Under the current New Funding Model grant, a considerable proportion of the grant is allocated to Behaviour Change Communication (BCC). Two of the key modalities to deliver information are through Community Conversations (run through UNDP) and peer education programs (run through OSPAD, WAWA, HDC, CCS, PUNCHAD, SAHAN, BADBADO and TALOWADAG).
In the Somali context, the HIV epidemic is fuelled by structural and social factors, such as poverty, gender inequalities and human rights violations which increase vulnerabilities to HIV infection. These factors significantly determine access to information and services. Therefore, there is a need to go beyond sensitization, awareness and media campaigns to more community-based and community owned approaches, which both address underlying socio-cultural dynamics in a way that empowers people to analyse and plan against HIV&AIDS in their own communities and examines risk behaviours and how to mitigate them. ‘Community Conversations on HIV’ were introduced in Somalia to help promote the meaningful engagement of civil society in a dialogue around HIV, as well as scale up efforts to intensify prevention, treatment, care and support towards the Universal Access Targets in Somali Populations. Peer Education was introduced in this grant to specifically target key vulnerable populations (vulnerable women, clients, uniformed personnel) with tailored prevention messages through outreach, and referrals into testing.
Stigma and discrimination, rife in Somalia, restricts people from accessing HIV Testing and Counselling (HTC), Prevention of Mother to Child Transmission (PMTCT), Antiretroviral Therapy (ART) services. This was confirmed in formative research done by BBC Media Action for UNDP (2012) and the Stigma Index Survey (2107), both of which indicated while there are significant behavioural and logistical barriers to the HIV and AIDS response in Somalia, stigma and discrimination are the most significant barriers for people seeking information, testing and treatment.
Current implementation under the New Funding Model 2015 - 2017
Under the New Funding Model Global Fund grant implementation peer education is conducted through partners, some also providing clinical services, some not, some PLHIV networks, some not. The peer education programme to date has been using a 2-day peer education/information session programme. It is unclear if this modality of information sharing has been successful in reaching those most at risk given the stigma in Somalia, and also whether it has been successful in promoting HTC uptake of those most at risk.
Under the current New Funding Model Global Fund grant implementation, the United Nations Development Programme (UNDP) is undertaking Community Conversations on behalf of the Principle Recipient. Community Conversations provide an opportunity to provide the facts on HIV as well as address myths and misconceptions associated with the disease which are common in Somalia. This is expected to help people change their behaviour, both in terms of the way they behave toward People Living with HIV (PLHIV), as well as their own risk behaviour, and access HIV Services. CCs include resource persons e.g. religious leaders, PLHIV, HTC staff to talk about the benefit of knowing your status. One of the main objectives of this project is to create/strengthen linkages between communities and health services such as HTC, ART, and PMTCT. Sharing information on these services is vital in order to scale up access to these services.
Community Conversations on HIV have run in Somalia for approximately five (5) years and peer education for three years without an evaluation ever having been carried out to evaluate the impact the project has made and make specific recommendations around planned implementation of CCs in the new funding request 2018-2020.
Planned implementation under the new funding request 2018-2020
Under the new funding request (2018-2020), peer education will be delivered through outreach through peers, including peers for vulnerable women, one for vulnerable men, one to link with private sector facilities to promote HTC uptake and the men’s hotline, one for PLHIV, and 6 for IDP across the three regions. In addition, one PE will be placed at each ART facility in each region to facilitate adherence and retention. The peer educator placed at ART facilities will be responsible to track all HIV positive patients to ensure enrolment and trace lost to follow up patients. A Mother Mentor will be placed at each ART site to support mothers and develop mothers and children’s support groups. These mothers are meant to counsel other mothers on disclosure, link them to GBV services if needed, and support them to link to livelihood activities. The outreach package for both consists of a certain set of messages derived from the Peer Educator’s Toolkits (to be finalized end year 2017) and specific referrals for services. An accountable monitoring and referral feedback system will be developed to ensure clients referred for testing reach testing or are able to be tracked.
From HIV NFM grant support, UNDP has developed 3 Peer Educator manuals which have been field tested (through development) and will be finalised and printed along with the related IEC materials before the end of 2017. The packages of services for vulnerable populations includes:
Under the new funding request (2018-2020), CCs will continue coordinated by the National AIDS Commissions. They will be condensed from the current 12 sessions to a half-day session as it cannot be expected that the same people would return to subsequent conversations, however, sites may be re-visited if it high interest is determined or if subjects are not covered. Cities may contain multiple sites. They will continue to be rolled out through each region, 9 sessions per quarter, under the new funding request grant application, with the same geographical focus as vulnerable populations to increase potential HTC uptake and contribute to stigma reduction.