HIV PREVENTION PROGRAMME

The aim of the programme is to reduce HIV infection rates amongst young people in Cato Manor. We believe that this is possible by reducing their risk-taking behaviour in general. This is only possible once children/young people understand that they are valuable and that they have a future and a destiny.

As has been noted in research conducted in both Zambia and Pakistan, more than just HIV/AIDS education is needed. Simply telling a child what they should or should not do, with the child not understanding or internalising the message, makes the message simply a list of rules to live by. Until the child can internalise the message and make the values their own, such HIV education is ineffective. The child needs to receive the message against a backdrop of their own value and destiny, in order for the message to have any positive effect on their lifestyle and behaviour.

iThemba Lethu runs an intervention in Cato Manor, a community in Durban. iThemba Lethu works closely with the provincial Education Department, local councillors, community structures, school principals, parents and care givers of the children. iThemba Lethu is also constantly networking with like-minded organisations involved in similar work.

Increasingly, research is showing that there are a range of visible and measurable problems that exist in many communities. These include:

• early commencement of sexual activity,
• early pregnancy,
• high incidence of HIV,
• a lack of success of many HIV-prevention programmes.

It is our belief that there are a range of other, deeper problems underlying these more visible problems. Therefore, by trying to intervene only at a symptomatic level there is little evidence of success.

The HIV Prevention Programme focuses primarily on young people. We emphasise their value as individuals, and develop in them an understanding of their self worth. We highlight the destiny and future that each child has. Once this base has been established, we explore issues relating to relationships and choices that they face. This has a direct impact on their current and future sexual behaviour and habits. As a result of young people engaging with iThemba Lethu and being exposed to this life-giving message, they will:

• exhibit a new understanding of their value;
• form healthy relationships with other young people of the opposite sex;
• make different and wise sexual choices;
• this will result in a decrease in HIV infections.

The design of our intervention begins by focusing specifically on young people who are beginning their sexual development and/or activity. Our aim is to interact with them before they are sexually active, or at least before they develop any sexual habits. The second phase of the intervention is then to support and facilitate the meaningful behavioural change that has occurred.

The programme was launched at the beginning of the school year in January 2002 in two junior schools in Cato Manor. The group consisted of all the Grade 5 children - 300 pre-adolescent children aged between 10 and 11 years. The two youth workers (one male and one female) assigned to each school then accompanied this grade of children through the next 5 years of their schooling. The second phase of the intervention (year 4 and 5) takes place at the two high schools in Cato Manor with the same group of adolescents and focuses on supporting behavioural change. Given the increase in the number of children per grade, the number of young people on the programme increased by 50% to 450 which necessitated a bridging course for the first term.

The effectiveness of the long term approach, has already been highlighted by our work with the children to date. Through the building of relationships, the young people have openly disclosed some of the struggles and issues that they have encountered. There are many examples of a decrease in risk taking behaviour which leads to a reduction in the rate of HIV infections.

Young people are our primary target group. We emphasize their value and destiny. From this platform we explore issues relating to relationships and choices that they face. The aim is for this to directly impact their current and future sexual behavior. Recognizing the need for the behavioural change of young people to be supported by living in supportive environments, the Youth programme is supported by two auxiliary programs:

1. Youth Programme - the intervention has four main aspects:

a. Classroom curriculum: a weekly two-hour session during school hours. The curriculum has been developed by iThemba Lethu and is developmentally appropriate to the age of the children. Year 1
to 3 focus on value and destiny, behavioural change and HIV prevention. Year 4 and 5 emphasize the challenges associated with maintaining behavioural change, HIV prevention, general life skills and orientation towards the future.

b. One-on-one meetings: the youth workers are available to meet with the children in the afternoon during which time issues and experiences that require intervention are disclosed. This allows the youth workers to support the children through a whole host of difficult situations including rape, abuse, poverty, family turmoil, death, and even HIV infection.

c. Youth clubs: clubs are held one afternoon a week during which time the topic discussed in the classroom that week is re-iterated using drama, art, song and guest speakers when appropriate. During the school holidays the youth clubs are a combined three-day event called a ‘holiday club’.

d. Leadership development: the programme is designed to redefine socially acceptable behaviour and create positive peer pressure in the grade and ultimately in the school. We work more intensively with a selected group of leaders – approximately 35 per school – and this includes a three-day workshop twice a year at a nearby campsite. The aim is that this group will set an example and promote a lifestyle of abstinence through their delay of sexual activity and their decision to not have numerous sexual partners.

2. Parent/Caregiver Programme

The parents/caregivers of the children are our secondary target group. Behavioural change amongst young people needs to be supported by existing mechanisms to help maintain these changes. Therefore the parents/caregivers are essential. The average experience of an adult living in Cato Manor includes violence, abuse, unsupportive (intimate) relationships, and the challenges and effects of HIV/AIDS. These experiences and demands have an effect on parenting and care giving. It is essential for personal healing to be facilitated, and for healthy relationships to be modeled and encouraged. Therefore home visits are conducted by our team of parent liaisons (one female and one male) to assess how best to assist in facilitating a safe environment in which the children can develop. The intention is for behavioural change to be facilitated for the young people through their being supported and encouraged at home. Families need to be strong, as this is the ‘first line of defense’ against the HIV/AIDS crisis. It is our vision that, rather than build new structures, we strengthen existing families. Our approach includes reducing the stigma and discrimination that is associated with HIV/AIDS, conducting men’s workshops , assisting in job placements through our ‘economic development program’, and linking families with relevant services that they may benefit from, and with which we have links. The aim is that through their engagement with iThemba Lethu, parents/caregivers are able to:

• become more confident in their role as parents;
• provide safe homes for their children;
• be in a position to provide food for their children.

It is during these home visits that the parent liaisons make regular use of related services and programmes that are on offer. In cases where a parent/caregiver needs HIV testing or treatment, or where the death of a parent has left orphaned children in the home, the parent liaisons are able to link the family with the necessary and relevant organisation to assist. This includes the government welfare department for foster and child care grants, nearby clinics and treatment programmes, and crisis homes (in the case of severe abuse).

3. Teacher Programme

The third target area that we have identified is the school teachers who influence the lives of young people and have the potential to create a supportive environment. The aim of this programme is:

• for educators to understand their own value in order to be able to appreciate the value of learners;
• to create a stable and supportive class/school environment to facilitate the healthy development of the children;
• for educators to be empowered to offer emotional support to learners affected by HIV/AIDS.

The full staff complement from the two junior and high schools has attended this programme. Combined with this, regular support has been given to the teachers on a one-on-one basis during visits to each school by the Teacher Trainer. The 2-year programme ran in 2004 and 2005.

4. Evaluation

Monitoring and evaluation was built into the programme from the beginning. The programme was evaluated by a premier external organisation – the Human Sciences Research Council. The report[i] concluded that there was a positive change across the board for psycho-social functioning. This is the foundation for behavioural change and therefore indicated that the programme is effective in beginning to meet its primary objective. Factors cited by the interview respondents as enabling behaviour change were ‘internal’ factors which were covered by the curriculum and external factors which were covered by our holistic approach of working with the teachers and parents.

An important measure selected to assess the degree of behavioural change in the young people was defined as an increase or decrease in their ‘risk-taking’ behaviour. The research showed that the programme has helped young people who initially displayed low ‘risk-taking’ behaviour to remain in this category of behaviour. This high percentage of “still not at risk” responses is a great accomplishment given the realities of their context. Furthermore our belief that a holistic support structure for the children is essential in order to motivate and sustain behavioral change, was also confirmed by the research.

The report concluded that an HIV prevention programme within a context such as Cato Manor should be aimed at pre-adolescents in order to prevent and address sexual risk behaviour as early as is developmentally possible, since once patterns of high-risk behaviour are set in place, they are incredibly difficult to intervene upon. Furthermore the need for long-term, intensive interventions was highlighted.

“The effectiveness of a school-based intervention programme to reduce risk-taking behaviour in adolescents in Cato Manor”, Tammy Brink, January 2006, University KwaZulu-Natal.

EXERTS FROM THE 2007 ANNUAL REPORT:

In 2007 we ushered in the start of the second five-year cycle of the HIV Prevention Programme. With the feedback and research findings of the first cycle (2002 - 2006) iThemba Lethu was well-positioned to begin working with a new group of Grade 5 children in Wiggins and Mayville Primary Schools in Cato Manor. A meeting at the beginning of the year with members from the Health Economics and HIV/Aids Research Division (HEARD) has led to the approval of a research study to explore the impact of the iThemba Lethu HIV Prevention Programme on HIV risk-taking behaviour among youth living in Cato Manor. Both quantitative and qualitative methodologies have been designed for the study to address the research questions. The pilot survey was conducted in December 2007 and the actual survey will be implemented in February and March 2008. To read more on the above or the updates on the HIV Prevention Programme, click here.