Please note: This archive was last updated in 2005.

RHO archives : Topics : HIV/AIDS

Program Examples

The programs described below illustrate activities developed to provide HIV/AIDS prevention and care services for people in low-resource settings. Wherever possible, outcomes and lessons learned are provided.

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Colombia

Colombia has a population of nearly 43 million, 140,000 of whom are living with HIV/AIDS. The virus has spread differently in different regions of the country. In the northeastern and Caribbean regions, for example, heterosexual transmission is the norm; in the country’s central-western and capital region, HIV has spread mainly through homosexual contact. A 1999 study in Bogota showed an 18 percent HIV prevalence rate among men who have sex with men.

The Program
Between 1997 and 1999, the European Community funded a project in three Colombian cities to promote risk awareness and safer sexual behavior among young people. Those planning the project found that young people were subject to a number of sexual and reproductive health problems, including unprotected sex and low awareness of its potential consequences, little knowledge about sexuality, and limited access to counseling and services related to sexual and reproductive health.

Project implementers decided to develop a primary HIV prevention program to mitigate the spread and impact of HIV/AIDS and other sexually transmitted infections (STIs) in low-income areas of Bogota, Cali, and Bucaramanga. The project provided HIV/STI-related education for adolescents and young adults of the three cities, as well as promote risk awareness and safer sexual behavior by developing training programs for secondary school teachers and adolescent peer educators. The project also aimed to build the capacity of local nongovernmental organizations responding to HIV/AIDS and improve national networks of HIV/AIDS NGOs.

The project conducted the following activities:

  • Information and education sessions for teachers (focused on classroom communication skills relevant to reproductive health and using information/education/communication training materials).
  • Training of teachers, students, and peer educators on HIV/STI prevention, reproductive health and the importance of safer sex.
  • Peer educator-led campaigns among community groups.

Specific methods included teaching correct condom use, raising self-esteem, and improving negotiating skills among sexually active young people. These took the form of group discussions, role plays, case studies, skills training, and lectures accompanied by discussion and films, including the participation of a person living with HIV/AIDS. Young people participated in the design of information, education, and communication (IEC) modules, and peer educators distributed condoms, brochures, pamphlets, information sheets, and videos. Nearly 950 teachers and more than 100 adolescents from 141 schools participated directly in the project. The teachers subsequently held 189 information sessions and workshops as well as six two-day camps, reaching more than 8,200 adolescents.

A post-project knowledge, attitudes, and practices survey showed that correct knowledge of STI transmission increased from 56 percent to 81 percent following the intervention. Knowledge of condom effectiveness increased from 53 percent to 92 percent among adolescents and from 69 percent to 93 percent among teachers. After the project, 92 percent of adolescents conveyed their intention to use condoms, as opposed to only 63 percent at the outset of the project. Following project completion, the Colombian Ministry of Health, Education, and Welfare and local NGOs adopted the health education modules as national tools.

Lessons Learned

The Colombian project yielded the following lessons:

  • There is a need to develop and conduct widespread school-based programs for sexual and reproductive health, including HIV/AIDS prevention.
  • Trained teachers and peer educators can achieve high coverage in implementing HIV/AIDS prevention activities.
  • Enhanced project success is associated with participant involvement in project design.
  • Activities should be culturally sensitive and relevant to the needs of intended beneficiaries.
  • The participation of national health authorities is important for the sustainability of HIV/AIDS education and prevention activities.

Information adapted from Perez, F. and Dabis, F. HIV prevention in Latin America: reaching youth in Colombia. AIDS Care 15(1):77-87 (2003).

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Ethiopia

According to UNAIDS, 3 million of Ethiopia’s 65 million inhabitants were living with HIV/AIDS at the end of 2000, a number that represents 7.3 percent of those aged 15 to 49. One million children had lost one or both parents to the virus. High levels of poverty (gross national product per capita was only US$100 in 1998) combined with a 65 percent rate of illiteracy, fluid borders, mobile traditions, and the threat of renewed conflict are factors that render Ethiopia’s citizens vulnerable to HIV infection.

The Program

To respond to the challenge of HIV/AIDS, the new Ethiopian Ministry of Youth, Sports and Culture decided to involve young people from all over the country in the process of formulating policy and planning action. The program is based on a methodology called “Participatory Learning and Action,” or PLA.

The process began with an in-depth training program and the selection of 51 youth leaders by regional HIV/AIDS Prevention and Control Offices and Youth Bureaus in all 11 regions of the country. The youth leaders proceeded to:

  • Implement peer education initiatives with more than 800 other young people from throughout the country.
  • Conduct participatory assessments with youth and adult stakeholders in both rural and urban settings nationwide.
  • Analyze the resulting data.
  • Lead workshops, validate assessment findings, and synthesize findings in their youth charter and action plan.

Several tools were key to the youth leaders’ activities. One tool employed during training was “body mapping,” a learning method in which participants draw representations of the human body. This tool demonstrates participants’ basic knowledge about the human reproductive system and other health functions, as well as highlighting gaps in knowledge and distorted information. The body-mapping tool served as a significant opportunity for youth leaders to discuss issues related to sexuality. Youth leaders also learned to use a “universe-mapping” tool, whereby they schematically depicted their family and community networks, and examined sexual and reproductive health issues from a variety of perspectives. Other important tools included assessments of youth-friendliness, cost, and accessibility of existing reproductive health and HIV/AIDS services. After youth leaders learned to use these participatory methods, they were able to lead assessments among their peers, in collaboration with adult advisors.

After training, assessments, data collection, and data analysis were complete, the youth leaders validated their findings with larger groups of young people during a series of regional consultations. They then reconvened in Addis Ababa for the first National Youth Consultation on Sexual and Reproductive Health and HIV/AIDS to present the results of their work. The consultation served as a forum for the young leaders to develop a national youth charter and a three-year action plan to mobilize youth for improved sexual health and HIV/AIDS preventive behavior. An important benefit of the process was the creation of a dynamic network of young people committed to the health and future of Ethiopia.

Lessons Learned

The Participatory Learning and Action process undertaken by the Ethiopian youth leaders points to a number of lessons for future work on young people and HIV/AIDS:

  • Participatory learning tools such as body and universe mapping can help young people understand how their sexuality relates to HIV infection.
  • Tools such as charters and action plans, with young people as key participants and catalysts, can serve to channel local energy and knowledge into a national arena.
  • The participatory process can help adults overcome stereotypes of youth and reinforce ideas for a broader array of programs.
  • Adult advisors need to embrace a long-term commitment to nurture youth networks for future action.

Information adapted from the website of the Global Health Council (www.globalhealth.org/reports/report.php3?id=88).

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Ghana

UNAIDS has reported that by the end of 2001, three percent of the adult members of Ghana's population of nearly 20 million were living with HIV/AIDS. In addition to these 330,000 people, 170,000 of whom are women, 34,000 children under 15 were living with the virus, and 200,000 currently living orphans have lost one or both parents to AIDS. Even more recent studies suggest that the total number of people living with HIV/AIDS in Ghana may now be closer to half a million. The HIV/AIDS epidemic is a heavy burden for a country that has otherwise made great development-related strides, including improvements within the areas of reproductive health, the national economy, education, and literacy.

The Program

In February 2000, several national and international entities came together to launch the "Stop AIDS, Love Life" national communication program in Ghana. These partners include the Ghana Ministries of Information and Health, the Ghana Social Marketing Foundation, and the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP), with support from the U.S. Agency for International Development. The newest phase of the program, "Reach Out, Show Compassion," began in November 2002 with the additional partnership of the Christian Council of Ghana. The new aspect of the program aims to encourage support and compassion for those living with HIV/AIDS. During the launch, 23 Muslim leaders and 25 Christian leaders made a concrete commitment—in the form of a communiqué presented to the country�s vice president—to collaborate with the Ghanaian government and other partners to deal with the many problems linked to HIV/AIDS.

The "Reach Out, Show Compassion" program is now working to increase the number of religious organizations, congregations, and humanitarian groups engaged in responding to HIV/AIDS issues. Activities include training programs for 900 clergy, Imams, and other religious leaders to create compassion programs, as well as television and radio spots that support a compassionate response to people living with the virus (for example, through direct quotes from the Bible or the Koran that encourage compassionate behavior).

For more information, please contact:
Kim Martin, Center for Communication Programs, Johns Hopkins University, 111 Market Place, Baltimore, Maryland 21202
Telephone: 410-659-6140; Fax 410-659-6266

or the Reach Out, Show Compassion Coordinator in Ghana at
Telephone: 233-021-773429/233-021-774097; Email: [email protected]

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South Africa

At the end of 2001, five million people out of South Africa's population of nearly 43.8 million were believed to be living with HIV/AIDS, including 2.7 million women over age 15, who represent 54 percent of the total. The HIV prevalence rate in adults aged 15 to 49 is estimated at 20.1 percent. During 2001, 360,000 people died of AIDS in South Africa, and 660,000 children currently under 15 have lost one or both parents to AIDS. HIV prevalence has risen rapidly in this country. For example, national antenatal prevalence of HIV among women increased from 0.7 percent in 1990 to 24.5 percent in 2000. In the provinces of Gauteng, Kwazulu-Natal, and Mpumulaga, antenatal HIV prevalence escalated from 7.1 percent in 1990 to 36.5 percent in 2000. In Johannesburg, HIV prevalence among male clients of STI clinics jumped from one percent in 1988 to 19 percent in 1994.

The Program

In addition to soaring HIV-infection rates, South Africa has the highest per-capita rate of reported rapes in the world. To respond to the double challenge of HIV/AIDS and violence against women, EngenderHealth and the Planned Parenthood Association of South Africa (PPASA) launched the Men as Partners (MAP) program in 1998. The program is implemented in eight of the country's nine provinces. Its primary goals are (1) to challenge the attitudes and behavior of men that endanger both their own health and safety and that of women and children; and (2) to encourage the active involvement of men in responding to gender-based violence and HIV/AIDS. In particular, the program is constructed around the following premises:

  • Gender inequities enable men to exercise control over women's reproductive choices.
  • The risky behaviors that current gender roles encourage in men also endanger men's own health.
  • Men have a vested interest in changing current gender roles, for the sake of their own health as well as that of their female partners.

MAP program activities center on educational workshops with groups of men and groups of both men and women. The sessions are held in workplaces, trade unions, prisons, and faith-based organizations, among other sites. Life-skills educators from the PPASA—generally young men and women aged 20 to 35—conduct the workshops, which range in length from an hour to a week. Facilitated discussions help participants explore such issues as gender, traditional gender roles, gender power dynamics, gender stereotypes, and male and female views of gender. One of the key strategies is to broaden men's awareness of the inequities between men and women. Participants receive information on such related topics as HIV/AIDS prevention, healthy relationships, sexual rights, sexual violence, and domestic violence. Those who attend the workshop are continually encouraged to ask themselves how each issue affects men and women differently.

Lessons Learned

The following lessons have emerged from MAP program activities:

  • Although mixed sessions can be difficult, gender discussions should ideally involve both men and women.
  • Younger people are more likely to open up in discussion groups involving both genders. It is also easier to reach younger men than older men.
  • Holding sessions in workplaces with management support can be helpful in reaching older men.
  • It is important for MAP educators to take a strong stand against gender-based violence.

For more information, please contact:
Manisha Mehta, EngenderHealth, 440 Ninth Avenue, New York, NY 10001 USA;
Telephone: 212-561-8394; Email: [email protected]; Website: www.engenderhealth.org

Information adapted from the Men as Partners Program in South Africa: Reaching Men to End Gender-Based Violence and Promote HIV/STI Prevention (EngenderHealth).

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Thailand

Thailand's HIV/AIDS epidemic began in the 1980s, when the virus was first detected among injecting drug users (IDUs). In Bangkok, one percent of IDUs tested positive for HIV in 1987; by the following year, the same statistic had jumped to 30 percent. The virus was soon detected among other population groups, including commercial sex workers, their partners, and families. Today approximately 670,000 out of 64 million people are living with HIV/AIDS in Thailand, 290,000 children under 15 have lost one or both parents to AIDS, and 55,000 people died of AIDS in 2001 alone. Young people aged 10 to 24 account for a significant proportion of new infections.

Thailand has long been considered exemplary in its response to HIV/AIDS. From community activities to nationwide campaigns, both governmental and nongovernmental entities have striven to prevent new infections and care for people living with the virus. The "100 percent condom-use policy" implemented in commercial sex establishments in the 1990s led to an important drop in HIV seroprevalence among sex workers in Thailand.

The Project

In 1995, the Thai Youth AIDS Prevention Project (TYAP) was created to prevent HIV/AIDS in young people and increase their involvement in prevention activities in northern Thailand. Based in Chiang Mai, TYAP's principal goal is to create opportunities for young people to develop the skills and power to diminish the impact of HIV/AIDS in northern Thailand. TYAP's work is based on the following guiding principles:

  • The most effective approach to HIV/AIDS prevention and care is long-term, interactive education that incorporates life skills. Directly addressing attitudes, beliefs, and issues of gender and sexuality will help bring about behavior change and strengthen social support for people living with HIV/AIDS.
  • HIV/AIDS education should begin at each person's existing level of knowledge and behavior. Strong cultural norms encourage risk-taking behavior, but promoting a return to a different era is not the antidote to these norms.
  • Young people having benefited from training are most effective in teaching other young people about HIV/AIDS. Youth are best equipped to discuss with their peers such issues as sex, risk behavior, and protection, including condoms.
  • Young people should be informed about and involved in effecting policy change. To build the leadership skills they need to help effect change in their communities, young people must be respected, trusted, and believed.
  • Effective HIV/AIDS education requires cooperation with people infected with and affected by HIV/AIDS in focus communities.

TYAP Programs

TYAP implements an outreach program, a youth center, a train-the-trainer program, a youth leadership and advocacy program, a children's camp, a teacher support network, and an alternative women's project.

Each year, TYAP trains approximately 25 youth volunteers to be HIV/AIDS educators in their outreach program. These young people receive intensive training in HIV/AIDS transmission, prevention, and infection, as well as in gender, sexuality, and community building. Trainees then develop long-term HIV/AIDS-prevention curricula and implement their prevention programs in schools, vocational schools, orphanages, and the streets of Chiang Mai over the course of the year.

TYAP also developed a youth center in Chiang Mai to house all of its youth-based HIV/AIDS prevention and community-development activities. The youth center serves as an information clearing-house, a safe space for young people to assemble and plan activities, and a meeting place where both youth and adult leaders can work together to develop joint activities.

One of relatively few organizations focusing specifically on youth and HIV, TYAP uses a "train-the-trainer" program to help other organizations in Thailand and Southeast Asia integrate progressive youth-oriented programming into their HIV/AIDS prevention activities. In 1997, TYAP trained staff members from 18 nongovernmental organizations in northern Thailand, and continues to provide support as these organizations implement new HIV/AIDS activities in youth groups, communities, and schools. TYAP recently trained the staff of Thai/Burmese border refugee camps and has undertaken similar work in Laos and Cambodia.

TYAP works with promising graduates of its outreach training program to develop their own community-based projects. The Youth Leadership and Advocacy program serves as a valuable source of innovation and youth input into TYAP programming.

TYAP also runs Camp Sanook! Sanook! (sanook means "fun" in Thai), a five-day camp for 30 children aged 7 to 11 from families affected by HIV/AIDS and from families not directly affected by the virus. The camp is a major part of TYAP's effort to link its HIV/AIDS-prevention efforts with people living with HIV/AIDS in focus communities. The camp provides children with an opportunity to build peer-support networks and to enjoy themselves, as well as to reduce community discrimination against children affected by HIV/AIDS. Children attending the camp come together to play, exercise, create arts and crafts, discuss children's rights and HIV/AIDS, and participate in field trips. In the process, they build peer-support networks, reduce community discrimination against children affected by HIV/AIDS, and increase children's awareness of their rights.

Recognizing that teachers can help young people address the HIV/AIDS crisis, TYAP brings teachers together to analyze why young people engage in high-risk behaviors and trains them on topics such as adolescent violence, drug abuse, and HIV/AIDS prevention. Teachers work together to support young people in healthy decision-making, and to support peer leaders who run HIV/AIDS-prevention activities in schools.

Finally, TYAP's Alternative Women's Project supports women questioning the roles, pressures, and expectations assigned to women by society. Providing self-esteem and stress-management training, the project also brings support to their families and fosters discussion groups for families and youth about gender and sexuality. The project seeks to improve relationship and communication skills and introduce HIV/AIDS education. The participants in the project will eventually develop a program for further peer education, and will select a new group of volunteers to teach younger generations about alternative women.

Lessons Learned

TYAP is preparing for its first major evaluation in 2003. Informal interviews and other inquiries have yielded a number of preliminary lessons from the project's first seven years of work:

  • Young people's status as HIV/AIDS educators helps them gain credibility and respect.
  • Many HIV/AIDS educators have progressed from extreme inhibition to positions of leadership.
  • Several educators have gained the courage to discuss their own risky behaviors and others have voiced questions about their own sexuality.
  • Bringing together children from families affected by HIV/AIDS with other children whose families are not directly affected can help reduce community discrimination against children affected by HIV/AIDS.

For more information, please contact:
Amporn Boontan, Executive Director, TYAP, P.O. Box 287, Chiang Mai University, Chiang Mai, Thailand 50202;
Telephone: 66-53-274157; Fax: 66-53-808493; Email: [email protected]; Website: www.tyap.org

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Zimbabwe

At the end of 2001, 2.3 million people out of Zimbabwe's population of nearly 13 million were estimated to be living with HIV/AIDS. The HIV prevalence rate in adults aged 15 to 49 is believed to be 33.7 percent, one of the highest rates in the world. During 2001, 200,000 people are estimated to have died of AIDS in Zimbabwe, and 780,000 children currently under 15 have lost one or both parents to AIDS.

The Program

The Kunzwana Women's Association (KWA) was created in 1993. KWA's goal is improve the quality of life for residents of commercial farms, mines, and resettlement areas. KWA's purpose is linked to the impasse between the government and farm owners that has led to poor housing, inadequate sanitary facilities, and a lack of health services for farm workers. In 1995, KWA established its "Primary Health Care Programme" to help disseminate information and create awareness about HIV/AIDS. Women and young people are considered the most vulnerable population groups, due primarily to a general lack of education that impedes empowerment and a complete understanding of critical issues. Women are subject to oppression by both their male partners and the farmers who employ them for seasonal work. These factors result in women's increased vulnerability to HIV/AIDS.

To address the particular vulnerability of women and young people, KWA is raising awareness by mobilizing clubs and groups. KWA has also organized training workshops on HIV/AIDS-related issues facing women. In addition, KWA:

  • makes HIV/AIDS information available to women and young people in farming communities, mines, and resettlement areas;
  • works with farmers to make them more receptive to allowing their workers to attend KWA workshops;
  • uses drama groups, plays, and poems to disseminate HIV/AIDS-related information;
  • works to increase willingness to undertake preventive measures; and
  • develops community-support groups to care for people living with HIV/AIDS and orphans.

Lessons Learned

The KWA has learned that effective HIV/AIDS prevention and care depends on addressing the following factors:

  • low levels of female literacy in many communities;
  • a general lack of empowerment in women and youth; and
  • women's subordination in education and employment, as well as the disadvantaged social and legal status of women, which render them more vulnerable to HIV infection.

For more information, please contact:
MWENGO (Reflection and Development Centre for NGOs in Eastern and Southern Africa), 20 McChlery Avenue, Eastlea, Harare, Zimbabwe;
Telephone: 263-4-721469; Fax: 264-4-738310; Email: [email protected]; Website: www.mwengo.org

Information adapted from: Badza, S. "Kunzwana Women's Institute." In: The Impact of HIV/AIDS on NGO Effectiveness. [Part of the NGO Reflection Series of the Reflection and Development Centre in Eastern and Southern Africa]. MWENGO. www.mwengo.org.

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