Dominican Republic HIV/AIDS/STI prevention project : cooperative agreement # 517-A-00-97-07103-00 -- final report

The report summarizes activities in five areas (expansion of HIV/AIDS/STI information and services, awareness/behavior change, policy and advocacy, community-based programs, and data availability and use). Results are presented according to the primary beneficiaries: adolescents and youth, Bateye youth, sex workers, men who have sex with men, rural women, hotel and industrial workers, and people living with AIDS. Overall conclusions and lessons learned are as follows: HIV/AIDS services. (1) An integrated and multi-sectoral approach to HIV/AIDS is essential. The National Strategic Plan for HIV/AIDS and subsequent leadership under COPRESIDA have adopted this approach as fundamental. (2) Use of peer methodology has proven value as a low-cost way to engage communities and individuals on a large scale. (3) Integrated care for HIV-positive individuals is fundamental and requires partnerships and alliances at all levels. Consumer/client education is essential for the system to work well. (4) Access to condoms is essential for all groups. Social marketing needs to be reinforced where possible, and gaps recognized (e.g., in Bateye communities). The 100 condom policy model has been applied successfully to the sex industry and must be extended to other groups. (5) Formative work with each population continues to be fundamental. Where possible, existing materials should be used for new populations. Validation of materials through focus groups is a necessary first step to expansion. (6) The sale of prevention services to private companies is an important but underfulfilled strategy. Employment-based prevention and service promotion programs have fundamental advantages which, however, can be harvested only if employers are convinced and motivated to participate. Such participation is currently the exception rather than the norm. (7) Program monitoring and evaluation activities need to be standardized and simplified to be useful and sustainable. Information, education, and communication (IEC) and training. (1) A national IEC strategy requires a combination of diverse tools and sustained collaboration. The excellent IEC tools developed have almost universally been underutilized due to the limitations of initial funding levels. COPRESIDA and the donor community can do much to expand the use of these resources by prioritizing existing IEC tools for replication (a catalogue of such resources is annexed to the present report). Gaps for which new tools are needed must be identified. (2) Use of theatrical presentations continues to show untapped potential for engaging communities around HIV/AIDS and behavioral issues. (3) The combination of varied interventions utilizing a range of activities (such as community outreach, issues debates between target audience members, formal training workshops, and mass media messages) is a good way to reinforce and expand the impact of prevention efforts. (4) The popular style of educational materials developed in street language with commonly used terms, vivid illustrations, and text that deals candidly with sometimes sensitive issues increases the lasting impact of IEC efforts. (5) Technical training of health providers must be accompanied by training in client relations and sensitivity. (6) Amateur theater, the National HIV/AIDS Song Contest, TV variety and talk shows, the use of radio as a public forum, and the engagement of the advertising industry are proven approaches to making the HIV/AIDS response truly national and multisectoral. Strategic alliances involving well-defined working relationships with organizations or sectors not normally linked to HIV/AIDS-related efforts is an excellent way to expand and improve service quality and quantity. Examples of such successes during Accion SIDA included new relationships between NGOs and business, public health, education, faith and recreational organizations, and the mass media. These relationships are most successful when each side can point to a clear benefit, and when goals are tied to the missions and strengths of each institution. Social mobilization and networking. (1) Social mobilization is effective in sensitizing and increasing the awareness of key leaders. Public denunciation of cases of infringement on the rights of HIV-positive persons, employment screening, barriers to participation in the National Book Fair, and the abuse of sex workers have been effective in mobilizing public opinion. (2) Mobilization of HIV-positive persons through the national REDOVIH+ network has provided a powerful and effective forum for dealing with stigma, discrimination, and pricing and access to services. (3) The creation of the National Youth Network on HIV/AIDS has included a network of multipliers, leaders, and volunteers aged 14-24. This network has participated in youth education and sensitization, training of youth and adolescents as leading multipliers, and assignment of community roles. Policy training of the national network of youth resulted in the drafting and support of the National Youth Law that passed the Dominican Legislature unanimously. Policy. (1) Creating a mechanism for a neutral space for policy discussions has been key in promoting and advancing supportive HIV/AIDS policies. This approach complements advocacy-focused efforts. (2) The establishment of COPRESIDA as an umbrella council has been crucial in mounting a truly national response to HIV/AIDS. This central role will require significant support as COPRESIDA learns how to play its role smoothly.