The HIV/AIDS Prevention Project in Indonesia

Summarised from the report HIV/AIDS Prevention Project (HAPP) 1996-2000: Lessons Learned.

For further information, contact FHI/Asia Regional Office, Arwan Building, 8th Floor 1339 Pracharaj 1 Road, Bangsue, Bangkok 10800, Thailand

In the early 1990s, the Government of Indonesia started mobilizing donor assistance to meet the emerging threat of HIV. Discussions between USAID and Family Health International (FHI) began in 1992 and a formal agreement between the Government of Indonesia, USAID and FHI was established in 1995. HAPP was a bilateral partnership between the Government of Indonesia and the Government of the United States, implemented by FHI and CDC Participating Agencies Service Agreement (PASA) with funding from USAID.

The overall goal of HAPP was to reduce the rate of HIV transmission in order to promote the general health and economic well being of people in Indonesia. The Project’s purpose was to develop and implement programmes aimed at preventing HIV and other STIs based upon the documented effectiveness of interventions. Its purpose was also to encourage and support the development and implementation of related policies supporting HIV and STI control. HAPP activities took place primarily in three ‘demonstration sites’ selected by USAID and the Ministry of Health: North Jakarta, Surabaya and Manado/Bitung.

The main activities carried out during the project included Behaviour Change Communications, Condom Social Marketing, STI Treatment and Policy Support. Considerable collaboration and capacity building with partners also took place. Interventions mostly concentrated on those whose behaviour put them at greater risk of infection such as sex workers, waria (biological males who, by combining feminine and masculine gender characteristics, construct a third gender identity) and their male clients (truck drivers, sailors and dock workers). HAPP also conducted a number of activities at the national level including facilitating policy dialogues, organizing a mass media campaign, sponsoring participation in international and national conferences, seminars and study tours and co-hosting national seminars with the GOI and other donors.

During the five years of HAPP, there were massive changes in both Indonesia as a whole and in the epidemiology of HIV and AIDS. The economic crisis hit the country, the first democratic elections were held and Indonesia is now moving quickly towards decentralization. The Indonesian response to HIV/AIDS is embodied in the National AIDS Strategy which emphasizes strategic partnership between all involved sectors: the Government, the community, the non-government agencies and those most at risk of infection. HAPP, as a project within the MOH, was a part of the Indonesian response to the emerging HIV threat in the midst of these social, economic and political changes.

The FHI Internal Evaluation Team, under the leadership of the Country Director, carried out the internal evaluation of the FHI managed component of HAPP between January and September 2000. The Team consulted widely in this process and received information and comments from USAID, the Government of Indonesia, other donors, its technical and implementing partners and the Project’s beneficiaries. This process will result in a set of six reports that communicate the findings of different aspects of the internal evaluation in varying formats and styles. This report tries to capture the lessons learned in all aspects of the Project. It is hoped that this practical and durable report will be useful when planning and implementing HIV/AIDS prevention and care activities in other districts and provinces of Indonesia.

Behaviour change communication

Overall, BCC interventions were effective in reaching high-risk audiences in their own communities and were well received. All groups of beneficiaries stated that involvement with HAPP-funded NGO programmes enhanced their self-esteem and pride because they were treated with respect and were made to feel useful and fully part of the project. This was especially true for Peer Educators. Some owners of commercial sex establishments explained that the involvement of sex workers in HAPP was beneficial for their business as they gained the reputation of providing ‘clean’ services and their clients were willing to pay more.

The peer educator approach was used with sex workers and waria in all three sites and with young people in one site. Waria peer educators in Jakarta, for example, visited waria in places where they sold sex and provided them with education, BCC materials and free condoms. While peer educators were generally volunteers, some went on to become paid outreach workers. Other peer educators were provided with transportation money and this led some sex workers to leave their profession and their role as peer educators gave them more confidence. Some peer educators organised themselves into self-help groups and held regular meetings. Based on these experiences, HAPP has produced a practical guide to peer education programmes for Indonesia called ‘ Peer Education - Lessons Learned’. This guide explains the philosophical shift from peer to peer information dissemination to the more sustainable peer to peer motivation for behaviour change.

Lessons learned on peer education include:

· Capacity building for peer educators leads to their empowerment and decreased dependency on the facilitating NGO. The increase in self-confidence and skills allows some to find other employment and also contributes to sex workers’ ability to negotiate for safer sex.

· Peer educators influence behaviour change among peer beneficiaries when they can show real care and concern and are easily accessible.

NGO Implementing Agencies were funded to develop BCC materials. These were developed for female sex workers, male transport drivers, waria and fishermen. Materials were also developed for doctors providing services for STIs and reporudtcive tract infections (RTIs), STI clinic attendees and women attending reproductive health services for the treatment of RTIs.

Lessons learned on BCC materials included:

· Training NGOs about how to produce targeted materials early in a project leads to effective design and makes the material more useful. This training has to cover the production and adaptation of BCC materials as well as techniques for quality control.

· It is important to ensure that NGO Implementing Agencies understand that BCC materials are a support tool for use in Behaviour Change Communication rather than a substitute for interpersonal communication.

· Ongoing training about the appropriate and efficient dissemination of BCC materials is crucial for effective interventions.

The Futures Group International(TFGI) implemented an extensive communications programme in collaboration with private partners, including communications service firms and condom manufacturers and with NGO Implementing Agencies. This programme was designed to increase condom use among sex workers and their clients and to increase sales of commercial condom brands. The programme included a public service advertising (PSA) campaign promoting condoms in TV and the radio and in printed publications.

Lessons learned on condom social marketing included:

· Developing a Task Force bridges the gap between suppliers and retail outlets and increases the number of non-traditional condom sales outlets.

· Effective campaigns are sensitive to religious and cultural issues and also target the myths and stigma attached to condoms.

· Given the limited resources and the controversial nature of condoms, targeting condom promotion to high-risk populations using “media tunnelling” around red-light districts is an effective strategy.

· The most effective and efficient way to reach clients is through mass media campaigns rather than community events.

This report also includes lessons learned on:

· STI treatment and surveillance
· Working with partners
· Programme management
· Capacity building
· Policy support