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This report comprehensively summarizes the FHI/AIDSCAP program in Senegal (1993-1997). The report includes a discussion of accomplishments, outcomes, implementation and management issues, as well as a series of lessons learned and recommendations.
Table of Contents I. Country Program Description C. Accomplishments and Outcomes D. Implementation and Management Issues II. Lessons Learned and Recommendations III. Subproject Highlights III. Subproject Highlights BCC Projects AIDS Prevention and Empowerment Through Market Women's Associations
Background and Scope of the Intervention The Christian Reformed World Relief Committee (CRWRC) conducted a needs assessment of market women's associations in Dakar and Kaolack in 1995 under the AIDSCAP/Senegal program. As a result of this study, Femme Développement Entreprise en Afrique (FDEA), a Senegalese NGO, was asked to implement a project in collaboration with CRWRC to address the needs of market women as identified in the CRWRC study. This project was designed to target Sérère market women and young girls working in the markets of Dakar and Kaolack with the purpose of educating these women and girls on the risks of STI and HIV infection, increasing AIDS awareness and providing them with means to protect themselves. The global objective was to reduce the prevalence of STI and HIV infection among the target group. This particular group of women was chosen as they were identified to be a group at great risk for STI/HIV infection due to their low economic status, migratory nature and sexual behavior. These rural women travel to urban markets to sell their products, however, due to economic constraints, are forced to sleep in the markets and often resort to sexual activities for economic gain. The young female children of these women are often without supervision in the markets and are also at risk of men in the marketplaces looking for sexual favors. An assessment study was conducted at the beginning of the project as a result of which 10 markets in Dakar and Kaolack were identified and 10 groups of Sérère women and young girls selected to participate in the training sessions. This same study identified Sérère women's associations and evaluated the level of organization of the women, the family situations of members, the actual level of knowledge of STIs/HIV/AIDS, the level of training and training needs of the women and the facility with which training concerning health and sexuality could be conducted. The majority of women chosen for the training sessions had received no previous health training, however some demonstrated an awareness of STIs and AIDS. The women showed interest in receiving training and indicated a desire to share the information with other members of their home villages. Four main strategies were adopted for this project:
Principal Accomplishments A Training of Trainers (TOT) workshop was conducted for 20 FDEA trainers, as well as technical training in the prevention of STIs and HIV/AIDS. The workshops allowed the FDEA training team to establish a basic work system for all members of staff. In consequence, the trainers and facilitators have improved their training capacities and techniques and have developed skills in establishing and executing a participative health education program. Ten IEC sessions were held for the groups of Sérère women identified, for a total of 198 women. These IEC sessions consisted of four themes: reproductive anatomy and communication on sexuality; STIs and AIDS; behavior change and education; and evaluation activities. Each group participated in 12 sessions to complete the IEC program. Sessions were complemented with IEC materials -- photos and slides on STIs, anatomy puzzles, card game on AIDS, a flannelgraph on BCC, and a flipchart on AIDS -- produced by Education pour la Santé (EPS). The training manual, a workbook for participants, and the guide for the card game were translated into Sérère and reproduced for the project. Each participant received a workbook which they could keep for future reference and use as a tool in providing AIDS awareness information and training to other community members in their home villages. As economic independence empowers women to control their personal situations and reduces the risk of sexual activity for economic gain, training sessions were held for the 198 women in the attainment of credit to improve their ability to establish economic self sufficiency. IEC sessions were also conducted for more than 85 young girls, between the ages of 8-15, with IEC materials translated into Sérère. There was much enthusiasm and interest on the part of the young girls for these training sessions and many other girls not included in the original groups were allowed to participate. In addition, the women trained, with the assistance of poet and animator Thierno Seydou Sall, published a book of poems entitled "Paroles Séropositives" in Sérère. These poems, containing powerful images and creative language, demonstrated the women's strong commitment to the fight against AIDS. Important Constraints The greatest constraint faced by this project was the market women's lack of time. As these women are extremely occupied with issues of survival, and in particular, economics, they had to go to great measures to allow themselves the time to participate in the IEC sessions. In addition, the frequent number of religious holidays, in which women return to their home villages, interrupted the planning of training sessions. Social taboos and restrictions of the Sérère culture required that the FDEA trainers and facilitators approach subjects of sexuality with much tact and respect for cultural beliefs. Lessons Learned and Recommendations It is recommended to expand women's health and AIDS training programs to other market women's groups. Training programs should incorporate income-generating activities when possible to allow women to improve their economic situations and thereby allow for increased time to participate in such activities, in addition to the other advantages of economic empowerment. As many women are illiterate or of low literacy, visual aides, games, music, dance and theater-type activities prove to be effective methods of communication and help to reinforce messages.
NGO Grants for the Association Des Professeurs Des Sciences Naturelles
Background and Scope of the Intervention The Association Des Professeurs Des Science Naturelles (APSN) is an organization of secondary school teachers working together to improve the lives of students through social education activities. APSN's activities have highlighted the increased problem of sexual activity among young students placing them at higher risk for STIs and HIV/AIDS infection. AIDSCAP therefore supported ASPN in the implementation of an STI and behavior change communication project targeting high school students. The goal of the project was to reduce the prevalence of STIs among high school students in the district of Ziguinchor by targeting the young people at school, their teachers and their parents with behavior change communication messages on STI/HIV/AIDS and the promotion and distribution of condoms. In addition, the project sought to improve social and cultural values regarding sexual behavior among the youth and improve communication between parents and their children. Principal Accomplishments 34 teachers were trained in STI/HIV/AIDS prevention, who in turn trained 30 students as peer educators. They subsequently held IEC sessions with the projection of a film and discussions to educate parents and students of the dangers of STIs and AIDS. As a result, 8,500 students and 208 parents were educated. Monthly meetings with religious leaders were organized to discuss social and cultural issues affecting sexual behaviors and to incite their support and assistance in attaining the goals of the project. Two conferences on AIDS were also organized at the high school. Much enthusiasm was shown by students and teachers in attendance of these activities. Following these IEC interventions, school authorities reported a decline in unwanted pregnancies among female students and also reported a decline in the presence of older men frequenting the school in search of young girls for sexual relations. Important Constraints The delay in provision of funds diminished the motivation of some project participants as materials were not readily available after sensitization about the project took place. Lessons Learned and Recommendations Future training sessions should increase information on project monitoring techniques and on counseling to provide teachers with a greater capacity to assist students of high-risk behavior and persons living with HIV. Greater support in materials and equipment, particularly audio visual, would also increase the effectiveness of this type of intervention.
STD Reduction at Eating Establishments (Gargottes)
Background and Scope of the Intervention UGAPS conducted a behavior change communication (BCC) project targeting owners, employees and clients of small eating establishments called "gargottes", and CSWs. These gargottes are located next to weekly and daily markets in the district of Koungheul and are also sites of commercial sex activities. There are 115 gargottes (90 permanent and 25 itinerant) which are in the area of the daily market which draws between 5,000 and 20,000 persons per day. The owners of the gargottes are mostly women (65 percent), 87 percent of whom are married, however living away from their husbands. The goal of this project was to reduce the prevalence of STIs in the district of Koungheul by targeting the managers, workers and clients of the permanent gargottes with behavior change communication messages in STIs/HIV/AIDS and the promotion and distribution of condoms. Sixteen peer educators were trained in BCC and condom promotion. Eighty percent of the gargottes' workers attended health education talks on STI/AIDS prevention by peer educators. UGAPS also conducted seminars and demonstrations on AIDS for the general population.
NGO Grants for the Association National Pour le Bien-Etre de la Population
Background and Scope of the Intervention AIDSCAP supported ANBEP to conduct a behavior change communication (BCC) project targeting sexually active adults (men and women) and youth (both in and out of school), in different sites in the district of Tivaoune, Thies Region, including 19 villages located in the rural area. The objective of the project was to reduce the prevalence of AIDS transmission in the district of Tivaoune through BCC and IEC activities with emphasis on:
Principal Accomplishments Fifteen peer educators were trained in IEC interventions for behavior change and subsequently conducted activities targeting men, women and youth in their villages. Fourteen villages held events with the projection of a film on AIDS prevention and 405 focus group discussions were organized reaching an approximate 21,350 people. In addition, two theater presentations were conducted in Pire and Mekhe with approximately 4,100 participants. IEC sessions included the promotion of condom use and information on the location of condom distributors nearest each village. ANBEP also conducted 20 supervisory visits to monitor the execution of the project.
Background and Scope of the Intervention AIDSCAP supported MIDA in the implementation of a BCC intervention targeting young apprentice workers (approximately 900 mechanics, metal workers and carpenters) in 42 workshops in the neighborhoods of Khar-yalla, Gran Yoff, and Castor in Dakar for STI/HIV prevention activities. No other NGO has targeted apprentice workers, composed primarily of men aged 15 to 25 years old, in these three disadvantaged neighborhoods. These men were identified as particularly vulnerable due to several characteristics: high illiteracy rate, low economic status, high-risk sexual behavior and drug use. The goal of this project was to reduce the prevalence of HIV/AIDS among the target group. Principal Accomplishments Eleven men were trained as peer educators and subsequently organized 300 IEC sessions, 3 conferences, and 36 projections of a film about AIDS and follow-up discussions, educating over 2,000 men. The training and IEC sessions covered the following topics: knowledge and awareness of HIV/AIDS; methods of transmission of HIV; HIV/AIDS prevention; high-risk behaviors and situations of risk; persons with HIV and HIV testing; and the AIDS epidemic in Senegal. Approximately 4,000 IEC materials and 29,000 condoms were distributed during the project. In addition, 5 dances and 8 radio contests were organized, reaching over 3,700 men and women with HIV/AIDS education messages. Important Constraints Certain characteristics of the targeted population, for example their low literacy rate, required additional support by MIDA in the execution of the intervention. In addition, workshop leaders sometimes hindered access to workers due to their religious or cultural beliefs. These leaders made it difficult for the MIDA educators to maintain schedules for planned activities at the beginning of the project. MIDA trainers required extra time in penetrating the workshops, but once activities began, they witnessed a positive level of interest among workers and increased demand for condoms. This subproject suffered from a lack of management on the part of the implementing agency, and insufficient monitoring by the country office due to the absence of a Resident Advisor during a 5 month period. Monitoring visits were made to the project and written communications given to the partner requesting documented information on the accomplishments of the project and certain deliverables, however the agency did not comply.
Behavior Change Communication for Localities in Thies
Background and Scope of the Intervention APROSOR conducted a behavior change communication project targeting sexually active adult men and women and in-school youth in the District of Khombole, in the region of Thies. APROSOR has identified the need for HIV/AIDS awareness in the District of Khombole and has targeted four project sites with the district: the village of Thienaba (a religious pilgrimage site), the village of Toubatoul (a major weekly market site), Yoff (a suburb of Dakar) and Khombole (the district capital). APROSOR worked in collaboration with the Institut de Prévoyance Maladie (IPM), the Institut de Pédiatrie Sociale (IPS) of the University of Dakar, teachers of secondary schools of Yoff, Thienaba, Khombole and Toubatoul, local social and cultural associations, and local authorities and community leaders. The project goal was to prevent the spread of HIV and reduce the prevalence of HIV/AIDS in the District of Khombole through behavior change communication interventions, such as drama and educational sessions, and condom promotion. In addition, as APROSOR works in the field of social improvement in the district, the project sought to sensitize the target audience to the socioeconomic consequences of AIDS. Principal Accomplishments A KABP study was conducted in conjunction with the Institut de Pédiatrie Sociale of the University Cheick Anta Diop (IPS/UCAD) of Dakar at the beginning of the project. Fifteen people were trained in survey techniques to conduct this study. Three villages -- Thienaba, Toubatoul and Khombole -- were chosen for the study and participants were randomly selected among persons having lived in one of the villages for at least two years and of at least 15 years old. A total of 153 people -- 77 women and 76 men -- participated in the study. Some of the main findings of the study include:
A conference was held with the project collaborators to discuss the appropriate strategies for the BCC intervention. During this conference IEC materials were distributed, and a film on AIDS education and prevention was shown. A theater presentation was produced which addressed the issues of STI/HIV prevention and an estimated 7,500 men and women saw the presentation of this play in the three villages of Thies. Eight teachers of primary schools in the four villages were trained in AIDS education who in turn educated 180 students (between the ages of 12-14 years). These schools had existing AIDS education curricula, however, were lacking in material supports and teaching techniques. APROSOR complemented the school's AIDS programs with material supports and technical assistance improving the training techniques and communication skills of teachers in the domain of AIDS education. APROSOR also worked with women's economic groups, Groupements d'Intérêts Economiques (GIE), and sport and cultural associations through training of trainers workshops. Seventeen leaders of the different groups were trained in IEC activities, who subsequently organized 12 IEC sessions in their villages and educated 137 people. During the life of the project 10 banners, and 4 wall murals with AIDS messages were produced. Three dancing events were organized with an estimated attendance of 2,500 persons. 4 articles were published in local newspapers reaching approximately 75,000 people and 4,000 condoms were distributed. In addition, 560 booklets donated by the National Committee for the Prevention of AIDS entitled "Attention Sida" and 500 leaflets donated by ENDA-Santé were distributed. There were also two IEC sessions held at the Cultural and Lecture Center in Khombole with the showing of the film "Fils d'Afrique" and discussion targeting the youth who attend the center. APROSOR has become a respected organization among the communities in which it works and recognized as a credible source for AIDS information. As a result of the experience acquired in AIDS prevention with the execution of this project, APROSOR is working towards the opening of a Community Center for HIV/AIDS Information, Education and Communication in Thies. It is planned that the Center will provide training sessions and conferences, as well as being a documentation center. Important Constraints The lack of electricity in some villages posed problems for animated events and the projection of films. Project organizers were required to rent auto batteries as an energy supply. Lessons Learned and Recommendations The purchase of a generator would be beneficial and more cost-effective for IEC presentations and activities involving video or audio materials in rural areas without electricity.
Background and Scope of the Intervention The Red Cross of Thies is a chapter of the Senegalese National Red Cross organization which supports many social and health programs. The Thies chapter has been working in the domain of AIDS prevention and supports the regional committee for AIDS prevention. It is a social NGO with a wide experience in community mobilization. This project employed an outreach strategy by providing health information kiosks around the weekly rural markets in the Thies region. These health information kiosks operated five days a week and offered information and educational materials on HIV/AIDS and other health concerns aimed at the general public. Each month, one health kiosk featured a special program with lively activities and music, including theatrical performances during special events such as World AIDS Day, Women's AIDS Week and Youth AIDS Week. This intervention targeted clandestine commercial sex workers (CSWs) and out-of-school youth as they are known to practice high-risk sexual behavior and are often difficult to reach. The purpose of this project was to reduce high-risk sexual behavior among the targeted groups in the Thies region with the following objectives:
Principal Accomplishments Ten animators were trained as peer educators to run the information kiosks and disseminate correct information about STI/HIV/AIDS prevention and promote condom use. Five kiosks were constructed in strategic locations in Thies. In addition, the peer educators made visits to the 8 large daily markets of Thies where CSWs gather and disseminated information and IEC materials. There were conferences and meetings held during large religious ceremonies to encourage the people to talk about AIDS prevention and to adopt safer sexual practices. All of these activities permitted approximately 2,100 people to be educated. During the life of the project 9,000 IEC materials (in two languages, Wolof and Sérère) were distributed, in addition to 8,200 condoms. Important Constraints Only 5 of the 10 planned kiosks were constructed due to administrative problems. A lack of security for the kiosks required that kiosk managers store some materials and equipment in their homes, requiring them to transport materials each day to the kiosks. There were also obstacles in terms of social and religious beliefs in the promotion of condom utilization. Lessons Learned and Recommendations Additional IEC materials are necessary for the continuation of activities. Solutions should be discussed as to the security of kiosks and equipment.
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