Designing a Behavior Change Communication Strategy for Hiv Prevention Among Teachers in Uganda

DESIGNING A BEHAVIOR CHANGE COMMUNICATION STRATEGY FOR HIV PREVENTION AMONG TEACHERS IN UGANDA

Lillian Ayebale BA/ED, MA.DEMO MakSPH-CDC HIV/AIDS FELLOW 2010/2012

JUNE 2012

Declaration

I, Lillian Ayebale, declare that this programmatic activity report entitled Designing a behaviour change communication strategy for HIV prevention among teachers in Uganda, has been prepared and submitted in fulfilment of the requirements of the MakSPH-CDC

HIV/AIDS Fellowship Program and has not been submitted for any academic qualifications.

Signed ………………………………… Date…………………………………..

Lillian Ayebale

Fellow

Signed ………………………………… Date…………………………………..

Mr. Erasmus Otolok-Tanga

Host Institution Mentor (SPEAR Project)

Signed ………………………………… Date…………………………………..

Dr. Lynn Atuyambe

Academic Mentor

Signed ………………………………… Date…………………………………..

Ass Prof. William Bazeyo

Academic Mentor

Dedication

To my family: my husband Mr. Samson Tweheyo and my sons Jerome Manzi and David

Jethro.

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Acknowledgements

I thank the Supporting Public sector workplace Expand Action and Responses to HIV and AIDS-SPEAR project (a USAID/PEPFAR funded project) for allowing to host me as a fellow and giving me the lead position to develop this strategy.

I thank SPEAR staff, Mr. Erasmus Tanga the Chief of Party, Mr. Warrem Blessing Tukwasibwe the Program manager, Thomas Emeetai M&E, Mrs. Caroline Odongo Turyatemba Communication and Prevention Specialist, Dr. Alfred Mubangizi care and treatment specialist, Dr. Joseph Lubwama the ICB specialist, Mr. George Luboobi the Policy specialist, Mr. Wise Besigye the Finance and Administration Manager, Ms. Grace Nantale the Accountant and the entire SPEAR field teams for supporting the entire process of developing this strategy.

I thank the Ministry of Education and Sports (MOES) HIV focal persons who supplemented to this strategy during the development process, the task team, the HIV and AIDS unit. Particularly I am grateful to Dr. Yusuf Nsubuga the Director Basic and secondary Education / HIV sector coordinator, Mr. Stephen Opio Okiror the Assistant Commissioner Personnel, Ms. Jessica Naluzze, Mrs Florence Sembatya Musinguzi and Mr. Roland Biryahwaho MoES HIV Technical Advisor.

I am grateful to Makerere University School of Public health CDC HIV/AIDS fellowship programme for funding the development of this Behaviour Change Communication strategy. I also thank the consultants that guided me through the processes; Mr. Basil Tushabe from Communication for Development Foundation Uganda (CDFU) and Mr. Michael Muyonga from Ministry of Health (MoH).

I am grateful to my academic mentors Dr. Lynn Atuyambe and Associate Prof William Bazeyo, and Mr. Joseph Matovu, Dr. Rhodha Wanyenze and the entire fellowship staff for their support. I am grateful to my fellow fellows 2010/2012 and alumni fellows.

I also thank the teachers who participated in the processes particularly the rapid assessment and the strategy development workshop.

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Executive Summary

This report presents the processes that were undertaken to develop the Behaviour Change communication strategy for HIV prevention among teachers in Uganda.

A rapid assessment was conducted among teachers that included administering individual questionnaires with teachers in Kampala and Kalangala districts. The assessment also involved Focus Group Discussions (FGDs) with teachers grouped by age, sex and teaching level. We also collected key Informant data from key stakeholders who influence the teachers. The data collected supplemented the findings from literature reviewed. We established that teachers have risky sexual behaviours that put them at risk of HIV infection, and therefore identified key priority issues that the strategy addressed as,

 Multiple sexual partnerships

 Low condom use

 Transactional sex/ sex for favours

 Low service utilisation

 Alcohol abuse

We held a three day strategy development workshop with key stakeholders who included; teachers‟ representatives, Ministry of Health (MoH) representative, UAC representative,

District Health Educators and Ministry of Education and Sports (MoES) representatives from key departments. We also had a validation meeting with the stakeholder and a committee was formed to finalise the strategy.

The expected overall impact of the strategy is, “to contribute to the reduction of new HIV infections among teachers by 2016.” And the main communication objectives are;

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1. Increase knowledge and personal perception of risk of HIV infection among teachers

through multi-dimensional communication campaigns.

2. To increase the proportion of teachers who adhere and utilize HIV services (HCT and

ART)

3. Stimulate community dialogue on the basic facts of HIV and AIDS and the underlying

factors that contribute to the epidemic among teachers, such as risk behaviors and risk

settings related to structural factors like staff transfers.

The primary target audience is teachers, Tutors and Student teachers. The secondary target audience include Non teaching staff in primary and secondary schools, School administrators,

Principles and Education managers, Teacher training institutions, Parents and the community.

The strategy identifies various channels and materials to reach out to the target audience. We also developed an implementation plan and a monitoring and evaluation matrix.

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List of acronyms and abbreviations

ART Anti Retroviral Therapy

BCA Behaviour Change Agent

BCC Behaviour Change Communication

GoU Government of Uganda

IEC Information, Education and Communication

MoES Ministry of Education and Sport

MoH Ministry of Health

MoIA Ministry of Internal Affairs

MoLG Ministry of Local Government

PEPFAR President‟s Emergency Plan For AIDS Relief

PMTCT Prevention of Mother-To-Child Transmission

PLHIV People Living With HIV

RTI Research Triangle International

SPEAR Supporting Public sector work places Expand Action and Responses to

HIV/AIDS

USAID United States Agency for International Development

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Table of Contents

Declaration ...... i

Dedication ...... ii

Acknowledgements ...... iii

Executive Summary ...... iv

List of acronyms and abbreviations ...... vi

Table of Contents ...... vii

1.0 Introduction ...... 1

1.1 Objectives...... 2

1.2 Rational for the BCC strategy ...... 2

2.0 BCC strategy development process ...... 4

Rapid assessment ...... 5

Strategy design workshop ...... 8

Final BCC strategy ...... 8

Appendix ...... 10

BCC strategy...... 10

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1.0 Introduction

Teachers in Uganda are regularly singled out as being a „high-risk group‟ with respect to

HIV/AIDS1. It is commonly suggested that teachers are more likely to engage in high-risk sexual behaviour compared to the rest of the adult population2. Yet the education sector could be a major vehicle for imparting knowledge and skills of avoiding and/or coping with the pandemic.

Teachers are said to be particularly „prone‟ or vulnerable to HIV infection because the teaching profession is relatively young, which means that the large majority of teachers are in the highest HIV prevalence age cohorts3. Also, the teaching profession is female dominated, yet overall HIV prevalence rates among the adult population are generally significantly higher among females. These reports also revealed that, teachers are relatively well off especially when posted in rural areas (compared to the local population), , and in the case of male teachers, it is alleged that sizeable numbers have sexual relations with their students. The MoES also identifies structural drivers of the epidemic among teachers as high level of stigma and discrimination, teacher transfers which separates teachers from their spouses or regular sexual partners hence increases the likelihood of starting new relationships that may predispose them to HIV infection.

While the role of education and educators in HIV prevention efforts has been recognized as a key factor in tackling the HIV epidemic, less attention has been paid to mitigating the impact

1 Bennell, P. (2005). The impact of the AIDS epidemic on teacher mortality in sub-Saharan Africa, Knowledge and Skills for Development, 60 Rugby Road, Brighton BN1 6ED, United Kingdom 2 Supporting Public sector workplaces Expand Action and Response to HIV/AIDS-SPEAR (2009), Access and Utilisation of HIV/AIDS Prevention, Care and Treatment services by public sector workers in the ministries of Local Government, internal Affairs and Education and Sports, A baseline report

3 Ministry of Education and Sports (2011), Education and sports sector HIV prevention strategic plan 2011-2015.

among educators/teachers themselves. The apparent vulnerability of teachers may be due to their status and conditions of service. As a group they are better educated than the general population, their income is higher, and their mobility is greater.

The rapid assessment findings laid the foundation for the development of the BCC strategy.

1.1 Objectives

The objectives were;

1. To design a behavior change communication strategy for teachers.

2. To guide the implementation of BCC activities among teachers in Uganda. 1.2 Rational for the BCC strategy

Studies have revealed that teachers manifest high risk sexual behaviours, yet currently there is no systematic behaviour change communication strategy guiding the process of message and material development in the sector for behaviour change among them. The Education and

Sports Sector Strategic Plan 2011-2015 acknowledges that Majority of teachers are in the sexually active age group and many, especially those that have just joined the service, are single; many are sexually experimenting with potential partners of unknown sero-status. It also acknowledges that teachers are involved in multiple sexual relations involving learners, fellow teachers, workers, communities and education managers for cash, promotion, favors relating to transfers etc, there is sexual harassment of learners, workers, teachers and subordinates and that nearly a fifth of teachers engaged in sex with non-regular partners do not use condoms4. It is also pointed out that many teachers and managers are engaged in

4 Ministry of Education and Sports (2011), Education and sports sector HIV prevention strategic plan 2011-2015. Ministry of Education and Sports (2006), Education and Sports sector National Policy Guidelines on HIV&AIDS Ministry of Finance Planning and Economic Development (2007). Assessing the Macro-economic Impact of HIV/AIDS in Uganda. Page | 2

alcohol consumption that exposes them to unplanned sex with non-regular partners leading to

HIV infection.5

Although the sector has got sector HIV prevention strategic plan that acknowledges the risky sexual behaviours of teachers, the plan does not consider developing a behaviour change communication strategy. However the strategic plan considers developing IEC/BCC materials and distributing them. There was need for a BCC strategy to guide the process of materials development and dissemination in the sector for behaviour change.

5 Ministry of Education and Sports (2006), Education and Sports sector National Policy Guidelines on HIV&AIDS, Ministry of Finance Planning and Economic Development (2007). Assessing the Macroeconomic Impact of HIV/AIDS in Uganda.

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2.0 BCC strategy development process

The development of the BCC strategy was in two phases which are diagrammatically expressed

Document Rapid Strategy design review assessment workshop

Key risk behaviours Final BCC strategy -Multiple sexual 2 partnerships 3 4 1 -Low condom use -Transactional/sex for

favours -Low service Consensus utilisation Validation building meetings -Alcohol abuse meetings

Design phase one Key findings that Design phase two formed the basis for BCC strategy

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Rapid assessment

A rapid assessment was conducted among primary and secondary school teachers in Kampala and Kalangala districts. The assessment included a structured questionnaire and Focus Group

Discussions (FGDs). We also collected key Informant data from key stakeholders who influence the teachers.

Participants in the primary male teachers FGD Participants in the female primary and secondary teachers FGD

Key findings from the assessment

A total of 183 teachers were interviewed in Kampala and Kalangala districts. 98/183 (53.6%) were from Kampala, 114/183 (62.3%) were primary school teachers. Regarding marital status, sex and age, 71.6% were married, 53.0% were females and 63.4% were more than

30years old. With regard to education level, most of the primary school teachers were diploma holders while the secondary school teachers were mostly graduates. Generally both districts were well represented though the Kalangala had the smallest (20/69) number of secondary school teachers. In terms of sex distribution of the respondents by school category, there were 45 male respondents from primary school compared to 41 males from Page | 5

secondary schools. With regard to females, most female were from primary schools, a total number of 69 compared to 28 females from secondary schools. Most of the teachers from both primary and secondary schools were aged above 30years. The identified behaviours include;

Multiple sexual partners

Multiple sexual partnerships were defined as two or more partners in recent past or currently.

Whereas all respondents were asked what they think are the risky behaviours among teachers, only the sexually active were asked of the number of sexual partners in the recent past or currently. In this study, only 6.0% (11/183) reported not being sexually active. Respondents who were sexually active were asked about their sexual relationships and particularly number of sexual partners. Teachers aged below 30 years were found to be more likely to have two or more sexual partners compared to those who were 31 years and above (OR 2.64, CI 1.31-

5.34).

Limited condom use

Regarding condom use, all respondents were asked whether they think condom use would prevent one from HIV infection. It was revealed that teachers do think that condoms prevent

HIV infection. Of the respondents who reported multiple sexual partnerships currently or in the recent past, only 24% acknowledged having used a condom at their last sexual encounter although this was not statistically significant across all categories; age, sex and school category. However condom use varies with the type of partner and one was more likely not to use a condom if the partner is a consistent partner or a spouse. This was elaborated in the

FGDs.

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Knowledge of partners’ HIV status

Respondents were asked whether they knew their partners HIV status. Only 15/172 sexually active respondents, knew their partners‟ HIV status. Primary school teachers were less likely to involve with partners of unknown HIV status compared to secondary school teachers (OR

0.43, CI 0.19-0.97) and teachers aged below 30 years were also more likely to engage with partners of unknown HIV status compared to those above 30 years. However, most of the participants in the FGDs acknowledged that ignorance of partners‟ HIV status increases the risk of getting HIV.

Transactional sex/ sex for favours

Transactional sex, in this study defined as sexual acts that are performed in exchange for money, gifts, or transfer favours, promotional favours among others. Respondents were asked whether they think teachers engage in transactional sex and if they had ever given or received money or favours like transfer, promotion, or gifts in exchange for sex. Primary school teachers were less likely to have involved in transactional sex compared to secondary school teachers.

Alcohol use

Among primary school teachers, 64% reported taking alcohol and 45% of secondary teachers interviewed reported taking alcohol. The respondents were asked whether alcohol use impairs ones judgement and primary teachers were more likely to acknowledge that alcohol impaires one‟s judgement compared to secondary school teachers (OR 2.18, CI 1.14-4.21). In FGDs,

One participant said that

“Alcohol can increase one’s urge for sex, and after getting sober they may think of why they did it.” A participant in FGD of primary teachers aged 30 years and above.

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Another from an FGD composed of male primary teachers said; “you take a beer and then you want someone of the opposite sex besides you yet you wouldn’t have admired that person before.” In all FGDs the participants agreed that alcohol impairs ones sense of judgement and increases their sexual urge. However, it was indicated that many teachers engage in drinking alcohol.

Strategy design workshop Strategy development workshop We held a three day strategy development workshop with key stakeholders who included; teachers‟ representatives, Ministry of Health (MoH) representative, UAC representative, District Health

Educators and Ministry of Education and Sports

(MoES) representatives from key departments.

A teacher presenting during the workshop Final BCC strategy

We also had a validation meeting with the stakeholder and a committee was formed to finalise the strategy.

The expected overall impact of the strategy is, “to contribute to the reduction of new HIV infections Some of the participants in the strategy development workshop among teachers by 2016.” And the main communication objectives are;

4. Increase knowledge and personal perception of risk of HIV infection among teachers

through multi-dimensional communication campaigns.

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5. To increase the proportion of teachers who adhere and utilize HIV services (HCT and

ART)

6. Stimulate community dialogue on the basic facts of HIV and AIDS and the underlying

factors that contribute to the epidemic among teachers, such as risk behaviors and risk

settings related to structural factors like staff transfers.

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Appendix

BCC strategy

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FOREWORD

The HIV and AIDS epidemic continues to be a major development challenge world over. The impact of the epidemic has worsened the already existing challenges within the education sector and compromises the ability to provide desirable levels of quality education. The education and sports sector is experiencing an increase in staff attrition partly due to HIV and AIDS related factors, low morale, stigma and discrimination especially in schools and other learning institutions. This is fuelled by individual behavior since the infection is a result of human behavior. The sector acknowledges that teachers do engage in risky sexual behaviors such as multiple sexual partnerships, alcohol abuse and transactional sex among others that expose them to HIV infection. The Ministry of Education and Sports, in response to the above challenges has developed a behavior change communication strategy for teachers in Uganda. This strategy aims to reduce the spread and risk of acquiring HIV among teachers. The strategy also compliments the Education and Sports sector HIV prevention Strategic plan 2011-2015. In line with the Education and Sports sector HIV prevention Strategic plan 2011-2015, the behavior change communication strategy will strengthen the sector‟s response to HIV. The strategy will be used to guide the planning and development of messages and materials specific for teachers for HIV prevention. Finally, I take this opportunity to extend my gratitude to Ministry of Education and Sports, partners especially the SPEAR project that initiated the development of this strategy and for the continued efforts working with the ministry in the area of workplace HIV interventions. To all teachers, teachers are a major vehicle for imparting knowledge and skills of avoiding and/or coping with HIV, therefore risky behaviour should be fully mitigated and live by example.

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Acknowledgement The development of the Behaviour Change communication strategy for teachers has been a collaborative effort. The sector wishes to recognise the following organisations and individuals for their invaluable support;

The Supporting Public sector workplace Expand Action and Responses to HIV and AIDS-

SPEAR project ( a USAID/PEPFAR funded project) for initiating the development of this strategy and for the continuous support for the HIV workplace programmes with the Ministry of Education. We thank SPEAR staff, Mr. Erasmus Tanga the Chief of Party, Mr. Warrem

Blessing Tukwasibwe the Program manager, Mrs. Caroline Odongo Turyatemba

Communication and Prevention Specialist, Dr. Alfred Mubangizi care and treatment specialist, Dr. Joseph Lubwama the ICB specialist, Mr. George Luboobi the Policy specialist,

Mr. Wise Besigye the Finance and Administration Manager, Ms. Grace Nantale the

Accountant and the entire SPEAR field teams for supporting the entire process of developing this strategy.

Makerere University School of Public health CDC HIV/AIDS fellowship programme for the

Fellow attached to World Vision SPEAR project Ms. Lillian Ayebale who led the processes and development of this strategy. We are also grateful to the fellowship programme for funding Lillian to develop this Behaviour Change Communication strategy. We also thank the consultants that guided Lillian through the processes; Mr. Basil Tushabe from

Communication for Development Foundation Uganda (CDFU) and Mr. Michael Muyonga from Ministry of Health (MoH) not forgetting the fellow‟s mentors Dr. Lynn Atuyambe and

Associate Prof William Bazeyo from the School of Public Health.

The MOES HIV focal persons who supplemented to this strategy during the development process, the task team, the HIV and AIDS unit

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We are also grateful to the teachers who participated in the processes particularly the rapid assessment and the strategy development workshop.

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Definition of key terms

Behaviour Change Communication (BCC): An interactive process with communities to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community and societal behaviour change and maintain appropriate behaviours.

Behaviour Change Agent (BCA): Peer Educators

Opinion Leader: A person who has great influence over members of a target audience

(teachers).

Satisfied users/clients: People already practicing the desired behaviour who then can be utilized as a point of reference

Strategy: A coordinated and comprehensive plan for guiding multiple actions or activities that are aimed at reducing teachers‟ risky behaviours that put them to risk of HIV infection.

Stakeholder(s): A person or group with an interest in the outcome of the BCC strategy.

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Executive summary

Sports Sector Strategic Plan 2011-2015 acknowledges that Majority of teachers are in the sexually active age group and many, especially those that have just joined the service, are single; many are sexually experimenting with potential partners of unknown sero-status. It also acknowledges that teachers are involved in multiple sexual relations involving learners, fellow teachers, workers, communities and education managers for cash, promotion, favors relating to transfers etc, there is sexual harassment of learners, workers, teachers and subordinates and that nearly a fifth of teachers engaged in sex with non-regular partners do not use condoms (MoES 2011, MoFPED 2007, MoES 2006). It is also pointed out that many teachers and managers are engaged in alcohol consumption that exposes them to unplanned sex with non-regular partners leading to HIV infection (MoES 2011).

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level. We also collected key Informant data from key stakeholders who influence the teachers. The data collected supplemented the findings from literature reviewed.

We held a three day strategy development workshop with key stakeholders who included; teachers‟ representatives, Ministry of Health (MoH) representative, UAC representative,

We identified from the rapid assessment, the priority issues that the strategy hopes to address among teachers as,

 Multiple sexual partnerships

 Low condom use

 Transactional sex/ sex for favours

 Low service utilisation

 Alcohol abuse

The expected overall impact of the strategy is, “to contribute to the reduction of new HIV infections among teachers by 2016.” And the main communication objectives are;

7. Increase knowledge and personal perception of risk of HIV infection among teachers

through multi-dimensional communication campaigns.

8. To increase the proportion of teachers who adhere and utilize HIV services (HCT and

ART)

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9. Stimulate community dialogue on the basic facts of HIV and AIDS and the underlying

factors that contribute to the epidemic among teachers, such as risk behaviors and risk

settings related to structural factors like staff transfers.

The primary target audience is teachers, Tutors and Student teachers. The secondary target audience include Non teaching staff in primary and secondary schools, School administrators,

Principles and Education managers, Teacher training institutions, Parents and the community.

The strategy will utilise various channels and materials to reach out to the target audience.

These will include; Mass and print media and brail materials among others.

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1.0 BACKGROUND INFORMATION

1.1 HIV situation in Uganda

HIV and AIDS epidemic remains a big challenge globally. In Uganda, the country has a generalized mature heterogeneous epidemic with heterosexual contact as the ma in route of transmission. HIV and AIDS affect all population groups. It is estimated that about one million people are currently living with HIV while 130,000 new HIV infections occur per year. The results of the 2011 Uganda AIDS Indicator Survey (UAIS) indicate that 7.3% of adults age 15-49 years are living with HIV. The table below shows a summary of the current

HIV situation.

Table 1: Summary of current HIV situation in Uganda

Indicator Population December 20091

Number of people living Total 1,192,372 with HIV Adults 1,042,711

Women 606,154

Children < 15 years 149,661

People newly infected Total 124,261 with HIV Adults 67,163

Women 54,873

Children < 15 years 24,548

AIDS deaths Total 64,016

Source : 1 MoH, Estimation and projection group 2010

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According to the 2011 UAIS by geographical location, the Central region had 10.6%, North

Central (8.3%), and Mid western (8.2%) regions had the highest HIV prevalence rates. The lowest prevalence rates were in Mid Eastern region (4.1%) and West Nile (4.9%) regions.

Source: 2011 Uganda AIDS Indicator Survey (UAIS)

The cumulative number of deaths due to AIDS stands at 900,000 people, while an estimated

1,763,300 are orphans under 17 years6. The increase in reported numbers of people who are infected with HIV every year is evidence that there are still more new infections than AIDS related deaths; resulting into the burden of HIV continuing to grow.

6 Uganda Bureau of Statistics (UBOS) &Macro International Inc.(2007), Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA

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1.2 HIV Situation among teachers

Teachers in Uganda are regularly singled out as being a „high-risk group‟ with respect to

HIV/AIDS7,8. Teachers are particularly „prone‟ or vulnerable to HIV infection because the teaching profession is relatively young, which means that the large majority of teachers are in the highest HIV prevalence age cohorts. In addition, the teaching profession is female dominated, yet overall HIV prevalence rates among the adult population are generally significantly higher among females9.

Secondly, it is commonly suggested that teachers are more likely to engage in high-risk sexual behaviour compared to the rest of the adult population. This is mainly because they are relatively well off especially when posted in rural areas (compared to the local population), are frequently posted from one school to another, and in the case of male teachers, it is alleged that sizeable numbers have sexual relations with their students 10.

According to SPEAR baseline (2009), although teachers have high knowledge about the basic factors about HIV, they frequently engage in risky sexual practices. Evidence does not support that the high knowledge level had been translated into practice. At 14% of respondents reporting that they have engaged in multiple sexual partnerships in the preceding

12 months, 16% reporting sex with irregular sexual partners and only 33% of unmarried

7 World Vision, U. (2009). Access and Utilisation of HIV/AIDS Prevention, Care and Treatment services by public sector workers in the ministries of Local Government, Internal Affairs and Education and Sports. Unpublshed A baseline report. SPEAR. 8 MoES, Ministry of Education and Sports (2007). Combating HIV/AIDS in Uganda, Work place projects in Arua, Butaleja and Mpigi. 9 MoES, Ministry of Education and Sports (2011). Education and sports sector HIV prevention strategic plan 2011-2015 10 IDC. (2008). Assessment of the Impact of HIV/AIDS on the Education Sector in Uganda. Kampala: Ministry of Education and Sports.

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respondents reporting abstinence from sex, a big proportion of teachers can be considered to be at high risk of HIV infection. Moreover most of the sexual activities with irregular partners were not protected with consistent condom use (SPEAR Baseline2009). There is evidence of reported transaction sex among teachers at 1.6 percent (MoES 2007, ESWAPI

2005). Although there percentage reported transactional sex seems small, it is undesirable in the education sector especially among teachers.

These behaviours are attributed to relatively high social status and income, spouse separation/staying away from their spouses for long periods, lack of accommodation and alcohol use and abuse. Living away from the spouse for extended periods of time is a major contributor to casual sex with non-regular sexual partners, and having multiple partners.

1.3 Justification for BCC intervention for teachers

Teachers form a big proportion of public servants in Uganda. Previous studies show high risk sexual behaviours among them, yet currently there is no systematic communication strategy guiding the process of message and material development in the sector for behaviour change.

There is need to promote accurate individual knowledge and perception of risk and increase individual motivation to avoid risky behaviours as well as protect the rights of PHAs teachers. The design of an all round BCC strategy is ideal to address the current behaviours.

Other than HIV prevention among teachers, the strategy will aim to decrease the stigma associated with both HIV and sexuality, to promote open discussion and encourage access to treatment care and support for teachers.

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2.0 SHARED VISION, GOAL AND OBJECTIVES

2.1 Shared vision

A community of teachers free of new HIV infections and the infected receiving comprehensive HIV care.

2.2 Goal of the strategy

The goal of the strategy is to contribute to the reduction of new HIV infections among teachers by 2016.

2.3 Communication Strategy Objectives

1. Increase knowledge and personal perception of risk of HIV infection among teachers

through multi-dimensional communication campaigns.

2. Stimulate community dialogue on the basic facts of HIV and AIDS and the underlying

factors that contribute to the epidemic among teachers, such as risk behaviors and risk

settings related to structural factors like staff transfers.

3. To increase the proportion of teachers who adhere and utilise HIV services (HCT and

ART)

3.0 THEORETICAL FRAME WORK

In order to design and implement an effective communication strategy, theories and evidence have to be integrated. Communication as a process occurs over time. People select what they see, interpret and remember. Behaviour change theories help to explain the process through which individuals receive information, interpret it and react to different messages. How people see things shape what they know, what they know shapes what they believe and what Page | 5

they believe shapes how they act. Factors that influence behaviour change may include benefits of the new behaviour, the cost implication (both monetary and opportunity cost), opportunities that may arise from the new behaviour, individual self efficacy (belief that one can change and sustain the new behaviour), influence from the environment, behaviour of others in the community and availability of information and services.

Different theories of behaviour change informed this strategy although specifically, the strategy is based on two theories as highlighted in the next sections. The theory mix is an attempt to maximize guidance for factors that influence behaviour change:

3.1 Individual Behaviour Change theory

It has been argued that in most cases individuals are influenced by others in their social environments to change. However, an individual can also change behaviour without being influenced by others. The figure below describes the process through which individual behaviour change occurs. In addition, key interventions at the different stages are also provided.

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Figure 1: The individual behaviour change theory

An audience can be described as:

• Unaware: The audience doesn‟t know the problem or their personal risk

• Aware, Concerned, Knowledgeable: is aware of the problem and knowledgeable

about desired behaviour

• Motivated to Change: is in favour of the desired behaviour

• Tries new behaviour: practices the desired behaviour

• Sustains new Behaviour: practices the desired behaviour and advocates it to others

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Development and implementation of a communication intervention should determine at what stage the audience is. This will enable program implementers determine whether the audience needs knowledge or they have the knowledge but are not convinced about the need to change.

In addition, the assessment can establish some people already practicing the desired behavior who then can be utilized as a point of reference (such as “satisfied users/clients”). These can be good advocates for products or services.

The communication strategy for teachers will integrate aspects of peers who may act as

“satisfied users” since peer influence plays a critical role in shaping behaviour among teachers.

3.2. Social Learning Theory

This theory by Albert Bandura (1977), recognises the influence of external environmental factors on individuals. The interactions of the family, peers and the community are also responsible for shaping ones individual behaviour. Such influences have been manifested among the teachers who attribute risk behaviours to peer influence (alcohol groups etc), deployments away from their spouses, economic benefits resulting from sexual relationship.

This theory underscores the importance of creating an enabling environment to influence behaviour. For example when an individual attempts to take on new behaviour policies, services and the products to facilitate this change must be available and accessible.

4.0 BCC STRATEGY DEVELOPMENT PROCESS.

An assessment was made among teachers that included administering individual questionnaires with teachers in Kampala and Kalangala districts. The assessment also involved Focus Group Discussions (FGDs) with teachers grouped by age, sex and teaching level. We also collected key Informant data from key stakeholders who influence the teachers. The data collected supplemented the findings from literature reviewed. We held a Page | 8

three day strategy development workshop with key stakeholders who included; teachers from

Kampala and Kalangala, Ministry of Health (MoH) representative, UAC representative,

The Communication strategy development process also included presentation of a framework for strategy as below;

Priority Issues:

We identified from the rapid assessment, the priority issues that the strategy hopes to address among teachers as,

 Multiple sexual partnerships

 Low condom use

 Transactional sex

 Low service utilisation

 Alcohol abuse

Goal:

Expected overall impact of program activities is, “to contribute to the reduction of new HIV infections among teachers by 2016.”

Communication objective:

10. Increase knowledge and personal perception of risk of HIV infection among teachers

through multi-dimensional communication campaigns.

11. To increase the proportion of teachers who adhere and utilise HIV services (HCT and

ART)

Primary audience: Page | 9

 Teachers

Secondary audience:

 Non teaching staff in primary and secondary schools.

 Head teachers

 School administrators

 Principles and Education managers

 Teacher training institutions

 Parents and the community

5.0 Priority issues

5.1 Multiple sexual partnerships

Problem profile

Studies in multiple Sub-Saharan African countries have shown that married women increasingly have higher rates of HIV infection than sexually active unmarried women11.

Findings are associated with more regular sexual activity, decreased condom use, and the lack of the ability to abstain from sex once married, all exacerbated by women‟s increased biological susceptibility. A separate study in Uganda showed that men were twice as likely as women to bring HIV infection into a marriage through extra-marital sexual behaviour12.

Thus, married women are in a higher risk category for HIV infection. The modes of

Transmission Analysis study- MOTA found that, within the general population, the largest proportion (43%) of new infections occurs within “mutually monogamous” heterosexual couples. In this study, multiple sexual partnerships were significantly more common among men and women living away from their homes.

11 Clark, S. (2004). Early Marriage and HIV Risks in Sub-Saharan Africa. Studies in Family Planning, 35 149-160. 12 Carpenter, L. M., et al. (1999). Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero- status of the partners. AIDS 13(9), 1083-1089. Page | 10

Other studies by MoES have also suggested that multiple sexual partnerships are common among teachers involving learners, fellow teachers, workers, communities and education managers for cash, promotion, favors relating to transfers among others 13. The assessment revealed that 30% of teachers engage in multiple sexual partnerships.

Current behaviour

Teachers engage in extra marital sex and multiple sexual partnerships

Desired behaviour

i. Teachers have reduced extra marital affairs to prevent HIV infection.

ii. Married teachers remain faithful to each other

iii. Teachers who engage in extra-marital relationships and multiple sexual partnerships

use condoms correctly and consistently for HIV prevention.

Desired action response

i. Now that I have realized the dangers of extra marital sexual relationships and multiple

sexual partnerships, I am going to reduce the number of casual and regular

partners.

ii. Now that I know the dangers of engaging in multiple sexual partnerships, I am going

to remain faithful to my partner.

Behaviour Change Objective

To reduce the proportion of teachers who engage in multiple sexual relations from 30% to

15% by 2016.

Key messages

i. Faithfulness in marriage increases trust between partners and reduces risk of acquiring

HIV.

13 MoES, Ministry of Education and Sports (2011). Education and sports sector HIV prevention strategic plan 2011-2015.

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ii. Multiple sexual partnerships can increase the risk of HIV infection

iii. Condom use can reduce the risk of HIV infection in multiple sexual partnerships

iv. You cannot tell who is infected by HIV or has AIDS by simply looking at the person

v. Even if you are HIV positive, using condoms will help prolong your life

vi. Every sexual encounter that you have without condoms carries a risk of HIV

infection.

Key Promise

If you reduce the number of sexual partners, you will benefit by protecting yourself and your family from HIV infection.

Support points for the promise

 Engaging in multiple sexual relations exposes you to a higher risk of acquiring HIV

infection

 Research has shown that people involved in multiple sexual relationships and often

having unprotected sex are at higher risk of HIV Infection compared to the other

counter parts.

 Condoms are available in all health outlets free of charge.

 The government of Uganda and World Health Organisation (WHO) endorses the

ABC strategy in the fight against HIV

 The national prevention strategy and other national frameworks support reduction of

multiple sexual relationships

Competition for the message

Cultural belief that having more women makes you more of a man i.e. status symbol

Ways to minimize the competition

Sensitization of both male and female teachers about the risks involved in extra-marital, multiple sexual partnerships. Page | 12

Debilitating factors that the communication team should be aware of

i. Egoism: the belief, especially among men, that they can have more than one sexual

partners as opposed to women, who should stick to only one sexual partner

ii. Peer pressure: the pressure from fellow men to have more than one sexual partner at a

time.

i. Alcohol use that impairs ones judgement.

5.2 Low condom use

Problem profile

MoES studies among teachers reveal very low consistency in condom use with non-regular sexual partners14. However, teachers do believe that consistent and correct use of condoms is effective is preventing HIV transmission just as was the finding in this assessment. Low consistent condom use especially among teachers with non-regular sexual partners puts them at risk of HIV15. In the assessment condom use varied with the type of partner and one was mo re likely not to use a condom if the partner was a consistent partner or a spouse. The

SPEAR/RTI follow up study; Assessing Drivers of HIV Infection Among Targeted Public

Sector Workers in the Republic of Uganda16 revealed that, while the acceptability of condom use for single men and women was high at 73 percent and 71 percent respectively, it was low for married people. This finding is consistent with the rapid assessment.

Current behaviour

Teachers engage with non-regular sexual partners with limited condom use

Desired behaviour

14 MoES, Ministry of Education and Sports (2011). Education and sports sector HIV prevention strategic plan 2011-2015. 15 MoES, Ministry of Education and Sports (2007). Combating HIV/AIDS in Uganda, Work place projects in Arua, Butaleja and Mpigi 16 SPEAR/RTI. (2011). Assessing Drivers of HIV Infection Among Targeted Public Sector Workers in the Republic of Uganda Page | 13

Teachers who engage in extra-marital relationships and multiple sexual partnerships use condoms correctly and consistently for HIV prevention.

Desired action response

Now that I know the dangers of engaging in multiple sexual partnerships without a condom, I am going to correctly and consistently use a condom.

Behaviour Change Objective

To increase condom use among teachers engaged in multiple sexual partnerships from 24% to 50% teachers by 2016.

Key messages

i. Multiple sexual partnerships can increase the risk of HIV infection

ii. Condom use can reduce the risk of HIV infection in multiple sexual partnerships

iii. Stick to your marriage partner

iv. You cannot tell who is infected by HIV or has AIDS by simply looking at the person

v. Even if you are HIV positive, using condoms will help prolong your life

vi. Every sexual encounter that you have without condoms carries a risk of HIV

infection.

Key Promise

If you use a condom correctly and consistently you will benefit by protecting yourself and your family from HIV infection.

Support points for the promise

i. Engaging in multiple sexual relations without a using a condom exposes you to a

higher risk of acquiring HIV infection

ii. Correct and consistent condom use protects you from getting HIV.

iii. Sex with a condom is enjoyable

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iv. All the Condoms are tested for quality internationally and locally once they arrive in

the country before distribution.

v. Female condoms are also available, ask at a health facility

vi. Condoms are available in many places including, health facilities, drug shops, lodges,

gas stations, work places and bars.

Competition for the message

i. Misconceptions that condom use is a sign of promiscuity

ii. Desire for natural feeling

iii. Alcoholism

iv. Inconsistent condom use

v. Poor knowledge on correct condom use

Ways to minimize the competition

Sensitization of both male and female teachers about condom use.

Debilitating factors that the communication team should be aware of

i. Alcohol use that impairs ones judgement.

ii. Misconceptions that condom use is a sign of promiscuity

5.3 Transactional sex/ sex for favours

Problem profile

Studies have shown evidence of reported transaction sex among teachers 17. Although the percentage reported transactional sex seems small at 1.6 percent, it is said to be undesirable in the education sector especially among teachers. Transactional sex, defined as sexual acts that

17 MoES, Ministry of Education and Sports (2007). Combating HIV/AIDS in Uganda, Work place projects in Arua, Butaleja and Mpigi. Sekirime Wilberforce Kigongo, Jerome Tamale, , John C Lule, , Fred Wabwire-Mangen. (2001). Knowledge, attitude and practice about sexually transmitted diseases among University students in Kampala. African Health Sciences Vol 1(No 1). Page | 15

are performed in exchange for money, gifts, or transfer favours, promotional favours among others. According to the UDHS 2006, transactional sex accounted for 22% of new infections in Uganda in 200518. Teachers are often transferred and work away from their homes, move without their families, have poor housing facilities and above are poorly paid. It is urged that teachers therefore engage in transactional sex and sex for favours to achieve some of their desires.

Current behaviour

Teachers engage in transactional sex/sex for favours

Desired behaviour

i. Teachers do not engage in transactional sex.

ii. Teachers involved in transactional sex can negotiate for safe sex.

Desired action response

Now that I know the dangers transactional sex, I am going to stop this habit.

Behaviour Change Objective

To reduce the number of teachers engaged in transactional sex.

Key messages

Transactional sex can increase the risk of HIV infection

The Promise

If you stop the habit of transactional sex, you will avoid the risk of acquiring HIV.

Support points for the promise

Transactional sex among teachers is against their professional code of conduct.

Competition for the message

i. Low teachers‟ salaries

18 Uganda Bureau of Statistics (UBOS) &Macro International Inc.(2007), Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA Page | 16

ii. Desire for promotion and transfers

Ways to minimize the competition

Sensitization of both male and female teachers about the dangers of transactional sex.

Debilitating factors that the communication team should be aware of

Low teachers‟ salaries and the desire for transfers and promotions.

5.4 Low service utilisation

Problem profile

HIV counselling and testing is a very important entry point for ART. However, its been reported that uptake of HCT services is still very low in Uganda at 25%. Several factors have been cited contributing to this scenario. These include; fear of knowing ones sero status and related consequences such as loss of job, stigma, low risk perceptions, inadequate knowledge about the testing sites and benefits of HCT, myths and misconceptions related to HCT. The

ESWAPI baseline 2005 found out that 75% of teachers who have never tested but would like to test however, 90% of the respondents reported that they knew of a place where one could get HCT services.

According to the National ART strategy, health seeking behaviour for ART services is still poor. This has been attributed to limited information on the location of service sites and the

ART services provided. Other factors cited that limit adherence to ART include: Negative attitudes of service providers, Inadequate HIV/AIDS testing facilities, Fatigue of taking drugs for a long-time, Fear of Side effects of treatment and Stigma (Fear of being seen taking drugs.) According to ESWAPI baseline report, Reports from both service providers and the education departments indicated that access to ART is constraint due to fear of stigma (a qualitative finding).

Current behaviour Page | 17

Teachers do not seek HIV care services.

Teachers do not know their HIV status

Desired behaviour

Teachers seek for HIV prevention and care services from the available service providers.

Desired action response

i. Now that I know the benefit of HIV testing, I will take an HIV test to establish my

status.

ii. Now that I know that I am HIV positive, I am going to seek for care and support from

the nearest service provider.

Behaviour Change Objective

To increase the proportion of teachers seeking for HIV services.

Key messages

i. Knowing your HIV status reduces the risk of HIV infection

ii. Knowing your HIV status early, helps you get treatment early and live a good life.

iii. HCT tests are safe and accurate.

iv. Your HIV results remain confidential and health workers are trained to maintain

secrecy about your situation.

v. HCT is an entry point to care and treatment

Key Promise

i. If you seek for HIV services early and know your status, you can prevent yourself

from getting HIV.

ii. If you seek for HIV services early and find out that you are HIV positive, you can be

put on treatment and lead a healthy life.

Support points for the promise Page | 18

i. Most of the health facilities provide information on ART services

ii. Major government hospitals and most Health Centre IVs provide free ARVs while a

number of not for profit private health centres have ARVs at subsidised rates.

iii. Government in collaboration with partners is committed to scale up the ART

Programme through out the country

5.5 Alcohol abuse

Problem profile

Engaging in sex under the influence of alcohol can impair judgment, compromise power relations, and increase risky sexual behaviour. A study in South Africa found that alcohol use was associated with a greater number of sex partners, higher rates of unprotected intercourse and more frequent condom failures19. In Rakai district, south-western Uganda, Zablotska et al.20 found that alcohol use before sex was significantly associated with inconsistent condom use and multiple sexual partners in men and women. Another study of the relationship between alcohol use and safer sex among HIV-discordant couples in Rwanda and Zambia found that Rwandan and Zambian males who reported alcohol use in the year prior to enrollment were 1.5 and 1.7 times, respectively, as likely to have unprotected sex at least once in the three months following enrolment as their non-drinking counterparts3. There is also evidence that alcohol use increases the risk of physical, sexual and emotional violence in the home (Koenig et al. 2003)21. Battering of women –and in some instances men –has been linked to increased alcohol abuse in marital relationships. As battering and other forms of

19Coldiron ME, Stephenson R, Chomba E, Vwalika C, Karita K, et al. The relationship between alcohol consumption and unprotected sex among known HIV-discordant couples in Rwanda and Zambia. AIDS and Behavior 2008; 12: 594-603 20Zablotska IB, Gray RH, Serwadda D, Sewankambo NK, Lutalo T. Alcohol use before sex and HIV acquisition: A longitudinal study in Rakai, Uganda. AIDS 2006; 20:1191–1196. 21Koenig M, Lutalo T, Zhao F, Nalugoda F. Domestic violence in rural community -based study. Bull World Health Org 2003; 81: 53-60 Page | 19

physical and sexual violence increase in the home, the risk of HIV infection increases in equal measures.

Among teachers, many are also engaged in alcohol consumption that exposes them to unplanned sex with non-regular partners (MoES, 2011)22

Current behaviour

Teachers engage in sexual activity under the influence of alcohol.

Desired behaviour

Teachers have reduced alcohol abuse before sex to prevent risky sexual behaviours which lead HIV infection.

Desired action response

Now that I have realized the dangers of alcohol abuse before sex, I am going to reduce my intake of alcohol.

Behaviour Change Objective

To reduce the proportion of teachers who abuse alcohol 50% by 2016

Key messages

i. Alcohol use can impair judgment, compromise power relations, and increase risky

sexual behaviour which increase the risk of HIV infection

ii. Alcohol use increases the risk of physical, sexual and emotional violence in the homes

iii. You may not use a condom correctly when you take alcohol

iv. Alcohol impairs your sense of judgement

v. Alcohol reduces your personal risk perception

22 MoES, Ministry of Education and Sports (2011). Education and sports sector HIV prevention strategic plan 2011-2015.

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vi. Alcohol puts you at risk of multiple sexual partners

Key Promise

i. If you reduce alcohol use before sex, you will benefit by making correct sexual

judgment and protecting yourself and your family from HIV infection

ii. If you reduce alcohol consumption you will safe money to cater for other

development concerns

Support points for the promise

 Alcohol abuse exposes you to a higher risk of acquiring HIV infection

 Alcohol impairs judgement

Competition for the message

i. Some people feel that they can‟t spend a day without taking any alcoholic drink

ii. The belief among drinkers that alcohol gives them the courage to do things, e.g.

initiate a sexual relationship.

Ways to minimize the competition

Sensitization of teachers about the dangers of alcohol consumption before sex.

Debilitating factors that the communication team should be aware of

The belief that alcohol takes away people‟s problems.

6.0 Media, Materials and Channels

6.1 Radio spots

The radio spots on multiple sexual partnerships and condom use will be developed or even adopted. Partners like Uganda Health marketing group (UHMG) will be brought on board to spear head this campaign among teachers. Avenues for reaching to the furthest teacher will be explored.

6.2 Radio program Page | 21

Thirty minute radio talk shows of a magazine style will be developed. The programs will be broadcast once a week, on selected radio stations. The program will feature guest speakers, discussions, questions and answers. The guest speakers will include experts in the HIV field,

MoES officials in the HIV sector, TAAG members and other professionals. The programs will be pre-recorded.

6.3 Poster

A poster (A2, art paper) on HIV and one or more risk behaviour will be developed. A designer will be contracted and given a creative brief from which he/she will develop a concept. The concept will be reviewed by MoES and other stakeholders and drafts in English will be pre-tested among the intended audience. The final poster will be revised and finalized.

All schools will be availed with these HIV messages.

6.4 Leaflet

A leaflet with more or less similar information as the posters will be developed. These will be availed to teachers in all schools.

6.5 Training

There are special skills which would need to be enhanced and a focus would be trainers o f trainers in Peer Education called Behaviour Change Agents-BCAs. Efforts will be made to identify training needs especially of communication nature which would be addressed.

6.6 Community Education by BCAs

Some materials will be developed to aid Behaviour Change Agents-BCAs as they conduct small group sessions. A flip chart will be developed for the BCAs and packaged with different messages and a manual.

6.7 Entertainment Education

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It has been observed that people learn best when the education sessions are accompanied with entertainment. Specifically, Music Dance and Drama (MDD) plus film-shows with key messages on HIV and AIDS will be developed for the key target audiences.

6.8 Staff meeting

Teachers have regular staff meetings and these are a great opportunity for passing on behaviour change messages. Specific messages will be designed for a peer educator to communicate to teachers on HIV during such meetings.

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7.0 BCC strategy Implementation matrix Behaviour Change Activities /Strategies Output Target Audience Channels Responsible Time Frequency Objectives Persons/Office Frame

ISSUE 1: MULTIPLE SEXUAL PARTNERSHIP

To reduce the proportion a) Trainings(workshops & a)Number of training Teachers, Tutors, Peer MOES & Dev. Years - Quarterly of teachers who engage seminars) workshops /seminars Lectures Student Educators Partners 2012-2016 in multiple sexual carried out teachers (BCA); relations from 30%-15% b)Number of teachers trained Mass and print media

b) Radio Talk shows c) Number of talk Teachers, Tutors, Mass media MOES & Dev. 2012-2016 Quarterly shows held Lectures Student Partners teachers

c) Prevention services e.g Number of teachers Teachers, Tutors, Mass media, MOES & Dev. 2012/2016 Continuous Condom Provision/SMC accessing prevention Lectures Student Dispensers, Partners services e.g. condoms, teachers peers SMC,P MTCT

d) Procure & distribute Number of IEC Teachers, Tutors, Peers MOES & Dev. 2012/2016 Quarterly IEC(Posters, leaflets& materials procured and Lectures Student Partners brochures) distributed teachers

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ISSUE 2: LOW CONDOM USE

To increase condom use a) Condom Campaign; Number of campaigns Teachers, Tutors, a) Mass and MOES & Dev. 2012/2016 Biannually among teachers from held Lectures Student print media Partners 24% to 50% teachers b) brail materials c) Expert talks

b) ABC strategy Talks number of talks held Teachers, Tutors, a) Mass and MOES & Dev. 2012/2016 Quarterly with teachers Lectures Student print media Partners teachers and brail materials b) Expert talks

c) Sensitize teachers on Teachers sensitised on Teachers, Tutors, a) Mass and MOES & Dev. 2012/2016 Monthly proper and consistent proper and consistent Lectures Student print media Partners condom use condom use teachers and brail materials b) Expert talks

ISSUE 3: TRANSACTIONAL SEX/SEX FOR FAVOURS

To reduce the number of a) Create Partnerships with Number of partners Teachers, Tutors, a) Mass and MOES and Dev 2012/2016 Annually teachers who engage in other stakeholders e.g. broad on board Lecturers, and print media partners transactional sex from UHMG, PACE students teachers and brail 1.6%-Zero CDFU(Communication for materials Developments Foundation b) Expert Uganda ) talks

b) Sensitize teachers on the Number of teachers Teachers, tutors, a) Mass and MOES and Dev 2012/2016 Monthly dangers of transactional lecturers and print media

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sex sensitized student teachers and brail partners materials b) Expert talks

c)Disseminate the Number of Teachers, tutors a) Mass and MOES and Dev 2012/2016 Annually Teachers' Professional dissemination Lecturer and print media partners Code of Conduct and workshops carried out student teachers and brail Workplace policy materials b) Expert talks

ISSUE 4: LOW SERVICE UTLIZATION

Increase the proportion a) HCT outreaches Number of out reached Teachers and Mass media MOES and Dev 2012/2016 Quarterly of teachers seeking for surrounding partners HIV services community

b) Sensitize teachers on Number of teachers Teachers, TAAG Mass media MOES and Dev 2012/2016 Quarterly SMC,ART & PMTCT sensitized and community partners

c) PHLIV giving expert Number of expert TAAG Expert talks Dev partners, 2012/2016 Quarterly client talks client talks made TAAG

d) Publicize HIV services Documented service Dev partners Documentati Dev partners 2012/2016 Once providers providers on

e) Partner with other Number of partnerships Dev partners Dev partners 2012/2016 Continuous service providers for wrap made around services

ISSUE: 5 ALCOHOL ABUSE

To reduce the proportion a)Sensitize teachers on Number of teachers Teachers, tutors, Mass media MOES and dev 2012/2016 Quarterly of teachers who abuse dangers of Alcohol abuse sensitised lecturers and and expert partners

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alcohol student teachers talks

b)Disseminate the Number of Teachers, tutors a) Mass and MOES and Dev 2012/2016 Annually Teachers' Professional dissemination Lecturer and print media partners Code of Conduct and workshops carried out student teachers and brail Workplace policy materials b) Expert talks

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8.0 MONITORING AND EVALUATION PLAN

Narrative Improvement target Indicator Means of Frequency Responsible Deliverables Assumptions Summary Verification of data Officer/Organi collection & zation analysis Target Audience: Teachers, tutors, student teachers Issue 1: Multiple sexual partnerships Desired i. Reduce multiple Percentage reduction -Surveys Mid-term & -MoES HIV AIDS Survey report Outcome sexual partnerships in reported multiple -Progress reports end-of-term unit (Reduced among teachers from sexual partnerships -Peer educators‟ evaluation multiple sexual 30% to 15% by 2016 records partnerships among teachers) Communicatio i. Increase awareness -Percentage of Monitoring Quarterly MoES Monitoring n Objective] about the risks teachers who know the reports Reports involved in extra risks involved in extra marital and multiple marital and multiple sexual partnerships. sexual partnerships

ii. To increase the -Percentage of motivation for teachers who report teachers to use condom use with an condoms whenever irregular partner they engage in with irregular partners

Desired Increase percentage of -Number of materials Activity reports Baseline, MoES Progress reports Outputs teachers who have and messages quarterly data Partners received messages on produced collection multiple sexual -Number of drama and partnerships & risk of radio shows staged HIV infection -Number of peers trained Issue 2: Low condom use Page | 28

Narrative Improvement target Indicator Means of Frequency Responsible Deliverables Assumptions Summary Verification of data Officer/Organi collection & zation analysis Desired Increased proportion of Percentage increase in -surveys Baseline, mid- MoES Evaluation Outcome teachers who state that the proportion of -Progress reports term and end- Partners reports [Teachers use they use condoms teachers who state that term evaluation condoms consistently and correctly they correctly and surveys correctly and from 24% to 50% by consistently use consistently for 2016 condoms. HIV prevention] Communicatio To increase the Percentage increase in -Review reports Baseline, mid- MoES Report n Objective motivation for teachers the number of teachers term and end- to use condoms who use condoms term evaluation whenever they engage in whenever they engage with non regular with non regular partners. partners

Desired Increase the number of -Number of materials -Activity reports Baseline, and MoES Progress reports Output teachers who have and messages -Peer education then quarterly received messages about produced records data collection correct and consistency -Number of radio condom use talk-shows/spots aired -Number of peer educators trained Issue 3: Transactional sex/ sex for favours Desired i. Reduce the Percentage of teachers Survey Baseline, MoES Evaluation Outcome number of involved in midterm and reports teachers transactional sex/sex end of term [Teachers do involved in for favours surveys not engage in transactional sex transactional form 1.6% to 0% by 2016 sex] ii. Increase the Percentage of teachers Surveys Baseline, MoES Survey reports percentage of still involved in Reports midterm and teachers transactional sex but end of term

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Narrative Improvement target Indicator Means of Frequency Responsible Deliverables Assumptions Summary Verification of data Officer/Organi collection & zation analysis involved in can negotiate for safe surveys transactional sex sex. who can carefully negotiate risk Communicati To increase the Percentage of teachers -surveys Quarterly MoES Survey reports on Objective motivation for teachers to abandoning use alternative ways to transactional sex for improve on their well alternative ways to being other than improve their being transactional sex Desired Number of teachers who -Number of materials Reports Quarterly MoES Progress reports Output report to have abandoned and messages Partners like, transactional sex produced Uganda Health - -Number of radio Marketing Group talk-shows/spots aired -Number of peer educators trained Issue 4: Low service utilisation Desired Increase the proportion of Proportion of teachers Service provider Baseline, mid- -MoES Reports Assuming Outcome teachers who seek for who go for HCT, ART centres term and end- -AIC teachers are [Teachers seek HIV prevention, care and PMTCT SMC term evaluation -Other testing willing to take up for HIV treatment services from Records for HCT centers in Uganda the services like prevention and the available service facilities SMC care services providers from the available service providers] Communicati To increase the number of Proportion of teachers surveys Baseline, mid- MoES Reports on Objective teachers seeking for HIV who seek for the term and end- -AIC prevention, care and services term evaluation -Other testing treatment services from centers in Uganda the available service Page | 30

Narrative Improvement target Indicator Means of Frequency Responsible Deliverables Assumptions Summary Verification of data Officer/Organi collection & zation analysis providers. Desired Increase in number of -Number of materials surveys Baseline, then -HCT centres Reports Output teachers who seek for and messages quarterly data HIV prevention, care and produced collection treatment services from -Number of radio the available service talk-shows/spots aired centres -Number of expert talks Issue 5: Alcohol abuse Desired Reduce the proportion of Reduction in the surveys Baseline, mid- -MoES Reports Teachers are Outcome teachers who drink proportion of teachers term and end- -MoH willing to stop [Reduction in alcohol before sex by who drink alcohol term evaluation -All health-related taking alcohol proportion of 50% by 2016 before sex NGOs before sex teachers that -All health drink alcohol communication- before sex] related NGOs Communicati Increase awareness about Proportion of teachers -KAPB surveys Baseline, mid- -MoEs, MoH Reports on Objective the dangers involved in who have got the term and end- -All health-related drinking alcohol before knowledge about the term evaluation NGOs sex dangers involved in -All health drinking alcohol communication- before sex related NGOs Desired Increase number of -Number of materials -KAPB surveys Baseline, mid- -MoEs, MoH Reports Output teachers who have got and messages term and end- -All health-related correct messages about produced term evaluation NGOs the risks involved in -Number of meetings -All health drinking alcohol before held with teachers communication- sex -Number of radio talk- related NGOs shows/spots aired

Page | 31

Appendix

Participants in the BCC strategy development workshop

Name Place of work Designation

1. Florence Sembatya Musinguzi MoES PEO/PS

2. Naluzze H.S Jesca MoES SPO/HRD

3. Micheal Muyonga MoH B/S

4. Namulondo Joyce Kadowe UAC

5. Tabuzibwa Micheal KCCA Health Educator

6. Adyanget Nelson Kololo high school Teacher

7. Kyabukasa Lubega Joseph Kibanga-Kalangala Centre Coordinating Tutor

8. Tumwiine Daphrosa Nakasero Primary School Teacher

9. Achieng Susan Nakasero Primary school Teacher

10. Mulindwa Sahu Bat valley primary school Teacher

11. Mabaale Florence Bat Valley Primary school Teacher

12. Katongole Mariat Kibuli Demonstration School Teacher

13. Namakula Amina Kibuli Demonstration School Teacher

14. Badru H Segujja Kibuli secondary school Teacher

15. Namutebi Josephine Bbeta Primary school-Kalangala Head teacher

16. Tusuubira David Kibanga Primary School-Kalangala Head teacher

17. Leticia Anyokot Oidu Mengo Senior School Teacher

18. Kenneth Lukwago Makerere College School Teacher

19. Gulaale Paul Munyonyo Primary school Head Teacher

20. Kaboyo Frank Nateete Mackay Primary school Teacher

21. Anguzu Charles Kololo Senior Secondary School Teacher

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