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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description II. Subproject Highlights (See Below)
III. Non-Subproject Highlights II. Subproject Highlights Workplace Interventions
Background The Centro de Orientación e Investigación Integral (COIN) was the first NGO created to address HIV/AIDS prevention among populations engaging in behaviors that put them at an increased risk of HIV infection. In 1992 COIN initiated an intervention to target industrial zone workers in the area of Haina called the "Proyecto Trabajo y Salud". In 1994, the project expanded to include employees in the industrial zones of Nigua and Herrera. In 1996, additional factories and mills in the Villas Agricolas industrial zone were added to the existing intervention sites. The industrial zone workers report having multiple sex partners, and in focus group discussions conducted at the beginning of the project, 6 out of 10 workers reported having had at least one STI. Despite such high HIV/AIDS susceptibility rates among this target audience, employers have historically left prevention efforts to the government health programs. Objectives The purpose of COIN's workplace interventions was to:
The main project activities fell under two categories: 1) to implement HIV/AIDS prevention activities and health services for industrial zone and seaport workers in Haina, Herrera, Nigua and Villas Agricolas through face to face interventions, video fora, workshops, and condom social marketing; and 2) to sensitize management to the threat of HIV/AIDS and to promote future project sustainability among industry managers and executives, labor unions, and public health authorities through marketing efforts. Accomplishments Throughout the life of the workplace project, COIN continually recruited, trained and provided refresher training for new people, due to the high mobility of workers. A total of 2,126 training contacts with employees (860 women, 1,263 men and 3 gender not specified) were made. A network of an average of 75 Health Messengers was maintained throughout the life of the project. These Health Messengers Leaders (HMLs) and Volunteer Health Messengers (HMVs) from the workplaces, as well as staff from COIN and the Dominican Social Security Institute (IDSS), participated in training workshops on HIV/AIDS, behavior change communication methodology, STI and other topics related to reproductive health and human development. HMLs and HMVs conducted face to face interactions, educational sessions, video presentations and correct condom use demonstrations for employees. With AIDSCAP's assistance, COIN initiated a condom social marketing program distributing 169,174 condoms (33,974 free and 135,200 sold) throughout LOP. Audio messages played over the mills loudspeakers reinforced the information in the materials that the health messengers distributed. The employees and their family members were also educated on HIV/AIDS at the Centro de Salud Integral Health fairs, labor union meetings, and management-run events such as the Expo Herrera 1996, all of which provided additional opportunities for HIV/AIDS education activities. In addition to these direct contacts made by COIN, the health messengers reported that the workers themselves conveyed the information learned to friends and relatives thereby extending the reach of the project. In sum, the HMLs and HMVs reached a total of 113,207 employees (51,991 women, 54,099 men and 7,116 gender not specified). During the 1994-1996 funding cycle, its was found that female workers expressed a desire to improve their self-esteem and ability to deal with sexual matters. This propelled COIN to incorporate a gender component into the health messengers approach to HIV/AIDS prevention. Training sessions on "Women and AIDS", "self-esteem and Sexual and Reproductive Rights" were held. COIN ensured that project educators provided constant supervision and follow-up to the health messenger network through LOP. Educational materials were designed to address the specific needs of the target audience. For example, COIN distributed comics and brochures on the correct use of a condom, pamphlets on "Women and AIDS", information on STDs, and a newspaper called The New Story which addresses themes on reproductive health, sexuality and self-esteem. In addition, support was gained from the IDSS to reproduce and distribute HIV/AIDS prevention materials designed by COIN for the last phase of the project. By the end of the project 58,369 educational materials had been distributed. COIN signed a letter of agreement with IDSS to ensure the provision of medications and health services for workers and members of their communities through the Centro de Salud Integral. The two organizations have also agreed to exchange technical assistance in training personnel and developing educational activities in factories affiliated with the IDSS. COIN, in collaboration with the Secretary of Public Health, developed agreements to coordinate reproductive health and medical treatment efforts with the National AIDS/STI Control Program (PROCETS), the Public Health Essential Drugs Program (PROMESE) and the Environmental Health Office of the Ministry of Public Health. Promotional visits and meetings were conducted with business executives in COIN's area of operation as well as in the industrial zones of Santiago, San Cristobal, La Romana, San Pedro de Macoris and Las Americas Industrial Park. These interviews established preliminary agreements for future support of the project and provided valuable information on funding sources within the industrial sector. Over the life of the project, COIN also promoted the Trabajo y Salud Project through two radio programs, and gained the support of key labor unions to integrate the project into their existing educational programs. With AIDSCAP technical assistance and funding COIN successfully designed a marketing strategy that includes a fee-for-service program wherein employers integrate COIN's interventions into their existing employee programs. A dossier for the industrial sector was also developed. This portfolio includes educational services, costs, information on HIV/AIDS and the socio-economic impact of AIDS in the industrial sector. Constraints In addition to the two aforementioned gaps in USAID funding for the project, COIN cited three main limitations that hindered implementation efforts. Changes in the management structure and personnel of the factories delayed the signing of agreements for continued project support. There are no clearly defined national funding agencies for a project of this type, and in the future some activities will have to be conducted through existing institutions such as the Association of Industrial Factories of La Romana. Another factor that affected the development of activities was seasonal changes in the industrial process. The Christmas season is used for collective vacations in several industries in the Dominican Republic. Others, such as textiles and houseware products, double their production during this time. These situations made communication with managers and workers extremely difficult. Some project activities had to be suspended during the time surrounding the presidential election in May and June of 1994 and again in the summer of 1996. Lessons Learned Entrepreneurs and managers need more information on the production/health/cost-benefits of timely HIV/AIDS prevention efforts to view health education as an investment in their business. HIV/AIDS programs for people at the workplace should also include community activities that reinforce interventions. Project should also include HIV+ individuals and their families, who could contribute a great deal to prevention efforts. The ties between the NGO and the official sector, specifically IDSS and the managerial staff of the factories, facilitated the expansion of both the educational and health components of the project, especially in the new zone of Villas Agricolas. For instance, the formal agreement signed by COIN and IDSS allowed the project to continue uninterrupted despite changes in personnel within IDSS. The establishment of these relationships also promoted the possibility of future agreements with other governmental institutions. Although there are donations for short-term activities within factories, the most viable financial support for this type of project comes from industrial consortiums and from business taxes.
Endnotes
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