HIV/AIDS CONTROL IN THE EDF EXPERIENCES AND LESSONS LEARNED

1. HIV/AIDS CONTROL IN THE EDFEXPERIENCES AND LESSONS LEARNED DEPT.OF HEALTH EDF

2. INTRODUCTION COMPOSITION AND MISSION OF THE EDF COMPOSITION The EDF is a melting pot of all Eritrean youth representing diverse nationalities, religion, cultures and values, education and economic backgrounds. • Regulars – 15% mainly former liberation fighters • national service conscripts- 85%

3. MISSION Military- Safeguard, sovereignty and national integrity. Non-military- the major force behind the national economic development campaign and spear heads :- Realization of food security at the national level. through soil and water conservation, development of irrigation schemes, terracing, aforestation, construction of dams, growing and harvesting of essential crops.

4. DEVELOPMENT OF INFRUSTRUCTURE • Reconstruction of the war destroyed only railway line of the country • Construction of roads and bridges • Construction of school, health facilities and residential housing Curb the spread of HIV/AIDS by increasing the level of awareness of rural communities via the EDF-community outreach program MISSION REQUIREMENTS • YOUNG • ROBUST • HEALTHY & FIT

5. INHERENT & AQUIRED RISK FACTORS INVOLVED • Young and sexually active • Sense of invincibility • Split- second risk taking • Risky profession • Living outside barracks • Staying away from home for long periods of duty • Alcohol intake Thus, the EDF has the potential to enable or disable the transmission cycle with either huge beneficial or detrimental long term consequences for the country. It is to tap the positive aspects of having all the youth in the EDF that the HIV/AIDS control program was launched in consent with other sectors i.e. MOH, MOLG, ESMG, NUEUS, UN agencies and other stake holders.

6. EDF HIV/AIDS CONTROL PROGRAM • Dictated by the concept “protect the healthy and care for the afflicted.” Essentials preventive in nature. • Integral part of the country wide control program • Adheres to the national policy and strategies, adapting the latter to military realities, i.e. existing commands structure, and organization of health care facilities at different echelons

7. PREVENTION STRATEGY FACING THE PROBLEM – AN ENTRY POINT TO PREVENTION • Sensitize and gain full involvement of the military bureaucracy through the provision of true hard core data and good rapprochement • Make the rank and file appreciate the challenge first hand • Opt for military to military approach of communications In line with the above a campaign denoted “SEEING IS BELIEVING” was initiated early in 2002 and lasted nine months.

8. PHASE 1:- Commanders – From the minister down to the unit leader- total 30,000

9. PHASE 2:-All privates- totaling 195,000

10. CONTENTS: • HIV/AIDS and other STIS cause, transmission, prevalence • Deaths due to AIDS with categorization by rank , age, gender, education etc… • Modes of prevention- esp. condom use • Testimonials by 11 EDF members living with HIV/AIDS stressing family background, education, practice of unprotected sex, alcohol intake, personal habits, reaction on diagnosis and living positively with HIV/AIDS • Open discussions • Opening and closing statements by senior commanders

11. BENEFITS ACCRUED • HIV/AIDS and its prevention were included in the agenda for the monthly activities evaluation meetings at all echelons and reporting became mandatory. • In addition the routine formal & informal distribution, picking up of condoms as part of other rations became compulsory. • Garrison commanders were ordered to strictly observe the welfare of their men by preventing the setup of tea and beer houses and commercial sex work around their garrisons. • Open demand for universal testing by the audience • Increased attendance in VCT sites

12. ROUTINE PREVENTIVE ACTIVITEIS • Production of IEC materials, posters, brochures and stickers • Demonstrations and video shows • Promotion and free distribution of condoms to all military personnel • Distribution of condom carrying pouches • Ascertaining blood safety • Early syndromic management of STIs at battalion level • Post exposure prophilaxis

13. Continuing education and training is a necessity to carry out repetitive and sustained preventive activities.

14. CARE AND SUPPORT • Retention of all seropositive members (HIV/AIDS- doesn’t qualify for discharge from the EDF) • Assignment to sedentary duties • Periodic follow up of CD4 count • Provision of HAART for those with CD4 < 200 (based on national treatment guidelines) • Treat opportunistic infections • Routine prohylaxis against opportunistic infections • Sequential follow-up and counseling for compliance • Senior level extensive discussions are underway how to engage PLWHA in sustainable profit making enterprises within the military in order to support themselves and their dependents.

15. TESTING AS A TOOL FOR PREVENTION, CARE & EVALUATION Following the demand for universal testing at the “seeing is believing” campaign of 2002, a series of consultative meetings at different command level reached consensus to conduct periodic universal testing of the EDF

16. Why Universal Testing? (comments from consultative meeting participants) VCT is too little and too late intervention, God knows how many soldiers we have driven to their death through arduous military exercises. • We are not interested in statistical indices. That is for you, the health professionals. We only want to talk about our servicemen and their dependents. Do the testing and inform us about the results for we are the only people that can assist them. • It is now several years since the program was initiated, and the greater majority of EDF members have a good awareness about HIV/AIDS. But do they really practice what they have been taught.

17. Cont… Lets not play hide and seek games – universal testing is the only reliable yardstick of behavioral change, so do it please. • You, the health professionals, are part of the problem. We frequent your health facilities and you order a gamut of tests without asking consent and have no qualms in disclosing the diagnosis, fatal or otherwise. When it comes to HIV/AIDS your extreme secrecy, has become a major obstacle to overcome the silence that has shrouded the disease. Universal testing is the way out. CURRENT TESTING PRACTICES Routine • All clinically suspected cases • All patients undergoing surgery • All blood recipients

18. VCT • Any body who requests UNIVERSAL CHECK UP, DISCLOSURE, OUTCOMES • CONDUCTED EVERY 2 YEAR • Round 1, 2004 • Round 2, 2006 DISCLOSURE • Follows the channel of command • All seropositive are informed individually depending on rank and position, by the most immediate superior commander (Battalion, Brigade, Division Op.zone) • All seronegative are informed collectively by their immediate superior commander

19. OUTCOME • Very favorable • Decrease in prevalence in 2006 compared to 2004 • Incidence rate has been established. • Magnitude of problem defined. • Planning, has become easier.

20. EDF - COMMUNITY OUTREACH PROGRAM • Evolved as an idea in early 2002 • Deploy national service conscripts trained as change agents, to their communities of origin (rural) with the objective of up scaling HIV/AIDS awareness and prevention • Funded by the Norwegian Govt. via UNFPA in 2003 • 325 change agents, selected, trained and deployed to southern, western and eastern part of the country for period of 2 years. • Covered 22 administrative sub zones and reached a total of 1,083,370 people of both genders. • Impact evaluation done by an independent consultant in the last quarter of 2006 by comparing communities who availed from the program with communities who had not. The outcome was found to be positive and an extension period has been recommended.

21. CHALENGES • Sustainability of the whole program • Sustainability of the EDF – community outreach program • Decentralization of ARV therapy • Logistics • Equipments • Reagents • Rapprochement with families of HIV/AIDS members of the EDF

22. THANK YOU FOR YOUR ATTENTION