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This special report documents the work of the FHI AIDS Control and Prevention Project in the Dominican Republic from 1993 to 1997. Topics covered by the report include empowering core groups; investing in workers' health; reaching youth; supporting women at risk; promoting sustainable prevention efforts; and sharing lessons learned.
Table of Contents III. Investing in Workers' Health VI. Promoting Sustainable Prevention Efforts VII. Sharing Lessons Learned (See Below) VII. Sharing Lessons Learned During its six years of work in the Dominican Republic, AIDSCAP organized dozens of conferences, training workshops and other educational events. One of the program's last major dissemination activities, held in Santo Domingo in July 1997, brought together more than 300 representatives from the Dominican government, the business sector, NGOs, and USAID and other international donors, to hear a summary of the experiences of AIDSCAP and its many partners. Another part of the assembly was an "open house" in which NGO staff talked about what they had learned and distributed marketing materials created with AIDSCAP's assistance as part of their efforts to move toward financial self-sustainability. That kind of dissemination of lessons was one of the reasons AIDSCAP achieved so much and left such a strong legacy in the Dominican Republic. The program's legacy also reached beyond the country's borders as AIDSCAP's Dominican partners borrowed from other countries and shared their behavior-change techniques and materials as well. Some of this "cross-fertilization" was relatively simple, such as the use of AIDSCAP-supported comic books with sex workers in other countries. Other transfers were more involved, such as the Dominican Republic's efforts to replicate the 100 percent condom policy the Thai government developed for sex businesses in that country. Comic Books An AIDSCAP comic book series that has traveled far from the Dominican Republic features a sex worker named Maritza who dispenses friendly, supportive advice to other women working in the business. Created by the Dominican Republic's national sexually transmitted infection control program and several local organizations that later worked with AIDSCAP, the Maritza comic books have been reproduced and used with sex workers in Puerto Rico, Germany, Holland and Belgium. In several instances, according to Ceneyda Brito, the communication coordinator for AIDSCAP's program in the Dominican Republic, Dominican women took the comics with them when they moved to work in other countries. A comic book borrowed from the AIDSCAP program in Brazil proved useful with employees in the industrial zones in and around the capital city of Santo Domingo in the "Trabajo y Salud" (Work and Health) Project implemented by the Centro de Orientacin e Investigacin Integral (COIN). Martha Butler de Lister, AIDSCAP's resident advisor in the Dominican Republic, had visited the AIDSCAP program in Brazil in 1995 and brought back comic books and other educational materials. When focus group discussions revealed that many women workers wanted to improve their ability to discuss condom use and other sexual issues with their partners, COIN adapted a Brazilian comic book on sexual negotiation to use with the industrial zone women. One approach that AIDSCAP borrowed from another country, Thailand's 100 percent condom policy, required much more extensive customizing. In Thailand this government policy has made condom use in commercial sex a nationwide practice, contributing to reductions in STI rates and male HIV incidence. The national strategy was modeled after a pilot project the Thai government began in Ratchaburi Province and expanded to eight provinces with support from Family Health International's AIDSTECH Project. Tony Schwarzwalder, AIDSCAP's deputy project director, mentioned Thailand's experience during a meeting with officials from COIN, and the NGO "took off with the idea," explained Maura McCarthy, a field officer for AIDSCAP in the Dominican Republic. Many businesses that COIN staff members contacted agreed to a 100 percent condom policy, but the NGO lacked the enforcement authority and national government backing that made the policy work in Thailand. "COIN had really good relationships with the bar and brothel owners," said McCarthy, "but they didn't have a commitment." COIN asked AIDSCAP's Dominican Republic country office for technical assistance, including more detailed information on the Thai experience. In the summer of 1996, an AIDSCAP consultant spent several months interviewing sex workers, their clients, brothel owners and government agency officials. That research showed that many of the persons involved in the sex business would support policies requiring condom use. The data were used to develop a pilot 100 percent condom project that began in May 1997 in ten sex establishments. Nevertheless, more widespread implementation of the project will require a government policy requiring condom use in commercial sex, as well as penalties for businesses that fail to comply. Such new regulations may result from the discussions that AIDSCAP and COIN began with government officials. Once in place, such a policy could provide strong structural support for the behavior change efforts that individual sex workers have been trying to make with their clients. Lessons Without Borders AIDSCAP's experiences in the Dominican Republic also benefited HIV/AIDS prevention groups in the United States. In 1995, the project undertook an experiment that brought together NGOs from the Dominican Republic with community-based organizations (CBOs) in the U.S. that serve immigrants from the Caribbean country. Program participants attended the Third USAID HIV/AIDS Prevention Conference in Washington, D.C., as well as a special preconference roundtable session. Representatives from the U.S. groups traveled to the Dominican Republic, and the Dominicans visited their counterparts in the United States. "It was a great experience, a great exchange of ideas," said Eduardo Aguilu, the deputy chief executive officer of the Latino Health Institute (LHI). That Boston-based group operates statewide programs in Massachusetts focusing on HIV/AIDS prevention and other health concerns of Hispanics. One technique the LHI adapted from the Dominican Republic organization is the "provocative street theater" that AIDSCAP-supported groups used in prevention programs for sex workers and their clients, men who have sex with men, and hotel and industrial zone workers. The LHI has revised the approach and uses it in areas where youth get together, such as schools and playgrounds. A New York City social service agency that also participated in an exchange with the Dominican NGOs is the Alianza Dominicana. "It was an opportunity to get first-hand information as to public attitudes, government response and living conditions," said Julio Dicent-Taillepierre, the group's director of AIDS services. "It deepened our understanding of the nature of AIDS for Dominicans." From the NGOs in the Dominican Republic, Dicent-Taillepierre said, Alianza developed a more profound appreciation of the need to gather ethnographic and epidemiological information on Dominicans in New York. His agency helped the Dominican NGO better understand services for persons living with HIV who are still relatively healthy, including comprehensive education, mental health services and case management. The way Dicent-Taillepierre described the Alianza's collaboration with its Dominican counterpart organization could summarize much of AIDSCAP's years of successful work in the Dominican Republic and the lessons that other countries could draw from the program's experiences. "The issues and patterns overlap," he said. "They need to be examined together if an understanding of the reality of HIV/AIDS is to be fully addressed." |
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