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Table of Contents

Executive Summary

I. Background and Country Context

II. Country Program Description

• Part 1
• Part 2 (See Below)

III. Lessons Learned

IV. Subproject Highlights

• Part 1
• Part 2

V. Attachments

Glossary of Acronyms

II. Country Program Description (continued)

B. Accomplishments

4. Policy Dialogue

The AIDSCAP program made a number of significant contributions to the HIV/AIDS policy in Cameroon. AIDSCAP activities were an integral part of every aspect of the national STI/HIV prevention program and as such promoted positive changes in the policy environment. Some of the accomplishments in policy efforts are highlighted below:

• The establishment of national treatment guidelines for STI case management and the institutionalization of the guidelines within the decentralized training program has significantly enhanced STI case management in Cameroon. Prior to the national treatment guidelines the management of STI cases was limited by expensive, labor, time and resource intensive laboratory exams. With the national guidelines, combined with the sensitivity study of antibiotics and training of providers, Cameroon's STI case management is more efficient and cheaper.
• AIDSCAP supported a number of meetings of policy makers and other leaders to promote priority status for HIV/AIDS on the national agenda. These meetings included the first International Conference on STD and HIV in Military and Police Medicine which hosted 500 participants from 30 countries, and a workshop with political, traditional, and religious leaders held in 1995 for over 70 participants. In addition, World and National AIDS days were effectively used as fora to raise awareness of national policy makers and the media and mobilize leaders in the fight against AIDS.
• The signing of a decree by the Ministry of Defense, introducing an STI/AIDS prevention module in the training, retraining and promotion curricula of the Armed Forces began the institutionalization of AIDS prevention within the military and was the first step for integrating STI/HIV/AIDS prevention in everyday life of the military. This official decree advanced a sustainable AIDS prevention program within the armed forces.
• At the outset of the project, HIV/AIDS prevention was seen as the sole domain of the medical profession, however, AIDSCAP programs, and the peer education activities in particular, demonstrated that public health issues are most effectively addressed through a concerted effort by individuals at all levels of society and should not be limited to the medical profession. Focus group discussions provided evidence that peers and other non-medical professionals can effectively create and deliver prevention messages in an approachable, culturally acceptable manner. The AIDSCAP program changed attitudes, among policy leaders and medical personnel regarding the value of including target populations in the design, implementation and evaluation of programs. AIDSCAP activities modeled ways for health and non-health staff and educators to work hand in hand to deliver effective and accurate messages to their respective audiences.
• The involvement of gatekeepers, health, university and military authorities, political and religious leaders early on in the program ensured that the project was well received within the community. For example, early in the program, discussions were held with religious leaders in the Catholic church regarding marketing condoms specifically for AIDS prevention and not family planning. AIDSCAP worked with church leaders to prevent resistance. As one PSI staff member said: "all we ask for is their silence on the subject".

AIDSCAP also worked to strengthen the involvement of national NGOs in the fight against STI/HIV/AIDS. In addition, relationships between NGOs and governmental agencies were enhanced through coordination meetings. The AIDSCAP program and the activities implemented through NGOs and community based groups demonstrates how nongovernmental groups reinforce and diversify the activities implemented by the government.

5. Behavioral Research and Evaluation

Defined behavioral research activities were provided for in the strategic and implementation plan for Cameroon. In the Fall of 1993 an AIDSCAP behavioral researcher visited Cameroon to meet with local social scientists to explore the possibility of conducting ethnographic research in Yaoundé and Douala among selected target groups in order to contribute to the basic knowledge of behaviors associated with the transmission of HIV and the contexts to determine these behaviors and methods for modifying them. The exploration of research priorities led to the identification of three general research objectives: (1) Describe the operation and evaluation of the peer education program over a period of one year in three sites; (2) Define the major barriers to behavior change among CSWs, potential clients, and university students, especially among those resistant to current intervention strategies, and (3) Describe beliefs and practices with respect to STIs among CSWs, clients and university students, focusing both on disease names and symptoms. A concept paper was developed; however, due to the untimely closing of the USAID/Cameroon Mission in 1994, no new projects were allowed to be implemented and all available funds were needed to continue ongoing projects.

Qualitative and quantitative research and evaluation activities were conducted with all the AIDSCAP supported subprojects. In conducting these activities AIDSCAP Cameroon first employed an independent local consultant, and later worked with IRESCO, a local research NGO, to conduct focus groups and KABP surveys, and to assist with the development of educational messages and materials. IRESCO was also responsible for the mid-term and final evaluations of the different subprojects. Over the course of the program, process information was collected by each project by completing monthly Process Indicator Forms (PIFs). This information was aggregated at the AIDSCAP Africa regional office and used to monitor the progress of each subproject.

6. Results and Impact

Biological Impact

Measuring the biological impact of an intervention or combination of interventions on the spread of STIs and HIV would require costly and logistically complicated studies that are beyond the capacity of most governments in the world. However, conducting HIV surveillance in sentinel groups is an important activity whose data can significantly enhance understanding of the epidemic. Although sentinel surveillance was heavily supported by WHO/GPA in most African countries in the early years of the epidemic, the system proved not to be sustainable when both financial and technical support were withdrawn by early 1994. AIDSCAP together with GTZ provided support to the National AIDS Control program to continue limited surveillance activities among antenatal women in six urban sites in Cameroon. Pregnant women are somewhat easier to sample, and are more representative of the sexually active population than most groups. The surveillance system in Cameroon has continued to produce data up to the present, however it has suffered from several constraints which threaten the reliability of the data in some instances. Nonetheless, the system still provides data that are quite useful for examining general prevalence trends.

Data from ANC attendees from 1989-1992 in 6 urban cities showed prevalence levels from less than 1 percent in 1989 to ranges of about 1 to 3.5 percent by 1992 depending on the geographical location of the site. Secondary analysis of the 1992 data suggests that among ANC women, who are mainly urban, the level of infection was especially high among young, single women and women with secondary or higher education. By 1995, as can be gleaned from table 5, results in most sentinel surveillance sites showed a slow but increasing trend in seroprevalence among ANC women.

Table 5: Sample sizes and HIV seroprevalence levels among pregnant women per sentinel surveillance site, Cameroon, 1992-96.

	Sentinel Surveillance Sites
Year	Yaoundé		Douala		Bertoua		Garoua		Bamenda		Limbé
	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
1992	303	1.7	328	5.5	–	–	140	2.5	200	4.0	136	3.0
1993	301	1.3	275	4.7	–	–	301	3.0	165	7.8	142	4.1
April 94	300	3.0	300	7.0	311	10.8	300	2.3	171	14.5	103	3.0
Nov. 94	300	3.0	299	4.4	300	10.3	300	4.0	336	4.2	NA	NA
April 95	300	2.7	NA	NA	298	6.0	298	3.4	251	6.8	102	7.8
Nov 95	–	–	–	–	–	–	–	–	309	10.2	–	–
April 96*	NA	NA	398	4.5	254	6.3	399	3.3	419	8.8	394	11.2

*1996 data was provided after the closure of the sentinel project by the AIDSCAP/Cameroon Office and is not reflected in the Final Report on Sentinel Surveillance.

Although HIV prevalence has remained relatively low in the adult population in 1990, a much higher prevalence has been documented in Cameroonian sex workers. A seroprevalence study in 1990 found an 8.6 percentage among 314 sex workers in Yaoundé . A subsequent sero-survey in 1992 conducted by the NACS with technical assistance from WHO, found an HIV prevalence of 25 percent and 45 percent respectively in Yaoundé and Douala, indicating a dramatic increase in HIV infection in this group. A more recent HIV study conducted in 1994 among a random sample of sex workers (360) in Yaoundé revealed a 21 percent prevalence of HIV, still indicating a high prevalence of infection in this population, although not nearly as high as documented in other African countries. Most recently, sero-surveys conducted among a cohort of sex workers in Yaoundé and Douala in the context of a research study on the effectiveness of N-9 found rates ranging from just over 16 and 18 percent, respectively, in Douala and Yaoundé.

These data suggest that infection rates may be stabilizing or even decreasing among sex workers who are operating in cities where prevention and intervention campaigns have been waged for several years and condoms use among sex workers is relatively high.

The military, on the other hand, has not seen the same downward trend in seroprevalence. A 1990 survey showed 3.3 percent of military personnel HIV positive. This was based on a sample of 1,300 military and police from all ranks in seven sites. A subsequent survey among the armed forces in 1993 showed a seroprevalence of 6.3 percent among a sample of 1,000 soldiers. In 1996, from among 1,052 samples collected from 11 army bases, 154 were positive or 14.6 percent. It should be noted that there were several methodological problems with the collection of sera within the military: Foremost these military subjects were not randomly selected. In fact they were men who volunteered to be tested, so this figure is not indicative of the real prevalence of all men in the military.

Behavioral Impact

• Data Sources

The quantitative data presented in the following sections was collected at the beginning and end of the project through KABP surveys among the target groups. Detailed results are available in the following reports:

• Baseline survey with Armed Forces*
• Baseline survey with Commercial Sex Workers and Clients*
• Baseline survey with University Students*
• Projet de Prévention de la Transmision Sexuelle du VIH/SIDA auprès des Forces de Maintien de l'Ordre du Cameroun. Données de Suivi Projet Militaires. IRESCO, Juillet 1996.
• Projet de Prévention de la Transmision Sexuelle du VIH/SIDA auprès Des Filles Libres du Cameroun. Données de Suivi Projet Prostituées. IRESCO, Yaoundé, Juillet 1996.
• Projet de Prévention de la Transmision Sexuelle du VIH/SIDA auprès Des Etudiants. Données de Suivi Projet Etudiants. IRESCO, Yaoundé, Juillet 1996.
• Enquete CACP sur le SIDA et les Maladies Sexuellement Transmissibles. Chez les Jeunes dans la Province de l'Est, CARE International au Cameroun, Janvier, 1994.
• Enquete CACP d'Evaluation sure le SIDA et les Maladies Sexuellement Transmissibles Chez les Jeunes dans la Province de l'Est. CARE International au Cameroun, Juin, 1996.
• Enquete CACP MST/SIDA en Milieu Urbain de l'Extrême Nord Cameroun, Save the Children, Décembre, 1994.
  
• Knowledge

Knowledge about HIV/AIDS has significantly increased in all target groups over the life of the project.

CSWs and clients	In 1994, 40 percent of CSWs were able to cite spontaneously (i.e. unprompted) two correct ways of preventing HIV. This proportion went up to 87 percent in 1996, although in the 1996 survey responses were prompted. Fifty percent of clients were able to cite two correct ways of preventing HIV spontaneously in 1994, and in 1996 this proportion increased to 86 percent prompted. Since survey questions were asked differently in the two surveys, it is difficult to compare the responses. However, the goal of 85 percent for this indicator by the end of the project was attained. Improved knowledge and awareness among CSWs was confirmed during interviews with project managers, stating that in the beginning CSWs were resistant to awareness raising activities, but as soon as they started to see their peers die of AIDS, they became a lot more receptive and interested in the project activities.
Students	According to project managers, students no longer question the fact that AIDS exists, they know the modes of transmission and prevention of the disease, which points to increased awareness among this target population. In both male and female students, the proportion of respondents that are capable of citing two correct ways of preventing HIV has increased from 79 and 84, respectively to 95 and 96 percent (see table 6 below). Therefore the goal of 95 percent for this indicator by the end of the project was achieved.
Military	In the military population, 90 percent of the interviewees were able to cite two correct ways to prevent HIV. The goal for the project was 95 percent. According to project managers, high knowledge is a reflection of the Ministry of Defense priority on making HIV prevention a part of the general training for military personnel.
Youth	At the start of the intervention in the East Province in 1993 almost everyone among the interviewees (99 percent) had heard about AIDS, but only 37 percent percent were able to cite two correct ways of AIDS prevention. By 1996, this had increased to 70 percent, and increase of 33 percentage points. (The goal for the project was an additional 40 percent, of the target group). The most frequently cited method was condom use, 79 percent at follow-up versus 48.9 percent at baseline. A great number of youth indicated sexual abstinence as a sure means of preventing AIDS, 41.3 in 1996 versus 22.4 percent in 1993. Also cited were reduction of partners and delay of first sexual encounter (13.8 vs. 21.3 percent in 1996) and fidelity (34 percent and 48.2 percent respectively in 1993 and 1996).

Table 6: Evolution of knowledge over the life of project among the different target groups.

• Behavior Change

Number of Partners

Students	There is evidence that the objective of a 25 percent reduction in high risk sexual encounters was achieved among male students. The percent of male students reporting more than one sexual partner in the last three months dropped from 53 percent to 36 percent between 1993 and 1996; there was no significant change among female students (14 percent in 1993 and 17 percent in 1996). In 1993, 18.6 percent of male university students reported having had sexual relations with an occasional partner during the 30 days preceding the survey, but by 1996 this figure decreased significantly to 9.4 percent.
Military	Between 1993 and 1996 the percentage of male members of the military police reporting more than two sex partners in the past three months dropped significantly from 47 percent to 37 percent, thus the goal of a 25 percent reduction in this indicator was achieved.
Youth	Sexual activity is generally low among youth with little differences between 1993 and 1996. At follow-up, close to 60 percent of youth surveyed had not had a sexual partner in the last month, and almost half had not had a sexual partner in the last three months. For those that did engage in sexual activity, their was a noted increase among female youth having had more than one sexual partner in the last three months, from 17 percent to 67 percent. From focus groups with young people this increase is due to increased poverty and survival problems.

Table 7: More than one sexual partner in the last three months

Condom use

CSWs and clients	Among CSWs, during the life of AIDSCAP, condom use increased significantly and the goal of 70 percent condom use during high risk situations was attained. Of CSWs who report having ever used a condom, the proportion rose steadily from 28.3 percent in 1988 to 56 percent in 1990, to 68 percent in 1994 and finally to 88 percent in 1996. The proportion of clients who report ever having used a condom also rose significantly from 55.5 percent in 1990 to 81 percent in 1996. Consistent condom use by CSWs with non-regular clients increased from 52 percent in 1994 to 75 percent in 1996 and 63 percent with regular clients. However, only 13 percent report condom use with their regular (non-client partners). Thus the degree of condom use seems to decline with sex partners the more they are known and "trusted". However, given the high prevalence of HIV in the CSWs, the non-use of condoms with regular partners represents a threat to the men and to any other partners they might have. The proportion of CSW clients who report using condoms during their last sexual encounter with a non-regular partner increased from 54 percent in 1992 to 97 percent in 1996.
Students	The percent of male university students who have ever used condoms remained the same at approximately 85 percent between 1993 and 1996; however, among female students the percent increased significantly from 65 percent in 1993 to 85 percent in 1996. Seventy-five percent of male students reported using condoms with high-risk partners (occasional or prostitute) during the last sex act and this proportion had not increased by the end of the project. This was despite the fact the condom sales increased significantly during the life of the project. The objective of increasing condom use by 15-20 percent was not attained.
Military	The percentage of men in the military reporting consistent condom use during the past 30 days with CSWs increased significantly from 48 percent in 1993 to 59 percent in 1996, thus the goal of a 15-20 percent increase was achieved. With occasional partners, consistent condom increased 15 percent from 23 percent in 1993 to 30 percent in 1996. However, these are still low condom use rates for potentially high risk situations.
Youth	Condom use did not change among sexually active youth between 1993 and 1996 (54 vs. 55 percent). However, there was a significant increase in one of the subgroups, young out-of-school girls (from 27 percent in 1993 to 40 percent in 1996). Condom accessibility has increased significantly and 96 percent of youth know where to get a condom versus only 72 percent in 1993.

Self-Reported STIs and Treatment-Seeking Behavior

CSWs and clients	The percent of CSWs who reported an STI in the past three months declined significantly from 13 percent in 1992, to 10 percent in 1994 and 7 percent in 1996. The trend was even more dramatic among clients of prostitutes with 9 percent reporting an STI in the three months prior to the survey in 1996, down from 34 percent in 1992. The objective of the project was to decrease this percentage by 10-20 percentage points, however, this was not possible because baseline levels were lower than expected.
	As for treatment seeking behavior, the proportion of CSWs seeking care at a health care clinic went up from 34 percent in 1992 to 86 percent in 1996 and among their clients, from 65 percent in 1992 to 84 percent in 1996. Thus the project's objective of a 10-15 percent increase was more than achieved.
Students	According to the project manager and head of student health services, STI consultations went from first to third place as the reason students were seeking medical attention at the university health centers. Lifetime history of STIs (i.e. ever having had an episode in one's lifetime) dropped from 42 percent to 29 percent. There was a significant (35 percent) drop in reported STI episodes among male students during the last six months, from 6.6 percent in 1993 to 4.3 percent. In female students, reported episodes rose from 5.4 percent to 6.8 percent, but the increase was not statistically significant.
	A very important achievement of this project was the improvement in STI treatment seeking behavior. In 1993, 72.6 percent of students who had an STI report seeking treatment for their most recent STI either at a health center, with a nurse , with a doctor or with a pharmacist. In 1996 this rose significantly to 85.7 percent (an 18 percent increase). Although this fell short of the project goal of a 50 percent increase, this was because baseline levels turned out to be higher than expected. Among female students interviewed, the percentage reporting ever having had an STI was too low to draw conclusions, however, there was an increased tendency to seek treatment in a medical facility.
Military	In 1993, 36 percent of men in the military reported that they had had an STI in the past six months. By 1996 this percent had dropped significantly to 15 percent. The percent who sought "appropriate" STI treatment for their most recent STI (i.e. at a health center, with a nurse, a doctor or a pharmacist) was already high in 1993, at 89 percent. By 1996, this had risen to 91 percent, however, the objective of a 10-15 percent increase was not achieved. Partner notification went up among military men, from 49 percent at baseline to 60 percent, and up to 78.3 percent for the most recent STI. The principal reason stated for not notifying a partner was that she could not be found (e.g. CSW or occasional partner).
Youth	Reported "chaude pisse" or urethritis remained unchanged at nine percent among youth interviewed. Among those reporting urethritis in the last 12 months, three quarters notified their partner, and a similar proportion consulted a doctor or nurse. These proportions did not change by the end of the project.

• Risk Perception

CSWs and Clients	Among sex workers and their clients, about one third (32.2 and 30.7 percent respectively) consider themselves to be at increased risk for HIV infection and one out of five sex workers does not feel at risk at all. This perception has changed little from previous surveys. Focus group discussion with sex workers confirm that many of them do not feel at risk because they are taking appropriate precautions. Stated one at Kribi:
	"Married women are at much higher risk than we are, their husbands running around with high school girls who do not know how to protect themselves. A married woman cannot afford to make her husband use a condom, whereas we sex workers demand condom use, otherwise, he goes."
	Another one added: "a woman who knows her "job" knows how to avoid STDs and AIDS. That's why we don't have sex in the dark, we want to be able to examine the penis, make sure there is no discharge".
Students	There was no significant differences between risk perception among University students from 1993 to 1996, with those stating they were not at risk accounting for 24 and 27.7 percent respectively among male and female students. Risk perception was associated with ever having had an STI.
Military	In the military there was no correlation between risk perception and number of past or current STIs. For example 45.3 percent (N=117) of respondents with an STI in the past 12 months stated being at high risk for HIV, while 43.4 percent (N=382) of respondents who did not have an STI in the last 12 months also felt at increased risk for HIV.

7. Project Implementation and Management

The AIDSCAP/C program was implemented through the Cameroon country office , which was headed by the Resident Advisor, a native Cameroonian, and housed within the MOH.

The project implementation can be divided in three stages:

1. During the first stage, preliminary discussions were held in June 1992 with the USAID Mission in Cameroon, followed by an AIDSCAP team in October 1992, to design an AIDS intervention strategy in concert with Cameroonian health authorities that would address the specific needs of the country and be consistent with the National AIDS Control Program's medium term plan (MTP). The team consisted of experts in condom social marketing, STIs, IEC, program management and evaluation. For three weeks they met with USAID and GOC authorities, NGO representatives and members of the proposed target groups. The resulting document focused primarily on improving behavior change communication for targeted groups, expanding condom distribution through condom social marketing, and assisting the Ministry of Health to establish a national STI control program and maintain its sentinel surveillance system.
   
2. The second stage was the development of contract documents and subagreements for the four projects to be implemented by the Ministry of Health. A team lead by the AIDSCAP regional office and assisted by the country office staff, developed budgets, workplans and logframes with the representatives from the ministries of health, education and defense. In addition, a preliminary program evaluation plan was drafted. Subproject proposals from CARE, PSI and Save the Children were developed by the respective agencies and forwarded to AIDSCAP for review, approval and funding. LOAs were signed between FHI and IRESCO and the Institute Pasteur to implement their respective scopes of work.
3. The third and most important step was the actualization of the subprojects by the implementing agencies. In all, over the life of the project, ten contracts were signed with government institutions and international organizations to implement and conduct the activities outlined in the Cameroon Strategic Document.

Dates	Title	Implementing Agency
9/92-7/96	Intervention with CSWs/clients	Ministry of Health
9/92-7/96	Condoms Social Marketing	PSI
1/93-6/94	MSTOP	PSI
4/93-7/96	University Students	Ministry of Health
4/93-7/96	Military	Ministry of Health
4/93-6/96	Sentinel Surveillance	Ministry of Health
7/93-9/96	Youth intervention East Province	CARE International
2/94-7/96	Community based intervention/Far North	Save the Children
2/95-6/96	Antibiotic resistance study	Pasteur Institute
2/96-9/96	Project evaluation	IRESCO

Project Management and Administration

The AIDSCAP/Cameroon field office was responsible for the coordination of the program and technical assistance input in the project. This included coordination with USAID, the Ministry of Health and all subproject managers. The field office was physically located within the National AIDS Control Service. Office space, utilities and photocopying services were in kind contributions from the Government of Cameroon. The Resident Advisor had overall responsibility for the program management and monitoring of all subprojects. He reported to Director of the Africa Regional Office. The RA had previously worked as the FHI/AIDSTECH Resident Coordinator.

The subprojects were executed by each implementing agency under the supervision of the Ministry of Health or the respective headquarters of the International NGOs.

Ministry of Health Projects

The four projects implemented through the Ministry of Public Health (Students, CSWs, military and sentinel surveillance) were under the supervision of the Department of Community Health (previously called the Department of Preventive and Rural Medicine) and the National AIDS Control Service (previously called the National AIDS Control Unit). The day-to-day management of the projects was assured by qualified staff from the Ministry of Higher Education, the Ministry of Defense, and the Ministry of Health. Project managers were selected on the criteria of their competence and accessibility, availability and willingness to work without additional compensation. The project managers were assisted by field coordinators. The student project's field coordinators had their office within the resource center on their respective campuses. In addition to managing their site, they were also responsible for managing the resource center. The CSW field coordinators were allocated office space at the government medical headquarters of their respective sites. The above coordinators were hired and paid for by the project. Military coordinators were selected at the central and garrison level and were not remunerated.

The AIDSCAP/Cameroon office provided assistance to the four government projects in planning, training and implementing activities. The AIDSCAP office in Yaoundé also provided substantial financial and accounting assistance to the government subprojects.

Projects with International NGOs and Institutions

Projects implemented by International NGOs, PSI, CARE and Save the Children, received funds through the intermediary of their respective headquarters. Financial transactions were between headquarters, e.g. from FHI to the US-based NGO. In-country offices for each NGO were responsible for in-country costs and accounting. Monthly financial reports were reviewed by the AIDSCAP/Cameroon office for accuracy and approval before reimbursement by AIDSCAP HQ to the respective NGO's headquarters.

Management roles for the NGO projects at the country level were divided as follows:

• The NGOs were responsible for implementation of their respective projects, achievement of all activities listed in the subagreement's timeline and LogFrame, and reporting to their respective headquarters and AIDSCAP. PIFs, quarterly and annual reports were submitted to AIDSCAP/Cameroon.
• AIDSCAP/Cameroon assisted in the planning of the activities and ensured the subprojects were on schedule. When requested, AIDSCAP provided technical assistance in the development of educational messages, and assisted with training and evaluation. AIDSCAP/C also held regular meetings with the NGO representatives and facilitated coordination between NGOs and the Ministry of Health.

The AIDSCAP/C office was also responsible for coordinating technical assistance to all projects, whether provided by local or international experts. Requests and recommendations for regional and/or international technical assistance were forwarded to the regional office for approval and processing.

8. Capacity Building and Institutional Strengthening

AIDSCAP Cameroon assisted in building capacity and strengthening institutions at several levels: the project strengthened skills of individuals within organizations; organization's effectiveness in designing implementing and evaluating AIDS prevention programs was enhanced through training, technical assistance and practical application of learnings; at the national level, national STI treatment guidelines were established, the relationships between and among governmental, religious, and nongovernmental agencies were improved, the overall social and political environment became much more supportive of positive behavior change. Much of the capacity building efforts focused on training of local experts to improve their skills to be more effective in their assigned responsibilities within the AIDSCAP program and their respective organizations. Training and technical skills transfer included:

Training of the STI unit chief in STI program management -- The training focused on the management and design of STI programs in resource-poor settings. The training also included STI case management and counseling and care of AIDS patients.

Training of Trainers in STI case management -- Ten physicians were trained as master trainers in STI case management using the national treatment guidelines, and 40 military physicians received training in the use of standardized treatment guidelines.

Training of trainers in health education -- A core group of ten trainers, both from the within the MOH and international NGOs were trained in 1993. Members of this core group of trainers have assisted with peer and health education training throughout the project

IEC materials development workshop -- Four IEC staff and health educators from collaborating international NGOs participated in a regional workshop on IEC materials development held in Nairobi organized by AIDSCAP and PATH.

Evaluation and data analysis training -- The Institut de Recherche et Des Etudes de Comportement (IRESCO) received technical assistance and training from the AIDSCAP evaluation and BCC units. Training was provided in the development of the end of project evaluation strategy, data collection methodology and data analysis and report writing. IRESCO staff were also trained in the use of Ethnograph, a new software to analyze qualitative data. The AIDSCAP/Cameroon country office provided training in accounting and financial reporting.

Training in counseling and care of HIV positive persons -- The Association des frères et soeurs unis (AFSU), a local NGO composed of HIV positive persons received a small rapid response grant to implement support activities for HIV positive persons in Cameroon. Members of the association received training in counseling and care of HIV positive persons and AIDS patients.

Technical assistance in development of training materials -- The four training manuals and the Guide Thérapeutique produced over the life of the AIDSCAP Program in Cameroon were adapted locally, with the assistance of local health, social science and IEC experts. The development of these manuals locally was made possible through expert hands-on-training provided during AIDSTECH and early stages of the AIDSCAP Program. Local experts were responsible for focus groups, pretesting and finalizing the manuals. The manuals and materials developed in support of peer education will be very useful in any continued or new project undertaken by the National AIDS Control Program.

The AIDSCAP/Cameroon country office staff benefited from training in program management, accounting and counseling. These training took place at the regional office and in the US.

In addition to the training and technical assistance, the MOH now has additional behavioral and sentinel data, which will be useful information to assist in the planning and allocation of scare resources for STI/HIV prevention activities.

 

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