HIV and AIDS stigma and discrimination reduction through raising awareness in Kabul city, Afghanistan Afghan Family Guidance Association (AFGA) Dr. Naimatullah Akbari CEO, AFGA The South Asia Regional Knowledge Forum 15 16 March 2010 New Delhi, India
Afghan Family Guidance Association (AFGA) An Afghan NGO established in 1968, working in the field of Reproductive health and rights; Full and Accredited member of IPPF in South Asia. Main working areas 1. Five A s Strategic framework of IPPF: a) Access b) Adolescence c) AIDS/HIV d) Abortion (awareness on unsafe abortion) e) Advocacy 2. Promote family welfare and family-based violence reduction 3. Organizational development
Background Project Objectives: 1. To increase awareness of the target population (high risk groups) on HIV and AIDS in Kabul city 2. To reduce misconceptions and address cultural beliefs through appropriate BCC intervention in the target area Target Beneficiaries: Prisoners Prison staff (medical and non-medical) Health workers Youth Religious leaders Media representatives
Background Why are prisoners particularly vulnerable to HIV? those most at risk of contracting HIV are overrepresented in prison; high risk activities are prevalent in prison; Poor prison conditions contribute to the spread of HIV; Medical practice may involve the use or re-use of non sterile medical or dental equipment and therefore not be safe.
Program design and components Strategy and approaches: Addressing prevailing root causes of Stigma and Discrimination: 1. lack of accurate knowledge and information on HIV and AIDS 2. misconceptions regarding Islamic principles and cultural beliefs Through: Awareness raising and sensitization( focus on prisoners and prison staff) BCC interventions (e.g. religious leader and media campaign) Measurement Strategy: Pre- and post-test assessment of training and sensitization Focus group discussions Regular supervision and monitoring visits
Results and Achievements 1. 320 member of the community sensitized and oriented on HIV and AIDS stigma and discrimination. 2. Launched religious leader and media campaign 3. Developed and broadcast TV spot on reduction of HIV and AIDS stigma and discrimination 4. Developed materials for Friday sermons in local language 5. Built organizational capacity to address stigma and discrimination 6. Developed, printed and distributed 2 posters on reduction of HIV and AIDS stigma and discrimination 7. Translated resource materials into local language 8. Developed, printed and distributed informative leaflet 9. Built network with religious leaders, media and other agencies
Results and Achievements 10. Sensitization and orientation of all medical and non medical staff of prison on HIV and AIDS. 11. Get support of prison officials for stigma Reduction. Increase VCT service utilization. Provision of transport facility to HIV + prisoner to ARV. 12. Introduced peer-education program in female prison in Kabul city. 13. Peer educators as member of women support group are active to: Disseminate information to other prisoners. Communicate prisoners health problem with service providers. Organize monthly meeting.
Key Findings and Lesson Learnt 1. The analysis of focus group discussion suggested that ignorance, lack of awareness, and misconceptions were main sources of stigma and discrimination towards people living with HIV and AIDS. 2. Comprehensive awareness-raising programs using culturally appropriate IEC and BCC materials are effective approaches. 3. Involvement of religious leaders (disseminating messages through mosques) and media are effective approaches to address sensitive issues. 4. Building trust, effective communication and addressing misconception are key success factors to initiate such sensitive program in prison settings.
Key Findings and Lesson Learnt 5. We realize that peers are persons able to speak easily to other prisoners about ways to reduce the risk of contracting infections. 6. Peer educators are able to realistically discuss the alternatives to risk behavior that are available to prisoners; 7. Prison staff plays a crucial role in HIV prevention, treatment, care and support programmes in prisons and they needs to be trained concerning the use of universal precautions. 8. Stigma and discrimination also exists among service providers and should be addressed. 9. Substandard living conditions can increase the risk of HIV transmission among prisoners by promoting and encouraging drug use in response to boredom or stress
Recommendations General Provide complete and correct information on HIV and AIDS to improve knowledge Continue to encourage discussion about HIV and AIDS (break taboo) Check & change YOUR OWN attitude Build on established networking and collaboration to reduce stigma & discrimination. Provide care and support for people infected and affected in our communities. Ensure inclusion of PLWHA (in social and religious events, in our programs). Encourage PLWHA to disclose their status to family and friends and support them during the process.
Recommendations We suggest the following as key elements to preventing and responding to HIV/AIDS in prisons ; Introducing comprehensive HIV prevention measures; Providing equivalent health services in prisons to those in the community, including provision of antiretroviral; Improving prison conditions and undertaking other prison reforms; Reducing prison populations. Prison authorities should take all necessary measures, including adequate staffing and appropriate disciplinary measures, to protect prisoners from sexual violence and coercion.