Naomi Nkinsi, 1

Republic of Cameroon HIV/AIDS Reduction Initiative

Naomi Nkinsi
Global Health 101
Winter 2014
Section AD: Mohamed Albirair

Naomi Nkinsi, 2

I. Introduction
Historically, the Republic of Cameroon has fought a long struggle against an HIV/AIDS
epidemic that has plagued the region for decades now. Unfortunately, the high numbers of
individuals impacted by this disease either directly, or indirectly through the loss of income and
family members has only been compounded by the abject poverty that is found throughout the
developing nation and the mismanagement of funds provided by non-profit and governmental aid
efforts. Although Cameroon boasts a 24% decline in the number of pediatric HIV infections from
8,900 to 6,800 between 2009 and 2011, there is still much work to be done to reduce the number
of deaths due to the disease and decrease the overall impact of new cases of infection.
This proposal focuses on the prevention of HIV/AIDS transmission in the West African
country of Cameroon through the formulation of affordable treatment plans for individuals
already infected with the disease, HIV/AIDS prevention education for youths, and providing
alliances for those who are infected in order to remove the stigma associated with the disease. In
order to achieve the goals of this proposal, it will be essential to ensure productive partnerships
with local community leaders, government officials, and aid organizations already established in
the area so that all available resources may be utilized properly, efficiently, and effectively.
Improving access to services such as affordable treatments and providing education
seminars to local health officials will serve to provide a diagonalized approach to reducing the
impact of HIV/AIDS in Cameroon. With the addition of more carefully trained and able health
workers, family planning and education for young woman, and more access to preventative care,
the Cameroonian people will be better prepared to implement their own strategies to keep their
communities healthy and free of the virus.

Naomi Nkinsi, 3

II. Goals and Impact

The overarching goal of this proposal and the methods discussed throughout it id to
decrease mortality due to HIV/AIDS through increasing access to much needed health services
in the areas of Cameroon that appear to have the highest rate of this disease. Data indicates that
the South Region of Cameroon has the highest prevalence of HIV/AIDS infections, with 7.2% of
the population being infected (DHS-MICS). In addition to this, the East Region (6.3%
prevalence), the Central Region (6.1% prevalence), and the Northwest Region (6.3% prevalence)
also have relatively high rates of HIV/AIDS prevalence, especially considering that some areas
of the country, such as the Extreme North Region have prevalence rates of the disease as low as
1.2% (DHS-MICS).
These trends in HIV prevalence throughout the country are indicative of other social and
economic forces that may be influencing the high rates if some regions and the very low rates in
others. For example the Central Region of Cameroon, which holds the countrys capital of
Yaounde, has one of the highest rates of HIV/AIDS prevalence in the country. This could be
attributed to the high volumes of people living in the region and the fact that large city setting
tend to be large hubs for sex workers and high rates of prostitution. This would undoubtedly
contribute to an increase in the prevalence of HIV/AIDS as condom use in the country remains
inconsistent. This high prevalence rate could also be due to the fact there are two major airports
located in this region of the country, Yaound Airport and Yaound Nsimalen International
Airport. Increased international travel in the area and the movement of populations from one
place on the globe to another could contribute to higher prevalence of HIV/AIDS. Prostitution in
Cameroon is illegal, but has been known to attract sex tourism from the west, especially for child
prostitutes (BBC News). Although Cameroon is a member of the Universal Federation of Travels

Naomi Nkinsi, 4

and Agents Association (UFTAA) which pledges to combat prostitution of children related to sex
tourism, this continues to be an issue for the international hubs of the nation and has been linked
to cases of HIV/AIDS in young children, especially young girls (BBC News).
Although prostitution has been identified as a major issue in this region of Cameroon, it
has recently been acknowledged as a far more overarching problem for the country as the
nations commercial logging industry continues to expand. There are approximately 35,000
commercial sex workers along Cameroons logging routes from the East Region to Doula, a city
located in the Far North Region of the country (AOL News). Until recently, Cameroon had one
of the lowest HIV prevalence rates of all of Africa, but as the market for commercial sex workers
continues to increase much faster than the popularization of condoms and other prevention
methods, this appears to be changing dramatically (AOL News) .
Due to these reasons, one of the goals of this proposal is to identify ways in which
prostitution in the country, especially that of very young girls can be reduced through the
education and empowerment of women. It is another goal of this proposal to increase the levels
of education, acceptance, and utilization of condoms and family planning practices to reduce the
number of new infections. Because this proposal focuses on the empowerment of women in
terms of education of prevention methods for HIV/AIDS, one of the indicators of whether or not
this goal is being achieved are the percentages of females aged 15 to 24in Cameroon who have
knowledge of HIV prevention methods. We also aim to measure the reported condom use
percentage at last higher risk sex among women in Cameroon also aged 15 to 24. The rates at
which women are choosing and enforcing the matter that they be protected when engaging in sex
are a direct measure of the efficiency of the empowerment and education seminars that are

Naomi Nkinsi, 5

essential to this proposal. This is especially important for areas in the country where prostitution
rates are high.
Overarching Goal: Overall Reduction of HIV/AIDS in Cameroon
HIV Indicators (WHO)
Indicator
Date
Estimate
Year 5 Goal
(Baseline)
Adult prevalence of HIV/AIDS
2003
4.8-9.8%
1.5-2.9%
(15-49 years)
Estimated number of people living
2003
390,000-810,000
100,000-200,000
with HIV/AIDS (0-49 years)
HIV testing and counselling sites:
Sept. 2005
89
200
number of sites
Knowledge of HIV prevention
2003
27%
75%
methods (15-24 years)% - female
Knowledge of HIV prevention
2003
35%
80%
methods (15-24 years)% - male
Reported condom use at last higher
2003
47%
80%
risk sex (15-24 years)% - female
Reported condom use at last higher
2003
57%
80%
risk sex (15-24 years)% - male
http://www.who.int/hiv/HIVCP_CMR.pdf
In addition to monitoring the percentage of women in Cameroon who have knowledge of
HIV prevention methods and the percentage of them using condoms during high risk sex, the
percentages of men in these indication categories will be measured as well. Although it has been
shown repeatedly that empowering women and providing education for young girls has a
significantly positive impact on the health of communities, it is also very important to ensure that
the men in these communities are also well informed of their HIV risks. In a patriarchal society,
men hold a lot of power over the women in their communities and marriage arrangements are not
always mutual. In fact, much of the child prostitution cases in Cameroon occur when community
chiefs sell young women to visitors from the west for money (AOL News). In order to keep the

Naomi Nkinsi, 6

infection rates in females low, it is crucial to keep the HIV rates among the men who infect them
low as well.
Because data collected as a baseline source of comparison for the work of this proposal
was collected form the World Health Organization (WHO) in 2003, this proposals aims to
accomplish its overarching goal of reducing HIV/AIDS in Cameroon by the year 2020. Although
this seems likes a lengthy period of time, we found it to be appropriate based on the fact that the
establishment of health care systems, the raining of adequate health workers and the education of
women, children, and men to a level that can produce significant and long enduring change takes
time. However, seeing as this proposal requires a lengthy time to run its course, data collected
throughout the process of program implementation will occur to demonstrate the effectiveness of
measures being taken and reports will be distributed to stakeholders in this program with five
year updates. The hope is that by the end of this program implementation process, the people of
Cameroon, rural and urban health workers, the government, and clinics will feel as if they have
been provided with the appropriate tools and knowledge to continue with the progress of our
work without continued direct intervention.
Interactive Map of HIV/AIDS in Cameroon
Map Link: https://mapsengine.google.com/map/edit?
mid=zdjnFNx_Yd6U.kJingOJMvhno

Naomi Nkinsi, 7

III. Objectives and Expected Outcomes

Objectives
Indicator

Year

% of people receiving antiretroviral therapy

2005
that need it (0-49 years)
HIV testing and counselling sites: number of
2004
people tested at all sites
OVC prevalence in Cameroonians
2009
aged 15-49
http://www.who.int/hiv/HIVCP_CMR.pdf

Estimate
(baseline)
16.61%

Year 5 Goal

49,378

100,000

5.30%

1.20%

30%

To achieve our impact goals for this program, this proposal utilizes and focuses on three
key objectives and the impacts that they will have on communities. First, we propose to increase
the percentage of people currently receiving ARV therapy who need it from 16.61% to 30% by
the year five of the program. Based on a demographic health survey conducted in 2004, the
burden of Cameroons HIV prevalence is felt mostly by the women of the country and the
numbers of orphans and vulnerable children (OVC) from HIV/AIDS have increased
significantly.
However, in 1986 the Cameroonian government created a National Aids Control
Committee to work in partnership with the National AIDS Program. This initiative was launched
in two strategic plans. The first plan, which was enacted from 2000-2005 included strategies for
the prevention of transmission of HIV and other STIs and had a heavy focus on women of child
bearing age, as they are most vulnerable to the disease. Individuals that were already infected

Naomi Nkinsi, 8

were managed by enhancing access to treatment and care or referrals to certified treatment
program and working to protect and promote the rights of the infected. In order to reduce the rate
of HIV infection, the government also began to provide family planning counseling at treatment
clinics, free HIV testing for pregnant women and children under the age of 15, and well as free
or subsidized ARV for infected individuals.
The second part of the plan, launched in 2006 focused on six main aspects: universal
access to treatment for adults and children with HIV/AIDS, Protection and support for HIV
orphans and vulnerable children, involvement of stakeholders, epidemiological surveillance and
research, reinforcement of the programs already enacted, and evaluations of these programs.
Despite the fact that so much has been done to ensure that all citizens of Cameroon
infected by HIV/AIDS receive the treatment they need, it remains that only 16.621% of these
individuals are on ARV therapy. This could possibly be due to the distance that most individuals
are located form available clinics and lack of transportation. As we aim to increase the number of
clinics available in the country and the number of people that these clinics are capable of testing
and treating, it is out hope that the percentage of people receiving ARV therapy increases
dramatically.
In addition to this, out last impact goal is to reduce the prevalence of OVC in the
Republic of Cameroon. Decreasing the number of children orphaned due to this disease
alleviates the high pressures that orphanages in the country are under to properly care for the
children in their hands. Also, these children will then be available to teach their parents
preventative practices for HIV and can serve as a source of change and education in their
communities.

Naomi Nkinsi, 9

IV. Practical Activities to Achieve Outcomes

Practical Activities to Achieve Outcomes

Implementatio
n Agencies

0.08

Ye
ar
5
2

4.4

10

47%

80
%

% of men and
women
knowledgeable
about HIV/AIDS
prevention
methods

27%
(female)
35%
(male)

50
%

Cameroon MOH
and Local
medical
Universities
Cameroon MOH
in partnership
with local
community
clinics
Cameroon MOH
in partnership
with local clinics,
schools and
community
leaders

% of men and
women
knowledgeable
about HIV/AIDS
prevention
methods

27%
(female)
35%
(male)

50
%

Main Activities

Process Indicators

Year 1

Train and
educate
community
health
workers
Train and
educate
nurses and
midwives
Distribute
condoms to
local health
clinics

physicians per
100,000
population

nurses and
midwives per
100,000
population
% of women using
condoms during
high risk sex

Community
theater
programs to
educate
people about
the risk of
HIV/AIDS and
prevention
methods
Distribute
comic and
coloring
books to
children
enrolled in
school that
educate them
about
HIV/AIDS so
they can
inform their
parents

Cameroon MOH
and Local
medical
Universities

Cameroon MOH
in partnership
with local clinics,
schools and
community
leaders

First, this proposal suggests the increased training and educating of community health workers,

Naomi Nkinsi, 10

nurses, and midwives in order to increase the numbers of these workers present within a
population of 100,000 people. However, in order to accomplish this and maintain the new
workforce for a longer duration of time, adequate compensation needs to be provided to prevent
a brain drain to non-profit organizations offering high wages and financial security (Bristol). As
it stands, Cameroon has very few available health workers, making it difficult to provide
adequate and timely care for those infected with HIV/AIDS and testing for those suspected of
having the disease (Cameroon Health Profile). The low numbers of nurses and midwives
available also contributes to high risk deliveries for pregnant women and a higher chance that an
infected womans child will become infected with HIV/AIDS during birth.
Second, we aim to distribute condoms to local health clinics for free of charge and
educating the health workers in these clinics of the proper way to use the condoms, how to store
them, check for expiration date, and properly dispose of them once they have been used. Studies
have shown that 90% of all HIV transmissions in Cameroon are due to lack of protection during
sexual activity (Sanou, Sobzer). Researchers have suggested that combating the spread of
HIV/AIDS must first begin with changing the behaviors and attitudes of young Cameroonians
regarding condom usage. A 2013 study conducted at the University of Dschang among 518
newly registered students showed that 41.1% of the students did not know the transmission route
of HIV and that 5.4% of these students did not know the correct way to use condoms (Sanou,
Sobzer). Furthermore, the researchers were especially astounded that although 97.8% of students
knew that condoms could be used to help prevent the spread of HIV/AIDS, 34.5% of them failed
to use condoms during intercourse and 69% were not in favor of the female condom (Sanou,
Sobzer).
An example of an HIV/AIDS prevention
campaign add targeted at young girls in Uganda
http://www.iavireport.org/Back-Issues/Pages/IAVI-Report11(2)-GoingPublic.aspx

Naomi Nkinsi, 11

This type of data provides concrete

evidence that although Cameroon currently has
campaigns emphasizing the use of condoms,
the overall perception of condoms among the
youth of the country is still extremely poor. It
is because of this staggering data that this
proposal recommends a method of HIV/AIDS
education for the Cameroonian youth in the
form of comic books, open dialogues and
community theaters along with providing
condoms free of charge at local clinics and all
university health centers. Having free condoms
available to those who utilize the clinic will
help to normalize the practice of using them on
a regular basis as people will be more accustomed to seeing them around. Also, the fact that
these will be distributed by local clinics rather than outside organizations increases the
legitimacy of the products because people are more likely to trust those who speak their language
and know their customs that those that are outsiders. The increased use of condoms in high risk
communities will reduce the rate of new infections. We hope that the reduction of people
becoming ill will serve as further encouragement for their communities to continue with this
healthy habit.
Finally, our last two activities aimed at communities with high prevalences of HIV/AIDS
serve as community centered education programs that would allow for the education of all

Naomi Nkinsi, 12

members of an area young or old in a manner that is friendly, easy to understand, and highly
interactive. Much of African culture and community draws on the art of story- telling and for the
purposes of education; we propose that this type of familiarity is used when educating
community leaders, community members, and children of the risks of HIV/AIDS and how to
prevent transmission. This allows for material to be presented in a manner that is not
intimidating, but rather welcoming for questions and further elaborations. Community education
theaters and informative comic books all work towards the overarching goal of this proposal to
reduce the rates of HIV/AIDS in Cameroon because it empowers communities with the ability to
take charge of their own heaths and change habits or mentalities that put them at risk of
transmission.
V. Compatibility with Existing Programs
There are currently many other programs established or in the process of being
established in Cameroon with similar goals of reducing the instance and prevalence of
HIV/AIDS in the country. Many of these programs, however, are either funded or run in
partnership with non-profit organizations based in the United States or Western Europe. While
there is nothing inherently wrong with these efforts, they do, however, create a sense of
dependency on foreign aid and assistance. In contrast to these aid efforts, this proposal aims to
implement programs in Cameroon that are firmly centered in the idea that training citizens of the
country to take charge of their own health with provide better improvement and long lasting
results further down in the future. We believe this method to be more sustainable, but recognize
that we must work in partnership, not against other organizations and government aid efforts in
the area.

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One of the major organizations currently at work in this region is the Centers for Disease
Control and their recently launched Strengthening Disease Surveillance and Response in Central
Africa (SURVAC) program which was started with a $25 million grant from the Bill and Melinda
Gates Foundation (CDC). This program, although not specifically focused on HIV/AIDS, but
other diseases that plague this region of Africa as well, works to help countries create short and
long term trainings to create a network of local disease detectives. Other organizations in the
country with similar goals are Care International, and five proposals currently being funded by
the World Health Organization.
Of course, in addition to these efforts, there are steps being taken by the government to
reduce HIV/AIDS in Cameroon that have been previously mentioned. Overall, because all of
these efforts are working towards a common goal, it is in the best interest of the enactors of this
proposal and the citizens of Cameroon for these organizations work together as they each fill in
different gaps in the currently broken health system.
VI. Related Issues
A. The goals and activities indicated in this proposal place a great amount of emphasis on
the beneficiaries (those in Cameroon living with HIV/AIDS). This is heavily due to the
philosophy that this proposal is based upon that aid is best used and most efficient when
it is conducted in a way that empowers the beneficiaries to take charge of their own
health outcomes. For example, we aim to train community health workers rather than
bringing in doctors from abroad so that these workers may remain involved in their areas
and continue to help their friends, families, and neighbors. This provides a sense of
building a community from the inside rather than having outside forces implement rules
that are sure to be broken once those forces have left.

Naomi Nkinsi, 14

B. As described above, the proposal really values beneficiary empowerment and community
participation in healthcare, A great example of how we aim to accomplish this is through
the community theaters that have been proposed to teach people about the risks of
HIV/AIDS and how to prevent it. Teaching the youth about these issues through comic
books also encourages community involvement as it allows parents to learn from the ir
children about how to prevent HIV/AIDS and where to go for treatment.
C. Because the data that we collected for this proposal indicated that there was a large
discrepancy between the knowledge of HIV/AIDS between young men and young
women as well as with condom use, it will be one of our focuses to ensure that women
become empowered with knowledge. The data also showed that fewer people were
comfortable with the idea of female condoms. Education targeted towards women and
campaigns to provide prostitutes with either counseling to leave their line of work or free
condoms to protect themselves with future clients is also essential.
D. As previously discussed in part C of this section, social equality issues will be addressed
in this proposal to ensure that services provided are equally provided for both men and
women. Another social issue to consider is the stigma that many with HIV/AIDS face in
Cameroon; often losing jobs, homes, and loved ones. As discussed earlier in this
proposal, we also aim to continue on government efforts to protect the rights of those
who are infected and educate communities on how HIV/AIDS is spread so that they do
not grow to fear those neighbors that have the virus.
E. We aim to increase human resources development through the training of medical staff
and the construction of more clinics in rural areas so they are more accessible to those
without reliable forms of transportation. These improvements will increase the resources
available to the HIV positive, but also provide spaces for people to be tested and receive
treatment for HIV/AIDS among other diseases.

Naomi Nkinsi, 15

VII. Addressing Potential Opposition

As a Global Fund funded program, this proposal does not seek to Westernize Cameroon
nor to push values onto its people that work to reduce the great cultural diversity of the country,
but rather to use these ideals I a way that favors better health. We strongly value the ideals that
the Cameroonian people hold true and have demonstrated a commitment to ensuring that
healthcare provided is provided to Cameroonians from Cameroonians as to not push cultural
boundaries too far.
However, this being said, we do recognize that there will be opposition to this program
by local community leaders because our ideals require that communities change certain habits
that are putting them at risk of disease. We will also face great opposition in our path to seek
social equality for women in this highly patriarchal society. In addition to this, our desire to put
an end to the prostitution of women for profit will be met with opposition as the commercial sec
trade is a large source of income for many families and a source of tourism for the government.
These foreseeable emphasize the importance of open communication about the work of our
proposed programs and the release of data to provide evidence of health improvements in the
country as a result of these programs. There is no way in which to squelch all opposition to our
proposal, but it is rather more productive to work with the opposers to provide clear evidence of

Naomi Nkinsi, 16

why our methods work and formulate a communications and public relations team to ensure that
our programs are being met with open arms prior to expanding to new areas.

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Naomi Nkinsi, 17

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