FHI – Nepal Rapid Response Fund
Narrative Report Format
Name of Organization: Blue Diamond Society
Date of Submission: 8th, August 2002
A brief description of the organization receiving RRF and why funding was requested.
The issue of male to male sexual behaviours has profound implications for the STD/HIV/AIDS epidemic in Nepal and whether its rise can be halted or reduced. Due to cultural, religious and social reasons, these behaviours are to a large extent invisible, often difficult to access in terms of standard sexual health promotion frameworks, and not contained within a heterosexual/homosexual framework. In fact anecdotal and direct research indicates that levels of male to male sex in Nepal are very high, that a significant number of males involved in these activities are married or will become married, and that many boys and male youths are also involved in these activities.
What appears to exist in Nepal is a range of sexual networks that cut across class, religion, age, ethnicity and income status. However, male to male transmission of STDs and HIV will be invisible because of the relatively low levels of testing of males and because such behaviours are denied by the boys/men themselves. Further many of these males will also have sex with females, thus having an impact upon women's reproductive and sexual health. From our evidence, most of this sexual behavior is risky and unprotected.
Blue Diamond Society (BDS) was founded in 2001, following a five-month consultation, in an effort to address the needs of MSM. Its initial efforts focused on distribution of condoms and lubricants to MSM living in Kathmandu. BDS has developed services in Kathmandu, including outreach education, a social support group and general support to individuals. At present, BDS conducts the only STI and HIV/AIDS prevention programme in Nepal that targets the MSM community.
A rapid ethnographic study of male-to-male sexual life and related sexual health issues in Kathmandu, Nepal was commissioned by Family Health International (FHI/Nepal) and was carried out between 18 November and 7 December 2001.
Blue Diamond Society organized a two-day training workshop from 24-25 November 2002 for MSM in Kathmandu, sponsored by UNAIDS. The aim of the workshop was to gather together men from amongst the nascent communities and networks of MSM in Kathmandu and to begin a process of outreach training and self-exploration.
BDS organized another special consultation meeting on "Male Reproductive and Sexual Health" from 11-13 January 2002. Participants went through a 3-day process of identifying issues, clarifying needs, and generating recommendations for action. There were 30 participants, representing a broad spectrum of Kathmandu residents from different social, economic and ethnic backgrounds, and of various geographic origins. A number of guests and observers were invited to participate including representatives from UNAIDS, World Food Programme (WFP), FHI, and from local NGOs working on similar issues.
Because of social stigmatization, invisibility and denial, there were almost no STI/HIV services focused on the issues of male-to-male sexual behaviors nor on anal sex as a high-risk behavior. Reproductive and sexual health information and services are primarily focused on so-called "heterosexual" behaviors, i.e. vaginal sex, and ignore the high levels of anal sex between males, many who also have female sexual partners, including wives.
With the rapid ethnographic study and the needs of MSMs/MSWs/Clients in mind, funding was requested to address the lack of appropriate provision of sexual health promotion for males who have sex with males in Kathmandu through the development of appropriate outreach STD/HIV/AIDS education, condom promotion, and empowering such males to access STD treatment services to reduce risks of STI/HIV transmission.
This project has been in development in the four months preceding April 2002. The project seeks to address the lack of appropriate provision of sexual health promotion for males who have sex with males (MSMs) and male sex workers (MSWs) in Kathmandu. This has been addressed through the development of appropriate outreach STI/HIV/AIDS education, condom promotion, and empowering such males to access STI treatment services to reduce the risk of STI/HIV transmission to their partners.
Through outreach activities the MSMs/MSWs have been contacted and provided with repeated one-on-one educational contacts to encourage them to promote the adoption of safer sex practices including partner reduction, correct and consistent condom use and alternative sex (masturbation, frottage, avoiding anal sex).
i. Capacity-building of BDS through the establishment of an office/drop in center, team-building exercises and recruitment and training of community based outreach educators.
BDS, a registered NGO, has established its office for this Behavior Change Information (BCI) project. The Kathmandu office supports program management, coordination, and networking activities.
The major component and central focus of the project is outreach activities including contacting (identifying) MSMs/MSWs and their clients and regular one-on-one educational contact by outreach educators. This approach aims to first create awareness, and then bring about changes in high-risk behaviors, among the primary target groups namely MSMs/MSWs and their clients. Outreach activities have intrinsic value since information flows directly to the target audience, thus the quality of information can be controlled. The community based outreach educators visit the MSMs/MSWs and their clients at different locations, where they feel accessible and comfortable, to have behavior change interactions and discussions.
Initial contacts with newly contacted MSMs/MSWs and clients are individual. Group interaction and social meeting is done at a later stage, especially with the established MSMs/MSWs and clients. The outreach educators educate clients on basic and general information on: HIV/AIDS/STIs and condoms; and different aspects of safer sex practices (including consistent and correct condom use, reduction of non-regular sex partners and alternative sex practices like non-penetrative sex activities etc.) Outreach educators perform demonstrations of correct condom use during the interactions. At the same time, IEC materials and condoms are provided. An important component of the project, supporting targeted BCI, is awareness creation among the MSM population in the project area. Awareness raising activities are comprised of interactive dialogues, condom promotion, IEC distribution, HIV/AIDS awareness related audio/visual programs, etc. IEC materials for creating and raising awareness among the targeted population are developed by BDS itself. Besides this, other relevant IEC materials are acquired free or purchased from different institutions and distributed to the primary and secondary target populations. BDS provides the IEC materials and condom wallet.
Ten peer educators (PE) were to be identified from the group of contacted MSMs (eight) and MSWs (two) and trained. These individuals are to serve as an asset for the future in aiding BDS's pilot BCC project for behavior change interactions and interventions such as one-on-one repeated educational contact, condom use demonstration and condom distribution and awareness raising activities like interactions, IEC material distribution, camps and campaigns. Besides this the MSMs and MSWs will be encouraged to make use of a hotline at the Drop-In Center (DIC) of BDS. BDS accomplished these objectives.
iv. Condom promotion and distribution
Condoms are available in the project areas but the MSMs/MSWs and clients do not have access when required. Most of the contacted MSMs/MSWs and clients do not use condoms during sex.
BDS will provide knowledge and skill on correct use of condoms and lubricant as well as foster increased use of condoms by increasing accessibility to the primary target group. Condoms and lubricant will be obtained at no cost for free distribution from The Foundation for Integrative AIDS Research (FIAR; http://aidsinfonyc.org/fiar). Condom distribution will start from beginning of Month 2.
3. Outcome of Activity - Impact or Achievements
There were many exciting results since April 1, 2002. Perhaps the most significant outcome has been the trust and community sense that has been developed between Blue Diamond Society and the MSM community all of whom are working and helping each other with dedication and commitment. This made for a stimulating four months raising many issues and indicating the way forward for future activities for Blue Diamond Society. Here are some of the objectives achieved:
From the 1st of April Blue Diamond Society has rented a space in Lazimpat, Kathmandu as an office cum drop-in center. Office equipment and materials have been procured as required. Six community-based outreach educators (OE) were recruited immediately.
Through outreach, BDS shares knowledge, awareness, and provides information on practicing safer sex. Outreach workers have been conducting field research since, 1st April 2002 with the help of Family Health International (FHI). Before the outreach programme, BDS had conducted two 2-day and two 3-day outreach sessions under the collaboration of UNAIDS and FHI. After implementing the outreach programme, BDS has been able to complete four months of outreach beginning 1st April 2002. In these four months, BDS has implemented its outreach programme, administration work, and a drop-in center. Its achievements, plus and wishes are described below.
For four months, BDS, with the help of six outreach workers six days a week, has been doing field work. Working in areas of the Kathmandu Valley where MSM gather, meet, and choose sex partners, the following places were initially targeted:
Other areas have been identified and covered subsequently.
While doing outreach, the above places were found to be most accessible for the MSM community because of the following:
The outreach workers went to theses places six days a week. While working there, workers were able to acquire a large amount of information and faced some difficulties, challenges, and feedback, which are as follows:
Outcomes of the outreach
Difficulties and challenges of the outreach
Outreach worker feedback
By working in the field and gathering all the information: total number of condoms distributed, total number of lubricants distributed, number of clients referred to STD treatment organizations, numbers of people using or not using condoms in different sexual activities, and awareness by MSM if they are HIV negative or positive, the responses are stated in the diagram and flow chart (see the attachment"chart")
In the four months of fieldwork, April, May, June and July responses seem to be increasing on a monthly basis. This may be due to the increased popularity of the work and the success of the outreach.
Likewise, within the span of four months, the total distribution of condoms and lubricants is shown. This demonstrates that the there is an increase in the number of the people using condoms and lubricants each month. But due to the scarcity of lubricants in the organization, there were problems in the final month.
Likewise, during different sexual activities, condom usage has increased drastically as compared to before the last four months. This may be due to counseling by the outreach workers, as the data represents that after a month, condom usage had greatly increased. The Blue Diamond Society has considered these changes in behavior as a measurable success.
Office drop-in availability is a part of the organization's objectives. This has resulted in large numbers of drop-in clients in these four months. Through drop-in, the MSM received information like health guidance, psychosexual counseling, and trainings that would help them take responsible for themselves. This is the main ideology of Blue Diamond Society. As a result, the number of recorded MSM increased.
Within the last four months, several drop-in clients were given counseling. These clients were given sexual health as well as psychosexual counseling. Since there is no clinic at Blue Diamond Society, they were referred for treatment to Chechen Clinic of Boudha. Because of its specific issues, there is a need for a separate clinic for the MSM community.
Workshops and trainings related to HIV/AIDS, STDs, and safer sex were organized on different dates. Through outreach workers, many members of the MSM community of the Kathmandu valley were met and called for the programme.
Blue Diamond Society has been organizing different social functions, gatherings, and meetings for the MSM community so that they can come together, show support to one another, and share their joys and sorrows. The following are the main programme organized by Blue Diamond Society for the MSM community in the past four months:
In addition to the above programme to raise the voice of the MSM community in different parts of Nepal, Blue Diamond Society has been successful in giving information in different newspapers of Nepal on different subjects like health and social problems. Within a small period of time, Blue Diamond Society has become a hugely successful organization in raising the awareness the people of Nepal.
In the span of four months, Blue Diamond Society (BDS) has been conducting various staff training and general sexual health training programmes. The following points demonstrate the strengths of BDS. The single greatest achievement is the vast improvement in services offered by BDS now compared to when the organization first began. The following are the achievements of Blue Diamond Society in the span of four months:
1. Achievements in the field
2. Achievement through social group
3. Achievements at the DIC
4. Achievements in Training Classes
The most important achievement:
There is a substantial difference in the behaviour of MSM now from their behaviour four months ago. Many MSM used to follow anyone they found attractive without thinking about their actions or if they had a condom with them. MSM rarely, if ever, carried condoms. Now, when they meet someone for sex, they check to make sure they have condoms, or they call and meet an outreach worker for a new supply. Because of the outreach workers' efforts, there is no shortage of condoms in the community. MSM now insist upon using condoms for sex. This is one of the biggest achievements of Blue Diamond Society. With the change in behaviour of MSM, Blue Diamond Society has increased its hopes to obtain its goals and objectives, and to further serve the MSM community.
Even though Blue Diamond Society has been established for a short period of time, it has been able to positively affect the MSM community in many ways. MSM have faced such problems as physical health problems, mental health problems, and social issues. Being a MSM usually accompanies many societal pressures, stigmas, and fears of being ostracized. BDS has reacted by integrating social and psychological issues into its objectives. With this commitment, the organization hopes to improve the lives of MSM community members.
Total number of Manuals produced during the three months: 6
First phase of OE 3 days training workshop on Outreach, IPC (interpersonal communication ) and advocacy was conducted on 7th-9th April, 2002. Outreach Education was started from the second week of April, 2002.
IEC and BCC materials was designed in the month of April and distributed for testing.
On 8th- -9th of May, 2002, 2 days training workshop for 25 MSMs on Basic HIV/AIDS/STI and safer sex was conducted. Another similar training for another 25 MSMs was conducted on 24th – 25th, of May, 2002.
In the month of June from 23rd- 24th two days training workshop for 10 MSWs on Basic HIV/AIDS/STI orientation training was conducted.
In the month of July from 3rd- 5th 2002, three days training workshop for staff on Pre/post hiv test and psychosexual counseling training was conducted. Number of participants :10
On 23rd –24th July 2002, Peer communication training for 16 peer communicator was conducted.
The total number of MSMs (distinctions such as Meta, Ta, Gay are self proclaimed) reached overall is 5258 of whom 2636 were new in the past four months; 13171 condoms and 1843 lubricants were distributed in Kathmandu.
Please find the attachment for other details: Chart
4. Lessons Learned
A brief description of any major lessons learned by the organization from this activity
Lessons learned through the Field
Lessons learned through Social Groups
Lessons learned through Drop – in
Lessons learned through Training classes
And the most important achievement for Blue Diamond Society is that for many MSMs, using condoms has become a habit.