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Focus Area - HIV/AIDS
Reducing HIV/AIDS Transmission Among Police and Their Families in El Salvador
 

Traditionally, HIV/AIDS prevention activities have focused on high risk groups, such as adolescents, men who have had sex with men and commercial sex workers. However, another high risk population is the uniformed services (police and military). the uniformed services are primarily men who are sexually active and vulnerable to other determinants of risky sexual behaviors, such as cultural expectations, sexual beliefs and stereotypes. The police in El Salvador are at further risk because their jobs frequently demand that they be posted far away from their nuclear familes for extended periods of time.

The United States Agency for International Development (USAID) supported the development and implementation of a behavior change strategy for HIV/AIDS prevention with the Salvadorian police through technical assistance provided by the CHANGE Project.

The objective of the HIV/AIDS prevention program was to strengthen institutional capabilities in behavior change to reduce and prevent HIV transmission in members of the PNC, their families and key sectors of the communities they serve. The goal was to modify high risk behaviors to reduce the probability of HIV transmission through sexual contact. The HIV/AIDS prevention project with the national police force began in February 2002 and project activities ended in December 2004.

The primary components were:

  • Creation of a peer network
    Administrative and police personnel were trained to work with their peers through individual and group behavior change interventions aimed at reducing behaviors that place them at risk. Peer leaders conducted "mini-jornadas" (interactive talks), lectures, socio-dramas, facilitated discussions, movie/discussion sessions, interactive games, etc. and distributed supporting print materials, condoms and gloves.
  • Establishment of a counseling network:
    Staf from the Medical Services and Occupational Health Departments within the police was trained as professional and lay counselors to provide preventive and pre/post-test counseling services. Access to testing, which initially did not exist, was established.
 
Formative Research
 

The research used as a planning model called Modelo de Cadena de Cambios (known in English as the BEHAVE Framework). The framework strengthened the planning process by carefully examining data for various HIV/AIDS risk and prevention factors and make three key decisions:

  1. priority audience segments for the intervention focus;
  2. the behavioral objective to decrease the transmission of HIV; and
  3. specific determinants of existing and improved practice.

Only after these three decisions were made was the activity plan devoted to directly address those factors most influential in changing the particular behavior of the priority audience segment. The Cadena de Cambios Framework also examines the way in which changes in behavior are necessary at different levels - civilian police (PNC), national police academy (ANSP), home, community and public institutions - in order to achieve the overall goals. The model considers the necessary changes by all these actors, including the range of actors who might influence thr priority audience (these other influentials are known as "secondary audiences" because they play a key role in influencing the primary or target audience).

 
Peer Leader Network 
 

Peer leaders were trained to work with their peers to affect changes in knowledge, attitudes beliefs and behaviors and to initiate shifts in personal and social norms that lead to more protective behaviors. Peer leaders conducted mini-jornadas (interactive talks), lectures, socio-dramas, facilitated discussions, movie/discussion sessions, interactive games, etc. and distributed supporting print materials, condoms and gloves. The technical team (CHANGE/ASAPROSAR/AMS) developed mini-jornadas, which were aimed at providing information to PNC/ANSP staff and to encourage behavior change.

The mini-jornadas were an excellent forum for the peer leaders to practice their skills in facilitating group activities. As their skills improved, the peer leaders took over conducting the mini-jornadas from the technical team.

Each peer leader receieved basic training and technical assistance and monitoring. Regular meetings were conducted to update and improve their knowledge about HIV/AIDS.

Peer leaders carried out one-on-one interventions and group activities focusing on messages and behavior change activities related to abstinence, mutual fidelity, reduction in number of partners, safer sex and proper condom use.

 
Counseling Network 
 

Access to HIV/AIDS testing by ANSP and PNC personnel was investigated and very different conditions were found in each institution. At the beginning of the CHANGE project, PNC staff essentially had no access to testing. The police have workplace clinics that are stocked with supplies, but have none or very limited lab capabilities and did not process HIV tests.

CHANGE was tasked with improving competencies in providing risk reduction counseling in professional health couselors and other health personnel serving the police and police academy.

A set of state-of-the-art manuals from CDC on VCT training were translated from English to Spanish and adapted for use in El Salvador; these manuals formed the basis of the counseling training curriculum.

As training was taking place, parallel efforts were implemented to try and obtain easier and more reliable access to HIV testing at those clinics, thus overcoming the largest hurdle to the counseling and testing program.

PNC clinic staff chose to personally transport blood samples to labs for processing and subsequently deliver the results to their clients at their respective PNC clinic. Through this impressive level of commitment to HIV/AIDS prevention activities, PNC staff has overcome another hurdle to accessing testing through providing testing. By making access to testing easier for the client, it is likely that a larger number of PNC personnel will cose to get tested.

Substantial time and energy has also been invested by CHANGE staff to ensure that testing for PNC staff is strictly voluntary and confidential. Proper handling of medical records and confidentiality protocols were established in all workplace clinics.

 
Institutionalization and Sustainability 
 

One focus was on strengthening the institutional capabilities to plan, manage, and monitor HIV/AIDS prevention activities so that they will continue well beyond the period of intervention by CHANGE. These activities include:

  • Developing informative/educational activities directed at high ranking PNC/ANSP officials to keep them informed of the magnitude of risk of PNC personnel and to obtain their support for activities carried out by the peer leaders and couselors.
  • Organizing and training interdisciplinary planning and monitoring teams to support the peer leader and counseling networks.
  • Identifying one liaison per Delegation who is assigned to oversee HIV/AIDS prevention activities for that Delegation and solve problems that arise.
  • Integrating the activities carried out by the peer leader and couseling networks.
 
Developing Support Materials 
 

CHANGE worked in conjunction with staff from ASAPROSAR, AMS, PNC, and ANSP to develop support materials for all of the project activities.

Materials that were developed included

  • Manuel de Capacitación: Apoyo de Redes Pares en Prevención de VIH/SIDA en la Población Policial Salvadoreña. 2003 (PDF - 1.37MB)
  • Guía de Ejercicios: Apoyo de Redes Pares en Prevención de VIH/SIDA en la Población Policial Salvadoreña. 2003 (Ejercicios - PDF -1.34MB; Materiales - PDF - 200k)
  • VIH/SIDA Lotería
  • VIH/SIDA Triptico (PDF - 1MB)
  • ITS Tríptico (PDF - 480kb)
  • Recordatorio (PDF - 421kb)

>> More Support Materials

 
Follow-Up Study 
 

A quantitative follow-up study was conducted during August and September 2004. The purpose of the research was to assess the impact of CHANGE-guided prevention interventions through the implementation of a follow-up survey. Data from the survey was compared with baseline activities and improvements associated with the two and a half years of USAID-sponsored behavior change activities.

Global Society Consultores, with assistance from CHANGE, ASAPROSAR, AMS, PNC and ANSP, conducted the survey of risk and preventative behaviors related to HIV, and the range of factors influencing these behaviors, among members of the PNC and ANSP through a representative sample of individuals.

While significant changes in condom use behavior with "non-stable" partners, the direct objective of behavior change activities, was not yet documented, changes were significant in a number of antecedent factors such as HIV prevention and transmission knowledge; access to condoms and condom use skills; self-efficacy to negotiate condom use and periodic abstinence. reduction in sexual relations with casual partners and commercial sex workers were associated with CHANGE-Project supported activities.

Notable improvements in reducing HIV stigma were also seen. The results reflect movement along the pathway to changing key behaviors, but have not yet achieved sustained behavior change due to the relatively short time that interventions have been underway.

     
 

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