Youth & HIV Research In Camerooon

Research On Youths & HIV In Cameroon
By James Achanyi-Fontem,
Cameroon Link, P.O. Box 1460,
Douala, Littoral Region,
Cameroon
Tel: (237)77758840 Fax: (237)33391356
Email:camlink99@gmail.com
Yvonne Bekeny, Development and International Cooperation Researcher on Youths and HIV in Finland announced she would like to do internship at Cameroon Link in June 2008. This period was summer holiday for schools in Cameroon. Her investigation had to lead to improving HIV/AIDS education in schools in Cameroon. On completion, she acknowledged that her work with Cameroon link gave her an opportunity to see the bigger picture of the connection between health and development not only in the secondary school milieu, but also within the communities.
INTRODUCING CAMEROON LINK
Cameroon Link is a development and humanitarian umbrella NGO based in Douala- Cameroon,`that co-ordinates activities of six Women and Gender AIDS Councils, (COGESID) acronym from its French name legalised by the government within the frame work of a Gender, AIDS and Development Promotion project. Cameroon Link had put in place five Local community AIDS control Committees (CLLS), acronym from its French name) within the assistance framework of the Canadian Co-operation and the National AIDS Control Committee. These eleven community based organisations operate in different health areas of Bonassama District and Cameroon Link co-ordinates the execution, supervision and evaluation of the entire health organisations network.
Cameroon Link is also a member of the World Alliance for Breastfeeding Action (WABA) and is affiliated to the International Baby Food Action Network (IBFAN) Africa. Its activities fall within the range of Health and Development, social mobilization, gender promotion, women’s reproductive rights advocacy, reduction of maternal and infant mortality, reduction of malnutrition, initiation of socio-economic development empowerment projects through micro-credit promotion activities and media involvement for information, education and communication (IEC).
All these fall within the frame work of the United Nations Millennium Development Goals. For eighteen years, Cameroon Link NGO has been serving the community and during this period, it has made its impact felt. It has been able to mobilize the community to create community health centres in the slum areas where health care is meagre and sometimes the inhabitants of these areas are very poor and cannot even afford money to transport the sick to the district hospitals.
In gender, Cameroon Link has been able to organize and train women on gender sensitive approaches to development and self help initiatives and empowerment through the creation of COGECID Women Gender Councils. The gender councils begin women together to discuss women’s rights and work out strategies for the reduction of the spread of HIV in the community and through the centres counselling activities are undertaken to guide against stigmatization. As a member of IBFAN and WABA, its gender sensitization activities have also lead to greater support for breastfeeding mothers and their families with the promotion and protection of exclusive and effective breastfeeding practices as stipulated by, WHA, WHO and UNICEF regulations.
Yvonne Undergoes Induction
The first week of activities was actually an induction period. She was introduced to the activities of Cameroon Link and given a whole lot of documents to familiarize herself with what she came across as she move from one health area to the other. She was introduced to the relationship between HIV and Breastfeeding. James Achanyi-Fontem, CEO of Cameroon Link had just returned from a WABA policy orientation training and workshop in Malaysia. The information packs brought from WABA are very vital, and there is hope these would change the face of breastfeeding among mothers who are HIV positive.
It through these documents that Yvonne Bekeny learnt about the new scientific findings which reveal that exclusive breastfeeding could be done even by mothers who are HIV positive and there are enough recent statistics to show that babies born to HIV positive mothers would be healthier if breastfed exclusively than those who were not breastfed exclusively. During this period, Yvonne Bekeny joined and arranged campaigns to sensitize mothers to this effect with other Cameroon Link partner associations. She participated in working sessions on the rationale of western countries and multinational food processing companies, that insist on formula feeding as opposed to exclusive breastfeeding which in recent years has been encouraged by the WHO and UNICEF. Not only is exclusive breastfeeding healthy for the baby, it is the most practical feeding method for mothers in Africa. It is not only natural, but get the mothers to save money and prevent their babies from common diseases. Considering that an average African woman cannot afford three square meals a day for the whole family, considering the nutrients that breastmilk can offer to the baby, it is only natural that this should be encouraged worldwide and especially in Africa for nutritive, economic, health and other social reasons.
In Cameroon, statistics show that only 24 % of the population has access to pipe borne water and if mothers are to depend on formula feeding they need good water to go with it, yet a bulk of the population does not have access to portable water. We are therefore advocating that formula feeding be discouraged because it is not sustainability, affordable and regularly available.
For many years, the dilemma of HIV positive mothers breastfeeding has been an issue of debate and controversy, but recent research and studies have shown that breastfeeding is the safest option for mothers in developing countries because it is affordable and practical even when the mother is HIV positive.
We have therefore been educating mothers because what they need is the right information, education and counselling on the important and values of breastmilk. During field exercise, Yvonne Bekeny spoke with health practitioners and their major limitation was lack of proper education on the issues addressed, inadequate human resources and lack of capacity building possibilities, to enable them educate and counsel mothers on a daily basis. Despite these limitations, Cameroon Link is advocating that mothers should be able to decide and make informed choices based on their knowledge and updated resources at its centre. These efforts contribute in the reduction of malnutrition and infant mortality in Cameroon.
Social Mutual Health Insurance
From HIV and Breastfeeding to Social Mutual Health Insurance. Cameroon link together with its partner associations, NGO, FBO and CBO organized a training workshop for the initiation of a new community health insurance scheme, at its pilot phase in some ten communities in Cameroon. Yvonne was associated to the theoretical and practical phases of this initiative. This started with her joining in the training session with community health workers and traditional leaders. She later was involved with other in marketing the insurance scheme within the communities as a first step to constitute shareholders of the initiative for community ownership.
In view of the fact that health care in Cameroon can be very expensive and despite the government efforts to subsidize drugs, each hospital is autonomous and therefore determines the prices at which it offers health care. There is actually no price control mechanism. Therefore the Ministry of Health has decided to empower the local communities to stand up for their rights through this community health insurance scheme. Yvonne Bekeny expressed her delight in the resourcefulness of the training sessions.
Her third week was very much concerned with field work in the different community health centres. She visited three of the community health facilities and had working sessions with medics, health and social workers involved especially in the HIV/AIDS prevention service deliveries. The field surveys facilitate her appraisal of Cameroon Link interventions in the health facilities within the communities. The health centre in Bonendale was apparently deserted at the time of her visit and patients complained that the centre was too far from the residential areas.
Curiously, the Bonendale Health Centre is the biggest community health facility , though it was not actually serving the population as expected. A lot of social marketing is done to reverse the situation and get people attend for at least, the immunisation of their children. The other health centres are rather small outfit for health area target populations. In these centres, Yvonne observed the work spirit, interviewed patients and nurses to understand their challenges before making some recommendations on how they could apply for funding to expand their facilities and improve on the quality of services.
She also made recommendations on how future projects in the health areas could be improved, if there was proper planning that involves all stake holders through the participatory rural appraisal approach, participatory learning and action approach (PRA/PLA) or mechanisms put in place during the planning phase. The field exercise was very practical and exciting for Yvonne, because she actually applied my knowledge on project planning and management in some cases as an ‘evaluator’. This field work also gave her an opportunity to get into the HIV/AIDS registers and get more facts which were significant in making recommendations to the education sector after analyzing data from her research.
INTERNSHIP FIELD ACTIVITIES
The second phase of development cooperation internship of Yvonne Bekeny was packed full of activities out of Cameroon Link office. Yvonne moved from the community into the school environment to collect data for her thesis. The capital city of Yaoundé was the venue to meet the youth target population for her study. It was a very challenging exercise because it was the first time she was collecting data for analysis later. It was less strenuous because securing research permit was not as difficult as her research assistant had anticipated. On the other hand the schools were so big, with large numbers on roll that distributing the questionnaires was a bit difficult and even more so because students could not work individually as she had expected given the large numbers on roll. Despite these hindrances, she was able to administer the number of questionnaires required for her study.
After working with students for on week she returned to the office in Douala to continue administrative work and reviewing some reports and also assembling material that was to be used at an up coming workshop organized by the Cameroon Ministry of Public health on infant and young child feeding counselling in Obala, 100 kms from Yaounde on the road to Bafoussam. The preparations led to Yvonne Bekeny attending the week-long workshop as representative if the Chief Executive Office of Cameroon Link. The workshop was attended by representatives of some fourteen Non-Governmental Organizations, Faith Based Organizations and Community Based Organizations involved in the promotion and protection of breastfeeding and infant and young feeding rights in Cameroon. It was facilitated by professional medical staff from the ministry of public health, social workers and nutrition counselling consultants.
It was during the interactive exchanges at the workshop that they were taught the advantages and the benefits of breastfeeding to the baby and the mother. The discussed the health benefits, the economic benefits to the entire family and the community. It was repeated echoed that if the mothers breastfed exclusively for six months, their babies’ health was guaranteed, therefore the family saved money that would otherwise have been used for artificial feeding. Breastfeeding has no cost and helped reduce spending and was seen as a poverty alleviation ingredient that also safe guarded the family income.
● Yvonne and her colleagues at the workshop were equipped with negotiation skills on how to approach women and convince them to practice exclusive breastfeeding for the first six months after birth and how they could also encourage women to begin introducing complimentary feeding from the age of six months while continuing breastfeeding up to 24 months.. They were informed that it was easy to meet women in their community groups, in the community health facilities and also in the district hospitals to address these issues. With the creation of WABA Men’s initiative, it was decided that the men or fathers and youths be involved in the breastfeeding campaign movement because the mothers would need their support if breastfeeding practices are to be successful.
The issue of breastfeeding in the context of HIV/AIDS was also discussed lengthily. The facilitators told the participants about the advantages and disadvantages of breastfeeding when a woman is HIV positive. Statistics were quite revealing and Yvonne was equipped with the facts about breastfeeding in the context of HIV/AIDS. Every woman who is HIV positive should know the facts, be well educated and be able to make an informed choice of feeding for her baby.
Considering the advantages of breastfeeding and the fact that only about 22.5% of mothers in Cameroon breastfeed exclusively during the first six months of birth, this among other strategies are implemented by the Cameroon Ministry of Public Health to improve on infant and young child feeding, so as to mitigate malnutrition and therefore reduce infant mortality. At the end of the workshop, Yvonne and her colleagues drew up a feasible project for a period of six months, and this was used to evaluate the participating organization’s level of understanding the subject. This was yet another opportunity for Yvonne to apply her knowledge of project planning and management. She was able to come up with a short doable project from January to August 2009. Within this project, the two persons who represented Cameroon Link could also train other members of staff attached to the six Women Gender and AIDS Councils (COGESID) mentioned in her first report. As at the moment of writing this report the newly trained infant and young child feeding counsellors had started social mobilisation and sensitization activities within the communities and on the media on the importance of breastfeeding.
Upon their return from the seminar they immediately got into activities and celebration marking the 20th edition of the World AIDS Day. Yvonne and others attended the ceremony launched by the Governor of the Littoral region of Cameroon and they were involved in the organization of educative talks in secondary schools. The activities were focused on the animation of college health clubs. Other Health NGOs and women’s groups were also involved in these activities. During this celebration, the regional coordinator of the National AIDS Control Committee presented the most recent statistics on the situation of HIV/AIDS in Cameroon.
Yvonne seized the opportunity to interview the coordinators of health clubs and students in the littoral region about the activities within their respective schools. This constituted vital information for her thesis since she was researching on HIV/AIDS prevention and education in secondary schools. It was observed that all secondary schools are involved in AIDS Communication. AIDS communication embodies advocacy, behaviour change, social mobilization and social change. This strategy addresses issues that immediately impact on HIV and AIDS, the lack of knowledge on the practice of safer sex, and the driving causes of the epidemic, such as gender relations hindering safer sex practice.
A key factor in effective AIDS communication is the understanding of audiences’ needs and circumstances. It is even made easier by the training of peer educators with whom the youths and other sub populations can identify. It was very amazing that most schools pay attention to the importance of the social context of communication, including religious, economic and cultural factors. These factors determine the nature of AIDS communication in and out of schools and within communities. Consequently, practitioners are increasingly focusing on the creation of enabling AIDS communication environments through work with institutions such as the media and civil society organizations. Cameroon link was an ordinary participant during the event because Yvonne and others had just returned from a training workshop in the Capital City of Yaoundé ahead of World AIDS Day and the memory was still very fresh on Mother to Child HIV Prevention. They did not participate in demonstrations but planned some counselling and educative campaigns with women groups during the week that preceded the World AIDS Day as part of the National AIDS Week declared by the Minister of Public Health. She also conducted interviews with the Littoral Regional Coordinator for AIDS Control Committee. The World AIDS Day activities were very significant to her because she was able to get recent statistics on the situation in Cameroon and other issues concerning prevention, care and support for people living with HIV/AIDS (PLWHA) and the rehabilitation of HIV orphans.. This would have been a bit difficult during ordinary times because getting information in Cameroon is quite complex. Officials are usually very reluctant to give statistics and other vital information on their work..
LOCATING INTERNSHIP RESEARCH SITES
The first phase of the research study was carried out in Douala in the Littoral region, while the second phase in November 2008 was in Yaoundé, the capital city of Cameroon situated in the centre region. The choice was based on the resources available to Yvonne Bekeny. This means that the choice of research site was based strictly for convenience reasons, especially as other schools running the new HIV education programme are situated in the far south and distant northern regions. Yaoundé’s location makes access a lot easier as it is situated at the centre of Cameroon and it is the administrative capital of the nation. Considering the bilingual nature of Cameroon, Yaoundé has many public and private bilingual secondary schools. The choice of Government Bilingual High School Yaoundé and Government Bilingual Practicing High School Yaoundé was based on the similarities in characteristics of both schools. These are very thickly populated government education institution. Most of the students attending these colleges live in the out skirts of Yaounde City. Since one of the secondary schools undertook the new HIV/AIDS education programme and the other did not, this formed the basis of Yvonne Bekeny’s comparison.
APPROACH
To achieve the objectives of the study, a quantitative research approach was employed. This was important because it provided statistical data on the actual number of students involved in the research survey, their basic characteristics, level of education, gender differentiation, and religious inclinations among other variables. Secondary data from the National AIDS Control Committee was also consulted, to know the actual national statistics and to find answers to some of the research questions.
COLLEGE SELECTION
The choice of the colleges for the research survey was based on the following criteria:
1. Geographical location of colleges putting into consideration proximity and access to all.
2. Similarity in characteristics of both collegs. Both are bilingual educational institutions with English and French speaking students undertaking English and French systems of education respectively. They are similar also in terms of enrolment of large number of students each year.
3. Most of the students live at the heart of the city, while a few live in the out-skirts and neighbourhoods of Yaoundé..
4. One school does the new HIV/AIDS education programme and the other does not. This constituted the basis for a comparative analysis.
Due to the researcher’s English speaking background, only the English speaking students in each school where involved for the survey and research study.
SAMPLING
The study utilized a random sampling frame. The two schools formed appropriate basis for comparison as the age group required for the study where easily identified. The main guiding criteria for choice were:
1. The age of the students. The age was considered as a major criterion for sampling and this lead to the next level of sampling.
2. The class of the students strictly followed the age. It was realized that the classes had different age ranges. But then, each level for example like form 3 classes had the same age range between 14-16 years. It is for this reason that random sampling of classes was done for each level. This gave the students equal chances to be drawn from the population.
The two colleges have different populations. GBHS Yaoundé has a total population of 6000 with 3000 English speaking students and 3000 French speaking students. The sample size for this school was 320 (10.6 percent) and it consisted of students with ages between 12-21 years. While GBPHS Yaoundé had a total population of 4800 students with 2300 English speaking students and 2500 French speaking students. The sample size in this school was 322 (12.8 percent). The sample also consisted of students with ages between 12 -21 years. The research expected to have a larger sample, but due to resource constraints on the part of the researcher, only the above sample could be considered. The sample strictly took into account the age, sex and gender of the respondents.
DATA COLLECTION METHOD
The research used two methods to collect the relevant data to measure the students’ knowledge, attitudes and reported behaviour on HIV/AIDS and to see the impact of the new HIV/AIDS education programme on the students. Secondary data was used to review the relevant literature on HIV/AIDS related issues within schools in Cameroon and within the youth population in general. Primary data was used for the most part and the instrument used was a questionnaire.
Some 642 questionnaires were administered to students in English. The questionnaire took into account the target age group for the study. From the college environment, Yvonne Bekeny returned to Cameroon, where she was initiated on information, education and communication strategies, networking and report writing.
Information, Education and Communication
A press conference was organized at the headquarters of Cameroon Link in the third week of December 2008 to highlight advocacy strategies by NGOs using the Sickle Cell Society UK approach. The conference speaker was the Director of Sickle Cell Society UK, Dr. Asaah Nkohkwo, who paired the relationship of sickle cell disorder and other diseases and how they affect African and Asian communities most.
Yvonne Bekeny was involved in the organisation of the conference logistics and report writing. The use of media for advocacy was also an aspect valorised by her participation in a live programme presentation at the Catholic Community Radio Station « Radio Véritas ». The live show was on highlights of the 5th Anniversary celebrations of the radio station. Yvonne and James were invited as guests speakers to the programme audience on what they considered to be the truth and how it is employed within the Cameroon communities and elsewhere. The live show was recorded and rebroadcast twice on the same channel at different peak listening hours.
Networking Linkages
Yvonne Bekeny had the opportunity to learn from Cameroon Link the importance of networking at national and international levels. Cameroon Link leads the Federation of Cameroon Breastfeeding Promotion Associations, FECABPA, and is also affiliated to two international health networks.
Cameroon Link is affiliated to the International Baby Food Action Network, (IBFAN) Africa, and the World Alliance for Breastfeeding Action, (WABA). In the latest development, the Executive Director of Cameroon Link was appointed to the position of International Coordinator of WABA’s Men Initiative, which calls for the mainstreaming of gender promotion within infant and young child feeding promotion and the encouragement of youths to get involved in health development issues.
Yvonne Bekeny ended her field research studies at Cameroon Link with designing of a project for the initiation of fundraising in Finland to support the execution of humanitarian activities planned within the next four years. This aspect is found to be vital for the survival of any organisation, especially as all projects aim at durability of impact social change and behaviour change communication, BCC. This is how Yvonne Bekeny was given the opportunity to test all her skills. A project for Sickle Cell Awareness in Cameroon was designed as a team for fundraising lobby by her in Finland.
The strategies of Cameroon Link transferred to Yvonne will serve her at any time when she would have completed her studies in development and international cooperation.