This report covers the FHI AIDS Control and Prevention (AIDSCAP) Project (1991-1997). Volume 1 covers regional program overviews, technical strategies, and program support strategies.

Table of Contents
Volume 1

Introduction

Regional Program Overviews
-Africa
-Asia
-Latin America & the Caribbean

Technical Strategies
-Behavior Change Communication
-Condom Distribution
-STI Services
-Policy
-Behavioral Research

Program Support Strategies
-Program Evaluation
-Program Management
-Women's Initiative
-Information Dissemination (See Below)

Appendixes

Volume 2

Program Support Strategies (continued)

Information Dissemination

Strategy Overview

One of the legacies of AIDSCAP/FHI will be the information that was collected, shared, and disseminated by the project in the course of the unprecedented experience of directing 540 subprojects in 44 developing countries. Over the 6 years of the project, AIDSCAP/FHI's information dissemination efforts grew substantially, fulfilling two responsibilities of global leadership: the worldwide sharing of information on the HIV/AIDS pandemic and the dissemination of AIDSCAP/FHI's strategies, best practices, and lessons learned for preventing the spread of HIV and other sexually transmitted infections (STIs) in developing countries.

AIDSCAP/FHI disseminated information to AIDSCAP/FHI field offices and implementing agency partners, USAID Bureaus and Missions, policymakers, USAID collaborating agencies, the international HIV/AIDS community, the military in developing countries, and the media. With this information dissemination, AIDSCAP/FHI provided program managers and field implementers in the international HIV/AIDS prevention and control community with the most effective prevention strategies and intervention models and influenced policymakers to devote more resources to HIV/AIDS by giving them with a better understanding of the pandemic.

Originally conceived of as a support mechanism for programmatic and technical activities, AIDSCAP/FHI's information dissemination component grew into a multipronged, proactive program that reported, published, and globally disseminated a wide range of HIV/AIDS-related information. This information included best practices and lessons learned in HIV/AIDS prevention; behavior change communication (BCC) strategies and methods; effective models for designing and managing STI programs; behavioral research on HIV/AIDS; condom distribution and sales data; policy assessments; socioeconomic impact studies; models for the design, implementation, and evaluation of HIV/AIDS prevention programs; assessments of the status and trends of the global HIV/AIDS pandemic; AIDSCAP/FHI's magazine, AIDScaptions; AIDSCAP/FHI quarterly and annual reports; information on AIDSCAP/FHI's 584 subprojects; country-specific program information, including HIV prevalence and incidence data; information on AIDSCAP/FHI initiatives; and, finally, news about AIDSCAP/FHI's success stories in HIV/AIDS prevention.

Accomplishments and Results

Conferences/Symposia/Workshops

One of the most important information dissemination activities organized by AIDSCAP/FHI was the Third USAID HIV/AIDS Prevention Conference held in Washington, D.C., in August 1995. The 3-day conference was attended by approximately 750 HIV/AIDS prevention professionals from 52 countries. It included 17 plenary speeches, 8 roundtable sessions, and 90 oral presentations, and it received prominent media coverage by the U.S. and international media through WORLDNET TV and the Voice of America. Main topics at the conference ranged across the HIV/AIDS prevention and care continuum, and included communities and the context of interventions, specific strategies and components of behavior change, and the AIDSCAP/FHI plenary speech on a comprehensive approach to the prevention of the sexual transmission of HIV. A 300-page conference proceedings report was distributed to the conference participants and to several thousand other HIV/AIDS professionals around the world.

In October 1997, AIDSCAP/FHI held a special one-and-a-half day lessons learned forum in Washington, D.C., where AIDSCAP/FHI staff and implementing agency partners presented the lessons learned from the project's 540 subprojects in 44 countries. Some 250 people attended the forum, which consisted of 2 plenaries and 12 break-out sessions on such topics as lessons learned in peer education, implementation of behavioral surveillance surveys, advocacy for HIV/AIDS policy, STI syndromic management, HIV counseling and testing programs, and working with women as a primary target audience. Making Prevention Work, the AIDSCAP/FHI global special report on lessons learned, success stories, and accomplishments, was released at this forum. In addition, each major AIDSCAP/FHI country program held a lessons learned conference or series of workshops in 1996 or 1997. These activities were designed to share the lessons learned with implementing agencies, other HIV/AIDS-related programs, nongovernmental organizations (NGOs), donors, and governmental agencies.

Another AIDSCAP/FHI information dissemination activity was organizing the 2-day Status and Trends of the HIV/AIDS Epidemics in Africa Workshop with the François-Xavier Bagnoud Center of Health and Human Rights at the Harvard School of Public Health, which was held in Kampala, Uganda, in December 1995. The first meeting of this kind, the 2-day preconference workshop for 35 international HIV/AIDS experts was held prior to the IX International Conference on STI and AIDS in Africa. A provisional 20-page report was distributed to the conference participants in Kampala, and the workshop's final report was disseminated worldwide a month later. The lessons learned, best practices, and HIV/AIDS-related information in the final report prompted USAID and the World Bank to reprogram their HIV/AIDS activities in Africa and provided the impetus for a front-page story in The New York Times on the epidemic in Uganda.

Based on the success of the Status and Trends Workshop in Kampala, AIDSCAP/FHI organized a similar 2-day symposium with Harvard's Bagnoud Center and the Joint United Nations Programme on HIV/AIDS (UNAIDS), titled the Status and Trends of the Global HIV/AIDS Pandemic. This symposium was a satellite to the XI International Conference on AIDS held in Vancouver in July 1996. The satellite symposium, attended by 50 internationally recognized HIV/AIDS experts, resulted in a 50-page provisional report that was released at a press conference during the Vancouver conference. This report received international media coverage, and 8,000 English copies and 1,000 French copies were distributed to conference participants. The final report was published a month later, and 4,000 copies were disseminated worldwide. Within a few months, the final report was translated into French, Spanish, Portuguese, Russian, and Japanese, and the translations were disseminated worldwide.

Building on the momentum of these two symposia, AIDSCAP/FHI organized the Monitoring the AIDS Pandemic (MAP) Network (December 1996) with the Bagnoud Center and UNAIDS. The goals of the network were to collect and analyze information on the status and trends of the global HIV/AIDS pandemic; to identify the information needs for improved monitoring and forecasting of the HIV/AIDS pandemic and fill those needs; and to monitor the impact of prevention, care, and social interventions on regional epidemics. AIDSCAP/FHI served as the HIV/AIDS interim secretariat for the MAP Network, whose members consist of approximately 100 international HIV/AIDS experts. MAP symposia were convened by AIDSCAP/FHI and its MAP partners in conjunction with the three biennial regional AIDS conferences held in October and December 1997.

Another AIDSCAP/FHI information dissemination activity was the sponsorship of individuals from developing countries to attend regional and global AIDS conferences. In addition to sponsoring AIDSCAP/FHI staff and its implementing agency partners, AIDSCAP/FHI worked closely with USAID Missions to sponsor representatives from governmental and nongovernmental organizations to attend international conferences. Overall, AIDSCAP/FHI supported the attendance of 550 individuals at 15 international conferences. These included: 55 individuals from 13 countries presenting 16 posters and one oral presentation at the global AIDS conference in Amsterdam in 1992; four individuals from two countries presenting one poster at the Asia AIDS conference in New Delhi in 1992; and 28 individuals from 12 countries presenting three oral presentations at the Africa AIDS conference in Yaoundé in December 1992 (AIDSCAP/FHI also held a one-day workshop on behavior change communication and another on sexually transmitted infection prevention at the conference in Yaoundé).

In 1993, 56 individuals from 10 countries presented 12 posters and four oral presentations, including one plenary speech, at the global AIDS conference in Berlin in June; three individuals from two countries presented one oral presentation at the Latin America AIDS conference in Bogotá in November; and 49 individuals from 14 countries presented five posters and four oral presentations at the Africa AIDS conference in Marrakech in December (AIDSCAP/FHI also held a 2-day workshop on lessons learned in HIV/AIDS prevention). In August 1994, 34 individuals from 12 countries presented 22 posters and six oral presentations at the global AIDS conference in Yokohama.

In September 1995, 52 individuals from seven countries presented 17 posters and eight oral presentations at the Asia AIDS conference in Chiang Mai, Thailand; in November 1995, 19 individuals represented eight countries, and a plenary speech was delivered at the Latin America AIDS conference in Santiago (AIDSCAP/FHI also sponsored two meetings by the Civil-Military Project on HIV/AIDS in Santiago); and, in December 1995, 80 individuals from 12 countries presented nine posters and one oral presentation at the Africa AIDS conference in Kampala, Uganda, where AIDSCAP/FHI also held the first two-day status and trends workshop; a one-day workshop on behavior change communication; a one-day workshop on the control of STIs, including results from the Mwanza study; and two half-day workshops organized by the Civil-Military Project on HIV/AIDS.

At the XI International Conference on AIDS in Vancouver in July 1996, 55 AIDSCAP/FHI staff and implementing agency partners from 18 countries provided 65 poster presentations and 11 oral presentations. In addition, AIDSCAP/FHI conducted the Status and Trends Symposium; a one-day satellite workshop on gender issues; and a conference roundtable on HIV/AIDS and the military that was organized by the Civil-Military Project on HIV/AIDS. AIDSCAP/FHI reproduced and published the learned lessons that were presented in each of the 76 abstracts its representatives presented at the conference in an 80-page booklet and disseminated the booklet worldwide.

In 1997, AIDSCAP/FHI was represented by 22 staff and implementing agency partners at the Asia AIDS conference in Manila in October, by 9 staff and partner representatives at the Latin America AIDS conference in Lima in December, and by 25 staff and partners at the Africa AIDS conference in Abidjan in December. In addition to presenting a number of posters and oral presentations, AIDSCAP/FHI organized MAP symposia with Harvard and UNAIDS in Manila and Abidjan prior to the conferences and in Rio de Janeiro prior to the Lima conference. AIDSCAP/FHI also cosponsored a workshop with UNAIDS in Abidjan on behavioral surveillance surveys.

Throughout the life of the project, AIDSCAP/FHI sponsored hundreds of subproject planning, design, evaluation, and implementation workshops in the 44 countries in which the project was based. While the major objective of these workshops was to build the capacity of developing countries to prevent the spread of HIV/AIDS, they were also important for disseminating information on AIDSCAP/FHI's technical strategies, best practices, model programs, and lessons learned.

Publications

AIDSCAP/FHI staff wrote, produced, and disseminated hundreds of publications in English, French, Spanish, Portuguese, Swahili, Kindi Rwandan, Russian, Japanese, and Pidgin. Publications include 7 books, 60 reports, 3 special reports, 14 magazine issues, 14 newsletters, 10 book chapters, 6 brochures, 28 fact sheets, 7 flyers, and numerous press releases. Since 1991, more than 150 articles written by project staff and implementing agency partners have been published in medical, scientific, and other professional journals. Several representative AIDSCAP/FHI publications are summarized in the rest of this section, and a complete list is included in Appendix A.

• AIDScaptions, AIDSCAP/FHI's magazine, was the first magazine to address the prevention of HIV/AIDS and STIs globally. Ten issues were published in English, two in French, and two in Spanish, and readership totaled more than 350,000 people worldwide. Themes of AIDScaptions issues included: AIDS and Adolescents: Protecting the Next Generation; Communities and AIDS Prevention; AIDS in Asia; Women and AIDS: Empowerment and Prevention; HIV/AIDS Prevention: Mobilizing the Private Sector; Building Capacity in HIV/AIDS Prevention: Learning from Each Other; STI Prevention: New Challenges, New Approaches; New Paths in HIV/AIDS Prevention; HIV/AIDS Prevention: Perspectives from the Field; and Building on Success: The Next Generation of HIV/AIDS Programs.

AIDScaptions In many developing countries, AIDScaptions has been the only readily accessible source of HIV/AIDS prevention information. The impact of the magazine can be seen in the following quote from a reader: "I would like to thank you and all the staff who work for AIDScaptions. The journal is the main information resource for me since I came back to China. Based on the information I get from AIDScaptions, I developed a proposal, Integrating AIDS Prevention into Family Planning in Yunnan, China. We received $55,000 funds from the World AIDS Foundation. The program is going well." Zunyou Wu, Center for AIDS Surveillance and Control, Chinese Academy of Preventive Medicine, Beijing, China

• One of the most important AIDSCAP/FHI publications was the Control of Sexually Transmitted Infections: A Handbook for the Design and Management of Programs, which was written collaboratively by more than 40 internationally recognized STI experts. Launched at the Vancouver AIDS conference in 1996, the 325-page book outlines AIDSCAP/FHI's best practices for designing and implementing STI programs in developing countries. It has been well received, and is being used as a text for graduate students at the Harvard School of Public Health, the University of Washington, and the University of Alabama and as supplementary text at the London School of Hygiene and Tropical Medicine and the Royal Tropical Institute in Amsterdam. UNAIDS, UNICEF, the United Nations Development Programme (UNDP), Médecins sans Frontières, among other international organizations, are also using the handbook in their field programs. AIDSCAP/FHI translated the book into French and Spanish, and some 4,000 copies of the translations were disseminated worldwide.

STD Handbook AIDSCAP/FHI received more letters of appreciation after publishing its STD handbook than for any other single publication. The following is an excerpt from one letter: "I received the STD handbook, which has a wealth of information useful to me in STI program management. I will try my best to disseminate knowledge which I gained from this handbook to anyone in the community, in order to enable our country to participate better in STI prevention." Dr. Truong Tan Minh, Khanh Hoa Provincial Health Service, Nha Trang City, Vietnam

• Other important handbooks and publications on best practices in behavior change communication, evaluation, and policy work with the private sector include the BCC handbooks: How to Create an Effective Communication Project: Using the AIDSCAP/FHI Strategy to Develop Successful Behavior Change; How to Create an Effective Peer Education Project: Guidelines for AIDS Prevention Projects; Behavior Change through Mass Communication: Using Mass Media for AIDS Prevention; How to Conduct an Effective Pretests: Ensuring Meaningful BCC Messages and Materials; Assessment and Monitoring of BCC Interventions: Reviewing the Effectiveness of BCC Interventions; and HIV/AIDS Care and Support Projects: Using Behavior Change Communication Techniques to Design and Implement Care and Support Projects.
• AIDSCAP/FHI's Evaluation Tools Modules series includes the following publications: Module 1: Introduction to AIDSCAP/FHI Evaluation; Module 2: Conducting Effective Focus Group Discussions; Module 3: A Framework for Incorporating Evaluation into Project Design; Module 4: Application of a Behavioral Surveillance Survey Tool; and Module 5: Qualitative Methods for Evaluation Research in HIV/AIDS Prevention Programming.
• AIDSCAP/FHI's Private Sector AIDS Policy: Businesses Managing HIV/AIDS kit includes the following publications: Module 1: Introduction; Module 2: Representation, Leadership and Support from Top Management; Module 3: Determining the Impact of HIV/AIDS and the Cost of a Prevention Program to a Workplace; Module 4: Developing Workplace HIV/AIDS Policies; Module 5: Developing an HIV/AIDS Prevention Program; Module 6: Conducting a Workplace HIV/AIDS Needs Assessment: A User's Guide; Case Studies on Businesses Managing HIV/AIDS; Facilitator's Guide for Conducting Business Manager Presentations and Workshops; and African Workplace Profiles.
• A series of AIDSCAP/FHI special reports was published in the final year of the project to highlight AIDSCAP/FHI's accomplishments, success stories, lessons learned, and best practices. One global special report was a compilation of this information from all AIDSCAP/FHI projects, and two others focused on AIDSCAP/FHI country and programs in Tanzania and the Dominican Republic that could be used as models for other countries or regions. As part of AIDSCAP's information dissemination activities, the special reports were distributed both in their respective countries and regions, and globally.
• By the end of AIDSCAP/FHI, more than 150 peer-reviewed articles about HIV/AIDS or STI issues written by AIDSCAP/FHI staff or implementing agency staff had been published in professional journals around the world. Among the journals in which articles appeared were The Lancet, the New England Journal of Medicine, the Journal of the American Medical Association, AIDS, and approximately 40 others (for a complete list, see Appendix A).

One of the most important dissemination activities of AIDSCAP/FHI, which was lauded by some of the most prominent individuals in the field of international HIV/AIDS prevention, was its dissemination of key journal articles on HIV/AIDS and STI issues. These articles were chosen for their significance and currency in the field. The dissemination of journal articles service was provided four times a year in English and twice a year in French, and each information packet included more than 15 key articles. Special publications and reports, in addition to the articles themselves, were also included. The packets were distributed to approximately 1,000 individuals and institutions in developing countries, where, in many cases, they were the only form of readily accessible, current information on HIV/AIDS-related issues. Thirty packets of articles (for which AIDSCAP/FHI negotiated special rights for dissemination to developing country audiences) were sent, bringing the total number of distributed articles to approximately 450, which included many of the most important articles on HIV/AIDS and STI prevention and care published worldwide from 1991 to 1997.

AIDSCAP's Article Dissemination Service AIDSCAP/FHI's packets mailings were well received. The following is an excerpt of one example of the positive feedback received: "I cannot begin to tell you how beneficial and informative the AIDSCAP/FHI mailings have been to me in my three years in Ghana." Joanne M. Hetrick, Ph.D., MPA, CLDir, Family Planning and Health Project, c/o USAID, Accra, Ghana

• AIDSCAP/FHI project reports were published on a semiannual basis from 1991 through 1993. In 1993, AIDSCAP/FHI changed from a cooperative agreement to a contractual agreement. At this time, AIDSCAP began to publish quarterly reports and, from 1994 through 1996, annual reports. This AIDSCAP/FHI final report replaces the AIDSCAP/FHI annual report for 1997, and AIDSCAP/FHI is publishing individual final reports on each of AIDSCAP/FHI's 18 major country programs.
• On behalf of USAID's HIV/AIDS Division, AIDSCAP/FHI produced and published the agency's annual HIV/AIDS reports to Congress and a special biennial version that was disseminated worldwide by mail and at international conferences. Because USAID is the largest donor of funding for international HIV/AIDS activities, this report has been a critically important document to the agency, its implementing partners, other donors, governments, and NGOs worldwide. As it comprised approximately 70 percent of the agency's HIV/AIDS portfolio over the life of the project, AIDSCAP/FHI was in the best position to document overall activities and work closely with other USAID partners and the bureaus and Missions to accurately describe the agency's strategies and project activities.

AIDSCAP publications that document the status and trends of HIV/AIDS worldwide proved to be a valuable source to highlight USAID's work and to track past and future directions of international HIV/AIDS prevention strategies and initiatives.

Films and Video

In 1992, with its precursor project AIDSTECH, AIDSCAP/FHI coproduced a 20-minute, 16mm film, titled The Faces of AIDS, in collaboration with local counterparts in Zimbabwe and Cameroon. The film was made in English and French and distributed worldwide. It won two awards, a first place in health category in the 1993 International Black Independent Film, Video, and Screenplay Competition, and a certificate of educational merit in the British Medical Association Film and Video Competition. AIDSCAP/FHI produced a 13-minute projectwide video, AIDSCAP/FHI: Global Partners in Prevention, that was shown at the XI International Conference on AIDS in Vancouver in 1996. It was also showcased at three events in Washington, D.C., and on Kenyan, Nepali, and Tanzanian television, and it was translated into Portuguese for TV broadcast in Brazil. The video was disseminated to all AIDSCAP/FHI offices to promote the need for policymakers worldwide to increase support for HIV/AIDS prevention efforts.

Electronic and CD-ROM Dissemination

• In 1996 AIDSCAP/FHI began its electronic dissemination worldwide via the Internet through the AIDSCAP/FHI site on the World Wide Web. More than 30 AIDSCAP/FHI publications, with an emphasis on technical best practices, model projects, lessons learned, and status and trends of the HIV/AIDS pandemic reports, are available electronically on the website. AIDSCAP/FHI publications are available in English, and some are also available in French, Spanish, and Russian. The website receives more than 17,000 hits per week and is accessed by NGOs, universities, government agencies, donors, and health and development professionals from around the world.
• In the fall of 1997, AIDSCAP/FHI produced and disseminated 1,000 copies of a CD-ROM of more than 300 AIDSCAP/FHI publications, including how-to handbooks, manuals, journal articles, annual reports, project modules, and conference abstracts. The compact disc provides a single mechanism by which a large amount of AIDSCAP/FHI information can be easily distributed to those who have access to this technology. It was launched at AIDSCAP/FHI's Lessons Learned Forum held in Washington, D.C., in October 1997.

Media Outreach

News and information about AIDSCAP/FHI project activities and research results were also disseminated through press conferences, press releases, and other types of media outreach. Broadcast outlets that covered AIDSCAP/FHI include CNN, NBC News, BBC World Service, National Public Radio, C-Span, Radio Germany, Voice of America, WORLDNET TV, JBC Radio West (Jamaica), Kenya Broadcasting Corporation, and Nepal TV, among others. Among the wire services that covered AIDSCAP/FHI were Reuters World Service, Associated Press, United Press International, Kyodo New Service, Cox News Service, Scripps Howard News Service, Deutsche Presse Agentur, Inter Press Service, U.S. Information Agency, Medical News Network, and Earth Times News Service.

Newspapers that covered AIDSCAP/FHI over the 6 years of the project included The New York Times, The Los Angeles Times, the International Herald Tribune, The Christian Science Monitor, The Independent, Financial Post, The Chicago Tribune, Newsday, San Francisco Chronicle, Toronto Globe and Mail, Journal de Genève et Gazette de Lausanne, Folha de São Paulo, Jornal do Brasil, Indian Express, Hindu Times, The Kathmandu Post, The Rising Nepal, Daily Nation (Kenya), East African Standard (Kenya), Daily Times (Nigeria), The Guardian (Tanzania), Sunday News (Tanzania), The Herald (Zimbabwe), Sistin (Haiti), and many others. AIDSCAP/FHI also received coverage in the journal Science, the Brazilian magazines Claudia, Playboy, and Istoé and in Africa Health.

Other Dissemination Activities

Civil-Military Project on HIV/AIDS

From 1994 through June 1997, AIDSCAP/FHI funded the African-Caribbean Institute, which, in collaboration with the Civil-Military Alliance to Combat HIV and AIDS, implemented the Civil-Military Project on HIV/AIDS. The project's goal was to inform military and civilian populations about the need for and methods of STI/HIV/AIDS prevention. Because military populations are mobile, they have played a key role in the transmission of HIV to civilians in developing countries. Their sexual contact with local populations, including their spouses, girlfriends, and sex workers, puts civilians at risk of HIV and STI infection.

The Civil-Military Project's activities consisted of organizing training workshops and conferences, publishing a newsletter and training documents, and operating a resource center. Training workshops on HIV/AIDS prevention were held in Harare, Zimbabwe; Zomba, Malawi; Kampala, Uganda; Windhoek, Namibia; Santiago, Chile; and Vancouver, British Columbia. More than 660 participants (and an additional 1,000 observers) from some 40 countries attended these workshops. Among the participants were surgeons general, government ministers, army generals, medical commanders, and significant military representation.

More than 26,000 copies of 12 quarterly newsletters (including three in French for Francophone Africa) were published and disseminated, reaching more than 105,000 readers. Proceedings from each workshop, briefing books, other training documents, and five occasional papers were also published and disseminated worldwide. In addition, materials from the resource center were exchanged with individual researchers, planners, trainers, and policymakers in the United States, Africa, Asia, Latin America, and the Caribbean.

The Civil-Military Project was extremely successful in its outreach efforts and information dissemination activities. Based on its achievements and effectiveness, the Civil-Military Alliance has received funding from the European Community, UNAIDS, and the Ford Foundation to continue its initiatives and replicate them in other regions. Also, a branch of the Civil-Military Alliance in South Africa has been funded by the South African military.

AIDSCAP/FHI Library

The AIDSCAP/FHI library has been referred to as the third-best library in the United States for international and domestic information on HIV/AIDS and STI issues. It contains thousands of articles, reports, and books on all issues of relevance in the field. The library filled information requests and performed online searches for AIDSCAP/FHI staff and partners, USAID staff, and collaborating agencies. It also produced AIDS Awareness, a monthly compilation of 75 or more citations of articles and publications on HIV/AIDS and STI issues, for dissemination to AIDSCAP/FHI's 20 field offices and USAID's HIV/AIDS Division.

AIDSCAP/FHI's library housed the AIDSCAP/FHI slide database, which contains descriptions of the more than a thousand 35mm slides and overhead transparencies on HIV/AIDS and STI topics and data that have been used in hundreds of AIDSCAP/FHI's presentations. AIDSCAP/FHI used this database to create an AIDSCAP/FHI slide show documenting the project's strategies and activities that was shown at a variety of venues in the United States and internationally. Both of these audiovisual databases were used frequently by AIDSCAP/FHI and USAID staff to present data at meetings with officials from foreign governments and international agencies, project partners, and target audiences.

Information Requests

In the final year of the project, AIDSCAP/FHI received and responded to, on average, 15 requests for information or materials each day. These included requests for funding information, HIV/AIDS, and health-related information, printed publications, videotapes, posters, and training materials. As funding for international development declined and the HIV/AIDS epidemic expanded in many developing countries, an increasing number of NGOs and government ministries looked to AIDSCAP/FHI for HIV/AIDS resources. Requests came from persons living with HIV or AIDS, U.S. ambassadors, foundations, universities, community groups, physicians, graduate students, village schools, refugee groups, the media, and others. The range and quantity of information requested is, to an extent, a recognition of AIDSCAP/FHI's as a global leader in international HIV/AIDS prevention.

To respond efficiently and comprehensively to information requests, AIDSCAP/FHI used a wide range of resources, including its own materials and publications, reports from the U.S. Bureau of the Census, the Centers for Disease Control and Prevention (CDC) daily news summary, online sources from AIDSCAP/FHI's library, the AIDSCAP/FHI behavior change communication database, and the AIDSCAP/FHI subproject database, and the AIDSCAP/FHI process indicator form database. Other sources of information included governmental agencies, relevant organizations, and universities. All funding requests were referred to at least one potential funding source in the country or region of the request's origin.

Mailing List

Starting with FHI's HIV/AIDS mailing list initially developed for the AIDSTECH Project, AIDSCAP/FHI created an active working list of approximately 10,000 individuals and institutions around the world with interest in HIV/AIDS and STI issues. Most of AIDSCAP/FHI's target audiences for dissemination were in developing countries. During the last two years of the project, however, many U.S.- and European-based organizations and institutions asked to be added to the list as AIDSCAP/FHI became widely recognized not only as an excellent source for HIV/AIDS and STI prevention information for use in developing countries but also in more developed countries.

Lessons Learned and Recommendations

Expansion of Effort

While the value of HIV/AIDS-related information is increasingly recognized, there has not been a commensurate commitment to worldwide information dissemination. In countries where the epidemic is in its early stages, the timely dissemination of up-to-date HIV/AIDS prevention information to policymakers can help thwart an expansion of the epidemic. Any individual or organization involved in HIV/AIDS prevention can also benefit from the dissemination of prevention-related best practices and lessons learned. To this end, information dissemination should be a high priority when staffing and budgeting decisions are made at the beginning of a project, rather than near the end, when it will be too late to have an impact on the epidemic or when project funds have diminished.

Policy Advocacy

One major obstacle to mobilizing resources for HIV/AIDS prevention and care has been the lack of understanding by policymakers of the political impact the epidemic could have on their countries and lack of political will to change the policymaking dynamic. To ensure more effective policy advocacy, more effort needs to be put into packaging HIV/AIDS-related information for policymakers in a language and format that they can readily understand and use. In addition, advocacy activities, such as personal visits, briefings, community organizing, and media outreach, need to be organized to highlight the importance of the information policymakers are given and foster the political will to use it quickly and effectively.

Lack of Staffing

Because AIDSCAP/FHI's information dissemination staff was based at the headquarters in the United States, the project experienced difficulties disseminating lessons learned and best practices in the field of HIV/AIDS prevention and control to AIDSCAP/FHI staff, its partners, and other organizations in the international HIV/AIDS community. Specific individual in prevention and care field projects should be tasked with disseminating information about a project while it is taking place. This will facilitate better cooperation, collaboration, and support during the life of the project; widen the potential for sustainability; and provide a base for sharing lessons learned and best practices with a wider audience.

Donor Collaboration

During the project, AIDSCAP/FHI had difficulty funding the much needed worldwide dissemination of how-to manuals for the field of HIV/AIDS prevention and control. One way to ameliorate this problem would be to pool international donor funds to meet the need to produce up-to-date training manuals, translate them into more languages, and disseminate them more widely and quickly.

Need for Training

AIDSCAP/FHI found that levels of knowledge and technical skill vary greatly among audiences who need HIV/AIDS information. Consequently, some audiences need specific training through workshops or other forums to be able to effectively use the disseminated information. Projects with an information dissemination component should consider including regional training-of-trainers workshops in their planning and budgeting to ensure that materials are understood and used efficiently.

International Exchange

In developing countries, there is interest in up-to-date best practices for STI/HIV/AIDS prevention and control, especially best practices for areas where resources are limited. To this end, efforts to share information among developing country professionals through international workshops, study tours, and conference facilitation need to be expanded. Workshops, tours, and conferences will enable those working in prevention and control to learn from the experiences of their colleagues in other countries without the delay involved in publication and dissemination of best practices and lessons learned.

The Civil-Military Project on HIV/AIDS: Lessons Learned and Recommendations

Confidentiality

Military institutions around the world tend to be insular, protected by confidentiality, disinclined to cooperate with civilian organizations, and committed to secrecy, especially about their own troops and troop deployments. The separation between the military and civil society does not encourage civil-military cooperation, including the reporting of activities about the health and well-being of personnel and commercial sex workers. Nonetheless, militaries in countries with high rates of HIV prevalence have been encouraged to cooperate with civil institutions to prevent and control the spread of HIV. To further encourage civilian-military openness and cooperation, more NGO projects that focus on the military, prevention workshops for military at the garrison town level, and mobile teams visiting military institutions in remote locations should be developed.

Western Military Involvement

At times, the U.S. Department of Defense and the military leadership of NATO do not regard HIV as a high priority, and do not see its spread as a direct threat to their military readiness and combat capability. This lack of support may have a negative impact on the success of international prevention initiatives, as the absence U.S. military leadership in HIV/AIDS prevention and control has lead to other Western militaries drifting away from a serious overseas commitment to assist Asian, African, and Latin American nations. Western militaries tend to position the issue of HIV within the foreign aid agencies of their countries, but by structure and design these agencies do not have easy access to the military in developing countries nor the cooperation common to military-to-military projects. Until HIV is recognized as destabilizing political and military issue in regions of potential crisis, American leadership will be needed to encourage the involvement of other Western nations, including members of NATO, in HIV prevention.

Policy Advocacy

Few surgeons general are experts in HIV or know much of its potential impact. For these leaders, HIV is a new threat that plunges them into the uncertain world of sexuality, sex-based politics, condom issues, church issues, gay issues, and other potential career-curtailing pitfalls. The usual reaction is not to deal with these issues, or to delegate them to a lower echelon and avoid or deny their importance. Efforts must be made to recruit high-level advocates in national governments who will support HIV prevention and be willing to speak out on behalf of prevention programs.

Gender Bias

In developing countries, women in military service, including officers and enlisted women, wives of soldiers, and civilian women working for military institutions, are often subject to discrimination. In garrison towns and neighborhoods surrounding military bases, women live in conditions that lead to bias, harassment, and occasionally violence, particularly in bars and brothels. Commercial sex workers near military bases often live in unsanitary conditions and have limited access to condoms, health advice, or health care services. NGOs need to address gender-related and women's health issues in these situations as part of a comprehensive HIV/AIDS prevention and control program.

"Safe Zone" Forums

One way that AIDSCAP has effectively dealt with civilian-military prevention and control coordination has been the "safe zone" forum. First developed at the Civil-Military Workshop in Namibia in 1997, a safe zone forum is a setting where representatives of military bases (particularly in garrison towns) and representatives of commercial sex workers meet to coordinate and develop joint HIV prevention policies. Issues such as condom use, alcohol control, behavior in brothels, control of violence against women, codes of sexual conduct, and education for commercial sex workers and their clients are discussed at these forums, and the opportunity for coordinated policy development has benefited both commercial sex workers and soldiers by reducing the risk of HIV transmission. Safe zone forums could be organized worldwide.

Codes of Conduct

With the exception of the United States, Canada, and a few European nations, few countries demand adherence to codes of conduct for off-duty military men and for male and female military personnel. The rules of sexual engagement, debated in U.S. courts and in U.S. military courts-martial, have not spread to the military leadership in developing countries. The standard answer from military leaders is that the existing military law in their country is adequate to ensure codes of conduct are maintained. The search for sexual codes of conduct in the United States is seen as irrelevant, despite ongoing reports of gross violations in the militaries of developing countries. However, public opinion in some developing countries might gradually put pressure on militaries to create such codes. This issue provides an entry point for NGOs working on health and human rights issues to advocate for such codes to safeguard local populations and foster HIV prevention efforts in the military.

 

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