Abstract

Creation of a network for counselling, testing and prevention of HIV/AIDS in a resource poor rural setting in North-Central Nicaragua through the coordination of a faith-based organization and state institutions

T.M. Hansell

Parroquia la Inmaculada, Programa Integral en Salud, Managua, Nicaragua

Issues: The municipality of Waslala, in the northern mountains of Nicaragua, Central America, is an isolated resource poor setting that in 2007 received virtually no information about HIV/AIDS and had no services for counselling and testing. Although 80% of the rural population of Waslala identify with, and organize their communities around their religion, the Churches had largely ignored the problem.
Description: The Integral Health Program of the Waslalan Catholic Parish has worked in coordination with Catholic and Evangelical rural communities, in coordination with the local Ministries of Health and Education, to provide services for counselling, testing and prevention of HIV/AIDS. In three years the municipality of 60 939 inhabitants has increased annual testing from nothing to 3 400 tests with counselling, including 70% of pregnant women. Community health leaders, midwives, religious leaders and teachers are trained to inform the population about HIV/AIDS and risk behaviour. Trained counsellors visit rural communities by horseback to provide access to counselling and testing, and Ministry of Health personal offer this service in the health posts and health centre.
Lessons learned: The coordination between state actors and a faith based organization has been important to reach a population that principally organizes itself around religion. The program also relies on an extensive network of community voluntary health workers and religious leaders to reach the communities. Finally, twenty two years of consistent work in community health has created the basis to maintain the confidence of the population around a topic that is new to them and challenging to their worldview.
Next steps: As the population comes to understand the problematic of HIV/AIDS, it is important to intensify work on social conditions that increase risk such as domestic violence, alcohol abuse and unequal gender relations.