Nurturing the MOU-JAP Through Country-level Initiatives: HIV Prevention and Infrastructure Mitigating Risk in the Greater Mekong

Subregion: SubProject 10: Pre-construction HIV Prevention in Lao PDR and Viet Nam (July 2011- June 2013)

Bounpheng Philavong, MD, MPH, DrPH Director of Centre for HIV/AIDS and STI Ministry of Health of Lao PDR
Satellite session: Reducing Vulnerability among Migrant and Mobile Populations and Communities in Cross-Border Areas in the GMS 18-22 11th ICAAP, Bangkok, Thailand
Disclaimer: The views expressed in this paper/presentation do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Sub-project 10: Pre-construction HIV Prevention Associated with the Second Northern GMS Transport Network Improvement Project
A cross border initiative spanning Lao PDR and Viet Nam implemented as a collaborative arrangement by the Burnet Institute and the Research Communications Group (RCG) Key implementing partners:
Lao PDR: Centre for HIV/AIDS and STI (CHAS), the Subprojects National Executing Agency, and the Houa Phanh Provincial Committee for the Control of AIDS (PCCA) Viet Nam: Viet Nam Administration for HIV/AIDS Control (VAAC)and the Provincial AIDS Committee (PAC) in Thanh Hoa province

Timeframe: 18 months, with the project inception in July 2011 and completion in December 2012 (extension until June 2013)

BACKGROUND
The GMS Northeastern Economic Corridor(NEEC) aims to improve transport connections between Viet Nam, Lao PDR and Thailand, thereby increasing mobility and economic activity in the region. The improvement of Road 6 in Houaphanh Province, Lao PDR, and the connecting Road QL217 in Vietnams Thanh Hoa Province forms part of the 2nd Northern GMS Transport Network Improvement Project, which in turn is part of the NEEC.

Map of Sub Project 10 Area

PROJECT GOAL

To reduce HIV transmission and STI prevalence among migrant and mobile populations and communities along the road construction route.

OBJECTIVES
1.
2.

To build capacity of local authorities in addressing HIV so that they are ready for heightened level of activity when road construction begins ;
To prepare communities living along the proposed route for the road upgrade for any new HIV vulnerabilities that will be associated with the road development ; To address the immediate HIV transmission risks already present in the communities during the current phase prior to beginning of road construction ; and To build capacity of health systems required to support HIV programming like VCT and Sexual and Reproductive Health services including STI management services.

3.

4.

FUNDING THE PROJECT

The project was funded by ADB, with support from AusAID. This included funding for:
Burnet Lao technical and management staff Occasional international advisers from Burnet Australia Travel and workshop costs Travel costs to support involvement of technical staff from CHAS and MPWT

PROJECT MAIN BENEFICIARIES

Local people, mostly rural villagers, including different ethnic groups.
The project helped these people to understand HIV, consider their own risks, and prepare for further HIV risks which will occur as more people visit the province during and after road construction. It was based on the concept of Early Warning and Rapid Response.

POTENTIAL HIV AND STI RISKS

If the local village women have sex with the male road construction workers, for money, for exchange of goods or services, or in hope of future marriage;
If more men and women start using drugs because the road makes drug trafficking easier (there is HIV associated with drug using in the nearby provinces of Viet Nam); If the number of MSM increases: as has often happened elsewhere in Asia, this is very likely as the provincial capital Xam Neua grows from a small town to a small city.

HOW THE PROJECT WORKED (1)

The project focused on building long term sustainability of responses to HIV. It did this through the development of the district Project Working Teams. This ensured long term engagement in responses to HIV by people who themselves live in the districts. The project built their understanding of HIV, then helped them to analyse local situations, future challenges, and planning of long term responses.

The district Project Working Teams included staff from the provincial Health and Transport authorities, along with others from the Provincial Committee for Control of AIDS. Partners included the Lao Womens Union; the Lao Youth Union; the Lao Trade Union; the provincial staff of the Ministry of Information, Culture and Tourism (who produce radio and television services for the province); provincial staff of the Ministry of the Interior; Police; and the Military. These local organisations will continue to allocate staff time to responding to HIV in the long term.

HOW THE PROJECT WORKED (2)

The members of the district PWT are people from different sectors, and their salaries were not paid by the project.

They understand their own communities better than any outsiders. The project focused on building their understanding of HIV and how this might affect their own communities.
The project also encouraged them to think about the economic benefits of having a new road for the province, and how the local people might work to maximise these benefits. The district PWT Teams worked with their own local communities. They helped these communities to prepare for changes in HIV transmission that are likely to occur once the road construction commences, and after the road is completed. The project built capacity in HIV awareness, situation analysis, mapping of services, peer education, communication skills, referrals to HIV and STI services, and some enhancement of those services. A Burnet Project Officer lived in Houaphanh Province for the period of the project. In the later stages, the Project Officer was an STI expert seconded from the national Centre for HIV/AIDS and STI (CHAS). This ensured even closer collaboration between national and provincial partners.

BASIC TRAINING IN HIV

Delivery of prevention activities

Support for community discussion

Behaviour change Upgrading capacity for HIV and STI testing and counselling, and Linking the districts with national M&E systems

MATERIALS, PRODUCTS AND OUTCOMES

The understanding and relationships that have been built. Relationships were developed between national, provincial and district project partners; and between the Project Working Teams and their own communities. All partners learnt to address HIV and to work better with communities. Sustainability Proposals produced by the project can be used to inform future projects whether those projects are related to road construction or not.

CHALLENGES
(i) to build capacity of local communities to understand what changes may occur in the future, even though they have little experience of HIV to date; and (ii) to plan for future sustainability when it is not known how much external funding will be available.

KEY LESSONS
Sustainability is best built through multi-sectoral Project Working Teams Cross country learning exchanges are valuable for increasing capacity both ways Pre-construction phase projects require saturation of all communities as there is no clarity on where road construction workers will focus themselves during road construction In the final six months, the Project Working Teams prepared their own proposals for sustainable responses to HIV during the next phases of road construction and post construction.

SUSTAINABILITY AND TRANSITION

Support for PWT to continue preparing communities for the challenges they will face when road construction begins

Cross border activities for migrating populations

Cross border meetings at provincial level to discuss potential collaboration e.g. addressing migrants health and develop a mechanism for supporting ARV access for Lao people living near the border Support HIV prevention among people who use drugs by building capacity in harm reduction A cross border advocacy meeting held between the Lao PDR and Viet Nam authorities where Vietnamese health authorities can support the Lao authorities to develop plans for harm reduction implementation

Beyond the specific duration of the project, it is necessary to build mechanisms that will allow the co-ordination of pre-construction and construction period HIV mitigation activities

Thank you for your attention.