Natural Resource Management

Specific elements of the project included:

• Prevention outreach: Building on its research findings on MSM in Ghana, and in consultation with USAID and its government and non-governmental organisation (NGO) partners, SHARP worked with the Ghana Sustainable Change Project (GSCP) - another USAID-funded project implemented by AED - to develop a basic package of BCC tools and interventions for MSM, including a participatory training curriculum for peer educators. The package contained BCC materials that could be distributed to participants in prevention outreach sessions. The materials included pocket-sized brochures listing MSM-friendly clinics and drop-in centres or illustrating HIV and sexually transmitted infection (STI) prevention behaviours. One of the brochures is purposefully graphic in its visual representation of behaviours that can reduce transmission risk of HIV and other STIs (see image above). The direct nature of these materials was designed to reinforce the lessons taught during peer outreach.
  
  

  Peer educator-led outreach sessions for MSM promoted risk reduction behaviours, offered referrals to testing and clinical services, sold condoms and lubricant, and provided counselling by trained health care workers.
  
  

  The programme also worked with its implementing partners on outreach events that included large community parties and small gatherings at private homes and at hot spots such as bars and clubs that attract MSM clientele. Integrating HIV prevention messages into social activities, these events were designed to raise awareness, within a broader peer group, of the value of open communication in MSM relationships and the importance of condom use and other prevention behaviours, such as partner reduction.




• HIV and STI services: Clinical services for MSM were also supported at government-run clinics as well as at the four drop-in centres run by SHARP's NGO partners. Services included STI diagnosis and treatment, HIV counselling and testing, post-test counselling and support, antiretroviral therapy (ART), and referrals to other services if necessary.




• Health care worker training: SHARP developed a most-at-risk-population (MARP)-friendly curriculum and trained providers to increase their understanding of MARP-related health issues and expand their capacity to provide responsive care in a supportive and non-stigmatising environment.




• Support groups: SHARP encouraged CEPEHRG and Maritime to set up support groups for MSM living with HIV.




• "Text Me! flash Me!" Helpline: In Ghana, if people have charged phones and a minimal amount of call credit, they can receive calls and "flash" others (call and hang up before the recipient of the call picks up). This costs nothing and signals that the caller at the number shown on the phone's screen wants to be contacted. Branded as part of the "It's My Turn" campaign, the Helpline was staffed by employees of implementing partners and by HIV counsellors from government clinics. To prepare them for this new role, SHARP worked with a number of stakeholders to develop a training curriculum and provided ongoing support to the counsellors. The Helpline was designed to function during a set period of time each day, and callers would "flash" the counsellor on call, who could then phone back directly to answer questions, provide support, or share information about where to find services. Users were also able to send text inquiries that generated automated text responses on a variety of basic topics relevant to MSM health and well-being. In turn, the callers' cell numbers were recorded, with care taken to maintain confidentiality and protect their identities. Subsequently, these contacts were sent regular text message reminders about condom use, the need for testing, and the availability of the Helpline to answer questions or provide directions to clinics.

HIV/AIDS.

MSM are, on average, over nine times more vulnerable to infection than the general population. And yet, according to James Robertson, author of the case study "CEPEHRG and Maritime, Ghana: Engaging New Partners and New Technologies to Prevent HIV among Men Who Have Sex with Men", MSM have been neglected in HIV programming in sub-Saharan Africa - frequently ignored in national strategies and hidden in the face of intolerance, stigmatisation, and punitive laws. The media and most prevention programming in the region consistently describe HIV vulnerability in terms of heterosexual risk, and many African MSM do not realise that they too are vulnerable. (Robertson points out that, in discussions with MSM in Ghana, many said that before they received MSM-specific education, they had thought condom use was only necessary during vaginal sex.)

That said, Ghana, which, like its neighbouring states, condemns homosexuality, is distinguished from most countries in sub-Saharan Africa by the level of activity addressing HIV among MSM. Although the Ghanaian government has not publicly embraced these efforts, officials have also not prevented the development of these interventions, despite the legal prohibition of homosexual behaviour.

Radio Ada is located in Ada in the Dangme East District, southeastern Ghana and broadcasts to four Dangme-speaking districts which cover a population of approximately 600,000 people of whom 60% are non-literate. The radio staff is comprised of approximately 50 full-time and part-time volunteers, all of whom come from the four Dangme districts.

According to Radio Ada, their approach to broadcasting is participatory and grounded in the needs and identities of the Dangme-speaking audience. The station's programmes are developed and produced with the active participation of people in the respective communities. Radio Ada also uses a broadcasting technique called "narrowcasting" to reach the different occupation-based groups within the four Dangme Districts. The occupation-based groups are comprised of farmers, fishermen, fishmongers who are exclusively women, breadmakers, taxi drivers, and tailors. Each week, a 30-minute radio programme is recorded with the specific occupation-based group and then re-broadcast later in the week. These groups determine the content of their own programmes and act as co-producers. For example, Radio Ada has created opportunities for voice and dialogue amongst fishermen and women fishmongers. The fishmonger programme producer would visit a different fishing community each week, gather together the fishmongers from that community to ask them questions about their fish smoking work, and facilitate a discussion on issues of importance to them. A 30-minute version of the discussion is later broadcast on Radio Ada. The fishmongers are therefore communicating with the men in their community, and men from all communities are listening to the women over the airwaves.

In a bid to involve and ensure a community voice in its operations, Radio Ada has trained about 500 people in various broadcast skills, which include programme recording, producing and delivering the news, marketing, music programming, and programming on conflict prevention.

As part of its programming, Radio Ada also tackled the poor treatment of physically challenged people through the "Advocacy through Radio" project. This was an initiative financed by the Danish International Development Agency (DANIDA), which, according to organisers, contributed significantly to changing attitudes towards the disabled in the communities.

The station also plays a role in conflict resolution in the community. The station gives the community the space and opportunity to talk about burning issues that create conflict and to resolve their problems peacefully. For example, Radio Ada has resolved conflicts over cultural issues between churches and traditional worshippers in the district.

Economic Development, Natural Resource Management, Conflict Resolution.

According to Radio Ada, community radio can play an important role in poverty reduction. Access to voice, information, and knowledge is vital in facilitating poverty reduction and sustainable human development, as voicelessness is a key dimension of poverty and exclusion. For many, Radio Ada is the only source of information; they have no television and more than 50% of the 600,000 in the station's broadcast range are illiterate. Community radio is also being used in the effort to create national functional literacy.

Research suggests that through Radio Ada's advice programmes, husbands and wives in Anyakpor are learning how to communicate and respect each other, which is helping to reduce household quarrelling and abuse. For example, men are learning to share money with their wives and learning how to explain to their wives that they have no money to share with them. They are realising that they should discuss problems with their wives rather than becoming angry and resorting to abuse. Women are learning how to respect their husbands, but also how to offer critical advice or approach them for help.

The SHARP team worked with the Ghana Health Service and the National AIDS Control Programme, with health planning bodies, and at the district and community levels with multiple traditional and formal sector entities, to achieve the following four goals:

1. conducting operations research and second-generation surveillance to guide evidence-based HIV programming across the continuum of care;
2. supporting the establishment and expansion of interventions among most-at-risk groups and in high transmission areas;
3. strengthening capacities of the national response at all levels; and
4. maintaining and ensuring HIV/AIDS programme information and results reporting integrated with the Government of Ghana (GOG) programme.

According to the organisers, the SHARP project has:

• focused its work on over 20,000 female sex workers (FSWs), 8,000 men who have sex with men (MSM), 8,000 non-paying partners (NPPs), and 10,000 people living with HIV (PLHIVs);
• developed tools, materials, and interventions that support behaviour change and improved access to quality services;
• facilitated performance-based funding and capacity-building for non-governmental organisation (NGO) implementing partners;
• developed knowledge management capacity and disseminated tools and best practices to NGOs and government;
• conducted research, monitoring and evaluation, performance feedback, and supervision activities;
• initiated and participated in evidence-based lobbying and advocacy for improved policies and programming at the national level; and
• provided systems strengthening and technical support for sustainable interventions and quality service delivery for NGO implementing partners.

Another project that was part of SHARP initiative is the Text Me! Flash Me! Helpline service which was launched in September 2008. This project used cell phone technology to provide most-at-risk populations in Ghana with HIV and AIDS information, referrals, and counselling services from qualified providers. While the initial pilot reached out to men who have sex with men (MSM) exclusively, it was expanded in February 2009 to include female sex workers (FSW).

The 5-year SHARP programme developed a number of tools and resources for HIV and AIDS prevention, including training manuals, discussion guides, and video clips.

HIV/AIDS