Evaluation of the AIDS/STD prevention and control project (522-0216)

Interim evaluation covers the period 7/97-11/99. In general, the project is well-designed, combining behavior change, condom distribution, and an STI control program. The choice of the private sector-focused National Center for AIDS Awareness and Prevention as an implementation mechanism is sound. The Center is run by Fundacion Fomento en Salud (FFS). FFS has a knowledgeable, innovative, and motivated staff and provides excellent administrative assistance to participating NGOs, which have set up several distribution points for condoms. However, all FFS staff are based in Tegucigalpa, and not one has intimate, first-hand knowledge of the high-risk behavior groups. Furthermore, the referral system from NGO to STI services, set up primarily through peer educators, is weak. The Ministry of Health (MOH) has implemented a national second-generation surveillance system, and its HIV case reporting system is providing improved data. Also, a large number of distribution points for condoms have been set up. However, little training has been provided in syndromic management and STI service implementation, and there is poor monitoring, supervision, and evaluation. According to the AIDS Policy Environment Score (APES) developed by Programa Accion SIDA de Centro America (PASCA), Honduras has the most resources, research, policy support, and policy formulation in Central America, but it has a low score in program components. It is important to note that Honduras made significant progress in two key areas of policy dialogue during 1999. The MOH presented its national strategic plan in August 1999, and the AIDS law, which had been pending for over a year, was passed on September 9, 1999. A large gap in the project is the limited coordination among key stakeholders, a core reason for USAID support. There are no joint planning processes between FFS and the MOH, and many opportunities are being missed to bring NGOs together with each other. Also, there is no coordination between NGOs and the state or among donors, resulting in many overlapping activities. A new structure and direction for the project is advisable and feasible not only in the content of specific areas, but also in reconceptualizing needed services and products and how they are used and delivered. It is necessary not only to revise the format and content of educational materials, for example, but to develop utilization strategies that go beyond dissemination. It is also necessary to rethink HIV-related activities and to respond to the overwhelming perceived need to integrate HIV prevention and other priorities of the target populations. This means addressing sex workers as mothers with maternal and child health needs and not just as people in need of STI care; and promoting adolescents" need for community involvement and not just their use of condoms. Such changes will have to address key issues such as stigma, representation, the potential impact of interventions, and the perceived needs of NGOs and their staffs. FFS administration has expressed an openness and readiness to explore alternatives internally and to receive external TA where necessary. (Author abstract, modified)