Fourth progress report of the HIV/SIDA Program Round 6
- target underachieved
- target overachieved
Reporting period: January 2009 - June 2009.
The report presents the program progress according to the key indicators included in the Attachement 1 to the grant agreement.
The full progress report can be accessed here.
SDA1: Prevention: BCC - community outreach
Number of injecting drug users reached with HIV/AIDS prevention programs
"Prevention programs will include provision of services including needle exchange, distribution of IEC materials, referral to voluntary counseling and testing, condom distribution, risk reduction counseling and referral to services.
Cumulative targets partially reflect beneficiaries included in the baseline who have benefited from prevention services prior to the start of the reporting period. The program will cover five cities (Bucharest and four other cities with population of over 300,000 inhabitants)."Reached value: 9774 Planned target: 7000 Value to target ratio: 140% 140% planned target: 7000reached value: 9774
Number of commercial sex workers reached with HIV/AIDS prevention programs
"Prevention programs will include provision of services such as risk reduction counseling, needle exchange, condom distribution, basic medical and social services, referral to services and interpersonal IEC.
Cumulative targets partially reflect beneficiaries included in the baseline who have benefited from prevention services prior to the start of the reporting period.
Program coverage: 11 counties (out of 42 counties)"Reached value: 3558 Planned target: 4800 Value to target ratio: 74% 74% planned target: 4800reached value: 3558
Target partially met (74%). The value reflects the number of clients (unique codes) who received services since the beginning of the Rd6 program. Following the mapping (in Q4-Q6) of the indoor sex work locations (massage parlors, apartments, hotels, bars etc.), ARAS opened 4 indoor outreach sites (in apartments). Moreover, the data collection during the BSS conducted in Bucharest (Q8) indicated that from the sample (N=204), about 30% have been working in another location during the last 12 months. For 16% of them, the other location has been a foreign country. Implementer: ARAS. Geographic coverage: Bucharest, Ilfov, Bacau, Brasov, Cluj, Constanta, Dolj, Iasi, Neamt, Timis, Arad.
Number of men having sex with men reached with HIV/AIDS prevention programs
"Prevention programs include provision of services such as condom distribution, distribution of IEC materials, interpersonal IEC and referral to services if needed. Services will be offered in venues or MSM meeting places. The targets refer to person-contacts.
Program coverage: 10 cities."Reached value: 37541 Planned target: 14000 Value to target ratio: 268% 268% planned target: 14000reached value: 37541Target exceeded (268%). Both ACCEPT & PSI target MSM from the same 10 cities. ACCEPT reaches them through face-to-face outreach interventions, while PSI through online IEC. Therefore, the value counted for the key indicator represents only the number of person-contacts reported by ACCEPT. Besides ACCEPT, PSI reported 37,292 person-contacts in Q1-Q8 . The number reflects: # of chat room users who engage in discussions with the chat moderator (2,209) + # of users of the online portal (31,162) + # of online users (on hi5.com, plantromeo.com) with MSM identified personal profiles, who receive sexual health messages (1,157) + # of recipients of the email newsletter Total Gay (2,764) . The chat rooms, as well as the Internet portal, address issues related to sexual health, HIV prevention, referral to and information about health and psychosocial support services. Using a capture-recapture method (starting Q6), PSI & ACCEPT reached with prevention services reportedly 1,154 MSM counted as unique individuals. Implementers: ACCEPT & PSI. Geographic coverage: Bucharest, Cluj, Constanta, Dolj, Timis, Mures, Buzau, Brasov, Galati, Iasi and visitors of the online prevention resources.
Number of Roma reached with HIV/AIDs prevention programs
"Prevention programs include provision of services such as IEC, condom distribution, peer education and prevention through community mediators. Cumulative targets partially reflect beneficiaries included in the baseline who have benefited from prevention services prior to the start of the reporting period.
Program coverage: 12 counties (out of 42 counties)."Reached value: 15259 Planned target: 10000 Value to target ratio: 153% 153% planned target: 10000reached value: 15259Target exceeded (153%). The value represents the number of individual Roma persons participating in group IEC sessions organized in their communities. Explanation: Save the Children increased the number of project locations (villages or neighborhoods) from the planned 15, to 56. The three implementing organizations work in different counties (there is no danger of clients' overlap). Implementers: ARAS, Save the Children, DGASPC Hunedoara. Geographic coverage: Bucharest, Ilfov, Timis, Dambovita, Vrancea, Hunedoara, Craiova, Bacau, Iasi, Neamt, Constanta, Brasov, Cluj, Arad.
Number of street children and youth reached with HIV/AIDS prevention programs
"Prevention programs include provision of services such as IEC and condom distribution and psycho-social support. Cumulative targets partially reflect beneficiaries included in the baseline who have benefited from prevention services prior to the start of the reporting period.
Program coverage: 9 counties (out of 42)"Reached value: 2313 Planned target: 1000 Value to target ratio: 231% 231% planned target: 1000reached value: 2313Target exceeded (231%). Explanation: 1) The implementer identified and opened more project areas (railway stations, sewers systems, abandoned buildings etc.). 2) The indicator includes also the growing number of children and youth who choose to be with their peers in the streets, but who, in fact, have (dysfunctional) families, a place to stay occasionally or live in institutions. A KAP study conducted by ARAS in Q7-Q8, on a sample of 247 street-children, indicates that during the last 12 months the respondents lived in several places. The majority (78%) have slept for at least one night in improvised shelters/abandoned buildings/buildings in constructions (78%), 56% under the open sky (e.g. parks), in community night shelters (26.3%), with their families (17.4%), in foster homes (14.6%), in residential centers for minors (3.2%) and in a penitentiary/reeducation center (2.4%). Asked about their occupation, the respondents mentioned mainly: begging (46%), car window washing (37%), collection of metal waste for recycling (34%), un/loading merchandise in warehouses (30%). By enlarging their perimeter of outreach (including abandoned buildings, buildings in construction, busy streets during rush hours, markets) ARAS teams managed to reach during Phase 1 more street youth than planned in the original proposal.
Implementer: ARAS. Geographic coverage: Bucharest, Bacau, Brasov, Ilfov, Cluj, Constanta, Dolj, Iasi, Neamt, Timis, Arad.Number of prisoners reached with HIV/AIDS prevention programs
"Prevention programs include provision of services such as distribution of IEC materials, condom distribution and peer education.
The estimated prison population in the country is 35,000 on an annual basis. Cumulative targets partially reflect beneficiaries included in the baseline who have benefited from prevention services prior to the start of the reporting period.
Program coverage: all prison units (40) in the country"Reached value: 15536 Planned target: 28000 Value to target ratio: 55% 55% planned target: 28000reached value: 15536Target partially met (44%). The number includes 1,193 individual prisoners trained as peer educators and other 14,343 individual prisoners who participated in group IEC sessions, conducted by health educators. The interventions started at the end of Q5 (sub-grant agreements have been signed at the beginning of Q4 and have been followed by a period of preparation and summer holidays). By Q8, the implementers reported an additional number of 7,798 prisoners (person-contacts) that have benefited from information about HIV/AIDS during individual or group sessions held by the peer educators. These sessions have been documented by each penitentiary according to its internal procedures (most lists include just the printed names of the prisoners, the date when the session was organized and are signed by the psychosocial staff of the penitentiary and the manager of the unit). The PR will validate these number only after each implementer will check the lists available in penitentiaries and will compare them to the lists of prisoners who participated in IEC sessions held by the implementers' staff. The validation process will be over by the end of Q9. Implementers: Romanian Harm Reduction Network, ALIAT, ARAS, INTEGRATION, Close to You. Geographic coverage: all the penitentiary units in the country.
Number of injecting drug users (IDUs) and commercial sex workers (CSWs) temporarily in police arrests reached with HIV prevention programs
"Prevention programs include provision of services such as distribution of IEC materials, condom distribution and referral to existing medical and psycho-social services.
Program coverage: 11 counties (out of 42)"Reached value: 933 Planned target: 1300 Value to target ratio: 72% 72% planned target: 1300reached value: 933Target exceeded (132% ) for IDUs and target not met (1,5%) for SWs. Following the last year's changes in the Romanian legislation, the street police just fines SWs in the street, it is not required to bring them to the police arrest. Therefore the number of SWs who reach the police arrests has decreased dramatically. Moreover, the identification of a SW in a police arrest is difficult, since most of them, IF brought in, are usually charged for other offenses than sex work (loitering, drug possession etc.). However, the arrests' staff trained in the project provide IEC materials and referral services also to non-injecting drug users who reach the police arrests (112 persons reached by Q8). Implementer: Ministry of Interior and Administrative Reform. Geographic coverage: police arrests in 22 counties.
Number of people from vulnerable groups trained to deliver HIV prevention through peer education and community outreach programs
"The indicator and related targets refer to peer educators trained to support positive prevention among PLWHAs, peer educators among prisoners, street children and youth, peer educators andpopular opinion leaders (POLs) among MSM, community leaders and peer educators among Roma."
Reached value: 1709 Planned target: 1610 Value to target ratio: 106% 106% planned target: 1610reached value: 1709Target exceeded (106%). The value represents the number of Roma, street children, PLWHAs, MSM and prisoners trained as peer-educators. Implementers: ARAS, ALIAT, INTEGRATION, CLOSE TO YOU, PSI, ACCEPT, LIZUCA ASSOCIATION, SAVE THE CHILDREN. Geographic area: all the counties.
Number of condoms distributed to vulnerable groups (IDUs, CSWs, Roma, street children and prisoners)
"Program coverage: 12 counties and all prison units (40) in the country."
Reached value: 1982577 Planned target: 2485000 Value to target ratio: 80% 80% planned target: 2485000reached value: 1982577Target partially met (78%). The condoms distributed during Periods 1-3 are not from GF funding, they are from donations facilitated by PR (sources: John Snow Institute, Trojan distribution in Romania) or obtained by SRs directly from donors (e.g. PSI condoms). In prisons, besides the condoms, have been distributed 93,860 lubricants (source: PSI). While for most groups the distribution targets have been met or exceeded, for SWs the condoms distributed amount to 36% of the target. The main reason is that the number of SWs reached is lower than the set target (74%). Implementers: ARAS, ALIAT, ACCEPT, PSI, Save the Children, INTEGRATION, Close to You, Red Ribbon Falticeni, New Hope Against AIDS Association. Geographic area: all the counties.
SDA2: Prevention: Testing and Counseling
Percentage of men having sex with men (MSM) reporting having ever been counseled and tested for HIV (including provision of results)
"Numerator: Number of MSM reporting ever been tested and aware of result.
Denominator: Number of MSM included in the survey sample
Program coverage: 10 cities "Reached value: 50 Planned target: 35 Value to target ratio: 143% 143% planned target: 35reached value: 50This is the correct value of the indicator ( 185 MSM who have been tested and know the test results/ 337 MSM in the sample). The value indicated in the second progress report (98.4%) is not referring to this indicator. Source: BSS among MSM, research report, May 2008.
Number of injecting drug users, commercial sex workers, Roma and prisoners who have received HIV pre-test counseling/information, were tested and received test results
"The baseline refers to national data and represents numbers of HIV tests carried out. However, the indicator will measure the number of individuals taking voluntary HIV tests in the areas of program coverage. IDUs, Roma and CSWs will be tested with HIV rapid tests (as part of the community outreach activities), while prisoners will be tested with ELISA tests in prisons. Break-down of cumulative targets by vulnerable groups will be available upon sub-recipients' selection.
Program coverage: 30 prison units and 10 counties"Reached value: 9995 Planned target: 11700 Value to target ratio: 85% 85% planned target: 11700reached value: 9995Target partially met (85%). The value reflects the number of IDUs, Roma, CSWs (2,109 reached compared to the 3,250 targeted by Q8), prisoners (7,770 reached compared to the 9,000 targeted by Q8) and MSM. The testing of MSM is a new activity included by ACCEPT in their prevention programs starting Q8. They plan to provide testing only during MSM events (such as festivals, campaigns or summer camps). Following the dissolution of ANA (May 2009), the testing service in prisons was implemented exclusively by NAP during the month of June 2009. Implementers: ARAS, ALIAT, ANA (in partnership with ARAS & NAP). Geographic area: all the counties.
SDA6: Care and support: Care and support for the chronically ill
Number of young people living with HIV/AIDS reached with information and education activities within the "Education for life" framework
"The ""Education for life"" services include provision of information, education and counseling on family planning, unwanted pregnancy, drug use and STI prevention. The activities will be implemented in out of school settings.
Program coverage: 16 counties (out of 42 counties)"Reached value: 2100 Planned target: 1463 Value to target ratio: 144% 144% planned target: 1463reached value: 2100Target exceeded (144%). The number represents YPLWHAs counted as unique clients. The overachievement is due to the activity of UNOPA's 20 member organizations; they implemented the Education for Life program using monthly group sessions with 6-10 YPLWHAs as participants. Implementers: UNOPA, Foundation for People Development, Inima de Copil, New Hope Against AIDS Association, Lizuca Association, Baylor Black Sea Foundation, I Nostri Bambini Association, Red Ribbon Association, SCOP, Close to You, Health Aid Romania, Romanian Children's Appeal. Geographic area: Bucharest, Arad, Dambovita, Galati, Hunedoara, Bacau, Constanta, Dolj, Suceava, Timis, Iasi, Neamt, Caras Severin, Vaslui, Botosani, Sibiu, Mures, Giurgiu, Prahova.
Number of PLWHA receiving professional and occupational integration counseling
"The counseling services for professional and social integration of YPLHWA will be provided by trained service providers (social workers, psychologists, educators) and will be geared towards providing adequate combination of services and support for the YPLWHA seeking social and professional integration.
Program coverage: 18 cities"Reached value: 898 Planned target: 623 Value to target ratio: 144% 144% planned target: 623reached value: 898Target exceeded (144%). Explanation: According to the implementers, more YPLWHAs than expected have showed interest in receiving counseling for aspects such as writing the resume, finding a job, identifying and registering for vocational trainings etc. Implementers: Heart of a Child, Close to You, Baylor Black Sea Foundation, Foundation for Peoples' Development, Health Aid Romania, Romanian Children's Appeal, SCOP, Children's Smile, I Nostri Bambini. Geographic area: Bucharest, Iasi, Constanta, Arad, Dambovita, Galati, Timis, Targu Mures, Dolj, Falticeni, Bacau, Petrosani.
Number of service providers trained in family planning and professional integration for PLWHA
"Program coverage: 18 cities"
Reached value: 462 Planned target: 340 Value to target ratio: 136% 136% planned target: 340reached value: 462Target exceeded (136%). Service providers have received training in family planning (trainees: family planning doctors, gynecologists, general practitioners) and in providing counseling for the professional integration PLWHAs (trainees: psychosocial personnel). Other results: 217 clergy men and psychosocial specialists from faith-based organizations, have received training on how to reduce the AIDS related stigma at the community level; 201 medical and psychosocial specialists have been trained on how to reduce discrimination in the medical & psychosocial services attended by MSM (infected or not infected with HIV). Implementers reporting on the key indicator: Romanian Children's Appeal, SECS, Foundation for Peoples' Development. Implementers reporting other results: AIDROM, ACCEPT. Geographic area: training participants from Bucharest, Bihor, Vaslui, Cluj, Iasi, Dambovita, Hunedoara, Covasna, Brasov, Constanta.
Outcome indicators
Case notification rate - Number of new HIV cases registered yearly per one million of general population
Indicator measured annualy
Reached value: 9.8 Planned target: 9.5 Value to target ratio: 103% 103% planned target: 9.5reached value: 9.8The impact indicator reported at the end of Q6 has been measured using data from the National AIDS Commission located at the Institute for Infectious Diseases "Prof. Dr. Matei Bals". According to the data available at the last reporting ("The Evolution of the HIV/AIDS Phenomenon in Romania between 1985-2008"), the number of new HIV cases registered during the period January - December 2008 is 211 - meaning a case notification rate of 9.8 for a 12 months period (calculated at a total population of 21,500,000 inhabitants, estimated at 31st of December 2008 by the National Statistics institute). NO REPORT IS YET AVAILABLE AT THE TIME OF REPORTING. (Sources: 1) National AIDS Commission, "The Evolution of the HIV/AIDS Phenomenon in Romania between 1985-2008", page 16, www.cnlas.ro; 2) Press Release by the National Statistics Institute, No. 34, Feb 16th 2009, http://www.insse.ro/cms/files/statistici/comunicate/populatie/a08/pop12r08.pdf). In order to analyze the evolution of this indicator, it is worth mentioning that according to the 2007 ECDC report entitled "HIV/AIDS Surveillance Report in Europe", the HIV case notification rate in 2007 was 7.3 (158 new HIV cases in a population of 21,530,000 inhabitants). (Sources: 3) ECDC, "HIV/AIDS Surveillance in Europe", 2007, page, www.ecdc.europe.eu; 4) Press Release by the National Statistics Institute, No. 35, Feb 15th 2008, http://www.insse.ro/cms/rw/pages/comunicate/arhivapopulatie.ro.do).
Percentage of injecting drug users (IDUs) who have adopted behaviors that reduce transmission of HIV
"Numerator: Number of IDUs who report having adopted behaviors that reduce transmission of HIV (avoid using non-sterile injecting equipment and use condom in the last month)
Denominator: Total number of IDUs from the behavioral surbeillance survey (BSS) sample that injected drugs and had sex during the last month
Program coverage: 5 cities"Reached value: 14 Planned target: 5 Value to target ratio: 280% 280% planned target: 5reached value: 14The indicators is calculated as: NUMERATOR (55): # of IDUs who have adopted behaviors that reduce the transmission of HIV (used condoms at the LAST sexual contact and a used sterile syringes at the LAST injection). DENOMINATOR (385) # of IDUs who injected drugs and had sexual intercourse during the last YEAR.
Percentage of commercial sex workers (CSWs) reporting condom use with all sexual partners
"Numerator: Number of commercial sex workers (CSWs) reporting condom use with all sexual partners
Denominator: Total number of CSWs included in the BSS sample
Program coverage: 11 counties (out of 42)"Reached value: 50 Planned target: 25 Value to target ratio: 200% 200% planned target: 25reached value: 50The indicators is calculated as: NUMERATOR: # of SWs from Bucharest and Ilfov who report using condoms all 10 last sexual contacts (regardless of the TYPE OF CONTACT - oral, vaginal, anal). DENOMINATOR: # of SWs included in the sample from Bucharest and Ilfov. A second consistency indicator uses as a NUMERATOR "# of SWs from BUcharest and Ilfov who report using condoms all 10 last sexual contacts (regardless of the type of PARTNER - regular, occasional, client)", however, the value of the indicator is higher - 58%. In the next BSS we will follow-up with both indicators, to assess the progress of the program.
Percentage of men having sex with men (MSM) reporting condom use at last anal sex
Numărator: Număr de bărbaţi care au relaţii sexuale cu bărbaţi care au declarat că au utilizat prezervativul la ultimul contact sexual anal
Numitor: Număr total de bărbaţi care au relaţii sexuale cu bărbaţi inclusi în eşantionul de studiu care au avut relaţii sexuale anale cu un bărbat în ultimele 6 luniReached value: 63.5 Planned target: 63.5 Value to target ratio: 100% 100% planned target: 63.5reached value: 63.5The percentage reflects the baseline value of this indicator. The Behavioral Survey among MSM was conducted from October 2007 until March 2008 in 10 cities. The study was planned as an RDS, but following the early interruption of the RDS chain it had to be redesigned as a survey based on two convenience samples: one sample based on face-to-face interviews, the other based on on line interviewing. It is expected that by the end of Y3 of the program, the indicator increases by 15%.
Percentage of prisoners who report condom use with all sexual partners
"Numerator: Number of prisoners reporting condom use wil all partners
Denominator: Total number of prisoners included in the BSS sample
Program coverage: All prison units in the country (40 units)
The baseline data for this indicator will be established by the end of Year 1 based on a behavior surveillance survey (BSS) to be conducted among prisoners in Year 1. "Reached value: 22 Planned target: 22 Value to target ratio: 100% 100% planned target: 22reached value: 22The indicators is calculated as: NUMERATOR (64): # of respondents who did use condoms at all the sexual contacts; DENOMINATOR (296): # of respondents who had sex during the last 12 months. The data has been collected from June 22 until July 10th, on a sample of 840 prisoners.
Percentage of young people living with HIV/AIDS (YPLWHA) who report consistent condom use with all sexual partners
"Numerator: Number of YPLWHAs reporting consistent condom use with all partners over the last 12 months
Denominator: Total number of YPLWHAs included in the BSS sample who reported having had sex during the last 12 months
Program coverage: 16 counties (out of 42)
The baseline data for this indicator will be established by the end of Year 1 based on a behavior surveillance survey (BSS) to be conducted among YPLWHA in Year 1. The target for Year 3 will be set based on the results of the baseline BSS of Year 1. "Reached value: 65 Planned target: 65 Value to target ratio: 100% 100% planned target: 65reached value: 65The indicators is calculated as: NUMERATOR (219): # YPLWHAs reporting condom use at THE LAST SEXUAL CONTACT (regardless of the type of the partner); DENOMINATOR (335): # of YPLWHAs who reported havin sex during the last 12 months. The original numerator ("# of YPLWHAs reporting consistent condom use with all partners during the last 12 months") cannot be extracted from the data, because of a translation that narrowed down broad term "ALL the partners" to the Romanian "toti partenerii stabili" (all the REGULAR partners). However, the original numerator will be included in the next BSS, while for the program progress the above presented combination of numerator/denominator will be used. The data has been collected from February 22nd until April 6th 2009, 600 YPLWHAs (aged 18-24).
Target exceeded (140%). The value reflects the number of new IDU clients (including an estimated 2% codes that duplicate among implementers) who received services in outreach and in the drop in center since the beginning of the Rd6 program. The value reflects an addition (to the 6,255 UNIQUE codes validated by Q6) of : 2,644 UNIQUE codes from ARAS (IDUs from outreach, IDUs from the drop-in center, SWs who are also IDUs), 872 UNIQUE codes from ALIAT (IDUs from outreach) and 3 UNIQUE codes from INTEGRATION. Geographic area: Bucharest, Ilfov, Timisoara.