Using the Make A Positive Start Game
and Jessica/Mike Audio with HIV Positive
Adolescents in the Community:
End-of-Project Report
SUBMITTED: APRIL 2010
Treat for Life Campaign: Giving Hope to Young People Living HIV and AIDS
Table of Contents
Acknowledgements ...................................................................................................................... i
Acronyms .................................................................................................................................... ii
EXECUTIVE SUMMARY ........................................................................................................... iii
1.0 INTRODUCTION...................................................................................................................1
1.1
Background .............................................................................................................1
1.2 Goals, objectives, implementation strategy and partners ...................................................2
2.0 PROJECT PERFORMANCE .................................................................................................4
2.1 Orientation of Peer Change Agents ...................................................................................4
2.2. Using the Make A Positive Start Game and Jessica/Mike Audio .......................................5
2.2.1 Mobilization of Adolescents ........................................................................................5
2.2.2 Facilitation of Sessions................................................................................................5
2.2.3 The Community Sessions ...........................................................................................6
Treat for Life End-of-Project Report
Acknowledgements
UNYPA would like to thank HCP for the opportunity to take on this landmark project and, over
three challenging, important months, to be able learn, play and share experiences on using the
Make A Positive Start Game and Jessica/Mike Audio with adolescents living with HIV and AIDS
in 7 districts of Kampala, Gulu, Jinja, Kabarole, Mbale, Mbarara and Mubende. UNYPA gives
special thanks to Ruth Musekura, the Deputy Chief of Party, Laura and Joseph of HCP who
provided critical guidance and support. Amon and the team from YEAH who conducted support
supervision and offered valuable feedback during the project.
UNYPA was fortunate to leverage on its membership with the National Forum of PHA Networks
in Uganda (NAFOPHANU) to support the Sessions in the Community to the respective District
PHA Forums, and greatly appreciates the contributions of NAFOPHANU and District PHA
Forums of Kampala, Gulu, Jinja, Kabarole, Mbale, Mbarara and Mubende.
The Treat for Life campaign had a team of 5 UNYPA staff during its lifetime, and the success of
the project is a result of their leadership and dedication to the needs of young people living with
HIV/AIDS. The UNYPA team composed Paddy Masembe executive director, Moses Engadu
programme and finance manager, Raymond Kwesiga programmes officer, Lillian Magambo
programme assistant and Joel Kawule programme assistant. We would also like to make
special mention of Princess Nuriat Kisitu, David Kizito, Ritah Alimpa and Gordon Turibamwe
members of UNYPA who participated in the development of the FAQ Booklet and appeared on
the Posters for the Treat for Life Campaign.
As always, UNYPA greatly appreciates the work of its partner organizations and the
communities they serve. These organizations and community members displayed amazing
innovation and persistence in the face of many challenges. Their selfless commitment to
strengthening care and support of young people living with HIV and AIDS is an inspiration.
This report was prepared by Moses Engadu and Raymond Kwesiga of UNYPA using reports
and documents since the project‟s inception.
Treat for Life End-of-Project Report
Page i
Acronyms
AIDS
Acquired Immuno-Deficiency Syndrome
ART
Anti-retroviral Therapy
CHAIN
Community HIV and AIDS Initiative
FP
Family Planning
HCP
Health Communications Partnership
HIV
Human Immuno-Deficiency Virus
IEC
Information, Education and Communication
IDI
Infectious Diseases Institute
JCRC
Joint Clinical Research Centre
M&E
Monitoring and Evaluation
NAFOPHANU
National Forum of PHA Networks in Uganda
PHA
People Living with HIV/AIDS
RCEs
Regional Centres of Excellence
UNYPA
Uganda Network of Young People Living with HIV/AIDS
USAID
United States Agency for International Development
YEAH
Young Empowered and Healthy
YPLWHA
Young People Living with HIV and AIDS
Treat for Life End-of-Project Report
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EXECUTIVE SUMMARY
UNYPA is pleased to provide an End of Project Report covering the period July 2009 to
September 2009 on its Using the Make a Positive Start Game and Jessica/Mike Audio Story
with Adolescents in the Community funded by USAID through Health Communication
Partnership (HCP). This Treat for Life End-of-Project Report provides an overview of the project,
details its achievements and impact, highlights lessons learned, and presents insights into the
current challenges adolescents living with HIV and AIDS, as well as their current and future
needs.
The mandate for UNYPA is to provide leadership and a voice for young positives to create an
enabling environment to participate meaningfully. Through its Young Ambassadors for Positive
Living UNYPA assists young positives to cope and mitigate the impact of HIV and AIDS.
Currently, UNYPA has a membership of over 50,000 young people living with HIV and AIDS
across the country.
During the project, UNYPA worked with twenty (20) peer change agents from 7 districts who
were trained to facilitate sessions in their localities. The sessions in the community were
conducted in the seven (7) districts of Kampala, Gulu, Jinja, Kabarole, Mbale, Mbarara and
Mubende. A total of 66 sessions were to be held in July, August and September 2009.
1,802 adolescents living with HIV and AIDS attended the Make A Positive Start game and
Jessica/Mike audio sessions in the community and gained critical information and skills on
positive prevention, disclosure, adherence and family planning.
The purpose of the sessions was to empower and reinforce the knowledge of HIV Positive
Adolescents and lead to behaviour change through Positive Prevention, Disclosure and
Adherence to treatment. The focus was on how one can disclose his/her status to a partner,
relatives and friends and also to equip the HIV positive adolescents with life skills that can help
influence behaviour change.
The expected outputs in this project comprised of the following:
1. Mobilize a team to be oriented as peer change agents;
2. Provide schedules, mobilize adolescents and facilitate sessions using the game and
audio within the communities in 7 RCEs in July, August and September 2009; and
3. Work with HCP to capture information regarding participation in the sessions using the
YEAH data tools; and feedback from adolescents before and after sessions.
The key achievements included holding of all the 66 planned sessions in 7 RCEs as well as
reaching 1,802 adolescents with information and skills on treat for life.
The key challenges included; mobilization as some parents, guardians and caretakers of the
young positives required a lot of convincing to release their sons and daughters to attend the
sessions. Another key challenge was lack of adequate funding to finance all components of the
project since HCP was releasing 50% of the total sum with UNYPA expected to raise the 50%
balance complete the session and receive the balance which resulted in delays in
accomplishing some planned activities.
The key recommendations include provision of adequate learning materials and participant
incentives (giveaways) and scaling-up sessions to enable more HIV positive adolescents to
„break the code of silence‟ as the sessions give interactive time for sharing their everyday
experiences, their challenges and how they overcome hence mitigating the impact of stigma
and discrimination which is still very high in most communities up-country.
Treat for Life End-of-Project Report
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1.0 INTRODUCTION
This Treat for Life End-of-Project Report provides an overview of the Treat for Life project from
its inception, details its achievements and impact, highlights lessons learned, and presents
insights into the current challenges HIV positive adolescents face, as well as their current and
future needs.
1.1 Background
Uganda Network of Young People Living with HIV/AIDS (UNYPA) was established in 2003 and
works with health care providers, schools and community based organizations to assist young
positives to cope, enhance adherence to ARV therapy and give young positives a “voice” at the
local, community and national level. Presently, UNYPA has a membership of over 50,000 young
people living with HIV/AIDS across the country.
UNYPA exists to improve the quality of life of YPLWHA through the creation of a supportive
environment for people living infected and/or affected by HIV/AIDS to meet their material, health
and emotional needs.
Health Communication Partnership and Joint Clinical Research Centre produced the Make A
Positive Start and the Jessica/Mike Audio/discussion guide for use in adolescent clubs for HIV
positive adolescents.
Health Communication Partnership wanted to ensure that these IEC materials are effectively
utilized as educative and entertaining tools during community sessions for Adolescents. The
sessions were to be held in the months of July, August and September 2009 with the impact of
using these games on the adolescents being monitored.
The sessions with HIV positive adolescents were to be held in the areas surrounding the JCRC
7RCEs namely Kampala, Gulu, Jinja, Kabarole (Fort Portal), Mbale, Mbarara and Mubende.
The sessions within the community were to be supplemented by the health centre sessions
coordinated by the JCRC Adherence team with the community sessions intended to reach out
to HIV positive adolescents who are not on HIV treatment and therefore most likely do not
attend club sessions at health centres.
Treat for Life End-of-Project Report
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In July 2009, UNYPA signed a Cooperative Agreement with HCP for implementation of Treat for
Life campaign. Under this agreement, HCP agreed to provide UGX 53.368 million or $26,184 in
funding to implement a 3 month pilot project ending in September 2009. The pilot project was
aimed at conducting sessions with HIV positive adolescents in the community using the Make A
Positive Start Game and Jessica/Mike Audio and discussion guide. The purpose of the sessions
was to empower and reinforce the knowledge of HIV Positive Adolescents and lead to
behaviour change through Positive Prevention, Disclosure and Adherence to treatment.
During the period of agreement, UNYPA was also to provide support in the development and
testing of the Treat for Life Campaign messages, posters and the FAQ booklet.
1.2 Goals, objectives, implementation strategy and partners
The goal of Treat for Life (July – September 2009) was to reach HIV positive adolescents with
information and skills to empower and reinforce their knowledge and lead to behaviour change
through Positive Prevention, Disclosure and Adherence to treatment.
The objectives of the Treat for Life were:
1. To effectively utilize IEC materials as educative and entertaining tools during community
sessions for HIV positive adolescents.
2. Monitor the impact of the use of the Make A Positive Start game on HIV positive
adolescents.
The primary beneficiaries of the project were HIV positive adolescents in the 7RCEs both
in-school and out of school targeting those who do not attend adolescent club sessions at
health centres.
The implementation strategy was to train and support 5 peer change agents from each of
the 7RCEs to facilitate community sessions in 7 districts to ensure appropriate, effective,
and sustainable community-based interventions for HIV positive adolescents.
Treat for Life End-of-Project Report
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The expected outputs in this project comprised of the following:
1. Mobilize a team to be oriented as peer change agents;
2. Provide schedules, mobilize adolescents and facilitate sessions using the game and
audio within the communities in 7 RCEs in July, August and September 2009; and
3. Work with HCP to capture information regarding participation in the sessions using the
YEAH data tools; and feedback from adolescents before and after sessions.
The deliverables of the project were:
1. Interactive sessions in July (22), August (22) and September (22);
2. Three reports for the months of July, August and September 2009;
3. A schedule of detailed timings and dates for game and audio sessions;
4. Filled in data collection forms which include the YEAH/HCP attendance forms; YEAH
report form.
Monitoring and support supervision of sessions was done by HCP and YEAH to ensure that the
sessions were successfully conducted.
Treat for Life End-of-Project Report
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2.0 PROJECT PERFORMANCE
2.1 Orientation of Peer Change Agents
In line with the implementation strategy, to train and support peer change agents from each of
the 7RCEs to facilitate community sessions in 7 districts to ensure appropriate, effective, and
sustainable community-based interventions for HIV positive adolescent, UNYPA mobilized peer
change agents who attended both the first orientation session on June 22 nd and 23rd and
second orientation session on June 29 th and 30th 2009 at Kati Kati. The first orientation session
had 20 peer change agents from Kampala (10), Mubende (5), Jinja (5) and 5 coordinators
(UNYPA staff) while the second session had 20 peer change agents from Gulu (5), Kabarole
(5), Mbale (5), Mbarara (5).
These peer change agents became the fulcrum and focal contact of the Treat for Life in the
community for ownership and making it easier to integrate the Treat for Life Campaign in the
ongoing Young Ambassadors for Positive Living programme of UNYPA hence achieving
sustainability.
There was also ongoing peer change agent orientation especially with the introduction of the
component of Family Planning for HIV Positive Adolescents.
Peer Change Agents of Kampala district being oriented on integrating Family Planning and Skills
Building into the UNYPA Treat for Life Community Sessions
Treat for Life End-of-Project Report
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2.2. Using the Make A Positive Start Game and Jessica/Mike Audio
UNYPA successfully conducted 66 HIV Positive Adolescent sessions using the Make A Positive
Start Game and Jessica/Mike Audio in the 7 districts of Kampala, Gulu, Jinja, Kabarole, Mbale,
Mbarara and Mubende.
2.2.1 Mobilization of Adolescents
Mobilization in the districts was carried out by
the Peer Change Agents. The HIV positive
adolescents who were targeted were those
that had not attended the sessions in previous
month. We recorded no incidence of
participants who had attended the JCRC
conducted sessions because most of our
sessions were held in the sub-county health
centres (rural settings) in the districts while
those of JCRC were held at the Regional
Centres of Excellence which are located in
towns.
The month of August being holiday time, we
also reached a niche of HIV positive
adolescents who are in boarding school and
normally don‟t access Behaviour Change
Information in the Health Centre setting.
Some of the HIV Positive Adolescents
mobilized and in session in Mbarara
2.2.2 Facilitation of Sessions
The facilitators of the sessions were the peer change agents who were trained/ oriented to
familiarize them with the game and facilitators‟ manual and the audio.
During each session, there were at least 4 facilitators with a ratio of 1:8 (1 facilitator to 8
participants). The sessions were also attended by UNYPA who provided support supervision
A peer change agent supporting adolescents to play the Make A
Positive Start Game during 1 of the sessions
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2.2.3 The Community Sessions
The Community sessions started at 10:00am and lasted up to 5:00pm. The sessions were
divided into three sub-sessions/activities which comprised of the Make A Positive Start Game;
the Jessica/Mike Audio; and Family Planning/Skills Building
2.2.3.1 The Make A Positive Start Game
The Make A Positive Start Game was played for between up to 3 hours depending on the
district. Participants were put in groups of 6 – 8 with each group given a board game. The first
task for the groups was to select their leader which was duly done. The groups presented two
methods for selecting the order of the players for the game. The participants each wrote a
number (i.e. 1 to 8) on a small piece of paper, wrapped them. Each member picked and the
number picked determined the turn in playing. The groups were then spread to various corners
of the hall and each group was assigned a facilitator to support them to understand the
dynamics of the game and also direct them on how to use the guide.
Before the game started, the facilitators took participants through the rules on how to play the
game. It was also agreed that while playing the game, participants could use the language
which they are comfortable with (that is English or Local language) to explain to others the
information on the board. The participants were also informed that there will be some
giveaways/prizes for those who finished first and those who actively participated. This was done
to motivate and get all participants to be involved.
The Game was played by all the participants and as required different players answered
different questions. The participants engaged in group discussions around the issues raised by
the game and the facilitators helped the participants to understand how to play the game and
use the guide book as well as answer some questions. Those who finished playing the game
earlier than others were recorded and asked to reflect on the game while other players also
finished.
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Feedback about the Make A Positive Start Game:
After all teams and players had finished, the
participants were reconvened to share in a plenary
session the feedback about the game including what
they learnt, what they didn‟t understand and how the
game can be improved. The responses were that the
game was:
Fun
Educative
Informative
Interesting
Easy to play
Only in English
Most participants acknowledged that they had
acquired new knowledge from playing the game
especially it helped them on the issue of how
disclosure because many had not yet disclosed.
2.2.3.2 The Jessica/Mike Audio
The organizers made sure that there were
equipment for listening to the audio. Before the
audio the participants were engaged in a
discussion about whether they had heard about
the Jessica‟s audio before on Rock Point 256.
Most participants in the rural setting had not had
about the audio and we excited because it was
their first time.
The participants were informed that they needed
to listen attentively, write down the issues they
have not understood well and that after each story
clip they will be required to discuss and role play
some of the scenes.
The participants listened to the Jessica and Mike
Audio story clips and thereafter they contributed
well towards the answering questions from the
audio. They enjoyed role playing and acting the
scenes especially those in the camps in Gulu
district.
Treat for Life End-of-Project Report
Feedback about the Jessica and Mike
Audio:
The feedback captured after listening and
discussing the Jessica and Mike Audio was:
- Most
participants
appreciated
the
usefulness of the information in the audio;
- Many participants agreed that disclosure is
very important to your partner and that if
they were in Mike‟s place, they too would
have chucked Jessica;
- Many participants shared why people do
not disclosure and the thing that came out
clearly was fear of stigma and
discrimination.
- Just like in Story 8, all participants agreed
that there is a big benefit if you disclose to
your partners and the people you trust
because they will help you to adhere to
treatment.
- Some participants especially the ones in
proposed the Jessica/Mike Story be acted
as a film so they can watch the video.
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2.2.3.3 Family Planning/Skills Building
During the some sessions, Family Planning and a skills building component for HIV positive
adolescents was introduced. On family planning, the participants were trained on what FP is,
the methods and benefits of family planning for young people living with HIV while on skills
building, each adolescent participated in a condom demonstration exercise.
Achievements
Challenges
UNYPA recorded the following achievements:
The key challenges included; mobilization as
some parents, guardians and caretakers of the
young positives required a lot of convincing to
release their sons and daughters to attend the
sessions.
 All 66 community sessions were held in the 7
RCEs
 1,802 HIV positive adolescents were
reached/trained on positive prevention,
disclosure, adherence and family planning
and played the Make A Positive Start game
and listened to the Jessica and Mike Audio.
 The HIV positive adolescents contributed
well towards the discussions during the
sessions and in answering questions from
the Jessica and Mike audio.
 The HIV positive adolescents appreciated
the Treat for Life Campaign and agreed that
Positive Prevention is important to avoid
transmission and re-infection; disclosure is
important for support; and adherence to
treatment is the only way to live a happy and
long life.
 The HIV positive adolescents appreciated
the usefulness of the information in both the
game and the audio.
 The sessions gave interactive time for the
young people (HIV positive adolescents) to
share their everyday experiences, their
challenges and how they overcome them
hence motivate and encourage each other.
 The peer change agents were able to
mobilize the young positives well in time,
ensure their timely arrival and prepared them
well for the sessions.
Treat for Life End-of-Project Report
Another key challenge was lack of adequate
funding to finance all components of the project
since HCP was releasing 50% of the total sum
with UNYPA expected to raise the 50% balance
complete the session and receive the balance
which resulted in delays in accomplishing some
planned activities.
Most materials including the Make A Positive
Start Board Game are in English which gave
some participants a problem in comprehending.
Some participants said that the audio clips were
too long.
Partners
UNYPA worked with the following partners
towards the execution of the sessions in the
community:
 Kampala (JCRC, YEAH, Baylor College of
Medicine, IDI, CHAIN, Nsambya Home
Care, Kawempe Health Centre);
 Mubende (District PHA Forum);
 Kabarole (District PHA Forum);
 Gulu (Health Alert and District PHA Forum);
 Jinja (TASO and District PHA Forum); and
 Mbale (District PHA Forum).
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Recommendations
The following are the recommendations from both the participants and UNYPA:
 That, there is a need for the translated version of the Make a Positive Start Game and
adequate learning materials should be provided;
 That there is a need of scaling-up sessions to enable more HIV positive adolescents to ‘break
the code of silence’ as the sessions give interactive time for sharing their everyday
experiences, their challenges and how they overcome hence mitigating the impact of stigma
and discrimination which is still very high in most communities up-country;
 Support establishment of HIV adolescent peer support clubs in health centres in rural areas
for sustainable access to community HIV programs for young positives;
 That the Jessica and Mike Audio should be made into a video film as most young people
prefer to watch (see) than to listen;
 Improve facilitation in order to effectively implement the various sessions in different locations;
 Provision of session incentives to all participants such as the adherence clocks and t-shirts;
 Documentation through pictures and videos especially for testimonies is very important; and
 During the scale-up to reduce the financial strain and to enable UNYPA easily carry out all the
required sessions in the community, we that all the budgeted funds should be released to
UNYPA as opposed to the 50% since UNYPA is a non-profit entity which depends on grants
and support from donors and well-wishers
Testimony:
“One time, I asked my teacher to go and get my drugs, he told me that if I go then my drugs will
teach me, so I didn‟t go to take my medicine but now I have learnt and know my rights as a young
positive”. 15 year old Girl, Gulu District
Support Supervision and Evaluation
Sustainability
Support Supervision was carried out by the
In order to ensure sustainability, UNYPA is
YEAH team in some districts.
working to integrate the playing of the Make A
After each session, the participants were
given the HCP evaluation forms for the
Make a Positive Start Game and Jessica/Mike
Audio which they duly filled in groups and
were submitted to HCP together with the
HCP registration forms.
Treat for Life End-of-Project Report
Positive Start Game and listening to the Jessica
and Mike Audio into the ongoing young
positive activities and dialogues in the districts
and community. This will ensure that we tap
into HIV positive adolescents who have played
the game and/or reinforce the message for those
who may have already played the game.
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