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The “Bashy” Bus

UNICEF Jamaica ‘One Stop Shop’ Mobile Service for Vulnerable Adolescents A Children First (NGO) Initiative Jointly funded by UNICEF & Global Fund Penny Campbell January 2006. The “Bashy” Bus. Inside – the Clinic Area. A non-threatening environment. Child-friendly outreach.

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The “Bashy” Bus

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  1. UNICEF Jamaica‘One Stop Shop’ Mobile Service for Vulnerable AdolescentsA Children First (NGO) Initiative Jointly funded by UNICEF & Global Fund Penny CampbellJanuary 2006

  2. The “Bashy” Bus

  3. Inside – the Clinic Area

  4. A non-threatening environment

  5. Child-friendly outreach

  6. Edutainment – “Bashy Bus Crew”

  7. Overview • Jamaica's 2.6 m population experiencing a generalized epidemic • Estimated prevalence of 1.5 – 2 % • 22,000 persons living with HIV/AIDS • 9,209 reported AIDS Cases (Dec 2004) • Average rate of 354 per 100,000 • Over 800 per 100,000 in some parishes (urban and tourist) • Predominantly heterosexual transmission (71%)

  8. S u m m a r y o f A I D S C a s e s b y P a r i s h i n J a m a i c a 1 9 8 2 - 2 0 0 4 (R a t e p e r 1 0 0 , 0 0 0 P o p . ) The Bashy Bus Route N W E S H a n o v e r T r e l a w n y S t . A n n S t . M a r y W e s t m o r e l a n d P o r t l a n d S t . E l i z a b e t h S t . C a t h e r i n e M a n c h e s t e r C l a r e n d o n S t . T h o m a s AIDS/100,000 Pop. 100 . - 150 150 - 200 . . 200 - 300 . - 400 300 500 - 810

  9. The Challenge • Children and adolescents 40% of population • Early sex initiation (boys 13 yrs.; girls 15 yrs.) • High rate of forced sex (20%) • High rate of transactional sex (20%) • High rates of multiple sex partners (48% men, 16% women)) • Adolescent girls 3 times more likely than boys to become HIV infected • Young girls having sex with HIV infected older men (50% report sex partner to be 5-10 years older) • “Sex on the Bus”: risky sex practices between young people and transport operators widespread (Youth.now, 2004)

  10. “Turning a Negative into a Positive” • An alternative “bus service” for vulnerable adolescents (along major transport & high prevalence routes) delivering: • HIV/AIDS and sexual reproductive health information, STI clinical services • Counseling: relationships, sexual decision making, risk assessment skills; drug abuse; domestic violence and abuse; help restarting school after pregnancy • VCT – rapid testing • Referral and follow-up

  11. Specific objectives • By December 2006, 5,000 vulnerable adolescents will have access to information, skills based counseling and services that serve to: • Increase access to information about HIV/AIDS and SRH issues • Improve sexual health behaviours & practices • Improve risk assessment & sexual decision making skills • Increase access to HIV/AIDS/STI services Penelope Campbell

  12. Expected outputs • Increased consistent, correct condom use • Increased contraceptive use (dual) • Reduction in multiple sex partners • Delayed first sex Penelope Campbell

  13. Baseline Study Commissioned to: • Determine adolescents’ interest and preferences in the services and design of the Bus. • Build a profile of the targeted adolescents to show their SRH knowledge, attitudes and behaviours • Prepare a performance framework for monitoring & evaluation (process & impact) Research Design • Survey: 452 adolescents (structured interviews) • Focus group discussions (96 adolescents) • Disaggregated by age and gender • 212 (47% boys) and 240 (53% girls) • 4 targeted & 3 control communities

  14. Criteria: Vulnerable Adolescents • High prevalence areas of HIV/AIDS/STIs • Communities where infrastructure limited (urban or rural) & adolescents have to travel far to access health or education services Sampling Process • Key informants asked to list 3 communities that met criteria • Communities most frequently mentioned selected • Snowball sampling

  15. Findings • Profile of Sample: • School enrolment high (89%) • 74% live with mother; only 32% with father • 1 in 5 live with neither parent (visiting relationship) • 1 in 4 rely on neither parent for financial support • 78% knew where nearest health centre located • But 59% did not have positive impression • Girls and younger adolescents were especially reluctant • Boys felt pride when accessing services (machismo reinforced)

  16. Felt vs. Actual Needs • High interest in range of services proposed (70%) • … but few (19%) felt need in past 12 months • ‘Actual’ needs however were high: • 1 in 2 reported having sex: boys (62%) girls (38%) • Mean age sex initiation: girls (15 yrs), boys (12 yrs) • Only 33% correctly identified 3 safer sex practices • 69% held 2 or more sexual health myths

  17. Among sexually active adolescents: • 20% females & 66% males did not use condom at first sex • 37% females and 30% males did not use condom at last sex • 1 in 10 girls are teen mothers • (94% unintended , 18% under 16) • 1 in 10 reported forced sex (93% did not feel need to ‘get help’ afterwards) • 1 in 4 reported multiple sex partners • 1 in 4 had sex partner - 5 years or older

  18. Taking services to target group • Over 80% interested in mobility of service: • Bus will allow them to express themselves freely and in privacy • ‘Bus workers not from area’, do not know parents • However, avoid taking Bus to adolescent corners because: • Don’t want it to look like ‘dem have AIDS’ • People/peers will know ‘their business” • Go to central, more ‘neutral’ locations

  19. Adolescent Expectations of Service • Top 3 priorities: • Building healthy relationships • Family planning • HIV testing • Most important youth-friendly qualities: • RESPECT (90%) • Clarity of information (90%) • Confidentiality (80%) • Participation (80%)

  20. Preferences and Interests • Entertainment (music, skits) • Simple IEC materials visual that ‘do not look too educational’ • ‘Good’ condoms • Contraceptives • Live testimonials and… • Sanitary pads • Timing: • Sundays – because they are ‘boring’ • Weekends – evenings • Mon to Fri - afternoons

  21. Deterring Factors • Too many “old, grumpy, grumpy people” • Judgmental people; staff with ‘attitude’ • Magazines showing ‘nastiness’ like oral sex • Any association with homosexuals • Should not look overtly educational • Negative slogans or messages (e.g. ill health) • Explicit references to HIV or AIDS

  22. Performance Framework • Process: • # of visits (1st time & repeat) • Approval rating (exit interviews) • % of follow up visits fulfilled • % of referrals fulfilled • Output: • % correctly identifying 2 HIV/prevention methods • % correctly identifying 3 myths • Outcome: • Condom use at last sex (regular & non-regular) • Age of sexual debut • % with multiple sex partners • % unplanned pregnancy

  23. Pilot Period (Aug – Nov 2005) • 2 major launches: Spanish Town, Montego Bay • 9,822 persons sensitized: 1,445 adults & 7,185 young people • 138 adolescents used services of doctor • 110 undertook HIV/STI testing (pre & post test counseling) • 217 counseled: relationships (especially with parents), education and skills access

  24. The Way Forward • Full scale implementation • Establish regular schedule • Tailor services to specific needs of adolescents (gender, age, location) • Visit “neutral” locations rather than corners that young people own • Build capacity of non-adolescent groups (e.g. parents, older “friends”) • Build capacity of local SRH services to serve adolescents (as referral sources) • THANK YOU

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