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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights Interventions for Youth
Background The Coordinadora de Animación Socio-Cultural (CASCO) was established in 1984 by social scientists and educators dedicated to improving the well being of those living in marginal urban areas of Santo Domingo. CASCO's first HIV/AIDS prevention activities began in 1987 and consisted of peer to peer education for youth between the ages of 13 to 24, commercial sex workers and women working in the sugar plantations. The Instituto Dominicano de Desarrollo Integral, Inc. (IDDI) began operating in 1984, with the goal of promoting active participation of communities in the areas of health and environment, community development, small business development and family planning. In 1993, CASCO and IDDI co-implemented the "Acuario" Project. This project targeted youth in 19 marginal communities in and around Santo Domingo. Due to the low socio-economic conditions in these neighborhoods, there are minimal educational and job opportunities for young people, and the traditional nuclear family is disintegrating. Drug use, high STI prevalence, and pregnancies at an early age all point to the lack of governmental assistance in the areas of health and sex education for this group. CASCO/IDDI have sought to fill this gap by organizing and training parent and neighbor associations, youth leaders and teachers in primary prevention and youth health programs. Objectives The purpose of the Acuario project was to reduce the incidence of STI/ HIV/AIDS among the adolescent population of poorer communities in Santo Domingo: Villa Mella, Guaricano, La Zurza and Herrera. In order to reach the goal of reducing STIs/HIV/AIDS, the project activities focused on reducing high risk behaviors among the target population and working to change environmental barriers to behavior change. In addition to CASCO/IDDI's interventions with individuals, special events were held to set the groundwork for national level HIV/AIDS prevention activities. For example, in the last phase of the project, CASCO/IDDI held two special events: a National Youth Forum and a Training Workshop for Youth Organizations. CASCO/IDDI collaborated with the Ministry of Health's Adolescent Integral Health Program (SIA) on both activities to ensure future collaboration between NGOs and the government. They also counted with the participation of the National Direction for the Youth Promotion, GO in charge of national youth policies. Outcomes CASCO/IDDI developed community-based interventions in order to promote behavioral changes in the target population. This involved frequent coordination meetings with CBOs, parent-teacher associations, and other youth groups. Training for the leaders of these groups were constantly provided to ensure that all players were working together to achieve the project's objectives. The youth themselves received training in order to become part of the 120 member health messenger network. The training workshops ran continuously throughout the life of the project and covered topics such as reproductive health, STI/HIV/AIDS, contraceptive technology, sexual education methodology and syndromic management of STIs. By the end of the project 4,698 training contacts had been made with individuals from the target population (2,955 women and 1,743 men). To reach a greater portion of the target population in a shorter time frame, CASCO/IDDI held mini-workshops for youth. These courses also included information on adolescent health, modification of unsafe sex practices, gender stereotypes, and self-esteem. Trainings were reinforced by health messengers during bimonthly visits to young persons or during group sessions at education centers in each neighborhood. In addition to youth, thousands of adults were reached during special community events. CASCO/IDDI took advantage of neighborhood cultural, sports and recreational activities such as basketball tournaments to broadcast HIV/AIDS prevention messages, distribute condoms and materials, and to meet face to face with residents. Through all of these educational activities 183,554 individuals (79,503 women, 82,474 men and 21,577 gender not specified) were reached. CASCO/IDDI designed, printed and distributed 114,692 educational materials for the Acuario Project. These included pamphlets such as "AIDS, You Can Avoid it Too," "Take Care of Yourself," and "Speak to Your Children about AIDS." Also, flipcharts and user guides for youth leaders were developed under the "It's Your Life" slogan. As part of its condom social marketing strategy, CASCO/IDDI installed condom distribution sites in the four communities. Through which 206,092 condoms were either sold (14,750) or distributed for free (191,342). These condoms were not supplied by the AIDSCAP/DR project. They were donated were donated to IDDI by UNFPA. CASCO/IDDI maintained excellent coordination with other AIDS prevention and youth organizations. Meetings were held with the NACP (PROCETS) to increase access to improved diagnostic and treatment services at public STI clinics. They also worked with the national BCC Commission to design and implement a sustainability and collaboration plan. CASCO/IDDI continuously evaluated the project's activities and redirect strategies to better meet the needs of its target audience. As the project progressed, a component on gender and HIV/AIDS was incorporated. Female volunteers were trained on the implications of HIV/AIDS for women. A large study to identify the barriers to adopting low risk behaviors among females was conducted with the young women in the target areas. Study results were presented during AIDSCAP/DR's July 1996 conference on "AIDS : A Challenge to Development." The presentation, entitled "Y es facil ser mujer?", was an analysis of the factors which structure, reinforce and modify young urban women's behaviors and sexual practices and their relation with HIV/AIDS prevention. The results of this study served as input to the "Strategy for Young Women" developed later. After termination of the Acuario project, CASCO/IDDI became involved in coordinating a broad spectrum of activities to define national level actions involving youth. In March, CASCO/IDDI hosted a three day National Forum with 109 young leaders (15-24 years old) involved in youth programs. The purpose of this forum was to review youth risk behaviors and devise a new approach on Adolescent Integral Health with emphasis in STI/HIV/AIDS Prevention. This event involved youth throughout all stages of planning, implementation and evaluation. They were able to thoroughly discuss risk behaviors and decide what actions they should take. Significant intersectorial collaboration was achieved. Several governmental agencies and programs such as MOH-PROCETS and the Adolescent Integral Health Program (PRONAISA), the National Drug Control Program, Ministry of Sports-SEDEFIR, and the General Office for Youth Promotion (DJPJ). Twelve AIDS NGOs and private sector Universities, such as INTEC, also participated and endorsed this event. A "Manifesto" on health (including reproductive health and HIV/AIDS), education and labor issues in regards to youth was defined by the group. Plans are being made to present this document to the President of the DR to secure his support. CASCO/IDDI also held a training workshop on HIV/AIDS Prevention Methodology for Community Youth Organizations in April, 1997. Numerous community leaders representing over twenty organizations participated in the training, as did members of the National STI and AIDS Control Program (PROCETS) and the Adolescent Integral Health Program. The specific objectives for the course were to 1) promote integration of health and sexuality components into the community organizations' existing work; and 2) to develop skills necessary to arrange and implement HIV/AIDS prevention activities. During this workshop Youth Organizations developed HIV/AIDS prevention action plans for May-November, 1997 for several communities and sugar cane plantations (bateyes) in Santo Domingo. In addition to STI/HIV/AIDS prevention, activities were also included to address teenage pregnancy, STI, and problems brought on by the disintegration of the family unit. Constraints CASCO and IDDI were both affected by delays in funding disbursements at the inception of the project. Other financial constraints were noted. For instance, CASCO/IDDI reported that salaries paid to field staff were low. In spite of their enthusiasm and commitment the staff worked fewer hours than planned, thus, objectives were achieved at a longer term. Another financial constraint occurred during the National Youth Forum. Fund raising efforts were not as successful as expected. This problem was aggravated by the fact that one governmental organization pledged a large amount and at the close of the activity had still not made the funds available. CASCO/IDDI learned that in future events all pledge agreements must be made in writing and funds secured prior to implementation. Although fourteen organizations were involved in the forum's planning and logistics, the burden of the work fell on a few groups causing a limit to what could be accomplished in a timely manner. Findings and Recommendations Two main findings arose from the Acuario Project's educational intervention component. The first was that collaboration among agencies with common concerns, but varying areas of expertise, can increase a project's effectiveness and allow for a more participatory process in achieving common goals. The second finding was that the educational process was greatly improved when parents, teachers and schools were incorporated into the process and allowed to provide input. In regards to the Youth Forum, CASCO/IDDI attributed much of its success to the active role played by youth during the design and implementation of the activity. As a result, the activities that emerged are already adapted to the target audience they hope to reach. The high level of cooperation and participation of NGOs and GOs during the Forum and the Training Workshop for Youth organizations also bodes well for future planning of national level HIV/AIDS prevention activities.
Endnotes
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