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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights II. Subproject Highlights Interventions for MWM
Background Amigos Siempre Amigos (ASA) is the first NGO in the Dominican Republic dedicated exclusively to working with men who have sex with men (MWM). It has six years of experience implementing HIV/AIDS prevention under its "Triunfadores" and "Alto al SIDA" projects. The Dominican Republic consists of an eminently Catholic society and exhibits a traditional machismo culture, factors which combine to alienate the MWM community from the mainstream concepts of sexuality. Initial prevention campaigns targeting MWM even referred to HIV as the "Gay Cancer". Studies have shown that MWM who have lower self esteem tend to exhibit more depression and anxiety, consume more alcohol and exhibit behaviors that place them at higher risk of HIV infection. During 1992 - 1996, ASA co-implemented the Triunfadores Project with another AIDSCAP funded IA, COIN. The project goal was to reduce STI/HIV/AIDS prevalence among MWM in the Dominican Republic by reducing high risk behaviors. Main project activities consisted of outreach activities, educational sessions, workshops and support groups. These activities were conducted through a well trained team of peer educators. During the activities educational materials and condoms were distributed. Activities took place in Santo Domingo on the southern coast, Puerto Plata and Sosua on the northern coast, and Santiago in the interior of the island. A evaluative survey conducted in 1994 among gay and bisexual population found that while the MWM group has a high level of knowledge of HIV/AIDS, condom use remained low. The need to incorporate further actions led to the design and implementation of the Alto al SIDA (Stop AIDS) project. Objectives The purpose of ASA's intervention during the "Alto al SIDA" ("Stop AIDS") project was not only to continue the educational work of the Triunfadores project, but to facilitate behavior change through improving MWM's self esteem and sexual identity. To do this, ASA adapted the methodology of a successful MWM intervention conducted by the AIDS Foundation in Puerto Rico and based on a model used with MWM in cities throughout the United States. Another goal of the "Stop AIDS" project was to develop a methodological manual to facilitate reproduction of the project in the future. Outcomes During monthly workshops 4,457 training contacts (4,298 men and 159 women) were made by the network of volunteers and staff members . ASA's peer educators network consists of 10 Health Messenger Leaders (HMLs) and 56 Volunteer Health Messengers (HMVs), all of whom were trained in HIV/AIDS, opportunistic infections, sexuality, practical support for HIV+ individuals and correct condom use. The HMLs helped train the HMVs who in turn shared prevention messages with their peers. Over the LOP 67,213 individuals (52,622 men, 3,981 women and 10,610 gender not specified) were reached, principally through face to face activities and larger educational sessions. Approximately 70,168 educational materials were distributed and 376,794 condoms were sold (249,630) or distributed for free (127,164). An overall condom distribution strategy was designed, implemented and revised to best meet the needs of the target audience in the numerous project areas. Through this strategy, 11 condom distribution outlets were established. COIN/ASA also increased the access of MWM to STI diagnosis and treatment services through cooperation with public STI clinics. Weekly and monthly evaluation meetings were held to modify training and educational sessions as needed. During the "Stop AIDS" phase of the intervention, project promoters conducted outreach visits to discotheques, bars, and theaters to present "Stop AIDS" project goals to MWM and to extend a formal invitation to participate in the project's discussion groups and other activities. Discussion groups were lead by trained project facilitators who covered the impact of HIV/AIDS within the gay community, and discussed issues such as antibody tests, safer sex techniques, and the relation between transmission of HIV and other STI. MWM were also invited to participate in the "We Can do It" Workshops, held in February and March 1997. The Workshops addressed sessions on self-esteem, alcohol, drugs and STI, sexuality and behavior change. MWM who attended the workshops were then invited to join in one of the support groups and to participate in the project as volunteers. Each support group consisted of 8 to 11 persons. Educational activities have served not only to disseminate information, but have been used to provide a supportive environment where MWM are free to discuss their feelings about HIV/AIDS. In this environment they learn to accept differences within their own community as well as to view themselves as worthy and productive members of society in the face of the existing negative stereotypes. In addition to the extensive numbers of new participants in the Stop AIDS project, ASA produced a methodological manual for use in interventions. ASA also worked with AIDSCAP on sustainability plans to continue activities among the MWM target group and better prepare their organization HIV efforts post AIDSCAP. Constraints The Triunfadores Project work was interrupted by disruptions and delays in USAID funding. The ASA team had administrative system weaknesses. Therefore, COIN assumed the administrative responsibilities and ASA the educational work. During project implementation, ASA's management capabilities were strengthened allowing them to work independently. At the end of the first phase of the Triunfadores Project (early 95), the ASA team was greatly affected by the death of their Executive Director to AIDS. After adapting to this loss and tackling other technical and logistical difficulties, project implementation began again in November 1995. Findings and Recommendations ASA found that many self-identified sub-groups existed within the larger MWM population. This included bisexuals, transsexuals, transvestites, and homosexuals. Some of the sub-groups also involved in commercial sex work deemed necessary the development of specific STI/HIV/AIDS strategies for these sub-groups. ASA also found that the level of effectiveness of its educational interventions depended on the involvement of the target audience. Therefore, it recommended that all future interventions incorporate a broader group of MWM in the design process from its inception. Violence and homophobia continue to be major problems encountered by MWM. ASA recommends that these issues, as well as the low levels of self-esteem be addressed in future projects.
Endnotes
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