Chapter 1 INTRODUCTION

Transcription

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2 Contents Chapter 1 INTRODUCTION... 2 Chapter 2 ACTIVITIES AND ACHIEVEMENTS... 3 Chapter 3 ANALYSIS OF COLLECTED DATA... 5 Chapter 4 ANALYSIS OF COLLECTED QUALITATIVE INFORMATION... 9 Chapter 5 CONCLUSION

3 Chapter 1 INTRODUCTION In many countries the telephone hotlines are an integral part of national responses to the HIV/AIDS epidemic. This service is an essential component in services for the general public aimed at prevention, information and psycho-social support. INTHANOU Association is the sole hotline on HIV/AIDS in Cambodia. It was established in July 2000 with support from UNICEF and MOBITEL. The hotline provides free of charge, anonymous and confidential counseling nationwide, through two phone numbers made available by MOBITEL 1 (a major mobile phone company in Cambodia). The primary mission of the hotline is to promote better understanding among Cambodian people, particularly most at risk populations, on prevention and care of HIV/AIDS, STIs and reproductive health by providing them with correct information, informed choice through telephone counseling, so that they can reduce at-risk behavior, make proper decision and have safe practice. The hotline also encourages timely access to health services by informing those callers who need a specific intervention or support, on the existing public or nonprofit organization services which are addressing sexual and reproductive health, HIV/AIDS and STIs. The callers are not referred directly but they are given the address of the services they need, according to their problem and their convenient location area. Public health services shave the first priority, followed by NGOs and private providers 2. Since its creation the hotline has reached more than 530,000 people 3 with around 50%of them aged less than 25 years old. Our callers are the direct beneficiaries and people around them also get benefit from their awareness and proper behavior. Over the years, in response to the evolving health needs and priorities of the Cambodian society, the hotline s service has been extended to reach young people through new communication strategy 4 on life skill, sexual reproductive health, and right linking with Youthchhlat project ( of Ministry of Education Youth and Sport. New communication platforms have been introduced for more effective outreach to the younger population (and especially out of school youth), using up to date communication media 5 such as SMS, and Facebook. This new strategy expects to reach Cambodian young people as the telephone and internet access in Cambodia market grow up quickly (92% of Cambodian youth have access to mobile phone, and more than 30% of them use their own device to send and receive text messages 6 ). INTHANOU Association has received technical and financial supports from the following donors/partners: UNICEF ( ), MOBITEL (since 2000 until now), UNESCO ( ), BBC-World Service Trust ( ), French Embassy( ), ESTHER, SidaInfo Service 7, Pharmacien Sans Frontier Committee International ( ), Fondation de France ( ), Family Health International ( ), Population Service International and One World UK. During the period , UNFPA has supported INTHANOU 20% to 28% of its annual budget of the hotline, allowing having sufficient staffing to fully operate twelve hours per day 8, five days per week and special three hours Sunday operation linking with Love9. This report presents our achievements from 2012 to 2015 as well as the analysis of main key data finding and qualitative information collected from young customers. 1 Nowadays called Cellcard as a brand name 2 Sun Quality Health Network supported by Population Services Khmer (PSK) 3 Number of hotline counter database by 30 th September 2015, 4 Brought to Cambodia by One World UK, 5 E-learning, Q&A Platform (young people can SMS to 1293 with free of charge asking question on SRHR and Gender) 6 Research Study,Mobile phone and internet in Cambodia 2015, Asia Foundation 7 French hotline on HIV,STI and Hepatitis Hotline provide all technical support and fund raising for INTHANOU 8 Start in

4 Chapter 2 ACTIVITIES AND ACHIEVEMENTS The hotline operates twelve hours per day without interruption from 8:00 am to 8:00 pm, five days per week with a break on weekend. Special 3 hours operation on Sunday was set in 2014 to support Love9 media Sexual Reproductive Health and Right Intervention link with Love9. There are 15 counselors (12 women and 3 men). All of them are medical staff with experience in Reproductive Health and HIV/AIDS prevention and counseling. The hotline has achieved its objectives as planned despites some financial constraints. In total, 87,473 calls were received from January 2012 to September Among those, 34,176 calls (39%) are from young people under 25 years of age. The group of age 25 to 34 years has the highest number of calls, followed by the group age of young under 25 and the group age of 35 years or above has the lowest number of calls (9 M) Total number of calls per year 25,719 22,198 24,194 15,362 87,473 Percentage of young callers(age <25y) 40.7% 36.7% 38.2% 41.1% 39% Percentage of callers aged 25 to % 48.3% 46.8% 45.1% 47% Percentage of callers aged 35 or above 10.5% 14.9% 15.1% 13.8% 13% Since 2014, INTHANOU has a new communication platform using SMS, and Facebook. This innovative approach is part of the project Smart Youth Good Future supported by OneWorld-UK which aims to provide young people with information related to Sexual Reproductive Health and Right, Gender through electronic system. The project was officially launched on 24 th March 2014 under the auspice of the Ministry of Education Youth and Sport, National AIDS Authority and Ministry of Post and Telecommunication. Young people can send questions about Sexual Reproductive Health, Right and Gender by SMS to 1293 or to 1293@youthchhlat.org. The platform presents several advantages. It is accessible to those who cannot speak(mute) or people too shy to express orally. It is more discrete than in a public place. But it has some inconvenience too: writing style of some clients is hard to 3

5 understand, our answer via SMS cannot be detailed (we suggest the persons to call if they need further explanation). Confidentiality is protected as the ID and personal of users are not revealed on the platform.the SMS service is available in English, Khmer and most importantly Khmer-Latin, a phonetic version of the Khmer language that young Cambodians have been using to facilitate their written communications method. Since April 2014, the hotline has a special operation on Sunday linked with radio talk-show Love9. This weekly event of 3 hours is very helpful to support Love9 callers who missed or hesitated to expose their queries in public, they uses anonymous hotline service as a reference. This collaboration contributes to give more opportunities for all Cambodian young people to access Sexual Reproductive Health and Gender by both anonymous and public ways. From April 2014 to September 2015 we received 828 calls, with more than 50% of them from young people aged less than 25 years. Most of the issues raised in Love9 are related to Sexual Reproductive Health and Gender which are sources of misunderstanding in Cambodian society. Noticeably, after the radio talk-show of Love9isdone during one year and a half, young people have brought those issues to discuss via hotline, particularly young girls who represent more than half of total young callers. In October 2013, under the support from UNFPA, INTHANOU updated its directory of services: a database of 2,300service providers across the 24 provinces and municipalities, addressing a wide panel of issues (Family Clinic, Antiretroviral Therapy, PMTCT, HIV testing, check-up or treatment of Sexually Transmitted Infection, People Living with HIV Network, Home Base Care, Drug Rehabilitation Center, Mental Health, Health Equity Fund and Child Protection). In 2014, two newsletters were produced with the funding support from UNFPA, one issue in June 2014 and one more issue in September 2014, to inform about the progress of our work, and to share relevant analysis of collected data.the main topics presented in the newsletters were the key achievements in the year 2013, analysis of data in first semester of 2014, main issues raise by hotline customers and the family planning for young people. The newsletters were distributed electronically to all donors and partners. INTHANOU s representatives regularly participated to key national events such as the Consultation on National Strategic Plan for HIV/AIDS, National Consultation on Youth Key Population, National Review and Consultation on Legal and Policy Framework on HIV and AIDS, Join the consultation on Gender Assessment of Equal Access to HIV service with NCHADS. INTHANOU has also provided technical inputs in preparing life skill lessons and ComprehensiveSexual Reproductive Health of Ministry of Education Youth and Sport, and Financial Resource Flows for Population Activity and Family Planning Survey of UNFPA. 4

6 Chapter 3 ANALYSIS OF COLLECTED DATA For activity monitoring and the epidemiological purpose, some key information about the callers are collected by the counselors and entered during the phone conversation, directly into the Profile Management System via the onscreen data entry sheet. The Epi Info software is used for data analysis and reporting. Profile Management and Information System The collected data are analyzed monthly, quarterly and annually or in special period if needed. For the time period of this report (January 2012 to September 2015), the analyzed data regarding the group of young callers (aged less than 25 years) show that: 1. In the group of young callers, there are significantly more women than men. 2. The big majority of young female callers are married. In contrast, the big majority of young male callers are single. The percentages of divorced and widow in both genders are less than 1%. 5

7 3. In the group of young people, there are every year more new callers (who call for the first time) than those who have already used the hotline before, especially for the young women. In contrast, there are more calls from those who have already used the hotline before among the young men. New young callers by gender (9 M) Percentage of new callers among young (total) 52.8% 53.2% 58.7% 56.2% Percentage of new callers among young women 56.7% 56.4% 61.1% 59.1% Percentage of new callers among young men 44.3% 47.2% 52.9% 37.4% 4. It is not possible to know the frequency of HIV zero positive among the young callers because the rate of non-response to this question is very high (over 80% in both genders). Less than one percent of young customers declared being HIV zero positive. 5. The number of young callers by geographical location is proportional to the number of population of each province and municipality. Phnom Penh is the largest source of calls from young people with nearly one third of the total calls every year, followed by Kampong Cham, Battambang and Kandal province. Every other province makes less than 5%. Many young people have migrated from the rural areas to Phnom Penh and its surrounding areas to find jobs in factories, constructions etc. Most of them have low education background and face difficulties to access accurate information to make decision for their sexual and reproductive health and to find the appropriate health services. 6. Regarding the occupation of the callers, housewives are the first sub-group among the young female callers and students are the first sub-group among the young male callers.it is worth to note that these results are in line with the objective of the hotline to reach out of school youth as they represent 73% of young female and 65% of young male. 6

8 7. The issues raised by young callers are most often about sexual and reproductive health, and are directly related to their love relationship. The two top subjects of call for young female callers are abortion and birth spacing. Most of young women want to be certain about the long term consequences of using modern contraceptive methods in the early age. Noticeably, to prevent unwanted pregnancy, young people prefer short term birth spacing more than other methods. Especially some young people frequently use an emergency pill after sexual intercourse. Some young people have concern about the irregular menstruation and to know 7

9 whether they are pregnant or not. The vaginal discharge is also the big problem of young women after having sex. Furthermore, some young women like to discuss with the counselors about their private issues in relation with sentimental problems as well HIV/AIDS is the first subject of calls from young men (50%) and reproductive health is the second subject (30%). The questions about sexual health are more frequent from young men than from young women, however they are overall not frequent (1-4%). Other issues are mother health, child health, gender, life skill, drug, nutrition and hygiene. Altogether they account only for 8-11% of the total calls. Contents of calls varied between men and women. Young male callers are generally interested to know about sexual health. They have questions about masturbation, premature ejaculation as well as are concerned about their sexual performance. Young people are also curious to learn about homosexual relationship (between men or between women). Married women who suspect their husband to have an extra-marital love affair express the fear of getting sexually transmitted diseases from them. Men often call the hotline after an episode of drunkenness followed by non-protected sexual intercourse with occasional partner, they inquire about the risk of HIV contamination and other possible consequences. Most of the time they ask where to seek for the post-exposure prophylactic treatment, where they can do a blood test with a quick result to know whether or not they are HIV infected. Questions regarding the prevention, diagnosis and treatment of cervical cancer and breast cancer are becoming more and more popular subjects among female callers because they hear about these diseases through the mass media (TV, radio) or from the health service providers during a health check-up. 8. Among those young customers' who asked questions about Reproductive Health, birth spacing and abortion issues are the main concerns for women as well as for men. The most frequently asked questions are about how to use birth spacing devices, side effects of birth spacing methods and long term risk of birth spacing methods. 8

10 9. The hotline is a resource for the women who have young motherhood. Among the female callers aged years, those having a pregnancy represent in 2012: 14% (123/856); in 2013: 39% (198/504); in 2014: 21% (161/759); from January to September 2015: (86/437). 10. Between January 2012 and September 20115, the hotline counselors have informed 7,145 young persons of both gender to access a service provider. This represents 21% of all young callers. The percentage is higher for men than for women. 11. When the young customers are asked From which source do they know about the hotline?, they mention the IEC materials(because Inthanou hotline operated nearly fifteenth years and the numbers were included in many IEC materials of partners and donors as well such as leaflet, booklet, take away voucher, or some organization put our hotline numbers in their education materials)as the most frequent source (23%), followed by radio spot (20%), friends (18%), magazines (14%) and TV spot (11%). This shows that the word of mouth is as important as the communication media. The effect of internet website is still low at less than 2% of total calls. In general we observe that when we launch a promotion campaign through TV, radio or magazine, it boosted the number of calls during the period of the campaign. Promotion campaign is very useful to maintain a high level of utilization, when it is done with a proper plan and simultaneously through a multi-channel. Chapter 4 ANALYSIS OF COLLECTED QUALITATIVE INFORMATION From the phone conversations with clients of the hotlines, our counselors have observed that some issues are frequently raised. They may be new topics or new trends in sexual and reproductive health behaviors. Sometimes, social issues related to gender or to sexual behavior are also raised by the callers. Family planning: many young women expressed their preference for using emergency pills rather than the standard family planning pills.<<a single young woman who bought contraceptive pills has suffered gossips in her village. So she choose to use instead emergency pills that her boyfriend bought for her>>.<<a woman said: I prefer to use the pills 72 hours after having sporadic intercourse because it is easier than to take contraceptives every day>>. Abortion issue: with a recent availability of medical abortion medicines in the market, most young callers say that they are likely to choose the medical abortion rather than the manual vacuum aspiration. Gender based violence: a female caller testified <<Every time he wants to have sexual intercourse, my partner never cares if I agreed or disagreed>>. Sexually transmitted infections: It is difficult for a female patient to ask her partner to get treated at the same time as her (<<The doctor said that I have to tell my partner to also get the treatment. But it is very difficult, I don t know how to tell him because he has no symptom and he may suspect that I go with someone else...>>). Another frequent concern for women is the fear that their partner could transmit STI to them (<<My husband likes to go out very late. I am very worried that he may forget to take protection measures against sexual infections for himself...>>). Gender inequality inside the family: (<<My mother wants me to stop school because a girl will get support from her husband... She only wants my brother to continue his study because our family doesn t have enough money>>). Discrimination against homosexuals: (<<My schoolmates like to make fun of me and they call me Nhy (girlish). 9

11 Young motherhood: (<<My mother wants me to get married early and have children because she believes that young mothers have smart children... But I heard on the radio that having motherhood too young is not healthy. What are the potential problems?>>). Chapter 5 CONCLUSION The social changes in the Cambodian society have influenced significantly the behaviors and practices in the area of sexual and reproductive health, especially among the younger population. This is largely reflected in the questions and issues raised by the callers of the hotline. We have constantly modified our topics and messages according to the needs of our users. Furthermore, the services offered by the hotline became more diverse in response to the new communication landscape in Cambodia and the way people are seeking information, from the traditional voice phone to others electronic communication media. The research study made in 2015 by the Asia Foundation has found that94.5%of Cambodians own at least one phone. The rate of phone utilization is high in both gender (92.2% for women and 96.8% for men) and the rate in the rural areas (93.5%) is almost as high as the rate in the urban areas (95.9%). The use of internet Facebook constantly increased (from 23.2% in 2014 to 34.4% in 2015), however it is much higher among men (43.5%) than among women (25.2%) and higher in urban areas (49.2%) than in rural areas (28%). The study concluded that following this trend, the internet will become soon the main channel for news and information in Cambodia. Our results showed that there is still a need for having the phone counseling hotline to offer up to date and custom made, high quality information to the public. A key draw for the service is its easy access, confidentiality and privacy. The greater anonymity that the phone service offers has attracted a wide range of callers, especially the younger people. 10