Confidential Approach to AIDS Prevention (CAAP)
Center for HIV/AIDS Information, Counseling, Testing, Care and Support
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Information and communication

Information and communication unit focuses on the following issues:
• Education and counselling of families for enabling environment and lobbying in the community to reduce stigma and discrimination and to establish rights of the PLHIV
• Home based care, basic education of caregiver on care of PLHIV.
• Strategic collaboration with public/private health service provider for access to treatment of PLHIV
• Advocacy with recruiting agencies for departing migrant worker for safe sex practice.
• Advocacy with pathological laboratories to advise person found HIV positive to take treatment and counselling.

A. Education and counselling of families for enabling environment
HIV infection and AIDS are always associated with fear and stigma. The reaction of the member of a people living with aids (PWA) is fear and shame. They are frightened to accept the HIV infected member to live within the family for shame, social pressure and fear of being infected. This compels the infected person to go on hiding and live with indignity, deprived of care and support from family and community.

To address this issue counselling against stigma and education of PWA/families/care givers on home-based care are provided at the centre and at their home or at a place of their choice. Home-based care staff visit PWA on a fixed date and time and provide the education.

B. Home-based
Care Home-based care is provision of care for PLHA at home where family members take the role of caretaker and take responsibility for taking care of the PWA. It is intended to prepare the caregivers for batter management of HIV/AIDS in their home environment and to initiate contact with community people/leaders to raise awareness on HIV/AIDS and generate support to address stigma. Trained and experienced staff provide training on home care, home management of symptoms, palliative care, and psychological support to family of PLHA to cope with the situation and to address stigma. Objectives of the home-based care education are:
1. To provide care to people living with HIV/AIDS in their home
2. To care and cope with sufferings of PLHA
3. To educate PLHA and care giver in basic nursing and infection control
4. To meet the physical, psychosocial and spiritual needs of PLHA

During home visit the staff discuss with the care giver how to display good hygiene behaviour and take precautions, how to take care of and give comfort to PLHA without getting infected, how to give simple relief of symptoms, what types and proportion of locally available foods to be chosen for diet of PLHA, when to see a doctor and give reinforcing knowledge on HIV spread and prevention. The staff provide clinical help/advice to any chronically ill family members of PLHA to establish good relationship with the family as well. In case the situation is too critical for them they communicate with the Medical Officer (MO) attached to care and support to receive necessary instructions. The MO visits PWA at their home if required to treat difficult cases. Trained home and abroad the Senior Medical Officer provides in-house on the training to and supervises the staff.

C. Strategic Collaboration with private/public health service provider
The collaboration with other NGOs working in the field of HIV/ART is very important. At present the clinical staff of CAAP have close contact with relevant clinical staff of organisations like ICDDR’B, Ashar Alo Society – at present lead organisation of consortium receiving support for ART, Mukto Akash, Marie Stopes International and World Vision. Collaboration and communication have mainly with ICDDR’B has become a routine: Patients who need to be admitted are transferred to ICDDR’B, and patients who are discharged from Jagori Ward (HIV ward at ICDDR’B) are then be followed up by CAAP or one of the other NGOs in the consortium. The collaboration with Marie Stopes International for obstetrical problems proved to the worth it.

In order to generate support and to create opportunities for PWA to have equitable access to treatment at public and private health service facilities without any prejudice, lobbying meetings are conducted with public/private health service providers at policy and operation level as well as with community leaders.

The front desk personnel of CAAP distribute informative IEC materials to the visiting patients and their relatives. IEC materials are distributed to different pathological laboratories for promotion of accessibility and availability of VCT and treatment services. Advocacy meeting are conducted in the offices of recruiting agencies for advising the departing migrant workers to practice safe sex.

D. Advocacy with recruiting agencies and pathological laboratories
CAAP reached agreement with 10 recruiting agencies and pathological laboratories for conducting STI/HIV and AIDS awareness sessions for the departed migrant workers and other laboratory clients. Advocacy and lobbying meetings were also conducted with the security agencies for holding STI/HIV and AIDS awareness session for their security personnel. The organisations have agreed to allow CAAP to hold such activities for their personnel and CAAP is looking forward to holding awareness programmes.

Other activities

A. Capacity building:
CAAP organises capacity building workshop/training programmes for staff once a year or ad hoc basis. A list of resource persons/guest speakers is maintained for this purpose. At the end of each project year, CAAP organise information sharing seminar participated by representatives of GO/NGO working in the same field, community leaders and women’s organisation.

In addition, SRC financed external consultants experienced in advising and managing HIV/AIDS programme abroad to support and train CAAP personnel on various HIV/AIDS aspects. The staff received on the job training from the consultants in 2006, 2007 and a three-month backstopping support in 2008. In 2010 a follow-up of the previous supports including a clinical training for the staff was financed by SRC.

In the 3-day clinical training on HIV/ART in 2010 limited sits were open for other medical doctors from Dhaka. Among the 12 participants doctors from government organisation i.e. NIPSOM, Infectious Diseases Hospital (IDH) participated and Dhaka Medical College. Two persons from Jagori Ward (ICDDR’B), the medical doctor of Mukto Akash, the doctor from Save the Chilren USA responsible for the GFATM and several virologists from a medical university. The training focused on HIV in general, the most important opportunistic infections, ARVs (pharmacodynamics, pharmacokinetics and side effects), drug allergies, PMTCT, PEP, ART for children, HIV resistance and 2nd line treatment.

The training programmes are organised keeping in mind the following objectives:
• To be a resource for organisational and program development and skills building trainings in Sexuality and HIV/AIDS prevention, counselling, laboratory methods and clinical care
• To build capacities to use the best public health practices for the prevention, diagnosis and management of HIV and sexually transmitted diseases
• To increase access to and scale-up services that promotes quality of life and well being of persons living with or affected by HIV.

CAAP’s agenda for training sets forth the following key guidelines:
• Decrease the stigma and fear associated with HIV and AIDS through building local resources in delivery of HIV, sex and sexuality IEC for adolescents and young adults
• Reduce mother-child transmission of HIV through training on preventing perinatal transmission of HIV
• Develop skills of the medical personnel in diagnosis of HIV related illnesses and its treatment and update knowledge of medical practitioners and nurses
• Increase the capacity of volunteers and CBO representatives in nursing and counselling, building capacity in the community, to care for people with HIV and AIDS.
• Upgrade the skills of our staff to achieve the vision

Training programmes at CAAP address key issues in HIV prevention:
• Mentoring
• HIV management
• OI management
• Syndromic management of STI
• Counselling
• Peer education
• Universal precaution

B. Networking
To develop better coordination, cooperation and networking between NGOs working in the field of care, treatment and support for PWA, we organise training programme on HIV/AIDS for grassroots level NGOs, share experience from other NGOs through study tour, exchange of guest lecturer program and presentation of paper and participation in national and international seminars. CAAP has good working relationship with national AIDS/STI programme (NASP), directorate of health services of the government. CAAP is a member of HIV/AIDS/STI network of Bangladesh, member of Asian peoples alliance to combat HIV/AIDS (APACHA).

C. Media linkage:
CAAP participates in HIV/AIDS related programme broadcasted by Bangladesh Betar (radio) and occasionally on television. Contribution to national daily newspapers, national and international journals through publication of articles on HIV/AIDS is another worth mentioned activity of CAAP.

Societies Tackling Aids Through Rights (Star)
This is an ACTIONAID international project implemented in 7 countries of the world funded by European Commission. ACTIONAID Bangladesh is responsible to implement it in Asia in partnership with NGOs. CAAP is one of their partner organisations to work in Bangladesh.

The overall objective of the project is to develop an integrated right based approach and community empowerment to tackle HIV/AIDS through action in the community at district and national level. The activities include raising awareness at the community in regards to their various problems/needs and mobilise/sensitise community people to influence policy makers to promote the rights of the people and of the HIV positive persons.

Through this project a group of community facilitators are developed who shall work as a resource person in their respective communities (circle) to identify and solve their own problems in relation to health including HIV/AIDS, hygiene, sanitation, education, income, repression/violence against women and other social problems.

The staff for this project consist of a trainer and an advocacy officer who responsible for implementing the project.

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