The USAID/Uganda HIV/AIDS and health Initiatives in the Workplaces Activity (HIWA) is a 5 year program funded by USAID. The program is a national program implemented in 33 districts by World Vision Inc in partnership with RTI International (RTI), Uganda Health Marketing Group (UHMG), The AIDS Support Organization (TASO), Environmental Conservation Trust of Uganda (ECOTRUST) and The Medical Concierge Group (TMCG).
The overall goal of the Activity is to improve the health of the members of the UPF, private security guards (PSG), UWA staff and staff in selected hotels affiliated with the Uganda Hotel Owners Association (UHOA). This will be achieved through improved quality of care for those infected or affected by HIV. In order to achieve the desired goal and purpose, the HIWA activities are designed to meet three measurable results and nine intermediate results (IR), namely;
- Increased availability and access to comprehensive HIV and AIDS and other Health services.
- Improved quality of HIV and AIDS and other health services
- Increased uptake and utilization of HIV and AIDS and other health services
ECOTRUST’s role has been able to implement the HIWA activities in the 3 conservation areas of Queen Elizabeth Conservation Area, Murchison Falls Conservation Area, and Mt. Elgon. These activities have been implemented in the communities in and around these three conservation areas, targeting the hard to reach communities with key focus on the employees of Uganda Wildlife Authority.
During the first quarter of this year, ECOTRUST conducted integrated mobile community outreaches in conservation areas to the undeserved population in the national parks targeting at least 400 beneficiaries of HIV Testing & Counseling (HTC). The organization also had a target of enrolling 100% of the newly identified people living with HIV (PLHIV) in clinical care & treatment and initiating them into the Antiretroviral Therapy (ART) clinic.
ECOTRUST held focus Group discussions, in each conservation area with stakeholders which resulted into the generation of working strategies for activity implementation. This involved awareness and sensitization on HIV/AIDS related issues by the HIV project specialist.
Below is an excerpt of the question and answer session.
Excerpt of the Questions asked.
Q1. The percentage of women infected is higher than men. So were men speaking the truth about their status?
Q2. The female condom is still a mystery to us, so will there be no situation where a woman and man will be wearing a condom each?
Q3. Do we have a sample?
Q4. There are cultural limitations on use of condoms among the marrieds, how will the project address this?
Q5. At what age of the pregnancy should the women go to test for HIV?
ECOTRUST sensitized and raised awareness on HIV/AIDS, and carried out 5 Provider Initiated Testing and Counseling outreaches to offer HIV/AIDS services in Mt. Elgon Conservation Area and Murchison falls Conservation Area
HIV Counseling & Testing (HCT) was provided by qualified health workers of Kabalye Police Clinic and Paraa Clinic with support persons from Masindi Referal Hospital and TASO-Masindi in Masindi District for Murchison Falls Conservation Area, and Mbale Police Clinic with support persons from Mbale referral Hospital in Mbale District for Mt. Elgon Conservation Area. This was done in observance of the 4Cs of HCT which are: Confidentiality, Consent, Counseling and Correct results at all times.
To every group reached, the toll free number of the project call center was given to further the Q&A sessions even after the outreach activity. The call center number was very well received as rangers felt more comfortable calling a doctor privately.
For every positive client that was identified, counselling was done on an individual basis in preparation for linkage to Care and treatment. 20 out of 21 voluntarily consented to linking them to care and treatment, while 1 out of 21 requested for time to deal with their HIV status results.
The positive clients have been enrolled into care and treatment for initiation into the ART clinics of Lacor Hospital, TASO Masindi, and Masindi referral Hospital for Murchison Falls Conservation Area clients, Mbale Police Clinic and Mbale referral Hospital for Mt Elgon Conservation Area clients. Paraa Clinic and Mbale Police Clinic health workers are providing continuous counselling for the positive clients, helping them understand the need and use of disclosure to their partners and peers in a bid to reduce the effects of stigma.
Commonly asked questions by rangers during HCT outreaches
- Can I get HIV through mosquito bites?
- What is discordancy?
- Why does my CD4 count drop, yet I am taking my ARVs?
- Won’t I lose my job when I disclose to management my status?
- Why do some people test positive then after years negative? Does that mean they have been cured?
- Can I get HIV through kissing?
The organization also strengthened Functional health literacy among the target population by adapting and executing a multi-dimensional Behavioural Change Communication (BCC) program to reach target priority populations in the conservation areas. All BCC activities under HIWA are implemented through the Stepping Stones Methodology which involves a training package to address issues of gender, condom use, sexuality, HIV/AIDS, gender violence, communication & relationship skills among others. Stepping Stones is a peer to peer interpersonal communication tool developed to promote sexual and reproductive health. It is implemented through small peer group sessions of 20-25 people led by trained facilitators for a period between 12-18 weeks as a way of initiating and sustaining meaningful dialogues around sexual attitudes and needs. By the end of the stepping stones orientation, behavioral change communication agents are expected to;
- Understand the risky sexual behavior among their community.
- Know what Stepping Stones Methodology is, and how it can be applied with in their work places.
- Help identify facilitators who will act as behavior change communication agents for their communities.
An orientation of 30 Behavioral Change Communication agents from Mt. Elgon Conservation Area was conducted in the month of January.
In March, a group of 40 facilitators were trained in the implementation of the stepping stones methodology and identified as Behavioral Change Communications agents.
The training was conducted centrally in Mbale District for 5 days using participatory adult learning approaches i.e. group sessions, discussions, role plays, case studies, community visits among others. By the end of the training, the selected Behavioral Change Communication agents/facilitators were able to demonstrate knowledge in stepping stones for behavioral change, developed and shared implementation plans.
Condom education at every activity was given, highlighting the need for correct condom use. Continuous condom education is being offered by UHMG as project partners after realizing that there were cross cutting questions about condoms and their efficiency in HIV/AIDS prevention in the 3 conservation areas. After the education sessions, there has been an increase in demand for the condoms, and we plan to increase the supply come next quarter, in order to meet the demand, and ensure that there are no run-outs.
Facility support supervision was also carried out in the first quarter with 4 visits for Paraa Clinic in Murchison Falls Conservation Area, 2 visits for Mweya Clinic and 1 visit for Katungulu clinic both in Queen Elizabeth Conservation Area. During these visits, the facilities were supervised to ensure that monthly reports were submitted. The health workers were mobilized to participate in the project trainings to be able to deliver on the project interventions in the conservation areas.
There has been continuous capacity building for the health workers in the UWA facilities during outreaches to help them attain operational standards for the project activities. A number of reporting tools and GIKs have been delivered to the facilities as availed by the project specialists for standardized required reporting at district level.
It has been a successful quarter for the HIWA project, with highlights of introducing project activities at conservation area level. The managers of these conservation areas were able to understand and embrace the USAID HIV project, making it easy for project staff to implement the project activities with minimal resistance. There has also been good reception of the HTC services after extensive awareness and sensitization this quarter, with rangers now demanding for the services.
- Strategies for project implementation were generated during planning meetings at the conservation areas.
- 410 people were sensitized on issues of HIV and VMMC to promote positive behavioral change at their workplaces.
- Continued awareness and sensitization will be done using the stepping stones methodology in groups of peers at their workplaces.
- 345 people voluntarily tested for HIV and hence all know their status, as results were given to them on the same day.
- 95% of PLHIV people were linked to clinical care and treatment.
- 13 men registered to receive the tetanus vaccine in preparation for the VMMC services for HIV prevention during the HIV awareness and sensitization sessions.
- 40 Behavioral Change communication agents trained and equipped to implement the Stepping Stones methodology in Mt Elgon Conservation Area for HIV prevention and raise demand for the other project thematic activities.
- 63,000 condoms distributed to the conservation areas for HIV prevention.
- 3 UWA facilities supported and supervised to increase intake of the services.