CAMEROON LINK I.E.C. AND HIV OPERATIONAL RESEARCH

CAMEROON LINK I.E.C. AND HIV OPERATIONAL RESEARCH
EXECUTIVE SUMMARY
Nearly two decades after the emergence of the HIV/AIDS pandemic, biomedical, and epidemiological research has identified and described in great detail the nature of HIV infection and its modes of transmission.
These findings have been used by scientific experts to develop effective drug treatments, targeted behaviour change strategies, and sensitive surveillance and modelling tools.
Yet far less research has been devoted to basic operational issues that affect the delivery of services in prevention, care, and support.
We have learned much about which behaviours place persons at risk and have some sense of what types of interventions work to prevent HIV transmission, but we know far less about why and how these interventions work, what they cost, and where and when they can be successfully replicated on a large scale.
These questions are especially important in Cameroon in general and the Littoral or the south west provinces in particular, which are our main target populations, where more than 90 percent of HIV infected people live, because prevention, care, and support interventions remain the primary tools for dealing with the pandemic.
To successfully design and implement effective HIV/AIDS prevention and mitigation activities, we suggest that the program managers and policy makers urgently need accurate and timely information on the operational mechanisms that make these programs work in an era of scarce resources.
It is also critically important that decision makers be guided by the best and most current research evidence to determine which elements of policy and service programs are the most cost-effective in reducing new HIV infections and mitigating the effects of AIDS.
BREAKING NEW GROUND
As we apply for the frame work agreement for collaboration with the ministry of public health and international institutions in Cameroon, we would be reinforcing our strategies in the next five years (2001/2006) with focus on operational mechanisms of implementing policies and programs.
In addition to previous objectives, the focus will include:
-Identifying cutting-edge issues affecting the design and delivery of STD/HIV/AIDS programs.
-Test new approaches to prevention, care, and support programs through practical, field-based research.
-Disseminate the findings from the research.
-Recommend best practices to improve policies and programs.
Since the inception in 1992, the Cameroon Link (Human Assistance Programme) has worked with a bread group of local, regional, and international organisations to identify the key constraints to service delivery and to test viable alternatives to programs with limited effectiveness.
Focusing on some broad topic areas, Cameroon Link HAP is one of the first STD/HIV/AIDS projects in Cameroon to use operational research to identify program problems and test new solutions to overcoming these problems.
The operational research process has been employed extensively by Cameroon Link in collaboration with the ministry of public health, the German Technical Co-operation, GTZ, Care International and the Cameroon Association of Newspaper Journalists, AJPEC, over the last five years in reproductive health activities.
It has proven extremely effective in improving the quality and effectiveness of service delivery programs in large part because it has applied research that places a premium on involving key stakeholders in the entire process.
These stakeholders are many and include government ministries, local NGOs, Local community leaders, people living with STD/HIV/AIDS, research agencies, and international organisations, amongst others.
Multi-stepped Approach
Cameroon Link operations will in the next five years involve five basic steps:
-Problem identification and diagnosis.
-Strategy selection.
-Strategy experimentation and evaluation.
-Information dissemination.
-Results utilisation.
From past experiences, we have noted that this process increase the efficiency, efficacy, quality and cost-effectiveness of prevention and care services, and changes individual behaviour by making services more accessible and acceptable.
The Cameroon Link Human Assistance Project concentrates on working with local service delivery organisations and groups to design and implement three basic types of field-based studies.
EXPLORATORY STUDIES
These studies are needed whenever there is a perceived problem, but the nature and extent of the problem are not known. Such studies can identify individual behaviours, and the legal, cultural, and socio-economic factors that influence risk and vulnerability, as well as the parameters of a service delivery.
FIELD INTERVENTION STUDIES
This study is useful when the factors responsible for a problem situation is or are known (i.e., lack of finances, lack of training, inadequate involvement of local NGOs, lack of collaboration of target groups, high prevalence of risk behaviours).
The most efficient and cost-effective means of prevention have yet to be determined. Field intervention studies test new approaches to behaviour change and new modes of configuring and delivering prevention and care services.
EVALUATION STUDIES
Often the problem situation is known from earlier diagnostic studies and a range of possible solutions have been identified from earlier field intervention studies, but the effect and sustainability of implementing these solutions in the larger community, beyond the confines of a tightly controlled intervention study are not known.
Evaluative studies are a valuable approach for examining the out come or impart of interventions that are implemented through out a service delivery environment.
Regardless of the type of study, the goal is always to improve the way in which policies are designed and implemented. This goal can only be met if each activity is accompanied by a strong information dissemination and results utilisation program.
This explains the connection of the Cameroon Association of Newspaper Journalists, AJPEC, partnership in the Human Assistance Programme and the raison d’être of the revival of the Cameroon Link newspaper for the presentation of NGOs activities through the forum columns. Articles, feedback and suggestions or information will be welcome.
STD INTERVENTIONS
PUTTING NEW PREVENTION AND TREATMENT
APPROACHES TO THE TEST AS PROJECT
One of the most important prevention discoveries made about HIV is that the presence of other sexually transmitted diseases (STDs) greatly increases vulnerability to and transmission of the virus.
This has been a key factor in HIV’s virulent spread in Cameroon, where untreated STDs are also endemic. Thus, strengthening STD prevention and management and, wherever possible, incorporating these efforts into HIV prevention programs have become a key global strategy for curbing the virus that causes AIDS.
But this is not a simple matter. The stigmatisation of those with STDs, a very common problem, inhibits people from seeking treatment.
Designing effective behaviour change campaigns that address sexual behaviour is often difficult, especially if literacy is low. Several constraints on national health budgets restrict the implementation of STD prevention and treatment programs, just as poverty limits the ability of individuals to pay for their own treatment.
Access to care is also limited, particularly in rural areas isolated by weak infrastructure. Even in urban towns with more resources, STD prevention and control programs are often insufficiently funded.
Despite the growing wealth of knowledge about STDs, few large-scale prevention and treatment programs have evolved in the districts where the need is greatest.
One of the biggest challenges is how to translate important research finding into effective, affordable and real programs that can be adapted to very different settings.
A key lesson learnt from past experiences is that like the HIV and STD epidemics themselves, real solutions are complex and multi-faceted.
STI PREVENTION STRATEGIES
PERIODIC PRESUMPTION TREATMENT
This is mass treatment of individuals presumed to be infected with one or more STDs, without attempting to make an individual diagnosis. This strategy can be targeted to persons with known high-risk behaviours like sex workers or free girls.
SYNDROMIC MANAGEMENT
Treating a patient for all likely causes of a symptom or sign of STD, rather than on the basis of a specific diagnosis.
PEER EDUCATION
Training individuals in health education and counselling techniques so that they can educate others in their peer groups.
POLICY OF 100% USE IN SEX ESTABLISHMENT OF CONDOMS
An intervention that seeks to reduce transmission of HIV and other STDs to and by sex workers by ensuring that condoms are used for every act of intercourse.
I.E.C PROJECT OBJECTIVES
LONG TERM
The training of staff and production of information material and publication will enhance a greater awareness of the local communities and contribute to the process of community development by mobilising the local communities towards involvement in the prevention of STD/HIV/AIDS/TB and social welfare. Media organisations must be regularly implicated in I.E.C programs.
CONCLUSION
To back up this executive summary, we have enclosed a profile of Cameron Link, its projects plan of action from 2001 to 2006, a budget estimate, a calendar of major annual events and a list of documented projects realised.
Cameroon Link Profile
Cameroon Link (Human Assistance Programme) is a global Reproductive Health and Nutrition Operations project designed to identify effective practices and test solutions to problems in HIV/AIDS/TB prevention, promotion of family planning, breast feeding, health care support.
Communicating research results is a very important part of the work of Cameroon Link. It reads opinions and publishes information about health and environmental activities. The areas of interest covered by Cameroon Link include community mobilisation, capacity building and scaling up programs, in work place, private sector, social marketing, stigma and discrimination, sexually transmitted infections, prevention, care and management, barrier methods (condoms, etc.), youths both in and out of school, policy, integrated health services, cost-effectiveness, people living with HIV/AIDS, AIDS-affected children and orphans, sex workers, mother-to-child transmission, HIV/AIDS and breast feeding, care and support, voluntary counselling and testing.
As a national, non-profit and non-governmental institution, Cameroon Link seeks to improve the well being and reproductive health of current and future generations around the country and to help achieve a Humane, equitable, and sustainable balance between people and resources.
It conducts I.E.C. programmes and training, as well public health research and helps to build research information capacities in urban and rural areas of Cameroon.
AJPEC/CANJ handles the communication aspect of the project, within the frame work of the human assistance programme of Cameroon Link.
STI-HIV-AIDS PREVENTION
What Makes It Work
In some places, at some times, with some groups of people, prevention has worked. Senegal, Uganda and Thailand are often quoted as examples of this.
There is also evidence that rates of infection have dropped in some populations in Cambodia. Nevertheless, we know that the HIV epidemic continues to flourish globally and that we are not succeeding in preventing it.
Maintaining safe behaviour, and protecting young people who are becoming sexually active continue to be challenges. There are some real successes, though mainly limited to particular populations.
We need to learn from these and translate the lessons they illustrate into everyday work to prevent infections in the different countries where we work.
Cameroon Link and AJPEC experiences have shown that at different stages of the epidemic, different approaches are appropriate. At early stage, there may be a concentration of infection in a few especially vulnerable groups such as sex workers or injecting drug users.
This is an opportunity to prevent further spread so long as we can identity the right approaches. In stages where more than 10 %of the sexually active population is infected, approaches have to be broader and have to reach even more people.
With limited resources, this means making difficult choices about how to identity the most effective approaches. Cameroon Link and AJPEC have developed and are developing tools to help communities assess their needs in a participatory way. This is Cameroon link’s particular strength.
In our search for a framework agreement with the government through the ministry of public health, we are fostering our partnership to ensure that there are facilities for treatment of STDs, access to treatment for HIV related illnesses, and provision of condoms.
STRATEGIES FOR BEHAVIOUR CHANGE
It is now widely agreed that effective prevention needs more than information and awareness, though these are essential as a starting point. Individuals exist with the community and society and there are many factors which affect a person’s stability to change.
A prevention framework being used by Cameroon Link to guide programme design and implementation looks prevention at three levels: individual needs, social context, and access to medical commodities and services.
Another common perspective differentiates amongst: information through media campaigns, theatre and peer education, empowerment by building negotiation skills or understanding and challenges to gender roles which lead to vulnerability, change in the environment through changing laws and societal responses, or by providing access to services such as STD treatment or resources such as condoms or clean needles. Projects carried out by Cameroon Link through its partnership organisations illustrate how the above three elements can be combined effectively. The ministry of public health and GTZ has been giving financial and technical support to Cameroon Link and AJPEC since 1992. UNESCO and PAMOL started giving support to AJPEC in the year 2000.
A community needs assessment led to the decision to work with highly vulnerable groups of young people and women. At that time, condom use was almost non-existent. Cultural norms made it acceptable for young men to buy sex frequently, whilst young women were not well educated about sex.
One of the groups (Filles de Bonabéri-Douala) supervised by Cameroon Link which received technical and financial support from CARE Cameroon in the District of Bonassama.
The phase of the work in sexual health, STI and HIV/AIDS prevention with women from a rural community started in 1996. This is how we intend to reinforce our strategies in the next five years, starting from 2008 to 2012.
For more on Cameroon Link, please click on the following link,http://www.worldbreastfeedingweek.net/wbw2008/cameroon.htm