HIV/AIDS HIV/AIDS

PREVENTIONPREVENTION

A COMMUNITY BASED A COMMUNITY BASED ORGANISATION APPROACH IN ORGANISATION APPROACH IN MGBALA AGWA, NIGERIAMGBALA AGWA, NIGERIA

BYBY

Nduka ozorNduka ozor

CONTENTS OF THIS CONTENTS OF THIS

PRESENTATIONPRESENTATION

�� OBJECTIVESOBJECTIVES

�� WHAT IS CBO?WHAT IS CBO?

�� WHERE IS MGBALA AGWAWHERE IS MGBALA AGWA

�� HIV/AIDS PREVENTION STRATEGIES BY MAYFHIV/AIDS PREVENTION STRATEGIES BY MAYF

�� OTHER STRATEGIESOTHER STRATEGIES

�� CHALLENGES /CONSTRAINTSCHALLENGES /CONSTRAINTS

�� STRENGTHSSTRENGTHS

�� MONITORING AND EVALUATIONMONITORING AND EVALUATION

�� OUTCOMESOUTCOMES

ObjectivesObjectives

The main objective of this presentation is to The main objective of this presentation is to

provide a preliminary overview of the suitability provide a preliminary overview of the suitability

of community based organization (CBO) in of community based organization (CBO) in

Mgbala Agwa to contribute to HIV/AIDS Mgbala Agwa to contribute to HIV/AIDS

preventions.preventions.

The presentation will highlight the strategies The presentation will highlight the strategies

adopted in the program, challenges and adopted in the program, challenges and

strengths. It will also discuss ways of strengths. It will also discuss ways of

overcoming the constraints in similar settings.overcoming the constraints in similar settings.

What is CBO?What is CBO?

CBOCBOCBOCBOCBOCBOCBOCBO-- Community Based Organization, to Community Based Organization, to

us means organization working in the us means organization working in the

grass root areas to implement certain grass root areas to implement certain

social services that has direct impact in social services that has direct impact in

the community e.g.Mgbala Agwa Youth the community e.g.Mgbala Agwa Youth

Forum(MAYF) Nigeria,IKU osttersund Forum(MAYF) Nigeria,IKU osttersund

Sweden etc.Sweden etc.

Where is Mgbala Where is Mgbala

Agwa?Agwa?�� Mgbala Agwa is a rural community in the Mgbala Agwa is a rural community in the ogutaoguta local local

government area of Imo state, Nigeria with a population government area of Imo state, Nigeria with a population of over 100,000 people. 65% aged 1of over 100,000 people. 65% aged 1--35 years.Mgbala 35 years.Mgbala Agwa community depends on crude subsistence farming Agwa community depends on crude subsistence farming as its mainstay. It can best be described as a community as its mainstay. It can best be described as a community in the dark era in the 21in the dark era in the 21stst century.century.

�� It has an unIt has an un--investigated HIV/AIDS prevalence rate, this investigated HIV/AIDS prevalence rate, this is due to lack of resources to conduct the survey, but is due to lack of resources to conduct the survey, but deaths related to AIDS is adding up seriously, children deaths related to AIDS is adding up seriously, children orphaned by AIDS is also unestimated.The HIV/AIDS orphaned by AIDS is also unestimated.The HIV/AIDS prevention programs are implemented by Mgbala Agwa prevention programs are implemented by Mgbala Agwa Youth Forum (MAYF) in partnership with IKU Sweden.Youth Forum (MAYF) in partnership with IKU Sweden.

OUR StrategiesOUR Strategies

�� HIV/AIDS massive awareness programs through street HIV/AIDS massive awareness programs through street walk, distribution of Information and Educational walk, distribution of Information and Educational materials, rallies etc. materials, rallies etc.

�� InIn--School Programs; Catch them young (CTY),peer School Programs; Catch them young (CTY),peer education, Teachers training,anti education, Teachers training,anti --AIDS club,etcAIDS club,etc

�� Behavioral change communication(BCC),condom Behavioral change communication(BCC),condom education, village meetings, Voluntary counseling and education, village meetings, Voluntary counseling and Testing (VCTs), Prevention of mother to child Testing (VCTs), Prevention of mother to child transmission, (PMTCT), prevention of STI transmission, (PMTCT), prevention of STI

�� Community coordinating Mechanism; women Community coordinating Mechanism; women organisations,age grades, youth association, traditional organisations,age grades, youth association, traditional rulers, churches etcrulers, churches etc

�� Out of school program; oneOut of school program; one--onon--one peer education, one peer education, female and male football competitions, artisans and female and male football competitions, artisans and housewives.housewives.

Other strategiesOther strategies

�� Shift emphasis from individual to community levelShift emphasis from individual to community level

�� Identification of the risky groups and high transmission Identification of the risky groups and high transmission areasareas

�� Information for a community profileInformation for a community profile

�� Participatory Rapid appraisalParticipatory Rapid appraisal

�� Participatory Planning process for HIV/AIDS action Participatory Planning process for HIV/AIDS action committeecommittee

�� Basic steps in AIDS education and training sectionBasic steps in AIDS education and training section

�� Training for community health educatorsTraining for community health educators

�� PrePre--testing and using of picture codetesting and using of picture code

�� Monitoring and evaluationMonitoring and evaluation

Shift emphasis from Shift emphasis from

individual to community individual to community

levellevel

During the development and packaging of the During the development and packaging of the intervention program for inintervention program for in--school, it was school, it was discovered that exclusive targeting of students discovered that exclusive targeting of students without involving the teachers and parents will without involving the teachers and parents will not produce effective result. We therefore not produce effective result. We therefore decided to train teachers who will in turn train decided to train teachers who will in turn train students and form antistudents and form anti--AIDS clubs in the AIDS clubs in the schools. This is for sustainability. schools. This is for sustainability.

The reaction of the town was positive; they The reaction of the town was positive; they requested that such programs be extended to requested that such programs be extended to other primary and post primary schools in the other primary and post primary schools in the clan and subclan and sub--villages after the pilot project.villages after the pilot project.

Identification of Risky group and Identification of Risky group and Identification of Risky group and Identification of Risky group and Identification of Risky group and Identification of Risky group and Identification of Risky group and Identification of Risky group and

high transmission areashigh transmission areashigh transmission areashigh transmission areashigh transmission areashigh transmission areashigh transmission areashigh transmission areas

The lifestyle of youths is a burden and their The lifestyle of youths is a burden and their

behaviors were extended to teenagers, behaviors were extended to teenagers,

youths were trained as peer educators for youths were trained as peer educators for

behavioral change. behavioral change.

High transmission areas identified included High transmission areas identified included

schools,roadsides,private male houses and schools,roadsides,private male houses and

some drinking joints. Plans were made at some drinking joints. Plans were made at

these areas for private meetingsthese areas for private meetings

Information for a Information for a Information for a Information for a Information for a Information for a Information for a Information for a

Community profileCommunity profileCommunity profileCommunity profileCommunity profileCommunity profileCommunity profileCommunity profile

�� Demography;population,sex,age distribution, family sizes, migratDemography;population,sex,age distribution, family sizes, migration ion patterns, other ethnic groups in the community were obtainedpatterns, other ethnic groups in the community were obtained

�� Economy; economic activities, employment and unemployment, Economy; economic activities, employment and unemployment, local bars,shops,palmwine tappers,etc were assessedlocal bars,shops,palmwine tappers,etc were assessed

�� History; History of community, issues of concern, history of warHistory; History of community, issues of concern, history of wars, s, community actions, history of community actions, history of HIV/AIDS/information/campaigns/activities collated.HIV/AIDS/information/campaigns/activities collated.

�� Health and social services; number of health services available,Health and social services; number of health services available,chemist shops,VCT chemist shops,VCT programs,PMTCTprograms,schools,market,churches,clubs,identify programs,PMTCTprograms,schools,market,churches,clubs,identify potential partners in these relevant sectors.potential partners in these relevant sectors.

�� Organisations;religeousOrganisations;religeous organisation,youth organization e.g. organisation,youth organization e.g. (MAYF),women groups,NGOs,which of these are potential partners(MAYF),women groups,NGOs,which of these are potential partners

�� Power and leadership; Traditional institutions,influntial leaderPower and leadership; Traditional institutions,influntial leaders, local s, local government officer,councillors,government officer,councillors,

�� KAPB information for HIV/AIDS program, gender specific perceptioKAPB information for HIV/AIDS program, gender specific perception, n, HIV and STD problemsHIV and STD problems

Participatory and Rapid Participatory and Rapid AppraisalAppraisal

�� Information were collected, working with smaller team like Information were collected, working with smaller team like villagers, health workers and community development villagers, health workers and community development workersworkers

�� Participation from representatives from villagers in team Participation from representatives from villagers in team was essential; village leaders, opinion leaders, women was essential; village leaders, opinion leaders, women leaders and youth leadersleaders and youth leaders

�� Composition of team was balancedComposition of team was balanced

�� Daily team discussion in the field served to adjust Daily team discussion in the field served to adjust guidelinesguidelines

�� Initial appraisal was for a short termInitial appraisal was for a short term

�� A rapid appraisal was actionA rapid appraisal was action--oriented; it was intended to oriented; it was intended to provide a basis for program design and implementationprovide a basis for program design and implementation

Participatory plan process for AIDS Participatory plan process for AIDS

action committee action committee �� We mobilized a committee for action stimulating We mobilized a committee for action stimulating

awareness of the problem of HIV infection awareness of the problem of HIV infection

�� Involved broad variety of community Involved broad variety of community residents,analysedresidents,analysedbehavioursbehaviours and problem base of the communityand problem base of the community

�� Focused on the potentials for change, motivated actionsFocused on the potentials for change, motivated actions

�� Selected strategies that strengthen potentials and Selected strategies that strengthen potentials and remove obstaclesremove obstacles

�� Choose actions that provided immediate successChoose actions that provided immediate success

�� Did some basic trainings, Prepared materials for work in Did some basic trainings, Prepared materials for work in the communitythe community

�� Choose peer educators from vulnerable and risky groups Choose peer educators from vulnerable and risky groups for trainingfor training

Basic steps in AIDS education and Basic steps in AIDS education and

training sessionstraining sessions

�� Assessed what the people already know about Assessed what the people already know about HIV and STDHIV and STD

�� Build on what is knownBuild on what is known

�� Stop and check peopleStop and check people’’s understanding oftens understanding often

�� Build sessions around problem solving and Build sessions around problem solving and decision making, involving everybody in bothdecision making, involving everybody in both

Plans in evaluation of education or training Plans in evaluation of education or training activities as part of the process.activities as part of the process.

Training for community peer health Training for community peer health

educatorseducators

�� Basic facts on HIV/AIDS and STDs,reproductive health and the relBasic facts on HIV/AIDS and STDs,reproductive health and the relationship ationship of HIV infection and TBof HIV infection and TB

�� Treatment of STDsTreatment of STDs

�� Family planning methodsFamily planning methods

�� Gender issues in behaviors changeGender issues in behaviors change

�� Care and support for people living with HIV/AIDS and the role ofCare and support for people living with HIV/AIDS and the role of stigma, stigma, ways to promote positive living.ways to promote positive living.

�� Basic training in the principles of health, the use of picture cBasic training in the principles of health, the use of picture codes and short odes and short role play as discussion startersrole play as discussion starters

�� Monitoring and evaluation methods,including identification of riMonitoring and evaluation methods,including identification of risky sky behaviors of behaviors of peers,the peers,the role of alcohol and drug abuse, choosing evaluation role of alcohol and drug abuse, choosing evaluation questions and indicators of measuring success, and ways to monitquestions and indicators of measuring success, and ways to monitor or activitiesactivities

��

PrePre--test and using picture codes test and using picture codes

We adopted the following questions for preWe adopted the following questions for pre--test picture codestest picture codes

�� Who are the people in this picture?Who are the people in this picture?

�� Are they from this village?Are they from this village?

�� What do you see happening in the picture?What do you see happening in the picture?

�� Why is it happening?Why is it happening?

�� Does this happen in real life?Does this happen in real life?

�� What problem does this led to?What problem does this led to?

�� What are the root cause of this problem?What are the root cause of this problem?

�� What can be done about itWhat can be done about it

��

Challenges/constraints Challenges/constraints

�� Poverty level of the communityPoverty level of the community

�� Farming/agricultural systems in the community.Farming/agricultural systems in the community.

�� Illiteracy levelIlliteracy level

�� Socioeconomic problems; gender related problems, Socioeconomic problems; gender related problems, traditional traditional practises,completepractises,complete lack of social lack of social aminities,socialaminities,social structures.structures.

�� Weak health institutionWeak health institution

�� Lack of Lack of resources;funds,materialsresources;funds,materials,,

�� HighlevelHighlevel unemploymentunemployment

�� Denials and low level awarenessDenials and low level awareness

�� Inadequate capacities Inadequate capacities

Strengths. Strengths.

�� Availability of manpower or personnelAvailability of manpower or personnel

�� Non language barriersNon language barriers

�� Community ownership of the programCommunity ownership of the program

�� Acceptance of youths as an part of Acceptance of youths as an part of

community decision making body.community decision making body.

�� Knowledge of Community culturesKnowledge of Community cultures

�� Supports from the traditional rulers Supports from the traditional rulers

councilcouncil

��

Monitoring and Evaluation Monitoring and Evaluation

Indeed monitoring and evaluation should Indeed monitoring and evaluation should be built into programs during their be built into programs during their planning phases. It is very important to planning phases. It is very important to work with the community to determine work with the community to determine what should be evaluated, how it should what should be evaluated, how it should be evaluated and the expectations from be evaluated and the expectations from the project. It is also very important to let the project. It is also very important to let the community know those who will be the community know those who will be involved in the community evaluation involved in the community evaluation process, this will help evaluators a lot. process, this will help evaluators a lot.

OUTCOMES OUTCOMES

�� After the 12 months programme, children and other After the 12 months programme, children and other participants were better informed on the dangers of risky participants were better informed on the dangers of risky behavior which led to minimal incidence of unwanted behavior which led to minimal incidence of unwanted pregnancies in the villagepregnancies in the village

�� Secondly, teachers were adequately trained on how to Secondly, teachers were adequately trained on how to sustain the programme and continue to teach their students sustain the programme and continue to teach their students about HIV/AIDS, the schools now have one hour moral about HIV/AIDS, the schools now have one hour moral class where HIV and sex are discussed with students.class where HIV and sex are discussed with students.

�� MAYF project also helped young people instigate live MAYF project also helped young people instigate live style changes to slow AIDS infection in the community and style changes to slow AIDS infection in the community and to improve understanding of people currently living with to improve understanding of people currently living with the disease, at least condom consumption increased based the disease, at least condom consumption increased based on our investigations from the patent medicine dealers on our investigations from the patent medicine dealers

��THANK THANK THANK THANK THANK THANK THANK THANK YOUYOUYOUYOUYOUYOUYOUYOU