *>%, ,-,,., "k'>: - ' s,... ',,-"- ", QUESTIONARIE='P OR-.As S]E:micjyu8"gTr' .$gfim C.Es "", ." . . Questionnaire number I _I_ I Date: *I-II month1 I I year1 I 1 ., ". Int6iViewer's code: I I *' I- ma ', ' , , , . , , , :;.:..". " , , . .' ' , . . ................ -~ > " , : , , ; " > . , . - . -., .,. , " ., " . ............. ......... , .. " .1_ .. . , ." .%\ ..,. . ,~*." > . . .........>............. .'*^ .I-. (. .>, .. , ............... C. ......... -."- . :. ... , . ......... C , ,. . , ' 8 t -. . 4 ...... ......... ...... . ,-. . , . " 6, . . -- - - ~ z Name of health. . ,. .-*, care . facility: * , , ..................... .", . *." ................. ; , .......... ""." .......... "'." ......... ;'..."'.."'.~...'"'."......~.....~'... ;.. ................" ' -. . , . /Il. r , , , . . Facility number I 1 I "1 I . ' . . m Health care provider (HCP) code / 1 I ;. Profession of HCP (nurse =l; doctbr =2) 1-1 ................ .. ............._. Sex O~HCP (male = 1; female = 2) 1-1 Was this HCP observed managing an ST1 patient? Y 1-1 N 1-1 "" h. 1. How many cases of ST1 dicTyoii'see at'this clinic'last week? M']' ' I -1 F I ' I I I . " ,.. 2, How many cases of ST1 do'you see at this 'clinic'~~u~ng'an'averagk~~onth? ,. ' . . rn M II 1-1 1-1 F I1 lI 1- . , . . .......-............... >> ..... ,.*., .... ",a,,.+ ......... ...? ............... ,,,- . .a ................... 3. When patients report with a complaint of ST1,"do you'rout~nely ask them questions? - ' . ' Y ....... II'N I/ .................. ........ ..,..-. ......... ,-<. . \ rn 4. IF YES, do you ask about: .... Present symptoms? Y 1-1PROBED Y 1-1 N 1-1 . ," ",,. - Onsetlduration of symptoms? Y 'I] PROBED Y '11 N 1-1 Recent sexual c'ontactTY 1-1 PROQED'Y 1' ' IN I - - I 5. Do you routinely perform a physical examination on your male'STI'patients? . , -y II N I1 NA* 1-1 m 7. IF YES, please describe each step of how you would examine a'rnaIi ST1 patient: A Patient asked to undress so that genitals are hlly exposed Y II PROBED Y I/ N 1-1 m~ B Patient examined for a urethrallpenile discharge Y I'I'PROBED Y 1-1N 1-1,~. ,,, . ... ,, .-, .. ................. .......-........................... ,j' , , -4 , . ., . , ~, ...... ,- , ................ , . C Genitals examined for lesions aRer retracting the'for&liii. ' "" - I I PROBED-Y I .,. .......................................... " .. ' ,,. ,~ . . . - \ . < . ., ,. . -. a,.., - i< *- s: .e -*;., .::+*<**:~*-y 1 - , ....... ........... .. ., . . - ma, ' ~ *+ " ,, ,,., - . . ,*; ' &2%"'" - - *. 2% ~,-_, .,=- - ...... .... .... _"_. 'I_.*i,,- h.._-** ................................ *$ :. :... ,:,* >.*A*:<.& s. Do you p.eifb;rm a" 6-Gf; i"63~e;;aa"11n Tt'ic;- b5nnnjfoG.r'-f&r;iaT;,STI patients? -.-------* .. I ...-....... N.[ " - I-RA* "-- -- . -?--- , * --?-.**. .--.-iqc. ..-- +. .. . -.-- <*_. .............._... "__ ... . . .- ..... --. --. "zz2z%=z-".%-'ri.,#..+ , , .............-... ,, . L.:yw:%+-: - - - .......... - " . , . . " ,- *~, $"., &\*-.",.,.>, 3v,*",>' " 2 ". . , ., -..-. .... , - ........ A . .. ..%.*x.L:2...-v.. ma 9 If YES, please describe each step 'of hdw yoti would examlne a fem~le ST1 pitlent: ........ . .~ M, ' . "', .. " . A Patient asked to undress so that genitals are hlly exposed " Y 1-1 PROBED Y 1-1 N I1 dBQ I I N"I" "/,. ", "\ . + .. ." , . ........ B Patient asked to lie down Y I , - C Patient examined for lesions on vulva aid libiaY130~~~ Y 1-1 N 1-1 * .' I PRO .,, ] [ ' "., , ,\. s. , . , - - > = . .. * .:. , ,", ." .- . -. bivalve vaginal sp&uIa?*Y 1-1 N 1-1 an examination light? Y I I N 1-1 m - , ..,. *. examination gloves? Y 1-1N 1-" , .& ,., . . -" . " ., . 11. What type of diagnosis do you base your treatment on: ............... .-i' ... '4'. ...... .... .?% ............ F*b An aetiologic diagnosis such as gonorihea . or syphllls? Y 1.1 ....... N I ' '"I ,.-'/(*, ...... a. ".-A ......... -.- "*, .- .................. r .* ...... A syndromic diagndsis"such'as ureth'ial'd~scharge Y 1-1N 1 I . , ., ~ - or genital ulcer disease? CII . Both Y 1-1 N II 12. Do you have a microscope in this clinic? Y 1-1 N I I a. ,, , . , - ",, , ba ". . . 13. IF YES, in this clinic, do you perform: - Wet-mount microscopy to diagnose STIs? Y 1-1 N 1-1 Gram stains to diagnose STIs? Y 1-1 N 1-1 VDRL tests? Y (1 N 1- Dark field microscopy? fi 1- N 1-1 14. Do you send your ST1 patients (or specimens) to another facility for laboratory investigations? Y (-1 N 1-1 IF YES, what tests have you requested most offen in the past month? 1 ...................................... 1-1 2 ...................................... 1-1 3 ...................................... II 15. In your experience, what is the first choice of treatment that you usually prescribe for a patient with: A Gonorrhea? *Refer to code portion of this section (-1 DRUG name ........................................................................................................................... . " . Quantity: .......................................................................................................................... . . . Dosage: daily 1- bid (1 tid 1-1 qid (-1 other ................................................. ,~ ,- ,, ,"., . .~ ~. ~ Route: im 1-1 oral 1-1 topical.'~~l . Duration of treatment (days): .......................................................................................... B Non-gonococcal urethritis? *Refer to code portion of this section (1 DRUG name .......................................................................................................................... . Quantity: ......................................................................................................................... . Dosage: daily 1-1 bid 1-1 tid [I qid 1-1 other ................................................. Route: im 1-1 oral 1-1 topical 1-1 • Duration of treatment (days): .......................................................................................... C prima^ syplzilis? *Refer to code portion of this section 1-1 DRUG name ......................................................................................................................... . Quantity: ........................................................................................................................... Dosage: daily 1-1 bid 1-1 tid 1-1 qid 1- I other ................................................ Route: im 1-1 oral 1-1 topical 1-1 . Duration of treatment (days): .......................................................................................... D Chancroid? *Refer to code poh'ion of this seciion 1-1 DRUG name .......................................................................................................................... . Quantity: ............................................................................................ .,,. ........ :. ......... ,. ....:. . Dosage: daily 1-1 bid 1-1 tid 1-1 qid 1-1 other .................................................. . Route: im 1-1 oral 1-1 topical 1-1 • Duration of treatment (days): .......................................................................................... 16. In the absence of a definitive diagnosis, what is the first choice of treatment that you usually prescribe for: A malepatient with a urethral discharge? *~efer to code portion of this section 1- DRUG name ............................................................................................................................ • quantity: ........................................................................................................................ • dosage: daily 1-1 bid I - [ tid 1-1 qid 1-1 other ................................................. route: im 1-1 oral 1-1 topical 1-1 • duration of treatment (days): ............................................................ ,. .......................... . . , . &. ....... . -. .I ,"' ,, i . , I!, .. .u.. .......... '- .: i^ .: . . ..............,.. %, .. .-:. --... .. :": .... I;" i; . ., - . ...... '";;,"'%s""l;' "*'","' .,b',2: .... 2 ',"~>% >* ,,:- :>'>:,<- A male patient with a genital ulcer? *~efe'r tocode poition of th~section 1- DRUG name ..............................., .... . .. i .................... *,.. ......... .^. *. ..i.iii. ...... ii.iiii .*.., ii-i-i+i%-.a. s.*k -%. .Z.Z.-J.~i~.iii I~~~t~PPPP~P, ! . . . quantity: ......................................................................... ,.,. .v. i.I. i..,eid..ii. 2-is'.~:.,,... ..: .0..l"i2ii.Aii -.,. :.ii.2,2f*<'.-;1. .......... L+, .‘..., ... . . . > . dosage: daily 1-1 bid 1-1 tid (1 qid1-1 other ................................................ . . .,.. . .. ,?,:. ~ . . . . s, . , , - route: im 1-1 oral /['topical 1-1 . duration of treatment (days): ........................................................................................ ..... . ,, . A fen~alepatient with a genitalulrir? *~efei tocod6 portion df thii si&i&.-lj. DRUG name ...................................: .......... ,. .................,: 4. .:yr.n.-::.;; ;.a-i;&dai. :.:.:.~.~:);;;;:6::.. :i:.;~:.ij.:.i'-::.:.,'~?:i~-~.~. :. i d. .*er* .. . ........ . ., ' - quantity: ....................................................................... ;. .... L,:.,,,~,w,..,;,,J,~~,,,~,:,,~7.~~,,,,.+,~,,.~:. ...:.... .:~... .... ....a,..... " ' .,- >. ,,.* r*uc di ..> i.",--ar r..-i sr, *r-i ...i.-i-.l. L. dosage: daily 1-1bid 1-1 tid 1-1 qid 1- [&her .................................................. ['-toobi.iarl.* ,".,or-a ' -<" .,' " , , ,~, ., -,~ *,",*" .*.**~..",~,>.-s>bs+ .,eL- + .*-,,a's -~ * "".> '7.~. " ',-- , . route: im 1-1oral 1- - ,, . .,_; "_ .>,. ." ., . _.>_." ,., • duration of treatment (days): ............................................................ ....... ..... ...s..~..+ ;~c;..-.ip ....... :. . - ........ s . . 17. Where do your patients'usually obtain the drugs you prescribe for them? ................... h, ...... -. 1. At this clinic saweday (free) 1' [ '-' ....... - , , 2. At this clinic same day (paid) If .,. - , . -. . - 3. At the pharmacy/chemist shop 1-1 4. At this clinic and at the pharmacy (1 5. Other, SPECIFY: ............................................................. ............................... 18. Do you have any problem with drug supply? Y 1-1 N 1-1 IF YES, what problem(s)? .............................................................. :.,,.. ....... ,, ...i..w~.~.~~.r...~i.~.~.b:.I~~... .......... ....... 1-1 19. Are there any particular drugs which you feel are essential , , for ,A:e.',?. the treatment .". of STIs but to which you have no access? Y 1-1N 1-1 . , -. ... IF YES, which? ........... ..: ........ ,... i.,. . +.+..d,,f.r;-.-, s,...~~~.~. i(iPP(i . , .. .. - ~~$~~*%,,~'p&z<:,l$e* s.7 d < ' . . . . ........... ,. . ..-: ... i ,:,*:4 ~i"":~c+.i~.;.....:7>* - ..,.. ...I... i;*ini?.r...Wr i, .. \rr ,-c 20. What type-,ofsynnges~~d,es$les do y - .- --.,"*- . . -. ,, .."..&--:~&4z~'&.,--..,: -a*, , . .................... .% .. Disposable ............... .... ... ... I-[' ' - .: .;.~. ; .-..... ..+.A,>,.i. - .7~...7....w.l.i .ay-.i a ...+"* - . ..*. ............... is - A<,:.,.3,~<,,.%A+.-,-.~.a, ...... .:~ ...... ......... .... . . ... .- "-,r .,.. l..c.;":":; ..;: " .. ' . Reusable I - I . , ........................ . ., _ _,&_ _ *" _", _***_ .l.iL.," I*lll*.,~.% i.-,, ..>*".,-,-A --- I ,. - . - -- - ) --I " Both 1-1 ..... - ....... 21. Do you give any special educatiodadvicti to youi ST1 patients? , . ., a) Do you tell your patients to take all the medications you have prescribed?' Y II PROBED Y 1-1 N 1-1( PROBg:D ., . , ,,. . " -,-..,-. " . - , b) Do you advise your patients to use condoms? Y 1- - - c) Do you tell your patients to tell their sexual partner(s) to have treatment? Y 1-1 PROBED Y 1-1 N I I .... *J ..... %* .. ':<,? ..... /". ..%s..... IF YES, do you use contact birds or referral slips? (IF YES, ASK TVHAT?$ ON$ - ,. y 1-1 N 1-1 .; -. . , ...... . . 22. Do you keep a supply of condoms this clinic? .............. . .... ..... I I ASK TO HAVE.ONE: ..;,N~I , , 3KIPf b"Q27 .....; ......... 4: .:. ,%d. ?- 6~ ..:. .: g,, ... : ... IF THE - ANSwR.TO Qms~f6N'ZZ';IS .' ............................................... . ,. . . ................ +" ,.*.. ./.............. . , ,< 23. How many condoms are in stock at this clinic today? 1-1 Did you verify this number? Y 1-1 N 1-1 24. Was this clinic ever out of stock of condoms in the lait 12 months? Y 1-1N 1-1 25. Do you provide condoms to your ST1 patients? Always 1-1 Sometimes I - I ......... . \ . ,. , " ,. % . :,. ,n,.- 2. :. . . ............... ,: -. ?_ Never (1 26. IF ALWAYS OR ' ................... Howmanycondomseachtime?Number~ --- (1 11 1 Are the condoms free? Y /A N JJ 27. Do you provide instructions to your patients on how to use condoms? Always 1-1Sometimes 1-1 Never 1-1 28. Do you follow any specific treatment guidelines in your management of ST1 patients? Y I1 N I1 IF YES, which? ......................................................................................................... I1 "Refer to code portion of this section 29. Have you received a'cGpy of . ,, the ST1 ., treatrqent .Ni , . i, schedules ....... ~ico@*ended by the ,. , ... National ST1 Control ~rogram?.~''l - 30. Do you provide drugs'to ~&%NT3ur clients from ...,...._ coitr&,ting STIs (do you .. .<..**..* ............. .AX, provide ST1 prophylaxis)? P 1-1 N 1-1. 3 1. What is your main qualificajion Qualified nurse I - 1 Medical practitioner I - I Other 1-1 32. Do you work in both public and private clinics? Y 1-1N 1-1 33. What are the main constraints-on your work with STI? Drug Supply Checklist Questionnaire number / -- I I Date: 1-11 I-1 1-11 day month year COMPLETE-THIS SECTIONE3EFORE COMPLETING CHECKLIST: Observer/interviewer code 1 1 I Name o f health care facility. ................................................................................... Facility number 1-1- 1 -" I Position of person interviewed: 01 = Hospital ~drninistrative Officer; 02 = Doctor; 03 = clinical Officer; 04 = Other " -' ' " ) 1-1 1. When was the last invent06 of drugs, equipment or supplies? (MONTHAND YEAR) " .............. MONTH 11-1 YEAR 11-1-1-1 2. Who holds requisitions for drugs, equipment and supplies? FACILITY INCHARGE 1-1 DISTRICT 1- REGION 1-1 OTHER, 1-1 5.'What DIST is done mwE.D with all ~u~~lies O..aEqTrQmca that have expired dates? I;' , ; . . ,. . . -. ,- .* ,. ,> ,- - *. . RET,~~, IN..GPiRBA~~Egm-m. TO 's~~~cE 1 I I . I ", ............... ,,. . , ORDES . . TRa*DUNDn --gsUPe."mSiiiNj , , . , . . . - NOTHING , , .... , .- " ,- . - . , -. \,... . . . ,, . ,, , . ." , _( %,. / ) ..(_-",I ..,v-..-., - . , , > , , c 8 .a ..7 . , -. _, _ ., . -. '" <. , -, , , '._ ( .'. i-- " .-. , ", ..., ".,Yi. , - . - - .- ~ d .' I .~' , - _ . .~ . ," ,, ., , . ',, , < , ',,/'-..i"""' " '"' "." *.<..'.. ,,i: - --- ' ' "-.,'-. ' . . ..,* .*A" ,,, - , , , ~%, ',, __, I .\ (_I, ,- <,. , .,.. -... ,~ ? . **,~.." ,,-, . - . " , " *,,. ,. ,* . :'* ,"*, .*,. *' ; .'r .... I ; . . . >.l:r-.l L ,- "- . - "I-- -I￾OTHER ll , -,. ,."..A. ," -.,. , .. ,. ., * 4. Is there a stock record for ST1 drugs?'YI ' l'Ni-j' "' 'a% . ' . 5. Are $TI drugs stored by expiration date -1 Nl-I I - . ~ ., ,. ., . . . 6. Are STI drugs stored such that they are protected frpm rain, :urt;adverse temperatures, rats, and pests? YI-I Nf-1 . . , _ , . , " I, , _.., l,,*...-':,. ST1 DRUGS AVAILABLE IN THE 'I'A~LITT;': Now I would like to ask you about the medications available to treat STIs in this facility, When we are finished, I will need to see your stock of some of the medications that we discuss. . . ..' a. ~ 7. Do you have this WDTCXTION nbw? , . '. ,,~ ..~.",,.. ' , , . - . , . , , ,, . . ' , . . . ,, ", .,, 8. At any time in the last 12 months did this facility run out of MEDIC AT SON^ ' ' ~ .. - . .. ,. . , I. , . . .., ... .,<, *, .*.. ..,.,,. ,<., ,. #.?.< ',,X .*$,. e;+\#,*F .*.~ a,,.,. +%* ,".>" ;"4, ..,." ,%?"',, --,.,h 3.L. b ,.,~~*.~<"+-:"*3=,,,c--%.;*e-.fih. ,?<-.**...%e-=>? 111 Issues Included in ~trucfured Questionnaire (~ranslaf-id from . , ",, Amharic) . , , . . . Date data collected Data collection siteltown Person who filled the questionnaire 1 . Social & ~~onomic st~~~~..ofhou~ehold i.nformatio9 , .~, ,> ," ,.c , . ."? ,..", 2. .-, ,,",,, ,.,*; .;, :, :'.;,.*-,;. .- .;: Marital status , , ...,..,,..,,...,,.. . - - " " - - , . ... . -. ,",.\ 'b- ..' .~..,<,." *..'+:"-~.=-'-"*$'~.--'--" , . . . . . :.. . .. . ;- . 6 b. From boyfriend~~lilfriend to ... girlf~iendfidjrffi~d .. .. ,., -. c. From a friend to fri&h - _ ...._ ... . ~. -id - 'I. iiiairlr.__*.;_l . . .~. , - -- d From neighbors e Mother to child * " i f. Pregnant mother to child Age I . - L Unmarried - Head of g. Others 6. What other possible ways of HIVIAIDS transmission? Data collectors are asked to ask open ended question only - --- -.-. ~ ----, "--" ---- 2. Indicate 5 major diseases in your'residential .area 3 On which age group are the diseases observed most? 4. Do you think that you have adequate understanding about HIVIAIDS? ~esR\lo . *,. , - ~. #. ~,.>? .%.'-->- . . A . . 5. What is the possible ways amongpeople'forthe HNlAIDS V$&'transmiSsipn? ,*+. ,,.+***.,**+ ,,*+..."*: e ,w,,, #q2.%a.>**L";"*": ..>-*-. - ,'-'. , - b . .~.. ,.. Data collectors are asked to askopen ended question only .. - . . .. *. .~,. . a. ~usband1wife"to 'spouse Household 1" wife 2nd wife 3rd wife #of < children ' , Occupation Income & status Status / Income . .. ,. . -, . ::+: ~ ,'.I .l ,,, . y. ,.* * ..... ,.._ . , , pa , . , . , . .. . . .. . - 7. whatarethe Possible symptoms that ah DS could manifest?'~,ata . . , . ,:,.>. ,*> .,~,.. . ,,. .* , z ,, *&. '. , ~ .. . - '.collectors are asked to-ask open ended question only a. Loss of weight b. Chronic~cough , , '* ,, . , . ' ,*** - ~,,e*qs..4,r4"".++ c. Frequent sickness d. ~epeatedw"" , ' ,, . e. Long lived diarrhea f Others 8. What action would you take if you have a family member has chronic illness? In chronological order. . < ,,. , . ~ .. . , a.' Keep hidher at home b. Auto medication c. Use traditional medicine d. Consult pharmaczes and buy medicine e. Visit VCT f. Visit health center g. Visit hospital h. Consult information center i. Consult HIV~AIDS committee j. Consult CHBC k. Other 9. Do you know about the activities undertaken by SC/USA or HRCI? Yeslno 10. If yes, from how did you get the information? Meeting, neighbors volunteers HIV/AID S committee, others specify 11. If you know the activities of HRCI, please indicate 12. do you know about the following activities conducted by HRCI 13. Do you believe that SC/US intervention is beneficial for your community? ma 14. If yes, what are the benefits? 15. Do you believe the intervention on HIVfAIDS in the last 2 years has brought - change in your community? Type of service Voluntary Counselling and Testing Information center HIVIAIDS committee Community Home Based Care Support to Orphaned & Vulnerable Children Yes I know It is supported by - _ ,, ,; ,~. ~ ' " ,:" :.., -, ,, . . 16. If your answer is yeqplease indicate what the changes are and other pertinent info. . I.. . ,*" , \.' . , .: -. . ,.IS . ~ \ " " , . -, ""5" ,ed<. -+-. ** ,.-wa,* ,*,,: .,., "&*-%:,,*>$ ,.,, '," ?, -,d+ A:"., ">:..~.!~;L*'~~~S..:> .+i,? ;?$, vL+,9&2::25*&%'&;$z*;)t,> :+:;A,<::::; ,*;,<>-&&:*~ ,-:,;:.-. ;. - - ,. ,.,. ...," .,I.2.. ,,..., ~,.i.C..,..'"-.'.-- - ..I.' ,,b, - 17. Give example for the-Change ..,. , you'indicated above? . ,. . ,. ,., , ,, z* * -L c. , + ," -3 . .. . , . " ", ., ,'. ,, ..* ." " ,:-. <- "\,-n,-l*?j$a -:&*'.*? .es.?-*, .". '. ' - """. .. '2: .' , ,. - --:. ,,~. ,, .. , -;-.-.,. ;,. . . ,..,- . , a *... .,.a. -... i~ -....-.... '-r.- .. - - - 18. If you mention that you are not-user ofthe service in no. 17, please indicate your . ., ". reasons , ., ., . ~ a. I have good knowledge to protect myself and my family b. I have dependable marriage (high trust with spouse) c. I have abstained d. I believe in God e. I have only one partner f I have limited my partners Service that brought a change I service ,,,.. .4 g. I did not want to bother myself .-.,. C I -: "i. . '. _*_, . " ' . , . I , . ., & . -_., . ..'".,i. .?^.* -.-. ,. -,_ i h. I am ~3i.i~ condom ,, ,-.x &\". , ,'" . *d".A**.,<,, .*~ *~\, ,,, . , . . , , ,.*, , . -~ , ... . a*-,pe-,, %. -+*v,," 1L.j~e7~~h~~a*~-m~.d~~*s.*wk*3-~a.~*~~3-..+~-'.-~:-~. a Esl, ".. \ .. ",.. ,.,.. .. i. I did not t&e injections , - - . .-,... . ,t. ..,..:,.?I .A,.>., , , .-lr9,.rr.;... . .-.,. .. . - ., ; ".::~;*;,,;~,:: :, ?t > t-8 . > 1. k. I did not b&&xi' _.I 6d _ thi ,. ,,, 'iervice provided ~ g a 1. Others specify ~. 19. Do you know from your family, work place or neighborhood that has contract HI.V or is AIDS patient? Yeslno ... .., 20. Do you believe that prevention of the transmission of HIV/AIDS is possible? , ,.,.". . . - Yeslno -,, , . ~ ,~ - -. , 21. What are the measures that can betaken to prevent the transmission of HIVIAIDS? ..,,, -. . - . . . .., . 22 What efforts are you making to prevent the transmission of HIV/AIP)S? -. a. Personai.'leveI' . ' ,. 9%" .. - . ," ,.. :, . -..- b. Family level . . c. Community level , . .,. ,, - 23. Do you u%'condomi ~eslno . ' 24. If you are not using condom, please indicate your reasons a. It reduces satisfaction . , - ., . ; ".. . t ~ ,." ,,, , , b. Want to have a chiid ~es~onsible body for the c. Not allowed in my rdigion d. Unavailability of condom e. Don't have the courage to buy condom from shops Service that you are using . - '. ;p .. I I a. With spouse/boyfriendlgirlfiiend ' ' b. With &i&d-s -* , a..m C. With family members d. Other specify 26. If you are not discussion about HIV/AIDS with others, please indicate your reasons srms sr a. I didn't want to b. I feel shame c. People did not want to discuss d. HIVIALDS is personal secret e. My partner is shy f Other specify 27. Please indicate the following a. Strength of HRCI project b. Weakness of HRCI project c. Possible action for the fkture Threat for HRCI project ASSESSMENT OF VCT/STI SERVICES i ......... .' .- -. ........... ,v,-., . ~TRoDUCT~oNlslzc.I(..C;R.Ow .......... _ -. "8 .. *,.. ... '. ..... .-.. ... -, - .* .*. a.e %.,- ~e .>., >,- ..-. . ...... a. . , ,, . . ~, ....... . .. . .... . . '. .-" ...... .. " .. *"... - .. ,. ,,,,. - ,", *- 8 ,.&. a . ,.> -, , ,++, . , -." . , , __ I ..,. % , , ,. , ..'.< .,., ',-.:> ,. ~ ' - ,t ., ,, One of the objectives of SCAJS comprehensive HIvIAI~s prevention and contro1project is to increase the accessibility to and availability of VCT for HIV, treatment of ST1 and opportunistic infections. The preventiveltreatment services are the cent61 elements of , , ,"," ,,. the HRCI HIVIAIDS program. According~tbproject plain, the service are considerd,by . . SC-US as important sector of the mCI progr&'with critical advantage 'for 'tjeing an. '. , . . , entry point for the comprehen'sive Hlr'VIDS prevention and care pr'ogram. . .. ..,.,, .-, ., , .. .>( i. ., ....... The responsibilities for the planning, I .. implementation .. and techniial support of the services of the projects sub component have been entrusted and -;sub grarited ........... to OM' ..*,, -a. .... to ' % " ..... .' establishlstrength VCTISTI treatment mainly in government health' facilities. However, the actual implementation and co-ordination of VCTISTI services are also executed by the HRCI and sub project offices of the program The responsible organizational unit in the program oflice for VCTISTI activities is the medical sector coordinator. The team conducted interviews with different groups that include regional AIDS Program managers, counseling service coordinators, and NGO coordinators involved in VCT activities, health servicem6nagers~as'~ell'as othei- policy-makers in- assodated-.s*ectors ..... ,,". . .... ..>-. ............... A2.v,,v.. .....r. *,.--sA,d ++-",.. In , addition inteFv~wsw~~Eounse~9~~1 ",".,,'.. *.+" -MX.-.i.s*...*k in-rQa* .%+,-~- &~~~~~~'~.fa~i~&ty .., -,- -. survey was conducteg . , ..~ The .. - . . , : interviews were condu.cted,.~i~d~.ally .................... and -...,, the respbndents .... ,.*, ..... encouraged .-. elaborating on ....... .... *">*-~--.--.-~...%t~. . ZZ.?+? ?%~2wsdk5:.?~>-~*?*L..* any of the items, qualifying , stateine3fsbw$hd . . -. . ., .~ providing additional comm~as w&re ., -,> ,.,:' .................... . ,. , ,-- . . '. A. ,...., ~- ;s ,--..-,--.-F -.--...*a. .;;.v. .-*.,, ; :q.::.. , " 9, ,. , ........ :z. ,::?>?..*, 2, ......... 3 :.;..* ... . - appropriate. ". ." ' - ..,. ::< . ,, ........................ L .. ,:.: .A , ............ .;, 1-.>\,,fy .......... ...s:t.s. :. . , , -;: :. 3; - j . , . , *. , . , .- ... Both the interviews and survey was carried out using a cheek list , developed . (adopted) ' . from the national HIVIAIDS mentoring IeGaluation famework and 'thk'~~~~' " ' . .' guideline (Tools for evaluating VCT service). To this effect, the assessm~nt/evaluatibn of the CmS HIVIAIDS progr,am in exe-cui;;nz,tK; vcT/ STrssce ecfi was,evaru'ilea ,. . ,. . , . -. ,.% . ~ ?. from the following point of views and criteria. , ~ . ~ , - ,, . .", 1. Institutional arrangements/organizational perspective Availability of Institutional arrangements/procedures/ relevant services, Organizational preparedness for and commitment to VCT implementation d - Available program support, resource availability, training suppor2. and" supervision) 1. The operational aspects of VCTfSTI sites and services 2.1. VCT services implementation SITES (Accessibility and convenience, Privacy and waiting area) SERVICES (availability, effectivenes's, quality and sustainability of the services) The counselors perspective (satisfaction " - and requirements <. ) . . ... . , ,. . ,, , . .. . me 2.2 SIT services implementatiott " ~ .. *,. ,"~- ,~.-,+.e L a" .. ,,.~_, __ , _ . ,. . .l Y " "._ Appropriate d~agnosis and treatment^ofSTIs Advice to ST1 patients on prevention and referral to HIV testing services m~ Drug supply at ST1 clinics C ,a\ ASSESSMENT/ EVALUATION FINDINGS =r I￾L ,* , 1. INSTITUTIONAL ARRANGEMENT/ORGANIZATIONAL PERFORMANCE ", ., . _ * , - . , ~, ~ " W' .% ". ', - . I _ IOM launched the implementation in February 2003 to establish /strengthen the major components of services namely 'VCT and ST1 in government health facilities and OSSA . . (Nazareth) respectively. The following major activates were conducted m; - I Institutional assessment of health services was conducted and a total of 7 sites (4 sites in afar, and 3 sites in oromiya) were identified for VCT implementation. ma Additional 10 sites were later included after the requests from regional /Zonal administrations making the total sites to 17 for establish VCTISTI. However, there was no additional budget allocated for these 10 sites selected out of the initial plan. Lm4 e The local allocated budget for the program sun component was 163.000 USD at first and reached to 233.000 dollar with a budget increment of 30% (10,000 USD ) while the proportion of sites increased by 60 percent (10 in #) approximately therefore, to accommodate the other sites. laa as certain planned activates like BCC were omitted the budge transferred/ used. The following are major successes and limitations of the services with regard to the institutional arrangement/organizational performance for the implementation of VCT by HRCI program and sub grantees based'on the study findings and'o&er+ations of the team of Consultants 64 Strength and Successes VCT services were developed and provided in conjunction with support services for those who test sero positive and HIV prevention services In addition, the existing link between the type and quality of HZV education in the community as well as information centers and offering VCT has contributed to making the target community attitudes favorable and their interest in VCT to be high In all the project sites, the VCT/STI service activities of the program are carried out through operational guidelines/manuals, training handboolis, :s,riatiOnalilexecution guideline . ,.,.... #"!4*. "a,,* "*a Y*+%- <"~,,,%.. >,,;.,, ', . and other relevant forms and formats. Several ITTlSTI service implementat~on ~,* s.. ,&.. . procedures and guiding manuals have been put in place that assists the sta'ff'to carry out ., .* . ., , . their duties effectively. As a result 'there' seems to 6e no significant 'prob'lems in the - ,,, . ,.'",.> . ,*.~ ,implementation of VCT/STI services due to lick of 'in~houG'capac"i"ty~'~his is one of the strong aspects of the programs VCTJSTI system that gives systematic approach and standardized procedure on its day to day operation. The evaluation conducted has found that thebvel of priority given to VCT ser~ices (in all program areas) by political .6E1, .-., " r... >.">.,", ,.- ,.. . , . ,. . "> .,.9.. ~ , . , .,. ...,-. ',ax, :\ : ,..- ' -. . .-<:,.:4.... ." . ~ ,, , ..)_ 2. ',._,'_ . ._ ~ , -. - ., , " ,*., . ,... , ", ,, ~ ,,,,,,-,.,, z . , ,. . ,:. , , ". 2". . "" .' i . . .. '~ . , .:.. . - ., , ,,,, ' .., .' ". -. ..~.?: . ,. , ....;- ' ' , .. . . ,, I _ '! .... ;I .-d:..-: ;,:">b<':.,;...~ * 2 ~ ' . ..., , ..-. 2 ,.-.. . ' . *.'<'<. -.iirx>q , -y .,' ;.i %.i. ::.:.s*'.., * 7-,.>. 1, .:,,:'- i;. ., . ,>? c.., - .--.* .; .:.": . :, , The reluctance by.thk mojo h&ath.Cintei management .- ., .." 4 ,.., ...- -.,. to .* .--,....,. provide .,., ..-+ "additi&ial"i*ok ,LW.-,,~.&~ -ir.:;w~vb.icr;s for., VCT to handle theincreasirig flow ofclients but agreed to hand over t&e ava1k~1"e~'*'.''' ~' ' ,-. , ' . ^ .- , -. * ., ."*,, a,.>~..a, ,.Y;,*,.- +. , , . ;. - . , room for an NGO - wis ,A *. '.." sited'@'aKe~~~ple. .~. .+-,* >,.%.- .- On the other hand, HAPCO officials, clients, HBC providers in'a~ar- reportedthe health center management in Mille and Logia give poor attention to"VCT/ST'I"-and is not seen as a major priority of the health service. VCTISTI site and 'service provision in mille that has been fknctioning 2 days per week despite high and growing demand for services. , . -_ . , , '. < ,.." -- .,... ", -. --- ".r. irx-.a -ir..%,.4- T." -' , -*. >"..*...>-'-^il.l .x - . ,- , . .; there was lack of systematize8 and coordinated aClvocacy effort among stakeholders ." , ',,,, - . in order to sensitize, maximize the awareness on the existing preventive serViCe provision and the benefits of VCT/STI services to 'the Community sb as'to make .., . .,...,, ' .. . . . people more likely to accept it and for sustained attendance:" , . , ," ,. , ' . ..r.,.. .*" - . .... *....<.-. .:-..^;..:.'... ,.%. < : . %. -; 2. EVALUATION OF OPERATIONAL ASPECTS OF SITES AND SERVTCES " . . > . .- .*. . . 2.1. VCT services implementatih Prevalence of HIV/coverage/attendance ., . :,.< .. , .. " ? ,a.: ,,,,.-.,, ,e ..., %,! ~W.~X".>.W",,*.-,. < .: *, ;-.>;, ,,," .,;,.<, "*.? " ,..: ;,&,? .,.r,. .**., 9~,~>>0 " ,. < -*. .~. ,,., ~. <,,.*, ": ?"',? . . . , . s&, ::,.>.:*.**: a. ; < . : . . , ,. .. , "3 > . " ' $8 ,.i, -.; The prevalence and iefiice''&jv&@ , .*- ,< d"m . ,,.,,'. ~ ,*,+ . ." &'VCT ;, v,*e.av,, $qrvice~ ,.*. ..< .*~. ,z" . . .& ,established ,," -a:e:-. '-- -*-..>- in government health services and OSSA bf"'C~ program indicates that there 1s a high"AIV s'ero-prevalence among the community in the program ireas studied 6y the-consultant team as shown below. According to the data from the council Health Bureau HIV focal person there are two sentinel survey sites at the hospital and health center, with different statistical data on HIV prevalence. The figures from the health center show the prevalence to be at 7.7 percent while it is 14.4 percent as per the data from Hospital. The bureau uses the average figure from the two that is 11.1% percent. HIV sentinel survey figures were available for Dire Dawa council-area only. In all other areas studies the other available sero prevalence data is based on the statistical data from VCT services which is presented in the table below. '. ' . . I VCT site I Total cases I Positive cases I I I Mojo health center 1 670 1 131 1 19.55 1 f I Nazreth OSSA (three months) [ 873 1 96 1 10.99 / Logia clinic / 231 1 38 1 16.45 The following are major successes and limitations of the services with regard the Chelenko Health Center Mille clinic implementation of VCT by HRCI program and sub grantees based on the study findings and observations of the team of consultants . . 28 193 Strength and Successes The overall figures from sentinel surveillar.ie survey in Dire ~awa and VCT reports of other 5 areas evaluated indicated the high HIV sero-prevalence in the community has brought a high level of understanding on the benefits of VCT among health service '" ,. '" .",. managerslplanners who revealed the program has been-effective in target &okp identification and selecting more appropriate strategies to develop services' for the general ?opulatian with such high-prevalence in the areas. 5 28 The services in all areas were found'to be affordable fd; thk majozti of peo$le'fbr they get free service free of charge and in Nazareth OSSA and'Dire Dawahospital they are provided at low cost. 17.86 14.5 1 The VCT sites have mostly well-trained and motivated manpower who felt to have got good recognition and given high value by the community and staff the HRCI program has done a commendable job in.-building the requirecf institutibnal capacity at project level. . ., , &'y -, " *'. d ," ; . ., ,< ., ..' - " . . >.. ;*..>-, ..;< . . , . .( ". , I., ,.>, L.~-... ~' ' , ,,~, ...I,,..". .. ., . . -, .. In all settings visited there have been coinm+(@bl<~ffijrj~ 6i cciuhiklcjrs in &arhtieifig and respecting confideritialit'y and it has been observed that people feel m6re'SomfortabS " ,.,,... .,. -:.",," , ..'. " .- , . . , ' . - .',, -, . .",,-*.'~I..~. ~-.-*. ,LL,",.~ ..i *-~, - ^.,- .,... " about attending VCT 'services for they can give a pseudonym, and anonymous testing is available. I ,%' , . . ,, ,_ , LimitationsfGaps Although, there are well-ventilated waiting areas, Counselors stated that absence of separate private space in dire Dawa health center and separate room in mille and logia. In addition, the absence of sign posts in all sites to indicate the VCT rooms has brought challenges for ensuring privacy and for VCT . , to , , be ., . carried . .,~.,",. out m correctly - . , , and effectively. . , :,, <_ ., , . ". .- ". .. -- i- ,' - . ' r- . ,,& -.*".--,.' *a,>*...',-.L. " *- >.rw: ..... ".' -A: ,." ., . It was reported that there was a high demand and clients flow following the promotion conducted. In all areas except Nazareth and chelenko, lGk'-of adequate , . . - ." ,,', 1' : ,. . preparation or absence a medium-term plan for the service, . , the I ~..; supply .,,. -\:I I-, couldn't .-. cope up with demand and coun~elors reported that a lot of clients were returned back without appointment for there was no appointment system for to under take VCT at another time In addition, the service was scaled down after an initial period in mille (working only 2 days a week) and logia because of other workloads of coun,selors. These are major challenges to ensure sustainability as confidence will be lost and the'community will feel let down after expectations have been raised. In all the sites ,. I..,. i..l.i suiveyed i.i,- the Cappillus test kit was found, tohave~,@pirea'~as'of march 8, - ,.* . --;,- i ,, ...- %* i, <"W -&*NWx.waFY W,+I.XP ,33 3iiiiiy- Y--.,. " r- .. ', . 2004. , . _ _ Accord-inggt ,._ _ .>_ .+.,._, _L &.,.,. the ,_*. _.* guideline __. j_ ., the services shoua have 6ee-n shut until .the teSt"kit ' ,.. . , >, --. , , - ,.-,.- ,-*.-.,vz+#.-?+s.* ,~.~m<~*"~w~<,&*2."~:~>.~ . . .L%. . ~.,- % - . . , " . . , is.,made available - but . counselbrs . .., . . were , referring . ., clients,to ot6,er C-...,. sewrces,.vhich A,l u.-LrC, in -"-.- .- eff&ct +gfi-,jnddermmin;e th~ee~iieed~~ll~y s.~~ie~i:es~~~~~~%r&&$&~~~&~~j~*~110~'sr^r^f~11:2.".": .. .," . , . &.$ + _.-. ii:-__i ,-., ". . . . ,_ >_.,. , ,, . " .. . , .. , _. , _, .. __%/ >i , _i.S_,. , /*..~W . . :, . .,.,. ,*.,,.. -4~+f> *-r s**:;,-.~.. Sr2,Lo " -$?A- :: ' . . -"- -- ". , . ~, ,, , . , .-, .; ,. . -:; ..-,:2,3:..j,83b.,?a,.b +~~~r;';rr~~+~~&~~b@~~~rkii c""',' ""' - .. "' &-:~ , . , - : ..; , , , ., , \ . : i The program Eail'a~rosschecking'system for results that was put m place in all sites when setting up an HIV testing services after which samples have been,collected, but no tests samples were taken to cross checked at a reference , . center for quality control. .. . - . , .'. " .,,. ,..: '<.. , ' . Although HIV testing methods have become much more sensitive ,and specific, evaluations have shown that without rigorous quality iontibi high numbers of false positive and' negative results are common. Not onlyM can-thi's be'kxtGmkijr damaging for individuals, but it can undermine the credibility of the sefiick. ; . <.i-, ' -,* ,--ti .--,; ."- ..... Although Counselors are aware of the special medical needs of people living with " ", -.. .-..-. 13; * i,;L' -d""-,c *";" -.-. ," ""'4 HIV or' AIDS, ab^senc-e of free treatment at public health facilrties (except in 'logray and inadequate availability of drugs for opportunistic infections was reported to be ,, . , ,.. the major ". challenge. . . s ,- . - . .'.>" 1 :.*, - ' .. , . . .. , , ,., However, the counselors have mentioned work load bi&u&. bf iivol~iiiieit in Other . ..'_c"_ \ .. . l, departments, lack of adequate co~nsel~r~~s~pport, pi~&rement 'of test kits for VCT . ' . '. . .. , . activities have been a major problem. . , ~ssessment of the diagnosis and treatment of STIS by providers revealed that patients with STIs or STI symptoms at all sites are appropriately diagnosed and treated according to national guidelines. This reflects the success of provider training in STI case management and the adequacy of the history taking, assessment and treatment of patients . .. . .. reporting to facilities with specific sfis. All providers make satisfactory efforts not just to treat STIs but also to prevent their recurrence by promoting condom use and. by encouraging the treatment of partners to avoid reinfection. Although STI dmgs are due to expire in two months time, all . services , . .,.,. except ~., mojo health center had current supply of essential ST1 drugs and reported no stock-outs lasting longer than one week in the preceding 12 months, among all ST1 patients seeking ST1 care. Limitations/Gaps In all areas ST care was not given adequate attention as an entry point for referral for voluntary counseling and testing (VCT) for HIV. This indicates the need to improve the extent to which these aspects of STI service provisions are functioning. Unlike all sites visited, all Drugs at Mojo health center arekept at the drug store and the . .. , store keeper not always available making it difficult to ensure adequate supplies of drugs and other necessary materials to facilities. This poses a negative impact on improving drug distribution services and ensuring adequate supply of the essential drugs used for ST1 syndromic management. Annex 7: Trans'cription of the In-depth Interview of service prdviders . , In-depth Interview IC Counselors . . ........ +,,.. ," ...-. .... :..:I' ,.::,.: I.. :.‘.. ...,.. A'. ............................. :. ".: :r . : "...........: :. ,. (, ............. .............. ....-..'..... ~i~& I)';$& .. ,: .... :::.,:::;li:,.fj:;":-j:~~y:, ........i,-. :.., ., .. ,- .,,;:.?::;,j.,ti': .. ;;., ..<;,;;; .' .-: .. :,.,.. i. . ; ....... ..... ..,: y,..k:... ... :, <. , ....................... L ...... ..<.. ..... >-:,"..:"':,:..;:,~: :. t'. '-.:"': ......... ' ','",.. -. - ,. . i . ..... '< ;. ., +.., ........... >. . , r ., ',-, , Background I ,.., ._* ......... .7 <,,,+. ,.; .... ~4 ......... . " . , A>.", ____ - . . i_ .^_ .( - Both counselors are 12 grade completes, . ,- - One trained as CHBC aid the,~th&;~e~ed~i~ , . s.'...4.,c.&.2...t IC voluqttyx . . *,. s.,., ., , ................ "~ *:. *-.: - Both did not feel .pressurized as they are voluntarily initiated and were . ,, , .- ...... interested. , &.%,., . . , , . . - Both haven't received counseling training. - need more training on counseling are' counseling because it fbrther knowledge and is not enough to use own earlier experience only Job nnd sntisfnction The IC center works from 8 in the morning to 5 in the afternoon weekdays and is open Saturday morning. Counseling is provided for five 'dayslweek and s'atUrday morning. 'Daily intake is 2-4 'persons for four days /week ..... and ... one working day is allocated ,+, . . - ,' - - ,, . -. - ,, , ,~ .,., .. out re?+ *e.$uci!tiiin:,. .,- ,A*>.r22; $&F.?*w; j$B9s23 G%;@ $& *;$ ,<*,;,.: ;;,:. , j +.,!,, ~$$:; ,av.,$rs:<.@*s.:* k;e5&$;g&*$~. Group & one to one education, pr~nt mediz, mini media to disseminate ,:-aa..s <*--- &'" .,<. &.&&:$l2;.&,&g,f&>>~ '. , ~ ... . , . . . ,. ,? .*.<::*h,gC',*-. 6- .**.*m4.%wsmar* inforination are-conijucted z ., . . .., ..* .. , ,.~"& # * : "'>,'L>,; 4. ..;,- "<, , . ,,." . .. . -.... . , . " ., . ,. "4 "".- . Conduct 6-7 home visits to I?$W and edgcate.thirty _ ,_% lei^,_. _.. six workeii. ' . ................ ......... IC is regularly supervised by sc grid ISAPS'U* . '' .- DKT supports IC in provision of different^^ materials - There is a reference from the training manual' but hive no guidelines are available for counseling and on confidentiality. - Both are satisfied by their work because they believe have contributed to saving many lives - Counseling is a job that has strain and'the'hajor challenge is lack of Up-to- . . ,.! .", , . . %.&., ~A'~,, . , ........... date materials and information .c, .. ,, . - Counselors believe that the aim of-IC is to reduzi the HIV transmission through bringing behavioral change ,:, ,L to' practice safe sex among the . , < ' .. , population ...... ....... , , IC Services in the eyes of stakeholders - Any person who comes gets services - Service regarded as important by ISAPSO and community - High demand for up to date BCC Materials and different serial drama cassettes ' u , . .,, ." ,' . . , -. ." . ., . ., : .. . . , ,, .." , .r " . .; . . '. -. ..,. .. .; ,i -*.. .%, . , ., , , ,. ', - . ., ' , , .,-, .. . . ' _ _- .. . .~' . . ".., ..- . . .. . I.,". ., .." ,,.. . ^, . , :;. ' ,;... ,. , ,~ ., " .",." r...> . ->.,. .. -. ,'... .,,: jp* 4.<','> <.$. ,. *. .r.- . "" ," ."." = ' . ', ' r - . .,'.,. -a. t.. ... - ,. .. .. . ,. ma .-,:y3r.. ..,:l...ia,b,e,s.: .... ;.., ' .",. - -- Both Iddir ~eaders and their:;mkiibers', are:*t ~operatlve to allocate time - ; , . , , , ; , , , , . , . , for ' .Conducting , , > . . - >W,M$ -- ' - - - . ed-d:+ & d~"' 9 . ,- :. :. , - ,. ., .. t .;.' - counsiling room space is adequate for ensuring privacy .and is done one to one - Demand for video cassettes is high - High demand for condom Clzallenges - There are no guidelines available for developing, designing, pre-testing and ' developing target specific BCC materials. IEC materials are developed from different source and disseminated - No counselors support group exists but only one experience-sharing meeting was conducted. - Lack of training on mini media, designing of IEC materials. - Absence of assessment for the information needs of the clients - Absence of up to date reading and information materials - Clients requested for placing a suggestion box for their feedback but could not hlfill this request Other programs run by other institutions - HIV education in the military camp - Anti AIDS clubs (we network) in providing HIV education for the military, cooperating in production of IEC rnaterials'fro educating the military personnel. IC service and its referral to VCT and ST1 services - The service is backed by the health center & the hospital - Problem of secrecy reported - Counselors have own records, referral slips kept confidential. - IC receives, self-referred clients and refers clients to the' VCT and ST1 management in the Health Center. Challenges -- Clients are asked to pay at the hospital. - Clients complain that they are not given adequate time for counseling in the VCT - Access to VCT at the hospital Success of HRCI - Raised awareness and brought some attitudinal change among the community on HIV/AIDS - Created demand for condoms, information and counseling services Strengths of the project - Regular visits and supervision &om SC' staff - Prompt respo&e-tb care-and support for PLmA . .' ..,......... ,:,. .* ................ ,,.,. .. +. .... ! , ., I ................................... . . , ........................ " .- " . 'I _.._....._ . ,., ... , .... .... , ,;.; ,A, . , '= ...... * ...... A. ..-........... , . . ,- .~ , ,." imitations of the project - Lack of up to date information and IEC materials I Background - Grade 10 complete and previously actively involved anti -aids club activities - Selected based on previous performanc-e and aft'er passing the exam . ,' ,- '. " given by ISAPSO. - ,. . ., ., ." ,a , . ,,, .. % ." - ,, . . - - NO training received by both counselors - They felt Have inadequate knowledge an a*... sEi4sl';".-, *"d ,..-* *'> ,->, : .:" -A ,. : &. demonstration and distribution 'ad Couns6lina and referral for 'VCT. .............. ."> .... :?:..*.'"%.>",, i ..... 7 .. ....,.... . *---.-.-.,>.-.--.,..- "r ........... One to one, groups as..well as mass~c&~ri;atlon (nii'aimed~a) are the ................ . <, ... i ............. media - :, .- , , methoas . . *> *, ea~ uised. ............. ..< ........-.,-,... ,*:' +..-... -.,, a~~l-----a~iiiiii.ii-i-.+ -.A.....r,..- *... 4 -r%___r_=-ilLi. "i--..."i--"i--2"i--. * ., "'~, ,>.,,* , ?:;3;c2;~w:.~;s~~;t~,.~~"-A!;~~:~:~~,-~:~~?~~:~.-~::; -:'< :+ . ",.: we woik frbiii -9 in the :@bing up to 8 evenrng on week days and Saturday morning. $." ," \ ~. <-., &,. " >,'. .<.<. *". .,, .. - Feel mentally satisfied with job but 'ihc job has stram bkiausi' of shortage of volunteers who work only 2days per week - Regular I~".~ro~~eEi"dd;*igK ?##."-F~ *; .-supp.d* from 'he health center ........ , .. - There is regular supervision from our "senior . staff . visits and HIV secretariat. IC Services in the eyes of stakehorders ~ " .., .... - Community, CBOs and the governnient have view and give us supportive ideas - Program management closely follows our work ,. ,. . while the community committee supports us. \ - ........ Challenges ... ................... - The existing services in chelenko however are hadequate with only 2 volunteers and counselors. - There are no guidelines available in designing, pre-testing and .) .- . . - . I.' . I* developing target specific BCC materials. . ". > ", , .. .. - , ' :>, , - . , - There is shortage of BCC materials available to provide information and ahar ,- $ education tq I needy )+ clients ).% -. - here is one room for all IC activities located on the road 'side and there is too much noise and intekptions' to ensure coinseling sessions can be mc" , .. private. I8 C..f - The room is usually affected by flood and don't 'have adequate space for counseling Other programs run by other institutions - Except the HC, there are no other relevant programs/services in the area available. ,, , .,,,. , , , , . , , , ,..\ .., IC service and its referral to VCT and STI services ' . ' ., , .. . , - We refer clients mainly to Health center VCT services and ST1 management. Success of HRCI - Increased demand and use of condom - People have started to discuss HIV freely - Problems are absence of up to date reading and information materials and inadequacy of the rooms. Strengths of the project - Improved access to information, condom and VCT - Regular visits and supervision from SC staff Limitations of the project - The room inadequate and not conducive - Condom getting affected by hot room temperature and flooding - They don't provide us with up to date IEC materials . . . ,, . .- ' ' - I" , ,. . L A.~.b,.-~,- . ,,., >, ,.x .-~ ~,A> ,:s .R.d:.,~,*b.%,.%?$ I..* ~**,,.:<; ... .,,,: ', ,'.".7 ., ,;" LO&&- ,.,.. ".!,' i...::;;, ;,; .;.'i::;ii : ::: ::I:.'. '...:'.,;':..;': ; ,., .: :'::.:':;:;: ::::; ;';,,.: ,~>I..:, :.,:;:-,;!::,. : :::;' , ;,;I-. ,:':, ,;f:' :, .', I;.: :. :,.. ;,::, ' :..,, - . . . . , . . . ___._' . . . . - .. . . . .- . . '.. :. .. :I: .:.. : - : . :... . : .... .:..; .:., . . ,, :;. .: : :' - Both Grade 10 complete and were trained as peer educator by ISAPSO before joining the IC. - selected based on previous performance in ISAPSO and after passing the exam given by ISAPSO. - Both took the initiation and applied for the position and did receive training on HIV/AIDS counseling for 5 days. , ~*, .+ '. ,. *. . . ,. .""" *,.-, >.~, - ,, .. , ,#"< ' -.*. %. ,-.> ,,...6*." .,.-,.s, .*..r %,%> ' ,* % -,> - - Training was rated as good in general because we had good theoretical . " , . >* s., ,, % " -", .- < .*.-. ,. .. ..<' . knowledge' but the poor thing IS ,that there was no practical - { . .". > r.- .. .~ .,. . ,,. . , .' demonstration with ieai people. - Training did not go as scheduled because of Hot ðer G ."".% ,*\,* and'shohage' >: , , -, ,.we" .aA'&G .. ,, , . . , , of time given for topics and 'some impoitant topics were not covered such as code . df ethics in couns~~ing,".mC.'...a'ii'aaa .rep'o* ' wiiti. an'd , . ", evaluation of problems. - Both had one7day follow up training on improving Counseling and HIV " , * *., ,, ,, ., . *,,.". " % ,% *. -.W+' - -.*,. A<,,."WS--**~~,~.,.>*~. -"* ..A "" A-. education service provision'would"'l~ke to have more trainiiig on mlni media management, Communicating with and counseling of partners and edutainmentip HIV . education ,, &id 'to ,be able to' gibe .. ,.,, ~ iidiqiati ~ information-and better ikiilb f6i cbiiriikling bifficblt cases * .. , . , . 1.. ~. .( . ..> .-., .." .""*" . , -..> : . "., ,,l,..". -., Job and satisfaction . .., ,,. .. -. , -~.: ~+->L .:.. v.-,"es.. . -. -.,, , .,. . a, .#,.< * . .., ,. ,,, . .. - We provide the IC services to any cli& cbming td us - Aim of IC services [S to 'reduce HV prevalence by bringing behavioral change among the community , 5 .,,. .. ..., ,..""ri,. , -6 "l* L-. , >>51. ,-. . - Counselors proviae HTV' kducation foi FSW, ''''I?$ youth and parents, Condom demonstration and distribution, Counseling and home visits to .. ~ sexual abuse case and Preparing mini-media materials - One to one, groups as, well as mass communication'(~ini media)'are the media methods used. , ' . , - The IC . center . ai.v works - .. . . from . . i 9 in the morning to 8 in the evening weekdays - -.' . >. - ..;- ,:-" . and is open Saturday morning. We conduct' from 3 up to 5 counsel~ng . , ., ,.. ,.-.. . " .' ... '. "* . &....$ . ,, " . -. . . ' *', " ,*. '" ,.,. " %, .'- I*. -Av.'*. ..% ;. 4r . u.*,LA.-x <.a,.* %,$-Ye-& ,*x,.r,r ,**%h<*riy%L'- - . sessions ancJ 2-3 visits per day but a lot number of clients come seamg .-I""" .- ,. &2&~&& *,.- 4-i ~:." ".-*$>"a .,.,,.id. <- . - .- . . I - . . . . * .?. ... >;a'-. -. *\<*<,-we.>w$ infor&i& and^*condom, .- . ' . " .., " - ": " , ,. - .--- ?*-< +.&--*,.. ;-" --.+v!$**# <,- -,* %"- - ~~~*~:;::* ::~;z,--: ::; :$L %.>" ;~.*2@$*% %..,& . fe"eT~P;To't-fk L-'a" - - ing . t e ., jo6Lbecause ,\.._ they . have go . : : a. - r , ,",. ., , environment .- . . .. , , ,,, " . , . . .. . . . . -. . . :." - .' . ~- ,* ,..,.> .<~ < , , .:* -, . . . L . , . *;,":;z>&. ~~~~.~,d~.~s~,::~~~~~";:;2~&::~&~~~~~*i.~~~: : - the job has striin'because we are involved in multiple otter SC program -. - . sectors in the committee besides the IC' activities, Very'^hot 'whether 'and " . . lack of transport and' Shortage of vol~nteers~ . " . . . ~" . . . . Views on the IC Services and tIie stakeholaers' - The kebele provides us wit6 support or else We do not have any regular support nearby. '> . . ,, . - here is regular supervision from SC staff and Oui bffice-staff ,*,% ,,,;,> -..,, .-' ,'.",-,~,<. .+:<,,,,, .,<"., -..,+*:.,-,: :., .>.", ~ .- ~,, . . ," ... ,., ,,,*% i"* ,&*>*<:., .C',* - '&.<..,: z.. - .s < , :'.-.$ .;,w"'i -." - ~oth Sc'and ISAPSO program management see our works as priority area. - ,. - The town kebele administration also gives due attention to our work ..&*.A. ..;-.axr * -,;~.i..',.*~rA*,~~"*~.-.~~e *,L. 5. *, , .a ,..-.,.., - The good attitude and emphasis given 6yyoUth"' ,FSW and TW and,, .~ . % . "- .> .*. . ., , ^ . ' .. I . response from elders and Kebele is good . ,. . . . Challenges - have been trained & have no guidelines for counseling and on confidentiality - no guidelines available in designing, pre-testing and developing target specific BCC maferials, ,~." , - workload and Lack of basic skills in mini' media management - inadequate skills in developing &get s$cific.I~C materials -il" .... ^"..,- .......... - here is shortage of BCC materials available to provide information and lack variety. There is one room for allIC aci'ivities'and hive inadequate space. - there is no mechanism for continuously assessing the information needs of clients on HIV issuers prepare materials based on the frequently asked questions and suggestions from audiences fro BCC activities. ..,. . - There is lot d^disturbiiiice as the roomis'connected with themain road . ..> - The IC room is on the main road and a lot of voice to ensure counseling sessions ... .- ........... can be private. While conducting counseling there are ... ,,.rr/l" ,......-........... -.uw-.ai i .......... interruptions and the clients finding it to discuss with us with secrecy sometimes a problem. Other programs run by other institutions - Besides the health center that gives condom, there are no other available , . . . ....... . ., services. - Only collaboration with kebele but there is no coordination mechanism relevant local actors. ,,. . i +Y ., IC service and its referral to VCT and ST1 sewices - The clinic backs the counseling - We receive self-referred clients and the counseling service refers clients to the clinic for VCT services and ST1 management. But post test cases come back to The IC. - Referral links are adequate for there is free medical service, spiritual counseling besides the HBC. Success of HRCI . ., . , , ,. ,,". - People have access ~O'VCT and &dom when ever they want ,. .-~, ~ - Reduced cost incurred by people for VCT Sfrengfhs of fh-e projecf - Increased access to VCT, care and support - Regular visits and supervision from SC staff - PLWHA and ofins are getting'adequate'care Limitations of the project - Inadequate technical support and training - Inadequate knowledge on mini media and bcc material production . . - Staff at times mistreat volunteers - ~nadeiuate function of the'two sub committees . , - Both Grade 12 complete and actively involved in school anti -aids activities - Selected based on my previous performance and after passing the exam given by ISAPSO. - Received training on HIV/AIDS counseling for 5 days. - Training was good in providing theoretical knowledge but lacks practical demonstration with real people. ",<. r*c ..,&,* imr. d. " " .i *."'<", ",.%* - *" .. , ,... ,. -" . - Counselors received a one day . follow . %,%. , up training 'on" im.proviing . ,"., ,-." -.*. ... . - . Counseling and HIV education service provisiontjut would like to have ' ,. .',',,. ., -.,,*,*, .*e%,,"..,." ,u* . ..- ..',. .'* "..."*.~\ .,,a~"*J,:-~.~&:8%,,>"~ ,~S,>',, more training ~~%HIv,' training on H~W/~S testing and on ST1 so as to - ,.... >, ,,. .. ., -,. , , . . , . . , . , l . be able to give adequate information. , .& , . , , , Job and satisfaction , ..- .. ~ , . - The IC center works from 9 in the morning to 8 in the evening weekdays and is open Saturday morning. they condud from 4 up to 5 counseling sessions and 2-3 visits per day - The counselors feel happy doing their job because they believe what they do is saving many lives. ~ .,. . . - The job has strain and there are challenges .3 ,, ,- in work when observing the , ,.,.,,.*-., . ~*&..<,,. ' -' .. . challenges , of , PLWHAS . ,. . .L~,,,.......-..,~. who -, r:y.* he. ul.,: hem , ,... -: .it"ir~xe~.,-"-:L+,~~~..~A and discus with .- -.. us. . - . - . - .,=s--.A-. . -",.-+a- ,+'.,,a.fiqa *- > . .r,, *".'.~ ,.,.* .*,: -A*. ;" ..*, , , . . ", * ..T. - . * ,>, <. ,*",-.."-,s.+*,+a:*<*. . , ," $ IC Services in the ejrks of stak&o@fers . " ,... . , -. -"> e, ...,. *.A,< .2"A ,?.-*,, .,q!,*"q,+" , " I ,_.. , .( iX *. ' ,, . '> .*, - - - -, .---.---- . ---.--...- . . ". .. -.-,-." .- ...---- ". .- -".., ----,.-".m..--M---*,,.-. . ,-.- .*-, -*-. ,- - .. . . ... , .,*. ~ - *.,.,-, * . , ",,.: <.~ -".,*;-:*:a&4*3+m*z&**%+%-*--.--*-~ S?l., .--. *.,b -*a. .. * -, - *- . ,:. - '<,-, ..-....-.- &-.-,- -v.y~~\ , , .,. ~ . ..<- ...,,*., *.. , ;.- i - ;? .<., -",'ir; ,.* %* i'.*,' -. . - i i - - .i - .. -. . . .,,.,s A. : ~9" , - .-,.. , . . . *. *.- -" < .. ..- .,.,,.. -,.*-.-..-*., - Counselors provide the ~~-$k&i~$$.t&.,$r& coming. ..~ -. - Counselors ' piovide fOnT; e;ici;"- *. - ">, % * ?v.;v,3a:* 32,&%>:?.,?* -2; :\ ,a,,,:?: . . ,: -.: . , . ,",,<, '*: dz~.Z+~*."%".:'.-, ,, ... ?,,+.; *2, - We get support fro the committee, pofice and governmentoffices. There is regular su'fiervis.idn fr.ijmSC'SSi:aff aiid 'triiir .*Gr ic"T' staff "" . ~.- ...~., '.. " ' ". ,.. -. - Both Sc andISAPS.o~prog.ra~~:.G~n;g~&'ment s,ee,;ihe works as.piibiity . , ," , . ,. . *, area. - The town administration also gives due attention to IC work - The emphasis given and response from eders is good and eder representatives collaborate with us when we request them to arrange and . <-( .,.. . " . conduct education sessions on their meeting. .. - --.-X.<, .. , .. .. ' r.. . - . -r. :; ... *.<,* .> i .. .nwfwtPs. -I'*L%&V.~-~~:.?~*I'.P q.yY- U"G- -m.w-ytm ... !' --.:y.- .":. ...... ... .I ' . , , )- -.= , .... , ...... : . : .. : : ...... :; .! ......... - , .... 9.: .; 5;r,.:% *. .... , , . .,..:, ........... ......... ...- ...... .,.?. .i& ... , . ,*-. . , .. ~ .,: . :, . ., ., . ..... -. ... . :,-. i ... . ~ . .;:yf:":;.::!?h .,. .... >.&&?. ......... ,-: .; << > ......... .... -. . ., . ,.. ... ?., .,.._I % "': s,< .*. . . ... ... . .a . , ..: ,':. .. :. .... . . < , , . -1 . . ,:.. , . ;-. . . , .. . . -- . ;., .: i;. ; ,. -. ' ' - ' . .... ', .... *.. ... -. ,%. .. ,. .~. .,,.,. ........... 2 ..:p "." 0'; ,,..) .... ' - /,. _.. . . ..., ,., ?. ,'" - -, ' , .'" ' ' . .' ,- . ;. ) ,. , , ,.,. r"..*>..*: -.,. "? i*ii.,:.i .*iiiii~i~: .:.,.." ,>.I >,..> ;:. >& ~.l.-l-.,.I'~:,,~. ,: *::::_.'? *L3:,.:L? iiii iiii ,= ,. ~ ~ ~- '7. .- - ~-: - The existing services in-mi1l'e.G iiiadequate and no dtgnati* sources. ,,e>*w**.L".Ai-P.9~i.<-h s3*L?,A, % ?*,*-" ,>,%f,., *", ,,*, , , . ,,\ - Clients are requestinCS formore &fferent cassettes nsW. education and , . . ,., also requetius to bring similar ;idko"ci&ettes for clients 6 rent. 1A"""rs i:' * .>. -* .. - We have bee trained and have guidelines for counseling and on confidentiality. Challenges - there are no guidelines available in designing, pre-testing and developing target specific BCC materials, for continuously assessing the information needs of clients on HIV issuers - There is shortage of up to date reading and BCC materials available to provide information. - There is one room for all IC activities and don't have -*- adequate space to ensure counseling sessions can be private. - There is lot of disturbance as the room is connected with the kebele office - Poor access of referred clients to VCT services Other programs run by other institutions - Besides the health center that gives condom, the woreda HAPCO ofice involved in HIVIAIDS there are no other organizations. - The health center provides us condom when we run out of supply and ........ " ..... we work in colI'a6oration 'with HIV office aXd the police to refer sehal abuse cases but there is no coordination mechanism relevant local actors. .," " - . , ',*. - .... IC service and its referral to VCT and STI services - We receive self referred clients and the counseling service refers clients to the clinic for VCT services and ST1 management. - The clinic backs the counseling but there are problems in that many clients wait longer appointments because VCT is provided 2 days a week - Many clients complain the we are not given adequate time and care for caunseling as well as ST1 management at VCT site Success of HRCI - People have access to condom when ever they want - Good community attitude towards IC activities - The care and support program has improved community attitude and demand for services Strengths of the project - Regular visits and supervision fiom SC staff - PLWHA and orphans are getting adequate- care Limitations of the project ...... ,, , .- .. , . - hey don't provide us with up to date IEC materials ... .- ...... --'.i.- ... <'..-.. : ....... "e,$".<, :.. ...... . ., . , ,,,---- .*; , , , .., , .,.., . " . , , - Inability to improve the VCT firr?ct.i% i. >.*., .i.1 .. ,.:.. 1. -,: ...*. ;..,,.,.& .._, ,.", . .,.. .... . . . . . . > .- ,. ., I . : . . " .. . ' , . ' ,' Background P - Both Grade 12. complete c: ,. ' - Both actively involved anti -aids activities, as peer educator , - ., and volunteer counselor for OSS A Rap - Took the initiation, applied for the position and selected based , on , previous ' 1 performance and a&r passing the exam given G;jtsAl?SO. - . ... ~, - Both received training on HIV/AIDS counseling. ' ~ gsss, - Training received was felt well in providing theoreti~cal knowledge and but -. ,-. , .~ .. ~ , ..-, -: 4 . ',. , . poor foithere was nd practical dem~nstrati,o.n~,,~it~~real people. - Counselors had one day follow up training on improving < . . Counseling *. , , , and' " .,.. ."~ -~, ". m .., , .. ',A< . i R' HIV education service provision. - ~0th. wdu1d::like to--haye,, ,more training have inadequate and up to date ,,.", \ information on HIVIAIDSlSTIs, on HBC provision m Working conditions and ~ob satisjiaction P - The IC center works from 8 .,,,. in the morning I to 5 in the evening weekdays B, and is open Saturday morning. We conduct fr0m.4~' ., , . up' to '5"cbuiiseling , . I, , " . .,. ;,.:;.;";.il,<,,j;,, *;,:(1'p?>! :-)-;:1p".:: . i.. ".' - .. sessions'and 2-3 visits_ger day. . . , , - ,.* . .. . . ~ . . - --,*-~~,-~~=.w v. ..** ' ,...-..*'i'. I -' " -. ", ".~%',p,% .**. . .;. ... ~, .. . . '.r:- ,r.: " .. .r ' . . . m - 130th feel thg job is interesting and are happy'd6iiig'tfieii'jobs.'~he job has .. - , , .- , . , . . . . , ~ ,% ,z;* ~ ;.te"py; eeA-"*w.*s~" ---**e %-+S%*.d*. .,"*. :,.~ , ~ < - - - - - . . . - . . . - - . *--- -. .----, - - stri~1~c~nges -. . , in. ,.workd $e$g~jg~-$p~;~~~ge~& M~~+2Ly~:~ :- . , , , ..> . . ..,,,,:~,..% '. - : -, , , " and lack of.trtransport. ~ , ,a ," k., ,p~-4~4x3~+,sai~a;e~~2.~,~~.i8L2ei:~ :z~iz.:x2.~L.~..~t~y- *,., ).F7,.., ,. ,;- . . p - ' There is regular supervision from SC staff and.Qur offi~g~&ff(lS&'SO) - + 1 i IC Services in the eyes of stakeholders , .~ ~ ,, , - Counselors provide HIV 'education, condom demonstration arid distribution, counseling and home visits to sexual abuse, case, Pretest and ongoing . It .L'_ .. ,". l-l*l\-i(,, ,. ." '*,. <" .,,., ,- ,_ . _" counseling. - ~im',of IC is to reduce HN prevalence among the ,, . community ..,*: <- .: ~ by-bringing .*, , , behavioral change FSW,TW, youth and parents. + ,. ... , , ,., .. 1 _ _._,- _ _I _ - One to one, groups as well as mass communication (mi"ni , media) :., .,,* . ",. are the media methods used for IEC. We have bee'trained,"ad :have gutdeliries for counseling and on confidentiality. - Clients seeking information and condom qs.we11,. as".,degand?ng for more different audio and video cassettes on .HIV .educatio.n,is increasing. - Both Sc and TSAPSO program managemei.lf'see~oiir"works as priority area. - Good emphasis and response given by community and eder representatives encourage caiiBelors and provide moral support. , . ", . 5 ~"?"'":;-""-f*i*i>ypi~~y>~~ ,. ;, ->;~., : .,.?~- ' , -, ., , ,I .. -<*.,-q,y>b. ., & ,,. ,:;,,*- <&.; -:.i , Z6.i V.<%S 4&..&. r:.'.,.' ., '.,. - -, :. . - ' ..' - . ,, --, . I I. P . , , , , . , ; . . - .: .,:.: . .r -.' - . ., , , ..., ", . ., ' ~ ,."- *>.* .<,; ,* . , ,' ~,,," . . ' -,< ... ,. w ., ,, , c, ,.: ., -," ,"-% ,, , .. , , " ... ~ . ' . , . , . . * . . . . , , , , Challenges . '.,, .. - . .. ,., ", ,. " ... " ~.. ,~ ... . _._(_._ .. ", ^ ..., .. ,. , , -. ", , , . . .". - there are no guidelines'. available in designing, pre-testing and developing $9~ target specific BCC materials, - There are a lot of qu&ti6ni aiked 'by 'clients and-we rely'on information of year 2001 and yet we are expected to have adequate knowledge to provide ?-yy information. % ' .* . ~. - ,; A< - Shortage of BCC'inaterids. - Difficulty to ensure counseling sessions are private and confidential because F?n. - . ?. , of lack of private counseling space and too much nGse"8nd inte~ptions -' . rr. * - .. .. - < , . . ,,. . ." ..>,3.r:.,.., I ..., "... ,-.. ,.- .. . ., , . , . . . p... around the IC. - Lack of knowledge or" mechanism ' for continuously assessing the F; - information needs of clients on HIV so as to prepare need based materials. Other programs run by other institutions - Besides FGD that provides condom and education in Kebele 07, there are 23 Anti aids clubs involved in education and condom promotion, and Various religious organizations involved in,,HBC. , .. - Coordination with ,.", the .".. IC exists only with 5 anti aids clubs in outreach ~ ..,. * ., education and medi'a activities. m IC service and its referral to VCT and ST1 services - The counseling service is backed by hospital, FGA, OSSA and bethezata VCT center. - We receive self referred clients and the counseling service refer clients to the hospital, FGA, OSSA and bethezata VCT center for VCT services and ST1 management. - VCT SeGices at OSSA were advertised as being free of charge by SC and clients are disappointed with us for misinforming them Success of HRCI Success - People have access to condom when kver they want - Good community attitude towards IC activities Strengths of the project - Regular visits and supervision from SC staff - The SC program initiative is new and participatory and has improved community attitude and demand for services - Highly integrated services Limitations of the project , ,... ti"*. -'" They don't provide us With up to date IEC mateiials m: 5. - The IC is not klly equipped with materials and shortage , of volunteers . ,, . $ - Clients ask uq why ndl counselors were not tested' - Poor information exchi'i@e in' the cost-of services at OSSA ' ' ,.; .. . , . . ,, ?<.,,,.,~ ? .,.. ',, ." , . ., .',.,.. .~.'.%* .,-",,,.,> +.i:s;:s ,. ' . >,w;.-~, :".' ,*.> 2.~" - ,. & rn' -. ,, , , ,- ,.-, >."' .-.. , . , , . ., ~ ~, , , f.,"~ <" .,.zd*,. ,>."..a. ~ ~*., ,-,. :~, : .s.".~." %,,. , , ., . . .,, 1 _, .,< ,,,,, , ,;* ,.. . .;, .,. 2.'. : . .':: .. 3 _ ,. L $1 - . . ,,, 4 . .- :~.:- . . -. , ~ - .. , . % r ?+ -,:.: :;,, .*$, ;.< $, ->, , f ;;.!...~:~"~, L:;?;;;; ;-:::::F'bg;>;;~$;:~;~::;i;;, L-;, e+ b<'."+.\.,- ,>.- -- -4,- .y. :.+- '. . ,. - _ .,,, -., "." -" , . ". .-. . a % ..,, ,*.". . .. ,. ,* . ,*a -+g!k4Fe,j355.r;7?':, .: ',:, ,, ;;2+; ,' "; , . , : :.$, :: %, ; &a - .. , -.,< <.,.<. ", .' ., ,. .>." ,.,,,. -, , ,a . . ',. , " ". . -.'..?' : .); -,., '. ' ,. ... '$3;' ., ,... , : " ,: \. . ,".>. ~ ' ~ , , - . p*~v4*..z> >* ,,.% :*: .> .,<- . . . >,>. - ."?' \% ., ." , .. ~ . . - absence of up to date reading and information materials - Inadequacy of the rooms for counseling. I 1 Background - One is a 12 grade completeand the other a diploma holder in'accounting. - Both Used to work in HIV ,clubs, in Mojo were actively participating because of personal interest and one mentior?&, tphav$,ccmm"$~cdl;~m&f wz,,,s.".+bv- ,',* ,, ,6 -w+.%A, % -.".-. after he lost sqmeo~~,~.~~~~,.,~nn299000. , . , ... _ _,_I_. ..I*IS ........ .,.( ljll--al ............ *Or ill".--..I-(._^ _.*__ _........__._. - Established contact with SC issince the start ,*of&? project and through Sr .Tsehay during assessment with FS W in the t0.w wascarriedout, ~..a~+~~_+~,~L.,__..g+,a,uL~ ,<, ....... >>. . - Counselors believe ,the,ir,, active participation is the. herit. that , they -. ,, were trained as counselor and tookover the $!!.last .~~~~ke5~-s~iiiiiI-i-i6 >,\< --\ .............. ...................... - Onlyonecounseloristrainedwh~statedt~h~co~~~$~~~~~-~~~~~,~~~~,~~~~g. personally. - The training I received for counseling had good result the teachershad good ability, provided the necessary materials but there is no follow. up for updating ourselves. - The training about on the subject of communication 'withthe person who wanted to be counseled is not detailed ands~metimes .,,. we,L$n{$,,!!ifficu$,to ,..+ -- . I. ,,,., __ _ .;&, ; , ,> . .* , . , communicate.. . - ~efrisher .,-,. %,%, training *:,, "e +.x.x+.,e7,, and .>,, updating oneself .- **, ....................... about :new ..jin$ings ,-.-.,, on HIV and qn .. .. ............ .. ......... counseling ... helps to equip ............... myself with adequate informtitlon ......... toco&&%$~&.. .. ................... =~.~~,w. .* ~?$~, .... ; .......... -r ,-.*.-A,-..w .,,*=. ,+,-'",L-, .A.,, *"-", > - ' ..,.., ., with people ~f.all$o&~ and& ,&g-a&?uate. coun~el~ng..sla.!h~ ._ ... .-.. ........-. -...... , . .. , .... p. *:&i $&* *,~~~>~~'~~~~&~~~~~.j~j~i~:c~~n"n"j~~~,~~.t~~~~i?:>i::~Y:iii.~.&~L~ig l,?. ..... ............. " . ,; -.,,,-:--."'* .. , . ,. . ..~ ~ ' , 6.. ........................... ,. ; . ; : -.~-. " ,,', " .t." ".<* tG. .,,. ."&.::,".~ . ,,<> - >, ., ?/, , ,, . , Working cbiZtiori~[;d '3ob ,satisfaction . " -" . " _, . ' -.., ,r .,.* ',,& , , ..-. ..... ......... ,*" , .,.. >, ~ - We get people in our office and we go to meeting places, coffee ceremony, idir meetings, religious places, etc. - We talk to the drivers in the ,morning and some who take, tb.casset.t,e,,agd- ,, ~ return to use. - THE Goal of IC is the change in behavior of the people. There are students who take condom, people talk openly, drivers, FSW have started, not to go without condom. There is behavior ,change and IC is achieving its'goal. . . - We do not receive referral but we send to them,.and;no . . problems'obse~e~. . .. , . on confidentiality. - Start working at g and close at 11 Mon-Sat. On,"average I work more than 48.. ,, ,. hours. We .. are supervised by staff of IS APSO." They provide "us '.IEC " . ", materials. - The service we are providing is not enough. There is a very high demand for ............. condom. The cassettes circulation has incr.ease&.~~.~.at,',n(~,.~s~,~~ *. , ., ,-~,,. ., ',. ,, . < ... e.fi.*ss, ., ~.- .................. + - The job is difficdt'bicause we have' to go into the community creating our' own venue. We did not have leisure time. The job itself did not give us time: . , We do conduct education during coffee time. . . m . ,", -. , ,. - ~. .- , ' +;, **.a, ~. , '.*. . , , ", "a " ' .. ., -, " .,.," , . ,. .~ ,-,* .. ,~.S 2 6.;~ At,,* ::s>;>2&z,, .,&,<$% .,.&.&A. ,*,,<,*.~4.':\, we. 3. ,~..*.?,:.-"<. "*?=6.:,~8!*<~%%, * :,."-~-I. "' < ..:. <, .;. " .-,.<,,.-, \..- . ... i.-. r.- r, .-r - I--. ' " .* ' ,., .. r..... "*'...,... . - . rn - We GSAPSO) are evaluii6d by ISAPS~. SC pFo$&i bi-.'&h mC, "rIsl&, condom " thiGgh Sc ':c;6i;i;, -.&e.';piovide tb "the f-ei's' ;. >~ih; ,.+@. .. --, ,- .'.." ,. "*-.* . I materials did not discrimhate groups. '. . .- ~. ~ : . ,, ., Esrsr ",~ . ", ,', " , ,. I- Other programs- run by other insiitutijns par*, - There is no other agency that works on HIV except condom distribution by health centre and Shops. - We did not have any communication with other agencies. IC Services in the eyes of stakeholders ".",. . " .. .. , , ' - The relationship we have with ISAPSO is very good. - The IC has not yet worked with social networks and plans to start. ~.*** *, ,, ., -,,, .. ,*~ ", %., &,4' .x,.**. .,,- ~*:' - "" *~db. -* ,?W.~%e.** .v. .+:-.-.-,-~. -". - But with.'& ~t is only the vague chain of command and there are a number of people coming and passing orders for counselors. This has a repercussion , . ., on our self confidence and plgneil outreach ac6vities. - The committee has good work but is not yet integrated with the community. Community is not participating. Many people did not know it. Clzallenges - Do not have policy on confidentiality and we use our own professional discipline. - We have a reference but lack teaching aid (models). - We did not have tape recorder to be used for mini media and demand for video cassettes is high. , - We have to go to the people to educate and have no budget for operational expense and counselors are spending their own money for transport, etc. IC service and its referral to VCT and ST1 services - The existing referral system is adequate but we have many people just receive our information and go to VCT. - Referral system required a separate space counselors who are working at VCT center have other medical responsibility and people may not get them. - Care and support human resource is very small. Additional personnel are required as more people are expected to come out. Support is also required for PLWHA .. , , ,," ,.. u , "',. .." ~ - ," ,,. .-- . . Success of ERCI ' ' - SC/HRCI is the first to start movement on HIV in Mojo. - Mojo is a town that is always skipped from developmental interventions and we are happy the IC is working because of SC. Sfrengfhs of the projecf - SC makes regular contact and we understand its vision - SC realizes its promisesmd it has build trust, , I ,# - ., . .." " " .- . .." . .- . . ., ~ ',.t . - .. . Limitations of 'tIiis'pGject ' .., . .- &... .SrSe .... , -.. .-: . " ... , , \. , .* ." ,, , , ,,", .." , - Sc did not introduce itself and has , poor ,: 3., iinkigiwith ,<, g&ikimeG"dffices. ~ .., - IEC material shortage . I " , . 3 . . "-, •.-.....-.A.i ---.-",,....-..-*. .t6.d, -. ' ' .-" , . - ~kck of clear management chain wlthSC. here are orderi given diiectly from SC which sometimes .., \.. conhse us. They should communicate with ISAPSO not IC. - HBC should be handled by itself. The committee is not capable of managing this activity. - FSW drop in centre is closed and we could.nYt.have FSW in one place that is also very essential for them to discuss their issues. ""f , , ,- . . , ,- . ,:*..-< ", ',$.,>-.-$a >,~ ~ ;* 2c**<-6,,*3 ~,$>~:p*%:~<:e;~#"",~,*;:,:,~~~~,:%f% A.* r.3; w:.r -, .-.':$;<*- ",~:.q.-'+:".'-:c~::, :' ,$- :' * .', <: ' ".- ', . ' .... .-. - .. .. . . .. ...... _.. ___.._.__ ., . . . . . ..:. ,,.. -;..a &.,a,d.*;*.rr'~;-. :.. ,.;. '- .- i( .' ::~:~~~g~~a;;;::~~;,:;::;;;;;;;:::;;:;;::;;;;:;:;:;;::;;;{;;:::!:;;;;:~;.~;.;:;;;..;.:::;~. ;,.. ;:.;.:.::.;; ;:;<:: ;:::(; ::,:;.:;:';;.:;;:;i:;.::;;-ci::::;::::;:: :, ..;.-: :- ::. -. . . . . . . . . . . . . . . . . . . . . , , . . - . , . . . . . . . . . .. . .... . . . ... ... ... ..... .. .......... . .. . . _ . _ ,__,__ ... ..... .. ...,. .. ...., .. . ..,, :..: .::::.:::;.::.: : ....:- . . . . . . . ,:. ..:. . ..;... , . . I... . i.. . ... ... /. . . .- ... . ..... . .. . ,._ .. _ __ _ _. _ __ _ . . _ _ ( _ _ -_ _ ,_- _ . _ _ __ . . ,. ~%.. Background . . - Both were group members to institute HIV/AIDS club in the town - Replace in January colleague-club members when they moved out of town for education - Club was dismantled when two volunteers join IC although there were many members - One completed high .~. school ,. and , one attended up to 10& grade - Know that SC~S working on FSW, TW hotels but we go to rural areas, tutorial classes, chat chewing places. Volunteer Job and satisfaction in the IC service - Aim of IC is to bring behavioral change - Majority visiting IC are youth, few elders come - Any person has the right to use the service - Distribute condom to FSW, TW, hotels and other community members. Hotel owners provide FSW and clients freely. - Condom supplied in few shops - Distribute IEC materials in schools (HIVIAIDS club) - Provide education at Iddir meetings, chat shops, tutorial classes, rural areas - Inform clients availability of ST1 services - There is workload - Advise hotel owners to supply condom in rooms - Group counseling is conducted with the youth group in town - Counsel people to visit VCT and STI free of charge - Conduct outreach education in hotels and other places in the town two days/week - Provide education for about 15 minutes during Iddir meetings using existing IEC materials - Have received guidance and explanation far 3 days From ISAPSO field officer Kebele Administration supports IC activities very positively in settling dispute, calling public meetings Challenges - IEC materials are in Amharic and are shon of supply of Oromiffa IEC materials - No systematic assessment of information needs of clients - Shortage of IEC booklets and fliers, cassette serial drama, office supplies and microphone to use mini media in another direction - Inadequate trained counselor - IC is not convenient for confi~dentiality ., , :' , . ..... ............ .. t ..... ........ I . . , - ,%.% 'S,,. ,-*.., ,- ,s.,, P ..,,, t*, ,..../,,", . ./ ,..7r:i ..,. :,..*,,:. iid.,i.li n ... .:;. -1. ..>.>..#..:....'..2. .. .-.: -:.<:- - . ." . -, <, -. , , . . , . -- ."\ - - - . . , ,' ... ......... ---,, . - . . ( ,... .:,tii., jmp.;n ~.~.w;i..... ?ilil x'. x.:~,;.;~-~<~ ".;.r-:i b:i :. - Shortage of volunteers, training to recruit new yolunteers required .............................. ........ - There is no &d$!inti 'on &6nfidintiility an& CDC" , .. ," .,. ,,. , , , ,, .* a. - There are p&$le ihiiequest for unfaii deinbhstrition from the society Perception on voluntarisnz and misconceptions , . _^_. - Married people have never come and asked for condom. Married need not use condom instead lady should go to take injection for birth control. They . . need to trust each other. . ," VCT and ST1 service.and the referral system - Other VCT .;TgE -'af~not'coope;gtiv.i when permanently .assig&d ..... 'is - ., . absent ...................... , .......... ..ll.llI;. I.;. . , - Counseling is conducted in one ,.: .,r., room a i7:,.1.32.., and .c..i blood .a I--:.i- sample taken-in another. - IC staff and-frc~ 'counielor keep confidentiality, we trust each other - Clients wait same room with other patients, rn - 3 couples from rural area came and-have undergone VCT iestfo; their marriage - Referral system: IC refer to VCT, results are referred back to IC and IC refer ' ma to CHBC, committee approve for care and support . . - Challenges - There is no guideline for confidentiality but the IC councilor has informed us well about it. .<,, ,2&...,,&" ............ ..,<:~,.~x,*~~>..~'~. 5. A ... *.A*.. >> . J 2 .:.. ".. ....... - Blood sample is taken and tested by the lab'te'ch~c~an m another ro,om ,- , , .,. , .:, . - Closing the ..-,, door X*._,__ when _ __ __.. aclient __ .,. - .,.. entered , .. counsiliig . . rbom'expos&s to' breaking ..... ...... ..-.......... I confide'ntidity .'.~._.."__ ,__ "._._. *. ,.-" .~ - , . ~*~*%. tv-..: - *. *.A. .... . I- , .... ........... IW .. ,. .. .. . cre;e++,;.T ~Y.. .*,p-.>~, .*,w "~>*,'.*?*" >,yy &. ! --':>d, .A.....x.t.'...'w+.:'.<~ %..*P.A.'.... ~$,V.&* ' ,,: p !; -++, ,**,?,- ,,L!sc, ?~ .*,,, .. .~>,-a..*.,'.*,4,--* ~>~* *-, c.,- . >.>.",?, ,?$?+* =a- .*-% h 4#x** -**w'~&%m " :.-,. , .::\ii..=i *xi,r.* an*- a&" 7- .... . , .. . ............. ... , , . . ............ ; ,$ ,M .,..,. ,S& "~*<~~-..~.~~-.:'.~~-*~~=~~~~#s~~~'~~.~. , , , .~ , , .. -s.. ,, . .2.. .... . ‘... -?.. a%. -*~*,% ,*,; ,.=. *.=.+ *' "riY"riY"riY,4ii.iiii... *IIIIiX<+*w +&" ... ":?'L;e<..wM~&w~*~ '" : ---*. * " ., . "- ..-. .......- ....... _.. .,.....,., .. ,,--s ...- ,%. ,*I, : ". Other programs run by other institutions ,' , ,. . ..,,~ ~ ..,." , .. ,.%?,,. ,.,,:, ,:;$; <" .......... ,=svv.> ............... ,+ :+ $.?? - *>:?* ,.,? ; $.. .,- .. ; ?.;f?*~~$~~<*'@>>&~'&~~:$~gy&;~.&z~%~v~y::~ . - ,.a.*v&A\ --,, -. " V ." ,. . ,.", .... ..*..... ........ m - No other inst.itution runs si@dar program, ........... , - ,,,' .,< , ., , ........ .. , . ",; *,., :* .L;-,:-,.x;rif C;LC,.,I ...,, i,.7*' .......*.. ,"a ,.-\>.r':< .-., I>, &.>*+*m.>+"c -, . I _ / _ _,", +,I Strengths of the project ....... .., " . , .,d^ - Communities have accepted' , . aid started supporting econ6mically (food, money, etc.) PLmA . ,. ...... ............ - High demand for~condo~is~cre,it~ ' ' - Community regardsthe volunteers activity as relevant and .,i .. ., . , - - Elderly people are also getthg involved in the discussion now. , .~ ........ .............. - Limitations . . . ,, .... .. ,, - Inadequate number of volunteers available(one is supportin~frekly since the last 3 months) Background - One connected by Ethiopian Red Cross Society to ISAPSO and one competed 9th grade and is voluntarily initiated to serve as volunteer r . .. , , " : ! " " " -. " '* " ' ' i, - One trained ...,*. by 1SAP~0,'andboth by- sc four n.,rdl times -Id.,n (including refreshers) - One is employee of the Kebele ~d~i~i&fati~~, one ~~~g-*g~-**vdr i&HIv/bS committee - " .. < ' . - , %"-," ?.' ".'.,., - -, . ."~ ' . "'. Volunteer Job and satisfaction in the IC sewice - Aim of IC is to bring behavioral change and eliminate HIV/AIDS - ~ocation of IC is central - participated in a training that is satisfactory and necessary for the job - I$stribute condom and counseling to FSW in 2 days/week and TW 2 dayslweek (outreach) - Distribute condom, 1E.C materials and counseling TW - Training will assist us to be able to answer questions arising From clients - No work load and are satisfied. We work 1 day/week only (there are 5 volunteers) . -. ,.. - Community and HIV/AIDS committee considers the project very positively - IC service is adequate to the existing demand as 29 sub districts are covered provided that we get support from health workers - Provide education for Iddir meetings using existing IEC materials on HN/AIDS and ST1 - . - Produced EC materials with support of Hussien - IC acquires EC materials adequately from DKT - Topic covered by the HIVNIDS education is planned and prepared based on the questions from clients - Sexual harassment is settled involving Kebele Administration Challenges - No training and guideline on IEC material production - IC is not convenient for confidentiality VCT and ST1 service and the referral system - Confidentiality is strictly followed up (only CBHC volunteers receive the counter referral from VCT) for those who want it to be confidential. Otherwise there is social event organized for them in collaboration with religious leaders. Other programs run by other institutions - ' There is one association working on HIV/ATDS and IC provides condoms and EEC materials Strengths of the project .. Support to the PLWHA - Close supervision and support to volunteers by SC - TWs behavior is changing - Very strong supervision organized by ISAPSO (at least once in a week) - High demand for condom is created Limitations ., . ,. A,:., ,", ,.- - . . -,-, . . . ' -- , ~ _ " . I.. "' .,. > $ ,_ / _~.<.'. . ,' .- . . ., . . " i C, .-"-:" . .* .?.... ";?" ,-?>\ : LC,. t: ..... *.44.....*<*. -:.>.": ;, ; .. , ....... .. .. , ..... , ' ................. .,<.' "."' ." ' " .. k,..,. . < ;,-. ~. ................. ..... ................".. , .,, ' ,. :< .,<, '.: ., . , -., ,. . . , - Late arrivalof sip$R for PLWA. ., " , . . ~. . .=, , Recommendation .- I I , , r,, ,: ', ' - HRCI to organize information updating sytem, ,,, ". , . .,. . , ,. , ....._.. X ... - Training and experience sharing forums as are necessaij.' "'- Volunteers and their working conditions . , ., . . ., ' .. , IC Volunteers Background , . . . ", , .-.- .,. ,.,,. .--.. . , .-. - ., >- - " '"' - . - ' 'th One completed high school an'd one attended up to 8 grade - One Served as volunteer in Ethiopian Red ~rois.~ociet~ - Know that sc is working in Mille when invited for meeting before one .... .:,>?-+:,. .. year aid frbm its itireand support to PLWHA and OVC - One recruited 6ecause~,she is resident (Independent) FSW - Both volunteers seke ih the c0mmittee.a~ a treasurer and a member - One is trained as volunteer by ISAPSO before SC started work and more 5-6 trainings. One received training of peer educators provided by SC. . , ~. , . Volunteer Job and satisfaction in the IC sewice .....__.-..... - Counsel people to visit VCT and ST1 free of charge - No workload and are satisfied their Contribution to the society ,_____ ..... bL ....,. %. L..........'. - Meet up to 5 peoplelday (1-2 hrs/day) on aver6gcC ' "-' - Know target specific (age wise) information to be provided - Participate in counseling in IC while the counselors are busy - Address problems~of FSW particularly when there is sexual harassments - Provide education for about 10 minutes during Iddir meetings using existing IEC materials (since last 1 year) - Developed a network with the community to identify PLWHA of sick due to other health problems- and did not have any support . . _ _ '__ _- ".,, '- . %".. , . -.:,,- ,>, ' : *-, . ,<: ,.,.< *,:,s. .,. -, . - . _-_j. -, . ,. .. , , , , . . " -'A.- * u 2-.: .., . .' ~ , '*. " - '. . , , . ," , , , .. . , ........... .......... *" .... ?. ."........ .,- .C .* . , ,,_ ',. m - Need to learg from experienceof people engaged "., in . similar ~ ., 'activity and E,. new dey-G!.*fgi-'*i in HIV,AIDAIDS .iG L ., - 'one speaker cannot'reach all parts of Mille and the other Milles are ma missing *- - Inadequate human resource 1 -i Perception on voluniarism and m~sc~n~e~tiions m - Voluntarism requires great patient, trying to disseminate information in r :* various way and treat people according to their behavior and age - IC does not include all segment of the population 6ut committee hoes m because it includes representation of every part of the society - Person who goes to IC should be voluntary, patient, have good behavior m and would like to talk tocounselors senices of volunteers in the eyes of stakeholders - Community regards ... the volunteers activity as relevant and positive m - ~ttitude of community changed most aRer SC's intervention on care and support - Committee need not discuss about the speaker, .instead ISAPsO should assess and bring it , . . . Other programs run by other institutions - No other institution runs similar program. SC came after ISAPSO stopped - There is no coordination effort to work with government offices Strengths of the project - Brought attitudinal change for example elderly people are also getting involved in the discussion now. - High demand for condom is created - Multi media addresses information needs of all categories of people and all residents of Mille have listened to serial cassette drama - Close follows up of the care and support to PLWHA and OVC by committee Volunteers and their woiking conditions IC Volunteers Background - Completed 12& grade and were actively involved in anti -aids activities - Applied for the position - Not -.._ trained ,.. ............. .. , - TrGnlng ....... ....- helps to improve knowledge and skills particul~ly to better educate the . . community and counsel ." . ,. ,,. . " ..... , , , ................ - .-... ....'.... 4 .>...- :-.-'"."', - ..... ." ". '-&? ". "--' . . , ....... .... .......... ......... ** ;,>. ... , -. ................ .. -. .............. , . , "". .;, a: . \ ~ ' -. . , ~<>. , ' . . . . . . x..,s **.:t a:; ....*. t*w....'....><.-.$..... .,-.$? *,, -- .... .. . -. . . ....... . ..... ....... ...'...-. ....... ... . ......... .. *.-....-. -- ,.- -+6i.rr ,. ' : ",. :., .-,: r :'!, :.: .A;;. ,:'. <;.:$ $!k+?;;:. ';i -'?..': -, .. .............. "... i-. " ., ............. . ....I... - ., . __bC,Xn. _.l._,_, a d .- . . .' "<~ .7..,,.,,L;. ".,~ ,<,& ;;,:,:,, --:,,: ,, b --:-,, ., ,-' -. , . ". . ,. 'i .' v - .,. , I , . - . ; .. . .,, :. -' ,-= .- . - %. - < I ,, ,. ,. , - provide support to counselors. The job has no strain -. ., - , Provide educatiqn twice 'a-week . - .... mainiy~'in I.,.i-...: the evenings andl holidays, . ..., <\ _,". , .: . . .__ ( prepariningcoffee cdremoriies and dramas - Community education is planned on regular'5aSi.s in consultations with counseiors. . : , I - Regular supervision made tiy senior staff*vi'sits and reports. em Volunteer Job and satisfaction in the IC service. Any client has the right to use the service , ,..~, Aim of IC is to bring behtivioral change among youth, -m, sex workers ._,,'/ . , ..... _..)_ I*... , and practice safe sex -. ."" -. ^ . - . ^,.", l.(.l" '.,"... *.,, ?-, %. -- , , . .,. - , " . .. , ,"",, ,_* ,-. .ll~l\",'l - ".l. ". ... . .. . "~." Volunteers provide counseling durlng lunch hours . . ' "**'.-"&:* -. . - .,s , ," - . . . . . . . . Volunteers provide service to clients comiiig far ,counsellng .. ,.~.~ .*+,* ."".A *..*-v"*, fa-"-*.. . - . . , Feed back from clients is systematically collected ~ -,, -.- *\- a&"+> ,w,,o<-,<,. >."\~,<.,<,,*,,*,<>*. "'-- ,."*. ,."~"*. " -L.. ~ .. , ..,e. " .A < ,..a Both SC and'ISAPS0 progan? miixge~ent give . . pr~ority to our works. Demand for print IEC materials is increasing .. . Demand for condom and information is increasing - High demand for serial' drama cassettes and ,video-cassetteto rent @!a - Better emphasis and response from elders 6 PLx . ,> Clz allenges - But there are no guidelines available in designing, 'pi&-testing and developing target specific BCC materials, . . .., - Shortage of BCC materials . , , . , 2, , ."'".'.*,, , :*. . <. , ' . _ . " L'.. ."I 'ii :- - Have no knowledge about: mecfian~sms for continuously assessing the , ~. - , .'b~ *." ., f. .-, ,,- '#&.."Fs,#~;< ;> . , , .>.. ~l~l frequently asked informationaid questions by clients and use 'it 'is B .. '. ' - '> . 2 s,:'~'Jp*:*" ..,. ,?<""," a*,.>> \ , .,,. ,>,-. ,,, , , ,; ' - , ,. ..- . . ~,. . ,. . , .,, -, . -,. ",,,. . , . \, ,. . . . basis to prepare education sessions: ., -; L- - .,...,---. _. .- . . .. " . -. "~-".~ .-*.. ...--.- - *-,, ,. -.-. ., ,,-. , - . " .- ,,:.,...,.--.&:L*.;, . . . . . . > . ".". ,, *,*,, . * T--*&,-,-,-." *---,-,.& **>.*:&q&-d. , ' . -", ~. ,< , **., ,," d* <.*".?.,."":.,.b**',*" .<. v, ~ ,. 3 .,, , , , . .~ , - .,<,~, - No other institiition &iE'in similar a&ivity Strengths " .... "<-* +,*&,-" ,,., >..~ , ." , ,- .". , - Regular visits and ~Lipervisionfroiri . % e staff "%. ~, :, ,.. , ..- . ... - Prompt response when ever we need . . .,,." . - , - Limitations . , - Provision of up to date IEC materials , " S* HBC Volunteers Background - 12 grade complete who has been involved in anti aids club activities - Interested to work in HBC and voluntary applied to work. - Rated the training as being very good and doesn't feel there are areas in which he needs more training. However ongoing training will be goodlfdr it $11 help me acquire more knowledge and skills to work better filly independent. Volunteer Working conditions and Job satisfaction in the HBC service - There are no eligibility criteria; all clients coming for HBC are provided services. - Volunteers provide education and skill training for Home care givers. - The aim of HBC is to enable PLWHA get the necessary support and care so that they have longer life engage in productive work. - Home care activates include counseling, Visits for medical care activities like First aid care, providing referrals and education of Home care givers their families. - Volunteers work there times per week and conducts 2-3 visits per day - The stated feeling towards HBC job as good and comfortable Views on HBC Services and stakeholders - receive support and supervision for any HBC work for sclworeda committee regillarly. - The existing view of the community, CBOs positive and our work is also given emphasis by HRCI program. Challenges - There is no guideline/policy on confidently. - The supply of HBC materials is inadequate and volunteers have no transport to make frequent visits. - The existing HBC program under HBC is inadequate, Other programs run by other institutions - There are other HBC programs like Jerusalem, mission of charity that provide care for PLWHAs but there is no coordination/integration mechanism. HBC service and , its . Linkages and referral to other sewices ., . , ', - The HBC service is backed by the HC but not hospital but the existing linksheferrals for PLWAS for specialized care services is inadequate. "' . ,, . ' - ..... ,- . ". ., . ' ,. ., . . 2 . . , ., ,,.,. ., , ,. .., ., ,~ .,.~: ; , '* '8 '. .............. , ., 4. , -: . , ~;-, : : ,,' ...... .".. .. ,-,,,, ... ,,<,<-*,* * q* ........ ~r $>$,,' \rL, :-, .,:~:.~:<.,* zs&;7,. . 2- . ..%2.8.5.*<>...s%*.<. ..A'..'.* ?. .l-~~-'~~":'+-- .... ~- "d:#>. ........ .....*.*-'. ,$,?,st >.% ....... - We receive'referrals from Health Center, , , . the ,,...I hospital . and FGA. We xx-fgz . to the health cent<~&~~;&*~*&4 A: :,; .$i ,: .. ... ..... CheIe&o ...... . :. ' i,,;:. :: .:i : ::.;:- ::.-: :-, ,::.,,:.:..: ., :';.,. ,,. ., I .:;:.:.:, . ' , ,: ;:. : , ? .: ........... .. < ....................... . ............ . . . . ............... .. %._._. . -, .. / : ..... .:. .(-: ... ,: .. :: :. ". . . - .. - -? ,,\" ... .,< . . .. ,,, . .,*.,>,*.. ;..'~.<4 .,s~%- esm,+'P-,""--.,, ' ;, ' .,,, ., , ,; .-..<, ,., .. ,,, ~ ' ,,c .,*!*? *.F:&**a,@*g 6*T,. .L., .,d~'k,:,' . :.- .4 ".Y,'? A '. , .%":.', , ,:. , ,', ,- l"l*r......... , ,-- r','" ..*. '" ., .*-; ".."""*%-2*j*%MM;+41~a~?:.&~i'&! ......... ' *~..~~X ........ Y;tX , - HBC Votunteel;s-Ba6kgr~ci~d:d'~ -. , ,. ..." -,ww-e,- .*.,..--.-..-.- --. k?% ZZZZZ >..A *" ... .-..*: .,*.&>. "... *. ,.---*.--. ....... . ".....* ,"%, .. . . . , ,, . ..>- - " . ,>, .,.~-' ~.:.:.%: # , ~ " .... . , . .., ,, " .,-& ?+: ,- .-."--. -- . .-."- ..-....... ... .- ------Tw---r +y-,:,2eI_ . ...l~~~vB:ycF2;z yz:2:r.+-ie:L -~>,-::;::*.::,T-~+yy;:~,~f 5:i~:~.~$.$<:~BC1~4~g+~r~~i~i~~ --?e,G-b,--- ,; .. . ,,.,-." ,,-&- =*-- -~~_.~___A~~~_9q,_,~.~,~.. ,- . .,_ ...... , , , , I,. _ . .") . .: .... 2 ..-+ 8.e r*.+:i- --. a. -+--*-..=*------...i,. ''-.'*'*"'. . ,,, ;,. - . . , ,. .L-.*,*.xjrw&M- . * . , ,, i,.;..: ..i.:..>ii~.~~*f~A&~~*-:''".~ ~- qw<,*x&*> *,- -,> ..:?.<. . ' - Both 10 grade,~o_mlete,who.has _, .)__ ,. ./....U, ,. __ . ._ beenin,+olvkd . . in anti aids club a~ti~iti.~~, ,. .- , llr~l - They were self initiated and volunta&appIied to work, - -- - Both trained on HBC for two weeks on caring for bed ridden patients, how to communicate with patients, families and care givers. - Both rated the training as being very good and but inadequate - Both felt ongoing training will be good for it will help them acquire more information on HIV/AIDS knowledge on behavioral change skills. - Subject areas felt for more training like ongoing counseling, psychological support and behavioral change issues. Volunteer Working conditions and Job satisfaction in the HBC service - The is no eligibility criteria, all clients coming for HBC get the service - The aim of HBC is to enable PLWHA get the necessary support and care so that they have live quality of life and become productive. - Home care activates include Counseling, giving first aid, referrals to HC and education of Home care givers. . .. ..f, " ths *.I _, ,k~*~,

+#p ,, :c.<~~~~~~~~3~~;s~t,~, . ... .... -.--..c, ~~~~~~29~~ %- .4 hP, ,,*, ~-,+ *P,' .s.9h .?#Y;:r -.,- g$ + ! ?2r: z*:, ~>~~,i~~.~~<.~:~~.~~~~~~h:,hhs2;, ;: - a.&4~333~~~9~~4~~~~3~$%8F? si+- 4~2+33~,~3~~+~~ - ." , . , #, , . & * .:=; ;<&" &<,; **.*k$.:" ::; $+;wi%sfz,~;z:,i!:~&i;Lf3;~5<<;$2,7 . . . . , . .".. .',* ~, i - .-:1**.., 'i ',.. ' .\. . , : $>; !*#4;T2*" ,;7*~~>~i$.;M>,,$2 +:;$$; $F*mG &<,:23?" *,:? :;j~:2?~~.2&<2k -,,, "Z'., *-, , -. x. . -, , ,*"~., , ~ , , .,, , . . . , , . .. -,-~.. . . . .* ,%7% - .9 , -'.S.. .**#a- .*3 "; '?:, ~. . >,,.*: g T;r< >*3c>,.x> c:y,y " ,, -. . . . : -* ~ .. - , .. .>.,~~.~.. ~,. ,'-*.%, : .'. -. ,; ' * ; . . ~ ,. .?"" ,; , '> , ,, ," .., *$:,;e2b% ;.~ , ,, c.-p j*;$;".;5$~y"3?:?~$,$;9f$: .$.? .? ;:.-.-;:;, :r! ,:.,; ,: . , . '. :' ' :" : - * - ~ , . , . . "~. ,- ,.--. ' " ,',_ ~,,, ,__ I _ ,,.. , _, . .- ."j f ., - ' ( , , ,I. - 'l - . '.' , , , . , . , ' , , , ., , , . ; . . . . . :, : . . . >.;..L. ,. .. r:.- .:. '. '.. .- - " .' - Both vofunteers work there times per"W6ik and conduct 34 visits per day." .. ..- , . , .A ,& .>>" > - * > " ,e... ,-. * * _. _ _.", L1(.M* _I>" "A ,, i. I .\,; -.:*.w.. But provide - service ,. .. - ---.% any *, , . , time upcn-req~sst: ',i , ,. ~. . , -3 , ; -_ ., ,. t... - .. Statkd'"their feeling towards their jo% is seeing the r&oise from PLWHAS and being able to give them money cafifief buy. , . 2 ,, . .. - . .. "., . " . . . Views on HBC Services and stakeholdkrs - Support and supervision for the HBC work from sc/woreda committee is inadequate and not regular. - The existing view of the community, CB,Os positive and our work is also given emphasis by HRCI program. But the committee members lack commitment and the commit members are not always available for patients to get registered for HBC. . . - The long process of registration that all committee members have to sign to commence~'HBC for'new client is the major challenge. Challenges . . - There is no guidelineipolicy on confidently. - The existing HBC program under HRCI is inadequate. - the supply of HBC materials is inadequate and volunteers have no transport to make frequent visits. Other programs run by other institutions - - There are no other HBC programs in the area nor there coordination/integration mechanism HBC service and its Linkages and referral to other services - The HBC service is backed by the HC. We receive referrals from Health center and We refer to the health center. - The problem with referral is that Patients don't get adequate treatment and lack of medicine at HC. - The existing linksireferrals for PLWAS for specialized care services are inadequate. Project in the eyes of HBC volunteers Success - SCius has placed significant role empowering the community and prolonging the lives of many PLWHAs through. Strengths of the project - Providing training to involve in HBC and efforts to involve the community fi~lly. Limitations of the project - Unavailability of committee members to facilitated fully HBC. - Inadequate Regular supply of HBC materials. . . I" ._, I" , HBC Volunteers Background ,, , 1. ............................ " " '. .... %i_ ............ ... ......*............ ,. .. .~ . ! , :>.-i,>.-l.. -C,-' - Both have been involved as volunteer peer educators before he started working as HE3C. . . - Both were self initiated and interested to work in HBC and voluntary applied to work and were selected based on recoinrii.ei-iaations of committee members and their previous performance ..... ........... _* . _ "._. _, . , I _................... : ,, .* . - - Both trained on HBC for two weeks. he training attitudinal change towards . - .......... ,-.,%*+>*-s-. .... - .. - ..... PLWHA acquired skills in approaching sick people and enabled'us care for bed ridden patients. ... . .............. , ........... , ......,.. ,, -"a. , -i---.*".-- --.y...-..--'. -... . . .,- . . ...... :,, ",_: .-,...i,. Volunteer Working conditions and Job satisfaction . ,. .- ...... . ', , ,. - The is no eligibility criteria, all clients coming for HBC get the service - Volunteers stated the aim of HBC is to enable PLWHA get the necessary support and care so they become productive. .. -. " - Home care activities include Counseling, giving first aid, referrals to HC and education of Home care givers. , . . ., > ,., .. - - Stated their feeling towards their job as satisfying with regard to caring for sick and helpless people .... ~ .- ." , - - - Both work any day when requested but regularly conducts 4 visits per day .. , - .\ . , , ..... ................. and work three days per week: .......-..... :-. T,, .+>--:*e3b . " 5t24'2jce . % .>&-:L ... . ,+,.*~. %*<$," *,,*... .?*.,;-*-?, bz;:'% *': ;7 74." . . ,~ - get support from SC and clinic ( prodis materials) , , .".:-*-":.,:;: ;.2.3 L'zL..i.G-e*a , , Views on HBC.&wrces aijd staf~~,'.' ' -- . . . -.--* d~.~% *6-,A--M4-k--------- -.--,-- . . , . -I_- _--\*.*_I--- , .............. . , . . .' ..--- "". C' - ^ x . , , ,-a ,- , > 2.. ,,, " >w\23eL<**,.5 """;j*y@i"m*; zs2q5**7,,d*, #?#..', "? .*. *- , , ,: *". ~ : . ' .*'3+.~**i**+i&~~~d**& +TF?*?"""'-'' ....--. s ..... -r...~ ,:; 5~!j$~d:~~,,c.s~,12;8;A'--. , , *:, .<'. ,"~., ,~..*..,:.: - ,**,.,.-, 4- .......................................... .......... ,a,.--.--*. w'w*v%a*~'.'..> - The community attitude is good, CBOs &ye positive view. - our work is also given emphasis by HRCI program-. - We have problem working with the compound we share with police department who don't allow,us ente; any time we want. Challenges ~. .. ,. - the supply of HBC materials is inadequate and volunteers have no transport to make frequent visits. ................. . . . . , . ~ , ', . - There is no guid~line/p61icy bn confidently. Other programs ruriii by other institutions '." . . -" " *- ,~ , . ,- ".>, , - ' There are no other HBC programs in the area. The existing HBC pr&am~" under HRCI is adequate for the existing number of PLWHAs: .," , . ,. .', .~ - , , HBC service and its Linkages and referral t"o other services ...... . - - \ .> . ., . - The HBC service is backed bythe HC. We receive referrals from IC and we refer to the health center. There are no problems with referral except that Patients don't get adequate treatment .................. and.Iack of medicine at HC sometimes, ........ ,, .-.........i ~ . .....- .. ... ~. . i - , : "., , ,,;?r4,;?,*i,i:" &% .s .; .#, ;,, .':'-. l,pX"i*:-'% ".'."-;.'"Ix:.""-Y .'"" ." .. , Project in the eyes of HBC volunteers success - SC has done well in starting HBC program for the destitute positive people and prolonging the lives of many PLWHAs. Strengths of the project - Providing training to involve in HBC - All referred cases have got care and support Limitations of the project - PLWHA don't get money on time always and they lack adequate food. - Inadequate /Regular . ... , .- ,.,,< supply of 13&'materials. . . HBC Volunteers Background - Both grade 12 complete and has been involved as volunteer peer educators before . - - voluntary applied to work in HBC and 'decided to do so for their high interest in the area and motivation to help people. - were selected based on recommendations of committee members and previous performance. - Both trained on HBC for two weeks and perceive the training as good. - Ongoing training is good because it upgrades our skills to provide better care and support and improve the quality of service. No areas for training on HBC but counseling. Volunteer Working conditions and Job satisfnction in the ~~~'sk&ice - There are no eligibility criteria, We respond to all clients when families request our help. - The aim of HBC is to create conducive environment for PL'NHA and rheir families. - Home care activities include regular home visits, Counseling, giving first aid, referrals to HC and education of families on Home based care. - Both work three times per day and regularly conduct 4 visits per day. - Stated their feeling towards their job as satisfying with regard to caring for sick and helpless people Views on HBC Services and stakeholders - get support from SC and Clinic ( provides materials) - The community attitude is good, CBOs have positive view. - We get good support from HRCI program. Challenges - There is shortage of gloves and plastic aprons and volunteers have no transport to make frequent visits. Other programs run by other institutions . . ".. +" -- - ...... -. ... ,- ..- - There are no other HBC programs in the area. The existing HBC program under HRCI is inadequate. HBC service and its Linkages and referral to-other services , ., .,* .,, ;.,>. ,r.h.,.i. .&* rl.lcdT,.- .>;. . >, .. , .- . ": -i,%. i~-.* ,..+ .~ .+- s--~.~ -.?~-~,--~~a*. -* - l---.-;i,r-- *- - The HBC service is backed'by the'clinic. he receive referrals from VT , ,, and we refer to the clinic. . . .., "",. - - There are no problems with referral except for lack of medicine itclinic sometimes. - The existing linkslreferrals for PLWAS for specialized care services, are inadequate. Strengths of the project . . . . __ _,, - People came to see'PLmA for the fiisi-~tin;e..a-;d-broughi in ar attitude towards them. .* ., ._\ 1 ' , ' . I ~. ...... - All referred cases have got careand suppoolt. ... _ ............ , . Limitations of the project " w" I.... , ,.. an .............. ,.. , . , ~ , .............. *,,.*< ~,"*& a&,*-*." ,*,ma *&g&"t <6*sr$*%" Lp~ :.* ,&,*., : , .,X" ,.'~2.q~1.a+*~~. -* A****$%s%"~-v : ~ ,~,",~ .*-.. ,, dyd ,, "<-,,.a ~" ;*,,- w4'~ ;,*>. > &&*wy&&***~*::A?~?.3,- ,*:. :,ws9s* d~~$>>c?<~:*b:<'~~v'*>.*2*'$~54;z<2+d*. .< . '<:;,:.>.: "";<>:.;*.:~, s-, . ~.T/.. ........ ,:.: #3.::% : ...".. %! ..:;...:.?.T!': _--; _i_-.>---,a .-^-( ' \ < ,. %-:. . , <*"b3*k,,;, e . *-*a. * <-&.&&-A * .-.-;. :*%>~~.~A~.6~>~-da*~>p&#*"*sL*ek*~**e>. ......... ~ . .- .~ - PLWHA don't get money-'antime aKand they lack adequate food, - ,~ ,. +*8az,$kc** .. *, .... .. , . m ,.,. ~ - inadequate' /Regular supply of HBC material,; like gloves and plastic sheets. . . . . , 2-;2 " ~ . -. . - ......... ,. ?, .,.% . ,.,, "*A,CIt". .*~ir,~*~P;&,*&~*~"~x#i&uJ*,"" -2 ...... ............ --;---i *%**"j.$G ,.:< "a*~~&A+z7:v::~A.:$&, y ,: k-::?, ,"*':g,+t."'. .............. :Na&,th <' :- , :, :.- :' :;:..,,; .. : ....... . . .. , . . .\ ;. ......"I. . .. .I..)..; ..... . !. , ,., ,,,, > .'. '.. ,_ ._. ( -. ../ 2",. ., . .'.. ,. ; .::.: '. , .. ........... . . . .' . . . ,. , . ....... ,> .. .................. .......................... I,. " . . " ; .*,, : -i"j:",:.k6-. ', : .: --"" .! ' .. - ,,, "" ...........*..... ..... ...... .." .. HBC Volunteers ~ack~round ..... .......... *',%,.. ..._._ *. ............. il-.-X. ..... -, ... '> . .a,A, ........... =...a "$.%..,. - ............... ,* ~,, ,, - , , . - Both Grade 12 comrjf6te. - One has been invoked in anti aids clubs and the other working as HBC volunteer -; . ,, ~, , , - Both self initiated and voluntary appliid'to work. - Both trained on HBC for two weeks and felt the training brought attitudinal change towards PLw and before we had fears and don't know how to car., acquired skills in approaching and providing care for bed ridden patients. ' * ...... , . - Need more training onc~~n3elin~, caring for dead-body. - Volunteers counseling, giving first aid, referrals to HC and education of Home care givers and family members. - The aim of HBC is reduce stigma and discrimination against PLWHA, to convince the community and enable PLWHA get the necessary support and care so they live longer and become productive. - We work three days per week but also work any day when requested. - Stated their feeling towards their job as rewarding and satisfactory. - We get suppok &om HRCI and a HBC supervisor selected among us. Views on HBC Services and stakeholders - The community attitude is good, CBOs have positive view - Our work is aIso given emphasis by HRCI program. - The major problems is with landlords who rent their houses for PLWHA and stigmatize them Challenges lrag i F* - There is no guideIine/policy on confidently. - The supply of HBC materials is inadequate at times and volunteers have no transport to make frequent visits. rn Other programs run by other institutions S - There are other HBC programs as wogen lewogen and other religious organizations the area but don't have contact or coordination. The I' b""l. existing HBC program under HRCI is inadequate. r: dw HBC service and its &inkages and referral to other services . . , .. . :- @ . 8,. - The HBC service is backed by the hospital and HC. - We receive referrals from OSSA and other VCT and we refer to the health center and hospital. - The problem with referral is that Patients don't get adequate treatment immediately and Icck of medicine at HC som&mes. - The existing linksireferrals for PLWAS for specialized care services are also inadequate. Views of HBC volunteers on the Project Success - SC/us has placed significant role in prolonging the lives of many destitute PLWHAs. m Strengths of the project , e . +-. - .. .( :, . yeople have raised understanding and acting on caring and supporting , - Many cases have got care and support even'at their homes Limitations of the project - People expect us to care for dead body which we have inadequate skills. - PLWHA don't get money on time always and they lack adequate food. - ~nadequateke~ular supply of HBC materials. , . , , , . . . . , , . --- .>... . ... .. . . -. ," .. . . ... .+ ,.,,,. .ievc-6j.>t~~$jzk+;~7.$~;T>>r2~.3~..~~.~2.Jl.;*,;+;;;%5iiiiiii-iI' r:' 'di ~:* '-:'li " ...... ..................... . . . . - ., , ". .,.l ,.,-4,, . , ~ , . ..... :;::: ..:::.:. ......._._........ : : :: :~: _/__._. i.':;: .. : .;::;;.: ......................... ji. ..: .-:-I .:!. ::.:. ::: ...................................................... ....................... ..........................._..___...... ............ ... ........._.__.... ........................................... HBC Volunteers Background - Previous working as a religion volunteer in providing care support to the sick and poor who took shelter in the churches. - decided to be trained as HBC volunteer because of personal interest and religious obligation to help the poor and destitute - Received training on HBC but feels the 15 days training is not equivalent to the current job involved. - The training covers only general issues only and training is lacked detailed and thoroughly education on the subject. - Further training will help for providing a better HBC acquiring knowledge on how to care for dead body, which I don't know but do it regularly. The subject areas felt for more training are on counseling and detailed /training on HBC Volunteer Working conditions and Joh satisfaction in the NBC service - There is no eligibility criteria form HBC provision. - We provide counseling over telephone connection and HBC through home visits. - Volunteers also involved home visits, Conducting follow up and discussions on the need for care giver at home, assisting the PLWHA select a family member he prefers and Providing education and skill practical sessions on area processing for the caregiver. - Volunteers work 7 days per week, weekends including Holydays, conduct l2.Home visits per day on average for the past 8 months. - Volunteers feel happy and satisfied doing the HBC job because of the value that the community gives us and personal believe that it is good in the eyes of god. But there are strains for there are inadequate volunteers. Views on HBC Services and stakeholders - The community response towards HBC has been improving. - There is lack of support in Providing gown clothes and Protection materials - There is lack of regular or support or supervision from the committees. , , <. .. ..^ , . . _ ... . , , ,,, '" ,.,," .,.,* <",, ,..",. ~..*;' > ,..:,%sJ&:* .>,,<'b,"b ,*,..-a +.--.-*. , . ,, , < .- ., < . ,\,~,~,-, ,-, :',. ' -,.* "., ,\. , ,,. . . , ,, *. , ,.*,. ' ,~ "., ,'La". .,..-. .;s .:.<. ,.d$, > v ,., . ..:";;.;:;-? - , . . , . . - . . .. **. , 7 " : . , . ., , .-. . . , ,~'< ' , , , , . . , ,.A ,A : - , . . - . - . , :~::i r .i-: : t'r.rc~~+ ,,,-.. .r, .&- . . .. .+,r-. ,;:,,~r-.p&7.:,.' %;;. , . .- ,i: .. >I- . ' " : -. . ,.' " .-., ". . " , ..' "* - . -- .^ ,".' ", " . - > .,,, , ." ,:? . ,-; ~- , - "' , :;. ^<- . , - ' .; ., . .- i ," , ' " .,., ".. ... <.*," -.., '. -' 1 ..- , .I - Other programs run by other kjtiiitibni - There are no other relevant services in ;he area. - But there is coordination in activities only at the death of PLWHAS with the municipality and the orthodox church. We prepare the body to the church provides burial place and the municipality gives vehicle and the labor for preparing the cemetery free of charge - The existing HBC service is inadequate and there are no others sources for clients to get the service. - Challenges ,. . . . . ,. " -. .. . " . , . ,,',: .,, " . '..-:&.Ai",:..&.- i- i. - . '. - HBC materials like (gloves, soaps) are inadequate and no regular supe17;lisio;ii_" ~ - , . . _ , ,", .I _ *. -_ . .. - . ., , . .. b ,- ,- ., ~,-..-. , - Lack of tri-&pb% t6 mark &&&eit visits' . .. - Lack of file cabiheftb 'put clients' information. , .. , .. . a .".-, '" .-, .. - There is no guideline developedon confidentiality - Misconception of the about HBC volunteers. People used to believe that we are employees of HRCI and only recently that they learnt we are volunteers' , . . . , . HBC service, its ~inka~es and referral to other services . .' . .__ .I . , ". .~, ,\ _ _" " '" . ,. ".. . - We get referrals ,from,, Healtk:Center but -have"-~~" .>.,,.e.,hA- *,"., ~,.,>" "A,- .' el:" .il,.2i. .'. .". ^ *.< . - I , . . ' " , . . , ,.- , . - *., , ,.e,.*.* ,i:,.3i;a~k.k~.21d~*ii <~;s;~>"tt~:~~~~::i;i;?~~* - _ .,._. ; . . . , , , - , ., .. ~~ , a.'.,. - ., bs...>..-. .& .:>,-<* , , . . , . : *. , C"$!GWSWei.i , , " " " ~ , , "" . , ,&.. ,". *;<.~:-..a-L&~~rc*~w*~~*-"* u &-,.-,.4" *Gz:"*z ,. , , .. . ' a',.,: ",'*i,"i :*.*xi i I " .. ".a-,,-'""" . , ', , . ,; ,,,.%, 4:.:.-r ;:. -;".,:; ,.;,. :-. ~, ,.,", , , - .. . educate ,* ." ..,. ,., the , , , ,. .,., , , . ,-+,,,.~ *.<. r. **<*",-.;:-.i, ".,r.".nr.; -,..,, , .A. , -. ii .. i L "l:e-:\:lli.r*-.-Sk*<$*~,~*"- -l-.*s%e*~**-;%*Ali->%*~~7.~.'~C'.' '- ,. ' . -. 'A . Fs -, .:f.~.,"" *-.,- ~ " . $, . ," . .zn ormants , , . , ................. . ,"., , -,... /,' '- ,,. . , . f \> , .~ ." , , ~ :, , " - an- '. ., ,, . This committee is re-structured in October 2003 and it has regular committee EBB* meetings every month. There are 4 members only who are trained on Community L Planning Response (earlier committee). Although the youth committee did not have budget and members participate in educational forums organized by others only. m The committee has faced a challenge to raise fund for hlfilling its objectives. The Regional HAPCO banned the public event they organized for fbnd raising and this i has to be investigated more by SC. The counsel has contributed to the project but it w is not sufficient. The support initiated for PLWHA is good and has to continue. The committee does the selection of the PLWHA as well as orphans. PLWHA stigmatise themselves and communities are willing to support them. However, there are also other who stigmatise with good reasons. For example, a street tea vendor refbsed to serve a p PLWHA and when asked she said that "no one will come and buy me if they see hidher using my cups and I have to protect my business to survive". The referral from the hospital however, is not efficient. Absence of health care service from the m project is a problem. The referral from the hospital to committee is inadequate. The % s Kebele is committed to support the clubs P The budget allocated for the purchase of uniform is half of the current price and SC b6. did not respond to the problem. There are also 3 volunteers trained and not providing service due to absence of funding. The shortage of the fund arises from 4~"l reallocating the budget to cover 7 Kebeles without any discussion against the initial plan of 3 Kebeles. The committee expressed that they have observed that clubs are actively participating in public education for communities to increase the awareness of people in the last 2 years. Strength of HRCI - The support initiated for PLWHA is good and has to continue. - Inadequate budget release for implementing the project - SC intervention seems a pilot but has broader coverage and strong effect. It needs to help HAPCO to be active in the area. - Use of condom and using the services of VCT has increased The weaknesses are ..-, I - HAPCO is extremely weak even at national level to utilize money -, ... ... ...... . .-..... ~; .3L ,:?-.a .s ':,&:*x',~<>.:+*~~:~.-* O>~.\. ;, .............. .i,...*T lo,A~..+-w-<*,, ~-~I-*I~YI-- ............. .: _I - - Have to support PLWHA and child-headed households to be productive and help themselves. - he VCT in-the hospital is very weak. Results of tests are obtained in 2 days and only one coonselor is taking the responsibility. The health workers behavior in the hospital is extremely weak. In addition, it charges Br. 6 per test. FGA provides Br. 5 and delivers results in a day and sometimes in an hour. - Absence of health care service fiom the project is a problem. - SC should study why the IG initiated by OSSA for PLWHA failed before venturing in another IG with this project. - Organizing regular forum for information exchange is very important. The committee was formed after attending a workshop, conducting need assessment and designing project document last year. Although the committee started early, is progress was slowed down due to the transfer of the SC senior staff In addition, the inability of the majority of the committee members to attend meetings and discharge their responsibility, the workload on few members had affected the smooth progress. The establishment of the CBCCC was also a challenge for the committee as there were issues unclear on earlier arrangement with the Iddir that has taken the initiative in taking the lead responsibility for CBCCC. Strength of HRCI . , ~ ., - The provision of support to PLWHA is relevant measure and the administration has made its priority to provide house for PLWHAs. - Communities have changed outlook on PLWHA because of the CHBC volunteers. - Providing training to the committee and the necessary firnding to start implementing the project Weakness of HRCI - PLWHAs reveal behavior that they stigmatize themselves and committee didn't have the budget to train them change their behavior. - Promises made by SC staff are not hlfilled (example is promising the Iddir to receive rent from its plots) ..... ....... PC.'' , ., The club ; has ,_,.. *_.,.. financial SuPPon with DSW (~erman~base ono or) and have a budget -.J[ . .;. 0f".,200Qhonth. It did not ha've,agy .... contactwith IC although it-is'*h{*e' *< v:,. ,.~ , -,' ~ ," . .. .I . initiated in the town. The club distributes 5000&000 6f condom ei;ry is; ,.* :,- ,.- ,% , , . , . . . , , quarter. It has institutional cooperation' with Ma? Stops for reproductive health + ..". *>, .." ,.a ,-,*,* .,>~.Pw,'&, 'a ,z , , -,.:'. .- - . . . I treatment and for a person,~iferred from .the;club (who has to undergo a-. ,,--a ;,.*?,a.3++&*:*,9"vtc~+f,w.&"*.. , '?>G * ..*'-"W& reproductive health education) , , is treated,fiee of charge (for the first incidence). . . . .... . , . . . . -,, \, i,i. -, -. .' - , ', ", ",. , ." . ~, . ,,~. ., , , , . There was a report the club received indicating that young boys rape girls using condom. This, said the chairperson, isin.indicafion . .. ... ..b.-F,. that people are attempting to . , prevent HIV/AIDS ,. ." ~ ..,... even >,,,-,-,,. for thejr$legal act and this shows that the issues is ,well taken 'in a way. ," " . ,,__,__I.,' On sexual harassments, the police is cp.i);perative and react,s well,: There is adequate'' ".,.. .. - supply of condomFSW ha,ve heve~ofed confidence in using conddm'and they are .... ._I.L.'I". -0 ( I.- - - ,- ^" able to protect themselves. However, there are wt . Gho . , live , _ _., with __ ,I , .. their .. . -. .families~ w,,--IV.,II.I ,.,*,.**re*.. w%-.eX-ni.-i and have partners. These are-duw'ently at high risk: PLWHA~ fi&ig-~tb.$c"i " .,-.,m,* < - s*,b* ~:**~*',s-&*~ -."s-v:2*<."-...L~~*e%'~. "..?a& <+ .,*", ,->* -,*-" ,s,.o,.'A."- UA-... -< , ".. \-. although there are somG who might find"ih1s dxcult due to their addictionchats and others things. . .., " ..,\ ,. ,. , .+ . . , .- . , . ." " ,-., ~*", ,--.,.a.aw*,wa.a.ji( *NN ,, ,. . . b.w~,KC&ur)ur)Y;" w~5r("~*OF~~*;~*?&I~&~~~4~~P~~<~4~"~;:.;;~;&i~&~~~~&~g~~~~g&$~;~g$&~~~~~'~ i?, . ... . I Dire ~awh '~er~~a,'C~air~e.rson~~f K&&, 15, W/o Wgi,itian& . , , , . ,, ~h&&ti. . , ,, , : ' : I Small business people, economically poor and many FSW are the dominant inhabitants of the kebele. She has expressed her sincere appreciation for the committed staff the IC. As the IC is located in the compound of the Kebele administration, it has been under the observation of every resident as well as the Kebele office. The IC has -.,+.& been ---. following ..+. . ; ".,.: vzr . . np strict scheduIe such as, ..- 12:00 .:.. ....,cC-I.X.-..-.., a.m - . . .". ~ ... .- .. . - . 2100 p.m. ~~ndom distribution, . -. 6:00 - ' u.u...~iii.s~r4dl.,~IIPe .m: ,- 8:00 ?: .., p.m. multi ,:me&a,~he~~,i~~vgry .. . . . cooperative to work with theZKebele , . -:<:; and :. .,+. ,Were& .-~s....fY.",,".~. Ad$inist&ion ". , - and th&'K&&Fg'.'*'. '-. *'-"-'*du "' - " .&- , .."'.rnS. '- " ' ' , the acceptable reporting system and.'hive d&+klop'ed fo(matszjointly. committee uses-its member,s ..au.-. .t. '-. ' ~ , ',*'*" .. , . -,,. . . ,* ..- ' ~ .~. -. ~. "" - ,l _' , ' , ,.,.,~.,~ , ,,,. .- .. " . , . ' ". _, _ ' Strength of project - Did not intervene in committee's activities - Mobilising volunteers and integrating them with our support CHBC - Close follow up and integration of CHBC service with health providers, administration, HAPCO - Supporting the PL ?FHA and OVC Weakness - Inadequate and late response to crucial questions from committee - The budget allocated for the activities is very low for ex. Budget for writing materials is Br. 50.60 for all sub committees - Supporting the PLWHA and OVC has raised hopes and need to continue - Covering transportation costs for urgent meetings and CHBC ex bicycle, supply for drugs for 01, etc - Committee is ignorant of SC/US overall program on HTV//AIDS its direction for the hture, the project agreement they signed with the government - The follow up of SC is not uniform in all Weredas for instance, Wereda 2 has a problem and seems it lacks support of SC The committee is structured last year after receiving training community planning process. It planned a project document and started operation in October after receiving the fbnd from SC. Members, however, claimed that most are busy. The committee planned support to OVC by assessing all parts of the town. The support includes education material, detergents for sanitation ar.d uniform:. The committee members expressed their concern about OVCs that do not have supporters and often do not have breakfast when going to school. Currently, they said, the committee identified more OVCs that require support. There is no psychosocial support provided. It was initially difficult to identify PLWHA as the community was. highly stigmatising the infected. Currently, there are 12 people and supported by the committee. All of these people are not tested positive and are yet attempting to convince them for the VCT testing. There ,,&,"A+@v,, are .,+*., ,, 4 diseasedafter -,.',, being idesiified. he support includes Br. 150 for food, blanket and sanitation, house rent (a total of Br. 750) for the _-, year. , ,,," _ ..\ The -- house Li.-l rent is Br 40-50. Supporting the PLWHA and confidentiality , . . , , ,.. has created a problem to manage the support. It is very difficult to ><. ,' keep confidentiality for a person who applies for support, as its application needs to . ., . , ",". , ", .?,~\. " ~e .I-" ,.&?.- ," .'*i.T-L --...hi' '"" '%' " " - .' ' , , i' "' - ' - ". ., . ,, ,; $ >- . ..' , ' ,.. .*-. .. , ' ~ . ,.. , ,..., , - " ,: .. . " , , -,,. . - >. .;< . , ,. ' _ . ",:~* .<.. -,;< s . ,- i .b t , , : .;:,,:.'-;: ",$<,;",;&., ,:*, +:'"y< .. ,>? ?:.,.,. ,?"-~.;&:$*;$ :&g:;;;::<;l::$z:x:b;:::;*:-,.?:: &:<:::'.:\ : , , . + , , , , . b . . - ' " ' '"' ~, . ~ . - ,, *., "., ...,. . .,."' ." - , be reviewed by the committee members: ~hii"& that require$-different approach. There are PLWHA who started receiving the support for few months and leave the town. _ ___ ' ,, "...1 - -- , , .,^,I z , ,,1 _ _ , .._ " . ., . . , I Committee has been closely assessing the existing situations to effectively disseminate information about HIV/AIDS. As long as SC continues to support, the committee can try to raise fund locally with improved proportion (for instance up to 20%). Strength . ", - All the activities are good - Project has contributed to increasing awareness-.and paved, the .way for the community to change behavior. ~. , ,' , ,/&.*" ".k. .$," ;,.-WP *,+.~*+:b3i-<-+,*:!-"'- - ,~",~ - - -"~s, , ". , ,, - High contAbution of the Multi media , _ ._ .. . .",~~. "-. ,- . *. , .. , ,. ,_.__ __I./ I.. - . ,, W eaxries s , , , ',. - ,, * ", ->', , ~ . . * , '%- . -. ' ".'. '- . .. ~ , ,, ,. > ~ . , a, ,. : ~ .\-, . .,z, .,, .. -. ."'.a ,<-. , .--" ". . . - Support to OVC is incomplete due to absence of support for food - Support to OVC need to be taken up by a strengthened government system - Provision of ARV to PLWHA and strengthen the VCT with the necessary facility - Need to get support for strong monitoring, exchange information and make . , the monthly meeting learning session - Weak supervision~from SC (did not give time to :..r...i discuss ,-,. ..Lsll....ll" issu~s;thoroughly) - hire is no doc~rfi%?Mied guideline for directing our activities , . . - . . . &eea;ta . *, C'.-.. '-5 --- - - , - . , .. ,.. ,- , . , , +. , ,-,,- , ,.9,,;J, .b,b,. &~wa~~Cm'm'.~,~-Li%&i~~,?&b~"*;~~%~~~~,~4f;"~'fY"ffii''~'~'~ ' 'Is' - ' ,_. ,, _._,..^" _ _^ - .,' . ., 'I' ( . , , ".,,. , . -, ~.,r ," . . . ,,.I.. ,- - I. . , The Administration selected the committee members from different groups in the society. SC provided training the elected and formed the committee. Some members who join the committee have been working with SC project before their'election to * ., join the committee. SomeYadfiImittee members serve as IC voluqteers, CHBC giver, counselors, etc. there has not been any attempt to involve other people t~~reduce the overlapping responsibility- taken by these members. , ,, ,.. , =I . ... - ., , ,' ,' - . %. -- The fund raidng committee was active initially (collected about Br 320; 190f~m members and Br 110"fromb~d~et allocated for tedcoffei for comittee,meetings to expecting that-communities may not be willing as there are-other contributions). The collection was made using receipt and official seal of the Kebele Administration. A total of Br 1100 was collected and others were.valued from services. ., ~, \. , ... - . . , ., . . ,_ . , .$.' , ' , *. ' .' ..I ., , The OVC committee started its support in September although it planned to start in June. The activities were delayed due to delay in the start of counseling services; house for opening CBCCC. The support to OVCs started in September. Support to PLWHA started by supporting people who are bed ridden even if they did not know . . . .' . ' ~.,, ".~ . - 116 :_ _ I , ;. _., . up their situation. They are supported by free health service but very often the . . . . .; public health providers did not have adequate supply of drugs. , . rn - There are receipts that are accepted by SC are used for financial transactions. The committee has its own documentation and others are released for liquidation to SC. RII However, there are some items that the committee could not find receipts (ex. i~ recreation to the committee). There is however a , _ . l.r . . . i +I - problem for lack offinancially acceptable system for paying PLWAlHA because payment is made by delegation ex ma CBHC. Strength m - The communities have released the existence of PLWHA within the community, . - - Every PLWA was k~0wn by all committee members initially and created conflict. +, - SC staff attend committee meetings *. . - Support to PLWHA and OVC ~n - Services offered by CBHC . . . , . " Weakness - Absence of guideline on confidentiality and its unattended implications on financial procedures ". - Lack of guideline for financial procedure and absence of receipts for small expenses has a potential to create problem - Late release of budget - Absence of auditing up to now will allow persistent mistakes to pursue if any - Overlap of sctivities by members - Frequent changes of receipts to used and many new instructions mxI Before initiating the committee SC was working with FSW peers. Later it provided .<..- . training on community response processand committee prepared a project to suppon PLWHA and OVCs. The committee ~ .,- was,able to raise Br. 5000 and labour ma. ..... contribution and the fund forthe project wa~approved ........ r-. after .-a ..... *.. 7 is>,, months .: ..... (October s 1. 2--. 2003). After the completion of the CBCCC and OVCs are provideifsip*,"the ...... - - . . C&C volunteers started providing support to PLWHA. ., ........... _,,.:_; ._., _, ,. '~ , ' ', -~ ~- . ~ @x%. ,-; , . . . - ~ -. - ," .%. ., , . . , . , , , . 8 ' , - ' ' . - - - "' i .8 > - . . -. . ., . . ", , ,.,~. , , ., ," .,.. . k.-a;x.r,., .,,, ~. ,,:, .*., ., .-. ...... ....- I...; A,.-.* . ~.;:~.~-~~-- '.--' =' ,:,., ,,.,... , ,. ..".,. ..-i . - 9- I ,, , ~ . ,, . 1. "/.__ - ,. '. . " -" ,.-, .*',,<, >.,!:$ q. ;-*,~z."2;,;s.:,;:~:.,;:: .;.,";., >- ':<.:. '. -' :: ''*" ., , ". , *.,~ . . Strength of the project ., - . . , ,\.-, ~- .r*. ,,,. ,, . . - +"=p'r , -? .. ' . r " . ~ ~ .,..: ..,., ,- . -. .." .,,.,,,.*, , ,.,,.;.. ~ , - Fund raisisinp activtty involved.the whole ,. community , . __.__ ,_,,.- ,-,~ - ~stablishing the CBCCC and addressing the OVC problems I. . ,.. . . - The care and support to the PLWHA . ,~ (~_ .,_ _._i.lY._"\ .I-I _. ,,l,."'i- * - ' - Involving the Iddir and religious leaders to regularly raise the awareness of their members - All members are committed and attend meetings (at least 15 will attend every meeting). , _ _ _ _,,_ ." -.*/,- _-. 11.-.1,."--.4,d -..- ... .:,- ,-. i-"."l-i. .-.,.. ' -- --*- ,, ., . . .. . . . . . '. , . . ~. -, , , ' -,, ..,,, 2 *>,> u.: +>.A. .... , S'" -: .,LL'- ' . , , .. '...* . . Ar'eas that require attention . , . - , . . .- . "- 9: -. , < .- . f-:.:~ .. *__ '% ., . _ ,.,..?, , ,,. " ..: ," > - ., .. i..,.\.l:.'..,: . . ;."- -. ' " -, Coverage the costs of drug for PLWHA are h~ghly necessary if we want to make them productive. Costs of health services irrealso necessary for the .". . <,,; 1 ;.. , - '" , -,*,.. ...* -,"< * ~.&a~,-~*~-,c .'.-.- -,,* ,- OVCs The drug availability in the governmFnt provider is very inadequate. - The OVC in the elementary school aresuffkringto'find food in the town ," . * ,#* after school and it would be difficult for them to their education. They can drop out any time they are unable to find their food. It is also necessary to start psychosocial support and work reducing the harassment , . they are facing. - There is a threat to the PLWHA support because 113 of the current beneficiaries came from other places and it very difficult to deny the support _ _ ,_ . I.& ,- if such people come in Milie. ,: ,.,< "-,, . .,,,:. . ~,2~~~~~~~~~~~~~r;;~,;~~~~~~U'~C.CC~s~~LL - ,,.. .:.. . . - -. ,a - .- - . - . -"- .', ,. . . , ..~.,. ..* .*,..-.-- . .L: ,,., , ,, , , , " ',,.",", " .. 3" ' :; .:, - " - - ' ' - ,- .-fq. The committee was initially not effective as it comprised large membership (30 people) and with higher responsibilities Conducting mee6*'gs and decisions making was a major challenges. The current committee is organized before six months and it 20 members and has planned to establish contact with religious and social organizations, health centers and workers associations. Its ?embers are well aware about the specific activities such as facilitating access for PLWHAS for food, , . .. CHBC, better healt6 care and VCT services. Regarding support for OVC, the committee works in close collaboration with the social court in the Kebele administration for screening and selecting children orphaned due to AIDS The criteria used for selection of OVCs include income status of diseased parents, availability and income status of guardians, history (in terms of health), of the diseased parents and economic status of a single PC~~~~'~~:'"& screening mechanism is subject for gradual revision in the future. Currently there are 25 .%... . OVCs who are directly benefiting from school' feeding program , , -~.,, ,.-.-. and L+ 7,5,,,,frorn, support for education. Few children are fiom a single PLWparent family. . ~ " .. , , . . .,. . ,.,. , . . . c ..~-, ,,? ,- '". -. , Sixteen volunteers are trained :, ... #..A, in ...byz."e: home-based ......... :. k&e .. @nd;%? cprently working with the. committee. They -:irePii3;tfdiid Gith tG nkcessab kit and replenishments from , . 6,mor;th^ .a pocEett' 'i;;loney " 'fGr '. . SCAJS. CHBC voluntehrs r6deiGi Bi-. transportation. In addition to providing palliative and psychosocial ........... , . care, the volunteers. are responsi6le for raising the awarenkss of the community; ref&ral to .............. VCT, HIV/AIDS committee, and information center. Strength of the project - Participatory need identification, targeting and transparency regarding budgetary information - Provision of training and home based care kit for CHBCs * * - Strong follow up and commitment of staff - Support provided for the OVC and PLWHA - Re-establishing of the committee Major weaknesses - Lack of flexibility to address changes arising from local salutations. Buaget limitations that doesn't correspond to existing needs - Weak response in correspondences - Low incentive for a volunteering activity that demand about 12 days of work in a month - Excluding health service for PLWHAs - Absence of support to the rural areas I*m 8. ' ..... ..\. ... ...-..... The committee started operation in May 2003 after members ?,.,, attended - a workshop .. , on ~bmmim&i Pli~ningPibciss. A project with a budget of Br. 131,006' 'was submitted to SCIUSA and Br. 83,300 was approved. The committee is aljle to Y support 15 AIDS patients, 3 5 PLWHA and 20 OVC'and 10 ojd aged .wfio lost their tu children due to AIDS are supported by thii project:'~he C&?miti""e haiiegiit&ed 5 1 PLWHA and has realized' that the demand for the "is -&creasing: The ml available hnding is not suEcient to address the needs of the PLWHA: OVCs were selected based on a criteria (including testimony from the social court in the Kebele Administration, income of guardian and self investigation) developed by the committee and on site investigation. However, waiver from school payment is made in discussion with schools. The committee has planned to work on psychosocial support for OVC, sexual harassment, stigma and discrimination, linking to as many Iddirs as possible (out of 87 Iddirs in Mojo) for social mobilization, and fund raising. The committee members has faced a problem of workload as only few can fuifil their commitment. 1n additi'oj-.it ib pianned that ....... #.... ...... >..>...+.A.. . *arJ;2,*ia: ..-.*, ....... PLWHA have to be produi3i'iG b;;t the Committee d~d not have adequate resources: ' '-' s . ,' . , .. <,. .,- .ti:" ' " ;",,;. . ,-- , , . ,:. .!* ". ,.A.i., ,,.: . . . . li , . . SF la+. ; ..-. , . . -,,; %.. ...,. . . ,, , , . ,. ." . . ... ". , ,. . .-" ,,,..lIl-, ., ,,.,_ _*" ".,* ,+< ., .,,i -. ,,. - . . ,- . . .,. ' , , , .. * ,- *. ,, , , ,. , .. . I_ I_ , . ,.,, 8 ,,.-*.. . . 1 I I Annex 8: a. . , ....... ,. . " ,- ",< service users . . , ~ " ,- . ,. . " In-depth Interview FS W ", First contact with SC . . . . . " ,..,." ..," .. ,*,. ~. A. , ..- $. ." - .. 9.. , %*.',,.+, :. >. ,*'*:~..x ,>-->a *.$,,v..% "a$**:>:><-.*;,k*,%"\ ,x< , - Know Family Guidance X~~iatibn"an^3 use its cou~sel~n~ servlce, ................. - Staff in FGA receive client's we.l[ aiid~provid*k.~:~~Ccgti~~;nOn Hm,'m~s: ." - I ,. ~ VCT and ST1 , . ~. \ -,- ............ , .-. ,,. ~, rs*~ Doesn't know the existence of VCT and ST1 services; , , ",. , .' . IC m ~, - Provided education on HIVIAIDS for 3 days and - Is a venue for FSWs' regular monthly meeting -. - Is important for us because we get various educative information on the appropriate use of condom, its management and learn about free VCT although ......_........ A' .___.._... .............. -,,.,^-' . ...- *'* -*. I~~....... we have not yet checked-with out syro-status. ..... ,,- , " ma . , .. ,, . - ... .... . - -, m- . . . ,.-, \,. , ?*~, ? .h , ~", .,*.~ 4.-~.~'*;*?:+,AL''-~d,<<.rL;+*<*:~.~q ..~ .# ,. .,- , ' - Educate other people but they did hot listen instead they scold us, - We provide advice to new entrants. .~ . Clients . . . " I",r , , . , . ,, -, ,. , . , , , -. < , ,. ,- - . . ..~ . ., - Some are not interested to use condom " ......... ,~. , . . , .-.., - They negotiate with high-payment .... fdi .*.; not .i...rua$b- using condom. .............................................. ---.. .... - Some force and sexually harass FSWs for not using condom. ......... h+*2.~%.: ................... ..................... - There are also FSWs who arenot friendly due to ignorance, carelessness and negligence. .........--....I......-.... .rr.*l--l.*.. X*+.i .......... .rl.-,"*-r .... ..?>,>l.u,li..i_ .^.x......~..iiL.?.~i:Ui.z.v.~r~*r..*.l;*?.' .... - FSWs are advised to limit their alcoholic ~ntake so as to effectively bargain and . .- - ~ "~. . protect themselves. ., *. ,. - .,, ,.,,. ,.". ,,.. Employers - Some were not cooperative initially becGse they were selling condom and-IC is providing us freely. - Now we have access from IC and rehse to buy from owners only when short of it. - There are hoteIs where employers are not cooperative due to financial interest from clients they request FSWs to accept what is demanded by clients P - Employers did not receive training. - Employers would not allow leave, do not help when we are sick FSW - Those working in small places do not meet people because ~ ,. ,- they are forced to confined themsel~eS.in'~faGi khere' tlieYi'Eo~Ses' and tliky are not maturd and are vulnerable to any kind of sexual harassmint. < d .A ic- - - . - ~ost men going to thi~i.~lakei , . driiik hard.liq;oi and . . tliisexp& them . , to .. sever violations. - Those living in street are the most exposed to serious violations by clients as they did not have any protection. They are also addicted to certain alcoholic drinks and harmful habits. . .-"* ....... ",^ .......ha -.."" .-ii-,. ..A*,-. .................. ur .. V'^ri .. '-7, ._... - Cannot form network, as FSWS are highly mobile. It is good to have the association but can only be organized by non-FSw6because we nee3 " to . be ~nformed , ., about the places. - Spend our time by chatting while chewing chat. - Most of the time we discuss about thetime we passed with someone We did discuss about HIVIAIDS, STI. There are some who has tested -ve and this encourages us. - I take care for my child, I did not feed him breast this time because-I want to reduce his risk of contracting the virus, I use condom with all partners although I have regular partner. I have only made 1 ?h year sinbe I st& ~~~'iktivit~. - I use the condom from ICY I have adequate supply except few time (buy from shop). - There are men who bring condom with them; some ask is the FSW has it. Harassment - The legal institutions did not cooperate when we are harassed (Kebele). - It is only the humanitarian people around who can support FSW if it happens in the hotel she is working in. - It is very likely that the FSW will be chased out after the harassment and returning the money she has been paid. Contact with the project and use of condom - Did not know about Hl?t chmittee, - -I know IC when they came to the glace I work and explained to me. - Did not know about HBC, but listen that there are some and OVC too, PLWHA. - Have not visited VCT, know about the transmission, ST1 and transmission mechanisms, did not know inst working on HIV, - there is a better use of condom now, it no more a shame to buy and/or have it, - I have never made a mistake of not using condom, there is no single situation that force not using condom, - Me and colleagues have listen to cassette serial drama. - FSW is risky job; it is like sacrificing ones' life. ~Giness is not encouraging - I want to contribute by educating people; . ,, . Goal of SC . . ................................................... .-. ..-...- -,,:." ,+., ej.".J.".> <.* ~* .......-. :, - To eradicate HIVIAIDS, this 'need peoples cooperation, unity and openness . . ... -; ' ., *.. , -.,, ,~ : I ............"... \ ., - , , _, ".~ - '",. . Strength of project - counseling, good reception, good educative cassette serial drama, Opportunity . . , $ . . , , ,. -,. - - Have videocassette, -, . ................... - Facilitate organize, access ..................... to credit for moving out from FSW, ,. .~. . . ., ..................... - ... .<;..-. . , . , . ,- d> x - .......A. ... . .. v;:.'. ....... , . , . ,,.. *":; .... .<:: :.,.., .':., .. .,< ............................ .-.A"... -i-.-.xr r,-. .............. ', d.*.L,-,,<*a~.,**~:.-,:.,. 'i!;.:;: ,;,,:,,;,- .. ..... .............. , , .............a,. ................. ......................................................... ." ,,", , , ' .>:. ~) ., 'A'. '.>, ',.' ,. . .C.' ,:'i ... '.......... . , -, ....-.... " . , . : . , .. ' ., .. ...... 6, _ L~d: -,Ay. 4 .- . "& ~* tm*..h .... * .......... "i ..&. ................... .>"<.<.,A> ............. *.*<.r,,,, Chelenko (Mike-cassefte is empiji) . , -, . ......._... _," ... - . First contact with SC - Know SC from a lady who was distributing condom when I first start this job - Was ignorant of using condom and the lady distributing condom did not exulain ................... . , .- - .," .~m*%*~&*A<** -:~~-~~~~i~~/~~~k~h~ ,.,~ -*. , . . .>i,:* .... &* *,>+ *.*x.*. .... &~:- ....4%.**..*8%s..~...*.* ,A*"**,~...m*5'.,->-J,"- ............... - Have listen to cassette serial drama and toolt it'to my famiSy also'to teach them ,- ....... -. ............................. about HIV/AlDS. , ",,,. . _* ,,;.. ,.. ,,.,~ , ,. ... ........ The IC , . >-, \ . ,,,. . " .,,,., ,,.,- ~&, "- .. ,>. .,*.. -,~- '.> - Contact IC for collecting IEC m&ti;iil<" tc6bflict -i&d&n fa; distribution to ,. . hotels. - Attend meetings called by Ashebir .,. ,:...""" ...... 2.. C: .,.. - Understand the diff& %..,. %, '1- .'..'. . about HIVJAZDS, 'ST1 " . .". I . . .+~, . . - FSW is risky job, it is'like sacrificing ones' . life1tisBife PO ;>-.", for me to work in Araki F .. , .- house because I am not involved in cash. It 'is beitei to work as housekeeper A -., . currently. . ,., ,, ~ I _ T' -, ,- . *. : " ' , .. . - ~.& 7 ".] , ,- . *.. . . , , . , . , , , .'$, *<' "' . '' , , ,'."\; , . .. . ~ ,,,, ':.. .... ..--. " k J . - . , . , - ,. . - - " - - ,.b .,,.. , . I '" . * ' ' '124' . . , . . . , ... . , ... . , .,,.. r*', ..... ;+&.A> ... e., --2 -,,--iw.': 9,- ; .")- .- , ," -,- .- .... >... :' .,;'.. ............. i. -... i ... .- .......... ..- .,- '.lX.i.b :?,~~a . ...>...I. :.. ........... I.- lX.thtl .. -. -. .I ,..... . ,, , . I <.. , , " *,_. '_ .................. ; .:.":?*:, .".. :' %',. ..... : ........ ., " ... -". . ,--., ..A. 2.,& .,. .... -b, .. Jx:".. .. : .. . "_. (. ," ,-.," > . :'. '*': .".. \' ........ ., . I , ) . ,~ , - I have never made a mistake of not using condom. ...... r,- ...... ,*c.ir-- :., ----**..".A '......^.*,;-. .... ..".-"". . +li',.. ............. - There are clients whobring 3vIL(".S i ,.,., condom with them; ................. some ask if .. the , FS~ . has, it! ... -, .. I , ", - FSW did not havehet~ork; theyar&highly ........... mobile .' , ... - We provide advice to new entrants. .. ', Clients - They negotiate with high payment for not using condom. - Some force and sexually harass FSWs for not usingcondom. Harassment ....... ', , , . d'., -. ., " ... - 1tis only the humanitarian people . .. around .. e , .. -,>-, who ,*a-X,.w,.*".Lsb-.-d.. $Kjp"oi% ., - ~~~if'it'hai~ens . . ~ in the hotel she is workingin: . , ........ .- .... .-*. *in, -4~k"a,ru,w'*c-*.lli.a~*ar.*ar'iliiii*~" *i.rb*",'u'll*n~. k2.. .,rlii. .... ,is"., ... -2- ... ...*.in' *. - It is very likely"tKat~.the~FSW~'wilr be cfiased out after the harassment and ............... '*., **** .A,**'......~<...<&k. ........I. a.,. ~,"Z..*.. ... 4.' ............... ,-- .% ...... returning the money she has been paid. .... *, - *... ,,.".,, ............ ~ ...... - Only protected in places where we work not in other hotels Knowledge about other inst workirlg on I3IV '~ , - Know support for OVC, PLWHA from meeting. - Did not know other agency working on HIV/AIDS and %HBC who provide . . support - ~etter use of condom, it no more , . . - , ; sap-biifi to. PLWHA ' ' "' . , . *~ ,,.-,-*.-.. - ,,.,-,., .>, *,,<* ..,*. ,*.*-+. > w=- .' Strength' .... - oT"f& ..... project ".. - .. ......... - It is strong in its every aspect .,." ." . ., -, *.,-: ~~~:~~~~~~~~~'WL*~*~~&~:&~~:~:~$.~~~~ : A ."V, 7,. :, ~ ' . a shame to buy and/or have it, ............ .~-:*~'"z~Gszi>%~+~ %... ..... ".-. T~..., .. .,: .. . ~ Opportunity ....... .,. . ,, , : .. ~, ".\<. , >.*>, th", ,,* .I* I%. -.t- -.. i.....:..... : ...... - To educate the commu:nity to cooperate in support of PLWA ..... Is.bp . &--* -.y,..+,i,w., .ar.+.,. u..~..~.;,...~ ............. ............. - Organize PLWHA like 'resfa'G6hb' ..... ........... .. ,. First contact with SC . . ~, , , " , ,. . ' . . 4' : , - - , ' I . - ...... - Attended a meeting in the IC of FSW~iiid f ~liuit~eqed'to become peer educator ".,,;& ,., ~&*S:#;~F~L;~~;*~V~&.:,* ,**a** A* >>,8.2,* , .a .,'* '~ . ,. - , - Peer 1. I am trained in Logia and had helped one colleague to know her syro. ...,\*.,, . ,a,,-'A ................. - Peer 2: I am a peer educator, volunteer and committee member. . - ' C.&wzr< >. ,,., , - Know SC from its support for OK,. PLWHA'.ancY$tbq s~k people until' ihey know their syro-status. ...... . , .,., """ ~ , .-. Trainingfworkshop ". ........................ 8.. .......... ... ,__-, . _ ,. lii ................. _I, . ." .- .., ., , ,",. ."., ~, + ........ *.." with health center. . . . . , , -,>- +. ..*:"." ...... ,,c,., ... ' ....... - SC came in 1994 and we-tiresattached to it - Association has established youth clubs for girls in the school and has volunteers . . who educate on HIVIAIDS - Association is able to train 80 students up to now - Association has legal status .. ..& .... - Association has sub,mitted.'i "project to t.he~s;;ci;t;zdttttb;lt.-has '*ot'"re;;iv"ed'in) . . ,, . support so far. (3 projects submitted at different time) VCT and ST1 services - A fiend uses ST1 counseling and treatment service without payment (free), had also received medicine, - I haven't gone to VCT but know colleague who have gone and tested - Results are obtained in 45 minutes - Service can be found on their schedule Tuesday and Thursday at all times. The other peer educator argued that counselors are not committed, are absent from work and this has created a problem. - Different persons undertake at counseling and blood sample taking. Confidentiality in this process is violated and I did not agree on this procedure. It ispossible to train the lab technician and have both the counseling and testing completed by one person. - Listen to cassette serial drama The IC - Contact IC for collecting IEC materials, to collect condom'for'distribution to hotels. - Received training on peer education at Logia - understand 'the difference between the -mV and STI, its tr&smission, prevention and know this since I was a school student. Use of condom - I know that married people are not using condom, - Some drivers also did not ~witnto ase condom - FSW should force them to use it. I use various systems to get out if the person is not willing to use condom. - I have never omitted the use of condom for people I have met since I join FSW except my first contact. - I did not use condom for my regular partner. - It is difficult to say that every one is using condom consistently. As there are military some women tend to have regular partner and inclined to omit condom. - an ST1 case was observed on FSW and the Association had meeting with the committee in the Military and the client was asked to get the treatment. This reveals that there are such practices. - - The military and community committees here have contact for education 6n the use pv 3 ................. . . of condom and FJIVIADIS. .... & -2 .. ... , " , ;, , : - .....- .. , ... ' ... : ............. . . ,, ,,. ......................................... ....... .."" , . .- , , . . , ,~ Peer educatiqn , - '. -f . .,> -, , *"-,?, ~*.." . "- ..., , I ' -- -" I " -, ' 3.. ".c ,*" i=;*ri..,. CI-. ,%. ,-.-.*,., ,.\., ci -*, - Out of the initially trained 7 peer educators 6 leftand one remainsd. A month, a go SC trained additional peer educators - Schedule peer education ex. Coffee ceremony where we educate each other~how,, to , . treat spouses, - Do not have connection with committee, CHBC unless have FSW who are PLWHA and sick - Counsel FSW, encourage and advise them to go to VCT - I work with CKBC without any protective shield. I have to be present provide them moral support - Educate other people but they did not listen instead they scold us, ,. , . . m - We provide advice to new ey?tra;nts ,A,..w . "- *.-.,.,, ," .+,,,'-. ~__ .,,, %. ~,. . ,,. , , .. , . - I , ,,. , .*..,~,-....-*..- - ducati ion to house ~ma~~~~-~,~,,~,~L@&~:~;~k\~~&~~~+,~~~~~~~~~~~ -.." ..:- ..# ~; -+* >*~;.<" <- .,*% .= ,.%- ~ A -,---s:,,--..9- --+.--.*+,--.,% - We did not have opportunity to participate . ~ .. ~.A ~ . .r,, in .*--+.A,"ty--.",,,-,: activities ., -..<,,.... other ,* , ,."# . than , . peer'education, as ." . ~ , I., .,, . 2 my employer would not allow me ' - " . . ,,~ , -.. >.>,. .~, '" ; ,',, , ,. " , , " ' gla) . . ., . . . , *- - . ., " - - , . ." . ..-....,.-. , ' . ~.. , ,. , Clients - There are many interested to u.se condomthey even bring different brand of condom 5 particularly drivers. But I believe and rely on Trust Condom. ? *, -, They negotiate with high payment for not using condom. 1111 - Some force and sexuall-y harass FSWs for,not,using condom. - . There are also FSWs who-.,are,,,not xiegdly due to ignorance, , "., carelessness .. and - - .- ' . in.r---rrarrrrtiA--.--.4s* -r~a~h~r~~~-i.14--ha~~ .",. - .exarlan ,i,xl_l 7 A..d : L-&_ "Al.*s. Lyrr , - - negligence. . , .- .. r,.,r. .... ..,I..L;: .<~.".,r&;&~;..+;*i. .,. . ,. .: .. ,.... .. -. ,: : .. . :. ,,. ,?. +62:.s,:. i;iiiLu9~i?i&L3d "*., . . , " .... .,..".-"- *. .. ..A. .- , . ,,, . , ,, , -. , -,,, .,.-.-.,... ~',~A . * .. - .. -.... .".l<*&"i::> - thi" *$:>,&,G~:*>*~*~~Z;"~" ,:I: :~ *.>, , , .: .,..) , ,.*. . -.. ,r. ,, ,. ; r, l.> .->#$ j2;z:>$.)y.~;a&~,,"~;,i-;;", tam .' ., ,,,, ' ,, '> - .-- ' .- . . ., 5 ._.,_. _ . ; . . "-, , , , . >. , .>p.;.~..~t%#:@,a,*d~.&,<~~.*::::*~<*~~-y~" b l y49*>"i.*,ni.... ,~~,sW"*cl~~*~~$%~~~,~~<~-&~~mrc~~ ,, . . L.~;':":.L~.~rb*:i~"<~p.~~<~,.~~7GG~~*+,iAI' 3. ,% ,. p:c".A :+- S" . " ., ~ - ," .~.- **" ,"~ 92%- " " .,.,,<, , ",$ ..\a* *,M\ '.. . ~. ,. .. - ... . ' . Employers ."" .,. . ,,\, . \< ' ,^.; ..- .-:.-,~~.~"~.&:~.~~~&~~..w.&m~~%~*~*.~~~ . >. ,,--".*t:5, ., -. ~ - ,* ,... :s-<"%< "A .,> ",+* .<::3~h%**. &~h,"," .%..:*-,,$d.*~** 36 oet,.&" ,*<" &,,*," ,.*<*.* . . . - , . +.-*- "",,c,,.,,r,_...i,.::' -.... -> , - - .. _.l_.li.___ -6 - *-,.. =-.-. -.-----r--z..-., . -., ", .-?. . . -- ," . -,. - " , '\ >," .... **ds~&.&*~~:j>qq&;;J;g *,.!* *&T~s*;&:&i*s~:'~a"?I.:::5?'2;%~~~;"i"f%5:k~* ,, .,,. .. . . .-. . -. c-: ,, 22,.f;*,,w&7b ,,-r.ip~~:+~~~~~,~'~. .: . .. ,."..'".>" <> ..2. d:, *.,< ,>, " . 6' .~ ' . .. - . .- m - . _ - ,.. Are not cooperative to allow FSW to, :$q in their h~useduringsickness, . . , .. FSW , , areA-'- ., , . -- . ..,, . . f'orced to move out andrely'on c-olleagues assist-ante,“. - We even did not have rooms to sleep, we lay down on chairs - Employers did not receive training FSW - Discuss about the HIV/&IJISqduing leisure time. - Discuss about our hture plan to get out of FSW, - Have a kind of consensus that SC would help us get out of FSW. - The objective of the Association is to ed~icite~all~~~~~~to preventHIV/AIDS, I can contribute to the Association.by education.. . ... ., , , - Spend time by chatting while chewing chat. .. . - Discuss about the time we passed with someone and , c';?nnect " discussion ~&h>&~ut,.,,. ,,.,,..am ~ \y+*,..-: +. .HIV/AIDS, ST1 .> , ..".,, i - . >I . , I . ,>., . , -- , . , . - FSW is risky job, it is like sacrific-ing ones' life - I have never made a mistake of not usi;ng condom; there is no single situation that force not using condom. - There are clients who bring condom with them; some ask if the FSW has it. j . . ., , "., ."~ - ' . . ,, X-p!! .. , ' . .. . Other concerns: , ,. ",_. *_,. ', .., . .",,. - - , , - - .,.'~,--.. ,. ."' ~. . ,. .. .. . , .. , - . : r~..%*-,"%A"v**,'-"<;~b~~-.. 4 st. ,&<,4%".: .,.*:. -.. ',<,. , ,, ,*.-; ,> - , , . '~ % .* , ' .;<. . '., : .:..,, , s. . - House maid because they $ighf'bk 'fikfited and/ may tempt FS'W to not use the condom. Harassment - It is only the humanitarian people around who can support FSW if it happens in . .. the hotel she is working in. - It is very likely that the FSW will be chased out after the harassment ,and returning the money she has been paid. Due to this project - There is a good support for OVC, PLWHA. - Reduced stigma and discrimination due to CKBC and education on mV1AJDS - The Association of FSW is active - Better use of condom, it no more a shame to buy and/or have it, Strength of the project - Education on discrimination, support to OVC, Opportunity - Support to FSW on IG as promised earlier and reduce the number of FSW . . - To educate the community to cooperate in support of PLWA - Give more education through CBOs - Support for the Association - running cost, - I want to contribute by educating people; Weakness - Inadequate support for the committee and all other sub committees (they need not rush to cover all sites in one day). One should not believe in reports. - Inadequate supervision on the activities already ongoing ,~ , First contact with SC - FSW on the street were working with FGA - Staff of SC (Ephrem) contacted them and called a meeting - Some met SC staff through a meeting called in our hotels. ......... . % ,, . ," Trainingfworkshop - Trained on HIV/AIDS prevention practices such as condom ... - . ...- s...iveb m.anagement ..f+77 ............. and ,,, use, .......... ST1 ............ ....... '. ..., ."._.. ............. , - - Regularly report to IC on our Peer education. .. ......................... - Are motivated with the expectation of assistance to change occupation ........... - Skill training was also planned and we have chosen ,'the training we want to receive. Peer education - We are responsible to educate new entrant on HIViAIDS and use of condqm. We also provide this training to male clients - Train about contraceptive, the challenges of being street girl, etc .. . - As peer educationwe have a plan to leave FSW job, to teach colleagues who are ,..*- ' .1 :( .- ., .*- . -, . ., " : .':.,':, > , , , : ., . ...... ... ignorant of HIV/AIDST~ - . , . . - If we . have thP,r?ssiGiii&~i,,;i?ur. . . . . efforts,. would j~ -, - . ,. , ,. . g;: .,% ,;:":,..ty;-:~-'s~ 5:!;+,.:p*"c*. 9::. , ".,," . ~ , explain some bf our aoubts. ,- ,. . ,< , . ................. , \_^ -: . ., VCT and ST1 services - We know the existence of VCT and ST1 only by one agency - Staff in the health center receive patients good and providing . ,,*" medicine ............................................................ The IC ........ - IC provide counseling, peer education, education on STI;' condom and !eaflet . , . . ~.. , distribution, - The street FSW and those working in the Hotel are called to a meeting separately. . . It is good for bringing us together. . . "-. - I come usually to collect IEC materials and borrow cassette serial drama ... - We haven seen and/or used the cassette serial drama from IC. . , - We get condom supply regularly and IC was not short of it: , . FSW - We explain to new entrants on the use of condom, the disadvantage of being FSW. I can-only advise her about condom once she decides to become F-SW.. . ., -- .,..*~"., . "...;.j#*":'..,.-,,, " ' - Spend time by chaiting whtle Lhaviiig &at (about 4hri) and~iicuss about the time we passed with ..+st',tWb, sorrieo% -t.j4.+5~v~"~pe~ -an3 ci:r:,.~-$ co~~e~t~~s~ssionn~th((.ab;out~~~~~, ,:.. >.-.&>. .:,,.a: :*.* ak<,:.s. >, ,.~<" *. ":, .a . ...." -* d ,'. .,. ST1 - Cannot say that X is beneficiiil or not because weare FSWdueto bck.of,ptbqr option. The cost is high 'because we 'did not have physical ability to withstand harassinent. - We did not want to be recorded otherwise we would like to talk to people learn using our leisure time. - FSW are willing to cooperate as long as they are FSW (on street or not). - It is difficult to educate people coming to our hotel because both men and women did not trust us that we are genuinely for educating them (they suspect that we are approaching them for developing our seimal contact) Use of condom - There are a lot of people using condom - There are some clients who did not want to use condom - The current use of condom is not satisfactory. There are a lot of people who did not understand the need for it. - We use various systems to get out if the person is not willing to use condom. - I have never omitted the use of condom for people I have met since - It is difficult to say that every one is using condom consistently you can see to my child, I have given birth. Stigma and Discrimination - There is stigma and discrimination. People did not understand the situation they are in - people are supportive if they did not know that someone is not positive and the moment they know, they discriminate . . Employers - Did not support if street FSW had a problem in hislher premises - Some employers advise us to use condom - Some are,not cooperative to allow FSW to stay in their house during sickness. In most cases, FSW are forced to move FSW out and we rely on colleagues assistance, Clients - They negotiate with high payment for not using condom. - Some force and sexually harass FSWs for not using condom. .. ., Harassment *.,. . - If there is a personwho forces us to 'contact without condom we will use-all the ' " .. - . .. . .:,*".,- ,, "*" .', "r' '. .;:' . .-. legal instrument to protecfo~selves , - '>.-.-.~f-one ,,- However, has .if . the one .- . evidence . z ,- . just~r-~~y..65.po.s~ce. and can go at the to.st-ct~idn,.it..iiiighi higher officials, no legal .t-5iK..lij'fu system l., supports. ,," >,,~. . . I.' --"' -. ... I ."I .... '- ...... : . sn- ..... ;~~taa~a~~.A~.~.~ri-~.ri~~4e~..;r~;,~s., .x~...r.r .. ur -;.ti LZ .s7 ........ e. .~....... A,-. ..... . - ~ ,. . , V"" .",I ," <-"*a ,.." - ,'" '6 i.. .... ,...* .. '..'. .,.- ... L"" i-' l.,i -,; _j., , .. r. . . . ,. . ... ,<.-.. ....... ..*... ................. '. - We assist each ,,. other if it happens within the premises , ,' . . ,.,. ~, 'I - - ' , 'I ,,, .:,, ,,,, , Knowledge about other i*stitutiohs.&orking on EIV 6m - Street FSW were affiliated to Catholic ~hurch'beforethe~~were , . contacted by SC ..Q - Most use the services of FGA - Most know about thisupport by MMM aiid OSS.A*fd the very sick and'PLWHA EFI) - Know about the CHBC who provide support ........ Due to this project - The training is very good for us, we have learned a lot - The IC is very important for information and is also our venue to meet - Better use of condom, it is no more a shame to buy and/or have it, - CHBC service is good and think it is sustainable as there will be more people expected Opportunify - Support FSW by recruiting them in certain activity First contact with SC " '. . ,. . - Have taken seminar in March for 3 days , . ,. , ... .-.. . hd*,&.A.,+."dk.*.. A". * .......... *..%.. ......>. '-3.~ .-.*.. ... >.,& "\ d,~.,: ,*.:,..,*, . - Some of us have learned. through the volunteers who conduct house to hbuse . , , - "-- ', ",. ;.-, "r.. -^-'+<-.-I. il. ,.*. ., . . - . - . ,. visit on Tuesday . . and ThuridayYana . ......... ..... :,*..... .. , .... . .... ...,,... ,..,...^, ,.;,.ii-xl*~$**>~&~*%.i.b.,Q"QQ"r,,,,. .L ...... .- .A .,., ..-,.i..* .. .... _.......... ...... - some'of us ..... learn through 'the raga. __l_ .l,_l.. . . '-&.-%%A -;r : -.-,-.a ... B... . >xi i- "r--;'i- ...................*..... ., . .-- .,--- i --A. 1 ---.---*7.>*.:8-b .... L; -- . ,__.- .& ........ 7s.?:.,;..1Lj_7(i*-- .......... ..... ., ............. * .............. 1.. .. L I. ._ ,_ - Peer education means to teach colleague. - Have been trained about HIVIAIDS, condom management and use, female - . ~.\, condom. STI. . . - Have gained behavioral change because we are peer educators. - Selections criteria for the trainees was being FSW and work in selected hotels - Our responsibility is to protect ourselves, to 'teach those wko 'are "ignorant, ~..'--.?,. ."-',.",.'-&,"~ ,.>- .... ...... protect the community by using condom anclteaching about condom for those who did not know. '. . ,~ . -"- " .. . ,." ,--. , ., ., .,. < - Our aim after being trained is to change my involvekient iriFSW'but did not . ~ access training and credit. We are told that the women.*affairs office willpay for. .'.. ,. .......:. .,: : .- 6 .. : ...... the training. We have given our names'in the tra~ning m March but have not heard since then. , , ,, " VCT and ST1 services - we know the existence of VCT and ST1 treatment in Chelekp - Staff in the health care provider did not rtibeive ui.pbIitel$:I did not get the .' ....... ...................................... , . ir .. ,. . ". service. Staff dutS00k~f0r'~~S'ixl is not . # i psra , .. .. ". ,. , . .. ilA.,P liii--L'l*j ,. - . . . !. . , , .... . . . , .,,:.A %&G&*"~ &.,*-*$, ', . ,,,'< *3 em - I have advised .. . kli& . .__ who . . has _ ,;., a problem df $I? @PP he. has got treatment in D.D. , . ..- ,. \,.,.. ~,,.* ,.,..,,.,A.,.v .,>" -..,,.,.. ',.",.> ,. ', ... " ~ . . . , " h- 4 , . ~..,:, , , .? ~' , . The IC - New entrant was also approached by volunteers and thought about the use of condom - I come usually to collect IEC materials and the volunteers come to distribute condom. - We haven't seen and/or used the cassette serial drama from IC. - We get condom supply regularly and IC was not short of it. - Know the volunteers and counselors of IC by their name. Misconception that volunteers are employees same as counselors FSW - We try to advise new entrants not to enter in FSW activity but most did not believe our advice. " One ,. new entrant witnessed. that she was advised'by the hotel owner not to continue working as FSW anduse'condom. -. - Spend time by chatting while chewing chat and Discuss about the time we passed with someone and connect discussion with about HIVIAIDS, ST1 - FSW is risky job but did ndt have other option. There is no benefit one could get from it. It is better to leave the job. There is a lot of sexual harassment and like sacrificing ones' life. - We are working until the WAO responds to our request. If they don't respond we will go back to our families. - We cannot leave chewing chat particularly if we remain in this job Peer education - we advise any person who come to the hotel to entertain on the use of condom, abstinence, limiting partners. - Use of condom -There are a lot of people using condom even those coming from rural places (fxmers). - There are some clients who did not want to use condom and some remove it during contact and we are cautious on it. We refuse if client did not want to use condom. -Have to test if I fall in love ,to have contact without condom. Otherwise we did not have contact without condom. -Know of a gentle man who is infidel and requested FSW to contact with condom and the lady refksed due to misunderstanding. -The current use of condom is not satisfactory. There are a lot of people who did not understand the need for it. -It is advisable if the FSW should manage the wearing of the condom - We use various systems to get out “. if 1 the ,,*> person is not willing to~use condom. ..--.- . .'' .. , - I have never omitted the of condo-m for people I have inetstnce " ." . ,, .. ., ,, - - It is difficult to say that'ivery One is using condom consist6iitly. . .- ' . s. . , . . ,,." .. , -- " . ,*.,,,."*. :-.s;**"".~",,.\'.*~. .. ",.,ri; .,, ;, ., ., ,., . , . . . . ,. ,, , . ' .;,- .=. , s ,<$' ~ <. ~S..%>? ,T,~,z<.d.4x*<,;s".7, .,<\;..;%X.."-"' ~> . . , . ,.. . ". ~ Stigma and Discrimination '' , - I . - , . ,n ,- .: ,". h,.. '& . . ..l ..i. . '. l ir -yri-l". , ., -'~t' -, . %, ., ..... ~. ,. i.* ,,,",,, ,,~',", %#%.;",,* ,..,,, ,L'.+ *,,, .>-. . 2*,.--.,. . <..,:<* - Staff of the health center'discriminate'~S~ , , ,,* ,~"* - FSW who test positive leave thetown and move t6'qthkr places. , , ,.*a,.,\,,? , ..~,', , . - , -. . -People are supportive if they did not know that someone is not positwe and the moment they know, they discriminate , . '.,+. . , , _ ,.. , - - .".. " . , -. % ,. ..",, '. ... .. ,. ,~ - . . ,... , "- . <_." .,I, Employers , . . . . , ,, , .: .". , ", ..-.- ., . . -. .:> ,.i",. . i( .I., , ....*T,<.*-I\:.. ,_ \ . . .-- L. _* " ,,,. . ., .v,7 ;, <,, .:. ,,., ":-~%*,- ... ' - ,.. " -. . . ' , , . ... . - , ' ,. . ,. . , '- .. , -, ,> -A. . . .-. , ' . . , ,- .,? .." ..< ..i . . ,",.. %.---.::.c,i:..',*<,";&?"."7:T,:9.' rr . , ,. * . ,' - Did not care whetlier we use condom or not "., ". ,. . .,," ***,. .~,$,,"< x;-',>&v" -.-.,." - .... i- ,I. . - .- - Are not cooperative to "allow .FSW to stay in their house dunng sickness. In most a '* ",, ,"_.u" .-- *. .-..*r.<.,,., x~r*,"L,,~tl,*i'.~,i,-~,LC i*,". I "%,~ i - --. , cases, FSW are forced to move FSW out and we rely on colleagues~assistance, - Employers charge FSW (Br. 10) to go out of the hotel even if' sheis not billing well. . \ Clients - They negotiate with high payment for not using condom. , , .. , ,. . -,. , . . ., . .- - - Some force and sexually harass FSWs for not using condom. '- . . . ,, . . , . ' ,,:~; 3, ' ' , .. Harassment . I I_ .A. . , . ..% . " ;$<+%s~>,%.nnniijljl-~r&~,d*r;:r;:r;:L :Ti... . -; r,. - ---~ .i . . .I ."^ ._ _ - .. , , c,. ' *:,.*r: , '-,<, <; . **xLG&B&-&shr*.;2"~- %h .c- 2:. ... " . . . . . - <: .,,. - We GoiL in 2 Face where there is no bed, , -- and hotkl owh6i-i;s s'f5tt if%; ' .@* ," .,. * "" "., , . , , - , ...; .,;;.<;,,;,.$z-% y r.. 22~ ;G,:;.;g%3;&*j;e$&+*>;T&g~z$$j ;$,:$&:;- ~~ , . . .;: ~:, . ,- . . - We assist )g .;. .;., .. . " 4. - " .~,, ' . .- ~ ,-,?, . , <,,, p ,,s*+2*, kS-+*.*; *3*,+,:A .A. <:*,+.:a*%,,-'<: : , , - ._ . A, . ,.~ - .- , ". . >,, . , .. .. , 3 ,. ... . ;; , ., ..,., ;-I ': i-:, ,,, *+*"~-~"~$.,,-"d.ii--'.. .. '.- r l, "A -rir. * - Knowledge about other ibstititi~woiking on HIV -Did not know other agency working on HIV/AIDS and CHBC who provide ., . support ,. . Due to this project - The education of through the radio/tape in market days is very good for informing people - CHBC for palliative care is very important and has brought change in terms of changing people's outlook. - Better use of condom, it no more a shame to buy and/or have it, Strength of the project - Education, free condom distribution, , ,,,* -% ., .".* " ,,., .,~ *,.,, ' ,. 0 ,,,.- ".,.,,\~,",<*, ..&~. ,,.* .a% ,., .~ 4 , " Opportunity - To further strength the condom distribution, *,* , . ....;. ,< ....... 3,.s- .... ,3*.:,%ey7,<.., ........ .... d%. .,. -2. +'> .. : -,., .. *, ** . ,., . -. - Support FSW by recru:ting them In certain , , , .. activity ,"*" .. >.... .. . . ...................... - ,,.--,, ~,. ,~, ,., - ~ . . .:.. t..':: ...... :: .... : .... : . ,:: : .. ..:.,.: .................... !~~:j;,;~;:,;;~;;;:;;;;;; .;;;?j:i;:,E;h;5i: ; . :;:::;.;:;:.:::: : ..: ............ : .............................. ..- ,. -\ " ,, . First contact with SC - Volunteers and counselors came to our hotel and informed us about the HIVIAIDS and use of condom - Peer inf'ormed'meto usecondom and there is conijlom disti-ibution Traininglworkshop - We are interested to work as peer educator to contribute'to the reduction of HIVIAIDS transmission and support colleagues - working in bai akd.et"d"?.*G*;,''-h.ouse t.;j r&duc,k .tlrie 'iiiim6er of contacts/pa~ners and work as FSW from home after the training - We have been trained about HIVIAIDS, condom management and use, STI. - We are motivated with the expectation of assistance that help us tb move out cif the FSW job. We have been told about this. m Peer education - We are responsible to educate new entrant on HIVIAIDS and use of condom. We also provide this training to male clients - Know about the uses of condom and teach also for clients who did not know how to use (especially people from the rural sites). - Community members contact are not quite receptive HIVIAIDS education - Bar based protect them selves well. - Ladies living with families are very much exposed to the transmission of HIVIAIDS. They even did not use shades or houses during contact and they do it . . in darkness. - Peer education is conducted individually and in-group as found appropriate VCT and STI services .... , . - We know the existence of VCT and ST1 - Service is not satisfactory because of weak staff commitment - Have opportunity to access free medical supply in the health center but is often out of stock The IC - Volunteers and counselors come to a place I work and they follow up our use of condom and availability in the hotel - We regularly go to IC to collect condom and distribute to FSW in different hotels in the town once in a week. - There is no cassette serial drama, IEC material is also short - We have contact with volunteers; they come every week. We discuss on our problems with clients and the siipply.bfcoi%im, 'etc.- FSW ,. , ................................. **v'.'-;.%..,91 ",A. *. _-)-l r-: 4, --I ................. ;,,. >,,? " - . , . -' .. i," .s -,;. ..,.: > .. -;::.:i:#~..>:A;>&,~, (;;< Y".: .. r;."c -........ ^..; .. ',' .. .................... ." ',, ., , ...... .. .<,... >.,. ..I....,.. i -4...,: ................ . . " . " " " , , . . , . , , , , -. ' i . . ,_ ,. . ,;"'_ , . .. , ... f ;.:., .; ....... ".".*, ..... ............... ,.*.. .,.,: -,.*<. ",:",.-: b.,. ;, *.:, ... ,. ';,. ... ~. ... . .. .. ~ ,. .............. '-.'~ ,*,% +~.;" :-, ,-. ............ :w.*~ :":*:o. q>: + .... ......... . . ..,.,I-" ., . " , .-,,- ., , . , , , .- , .. - Have been well informed by peers at when joining FSW I - The cost of being a FS\N out weighfs its benefit'due to the sexual harassme.nts ,and, 1, the risk of contracting HTV/&S. ! - Want to leave their occupation but need external support that can enable them . . . , % ' generate income for their survival - Have small association/Iddir to support members during sickness and loss ofjob - Three new entrants testify that she had received advise from colleagues - Leisure time is spent by-chatting while chewing chat and discuss-about the.time ... ,z-z.. .;,, ::."', ..... "? .... : .<,~ ............... we passed with clients 'and 'ielite discussion wit~'~V1AIDS.T1 - It id better to be employed as housemaid but it isdifftcultto getused to house keeping after being FSW (independent). Going back' to families,. savrng-and' try to ..........a>...-... .,\.?*'~,,, k,,2s. "< ,A.A,? ..... do own business are possibilities .... . ............. - - . _ - We are expecting that SC to support us to come out of FSW. We are told about ... this early on. - The IC is short of IEC materials, serial cassette drama. .... ............. Use of condom - Higher return from unsafe sex (ex. Without condom) tempts many FSW and are inconsistent in using condom - Don't use condom with regular partner because it provides a feeling of distant , . relationship - Nearly all drivers agree andlor ask for condom use. They also bring different brand of condoms but :FSW prefer to use the 'brand they have access to and can ......... .". - -. - ......*.-. Wi.* .,w,*4,*rZL,*-,%:-. . r;?..z+B#&*&**-~:. **, "rv,,3*,": :. " .k>,:*,$p$MfE*7$ , , . . " I L. ~,",; 57Z.T" ,aJ':- ,, ..,,:. *.. " .......:... ... . Employers ............ ,.- ' ....... . , . eMaw~~wu~Ga~dj ..... ...-. .......... - ,. .............. -*<-*.*+..,' ....... ...................... . " ',;c':". - " ' . . ...... ....>..'.>... ..*- ,, - . . ,, . . ,+ .,., .LA" " - . " '." . i. ", .*, "A&.< ''*:&+*,* . - Some employers discuss with us the disadvantage of*wo&ing ........ as '../*.. . A(,.4r ..... us to protect ourselves . . "- . . , ., - Are not trained ........... .............,......... .~.4~.~h...~~~A~~wc+.**#~.*~.s* - Some are not cooperative to allow FSW to stay in their house duriiig'sickness. .......... . . . , Clients .... . ,, , "%+, "<. \ ,. . , , , _ . , . ^,., . " . - V."., ,.,. \.,.+ 9. - They negotiate with high payment for not using condom. - Some force and sexually harass FSWs for not using condom .....I li"._~X",o ,.l_,l (.-., .. -. .........I....... - Most are getting interested to discuss on HIV/AIDS .............. ,, ,. .~. ..... i. .. ....- ',.. .... I>. ............. , ., ' -. . . ....................... Harassment .......... -' .. --,. ..- ..-... - Some employers cooperate to protect us from harassment ... - We can only be protected if we stay in the hotel we workin. - . , .,, " - We assist each other if it happens within the premises . r~ ,.. , ," ... ............... ,.>. Changes Due tothis project' ., . *,"., . ". - There is high rate of use of condom and is well accepted . - CHBC service is good and had-changed our aiiitude towards PLWA ,... ........ .-i .. ...--.aX.L-. (I-. ..................... - Care to OVC is new forthe tow&'"' . ., . , . , . *. ,." ., . #: ., " : .. .". ,-. ........ .,--..- -, ........‘........ .... *. -.,.a;*. ,s- A&;u;I.,~ -~.i.a;:~i;:?..& :~~ZZL"I~~I~;II:S~~~~~X%!~':~~~::,~:~~ 3.;,-i:tJ:?'Yrd: .':'.? ,.,::, ':;,{:;;: .,.:.,: ;:::,.~ :.;; ,,;: :.F.:;::::,:-. ,.:.,.)..:,,I .. ..:,...,: ~, .. ... ... :i:::..,;..,:;. ;.; ..............>. ......< .:: .........I....'.) .I:: ..''.' ............ ... , .................................... ,_.. _ _,_, _,_ ( . ... " - ', . ..,. , , -, ,. . ",,,, , ,. , 1 . ,, , , ., ,.-, ,,,+,**,.*.,, ., , ,," ,~> ",,.> >,,," $.-!;*.;:d ",-a *. ,=.,.: ,>n, 9. 1 I . *_,.._ . , - , , - ....* ",!, 1: .... ... . ~. ............... ...... . _ 1. - , . . , 1 , , ,. , I "A.. First contact with SC - Volunteers and counselors came to every hotel and inforhih aboutdthe'training of peer education. - Were trained by Dr. Zelalem - We educate FSW in small and big hotels. I' saw condom'fro'm people distributing it within a week I start work in Mille. . . ... . , . - . .~ .." Training/workshop - I am committed to work as peer education to -contribute to the reduction of . - ............ .~ ,<., HIVIAIDS transmission, support each other among'FSW: " - The first time I saw female condom is onthis training.' ' ................. - We have been trained about HIV/mS, condom management and use, STI. ... #.., . %%'<..... :.*,,u. -.--A" ".?.+. .. ,..,s, ..... .., .*- * .<. , - We are motivated with the expectation of'assist&nce that help us to move out of the FSW job. We have been told about this several'times. Peer education - Educating in Logia it are difficult people violating our rights when providing . . ." -. ., . , ~~. . ,, education by moving from hotelto*Kotel. - I am told I will be transferred to Mille (from Logia) but no one informed me about .,Y" .. (..-... .."- ...... ' .. the possibility of working after ........ I aiiive'here --. ..- ......... +..*.. pG--q.s,Ta. iri Mil1.e. w?--#.->.. ._...... .* ..% :. ........ -"',- .?# . . - I work as peer education on ..mlm ..in d""S m6ijij c6Tf;;G g.F, :sm:'l';~t'"fa"in;d")-") ")")%?* ...**.*=...a.*?..*.. .. as CHBC and want to cdntinue w.o'rking;,I &ll*ihi;&~~?aTe'ri"il"fGiu.ir wemr*iic rn,+,* *,,. .> ~, , ' .... >>.cY:'- ......... ....... .._. ,..... ‘..,. ,-';- .%u, s':+u&**->$"d:?..> jjjjhh .. , F.6 ,... ;. ....... - ....<. ": ...,. ,-* *.,Sl. - .~ ...... service. . -.~ *.~.-.&~,!".,,>, :, ,,~~JL~~~~~~~~~~~~~~~~~~+~~~:,~~~~~+~~~~;~~~;~,~,:: ... ~)-~.,h* &..... .:;, zc..,,;::-:-:; -:;z7:i $f~7~.$~e,+7~~ :5&gz+~2 .....\ .F.*;.-,~- .,,....... . . '. , ,, s,.,., , - New entrant is trained by senior'FSW iri'fhe hotels,& .... . . ... , ..%.......* ",*-A .. --,- .. ....>.-AT. .... "",a" ..... .**,**w ... .t.::$&"s+9:+C:7:;<. &,". :?%"' -7, .......... *> *:;..%':<~2< :-a rk%*>*!*~a~":T.*>->'Y$<:L: - We are'responsible to educate new entrant on,m/@~ and use of condom We ..........~.......... /._/.. ........I-....................,.. ....... also provide this trainingto male clients - We provide peer education in-group and some passersby join our discussion and m explain some of our doubts. ...... 1 ........... >, / ,, ' VCT and ST1 services - We know the existence of VCT and ST1 ~.. ,~. ."*,, .............. .. ... i - A case, absenteeism of the health stiff in ~~1.f6ried$lGI~ to 1kiG5 this area ......... ~,,*, ...................... ", - There is free medical supply 'in tfie liea1th"center ......... ...... ..., ... ...................................................... i - Have never seen any fr&-ST1 service in the last ?months. We get the treatment ,.,.,, ~"",> , . ',,. . ,-.. ",,.,," .'~ , . . and buy the medicine outside. ", The IC ,~, ,.. ~ ,. .- - Volunteers and counselors come to a place I work and they ask me various questions regarding use of condom. . *". - IC volunteers and counselors did distribute condom'bht &d"'not'e&cate tGeuse ;of ! <,*,. w." -.-,,.. . --..&....'>L>. . ,.-<. ...... *.. ....a-.... a it. We have provided comment and' now they a'rk providing the education i - We regularly go to IC to collect condom and distribute .... to F~~in'differ'ent hotels. ...... .. , I bring 1 packet of condom. a.s ............... - i - There is no cassette serial drama,--IEC material is also short . " . . -. , - . ,,.&" ..". - ,. . , . . , ?. ,.-.. , - . \, -. . , - We have contact w.ith'.yolunteirs, they come every-'week: We discuss on our - ' 1 - 7 .* .:* r.....,fir ..a ..n,.&i$ . -- . .. ., . ~ . .,., > ,.."#.. . ,,,.-,-.. 'problems with people, on the supply of condom, etc:'.' " ., '" ,,.. ,.- ..,, ~ .,'__ __, ' I" . , . %., , . ,." . FSW I j", , ,__i ,, I. _ _l,_ __ ,^ 1 (_.'.> ^ ; 1. '*. *_, , - We explain to new entrants on the use of'~6ndom,'ivorE~ condition (access to food shelter, peak business season, rate of payment, etc.), - - A new entrant testify that she had received the above"advise &om colleagues - We do not meet FSW working in other hotels. Within our place of work, we spend time by chatting while chewing chat and discuss about the time we passed ", with %I someone ,,, . , ,- .. .. , rn i- ' , ,. Clients [_l. ,- - . +.,- ... " . . ,',, ., ,~ ~I ,.-we.~ <~%.~~*~~wL,~~;.v.~>~>~&":y~~~s><'~~'~> .7,:<:.2t s,.. :<: 344..,*,8 '?,~.- , 2* "" a - .- ,. . .,.' . -- - They negotiate wrth high payment for not u.slng'condorn. . . p -il'+ii - . ", '.. :"?,*:>5";< . . .&. ..& ....... ,' ,.- .....- ,,-. ix " i^i,,'"L. ..... .-. -' ..: - - ., . ,:. . 'higker now. It is well accepted. . ," . . . , . . . i .- .,&. . . , , \ . , ., - Better use of condom, it is no more a shame to'b'uy and/or have it, - CHBC service is good and think Opportunity " e , , First contact with SC - Volunteers and counselors came to our hotel and informed us about the us of condom - During orientation for peer education. TrainingJworkshop . ,,, . . ,, ...., ,? .. ,. , , " .. . , , . .. ..-".,.*&-.,A$. ':"~l..":;*::c,~::.%~~<-*"~:~i>-~~ t ' :, ., :, .*, . , . . .~ .. . . . -- ' *. ,,* .z*av ~??'*.31*>I**T~*'?~~~,II~Lii~;~, ,.:, .,%Wrp*z: ; ... iii . ..,+,,, .>" . . . , " . - - . " 4 .".,.*? 3% > 4 , , ;. a. . . , '. - 3.. .,- . -. - 1 * .:.-.,~Trainedt,o . ~ get organized and start contri6ute . ~, that evgntually dXn help us to st& IG'. .. '.. .. . - .' . - %, ..,' . ' ~." ". '!OL,>..> ..-:J.*?* {.i,\,g< *+&*-" ,,-,* :;." ,.:a.>.;v-; , j . , >. " . .. . ,. ,. but Gkhid not attempt it: . , . ,. E . . A. "8". . . , ..~-. -,,--" . . - - MotAiv'aj*ed "edduTt;o~tth-e interest? 6f. .st *6ifftr~S;-i;6;1"~L-i-.-i-i--i--i'+' .-"s*~***%-=*: , . , - -*%$ ":. -$: + LgaX . ,-..<..*:> .. ce* $:,",.&-,----. ;(~.2;>~7di&: *> ,,,~ '. ",, .~" \,~. .-- . .. . ,-r,., -;;wa9;,~~u~~~~-~~&~~~~,.~~~rii1y~;iaa;~@+ib~~i-~,:::&<5i.:"i"i~+~~.iit:~.i sv.. .'"' , A ' , ' ' . - . '. ;. .<-t -. , .y*,:*%. a*~i,.i.xr*.r ~aa*" 4Ni i* "' < - . > ~ , - - - "Helbing us to change our occupation, . ... ;.*"..,~~.",..., -"~ -. . . . I ... ,. *. ... ..* ,,* 6,: ,. .I*.*-,,:<. --C.* ..,. *"L.*,. ". . -. r ,.. ".. "i . , . - . The advices we receive'd to pi-6tect us fib'm HIV/AIDS . .. - . .. ' .. + . ,- ' , '~ . ' ,. .. , -. ,." .;., 1,. - ,-. .. Peer education , , , + -, , , - Educating peers the reduction of HIV/An.)S transmission , , -. . . +", .. I "^, ,..""..,,* . ,,, . . -. -.. ... .. 'I I ^ i . - Supporting PLWHA peers morally and io'cially - We did not know what we can do if go out of this activity. We need others to come . " , """ . .. and support us - FSWs7 pass time by discussing HIV/AII)S"related to sexuai' harassment during leisure .., time .. (coffee ceremony, chat chewing) - Peer educators reach 8 people/week and spend longtime . . talking . ,,, once we- meet . , (cannot estimate the time-spent) ,* , . . VCT and ST1 services - Know the existence of VCT and ST1 services provided by OSSA , . - Did not think to visit VCT but need to change job .,,," *.,+ #"- . ,-. ,:A*, '. &,. " .,* . .',., - +.. ,%,"A ,,>, *A*. .S"~, ,. <..- ,~ ,%\".. > , ..~ - Know that FSW can get-VCT skr+ice"t'hrough volunteers - Did not know that some one can get VCT service directly from the VCT centers - Couples can go and have VCT service and know that people are using the service . . A*, ' , ,- .-.* "%,.,.> \. .7.,* , ..,",.., - Are not encouragedlmotivated _, , ._L.,_._ -. ._ . .( to .,,.,L~, know A *+*"?..,,i' syro status bkCiuse' pi*~le will stigmatize ... '. &d discrikinate if we are-p'odtive and did'nbt'have other gteiafive'to suGi% - Believe FSW should -'Gve' * cf;f -iKew.+ job ,,& %, 8 ",?,A - ""~,,X, + .,. , b ~ .'~ .". ,~ .- i-7 ,, - ,. Know . ~ .,. the . details , , . of .. ...-,2,.- the, support , s -....+- .":- and . care ,' . provided . , ,, , . C'...3,- by "CmC , .. .- . . ad'GV% ' . ..<- 8, The IC - Did not know the existence of IC in Nazreth - Did not know what the services of volunteers are - Know SC is providing training - (Call names of individuals) distribute condom and explain the use of it." FSW I" - We explain to new entrants on the use of condom, the inconvenient working condition (access to food shelter, peak business season, rate of payment, etc.) - Advise a new entrant not to join FSW but find job of house keeping in economically rarn &. a well .. ...,. off .. family i. ' - There is no,"benefit of being FSW. The disadvantage is that there . -. is ?,$ a .-.. high ,, " .. degree . .,, of human right violations and harassment, high'risE of contract~ng HIV/AlDS. b". - Think of moving out of FSW but need support from others' - We are expecting that SC to support us to come out of FSW. If support is availabIe, ", . , some of us know what we cadwant to do and others need skill training P Use of condom - There are a lot of people using condom - There are some clients who did not want to use condom - FSWs' use of condom for regular partner is not consistent Employers - Have cooperative and friendly employers - Lack of respect by the communities for us and our children - Can be told to leave the job any time without prior notice - Did not appreciate FSW's use of condom - Did not care for us. They are happy to receive higher money if I generate it by not using condom. - Some are not coopzrative to allow FSW to stay in their house during s;ck*css - Did *lot cooperate when FSW are sexually harassed Clients - They negotiate with high payment for not using condom. - Some force and sexually harass FSWs for not using condom. Harassment BRQ . . - Employers are not willing to protected us fiom sexual harassment L Changes Due to this project . ,.\ . , > ..~ ~ .,,. ,,.' , 7 p . . , .,- ,.. . ... . ., - . - High demand, availability and use of condom .." . . . "< . . ', . ... -" ." . 2 a , i . . - SC closely follows up and educate on use of condom , , ' . . , < d , , .- - . "*** .................. .&:,:%..- 2x2 * ~~~~>.!~"~,$:~*.a".+~~,~;i:'~~\~2,.~~~:~. ;, .. ; .......... '..: .. \<. ..... ,A" .\. . - .,.. ~ . .- ",. . , - , ....... . .< ". C" . , '~ . ' 'l. ", ' , >__ , _vI _ - _/l.i.,- %<_. , -. - -i * .. ,., . ,/. " _% < . ,/ <", , ' I .>........ / \ -, ,- ,. _^ / . . ... t ~. , . ,. >" ., ' ~ " ' .~ .,- - ..-:.. i.> .. ......... .... ..- ......-. .......... . . ' <... . ;.-:> .-,;.; ,,&~,[.;snn il.il:,;u'i:i -+<; .>..- ".i ; : ,&: -, :, ,.,,;,.,J~i~~l~~;:,.; G: -.,:,.: %I -:~;,:,; ::. ---2 -". .*>. ..-*..-:.-:a ,Aa,:ia..+ >:v;:s~~.:$:;&'"~2~ ;. ""-': w * ' , -, i ...... . .... .........-. .:;'i,~~."" ........................ . . ", . . ~. ~ - Open discussiori, suppdrt among FSW ,.,.-.,; .......... ............... ... dlb -.:.,- I - Better use of condom, it IS no ........ morea ;hamy to buy and/or have it, -. ~' I Strength .. I ~ ,..,< I-) 1 ")._ __ . - Very good education on the management and use of condom - The IEC intervention of the project and, care and support to those who need it Weakness ..................... - Education for the community to respect human rights .................. - To get support from SC for us to be generate income and move out of~SlV'." ..... .......... ."__ ',"._.( * -_ .......... ' .. ,& ......... - Extend counseling for people for 'lOO%~'us&of ; >w ......>.....",.* condom. .<,.. -+~ . .... ... ....... ",>it ',& >"~+,64.%&&*~**%":&?~>,&%,***:-b.~~,*%.,*-ff~4-*,~.~~~*.-x-w~-;* ... - Lack ofin&iati?on on the part o?F'S~~~who have been contacted ......."... ::,*. ............ ,'- - Lack of access to credit and serGices and b'sence of skill training .,.' . , . . ', . . . ,.- . , . First contact with SC - Volunteers and counselors were coming to our hotel to educate us about the HIVIAIDS and provide us condom - Peer informed us about it .. '. . . . , " ". . _, _",_. -,:-,, Training/workshop :.,a . ".$:.,>;::'<>~-;s,;*::!~:~~>,;;::+. ,.">, ;,, .: ,:; " -," , - Trained on .; HI.v,m .. $,,.'~~r,~*,~~y~..~;~~*~sj*<2 S"$*yrz;;*%dd'how . . ....-....>........ "to LjuMte our pdi~rr.; We ........ have -. ,d&;"*i:... i. -;., '"24' .....,. 'i . ...irc..r'.i.... --'itb Cr a;:,.: ,, , . ...... .. ;.:,;....... -, questions that needs ...... to be adzessed, .,,--, . .$%*a +sk>s ...Led..s .6.c..3,\ L;,:,~ :$-- > . .;.. .......... - ....... .". . , ,,, ., ,, ;; ,&<> ;,&1:.^r$&&2;&i@$*&@&g&$&:;g>j($:..: . ~ . .* ." ,, . - - Ex~ectedthat, t&sTg$in_g %?@$.also. p: education, ....r... :-.* - We iie'.ilnter+te&*@ "+ *-*.-" yp-k;,as peer educator to csntii6i.itk""t6 -,**" ,.".&4. ".~. ,,,..<* ,.<,* . ", "~," ,. ' pv,.'"*.?i:.b .... .... ~~~/~~~~'t'ransm~ssron~~ri'~ support colleagues . A, .~. .............. ,*r" *, .,\-."$,.%*. .*.... d.?..A. ,.-,-,.~"-*..-,-- ....... - We have been trained ib6ut~1~1~1~~;c0~doh'hini~ement and .. use, STI. ..*<.=....*. ....a '.*> ....... ,,-\ .,.r"", ............ - Motivated due to condom .". ;>). distribution, s ;, - . - the installation'of free VCT servi~~ln the. ; . .,? ." " ,. . town and wanted to leak more a6out HIV/AIDS -, , .- ." Peer education . .ii- '. . . ~ ., . \. ........ . ~ ,::Lyi'<.t- ii..:: ......... I,,, - We are responsible to educate peers and new entrant on HIVIAIDS and use of condom , . ...................... .. .. .-....... .."> -c .>"" "s,.'.;'. i";...,:L .'- *- - One needs to be activ&,dediiat2d,.opin tb bebeer educator - Three new entrants testify that she had received advise from colleagues on the " .. , . ,, , * I .>" ,,, , . .- - HIVIAIDS and the working conditton , .- - Bar based protect them selves 'well and some FSW in small 'bars are not'well aware about HIVIAIDS - Peer education is conducted individually and in-group as found appropriate Knowledge about services of VCT and 'STIS - Know the existence of VCT and ST1 - Did not know about the quality of the services offered by VCT and ST1 - Know volunteers who provide CHBC, care and support for PLWI-IA and OVC ma ., - - . --Know the existence andactivitieiof ,HTV/@S'mittee f" - .Know a PLWHA .and.we'di$cuss and morally suppoi? him I, . - Know that IC disthbutei condiim; piovidki iviilibility of cassette-serial drama ? -. ., , . and IEC material ., - , . The IC . . -. . - - Volunteers distribute &idom to FSW hotels - Know that IC volunteers and counselors provide education for TW, FSW, students and, communities. It provides cassette serial drama, IEC material. - Have listened to all parts of the serial cassette drama - The drama is very interesting and FSW listen to it during working hours. It . .includes issues about condom, the lady vendor who tried to protect the condom '&om the spoilage7 the dri&r7s, PLWHA behavior and others arevery impressive FSW - Have been well informed by peers at when joining FSW - Have small association/Iddir to support members during harassment is important and it can help liaise with legal institutions - Leisure time is spent by chatting while chewing chat and discuss about the time we passed with clients and relate discussion with HIV/AIDS, STI. Spend about 2hrslday on average - Economically pays off but exposure to various sexual harassment and contracting ofHIV/AIDS is high - Want to leave their occupation but need external support that can enable them generate income for their survival - Did not have skill, access to credit and shelter to start our own activity. One started IG for 1 year but could not be successful in sustaining their business activities - The IC is short of IEC materials, serial cassette drama. Use of condom - Clients negotiate contact without condom with higher pay ansni - FSW are takifig collective action against people demanding unsafe sex ?A - There are FSW who use condom with regular partner becailsc it provides a feeling of distant relationship &mr - Nearly all drivers agree and/or ask for condom use. They also bring different . . brand of condoms but FSW prefer to use the brand they have access to an-d can ensure its quality such as Trust Cond-om. m - Some clients ask for using double condom during contact - Most don't trust condom other than Trust Condom Wr* Employers '. "' I ., . .- . ,. - Employers did not encourage us to regularly check ST1 ', .. . , . . ., <*,<> G ,."?:(.l,d.> +?f>,.+. ,. ~.! ,,. . .-.-,> -,..Most are not cooperative during sexual harassment . BFns " . .*,,.,*; .\ .. " i /'.I..' , . . .+..,. -, , .;... -- Guards also harass in favoi'of the'clieni if FSW'EiaTa contact out of-her working . >". . ~ ij . ' area .. - . . . ,. . ,.~. .,~ ,.,. -. .,,. l.. ->.... _,-.i id.." .* .,, . . ,' ,., , ... " .-.-,.,. _ _l_*ll /..l . _. , ,__ __I . , "* . , . . , ... .r . .., - , , . ", ., , ( _', ..-. .( -, ".. .. - . . 6 . - .*" , " ,. . '. . , . , . , , ;, '.. . , >. .. ..,. - .--,..; '- ,. , -,- . ,.,.,,a - ~-- . ,- , . ,* ' i , ' . , . .. .,- .-.' .'."> ."., ,,*, !;. :<,' j;,.::"' .,^, , ",;I;; ""-~ . . ,..* , '=, ,i,".-, ~ ,,.." .,, ,ST..."< ,,,I.,*. - .,.-, * ~ ::: '"'. ."{..'",.';, ' ,, , . ". . ~ ., c,",-~ ",.,",,, , A . + ,. 8, - Some are not cooperative'to allow FSW to stay intheir house during iicknkis. , . > .i . - .,, . %~ :-..;,L,s'f>+w ,, , " ,, . - -/ .i .\ ., ,. .., ~ .q,. ' - 'I .,. , '. _ " . . ., ^ '1 Clients i. . ' , : ' , : . , , . " " .. r.: , , , > , . . . . \ I, .i, ., . .. . . .., ,+... ..:-A . - .,..+..,.: 2.. ;c., .-., ,: , ; .-r...., ,..,.., : -A .: -= :- :, . ,:h.,.r..- - I, n.,. ,, a * i... - .., - They negotiate with high payment for not using condom. -.. " - Some force and sexually harass FSWs for not uiingi&idom - Most are getting interested to discuss on HIVIAIDS '-- Harassment - - Sexual harassment is relatively sever in small bars (Areki, Telashops) - Many employers do not cooperate to protect us from harassment - We can only be protected if he stay in the hotel and coliiague are around , - We assist each other if it happens within the prehiHes"in8 nkig6G6"l;&oid- .- i . . ",' .. .* i.. , * . -, . .- , . .,. ,",.A ", --,A -,*?a 9" .,.., , ..- . . "' %.*.a:,h"%- L " , a\*.- ,.:**A *.*&,'. . ..,. *.,,-. . ., , .. -.. ,+.ri.r, , i..;.r.L .r. . ..~ . . , , - CHBC service is extremely impressive" and it has . contributed . . . .~., a. to , , behavioral . . change of the com'munity ",, ." ..,. ... ',. , ,- ,-, . . - Care to OVC' is new'for:thk town . 1. -i ,.,><.,." ." , - . ' ,. - I ,..'I . ~. .. ." .-.. . ,.I, . ;, . . ; ,..., a.*r,la~-&;;4:-~.,,,,.- .;-..::.-I; .. . -. ,. .I .., . .. ,-, , . . . . "., . .,: , . *.*.a. -... ".' . isn..'*r?h.*~'I~~It4-ni,<-i'ii. :. - . - .I . .. >--I>< .". .. .-.. -. "- . . , .- -.- .-.:.4....:.:.~-,.---.- ---.w .-., -.- -.- * , ." .. . , -... - > ., ,",. ,.. ..-., , " - ",', ._I , 1 *, , .,,: ,*I_ ... , . S" ."-r.,,'r ,.. :~t2,i?2--\.r*:. ..' *. .. -- : Strength . . .,,. .,, :+ .,*,. ,:;",'* L ;.-.L2,f-.;::*+;:.,;j;:4.> ,is- ,>:, - - .. ,I - . .. - , . -L---.%-~ -*-- -- i-i-----,l.l- :i(..i,.x .-.-.-+ rr-+i-l~i+..- -+&aa-w&.- - -"' p+x&+w$ww' . . . . , , . .. -. . ..,,. . .' .. . . . . , . .. . \ I , ~ " ~, ,, .. >,' ,~":, .~,a.:,*"">-Fw*:b&aa2? ,"A -L..*c,--a *& ;. .. ,$ :" ,::.-A.-,L -. , 2 . . . , , .>. , ., , , . , , , " " . . , . ' , , ' , . , " " ! " 6.. : " ; . . " - ' ' . ''.. , . .. - the il educatian.on ;, ,.,. _ i_r_.__. ,. HIVIAIDS . " . zc and creating underst-anding on then&6da-'t*"$s&;*we no more f&el sh.$ , '. ' - ' -. .,." .. , . .. 5. . ._, - .- -. . i " " ,. ,- *,,'."L.",\ -.,~.* ,,:.,.-.> ,", . , \, _ ( .,__.,.", -. . .,- . i '-"k*"":"?l",.l ,*:.;-w ," ., \ ., . . I . - want to prdvide CHBC if we are trained ihd'co~tiibutk ,., , .* ,.. to the-fight ., against mms Weakness . . . .. , . , "Ai" .."",)., .>, ?., .. ri ..- - Legal protection from sexual harassment through cooperative measures by the concerned offices - Educate, encourage ei'nployers and communities to participate in taking action , . on harassment .. ~ , . ,<" , .- ,~ , ,. ,,,,. ,.*,:~*.,; .-,2.>r,. b,:,:,a%. .-/? , :-, ,- ' , , , .., A, ... \ci, - 'Need more supply for New cassette serial drama, video cassettes - Absence of better quality of condom - Absence of socialization event for FSWs to get together to discuss their . . ,,.a,+,><, 3"7.%.,*~,&.,*w*. ~... -- '. . , . z problems . . , ., Report on , .. In-debfh Interview , with ~, .$>.?*, PL . 3L ,.,,. KHA ." . . , ,"' - "r ..;';; , , " " -., "" . - . --- ,., , ~,. . > .:,. . , , ' , ...,. . . . i. -' ,; ' - . . . ~- . - ". I Dire Dawa Km Contact with SC/USA-HRCZproject fi .., - A volunteer in the vi-cinity assisted me contact with S,CrUSA Perceived future participation in Community Activities - Existing stigma and discrimination does not encourage participation - Might face worsened stigma and its consequence on their children - Other PLWHA involved in expulsion by home owners Knowledge and Availability of Services and providers - Received counseling in a clinic and used its diagnostic referral for VCT - Had the VCT service in Addis Ababa Arsho - Used the the VCT service by FGA - Know existence of IC, support to OVC and benefited from care and support by CHBC and financial support for PLWHA - MMM provides very good service for the very poor and sick people - OSSA provides care and support for OVC - A11 provide good services but have service charges PLWHA Situation, Problems and Needs Family History and relation with siblings - Used to work as FSW for a short time - Have,a daughter aged 16 - used prescribed medicine for ST1 up to now. FGA charges for ST1 service Spend leisure time: take rest, chat with daughter after her school. - Advice daughter on HIV/AIDS and she is participating in HIV/AIDS club in school. She used to advice me to protect myself siid knows that I am PLWHA ma Views, satisfaction and expectations on VCTfSTI and ~edikal services VCT/STI SERVICES ~81 - Good reception by counseIors and the services of VCT center - Used private health provider - Service is good but it is not free and medicines are expensive !@a Major problems - Absence of drug supply - Absence of fiee medical treatment HIV prevention practices and condom use - Condom is found in every hotel rx Have experienced a client who had tear the tip of the condom before I know my status - - There are HIV positive FSW who are still in the job (hiding themselves) ............. - ~ . ,., ~ ..' .yr- + " ". "".> &*,, - ,,;,:~>*.>:*::;t;*$+.i, ::.A:.. ,:.., :>:, ';:::;'f; 2?- . . , ' ,, ,,' ,. - Many people did not want"; use condom with Qn . , excuse that Musl~ms could not be .............................. ~-3..<.<3 :............. ~> .>L ................ contracted, reduce satisfadYiOn' I< 'I <*A'.~,--, ",, .,L," .I.......... a",- ......... - id not know howto ~se'cbiiaoii gnd'hhe ............ a6sta1ned fiom .,.a" sex .......... slnceIknbw /my status - Strictly avoid sharing materials with family members but I am concerned about my daughter as we share a bed and I have infections over my body ............................. , . -- ., . , Access to .. care - ". and support . services CHBC services - Existing CHBC provision is appreciated the service and their reguSarviSits - CHBCs-give adequate attention given to bed-ridden patients . "%", ......................... .... - The service is "inadequate and getting unsatisfactory" mt4 - Monthly financial assistance is provided regularly - Received PLWHA were given bed sheets during disti-ibution" - Received medicines for from CHBC and moral suppoKfi-om"\;.dl~nGers - ' ' . tm - Received bed sheet ,* ~ - . While I was seriously sick, 'a physician advised me to eatG3^times"in an Kour and how can a poor person like me afford to eat 36 times a day. P: -, Major challenges faced by PLWHA - Stigma and discrimination b*1 - ~ack ofsufficient food ,. . , l.,-ll - . * ........ ........ ..-. ....... - ... 5::". :'. . ;:, .-.. v.", , ,, . , - Inadequate access to medical sefvi'ies ............... ,".: ..............I.x....... - Communit.ies a.re no,i .do.oper ..F6r .PxmKt*~.Fzi~iiiiiiaTin"~(j-ciiara""cdii~lties~ " ,., " . ................ ,. .'" . . (sa , , ," .... ........................... . , ," ................ ..... ..... .... . ,. . . <'.'. $.'%:.+.:. ' .. .st', ,:;, ...'. " ". ,. ", - " *, ,. -,~, - < *~.". ,- . ">*.,'*.,- *"*@;"aL,&a?&F ;s.'.""*~~z>:*:- s~";,;;,, ~, ~.. ,~- .~'::t . .. Atiltud-es on, existing .", kommunity ,.- ,. /sOcia]r support, ,. __ ._ -_ _ .<. _ .>:$".:,& ~""~,~:~~,.2.%7x.p ".?;:~%-,<;.~m- '- - There is.abig"-change in terms of raising the ~waf&;~SS.ofpeople on~~p/ms;',o@nn-nn "- ~.~- ., . .., ......... id ..xxrc . .-*4.,m.r ......... ; ,--.. ...I......, .^,. ... .,-. .... .,% ;.:'-u.-~<-rri..x*-,r< .. *,8':*s,q ......- . ........ IIA ... ,w,:,>::. 5. < ,*$~fh-,*\,-..x>..,% .? ".,?,=-.,,? .?......a. -.,.> ~.<-? ..:. .....'.-a . d~scusslon , . -. ......... ...,........... ..$ $-"-. ........ .................. *$> .......... ".\<.h". .a<. .%**A*. ......... , , ".. - Services of VCTare cheaper now. Earlier One should have pay about Br. 5080 for a test. . .~ .. ...... ..-.... , . . . at-"-> i .A C - Support for PLWHA - HIV/ATDS is attributed to other health and'superstitious p'ro61enis - PLWHA are not cooperative enough to discuss and sup'poit -e&ch"other. If we are ..... .,, supported individually, we might -be productive ......... L-...-.v-aw.... ..,. ...- Ll ......... . ' ., ... ...... .... .............. ........ ... . ., ...... .." - Stigma /discrimination ,, . . CB* .... ,i...- .. n*:.. ... :xi'.........'..'.. ..I...*. . " .. - Neighbors discrim'inate me and my daughter ,~.7%,':'. -t.-.'b", >s,*. .............. - Other PLWHA had been thrown Out frdmtheii il"t~zh,ou.se by home owners .... - sBl It is only 'the goor who- heed eibhomii support thattke eiposed'to the discrimination and stigma. PLWHA with , . adequate income need - not'disclose themselves ....... ........... - ., . . in public. la Institutional Responses . ji3 ---I ... , + Views on past HIV/AIDS Activities ,, ' . ,,. " _ '. - Improved access to VCT services - Improved community education - Improved attitudes towards PLWHAs Views about HRCIprogram Strengths - Securing means of subsistence for PLWHA - Access to CHBC services and care LMTAnONs - HRCI provides what they have budgeted but it is not suficient for survival - Need for free health service PLWHA are prone for opportunistic infections - Lack of income generation sachems for us to be productive Focus Grotcp Discussibn with PL WI%IA Involvement, Responsibility /Participation on 'Project Developed Contact with Project after The Following - FGA Counseiors referred us to SC project - Referred to SC by counselor from hospital and health center - HBC volunteers came and contacted us at home while being ill - Motivated to receive care and support service' for being too sick to work, absence of any other household income , highly disturbed and had suicidal intentions and ..... . . felt the services as appropriate after being c&nseled Responsibility /Participation on Project - Two participants received one week training . . on positive living/ counseling work as peer educators - Majority are currently involved in HIV education teaching other PLWHA on how to live positively with the viius on our weekly meeting - Others assist HBC volunteers on our visits prdviding care for other bed ridden and sharing our experiences , . Perceived Future Participation in Other Community Services Majority expressed their hture wide intention to - offer HIV education to our community and reduce stigma - House to hose visits to give one to one education for friends and nearby residents , , , ~. on HIV in general and how to live with , ~ .. the virus- . ,, . - involving in-HIV edLkitibi throiuih usinsing ~ohihtiiit~ meetingsaid skhobls e ,. .* %, . , ,., .. , - One respondent stated-'to.have recently got a support letter from the government. ,~ .. ,.&* , . 5 to educate the community traveling "in different 'prices ' .- . . .. , . . ,., , 2. .:.. ;r ... ... . ,. ... .%. -., " , ~.. * , ., . ~ . , -, . _ .,_ . . ,. . . ..... ,". .. 1.4 ..................... . . .- < , " .....:.. ,: .......... ,-,. ' , ., , . .................. -........ .-.. / i: - , ....... ; - ... ,, ........ ,;.~<:*"~"&,,~~ ?.,,> ZbA,i. .;, ;,,;;&,";>>- ;&.\;$;.;&;:$t$;;Hgi;. A..:>.......<. t-.r--; ), .. 1-1'""5 jl"l ........ -:..i*-. ., ,... .z l-...;: " ." - , ,. : . . ' ,, . . . ,,. , **-a. .~"+ ... .ir*,.-xr-* .............. ,,:A. .......... i. ill 2- . 7 ......‘ . ., ,. . , "'r' , ->: Knowledge and ~vai~ability of Sefvices and' Providers - Participants wei-e found to be aware about voI@teers 'ari~~~er GdbcaGrs 'and our ~ , .. services of thel'existing preventive services such 'as VCTTST~, m'edrc$~" s-~.i* r .. r .,i . " .~, "' - - regularly advise and educate ..... our children to protect them,from infection.' , .. s ... .:.... - ........... rr--.+ ............... - Two participants live with HI'V negative spouses who know our status and get ........ ( ,," ,*,'~-., ., .' ,- , good treatment and care at home. .- , . - All reported to have told our children aid family mem6ers"at;out our status, engage in discussion about HIV/AI[DS/STI'issuks anil statea'to be treated well. Existing HIV Prevention Practices and condom u8e. - Majority have abstained from sex while others use condomal~ays - Two participants live with informed HIV negative partners and use condom alwavs .......... , - We take strict care in avoiding . sharing -- materials withfamily rhemh'ers'aiid ......... , .......... p ....... 8 ..................... .............. m ... ' , - We teach our families on how to care fbr usif we get ifl *,~,.,."."s ....... 4,, #.9.$.*.'#G.'2n.-. <"s&.- - ,' A participant status, to a health worreer- Gfiol .Gas sktting TV -+ .L-~-..,,;-.~~~.-~~ * "* , \=. ......... ..A; ,.,! "+.-"G.3-.,%>' ->.A. .PA.... ~ .. ..- -.. ..... .. -- :.... - -.. .:.:,::: --- - . tr-eatment without wearing glove wfio tKankedher.[at-er ..". ,., ...... ~ .........= 7* , ..<-. . ,,.*,. ,-.,, * di..,v,,., -..-, h~ parents *-..*. "". . ,,., _ .,,, residing , _ L,J. li ,,,_*., in . a .,. i _la,i, rijli.j_i_lir-._l . . - rural area after the'.deathOf his wife who revealed his status and cor@ced us , . ~ <"-., .,.' .* ", . - . , . . , ,' , '5. .',""*.A,".. , *., . - . , . ................... ':+.*,aL. a.*~;3.~:,."A-,%~<%9,~*~>%'*+~{?.*., .. <.... .:~% .......... , . i. 1 ........ i-l,L-'.XY^. il'. ir*.",, ......... i Views, Satisfaction and Expectatidni.t-in VCT/STI,YXW and Medl~ai.'S&+ici~ E" .... ......................... VCTISTS 'Services - Participants that the reception of counselors and ....... the i&rvicieb'it mcentir were .-% a,,,,m- .*..w.m.%.* ...................... ". appreciated and felt satisfactory to whattt'we expected - VCT counselors were also reported to be highly supportive, receive and treat us verv well when we " net ill. , , .. .. "' " ,. ,. ~. . Medical' Services ................. . -,<, . - In general, We are dissatisfied by the medical services Bnd face many problems at ..-. *. ...... "A ....................... ... dil chora hospital in particular - Poor health workers approach and medical staff stigmatize and often mistreat us ............. 2" ........ ...*......*.*..*...- ........:......... - We are not given priority and'offen told to come another day when we are ill . ' .. 4 , - - Lack of access for free treatment and should pay' even having poverty certificate from the kebele social courts for Card and diagnostic sei%ices"l'lEeXLfay flied ^For inpatient treatment , drugs and often told to buy from private pharmacies . . ... ii " . 2' ... 7". . , , 2:. ....... .< . .. >< ...., I. .,," r*i,r;:,. .".. 3% \,G .... ;, ...... ; . .,b ...... . , ............ ...................... :',.* ,. . , ".., . , . - ',.., . .,- ......:..... .l.;"'~,v:~.?:~:g;. .. :4'.:.-:. .*.,1-*;,::. . - .. ,; , .:',:& .... *"" ... " ................ ..a.u-.... ......... -, -W(3 were being given ade@ate . ...................... irif0iiiiati:ori'and. were ...............,..A. adequately prepared .......*...... to ............. hear ...... : ..,..; -..t., -* ,- . ~.,., . . , , ,, our results -, , ~edical services ~ .. - We are satisfied by the health workers approach and support .... ,- .................. - we are given fiee medical services, pnority for service when we are' ill and medical staff receive and'treat us very well. CHBC Services ..................... .... .\ < ,.,, - The existing HBC provision by'volunteers wasreported to be good; proviaers' make regular visits to all clients and give adequate attention. - Monthly financial assistance comes late and irregular has made our life .... " ~ difficult - Provision of soap, detergents has stopped i i Attitudes on Existing Community ISociaT Support, we don't have much interaction nor do we get any support from the community m Views on Past HIVIAIDS Activities b -,,, Successes - HIV activities supported by VCT and HBC services has improved our lives and . . no one is seen dying without help because of AIDS - HIV is no more seen as dreadfbl and discussed in public - People who have been educated on HIV issues have brought positive attitudes towards PLWHAs Major Challenges Faced By ., PLWHA . . ., . . - Lack of suficient food - Inadequate financial assistance because high cost of living and house rent - Poor health to enable us involve in productive activities Views about HRCI Program 7 Strengths - Ensured means of subsistence for PLWHA which we never imagined - Strong HBC services and support from committed providers and committee P . , members - PLWHA have been made free from drug abuse and lead a positive life Limitations - hadequate provision of soap, detergents - We receive financial assistance very late and it has been 2 months since we got . . money - Lack of income generation mechanisms to free us from waiting for monthly aid ... - ., ,. , . '.. , .... . ... ....... . . . ................. -. ........I ... ............ .. ...... ............... (_.*, ......... :: ....., :,.: ,: ? i,: , :;;..:, . : , ..:, ...:.;:!,!, +*; .:.: :.;; ; :.;,,. ,:;,: .,,.; ............ % Nmre& : ,:. 1:. .... -'.: ,;::.: ::,:;$.: ':~:~;!~'~<;.::,:.~j~.;; ::::;.:;;.:;:;;;;: :, :$.: :';';::::, ..,:,;': '.::?-:! :'~,~,;~~~:;~;., t... ::..::: ;,!!: :,: /y';f;<:.:: :, ',;:.:.. . . , , _ . I I. I . . ....... -* ..& -v ~~~~ww~~- ~~w~.~,s~~~w94~44~~-~.~~%e~~~~;~~~~2~.~~ *. ,'a; z., .... : 5 ,- ",1.;--'-. 1.:;.*T.'2T~:s4."X~**&+*~~&~~:@$~%*<~$~$"~11 . ...>-I1,.. a. ...,,... ..... ;<-iiiiiii A', ', ..-.#, . ."";i. .. '...A .' '.vwxr. w , z~~~~~~~~w7.~..r.iiiiii.iiUU~"d4U ,, , <' . "" . . - ,, , , ~ .\. .--- - . .. , , . , , .. ... . -, . . .. . .... ,>. . , ~ ,.'S ,*.,.. .a-..-<*.,.v-.-, -,.- .<..,<... .* %/-'.'"~ -.,:.: >L.,az-*-, ..-w,*.<" ,* -%".,.- ,$-,, ,",.:,; >.,, ."..:,#.,*,@,., ~z;, ,I, .. % ., ." . ' Involvement, Responsibility /Participation on Project Developed Contact with Project after The Following - referred by OSSA VCT center after self referral for testing . . . , - After being informed by a neighbor - Contacted by HBC volunteers - motivated to i~&e _ ~LL~Q-G.. ~e~,~:ige~, j;4,&,r, ,r,ri?ez .".&mis for .s-ww4w. getting ........... inf~rmation,,.~~ t$$*~~,..&n,d~ positive living, for ong ---- treatmm.-anf, ..... .-y.,> .. <... " %. /$ .............. - . , support .and to. he._~!i!.i~~-*&ucgte~the communiiy ..-..-...-. .~, . , .. ,, , ..... , .". ~. . ....-. ..; .......%. Responsibility /Participation on Project - Received training on HIV and positive living, provide education to* peers , the community and educate colleagues at work place Perceived Future Participation in Other Community Services - Providing education to peers about HIV - protecting partners from getting ,411._.-' ll., infected .- ,- -. I l.il with ,.. the virus .......................... ..*.... - To develop personal career and become productive citizen through , -~ skills . training . - To be from dependent on monthly aid and get employed ., .\*3*7-- ..... > :-*:*s iG..,&"Z &s,;~:i..,"i.; -* \.'Z~ ?;-. A .<,. .. .- ', - ?.p **&.a<-**s<*<. ,#-~. . ,,:.e.*?.m.. - .:',' . :, , ~., -, ................ ............ ,* . .,s,,**.;" .**,-, .*b"*> \,*~ ,.t, :*: . ~?. s,,>, ....... .-- . , ... ..... .- - . << ,- >:: ".& :>.. & .""* - %*.-< ' :-a Zd *.4.,~*:*:?.-" , , . , . :< > ,* , , ,_ I. Knowledge and Avaifabiiib ofservices and Provid~?F .,+ ,. ...... *,_ i.~ __Luz 5r&wA~ a,~J,,dx ... a, .. ........ - Only three .of .t$e,&$-pai3ici@nts know the. in~~~.~~~&~~$$$~~~@@&~,,pr~v~~~~~ ....... ..- .-. .,-., . ?..-<. ....%2:.*-.?:, .--,-*; ,:$; *w,... >>: .. , . , ., : by HAPGO but all-h ndt";isitea .the -denteria .... -,~.*->. ......... -,.,. .".* ....... ~. ts- ~--~"-r~--~~-~-~~--~~$~~drx?.,~a~~~~-, .*<.Be<+ ~;:,r#kar.,:i~ .- *hi'> l+l+di_~l-Ll',1Dj47+&$,~gFi2~~ 8&&7?$$$*?~~ i'*." ',.' - Majority know volunteks , , ., x a ,a~ . 'a$&& .- . - qti-yiti es buttthave_.g~&gn wM43sJ .~.~i+x4~~, -,a*., - t .. % - . - Only one participant 1s aware of what peer educator - PLWHA receive ongoing counseling services from SC -. program, ... .,.pa* OSSA ,--, -,." ........ and -, - ............. -, Tesfa goh - Felt the services .and the staff ,reception is good . *( ' ..................... . " ~. , . PLWHA Situation, Preventive Practices and. Condom Use ........ Family History and Relation with Siblings , . . , .. ,. . . . ............ ,LA .............. - Three participants have children with age ranging from 3-16, only one lives. 5th , . own child who "never knows about her st?tus.~~~t~dis~~~~~~,~~~~~i~B,.&~&~&~V di_,a.,3,A,*e'2., ,**:, .: ;. .." issues. "., ,, . -, .* .", -. ' * .,-.* ~?,.?,d*>,) *., -5 .,*, ~~<",., ..~. < - Majority of the respondents do not live with the.ir, famil/e.~,.a.nd~.~haveno~good relationship with their families though they reside in the town. - Those who live with their fadies nev,er tal_dth~ir,~~t.at?1~~0~~~~~~~~~,~~~,~~~~$f~~ ~,CCCCC. .... t.,sw". .. they fear of being stigmatized if they inform. .,. ............ .-....... ,-,", ..... "8" , ~-'.,="., *.. '* . -a Existing HW. Pievent ion. pie vent and. Co,$P,~m*se +, .-- .. ..*, ,,, . , , . . . ." 8 ,> ,~,. ~ , ,~ , . ~. - L * - h. , . " . ,, _, ,, ,_. . , . ,,. ." f f - Majority reported to Use ofcovndo.~.a~,ways during sexual encounter rmn I.1 -., - . Others have abstained from ~~al, practices ,. . - All had no expe&nce or n6Gerpracticed sex that is unsafe, -_.I or .. without . _,. , . .. !as+ condom. - *VI Views, Satisfaction and Expectations on VCT/STI, BBC and Medical Services m VCT/STI Services t , The services were perceived to be satisfactory for - The reception of the staff was good ; the counselors approach and advise was also ma i. appreciated - Received pre test counseling and the sessions were perceived to be good with adequate time given fro us to get well pre pared for the results, arg - Adequate information was given as to their expectation at pea testing counseling - ' Medical Se-vfces ., , , , m - The medical services were perceived to be in general good at public health facilities. - The private medical services given by a medical doctor in town for PL~A was highiy appreciated CHBC Services - Received regular visits from Hl3C providers - ~s~cholo~ical and emotional support - Received counseling sessions Attitudes on Existing Community /Social Support, - One participant gets good treatment andsupport from land lady. - Two participants mentioned their @ends, provide them moral and financial support - It was reported that CBOsin general never give support to PLWHAs - IDDIR rneqbers oficy -. point fingers at positive members Views on Past HIV/AIP)S Activ,.." ".. ,:,A% '~ .-,", ,-> ', . , , . i 4, , . .,. . I : .................... .:* :>;- .. ,,; .. :is:-..< .. ,.-*,--: .... s,/*,:>;"::+iJ~;~ dL;+;: ;y :&,A,.. ::- :., ...-. .; L + .. &.;,.~:,;..;.: -.,.: .:<, "~;- ,;+, A%.-" :,.$4. $,, <2:,*:?.;z." ~>2c\;q<:lta$- *,*;{ '>A ".-+<.."*t,+-w*m.,,<- - -- ,-s ,.,%*$,&c*? &P,L;~;>' ,*: , 'b~4 .k~~>G*&*+*.s~<>;,~~~~.!$ , , **&..= %~:.!#J$z~."~.-'i~ .>, ' ,*,. # . . J:.-., ~. ,+. m* .a5 3 r". 4 -6*'>?N. \'># ,~, , . , ................... : :4 , ... ?.*~*.oL:".;w~+:c ...* ;.".* ........ ".:".* 1- ,* ..... ,?* ............... ..,; .. - The HBC providers should be more committ6d to. FiGidk the services and respond well to dl requests and emergency situation ' I .,. .- - As to stigma and discrimination, PLWHA."sliould rediii~es6rf stigma first for the society - Improve the provision of medical services to PLWHA Views about HRCI Program Strengths ..' .X .. _ ) . ~ .- - improved access to ongoing counseling, care and support servlces - The existing care and support to orphans is highly satisfactory - better HBC services when compared to similar serJJi*cespro.Itiakd by other NGOS ...................... ..... "&...a a,-#,, ,,.-*-,., ...,... . ,- , ~ . - ... &.. &. .. ,, . Lr'mitations .,., .._... ........ . .ilr.., -: r:,~*.-l..B' _; ...,.. .'........ ,*--.A ~ *.--. "., .. - Lack of on time and regular monthly financial aids' . - Difficulty to keep confidentiality for people now identi@ HBC providers by the .. ,,"?~ .. ...%....... ?., .-?>*6~~,..".~.:~->T,,~~-~',, -...* .~ " big they carry when they makehome visits ..... ?., ....... ......A,.... - Lack of access to ARV drugs .... :. >-, , . Involvement, Responsibility /Participation on Project , . ' . -,, *, Contact with Project after The Following <. " .... . ,,-C^r*.+* .. -.* .- , """" ". ._ , " .- *, , " , . . .... ...... ..... 9 . , .... ,, ' .~ '.L..' -. .;.>>*~~:>.~v.,%'4,,3. -,.-. - ,,,. ,'\*. ~,"". '*.'. . - - 2 i . . ~. '.''. .;;. , ;&d*.,,~~,.~z.~.j~kc~.RA.w.~~:*.b. 3 k<+.d>": ->,. >....... :., .<,<.~> *v,.. *,,. *.., ;+ -.. ..... ... - ori it acted bv HBC volunteei-s" . ,, . -.: -3, ; ~%41..:1.11- ~ ~ .~ J -.. . . . .". . . ,,-.*.- *.*<*'~,.,m >**%~*~*".%*WA-*$*.!<:*~I ~x.*~:<~:&>.t:,~~>;::,~ ? ;:--. ::,- -. .u,b,., :., ,, .",,.tz->A* %,&~~-r,s -: Received counseling and decided to Gndergo VCT .............................. , . .<<< *.- ............. *. ..... ,, . ~>? e,*;"?b"%a,.; "a+.. >,. :<. . *+..:cd;.:a&*s:-?cA'.~ ,-4: .:~, .... : : c'. ............. . - ... -~",<*..*.>"--*<,e,.,z .,&"..:>$ ---iic- ~il3&$$@~@ - ~~C.a&eg&~~gg&2gfa ..... .- .spouse -, "- .". ,..:*. , , ....--.- ......... &-,'-'- ;~~~7i:F;~7~~~~x6~-c7,:~~~z~<- ,;,, ;.?;':7'--: ":- 7 .-:".'°,~.--*i=~7.'i-ii-i.:1:.. ;'-"-L-\-~C*"'-'- - ?.iagnostic'referra1 to' VCT ~ ,,,. . ,, ., '. *.*, "-:',.' . '-. t. -, ..: .-..;. .m<-*;*.,c~,..l-. .-- .*- *-*., - . . ?,. " _ .+. ," ,, -- Xy - >- rSb% ........ -, .*...- ""A.sa-< - .-...-. '.....r->d'~s~~U~*i*i+..ki Eli".'" 2 ~ . -, . - ..",A .--- ...- .. "... .........*. > ,A.,-.* a :-4" -. .**. *<%*d""3.a*~%**.&+.*. bam$*.;&s;:.: .,., k"<.* ., " '-< '. ' ,- ~' ..*e. ** , ., - Motivated by the care and-support sefiice as.af1 d;, not have otfier householii"'income " , .I .', ;I. . ,:, -..! a.b,+'+;-C, ;..:,";.,. .. . . , r, .. : .A,._ - a,$,,. ;; ., ..,~~,~~~~,z'~~~~~~~~~~&~~&~~~~~~~&~~~,~~~~~~~~~~~~a~~i.~~~~:~p~~,, .vi.i,.~. , ,,-,~ ;- - . .:. ., .- ,,, ,-, . s:;. . . , , , . " .; . *. ; :' :,.-.:s .... 3 ",?,">:>;"<:*<:- ,ep,>*."G..~ ,,-.a,.. :. .. :.,a . ,,*., 2 ....... ?."-i, ..... %< .:... .,"I, ,<>. . . . . .. .-, .... ,, . . . Responsibility /Participation on Project ,. , . . .-'-,"-?*ea .. .sew&.sw.. *:we*,, &...*,~.<>@,a .**%%-*.*, ..... .*:*,.- .- . 4 .....%..... "%~" . - One received peer educator training on . positive _ ............ living A.,.a. .. a* ~", an&unsel~n A .... ,.,.- -,--*** ... - .... by SC and ", provides HIV'education on.community meeflngs organized by the project and'one ,;i- Jr;r-> . ...- Ij., .. .- .. \I - ,. ~erceived,~uture Participation in Other Community Sikiees' '"-.' '- ' . ,l , ." ..:: "1 . . ;- -; . ---- * ",, ^ . i<:::.)i<-,..^r>r . ' ' .-, .+.“., *>.. i, ........ - All, participants expressed their inteiit'ion to participate in public education on : WV!AIDS. : -I . - . , ,. , , *" . . - . , . ,\ , -.. , . - - .".. " l,.- ','" ,,<* , -1- 1. > .- - - , ". - However, challenges they fear facing worsened stigma.-and its' consequence on their children they .daily encounter"ad gettirig ... expellea%-om *. ... .*~.* ...... +,," ...... .* their ........ rented .-~ houses ...... by owners. Knowledge and Availability of Services and Providers - Participants are well aware of the existing services such as VCTISTI and medical services, CHBC, support to OVC, IEC/BCC and preventive services. - These services are considered good although access and inadequate economic support are identified as major problems 152 . - . .. . , ,.* "- :. " - -,- ,. , . . ,, , . . . .: . . .. ." , , . ,. ; .'.. ," . . ,.-..',. .., , , ,- . , ._ , : , ,*4, .> ., , ,"., . *,. ;% ,-.;, ,", ", ,, ,., ., -~, ' , k.3 .. . . . ". - ... , .. " -,.,. .. . ,.. 9 .. .- ., -. ,-: :" '- . . .. r :. , . - .,, ,,.. . . I ' ' . . , . ~~ . (_ I _. , " 7 - " , _ -* ._, .. .~ ' " ,."~,,..' ' , ' . , . .*/ ., _ _ ' .I .' , , p - -. , .* -., ~ .- - ., , . . .. , " __ I .. , , , .#&%.',. .,: ,. i,%.rs-..;. .*: *.. $".,. , . . .. 3. . . , , -. f ' PLWHA Situation, ~?&v~ntive~~aetices and ~bndom Use , ,< Wr, : ?1 .. .,".,. , ... . . k. , j ~a~ilj History and ~ilt%n'$it'h Si'btr'tigs a ~mn - All participants have children of age 1-30 who live with them I-* - Two participants have HIV positive children, others have then in good health - Parents of children with good health' regularly advise and educate their children to "4 a ,- protect themselves fiom HIV infection. - Two participants claim to have informed about their .$t,qtys,to their,ghild~gn and . . engage them discussion about HIV/AIDS/STI and expressed are treated ~,.,..*~" well .. . ,. em - - Most . . of the PLWHA met did not inform their close families ~ \ . s . .I_. _, . A> ,,., i._ _ ,^ _, .,_<.+, ,-,-- (," *., .. Existing HIV Prevention Practices and Condom Use - Majority have abstained fiom"sex and remaining use condom'always - Strictly avoid sharing materials with family members - Few inform about their HtV status to their casual partner who did not want to use condom Views, Satisfaction and Expectations on VCT/STI, HBC and Medical Services VCT/STI Services Satisfactions ~ ~ - Appreciable reception by counselors and the services of VCT center - VCT councilors were also reported to be highly supportive when PLWHA is ill - Expectations fulfilled - Given adequate time and information at pretest counseling - Adequately prepared to receive their results Problems Observed - One of the counselor's approaches and communication during counseling lack ,. . ,. , ~. , .. ethics as s/he mistreated clients - Clients going for VCT are usually maltreated by health center staff in the reception due to absence of sign post for the VCT in the health provider and inability of clients to directly go to VCT Medical Services Satisfactions - Satisfactory approach and support by health workers ' 5" .~ , " .,. . ' . - Appropriate priority given to'~LWHA when they.are ill , , Problems Observed . . ., . p? t. . . .+ -.' . ,.. .. . . - Lack of drug supply . ..* ". . . .,, - . . . . . ,. . . ., I, " . , . ~, *, . . . , Q ~ - Absence of free treatment ' ' .. , . . + '.. - .,.:- ,: ii..,, .. .- ". ,.. . .. . . . .,,,. ._ , . . ar% , . . . - . . , . , . _.,_ . ,( 'I @=<.., 8 " - Lack of diagnostic services like X-ray (the often are referred . to Nazareth) ,,.,.>.., ~ ., . - Lack of bed for inpatient treatment " i ..A. ~ ! - Existing CHBC provision is appreciated the service and their regular visits F - CHBC providers give adequate attention given to bed-ridden patients Problems Observed w - Monthly financial assistance is provided late and irregularly - Unavailability of sanitary materials (soap and detergents) supply - Inadequate first aid materials supply for CHBC givers grrr - Few PLWHA were given bed sheets during distribution Attitudes on Existing Community /Social Support, - Some IDDIRs have stooped penalizing PLWHA members when they fail to pay monthly contributions - Global clinic (private health provider) provides free medical services to PLWHA - Few community members also treat PLWHA well. (A participant receives good care and treatment from her land lady) - The level of stigma and discrimination faced by PLWHA and their children and family members was identified to be very high by all participants m Views on Past HIVIAIDS Activities Successes - Improved access to VCT services. ., ,. -" , . . - Improved community education (workshop for the community and barlhotel owners and workers) - Improved attitudes towards PLWHAs . *, ". ., ., ' . , -, Major challenges Faced By PLWHA - P Stigma and discrimination ? - Lack of sufficientfood a, - Inadequate access to medical services . ~ - ~8 Poor ongoing counseling, psychosocial and emotional support r ji . . , . t. Views about HRCI program ' $am Strengths - In Securing means of subsistence for PLWHA m - Access to CHBC services and support of health-care providers b .i Limitations m. - The need to register our children for care if we die any time * is Lack c of . income generation sachems for us to be productive