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Final Report for the
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9. Rapid Response Fund Activities
Background The Kenya Country Program used two sources of funds for Rapid Response Activities. From 1993-95, "core" funds were available from headquarters and were used to support two pilot projects, both for the target audience of students at institutions of higher education. These were a drama festival organized by students at the University of Nairobi and a project for AIDS prevention education to medical students. Mission funds also supported Rapid Response activities from 1993 to 1996. Activities supported fell into two major categories: project implementation and capacity building. The first category included the initial stages of support for larger projects that were under discussion, significant pilot projects, and individual small activities; the second, supporting attendance at meetings and conferences, and support for TA that fell outside the country plan. The total amount disbursed through the Rapid Response Fund (RRF) was $122,036, of this $11,805 was from core funds and $110,231 from Mission funds. Mission funds expended amounted to 6.3% of the total amount budgeted for subproject activities in the Delivery Order. Accomplishments Seven major activities were supported under the Rapid Response Fund. These were:
In addition, support was given to attendance at meetings, workshops, publications, and consultancies. A full list of activities, divided by topic, is given below. Description of the activities with NASCOP and of the AIDS WATCH column are described above under the related subprojects. A fuller review of three significant RRF interventions: AMSUNAAC, the drama festivals, and the intervention with matatu operators, is also provided in the Behavior Change Communication project section above. The type of activities funded by the Rapid Response Fund (RRF) changed over time. In the first two years of the Country Program (1993-95), the RRF was used more to support implementation. In several cases it funded activities that later developed into larger agreements: for example, AIDS WATCH, support for NASCOP's rural surveillance system, and TA to the National AIDS Control Program. From 1996-97, as projects were more established, the RRF was extensively used to support conference attendance and workshops as well as some support for implementation. Those funded to attend meetings often presented or discussed AIDSCAP projects, such as MAP and NASCOP at the USAID HIV/AIDS Prevention Conference, AMSUNAAC at the Vancouver Conference and the South Africa Conference, and FPPS's representation at the Youth Meeting in Addis Ababa and the AVSC meeting in Mombasa. Country Office Assessment The Rapid Response Fund was an extremely valuable component of the Country Program. It allowed the Country Office to initiate AIDS prevention activities that were either too small in scope to be developed as a major sub-project or proposed by NGOs whose limited organizational structure would have excluded them from larger funding. In addition, given the fact that the major components of the AIDSCAP Country Program were decided upon at an early stage, this gave the Country Office the opportunity to respond to unforeseen needs or proposed small new initiatives. The RRF was at first rather cumbersome to administer, since approvals were still needed from both the regional and headquarters level even for small amounts. However, after this ruling was changed to allow the Resident Advisor to approve amounts under $5,000, the RRF became a more efficient mechanism. The RA's independent role in selecting RRF projects enabled funds to be provided quickly; however, the CO lost the opportunity to use the RRF to foster collaboration, through setting up a funding committee to draw up criteria for awards. Both approaches have advantages. Perhaps the most important aspect of the RRF is its function in fostering creativity in the design of AIDS prevention activities. Because these are low-cost projects, the program can risk funding new approaches. The Country Office is particularly proud of the pilot projects that were started under RRF. Two will graduate into larger sub-projects and one has been widely disseminated through presentations at international conferences. Using the RRF approach also meant that funded organizations concerned could learn about USAID and FHI requirements for financial and program reporting without being overwhelmed by the need to comply with monthly reporting requirements. This proved to be an excellent means of gradually building their administrative capacity to handle more formal grants. Langata Matatu Workers' HIV/AIDS/Reproductive Health Education FCO 40475
Background Hardly any educational programs in Kenya have targeted matatu drivers and touts, the drivers and passenger operators of small passenger minibuses that run on public routes. The matutu operators are usually young men, notorious for their seemingly carefree and high-risk lifestyle. They play the latest music and have access to drugs, and consequently are very attractive and influential with young people. The main source of information on reproductive health and HIV/AIDS for these groups, however, has been the media (such as radio, TV, posters and print media). Other sources of information have been their peers, who are likely to spread information that is either untrue, contradictory or fear arousing. The Kenya One World Linking Forum (K-OWL) is an NGO, whose main objectives are to facilitate and provide all forms of local level adult community and development education. K-OWL requested AIDSCAP support for a pilot project to train a group of operators from one matatu route in HIV/AIDS and reproductive health. A small project was set up, in the last months of the Country Program, under the Rapid Response Fund, with a budget of only $7,500. The project was to be developed using the principles of adult education, including responding to the needs of the target group and a participatory approach. Objective The objective was to educate and train a core-group of matatu drivers and touts on reproductive health and HIV/AIDS who would then function as peer educators in order to foster adoption of AIDS prevention behavior among this very sexually active group of youths. Accomplishments Baseline Study A baseline study was designed by K-OWL to determine the current knowledge, attitude and practices related to HIV/AIDS and reproductive health among the matatu drivers and touts, and to provide guidance on operational issues, such as a suitable language for education and training. The study results were also used to establish the indicators for evaluation at the end of the training program. The age-range of this group was between 26-30 years old. Most of the operators (44%) had ordinary level education, 42% had completed their primary education (standard 8) and 2% had continued to advanced level. Most (96%) could read and write in Kiswahili, while 70% could read and write in English. The study showed that 56% of this group had at some time contracted an STD; and 20% indicated they had sex with casual partners or prostitutes. Few, however, used condoms for AIDS prevention. Most matatu drivers and touts had some knowledge about HIV/AIDS and reproductive health but did not know all the facts. The Education Content and Program At the start of the project, three meetings were organized with the leaders of the group of matatu workers interim to establish what kind of education they needed and wanted. Besides its primary focus on HIV/AIDS and reproductive health, the program that was developed covered supplementary topics that included: Human Relations and Communication, Gender and Courtesy, Planning for Retirement, Environment, Transport and Traffic Law, First Aid. It was important to select a site and time for the education sessions that was easily accessible for the matatu operators, who work very busy schedules under intense pressure. Space was made available by the Miujiza Players, who were themselves based in a library building close to the bus pick-up point in downtown Nairobi. The first time chosen, 10.30-11.30 a.m., was later changed to 11.30 a.m.-1 p.m. to respond to the drivers' greater availability during off-peak hours. The intervention was presented as a course of two sessions of 2 hours each per week, and methods of communication included lectures, drama (by the Miujiza Players), group discussions, video shows, and demonstrations. The active involvement of the drivers and touts during the training gave them the opportunity to ask questions that had bothered them for a long time. 45-50 drivers were involved in the course (not all drivers attended every session), of whom 35 graduated after attending every session. Future Plans The intervention had additional benefits. Drivers, who had met together as a group on a consistent basis for the first time, intended to continue to collaborate as an independent organization and have applied for registration as a welfare society. They are also enthusiastic about working with K-OWL to replicate the intervention for other matatu operators. Lessons Learned Matatu drivers and touts have a strong unmet need for reproductive health/ HIV/AIDS education. K-OWL discovered that matatu drivers and touts were extremely keen to learn the facts about AIDS, the consequences of certain sexual practices and what the scientific community was doing about HIV/AIDS. The initial AIDS education quickly led to a demand by drivers and touts for sex education. This unmet need for education on HIV/AIDS is illustrated by the fact that three other groups (matatu drivers of Route No.58-Buru Buru and Aga Khan and taxi drivers) have heard about the course through word-of-mouth and have contacted K-OWL to request similar training. Informal groups such as matatu drivers and touts can be reached with educational programs it organizations take time for community needs assessment and respond to the group's particular constraints. K-OWL contacted the matatu drivers by first identifying their leaders. K-OWL trainers spent considerable time explaining the program to the leaders, conducting a training needs assessment, and designing a training program that best fit the matatu drivers and tout's needs. As noted above, in organizing their educational program, K-OWL also took into consideration the logistical constraints facing matatu drivers and touts, for example in choosing the location and time for the training. K-OWL feels that their experience could be useful to other groups: there are many facilities such as theaters which go unused during the daytime and where groups such as matatu drivers can be trained. Trainers also understood the demands of the job, and allowed drivers who were "next in line" to take a bus out from the terminal to go do their run and then return to the training session. The adult education approach used in this HIV/AIDS program for matatu drivers and touts was successful in that it addressed a wide spectrum of needs for this community and has resulted in community mobilization around related issues important to improving these drivers' lives. While beginning with educational sessions on HIV/AIDS, K-OWL also delivered training sessions which met the expressed needs of the drivers and touts. For example, K-OWL included sessions on traffic laws, insurance issues, transport and the environment, and parking problems, inviting magistrates, local authorities and insurance agents as guest speakers. K-OWL also delivered sessions on gender and courtesy using adult learning theory where drivers themselves were brought to reflect on their own behaviors and subsequent outcomes. The drivers completing this session became sensitized to their behaviors with older women and girls on matatus (these behaviors include forcing older women to "dive" off the bus while it was still moving or inappropriate touching of young girls). The drivers suggested a campaign using posters be developed to sensitize other drivers. This session on gender and courtesy also led the drivers to recognize the long-term effects of playing loud music on buses. The adult education approach used by K-OWL mobilized the matatu drivers who have now registered themselves as a welfare society and are in the process of organizing a formal, self-help group. Faced with problems such as job insecurity and poor cash handling, the drivers have established goals such as buying their own matatus as a group. K-OWL also has assisted the group to meet Kenya Commercial Bank officials in order to open bank accounts and access loans. Country Office Assessment Like the project with security guards, this project has great potential as a methodology to reach a large number of young men at risk of STD/HIV infection, who are currently poorly informed. The initial groups of trained matatu workers are enthusiastic about continuing to work on HIV/AIDS education and could be instrumental in disseminating the information to their peers, and mobilizing other matatu workers for similar training programs and empowerment strategies. Future programs for this group would be strengthened by providing the participants with condoms to distribute to their peers, simple booklets to give out to their peers and even passengers on the vehicles, music cassettes with AIDS and health education messages, and posters. However, the challenge is how to develop a replicable model of education to reach this group in many different areas of Kenya. Process Indicator Summary
Group Peer Influence and Behavioral Intervention to Promote the FCO 40475
Background Despite the high prevalence of HIV in Kenya, medical students are not trained in HIV/AIDS prevention and are as likely as their non-medical colleagues to be uninformed and ill at ease in discussing approaches to safe sex. This project was developed by the Association of Medical Students of the University of Nairobi AIDS Awareness Campaign (AMSUNAAC), in order to help medical students understand the importance of AIDS prevention. Objectives The project objectives were: to identify students' knowledge, attitudes, and practices on HIV/AIDS; to determine factors hindering behavior change among students; to present the experiences of facilitators practicing safe sex as role models for behavior change; and to facilitate discussions to help participants internalize these models. Accomplishments Four facilitator couples (medical students and their girl friends) were trained as focus group moderators and through discussions presented models of safe sex practices to 119 medical students at the University of Nairobi School of Medicine. The survey and discussions took place in three phases. An initial introductory meeting was held with the medical students to present the study and administer a KABP questionnaire (121 respondents). Six mixed gender groups of 15-20 students were formed (with 119 participants in total), each led by two facilitator couples, with one group modeling abstinence and/or monogamy and one condom use. Discussion topic guides were used to direct the FGDs. Two meetings of each group were held in the introductory visit. Facilitators listened to groups' concerns, provoked discussion, and explained how they practiced safe sex or abstinence. In the subsequent two visits, follow-up discussions were held with the same groups of medical students to stimulate further discussion. These visits also assessed how the previous session(s) had impacted medical student behavior. A follow-up KABP study (101 respondents) was conducted at the close of the project. Technical assistance to AMSUNAAC in qualitative and quantitative research skills was an important component of the project. The facilitators received basic training in questionnaire design and how to conduct focus group discussions from Jan Hogle, AIDSCAP Evaluation Officer. James Muttunga, consultant, also worked with AMSUNAAC to train them in data analysis of the KABP findings and supervise the KABP report. Findings Students were well versed in HIV/AIDS transmission and prevention. Knowledge of transmission methods was 100%. With regard to prevention methods, some change was recorded in replies to the pre- and post-test interviews. At post-test, 81.3% advocated condom use (73.3% pre-test), 80.2% mutual monogamy (73.3% pre-test), and 75% abstinence (59.3% pre-test), though the practicality of the last was questioned. However, 26.3% at post-test had sex with multiple partners, compared to 18.9% at pre-test. Condoms and their use generated much debate on both acceptability and efficacy. Condoms are not popular and their use is affected by issues of trust; though only 7.7% (post-test) questioned their efficacy. In both pre- and post-test, 61% had sex recently without using a condom. About half the students discussed condom use before sex (58.2% post-test, 54.7% pre-test), although some (18.8% post-test) were too embarrassed to discuss it. Discussion of condoms tends to happen in the initial stages of a relationship and the more intimate a relationship grows, the less chance of discussion. Though many students were sexually active, some of the factors hindering change in behavior at post-test included not feeling at risk (42.3%) and having one faithful partner (53.8%). Attitudes to PLWAs tended to be condemnatory, and there were fears of handling AIDS patients without protection. Home-based care was advocated for AIDS patients to save on the limited hospital space. Lessons Learned AMSUNAAC used group discussions as a novel peer education methodology: evaluation indicated dramatic changes in students' attitudes towards HIV/AIDS. Although pre and post KABP studies of the students involved in their peer education program did not show sharp differences in behavior, the group discussions led to dramatically changed attitudes by students about HIV/AIDS and their willingness to talk openly about sensitive topics. In the group discussions participants explored their own attitudes and practices, while student facilitators acted as "role models" through sharing their own approaches to safe sexual behavior as a means to prevent HIV/AIDS. Facilitators who lead group discussions on sensitive topics, such as HIV/AIDS, have to establish a level of "optimal self-disclosure" to encourage discussion. The student facilitators began group discussions with a short presentation of their own safe sexual practices, their own experiences with condoms and their own experiences with abstinence. However, in one of the first university sites, the participants were shocked. Some ridiculed the facilitators and others walked out. The facilitators realized that they needed to share enough information to generate discussion on this sensitive topic, yet not so much it would elicit strong reactions which would inhibit discussion. Afterwards, the group facilitators revised their discussion guide to maintain the themes, but to introduce them in a more acceptable way. Training of group discussion facilitators to deal effectively with such situations is essential. For effective discussion and learning in group settings, it is important to develop a participant profile and use this to form the groups. In the university setting, attention was paid to gender, age and year of study. Gender was an important issue in the group discussions. In general, while men were able to talk about condom use, women shied away. With medical school students, it is important not to mix class years in one group, otherwise certain students will not effectively participate. With certain topics, facilitators may want to use homogenous groups, while with other topics, mixed groups may bring more contrast of opinions and thus critical debate into the discussion. Medical students' high knowledge levels of HIV/AIDS are still accompanied by discrepant beliefs. This situation calls for adequate study of perceptions and a mix of interventions to effect behavioral change. While knowledge levels among medical students about HIV/AIDS is high, some "gray" areas continue to exist. For example, 4.2% felt sharing cups could lead to HIV infection. Even among medical students, their own personal values and beliefs have a strong effect on practices. Some students idealize their current partner, and resist thinking about their partner's past history or possible infection with HIV. Despite presentation of data on condom effectiveness, some students still believe that condoms are not effective. It is important that HIV/AIDS education interventions be based on participants' perceptions of susceptibility; their perceptions of acceptable action; and the extent to which they feel competent to carry out prescribed actions over long periods of time. Country Office Assessment Perhaps the greatest value of this project was the long-term educational process that took place for its four medical student coordinators. From the inception of the project, AIDSCAP worked closely with the AMSUNAAC organizers to upgrade their research skills in both qualitative and quantitative research. Through a consultant, James Muttunga, the Country Office also provided them facilities for data analysis that were not available to them at the university. The Country Office is proud that this project was widely presented at several regional and international AIDS conferences, and that two of the coordinators, now graduated and starting their medical career, intend to continue working in the field of AIDS prevention. The project's findings that many of the medical student respondents resisted condom use and had condemnatory attitudes to people living with AIDS indicate that AIDS prevention education, personal risk assessment, and interpersonal skills are needed in the medical school curriculum. Process Indicator Summary
World AIDS Day Drama Festivals FCO 20475/40475
Background In 1994, the Nairobi Province AIDS Task Force, with the support of USAID, organized a youth drama competition festival to commemorate World AIDS Day. An orientation workshop was held in HIV/AIDS awareness and message development. Fifteen groups performed at the two-day festival in the categories of drama, dance, poetry and music. The following year, the competition was organized by APNET, a Nairobi-based NGO and funded by USAID through AIDSCAP. Forty-three groups, now including three groups from outside Nairobi (Embu, Mombasa, and Limuru), competed in a two-day event, and the winners performed at the national World AIDS Day commemoration in Kisii. It was emphasized that the festival was not supposed to be an end in itself: groups were expected to perform their presentations for their communities. Accomplishments In 1996, Artnet Waves Communications took over the organization of the youth drama festival. Demand to take part had again grown. At this point, an intensified training component was introduced, with the objective of increasing the professional abilities of the performers and improving the technical content of messages. A workshop, funded by the British Council and attended by 98 group members, was held to train groups in HIV/AIDS messages for behavior change, and theatrical performance skills. As in 1995, the organizers visited the groups to comment on their rehearsals and help them to refine their work. Publicity for the festival also intensified, with articles and programs in the national press, radio, and television that discussed the need for AIDS prevention as well as advertising the event. The US Ambassador, Ms. Prudence Bushnell, opened the 1996 festival, which was attended by about 10,000 people. Sixty groups competed, with four groups coming from outside Nairobi. In 1997, in response to the demand from the regions, which presented an opportunity to take AIDS messages to a wider audience, the festival is being organized on a year-round regional basis. Regional coordinators are responsible for training workshops, outreach activities and holding regional festivals in July, which will lead up to the World AIDS Day national competition festival in November. Minimal incentives are used (recognition and trophies given for a theatrical competition) and coordinators are encouragement to collaborate with local NGOs and the District AIDS/STD Control Programme. Over 175 groups have already expressed interest in the 1997 festival. Lessons Learned The training component was extremely important. It facilitated the groups' ability to understand and depict sensitive issues related to sexuality in public. For example, while at first, it seemed almost impossible to come up with scripts on condoms, it has become much easier and condom demonstrations are now done on stage with less controversy. The training also increased performers' self-esteem. The groups involved felt more confident that they had a talent they could use to teach others. Presentations by Persons with AIDS in the workshops were important in sensitizing performers on themes such as compassion for people with AIDS. These issues were then in turn better presented in their plays. The performers were encouraged to use real-life situations in their presentations on HIV/AIDS. However, this sometimes compromised the accuracy and/or sensitivity of the technical content relating to HIV/AIDS. Artnet staff observed that some groups inadvertently communicated negative messages about women, which reflected the real-life stereotypes that exist in Kenyan society. For example, some situations portrayed existing stereotypes, for example men as "conquerors" and women as "AIDS carriers". While Artnet encouraged groups to develop drama based on real-life situations, some dramatic presentations reinforced rather than challenged these situations. In addition, some cultural practices such as wife inheritance were superficially portrayed, especially by Nairobi-based groups. Group discussions with theater groups in Kisumu revealed that this cultural practice is not static; it has evolved and is evolving because of people's socio-economic situation. AIDS education efforts through theater must take into consideration these complex factors when portraying cultural practices and AIDS prevention. Artnet addressed these dilemmas through: hiring both women and men as regional coordinators and sensitizing them to gender issues, increasing the emphasis on long-term training and education of the performing groups, holding meetings in rural areas to better discuss and understand particular cultural issues of a region, and pre-testing performances to improve content and ensure that stereotypes were addressed before public performances. The expectation of financial reward can make it difficult to sustain activities with volunteer groups. While some groups have contributed significant resources to the project (such as churches) other groups have been influenced by NGOs who have established the practice of giving theatrical groups money and indemnities, or reimbursing participants in an event. This expectation of support for participation in the festival (e.g. for transport costs, per diems) has become increasingly evident as the event has grown from the local to the national scale. It raises important questions on how best a central group can foster independent community participation. Country Office Assessment The project has grown from its beginnings as one event in the World AIDS Day observances by the Nairobi Task Force, to its current status as a potential means of organizing the creativity of youth groups to support AIDS prevention, on an annual national basis. In addition, as it has expanded, the youth drama festival organizers have been able to attract funding from various sponsors, so that the event now has many donor stakeholders. AIDSCAP funds were thus able to support the capacity-building process of the young organizations, APNET and Artnet Waves, as they gradually improved the conceptualization and management of the youth festival. The challenge now is to ensure supervision of the drama groups at a regional level, so as to ensure that high quality messages are reaching the communities. Process Indicator Summary
Process Indicator Summary
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