How to protect from HIV

Overcoming the Challenges: Improving Young People's SRH

Project profile: KHANA began its RHIYA project on 1st September 2003 as an executing agency and also provided technical and financial support to 5 other NGOs which carried out community assessment needs regarding SRH and implemented a programme based on these needs. KHANA’s purpose was to enable safer SRH behavior and develop YFS for vulnerable and marginalized youth aged 12-25 in several sites in 3 Cambodian provinces.

According to KHANA, HIV/AIDS prevention must be one of a complex web of priorities for vulnerable youth. Girls represented 60% of the target group. The project provided youth with knowledge and skills to take responsibilities and make rational decisions towards SRH. It did so through identifying, documenting and disseminating modules and tools in the country, and by coordinating Youth Camps and Forums to advocate on ASRH.

KHANA also enhanced the effectiveness and the quality of NGOs’ activities in STI/HIV/AIDS prevention, care and support work: workshops and trainings were held to raise the capacity of partner staff, volunteers and peer educators on behavior change communication (BCC), information education and communication (IEC) development, gender and RH, and voluntary counseling and testing (VCT).

The project also contributed to the SRH improvement of families, communities and workforce, thus increasing the chance of sustainability of the project activities.

Strategy: Although there are encouraging signs of HIV epidemic stabilization, KHANA identified that basic awareness of SRH/HIV among youth was rarely accompanied with knowledge on how to access further information/services and apply this knowledge in personal contexts. Cambodian youth has rarely the occasion to discuss about issues such as negotiation, desire, drugs, violence, and gender issues are ignored. Moreover, NGOs / civil society are a relatively new phenomenon in Cambodia and few NGOs has therefore the capacity to develop, monitor or implement projects to address SRH needs. The project also recognized that there is an insufficient quantity and quality of services for A/Y especially in rural areas and for minorities. In addition the significant barriers/suspicions towards SRH interventions from certain gatekeepers result in a lack of advocacy in support of youth-orientated information and services. Girls, who are highly influenced by traditional and cultural expectations, are therefore very vulnerable.

In order to address these issues, KHAN identified a logic approach to respond to ASRH priorities. The project gave the youth the opportunity to discuss SRH issues with other youth and their families through non threatening ways such as through drama and comedy and practice life skills to access SRH services. KHANA also gave the opportunity to partner staff, volunteers and peer educators to attend workshop and training sessions and allowed them to share their good practices together to develop operational skills. Moreover, the project focused on making A/Y aware of and gave them access to SRH services such as STI care or VCCT facilities, especially through strengthening referral networks and establishing YFS with the collaboration of RHIYA partners. In addition, the project devoted specific focus to working with parents, brothel owners, religious leaders and garment factory managers to ensure that the benefits of SRH education were understood and that girls, sex workers and other vulnerable groups had regular access to vital health services.

Outputs: 1) Increased political, community and family support for ASRH interventions for an enabling environment: joint activities / public events were held throughout the project duration to help raise community support: religious leaders and Provincial Aids Authority were invited to workshops on HIV/SRH and events were timed to coincide with specific national / international dates to enable a large number of people to gain ASRH understanding. These events were also broadcasted on TV and radio to reach more people. In addition, gatekeepers, parents and local authorities were equipped with ASRH knowledge including through monthly meetings and group discussions: 1235 gatekeepers were educated and 1341 parents attended meetings in 2005. Subsequently, high levels of awareness and support were reported. Finally, officials’ participation to annual youth forums showed an increased commitment of the Government to improve ASRH information and services in the country: the MoE implemented HIV/AIDS education into the national curriculum and progressed with the training of teachers, and Clinical Guidelines for ASRH services were finalized.

2) Increased knowledge and attitudes of SRH issues and awareness of risk among A/Y: By collaborating with partners, utilizing peers and involving parents and other gatekeepers in the project, attitudes towards SRH issues significantly improved. It enabled the development of an appropriate training curriculum for outreach workers on how to conduct education sessions on topics such as condom-use, gender or RH with vulnerable/marginalized people. Testimonies, specifically designed IEC materials and gender sensitive approaches also helped in improving knowledge, attitude and behavior amongst youth. However, the most visible activities of the project that helped to raise awareness on SRH / gender issues among youth and their stakeholders were the Youth Camps and Forums (in 2005 the youth camp was attended by 250 youth from 17 provinces). In addition, each partner worked with KHANA to develop M&E and research skills, so that ASRH activities can be continually assessed.

3) Increased availability of access to quality SRH services to A/Y at risk in target areas: Access to SRH services by youth successfully increased: 1752 were contacted in 2004 by peer educators through group/one-to-one discussions and this number grew up to 27, 179 in 2005. This led to a rise in the number of referrals on birth spacing, STI and HIV/AIDS services. In 2004, 358 A/Y accessed VCCT and other services and this number rose to 4305 in 2005. The project showed that there is now an increased number of youth thinking that SRH information about contraception / HIV is easily accessible and also an increased awareness on STIs other than HIV especially amongst females, owing to outreach educators and the work achieved in SDPs. To reach the most vulnerable, numerous IEC materials were especially designed for sex workers and MSM to respond to their particular needs. Finally, essential ties with local partners providing ASRH information and services (RHAC, local health centers, and provincial AIDS authorities) led to an improved referral network ensuring access to STI/HIV/AIDS services.

4) Enhanced technical, planning and managerial capacity for local provision of youth friendly SRH services: Youth were involved in project planning and implementation to ensure the provision of YFS: peer educators met regularly with implementing partners to provide feedback in how best to approach youth, engage them and ensure them access to YFS. Local health providers were also involved in the project to strengthen the referral system. In addition, KHANA regularly visited each of its project partners to provide them with technical, organizational and financial management support. The financial, logistical, gender and cultural implications of the activities were reviewed to mitigate their impact on young people. A project review workshop was held in 2004 to help partners to conduct participatory project reviews/community needs assessments, and several other workshops conducted on IEC material develop, BCC, VCCT…etc. KHANA also helped local partners to implement an M&E framework allowing identifying changes in ASRH and access to services.

Lessons learned: Projects are more easily achieved in a multi-sectoral approach: KHANA worked at several levels with community’s key members, government ministries and a variety of NGOs. Using networks, advocacy strategies, media and involving peers and gatekeepers allowed to extend the impact of the project to a far wider audience and encouraged future development and sustainability. Improved and extend referral systems and greater accessibility of essential services have facilitated the utilization of VCT and STI treatment care.

Some A/Y required specifically designed forms of approach: availability and access to services are influenced by factors such as gender, education and social standing so projects implemented number of features assisting vulnerable groups: sex workers, homosexuals, highly mobile youth, factory workers, and illiterates. Women were especially difficult to reach. Negotiations with schools directors, brothel owners, garment factory managers helped to educate them on SRH issues. Some managers even considered supporting financially HIV education. However, a large demand of information and services for drug users was unmet:

ASRH: Using tools that relax and are familiar to A/Y such as drama, comedy and dancing is an effective approach to discuss sensitive issues. Information alone is not sufficient for improving SRH: there is a need to increase access to contraceptives and STIs screening and treatment. Women should be given more confidence and equipped with more negotiation skills to persuade their partner to use condoms. Financial costs associated with accessing health care are a significantly prohibitive factor despite mobile clinics and the role played by volunteers. Future projects should be opened to additional geographic sites, additional groups, cover more issues and continue for a longer period.

Partner Profile: KHANA is a local non-governmental support and linking organization of the International HIV/AIDS Alliance, organized as independent in 1999. It is Cambodia’s forefront for struggle against HIV/AIDS, but it collaborates with international supporters such as the Cambodian government. Moreover, it hosts grass-roots organizations within towns and villages across the country to develop and foster a response to the epidemic. Its work consists mainly in prevention, provision of care and support, advocacy, awareness-raising, community action and support as the cornerstone to the work. KHANA provided funding and technical support to NGOs through the UPSU and RHIYA. It organized the highly successful Youth Camps in the past two years and produced a Khmer adaptation of 'Stepping Stones'.

Contact: Address: n° 33, Street 71, Tonle Basac, Phnom Penh, Cambodia; Tel :+(855) 23 211505 Fax :+(855) 23 214049; E-mail: khana@khana.org.kh