Understand, engage and change!

NGO in San Kampaeng district has a community care project. Project has been working with children affected with HIV/ AIDS. They have taken care of these children who have now become teenagers. These boys and girls are now becoming sexually active. the NGO now started talking about life skills, sexual education, protection. They are recruiting these teenagers to become volunteers to help with education of younger generations. So they started with care for these groups and psychosocial support. When they now grew older, they see that the prevention part also needs to be addressed. The boys and girls have gone from the object of care to the subject of care. Care turns into prevention. They have seen their target groups are changing or evolving.

It's not shampoo, it’s a condom!

In Bombay, the AASDHA project has done intervention in sexworkers. Doing health education and identifiying peer educators for them. Started with the care component of STI treatment and saw the potential to use their ideas and insights for prevention. Teaching them what condom use and safe sex was about. Some of the sexworkers don’t know that they are in sexwork. They see that there is stigma when condom is in the bag.
They came up with a campaign where the condoms looked like shampoo packets. Together with FHI, the condom was designed in a shampoo package without anybody geting suspicious. Sexworkers were involved in the decision making process. Innovative powers and prevention message came across easier.

Tuktuk drivers in Mattakkuliya give free rides to VCT centre.

Sri Lanka is a low prevalence country. Mattakkuliya, a coastal community situated in the heart of the Colombo city, is peculiar in that common perception is that it is inhabited with aggressive, socially destructive and uneducated people. People are scared to even go alone. Lots of crimes do originate from the area. Youth in the area also have different characteristics to those in other parts of the country. They are extremely outgoing, there is little interest in getting educated and learning things, risk-taking - their role models being aggressive risk-taking type. This community was marginally affected by the Tsunami.
Therefore a lot of organizations active in this community. In 2007, we got funded by the UNESCAP for building life skills to prevent HIV// AIDS among youth. We met around 30 young men and women and started a discussion about HIV and what needs to be done. They confirmed that 10 organizations were working with them on HIV.
So: What did change? “Nothing, these programs are far from us. Most programs try to educate us in a language that we don’t even understand. We don’t understand all these technical terms. If you are coming to do the same thing, don’t bother to come”. OK, so we want to work with you if you think it is needed and what do you need? Community replied: there is a drug and alcohol problem and we are conscious of our risks. Why not provide our community a forum so we can discuss these issues ourselves? We provided the basic facilities and a facilitator who understands the community and is young and let them work for a while. After a while, the group grew so much it had to be split up in 5 separate groups. After 4 months, they started coming up with various responses they can make to prevent HIV/ AIDS. They were beginning to feel concerned about the community who were not involved and who do not get tested. “Now, there are musical events that our peers love to attend. We’ll educate our friends who do not join the forums, but who will join the musical events. We’ll use our own ways, not using chalk and blackboard.
A lot of the people involved were three-wheel (tuktuk) drivers who were aware of the peers who engage in risky behaviours. They now see it’s not just their job to bring these people from a to b, but also to inform their passengers and provide peer support. Three wheeler drivers became agents of change. They now offer a free ride to the National HIV/AIDS control programme’s laboratory to whoever is interested in getting their HIV status checked. Confidentiality is ensured. Not only that, they will promote getting an HIV test done among their peers and of course clients who they know had been engaging in risk behaviours. Funding ended after 1year, but the results are still continuing. They do not consider the things they do as “HIV prevention work”. They just lead their day to day lives. Educating and empowering their peers have become something in their day-to-day activities.

"What's the point of saving my baby if I will die?"

Mama Fatuma in Tororo district in Eastern Uganda came to the village clinic asking: “What is the point of saving my baby’s life if you can’t save me?” The reason she was complaining was that in that clinic the common practice for PMTCT was to provide mother and baby medicine only during the birth process and before., common practice. Mama Fatuman was angry. Even if I give birth to a healthy child, it won’t have a mother for long and there will be no care for the child. What is the point? The community decided to have a meeting with the clinic and discussed the way they practiced this program.
They came up with the idea that if they could put the mother on treatment as well, they would be able to save the mother who could then take care of the child. The partners gathered a meeting to bring many partners to the table including the ministry of health that agreed to provide treatment to the mothers, so they could then take care of their babies. Although the PMTCT program started with a focus on prevention, it changed into a program that also cared for the mothers. After the baby was born, the HIV positive mother was invited to come to the clinic, get advice and support from the staff. She was educated to how to breastfeed the baby, how to keep the baby healthy and was taught about future pregnancies.
Due to this intervention, in 5 years 300 healthy babies have been born by HIV positive mothers and both mothers and babies are still alive. At the same time the husbands were effectively stimulated to get tested as well.

"By the way, I also have a partner”

One afternoon, one staff member of Violet house MSM organization in Chiang Mai, Thailand received a phone call from an MSM and was infected with HIV. He was very worried what would happen and was very concerned. The staff advised to take care of his health and provide the counselling on the phone and suggested to test for viral load. And also to have a health check at the hospital. After that, the person was referred to home visits by peers.
And that first home visit, focused on the health issues. On subsequent visits, the person started to become more open with the visiting volunteer. He finally came to terms with his status and told his partner. The volunteer started to talk about the partner of the infected person. He shared that: “yes, I have a partner, but i haven’t shared my status yet”. The volunteer of Violet House started to talk about prevention. The prevention did not only focus on condom use but also negotiating with the partner. The person has started a new relationship with a partner, followed the advice and negotiated to practice safe sex with his partner every time. Care is not only medical care, but goes much further. The question that this story brings forth: Do PLHIV eventually have to disclose their status to partners?

A wake-up call!

In the summer of 2005, I was single. I had finished a relationship with a girlfriend, we were not practicing safe sex but both had had HIV tests. I had a short relationship with someone else which was over. I didn’t consider I was at risk and therefore didn’t worry about my relationships. I was attending a meditation centre in France. A call from an old girlfriend while at meditation retreat. She told me she had and STI, Chlamydia, and perhaps she had transmitted it to me. After the meditation week I returned and asked my friends where to go – went for tests for STIs and HIV. All negative but I had treatment for Chlamydia. The treatment was simple and painless. However it started my reflection on vulnerability and risky behaviour. I became more aware of risks I was taking. Also I noticed that because my ex-girlfriend cared about me, she called me to prevent further (unconscious) transmission.

"Cricket for Jagruti (Hindi for empowerment)”

In three communities in Uttar Pradesh state. First visit to 5 communities. Amongst those communities, 3 communities gave a good response. Those communities are muslim communities. Initially they didn’t accept the visitors, because they had other religions. After that, we decided to organize competeitions and different kind of games. One event was to organize a cricket tournament: Jagruti cricket tournament. We invited nearby villages and young people. 5 teams came to participate in the first tournament. District magistrate was also invited and other local leaders. Through the tournament, we provided awareness on HIV/ AIDS. IEC materials and verbal. After the tournament, youth capacity trainings were provided. A youth committee encouraged 3 people who were truck drivers and vulnerable who went for testing and were positive. They are now under treatment via the government hospital. Since 3 years, the month of December, the tournament is repeated and young people do the fundraising themselves.

"Community dialogue allows son of PLHIV to go to primary school”

In Azawl, Mizoram, India, CHAN is a centre that offers counselling and medical facilities for IVDU’s referrals, home visits and a facilitation team that does community counseling. It is run by the Salvation Army. The facilitation team follows up the clients in their communities to talk to people in the neighbourhood on their concerns. Since IDU is a big problem, the facilitation team talks to the community to listen and talk to people about their concerns. Then entry points are the clients. They go to their communities of clients who come to the centre. A young women of 20 who had abscesses and wounds resulting from IDU came to the centre for medical treatment. She tells the counseller, that there is a rumour in her community that I am positive and she has this bad feeling that people act differently towards her. Since the rumour is there she wants to get tested.
In the hospital she got tested and she finds she’s positive. Rumours still continue in the community. The facilitation teams (who was already working in that community) feel that they should go beyond home visits and start a conversation in the entire community as a group. The Community arranged a venue and time. They called representative of each of the most important associations. Issue of IDU’s and other issues were discussed. This women had a son and she to admit him to kindergarten in her locality. Other parents complained and insisted they would leave the school this child was admitted.
Community leaders asked if CHAN could come and talk about HIV/ AIDS during a second meeting. The facilitating team has been to the community to give seminars workshops and support as and when invited by the community. The son was admitted to the school. The community has now set but its own counselling centre in their community, has a counsellor and own a building and mobilizes its own resources, it has set up a board of directors elected by the community from different CBO’s, Churches, organisations in the community who looks after the running and management of the centre. The funds for the functioning of the centre is met by contributions collected from each and every house in the community. The facilitation team stills pays visits and supports the community.

"Home-based visits in Chiang Mai integrate care and prevention”

Christian AIDS Ministry (CAM), FBO under the church of Christ. Staff conducted home visits to PLHIV in different communities in Chiang Mai. The Home visits combined care and prevention in itself. If they visit PLHIV in their home they provide advice, emotional care, medical care, spiritual support and psychosocial support. Facilitators also talk to the care takers and wider family also to prevent infection and how to best care of them AND how to take care of themselves. They also talk to children in the family to provide emotional psychosocial support. They provide little training to the caretakers so that they can transfer this to other caretakers in the community. Care and prevention can be done in single home visits. Different needs are met throughout the community.