Karama S., Kagimu M., Ezati E., Bunnell,R . Islamic Medical Association of Uganda CDC Uganda

1. Community Mobilization Intervention Model for Prevention of Mother to Child HIV Transmission (PMTCT) and Antiretroviral Treatment in Kampala, Uganda • Karama S., Kagimu M., Ezati E., Bunnell,R . • Islamic Medical Association of Uganda • CDC Uganda

2. Background of PMTCT in Uganda • Annually about 30,000 children are getting HIV infected through mother-to-child transmission in Uganda. • 6.5% HIV prevalence among women attending ANC • 1n 2000 - a pilot programme to reduce MTCT was initiated by the Uganda government in collaboration with UNAIDS, UNICEF, WHO and other partners. • The programme targets women attending ANC

3. Background of PMTCT in Uganda Cont… • Todate 48 PMTCT centers are functional in 31 of the 56 districts of Uganda. • Despite the intervention, utilisation of PMTCT services has been poor mainly due to inadequate education & sensitisation of communities.

4. Community Mobilisation Intervention Model using faith based organisations • Goal: • To mobilise the community to utilise PMTCT services through community education. • Intervention: • Formative Research, • Curriculum Development, • Training of trainers & community educators, and • Community education & Mobilization

5. Community Mobilisation Intervention Model using faith based organisations Cont.. Intervention strategy: • Use Community Action for AIDS Prevention network. • Uses religious leaders of different faiths and local council leaders. • Use of key religious teachings to bring out messages • Community education and mobilisation. • Trained community educators • Sermons in churches and mosques; • Mini lectures, • Group talks and home visits. • radios, televisions, newsletters, T-shirts and use of referral cards with messages.

6. Status of Project Implementation 1. Formative Research (a) Overall objective: to obtain baseline data on community knowledge and beliefs related to PMTCT. (b) Method: 12 Focus Group discussions with community members and leaders (c) Data used to develop training curriculum for community leaders and members

7. Formative Research Findings • Low knowledge on PMTCT, ARVs & Discordance • Few people knew their sero-status or that of partners • Low utilisation of PMTCT and VCT services due to lack of information & stigma • Inadequate male involvement • Poor service quality at ANC/PMTCT sites • Community education through sermons, group discussions & homevisits recommended.

8. (2) Curriculum Development Curriculum for Community education developed • Main topics: • PMTCT, ARV, ANC, VCT • Men’s involvement • Behavior change communication skills • Community mobilization using sermons, group discussions and home visits

9. (3) Training • 25 Trainers trained to train community leaders/educators • 150 community leaders trained to train community educators • 38 Local Councils • 27 Catholics • 29 Anglicans • 29 Muslims • 27 Independent churches • Each community leader had 4 volunteers: 2 females and 2 Males • 600 volunteers were recruited and trained as community educators

10. (3) Training of community educators Cont….. • Trained in 5 day workshops • Baseline assessment of knowledge, attitudes and behaviour of the educators indicated • Low knowledge on meaning of • HIV negative result, • Discordancy, • Vertical transmission and • Infant feeding • Knowledge increased • Baseline average mark 45% • Post-training average mark 76%

11. (4) Community Education and Mobilization November 2002 to June 2003: • Sermons - 2,914 • Mini-lectures - 4,910 • Group discussions 4,498 • Home visits - 11,569 Number of People educated • Men - 159,363 • Women - 174,704 Clients reported to PMTCT sites • with referral cards - 272

12. In relation to stigma the Muslim leaders quote the following verse from the Qur’an: 1.       Surat Hujrat 49:11 “O ye who believe! Let not some men among you laugh at others; it may be that the latter are better than the former. Nor let some women laugh at others; it may be that the latter are better than the former. Nor defame, nor be sarcastic to each other, nor call each other by (offensive) nicknames…”.

13. (4) Community Education and Mobilization Cont… • Radio programmes - 25 • TV programmes - 4 • Newsletters - 7,500 • T-shirts - 800 (Message:Protect Children from AIDS )

14. (4) Community Education and Mobilization Cont… • Referral cards with messages • It is a sign of love and responsibility when a husband accompanies his wife to attend the antenatal clinic.

15. (5) Support Supervision • Monthly Community Educators’ meetings • Quarterly Community Leaders’ meetings • On-site supervision by trainers

16. (6) Lessons learnt • There was a low level of knowledge on PMTCT issues and services • High demand for PMTCT activities in the communities • Strategy of using religious leaders increases coverage

17. (6) Lessons learnt Cont… • Motivation of community educators (small financial, T-shirts, certificates and badges) encourages them. “I like IMAU’s transparency and their regular supervision,” – community educator • Community mobilization for PMTCT through religious and local government leaders is feasible and practical “This project has united people of different faiths to work together to fight a common enemy” – community leader

18. Acknowledgements • Community members • Community leaders • Faith based organisations • IMAU staff • CDC • UNAIDS/UNICEF