Stand up against HIV-AIDS Prevention project

Background

The HIV infection is a major public health issue in the Caribbean region, and Haiti is the most affected country. According to the UNAIDS Report 2012, the HIV prevalence in the Caribbean regrion is higher than in all other regions outside Sub-Saharan Africa; and Haiti is one of the Caribbean countries with a high HIV prevalence.

Fond-des Nègres is a town located in the Nippes department of Haiti. In past decades, the HIV prevalence in this department was one of the highest in the country. The Salvation Army Bethel Clinic of Fond-des Negrès provides many medical services at a low cost. The result is that many patients from different parts of the country go there for care and services. The goal of “Stand up against AIDS” project is to reduce further spread of HIV and to reduce the social effects of the disease in the communities.

After two years of the project implementation, a mid-term evaluation appears more than normal to assess the project impact related to its objectives. This will provide an interesting opportunity to appreciate the effects of the project and bring ideas about the eventual needed correction in the process of implementation.

Purpose/objective

The evaluation aims to achieve the following specific objectives clearly exposed in the terms of reference:

• Evaluate the results achieved by the project and their contribution to the achievement of national response to HIV/AIDS
• Assess the relevance of the objectives and strategic approaches of the project
• Analyze the factors (constraints, opportunities, threats) that have influenced the implementation of project activities and particularly the achievement fo results
• Assess the process of monitoring - Evaluate the efficiency in the management of resources
• Analyze the process of sustainability of project results including their ownership by beneficiaries

The Stand Up Against Aids (SUAA) project has two components: the care and treatment component and the prevention component, mostly implemented within the community. The second one has been co-funded by The Salvation Army and NORAD in Norway and is the one that has been evaluated.

Methodology

To conduct this mid-term evaluation, the team used different tools and strategies. Data were collected using different techniques like direct observation, in-depth interviews, review of documents and focus groups. The consultants reviewed the project national strategic plan, the five year plan and annual plans, as well as previous reports.

To carry out the direct observation and in-depth interview methods, some filed visits were realized. Interviews were done with the project coordinator, Bethel staff, the CHW, and some beneficiaries of the project. Ideas and data collected during these review, interviews, and meetings (focus groups, brainstorming) were analyzed.

Key findings

As clearly exposed in the project proposal, the goal of the project is to prevent the further spread of the HIV infection in rural sections of Fond-des Negrès, and the project managers have sought to do so through a dual strategy, institutional and community. And for the community strategy, they have used a three-way model that has worked:

• The facilitators/CHW disseminate directly the prevention messages in the villages by taking advantage of all kind of meetings. They also train community leaders who will be with them during the community activities and will continue the work when the project will phase out. 
• The facilitators/CHW reinforce the capacity of community groups and motivate them about the future of their community. They sensitize them to take actions and to think about ways to approach different dilemmas that challenge their community; and HIV/AIDS is naturally one of them. They help them understand that they have to find local and original initiatives to protect themselves. Women groups are particularly motivated to defend their rights and dignity.
• Evangelical and social groups of the Salvation Army churches are involved in the project. They integrate activities such as education for the prevention of HIV and visits to HIV/AIDS patients in their routine activities.

The facilitators have impressive knowledge and original ways to present the prevention messages to the population. But there is not enough emphasis on other STDs such as Chlamydia, Hepatitis B, Papillomavirus infections, etc.

Training of women and men on how to properly use condoms is a good part of the prevention component of the project. Nonetheless, as it is the case for many programs in poor countries, availability of condoms to cover the needs of the targeted population remains a real challenge.

Peer educator model is timidly implementing within the project through the mobilization of youth groups that promote abstinence. It would be more effective if this strategy could also be implemented within populations with higher risk of HIV transmission such as sex workers, LGBT, etc.

Recommendations

To better achieve the main goal of the project, managers should develop an educational guide that can be used by trained community leaders for the replication of the trainings in the subgroups of their respective communities.

It is not enough to be informed about HIV/AIDS, it is also necessary to have the means to avoid it. So condom distribution should have a preponderant place in project activities.

HIV/AIDS is linked to other health issues affecting young people, such as sexually transmitted infections, unplanned pregnancies, alcohol and narcotics abuse as well as gender-based violence. Therefore, it becomes increasingly necessary to focus more on education for all other health issues that may have an impact on the HIV epidemic.

Campaigns of solidarity and/or non-discrimination must regularly continue to foster a climate that discourages discrimination.

Given the very high prevalence of HIV among sex workers, particular attention should be paid to this at-risk group.

Comments from the organisation, if any

The Projects Team in Haiti are satisfied with the findings of the evaluation. They found the evaluation process valuable and appreciated the findings and recommendations that were put forward. They will in the continuance of the project reinforce the distribution of condoms in the communities; realize training sessions for facilitators on Sexual Transmitted Diseases (STDs), contraception methods and encourage them to replicate the training to leaders and community groups; and intensify education on safe sex behaviour among the sex workers.