JAPAN TRUST FUND UGANDA R E A C H I N G
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Population (2001): PROJECT TITLE: Care and support for STI/HIV/AIDS infected and affected youths involved in transient trade in Mbarara, Uganda
24 million
Urban population (2000): IMPLEMENTING BODY: Family Planning Association of Uganda (FPAU)
14%
AIM: To advance the sexual and reproductive health rights of marginalized youth and under-served rural communities
Main language/s: English, Swahili, Luganda
Uganda is one of Africa’s success stories when it comes to reducing HIV/AIDS prevalence rates. But, despite the inroads being made, there are still many marginalized and desperately poor rural communities at risk.
Main religion/s:
These are some of the facts that define this country:
Literacy level (1997):
Christianity, Islam
64%
Almost two million people in Uganda require HIV/AIDS care and support services. Around 1.2 million children have been orphaned as a result of the pandemic. HIV/AIDS is now more serious than either TB or malaria, accounting for as many as 12 per cent of deaths annually.
In spite of the stress on the country's health resources created by poverty, malnutrition and poor access to clean water, the success of Uganda's HIV/AIDS prevention programmes has been widely acclaimed.
Infant mortality (1995–2000): 106 per 1,000 live births
Life expectancy (1995–2000): 42 years
GNI per capita (1999): US$320
HIV/AIDS prevention messages have been taken to youth in schools as part of a presidential initiative. But only 12 per cent of Uganda's children continue education to
Adult HIV prevalence (end 2001):
secondary-school level, so it’s important to target out-of-school youth.
5%
DESIGNING INNOVATIVE APPROACHES FOR MARGINALIZED GROUPS Family Planning Association of Uganda (FPAU) worked with taxi touts, brick-makers, bodaboda cyclists (bike messengers and taxis), bartenders, car-washers, hawkers, hairdressers and other transient traders, as well as with poor rural communities in an effort to expand HIV/AIDS prevention, care and support services in the western Mbarara municipality. Many of those involved in these trades in the cities are young and highly sexually active, often with multiple partners. They also often face the difficult and isolated job of coping with infected partners, friends and family members. The primary goal of the transient trader project was to reduce the prevalence of STI/HIV/AIDS among some of the most vulnerable young people in the towns. The rural outreach provided health education and a reproductive health package to those who live too far away from the cities to normally make use of these services.
Few Ugandans are engaged in formal, waged employment. This makes traditional workbased HIV/AIDS approaches inappropriate. Like other vulnerable groups, transient traders are in need of specific and relevant HIV/AIDS projects.
THE INTERNATIONAL PLANNED PARENTHOOD FEDERATION (IPPF) is a global network of Member Associations in 148 countries and the world's foremost voluntary, non-governmental provider and advocate of sexual and reproductive health and rights. IPPF envisages a world in which every woman, man and young person has access to the information and services they need; in which sexuality is recognized both as a natural and precious aspect of life and as a fundamental human right; a world in which choices are fully respected and where stigma and discrimination have no place. 1
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KEY ACHIEVEMENTS INTEGRATED HIV/AIDS CARE The project strengthened the integration of HIV/AIDS care and support with the family planning services provided by the FPAU. VCT SERVICES DELIVERED More than 500 clients accessed free or subsidized VCT services. STI TREATMENT PROVIDED More than 800 clients received treatment for STI. PEER EDUCATORS EXTENDED IMPACT Peer educator clubs, made up of about 20 members in eight different clubs, were set up to serve different trades. Trained peer educators were kept busy. They conducted 3,000 home visits, created four drama shows, seven songs, four poems and two plays on HIV/AIDS themes in local languages, as well as in English. TOLL-FREE LINE SUCCESSFUL A total of 1,662 calls were made to a toll-free counselling service. SERVICES IMPROVED Five service providers were trained in the provision of VCT and care and support services. Laboratory services were strengthened and capacity was built in the provision of static and mobile services.
That’s not all. Through peer education clubs and a special youth-friendly clinic, voluntary counselling and testing (VCT) was offered together with family planning, antenatal and postnatal care, immunization, STI management and treatment, fertility, youth sexual and reproductive health (SRH) and counselling services for any related problems.
The good news is, after the project, transient traders started making more responsible health choices.
DRAWING ON FAITH-BASED COMMUNITY RESOURCES Reaching marginalized rural communities is usually very difficult, but was made possible through innovative church-based VCT outreach sessions.
Sunday church services provided a rare central gathering place for scattered rural populations. The faith community was central to the outreach project's success. Fortunately, the project workers’ initial fears that religious leaders would be reluctant to get involved with the initiative proved unfounded. Apart from providing ready access to their congregations, some church leaders were so supportive that they made their changing rooms available for use as counselling chambers.
LESSONS LEARNED INTEGRATION IS COMPLEX Integration of HIV/AIDS services with family planning services can be successful, but you need to take into account strategic, management and operational factors. FAITH-BASED INSTITUTIONS INVALUABLE The church and other faith organizations provide a great opportunity to access large numbers. Outreach through the rural churches recruited more clients than the static clinic in the city. Greater effort needs to be made to extend outreach to members of the Islamic faith. LINKS WITH OTHER ORGANISATIONS Networking with other organizations is important. It allows for sustainability and a multi-sectoral approach becomes possible. APPROPRIATE MATERIALS IEC materials need to be developed in local languages. PARTICIPATION Getting people involved in the project development is essential and has far greater impact than if the project had been imposed on communities from outside.
JAPAN TRUST FUND FOR HIV/AIDS (JTF): JTF is IPPF's first fund established exclusively to support the HIV/AIDS prevention programmes of its Member Associations. This is funded entirely by the Government of Japan and is a key instrument in IPPF's response to HIV/AIDS. The objective of the JTF is to enhance the institutional capacity and managerial skills of IPPF and its Member Associations in Africa and Asia to carry out effective and innovative prevention and care programmes for STI/HIV/AIDS. Since the establishment of the JTF in October 2000, 32 Member Associations in Africa and Asia have received support from the fund to implement a total of 64 projects. 2