Executive Summary
HIV/AIDS impacted lives of people negatively around the globe, especially in under developing countries. In Sub-Sahara African countries large numbers of people are affecting from this virus, marginalized groups who have lack of resources or limited access to health care services in resource constraint settings are most vulnerable and higher at risk for contracting this infection.
In Uganda the nature of this epidemic is generalized but certain marginalized groups are higher at risk for contracting of HIV due to their high risky behaviour. These groups are female sex workers, Men having sex with men, People who inject drugs and young and adolescent men women and people from Uganda’s transient fishing communities.
In 2018 population-based survey, it was reflected that an estimated 1.4 million people were living with HIV, and an estimated 23,000 Ugandans died of AIDS-related illnesses. The estimated HIV prevalence among adults (aged 15 to 49) stood at 5.7%. Women are disproportionately affected, with 8.8% of adult women living with HIV compared to 4.3% of men.
A national level study conducted by government authorities in 2015-16 reviled that prevalence of HIV among sex workers was estimated at 37% in 2015/16. It is also estimated that sex workers and their clients accounted for 18% of new HIV infections in Uganda in 2015/16. This study also found evidence that between 33% and 55% of sex workers in Uganda reported inconsistent condom use in the past month, driven by the fact that clients will often pay more for sex without a condom.
Keeping the above alarming situation in the mind present project is designed with multi-pronged strategy to cater the need of specific high risk groups FSW, which aims to reduce the further HIV transmission among the Female sex workers through effective behaviour change communication, diagnosis and treatment of STIs, improved their access to resources and mobilizes them to take the ownership of intervention activities at the end of project.
This project will be implemented with the Peer led approaches, project team will reach out to FSW community members and identify and select the motivated sex workers who will willing to work as peer for their community. These peers will be further trained on various aspects and topics of HIV/AIDS, STI, ART etc. Peer will organizes small session inviting all sex workers in her link to attend the HIV/AIDS education and information sessions, these sessions also supported by ORW, PM, and Counsellors. FSWs are motivated for Voluntary HIV counselling and testing and will refer to HCT centers. The Project will be implemented for three years and would cover more than 2000 FSW with prevention package.
Project Rationale/Background: Situation Analysis
In 2018, an estimated 1.4 million people were living with HIV, and an estimated 23,000 Ugandans died of AIDS-related illnesses.
The epidemic is firmly established in the general population. As of 2018, the estimated HIV prevalence among adults (aged 15 to 49) stood at 5.7%. Women are disproportionately affected, with 8.8% of adult women living with HIV compared to 4.3% of men.
Other groups particularly affected by HIV in Uganda are sex workers, young girls and adolescent women, men who have sex with men, people who inject drugs and people from Uganda’s transient fishing communities. There has been a gradual increase in the number of people living with HIV accessing treatment. In 2013, Uganda reached a tipping point whereby the number of new infections per year was less than the number of people beginning to receive antiretroviral treatment.
However, as of 2018 around 27% of adults living with HIV and 33% of children living with HIV were still not on treatment. Persistent disparities remain around who is accessing treatment and many people living with HIV experience stigma and discrimination.
Groups most affected by HIV in Uganda
Adolescent girls and young women
HIV prevalence is almost four times higher among young women aged 15 to 24 than young men of the same age. The issues faced by this demographic include gender-based violence (including sexual abuse) and a lack of access to education, health services, social protection and information about how they cope with these inequities and injustices. Indeed, young Ugandan women who have experienced intimate partner violence are 50% more likely to have acquired HIV than women who had not experienced violence. The lack of sexual education is telling. In 2014, only 38.5% of young women and men aged 15-24 could correctly identify ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission.
Sex workers
HIV prevalence among sex workers was estimated at 37% in 2015/16. It is estimated that sex workers and their clients accounted for 18% of new HIV infections in Uganda in 2015/16
A 2015 evidence review found between 33% and 55% of sex workers in Uganda reported inconsistent condom use in the past month, driven by the fact that clients will often pay more for sex without a condom.
Violence is common, with more than 80% of sex workers experiencing recent client-perpetrated violence and 18% experiencing intimate partner violence. More than 30% had a history of extreme war-related trauma.
The criminalization of sex work and entrenched social stigma means sex workers often avoid accessing health services and conceal their occupation from healthcare providers. In particular, stigma towards male sex workers who have sex with men is exacerbated by homophobia. Indeed, many sex workers in Uganda consider social discrimination as a major barrier in their willingness or desire to test for HIV.
The prevalence of youth engaging in sex work in the slums in Kampala is high, and these young people are in dire need of interventions which address these complex health risks.
From a public health perspective, the high HIV prevalence among the youth engaging in sex work is a significant cause for concern. Targeted interventions for youth engaging in sex work could substantially impact the HIV/STI prevalence of the youth as well as their clientele.
Purpose of Project
The proposed project will support efforts to halt and begin to reduce the spread of HIV/AIDS by 2025. The Project will assist the government as well civil society efforts to implement a comprehensive behaviour change communication (BCC) package for, including mass media and community outreach to effect behaviour change and reduce the risk of HIV infection among Female Sex worker, Females who are indulged in the commercial sex work activities and operating in an around Kampala city in Uganda.
The Project will be implemented for 3 years and intends to achieve reduced transmission of HIV among the targeted population, enhanced knowledge of safer sex practices, education about HIV/STI and other health conditions, correct and consistent use of condoms, creating supportive environment for better implementation of project activities, Treatment of PLHWA
Project Goal and Objective
Goal: Prevention and control of HIV/AIDS through BCC and reduction of incidence of STI among female sex workers of project area less than 10% from present level within three years in and around Kampala city in Uganda.
Objectives
The main objectives of the project are as below:
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- To enhance the perception of risk among female sex workers about STI, HIV/AIDS.
- To provide BCC services 100 % community for safer sex practices.
- To develop the awareness and knowledge of STD, HIV/AIDS among Truckers & CSWs.
- To increase treatment seeking behaviour among Female sex workers.
- To reduce the incidence of STI among Female sex workers by 60%.
- To promote the behaviour of condom usage among female sex workers by 80%
- To prevent and cure STIs among 100% of targeted population.
- To ensure 100% young and newly identified HRGs would be covered through BCC and prevention services.
- To establish linkages with care and support services for PLHA among target population.
- To mobilize HRG community for developing ownership of Prevention Program.
Project Strategy
The Project will follow multipronged strategy to cater the needs of highly specific targeted group.
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- BCC Behaviour Change Communication is a cross cutting issue that provides communication that is aimed at achieving the objectives of the other four components.
- STD diagnosis and treatment To promote that the knowledge, skills and services that are necessary for detection and treatment of STD infection are available for the high risk behaviour groups. In an environment that is empowering, the above situation leads the community to promptly access STD services in the event of STD infection.
- Condom To ensure that the knowledge, skills and services that are necessary for accessing and using condoms in penetrative sexual acts are available for the high-risk groups. In an environment that is empowering, the above situation leads the community to use condoms in penetrative sexual acts.
- Enabling Environment To support and facilitate changes in the environment that enables the community to practice safer behaviours. These changes need to become policies and get implemented at state, district and local levels.
- Community mobilization To support and facilitate changes in the community so that they are empowered to articulate their issues and develop their own solutions or advocate for the needed solutions.
Component Wise Project Activities
To achieves the set objective of project, we will implement following activities among the targeted population
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- Behaviour Change Communication:–
- One to One session
- Community meeting/Group meeting and discussion with groups.
- Condom demo and re-demo
- leaflets distribution
- Home visits
- Counselling
- Follow up
- Reporting & Documentation
- STI Management:–
- Selection & mapping of preferred providers zone wise.
- Rapport building & linkages with service providers.
- Training of preferred provider.
- Counsel and orient the preferred provider about TI roles, process of STI services and payment conditions.
- Develop medicine KIT according to guide line of NACO for preferred provider.
- Counselling and referral of HRG to preferred provider.
- Regular group discussion and one to one with HRGs and refer to preferred provider for RMC, PT, Syphilis screening.
- Follow-up.
- Record keeping at regular basis.
- Condom promotion:–
- Identification and selection of outlets.
- Gap analysis of condom use and condom used.
- Demonstration on condom Use.
- Condom re-demonstration.
- Establishment of condom outlets.
- Free Condom Distribution through Peer, outlets, outreach worker.
- Social Marketing through ORW and outlets.
- Follow up.
- Training on negotiation skills.
- Reporting & Documentation.
- Community Mobilization :–
- Meeting at hot spot level.
- Meeting at DIC level.
- Community event
- Reporting & Documentation
- Enabling Environment:-
- Stakeholders Analysis.
- Stake holder level meeting.
- Setting up network and linkages with other services providers.
- Networking meeting with service providers.
- Advocacy and linkages with line departments.
- Observation of important Days (World AIDS day, Women day, Childers day etc).
- 1 day Advocacy – cum –sensitization workshop with media person, Health department, local leaders, police department, NGOs.
- Referrals and Linkages: –
- Establishment linkages with TB clinic/ HTC/ ART.
- Referrals to HTC /ART/
- Follow-up.
- Linkages with other concerned Govt. departments.
- Behaviour Change Communication:–
Monitoring and Evaluation
The programmed will be monitored at all level Project Director will be overall in charge of the project which will be assigned by the implementation organizations and responsible for management and day to day supervision of the project activities, PD will be assisted by project manager who will responsible for plan, design, and implementation of all project activities at field level. PM will report PD for Project performance monitoring.
At ground ORW will be a manager of his site or area, ORW will supervise working and implementation of activities at micro level. ORW will be supported by peer educators and conducted day to day Bcc and services related activities with target groups and community members.
The programmed will be monitored at all at Field level project activities will be supervise by Outreach worker, and project manager. Project manager will conduct weekly performance review of project activities with all peers and ORW and project team, a weekly performance report will be prepared and target for next week will be set out with individual staff members.
A project monitoring committee will be formed which will include all key staff and beneficiaries and representative from public health service department. this committee will met every month and conducts monthly review of project performance, meeting will be conducted at project office with all the project staff team with project director/ NGO representative to access the performance and find out gaps, if there any need arise to for the intervention of NGO level functionaries it will be communicated with them , they will mobilize resources accordingly.
Reports of Monthly performance review will be shared with all stakeholders and funding agencies.
Performance Indicator
Following are some of key performance indicators.
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- No of Peers Identified, recruited and trained on BCC and service delivery.
- No of FSW educated on HIV/AIDS and STI through BCC.
- No of Peer regularly visiting at least two time in month to FSW for BCC and providing key messages and education on HIV/AIDS.
- No of FSW counselled on HIV/AIDS, risk reduction and STI treatment.
- No of FSW tested for HIV at least two time in a year at HCT centers.
- No of FSW who found Positive linked to ART center.
- No of Positive FSW are regular on ART and adhering the treatment norms.
- No of training sessions conducted for Peers and FSW.
- No of condom demo – re demo conducted during 1 to 1 sessions.
- No of one to one and one to group sessions conducted by all peers.
- No of FSW covered by project services.
Sustainability
The proposed project will be implemented with the active participation of the HRG community members. Over the period after initial implementation, HRG community members would be recruited as the project staff to take the ownership of the project, when community will get empowered than this project will get self-sustained and people working with the awareness and service delivery only needs to be put on paid roll which will cost very less amount thus that can be mobilized by other resources or INGO or local government. Project will also develop linkages within project span to build strong relationship with likeminded organizations and NGOs for support the activities after end of this phase of implementation.
Project Results
Project is intended to produce following outcome:
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- 2000 Female sex workers would have enhanced awareness and knowledge about, safe sex practice, and change in risk behaviour with treatment seeking behaviour and consistent use of condom.
- 2000 Female sex worker would be tested for HIV through HCT in every year.
- 100% STI cases would get complete treatment for themselves and their regular partners.
- 50 Condom dispensers would be installed in 20 Peers area. which will be fed by the free condoms supply.
- 100% PLHIV would be linked with ART services.
- Socially Marketing of condoms will be established.
- 100% of referrals of FSWs would be counseled on STI, HIV.
- 360 Behaviour change communication (BCC) events would be conducted in a year.
- 20 peer educators would be trained over a period of three years.
