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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights Avancemos Project - COVICOSIDA
Background COVICOSIDA is a non-profit organization created in 1988 by health professionals, journalists, psychologists, educators, and community leaders living in the northern region of the country. The main thrust of the Comité de Vigilancia y Control del SIDA (COVICOSIDA) has been educational interventions with commercial sex workers (CSWs) and with hotel employees in the north of the country. COVICOSIDA reports an increase in the commercial sex trade in the region of Puerto Plata over the past years, as the city is being promoted abroad as a sex paradise. Some 500,000 tourist visit Puerto Plata each year, and there has been an influx of CSWs who immigrate to the city from rural areas. Puerto Plata has 7.6 percent of the country's reported AIDS cases and studies show it has the highest seroprevalence of gonorrhea and syphilis in the Dominican Republic. Objectives The purpose of this project was to contribute to the reduction of the high seroprevalence of STI and AIDS among commercial sex workers (CSWs) and men involved in the commercial sex industry (MICSI) in the cities of Puerto Plata, Montellano and Sosua. To achieve this goal, the project worked through a network of trained Health Messenger Leaders (HMLs) and Volunteer Health Messengers (HMVs) who conduct prevention education activities such as face to face and theater presentations in bars and brothels. Another main objective of the project was to create a marketing strategy to secure continued support for the intervention beyond the life of the AIDSCAP project. Accomplishments COVICOSIDA recruited and trained health messengers from the target population on STI/HIV/AIDS and reproductive health. A total of 1,322 training contacts were made (224 with men, 1,092 with women and 6 gender non-specified). The health messenger network of an average of 15 HMLs, educated CSWs through face to face discussions, condom demonstrations, and weekly educational sessions. The interactive theater presentations produced by COVICOSIDA were very successful, creating a demand for performances at sites that were not originally included in the project design. The health messenger network also educated other "decision makers" in the commercial sex industry including bar and brothel owners, CSWs' fixed partners, taxi drivers, disk jockeys, bartenders and so on. In all, the HMLs reached 40,325 individuals through different educational activities (25,639 women, 13,757 men and 929 gender not specified). AIDSCAP provided technical assistance to COVICOSIDA in the elaboration of condom social marketing and condom distribution plans. COVICOSIDA also established agreements with public health authorities and other NGOs, such as the Dermatologic Institute, to contribute in improving health services for the target population. A total of 263,004 condoms were distributed. Of these, 200,723 were sold and 62,281 distributed for free. Distribution outlets included non traditional sites, such as brothels, bars, discotheques, and short-term sites functioning during special events and activities. A total of 75,112 posters, pamphlets and other educational materials were distributed. The Mario and Maritza comics were created with storylines specific for this target audience. Additional materials containing information on STI/HIV/AIDS that could be used by CSWs and other members of the larger community were distributed. A main component of the last phase of the project was to ensure sustainability. Focus groups were conducted with CSWs and brothel and bar owners to identify areas where further work should be done and to explore the business owners' receptivity of a fee-for-service program. The business owners overall expressed a willingness to continue the Avancemos intervention beyond the life of AIDSCAP. Since, several businesses were integrated into the fee-for-service program. Constraints COVICOSIDA reported several constraints which affected project implementation. The uncertainty surrounding the continuation of the AIDSCAP project caused a break between the end of COVICOSIDA's project in August 1996 and the beginning of the new project in October 1996. Delays in funding disbursements at the new project's inception forced the NGO to borrow money in order to cover expenses until the subproject funds were disbursed. Also, during the life of the project, the price for STI services doubled at the Dermatologic Institute's clinic where the majority of CSWs receive check ups and treatment. As a result, the CSWs' clinic attendance decreased significantly during the last phase of the project. Sanitary controls that regulate sex trade business operation were not enforced during the months following the change of government. This was due to delays in appointment of personnel within the Health Department. Despite these constraints, COVICOSIDA managed to surpass the majority of its expected outputs. Findings and Recommendations COVICOSIDA found that CSWs who work on the streets had lower levels of self-esteem and correct information about HIV and STI than those who worked in brothels. COVICOSIDA recommended that more work be done with this group as they are at a higher risk of infection. All CSWs must continue to be reached with themes such as self-esteem, and human and labor rights to allow them to secure other options besides commercial sex work. COVICOSIDA determined that the active involvement and support of MICSIs, as well as the local authorities, was an essential part of the intervention model and accounts for positive project outcomes. Face to face interventions with both men and CSWs were very effective as was the use of provocative theater. These program components should all be maintained in future interventions. During the final stages of the project, the brothel and bar owners expressed greater interest in the project by requesting and even paying for some of the health messengers' assistance. For future projects, COVICOSIDA strongly recommended that agreements be maintained with the business owners so they fund project activities. Also, intersectorial coordination in the northern region of the country should be enhanced to implement more effective HIV/AIDS prevention programs.
Endnotes
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