Final Report of HIV/AIDS Prevention Project for Matara District

Back Ground of the project

Sri Lanka is an Island situated in the Indian Ocean and its population is nearly 20.2 million. Around 33% of this population is fairly young, in the age group below 24 yrs. Though the per capita income of the country is far below the level of developed countries in the world, its health indices such as IMR (Infant Mortality Rate), and MMR (Maternal Mortality Rate)are much higher than those of most countries.

This was achieved by providing free education and free health services to the people by the subsequent governments of post independent Sri Lanka. Sri Lanka was able to reduce the occurrence of some of the communicable diseases such as Malaria, Leprosy, Filarial diarrhea and of course Polio, but problem of STD is still not under control. The problem had been aggravated by the occurrence of HIV/AIDS in the country since 1986.The 1st infected person was a foreigner, but in 1987 first native person infected with the disease was found.. Since then the number of infected person were gradually increased year by year. According to the most recent data (up to 31st December 2009) issued by the NHAPP/Sri Lanka number infected is 1169.

HIV 1161 AIDS 302 Deaths 197 Children with Aids 41

According to the UNAIDS, estimated number of people living with HIV in the country is around 4000. However the incidence of other STD is much higher as shown in the table.

Disease

0-14years

15-19years

20-24years

Syphilis 07 08 56

Gonorrhea 15 23 146

NGU 14 98 268

Herpes 12 121 419

G.Warts 04 79 261

Candidiasis 50 172 433

Tricomonasis 03 09 34

Total

102

510

1623

Fighting HIV/AIDS is one of the biggest challenges faced by the world today. Sri Lanka being a low prevalent country our national target is to maintain the low prevalence at least as it is. Though targeting preventive activities to the high risk groups is a priority, youth being fast growing dynamic population with vulnerable behaviors, programs to target youth is equally important. Development of knowledge, skills and attitudes towards healthy sexual wellbeing among school children is the foundation to prevent HIV/AIDS among youth.

The Sri Lankan population comprises of 3.7 million (19.7%) adolescents (10 – 19 yrs). Of them 56.2% receive an education beyond secondary level. In spite of introducing HIV/AIDS prevention to school curriculum, through Health and Physical education streams, according to the national survey conducted by the UNICEF in 2004 still the knowledge on HIV/AIDS among school children is low.

Social and cultural norms are changing. The capacity of parents and teachers to have an owl’s eye on the child is impractical with the present day to day activities. Therefore adolescents are left out to tackle their own challenges.

Considering all these factors mere scientific facts alone will not prevent HIV/AIDS among school children. It needs a skill based education with positive attitudes that empowers them to face the challenges of adolescence. Identifying this deeply felt need INDECOS prepared the current project proposal exclusively for young students in schools of the district.

With the prevailing social and cultural pressure against incorporation of sexual health to school curriculum, this objective should be achieved by a stepwise process. A well developed and pretested communication strategy is the corner stone of success in this process.

To promote a healthy sexual life style among school children, the commitment of a wide range of people this includes school community, educational officers, politicians, parents, religious leaders and opinion leaders is needed.

Most of the new recruits to armed forces also are in similar situation .They are just out of school and their knowledge on reproductive health and STD/AIDS is not different from that of students in higher grades of schools.

This project “stop aids through behavior change” on “Communication Strategies to prevent HIV/AIDS among school children and newly recruited youth in the navy” has identified this and clearly states the means and methodologies to fulfill this objective and ways to monitor and evaluate the outcome. I hope that this will open the doorway to prevent HIV/AIDS among school children and youth through the development of behavior change.

Sri Lanka is situated in the Indian Ocean and closer to India, Were 6 million

people are infected with HIV/AIDS

Map showing the number of schools comes under the project in every divisional

secretery divisions of the district.

Project

STD/HIV/AIDS Prevention Projecr for Matara District

Project Period March 2008-March 2010

Goal

Reduction of spread of STD/HIV/AIDS among ,vulnarable youth and students in the

district of Matara

Objectives

1. To increase knowledge of 2000 students in higher grades of selected 50 schools on

reproductive health and STD/AIDS in the district of Matara within two years.

2. To increase knowledge of 1200 police officers of Matara district on STD/AIDS

within two years period(This was ammended to include 3000 youths in Naval

Training School)

3. To prepare ,print and distribute appropriate health education materils among

students and teachers of the district selected for the training.

4. To train 50 peer leaders as ambassoders for the prevention of STD/AIDS among

students and youth of the district wit hin two year period.

5. To train 40 techers from selected school as master techers to continue training

programs among students in selected schools of the district.

Target Groups

1.Students in Grade 10 of schools and Higher education establishments - 2000

2.Police officers - 1200

3. Navy recruits and officers - 3000

4. school leavers-youth - 50

5.School teachers - 40

Major Activities

1. Recruitment of staff

2. Formation of steering committee

3. Preparation of health education materials

4. Preparation of training curricula

5. Selection of target schools & police stations

6. Advocacy for Head of department s and institutions

7. Preparation of training schedule for Police officers & students

8. Conduction of training programs for 2000students and 600 police officers

9. Training of 40 teachers from selected schools as trainers

10. Training of 3000 recruits and officers of the Naval training school

11. Training of student – school leavers as peer leaders to promote activities among

Colleagues.

1. Staff At the beginning following persons had been selected to the staff of the project’

1. Mr. Conrad Ranawake - Director

2 . Dr. P. Ekanayake MD. - Health Advisor

3 .Ms. M. N. Raseela Shamin - Project coordinator

4. Ms. K. Swarna Shanthini - Field coordinator

Recourse Persons for training programs

1. Dr. S. W. Pathinayake MBBS.MSC. Former PDHS/SP

2. Dr. P. Ekanayake - MD. Former director/General Hospital Matara

3. Dr. Sanath de Silva - MBBS. MSC. District Director Health services /Matara

4. Mr. Conrad Ranawake BA (special in Sociology)

5. Ms. Sripali Thilakawardena BA staff teacher MR/Kotapola M. V.

2. Steering Committee

Steering Committee consisting following distinguished people from the area and government

departments was formed for decision making and the supervision of the project.

1. Dr. S.W. Pathinayake - Chairman - Steering Committee Former Provincial Director of Health

Mr. S. K. Chandra soma - Chairman INDECOS Former GA Matara

Provincial commissioner of Sri Lanka Police Commission / SP

2. Mr. Gamini Jayasekera - Retired District Secretary Matara & Advisor to H.E. the President

3. Dr. P. Ekanayake - Secretary, Steering Committee Former Director Matara General Hospital

4. Mr. P.B.P. Ayupala - Senior Superintendent of Police (SSP) Matara

6. Mrs. Pushpa Ekanayake - Senior Lecturer – Dept. of Sociology University of Ruhuna, Matara.

7. Dr. Sanath De Silva - District Director of Health Services – Matara

8. Mrs. Nandawathi Wijesinghe - Additional Provincial Director of Education Southern Province

9. Mr. L.C.K. Pathirana - Manager, Commercial Bank – Matara 10.Mr. W.R. Weerakoon - Zonal Director of Education, Matara

11. Mrs. I.H.L. Padmini - Staff Teacher MR. Palatuwa M.V. Asst. commissioner Girls, guides SP

12. Mrs. Sripali Thilakawardana - Staff Teacher MR. Kotapola M. V.

Objective of the formation of this steering committee was to get expert guidance to carry out

the project in the district and also to do the monitoring and evaluation. In the first meeting

Dr. S.W. Pathinayake and Dr. P. Ekanayake were appointed as president and the secretary of

the committee respectively. During the project period steering committee had four meetings.

One of the meetings was attended by the President of SFCSL Mrs. Christina and in that

meeting it was decided to amend the target group by including youth in the Naval Training

School, instead of Police officers.

Steering Committee Meeting

Preparation of Health Education Materials

One of the objectives of the project was to prepare suitable health education

materials with updated information on the subject of STD/AIDS for schools.

This was done by a panel of experts including representatives from department of

health and the department of education there were two different brochures

produced in the local language of Sinhala, on Sexually transmitted diseases

including HIV/AIDS and Use of Condom. Colorful flip charts with basic

information of the subject & consisting 14 pages was prepared and distributed

among teachers.

1. Sexually transmitted diseases including HIV/AIDS - 7000 copies 2. Condom Use - 2000 copies 3. Banners (Police Training & School Training) - 02 4. Handouts on 5. Flip chart - 40

Brochure – 01 STD/HIV/AIDS Brochure – 02 Condoms Flip Chart

Banner for Program for Police of Banner for Program Students

Folder Cover Folder Cover Folder Cover

Training Programs for Security Forces

Program for Police officers in the District

Before commencing the programs an Advocacy meeting for Senior Police Officers

was held to create awareness among them and to get their support for the project. It

was held at the LHK reception hall on 5th September 2008. In this program we were able to create

awareness among Senior Police Officers of the district, and to draw a plan for training of 1200 Police

Officers from 14 Police Stations in the Matara district during the project period

Number of Participants

1. OIC Police station - 14

2. Assistant Superintendents of Police - 03

3. Superintendents of police - 01

4. Community development officers of police stations - 08

5. Woman police officers - 06

A decision was taken to have three training centers, (clusters) in the district for

convenience of the participants-police officers, as it is impossible to gather all of the

Police Officers for training in a single day in one place. Accordingly, training sessions

for Police Officers were conducted as follows

Training Centers for Police Officers

1. MCC – Matara Children Center

2. Kamburupitiya MOH Office

3. Morawaka Police station

The above photo shows the Advocacy Program for Senior Police Officers held on

05.09.2008 at the LHK Reception Hall

Training for Police Officers

Training programs for police officers were conducted in three centers as shown in the

following table 331 officers have been trained so far (Male 214 and female 117) At the

beginning of each session a pretest had been conducted to assess the current

knowledge on the subject and the result is shown in the table below.

1. [[[

Knowledge on Reproductive Health

25% [

2.

Knowledge on STD

30% [[

3.

Knowledge on HIV/AIDS 22%

4.

Knowledge on Attitudes towards STD 44%

During the pre test, it was revealed that 60% of the participants have poor knowledge on

STD while 78% have poor knowledge on /HIV/AIDS and 56 % have poor knowledge on

attitudes and behaviors towards these diseases.

Accordingly content of the training programs were designed including

following topics

1. Sexual behavior – high risk – low risk behaviors – sex offences

2. STI/HIV/AIDS diseases – spread, symptoms, investigations, treatments and

prevention

3. Use of Condoms ( Male & female)

4. Role of law enforcement officers in prevention of STD/HIV/AIDS

Training Programs for Police Officers – 2008 & 2009

Though it had been planned to train 1200 police officers attached to 14 police stations, we were able to

trained only 331 officers during the project period of two years. This was completely due to the lack of

interest shown by the senior officers of the district and the uncertain security situation of the country

demanding frequent mobilization of them with short notification.

Training programs for police officers are in progress………….

Advocacy Program for Senior Officers of the Education Department in the District

This meeting was conducted at the Samanmal Reception Hall Matara on 23rd September 2008

with the participation of 37 senior officers including 4 zonal directors of the district education

department. At the end of the meeting we were able to increase awareness among senior

education officers on STD/HIV/AIDS and drew their attention on the importance of giving

knowledge on Reproductive health including STD/STI to the young school children and to

draw a plan for training programs in schools.

All participants agreed on the importance of conducting such training programs for students

in their schools. It was decided to start training program as soon as possible, before beginning

the school tests and the vacation. 50 schools had been identified for training program to be

conducted. The all participant agreed to conduct training program for students in grade 10 of

the school. The number of students per session will be 40. Accordingly schedule for training

was prepared at the end of the meeting

Below is a scene of the Advocacy Program for Senior Education Officers held on 23.09.2008

at Samanmal Reception Hall.

[

Training program for students in Grade 10 of selected school in the Matara

district

Before starting training sessions in schools knowledge of the students on following issues had

been evaluated by doing a pre-test using questioner consisting of 20 questions, on

i. Reproductive health

ii. STD/HIV/AIDS and

iii. Attitude & behaviors towards STD/ HIV/AIDS.

All together 2438 students were subjected to pre test and the result received is shown in the

table below

Current knowledge of school children had been evaluated by conducting

Pre -test with a questionnaire consisting 20 statements on following issues:

1. Knowledge on Reproductive Health 54%

2. Knowledge on STD 25%

3. Knowledge on HIV/AIDS 30%

4. Knowledge on Attitudes towards prevention of STD 42%

The results of pre-tests show that the knowledge among students on the

subject is clearly not satisfactory.

Total Training Programs for School Children 51 Total Number of Participants 2438 Out of 50 schools that we planned to cover we were able to cover 48 schools only, as two of those were unable to find suitable time for the training. But we conducted 51 programs in 48 schools. As we decided in the steering committee meeting we conducted 5 programs in one school, namely Palatuwa Gunarathana M. V. where we had another project “Star for Life “for students above grade 6. Other than those we conducted two training sessions in Weligama Siddhrtha M. V. Deniyaya Central College and in Mahamaya College Matara respectively.

.

Above shows some training sessions in schools

Training of peer leaders – Members of children’s clubs

Peer leaders were selected from children’s clubs of the selected areas and trained them as Ambassadors for propagating the message on STD/HIV/AIDS among local youth. They were provided with necessary education materials.

Training program for University students:

As decided by the steering committee training program for university students was conducted on

25th November 2008 at the Department of Sociology of the Ruhunu University No of participants

46 mostly from the same department and some from the department of geography. At the pre test

conducted before sessions it was revealed that the knowledge on reproductive issues and

HIV/AIDS are very low. (31.1% & 21%) among this group of students.

Another program of awareness for 177 students in the first year of Faculty of Science/RU was

conducted at the request of Senior Lecturer and the Executive member of INDECOS Ms.

Kumudu Silva. Accordingly we were able to train 200 University students without any additional

cost to the project.

Training program for Navy personnel at the Naval Training school:

INDECOS carried out awareness program for trainees on STD/HIV/AIDS in this naval school

during last couple of years. It was highly appreciated by the authorities. A request had been done

by the Commandant of Sothern Naval Command and the officer in charge of the naval training

school recently, for commencement of such trainings for new recruits about 1000 youths. As

this is a very vulnerable group of youth, steering committee decided to request donor agency for

the inclusion of them in to the target group of the current project. In the 4th meeting of the

steering committee in the presence of the President of SFCSL Ms. Christina Riddeback it was

decided to include them as a target group.

Two days Training Workshop (TOT) on STI, HIV/AIDS for Teachers

“Ensuring accelerated in-service and pre-service teacher training is necessary to increase the

capacity and confidence of teachers to undertake skills-based learning approaches on such

topics as SRH, HIV and STIs. The Ministry of Education with support from the MOH

should identify and train one or two teachers in each secondary school to become subject

matter experts on SRH, HIV and STIs. Reinforcement should be undertaken through the

development of age specific, user-friendly supplementary reading materials. Specific sessions

should be organized for young people after they leave school. Integration of information on

HIV and core skills, along with SRH, into professional training programs and tertiary-level

education for young people should be considered.” (Review of the national response to STIs

and HIV/AIDS in Sri Lanka)

One of the objectives of the project was to train 40 master teachers from selected schools to

continue reproductive health and education on STD/AIDS in their respective schools. The

workshop was designed with the help of an eminent health educationist in the country, Mr.

K. D. C. Perera so as to give them through knowledge on STD/AIDS and the methodology

to impart this knowledge to their students. The workshop was conducted with lectures,

group works, brainstorming and video presentations. Out of 40 participants 39 attended this

2day workshop they were from all corners of the district representing 39 schools. At the

beginning of this workshop, two zonal directors of education department expressed their

satisfaction of the project for students. According to them this is the most successful project

conducted in schools on the subject during recent past. Hence they thanked our sponsors in

Sweden, Forum Syd, and SFCSL for the generous contribution. All the participants’

attendant the workshop for full two days showing their enthusiasm and interest for the

subject. A colorful flip chart on STD/AIDS was specially designed and printed for the

workshop and distributed among teachers to be used for school programs Some other

education materials ,such as games on HIV/AIDS awareness, Snake & Ladders, House of

Aids were introduced to them for group work among students The workshop was a highly

successful , and at the end of ,all the participants expressed that they had never attended such

a well organized and fruitful workshop ,throughout their services as teachers. Each and

every participant received a valid certificate signed by the President of INDECOS and the

District Director of Health Services

Monitoring & evaluation of the Project

1. Program for students

Monitoring of the school program was done, by visiting schools, getting report from teachers and principals, discussion with supervising officers of the department of education .Most of the student who’ sat for GCE (O) level exam for the subject of health stated that they were able to answer questions on Reproductive health, ST/AIDS very easily becau.sre they got a thorough knowledge on the subject by participating our school programs.

We expected to visit all the school where we had training programs for students and teachers to observe the outcome of the same. Already we have visited following two schools and observed the way the teachers’ conduct similar programs among students using health education materials and specially the flip chart introduced by us. We expect to visit other schools as well in the 1st term of the schools.

MR/ Malimbada Sri Sumedha M.V. MR/ Hallala M.V.

2. Program for Navy recruits and officers After awareness programs the number of persons doing inquiries about their suspicions of

having STD was increased. During the project period more than 15 persons were referred for

investigation in the STD/AIDS clinic of government hospitals. Common conditions were

Genital warts, gonorrhea and herpes. This is a very remarkable achievement of the training

program for naval officers. The inquiries were received from faraway places like Punani, and

Anuradapura as the massage had been conveyed by the participants to their brother officers

throughout the country.

What they say…………….

Mrs. Nandawathi Wijesinghe, Former Deputy Provincial

Director of Education.

I was able to attend nearly ten educational

programs on STI, HIV/AIDS conducted in

schools in various part of the district.

I was fully impressed with the programs

which were conducted by well experienced

experts of the subject in very efficient and

effective way. Seminars were well designed

to educated young students in the school setup,

on issues of reproductive health and STD

Greshan Kumburage, Public Relationship Officer (PRO), Morawake, Police Station

I coordinated five training programs

which were held at Morawake Police

Station. Since police officers have to deal

with vulnerable people including sex

workers, the knowledge gained in the

trainings were very useful

for them to perform their duty efficiently

G.N.H.K. Sarath, Chief Instructor Navy Training Camp Boossa, Galle. Most of the new recruits to SLNF send for the training in the Naval Training school are very young and just out of school. They have very poor knowledge on STD/ HIV/AIDS. Hence there is enough opportunity for them, getting those dreadful diseases during their stay in the service as sailors and officers in areas where the STD are very common. The

project implemented by INDECOS to educate these groups of youth of the Navy was a tremendous success. They had conducted more than 24 training sessions on the subject and trained nearly 3000 navy recruits and officers. I am not aware in the history of our training school any other education program so well received by almost all of participants. Personal attention given to people having some issues pertaining to the subject was very encouraging. Three medical Doctors and trainers did a Marvelous job to educate them on sexually transmitted diseases including HIV/AIDS. I was privileged to observe majority of these programs, and I wish to have your cooperation to educated future recruits as well.

K.P Rasanjali Dilhani, Grade 13 – MR/ Sujatha Balika M.V.

As most of the youth in the country we were very ignorant of the facts about STD, HIV/AIDS. Even our knowledge on reproductive health was very poor. As a result of the training program conducted by INDECOS in our school now we know how to protect ourselves from these diseases. I treat this program as an important and valuable for the school children.

World AIDS day 1st December

As planned earlier we successfully participated in celebrating world AIDS day

in 2008 and in 2009 in the district

World Aids Day 1st December 2008

It was held in Matara with the leadership of the District director of Health

services Matara .INDECOS initiated the organizing of the event. Most of the

NGO including Sri Lanka Red Cross/CHA, St John’s Ambulance Brigade,

Lions Club international and women’s in Need (WIN)and the government

departments, District Secretariat, Divisional Secretary’s office and the Matara

General Hospital and the SDT /HIV/AIDS campaign. As a result of our

training programs Members of the Police department including SSP /Matara

participated in the event in a big way. World Aids Day was celebrated with a

walk attended by more than 1000 persons and ended up with an awareness

program for public

World Aids Day 1st December 2009

World Aids Day 2009 was celebrated on 2nd December at Matara. The event

was organized by the DDHS Matara and the STD/AIDS clinic Matara with

the help of other government departments and NGO of the area. The unique

feature of this event was participation of prisoners and trainees of nursing

training School

Conclusion

Objective: 1. Achieved > 100% - 2438 students had been trained

Objective: 2. (Revised to include youth of Navy) Achieved > 100% (Police 331 & Navy

3310)

Objective: 3. Achieved 100%. All of scheduled health education materials had been

printed and distributed

Objective: 4. Achieved 100% 40 teachers from above schools had been given 2 days

training as Master Teachers.

Objective: 5. Achieved >100%. More than 50 peer leaders were trained

Constrains

There were not much of constraints in implementation of the project, except following commencement of the project was delayed due to certain logistics issues such as getting permission from education authorities to conduct reproductive health training in schools as there is circular issued by the Ministry of education preventing INGO/NGO doing such programs in schools. It was overcome by involving department of health services and the department of education using goodwill of the INDECOS. Getting required number of police officers for training program was always a problem due to the unexpected duty arrangement for them by the superiors. Sometime it is impossible to have alternatives due to the prevailing security situation of the country. Hence we had to revise this target group including new recruits and officers of naval training school.