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Abstract #213  -  Can communities drive their own agenda to achieve HIV prevention and care outcomes? Lessons from Uganda and Zambia sites
  Authors:
  Presenting Author:   Dr. Jane Chege - World Vision International
 
  Additional Authors:  Ms. Joan Mugenzi, Mr. Nathan Chitelela, Mr. Siyani Zimba,  
  Aim:
To share qualitative research findings and lessons learned from empowering communities to take leadership and ownership of HIV prevention and care interventions
 
  Method / Issue:
Due to funding mechanism, most agencies initiate development programs that require long-term support to communities for a short period. Community ownership and sustainability of project outcomes arise. To enhance community ownership and sustainability of interventions, World Vision International (WVI) designed and piloted three inter-linked community-led HIV and AIDS program models in Uganda and Zambia from 2002 to 2004 and implemented an operations research project between 2005 and 2009 to assess the effectiveness. This paper presents the qualitative results of implementing the three in one World Vision Uganda (WVU) and one World Vision Zambia (WVZ) Area Development Program (ADP).
 
  Results / Comments:
The models implemented were: 1) an HIV and AIDS prevention model to equip children aged 5-15 years with knowledge and life skills using existing structures such as schools and faith-based congregations; 2) a community-led Orphan and Vulnerable Children (OVC) Care Model designed to mobilise community groups and provide them with organizational skills to coordinate and implement interventions aimed to enhance the capacity of households and communities to respond to the needs of OVC and chronically ill household members; and 3) the Channel of Hope (CoH) Model designed to strengthen church and Faith Based Organization engagement and leadership in HIV prevention and care for OVC. To assess the outcomes of these models, the project conducted about 40 focus group discussions and 30 individual interviews with various community groups in each study site.
 
  Discussion:
The three HIV and AIDS models contributed to breaking the silence about HIV and AIDS and deepened knowledge about HIV and AIDS care and support of OVC and chronically ill household members. In both Uganda and Zambia, through the model implementation, access to basic services increased, as did positive living amongst OVC and chronically ill household members. In the Zambia ADP, sensitization of children and other members of the community reduced the stigma and fear of HIV testing and increased the number of people seeking Voluntary Counselling and Testing (VCT) services. Participants reported reduced incidence of early marriage, sexual exploitation of children (especially among females), as well as teenage pregnancies. The HIV and AIDS prevention model could be more effective in Uganda if positive parenting sessions were aggressively pursued, and in and out of school AIDS Clubs strengthened. The results showed that initial community entry strategies are important in determining the strength of community ownership and sustainability of interventions as demonstrated by varying community response in the two ADPs. In both countries, scaling up of the care component requires the mobilization of local and external resources to improve the livelihoods of OVC and chronically ill household members and to ensure sustainability of the programming due to high poverty levels among households. Linkages and enhanced networking with local governments to strengthen joint planning, implementation, and monitoring of developmental activities was essential in both countries. In Zambia, the sustainability of the HIV prevention model requires devolving further responsibilities of HIV and AIDS information dissemination to the communities. Some of the outcome level achievements described in discussions with community members are confirmed by quantitative household survey data collected through a randomised community trial in both study sites. Although project sustainability was not fully achieved within the 4 year period, the results demonstrate the ability of communities to drive their own vulnerable households’ care and health agendas.
 
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