HIV/AIDS PROGRAM

Background

With support from Plan Norway, NORAD is funding Plan Ethiopia's HIV/AIDS project which is implemented in partnership with Mary Joy and ISAPSO in Ethiopia. The project addresses the various challenges paused by the HIV/AIDS epidemic in Ethiopia and in particular as related to education, human resources, health and stigma attached to those affected.

Purpose/objective

The main objective of this evaluation is to identify the outcomes of this project and use study results for further programming of projects of this nature. Specifically the evaluation was intended to assess:
• the impact of the intervention on behavior change e.g. in stigmatizing behaviors towards those affected,
• the socio-economic impact of the epidemic on families and children (boys and girls), their living conditions,
• the quality of care to those suffering from AIDS related illnesses, psycho social support and status and effect of local capacity building

Methodology

The baseline survey informed this evaluation in terms of target population size and group etc. To that effect both quantitative and qualitative methods were employed to extract information and analyze the findings. Therefore structured questionnaires and focused group discussions were used. Relevant document review preceded the field work.

Key findings

The project start on mutually reinforcing elements viz: prevention, care and support are assessed as a good start as these elements need to be well integrated in project of this nature.
1. Behavioural Change Communication (BCC)
The intervention is assessed to have brought about a positive change with respect to reduction in stigma and misconception of core facts about HIV especially e.g. whether physical appearance is enough to determine one's sero status. There was observed to be increased understanding of how HIV is transmitted. More people are able to identify stigmatizing attitudes at this time of evaluation than they were at start of the project. The evaluation also indicates that there has been increased demand for Voluntary Counselling and Testing (VCT) and access and reported use of condoms particularly among those engaged in casual sex. On the other hand, the evaluation observes that there has been increased openness to discuss issues concerning HIV/AIDS between spouses and partners, within family and amongst/between people of the opposite sex.
The younger and more educated and those with increased access to diverse ways of information were found to be more informed about the HIV/AIDS facts. Multi media use in information dissemination increased reach of the various targets.
2. Support for Orphans and Vulnerable Children (OVCs)
OVCs received various forms of support including psycho social support (PSS), nutritional support and fees and academic materials. However due to increasing numbers of OVCs and limited budget available, it is not possible to reach all those in need. Enhanced coordination amongst the players could reduce overlaps in targeting.
3. Support for People Living with HIV and AIDS (PLWHAs)
PLWHAs have benefited in several ways e.g. business training, savings and credit schemes (in Kebele 15/16 - Tiret Iwetet Association); however many other PLWHAs developed a dependency syndrome thereby suggesting the need for developing interventions that promote the self sufficiency of the PLWHAs according to their capacity to utilize their skills.
4. Home Based Care (HBC) Services
Two VCT centres were constructed in Yeka and Arada allowing VCT, CD4 Count and PMCTC activities to be conducted there.
The HBC Volunteers have also been able to provide PSS and nutritional support to both OVCs and PLWHAs. The need to provide the HBC Volunteers with incentives to engage in their own livelihood activities was also observed.
5. Capacity Building
Organisation is assessed to be at an early stage and areas like enhancing local resource mobilization remain to be enhanced.
There is also need to enhance coordination and networking to avoid duplication and to allow for greater resource pooling amongst the various actors.

Recommendations

1. Behavioural Change Communication (BCC)
a. Trained Home Based Care (HBC) providers should also be encouraged to participate in BCC activities
b. Multi media approach to information dissemination is recommended and encouraged to be continued in order to provide the community members with information from all possible sources as the assessment revealed greater chance of reduced misconception amongst those getting information from multi dimensional sources
c. Continued increased participation of other stakeholders like CBOs like idirs and FBOs like religious institutions is found beneficial for better behavioural changes in the reduction of stigma and discrimination, to increase demand for VCT
d. Commercial Sex Workers (CSWs) must be empowered to refuse those clients who force them not to use condom. Legal protection must also be put in place also to protect those falling victim to rape and abduction. Skill training for CSW could give them alternative non exploitative means for generating income.
2. Support for Orphans and Vulnerable Children (OVCs)
a. While support in form of nutrition and educational materials is encouraged to go on, it is recommended that more effort should focus on building the capacity of CBO and FBOs to take up the role for livelihood support of OVCs. Care providers and guardians should be involved and be assisted along with the OVCs to gain practical skills for generating income.
3. Support for People Living with HIV and AIDS (PLWHAs)
a. Continue support to PLWHAs focussing on enhancing self sufficiency for group, sub group and individual IGAs.
b. Next phase should integrate an operational research component for PMTCT, care and support and access to ART by both parents
c. For more comprehensive health care responses community and home based care structures should be linked with Community Integrated Management of Childhood Illness (C-IMCI), and Integrated Management of Adolescent and Adult Illness (IMAAI)
4. Home Based Care (HBC) Services
a. The trained HBC members should be encouraged to take part in counselling, referral services and other BCC activities including need to refresh their knowledge and skills for their involvement in other development work including Reproductive Health (RH) and ART activities. PLWHAs should also be encouraged to work as HBC providers.
5. Capacity Building
a. Strengthen Community Mobilization and mainstreaming of sectoral offices, clarifying the roles of different actors which in the future should focus on capacity building leading to enabling communities to take over roles for OVCs, PLWHAs and prevention measures.
b. Anti Aids Clubs (AACs) both in and out of school should be strengthened and encouraged to recruit girls as members and leaders. On the other hand the youth forum should be encouraged to engage in panel discussions and mass sensitization using for instance community mobilization and peer education.
c. Build capacity of IDIRs in IGAs for enhanced economic capacity to support OVCS.
d. Next project phase should focus on building capacity of community to be able to take up their role and responsibility in solving the problems paused by the AIDS pandemic and in mobilizing resources.
e. Integrate succession planning and memory book writing as additional components to the program.

Comments from the organisation

• While it is much appreciated that the sampling methodology was limited to that applied in the baseline, focus on youth, ever married women and ever married men only is rather limiting since even never married men and women could and can be affected in one way or another.
• While as the evaluation recommends succession planning and memory book writing, these interventions are in some ways outdated in the HIV/AIDS context. The key focus should no longer be preparing for death but rather enhancing access to ARV and nutrition for improved lives of those affected. Nonetheless, issue of succession planning /will writing is relevant to developing world in that even in absence of AIDS, deaths without necessary arrangements in situations where laws are either never fully developed or enforced, children are the victims of evictions, property grabbing and hence can easily become destitute upon death of parents or guardians.
6. Pg27/67 The evaluators have included the details of their case study participant i.e. house location etc along his revelation of the promiscuous experience. We do not share this principle in view of privacy ethics that we feel ought to be applied unless if otherwise suggested by case study participant in this case
7. P30/67 The evaluators are commending the cessation of drug uptake by one of the ART takers. This is not to be encouraged as a good sign of physical progress because technically adherence is to be enforced for all those taking ART.