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Quarterly newsletter of the national AiDS Foundation 2008 ¹3(21)

saPlInGs We PlanteD mUst be nURtUReD


IntO becOmInG PROtectIVe tRees

w
e must turn these scattered trees of the national Conference of Peer educators since
prevention into a forest of resistance; 2006 to give them an opportunity to share their
establish a mini parliament; prepare experiences and thus learn from one another.
a tV show; improve our efficiency and the this year’s conference was held at nairamdal,
quality of our work by enhancing our capacity the international children’s center, on 19-20 aimag, and the Altanbulag project in Selenge
and skills; share our experiences and views September. its theme was Friendship trees. aimag.
with stakeholders outside Mongolia; establish
consultancy and testing centers in many more Support for this third national conference came on the first day of the forum, participants held
areas… from the UniCeF, the global Fund, and from the group discussions on the constraints and
problems they face in their work, and how they
tackle these. they also shared and evaluated
experiences to determine priorities and formulate
strategies on particular issues. they had earlier
been divided into four groups according to their
areas of work. the principal topics designated for
discussion included:

who is a peer educator?


A typical working day of a peer educator -- what
problems it throws up, and how they are solved;
how to get the most out of documentation? the
following is what some groups said about their
activities.

SProUt sows seeds of confidence


among sex workers

Members of this group said a successful peer


educator should have some legal knowledge,
should carefully listen to and review feedbacks
these are some of the recommendations offered hiV/AiDS and tuberculosis Project at the Ministry and critical suggestions from the community,
by participants at the 3rd national Forum of Peer of health. it brought together 50 peer educators, should be capable of expressing his/her own
educators when they were asked to plan our aged between 17 and 49, all of whom working for opinion cogently and confidently, should be
course of action in the coming months. projects we have been implementing jointly with
partner ngos such as trust and Faith, together
Several years have passed since the national Center, Youth for health, Mongol Vision, trust for
Aids Foundation (nAF) arranged the first Peer women, all in Darkhan-Uul aimag, help Support
educators` training Program aimed at raising in orkhon aimag, Bulgan’s Future in khovd
awareness of simple ways to prevent spread of aimag, health opportunity in Dornod aimag,
hiV/AiDS/Stis, and at distributing factual and and other organizations like Zamiin-Uud-1 run
accurate information. Since then, around 6,000 by the women`s Council in Dornogobi aimag,
peer educators have been nurtured and trained the erdenetsagaan - Bichigt project of the rural
at the national level. we have been organizing women’s Development Foundation in Sukhbaatar

Quarterly newsletter of the national AiDS Foundation


2 working together 2008 ¹3(21)

qualified to give psychological advice to those


in need, should have good interpersonal and
communication skills, and should have the
attributes to be a leader in a community.

They listed the following among the constraints


they face in their work: police arrest; inability to
reach sex workers skilfully kept hidden by bar
and hotel owners; misunderstandings between
drunken clients and women; and pressure to
reveal identity of girls newly recruited to sex work.
They want better and more effective co-ordination
with the police and law-enforcing forces, and also
regular updating of skills and information.

TWIG hopes to become a tree to protect


itinerant traders

This group’s members make appointments with


traders on the move, and provide information
and suggestions over the telephone. The health
promotion centre they run distribute scientific
but easily understandable information on HIV/
AIDS and STIs to these people. Itinerant traders
are usually in a hurry, and the only time they can
spare for a conversation comes when they are
in a car. So the peer educators frequently find
themselves travelling some way with such traders.
This does not make communication always easy,
particularly when the recipient of information has
been or is drinking.

APPLE wants to keep gay men in good


health, and so away from doctors they work to provide prisoners with knowledge and going as a prison administration is stubbornly
information on habits and measures to prevent bureaucratic and innovations are distrusted. Every
This group’s members recorded their unhappiness HIV/AIDS and STIs. They also look for suitable proposal has to pass through many stages before
with the generally incorrect and negative prisoners to be trained and prepared to work as approval is granted by the head of the prison.
information available in the mass media that peer educators. Providing such training is tough The team has to be persistent and patient in their
perpetuates the wrong perception of homosexuals
in society and among heterosexual people. With
discrimination against and intimidation of gay
people so strong and so common, adolescent
boys awaking to their homosexual impulses are
forced into hiding their true selves. This leads
to uncertainty and feelings of inadequacy and
guilt. The peer educators` team emphasized that
awareness raising activities on various kinds of
acceptable sexual behaviour have to be conducted,
ways of safe sex promoted, and use of condoms
enforced. They wanted close collaboration
between peer educators and organizations like
Together Center and Youth for Health.

ROOT goes deep into the mind of people


in prison

Members of this team described the problems they


face and the special issues that come up when

Quarterly Newsletter of the National AIDS Foundation


working together 2008 ¹3(21) 3
creative”, Green “the most cheerful”, Red “the T.Tsogtsaikhan, of Altanbulag: Every human
most active” and Blue “the most innovative” team being is different so we face a lot of problems
and all were awarded ribbons of honour and candy and constraints as we deal with individuals. We
necklaces. must be patient, and must not give up when the
challenge of the work appears too tough. We
Summary of recommendations and have set up a consulting centre, which allows
feedbacks from participants us to distribute information to a wider section of
the community we serve. We have implemented
Otgonbaatar, of Together Centre: I have been a suggestion from the last conference, and have
with this NGO since its establishment in 2003. issued identity cards to all our peer educators.
Over the years the scope of our activities has This enhances their sense of self-confidence and
expanded, and our biggest achievement has raises their status in the community, making for
been founding the NGO Youth for Health. We tell improved efficiency and productivity.
people to share problems and disappointments,
as only then can we develop the commitment to Batzorig, of Positive Life: I think the doctors and
work for and with others. It is always useful and medical officials associated with our projects
necessary to improve the knowledge and skills of should be invited to attend the conference next
peer educators. These days the best way to raise year. This will raise our credibility in the eyes of
awareness and disseminate HIV/AIDS prevention the general public. It will also be good to have
information is to show things on television. We a mini-parliament where all our projects can be
should design a telecast containing information discussed in a general assembly.
and arrange with TV channels that this shown
regularly. Byambaa and Oyunchimeg, of Help Support: We
are from Erdenet city and would like to establish a
Munkhtuya, of Trust for Women: This is my voluntary consulting and testing centre of our own.
third national conference. Our project now has At present we send our clients to the Government-
25 staff. Our sustained work has resulted in a run health centre for any tests, but they do not
significant reduction in crime in Darkhan-Uul wish to go, as there they have to get their name
aimag. This is admitted even by the police. We and address registered under the file named
now have a regular day to meet with mass media STDs. It would be very helpful to have a testing
organizations, and are working to protect the centre where confidentiality is guaranteed.
human rights and social reputation of our clients.
Our project helps those in our target community Optimism is the watchword
efforts to convince the prison officers at each level who want to change their profession attend
of the need and merit of the suggested activity. special trainings and then in finding placements There was a contest for the best “First Person”
They have however been lucky to find many for them as hairdressers, beauticians etc. So far account of anything relevant to NAF work. The
prisoner volunteers with leadership potential who eight such women have been helped to find work entries were judged at the conference, and a story
can really learn from the trainings, and are then in some other profession. submitted through Together Centre was selected
very effective in providing and raising awareness
among their fellows behind bars.

The colours of success

The second day saw participants divided into


Yellow, Green, Red and Blue teams, to help them
know one another more closely and to establish
ties through group work in the planned activities.
First came the puzzle contest Devjee, where
every team defined its motto by going around the
“funny stations” and expressing their responses
through images. The teams showed their strains
and stresses and also their sense of achievement
in innovative and non-verbal ways. Bonding was
established by exchanging bracelets as gifts.
There were sports stations offering various types
of competition.

Every team was found to have “THE MOST” in


something. Yellow was chosen as “the most

Quarterly Newsletter of the National AIDS Foundation


4 working together 2008 ¹3(21)

for the honor certificate. It was also decided to To be able to draw more people into their activities patient, non-judgemental, and tolerant; be able
have the contest every year. and to keep citizens informed and educated, peer to devise innovative solutions; and be ever open
educators should have adequate health and legal to learn something new. These are not qualities
The conference was marked by a permeating knowledge; be able to express themselves and easy to achieve. It is because our peer educators
sense of optimism and determination. With so offer proper counseling; show a commitment to are so exceptionally gifted and so unwaveringly
many people reporting on their work in difficult working for the well-being of others; have faith committed that our country is listed among those
conditions, in an area still marked by general in themselves and in what they are doing, be with the lowest prevalence HIV/AIDS.
societal taboo, it could easily have become a
litany of complaints, about unresolved problems
and unrecognized efforts. Instead, the peer
educators focused on what and how they can do
more to meet the challenges that crop up as they
work for the sake of a healthier, safer, and more
tolerant community. This mindset is what makes
our peer educators special and what distinguished
the conference from the previous ones.

Generally unreported by the media and relatively


unknown to society at large, these peer educators
have been contributing toward the reduction
of HIV/AIDS infection among the Mongolian
population through reaching high-infection-
risk communities such as homosexual men, sex
workers and their clients, itinerant traders, and
injecting drug users. They are always ready to
provide HIV/AIDS prevention information, free
consultation and testing services, arrange group
consultancy sessions, and organize awareness
raising activities among and for the general
public.

Quarterly Newsletter of the National AIDS Foundation


working together 2008 ¹3(21) 5
the best
case-2008
"Together Center" NGO

My name is “J” and my friends call me “Lady J”.


Nobody knows why they call me so and wants to
know about it either. I am supposed to study in
9 th grade of a secondary school, but I am not
going to my school currently. Maybe because
the others call me as “lady”, I feel strange. My
this feeling became worse leading to decreased
commitment to my study, and being isolated from
my colleagues and friends, and even my family
started to notice it.

What I am talking about is that I found myself


to be attracted to men, boys and my classmate
boys. While almost all my classmate boys have
girlfriends, I am somehow attracted to them. In My suffering did not come to end. One day, my I became like this and nobody wanted to know
the beginning, I used to find reasons to chat with class teacher called me to talk after class. I almost about it either. After the meeting, my mother had a
them innocently about many things. Later, I often knew what about our talk would be. Because, long talk with my teacher. On the way back home,
had a strange feeling to look at them and to be during the last few months, I was surrounded by looking at me with worries in her eyes, my mother
near them all the time. Although I was always that attitude, environment, atmosphere, and this said “Few days ago, you talked about someone
afraid, that someone would know about my thought has been kept in mind. My teacher asked named “B” when you were sleeping. In addition,
feeling, I showed such behavior without noticing many questions such as ‘’has someone influenced I asked about it from your teacher and I found
out that he was your classmate, said my mother.
Did he make you afraid or taught you bad things?
Suddenly, I hugged my mother and cried. After
a while, I told her everything. However, she did
My teacher asked many questions such as ‘’has not believe in what I said. My older brother, who
graduated a university recently, knew about the
someone influenced negatively on you?’’ ‘’why talk between my mother and me after few days.
are you like that?’’ and even threatened that I will Then he took me to “Sharkhad” psychiatric clinic
and we met doctors. The eyes of the people there
be removed form school if I do not tell the truth. were strange and I had treatment for quite many
days as if I was a real patient. But they found out
I answered none of the questions, and even I that I was healthy. Of course, I was fine anyway.
I did not go to my school when school vacation
wanted to answer, actually, I did not know was over. I felt like there was no space for me.
My mother and my brother persuaded me a lot
what to say. but they did not succeed. One day, my brother
got information about an organization and shared
about it with me. It was the “Together center”. I
thought that the people working there would
myself. Such behavior means I stared at boys and negatively on you?’’ ‘’why are you like that?’’ and be cold like doctors and went there without
touched their hand spontaneously and I felt shy even threatened that I will be removed form school willingness together with my mother and brother.
because of it. if I do not tell the truth. I answered none of the But my expectation was opposite. The people
questions, and even I wanted to answer, actually, working in this organization treated me very
My classmates noticed about me, and added I did not know what to say. warm as if they were my brother or mother, and
another nickname”Homo” to my previous one Time flew, summer vacations started, and explained about all things which I did not know
“lady”, and made fun on me. All these things parents meeting was held at the school. During about and the things I could not answer to others
were making my life very difficult. Firstly, my the meeting, they talked about every student and about. Yes, I knew that I was gay. But from these
classmates, then other students, later all school teacher told my mother that my study is getting people, I found out that I am a normal and ordinary
people and after that class teacher and the other worse and I was lonely. Maybe it was right. I person and a young boy. I will go to my school
teachers... know I became like that, but nobody knew why soon…

Quarterly Newsletter of the National AIDS Foundation


6 working together 2008 ¹3(21)

THE BEST PRACTICE OF ASIA PACIFIC:

Community Outreach and Peer edication (HIV/AIDS Prevention program)

The Philippines
T
he Philippines’ first AIDS case was diagnosed
in 1984. By 1992, 84 cases of AIDS had
been reported, and screening in a few cities
had identified fewer than 300 people seropositive
for HIV. Nonetheless, certain high-risk behaviors
were believed to be widespread, including
unprotected commercial sex, unprotected gay
sex, and injecting drug use. In 1992, the United
States Agency for International Development
(USAID) authorized the AIDS Surveillance and
Education Project (ASEP), designed to prevent
the rapid increase of human immunodeficiency
virus (HIV) and acquired immune deficiency
syndrome (AIDS) in the Philippines by reducing
HIV and sexually transmitted disease (STD)
risk behaviors and by promoting collaboration
between nongovernmental organizations and city
health departments.

From ASEP’s inception, Community Outreach and


peer educator (COPE) for people at high risk of
HIV has served as its centerpiece.
A list of key lessons follows.
Though COPE was supported by selective • Select implementing NGOs for their core
mass media campaigns, its focus remained values and strong grass roots community
in interpersonal communication: the efforts of organizing skills. Though some ASEP partner
scores of dedicated PEs and CHOWs who went NGOs already had a focus on health, this was
out into the communities where individuals at found to be less important for success than
greatest risk could be found and used all the tools connection to the communities where HIV
and ingenuity they had to help people reduce their and STD risk behavior is most prevalent. The
risk. ASEP experience showed that community
connectedness and organizing skills are support, and many opportunities to discuss
The NGOs developed key best practices and most important. and process what was happening in their
learned important lessons for future programs, • Recruit CHOWs and PEs with strong work. PEs and COWs also had the opportunity
especially for settings with low HIV prevalence connections to the populations at risk. In for training, travel, and possibilities of
country. some cases, PEs were current or former advancement within the project. NGOs
sex workers, IDUs, or MSMs. Others worked with local authorities to make sure
were members of sexual networks, such PEs and CHOWs were not arrested in police
as pimps or mamasans, or worked in sex raids, which made their working conditions
establishments as managers, security less hazardous. Most important, NGOs
guards, or even cooks. As members of the learned that PEs were most motivated by
community, these frontline staff were best pride and respect, so anything to emphasize
equipped to interact with clients and also those factors was helpful in retention.
to find creative ways to reach the hardest to • Take services to the community. NGO
reach. outreach posts and clinics offered alternative
• Retaining volunteer PEs takes ongoing and convenient access for hard-to-reach
support and efforts. PEs were given strong communities. Outreach workers brought

Quarterly Newsletter of the National AIDS Foundation


working together 2008 ¹3(21) 7
services to the client, whether in the
street, at outreach posts, at the SHC, or at
entertainment establishments, shooting
galleries, or other centers of risk activity.
ASEP encouraged SHCs to make services
more available in the community, in some
cases setting up mobile clinics. ASEP worked
with the condom social marketing contractor
to increase the type and numbers of outlets
in high-risk communities. These efforts
supported interpersonal communication
efforts by making protective behaviors easier
to implement and maintain and by creating
an environment that supports behavior
change.
• Meet people where they are and with services
they need. In addition to meeting clients
where they were geographically, outreach
workers also met people wherever they
were on the behavior change continuum:
For example, if a sex worker was not
prepared to reduce partners, but was ready
to learn skills to negotiate condom use, the
outreach worker focused on the most likely
opportunity for behavior change. Outreach
workers for IDUs in Cebu started outreach condom ads effectively used humor to relax • Be persistent: effective behavior change for
efforts with a service the IDUs needed – and lighten the discourse about condoms. most at risk groups takes time. Even the
antibiotic ointment for skin abscesses at the • Focus messages on issues that seem most best-connected NGOs had to invest up to
injection sites – building rapport in the IDU “real” and acceptable to the audience. ASEP four years to win the acceptance and trust
community before moving to more intensive effectively used STDs to approach HIV and of client groups. NGOs found that building
behavior change efforts. AIDS issues. Since STDs are seen as less rapport took as much as two years to become
• Use mass media selectively to support a remote than HIV, the project was able to accepted and another two years to build a
targeted education program. Though targeted promote the idea of safer sex more effectively. critical mass of contacts and clients. [29, 36]
interpersonal communication was selected as However, one concern with this approach is On an individual level, NGOs found that on
the prime approach for ASEP, selective mass that the focus on curable STDs could lead average, four to five interactions within two
media helped support the person-to-person individuals to depend on treatment, rather weeks were needed to transfer the essential
efforts by changing the public discourse than prevention. Since HIV is not curable, information and support needed to enable a
about STDs, HIV, and related topics, helping even STD control should be presented in the client to modify his or her risk behavior [36].
to create a climate of change. The mass context of promoting prevention. [29] ASEP In many cases, simply having an outreach
media campaigns raised awareness in the used a similar tactic among IDUs in Cebu, worker take an interest in them and their
general public about the link between STDs focusing safer injecting messages in part health served as a powerful message to
and HIV, about the need for STD treatment, on Hepatitis C, which was rampant in the the clients and helped the clients begin the
and the problem of child prostitution; generic community. process of adopting protective behaviors.

Peer edication The Project

(Women’s Health Club) The Women’s Health Club project provides a safe,
comfortable place for vulnerable women to gather

The Vietnam
Reason

• September 30, 2002: There are more than • The “Social Evils” Campaign against drug
55,200 known HIV positive people in Viet use, commercial sex work and HIV/AIDS
Nam; 15% of them are women, mostly female keeps women from coming forward to get
injecting drug users and/or sex workers. help, counseling, and care.

Quarterly Newsletter of the National AIDS Foundation


8 working together 2008 ¹3(21)

referral making for STI/HIV counseling, testing,


treatment and care. Training is provided by the
club health educators and consultants.

Achievements

• SWs trust the confidentiality provided at the


Club, feel it is free from stigma, and learn/
build self-esteem. The Club also provides
homeless FSWs with some free meals
through community donations

• The volunteer PEs feel pride over the first


community service work they have done,
proving they can reach street sex workers,
even when it is most difficult
for HIV/AIDS/STI and other health education, • Peer Outreach in the Community: Visits to
• Club members say the health education
counseling, recreation, entertainment and health Sites Where Sex Workers Work, Provide
there improved their knowledge of HIV/
care, especially STI checkups and treatment. information and advice, condom distribution,
STI prevention, care and treatment when
social support and introduction to the club.
other sources had not given them clear
The target groups are approximately 3,000
messages.
women involved in sex work who are at risk of TRAINING FOR PEER EDUCATORS • At least 86 FSWs quit doing sex work, as
HIV/STIs, and their families and friends. Project
a result of their involvement in the Club’s
staff includes one full-time manager, three health A number of six-day training courses were work.
educators/counselors, and one part-time STI conducted, in short intermittent sessions,on IV/ • The level of condom use improved among
physician. The three certified Health Educators, AIDS prevention, drug use, harm reduction, safe direct sex workers from 30 to 80%
six former Community Outreach Workers, and sexual behaviors, condom promotion and sales, • Community authorities (Police, Social
126 member Peer Educators.
Affairs, the Peoples’ Committee) must be
active players in the work. Advocacy with
Activities them is a key variable for the success of
such a project.
• Recruit Club Members • It is necessary to provide job training
• Provide Peer Education/health and sexual activities to support women wanting to
counseling, STI Health Care leave sex work. (and consideration should
• Recreational activities: Fitness, singing and also be given to introducing small business
dancing classes, karaoke, cooking, flower training and micro-credit schemes for these
arranging, sewing and beauty care women).
• Health and Other Topic Talks, Entertainment
performances on safer sex, Contests,
Targeted BCC Materials Developed / Contact address:
Distributed, Condom Distribution, Free
Meals for those in Need, Showers and Sinks C.P.O. Box 117, Ulaanbaatar 138, Mongolia
for Washing-up, Zorig Foundation Building, 9A Peace Avenue,
• Job Training in manicure work, Literacy Sukhbaatar district, Mongolia
Training Phone: 976-11-321659, 318016,
• Regular Monitoring Meetings, Random Fax: 976-11-321659
Interviews with Participants, Suggestion E-Mail: info@naf.org.mn,
Box, Mid-term and End of Cycle Evaluations/ Web: www.naf.org.mn
Meetings www.dotno.mn

Quarterly Newsletter of the National AIDS Foundation