The German HIV Peer Review Group (PRG)

This publication - available in both abbreviated and full-length (46 page) versions - looks at German-supported AIDS programmes in the Caribbean region. The first part looks at the region and its epidemic in context, pointing out that the region's epidemic emerged among men who have sex with men in a social and cultural environment that is deeply hostile to homosexuality. That hostility, the authors explain, has contributed to delays and distortions in mounting practical and effective responses to AIDS. They indicate that sex work and transactional sex are common throughout the region, and that macho attitudes and behaviour can contribute to the sexual exploitation and abuse of women, adolescents, and children.

The next section describes initiatives supported by the German Technical Cooperation Agency (GTZ) beginning in 1995 and aimed at HIV prevention among youth. These projects have been designed to strengthen the 3 pillars of effective youth participation in national and regional AIDS responses:

1) Delivering local youth-run services to the neighbourhoods and communities where the people most in need of them live and work. According to the authors, local services should be adjusted and improved based on growing evidence from serological and behavioural surveillance, special studies, and ongoing monitoring and evaluation.

• Rap Port Youth Information and Outreach Centres, Trinidad and Tobago - Rap Port centres grew out of focus group discussions with youth initiated by the National AIDS Programme. Staff members and volunteers are from 19 to 30, selected for their demonstrated interest in HIV prevention among youth (often because they are HIV-positive) and trained in communication, counselling, and peer education. Members of the team conduct most of the school-based activities but also train students of different ages as peer educators to carry on the work from day-to-day. In-school methods include presentations, drama, and role play where HIV and other sexual health issues are addressed in the wider context of young people's sexual feelings and experiences and how these differ between the genders and among individuals. Out-of-school activities include: group sessions and house-to-house visits to engage parents and community and religious leaders and groups in discussion; sessions in churches, many of which have agreed to condom demonstrations after church services; collaboration with nurses in health clinics to provide pregnant women with information and counselling; seizing any good opportunities where young people congregate to inform and engage people in discussion; and using day-to-day opportunities for informal exchanges that arise from the fact that the project villages are small and the staff and volunteers are well known.
• Toco Youth and Sexuality Project, Trinidad - In 1998, five young activists proposed a project, beginning with a survey covering in-school and out-of-school youth. The results opened local eyes to the reality of young people's sexual behaviour and won support for a range of in-school and out-of-school programmes delivered by young staff and volunteers. Then, staff from the Rap Port centres and the Toco Youth and Sexuality Project trained peer educators and developed modules for them to use in training others. Strategies the project uses include: mobilising and empowering young people to take responsibility for their own sexual and reproductive health; providing youth-friendly services; creating a more youth-friendly political, social, and cultural environment in which it would be easier for youth to develop sexually.
• Ideas Youth Café, Dominican Republic - A youth committee developed the concept for the café as a centre for youth culture and youth reproductive health, encouraging marginalised groups to define their special needs and to help shape services meeting those needs. Workshops, conferences, talks, exhibitions, poetry readings, music concerts, and theatre events are held. These gatherings are designed to: provide youth with knowledge and skills to prevent HIV and other sexually transmitted infection (STI) or, if infected, to manage their infection and stay healthy; to provide HIV-positive youth with opportunities to learn arts and crafts and to generate income from their products; to promote and support the participation of youth in activities to counter stigma and discrimination and promote human rights; to promote and support positive, healthy, and responsible sexual attitudes and behaviour; to encourage positive attitudes, personal development, the pursuit of knowledge, self-confidence, and self-determination.
• Puna y Letra, Dominican Republic - The group Puna y Letra uses reggaetón (with elements of reggae, bomba, pena, hip-hop, and rap) to address poverty, hunger, racism, macho behaviour, and HIV, and to show how young people can overcome those challenges. Puna y Letra has performed in economically poor urban barrios, towns, and villages, and reached thousands of young people across the country.

2) Building national and regional youth networks

• Trinidad Youth Council, Trinidad - Worked with the Rap Port centres and the Toco Youth and Sexuality Project to establish its own youth and AIDS programme. Now many groups belonging to the Council have their own peer educators.
• The Tertulia, Dominican Republic - A series of informal gatherings where organisations representing or serving youth came together to exchange information on AIDS among youth and how to prevent it. Attending were people living with HIV, gay men, male and female sex workers, members of gangs from the barrios, medical students, religious leaders, and representatives of government and United Nations (UN) agencies. [Editor's note: Beginning on page 23 of the document you will find a series of brief descriptions of some of the groups and individuals that participated in the Tertulia, and some of their experiences, approaches, and perceptions.]
• Caribbean HIV/AIDS Youth Network (CHAYN), 13 Caribbean countries - Launched in Santo Domingo in April 2002, CHAYN emerged as the principal mechanism for national and regional youth organisations and networks to collaborate on the response to AIDS among Caribbean youth. Amongst its objectives were to: advocate for regional and national policies and programmes; mobilise financial and technical resources from partners; establish an information and communications system through which national and regional youth organisations and networks could collaborate on developing and sharing information and experiences; and build the capacity of those organisations and networks. [After the end of the Regional Coordinator's contract in January 2005, CHAYN operated for awhile on a volunteer basis but then stalled, and has remained stall, due to lack of financial and technical support for its work.]

3) Involving youth in policy and programme development - In 2004-05, ProSuRe-GTZ supported the participation of more than 50 representatives from six youth networks in the revision of CARICOM's Regional Strategy for Youth Development. ProSuRe-GTZ also supported the work of the Trinidad and Tobago Youth Councils with the National AIDS Coordinating Committee and the Ministry of Sports and Youth Affairs to ensure that appropriate youth strategies were included in the National Strategic Plan 2004-08.

Beginning on page 31 of the document is a discussion of results of the above efforts within Trinidad and Tobago, the Dominican Republic, and the Caribbean region as a whole. For example, the section on Trinidad and Tobago details examples to illustrate the assessment that these projects are "innovative, cost-effective, sustainable, transferable, participatory, empowering, and well-documented and they demonstrate gender awareness. Like many AIDS-related initiatives, they are weak on quality of monitoring and evaluation and that weakness means that their effectiveness and success cannot be confidently specified." Challenges that lie ahead in each location are outlined. In addition, lessons learned are shared. In brief:

• The sustained, step-by-step process of building mechanisms for empowering youth in Trinidad and Tobago was made possible by strong partnerships among key players, including recognised national and regional AIDS authorities. These partnerships were secured by written agreements and maintained through close working relations.
• In Trinidad and Tobago, there is a long history of support for youth movements through schools, churches, and organisations such as the Boy Scouts, Girl Guides, YMCA, and National Youth Council and this means that the country benefits from experienced and talented young leaders who are full of innovative spirit and energy. The success of the projects they initiated has also depended on giving them and their projects sustained financial and technical support, including training, guidance, and supervision.
• Adult-run organisations serving youth too often assume they can engage youth as volunteers who will work for free. Youth from marginalised groups, in particular, are among the least well-placed of all people to be working for free.
• Avoid the tendency to assume youth-run organisations can be financed with small grants for events or short-term activities.
• At their best, youth are very open to new experiences and ideas and to people from backgrounds very unlike their own.

The following section describes an initiative funded by the German Development Bank (KfW) beginning in 2005 and taking a regional approach to social marketing of condoms and behaviour change communications (BCC). Caribbean Social Marketing to Prevent HIV and AIDS (CARISMA) addresses population groups with different activities and health products: sex workers and their clients; men who have sex with men; Garifuna populations (descendants of Amerindian and African people); migrants; and travel industry workers. To date, the programme has been implemented in Belize, the Dominican Republic, Haiti, and Jamaica. For example, in the Dominican Republic, 3 programmes have been undertaken to increase safer sexual practices: The Youth Programme reaches out to teenagers and young adults with a website and TV and radio spots done in cooperation with the United Nations Children's Fund (UNICEF), capacity building in social marketing and BCC, and condom promotion. The Batey Programme (reaching out to communities at old sugar plantations, now home to economically poor families descended from Haitian migrant workers) includes condom distribution, training of local non-governmental organisations (NGOs) in social marketing, and a televised soap opera. The Sex Worker Programme focuses on social marketing of condoms and lubricants to both male and female sex workers.

"The experience of implementing CARISMA, so far, suggests that regional approaches can have far greater beneficial effects than initially expected....[T]he following advantages have been observed:

• Harmonisation of policies and administration... - The regional implementing organisations, main national government and non-governmental partners, and international donor organisations have agreed to a common implementation and monitoring framework. This has increased their 'buy-in' to the framework and reduced the number of separate agreements and processes.
• Enhanced sustainability - Financing an HIV/AIDS prevention programme like CARISMA through several donors enhances the sustainability of all country programmes...
• Deepening regional integration - The regional institutions involved in CARISMA were able to extend their range of activities and gain greater acceptance...
• Increasing programme efficiency - Regional programmes allow economies of scale, with potential cost savings in procuring condoms or developing awareness and advertising campaigns."

The authors point out that it is also hoped that regional programmes to prevent HIV may have greater impact because they cross the borders, and because they make it possible to reach groups that would otherwise be excluded from HIV prevention efforts. For example, culturally appropriate regional prevention messages can reach the region's large population of expatriate Haitians. "Finally, regional programmes create a platform for regular exchanges of lessons learnt about programme implementation, making it possible to draw on the experience of a large number of different regional and national partners."

The German HIV Peer Review Group (PRG) website.