HIV/AIDS CONTROL IN THE EDFHIV/AIDS CONTROL IN THE EDFEXPERIENCES AND LESSONS EXPERIENCES AND LESSONS

LEARNEDLEARNED

DEPT.OF HEALTH DEPT.OF HEALTH EDFEDF

INTRODUCTIONINTRODUCTION

COMPOSITION AND MISSION OF THE EDFCOMPOSITION AND MISSION OF THE EDF

COMPOSITIONCOMPOSITION

The EDF is a melting pot of all Eritrean youth representing The EDF is a melting pot of all Eritrean youth representing diverse nationalities, religion, cultures and values, diverse nationalities, religion, cultures and values, education and economic backgrounds. education and economic backgrounds.

Regulars – 15% mainly former liberation fightersRegulars – 15% mainly former liberation fighters national service conscripts- 85%national service conscripts- 85%

MISSIONMISSION

Military- Safeguard, sovereignty and national integrity.Military- Safeguard, sovereignty and national integrity.

Non-military- the major force behind the national Non-military- the major force behind the national economic economic

development campaign and spear heads :-development campaign and spear heads :- Realization of food security at the national Realization of food security at the national

level.level.

through soil and water conservation, through soil and water conservation, development development of irrigation schemes, of irrigation schemes, terracing, aforestation, terracing, aforestation, construction of construction of dams, growing and harvesting of dams, growing and harvesting of essential essential crops.crops.

DEVELOPMENT OF INFRUSTRUCTUREDEVELOPMENT OF INFRUSTRUCTURE

Reconstruction of the war destroyed only railway line of Reconstruction of the war destroyed only railway line of the countrythe country

Construction of roads and bridges Construction of roads and bridges Construction of school, health facilities and residential Construction of school, health facilities and residential

housinghousing

Curb the spread of HIV/AIDS by increasing the level of Curb the spread of HIV/AIDS by increasing the level of awareness of rural communities via the EDF-community awareness of rural communities via the EDF-community outreach program outreach program

MISSION REQUIREMENTSMISSION REQUIREMENTSYOUNG YOUNG ROBUSTROBUSTHEALTHY & FIT HEALTHY & FIT

INHERENT & AQUIRED RISK FACTORS INVOLVEDINHERENT & AQUIRED RISK FACTORS INVOLVED Young and sexually active Young and sexually active Sense of invincibilitySense of invincibility Split- second risk takingSplit- second risk taking Risky professionRisky profession Living outside barracks Living outside barracks Staying away from home for long periods of dutyStaying away from home for long periods of duty Alcohol intake Alcohol intake

Thus, the EDF has the potential to enable or disable the Thus, the EDF has the potential to enable or disable the transmission cycle with either huge beneficial or transmission cycle with either huge beneficial or detrimental long term consequences for the country.detrimental long term consequences for the country.

It is to tap the positive aspects of having all the youth in the It is to tap the positive aspects of having all the youth in the EDF that the HIV/AIDS control program was launched in EDF that the HIV/AIDS control program was launched in consent with other sectors i.e. MOH, MOLG, ESMG, NUEUS, consent with other sectors i.e. MOH, MOLG, ESMG, NUEUS, UN agencies and other stake holders. UN agencies and other stake holders.

EDF HIV/AIDS CONTROL PROGRAMEDF HIV/AIDS CONTROL PROGRAM

Dictated by the concept “Dictated by the concept “protect the healthy and care protect the healthy and care for the afflicted.for the afflicted.” Essentials preventive in nature.” Essentials preventive in nature.

Integral part of the country wide control programIntegral part of the country wide control program Adheres to the national policy and strategies, adapting the Adheres to the national policy and strategies, adapting the

latter to military realities, i.e. existing commands structure, latter to military realities, i.e. existing commands structure, and organization of health care facilities at different and organization of health care facilities at different echelons echelons

PREVENTION STRATEGY PREVENTION STRATEGY

FACING THE PROBLEM – AN ENTRY POINT TO PREVENTIONFACING THE PROBLEM – AN ENTRY POINT TO PREVENTION

Sensitize and gain full involvement of the military Sensitize and gain full involvement of the military bureaucracy through the provision of true hard core bureaucracy through the provision of true hard core data and good rapprochement data and good rapprochement

Make the rank and file appreciate the challenge first Make the rank and file appreciate the challenge first hand hand

Opt for military to military approach of communicationsOpt for military to military approach of communications

In line with the above a campaign denoted In line with the above a campaign denoted ““SEEING IS SEEING IS BELIEVINGBELIEVING” ” was initiated early in 2002 and lasted nine was initiated early in 2002 and lasted nine months. months.

PHASE 1:-PHASE 1:- Commanders – From the minister down to the Commanders – From the minister down to the unit leader- total 30,000 unit leader- total 30,000

PHASE 2:- All privates- totaling 195,000

CONTENTS:

HIV/AIDS and other STIS cause, transmission, prevalence Deaths due to AIDS with categorization by rank , age,

gender, education etc… Modes of prevention- esp. condom use Testimonials by 11 EDF members living with HIV/AIDS

stressing family background, education, practice of unprotected sex, alcohol intake, personal habits, reaction on diagnosis and living positively with with HIV/AIDSHIV/AIDS

Open discussionsOpen discussions Opening and closing statements by senior commanders Opening and closing statements by senior commanders

BENEFITBENEFITSS ACCRUED ACCRUED

HIV/AIDS and its prevention were included in the HIV/AIDS and its prevention were included in the

agenda for the monthly activities eagenda for the monthly activities evaluationvaluation meetings at meetings at

all echelons and reporting became mandatory.all echelons and reporting became mandatory.

In addition the routine formal & informal distribution, In addition the routine formal & informal distribution,

picking up of condoms as part of other rations became picking up of condoms as part of other rations became

compulsory.compulsory.

Garrison commanders were ordered to strictly observe Garrison commanders were ordered to strictly observe

the welfare of their men by preventing the setup of tea the welfare of their men by preventing the setup of tea

and beer houses and commercial sex work around their and beer houses and commercial sex work around their

garrisons. garrisons.

Open demand for universal testing by the audience Open demand for universal testing by the audience

Increased attendance in VCT sites Increased attendance in VCT sites

ROUTINE PREVENTIVE ACTIVITEIS ROUTINE PREVENTIVE ACTIVITEIS

Production of IEC materials, posters, brochures Production of IEC materials, posters, brochures and stickers and stickers

Demonstrations and video showsDemonstrations and video shows Promotion and free distribution of condoms to Promotion and free distribution of condoms to

all military personnelall military personnel Distribution of condom carrying pouches Distribution of condom carrying pouches Ascertaining blood safety Ascertaining blood safety Early syndromic management of STIs at Early syndromic management of STIs at

battalion levelbattalion level Post exposure prophilaxisPost exposure prophilaxis

Continuing education and training is a necessity to carry Continuing education and training is a necessity to carry out repetitive and sustained preventive activities. out repetitive and sustained preventive activities.

Training Programs No. of trainee

VCT and counseling to all hospital nurses and health officers 140

training of lay counselors within military formation 175

HIV/AIDS awareness campaign to higher commanders 1500

Training of battalion health officers on management of STI using syndromic approach

650

Refresher course on STI management for battalion health officers using syndromic approach

240

HIV/AIDS and universal precautions to hospital staff including periodic refresher course

4800

Training of new peer educators 1630

Clinical management of OI in hospital setting care and support to PLWHA (hospital staff)

150

Senior trainers of training on peer education 46

Peer facilitators and trainers 100

Trainers for HIV/AIDS change agents 40

CARE AND SUPPORTCARE AND SUPPORT

Retention of all seropositive members (HIV/AIDS- doesn’t Retention of all seropositive members (HIV/AIDS- doesn’t qualify for discharge from the EDF)qualify for discharge from the EDF)

Assignment to sedentary duties Assignment to sedentary duties Periodic follow up of CD4 countPeriodic follow up of CD4 count Provision of HAART for those with CD4 < 200 (based on Provision of HAART for those with CD4 < 200 (based on

national treatment guidelines)national treatment guidelines) Treat opportunistic infectionsTreat opportunistic infections Routine prohylaxis against opportunistic infectionsRoutine prohylaxis against opportunistic infections Sequential follow-up and counseling for compliance Sequential follow-up and counseling for compliance Senior level extensive discussions are underway how to Senior level extensive discussions are underway how to

engage PLWHA in sustainable profit making enterprises engage PLWHA in sustainable profit making enterprises within the military in order to support themselves and within the military in order to support themselves and their dependents.their dependents.

TESTING AS A TOOL FOR PREVENTION, CARE & TESTING AS A TOOL FOR PREVENTION, CARE & EVALUATIONEVALUATION

Following the demand for universal testing at the “seeing Following the demand for universal testing at the “seeing is believing” campaign of 2002, a series of consultative is believing” campaign of 2002, a series of consultative meetings at different command level reached consensus meetings at different command level reached consensus to conduct periodic universal testing of the EDF to conduct periodic universal testing of the EDF

Why Universal Testing? (comments Why Universal Testing? (comments from consultative meeting from consultative meeting

participants)participants) VCT is too little and too late intervention, God VCT is too little and too late intervention, God

knows how many soldiers we have driven to their knows how many soldiers we have driven to their death through arduous military exercises.death through arduous military exercises. We are not interested in statistical indices. That We are not interested in statistical indices. That

is for you, the health professionals. We only want is for you, the health professionals. We only want to talk about our servicemen and their to talk about our servicemen and their dependents. Do the testing and inform us about dependents. Do the testing and inform us about the results for we are the only people that can the results for we are the only people that can assist them.assist them.

It is now several years since the program was It is now several years since the program was initiated, and the greater majority of EDF initiated, and the greater majority of EDF members have a good awareness about members have a good awareness about HIV/AIDS. But do they really practice what they HIV/AIDS. But do they really practice what they have been taught. have been taught.

Lets not play hide and seek games – universal Lets not play hide and seek games – universal testing is the only reliable yardstick of behavioral testing is the only reliable yardstick of behavioral change, so do it please. change, so do it please.

You, the health professionals, are part of the You, the health professionals, are part of the problem. We frequent your health facilities and problem. We frequent your health facilities and you order a gamut of tests without asking you order a gamut of tests without asking consent and have no qualms in disclosing the consent and have no qualms in disclosing the diagnosis, fatal or otherwise. When it comes to diagnosis, fatal or otherwise. When it comes to HIV/AIDS your extreme secrecy, has become a HIV/AIDS your extreme secrecy, has become a major obstacle to overcome the silence that has major obstacle to overcome the silence that has shrouded the disease. Universal testing is the shrouded the disease. Universal testing is the way out.way out.

CURRENT TESTING PRACTICESCURRENT TESTING PRACTICESRoutineRoutine All clinically suspected casesAll clinically suspected cases All patients undergoing surgeryAll patients undergoing surgery All blood recipients All blood recipients

Cont…

VCTVCT

Any body who requestsAny body who requests

UNIVERSAL CHECK UP, DISCLOSURE, OUTCOMESUNIVERSAL CHECK UP, DISCLOSURE, OUTCOMES

CONDUCTED EVERY 2 YEARCONDUCTED EVERY 2 YEAR Round 1, 2004Round 1, 2004 Round 2, 2006Round 2, 2006

DISCLOSURE DISCLOSURE

Follows the channel of commandFollows the channel of command All seropositive are informed individually depending on All seropositive are informed individually depending on

rank and position, by the most immediate superior rank and position, by the most immediate superior commander (Battalion, Brigade, Division Op.zone)commander (Battalion, Brigade, Division Op.zone)

All seronegative are informed collectively by their All seronegative are informed collectively by their immediate superior commanderimmediate superior commander

OUTCOMEOUTCOME Very favorable Very favorable Decrease in prevalence in 2006 compared to 2004Decrease in prevalence in 2006 compared to 2004 Incidence rate has been established. Incidence rate has been established. Magnitude of problem defined. Magnitude of problem defined. Planning, has become easier.Planning, has become easier.

EDF - COMMUNITY OUTREACH EDF - COMMUNITY OUTREACH PROGRAM PROGRAM

Evolved as an idea in early 2002Evolved as an idea in early 2002 Deploy national service conscripts trained as change agents, to Deploy national service conscripts trained as change agents, to

their communities of origin (rural) with the objective of up scaling their communities of origin (rural) with the objective of up scaling HIV/AIDS awareness and prevention HIV/AIDS awareness and prevention

Funded by the Norwegian Govt. via UNFPA in 2003Funded by the Norwegian Govt. via UNFPA in 2003 325 change agents, selected, trained and deployed to southern, 325 change agents, selected, trained and deployed to southern,

western and eastern part of the country for period of 2 years.western and eastern part of the country for period of 2 years. Covered 22 administrative sub zones and reached a total of Covered 22 administrative sub zones and reached a total of

1,083,370 people of both genders.1,083,370 people of both genders. Impact evaluation done by an independent consultant in the last Impact evaluation done by an independent consultant in the last

quarter of 2006 by comparing communities who availed from the quarter of 2006 by comparing communities who availed from the program with communities who had not. The outcome was found program with communities who had not. The outcome was found to be positive and an extension period has been recommended.to be positive and an extension period has been recommended.

CHALENGESCHALENGES

Sustainability of the whole programSustainability of the whole program Sustainability of the EDF – community outreach programSustainability of the EDF – community outreach program Decentralization of ARV therapyDecentralization of ARV therapy

LogisticsLogistics EquipmentsEquipments ReagentsReagents

Rapprochement with families of HIV/AIDS members of Rapprochement with families of HIV/AIDS members of the EDFthe EDF

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION