Interventions

DECEMBER 2011 I

GUARANTEEING SUCCESS THROUGH PARTICIPATION

PAStoRALiStS

community
respect through hbc services

EnHAncED

RiGHtS

CHANGE AGENTS from within

EPARDA

A look @ the past

Through its work with Health Unlimited, Enhancing Pastoralist Research and Development Alternatives (EPaRDA), launched its Empowering Marginalized Pastoralist Communities Project (EMPCP) aimed at to empower youth, women and men of the marginalized pastoralist communities in Hamer and BenaTsemay Woredas in South Omo to reduce the spread of HIV/ AIDS; to enable access to VCT services; and to promote their right to care, treatment and support.

CONTENTS
4 4 4 4 4 4 4 4 4 4 Message Message Message Message Message Message Message Message Message Message

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Director

MESSAGE from the

Zerihun Ambaye
PhD.
4

UNIT 1
INTRODUCTION
Through its work with Health Unlimited, Enhancing Pastoralist Research and Development Alternatives (EPaRDA), launched its Empowering Marginalized Pastoralist Communities Project (EMPCP) aimed at to empower youth, women and men of the marginalized pastoralist communities in Hamer and Bena-Tsemay Woredas in South Omo to reduce the spread of HIV/ AIDS; to enable access to VCT services; and to promote their right to care, treatment and support. Hamer and Bena-Tsemay woredas are found at distances of 742km and 702 km respectively from Addis Ababa and are located in the far south of the SNNPRS. Communities in BenaTsemay and Hamer live in the Great Rift Valley i.e. the transition zone between the southern end of the Ethiopian Highlands and the drier lowlands of northern Kenya. These two woredas are bordered by Bako-Gazer woreda of South Omo in the north, by Konso Special Woreda and Teltele Woreda in Borena Zone of Oromiya Region to the east, by Kenya to the south, and by Salamago and Bako Gazer Woredas to the west. As the data from the Knowledge Attitude and Practice (KAP) survey of 2003 indicates, 65% of people in these communities do not know any means of HIV transmission and methods of prevention. Around 25% of men have no knowledge of Sexually Transmitted Infections (STI). While 42% of respondents who have sex with in a year time reported that it was with a non-regular partner; and only 5.1 percent of them have ever used condom during sexual intercourse.

STATE OF AFFAIRS IN BENA-TSEMAY WOREDAS BEFORE EMPCP

Before EPaRDAs intervention the area was best described as an area populated by marginalised pastoralist and agro-pastoralist communities. For the past several decades they have been neglected and excluded from the overall participation in development endeavours. Hence, they were found to have negligible knowledge of HIV/AIDS, and its means of transmission and prevention. Prior to the Empowering Marginalised Pastoralist Communities to Prevent HIV/AIDS and Promote the Rights of HIV Positive People Project, there were a number of obstacles to overcome. People living in the woredas of Hamer and Bena Tsemay were engaged in a number of activities which increase the risk of contracting HIV, there was a very low level of awareness about HIV amongst the communities and any interventions present in the area were based in facilities and carried out by governmental organizations that did not necessarily adapt their activities to a pastoral context. Moreover, there existed promiscuous sexual behaviour at the traditional rites of passage events such as Evangadi where young, pre-marital, local girls are expected to have sex with men of any age and marital status. There is also low community awareness and poor access to Voluntary Counselling and Testing (VCT) services and there is extreme reluctance to go for testing.

The Youth were found to have adopted risky behaviours; and the fear of stigma and discrimination if test results proved positive is very high among the youth. On top of these, no other organizations were working on HIV/AIDS except the Federal Ministry of Healths HIV/ AIDS and prevention and controlling Office (HAPCO) facility based VCT, Prevention of Mother to Child Transmission (PMTCT) and Anti Retroviral Therapy (ART) activities. Until the advent of EPaRDas EMPC intervention programmes providing care and support service to People Living with AIDS (PLWAs) in the zone were nonexistent. HU and EPaRDA were the only NGOs working on health issues in the two Woredas.

THE CHALLENGES AT THE START OF THE PROJECT INCLUDE:

The project was a pilot comprehensive program and the natures of interventions were relatively new. There was no HIV related clinical services like anti-retroviral treatment (ART) Community Conversations (CC) were not held at regular intervals The concept and benefits of associations were not widely known or practiced Provision and awareness about the benefits of home based care (HBC) was very low In Ethiopia, it is estimated that 3.5 percent of the population is HIV positive, with the epidemic concentrating among women and in urban areas. However, according to recent studies the urban prevalence is tending to stabilize at a higher rate while the rural prevalence shows slight increase. According to the sixth report of ministry of health AIDS in Ethiopia, HIV/AIDS is still posing a threat to the development of the county. Around 1.3 million people are living with the virus and 744,100 children have lost one or both of their parents in the country. The estimated prevalence of HIV in the SNNP region is 2.3% (10.2 for urban areas and 1.5 percent in rural areas). This rate makes the SNNP region one of the four highly affected regions of the country, the other three highly affected areas, are the Amhara regional state, Oromia regional state and Addis Ababa. The intervention areas of this project, Hamer and Bena-Tsemay Woredas of the SNNP region, are pastoralist and semi-pastoralist areas. Like other pastoralist locations of the country, these areas are marginalized in terms of access to various services. The challenge in addressing their need is largely due to their pastoral- nomadic life style. This community is characterized by extremely law health service coverage, law level of education and thus perpetuation of strong cultural influence till present time. These communities particularly face challenge from lack of access to sufficient and reliable information. The two studies, the KAP survey by EPaRDA in 2003 and the base line survey by Health Limited in 2006, conducted in these two woredas underscore this fact. According to the findings of the KAP survey in 2003, 59 percent of the population of these communities do not have any knowledge of HIV and AIDS. And among those who reported that they knew something about HIV/AIDS, 60% of them could not mention any means of transmission and ways of prevention. Due to absence of sufficient information, education and communication activities about facts of HIV/AIDS including ways and means of HIV of transmission, stigma and discrimination is very high. Around 22.6 percent of respondents in this survey have said that they would not be willing to give care for someone who is ill because of HIV/AIDS, whoever he/she may be.

The findings of the baseline survey, conducted in 2006 after three years of the KAP study by EPaRDA, show that there is still a big knowledge gap in the area. Only 11.6% and 10.6% of the respondents have identified three and/or more routes of HIV/AIDS transmission and means of prevention respectively. As these pastoralist areas are far from the countrys capital, they are highly marginalized in terms of access to information. The intact traditional practices that are deeply rooted in the communities also put enormous challenge in controlling HIV in the area. Moreover, having multiple sexual partners both by married and young unmarried men; possibility of having multiple sexual partner for widows up to the time they get remarried; the practice of circumcision in mass using the same materials; abduction; and scarification using common materials are among the traditional practices that accelerate the transmission of HIV in these communities. In these areas, unmarried girls are expected to have sex before marriage. The traditional dancing activity, Evangadi, is mentioned as fertile areas for HIV transmission as girls and boys are free to have sex without any limitation. As seen from the 2003 KAP survey, 42 percent of those who had sexual intercourse within a year period had sex out of regular partner. The survey of 2006 indicates that only 5.1% of the respondents have used a condom during such sexual intercourse. The existence of high rate of multiple sexual partners, low level of condom use, reluctance to care for PLHA, and the perpetuation of cultures that encourage the youth to have sex before marriage show the extremely low level of information and behavioural change with regard to HIV/AIDS in the area.

ADDRESSING HTPS AND MISCONCEPTIONS TO REDUCE HIV VULNERABILITY

Ayalkibet Getachew is a health officer who has worked at Turmi heath center, Hamer Woreda for the past 13 years. He has worked in different positions as head of the health center. He has gained ample experience working in Hamer woreda. He expresses his concern and the need to address harmful traditional practices as a major focus of HIV intervention to reduce vulnerability to the virus. The encouragement of multiple sexual partners before and after marriage is a big concern but there are other HTPs that play a role in the transmission of HIV. He explains inheritance marriage is one in this regard. When an older brother dies, his younger sibling inherits his wife without any knowledge as to the cause of death. He explains, There are clients in ART unit under regular treatment for HIV who say they have acquired it after inheritance marriage. He also explains that polygamy is another HTP that increases vulnerability to HIV infection. Additionally, during the traditional bull jumping ceremony, there is a common practice of beating a brides sister with long whip. As a result of the beating, women bleed at their back and a caretaker rubs butter on their wounds. This is like the same person painting ones blood to another persons wound putting oneself and others at risk of HIV infection. He also expresses his concern that circumcision program carried out using the same sharp materials also increases vulnerability. Among the woredas in South Omo zone, the flow of tourists in and out is particularly high in the project areas of Hamer and Bena Tsemay. Ayalkibet feels the connection between tourism and HIV should be given due attention. Though there are tourists coming to visit the area for a variety of activities he is concerned with those coming for sex related tourism. Ayalikibet expresses his amazement to the request of a tourist visiting the area, I was surprised to hear when she told me that she has read about the Hamer culture, saved her money to come and stay with a native Hamer man. Men are also coming for similar reasons. According to Ayalkibet, the concern comes from the increasing occurrence of such encounters,

the low level of attention and the prevailing misconception considering white looking people at low risk. He appreciates EPaRDAs significant contribution to raise awareness, acceptance of VCT and care of PLWHA. Ayalkibet highlights there is still work to address the increasing vulnerability to HIV as a result of these HTPs and the increase in sex related tourism.

Although there existed VCT services at facility level, due to lower level of awareness, both about the availability and the importance of taking the test, there were only a limited number of people who took advantage of the services. Fear of stigma and discrimination from the community is still a challenge in regards to using these available services. Currently there are a number of PLWHA associations that were established and have taken part in the prevention education,

advocacy about rights, and providing care and support in various aspects of HIV/AIDS in the country. However, in the target two woredas, PLWHA associations were non-existent prior to the projects period. This allowed fertile grounds for the problem of stigma and discrimination to continue as a problem in the area. Given this challenging situation, MOH/HAPCO were the sole organizations working in the target areas in such issues until the advent of EPaRDA-HUs EMPC project. As a result, VCT, PMTCT and ART services were available only at facility levels. Hence, the government health services

to these areas, like other pastoralist areas, were very limited. Outreach programs were almost nonexistent. As it is well known, pastoralist communities move from place to place for their living. Thus, services needed to be available in the areas of new settlement. Access to the services needed to be strengthened with mobile services. But due to capacity limitation and the lack of defined strategy to address the needs of these pastoralist communities, such conditions were not met. And there were no other organizations to fill this gap except EPaRDA and Health Limited. EPaRDA and HU have been working as partners in the areas of Bena Tsemay and Hamer woredas since 2002 and implementing a comprehensive health care project. This HIV/AIDS project named as Empowering Marginalized Pastoralist Communities Project (EMPCP) to prevent HIV/AIDS and promote the rights of HIV-positive people Both EPaRDA and Health Limited have extensive knowledge in working with the pastoralist communities. EPaRDA, as an indigenous organization, established with a particular mission to empower the pastoralists with development, in an integrated and holistic way, by capitalizing on their indigenous knowledge took on the challenge head on. It has been working in these target areas since its establishment, December 1999. Presently, EPaRDA is implementing more than eight pastoralist projects that focus on issues such as pastoralist health improvement; risk management; conflict resolution and peace building; food security and small scale irrigation; natural resource/rangeland management and environmental protection; water development; enhancing pastoralist decision making; pastoralist capacity building; and emergency assistance, not only in the two target woredas but also in other woredas of South Omo zone. Thus, from all these interventions, EPaRDA has acquired extensive knowhow and practical experience with regard to pastoralist issues, needs, and development processes. On the other hand, Health Limited, has an extensive experience of implementing health interventions with marginalized communities in Asia, Africa, and Latin America. These experiences and knowledge have made the two organizations to be involved and committed to improve the health of the poorest pastoralist communities. According to the Federal MOH, Ethiopia, the HIV epidemic prevalence in Southern region continues to rise. Currently, government services to pastoralist communities are very limited with almost no outreach capacities. Therefore, these two vulnerable marginalized pastoralist youth, women and men of the two woredas before the launch of EMPCP were left with their own devices to combat the onslaught of the HIV/AIDS pandemic.

USING A HOLISTIC APPROACH FOR COMMUNITIES TO TACKLE THE SPECTRE OF HIV/AIDS

The EMPOWERING MARGINALIZED PASTORALIST COMMUNITIES PROJECT (EMPCP) project has five outputs: Addressing the needs of Pastoralists; enhancing Pastoralists rights; raising the level of the communities participation in local development; Strengthening local organisations and womens associations capacities; and strengthening EPaRDAs organisational capacity The project has three project officers spearheading it and employed an advocacy officer, a VCT officer and a care and support officer- all three worked under me. The main aim of this project was to empower pastoralists in the two woredas by raising their awareness on HIV/AIDS issues and by providing them with access to VCT services and promoting the rights of people living with HIV/AIDS to care and support; to create and environment for them to live in dignity without discrimination. Our interventions was focused on empowering the youth, elders and women in matters related to HIV/AIDS, raise their level of awareness in regards to the pandemic, allow communities to get access to VCT services and also provide

support to those living with HIV/AIDS. The project was funded by Comic Relief and was implemented with EPaRDA in collaboration with Health Unlimited. The project had a funding of 431671 pounds sterling [~ 7.7 million birr]. Our interlocutors and partners in the implementation included the regions health Bureaus, HIV/AIDS and prevention and controlling Office (HAPCO), the South Omo Zone HIV/AIDS department, the zonal finance bureau, the health and finance bureaus of the two woredas along with the respective womens affairs offices. In addition we partnered with associations of people living with HIV/AIDS in the two woredas [Tsemat and Chora associations]. Prior to the project the level of awareness in regards to HIV/AIDS was dismal. There was the prevailing belief that the disease does not affect the pastoralists and that the disease affected only those who come from the highlands. The problem was compounded with the prevailing practices of sharing blades as well as traditional practices such as women flogging which was prevalent in the area that exposed pastoralists to the pandemic. In addition the increasing flow of tourists into the area also exposed the communities to the pandemic. In addition the pastoralists had limited awareness in regards to the use of condoms this coupled with harmful traditional practices had put the pastoralists at high risk of contracting the disease. As there were very little interventions in regards to the HIV/AIDS prior to the launch of EMPCP EPaRDAs strategy primarily focused on raising awareness and community mobilisation. Among these much attention was given towards encouraging community conversations which was one aspect of the project. In fact there were no community conversations taking place in regards to HIV/AIDS prior to the launch of EMPCP. The community conversations were conducted every two weeks for 24 consecutive where discussions are held on social problems affecting communities these forums allowed health workers to provide the communities with the necessary knowledge on issues such as HIV/AIDS. Besides this youth associations were set up within schools or their localities where they are given training to act as change agents within their communities and spearhead awareness campaigns. In addition we worked with associations and people living with HIV/AIDS to help them go out to the communities and raise awareness on HIV/AIDS, prevention and other related issues. In regards to VCT prior to the EMPCP project there were little testing centres in the area in the Hamer woreda the Turmi health centre and in Bena Tsemay there was the kaya health centre and it was difficult to provide tailored services particularly to the pastoralist communities. So as part of the project we help build the capacities of health centres to provide VCT services. Our support was based on the need assessments of these health centres. Our support came in the form of providing VCT kits, equipment, support mobile VCT services in collaboration with the health centres as well as provide training to health workers on the provision of VCT services. In this regard we have made much headway through these mobile VCT centres towards bringing the services to the communities. The initial challenges were to provide linkages once the people were aware of their status providing them with ART was a challenge. Previously ART was provided separately in health centres and exposed people to the threat of being stigmatised and excluded by the communities once a persons HIV positive status was made known when they went to receive ART treatment. To mitigate this, what we did was provide an ART officer to go out with the VCT officers and provide ART and pre ART treatment services this allowed people to maintain their status confidential as well as receive treatment. Fantahun Alemu, EPARDA, EPaRDA HIV/AIDS project coordinator

UNIT 2
THE INTERVENTIONS
EPaRDA identified three core targets where it would address the issues of HIV/AIDS within the two communities:

Increase knowledge on the modes of transmission, prevention of HIV Promote the practice safe sexual behaviour and Raise awareness and create demand for access to HIV preventive services like VCT.

Through these three pillars EPaRDA was able to promote the rights of the pastoralists in relation to HIV/AIDS, including non-discrimination and non-stigma rights at the community level. In addition it succeeded in influencing policies and practices with regards to HIV/AIDS related rights of pastoralists

2.1 INCREASE KNOWLEDGE ON THE MODES OF TRANSMISSION, PREVENTION OF HIV

EPaRDA through using a diverse range of strategies and approaches to raise awareness about HIV prevention and safer sex, has seen a number of positive changes in the community. EPaRDA circulated a large amount of condoms, created and distributed locally appropriate educational materials, trained youth, teachers and traditional healers as well as involved health extension workers and local communities through the use of CC. Additionally, PLWHA were trained on advocacy and education

Promoting condom use among pastoralist communities

The involvement of youth in peer-to-peer education has been helpful in distributing condoms in Hamer and Bena-Tsemay. Mugo Wulfo is 19 year old from Borya School in a pastoralist village around Turmi. He is one of in school youth selected for training by EPARDAs project on HIV/AIDS. Mugo explained that the training enabled him to teach his peers who are interested in learning more about and discussing the subject. He educates his peers on the basics of HIV and makes them aware that everyone is at risk of the virus, not only the highlanders, or people who wear clothing. He also added, I have also conveyed messages consistently that using condoms will help protect one not only from HIV but unplanned pregnancy. Mugo explains an increasing number of both male and female youth and adults come and collect condoms from him. Community members also send messages to bring condoms to Evangadi dancing events. Mugo collects condoms from the HEW at the health post when he runs out of supplies. Mugo also suggests that adults should use condoms regularly especially in casual relationships. Before providing condoms to people, Mugo demonstrates how to use them and expresses that he also uses condoms. Mugo explains, If I dont use (condoms) who will accept my messages? If I cannot demonstrate, how will they know what it is and how to use it?

Mugo also encounters other peers who are not interested to discuss the subject or fail to accept the education that he provides. Although Mugo has been distributing condoms and disseminating knowledge about HIV/AIDS he feels there could be more awareness on the issue of HIV and benefits of using condoms. Mugo suggests people share their experience using condoms to make others more motivated to use them. I know that the issue of condom is raised at the community conversation sessions regularly. It will be good if those who have used condom share their experience at the sessions.

2.1.1 TRAINING OF TEACHERS IN YOUTH CLUB FACILITATION

The youth play a leading role in bringing about behaviour and social change among their community through both in school and extracurricular activities. These roles become real when the youth are organized and directed genuinely, freely and consciously. Meaningful, youth oriented and self managed structure of the youth and their association is only possible through approaching them by the group and/or individuals who have intimate and long time intact with the youth. Teachers are the major and relatively long-time associates of the youth. Enhancing the capacity of teachers is a key in youth club facilitation and management. This helps them in shouldering their individual and community responsibilities and play constructive roles. Accordingly, EPaRDA, in close collaboration with zone and woreda education department organized training on in and out of school youth club facilitation and management skills for five days in Key-Afer and Turmi towns. 28 teachers drawn from primary schools that operate in the two woredas attended the training conducted from March 20 24, 2009.
Major methodologies followed during the training were: Class room lecturing Group work Role play and field practice

In the overall rating, the five days training sessions were very successful in covering several topics and also was participatory in equipping the teachers with the necessary skills so that they can shoulder the required responsibilities of coordinating and directing the youth and their associations.

2.1.2 DEVELOPMENT AND USE OF IEC/BCC MATERIALS

In order to advocate about HIV/AIDS and its relation with harmful traditional practices IEC/BCC materials were produced in Amharic, and posters were produced with the local languages of Aerbore, Hamer and Tsemaye. The IEC/BCC materials disseminated messages on the following topics: Engaging in unsafe sex increases exposure to HIV/AIDS; the modes of HIV transmission; the importance of VCT on the future life of an individual ; and the impact of HTP on the transmission of HIV AIDS
These brochures, posters and leaflets were distributed to the community, social service institutions, zonal and woreda line departments and offices as well as to PLWHA and youth associations.

2.1.3 ORGANIZATIONAL AND MATERIAL SUPPORT FOR TWO YOUTH ASSOCIATIONS

Strengthening the organizational development of youth associations is one of the strategies to empower youth to prevent HIV/ AIDS. Therefore a need assessment was made to identify the gaps in the organizational development of youth centres. Based on their requests and gaps identified, two youth centres were constructed, renovated and provided with stationary materials, well-equipped libraries and office furniture. This material support was complemented with diverse forms of entertainment such as indoor games, musical instruments, tape recorders, televisions and DVD players. Additionally, the project office assisted the organization of youth association members into various clubs including; drama, music, HIV/AIDS advocacy and education and supervision. A chairperson and a secretary were elected in each club. Strengthening youth centres with organizational and material support is essential in creating conducive environments for peer-to-peer education, distributing IEC/BCC materials, circulating condoms and numerous other HIV prevention activities. These centres, strengthened, can act as a valuable entry point for working with the target communities.

2.1.4 TRAINING OF TRADITIONAL HEALERS ON COUNSELLING

Traditional healers are influential people in pastoral societies and have close contact with people with illnesses, including those living with HIV/AIDS. Training of traditional healers on counselling intended to equip them with the skills of preventive and adherence counselling as well as to create referral linkages with health centres on VCT. Training was provided to a total of 20(1Female) traditional healers and conducted at Turmi town of Hamer woreda from April 25-April 30,2009
The training was focused on: HIV/AIDS and counselling How to provide HIV preventive and adherence counselling Necessary skills to conduct counselling How to create referral linkages with health centres

The methodologies of the training were brainstorming, discussion and presentation, roleplaying and group work. According to the participants, the training helps them to acquire the skill of counselling and how to refer patients to health centres.

2.1.5 TRAINING OF 20 PLWHA ON HIV/AIDS EDUCATION AND ADVOCACY

People living with HIV/AIDS (PLWHA) play a significant role in bringing about behavioural change among the society through the provision of HIV/AIDS education and advocacy. Therefore, training on HIV/AIDS education and advocacy was given for 17 (13 Female) PLWHAs on the issue of HIV/AIDS education, communication and mobilization of the society in combating HIV/AIDS. It was conducted at Keyafer from December 20-24, 2009 for five successive days. PLWHA from Andinet (three), chora (seven)and Tsenate (seven) associations have participated in the training.

The training focused on Methods of providing HIV/AIDS education and advocacy Socio-economic impacts of HIV/AIDS Essence of care and support Promotion and advocacy Mechanisms to bring about behavioural change among the society

The training was participatory and completed with the preparation of action plan. Using skills acquired from the training, PLWHA have provided HIV/AIDS education to 8,383 (3,702 Female) people. As a result of the advocacy and education work, PLWHA who were worried about the stigma associated with exposing themselves joined associations and there was a rise in the number of people using VCT services.

2.2 INCREASED ACCESS TO VOLUNTARY COUNSELLING AND TESTING (VCT) SERVICES

The project worked to increase awareness about the benefits of VCT as well as create and meet demand for the service. Existing services were strengthened both with training for health professionals as well as the provision of materials to offer more comprehensive services. Mobile outreach was also implemented in Hamer and Bena Tsemay on a monthly basis. Preliminary reviews of outreach VCT services indicate the level of awareness in the target communities about the availability of the services has risen and that the number of volunteers coming forward for testing is steadily rising.

Overcoming challenges to promote VCT

A model community member, Hailu Bogale, has worked through many challenges to promote VCT in his community. Hailu, 30, has been trained as a health promoter in Zegrema Kebele. During his training, he gained comprehensive knowledge on HIV issues and the risk of transmission. In addition to learning about the risk of transmission through sexual activity Hailu is now aware and concerned about existing vulnerability to HIV infection through the common practice of sharing sharp materials. Hailu explains: At that time when I even hide the sharp materials that I used, others look for, find and use them. He further explains how community elders were highly resistant and discouraged people from volunteering for VCT. Some three or four years back, there was a wide prevailing suspicion about VCT among pastoralist communities. Misconceptions include that people who volunteer for VCT are selling their blood or wide fear that some thing will be put in you when you volunteer to give blood. Hailu decided to resist these misconceptions and volunteered for VCT despite possible repercussions. I went and got tested at Gisma 3 years back. But I was blamed up on returning to my residential community because I volunteered for VCT. Community elders alleged that he has gone to sell his blood and would be punished. Hailu tried to convince the elders and others in the community by asking, If any one wants to sell blood, will there be any one to buy it? After numerous arguments, debates and efforts to challenge misconceptions, Hailu resorted to threatening legal action if punished for volunteering for VCT. I finally responded to community elders that I will go and report to the local authorities if one tries to go through with the punishment.

Hailu overcame numerous challenges and continues to volunteer for VCT every three months or when he gets the opportunity. During the projects mobile outreach VCT in August 2011, he explained how it was his fifth time testing for HIV. He feels he is always at risk and should test regularly. He also wants to demonstrate to the community that one should not fear to volunteer for VCT. Sharing his experience, Hailu said community members say, we have seen Hailu give blood repeatedly but he has not died or nothing happened to him. He also explains that people are now less afraid to give blood and know their status. Hailus courage has been helpful in challenging misconceptions and promoting the benefits of VCT in his community.

2.2.1 VCT TRAINING

Voluntary Counselling and Testing (VCT) training is a basic and compulsory training essential to achieve the project objectives. The training was conducted from February 19 March 11, 2009 in Jinka town. The Jinka Zonal Hospital hosted 16 health Professionals (4 Female) drawn from 4 Woredas, the Zone and EPaRDA. In this 21 day training, the trainees acquired the basic skills of HIV counselling, lab testing and exercised clinical practice in three health centres according to the standards set by the Ministry of Health (MoH). There were participants from a cross section of the target woreda including:
11 from Hamer and Bena-Tsemay 2 from Dassenech and Nyangatom 2 from Salamaago and Zone prison centre and 1 from EPaRDA

The training was participatory and the participants were successfully familiarized with the basic skills and standard procedures of VCT.

2.2.2 TRAINING FOR LABORATORY TECHNICIANS ON LAB TESTING

Medical laboratories are the core centres in the provision of a standardized VCT service. In order to ensure the quality and care of the service, capacity building of MoH lab technicians was required. EPaRDA in collaboration with South Omo Health Department, organized lab testing training in Jinka Zonal Hospital and laboratory centre from February 19 23, 2009. Three laboratory technicians from Hamer and Bena-Tsemay Woreda health centres took the training, supported by a training manual developed by MoH at the national level. The training was facilitated by a qualified laboratory technician from Jinka Zonal Hospital.

2.2.3 ORGANIZING MONTHLY MOBILE OUTREACH VCT

The monthly mobile outreach VCT service is a significant achievement of project. EPaRDA, recognizing the need for a mechanism to reach remote communities with VCT and HIV/AIDS education began to implement mobile outreach camps providing these services. From the beginning of the project, the project team in close collaboration with MOH counsellors and lab technicians have offered mobile outreach VCT services to a total of 2,138 (915 Female) pastoralists in Hamer and Bena Tsemay. 14 (6 Female) reactive results were found and all except one were linked to ART services.

2.2.4 STRENGTHENING EXISTING VCT SERVICES IN 2 HEALTH CENTERS

Strengthening the existing MOH VCT service through providing kits for health centres is one of the major activities of the project .Accordingly, the project office handed over the following VCT Kits for Turmi, Demeka and Keyafer health center. Using the VCT kits, provider initiated HIV counselling and testing (PIHCT) was delivered to 810(395 Female) and PMTCT service to 91 females in Turmi and Keyafer health centers, and mobile outreach. Static VCT were provided to 482(236 Female) pastoralists in Mersha, Dembiyite kebeles of Hamer and the health centres respectively. 22(1Female) reactive results were found. On top of the supporting VCT kits, stationery support was also provided to Turmi health centre to fill the gaps in documentation related to the VCT centre.

2.3 ACCESS TO CARE AND SUPPORT SERVICES FOR PLWHA

Through establishing a formal PLWHA association, enhancing access to HBC services as well as providing support for PLWHA to start their own business, EPaRDA increased access to care and support services for PLWHA.

Gaining community respect through providing HBC services

Providing Home-Based Care (HBC) services to bed-ridden community members has gained the respect of volunteers in Hamer and Bena-Tsemay. EPaRDA trained Ato Dina Baraninika, a 50 year old religious service provider, on HBC provision in Hamer. Dina works with other HBC volunteers and PLWHAs in providing care for the sick, giving advice and referring people to health centres for VCT and other services. Equipped with the kit and materials required to provide services, Dina offers door-to-door education on HIV. During his visits, he asks communities if there are any bed-ridden patients residing in the area. HBC volunteers like Dina also follow-up with bed-ridden patients by washing their clothes and in some cases, contributing their own money for food.

Dina explains how people who test positive for HIV/AIDS are referred to ART services and are then linked with the PLWHA association, he continues, Even if someone turns out negative for HIV/AIDS HBC providers continue their support until they recover from their illness. Now the acceptance by the community is good. A challenge arises when requests come from remote areas to attend to bed ridden patients. He clarifies that HBC providers cannot provide services unless transport to reach these areas is available. He further notes that lack of transport is a major challenge to provide HBC services for patients residing far away from town. He explains how in these situations, Even if volunteers provide care one time it will be difficult to regularly follow the cases under care. Dina affirms, Working as HBC volunteer requires high level of commitment. Many colleagues trained did not continue providing HBC services. Some people had to stop for economic reasons while others failed to endure caring for patients who are constantly soiled or with chronic wounds. Although being a HBC volunteer is challenging, Dina emphasizes that the acceptance by the community and the level of respect is encouraging.

2.3.1 TRAINING OF YOUTH AND WOMEN VOLUNTEERS ON HOME BASED CARE

Home-based care is a major component of the project to address the care and support needs of PLWHA. In order to run the service, provision of training for youth and women volunteers was provided. The selection of home-based care trainees was conducted by the Woreda Health, Youth and Sport Office, Women and Children Affairs and Kebele administrators. Training on home-based care was given for 50 (29 Female) PLWHA for five successive days from March 01-05, 2010. It was conducted for Bena Tsemay Woreda at Keyafer and for hamer Woreda at Turmi. Volunteers from youth, women and PLWHA were participated in the training. It focused on
How to provide home based care and support Treating bed ridden patients Essence of care and support How to provide first aid Steps to provide care and support

The methodology of the training was lecture, group discussion, presentations, role-play and demonstration. The training was participatory and completed with the preparation of action plan for the next quarters by the participants.

2.3.2 PROVISION OF HOME BASED CARE KITS

With the consultation of South Omo Zone Health Department, the kits were identified and a recommendation letter for drug administration and control was written by the department. Based on the specification, the following HBC kits were provided for HBC providers in a group of five.

2.3.3 ORGANIZATIONAL DEVELOPMENT OF PLWHA ASSOCIATION

The key approach for promoting the rights of HIV positive people is the establishment and strengthening of their association. In relation to the organizational development of PLWHA associations, the project office in close consultation and cooperation of woreda HAPCO had completed the legal registration of the two associations namely Tsenat PLWHA in BenaTsemay with 41(30 Female) members, Chora in Hamar with 14(12 Female). The two PLWHAs have registered and get legal certificate from the South Omo Zone Justice Department. In addition to technical consultation and support to the PLWHA, EPaRDA covered all the financial cost incurred by the two associations to have their legal status and recognition and for the registration of membership at regional network. Furthermore, the project office also identified gaps of the associations, based on their gaps and requests, the following stationary materials and office furniture were purchased and distributed to the associations including Andinet . In addition to the above it also provided a technical support in organizing management committees for the associations and organized regional network meeting to have experience sharing with the well organized associations such as Tila ,Mimani and Down of Hope.

2.3.4 SUPPORT PLWHA ASSOCIATIONS TO ADVOCATE FOR CARE AND SUPPORT, VCT, ART AND PMTCT SERVICES
Advocacy and education on HIVAIDS is one of the mechanisms to minimize the number of new infections and a means to encourage people to find out their HIV status. Among the 17 PLHWA who were trained on HIV education and advocacy,14 of them chora(5) Tsenate(7), Andinet (2) had provided HIV/AIDS education and advocacy to 8,383(3,702 Female) people on the following topics
The importance of VCT, The impacts of HTP in relation to HIV/AIDS. Modes of HIV transmission How to stop Stigma and discrimination VCT and testing Advantage of ART Personal and environmental Hygiene How to use condoms PMTCT To prevent Opportunistic Infections through keeping personal &Environmental Hygiene Practice &use of condom

2.3.5 PROVIDE BUSINESS TRAINING FOR 30 PLWHA AND BUSINESS START UP CAPITAL
Training of People Living With HIV AIDS on IGA

Training of PLWHA in income generation activities (IGA) is one of the major activities of the project to enable PLWHA become economically self- reliant. A total of 30(22 Female) PLWHA from Chora (12), Andinet (5) and Tsenate (13) PLWHA were trained by the experts from South

Omo zone small scale industry and omo micro finance for seven days. It emphasized on
How to be entrepreneur? How could identify income generate activities? planning and saving Preparation of business plan

The training was finalized with the selection of IGA and preparation of business plan by the participants that they will be engaged after the grant is provided. After observing their business plan and in consultation with woreda HAPCO, a total of 135,000 ETB was provided to Tsenate (58,500),chora(54,000) and Andinet (22,500) PLWHAs. Each of associations had developed their bylaw on the utilization of the grant and to manage the beneficiaries. After the board, the management committee of the associations and the beneficiaries had discussed on the bylaws, the associations were accordingly distributed the grant of 4,500 ETB for each beneficiaries.

IGA training and grant

Training for Income Generation Activities (IGA) for PLWHA is helpful in reducing stigma and discrimination and showing that PLWHA are capable of living productive lives. An example that depicts the benefits of IGA is Etalem Mitiku, a 32 year old woman living with HIV in Key Afer town in Bena Tsemay Woreda. Etalem used to sell a few items on the street to meet her daily needs and those of her child. Her life was very difficult then as her income and other forms of support were meagre. Etalem is now a member of the Tsinat PLWHA association in BenaTsemay. Her life took a change for the better a year ago when she benefited from the IGA support through EPaRDA. Etalem explains, The support I got helped come out of the street and rent a place for a shop for which I pay 150 Birr per month. It also helped me expand my business in the shop through selling many household items. The profit she gained has enabled her send her child to school, pay her house rent and

undertake other activities. She has bought cattle, land and corrugated iron to build her house both as a shop and to reside in. She also saves and contributes 300 birr weekly and for a saving scheme called Iqub, a type of traditional rotating lottery system. Each person in the group contributes money at regular intervals and receives the group savings once during every rotation. Etalem expressed her aspiration to lead a life in her own compound in the future, free from paying rent for residence or her shop. The training and support for income generation activities (IGA) were geared at increasing the potential of PLWHA to gain greater economic freedom as well as indirectly reduce the stigma and discrimination they face. Zonal experts coming from small-scale industry as well as micro-finance institutions gave a 7-day training to select PLWHA. The training focused on questions such as how to be an entrepreneur, how to identify incomegenerating activities as well as how to plan and save and prepare a business plan. After the beneficiaries created and submitted a business plan, they received a grant to support the planned activities.

3.5 MONITOR AND PROGRESS OF BUSINESS AND PROVIDE TECHNICAL SUPPORT

On its part, the project office had conducted supervision and follows up on the progress of IGA beneficiaries.
Table 1: Small business in which the IGA beneficiaries are engaged items 1 2 3 4 5 6 Business they are engaged Selling of Sheforo (coffee cask), coffee and tea Preparation of spices and eaterie Livestock trading and dairy farming Wood work and metal work Traditional and consumer goods shop Corn retailing Tsenate M F 2 3 2 4 2 Andinet M F 1 1 1 Chora M F 3 2 1 1 3 1 2 Total M F 6 6 1 5 4 2 3

GUARANTEEING SUCCESS THROUGH LOCAL PEOPLES PARTICIPATION

From experience from the past interventions working with pastoralist communities EPaRDA hinged its interventions on belief that for interventions to be effective, there could be no replacing the role communities had to play to make the interventions a success as a result stakeholders from across the board of the communities were included in the planning, implementation and evaluation of the project and had involved the youth, men, women, elders, Traditional Birth Attendants, traditional healers, PLWAs, along with local health workers, teachers and government bodies. The rationale used here comes from the understanding that since the issue of HIV/AIDS is a social problem requires a concerted efforts from actors from across the board. As such community members including youth; women; PLWA; traditional healers; teachers and other community members had to be engaged as active implementers of the project activities and provided training when the need arose. At another level the project included mechanisms whereby other actors were included

into the foray to guarantee its success. Among these include building networks with other agencies that are providing care and support services to similar or adjacent communities; and other stakeholders such as health offices, government structures and private supporters be actively dealt with and made to contribute to the success of the project Youth are the most vulnerable groups of people to HIV infections. Especially those living in both Hamer and Bena-Tsemay woredas are under added risks from cultural practices prevalent in the area as both boys and girls are expected to have sex before marriage. Some cultural events like Evangadi are the most favourable situations where these expectations come true. As part of this belief they also have a profound positive attitude regardless of the risk it directed against their life. The lack adequate information about HIV and its related consequences has made them not to be able to minimize the exposure in having relations with several sex-partners or using condom. To bring the youth into realizing the danger of HIV/AIDS and to bring behavioural change, they need to have serious discussions and education as peer. IEC materials produced by the project and other accessible materials were also distributed to these clubs. Condoms were made available through volunteers from the clubs.

Bringing change agents from within the communities

Our task include providing support to people living with HIV/AIDS that have organised themselves into associations. We help strengthen the capacities of these associations through supporting them in coming up with income generating schemes so that they can help themselves and their families. We also provide house to house support and care for people living with the HIV virus and those that have not contracted the virus. We see the latter two as our partners in raising awareness about the pandemic within the communities they reside in. Our interventions starts with our partnership with the woreda administration office who provide us with the information on the associations and act as the bridge between us and the associations. Once contact is established with the associations in question we sit down with them and see where they see gaps that can be bridged. Before going into providing them with support to come up with income generating scheme we provide them with training on entrepreneurship and then follow up by providing them with seed money for their schemes. The support also extends towards follow up and monitoring support to make sure the schemes are successful and interventions are made to enhance the success of the schemes. This is done in partnership with the woreda administration office along with the leaderships of the associations we have constant communications and regular meeting sessions to assess the progress of the projects. Our interventions are based in the two woredas in Bena Tsemay we work with Tsinat People Living with HIV/AIDS Association where we have provided 33 individuals the opportunities to embark on income generating schemes. The schemes are diverse from providing cafeteria services, producing traditional arts and crafts, selling produce, animal husbandry- the schemes are diverse. In the same token we support the Chora People Living with HIV/AIDS Association which is operating within the Hamer woreda where we continue to support 22 individuals who are engaged in the schemes. In regards to our door to door service we make sure that we are in constant dialogue with the communities we cater to and we work closely with the health centres in the area. Besides providing treatment to those who require care and support we also canvas the areas looking for new cases that require support and care so that no one is left out. The activities also include educating the communities on prevention as well as dispelling perceived myths in regards to HIV/AIDS. Our work with the communities have been so effective that the communities when they encounter

people within they communities sick with the disease actually encourage them to seek us out and receive treatment. We also help in notifying the communities of the availability of ART treatment at the health centres We also provide training to members of the Chora and Tsinat associations on HIV/ AIDS so that they too could be change agents within their respective communities. Besides this we have worked with the zone health workers in training and also extend training of trainers. The trainings are designed into two areas one on life experiences where those living with the virus share their experiences with the communities on the diseases, how to remain healthy and teach the communities that there is life after contracting the virus. Those who provide door to door support also teach about the availability of the treatment, provide basic health education and how to lead healthy lives. The challenges we first experienced when we embarked on the project was in relation to harmful traditional practices such as wife inheritance which was common when the elder bother passes away his younger brother inherits the wife. This along with increased tourist traffic which provided fertile grounds for the proliferation of sex tourism into the area has been among the challenges that we experienced initially. But now the education and awareness campaign have helped raise awareness of the problems and the communities have started meeting these challenges head on. The myth that the HIV/AIDS disease is a disease that does not affect pastoralists is now being abandoned. We now see more and more people going for HIV/AIDS testing, using ARTs and using condoms more often. Nurse Tigist Mulwagaw, EPaRDa Care and Support officer

COMMUNITY CONVERSATIONS

As per the initial plan the project was conceived to enhance awareness of youth through different approaches. The first area focuses addressing the issue of HIV among school attending youth in the project areas through training on the basics of HIV and peer to peer education. It involved institutional approach aimed at strengthening school clubs and training teachers in preventive counselling and school community conversation. Likewise the approach for out of school youth also involves training youth association members and provision of support for edutainment activities. Both in school and out of school youth were trained on HIV and provision of peer to peer education. Teachers were also trained in preventive counselling and were engaged in strengthening the school clubs and facilitation of school community conversation. In this regard, the assumption was that the trained youth and teachers conduct peer to peer education and school community conversations as the basis for promoting awareness rising. This was anticipated will facilitate the further dissemination of messages to youth peers and the communities back in their village. On the whole, the progress made in undertaking the activities were directly related to the level of support and collaboration to enable trained youth and teachers apply the knowledge gained in to practice. How were they linked with the health system for further follow up and whether there was any form of support to implement activities and whether activities were reported regularity were also factors.

A good level of progress was noted in areas where trained youth were working both in and out of school environment with guidance from and in close collaboration with health extension workers. In this documentation there were interesting instances in which trained youth were involved in peer to peer education and provision of condoms in their villages. Trained youth distributed condom to both peers and adults. In addition they carry condom to Evangadi events and distribute to both male and girls. But these achievements more observed in areas where the HEWs are active at making follow up of the trained youth and supplying condoms. Project staff and Health workers expressed that peer to peer education and community conversation were carried out in schools. There were also instances among schools in which they invited PLWHA to schools during World AIDS Day and other occasions to raise awareness of students on HIV/AIDS both in pastoralist villages and urban areas. At community level, the project also carried out interventions to raise awareness through activities that include supporting kebele level regular community conversation sessions and the provision of community level education and preventive counselling through trained Community Conversation facilitators and trained traditional healers At the time of the design, EPaRDAs plan was made assuming that there was no such community conversation activity in government health programs. However the scenario was changed following the decision by the government to incorporate and undertake CC sessions as part of the health extension packages. As per the MOH expectations, Health Extension Workers (HEWs) are the key outreach actors and therefore be involved in community conversation and awareness rising. Therefore, looking for alternative strategies or making adjustments to undertake awareness rising among the community was a major issue to address right from the beginning. In general, how to go about or proceed with the initiation of the CC program as part health extension package was one major factor at the initial period of the project. Further, whether the project should carry the CC sessions separately or undertake the activities jointly was an issue. Regarding undertaking the CC by the project, how the project staff will be able to undertake or fully engaged in CC sessions among very large number of kebeles on a regular basis was one question. Further the potential duplication of resources as well as the difference in the proposed strategies for undertaking the CC sessions was an area that needed attention. In the end, there was an alteration in approach following the decision at local level that the project should support the ongoing CC program and work jointly with the government program. Likewise, the project approaches went on providing support to the ongoing efforts at government health facilities to undertake CC. The project at the start carried out an assessment to identify the gaps for undertaking CC sessions. Even to undertake CC sessions jointly, the HEWs or other relevant persons were not trained on CC facilitation despite being one of the activities in the health extension package. To this end, provision of training towards enhancing the capacity of HEWs was given priority and HEWs were trained on CC facilitation. The project besides the training provided stationary and material support for conducting CC sessions on regular basis. According to HEWs discussants, they lacked knowledge on how to carry out CC sessions prior to the training. The training has enabled them facilitate CC sessions and how to facilitate dialogue and decision making. HEWs expressed that the CC sessions involve community members selected from each of the villages in a kebele. The target groups included youth women and elders and up to 60 persons selected to participate. The selection process is made in collaboration with the kebele leadership and includes criteria as ability to convey information discussed on CC back to the community, those accepted youth peer leaders and related criteria. The decision as to the time schedule as well as the place for the CC sessions

is made by the community and varies from kebele to kebele. Accordingly, it is carried out at day time in some kebeles while it is convened at night time as per the preferences of the community. On the whole the CC session covered four major topics one of which is HIV/AIDS. According to HEWs, rule and regulations are set at the commencement of the full CC session with full participation of participants. In addition following the dialogue and discussions, decisions are recorded on the register book and signed by HEW, kebele leaders and participants. On each of the sessions the sessions were carried out every two weeks and participants complete the session after 30 hours after which they are referred as model households. But in order to be able to be stated as model household participants personal willingness to volunteer for VCT is one of the criteria. According to HEW, those who are willing to test will be registered and given assignment to convince other members from he community before preparations are made to provide the VCT at their villages. In general most of the HEW discussants expressed they follow the above stated process. However, there are differences in the actual process of implementation or details of practices followed as described by the following facts. Firstly there are no agreed criteria on the selection of participants for CC though HEWs explained to consider certain factors. Decisions are made through consultation with kebele leadership. The involvement of elders in the selection was minimal. It was also noted persons who are personally interested ad regularly attend the CC sessions area also registered as participants. In addition maintaining regular attendance by all participants was also another challenge encountered.. Furthermore the continuity of the session was affected by other different factors. whether the CC session are carried out on regular basis depends on the availability of the HEW, the existence of other seasonal activities like farming, mobility and the influence of other socio cultural events. For instance in the event of the death of a person in Gondoroba, Aeabore kebele, no activity will be carried out on the day of burial. At the completion of the CC sessions participants were expected to mobilize others for VCT which was found very difficult in the initial periods. As a result out reach VCT was provided only for those who completed the CC sessions. On the side of EPaRDA project, the level of involvement was mainly focused at provision of support and collaboration with the kebele based community conversation. The project working closely with the CC program provides support to identified gaps, conducts monitoring of the sessions , collects reports of the sessions carried out, the report of those model households that completed the 30 Hr sessions and volunteer for VCT. The project officer also attended the CC sessions to provide assistance, gather information on the conduct of the CC sessions, document the issues discussed, provide support to the trained HEWs and prepare those who volunteer for taking VCT services Community level awareness rising was also carried out through traditional healers and community CC facilitators. Project staff express these activities have also contributed a lot not only in HIV education but also raising awareness on the benefits of promoting the acceptance of VCT services. In this documentation it was noted that Trained CC facilitators were engaged in provision of education as well as condom distribution. Traditional healers on the other hand also provided education and referral for VCT services after counselling. It was interesting to note in the areas visited that these trained people have close communication and contact with HEWs. They also report the activities carried out to the health post regularly. The achievements could have been more pronounced had there been a regular follow up and supervision from the project.

Pastoralist communities have respect and reverence for traditional healers. Training traditional healers that are well accepted by the community or have more client flow can assist in raising awareness on HIV, help promote the benefits of VCT and create a referral link for HIV services between the healers and primary health care system. Bai Dejene a traditional healer practicing in Chali kebele of Bena Tsemay Woreda. He is 45 years old and has practiced traditional medicine for many years. He was selected and trained on HIV/AIDS education and preventive counselling. As to the benefits Bai got from the training, he explains, After the training I started to boil sharp materials that I use while providing services. In addition I provide education on HIV issues and refer those who volunteer to take VCT services. Bai also explains that the training has also brought other benefits. He said other peer traditional healers come to me to learn about the training that I took and also refer cases to me for advice. Bai reports the activities he has undertaken to the heath extension worker at the health post. He further expresses a future suggestion for project. EPaRDA provided us training on HIV that was beneficial. Myself and a friend of mine who was also trained would like to suggest that the project should strengthen follow up after the training. We believe that regular follow up will tell us whether we are on the right track putting the knowledge gained into practice.

ACCOMPLISHMENTS
Build the capacity of partners MOH and HAPCO in implementing quality HIV/AIDS prevention and care programs

UNIT 3

3.1 ENGAGING WITH POLICY MAKERS AT LOCAL, REGIONAL AND NATIONAL LEVELS

For any interventions in relation to HIV/AIDS a concerted and holistic approaches should be taken to bring about maximum success- this entails that all partners in the initiatives are best equipped to execute their respective undertakings. In March and September 2010 a biannual stakeholders meetings was chaired by the woreda finance and economical offices in the towns of Keyafer and Turmi with governmental stakeholders and PLWHA associations of Bena Tsemay and Hamer Woreda respectively.
During the meetings the following points were raised as a gap and discussions were made as follows The project office was asked to integrate activities with the stake holders Monitoring and evaluation wouldnt previously be conducted but right now it is planned to conduct monitoring and evaluation in every three month

 Since The Woreda health offices has planned to conduct 12300 VCT service per a year. Therefore they asked the project office to increase the annual targeted VCT beneficiaries. Problem related to organizing mobile outreach VCT in Hamer Woreda The Youth centers are not running efficiently .especially the Evangadi youth center The renovation and extension construction of Ediget Anti-AIDS association Absence of training on the use of musical instruments is a problem for youths to mobilize the society. Gaps on providing support community conversation and stipends for CC facilitators should be abandoned The supervision and follow up of PLWHA CC and VCT kebels and as well IGA beneficiaries should be conducted and the project office is not doing project based on plan.

On its part the project coordinator and the officers have provided response to the aforementioned question and indicated that these problems were occurred due to Woreda governmental officials were not available at the time when the project team needed to discuss. And eventually the meeting was completed with the consensus in between the project office and the stakeholders to integrate activities with GO, to fill the gap and to strengthen the partnership in executing project activities.

3.2 SUPPORT ANDINET TO HOST REGIONAL PLWHA ASSOCIATIONS NETWORK MEETINGS

A regional network of HIV positive people workshop was held in the town of Jinka from February 23-25 2009, chairpersons of 25 PLWHA associations from SNNPR state and regional, Zonal and Woreda HAPCO staffs. It was the administrator of South Omo who opened the workshop by addressing welcome and opening speech on the role of PLWHA associations to stop the spread of HIV/AIDS. The objective of workshop was to strengthen Andinet, Chora and Tsenate associations and to promote experience sharing among the associations.
During the meeting, the following issues were presented and discussed: Presentation on the current prevalence of HIV/ AIDS in global, national and regional level by the SNNP regional HAPCO. Experience sharing on the best practice of Tila, Mimani and Arbaminich down of hope and others. Achievements of Chora, Andinet and Tsenate PLWHA.

In the meeting the newly established associations acquired a good experience and good practices from the well organized associations such as Mimani, Tila and others. Finally the meeting was finalized with consensus of the PLWHAs to work exhaustively in the struggle to fight against the spread of HIV AIDS.

3.3 SUPPORT PLWHA ASSOCIATIONS TO ADVOCATE FOR CARE AND SUPPORT, VCT, ART AND PMTCT SERVICES
Advocacy and education on HIVAIDS is one of the mechanisms to minimize the number of new infection and a means to promote peoples to know their HIV stero status. Among the 17 PLHWA who were trained on HIV education and advocacy,14 of them chora(five) Tsenate(seven), Andinet (two) had provided HIVAIDS education and advocacy to 8,383(3,702 Female) people on the following topics The importance of VCT, The impacts of HTP in relation to HIV/AIDS. Modes of HIV transmission How to stop Stigma and discrimination VCT and testing Advantage of ART Personal and environmental Hygiene How to use condoms PMTCT To prevent opportunistic infections through keeping personal and environmental hygiene Practice and use of condom

3.4 PASTORALISTS RIGHTS ENHANCED 3.4.1 TOT FOR 10 MOH AND 4 EPARDA STAFFS ON CC FACILITATION SKILLS
Community Conversation (CC) is one of the major tools of Behavioral Change Communication (BCC) implemented nationwide by development and health practitioners so as to bring the desired behavior pattern on a particular community and address identified social problems. To reduce poverty, promote environmental and climatic adaptation, and prevent the community from the wild expansion of specific pandemics such as HIV/AIDS, BCC played a pivotal role in the history of human beings. But these methods of influencing and instigating behavior change should be facilitated and directed by well-trained community conversation facilitators. Considering these background information and importance, EPaRDA conducted capacity building training on the basic skill, premise and practice of CC as to prevent the socio-economic and health effects of HIV/AIDS on the pastoralist communities of Hamer and Bena-Tsemay Woredas. Accordingly, EPaRDA, in close collaboration with zone health

department provided the training for seven days from February 19 25, 2009 in Jinka town. A total of 16 health and non-health professionals drawn from the two Woreda health offices and two EPaRDA staffs attended the seven days event. The training has helped the trainees were familiarized with the fundamental skill, methodology and facilitation techniques of pre-planned, culturally appropriate and community centered community conversation facilitation methods among the pastoralist communities.

3.4.2 TRAINING ON COMMUNITY CONVERSATION

Following thorough discussion, information exchange with South Omo health department and the two woredas health offices on mobilizing health extension workers from their sites for training, the training formally conducted in each woreda for seven days. Two Trainers drawn from EPaRDA and MoH for each woreda trained the HEW on CC facilitation according to the CC manual from April 5 1, 2009. The trainings were organized in two woredas centers, for Hammar in Turmi and Key-Afer for Bena-Tsemay. A total of 45(30 Female) trainees, 21(17 Female) in Bena-Tsemay and 24 (13 Female) in Hamer have completed the seven days capacity building.
In the seven days event topics such as, Concept of CC The historical back ground of CC in Ethiopia The major steps or techniques of facilitating CC were all completely covered. The training was concluded with the preparation of action plans in each respective woredas.

3.4.3 COMMUNITY CONVERSATION SESSIONS SUPPORTED

Community conversation is one of the key strategies which the government is also currently used to bring behavioral change in the rural areas towards HIV/AIDS, HTP and to solve their communal problems by themselves through conversation. Having this understanding in common, CCs have been regularly conducted once in every 15 days in many Kebele of the project areas. However, because of the presence of some kebeles within the project catchments which are financially supported by (HAPCO) Global fund and AMREEF to conduct CC. Thus, in order to avoid resource duplication, the health offices of the two woreda assigned the project office to assist 15 and 11 kebels of Hamer and Bena Tsemay woredas respectively. After assessing the gaps of the CC of the assigned kebeles of the two woredas, stationery materials which are used to document and to send reports are distributed to the following 30 kebeles of Bena Tsemay and Hamer Woredas. Hand in hand to this, to motivate health extension workers to conduct the CC session regularly based on its formality. 300 ETB was given for each health extension workers of each kebele of the two woredas which our project office is assigned to support.

3. 5.4 TRAINING ON MONITORING AND EVALUATION FOR MOH AND EPARDA STAFF
Based on the project action plan, 10 trainees were selected from Hamer and Bena Tsemay woreda MOH staffs who are the main stakeholders of the project, 9 EPaRDA staff of the project, pastoralist health development and risk management project officers and coordinators also attended the training. In order to assist the trainees, the training manual about monitoring and evaluation has been distributed.
Monitoring and Evaluation training manual contains basic concepts and information adequately, and the topics treated for five days mainly includes: Planning and managing project with particular emphasis on steps of project cycle Project identification / Needs assessment by explaining the steps and tools such as FGD, interviewing including priority setting under Pair wise ranking Designing/ planning a project Result chain Application of Purpose, Goal , Activities, Outputs, Outcomes etc in different NGOs Logical framework analysis, Indicators, Means of verification and risks Proposal preparation and its major components Project implementation and monitoring Analyzing data and reporting

EPARDA

A look @ the past