Final Report of HIV/AIDS Prevention Project for Matara District
Back Ground of the project
Sri Lanka is an Island situated in the Indian Ocean and its population is nearly 20.2 million. Around 33% of this population is fairly young, in the age group below 24 yrs. Though the per capita income of the country is far below the level of developed countries in the world, its health indices such as IMR (Infant Mortality Rate), and MMR (Maternal Mortality Rate)are much higher than those of most countries.
This was achieved by providing free education and free health services to the people by the subsequent governments of post independent Sri Lanka. Sri Lanka was able to reduce the occurrence of some of the communicable diseases such as Malaria, Leprosy, Filarial diarrhea and of course Polio, but problem of STD is still not under control. The problem had been aggravated by the occurrence of HIV/AIDS in the country since 1986.The 1st infected person was a foreigner, but in 1987 first native person infected with the disease was found.. Since then the number of infected person were gradually increased year by year. According to the most recent data (up to 31st December 2009) issued by the NHAPP/Sri Lanka number infected is 1169.
HIV 1161 AIDS 302 Deaths 197 Children with Aids 41
According to the UNAIDS, estimated number of people living with HIV in the country is around 4000. However the incidence of other STD is much higher as shown in the table.
Disease 0-14years 15-19years 20-24years
Syphilis 07 08 56 Gonorrhea 15 23 146 NGU 14 98 268 Herpes 12 121 419 G.Warts 04 79 261 Candidiasis 50 172 433 Tricomonasis 03 09 34
Total 102 510 1623
Fighting HIV/AIDS is one of the biggest challenges faced by the world today. Sri Lanka being a low prevalent country our national target is to maintain the low prevalence at least as it is. Though targeting preventive activities to the high risk groups is a priority, youth being fast growing dynamic population with vulnerable behaviors, programs to target youth is equally important. Development of knowledge, skills and attitudes towards healthy sexual wellbeing among school children is the foundation to prevent HIV/AIDS among youth.
The Sri Lankan population comprises of 3.7 million (19.7%) adolescents (10 – 19 yrs). Of them 56.2% receive an education beyond secondary level. In spite of introducing HIV/AIDS prevention to school curriculum, through Health and Physical education streams, according to the national survey conducted by the UNICEF in 2004 still the knowledge on HIV/AIDS among school children is low.
Social and cultural norms are changing. The capacity of parents and teachers to have an owl’s eye on the child is impractical with the present day to day activities. Therefore adolescents are left out to tackle their own challenges.
Considering all these factors mere scientific facts alone will not prevent HIV/AIDS among school children. It needs a skill based education with positive attitudes that empowers them to face the challenges of adolescence. Identifying this deeply felt need INDECOS prepared the current project proposal exclusively for young students in schools of the district.
With the prevailing social and cultural pressure against incorporation of sexual health to school curriculum, this objective should be achieved by a stepwise process. A well developed and pretested communication strategy is the corner stone of success in this process.
To promote a healthy sexual life style among school children, the commitment of a wide range of people this includes school community, educational officers, politicians, parents, religious leaders and opinion leaders is needed.
Most of the new recruits to armed forces also are in similar situation .They are just out of school and their knowledge on reproductive health and STD/AIDS is not different from that of students in higher grades of schools.
This project “stop aids through behavior change” on “Communication Strategies to prevent HIV/AIDS among school children and newly recruited youth in the navy” has identified this and clearly states the means and methodologies to fulfill this objective and ways to monitor and evaluate the outcome. I hope that this will open the doorway to prevent HIV/AIDS among school children and youth through the development of behavior change. Sri Lanka is situated in the Indian Ocean and closer to India, Were 6 million people are infected with HIV/AIDS
Map showing the number of schools comes under the project in every divisional secretery divisions of the district.
Project
STD/HIV/AIDS Prevention Projecr for Matara District
Project Period March 2008-March 2010
Goal
Reduction of spread of STD/HIV/AIDS among ,vulnarable youth and students in the district of Matara
Objectives
1. To increase knowledge of 2000 students in higher grades of selected 50 schools on reproductive health and STD/AIDS in the district of Matara within two years.
2. To increase knowledge of 1200 police officers of Matara district on STD/AIDS within two years period(This was ammended to include 3000 youths in Naval Training School)
3. To prepare ,print and distribute appropriate health education materils among students and teachers of the district selected for the training.
4. To train 50 peer leaders as ambassoders for the prevention of STD/AIDS among students and youth of the district wit hin two year period.
5. To train 40 techers from selected school as master techers to continue training programs among students in selected schools of the district.
Target Groups
1.Students in Grade 10 of schools and Higher education establishments - 2000
2.Police officers - 1200
3. Navy recruits and officers - 3000
4. school leavers-youth - 50
5.School teachers - 40 Major Activities
1. Recruitment of staff 2. Formation of steering committee 3. Preparation of health education materials 4. Preparation of training curricula 5. Selection of target schools & police stations 6. Advocacy for Head of department s and institutions 7. Preparation of training schedule for Police officers & students 8. Conduction of training programs for 2000students and 600 police officers 9. Training of 40 teachers from selected schools as trainers 10. Training of 3000 recruits and officers of the Naval training school 11. Training of student – school leavers as peer leaders to promote activities among Colleagues.
1. Staff
At the beginning following persons had been selected to the staff of the project’
1. Mr. Conrad Ranawake - Director 2 . Dr. P. Ekanayake MD. - Health Advisor 3 .Ms. M. N. Raseela Shamin - Project coordinator 4. Ms. K. Swarna Shanthini - Field coordinator
Recourse Persons for training programs
1. Dr. S. W. Pathinayake MBBS.MSC. Former PDHS/SP 2. Dr. P. Ekanayake - MD. Former director/General Hospital Matara 3. Dr. Sanath de Silva - MBBS. MSC. District Director Health services /Matara 4. Mr. Conrad Ranawake BA (special in Sociology) 5. Ms. Sripali Thilakawardena BA staff teacher MR/Kotapola M. V.
2. Steering Committee
Steering Committee consisting following distinguished people from the area and government departments was formed for decision making and the supervision of the project.
1. Dr. S.W. Pathinayake - Chairman - Steering Committee Former Provincial Director of Health
Mr. S. K. Chandra soma - Chairman INDECOS Former GA Matara Provincial commissioner of Sri Lanka Police Commission / SP
2. Mr. Gamini Jayasekera - Retired District Secretary Matara & Advisor to H.E. the President
3. Dr. P. Ekanayake - Secretary, Steering Committee Former Director Matara General Hospital
4. Mr. P.B.P. Ayupala - Senior Superintendent of Police (SSP) Matara
6. Mrs. Pushpa Ekanayake - Senior Lecturer – Dept. of Sociology University of Ruhuna, Matara.
7. Dr. Sanath De Silva - District Director of Health Services – Matara
8. Mrs. Nandawathi Wijesinghe - Additional Provincial Director of Education Southern Province
9. Mr. L.C.K. Pathirana - Manager, Commercial Bank – Matara
10.Mr. W.R. Weerakoon - Zonal Director of Education, Matara
11. Mrs. I.H.L. Padmini - Staff Teacher MR. Palatuwa M.V. Asst. commissioner Girls, guides SP
12. Mrs. Sripali Thilakawardana - Staff Teacher MR. Kotapola M. V.
Objective of the formation of this steering committee was to get expert guidance to carry out the project in the district and also to do the monitoring and evaluation. In the first meeting Dr. S.W. Pathinayake and Dr. P. Ekanayake were appointed as president and the secretary of the committee respectively. During the project period steering committee had four meetings. One of the meetings was attended by the President of SFCSL Mrs. Christina and in that meeting it was decided to amend the target group by including youth in the Naval Training School, instead of Police officers.
Steering Committee Meeting
Preparation of Health Education Materials
One of the objectives of the project was to prepare suitable health education materials with updated information on the subject of STD/AIDS for schools. This was done by a panel of experts including representatives from department of health and the department of education there were two different brochures produced in the local language of Sinhala, on Sexually transmitted diseases including HIV/AIDS and Use of Condom. Colorful flip charts with basic information of the subject & consisting 14 pages was prepared and distributed among teachers.
1. Sexually transmitted diseases including HIV/AIDS - 7000 copies 2. Condom Use - 2000 copies 3. Banners (Police Training & School Training) - 02 4. Handouts on 5. Flip chart - 40
Brochure – 01 STD/HIV/AIDS Brochure – 02 Condoms Flip Chart
Banner for Program for Police of Banner for Program Students
Folder Cover Folder Cover Folder Cover
Training Programs for Security Forces
Program for Police officers in the District
Before commencing the programs an Advocacy meeting for Senior Police Officers was held to create awareness among them and to get their support for the project. It was held at the LHK reception hall on 5th September 2008. In this program we were able to create awareness among Senior Police Officers of the district, and to draw a plan for training of 1200 Police Officers from 14 Police Stations in the Matara district during the project period
Number of Participants
1. OIC Police station - 14 2. Assistant Superintendents of Police - 03 3. Superintendents of police - 01 4. Community development officers of police stations - 08 5. Woman police officers - 06
A decision was taken to have three training centers, (clusters) in the district for convenience of the participants-police officers, as it is impossible to gather all of the Police Officers for training in a single day in one place. Accordingly, training sessions for Police Officers were conducted as follows
Training Centers for Police Officers
1. MCC – Matara Children Center
2. Kamburupitiya MOH Office
3. Morawaka Police station
The above photo shows the Advocacy Program for Senior Police Officers held on 05.09.2008 at the LHK Reception Hall
Training for Police Officers
Training programs for police officers were conducted in three centers as shown in the following table 331 officers have been trained so far (Male 214 and female 117) At the beginning of each session a pretest had been conducted to assess the current knowledge on the subject and the result is shown in the table below.
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1. Knowledge on Reproductive Health 25%
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2. Knowledge on STD 30% [[
3. Knowledge on HIV/AIDS 22%
4. Knowledge on Attitudes towards STD 44%
During the pre test, it was revealed that 60% of the participants have poor knowledge on STD while 78% have poor knowledge on /HIV/AIDS and 56 % have poor knowledge on attitudes and behaviors towards these diseases.
Accordingly content of the training programs were designed including following topics
1. Sexual behavior – high risk – low risk behaviors – sex offences 2. STI/HIV/AIDS diseases – spread, symptoms, investigations, treatments and
prevention
3. Use of Condoms ( Male & female)
4. Role of law enforcement officers in prevention of STD/HIV/AIDS
Training Programs for Police Officers – 2008 & 2009
Though it had been planned to train 1200 police officers attached to 14 police stations, we were able to trained only 331 officers during the project period of two years. This was completely due to the lack of interest shown by the senior officers of the district and the uncertain security situation of the country demanding frequent mobilization of them with short notification.
Training programs for police officers are in progress………….
Advocacy Program for Senior Officers of the Education Department in the District
This meeting was conducted at the Samanmal Reception Hall Matara on 23rd September 2008 with the participation of 37 senior officers including 4 zonal directors of the district education department. At the end of the meeting we were able to increase awareness among senior education officers on STD/HIV/AIDS and drew their attention on the importance of giving knowledge on Reproductive health including STD/STI to the young school children and to draw a plan for training programs in schools.
All participants agreed on the importance of conducting such training programs for students in their schools. It was decided to start training program as soon as possible, before beginning the school tests and the vacation. 50 schools had been identified for training program to be conducted. The all participant agreed to conduct training program for students in grade 10 of the school. The number of students per session will be 40. Accordingly schedule for training was prepared at the end of the meeting
Below is a scene of the Advocacy Program for Senior Education Officers held on 23.09.2008 at Samanmal Reception Hall.
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Training program for students in Grade 10 of selected school in the Matara district
Before starting training sessions in schools knowledge of the students on following issues had been evaluated by doing a pre-test using questioner consisting of 20 questions, on
i. Reproductive health ii. STD/HIV/AIDS and iii. Attitude & behaviors towards STD/ HIV/AIDS. All together 2438 students were subjected to pre test and the result received is shown in the table below
Current knowledge of school children had been evaluated by conducting Pre -test with a questionnaire consisting 20 statements on following issues:
1. Knowledge on Reproductive Health 54%
2. Knowledge on STD 25%
3. Knowledge on HIV/AIDS 30%
4. Knowledge on Attitudes towards prevention of STD 42%
The results of pre-tests show that the knowledge among students on the subject is clearly not satisfactory.
Total Training Programs for School Children 51 Total Number of Participants 2438
Out of 50 schools that we planned to cover we were able to cover 48 schools only, as two of those were unable to find suitable time for the training. But we conducted 51 programs in 48 schools. As we decided in the steering committee meeting we conducted 5 programs in one school, namely Palatuwa Gunarathana M. V. where we had another project “Star for Life “for students above grade 6. Other than those we conducted two training sessions in Weligama Siddhrtha M. V. Deniyaya Central College and in Mahamaya College Matara respectively.
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Above shows some training sessions in schools
Training of peer leaders – Members of children’s clubs
Peer leaders were selected from children’s clubs of the selected areas and trained them as Ambassadors for propagating the message on STD/HIV/AIDS among local youth. They were provided with necessary education materials.
Training program for University students:
As decided by the steering committee training program for university students was conducted on 25th November 2008 at the Department of Sociology of the Ruhunu University No of participants 46 mostly from the same department and some from the department of geography. At the pre test conducted before sessions it was revealed that the knowledge on reproductive issues and HIV/AIDS are very low. (31.1% & 21%) among this group of students. Another program of awareness for 177 students in the first year of Faculty of Science/RU was conducted at the request of Senior Lecturer and the Executive member of INDECOS Ms. Kumudu Silva. Accordingly we were able to train 200 University students without any additional cost to the project.
Training program for Navy personnel at the Naval Training school:
INDECOS carried out awareness program for trainees on STD/HIV/AIDS in this naval school during last couple of years. It was highly appreciated by the authorities. A request had been done by the Commandant of Sothern Naval Command and the officer in charge of the naval training school recently, for commencement of such trainings for new recruits about 1000 youths. As this is a very vulnerable group of youth, steering committee decided to request donor agency for the inclusion of them in to the target group of the current project. In the 4th meeting of the steering committee in the presence of the President of SFCSL Ms. Christina Riddeback it was decided to include them as a target group.
Two days Training Workshop (TOT) on STI, HIV/AIDS for Teachers
“Ensuring accelerated in-service and pre-service teacher training is necessary to increase the capacity and confidence of teachers to undertake skills-based learning approaches on such topics as SRH, HIV and STIs. The Ministry of Education with support from the MOH should identify and train one or two teachers in each secondary school to become subject matter experts on SRH, HIV and STIs. Reinforcement should be undertaken through the development of age specific, user-friendly supplementary reading materials. Specific sessions should be organized for young people after they leave school. Integration of information on HIV and core skills, along with SRH, into professional training programs and tertiary-level education for young people should be considered.” (Review of the national response to STIs and HIV/AIDS in Sri Lanka)
One of the objectives of the project was to train 40 master teachers from selected schools to continue reproductive health and education on STD/AIDS in their respective schools. The workshop was designed with the help of an eminent health educationist in the country, Mr. K. D. C. Perera so as to give them through knowledge on STD/AIDS and the methodology to impart this knowledge to their students. The workshop was conducted with lectures, group works, brainstorming and video presentations. Out of 40 participants 39 attended this 2day workshop they were from all corners of the district representing 39 schools. At the beginning of this workshop, two zonal directors of education department expressed their satisfaction of the project for students. According to them this is the most successful project conducted in schools on the subject during recent past. Hence they thanked our sponsors in Sweden, Forum Syd, and SFCSL for the generous contribution. All the participants’ attendant the workshop for full two days showing their enthusiasm and interest for the subject. A colorful flip chart on STD/AIDS was specially designed and printed for the workshop and distributed among teachers to be used for school programs Some other education materials ,such as games on HIV/AIDS awareness, Snake & Ladders, House of Aids were introduced to them for group work among students The workshop was a highly successful , and at the end of ,all the participants expressed that they had never attended such a well organized and fruitful workshop ,throughout their services as teachers. Each and every participant received a valid certificate signed by the President of INDECOS and the District Director of Health Services
Monitoring & evaluation of the Project
1. Program for students
Monitoring of the school program was done, by visiting schools, getting report from teachers and principals, discussion with supervising officers of the department of education .Most of the student who’ sat for GCE (O) level exam for the subject of health stated that they were able to answer questions on Reproductive health, ST/AIDS very easily becau.sre they got a thorough knowledge on the subject by participating our school programs.
We expected to visit all the school where we had training programs for students and teachers to observe the outcome of the same. Already we have visited following two schools and observed the way the teachers’ conduct similar programs among students using health education materials and specially the flip chart introduced by us. We expect to visit other schools as well in the 1st term of the schools. MR/ Malimbada Sri Sumedha M.V. MR/ Hallala M.V.
2. Program for Navy recruits and officers
After awareness programs the number of persons doing inquiries about their suspicions of having STD was increased. During the project period more than 15 persons were referred for investigation in the STD/AIDS clinic of government hospitals. Common conditions were Genital warts, gonorrhea and herpes. This is a very remarkable achievement of the training program for naval officers. The inquiries were received from faraway places like Punani, and Anuradapura as the massage had been conveyed by the participants to their brother officers throughout the country.
What they say…………….
Mrs. Nandawathi Wijesinghe, Former Deputy Provincial Director of Education.
I was able to attend nearly ten educational programs on STI, HIV/AIDS conducted in schools in various part of the district.
I was fully impressed with the programs which were conducted by well experienced experts of the subject in very efficient and effective way. Seminars were well designed to educated young students in the school setup,
on issues of reproductive health and STD
Greshan Kumburage, Public Relationship Officer (PRO), Morawake, Police Station
I coordinated five training programs
which were held at Morawake Police
Station. Since police officers have to deal
with vulnerable people including sex
workers, the knowledge gained in the
trainings were very useful
for them to perform their duty efficiently
G.N.H.K. Sarath, Chief Instructor Navy Training Camp Boossa, Galle. Most of the new recruits to SLNF send for the training in the Naval Training school are very young and just out of school. They have very poor knowledge on STD/ HIV/AIDS. Hence there is enough opportunity for them, getting those dreadful diseases during their stay in the service as sailors and officers in areas where the STD are very common. The
project implemented by INDECOS to educate these groups of youth of the Navy was a tremendous success. They had conducted more than 24 training sessions on the subject and trained nearly 3000 navy recruits and officers. I am not aware in the history of our training school any other education program so well received by almost all of participants. Personal attention given to people having some issues pertaining to the subject was very encouraging. Three medical Doctors and trainers did a Marvelous job to educate them on sexually transmitted diseases including HIV/AIDS. I was privileged to observe majority of these programs, and I wish to have your cooperation to educated future recruits as well.
K.P Rasanjali Dilhani, Grade 13 – MR/ Sujatha Balika M.V.
As most of the youth in the country we were very ignorant of the facts about STD, HIV/AIDS. Even our knowledge on reproductive health was very poor. As a result of the training program conducted by INDECOS in our school now we know how to protect ourselves from these diseases. I treat this program as an important and valuable for the school children.
World AIDS day 1st December
As planned earlier we successfully participated in celebrating world AIDS day in 2008 and in 2009 in the district
World Aids Day 1st December 2008 It was held in Matara with the leadership of the District director of Health services Matara .INDECOS initiated the organizing of the event. Most of the NGO including Sri Lanka Red Cross/CHA, St John’s Ambulance Brigade, Lions Club international and women’s in Need (WIN)and the government departments, District Secretariat, Divisional Secretary’s office and the Matara General Hospital and the SDT /HIV/AIDS campaign. As a result of our training programs Members of the Police department including SSP /Matara participated in the event in a big way. World Aids Day was celebrated with a walk attended by more than 1000 persons and ended up with an awareness program for public
World Aids Day 1st December 2009
World Aids Day 2009 was celebrated on 2nd December at Matara. The event was organized by the DDHS Matara and the STD/AIDS clinic Matara with the help of other government departments and NGO of the area. The unique feature of this event was participation of prisoners and trainees of nursing training School
Conclusion
Objective: 1. Achieved > 100% - 2438 students had been trained
Objective: 2. (Revised to include youth of Navy) Achieved > 100% (Police 331 & Navy
3310)
Objective: 3. Achieved 100%. All of scheduled health education materials had been
printed and distributed
Objective: 4. Achieved 100% 40 teachers from above schools had been given 2 days
training as Master Teachers.
Objective: 5. Achieved >100%. More than 50 peer leaders were trained
Constrains
There were not much of constraints in implementation of the project, except following commencement of the project was delayed due to certain logistics issues such as getting permission from education authorities to conduct reproductive health training in schools as there is circular issued by the Ministry of education preventing INGO/NGO doing such programs in schools. It was overcome by involving department of health services and the department of education using goodwill of the INDECOS.
Getting required number of police officers for training program was always a problem due to the unexpected duty arrangement for them by the superiors. Sometime it is impossible to have alternatives due to the prevailing security situation of the country. Hence we had to revise this target group including new recruits and officers of naval training school.