Mid-term evaluation : USAID/Jamaica HIV/AIDS and STD prevention and control project (project no. 532-0153)

Mid-term evaluation covers the period 1988-11/95. With less than 10 months to go, this project has reached and, in some cases, exceeded targets. Despite problems, this is a good project which deserves continued support. While the behavior change and communication (BCC) component has made important progress using existing methods, new strategies and approaches are needed in order to move beyond the current plateau stage. Target groups have received sufficient information, which must now be translated into lasting behavioral change; this can be achieved through dialogue with target groups and integrating other social programs. The multiplicity of BCC sub-agreements -- perhaps due to the multitude of indicators and the need to achieve the predetermined objectives by target dates -- has led to a fragmented approach that can easily be corrected. It should be noted that the National BCC strategy, as well as AIDSCAP sub-agreements, promotes three messages: (1) increase condom use; (2) abstinence, and delay the onset of sexual relationships; and (3) one faithful uninfected partner. However, the BCC should have selected target groups on the basis of sociocultural and economic boundaries rather than along purely demographic variables. Also, the project strategy seems to leave out young males, who are the main sexual decision makers. The STD, contact investigator (CI), and sentinel surveillance activities have been well conducted. While the STD project in the public sector has reached its objectives, further studies and surveys are needed to quantify these achievements. It will also be necessary to consolidate the current level of accomplishments and refine some activities so that the next project cycle can achieve full institutional integration and capacity building of all STD-related activities and surveillance of STD HIV/AIDS. When the system is fully operational, it could be gradually decentralized (to some extent a pilot approach has begun in the Northwestern Region). Since 1988, HOPE Enterprises, Ltd. has conducted numerous social research projects with various international organizations and has provided invaluable and timely support to USAID-funded STD HIV/AIDS prevention and control activities in the form of surveys, impact studies, evaluations of project activities, etc. In view of these achievements, support to HOPE should continue, though HOPE should also develop the in-house capacity possessed by the Expanded Program of Immunization (EPI) Unit in conducting similar work. However, HOPE should always maintain an advisory capacity to the EPI Unit and the National AIDS Control Program. A weak point of the project is the overall level of institutional integration and capacity-building of the various project activities, in large part due to the design of the various sub-agreements. Some of the management problems could easily be corrected (in ways suggested in the present report). The private and public sectors did equally well managing the various sub-agreements of the project. This diversification should be continued, provided the level of activity output can be sustained. (Author abstract, modified)