Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 44309-44313 997

S44309 Using participatory evaluation to focus AIDS
interventions with traditional healers in Uganda
Rachel King', D. Kabatesi2, J. Homsy3. PO Box 21175, Kampala; 2 Theta,
Kampala; 3NSF Switzerland, Kampala, Uganda
Issue: Unique populations such as African traditional healers (TH) require innovative intervention strategies. Can participatory evaluation help focus the long term
planning and implementation of a Ugandan NGO, THETA, targeting traditional
healers for AIDS prevention and care since 1992?
Project: 6 years after starting it's intervention with traditional healers, THETA
conducted a participatory evaluation using both qualitative and quantitative methods and involving project staff, trained and untrained traditional healers, community members in areas surrounding trained and untrained healers, policy makers
and other stakeholders. Methods included a survey of traditional healers (n =
161), focus group discussions among community members (n = 19), key informant
interviews (n = 207), and observation of counselling sessions by TH (n = 18) and
of community education events by TH (n = 24). The process was facilitated by
expert consultants.
Results: Qualitative findings confirmed that program emphasis was placed on
empowering healers to educate their clients and community members about HIV
transmission and prevention especially condom use. Stakeholders, community
members, and policy makers all appreciated of traditional healers using correct
AIDS information to educate their communities, yet their concerns were related
to the limited coverage of the project. Community members claimed to have
changed their attitudes dramatically about TH role in AIDS prevention and care,
from believing that TH were directly responsible for spreading HIV before the
intervention, to considering healers as a valuable health information resource.
Quantitative and qualitative data on TH reflected their confidence in the new roles
they play as trained counsellors and community educators. Challenges noted
by stakeholders centered around involving more biomedical health workers in
collaborations with TH.
Lessons Learned: Having project staff design and implement a participatory
evaluation enabled the organization to accept and own the results. Individuals
who participated benefited by the self critique, and were able to assess their own
input into organisational goals. The process of collecting and analysing our own
data, comparing test and control groups, and discussing positive and negative
findings has enabled the organization to re-evaluate its intervention strategy and
focus on community and TH needs more effectively.
44310 Self-assessment modules: Evaluation and skill-building
tools to improve the function of Title I Planning Councils
and Title II Care Consortia
Stewart Landers', S. Young2, R. Conviser3, F. Marshman', A. Gambrell4,
M. Gomez5. '44 Farnsworth Street (Affiliation: Joh Snow, Inc.), Boston, MA
02210; 2Division of Services System, HIV/AIDS Bureau, HRSA, Rockville, MD;
3Office of Science and Epidemiology, HIV/AIDS Bureau, HRSA, Rockville, MD;
4Gambrell and Associates, Washington, DC; 5Division of Training and Technical
Assistance, HIV/AIDS Bureau, HRSA, Rockville, MD, USA
Issue: Title I Planning Councils and Title II Care Consortia have difficulty assessing the quality of their work in the areas of needs assessment, comprehensive
planning, priority setting and resource allocation.
Project: A national process was established to develop self-assessment modules (SAMs) for Ryan White CARE Act community-based coalitions responsible
for planning the utilization of federal funds for HIV services. Six topics were
selected for self-assessment modules: Developing and Pursuing the Mission,
Representation and Diversity, Needs Assessment, Comprehensive HIV Services
Planning, Priority Setting and Resource Allocation, and Continuum of Care. Consultants with expertise in each area designed the SAMs, each of which was
pilot-tested in the field by one planning council and one consortium.
Results: The completed SAMs constitute a comprehensive opportunity for
councils and consortia to obtain qualitative and quantitative information through
a systematic and self-led group process. Results may be kept internal or shared
with government officials or the community at large. The SAMs provide an opportunity for structured discussion and skills-building for council and consortium
members who may not have familiarity with the process of interagency planning
activities. Each SAM contains an introduction to the topic area, self-assessment
questions, benchmarks and scoring mechanisms, action plan pages, discussion
sections, and resource guides. The ultimate goal of each module is to improve
service delivery for people living with HIV or AIDS.
Lessons Learned: Self-assessment modules are successful at helping Ryan
White Planning Councils and Consortia assess the quality of their current activities
in crucial areas and develop action plans to improve operations. The SAMs are
also skill-building tools which can be used to orient new members and train all
members with respect to their responsibilities as council or consortium members.
44311 Evaluation of HIV/AIDS prevention for migrant
communities in Switzerland: An overview

Frangois Fleury, M. Haour-Knipe, F. Dubois-Arber, A. Jeannin. Inst Univ de
Medecine Sociale et Prev 17, Rue du Bugnon, CH-1005, Lausanne, Switzerland
Issues: Part of the HIV/AIDS prevention strategy in Switzerland is to make such
efforts available to all persons living in the country, including those of different
language and culture. The Federal Public Health Office commenced such efforts
in 1986, with the distribution of brochures translated into several languages.

Project: A specific programme, the 'Migrants Project', was started in 1991, with
prevention efforts in migrant communities co-ordinated by people of the same
language and culture. Field work has been preceded and followed with a series
of evaluations of feasibility, of process and of outcomes. These evaluations are
part of the overall evaluation of the Swiss AIDS prevention strategy.
Results: Successive evaluations among migrant communities have highlighted
the following:
- need for culturally and linguistically appropriate prevention efforts using already-existing community structures;
- need for identification and training of people from within communities to carry
out local prevention efforts;
- excellent acceptance of a government-sponsored HIV/AIDS prevention programme within migrant communities, considerable community engagement in
prevention activities;
- support for strategy of informing and sensitising general populations within
migrant communities before starting more targeted prevention with migrant
IDUs, MSM, and CSWs;
- importance of encouraging, facilitating and guiding health promotion projects
which emerge from within migrant communities themselves.
Lessons Learned: Successive feasibility, process and outcome evaluations
with migrant communities in Switzerland have shown that prevention among
such communities can be effective, respecting the migrant's right to access to
HIV/AIDS prevention, and also that such programmes may be able to draw upon
considerable resources within emigrant communities themselves.
44312 Room for improvement: Informing and evaluating
prevention communication programs for adolescents
through phone surveys
May Kennedy1 2, B. Seals2, J. Myllyluoma3. 11600 Clifton Road Mailstop E37,
Atlanta, Georgia; 2CDC, Atlanta, GA; 3Battelle Corp, Baltimore, MD, USA
Objectives: Many young people around the world have been exposed to HIV
prevention messages via entertainment media and other channels. The kinds
of knowledge, attitude, and behavior gains that prevention communication programs can achieve may have been achieved already. In addition, the source of a
prevention message may not be noted, making a new prevention communication
program difficult to evaluate. This study sought to quantify pre-program levels
of HIV message exposure, to determine whether new message sources can be
distinguished from usual sources, and to assess room for improvement in the
kinds of determinants of risk behavior upon which prevention communication
programs are likely to have an impact.
Design: Random sample phone survey.
Methods: In 1997 in 3 US sites (Sacramento, CA; Phoenix, AZ; and Northern
VA), anonymous interviews were conducted with 663 adolescents ages 15-19
who lived in zip codes with high rates of teen STDs and pregnancy. Exposure to
HIV prevention messages, false recognition of information about the Prevention
Marketing Initiative (PMI) program, levels of hypothesized determinants of risk
behavior, and frequency of condom use were examined. Twenty one per cent of
parents of underage teens refused to allow their teens to participate, and 7% of
teens who either had parental consent or were legal adults (at least 18 years old)
refused to participate.
Results: Although 73%-79% reported having heard HIV messages on the
radio or TV within the last 30 days, only 0%-1% said they heard about the
not-yet-launched PMI Demonstration Project (a coalition-based social marketing
effort that planned to employ media channels) through radio or TV. Respondents
agreed with certain condom attitudes (e.g., the view that a condom is necessary
even if you know the person), perceived a risk of infection, and felt able to negotiate condom use in over 90% of the cases. Participants reported that condoms
had been used at last sex with main partners by 2/3 of the respondents who were
sexually active, but only 34%-49% thought that most or all of their friends used
condoms regularly, and only 36%-51% thought their friends considered condom
use very important. While more than 90% of the sexually active respondents said
it was easy or very easy to get condoms, only 1/4-1/3 of them took a condom
with them the last time they left the house.
Conclusions: In 3 sites across the US, most teens hear media messages
about HIV often but almost all teens can distinguish between usual and new
message sources. Some determinants of risk behavior appear to be at or near
ceiling. However, there appears to be room for improvement in others such
as (1) how normative condom use is perceived to be, and (b) antecedent behaviors (e.g., condom carrying). These below-ceiling variables correlated with
condom use at last sex and are potentially subject to influence by communication
campaigns.
| 44313 On project review: The PHANSuP experience
Ma Rosario Charito Alcoreza. PHANSup 28 N Domingo Street, New Manila,
Quezon City 1112, Philippines
Issue: The Philippine HIV/AIDS NGO Support Program (PHANSuP) has since

1994 supported 35 local partner NGOs to design, implement and review 55 AIDS
projects in total, all of which have had many similarities as well as differences
(linked to their communities different culture, contexts, needs and resources, as
well as their own different stages of maturity, experience, involvement in HIV/AIDS
work etc.). Review of projects forms a crucial part in this work; not only as a means
to evaluate what has been achieved by individual NGOs, but - more importantly -
to help them assess their own strengths and further needs, to identify lessons for