Evaluation of the Antiretroviral Community education and referral (ACER) project - Ng'ombe project site
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In Zambia, the prevalence of HIV is estimated to be 16% among individuals 15-49 years old. Among 15-24 year olds, women (12.7%) are four times more likely to be infected by HIV than men (3.8%) (ZDHS, 2002).The Antiretroviral Community Education and Referral (ACER) project was conceptually designed on the basis of the findings from the community consultations, to improve health seeking behaviour, equity of access, adherence to Anti-Retroviral Treatment, prevention for people living with HIV and how to decrease stigma and discrimination.This evaluation assesses the role of the project in supporting access and adherence to ART so as to recommend ways of enhancing community access and adherence to ART.The specific objectives are: (i) To assess the adequacy of project design and implementation strategies and the extent to which gender issues were taken into consideration; (ii) To assess the contribution of the ACER project to the people's access and adherence to ART and recommend ways of enhancing community access and adherence to ART. The researcher questions are: (i) Were the project design and strategies adequate to take into account gender dimensions of ART access and adherence? (ii) What has been the contribution of the ACER project to community access and adherence to ART and how could it be enhanced and sustained? The first strength of the project has been the development of partnerships between organisations in the communities which has extended the reach of the project.However, specific strategies aimed at closing the gender gap in HIV infection and ART access were not included in the design of the project. The project put more emphasis on mobilising people for ART without adequate strategies aimed at prevention of infection, especially among women. The other strengthen in the design has been the involvement of people living with HIV/AIDS (PLWHA). The study findings suggest that stigma has reduced, indicated by the increase in the number of people seeking VCT services and those joining support groups and a reduction in incidents of experienced stigma. The study has recorded an increase in the number of people on ART from 11 to over 400 people over a 2 year period. Adherence data from the project shows high levels of selfreported adherence (about 99%). The potential for the activities to be sustainable are high-Based on the findings, it is recommended: (i) that a strategy must be developed to ensure that uptake for testing and ART is improved among men. (ii) that targeted efforts aimed at reducing infection levels among women must be adopted (iii) that the project must mainstream gender into all project activities.