Sustainable Action Against HIV/AIDS

1. Executive Summary

Kampong Cham is the capital of the Cambodian province of Kampong Cham. It is the third largest city in Cambodia with a population of 63,771 people (2006) and is located on the Mekong River. Kampong Cham is 124 kilometers northeast from Phnom Penh.

According to BSDA’s meeting research within Provincial HIV/AIDS Authority, Health Department in Kampong Cham and Kampong Cham’s CPN⁺, we found that Ponheakrek and Oraing Ov doesn’t have any support programs from NGOs and governments yet (specific on home based care program and coverage areas). Amount of PLHIVs are around 200 person and 315OVCs in both districts (in Ponhea krek, 75PLHIVs and 100OVCs, in Oraing Ov, 150PLHIVs and 200OVCs). Nowadays BSDA has decided to design the project proposal to submit KHANA on SAHACOM program to support the vulnerable group (infected and affected) by HIV/AIDS.

The project arm is to coverage fully achieved and maintained in Kampong Cham sites of high quality comprehensive care, treatment and support services for PLHIV and OVC, to improve and integrate the HIV-related services for health, social welfare and impact mitigation with existing home & community-based care services and increase access to services, HIV knowledge & related behavior change among community member by reducing discrimination and stigma.

Currently the project will make the supportive environment established for HIV/AIDS urgent intervention programming at provincial & districted levels as well as in community based.

The priority support help of the project are included:

• Facilitate CSV to conduct regular SHG Education Meeting on HIV management, ART adherence, PMTCT, hygiene and diet to PLHIV, to provide set of HIV prevention and sexual health education: positive prevention, VCCT and to Coordinate regular OVC- Support Group (SG) meeting including Happy Happy Program to provide set of HIV prevention, sexual health, life skill education and basic health care related to HIV/AIDS
• Help CSV to facilitate PLHIV & OVC access to loans and and business development, vocational skill training (Vision Fund Cambodia, DAI)
• Help CSV to facilitate referrals for PLHIV to access treatment and other HIV-related services, home visit to PLHIV household -Incentive for CSV
• Facilitate CSV & SG Leader Conduct home visit to OVC household -Incentive for SG leader and attend MMM monthly meeting
• Help CSV to facilitate PLHIV & OVC access to loans and business development, vocational skill training and support (clothes, shelter, funeral etc) to OVC and their households in urgent need
• Assist CSV network with community and pagodas and other religious groups for providing socio-welfare, food and emotional support to PLHIV & OVC and provide and manage welfare food support to PLHIV&OVC households in need and provide OVC with school supplies (clothes and materials)
• Facilitate CSV to train caregivers in symptom recognition, basic nursing care and general hygiene
• Conduct Training on HIV prevention and life skill education to CSVs (OVC)

2. Organizational Description

2.1 Background applicant Organization

BSDA is an independent, neutral, impartial and non-political NGO established by a group of seven Buddhist monks at Wat Nokor Bachey in January 5, 2005 in Kampong Cham Province, Cambodia. A five member Board of Directors supports the work of this organization; Mr. Kurt Brandenburg who comes from World Education Organization is a board director of BSDA.

BSDA is lead by Venerable Vandong Thorn as Executive Director and includes volunteer workers and supporters from various public stakeholders including monks, students, intellectuals, teachers, lawyers and civil servants, all of whom have a strong social conscious and the wisdom and desire to develop a better Cambodian society.

The Ministry of Interior officially recognized the organization in July 05, 2005 (under No. 612.S.C.N.) Currently, a number of people, most of whom are monks, are working for the organization under the overall leadership and management of Venerable Vandong Thorn, the Executive Director.

2.2 Relevant Experiences

There are five activities undertaken with relevant experience such as:

• Education
• Health
• Orphan and Vulnerable Children (OVC)
• Community Development (Livelihood, food security, income generation…)
• Social Accountability (Good Governance)

Education

2005-2009, BSDA had run the project called Buddhist Leadership Initiative (BLI) and School for Life project, with Civic Life skill, practical life skill and HIV prevention with youths, teenager and children at high school. This project focuses on children and adults’ education activities with foreign language training every day. The project especially provides opportunities for girls and women. As part of the language training monks provide morality courses for impoverished children and adults at pagodas or (rented) classrooms. Morality courses focus on the cause and effect of HIV/AIDS, drug abuse/addiction and violence in Cambodian society, and how they can be prevented. The project have granted by UNICEF and USAID through KAPE.

Health

2007-2009, BSDA applied and received the grant from UNODC and Global Fund round 7 by KHANA to run the project called HIV/AIDS Prevention and Harm Reduction of Drug Abuse. The project focuses on Radio awareness raising program to support HIV/AIDS prevention and harm reduction of drug abuse, Drop-in-Centre in each site and Community capacity Enhancement ‘for community and peer facilitator.

Orphan and Vulnerable Children (OVC)

2008-2009, BSDA received a grant from EcoSolidar to run the project. It is called Mekong Kampuchea’s Kid project. The project helps to support Orphan Vulnerable Children (OVC). The project activities carried out are:

• Life skills: Life skills are to educate and train the OVC to have specific skills like foreign languages and computer training, dancing, and musical training, cooking and sewing/embroidery.
• Scholarships: The project is intended to integrate the OVC into the public education system The BSDA has seen how provision of scholarships (pens, pencils, ruler, eraser, books, bag, uniform, educational fees, and in some cases supply of a bicycle and/or food supplies) can help to solve some of their problems.

Community Development (Livelihood, food security and income generation…)

2008-2009, BSDA received a grant from Courage e.V and Communal Development Fund of Government. The project called Single Women project and Natural Resource management and livelihood project. The project is to help the disadvantaged groups of people like Single Women and poorest of the poor people. The project has implemented Agriculture technical Support, material support and strengthening their capacity on pig, chicken and fish raising as well as organic farm.

Social Accountability (Good Governance)

2008-2009, BSDA designed one project called “Strengthening the Social Accountability Initiative” project. The project was granted by World Bank through ANSA-EAP. Its aim to integrate the Social Accountability tools to supply side and demand side by conducting the orientation training to local self-government and citizen, to increase the participatory act like participatory planning in Right to Information act in Cambodia, to increase the implementation of decentralization at the commune level defend against corruption, and to increase the implementation of decentralization and good governance at the communal level. The activities curried out are; Participatory planning, Right to information, Citizen report card, and citizen engagement.

3. Rationale

3.1 General Overview of (specific issue in nationwide)

Cambodia is one of the few countries that have seen declining HIV prevalence. HIV prevalence in the general population has declined from 1.2% in 2003 to 0.9% in 2006 (see Figure 1). This has been attributed to investment in and scale up of effective HIV prevention programmes, and a large number of deaths among persons infected during the early years of the epidemic when life-sustaining treatment and care were not available.

The HIV epidemic in Cambodia is concentrated in high-risk groups and is primarily driven by the sex industry, although there are indications of rising prevalence amongst injecting drug using populations and amongst men having sex with men (MSM). As shown in Figure 1, HIV prevalence among persons in the general population aged 15-49 years living in urban areas remains higher than among those living in rural areas, also there is higher HIV prevalence among women; 43% of new infections are occurring in married women, most of whom are believed to have been infected by their husbands. Using the Asian Epidemic Model (AEM), the projected number of people living with HIV (PLHA) in Cambodia in 2007 is 61, 400 (32, 200 women and 29, 200 men) and in 2010 will be 51, 200 (26, 800 women and 24, 400 men). (Reference: NCHADS’s Annual Report 2008)

3.2 Current Overview of (specific issue in selected province)

According to the report of the Provincial AIDS Office, Kampong Cham is also one among important provinces severely affected by HIV/AIDS. There are about 1914 PLHIVs, 1324 female in the whole province. The report added, there are only 1218 PLHA have got ARV and 806 PLHIV have got ART. It means that Home and Community Based Care and Health Service Programs are still limited. It needs to improve.

On other hand, there are 162 OVC have got ARV and 88 OVC have got ART. But the total amount of them is 2786 OVC who are HIV positive. Anyway, the infection rate in rural areas is lower than that in urban areas, but rural areas also suffer from this virus because VCT service is not provided at all places, there is a lack of health service, and studies on infection rates are still limited. (Source: Table of Statistics of PLHIVs in Kampong Cham, Sept’09)

3.3 Current Overview of (specific issue in the selected target areas)

Ponheakrek is located in the east of Kampong Cham municipality around 60 kilo meters away. There are 8 communes, 149 villages, 2786 families and 135, 341 populations, 68, 152 female. And there are 5SHG_ PLHIVs and 5SHG_OVCs.

Oraing Ov is located in the Southeast of Kampong Cham Municipality, around 46 kilo meters away. There are 7 communes, 141 villages, 19, 242 families and 93, 933 populations, 48, 067 female. And there are 10SHG_PLHIVs and 10SHG_OVCs.

The specific issues in this selected target area for PLHA and OVC are:

• Not enough food
• No convenient house
• Lack of health service (VCCT, ARV and ART) if there , it is so far from their home so PLHIVs cannot reach (no transportation support to access services)
• There is a lot of discrimination in the community with PLHIVs and OVCs (Stigma and discrimination still exist) to take place.
• There are no self-help groups or home and community based care
• OVC don’t have a chance to study at public school, because no family support them
• Lack of knowledge for self-health care amount PLHIVs and OVCs
• All most all of PLHA are unemployed and have no income

The people in this area are living in high danger to get infected by HIV. The size of HIV/AIDS impacts on families is a major factor. The most difficult problem is that men and women with full labor force immigrate to other places to earn livings. The second major problem is that even older people have affected by HIV and then died later. The succeeding generation of people to serve the nation has been lost. Some families need other people such as the elderly and children to look after them. A large number of children have the task of supporting their parents. Some patients have no one to take care of them, have no money to support them. Some others have sold all their property and end up in poverty. AIDS patients and children are discriminated against. According to the reports of both OD and the Provincial Health Department (PHD), there has not yet been any organization that plans a project that provides care of and support for PLHIVs in this Operation district.

This needs interventions and support from the outside like monks, local authorities, patients, elderly, volunteers, community assistants and institutions concerned if we are to prevent the deaths of youth with labor force, the HIV/AIDS epidemic, and motivate PLHIVs to sustain their hope and lives.

3.4 Mapping and Demography:

Kampong Cham is located southeast of the country. It borders Kratie and Kampong Thom to the North, Vietnam to the East, Prey Veng and Kandal to the South and Kampong Chhnang to the West. The area of the province is 9, 799 square kilometers (MAFF www.maff.gov.kh). The topography of this province is highly variable. Kampong Cham is bisected by the Mekong River. East of the Mekong the northern areas consist of upland areas including forest, rubber plantations and agricultural areas. The southern areas of Eastern Kampong Cham consist of lowland paddy fields and areas of lowland/ upland mosaic. Around the Mekong River are the river flood plains. In Western Kampong Cham there are large areas of lowland paddy fields to the Southeast. To the North of Western Kampong Cham, the topography is of lowland/ upland mosaic and uplands including forest, rubber plantations and agricultural areas. Kampong Cham is classified as a rural province.

In 2004 the estimated population was 1.8 million persons and was 52% female. The population of children aged under 5 years was 230 thousand which was 13% of the total province population (NIS 2004). The Dependency Ratio (numbers of persons <15 years and 65 or over years per 100 adults aged 15-64 years) was 75.

The total number of households in 2004 was 384 thousand, giving an average household size of 4.8 persons (MAFF 2004). The people of Kampong Cham live in 16 districts composed of 169 communes and 1, 768 villages (CDB 2004). The population density of the province is 187 persons/km2 compared to an average population density for Cambodia of 75 persons/km2. The detail information on Mapping and Demography of Oraing Ov and Ponheakrek, please see Annex I.

4. Proposed Strategic Intervention:

4.1 Project Title: Sustainable Action against HIV and AIDS in Community (SAHACOM)

4.2 Overall Goal: To reduce the impact of HIV/AIDS, especially among the PLHIV and OVC for improving their health and quality life in Kampong Cham

4.3 Expected Results:

Expected Result 1: increased capacity and sustainability of self help groups of PLHIV & OVC

Intermediate Result 1.1: Capacity of self-help group PLHIV and OVC is enhanced and built

Key Activities:

• Conduct regular SHG Education Meeting on HIV management, ART adherence, PMTCT, hygiene and diet to PLHIV
• Provide set of HIV prevention and sexual health education: positive prevention
• Conduct Training on HIV prevention and life skill education to CSVs (OVC)
• Coordinate regular OVC-Support Group (SG) meeting including Happy Happy Program

Intermediate Result 1.2: Sustainability of self-help group PLHA and OVC is increased

Key Activities:

• Organize the structure of self-help group and OVC-Support Group
• Provide the life skill education and basic health care related to HIV/AIDS
• Help CSV facilitate PLHIV & OVC access to loans and and business development, vocational skill training (Vision Fund Cambodia, DAI)
• Assist CSV network with community and pagodas and other religious groups for providing socio-welfare
• SHG members attend MMM monthly meeting
• SHG facilitate community resource mobilization (saving scheme, contribution box) for PLHIV & OVC

Expected Result 2: Provided high quality comprehensive care, treatment and support services for PLHIV and OVC

Intermediate Result 2.1: The high quality comprehensive care, treatment is provided

Key Activities:

• Facilitate CSV to train caregivers in symptom recognition, basic nursing care and general hygiene
• Help CSV to facilitate referrals for PLHIV to access treatment and other HIV-related services, home visit to PLHIV household -Incentive for CSV
• Facilitate CSV & SG Leader Conduct home visit to OVC household -Incentive for SG leader and attend MMM monthly meeting
• CSV provide counseling and refer pregnant women to specialized counseling services including ANC, PMTCT and VCCT

Intermediate Result 2.2: The services support for PLHIV and OVC is provided

Key Activities:

• CSV identify need, and provide OVC with school supplies (cloth and materials)
• support (clothes, shelter, funeral etc) to OVC and their households in urgent need
• provide and manage welfare food support to PLHIV&OVC households in need and provide OVC with school supplies (clothes and materials)
• Support bicycle for SG leader to conduct home visits to families of OVC

Expected Result 3: Increased the access to services, HIV knowledge and related behavior change among community member by reducing the discrimination and stigma

Intermediate Result 3.1: Access to services, HIV knowledge & related behavior change among community member is increased and discrimination and stigma amount community member is reduced

Key Activities: