Good Practices on HIV/AIDS Prevention, Care and Support

Key stakeholders
Youth.

Implementing organization/ Country
Yunnan Red Cross in cooperation with the Australian Red Cross /
Myanmar; Yunnan, China.

Approach
Build life skills and impart knowledge about sexually transmitted infections, including HIV/AIDS, through youth peer approach and the voluntary participation of young people and other local community members.

I. Problems tackled
Young people are particularly vulnerable to the HIV epidemic. Fifty per cent of all new HIV infections occurs among young people below the age of 24 years. An important element of young people’s vulnerability stems from the lack of life skills and knowledge to protect themselves from the harms that result from risky sexual behaviour and drug use.

II. Activities
Train youth facilitators, who work in teams, to provide other youth with training and knowledge on life skills needed to make healthy life decisions in areas such as HIV prevention, adolescent reproductive health and drug use.

III. Results

• A high percentage (e.g., 90 % of the 1,300 participants in Yunnan, China) of the trained youth acquired a good understanding about HIV/AIDS, with greater attention to self-protection, and improved attitudes towards people living with HIV/AIDS.
• Whole communities benefit indirectly from the training provided to youth. The programme has a high multiplier effect in that those involved in it serve as messengers of life skills and AIDS prevention information to peers, friends, families and colleagues.

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Key stakeholders
Teenagers

Implementing organization/ Country
A Group of Young Radio and TV Producers / Nepal.

Approach
Radio and TV “edutainment”: Life skills education and entertainment through peer approach.
Supplementary materials (booklets, photo novellas).
Interpersonal discussion and correspondence.

I. Problems tackled
Adolescence is a period of sexual curiosity and experimentation. Teenagers engage in a range of high-risk behaviours as part of the experimentation. Peer pressure and a lack of confidence lead many teenagers to make the wrong choices about their lives. There is also a common fear of taking responsibility when things go wrong. Such attitudes and behaviour have serious implications for HIV vulnerability among young people.

II. Activities
• Assess target group knowledge, attitudes, practices and skills.
• Design / implement communication strategy.
• Train young media producers to design programmes using real life situations, to stimulate reflection and inspire positive action among young audiences.
• Design / implement peer educator life skills training programme to develop critical thinking skills and help young people act more responsibly for their own health and development.

III. Results
• Nation-wide coverage of young people through weekly radio/TV programmes.
• 344 listeners’ clubs -- mass grassroots base for peer education on life skills training -- sprung up in 60 (out of total of 75) districts in Nepal, including in areas at high risk of drug abuse and HIV infection.
• Effective means of mobilizing young people by meeting their needs for emotional support and guidance on critical life choices.
• Mass popular appeal of radio and TV communication modality: active and high volume of correspondence (hundreds of letters weekly).

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Key stakeholders
People living with HIV/AIDS (PLWHAs) and their families, friends and communities.

Implementing organization/ Country
Sanpatong Thai Red Cross Society Health Centre and District Hospital, Sanpatong / Thailand.

Approach
Build capacity for self-care and self-reliance of PLWHAs and their families, and change negative attitudes towards people with HIV/AIDS.

I. Problems tackled
It is important to anticipate the needs of people who are HIV positive and provide them with emotional support and practical self-care and self-reliance skills. People living with HIV/AIDS themselves and their family members need support and training on home-based care.

II. Activities
• Training of family members in home-care skills.
• Monthly Thursday club lunch gatherings and support groups for people living with HIV/AIDS (health services; food; recreations).
• Small support groups: fostering of family bonding; sight seeing, camping.
• Meditation and spiritual care.
• Community care: mobilization of whole villages, especially neighbours, to provide care and support.
• Support for the special role of grandmothers: training in care and self-protection skills.

III. Results
• People living with HIV/AIDS have access to primary health care (self-care and care by family members).
• Costs of care are reduced through training for self-care, and care by family members and unpaid volunteers.
• Grandmothers receive support in their care giver role.
• Attitudes towards people with HIV/AIDS are changed from fear and discrimination to compassion and understanding.

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Key stakeholders
People Living with HIV/AIDS.

Implementing organization/ Country
National Sanatorium Fukui Hospital / Japan.

Approach
Fight social prejudice against HIV/AIDS by communicating hospital’s solidarity with people living with HIV/AIDS.

I. Problems tackled
People living with HIV/AIDS suffer from stigma resulting from prejudice against HIV/AIDS.

II. Activities
• Put the red ribbon on the façade of the outpatients’ ward of the hospital to attract the attention of visitors.
• Staff wear red ribbons to demonstrate their solidarity with people living with HIV/AIDS.

III. Results
• The project activities managed to break the cultural norm of “conformity” and demonstrated the ability of the hospital staff and the surrounding community to publicly declare and take pride in the solidarity between service providers and the people living with HIV/AIDS through the symbol of the red ribbon.

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Key stakeholders
Sex workers; owners, managers, clients of commercial sex establishments (hotels, massage parlours, karaoke bars, brothels).

Implementing organization/ Country
Phuket Provincial Health Office / Thailand.

Approach
Enforce condom use as a condition for all commercial sex transactions in a large area.
Promote strong political commitment and the cooperation of a large number of different individuals and agencies.

I. Problems tackled
Heterosexual intercourse is the main mode of HIV transmission in Thailand. There is an active international and domestic consumer demand for commercial sex services. Most sex workers want their clients to use condoms, but many clients refuse to do so. Many male clients thus contract HIV and infect their wives and / or girl friends. As a result, in Thailand, the epidemic has been mainstreamed into the general population, making

II. Activities
• Train sex workers to deny sex to any client who refuses to use condoms.
• Conduct targeted campaigns to: create demand for condoms; gain participation of sex establishment owners and managers in enforcing condom use as a condition of commercial sex; and ensure continuous and ready condom supply.
• Mobilize the collaboration of health workers, police and local leaders.
• Provide mobile clinic services for sexually transmitted infections (STIs).

III. Results
• Sex workers are better protected from STIs and the risk of HIV transmission.
• Clients, the majority of whom are men, are protected from contracting STIs and HIV.
• Owners of sex establishments become part of the solution rather than be blamed as the cause of the problem.

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Key stakeholders
Sex workers and clients in red light districts.

Implementing organization/ Country
Durbar Mahila Samity (a sex workers’ organization) in West Bengal/India.
Approach Empowerment of sex workers to value themselves enough to protect their health and lives, to organize themselves for mutual support and collective negotiation with clients for safer sex, to conduct peer outreach for controlling the spread of HIV infection.

I. Problem tackled
Sex workers are socially isolated, extremely marginalized and heavily stigmatized. Many are young girls trafficked into brothels for sex work. They live in an environment in which they have inadequate control over their own lives and bodies. This makes safer sex a difficult goal to achieve. They tend to suffer high rates of sexually transmitted infections (STIs). However, there are numerous barriers to condom use as a means of safer sex, sexual health protection and the prevention of the spread of HIV.

II. Activities
• Peer education and outreach services for male and female sex workers.
• Community-owned STI clinic/services, including condom sale/distribution.
• Interventions to create a better environment for sex workers (brothel-based and floating) to use condoms, including education, self-organization, advocacy, and improvement of working and living conditions.
• Cultural events to build self-esteem and a sense of dignity among sex workers.
• Support for HIV positive sex workers and their families to cope with the trauma of being HIV positive, and sensitize local communities and health professionals.

III. Results
• Control of STI/HIV infection among sex workers and clients (documented STI reduction: less than 50% from baseline).
• Increased condom use (more than 90%).
• Higher age of entry of girls into brothels.

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Key stakeholders
Highly marginalized and vulnerable working-class injecting drug users (IDUs), and community volunteers.

Implementing organization/ Country
Pink Triangle/Malaysia. Pink Triangle: first NGO in Malaysia to work on HIV and sexuality issues.<

Approach
One marginalized group (gay community) reaches out to another (IDUs).
Provide community-level services to meet immediate IDU need for care and support wherever IDUs feel least threatened.
Participation and peer outreach: Train and involve IDUs as community health workers.

I. Problems tackled
Injecting drug users (IDUs) face extreme marginalization and vulnerability. The sharing of unclean needles/injecting equipment is a potent means of spreading HIV. Drug injecting accounts for 75% of the total number of HIV infections in Kuala Lumpur. IDUs are sexually active. Around 70% to 80% of IDUs are HIV positive. Continued neglect of their needs facilitates the spread of HIV among injecting drug users and into the general population, the latter through sexual intercourse.

II. Activities
• Establish trusting relationships with IDUS as a basis for intervention: Meet immediate medical care, treatment, support needs.
• Focus on HIV prevention: provide information, education, condoms, microbicides.
• Meet other IDU needs (e.g., for basic hygiene facilities, food, jobs, official papers).
• Recruit volunteers on an on-going basis.
• Dialogue with decision-makers in the police force to address issues of police raids.

III. Results
• Peer support system: IDU community motivated / mobilized to address HIV vulnerability.
• Volunteers: Other community members mobilized to help counter rapid HIV transmission among a very-hard-to-reach group.
• Community-level drop-in and outreach care, treatment and support services to counter extreme IDU marginalization and vulnerability.

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Implementing organization/ Country
Nai Zindagi, Lahore /Pakistan.

Approach
Peer outreach and services (primary health care, drug treatment, counselling, bathing facility and drop-in services).
Income-generation activities by recovering drug abusers to sustain the programme

I. Problem tackled
Many injecting drug users (IDUs) are sexually active and HIV positive. Around 75% to 80% of them are also hepatitis (HEP) C Positive. Continued neglect of the needs of this group facilitates the spread of HIV infection, including into the general population. IDUS are frequently the target of police raids and arrests. However, police harassment and incarceration does not help drug dependent people to cease drug use. In practice, it hugely increases the risk of HIV transmission among this group and from it into the general population.

II. Activities
• Trust building.
• Self-organization.
• Outreach.
• Peer education.
• Provision of services (treatment, safer sex, condoms).
• Advocacy.

III. Results
• HIV prevalence has remained at zero percent.
• Levels of HEP C have been reduced.
• Rate of recovery from addiction is 30% to 40%.
• Recovered addicts learn income-generation skills, contribute economically to the programme, and gain a new lease of life.

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Implementing organization/ Country
Bandhu, Dhaka/Bangladesh.
Approach Field workers operate in specific sites to strengthen networking through friendship and building on shared concerns, mutual trust, confidentiality and solidarity.
Promote sexual health and reduce/prevent the spread of STI and HIV infection among men who have sex with men and their female partners.

I. Problem tackled
Male sex workers, transgender and transsexual populations and men who have sex with men (MSM) are among the most vulnerable to HIV infection. They lack knowledge about the HIV/AIDS epidemic and do not have adequate access to sexual health services.

II. Activities
• Friendship building and peer outreach.
• Education and awareness of STIs/HIV/AIDS.
• STI/HIV/AIDS and sexual health services.
• STI/HIV prevention through supportive advice, accurate information, counselling, condom distribution.
• Creation of an enabling environment.
• Advocacy.

III. Results
• HIV prevalence remained at zero percent.
• Reduced STIs.
• Increased knowledge of HIV/AIDS.
• Increased condom use.

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