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Stop HIV/AIDS Now from Persons with Disabilities! Reaching the Un-reached with USAID/World Learning Ethiopia

Federation of Ethiopian National Associations of Persons with Disabilities (FENAPD)

 Proposal

On

Stop HIV/AIDS Now from Persons with Disabilities! Reaching the Un-reached

To be implemented in Addis Ababa, Adama, BahirDar and Hawasa Towns

 

Duration of the project: May 2011– July 2012

 

Addis Ababa, Ethiopia, 

P.O.Box 18430,

Email: efpd@ethionet.et

 

June 2011

Addis Ababa, Ethiopia 

 

 

ACRONYMS

CBOs   Community Based Organizations

DPOs   Disability Persons Organizations

FENAPD  Federation of Ethiopian National Associations of Persons with  Disabilities

HAPCO HIV/AIDS Prevention and Control Office

HIV/AIDS  Human Immune Deficiency Virus and Acquired Immune Deficiency syndrome

PC   Palliative care

ILO  International Labor Organization

MOLSA   Ministry of Labor and Social Affairs

NGOs  Non Government Organizations

PE  Peer Educators

PwDs   Persons with Disabilities 

UN CRDP   United Nations Convention on the Rights of Persons with Disabilities

UNICEF   United Nations Children’s Fund

SNNPR  Southern Nations, Nationalities & People’s Region

STI  Sexually Transmitted Infections

USD  United State Dollar

WHO  World Health Organization

I. EXCUTIVE SUMMARY

With a very low resource base and rapidly growing population, Ethiopia is the poorest country in Sub- Saharan Africa in any development parameter and is one of the most seriously affected countries by HIV/AIDS in Sub Sahara. The rapidly spreading HIV/AIDS epidemic is one of the most serious challenges to human development and to the country's efforts to achieve the Millennium Development Goals. The current national HIV prevalence is 2.3 % (2.8% for female, 1.8% for male, 7.7% for urban and 0.9% for rural). Currently, there are a total of 1,116,216 adults and children living with the virus, 128,900 new HIV infections (53.2% female), and 134,500 AIDS deaths (54.5% female). More than 94.4% of PLWHA, 95.2% of new AIDS cases, 95.3% of AIDS deaths and 95.1 HIV positive pregnancies are estimated to be found in Oromia, Amhara, Tigray and SNNPR.

There are more than 7.7 million persons with disabilities -physical, sensory, intellectual or mental impairments in Ethiopia (WHO, UNICEF, 2009). Researches clearly demonstrate that persons with disabilities are sexually active & are at more risk of all known HIV infection. HIV/AIDS awareness raising, VCT and care and support programs remain largely inaccessible to persons with disabilities. Thus, they have very little awareness on the nature of HIV/AIDS, its mode of transmission and prevention mechanisms. Moreover, lives of PwDs living with HIV/AIDS are gloomy. Persons with disabilities receive far fewer general health and HIV/AIDS related services than others. Indeed, health care is not only often too expensive for the poor persons with disabilities but they are also physically inaccessible (lack of ramps at health facilities, physician consultation and counseling services with a sign-language interpreter remain meaningless).

Moreover, 80% of the needy PwDs living with HIV/AIDS have no access to care and support services as the services planned for the general population can not usually address the special needs of PwDs. PwDs have no access to VCT & related services. AIDS patients who need ART have not been practically reached. Stigma & discrimination on PwDs living with HIV/AIDS is double & extremely high. 

Therefore, the above described problems clearly show that there is a high need of multimedia awareness education targeting PwDs, PwDs living with HIV/AIDS, their families and health care providers; home based care, VCT, psychosocial support for PwDs affected or infected by the virus. Thus, FENAPD designed this project entitled “Stop HIV/AIDS Now from Persons with Disabilities! Reaching the Un-reached" to reduce the rapid spread of HIV/AIDS among persons with disabilities and improve the quality of lives of PwDs infected and affected by HIV/AIDS.

The objectives of the project are mainly to: build HIV/AIDs intervention capacities of the project implementers, increase access to HIV/AIDS information, VCT and care and support services to PwDs. The project will create an opportunity to access PwDs to wide range of multimedia behavior changing HIV/AIDS information through mass awareness raising activities and peer to peer learning through trained peer educators. It also creates an opportunity to home based cares to the needy PwDs living with HIV/AIDS. For clinical services including VCT, strong referral linkage will be established with existing health facilities through the peer educators and home based care providers. Therefore, this project will comprehensively address the needs of information and services such as home based care, VCT & related services. This in turn enables to reduce the rapid spread of the epidemic, stigma & discrimination on PwDs living with HIV/AIDS & improve the quality of life of PwDs living with HIV/AIDS. FENAPD in collaboration with its member associations (Ethiopian National Association of the deaf, Ethiopian National Association of Blind and deaf, Ethiopian National Associations of Persons Affected by Leprosy, Ethiopian National Associations of Persons with Intellectual Disabilities) will implement this project in Addis Ababa, Adama, Bahirdar and Hawasa towns where there is higher HIV prevalence relatively ,larger number of persons with disabilities, and FENAPD and its member associations have has better established branch offices. The direct beneficiaries of the project will be PwDs, PwDs living with HIV/AIDS, their families and disability associations at the 4 towns.

Developing HIV/AIDS intervention guideline to the project implementer, training DPOs’ leaders and project staff on disability focused HIV/AIDS intervention, establishing accessible HIV/AIDS resource center at FENAPD, organizing awareness raising workshops & special events, preparing disseminating PwDs focused print & audio video HIV/AIDS information, strengthening 4 PwDs anti AIDS clubs; training 12 club leaders and 40 voluntary palliative care providers; providing home based palliative care and support for 120 PwDs living with HIV/AIDS, providing capacity building training for 24 health service providers, conducting baseline survey and final evaluation are the major components of the project activities. Adequate care will be taken in all the trainings, awareness raising activities and services in addressing different disability types. The project has been designed for 1 year (June 2011– May 2012). The total project cost is 3,187,575 Birr (199,223 USD).

II. TECHNICAL SECTION

2.1. PROJECT BACKGROUND INFORMATION

HIV/AIDS and Disability Situations in Ethiopian

HIV/AIDS Situation

Currently, HIV/AIDS pandemic is one of the most serious challenges to human development and to the country's efforts to achieve the Millennium Development Goals in Ethiopia. 

Since the last many years, Ethiopia has been standing 16th in HIV prevalence in the world, 2nd in number of people infected with HIV after South Africa, 3rd in Africa in number of orphans following Uganda and Nigeria respectively (UNAIDS 2009). The 2009 HAPCO report shows that prevalence was 2.7% in 1989 and the current national HIV prevalence is 2.4 % (2.8% for female, 1.8% for male, 7.7% for urban and 0.9% for rural). Currently, there are a total of 1,216,908 adults and children living with the virus, 128,900 new HIV infections (53.2% female), and 134,500 AIDS deaths (54.5% female).  The country also has one of the largest populations of children orphaned by AIDS in sub-Saharan Africa, currently estimated at 855,720 (FHAPC, 2009). Moreover, evidences indicate that 7 to 10 million Ethiopians have been probably infected by 2010 because of the high current rate of adult prevalence, widespread poverty, low educational levels, and limited capacity to respond more actively.

Addis Ababa, Amhara, Oromia and SNNPR counted 86.6% of PwDS living with HIV/AIDS, 86.7% of the total HIV positive pregnancies, 85.3% of new HIV infections, 90% of new AIDS cases and 88.2% of AIDS deaths in Ethiopia. With regard to the proportion of people living with HIV/AIDS by regions of the country 30.2% are estimated to be found in Addis Ababa, 22.7 in Amhara, 22.2 in Oromia & 9.5 in SNNPR.

Addis Ababa has, currently, an estimated total population of around 3 million. It is one of the sub Saharan cities that have the highest HIV prevalence where its current prevalence rate is 9.2 %. There are a total of 210,306 people living with the virus, 22,926 new HIV infections per year and a total of 83,633 AIDS orphans in the city. 

Therefore, this project is aimed to be implemented Addis Ababa, Adama (Oromia region) and Hawasa (SNNP region) and Bahirdar (Amhara region) where the problem is more serious, focusing on persons with disabilities.

Disability Situation

In Ethiopia there are very few studies on disability and thus data on this is not adequately available. But there are some estimates which show that the proportion on PwDs in Ethiopia in general is 10% and that there are more than 7.7 million persons with disabilities -physical, sensory, intellectual, or mental health impairments in the country (WHO, UNICEF, 2009). In reality the proportion could probably be higher because of the high prevalence of its risk factors including disease, war, famine, accident, malnutrition and harmful traditional practices in particular and high poverty in general. 

The proportion is higher in some regional states of the country, i.e. 12.7%, 14.0% and 16.8% in Oromia, Amhara and SNNP regions respectively (Tirusew, 1995). The four project towns are located in these regional states and comparatively account for the highest number of persons with disabilities. Although there are no adequate data in these specific towns on this reports from FENAPD branch offices in these towns show that the number of persons with disabilities is about 390,000 in Addis Ababa, 128,000 in Adama, 142,000 in Bahirdar and 130,000 in Hawasa town. Data from the reports also show that 51% are male while 49% are female in average. The disability types included in the report are sight, hearing, physical, intellectual or combination of two or more impairments. 

World Bank studies have proven that persons with disability have equal or greater exposure to all known risk factors for HIV infection. This is practically true in Ethiopia and further confirmed by a joint study conducted by MOLSA, HAPCO, FENAPD and UNAIDS in 2010. 

Researches conducted by World Bank and others have clearly demonstrated that persons with disabilities are sexually active & are at more increased risk of HIV infections. The major factors for this include high poverty, lack of information and resources to facilitate safer sex, limited access to education and health care, lack of legal protection, increased risk of violence and rape, vulnerability to substance abuse, stigma & discrimination.95% of PwDs and their families in Ethiopia are living in extreme poverty (MOLSA, 2010). Therefore, PwDs under this situation have no ability to negotiate safer sex or evaluate the sexual partner and are more likely to have more sexual partners than their non-disabled peers. Thus, PwDs are at increased risk of substance abuse.

There are also deep rooted silent social sanctions of marrying a person with disability. Extreme poverty and the social sanctions against marrying a person with disability mean that they are likely to become involved in a series of unstable sexual relationships which obviously lead to be infected more by HIV.

2.2. PROBLEM STATEMENT & JUSTIFICATION OF PROJECT

While there has been good understanding, in Ethiopia in general and the four target towns in particular, on the impacts that HIV/AIDS epidemic had on the vulnerable population, it is commonly and wrongly assumed that persons with disability are sexually inactive and they are at low risk of HIV infection. In reality they are sexually active & are at more increased HIV risks. Hence, although there have been tremendous achievements in the country and in the target towns with regards to expanding HIV/AIDS programs aimed at prevention, treatment and care, people with disabilities have thus far often been ignored in many such programs .

Great majorities of persons with disabilities in the target towns have no education, employment and other opportunities in life and could not fulfill their basic needs (food, clothes and shelter) and do not have access to basic social services that could help reduce their dependency. 95% of them and their families in the in the target towns are living in extreme poverty (MOLSA, 2010). Therefore, PwDs under this situation have no ability to negotiate safer sex or evaluate the sexual partner and are more likely to have more sexual partners than their non-disabled peers. Thus, PwDs are at increased risk of substance abuse. There are also deep rooted silent social sanctions of marrying a person with disability. Extreme poverty and the social sanctions against marrying a person with disability mean that they are likely to become involved in a series of unstable sexual relationships which obviously lead to be infected more by HIV. But despite their vulnerability they have often been neglected in HI/AIDS programs.

PwDs (both male and female) in in the project areas, like in other countries, are three times more likely to be victims of physical and sexual abuse and rape than their non-disabled peers. This still makes them more vulnerable to HIV/AIDS while they still remained unaddressed.

Majority of PwDs in the areas have little access to education and their literacy rate is very low (less than 3%) which made the non-disability friendly communication of messages about HIV/AIDS all the more inaccessible for PwDs so far.

In most case, HIV infected persons with disabilities are unaware that they are infected and they account for the significant contribution to the spread of the disease.

HIV/AIDS related health services in the project areas such as VCT and ART at health facilities available for the general population have not considered or tailored to the needs of PwDs. Health practitioners often lack the necessary knowledge, skills and resources to provide accessible and appropriate services to PwDs at risk or living with HIV/AIDS. Lack of life skills, limited access to health care and counselling services and the limited role of the people in HIV/AIDS prevention programmes aggravates the infection. PwDs receive far fewer general health and HIV/AIDS related services than others. Therefore, lives of PwDs living with HIV/AIDS are gloomy. HIV and other health services are also physically inaccessible (lack of ramps at health facilities, physician consultation and counseling services with a sign-language interpreter is meaningless). Hence, PwDs living with HIV/AIDS experience a double stigma and discrimination.

Majorities of the needy PwDs living with HIV/AIDS have no access to care and support and consequently are in a critical problem in accessing basic needs such as food, shelter, medical care and school. Thus, they experience double stigma and discrimination as result of disability and HIV/AIDS.

Generally, awareness interventions, VCT Services, medical facilities, are often inaccessible to the majority of people with disabilities in these towns like the other parts of the country due to physical, communication, and attitudinal barriers that prevent them from accessing such services on equal basis with others.

Thus, the issue of disability as it relates to vulnerability to HIV/AIDS needs to be taken seriously by all government and non-government bodies involved in the HIV/AIDS prevention and control effort. All stakeholders need to be made aware that the country cannot meet its commitments of universal access if PWDs are left behind. DPOs in the country and in the target regions can play a vital role in promoting the inclusion of people with disabilities in HIV/AIDS awareness, prevention, treatment and care services. Their effective involvement however first requires that they are made aware of the current status of the country with regards to the HIV/AIDS prevention and control, the link between disability and vulnerability to HIV/AIDS, the current discrepancy between PWDs and non-disabled people with regards to equal access, and their roles in promoting equal access principles and practices and the contribution they can make thereof. The HIV intervention capacities of DPOs in the target regions including FENAPD branch offices is so far very limited.

Despite the above facts, although there are quite a number of NGOs addressing Sexual and Reproductive Health (SRH) and HIV/AIDS issues in Ethiopia in general and the four target towns in particular almost all have no PwDs focused HIV/AIDS related interventions at all while a number of international conventions clearly indicate PWDs should be given all the rights that non disabled persons have. 

Therefore, the above described problems clearly show that there is a high need of multimedia awareness education targeting PwDs, PwDs living with HIV/AIDS, their families and health care providers; VCT, care & support for PwDs affected or infected by the virus. Thus, FENAPD designed this project entitled “Stop HIV/AIDS Now from Persons with Disabilities! Reaching the Un-reached" to reduce the rapid spread of HIV/AIDS among persons with disabilities and improve the quality of life of PwDs infected and affected by HIV/AIDS by increasing access to behavior changing information and VCT, home based palliative care, and other related services. 

The project will create an opportunity to access PwDs to wide range of multimedia behavior changing HIV/AIDS information through awareness raising programs & peer to peer learning. It also create an opportunity to home based palliative cares to the needy PwDs living with HIV/AIDS. For clinical services including VCT strong referral linkage will be established with existing health facilities through the peer educators and home based palliative care providers. For the effectiveness of the referral services, health services providers at the target health facilities will be given trainings on how to deal with PwDs and some basic communications with PwDs. Therefore, this project will comprehensively address the needs of information and services such as home based palliative care and support, VCT and related services.

2.3. TARGET POPULATION & GEOGRAPHIC AREA

The project is planned to be implemented in Addis Ababa, Adama, Bahirdar and Hawasa, the relatively big towns and where comparatively large number of PwDs are residing and HIV prevalence is higher. These towns are also convenient for FENAPD to effectively coordinate and implement this project as it has better organized branch offices and member associations’ branch offices in these towns.

PwDs, PwDs living with HIV/AIDS and their families, DPOs, Health service providers at the target areas and HIV/AIDs organizations are the major targets of the project. The direct beneficiaries of the project will be PwDs (sensory, physical & intellectual), PwDs living with HIV/AIDS, their families and disability associations at the 3 towns. The general public, the government and other stakeholders are also indirect beneficiaries of the project. 

 

2.4. PROJECT OBJECTIVES,

General objective.

To increase HIV prevention knowledge and skill among PwD and improve the quality of life of PwDs living with HIV in the project areas.

Specific objectives:

Specific Objective 1: To build HIV/AIDS intervention capacities of FENAPD in terms of human and material resources.

Specific Objective 2: To increase the target population's access to behavior changing information on the nature, modes of transmission, prevention mechanisms and effects of HIV/AIDS by 50% from the base line by the end of the project period.

Specific Objective 3: To improve the quality of life of PwDs who are HIV positive in the target areas.

3. STRATEGIES & ACTIVITIES

General strategies:

Specific and Targeted Approaches: As it is well known, there are wide ranges of disabilities. FENAPD’s intervention will be specific to specific disabilities and targeted approach will be utilized. General guideline how to address HIV/AIDS prevention from person with disability will be developed and based on that guideline the intervention will be tailored. Besides detailed activity plan will be done to address disability specific interventions.

Volunteerism: FENAPD gives emphasis on voluntary services. Voluntary services will enable volunteers to acquire basic skill that they can take to home and help improve their lives. It also helps our FENAPD to minimize cost and to sustain the programs.

Family centered integrated approach: Once volunteer educators and care givers enter the home of PLHIV they will address all issues and concerns of the family.

Networking and referral:  It is true that FENAPD will not fulfill all needs and concerns of its clients. Clients’ needs will be addressed through network and referral services to other organizations working on HIV/AIDS prevention, care and treatment.

Gender mainstreaming: All our activities will be highly gender sensitive and all targets and beneficiaries will be at least 60% females. We encourage the participation of females in program leadership and voluntary works. Our M&E tool will be designed to capture indicators with sex disaggregation. All our training materials and methods will give attention to gender specific problems and how to tackle them. The project evaluation will give emphasis on the gender specific activities too.

Specific Objective 1: To build HIV/AIDS intervention capacities of FENAPD in terms of human and material resources.

Strategy 1.1. Strengthening of accessible HIV/AIDS resource center where disability focused HIV/AIDS information materials will be produced & disseminated sustainably. 

 

Activities:

Equipping Accessible HIV/AIDS resource center

To enable FENAPD to produce and disseminate accessible and disability friendly HIV/AIDS information, FENAPD will capacitate the already established accessible HIV/AIDS resource center in Addis Ababa and build the capacity of the center. The info center will be strengthened in terms of manpower and materials that are required for the effective production and distribution of the awareness raising materials mainly in consultation with federal HIV/AIDS Prevention and Control Office (HAPCO). It will be equipped with furniture, disability friendly ICT equipments and software, man power, information production equipments like radio message studio equipments (FENAPD has every 15 days awareness radio program), TV, tape recorder, CDs, DVD cassettes, computers & printers. The computers will also be networked.

With regard to manpower, 1 info center coordinator, 1 print materials expert and 1 Documentation expert will be hired. Other external experts will also involve in the process on part time basis as deemed necessary.

This resource center will also serve as an information center where PwDs in the environs can come and read information on HIV/AIDS and related issues. 

Strategy 1.2. Establishment of functional HIV/AIDS units led by a well designed HIV/AIDS intervention guideline. .

 

Activities:

Hiring HIV/AIDS project staff

With this project FENAPD will hire important staff as described under section 4 of this project.

Developing disability focused HIV/AIDS intervention guideline for the federation.

With this project the capacity of the federation and its member associations will be strengthened by developing a disability friendly HIV/AIDS intervention guideline to enable the federation and its member associations to make sustainable intervention on the issue. FENAPD will do these in close consultation with HAPCO and other organizations that have rich experiences in this regard while a consultant will be hired to handle the technical work.  

The guideline will elaborate intervention modalities for each type of disability (sight, hearing, physical and intellectual). It will also be in harmony with the already existing HIV/AIDS policy and other supporting guidelines of the policy. This guideline will be subject to improvement and modification through time after its implementation is tested.

 

Organizing capacity building training for the leaders and technical staffs on PwDs focused HIV/AIDS interventions.

Previously, disability organizations including FENAPD member association have tended to place a low priority on HIV/AIDS prevention and control and had limited capacities in addressing the HIV/AIDS problem. 

In order that they can play vital roles in promoting the inclusion of people with disabilities in HIV/AIDS prevention, treatment and care services, the DPOs leaders and technical staff, first, requires that they are well trained on, among other things:

HIV/AIDS prevention care and support with respect to PwD with emphasis on gender mainstreaming. the link between disability and vulnerability to HIV AIDS, the roles of DPOs in fighting HIV/AIDS. Accordingly, by this project leaders and technical staffs of the federation and the member associations will be given 5days capacity building trainings mainly on the above mentioned areas. These trained people besides leading the project activity will have contribution in the disability focused HIV prevention guideline development.

Specific Objective 2: To increase the target population's access to behavior changing information on the nature, modes of transmission, prevention mechanisms and effects of HIV/AIDS by 50% from the base line by the end of the project period.

Strategy 2.1: Dissemination of HIV/AIDS information targeting PwDs and their families and the public by organizing sensitization workshop and special events.

Sensitization workshop

FENAPD will systematically contact key community members, community leaders, youth leaders, religious leaders, and relevant government organizations and discuss with them on major HIV/AIDS problems of PwDs and on how to address the problems in the areas. Following such subsequent contacts, a one-day sensitization or planning workshop targeting community leaders, DPOs leaders, community representatives, relevant government and non-government organizations and CBOs will be held at the selected project towns.

Finally a community based project support committee will be established at each project towns comprising members selected from PwDs, DPOs, women, youth, girls, religious leaders and CBOs and other relevant institutions which will play key roles in establishing a strong linkage between FENAPD, its member National Associations, PwDs Anti-AIDS clubs and the community right from the onset to ensure the support from the community, and create supportive environment in the community and take part in monitoring and evaluation of the project activities.

Organizing Special awareness raising events

With this proposed project, FENAPD will organize awareness raising events on World Disability and AIDS Days on which carefully designed HIV/AIDS/STIs messages and information are disseminated in December and November respectively.

Strategy 2.2 Dissemination of relevant & target specific HIV/AIDS information to the target people using PwDs friendly medias.

Activities:

Awareness education materials Production and Distribution

With this project FENAPD addresses HIV/AIDS information needs of all disability types by developing appropriate materials. The blind people will be addressed by brail format print materials and audio materials including CD recorded materials, the radio program and personal communications mainly the peer education strategy. The deafblind people will be addressed by brail print materials and personal communications by peers using tactile communication through the peer approach.

The deaf will be addressed through print materials and personal communications using sign languages by the peer to peer education approach. Appropriate audio, print and video materials will be used for people with physical and intellectual disability. 

Quarterly Newspaper[BA1] 

Newspapers are best means to disseminate health information to a very large number of literate PwDs. Often a newspaper is read by more than one person and the total number of readership is thus larger than the total number of newspaper printed. Accordingly, 4,000 copies of newspaper addressing various HIV/AIDS/ issues including in brail format will be produced and distributed quarterly in the local language including using brails. They will be distributed at disability associations, higher education institutions where more disabled students found, schools, rehabilitation centers, clubs/groups of PwDs and other places where PwDs and their families could be accessed in significant number.

This newspaper will be a bulletin of four to six pages prepared by experts and will have articles, cartoons, illustrations, pictures and figures that will provide relevant HIV/AIDS information to the target population. In this regard the experts to be hired shall exert their knowledge, skills and experiences to develop the scripts and illustrations. Relevant available print materials by other organizations would also be adopted and used.

Leaflets [BA2] 

Brochures & leaflets that contain relevant, precise, factual and scientific information on HIV/AIDS/STIs issues and topics at a time will be produced and will be printed in sufficient copies and distributed including by brails. One type of leaflet each with 30,000 copies will be produced and distributed during the three years project period at all possible places to access PwDs and their families.

These will be written in the local languages and contain appropriate visuals produced by an artist and distributed at: schools, higher education institutions, PwDs associations/groups, rehabilitation centers, special events like disability days, major condom social marketing centers, other public meeting places and PwDs anti AIDS clubs.

Audio Messages

Audio cassettes are also important tools for promoting awareness on HIV/AIDS/STIs. They will enable to address the problems of persons with sight impairments both literate & illiterate. The audio cassettes may contain facts which depict important messages on HIV/AIDS/STIs issues.

Audio cassettes are convenient for users at home, etc… to listen individually or in groups. They can last longer, be borrowed and copied easily. FENAPD will produce 1 audio cassette in local language per year and reproduce in 500 copies and distribute for use annually. This cassette will be used to complement peer education session. Each peer education participant will receive copy of CD or cassette produced and discussion will commence based on the information delivered in the audio material. This audio material also serves as a reference material for future benefit of peer education participants especially for those with sight disability.

Radio Programs

To reach wider population radio programs will be used in this project. Except the high air time cost, it is less expensive for users in that it is run with batteries and could be owned by individual target population. Unlike print media radio does not require its audience to be literate. Its transmission reaches people off the roads or people who live in areas with poor or no transportation facilities. Moreover, people are usually more convinced with radio messages than any other source messages. FENAPD will effectively use this program to disseminate HI/AIDS related awareness information through this program since it has rich experiences in this regard. This will address large number of persons with physical, sight and intellectual disabilities all over the country at a time.

Accordingly, experts who will be working on this at the info center will produce the scripts of the radio programs, produce the program in the studio and there will be every 15 days 30 minutes radio message transmission in Amharic on different HIV/AIDS issues during the project period.

Strategy 2.3: Dissemination of awareness information on HIV/AIDS to the target population by organizing/strengthening PwDs Anti AIDS clubs that use multimedia information dissemination mechanisms.

Activities

Strengthen/reorganizing 4 PwDs Anti AIDS clubs

This activity entails strengthening 4 already established PwDs Anti AIDS clubs. Thus, FENAPD will properly approach these interested young people through its member associations in organizing their clubs and strengthen the establishment by providing basic technical, material and financial supports. FENAPD will provide relevant club management guidelines considering disability types, trainings, basic guidance on the overall club establishment, need based basic office furniture and materials and stationery to each of the clubs so that the clubs can run their subsequent awareness raising activities in an organized way.

This project will also address working place problems of the clubs by joint discussion with member disability associations, local community leaders to facilitate for the availability of a small working place that can accommodate peer learning meetings and small information corners.

This clubs are very important for the program, since FENAPD will select peer educators from these clubs; they will be involved in IE/BCC material distribution, in assisting special events organization and will serve as future project sustainability.

Preparing Club management and Peer learning guideline

FENAPD prepares/adapts a summarized but comprehensive club management and awareness education guidelines for the clubs to ensure the quality and uniformity of the club management and the awareness education. Copies of the guideline will be prepared in a way they could serve persons with different disability types.

Through strengthening the anti AIDs clubs, the PwDs will become actors of their HIV/AIDS problems. Using the club management guideline they will organize themselves, elect their leaders and address their HIV problems effectively. This process of club management will enable them to be potential leaders in the future. It also contributes to self assertiveness in particular and healthy life of the community.

Training Club leaders and peer educators

When the club establishment is ensured FENAPD will provide tailor made training courses in club management, local project planning and management and networking areas to 12 Anti AIDS club leaders (3 person/club) for 3 days to enhance the leadership and management capacities of the clubs. Clubs are organized in disability types and peer educators also form their peer education groups based on their respective disability types.

To conduct effective awareness activities, FENAPD will train 40 peer educators (10/club) at club level mainly on message design on HIV/AIDS/STIs, communication skills, counseling, referral systems, condom provision, home based palliation and support so that they can undertake pear learning, multi media mass awareness education activities on HIV/AIDS/STIS and provide counseling referral services at their respective club. The peer educators will be represented from each type of disability groups and the trainings will be tailored to the disability types so that they can address their special needs.

Clubs peer to peer learning

Following the in-depth training, the peer educators conduct the awareness education through peer –to-peer learning, coffee ceremonies and mass education (edutainment) on HIV/AIDS issues to the target population guided by the manual adapted for this.

Each of the peer educators will form 1 peer group comprising 20 members that will graduate the peer learning within a month focusing on what HIV/AIDS and STIs are, their mode of transmission, prevention mechanisms, their socio economic impacts and how to take care for PwDs living with HIV/AIDS and orphans due to AIDS. One club will have 10 trained peer educators and thus the wider PwDs in the 4 towns will also be addressed through edutainment activities, which use drama, music, role-plays and the like through the clubs.

As it is true other members of the population, PwDs enjoy coffee ceremonies on which all age & sex of closer neighboring households join. On such ceremonies it is usual that people chat on diverse social issues in a less formal way. Thus, coffee ceremonies are good opportunities to be used to discuss on HIV/AIDS issues & disseminate information on it for PwDs too. Accordingly, the peer educator will organize regular coffee ceremonies at their respective locations and use them as forum for discussing on various HIV/AIDS topics systematically.

Each club will also be provided with basic information materials like leaflets, posters, newspapers, audio materials, video messages and edutainment materials as necessary. Accordingly, the wider target population will also be addressed through edutainment activities, which uses drama, music, role-plays and the like through the clubs.

Peer educators quarterly review meeting will be conducted. Challenges and new developments will be discussed.

Specific Objective 3: To improve quality of life of HIV infected and affected PwDs in the target areas.

Strategy 3.1: Promoting community based palliative care and support for the needy PwDs living with HIV/AIDS.

Activities:

Palliative Care & support

Provision of palliative care and support for the neediest PwDs living with HIV/AIDS is one of the best mechanisms to control the spread of HIV/AIDS, reduce the double stigma and discrimination and to improve the quality of lives for PwDs living with HIV/AIDS. With this project, FENAPD will prepare/adapt palliative care guideline to keep the uniformity and quality of the service. Accordingly, 40 Voluntary palliative care providers - PCPs (10/ clubs), mainly female with disabilities will be selected and trained on palliation and counseling. The PCPs will be provided with palliation kits and in turn provide home based palliative care, support and basic counseling services for selected PwDs living with HIV/AIDS. The service will primarily focus on prevention with positive intervention strategies and PLHIV will be addressed in the following services, home based care for the bed ridden client, partner referral, STI and TB screening, ART adherence , FP counseling, nutrition support and psycho social support.

To address the basic needs of severely affected PwDs living with HIV/AIDS, FENAPD in collaboration with local self help organizations such as ‘Idir’ and kebele will select the neediest 240 (60 persons/ town) PwDs living with HIV/AIDS and provide basic things such as food, clothes and medical expenses through the PCPs providers.

VCT & related s