Foundation “Spirit of Love” Diakonia Agapes (DA)

The purpose of this project was to contribute to reducing HIV prevalence among women of reproductive age in the villages of the Elbasan Prefecture in Albania, through promoting HIV prevention and conducting VCCT for reproductive age women. The project
also increased community awareness about HIV infection and the importance of VCCT. The project was managed by Diakonia Agapes who worked closely with a medical and social team and in cooperation with the Institute of Public Health in Albania.

Diakonia Agapes was established in 1992 with the initiative of His Beatitude Archbishop Anastasios, Archbishop of Tirana, Durrës and all Albania as the social, development and relief office of the Orthodox Autocephalous Church of Albania. The office started its activity as a provider of emergency aid and later on, along with the changes in the country, shifted its activity from emergency to more development work, aiming to be near and to support the most needy individuals and groups in the Albanian society.

Project Title: 
VCCT for rural women

Duration:
23^rd October 2009 – 31^st March 2010

Target group:

• 500 women of 18-45 age group about STI, HIV and VCCT

• 300 women of reproductive age for VCCT

• the communities of 35 villages in the Elbasan Prefecture

• Indirect beneficiaries: Health personnel and communities of the above communes
  
  Budget:
  22.775 EUR
  (FPH 18.749 EUR
  Diakonia Agapes 4.026 EUR)
  
  Baseline information :
  Since the 90’s, Albania is facing a continuous movement of population within the country and abroad. Many are without knowledge of the dangers of HIV, AIDS or STIs. Women and girls in the country are vulnerable as they are often subject to discrimination, domestic violence and sexual abuse. HIV is seen as a sign of promiscuity. Therefore gender norms shape the way men and women infected by HIV are perceived and HIV positive women face greater stigma and rejection than men. Women have low knowledge on health or reproductive care especially about HIV, AIDS and STIs. The same is with information related to VCCT. In Albania, VCCT uptake is low due to stigma associated with a positive result. In rural area this is compounded by lack of access. Poverty, husbands as seasonal migrants abroad, low awareness are other contributing factors. This project’s aim was to raise women’s awareness and actions in HIV prevention and uptake of VCCT.
  
  The medical team was composed of one doctor experienced in working in rural areas and conducting rapid HIV testing, and a health personnel (family doctor or midwives/nurse) of each village of implementation. The social team comprised three persons (two social workers and a specialist for women counseling).
  
  Activities and outcomes:

Awareness campaign took place throughout the implementation period in each of the villages in order to increase the women’s awareness on Rapid HIV testing and VCCT. Each woman who participated in the meeting received a leaflet and information paper.  In order to make this information useful and accessible to everyone, posters were hung at the ambulatory centers and other buildings in the villages

Rapid Testing: There were no HIV positive cases. Six of the persons tested were young boys (reproductive age) and one was a ten year boy who had previously had a blood transfusion and his mother requested a test. The HIV test was done by the medical team in a separate room. (The doctor had previously been involved in the PMCT project implemented by the PLHIV organization). The team explained every procedure of testing to make sure that people had enough information about the test and felt comfortable during the process. During the process people were informed about the “window period” of the test and the interpretation of possible results which sometimes could be mistaken and how further confirmation tests are necessary. At the end of the HIV testing, the medical team explained the result in the post test consulting session.

The data gathered by from the personal cards were presented as a study during the Fifth Balkans Regional Conference on HIV and AIDS, in Zagreb, Croatia on 25-26 March, 2010 by Obs/Gyn Mimoza Pejo.  Some results were:

The interviewed declared the following data about their living style:

• 92% of the tested persons had permanent partners; 3 % had casual partner and 5% had no partner at all
• 8% have lived abroad
• 53% of the partners of the tested persons lived or are living abroad, 40% have never lived abroad

their sensivity related to HIV and AIDS:

• 2% of tested persons had already done the HIV test and 98 % had never done the HIV test
• 1% of their partners had already done the HIV test; 86% had never done the test; 13% declared they never talked about that
• 44% of tested persons felt no risk about HIV; 36% feel in low risk; 19% felt at high risk 1% felt nothing related this issue

Conclusions:
The project was an opportunity for the women inhabitants in rural areas to increase their level of information about STI-s, HIV and AIDS and VCCT. It also provided them with the possibility of having the Rapid HIV test conducted in their own villages. This helped those women who for economical reasons are not able to travel to the cities where such test are carried out, as well as those who face prejudices when they decide to take the test.

All of the activities of the project helped to bring the women together to share and to discuss with each other, issues related to their reproductive health.

Through the activities of the project the relationship between the health personnel and community was strengthened.  (During the implementation period the local health personnel and members of the community asked for an extension of such a project).

Based on the high number of participants and motivation of beneficiaries, the activities of the project fulfilled their needs.

Background:

The Association “For A Healthy Albania” has been working since 2005 in the Elbasan Area, supporting peer education structures among Roma people, MSM, Commercial Sex Workers, Illegal Drug Users and Migrant Workers. An important lesson-learnt is that working with women is likely to yield better results in terms of condom use and use of available services.

This project was entitled “To maintain low HIV prevalence among vulnerable groups in the Region of Elbasan” and was carried out by the organization For a Health Albania (FAH) targetting Roma women in Elbasan. Roma women are the vulnerable part of their community as a result of poverty and mentality regarding their social status. The project mainly focused on the following objectives: to increase the knowledge and awareness of Roma women on the mother to child transmission of HIV, to strengthen condom negotiation skills of Roma women and to start and keep increasing the attendance of VCT by Roma women.

Through these objectives two problems were solved: to start with, the existing peer education structures among Roma people was refreshed and supported, by having focus on condom negotiation and use of Volunteer Counseling and Testing Service. Secondly the awareness of women was increased regarding the conduction of HIV testing during pregnancy.
 

Project title:
To maintain low HIV prevalence among vulnerable groups in the Region of Elbasan.
 

Duration:
23rd May, 2008 - 23rd October, 2008 (extension allowed to March 2009)
 

Target group:
Roma community
 

Budget:
€ 4,300 FPH contribution
€ 470 Co financing contribution
Total: € 4,770
 

Baseline information:
The project focused on the women of Roma community who live in the periphery of the city of Elbasan and in Cerrik and Peqin districts. The total number of Roma people in Elbasan and surrounding area is about 15000. In the district of Elbasan the Roma community covers almost 10% of the community and they are the vulnerable part of this community as a result of poverty and mentality regarding their social status. The traditional Roma place a high value on the extended family. Once married, the Roma woman joins the husband's family where her main job is to tend to her husband's and her children's needs, as well as to take care of the in-laws. The power structure in the traditional Roma household has at its top the oldest man or grandfather, and men in general have more authority than women. As women give birth and get older, however, they gain respect and authority in the eyes of the community.

Because of the difficult mentality that exists in this community it causes women to be disconnected from the society. It is a challenge to make them visit the VCT center. Furthermore, they usually get married at a very early age of their adolescence and they might be married many times in their lives. They live in groups and are not fond of education. Also, the Roma community is a group of people who usually migrate a lot within Albania or Greece. All this makes the Roma women a vulnerable group for HIV infection.
Results:

Objectives Achieved:
Increased knowledge and awareness of Roma women on the mother to child transmission of HIV through VCT staff capacity raised workshops
Strengthen condom negotiation skills of Roma women
Start and keep increasing the attendance of VCT by Roma women,
Raise the awareness of women on the need to do the HIV test during pregnancy

To facilitate these objectives:
• 2,019 leaflets were distributed
• 3,727 condoms were distributed
• 600 Roma women took condoms
• 165 Roma women took VCT
• 48 Roma women repeated VCT visit
• 6 workshops were conducted - 1 for 8 VCT centre staff and 1 for 20 maternity staff
• 4 workshops reached 80 Roma women
• 1 TV spot aired on PMCT
 

Albanian Association of PLWHA	Albanian Center for Population and Development

Background:
This project aimed at piloting prevention of HIV vertical transmission from mother to infant in Albania by providing voluntary counseling and testing services in maternity wards covering clients for STI and GYN services, prospective mothers and HIV positive mothers ante-natal and post-partum, at 3 sites: Tirana, Vlora and Shkodra.

To achieve this, training was conducted among selected health care providers in these pilot sites. The 12-months project was implemented by a consortium of two NGOs, PLWHA and ACPD in collaboration with the National AIDS Program in Albania.

ACPD is a non-governmental organization with a long experience in reproductive health. It believes in the principle of free and well-informed decisions as a fundamental human right by assisting all individuals to enjoy reproductive health. Established in January 1993 by volunteers, ACPD works to improve the health and well-being of all people in Albania, particularly vulnerable and marginalized people like women and young people who are the two target populations for ACPD activities.

The Albanian Association of People Living with HIV and AIDS (PLWHA) is an NGO that was established on October 2004 and whose mission is to improve the quality of life of PLHIV, prevent HIV, ensure treatment access and promote and protect human rights in Albania. It often collaborates with other NGOs and state institutions, including the National AIDS Program. The PLWHA board has 40 members, 15 of whom are PLHIV.

Project:
VCT promotion for prevention of mother to child transmission (PMCT) of HIV

Start:
10th April 2008

End:
30th June 2009

Target groups:
  • Reproductive age women visiting the three sites
  • HIV positive women & spouses of these women through couple or individual counseling and VCT
  • Maternity service staff of the three pilot sites

Budget:
          € 20,600 Fondation PH Suisse contribution (with SIDA support)
          €   5,224 ACPD contribution
Total: € 25,824

Baseline:
According to the latest data available in December 2008, there were 303 HIV positive cases reported in Albania. In the first 6 months of 2009, 39 new cases of HIV were reported, of which 33% are females.

As of December 2007, there were 19 HIV positive pediatric cases in Albania, 14 of which were infected through vertical transmission and 5 from blood transfusion. All these cases were diagnosed after birth as there was no testing during pregnancy. Unfortunately, there is no prevention mechanism of maternal to child transmission of HIV at present in Albania. Even the National Strategy 2004-2010 on HIV/AIDS is silent on preventing the vertical transmission and on responding to children infected or affected by HIV. There is a definitive need for a revision of the current HIV/AIDS National Strategy in Albania in order to remedy this gap and ensure legal, policy and programmatic responses are in place to protect infants and children. Although the Ministry of Health and Institute of Public Health as well as the United Nations agencies and local or regional NGOs have all in some ways worked to prevent vertical transmission of HIV in Albania, this project was one of the frontrunners of such effort in Albania, and it was the first in these 3 sites. Hence the conception and implementation of this project served as a starting point to advocate for standards on preventing and addressing the needs of MTCT of HIV in Albania.

Project Objectives were to:
  • reduce the incidence of vertical transmission – from mother to child - of HIV in Albania
  • pilot the establishment of a programme for preventing MCT through VCT at maternity services in Tirana, Vlora and
     Shkodra and referral systems for care, support and treatment for HIV positive mothers and their newborn
  • provide capacity building for maternity staff on pre and post counseling and testing on HIV/AIDS
  • create standards to prevent the MTCT of HIV/AIDS (preparation of curricula, trainings, methodology and supervision)

Results:
  • A training curriculum was adapted based on WHO guidelines for health care professionals and adopted by the Ministry of

     Health as the national training curriculum
  • 70 medical staff (obstetrics, gynecologists, reanimations and newborn baby doctors, nurses) were trained during 3 trainings
     on PMTCT of HIV and VCCT
  • Some 1,500 brochures, leaflets and posters were produced and distributed for use during all activities. Some examples of
     these brochures are:
     “HIV pregnancy and the child health”
     “Introduction to the combination therapy”
     “Anti- HIV medicaments and children”
     ”Need to know more on HIV/Aids etc.
     “Preventing the HIV transmission during pregnancy, through delivery and breastfeeding”
     “HIV and New Born Baby”
     “Can my baby really be protected from HIV…?”
     “Protect yourself and your precious one”
  • Rapid test kits were purchased and free tests offered and a total of 1,300 free rapid tests were realized across all target
     groups. Maternity staff had been trained in the testing procedure and in pre and post counseling session skills
  • Two “Awareness Weeks” held in Vlore and Shkoder – open conversations were organized for pregnant women who
      attended the clinics to break down barriers and reduce embarrassment, and information leaflets were distributed.
      Afterwards, participants were much more open to accepting rapid tests.
 

Albanian Association for Prevention and Rehabilitation
from Alcohol and Drugs

Background:

APRAD was established in March 2000 and operates in Tirana. It specializes in drug and alcohol dependency prevention and rehabilitation as well as HIV/AIDS/STI prevention including VCT. APRAD had conducted a study on alcoholism, organized a national conference on drug and alcohol abuse and prevalence among Albanians, a campaign against juvenile delinquency among adolescents prone to alcohol and drug abuse as well as implemented a project on "peer education - protecting those at higher risk, especially youth" supported by Soros. With funding support from CORDAID, it piloted a centre for drug abuse prevention and rehabilitation with syringe exchange which resulted in establishing a drop-in centre.

Project Title:

Establish a voluntary counselling and testing centre with awareness campaign

Project description:

The project aimed to establish a voluntary counselling and testing centre in Tirana and to increase community awareness of the importance of VCT. At the start, the project procured testing equipment, furniture and supplies; conducted training for staff and developed VCT protocols. It proposed to provide counselling and testing for 1,000 high risk people; prepare two manuals: one for the staff and the other for the clients; promote the project through media; support social marketing of VCT by creating a network of organizations and organize a national conference; provide training and discussion of sensitive behavioural issues; support PWHA by involving them in project implementation and advocate for PLWHA  including making referrals.

Project duration:

January 2005 – April 2006

Target Groups:

IDU, MSM, CSW, mobile population and Roma living in Tirana.

Budget:

             31,330 € (Partnerships in Health)

               4,700 € (APRAD's contribution)

Total     36,030 €

Baseline information:

There was no community based VCT in Albania prior to this project.

Result to-date:

A community based VCT centre has been established with 2 staff and 3 outreach workers trained by the Institute of Public Health (IPH); tools for VCT centre prepared including staff manual, information for clients about VCT, intake log, questionnaires and client satisfaction form. To date 1,750 leaflets were distributed; 1,074 people received pre-test counselling, of which 819 were tested for HIV and received post –test counselling, among whom one was tested positive and 57 persons were referred to other services;1,050 persons participated in APRAD organized training, focus group discussions and social events; a VCT website has been set-up; there was one TV documentary, 4 newspaper articles and several TV promotions; in addition 6 local NGOs has joined the VCT referral network. In addition, a national conference on VCT was held in collaboration with the IPH in April 2006.

Non-anticipated benefits (co-financing, new partnerships etc.):

IPH provided a refrigerator for the centre. The VCT centre was included in the GFATM application for possible funding support.

Background:

FHA is founded in October 2002 in Elbasan. The organization aims to improve the health practice of different age groups; raise public awareness of STI, HIV and AIDS and anti-smoking, alcoholism and drug abuse. It has conducted studies on “Infant mortality in the Prefecture of Elbasan” and “Early detection of breast cancer and cervical cancer among women”. FHA focuses on marginalized groups in Elbasan: Roma and mobile populations and regularly collects morbidity data on vulnerable populations in the Prefecture to better respond to their needs.

Project Title:

HIV prevention among high-risk groups in Elbasan Prefecture

Project duration:

January 2005 – February 2006

Target Groups:

10,000-12,000 migrants in the districts of Librazhd and Gramsh, 7,000 to 8,000 Roma, 100 IDUs, 50 to100 CSWs and 50 to 100 MSM

Budget:

                29,998 € (Partnerships in Health)

                  4,100 € (FHA's contribution)

Total        34,098 €

Baseline information:

There has been no KAP studies relating to HIV and AIDS of these target groups in Elbasan.

Project description:

The project aimed to assess the knowledge and practice of HIV prevention in Elbasan through focus groups, quantitative data and increase the awareness of HIV infection with information tailored to the specific groups. Main activities included conduct baseline and end of project knowledge, attitude and practice (KAP) assessments of the target groups; train literate members of each group to be peer educators; develop and distribute leaflets/posters on HIV and AIDS; promote and distribute free condoms accompanied with information leaflet and publish a final report.

Result to-date:

Baseline qualitative and quantitative KAP Assessment of target groups in the prefecture of Elbasan was conducted; increased knowledge through 4 training sessions on HIV and AIDS for 86 migrants, 55 Roma, 6 CSWs, 6 IDUs and 5 MSM. Increased knowledge on HIV and AIDS through peer educators reaching 15,000 Roma people, 13,000 migrants, 100 IDUs, 80 CSW and 60 MSM. Three types of leaflets: one for general population, including Roma and migrants, the other for IDU and the third for MSM and CSW. Developed and distributed 10,700 brochures and distributed 10,600 packs of condoms.

Non-anticipated benefits (co-financing, new partnerships etc.):

The baseline KAP assessment was included as country data in the GFATM application.

Institute of Public Opinion Studies

Background:

IPOS is established in 1998 specializing in researching social issues in Albania. IPOS has a network of academics in public health, medicine, sociology and psychology. IPOS had conducted studies on “Reproductive health in Albania” in collaboration with ICMH, Geneva; “The impact of health messages for pregnant women” funded by UNICEF; “Improving the response to HIV/AIDS/STD epidemic through pilot projects on HIV/STD prevention among vulnerable groups” funded by UNDP; “Quality assessment of health services at rural area” funded by Soros; “Assessment of the situation about the quality of health services at rural area” funded by Ministry of Health; “Information, situation and needs assessment at reproductive health services in Shkodra communes” funded by Family Planning; and evaluation of the “Integrated community services” programme of UNICEF-Tirana. IPOS has participated in the Strategic Advisory Group of Experts for the preparation of the Albanian National HIV/AIDS Strategy.

Project Title:

Training and informing Roma community and health centre personnel in Albania about the risk of HIV and AIDS

Project duration:

January – November 2005

Target population:

38,500 Roma people, 110 to 140 Roma community leaders and 50 to 55 health personnel from 10 districts of Albania: Tirana, Shkoder, Kruje, Durres, Korca, Fier, Vlore, Berat, Delvine and Gjirokaster

Budget:

               29,010 € (Partnerships in Health)

                 4,070 € (IPOS's contribution)

Total       33,080 €

Baseline information:

There had been occasional local NGO conducted training for Roma population in a few of these ten communities

Project description:

The project aimed to improve the HIV and AIDS knowledge among Roma community leaders so they can be peer educators for their community and build the primary health care provider capacity to counsel Roma people about HIV and AIDS and make referral to specialized institutions. Main project activities were training of health centre personnel near Roma communities and 10 to 15 Roma in  each of the 10 districts on HIV and AIDS transmission, prevention and information on existing health and counselling services including VCT centres. Distribute information, education and communication (IEC) materials during peer education.

Results:

A IPH staff and faculty of social sciences conducted one training in each of the 10 cities covering 157 Roma peer educators. Ten local boards  were created to coordinate the peer education activities. The peer educators reached 10,000 Roma people. Sixty-six health staff improved their HIV and AIDS counselling, prevention and referral. Developed and distributed 5,000 leaflets and a manual on HIV, AIDS and STI for Roma people and primary health care providers.

Instituti i Studimit te Opinionit Publik
Institute of Public Opinion Studies
Rr. "Muhamet Gjollesha"
Pall: 5/241
Tirana, Albania
Tel.  +355-4-259-398
Fax. +355-4-259-406

IPOS was established in November 1998, and it is a non-profit organization of people committed to study social problems in Albania.