Preventing and Coping with HIV/AIDS in Post –Conflict Societies:

PROJECT SUMMARY

Ethiopia had put together massive military machinery for the Ethiopian and Eritrea, war that involved large-scale recruitment of combatants, most of them young. On June 18^th, when Ethiopia and Eritrea signed the agreement of cessation of hostility, the Ethiopian government launched a demobilization program that included IEC programs for the demobilized. About 100,000 soldiers were expected to return home, by the end of January 2001.

The purposes of this project are:

The initial timeframe of this project is one year, to commence in the year 2001, and to be further reviewed and adjusted to the needs.

BACKGROUND AND JUSTIFICATION

In Ethiopia, by the end of 2000, it was estimated that 2.6 to 3.2 million people were infected with HIV (9% of the total infected people worldwide). In Addis Ababa, more than one out of every six adults is infected (16.8%): The prevalence rate in urban areas is 13.6%, and in rural areas it is estimated to be 5%, although it is likely to increase rapidly there.  A reason to fear this increase in rural infection rate is the high mobility of certain high-risk groups, migrants, IDP'S, mobile population. It is obvious that the probability of these groups spreading the HIV infection on their return to their rural communities is high.

In the Ethiopian army, the estimated prevalence rate among soldiers is the same as the rate observed in their community of origin. During demobilization process, the soldiers have been sensitized about HIV/AIDS and other STIs, thus, the soldiers have benefited from an HIV/AIDS education  and information program, received at the demobilization centers.

Military personnel in general, even worse when at war, are highly exposed to sexually transmitted diseases, including HIV/AIDS.  But we have to consider them, not as infected bringing in infection to their homes and communities, but as a vulnerable group, still at higher risk during their demobilization process.

Demobilization can be seen as a dynamic process, like any migration with its three phases:- leaving their duty station on the front, traveling or in transit and the resettlement at home.  In this context, we have to consider the demobilized soldiers as a mobile population at high risk regarding HIV/AIDS.  If they engage in high risk-behavior during this process, they can on their return fuel the HIV epidemic in their families and communities. However, as they also have benefited from information, education and counseling toward this, most of them could be considered as informed men. Thus, they could also be seen as a useful strength to implement awareness and prevention programs regarding HIV in the home communities.

In recent years, there is a growing concern on the social, cultural, economic and political causes (dynamics) of HIV infection. Over much of the first decade of the epidemic, the general thinking was largely dominated by a notion of individual risk, a sense of the ways in which specific behaviors (linked to attitudes and beliefs and behavior) of particular individuals might open the way for HIV transmission. This thinking is now being transformed by shifting from the notion of individual risk to a new understanding of social venerability to HIV.

Policy Development

In 1985, the government of Ethiopia realizing the enormous implication of human suffering, social effects and costs of health services established a national Task Force to assist in the prevention and control of HIV.  By the end of 1995, The Joint United Nations Program on HIV/AIDS (UNAIDS) was established.

Since early 1997, the Ministry of Health has revised the national HIV/AIDS policy through consultation with the various national stakeholders.  The national HIV/AIDS policy advocates multi-sectoral approach in response to the HIV/AIDS epidemics.  This policy was ratified by the Council of Ministers on August 14, 1998.  The policy is designed to guide the implementation of successful programs to prevent the spread of HIV and AIDS, to care for those infected with HIV/AIDS and to reduce the adverse socio-economic consequences of the epidemic.  Among others, the policy calls for information, education and communication to inform the populations about the risks of HIV infection and impact and to encourage people to adopt protective behaviors, with emphasis on particular target groups, including high-risk groups such as prostitutes, truck drivers and military personnel.  In addition, the policy also advocates voluntary HIV counseling and testing (VCT), at the health institutions established for that purpose.

The development of a strategy for the implementation of the policy was simultaneously carried out with the revision of the policy. Situational analysis of the regional HIV/AIDS activities was completed at the end of 1997.  During the first half of 1998, the Ministry of Health and Regional Health Bureaus formulated the HIV/AIDS Strategic Plans for the period 1998-2002, for all the nine regions and two city administrations. Finally, the national HIV/AIDS priority strategies for this period were identified.  This provides a National Strategic Framework for the implementation of the federal and regional plans.  In 1999, a National Conference on HIV/AIDS was held under the auspices of the government of Ethiopia and in 2000, the National AIDS Council and National Secretariat was launched to intensify and coordinate multi-sectoral response to the epidemic.

Target Group background

Kembatti Mentti Gezzima - Tope (KMG) –or Kembatta Women’s Self – help Center Ethiopia, in collaboration with International Organization for Migration (IOM), has launched a program of preventing the spread and cooping with HIV/AIDS among demobilized soldiers, their families and communities in Kembatta, Alaba and Tembaro zone, in rural Ethiopia.  Most importantly, to introduce female condom to the wives of demobilized soldiers as to assist them to protect themselves and to create awareness among the women about their reproductive health.

When the young soldiers, some maimed, some having lost their comrades and childhood friends return to their villages, there is no psychosocial counseling or veteran association that is ready to assist and help to reintegrate them into the community. Thus, they are ideal without guidance, and support, therefore, they look elsewhere and other activities for their frustration, to spend their time and to satisfy their desire and fill the void in their lives. Simply, their lives are at risk and they are health risk to their families and communities. On the other hand, they are young, vibrant, and can easily be trained to support and take leadership in the prevention and control of HIV/AIDS epidemics.

These young men from rural setting, most of them single, are no longer naïve and timid as, when they left their families for war front. The heightened extinct for physical survival and their training have forced them to develop aggressive behaviors. The social and family breakdown, the pressure and the environment they lived can create more sexual freedom. This relaxed social norms and quest for survival can lead them to seek out lets with commercial sex workers and makes them more vulnerable to HIV and other sexually transmitted infections. Being male, unmarried or unemployed has been identified as the most popular risk factors for HIV/AIDS

The ex-soldiers had joined the army mainly for the reasons of economic survival. Thus, trying to introduce health or HIV/AIDS education without considering means for economic survival of the demobilized population would be unrealistic and abstract to them, and a futile exercise on the part of any organization that is trying to improve their health risks.

PROJECT DESCRIPTION

Training of Trainers for awareness, IEC and VCT programs.

Implementation and coordination of small mobile units, able to at grass-root level to train small identical units to motivate and organize the population for IEC programs, peer education, discussion groups, and condom distribution (male and female).  The team will preferably be recruited among the demobilized, the KMG young women’s group and youth association.

With the support of the coordinating mobile unit, implementation of VCT, reinforcement of local medical services and treatment of STIs, opportunistic diseases, following the national guide lines

Major Activities under the project would be as follow:

Peer Education: establish and sustain peer education activities among the demobilized and in their communities will be implemented and evaluated.

Distribution of IEC material:  Develop and Distribution of IEC materials (such as brochures, audiocassettes, short dramas and dialogues, leaflets, posters, permanent bill boards) developed by KMG, based on local culture, knowledge, behavior and practice of the target population,

Condom Distribution: social marketing and control of the availability of female and male condoms will follow, to support IEC programs.

Voluntary HIV Counseling and testing: has long been valued as a strategy for providing psychological support, especially to infected individuals.  However, its usefulness for HIV prevention was questioned.  Now, research supported by WHO, the UNAIDS Secretariat, USAID and other institutions has shown that VCT can reduce high-risk behavior.  Thus when voluntarily counseled and tested an individual who knows his or her HIV status can seek health care and also help others stay uninfected.  (The UNAIDS Report, June 2000).  Using an algorithm of double rapid tests, following the national guidelines on VCT, the mobile units will perform HIV testing and quality controlled by ENARP.  The tests will be performed on voluntary basis with individual pre-and post-testing counseling. Since people counseled on HIV risk donate automatically sign up for testing, a period of counseling-and-testing protocol should be established.

Effective Control of STIs:  Sexually transmitted infections can increase up to three fold the risk of getting infected by HIV (through increased mucous sensitivity, inflammation, lesions).  By counseling, diagnosis and treatment can, in time  can reduce the HIV incidence by up to 42% (study from Mwanza, Tanzania).  Moreover it has been proven that combined interventions, together with counseling promotion and STIs, VCT, condom control and distribution have shown much more impact than added effects of the same independent interventions (UNAIDS and 3rd edition of the report on AIDS in Ethiopia, from the Diseases Prevention and Control Department, Ministry of Health Nov. 2000.

Plan of Work

Training

 Equipment

Project Monitoring and Evaluation

Develop quarterly, semi-annual and annual reports on the implementation of the project based on monitor able indicators and project overall objectives.  Prepare project accounts and annually submit them for audits.

Executing Agency

KMG - is an indigenous, non-for profit women centered, community based organization in collaboration with IOM and Organization of Social Services for AIDS (OSSA) would execute the project. KMG was formed by Ethiopians who believe that if women are recognized and nurtured, the quality of everyone's life will improve.

KMG, as a community based, women focused organization is uniquely situated to access community members in general and the wives of soldiers in particular. KMG’s Young Women’s’ Group who have had training in family planning, reproductive health, including about HIV/AIDS, Harmful Traditional Practices, conceptualizing gender, women’s constitutional right as provided by UN Charter & the Ethiopian Law, are well equipped to work with the demobilized soldiers and their wives and the community at large.

Beneficiaries:

There are three beneficiaries of the project:  (i) the demobilized and their families (ii) the communities and (iii) the medical facilities supported by the mobile units for HIV/AIDS related activities.  The surrounding population will benefit from the services offered by the mobile units provided it is within time and budget constraints.

The beneficiaries would provide necessary staff, which would be trained under the project, and who are expected to conduct the activities after the completion of the project.

Expected output

Measure -project from the following indicators: