HIV/AIDS PREVENTION & CONTROL PROGRAM
Bangladesh is one of the fortunate countries where HIV infection rate is still low (less than 1%) compared to neighbouring countries. The relatively low level of HIV in Bangladesh today does not guarantee low prevalence tomorrow. Though, all the risk factors, which give birth to explosive HIV epidemics, are present today particularly in the border areas of the country. But high quality, good coverage and effective intervention program among the high-risk groups in these areas are not proactive with up to the mark.
CEDAR has commendable expertise on HIV/AIDS/STI prevention among truckers, sex workers, stone crashing women workers, transgender (hijra), heroin smokers and IDUs at different vulnerable locations in the country. The organization had designed and devised an intervention program on HIV/AIDS/STI prevention for the truckers and its allied communities since 1995 with prior community need assessment survey at Aricha Ferry Ghat. After that, this program had been implemented from 1996 to 2003 at same location with financial assistance of International AIDS Alliance, UK through its local counterpart HASAB NGO Support Program. This was the first intervention program on HIV/AIDS prevention among truckers community in Bangladesh, and in course of time, this program was recognized as Model Program for preventing HIV/AIDS in particular of truckers community. During 1998, this model program was replicated at 18 different locations by 18 different local NGOs/CBOs with technical assistance of CEDAR and financial assistance of the then Bangladesh AIDS Prevention and Control Program (BAPCP) of GOB. Keeping the line of this model program, CARE Bangladesh had designed RASTA-BONDOR project with consultation of the experts of CEDAR throughout 1999 to 2000. Afterwards CEDAR had lunched this model program with extended numbers of target communities like truckers, sexually vulnerable women, sex worker, transgender, stone crashing workers, rickshaw/van pullers, tribal community, heroin smokers and IDUs by adopting appropriate components at Benapole, Hili and Burimari CBZs (Cross-Border-Zone), along the Indo-Bangla border at Haluaghat upazila under Mymensingh district and Rangpur town with financial assistance of ActionAid, BPHC, CARE, CIDA and UNICEF at different span of time. About 90 thousands truckers were covered by this program at different locations.
Implementation Modalities of Our HIV/AIDS Prevention Program among Transport Workers, Commercial Sex Workers (Brothel based & floating) and Transgender
1. The ‘Sheba Kendra’ Approach
(Health Education and Recreation Center)
A center under the above mentioned name has been run throughout the year (except weekly and national holidays) at the project locations. The center is usually a rented shade located in close affinity of the target communities where they gather in each locale. Besides, there are a few numbers of DICs (Drop in centers) each in every pocket location. The facilities given are as follows:
- Seating arrangement
- Medicare facilities
- Recreational facilities
- Safe drinking water & sanitation facilities
- Education and counseling booth
The center has been functioning everyday from 10:00 AM to 5:00 PM. But, after 5 PM, the office remains open so that target people can come and avail recreational facilities.
Development and promotion of IEC materials
To bring changes in the risk-behavior of the target communities, well researched IEC materials have been developed and promoted among the Transport Workers, Commercial Sex Workers (Brothel based & floating), Transgender & Intravenous Drug Users in the South-West region of Bangladesh. The justification of development and promotion of these communication materials are given below:
Justification of mass IEC development & promotion
Till date, no treatment or vaccine is foreseeable, prevention is the only means to stop the onslaught of HIV/AIDS. For prevention, everybody should have knowledge about the modes of transmission, how to prevent transmission or interrupt the chain of transmission and how it does not transmit. Making aware people about these modalities need to be reached and also make people well aware about these issues. The literacy rate in Bangladesh is low so information needs to be addressed using variety of communication channel. Surveys of knowledge in relation to AIDS as a disease, methods of HIV transmission and means of protection, suggest low levels of awareness in both literate and illiterate groups.
NGOs working with commercial sex workers and truck drivers report very low condom usage rates coupled with next to no awareness of HIV/AIDS, and the protection that condom usage provides. Groups working with male-to-male sex suggest that there appears to be a misconception that this means of sexual practice is free from the risk of sexually transmitted disease. Whilst the mass media has been used to raise awareness, these campaigns have not been shown to be successful. Some of the reasons are lack of specific information with respect to means of transmission i.e. sexual (male-female; male-male) and blood routes and no reference to the use of condoms for the prevention of sexual transmitted disease and HIV/AIDS. Individual initiatives, largely of NGOs, are proving to be more successful in terms of raising awareness. However, total numbers involved are small and the nationwide coverage is not significant. Whilst it is understood that raising awareness alone, is usually insufficient to ensure that behaviors are changed, the provision of information has to be given priority as a first step without which other interventions to bring changes in behavior can't be possible.
Demands for well-researched and target-specific IEC materials on HIV/AIDS for the public and for those practicing high-risk behaviors will increase with awareness of the problem. In order to address these issues, this project would provide IEC packages for the transport workers, FSWs and their related community, persons practicing high-risk behaviors as well as for professional persons working with such groups. Besides, mass promotion of different IEC, billboards/hoarding at different strategic points of Bangladesh would create awareness among general population.
2. The Outreach Approach:
This is one of the important approaches to address the target communities. These encompasses the activities like spot campaign, one-to-one communication, group discussion utilizing informal gathering and campaigning through peer educators and outreach workers. Cultural programs and drama have been performed to convey messages about the prevention and control measures for HIV/AIDS & STIs.
3. The Mobile Clinic Approach:
A mobile van providing STI care services, condom promotion, health education & counseling are usually made available for the target people.
4. ACTIVITIES IN DETAILS
4.1. SUPPORT SERVICES
• Recreation Facilities
Following materials are to provide in the common room of Sheba Kendra for recreation purposes:
- News papers and magazines
- TV and VCP
- Indoor games equipment
• Medicare Facilities
Medicare facilities and arrangements include the following:
- A medical officer
- Some essential drugs
- Some basic clinical facilities
- Condom use techniques and its necessity
The medical officer will provide treatment, medication to common diseases. He will also treat STI patients following the SMx (Syndromic Management) and will refer serious cases to proper consultants in the nearest medical centers or in Dhaka.
• Safe Drinking Water & Sanitation Programme
Safe Drinking Water & Sanitation facilities have especially been provided for the truckers, as it is revealed in our previous assessment that the truckers are being faced problems while staying at Aricha. Therefore they are to face various difficulties with water supply and sanitation.
Moreover, campaigning on the different issues on safe drinking water and sanitation will be conducted for the local community.
4.2. HEALTH EDUCATION AND COUNSELING
Education and Counseling sessions are designed for the transport workers and run throughout the year at the center. The principle aim of the program is to aware and to educate, and to motivate the transport people about the risks and consequences of STIs/HIV/AIDS as well as about social and family values, danger of addiction and excessive drinking, personal hygiene and about good health practices etc. The sessions are addressed by the Health Educators and the process and contents of each session are as following:
4.3. OUTREACH CAMPAIGN
Outreach workers trained at training workshops at the beginning of the project are responsible to approach the driver and helpers' Addas and try to disseminate knowledge on AIDS, STIs and related issues in the form of chats. Simultaneously, a group of peer-educators have been developed through picking up the potential individuals from the target community.
4.4. CONDOM PROMOTION
Condoms are made available in the local pan-bidi-cigarette shops. The outreach workers take up a motivation program. Street song, postering, informal gathering and other relevant techniques are being used in this concern. Dissemination on the necessity and the correct use of condom will also be ensured by the Educators, outreach workers as well as the Medical Officer of the Sheba Kendra.
4.5. PROMOTION OF IEC
Well-researched IEC materials have been developed and promoted Transport Workers, Commercial Sex Workers (Brothel based & floating), Transgender & Intravenous Drug Users in the SouthWest region of Bangladesh. In this connection, Bill Board, Information Board are set up along the roadside and other key locations. Besides, flyers are being used in the period of outreach works among target communities. In addition, stickers are placed on the body of the trucks, car and important places where people conglomerate.
4.6. TRAINING/WORKSHOP & ORIENTATION
4.6.1. STAFF TRAINING
One introductory and two follow up training have been organized the project staffs for each year in order to orient themselves with project as well as for measuring their existing skill on the different issues and for scaling up their knowledge as well.
4.6.2. COMMUNITY ORIENTATION
Orientation courses on basic facts of HIV/AIDS and STIs with related issues have been conducted on regular basis at the center for the local community as well as truckers' associated communities viz. police-men, truck owners, union leaders, local community leaders, drug sellers, hotel & wine sellers etc.
4.6.3. PEER EDUCATION
The Peer Educators are selected among their own community from every pocket locations. Two male and one female peer educators have been selected from each location. After that they are trained up and assigned to the same location. They perform their duties on honorary basis.
PHONE: 880-2-9121504, 9145667
ADDRESS: 768 Satmasjid Road, Dhanmondi, Dhaka- 1209, Bangladesh.