STIs including HIV & A ; AIDS are planetary public wellness issues which are responsible for important ill-health universe broad. It is the fact that largely, immature population is affected ( WHO, 2007 )[ 1 ]. It is estimated that each twelvemonth about 340 million of curable STIs are predominating along with 1000000s of incurable STIs and 5 million new HIV infections ( WHO, 2007 ) . About 85 % of the estimated 340 million instances recorded in developing states, highest rates are shown by immature population and histories for 17 % economic bead ( Mayaud & A ; Mabey, 2003 )[ 2 ].
There are several hazard factors in Pakistan that are doing immature population more vulnerable for STIs and HIV e.g. more than 78 % of refugee population in N.W.F.P, conservative society impeding manner to awareness, prevalence of homosexualism, sexual maltreatment, male harlotry. Aangan is a community plan working on consciousness of immature male sexual maltreatment and misconception sing sexual wellness ( khan, 2003 )[ 3 ]. There is no such apparent policy on consciousness of immature population on the subject of importance of consciousness sing safe sex and effects of insecure sexual activities.
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In my sentiment it is required to reexamine National HIV & A ; AIDS Policy of Pakistan to happen out intercession scheme for HIV bar through making consciousness in immature population of Pakistan, if any. Because I am the national of Pakistan and I am to the full cognizant about the stigma related to HIV and lack/avoidance of consciousness among general population. Furthermore to analyse the bing consciousness options and measure different service bringing approaches to beef up it.
We discussed above some of the precedence identified jobs, adding to Pakistan HIV & A ; AIDS epidemic. This subdivision proceeds with the outline reappraisal of National HIV & A ; AIDS policy Pakistan. National HIV & A ; AIDS policy Pakistan concluding bill of exchange was launched in 2007. Policy papers focal points on a clear vision. After designation of precedence focal point countries National HIV & A ; AIDS Policy stresses on different policy attacks to care and forestall approaching HIV & A ; AIDS epidemic ( National HIV & A ; AIDS Policy, 2007 ) .
The National HIV and AIDS Strategic Framework guide the Pakistan ‘s HIV and AIDS plan, was reviewed in 2006 and a new model has been developed for twelvemonth 2007 – 2011. The model contains a monitoring and rating program to supervise advancement alongside the precedence countries and measure the effectivity of the HIV and AIDS plan ( National HIV & A ; AIDS Policy, 2007 ) .
Following is the brief lineation of the Policy papers ( National HIV & A ; AIDS Policy, 2007 )
Overall focal point of the policy is on bar of HIV, intervention, attention and support of people affected by HIV & A ; AIDS.
2.1.2: Main Focus Areas
Following are the chief focal point countries of Pakistan HIV & A ; AIDS Policy
Sexual spouses and households of septic people
2.1.3: Policy Approachs
As we discussed above that HIV & A ; AIDS policy purposes to forestall and bring around HIV epidemic. To transport on this battle efficaciously different Torahs and policies are made to back up communities and persons to avoid HIV and to assist persons affected by HIV. Following are the cardinal policy countries.
22.214.171.124: Reducing HIV and AIDS stigma and favoritism
This has to be done through
Treating HIV positive people with self-respect
Patients will be encouraged to portion at that place experiences
Health services will come frontward to cut down barriers coming Forth in HIV positive persons for guidance and intervention
Health suppliers will be trained for geting non judgmental intervention attitude
Anti favoritism Torahs will implemented
Media will be used as beginning of information and encouragement for cut downing stigma to the disease and accurate information about HIV & A ; AIDS
126.96.36.199: Establishing a supportive legislative and policy model
Laws and policies will be reviewed ( both authorities and other bureaus ) to work in line with the chief focal point and aims of this policy
188.8.131.52: Policy and plan based on accurate informations, grounds and Knowledge
Surveillance, operational/social research, monitoring/evaluation systems will be strengthened to guarantee at that place effectual response.
184.108.40.206: Integration of HIV and AIDS enterprises and consciousness into bing plans
Integration of this policy with other bing plan and services for illustration sexual and generative wellness services, maternal and child wellness services, STIs services, household wellness, hepatitis, national TB control plans, public assistance plans, lodging and work force plans, societal economic support and drug intervention plans
220.127.116.11: Promoting a whole of authorities attack aˆ? across all authorities sections and at all degrees of authorities
All authorities sections ( both provincial and territory ) will be encouraged to analyze there policies for effectual response to National HIV & A ; AIDS plan
18.104.22.168: Guaranting a multiaˆ?sectoral attack that includes the full engagement of civil society and community groups, spiritual leaders and the private sector
A multi-sectoral attack will be encouraged
to cut down the stigma related to HIV
to make to marginalise communities
22.214.171.124: Acknowledging the peculiar function of Peoples Populating with HIV and AIDS
HIV & A ; AIDS patients will be encouraged to come frontward and assist side by side in the HIV bar and attention for illustration in raising consciousness among general population, assisting other HIV patients in acquiring intervention and sharing at that place experiences
126.96.36.199: Health system beef uping
For safe, inter-co-related and incorporate attention of HIV persons
Health suppliers will be to the full trained to cover with this quandary
188.8.131.52: HIV Prevention
HIV bar will be more emphasized on population largely at hazard
Government, NGOs, society public assistance, community and spiritual groups will be working in co-ordinated mode to cut down the hazard of HIV infection through
coordination of HIV bar plan with sexual and generative wellness plan
run intoing with population most at hazard
needle exchange plan
drug supply services
proviso of information in local linguistic communications sing HIV infection, AIDS, HIV bar largely to marginalise groups
inclusion of HIV and AIDS information in school course of study
preparation of instructors
184.108.40.206: HIV proving and reding
through voluntary and confidential HIV testing
positive patients will be helped for farther direction
220.127.116.11: Entree to intervention, attention and support
HIV centres for diagnosing and direction will be established near to the communities most at hazard
Patients will be treated harmonizing to international criterions
Health suppliers will be trained to forestall and pull off timeserving infections
Antiretroviral therapy will be free of cost
Government will be working with UN bureaus to guarantee strong committedness to UN Universal Access by 2010 ends
18.104.22.168: Prevention of motheraˆ?toaˆ?child transmittal of HIV
Pregnant adult females will be encouraged for voluntary and confidential HIV testing, reding and intervention
Womans largely at hazard and partner returning from abroad will be focused peculiarly
22.214.171.124: Blood and blood safety
Public and private blood providers will be to test blood decently
Insecure patterns will be eradicated
126.96.36.199: Coaˆ?ordination between the national HIV and AIDS response and the national response to cut down illicit drug usage
In the reappraisal lineation above we briefly identified different policy attacks to undertake the job. As I mentioned above that there is demand for proper consciousness sing HIV and AIDS among general population. This is the ground I am taking to analyse HIV bar attack of National HIV & A ; AIDS policy for making consciousness among mark population. As we described in sub heading HIV bar that policy is nearing to forestall HIV through rubber publicity, aiming largely population at hazard, integrating with sexual and generative wellness, needle exchange plan and proviso of information in local linguistic communications. I personally believe that no clear medium of awareness tool is identified. There is a demand to place a proper manner to turn to mark population
3.1: Choice OF INTERVENTION STRATEGY:
As we discussed above that although National HIV & A ; AIDS policy of Pakistan is emphasizing on HIV bar through assorted ways yet there is a demand to beef up it by placing broader medium of consciousness to forestall HIV prevalence. In my sentiment Information, Education and Communication ( IEC ) is the right pick for making consciousness in targeted population, as National HIV & A ; AIDS policy of Pakistan opted for HIV bar. But it should non be merely focused on population at hazard merely, there should be mass consciousness sing HIV & A ; AIDS in order to diminish the stigma related to this disease and encouraging people to collaborate. Harmonizing to WHO ( 2000 ) , IEC means assortment of actions that aim to update, instruct and commune with the populations, and will hold a message, medium and wide audience. Following are two wide service bringing attacks of intercession scheme for IEC.
Degree centigrades: Print Media ( newspapers, booklets, postings, magazines )
A: Outreach-Services ( one to one treatments, equal instruction, school instruction )
Bacillus: Facility-Based ( clinics, workplaces, health-posts )
Degree centigrades: Group-Communication Workshops ( meetings, dramas ) .
Media and interpersonal communicating are two wide service bringing approaches for the above mentioned scheme. Media entirely can function efficaciously the propose of making mass consciousness still there is demand for interpersonal communicating to pattern the created consciousness in targeted population in a more incorporate manner. This scheme is already in the policy but dealt with a obscure mode that is why a elaborate reappraisal of different service bringing approaches for IEC will be of great importance. Under following header I am traveling to measure different option for IEC and will take best service bringing attacks.
4.1: REVIEW OF SERVICE DELIVERY Approach:
“ If medical specialty can handle HIV/AIDS, the media is capable of forestalling it with an ultimate end to bring around it through its capablenesss to impact instruction through amusement ” . ( Singh J, 2007 )
complete mass-media plan are of import in HIV-education, as initiated in Uganda. ( Bertrand and Anhang, 2006 ; Nakityo and Mugyeny 2000 )
A: Television and Radio
Harmonizing to Rahman and Rahman ( 2007 ) , Study showed that population whom watched Television had 8.6 % excess opportunity of consciousness about AIDs. They provide good coverage ; and effectual both for literates and nonreaders. Skilled staffs for TV/radio Stationss are required. Feedback could be a job. Programs need to be in local linguistic communications and within cultural-norms. In instance of Television, initial investing is high but subsequently cost per individual is low. Evidence emphasizes importance of Television in HIV instruction but fiscal barrier puts restraints on utilizing this signifier of media in refugee scenario.
Bad-reception, inaccessibility of electricity/batteries can be job. Radios are cheaper and there is opportunity that most of targeted population might already have them, can be donated by organisations. Plans can aim vulnerable groups e.g. adult females, kids, commercial sex workers ( CSWs ) etc. As compared to Television, wirelesss seem more appropriate for usage in refugees.
( Walley J et al. , 2006 )
Degree centigrades: Print Media
Provides broad coverage, can be delivered to risk-groups and influential people but nonreaders may non derive sufficiently from it. ( Walley J, 2006 ) .
It needs staff for distribution and skilled people to come-up with right messages, otherwise messages will be non-interesting and non-informative, e.g. in Nepal print-media battle against HIV was non really effectual because of deficiency of dept and fact-finding nature of study.
( UNDP and UNAIDS, 2007 )
The International Federation of Journalists, in research conducted into, “ media describing about HIV ” from November, 2005-March, 2006 found that out of 356 narratives, 281 ( 79 % ) were from print-media and 75 ( 21 % ) from broadcast-media. ( Pollard and Walter, 2006 )
In refugees print media can play of import function as it gives chance for audience-segmentation and is relatively inexpensive, can be given free in signifier of cusps, booklets.
“ Viva-voce ” , has been shown to be one of the most effectual communication-channels for geting cognition and promoting desired alterations in behavior ” ( UNFPA, 1999 )
A: Out-Reach Servicess ( ORS )
ORS gives chance to present instruction to specific groups harmonizing to their demands. Peer-education is most helpful in altering behavior and believes, as equals are people from same community, person whom locals can swear. Requires trained-staff, clip, conveyance, stuffs etc. ( UNFPA, 1999 ; Walley J, 2006 ) .
Feasible for under-privileged people, e.g. adult females, CSWs. ( Pinknews, 2006 ; International HIV/Aids confederation, 2007 ) . Street-dramas, puppet-shows, theaters are powerful media to distribute consciousness. ( Gurung N, 2007 )
It gives chance for feedback. Resources like forces, stuffs, conveyance and clip are required.
Facility-based instruction takes into history special-needs of community, instruction is delivered at clip as intervention, effectual in altering believe, attitudes. There can be time-limitation, merely those utilizing services will profit, instruction is dependent on communicating accomplishments of staff. Need to be done along with other agencies of instruction.
( Walley J et al. , 2006 )
School based sex instruction can diminish hazardous sex behavior. ( Kirby D et Al, 2006 )
Showing pictures in STD clinics has shown to be really effectual in raising consciousness.
( Cohen DA et al. , 2004 )
Degree centigrades: Group-Communication Workshop
They are of import in conveying community together ; more is achieved with less-time and resources but without readying and followup, will non take to durable alteration. ( Walley J et al. , 2006 )
Culture may forestall commixture of genders ; young person may experience diffident in-presence of seniors.
Large-coverage, easy both for literate and nonreaders, no feedback
trained professionals required, electricity
Plans have to be in local-language, and with-in cultural/social norms ;
Initial investing is high, subsequently cost per individual is low
Equitable, plans for
mark groups e.g. pregnant-women
Very high-coverage, apprehensible to literates and nonreaders ; no video-dimension ; no feedback ; quality of response may be bad
Needs radio-station, skilled-staff ; electricity/ batteries
Same as Television
There is opportunity that refugees might be transporting their wirelesss ; are low-cost, can be donated by givers
Equitable, plans for mark groups like CSWs
Good coverage ; can be distributed to target-groups and influential-people ; illiterate people ca n’t profit ; make can be limited
Needs imperativeness, skilled -staff, staff for distribution
To be in apprehensible linguistic communication to both populations and acceptable to them
Quite inexpensive, can be provided free
Gives chance for audience-segmentation, e.g. different stuffs for
Table 1: HIV Health-Education Service-Deliveries Appraisal Table
Can make vulnerable population, messages delivered to specific audience ; feedback obtained ; good coverage but requires clip
Staff, stuff, conveyance and clip required, staff demands good communication-skills ; locals and equals can be used
Locals and equals can pass on efficaciously
Needs forces, stuff, money, clip
Peers can be adult females, work forces and striplings, from different Fieldss so specific-groups targeted
Allows particular demands to be taken in history ; less coverage ; non really effectual alone
Merely reaches those who utilize service ; time-limitation, requires skilled-staff
Target-groups ( e.g. CSWs ) may non come from fright of stigma
Existing health-posts utilised
Education harmonizing to demands
Group -communication work stores
Can bring forth big sum of involvement, leads to community-participation
Less clip, greater population covered
Risk-population and target-groups may non go to
Less resource input, instruction is conducted at clip to large-masses
Less privileged groups possibly left out
Table 1.b: HIV Health-Education Service-Deliveries Appraisal Table
Plan OF ACTIVITIES FOR OUT REACH-SERVICES
Out-reach services will be aimed to make targeted population.
Designation of risk-groups e.g.CSWs
Audience cleavage ( into groups of adult females, work forces, striplings )
Ad for peer-educators within each group ( with aid of community-leaders )
( Time-frame, who ‘s responsible, input, result, and outcome-indicators are given in table-2 )
Development of IEC-packages From bing national IEC-draft in local-language
Recruitment of Trainers From international, local or community
Training of Trainers By Public-Health-Co-ordinator
Recruitment of peer-educators ; will be Males, females, striplings equals from groups with which they will be working, from refugees and territory.
Meeting of Trainers with Joint-committee To be after and schedule training-session of peer-educators
First Work-Shop Provides basic-knowledge and initiates development of accomplishments
Continued-Training Comprising of periodic study-days, weekly-sessions, audit-cases
( WHO, 2000 )
Meeting of peer-educators with District-health-management-team ( DHMT ) To acquire schedule-of-activities
Meeting of peer-educators with DHMT every 15 yearss to describe advancement
It will be systematic, uninterrupted procedure collection and analyzing information. It will be done through
Periodic studies from peer-educators
Review and periodic audit of these records
Exit interviews to supervise community satisfaction
Facilitative supervisory-visits to detect reding and health-education accomplishments of peer-educators
Interviews with refugee and community leaders
No. of people take parting in group-discussion ( quantitative )
No. of people educated ( qualitative )
Evaluation is assessment in one-point in clip.
It will be done yearly, initial-survey supplying base-line.
No. of people utilizing rubbers and using STIs clinics ( quantitative )
No. of people with changed behavior ( qualitative ) ( WHO, 2000 )
Table 2: Action Plan
Who is responsible
( hebdomads )
Surveillance to place risk-groups
District-staff and speedy questionnaires
Risk-groups identified and audience-segmentation into groups achieved
No. of groups identified right, Survey Record
Designation of peer-educators
PHC and MSF Rep.
District-staff, community-refugee leaders
No. of peer-educators identified
Development of instruction bundles
Time to develop
Learning stuff, course of study drafted
Course of study prepared
Recruitment of trainers
MOH HR -officer
No. of needed trainers recruited
Required trainers recruited
Training of trainers
Staff, stuffs, and money
No. of trainers to the full trained
Meeting between trainers and Joint commission
DMO and MSF Rep.
End of 2nd
Training-schedule for wellness workers
Minutess of meeting
Recruitment of peer-educators
Time, record stuff
No. of peer-educators recruited
Training of peer-educators
Trainers, instruction stuff, work topographic points
No. of skilled workers obtained
Meeting of trained workers with DHMT
Agenda of activities, job- distribution obtained
Minutess of meeting
Education of peer-groups
6th hebdomad onwards
Forces, IEC stuff, conveyance
Knowledge of STIs/HIV in both communities increased
Behaviour studies of communities
Time, forces, money
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