REPORT OF THE 5th ERNA MEETING
23-27 September 2001
1. Background: The 5th ERNA meeting was hosted by the Kazakh Red Cross and Red Crescent Society, in collaboration with the IFRC Regional Delegation Almaty. For the participants see the ANNEX 1. Except the Member National Societies (NSs), five new NSs (Albania, Turkmenistan, Bosnia and Herzegovina, Netherlands, Estonia) participated and were asked by the President of ERNA to consider their membership in the Network upon their return back and after consultations with their secretaries-general or Presidents. Representative of UNFPA were present as observer and for the first time a Board Member of the European Network of People Living with HIV/AIDS was invited. This is a historic moment for starting cooperation with perhaps the most relevant partner in the fight and addressing the issue of HIV/AIDS. Having done so, the Red Cross and Red Crescent Movement showed the commitment, enthusiasm and willingness to embrace new ideas, as it showed already during the UNGASS on HIV/AIDS.
Three member NSs (Finnish RC, Swedish RC, Spanish RC) cancelled their participation due to security reasons. The meeting was aimed at the organizational matters of the Network (1st day), workshop on youth peer education (2nd and 3rd day) and a session on TB (4th day).
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2. Opening: The 5th ERNA meeting started with a welcome speech and opening remarks made by Dr. Massimo Barra, President of ERNA. Dr. Barra made a preliminary summary of annual activities of ERNA and praised networking as a working method that strengthens solidarity and friendship among members. Dr. Barra pointed out the existing problem of funding; since the existence of ERNA, the core budget was hardly covered and the operational budget is still very poor, so that only two project proposals were able to be covered (Latvian RC and Slovak RC), others (Armenian RC, Kyrgyz RC, Kazakh RC, Bulgarian RC) are waiting to be financed from donor NSs. The role of the Red Cross Movement has been especially put in the foreground, taking into consideration the Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS, where the Red Cross committed itself to be a global and active partner in fighting this scourge. Dr. Barra made an appeal to all ERNA members — their NSs should be open homes for people living with HIV/AIDS (PLWHA). He also announced that the forthcoming European Conference in Berlin would be a unique opportunity for ERNA to present its activities, as HIV/AIDS will be one of the main topics tackled at this Conference. At the end of his speech, Dr. Barra raised the historical role of youth in fighting HIV/AIDS.
The opening ceremony continued with the welcome speech from the representative of the Kazakh Ministry of Foreign Affairs, in which he acknowledged the work and the contribution of the IFRC. Expectations from ERNA have been expressed: to take concrete steps that would have a significant impact on reducing the epidemic.
The President of the Kazakh RC/RC Society, Dr. Erkebek Argymbaev thanked ERNA for giving the opportunity to his NS to organize this important meeting. He is aware of the importance of peer education and thus requested from ERNA a seminar for trainers, which according to him would significantly influence the position of youth and would be able to provide psycho-support, to teach preventive measures, etc.
Dr. Argymbaev also pointed out the fact that the NSs in Central Asia are willing to expand their activities thanks to ERNA, if the Network will help in searching for donors and in knowledge sharing amongst NSs.
The Head of IFRC RD in Almaty, Mr. Per Jensnaes informed the participants about the IFRC Network in Central Asian region and stressed, among other things, the need for collaboration with media to spread information amongst members.
3. Knowledge sharing: Dr. Aikan AIKANOV, General Director of the National Center for Problems of Healthy Lifestyle Development informed the participants about the alarming situation in Kazakhstan, which has the highest incidence of HIV spreading in the region. Dr. Aikanov mentioned that the current legislation toward HIV+ people in the country is not adapted to international standards but there is action gradually being taken regarding this issue. The Kazakh Government undertook concrete measures — national Program for HIV prevention for 2001-2005, signed by the Prime Minister. As part of this, cca. 7000 teachers, educators and doctors are being trained in AIDS programs, while HIV prevention is taught in schools as an obligatory curriculum.
Dr. Alexander KOSUKIN from UNFPA — presented the overall situation in Central Asia. In general the HIV prevalence is not too high in the region but it is spreading very quickly. He pointed out the urgent need to develop programs of national response towards HIV, according to economical capacities of each country. Dr. Kosukin also stressed that from the five Central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Turkmenistan), Kazakhstan has the highest prevalence in HIV. The most vulnerable groups of people infected by HIV in Central Asia are drug users. Dr. Kosukin sees of utmost importance teaching these vulnerable young people (of age 15-16!) how to use drugs in order not to get infected, how to behave sexually in order to protect themselves and how to change their attitude towards risky behavior. What is necessary in a successful fight against this scourge is first of all the political will from the authorities, the spread of accurate information amongst the population, improved education in schools, raising awareness between youngsters, etc. As an example of a successful story Dr. Kosukin mentioned the city of Temirtau in Karaganda region, which is the most affected city in Kazakhstan and where since the year 2000 the situation has been stabilized due to a good and efficient preventive programs and information spread among vulnerable groups.
Dr. Turan CHAKLIKOV, director of the Republican Center on Prevention and Work against HIV/AIDS illustrated the situation of HIV/AIDS in Kazakhstan, presenting horrifying statistics on the development of the infection in the country. There has been an age breakdown, 80 % of infected people are under the age of 30 years and every fourth infected person is a woman. 28 children were born from HIV positive women.
Dr. Chaklikov mentioned the reasons for such a situation, among which were intravenous drug using, STI cases, and socio-economic factors, these are of critical importance in the fight against the HIV/AIDS and other STIs. If some success could be expected in HIV preventive efforts, this would imply support and interest from the local authorities, education, health care and mass media involvement.
Dr. Maria KOTNIKOVA, from the Center for peer programs in Almaty underlined the priority of raising awareness among youth and teenagers as the most vulnerable groups. She mentioned the peer-to-peer blocks, which is a successful program. What is absolutely necessary is a training of trainers that will further teach HIV preventive steps. Dr. Kotnikova stressed the need of extracurricular programs in the schools, which are still lacking. Therefore support and involvement from NGOs is needed, among other things for gender education, healthy lifestyle promotion, etc.
From the above presentations it can be concluded that there is an urgent need of mobilization of international NGOs and first of all of the Red Cross Movement which has the power and capacity to mobilize the population. A well-developed Network is needed in the central Asian region; the RC must have good relationships with local authorities. Last but not least, the Red Cross should cooperate with governments, offering assistance in the areas where the RC has its strength.
Dr. Getachew Gizaw, senior officer from the IFRC Secretariat Health Dpt. pointed out the problematic area of stigma related to HIV/AIDS. Measures such as strong advocacy for non-discrimination and non-segregation of PLWHA must be taken, as well as reconciliation of these persons with governments.
Julian V. Hows, Board Member of the European Network of PLWHA stressed the necessity and importance of understanding and non-discrimination towards infected and affected persons.
4. The ERNA Secretariat: report by Dr. Peter DUCHAJ, vice-president:
Dr. Duchaj in his speech resumed the activities of the ERNA Secretariat since the last ERNA meeting. The main topic was the strengthening of the ERNA Secretariat for the past year, its activities and partnerships with different national and international agencies, participation at the preparatory work for the UNGASS held in June 2001. Dr. Duchaj pointed out the particular and strong collaboration with the IFRC RD in Budapest that is extremely helpful for ERNA, especially for the Central European NSs. He namely thanked Ms. Ingrid Udden for her help in preparing the Plan of Action for ERNA Secretariat and for the workshop on youth peer education held in the framework of the 5th ERNA meeting. In his speech Dr. Duchaj stated that the health educational activities are the most appropriate for the implementation of activities of the RC NSs that is why the 5th meeting was except on the youth peer education focused on HIV/AIDS prevention as well as on drug abuse and directly related diseases such as STIs and currently TB. The lack of sufficient funding was also mentioned; the load of work done can be determined and influenced by the available resources. On this occasion the
Vice-chairman thanked the Swedish RC, Italian RC, Monaco RC and French RC for their contribution to the operational budget of the Network and made an appeal to other member PNSs to contribute according to their possibilities. He presented the budget proposal for 2002 that was agreed upon. At the end of his speech, Dr. Duchaj expressed his conviction that the best path to success is common understanding, mutual support and collaboration between Member NSs and other relevant partners and agencies.
5. Election of the Chairman: According to the original version of the TOR and based on the decision from the last ERNA meeting, the election of the chairman of ERNA was prepared during the 5th meeting. The Secretariat received two candidatures, from Dr. Jan-Olof Morfeldt from the Foundation Noah’s Ark, Swedish RC and from Dr. Boris Ionov, Russian RC. Dr. Morfeldt did not attend the meeting due to security reasons. Member NSs unanimously confirmed Dr.Massimo Barra, current chairman to serve this post until the next elections in 2003. Dr. Boris Ionov was nominated as elected chairman and will assume the position of the chairman the day before the next elections. It has been decided that the Bureau of ERNA (Executive Committee) will be composed of a chairman, elected chairman and two vice-chairmen, one from the NS that hosts the Secretariat and one elected. The post of the 2nd Vice-chairman is vacant, for this reason a letter will be sent out to all members in order to present to the Secretariat their candidatures and the election of the vice-chairman will be done par correspondence upon received candidatures at the beginning of November. It is suitable to have occupied this post before the IFRC General Assembly that will start on the 7th of November in Geneva. There was an agreement to amend the TOR, namely the paragraph that deals with the organizational structure of the Network. The amended version of the TOR will be sent to members together with this report.
6. ERNA Secretariat: According to previous TOR, it has been previewed that the Secretariat will be hosted by each member NS after a period of two years on a rotational basis. Such an idea turned out to be inefficient in practice, where the loss of the institutional memory and disruption of a long-term approach would be experienced. There was a proposal to keep the permanent Secretariat at the Slovak RC. This proposal raised many discussions among participants. Some NSs were against this idea (Norwegian RC, Armenian RC, Bulgarian RC, Russian RC) stating that it would not be fair to keep the secretariat forever at one place, other member NSs would not have then the possibility to have this experience and to contribute. The representative from Armenian RC proposed also to have the Secretariat hosted by some strong member PNS. The French RC strongly supported the idea of having a permanent secretariat, explaining that there would be, inter-alia, a loss of credibility and efficiency towards other NSs and partners if the secretariat moved every two years. We cannot afford to loose efficiency at this stage; it is necessary to continue building on the work done so far. The representative of the French RC expressed her satisfaction with the work done by the Secretariat so far, hosted by the Slovak RC. The Monaco RC, which was not able to participate, supported the idea of having the permanent Secretariat at the Slovak RC in a letter sent to Dr. Barra before the 5th meeting. Representative of Turkmenistan RC also pointed out that two years is too short, either for the service of the chairman, either for the Secretariat.
Summary of some reflections made by participants upon this issue:
· The secretariat should be permanently kept in one NSs
· The secretariat should be hosted by a «strong» NS
· The secretariat should be hosted by different NS so that they can also contribute
· The secretariat has not a representative status, deals with practical issues necessary for carrying out day-to day work
At the end it was agreed that the Secretariat remains for the following two years at the Slovak RC and afterwards can be recommended by member NSs for continuation at the same NS if they will be satisfied with its performance.
As to the middle and long-term dissemination strategies, it was agreed that there is an urgent need to have an ERNA website and to issue printed brochures with information about the Network which could be presented and distributed during the General Assembly in November. The website will be set up with the help of the Head of Communication Unit at the IFRC RD in Budapest. There was an agreement among chairman, elected chairman and member NSs upon having a Plan of Action for ERNA.
Dr. Gizaw urged the member NSs that each of them should develop a project document. He assured the audience about the availability of funds for strong project documents. ERNA as one of the key role players during the European Conference in Berlin must present action. During the 6th ERNA meeting next year there should be presentations made by each member NSs of their project documents and implementation of those who had such projects and whose ERNA helped to finance. Dr. Gizaw also stressed the important role of the chairman and elected chairman in lobbying and fund raising.
7. Presentation of existing programs and needs for the resources for development of future programs: In this section the participants presented their activities in the field of prevention of HIVAIDS, current programs run by their NSs and shared their problems. Participants in general agreed on a need of broad cooperation with partners, such as GNP+ to fight stigma around the people living with the virus and in fighting all types of stigma. RC must work in preventive programs such as e.g. condom distribution, street work, etc. In some countries drug addicts are still punished by law though ERNA members should advocate on changing attitudes of relevant governments, lobby them in order to soften these kinds of rigid laws. It is necessary to do advocacy in human rights through secretaries-general or presidents of NSs.
8. Workshop on youth peer education: A two days session was devoted to this educational methodology. It was prepared and facilitated by the Health and Care delegate from the IFRC RD Budapest Ms. Ingrid Udden, Senior Health Programme Manager from the IFRC RD Bosnia and Herzegovina, Ms. Vesna Durovic, Dr. Getachew Gizaw, Senior Officer IFRC Health Department and Julian Hows, ENP+.
The structure of this training was based on the results of questionnaires sent out to member NSs and on their feedback. The aim of the workshop was to focus on the major aspects of youth peer education so that the participants can have the general understanding of it — conceptual framework of youth peer education. Then practical aspects of a concrete training were undergone as well as a training and group work on writing and setting up of project proposals. During the first introduction of participants it emerged that many NSs do not have much experience in youth peer education. Moreover, many of them have not yet developed a project proposal.
The facilitators first drew a short outline of the history of this methodology and then explained which prerequisites are needed for starting a successful youth peer education, how to set up a peer program, how to design projects and programs and finally how the peer educator and project coordinator should act and behave, what kind of knowledge should they have in order to carry out a successful education program. There was very solid group work prepared by Julian Hows on teaching methodology in peer education with different techniques, basic knowledge and skills. During this group work participants learned about the 4 core areas — how people learn, how to be a good listener, what knowledge is needed for being a good educator and how to establish a trust between educator/audience. Within the first day there was a session on monitoring and evaluation of peer education program presented by Dr. Gizaw. It is very important to have a clear program plan or a project document in order to find partners and attract donors, as well as a tool for monitoring and evaluating success.
The second day of the workshop was dedicated to different topics. From the summary of the first day it was seen that only 7 NSs are running youth peer programs, 5 are about to start, 4 are not running it but would like to if they had knowledge and skills. 3 NSs are not interested in youth peer education as in their countries are dealing with HIV prevention. The representative of the ENP+ introduced this organization. The partnership between ENP+ and ERNA will be further strengthened. There are many areas in which ERNA and the RC in general can collaborate with ENP+: sensitization and basic awareness training, projects that involve PLWHA in a meaningful way, campaigns that address stigma and discrimination, primary and secondary prevention, resource dissemination, to mention but few. The most important work is to challenge the inequities, injustices and lack of in caring for those that are living with HIV.
The Head of the Communication Unit Mr. John Sparrow made the following presentation from IFRC RD Budapest. He pointed out the importance of having media as partners in addressing stigma and related issues in fighting HIV. He introduced the information that that the Federation is planning a global HIV/AIDS anti-stigma campaign that in the case of approval by the IFRC General Assembly in November would be launched on 8th May 2002. To fight stigma must be our priority as individuals are unaware of status, unwilling to accept the infection or to discuss it, governments refuse to acknowledge the problem, it is contributing to cultural barriers and the creation of taboos and inhibits changes in perception and behavior. Media are able to highlight all the sensitive issues and can influence and change the negative and discriminatory attitudes of people. Media must advocate on behalf of PLWHA.
In the framework of this Mr. Sparrow offered his help in setting up the web site for ERNA and in dissemination of its activities (radio emissions, articles, etc.). He stressed the importance of having a plan of action for ERNA that will significantly help e.g. in pooling resources, creating partnership initiatives with common media releases, press conferences, events and is of a service to ERNA members as well as potential members.
The last session of the 2nd day was organized and facilitated by Dr.Gizaw and it was devoted to program planning and writing projects-logical framework approach (LFA). In the first half Dr. Gizaw explained the theory of the LFA. The second half was devoted to a case study, participants worked in groups and their task was to prepare a project document on HIV/AIDS prevention among youth.
The workshop was highly appreciated by all participants as many of them did not have any previous idea how to set up a project proposal and many of them did not know which steps must be followed while preparing such a document. In the final closing remarks many NSs expressed their willingness to include in the future meetings 1-day discussions about best practices and sharing them amongst each other, to share practical information about prevention activities, to have present more agencies and organizations dealing with HIV prevention, to take into consideration TB and other related diseases. HIV+ people must be more targeted as well as IDUs and other vulnerable groups.
It has been stated that for a successful Network it is necessary to have more collaboration among members as good results depend on good communication. Dr. Barra sees the next step in attracting donors and therefore helping NSs in need.
9. Session on TB: — Chaired by Prof. Mayer, Slovak RC, facilitated by Terhi Heinasmaki, IFRC Health Dpt.
Tuberculosis is one of the biggest health problem in Eastern Europe and together with HIV forms the so called «deadly duet»: for this reason presentations on TB Control programs in Russia, Armenia and Kazachstan were heard. In these countries TB is considered as a disaster and the prevalence is tending to increase. This is mainly because of the collapse of the public health system, Ministries of Health cannot cope with this problem, and total lack of funds is experienced. In Kazakhstan TB is the leading disease of women. RC formed a partnership with public health system, providing visiting nurses taking care of TB patients.
Dr. Manan Ganguli, IFRC RD Health delegate in Almaty informed the participants that the TB problem is of an extremely large scale in Central Asia and that it is more serious than it has been presented. He pointed out three issues that need to be successfully tackled in TB:
— Continuity of the preventive programs
10. Date and place of the 6th ERNA meeting: It was agreed to hold the 6th ERNA meeting in Armenia, Yerevan, 2nd half of September-beginning October 2002.
In conclusion all participants thanked the Kazakh Red Cross/Red Crescent for the excellent organization of the meeting and for the kind hospitality. The meeting ended in accordance with the time frame of the agenda.
(*In the framework of the 5th ERNA meeting there has been a meeting of the working group on HIV/AIDS for the preparation of the Berlin Conference chaired by the French RC. The report from this meeting will be prepared and sent to members of the working group by the French RC.)