09.C.AC05: UNHCR- HIV/AIDS Support to Refugees

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

General Prevention:

Our FY2007 and FY2008 HIV prevention activities focused on community education to help refugees

acquire basic information on HIV/AIDS and to promote safer sex behavior practices and VCT. As a result of

these activities, 39,222 condoms were distributed in the camp and 209 refugees of the 2500 living in the

camp were tested for HIV. During the process of implementation of this project, new issues emerged which

require modification of the prevention strategies for FY2009 and FY2010. These include the gender

inequalities resulting in sexual- and gender-based violence (SGBV) and the potential for new HIV infections.

Women raised concerns of challenges that many of them face in the camp when negotiating safer sex

practices, due to power imbalances between them and their male partners, their dependency on men, and

the cultural expectations regarding child bearing.

Additionally, girls are more at risk of engaging in early sexual debut because of both the disintegration of

strong family connections and parenting issues. The FY2009 and FY2010 prevention activities will focus on

addressing gender inequalities by engaging men as equal partners in HIV prevention, promoting the

positive aspects of masculinity and encouraging men to participate fully in sexual reproductive health issues

affecting them, as well as their partners. This will be done through partnering with the Men's Sector

committee in the Dukwi area to conduct regular outreach activities.

Prevention with positives:

The capacity of people living with HIV/AIDS (PLWHA) to have a voice in planning, implementing and

monitoring of camp HIV prevention activities will be strengthened through identification and regular training

of those in the support group with potential to do so. Most will be engaged in the program as volunteers to

support community outreach education, health talks and lay counseling activities. A camp-based support

group will be developed to become a trusted service provider for PLWHA, including those in the local village

of Dukwi. It will be registered and affiliated with the Botswana Network of People Living with HIV and AIDS

(BONEPWA).

OVC:

Care and support for OVC will be extended from life skills development to include material support for

exceptionally vulnerable children based on thorough assessments.

Baseline survey:

As part of the continuing activities to strengthen HIV/AIDS activities in Dukwi Refugee Camp, a baseline

survey on the impact of HIV/AIDS, targeting Botswana's entire refugee population, will be conducted by

outsourcing technical support to a consultant. Such a survey has never been conducted among the

refugees living in Botswana. The objective of this activity will be to establish baseline data to provide

support for evidence-based HIV prevention interventions among refugees in the future. At the end of the

study, recommendations for future interventions on prevention, treatment, care and support will be

available.

From COP08:

The UNHCR office in Botswana continues to provide protection to approximately 3,113 persons who are

Dukwi camp based refugees (1,709), urban refugees (788), asylum seekers (137) and rejected asylum

seekers (479). Botswana's refugee population is made up of individuals from 17 nationalities, which creates

significant challenges when designing programs to address their diverse protection and assistance needs

including programs tailored to address the HIV and AIDS pandemic.

Dukwi Refugee camp is situated within the Tutume Sub-District, one of the four main districts in the northern

part of Botswana. The district has a high HIV prevalence rate. According to recent surveys, the district had a

41.5% HIV prevalence among pregnant women and 39.9% among the general population. To date no other

HIV surveillance has been conducted among refugees in Botswana.

Community mobilization and education on HIV/AIDS to overcome myths in the community and to promote

abstinence and healthy sexual behavior change among youth and adults are important focus areas. There

is evidence of alcoholism, intergenerational sex and having multiple sexual partners in this community.

A fresh approach to education needs to be adopted because the uncreative educational programs have

attracked few adult participants. Promotion of HIV testing will be intensified because refugees still test in

low numbers due to the fact that they have not had access to the national ART program.

In 2006, 254 refugees tested for HIV in Dukwi Clinic. Fifty-four (54) were diagnosed HIV positive.

Continuous advocacy with the GOB is expected to result in a change in the policy of exclusion of refugees

from the national ART program. The proposal will be presented by the MOH to the Cabinet for approval and

hopefully be endorsed.

The objectives of the program are:

1.To ensure continuous activities to prevent and reduce the spread of HIV infection in the camp by

supporting behavior change initiatives, particularly targeting youth.

2.To ensure improved welfare of refugees by providing access and utilization of HIV/AIDS services as well

as empower the community with continuous basic health education.

3.To support the camp clinic and community capacity to support PMTCT and ART for refugees with hope

that the clinic might become an official ART site.

Activity Narrative: In FY08, community-based prevention programs will include: education and awareness, condom promotion,

HIV counselling and testing. Education will include information dissemination on the basic facts about

HIV/AIDS strengthened by developing refugee friendly information and education materials. Condom use

promotion will aim to teach safe condom use methods. The accessibility of male and female condoms will

be improved by continuing to place them in strategic areas around the camp, such as the community hall,

bars, and provide them to willing volunteers to dispense outside working hours.

The program will liaise with UNFPA through UNHCR to get more condoms for the camp; especially the

female condom, which is popular amongst some women but is in short supply. Sports will be targeted to

promote HIV education for in and out of school youth to reduce their involvement in negative activities such

as alcohol and drug abuse which may expose them to the risk of HIV infection. Further more HIV education

and testing promotional materials such as a quarterly newsletter, calendars, pens, key rings and bags will

be printed and given to the community for learning purposes and as tokens to encourage them to test for

HIV.

Clinic based prevention will continue in the form of promotion of universal precautions, access to safe blood,

STI management and HIV testing and counseling for pregnant women (PMTCT is provided in Dukwi clinic

only to Botswana women and their infants)

Treatment preparedness will be developed and will include community preparedness for a full scale ART

provision through the Tutume Sub-District Council District Health Team (DHT) and Dukwi Clinic to educate

all refugees about ART.Community leaders, faith based organizations (churches in the camp), community

groups and volunteers will be engaged as referral agents. Pending the implementation of the Government

ART program for refugees, the Catholic Bishop's ART program will continue providing ART to 14 refugees

they started assisting in the year 2005.

Care and support activities include: community home-based care, treatment of opportunistic infections, and

nutritional support for chronically ill. Psychosocial support will continue to be extended to all children in the

camp especially orphans and vulnerable children (OVC) to address pertinent issues affecting them on a

case by case basis with the help of teacher counselors. An educational personal and group counseling

retreat for vulnerable and orphaned children will be carried out as a part of the 2006 child-mentoring

program. A social worker will run the retreat with the assistance of several caretakers from the refugee

community and/or the school guidance and counseling teachers. New inputs stemming from counseling

sessions and new assessment of environmental livelihoods will be used for the review/improvement of the

child-mentoring program established in 2006.

The PwP initiative will be strengthened. Emphasis will be on providing support for refugees who tested HIV

positive but are not on treatment or receiving counseling. A formal referral system between the Dukwi clinic

and VCT services will be continued to identify such persons. They will be encouraged to join the PLWHA

support group where they will receive education and ongoing counseling including counselor mediated

disclosure to their partners and referrals for related health services.

Gender issues related to HIV status including sexual coercion and lack of support from male counterparts

will also be addressed in support groups. Pregnant women will be encouraged to test for HIV in clinic

health talks. Regular support group sessions will be held to motivate mothers whose children did not benefit

from AZT to consider HIV testing for the children, in order to help estimate the number of children in need of

ART. Issues of gender inequalities and lack of support from male counterparts will be addressed.

Refugees will be encourage to participate as active support members, providing peer support to others as

well as receiving services themselves. This will hopefully indirectly or directly minimize the stigma

associated with HIV and AIDS if they see faces of others living with HIV in the education initiatives.

The program will work with MOH to provide palliative care training for 4 staff members to address the

palliative care needs. Psychosocial support and nutritional programs will also be provided. Four officers

including the HIV officer will be trained on ART protocols by undergoing KITSO training with the Botswana

Harvard Partnership Master Trainers program.

Teachers in Dukwi Primary school will receive training on pediatric ART from the Botswana Baylor Children

Clinical Centre of Excellence. This will enable them to support children who may be enrolled in ART in the

school if it is extended to refugees. Youth volunteers will be trained in drama to enable them to develop

creative ideas for community education. They will also benefit from an exchange program of mentoring and

visit to other youth facilities in the country.

Church leaders will receive training on lay counseling in HIV/AIDS to enable them to actively identify those

in need of HIV testing and follow-ups and refer them to relevant services in the camp for follow-up health

care.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17670

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17670 17670.08 Department of United Nations 7802 3617.08 PRM $200,000

State / Population, High

Refugees, and Commissioner for

Migration Refugees

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Refugees/Internally Displaced Persons

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08: