Increasing acceptance of HIV/AIDS prevention, treatment practices through religious leaders and

institutions

Pamela E. Mukaire, ME.d, MPH, Dr.PH (c)

APHA Annual Meeting & Exposition November 2013

Presenters Disclosure

I have no relationships to disclose

South Sudan Independence – July 9th 2011

Scared by more than 40 years of conflict (1955-1972 & 1983 to 2005)

Over half of the 8.26 million is under age 18, & 72% of SS population are less than 30 years old.

A history of underdevelopment

HIV/AIDS in South

Sudan HIV prevalance among 15-49 year olds estimated at 2.7%

(UNAIDS 2013)

South Sudan borders countries with high rates of HIV/AIDS (Uganda 6.5%, Kenya, 6.3%, DRC 3.4%, Central African Republic 4.9%)

Epidemic is generalized as low although there are “hot spots”

highest rates with Western (6.8%), Eastern (3.4%), and Central Equatoria (2.6%) and Lakes (2.3%)

HIV/AIDS Prevalence by State

HIV/AIDS Prevalence by State

Key Determinants of the Epidemic

Low knowledge of HIV transmission and risky sexual behavior

Only 11% of women 15-24 years knew about 3 ways of preventing transmission of HIV (Sudan HS 2010).

Only 53.8% women 15-49 years have heard of HIV/AIDS

41.1% of women and 58.1% of men knew how to avoid the HIV virus by using a condom correctly every time

Key Determinants of the Epidemic

Multiple concurrent sexual partners coupled with low levels of condom use

High HIV stigma - discrimination, and denial

Cultural norms:

like tribal marking practices,

polygamy and

widow inheritance

Vulnerability in South Sudan

Massive population movements

IDPs relocation

refugees influx

Repatriation

ex-combatants transition

to civilian life

commercial transporters

Gender inequality factors that expose women to HIV infection

Statement on the Challenge

Hon. Dr. Hussein Michael Milli, Minister of Health, Republic of South Sudan Dec

2011 Dakar meeting

“The legacy of the more than two decades of gruesome war for the independence of the Republic of South Sudan is more evident in

the health sector, where there is almost total collapse of the health system”

Innovative and Strategic Partnerships

Government, FBOs and community groups

Structures and systems of FBO’s add value to effective service delivery or programming in SS difficult terrain

Access to RH services is low,

health service user rates are estimated at 0.2 contacts per person per year.

Gov.SS AIDS commission joint venture with FBO’s and CBO’s to plan, develop and deliver comprehensive HIV/AIDS services

The South Sudan HIV/AIDS Project

Development Objectives:

Strengthen the capacity of the SSAC to plan, coordinate and monitor the GoSS response to HIV/AIDS

Increase community access to comprehensive HIV/AIDS services, and

Create awareness and measurable behavior change regarding HIV/AIDS.

GoSS – Government of South SudanSSMHA-South Sudan HIV/AIDS ProjectSSAC- South Sudan AIDS Commission

Christian Health Association of Sudan

Shared Vision:

A network of Christian health organizations, with 72 members drawn from:

Diverse Christian faiths,

Muslim faith groups

PLHIV groups

“All CHAS member organizations visibly and effectively participating in health service delivery and contributing to the attainment of health outcomes for South Sudan”

CHAS Partnerships

Awarded a service agreement to provide technical leadership and management of SSMHA Project (supported by Multi Donor Trust Fund)

Two states: Western Equatoria and Lakes States

Sub-contracted and strengthened capacity of 35 implementing partners

Western Equotoria Lakes

• 15 FBO 7 8

• 6 CBO 3 2

• 11 PLHIV Associations 10 1

• 2 Local government departments 1 1

SSMHA-South Sudan HIV/AIDS Project

1.Religious institutions as community mobilisers

2.Religious facilities providing HIV related services

3.Religious leaders and church groups as service providers

4.Religious owned business and individuals as lead participants in awareness activities

5.Religious leaders engagement in community assessments

6.Religious leaders as advocates for policy development and implementation

CHAS Strategies to FBO Health Promotion and

Service Delivery

CHAS Approach: Engaging Religious Leaders &

Institutions LQAs – Lot Quality Community Assessment:

processes that enable targeted communities to become actively and genuinely involved in defining the issues of concern to them;

making decisions about factors that affect their lives;

formulating and implementing policies meant to improve their conditions;

planning, developing and delivering services, and taking action to achieve change

CHAS Approach: Engaging Religious Leaders & Institutions Religious Institutions/ Leaders Training and Service

Delivery Strengthening: LINKAGE of traditional and modern systems

Trained 929 religious leaders and workers in WE& L States

Trained church service groups as service providers – youth clubs, mother union, catechists

Introduced HIV related services at FBO owned health facilities – VCT, PMTCT, treatment of opportunistic infections

Attracting 80 – 100 clients per session once a month

Established outreach service centers at FBO compounds

Integrated HIV educational messages in weekly sermons/services – and all other religious events

Engaged FBO owned and managed FM radios

CHAS Approach: Engaging Religious Leaders &

Institutions

Religious Leaders as Advocates and Change Agents:

advocate for a supportive social cultural environment for HIV care, treatment and prevention

Addressing high HIV stigma and tough social norms

how to utilize religious gatherings, and activities to mobilize community action,

raise awareness and educate on multifaceted issues of gender inequalities and HIV – delayed marriages, not to older men, increased male involvement, maternal referrals and follow-ups

FBO’s Contribution to SSMHA :LQAs Baseline – End line Results

Men's knowledge on HIV transmission and prevention increased by:

5% in Western Equatorial (Yambia County KAP Survey)

68% in Lakes state (Rumbek County KAP Survey) .

Women' perceived risk of contracting HIV/AIDS increased by:

17.8% in Western Equatoria and

10.7% in Lakes state.

The number of women seeking HIV counseling and testing services increased by:

21.5% in Western Equatoria and

21% in Lakes state.

Faith Communities and HIV in Humanitarian Settings

Why FBO’s are critical partners?

Faith-Based Communities and NGOs together provide an estimated 90% of all health services (40% to 50% - FBO – greatly contribute to HIV responses)

1 in 5 orgs working in HIV programs are FB

First port of call for vast humanitarian human development needs for over 40 years

Filled long-term displacement needs - food, water, poverty and HIV/AIDS related vulnerabilities

Bridging communities, AID organizations and government health agencies/ programs

Partnership with traditional health care systems to increase access to PMTCT

Implications for PH Practice

Religious leaders have contributed to scaling-up community HIV response by collectively implementing an innovative community health information system to increase the flow of information for effective community mobilization.

Interfaith program activities have highlighted the differences in message packaging between the different faiths in ways that are culturally accessible and acceptable to the diverse cultural belief systems influencing infectious disease acquisition, response and prevention in this population.

Thank you for your interest and for listening

SHUKRAN!