Supporting Addis Ababa University Students with AB

This is an ongoing AB activity in prevention. It also relates to COP 07 activity ID 5766 (OP) Supporting University Students with non-AB Activities project designed to address other activities outside of AB activities and links with the COP 07 Activity ID 5723(AB) design and production of TA for MARCH.

The study in Jimma University, one of the local universities (B. Tefera… HIV sero prevalence, MAY, 2002) showed that out of 490 students that participated 60 (12.2%) were positive for HIV and the highest prevalence was observed among year III and IV students who are well acquainted with the environment as compared with the fresh students.

In all Ethiopian universities, students come from all corner of the country. Due to their level of maturity and desire for new experiences, the peer pressure they experience, the absence of immediate parental control, the change of environment, and the need to "fit in", students are exposed to opportunities that present the possibility of engaging in unsafe behavioral practice that give rise to HIV infection. Further more especially students at the Addis Ababa university, due to urbanization, they are highly exposed to various hot spots surrounding the university campuses that increase the risk of exposure. The AAU has ten different campuses with in Addis Ababa and Debrezeit town (45 km south of Addis Ababa). The total number of students is estimated to be around 30,000 with academic staff approximating 3,000. Therefore; behavior change interventions that combine activities to promote social norms for safer behaviors (including use of services) and help build the students' ability for implementing the interventions are valuable HIV prevention activities.

The aim of this project is to prevent and control HIV/AIDS within the entire Addis Ababa University community, including regular and summer students, faculty and administrative workers through capacity building in the area of behavioral change communication. The project focuses on improving HIV/AIDS/STI/TB prevention and care activities on the ten campuses of Addis Ababa University through the MARCH model.

MARCH (Modeling and Reinforcement to Combat HIV/AIDS) is a behavior change communications (BCC) strategy that promotes the adoption of HIV prevention behaviors and encourages community members to care for people living with HIV/AIDS (PLWHA) and children whose parents have died of AIDS. Addressing stigma and discrimination towards PLWHA, tackling the existing gender imbalances and the removal of stigma and discrimination is expected to contribute to reduction of risky behaviors and also encourage a comprehensive care and support on the part of the community, promote better service uptake and most specifically - abstinence and faithfulness among AAU students and staffs. There are two main components to the program: modeling component (long running serialized printed dramas portraying role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level. The modeling component uses role models in the context of a storyline to provide information about change, to motivate the viewer, and to enhance a sense of self-efficacy. Reinforcement activity uses interpersonal strategies like peer group discussions and various events. The objective of the reinforcement activities include: applying message in the drama to their own lives, provide accurate information about HIV/AIDS and behavior change, provide an opportunity to practice new skills that may be required in avoiding infection and supporting those infected.

The project utilizes models that reflect the existing characteristics of the University community that face similar barriers and facilitators of behavioral change. These models are part of a printed serial drama that is published every two weeks and distributed among the university community. In the university context it is difficult to have peer group discussion as a reinforcement activity rather we have designed another mechanism for the reinforcement component. Using the certificate curriculum reinforcement agents has been trained and prepares practicum that could be used as reinforcement activities which includes events like public debate. Lectures, exhibition, music concert, live talk show, plays, sport competition etc. all these events will give the student community an opportunity to discuss on the printed serial drama.

In COP 05 the project started with piloting on the main campus and medical faculty and in COP06 the project has been working on developing organizational unit on every campus to run the MARCH program, develop certificate curriculum, designing and hosting website to create online interactive forum to the university community, producing printed serial drama , newsletter and conduct training to build the leadership skills of reinforcement agents, produce print and audiovisual materials for trainings.

In the second quarter of COP06, most of the preparatory works are already done and the TA through JHU/CCP is moving the work plan forward. Please refer Activity # 5723 to get detail on the role of JHU-CCP in providing TA to AAU. A Project coordinator is assigned and the creative team is on board. The first edition of the MARCH news paper has been developed. The web page development is contracted out and already started. The web site development will create interactive media through which the university community could get up-to-date information about the MARCH project, use chat room to discuss online regarding the PSD, reinforcement activities and other HIV related concerns and at the same time it will be used as monitoring tool to measure the achievement and progress of the MARCH project. So MARCH activities are presented as a package.

As financial systems and bureaucratic process has been found to be the major barrier in the implementation of the MARCH project at AAU, budget has been redirected to JHU/CCP to facilitate the financial utilization.

During COP07 the project will: 1. Strengthen the capacity of the liaison offices established in 06 in every campus to implement MARCH program to full scale reaching a total of 30,000 regular students, 2000 summer students and 3000 academic and administrative staff members 2. undertake reinforcement activities by organizing various events like drama, music, exhibitions, Q &A, sport competitions, talk show, public lecture etc 3. In addition to the MARCH program, the project will continue producing and distributing IEC materials to support an array of preventive activities on the campuses, strengthen alliances between the university and other Ethiopian universities, colleges and high schools, and eventually, educational institutions in sub-Saharan Africa and the U.S.

Supporting University Students with OP This is a continuing non-AB focused activity from FY06, linked to AB activity with Addis Ababa University students (5584) and to design and production of TA for MARCH (10386 and 10388).

A survey conducted at Jimma University (B. Tefera, May, 2002) showed that out of 490 students respondents 12% were HIV+. The highest prevalence was observed among third and fourth year students who were well acquainted with the social environment compared with younger students. A different study in Gonder University, by Dr. Yohannis F. (November, 2004) focused on condom use among university students. Of the 401 student respondents 25.3%were sexually active and had had 2-5 sexual partners. Of these, 40.6% had never used condoms; about 25% used them occasionally and about 20% reported having sex after taking alcoholic, increasing the risk of unsafe sex and of contracting HIV.

Ethiopian universities students come from all corners of the country. Factors such as maturity level, desire for new experiences, peer pressure, absence of immediate parental control, change of environment, need to "fit in", mean that students are vulnerable to HIV infection. Students at Addis Ababa University are particularly highly exposed to various hot spots surrounding the university campuses. The university has ten campuses in Addis Ababa and Debrezeit (45 km south of the capital). The student population is estimated at about 30,000 with academic staff approximating 3,000. Therefore preventive behavior change interventions that combine activities to promote social norms for safer behaviors (including use of services) help build the students' capacity for avoiding the virus for implementing the interventions are valuable HIV prevention.

The aim of this project is to prevent and control HIV/AIDS within the entire Addis Ababa University community, including regular and summer students, faculty and administrative workers through behavioral change communication. In particular, this OP will address problems related to stigma and discrimination towards PLWHA, promote consistent correct condom use and early treatment of STI, promote the uptake of services like VCT and ART with in the university context. Its intent is to reduce risky behaviors and also encourage a comprehensive care and support in the university and wider community.

MARCH (Modeling and Reinforcement to Combat HIV/AIDS) is a behavior change communications (BCC) strategy that promotes adoption of HIV prevention behaviors and encourages communities to care for PLWHA and children orphaned by the epidemic. Addressing stigma and discrimination towards PLWHA, tackling the existing gender imbalances and the removal of stigma and discrimination are expected to minimize risky behaviors and to promote community care and support towards members infected and affected by the virus. In the university community it promotes abstinence and faithfulness among AAU students and staffs. There are two main components to the program: education through entertainment and interpersonal reinforcement entertainment component uses role models in the context of a storyline to provide information about change, to motivate its audience, and to enhance a sense of self-efficacy. Reinforcement activity uses interpersonal strategies like peer group discussions, with the objectives of group members applying messages from it he drama to their own lives, providing accurate information about HIV/AIDS and behavior change, providing opportunity to practice new skills that may be required in avoiding infection and supporting those infected. A serial drama is distributed every two weeks, and follows the gradual adoption of positive behavior change by role models and the storyline forms a basis for discussion the peer groups.

In COP06 the project is developing organizational units on each campus to run the MARCH program, develop certificate curriculum and conduct training to build the leadership skills of reinforcement agents, produce print and audiovisual materials for trainings.

Most preparation is complete, assisted by JHU/CCP TA. Although implementation during COP06 was delayed, the planned restructuring under the TA will speed up project implementation. Budget aspects will be under JHU/CCP direction in future which will also reduce obstacles experienced earlier.

During COP07 the project will:

-Strengthen capacity of the liaison offices established in FY06 in every campus to implement MARCH program to full scale, reaching a total of 30,000 regular students, 2000 summer students and 3000 academic and administrative staff members -Undertake varied reinforcement activities and events such as drama, music, exhibitions, talk shows, sport competitions, talk show, public lecture etc. -In addition to the MARCH program, the project will continue producing and distributing IEC materials to support an array of preventive activities on campuses, strengthen alliances between Addis Ababa and other Ethiopian universities, colleges and high schools, and eventually, other educational institutions in sub-Saharan Africa and the U.S.

HIV/AIDS (ART) Program Implementation Support

This is a continuing activity from FY05/06 and relates to JHU activities: Technical Support for ART Scale-up (5664), Counseling and Testing (5728), TB/HIV (5754), Palliative Care (5618), PMTCT (5641), STI Services (5800), Laboratory Support (new) as well as activities implemented through the Twinning Initiative (5678). Partner is on track in achieving targets.

Addis Ababa University (AAU) one of the seven institutions of higher learning located in Addis Ababa, the Federal Capital and one of eleven regions of the country, trains a wide array of professionals, including different cadres of health workers and social scientists.

Having recognized that the university students constitute a high risk group that could be extremely affected by the HIV/AIDS epidemic, the University started to strengthen its response to HIV/AIDS related activities in FY05/06 through support from PEPFAR Ethiopia. The University has taker measures to accelerate the implementation of a comprehensive response to HIV/AIDS among the university community. It has developed and disseminated an HIV/AIDS policy and established a university wide structure to guide and coordinate program implementation. The University is also expanding its support to the national HIV/AIDS program, including ART services. It is increasingly involved in various HIV/AIDS and related activities both at national and regional levels. This includes in-service training of health workers to meet the high human resource needs to implement HIV/AIDS, TB and STI program activities.

In FY06, the university continues to expand VCT services in different campuses and strengthen prevention activities among students and staff. It will continue with the mainstreaming of HIV/AIDS training in its graduate and undergraduate training programs in various disciplines. Data base for clinical patient monitoring that has been established in the teaching hospital of the University will be effectively utilized. Guided by the HIV/AIDS Council, the HIV/AIDS related projects and activities will be implemented in a coordinated manner. The Office of the Associate Vice President will oversee HIV/AIDS program activities in all 16 colleges and faculties of the University. Different colleges, faculties and departments of the University will be actively involved in HIV/AIDS activities based on their areas of specialty and comparative advantages. The Faculty of Medicine, School of Social Work, Institute of Development Research, Departments of Sociology and Social Anthropology, School of Law, Center for Research and Training for Women Development, and others will be involved. The activities of each faculty and department will be coordinated so that the response of the University is a unified one with maximum impact on the epidemic, both university-wide and at national level.

FY06 activities along with the national experience and the momentum gathered in Addis Ababa region accord opportunities to the AAU's efforts to scale up its HIV/AIDS/STI/TB program implementation among the university students and staff and AAU's support to the national program. However, shortage of trained manpower, lack of adequate technical support, and constraints with scientific evidence to guide policy and programmatic decisions and activities will continue to pose major challenges to the national HIV/AIDS program over the coming years. The complexity of the response to HIV/AIDS/STI/TB, including moral, ethical and technical implications of different interventions, calls for a strong technical support to the national program. There is, therefore, a strong need for scaling up training at in-service and pre-service levels, operations research, and national, regional and international linkages and partnership. These programmatic needs can best be met by AAU in partnership with MOH and through innovative alliance with similar national and international institutions.

In FY07, in partnership with Johns Hopkins (JHU) Bloomberg School of Public Health, AAU will further consolidate and scale-up VCT service, expand prevention activities and strengthen linkages to care treatment for university students. It will coordinate its program support with JHU and continue to provide technical assistance to the Ministry of Health and four major regions of the country constituting ART Operation Zone 3 - Addis Ababa Administrative Council, Southern Nation's, Nationalities' and People's Region, Gambella and Benshangul Gumuz.

In FY07, the University will strengthen its support to in-service training and direct technical

assistance to MOH and initiate pre-service training on HIV/AIDS, including ART. AAU will be involved in targeted evaluation of HIV/AIDS program implementation and in national and regional activities related to data processing, documentation of best practices and dissemination scientific information. Through its cooperative agreement with CDC-E, the University will strengthen its engagement in managing its HIV/AIDS program and its support to the national and regional programs and the health networks that deliver ART. Using the funding support through this project and the direct technical assistance from JHU, AAU will consolidate its technical and managerial capacities that will, in the long-term, help the University to takeover the technical support currently provided by JHU and ensure sustainability of program implementation.