HIV/AIDS HIV/AIDS PREVENTIONSPREVENTIONS

A Community Based Organization A Community Based Organization Approach In Approach In MgbalaMgbala AgwaAgwa, Nigeria, Nigeria

ByByNdukaNduka OzorOzor

CONTENTS OF THIS CONTENTS OF THIS PRESENTATIONPRESENTATION

ObjectivesObjectivesWhat Is CBO?What Is CBO?Where Is Where Is MgbalaMgbala AgwaAgwaHIV/AIDS Prevention Strategies By MAYFHIV/AIDS Prevention Strategies By MAYFOther StrategiesOther StrategiesChallenges /ConstraintsChallenges /ConstraintsStrengthsStrengthsMonitoring And EvaluationMonitoring And EvaluationOutcomesOutcomes

ObjectivesObjectives

The main objective of this presentation is to The main objective of this presentation is to provide a preliminary overview of the suitability provide a preliminary overview of the suitability of community based organization (CBO) in of community based organization (CBO) in Mgbala Agwa to contribute to HIV/AIDS Mgbala Agwa to contribute to HIV/AIDS preventions.preventions.

The presentation will highlight the strategies The presentation will highlight the strategies adopted in the program, challenges and adopted in the program, challenges and strengths. It will also discuss ways of strengths. It will also discuss ways of overcoming the constraints in similar settings.overcoming the constraints in similar settings.

What is CBO?What is CBO?

CBOCBO-- Community Based Organization, to us Community Based Organization, to us means organization working in the grass means organization working in the grass root areas to implement certain social root areas to implement certain social services that has direct impact in the services that has direct impact in the community e.g.Mgbala Agwa Youth community e.g.Mgbala Agwa Youth Forum(MAYF) Nigeria, IKU osttersund Forum(MAYF) Nigeria, IKU osttersund Sweden etc.Sweden etc.

Where is Mgbala Agwa?Where is Mgbala Agwa?

Mgbala Agwa is a rural community in the Mgbala Agwa is a rural community in the OgutaOguta local local government area of Imo state, Nigeria with a population government area of Imo state, Nigeria with a population of over 100,000 people. 65% aged 1of over 100,000 people. 65% aged 1--35 years.Mgbala 35 years.Mgbala Agwa community depends on crude subsistence farming Agwa community depends on crude subsistence farming as its mainstay. It can best be described as a community as its mainstay. It can best be described as a community in the dark era in the 21in the dark era in the 21stst century.century.It has an unIt has an un--investigated HIV/AIDS prevalence rate, this investigated HIV/AIDS prevalence rate, this is due to lack of resources to conduct the survey, but is due to lack of resources to conduct the survey, but deaths related to AIDS is adding up seriously, children deaths related to AIDS is adding up seriously, children orphaned by AIDS is also unestimated. HIV/AIDS orphaned by AIDS is also unestimated. HIV/AIDS prevention programs are implemented by Mgbala Agwa prevention programs are implemented by Mgbala Agwa Youth Forum (MAYF) in partnership with IKU Sweden.Youth Forum (MAYF) in partnership with IKU Sweden.

OUR StrategiesOUR StrategiesHIV/AIDS massive awareness programs through street HIV/AIDS massive awareness programs through street walk, distribution of Information and Educational walk, distribution of Information and Educational materials, rallies etc. materials, rallies etc. InIn--School Programs: Catch them young (CTY),peer School Programs: Catch them young (CTY),peer education, Teachers training,anti education, Teachers training,anti --AIDS club,etcAIDS club,etcBehavioral change communication(BCC),condom Behavioral change communication(BCC),condom education, village meetings, Voluntary counseling and education, village meetings, Voluntary counseling and Testing (VCTs), Prevention of mother to child Testing (VCTs), Prevention of mother to child transmission, (PMTCT), prevention of STI transmission, (PMTCT), prevention of STI Community coordinating Mechanism: women Community coordinating Mechanism: women organisations,age grades, youth association, traditional organisations,age grades, youth association, traditional rulers, churches etcrulers, churches etcOut of school program: oneOut of school program: one--onon--one peer education, one peer education, female and male football competitions, artisans and female and male football competitions, artisans and housewives.housewives.

Strategies contd.Strategies contd.Shift emphasis from individual to community levelShift emphasis from individual to community levelIdentification of the risky groups and high transmission Identification of the risky groups and high transmission areasareasInformation for a community profileInformation for a community profileParticipatory Rapid appraisalParticipatory Rapid appraisalParticipatory Planning process for HIV/AIDS action Participatory Planning process for HIV/AIDS action committeecommitteeBasic steps in AIDS education and training sectionBasic steps in AIDS education and training sectionTraining for community health providersTraining for community health providersPrePre--testing and using of picture code for childrentesting and using of picture code for childrenMonitoring and evaluationMonitoring and evaluation

Shift emphasis from individual to Shift emphasis from individual to community levelcommunity level

During the development and packaging of the intervention During the development and packaging of the intervention program for inprogram for in--school, it was discovered that exclusive school, it was discovered that exclusive targeting of students without involving the teachers and targeting of students without involving the teachers and parents will not produce effective result. We therefore parents will not produce effective result. We therefore decided to train teachers who will in turn train students decided to train teachers who will in turn train students and form antiand form anti--AIDS clubs in the schools. This is for AIDS clubs in the schools. This is for sustainability. While parents were thought of the Basics sustainability. While parents were thought of the Basics of HIV/AIDS.of HIV/AIDS.

The reaction of the town was positive; they requested that The reaction of the town was positive; they requested that such programs be extended to other primary and post such programs be extended to other primary and post primary schools in the clan and subprimary schools in the clan and sub--villages after the villages after the pilot project.pilot project.

Identification of Risky group and Identification of Risky group and high transmission areas high transmission areas

The lifestyle of youths is a burden and their behaviors were The lifestyle of youths is a burden and their behaviors were extended to teenagers, youths were trained as peer extended to teenagers, youths were trained as peer Health Educators (PHE) for behavioral change. Health Educators (PHE) for behavioral change.

High transmission areas identified included High transmission areas identified included schools,roadsides,private male houses and some schools,roadsides,private male houses and some drinking joints. Plans were made at these areas for drinking joints. Plans were made at these areas for private meetingsprivate meetings

Information for a Community profileInformation for a Community profile

Demography: population, sex, age distribution, family sizes, migration patterns, other ethnic groups in the community were obtainedEconomy: economic activities, employment and unemployment, local bars, shops, palm wine tapers, etc were assessedHistory: History of community, issues of concern, history of wars, community actions, history of HIV/AIDS/information/campaigns/activities collated.Health and social services: number of health services available,chemist shops,VCT programs, PMTCT programs, schools, market, churches, clubs, identify potential partners in these relevant sectors.Organisations: religious organisation, other youth organizations , women groups, NGOs, which of these are potential partnersPower and leadership: Traditional institutions, influential leaders, local government officer, councilors,KAPB information for HIV/AIDS , gender specific perception, HIV and STD problems

Participatory and Rapid AppraisalParticipatory and Rapid Appraisal

Information were collected, working with smaller team like Information were collected, working with smaller team like villagers, health workers and community development workersvillagers, health workers and community development workers

Participation from representatives from villagers in team was Participation from representatives from villagers in team was essential; village leaders, opinion leaders, women leaders and essential; village leaders, opinion leaders, women leaders and youth leadersyouth leaders

Composition of team was balancedComposition of team was balanced

Daily team discussion in the field served to adjust guidelinesDaily team discussion in the field served to adjust guidelines

Initial appraisal was for a short termInitial appraisal was for a short term

A rapid appraisal was actionA rapid appraisal was action--oriented; it was intended to oriented; it was intended to provide a basis for program design and implementationprovide a basis for program design and implementation

Participatory plan process for Participatory plan process for AIDS action committeeAIDS action committee

We mobilized a committee for action stimulating We mobilized a committee for action stimulating awareness of the problem of HIV infection awareness of the problem of HIV infection Involved broad variety of community residents, Involved broad variety of community residents, analysedanalysedbehavioursbehaviours and problem base of the communityand problem base of the communityFocused on the potentials for change, motivated actionsFocused on the potentials for change, motivated actionsSelected strategies that strengthen potentials and Selected strategies that strengthen potentials and remove obstaclesremove obstaclesChoose actions that provided immediate successChoose actions that provided immediate successDid some basic trainings, prepared materials for work in Did some basic trainings, prepared materials for work in the communitythe communityChoose peer educators from vulnerable and risky groups Choose peer educators from vulnerable and risky groups for trainingfor training

Steps taken in AIDS education and Steps taken in AIDS education and training sessionstraining sessions

Assessed what the people already know about HIV and Assessed what the people already know about HIV and STDSTD

Build on what is knownBuild on what is known

Stop and check peopleStop and check people’’s understanding oftens understanding often

Build sessions around problem solving and decision Build sessions around problem solving and decision making, involving everybody in bothmaking, involving everybody in both

Plans in evaluation of education or training activities as Plans in evaluation of education or training activities as part of the process.part of the process.

Training for community Peer Training for community Peer Health EducatorsHealth Educators

Basic facts on HIV/AIDS and STDs, reproductive health and the Basic facts on HIV/AIDS and STDs, reproductive health and the relationship of HIV infection and TBrelationship of HIV infection and TBTreatment of STDsTreatment of STDsFamily planning methodsFamily planning methodsGender issues in behaviors changeGender issues in behaviors changeCare and support for people living with HIV/AIDS and the role ofCare and support for people living with HIV/AIDS and the role ofstigma, ways to promote positive living.stigma, ways to promote positive living.Basic training in the principles of health, the use of picture cBasic training in the principles of health, the use of picture codes odes and short role play as discussion startersand short role play as discussion startersMonitoring and evaluation methods, including identification of rMonitoring and evaluation methods, including identification of risky isky behaviors of peers, the role of alcohol and drug abuse, choosingbehaviors of peers, the role of alcohol and drug abuse, choosingevaluation questions and indicators of measuring success, and evaluation questions and indicators of measuring success, and ways to monitor activitiesways to monitor activities

PrePre--test and using picture codes test and using picture codes

We adopted the following questions for preWe adopted the following questions for pre--test picture test picture codes:codes:

Who are the people in this picture?Who are the people in this picture?Are they from this village?Are they from this village?What do you see happening in the picture?What do you see happening in the picture?Why is it happening?Why is it happening?Does this happen in real life?Does this happen in real life?What problem does this led to?What problem does this led to?What are the root cause of this problem?What are the root cause of this problem?What can be done about itWhat can be done about it

Challenges/constraintsChallenges/constraintsPoverty level of the communityPoverty level of the communityFarming/agricultural systems in the community.Farming/agricultural systems in the community.Illiteracy levelIlliteracy levelSocioeconomic problems; gender related problems, Socioeconomic problems; gender related problems, traditional practices, complete lack of social amenities, traditional practices, complete lack of social amenities, social structures.social structures.Weak health institutionWeak health institutionLack of resources: funds, materials,Lack of resources: funds, materials,High level unemploymentHigh level unemploymentDenials and low level awarenessDenials and low level awarenessInadequate capacities Inadequate capacities

Strengths Strengths

Availability of manpower or personnelAvailability of manpower or personnelNon language barriersNon language barriersCommunity ownership of the programCommunity ownership of the programAcceptance of youths as part of community Acceptance of youths as part of community decision making body.decision making body.Knowledge of Community culturesKnowledge of Community culturesSupports from the traditional rulers councilSupports from the traditional rulers councilConsistency in the mist of frustrations.Consistency in the mist of frustrations.Passion to bring about a change.Passion to bring about a change.Collectivism with open mindedness.Collectivism with open mindedness.

Monitoring and EvaluationMonitoring and Evaluation

Indeed monitoring and evaluation should be built into Indeed monitoring and evaluation should be built into programs during their planning phases. It is very programs during their planning phases. It is very important to work with the community to determine what important to work with the community to determine what should be evaluated, how it should be evaluated and the should be evaluated, how it should be evaluated and the expectations from the project. It is also very important to expectations from the project. It is also very important to let the community know those who will be involved in the let the community know those who will be involved in the community evaluation process, this will help evaluators a community evaluation process, this will help evaluators a lot. But we have not been able to do impact evaluation of lot. But we have not been able to do impact evaluation of this program due to funds.this program due to funds.

Immediate OutcomesImmediate Outcomes

After the 12 months programme, children and other participants were better informed on the dangers of risky behavior which led to minimal incidence of unwanted pregnancies in the villageSecondly, teachers were adequately trained on how to sustain the programme and continue to teach their students about HIV/AIDS, the schools now have one hour extra moral classes where HIV and sex are discussed with students.MAYF project also helped young people instigate life style changes to slow AIDS infection in the community and to improve understanding of people currently living with the disease, at least condom consumption increased based on our investigations from the patent medicine dealers

Thank YouThank You