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AKSI STOP AIDS PROGRAM

Cooperative Agreement No. 497-A-00-00-0038-00

Seventh Quarterly Report

(April – June 2002)

Submitted : 29 July 2002

AKSI STOP AIDS PROGRAM

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Cooperative Agreement No. 497-A-00-00-0038-00

Seventh Quarterly Report (April – June 2002)

Submitted : 29 July 2002

The STI/HIV/AIDS Prevention Support Program

is a USAID- funded program managed by Family Health International in collaboration with

the Directorate General of Communicable Disease Control and Environmental Health (PPM & PL),

Ministry of Health, the Republic of Indonesia

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TABLE OF CONTENTS 1. Introduction 4 2. Program Implementation and Achievements 4

RP 1 : Increase Risk Reduction and Behavior and Practices 4 FSW Peer-led Interventions 4 Prevention Marketing 5 Healthy Ports and Highways Intervention 7 Strategies Targeting MSM 7 IDU-focused Strategy 8 PLWA Involvement with HIV/AIDS Prevention 10 Client Interventions 10

RP 2 : Strengthen HIV/STI Services 11 Improved STI Diagnosis and Treatment 11 Care and Support for PLWA 12

RP 3 : Enhanced Capacity and Quality of Government of Indonesia HIV/STI HIV/STI Surveillance Systems and Their Use of Epidemiological Data in Key Data in Key Decision Making 13

RP 4 : Strengthened Capacity of Local Organizations to Plan, Finance, Manage Finance, Manage and Coordinate HIV/STI Responses 19

RP 5 : Increased Leveraging of Non-Program Programmatic Interventions and and Financial Resources 21 Supporting Activities

3. ASA/FHI Management and Staffing 22 4. Products and Materials Produced this Quarter 26 5. Major Activities Planned for the Next Quarter 26 Glossary 28 Attachments: Attachment 1: ASA Program Indicators 30 Attachment 2: RRFs Completed This Quarter 32 Attachment 3: ASA Program Funding Data Base 33

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1. INTRODUCTION The momentum of activities of the ASA Program continued to build over this quarter. The priority has been on developing proposals for subprojects; the sooner these can be completed, the sooner urgently needed interventions can get underway in the 10 provinces. Good progress was made towards this end, boosted by a workshop on proposal development and writing facilitated by ARO Bangkok for all ASA staff, followed by technical assistance at provincial level. Other highlights this quarter included the launch, after extensive field-testing, of the mass marketing campaign on HIV/AIDS prevention. Needs-specific capacity building for KPADs and NGOs continued, with the focus on strategic planning for the former and management and accounting competency for the latter. Surveillance activities have intensified, with BPS settling well into their role as a key ASA partner implementing the BSS, and after strenuous efforts from all involved, the MSM study is close to completion and promises to yield a great deal of valuable data. Attention to care and support for PLWA continued to increase: a series of national meetings this quarter accelerated the development of guidelines for STI clinic services, counseling and care for PLWA, and these should be in place in the near future.

2. PROGRAM IMPLEMENTATION AND ACHIEVEMENT This section outlines the activities that have been implemented in support of each of the five key result packages (RP) during this quarter. RP 1: Increased Risk Reduction and Behavior and Practices Female Sex Workers Peer-led Interventions One of the major activities of this quarter—and the first of its kind in Indonesia—was a workshop for project directors on Behavior Change Communication and Program Development. Ninety-eight participants from all ten ASA provinces attended the workshop, which was held on 15–25 May in Yogyakarta and facilitated by ASA staff, including the ASA Program mangers from Riau, Papua, North Sulawesi and East Java. The purpose was to give directors and program managers an orientation to BCC and the kind of support they can give to their outreach staff, as well as an opportunity to share information and experience. Approximately half of the 49 NGOs represented are already working with MSM, FSW, IDU, youth and clinics, while the other half are new to either ASA or to the field of HIV/AIDS. Some of the more experienced participants were trained as trainers for their respective regions, and the workshop also provided an opportunity to prepare for the establishment of a BCC network in the 10 provinces. Nancy Jamieson of FHI was the resource person for this workshop. In April and May ASA staff, together with PKBI Yogyakarta, conducted a needs assessment for 15 NGOs in South Sumatra and Riau. This was a continuation of PKBI’s task order, and the results of the assessment were presented during the workshop.

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In June, Studio Driya Media finished their desktop review of IEC materials that have been produced over the last few years by ASA, HAPP, other donors and NGOs. Their recommendations were taken into account in the planning of new IEC materials for FSW, among others, which are currently in development. These are described in more detail under the Healthy Ports and Highways section. Staff from Yayasan Kusuma Buana and ASA have been undertaking an FSW strategy assessment in Mapar, an area of West Jakarta where there is a very high concentration of entertainment establishments and massage parlors. Starting in April, this was the first stage of a pilot project aimed at developing appropriate strategies for establishing a 100% condom use policy in the area. Several interviews, FGDs, observations and meetings with stakeholders, including high-ranking government and business figures, have already been conducted, and this initial activity is scheduled to finish in July. Subagreement development continued with Yayasan Abdi Asih in Surabaya. They are working on a proposal for their organization to focus on internal management preparation, after which they will be in a better position to continue with outreach. Subagreements are currently being processed for new and established NGOs in North Sulawesi, Central Java and Papua. Most of these are proposals for outreach. In Papua, ASA’s IAs are continuing their outreach work with FSW. Throughout the quarter, the team has provided technical assistance to these NGOs and to ASA provincial staff. Together with other sections in the ASA Program Technical Unit, the FSW team had a meeting to plan activities and support for the coming year. These plans will be accommodated in the Year Three workplan. Prevention Marketing Work on the media campaign continued. Prior to this quarter, the communication concepts were tested on the target audiences and the general public in the 10 ASA provinces. In April, the results of this survey were presented to the Director General of CDC and EH and the KPA during the National Consultation Workshop on HIV/AIDS on 23 April 2002. This meeting was attended by some 300 participants, including the Minister of Health and the Coordinating Minister for People’s Welfare. The KPA accepted the concept in principle, and made further suggestions. The concept was also presented to the leaders of religious groups, including Rahima and Fathayat NU, who also gave feedback but were, overall, satisfied with the messages and the way they were conveyed. The Leo Burnett-Kreasindo agency shot the five television commercials in West Java in May, and prepared the four print advertisements and radio materials: four radio spots and three jingles. The entire campaign conveys four basic messages and is scheduled to run until the end of the calendar year. Post-production was completed on 8 June, and on 12 June, the press were briefed to enable them to buffer any negative public reaction that might arise. The first of the TV spots was aired on three national TV stations on 14 June. A number of complaints were received and

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two of the stations dropped the commercial after only 10 days, although it was supposed to be shown over a period of six weeks. They did, however, continue to run the “filler” giving basic information about HIV/AIDS. A meeting is scheduled between ASA and the directors of these stations to resolve this issue. Plans were made in June to produce and distribute a “Safer Sex Package”—a condom packaged together with a sachet of lubricant. The intention is to distribute these free of charge for a limited period in areas frequented by MSM and waria, and eventually to put them on sale. The condoms would be provided by DKT; proposals are currently being invited from lubricant companies to develop the packaging. The ASA Program is planning to participate in FHI’s global “Staying Alive” campaign in collaboration with MTV and the USAID-sponsored Youthnet program, either by airing one of the commercials on MTV or providing a segment for MTV/FHI’s planned documentary. Public Relations and Policy Advocacy The ASA Program recognizes that advocacy is a collective responsibility that needs to be incorporated into all programs. To address this, an assessment of basic advocacy needs was conducted for all Jakarta-based ASA staff. This resulted in a number of issues being identified, some program-specific, other cross-cutting. An in-house advocacy strategy workshop is now being planned for September, to be facilitated by Mansour Fakih PhD of INSIST. He has also been contracted to provide technical assistance on advocacy at the provincial level. Contract negotiations were also held with INSIST in June to develop a 100% condom use policy development handbook and toolkit. This will set out clear procedures for how to go about advocacy, including sections on lobbying, getting proposals through the legislative process and so on. In a good exercise in donor collaboration, Abby Ruddick, AusAID consultant Edward Reis and former senior official of the Ministry of National Education Dr Suharto developed a set of proposals for the revitalization of the KPA. After consulting with stakeholders from within and outside the government they recommended, among other things, that the KPA be a fully accountable body of experts from both government and non-government agencies, with an advocacy rather than an implementing role. The results of their work were presented at one of the Round Tables at the National Coordination Workshop and are also available in a report in both English and Indonesian. This quarter, ASA has been exploring the possibility of intensifying advocacy at parliamentary level by working with the Indonesian Forum of Parliamentarians on Population and Development (IFPPD), an advocacy and legislative “push group” set up in 2001. Discussions have been held with Dra. Hajja Ermalina MHS of IFPPD, and preparations are being made to contract Dr Suharto as a Parliamentary Liaison Consultant to work with the group.

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Familiarizing journalists with HIV/AIDS and STI issues is one way of promoting consistent, high quality reporting in this field. During this quarter, a series of monthly meetings was initiated, through Indonesia’s Press Council, to develop a network of AIDS journalists. Activities could include providing access to government officials for interviews and so on. Irwan Julianto, senior health editor of national daily Kompas, is the consultant on this project. Healthy Ports and Highways Interventions Most of the effort this quarter has focused on developing proposals and identifying prospective IAs. NGOs with potential have been located in Tebing Tinggi and Deli Serdang, North Sumatra, and one in Surabaya operating around the Tanjung Perak port. In Bitung, North Sulawesi, YBHK began operating a clinic offering STI services to sex workers and their clients. This subproject started in June. YBHK is working as part of a network with other NGOs that are doing outreach; ASA is currently developing proposals with these NGOs and continuing to socialize the program. Proposal development is also ongoing with NGOs in Tegal and Semarang in Central Java; proposals are being processed for outreach and a clinic. The cross-cutting nature of the Healthy Ports and Highways approach has been very clear over this quarter. The mass media public information campaign is a good example. The television advertisements have been aired in many of the Healthy Ports and Highways areas, and the print adverts have been carried in tabloids known to be read by truckers and other transport workers. The media campaign is covered in detail under the section on Prevention Marketing. Also this quarter, work has been carried out on the design of some new IEC materials. This will be a series of comics depicting the characters from the television campaign adverts. Five different comics are being produced, dealing with topics such as basic STI/HIV knowledge, common myths about STI/HIV, STI health-seeking behavior and voluntary counseling and testing. This is another cross-cutting effort which is being support by the work of other sections under the ASA Program, and which will, in turn, support outreach to female sex workers and clients and through STI services. Initial input was given for the development of an advocacy tool for 100% condom use (see under Public Relations and Policy Advocacy). When finished, this can be used by local legislatures, owners of entertainment establishments and so on. Strategies Targeting MSM During this quarter, RRFs were finalized for mapping and socialization of the program to end beneficiaries, and prospective NGO implementing partners in East Java, West Java, Jakarta and Riau are now in the process of writing proposals for subagreements. The mapping of MSM in was competed in Pekanbaru, Jakarta, Surabaya and Bandung. This has been a major undertaking but vital in order to build relationships with target groups and

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plan appropriate interventions. In May, the MSM behavioral and biological study started in Jakarta. This activity is discussed in more detail under RP 3. In Jayapura, a capacity building workshop on the management and implementation of behavior change activities was held in the last week of April for 15 participants from Forum Komunikasi Waria (FKW) with the intention of readying it to become an IA by next year. A subagreement is currently being finalized with Yayasan Kesehatan Bethesda (YKB), who will provide some of the capacity building for FKW. YKB will, in turn, be mentored by another NGO. ASA staff worked with Gaya Nusantara in Surabaya and Yayasan Priangan in Bandung on the design of their subagreement proposals. Both of these are now in the approval process. Meetings were also held with two new NGOs in Malang, one working with gay men and the other with waria to assess the possibility of contracting them under RRF agreements. On 15–19 April, ASA staff conducted a management and finance capacity building workshop in Bogor for three NGOs: YPPI, Srikandi and Yayasan Priangan. A total of 22 people took part. IDU Focused Strategy This quarter’s activities began on 4 April with a MoH-sponsored Discussion Forum on HIV/AIDS held at Hotel Santika in Jakarta. Later in the month, on 23 April, the National Consultation Workshop organized by the KPA and the Directorate of CDC and EH, and attended by the Minister of Health and the Coordinating Minister for People’s Welfare also focused attention on the problem of HIV/AIDS in Indonesia. At both meetings the Government reiterated its commitment to help address the increasingly severe epidemic. One of the central issues in trying to plan an appropriate response is estimating the numbers of individuals that are at risk of contracting HIV. This topic was tackled at an international meeting in Bali, 8–11 April, on population size estimation techniques. The organizers of the meeting included FHI, WHO and the UN. Other one-time events occurring this quarter included a visit by the FHI Review Team of Dr. Peter Lamptey and Steve Mills to Atma Jaya’s IDU intervention program, and site visits by USAID staff to both the Atma Jaya program and the YPI program in Kampung Bali. The latter visit, on 27 June, included USAID Interim Desk Officer David Schroder. The ASA IDU unit also completed two assessments and one intervention implementation training course this quarter. Intervention assessments were conducted in Bandung on 13–16 May and in Surabaya and Malang on 24–30 June. In each instance, field investigations of IDU social networks and meetings with NGOs and relevant authorities were included. Plans for the implementation of interventions will be finalized for each site next quarter. Plans are also underway at each site to commence ethnographic investigation internships. The purpose of these will be two-fold. First, they will provide vital information and insight into high-risk behaviors and factors influencing behavior change among populations targeted for intervention. Second, they will expand the extremely limited pool of Indonesian

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professionals who are experienced in working with active drug-using populations in community settings. In the first week of June, ASA conducted Indigenous Leader Outreach Model (ILOM) training with Yayasan Mitra Masyarakat in Manado. The trainees are very enthusiastic and their program promises to be one of the most successful implemented to date. Following training, on 7 June, a meeting was held with the KPAD and interested authorities to brief them on the training and discuss intervention plans. Activities with ASA Partners This quarter saw three visits by two of ASA’s partners, the Burnet Institute’s Centre for Harm Reduction (CHR) and the Asian Harm Reduction Network (AHRN). During the first of these, on 23–26 April, CHR and AHRN participated in a series of meetings to solidify consultation and activity schedules for Year 2 and to begin planning for Year 3. The second visit by CHR and AHRN (28–31 May) focused on the implementation of their work plans. On 28 May, a meeting was held for key players who will be involved in the Indonesian NGO Harm Reduction Network. On the following day, a group of senior police officials discussed opportunities for joint activities with ASA, AHRN and CHR. The third visit with ASA’s collaborating partners on 24–28 June allowed CHR and AHRN to become more familiar with ASA’s IDU initiatives in Jakarta. Annie Malcolm, CHR’s syringe exchange consultant, and Umesh Sharma from AHRN observed the intervention operations of Atma Jaya, YPI and UI. Dave Burrows (CHR), Ruth Birgin (CHR) and Umesh Sharma worked on finalizing Year 3 workplans and submitting revised Task Orders. CHR’s presence throughout the quarter in setting up its local office and working full-time in contributing to ASA activities in Indonesia has been extremely helpful and productive. A complete review of CHR’s activities can be found in their first progress report to ASA. ASA Implementing Agency (IA) Activities This quarter marked the beginning of regularly scheduled monthly meetings for staff of partner agencies, aimed at sharing experiences between IAs and promoting best practices among ASA’s collaborating intervention projects. Alternating between meetings of all staff and meetings of only supervisory personnel, the monthly meetings of Jakarta IAs (UI, YPI and Atma Jaya) have been received extremely well and it is agreed that they should be continued. UI has a staff of 10 outreach workers who have reached over 200 active IDUs to date, with their outreach activities currently covering 29 community locations. They have experienced greater difficulty in reaching members of target populations on campus rather than in the communities where they live. Increased police activities during May and June have made it more difficult to gain access to IDUs in public settings.

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Atma Jaya now has nine full-time outreach staff plus one part-time student. Together they have contacted about 350 IDUs, of whom 130 are in regular contact. They have recently switched to an outreach operations strategy of assigning specific staff to regular locations for which they will be responsible rather than having all staff visit all locations being covered. Atma Jaya appears to have the strongest management support for their outreach teams and they may serve as a model for some of the other projects that are still struggling with supervisory procedures. They also seem to be making major inroads in winning the support and cooperation of the larger community. YPI has 10 full-time outreach staff and 11 volunteers. To date they have reached about 150 IDUs in Kampung Bali despite the heavy police presence there. YPI has set up monthly support group meetings for their client population in addition to monthly meetings for the general community. Working in close association with the local puskesmas, YPI has been the most progressive in forging ties with the local government and involvement in external activities. On 29 June, they sponsored a major meeting including government officials and local authorities to introduce their intervention program and to stimulate discussion of related issues. PLWA Involvement with HIV/AIDS Prevention The first phase of the project to produce a traveling exhibit of portraits of PLWA from throughout Indonesia began in April. Yayasan Spiritia and Yayasan Bali+, coordinating the project, have identified several people who are willing to be photographed. Contracts were finalized with photographer Rio Helmi and national journalist Irwan Julianto, who is writing the captions. A number of subjects have been photographed already but it is proving to be a slow process due to the high emotional investment and possible risks for those involved. A number of companies—among them Levi’s Singapore and Reebok—have been contacted about the possibility of sponsoring the cost of the exhibits in some locations. A contract is being developed with Spiritia for them to travel to several ASA provinces to meet PLWA and government and non-government staff. Spiritia will them prepare reports on these visits as a starting point for developing care and support initiatives. Client Interventions April saw the results of January’s workshop on HIV prevention in the military being finalized. This has been distributed to decision makers at national and provincial level within both Ministry of Defense (MoD) and military hierarchies, and will be a useful advocacy tool. In May, the KPA signed an SK (Decree) which paved the way for a preparatory meeting of a “military/police” KPA comprising members from the MoD, the Armed Forces (TNI) and the National Police (Polri). The secretariat for this KPA will be a non-structural unit under the Ministry’s Directorate of Health, while the chairperson is an MoD official. This is an important step; however, the lack of experience among the personnel means that a great deal of technical assistance will be required. A further constraint will be the lack of any budget, as yet, for this KPA.

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In June, the MoD finalized the draft of an SK outlining an HIV/STI prevention policy for the uniformed services. Covering advocacy, planning, implementation, monitoring and evaluation, the draft agrees in principle to use the UNAIDS strategy, proposing several different approaches including active surveillance, STI services and behavior change intervention. The draft provides for these approaches to be implemented by NGOs from outside the MoD or the services—a highly novel approach for the military. ASA provided feedback on the draft and returned it to the MoD. Once it is signed—likely in July or August—interventions can begin. RP 2: Strengthened Quality, Accessibility and Utilization of HIV/STI Prevention Services for Individuals at Risk Improved STI Diagnosis and Treatment During this quarter, ASA technical staff made monitoring visits to ASA-supported STI clinics and several other clinics that are being considered for future support. The clinics visited were Putat Jaya Clinic, Surabaya (East Java); PKBI Clinic, Tanjung Elmo, Sentani; YKB Clinic, Jayapura; Dian Harapan Hospital, Jayapura; Klinik Reproduksi Kesehatan, Merauke and Klinik Bintang Timur, Sorong, all in Papua; and puskesmas and clinics in Tanjung Pinang, Batam, Pekanbaru (Riau) and Bitung in North Sulawesi. These field visits were made by different members of the STI/HIV consultant team, including Dr. Elizabeth Donegan (USCF), Dr. Tony McMullen, Dr. Kemmy Ampera, Dr. Ninik Sukartini and Dr. Atiek Anarti. Visit to the clinics included informal education around patient care, laboratory and examination techniques, and general problem solving related to the provision of STI services. The consultants worked side-by-side with clinic staff to demonstrate and improve techniques. Strengthening/Capacity Building in STI Services ASA prepared and facilitated an STI/HIV/AIDS training course for 58 puskesmas doctors and paramedics in Kabupaten Merauke, Papua, which was held on 10–14 June 2002. The resource persons and facilitators were selected from local, provincial and central office technical staff. The curriculum was developed in collaboration with ASA consultants, CDC and EH and district health staff at Merauke. The training was aimed at developing capacity in basic STI diagnosis and treatment using an “enhanced syndromic” approach, providing an orientation to HIV/AIDS issues and basic information regarding Universal Precautions and HIV epidemiology, and was delivered through a series of adult learning, interactive classroom and practical learning exercises. Based on an evaluation of this program, the training modules developed by the ASA team will be modified and used in other ASA areas to train STI service personnel.

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STI consultant Dr. Tony McMullen has developed a document outlining minimum standards for ASA-supported STI clinics, and this is currently being reviewed by ASA staff. This document will be used as an attachment to new subagreement contracts. Monitoring forms have been developed for use by ASA-supported clinics and ASA provincial offices. Gonorrhea drug resistance data has been compiled from existing data. A review of STI clinic and outreach services and current strategies for STI control was carried out in Sorong, Jayapura and Merauke in Papua during May and June. At each of these places, training was given on STI clinical management and control of STIs, and small-group workshops to develop local strategies for STI control were also conducted. Through this program, conducted from 6–20 May, some 25 health workers received “hands-on” mentoring training. The technical unit has assisted in the preparation of a proposal by JEN for a Baseline STI survey in six provinces. Strengthening/Capacity Building in Counseling The Counselor Support Group in Jakarta met once during this quarter. Experienced HIV/AIDS counselors, counselor trainers and related GoI technical staff came together for three days (24–26 April 2002) to make recommendations for HIV/AIDS counseling training. Among the outcomes of this working group were recommendations for the minimum standards for a counseling training curriculum and a set of minimum standard counseling skills for HIV/AIDS counselors. These were discussed with Dr. Jusni and Dr. Ysmansyah Idris, SpkJ, key technical and administrative personnel of the Community Adult Mental Health Services unit of the Ministry of Health. In preparation for the MSM Surveillance study, Yayasan Mitra Indonesia held a VCT counselor refresher training course for 12 counselors in the MSM study, from 29 April–1 May 2002. During the MSM study, ASA staff have been attending weekly counseling case conferencing at Yayasan Mitra Indonesia. Care and Support for PLWA Dr. Sarah Huffam, an Australian physician with an expertise in the care of patients with HIV/AIDS, has been contracted as a consultant for the ASA Program. Dr. Huffam began work in mid-June and is stationed in Merauke, Papua. She is accompanied by a local physician who assists with translation and can also benefit from the experiential training. Dr. Huffman will be consulting over a period of three months with the following expected outputs: (1) to assist in the development of a capacity building strategy for HIV clinical service providers in Papua, to include a rapid assessment of training needs, (2) to assist in the development of clinical care guidelines, and (3) to provide “hands-on” training and mentoring to local health workers in their diagnosis, care, and treatment of HIV patients.

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Initial discussions were held with Pusat Latihan Kusta Nasional (PLKN) Makassar on 13 June 2002 about the possibility of an HIV clinical training program for physicians and paramedics. The POKDISUS AIDS (AIDS Working Group of Cipto Mangunkusumo Hospital) facilitated a FGD with health workers and PLWA on Care and Support Issues, Jakarta, 11–12 June 2002. FHI provided support for the participation of Dr. Eric Van Praag (FHI Arlington) as a guest speaker at the ASEAN Workshop for the Exchange of Experience on Increasing Treatment and Care for PLWA, held on 6–7 June in Jakarta. Together with the AIDS Subdirectorate of CDC/MoH/GoI, FHI co-sponsored a workshop on “Outline National Care and Support Guidelines for PLWA” in Jakarta on 11–12 June 2002. Dr. Eric Van Praag assisted as a resource person. Guideline Outline documents and recommendations for a guideline-writing process were drafted and presented to Dr. Haikin Rachmat of the AIDS Subdirectorate of CDC/MoH/GoI. RP 3: Enhanced Capacity and Quality of Government of Indonesia HIV/STI Surveillance Systems and their Use of Epidemiological Data in Key Decision Making This has been a busy period for surveillance-related activity in Indonesia. The major activities during this period were as follows:

• Start of fieldwork for Behavioral Surveillance • Sero-survey among MSM in Jakarta • Review of HIV Sero-Surveillance system • Workshops promoting ethical surveillance • Initiation of population size estimation work • Workshops to increase the use of data at local levels

Behavioral surveillance surveys BSS activity is progressing simultaneously with two separate implementing partners. The Central Bureau of Statistics (BPS) has begun implementation of BSS among sex workers and mobile male groups, while the University of Indonesia has begun field activities among men who have sex with men and injecting drug users. Sex workers and mobile male groups BPS is making good progress on the BSS in these groups. In early April, senior BPS staff joined staff from CDC and ASA to visit the three provinces and districts chosen for the field trial (DKI/North Jakarta, North Sumatra Medan/Deli Serdang, Riau/Tanjung Pinang), to establish relationships between the agencies and the KPAD at the local level. This has resulted in a high level of enthusiasm for the activity at all levels, and very good interagency cooperation.

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Also in April (16–20), the Population Council, an ASA partner, led a training of trainers for 13 senior BPS staff to enable them to train BPS coordinators in the use of finalized standard operating procedures. Overall, the training materials and methods proved disappointing, and it soon became apparent that the BPS participants were far better versed in most of the technical issues surrounding field surveys than the Population Council staff hired to give the “technical assistance”. The most useful sessions were those in which University of Indonesia field workers shared their experiences of working with these populations in the field. Because the Population Council failed to deliver a set of operation guidelines as expected, the BPS team were not able to progress straight to the training of staff at the district level. It was decided that BPS should finalize all the field materials themselves, with direct technical support from ASA and participation from CDC. This was achieved at the start of May, in a very productive one-week meeting in Puncak. The BPS/CDC team worked with great dedication and enthusiasm. They also arranged a field test of the questionnaire at this time, and made final changes accordingly. The result is a field protocol and operational guidelines for conducting BSS in these populations in Indonesia. It is expected that these will be revised in the light of the trials in three districts before being finalized. Shortly after the materials were finalized, training of fieldworkers in BSS data collection and sampling processes began in the trial districts. The Population Council, whose task order specifies support for training and implementation in the trial districts, participated in the training for BPS staff from Deli Serdang and Medan districts, North Sumatra, on 10–15 June. ASA staff were present at the training in Riau on 4–8 June. The same training was given for BPS staff in North Jakarta district on 5–8 June. Twenty-five interviewers and supervisors were trained in each area. While some of the interviewers were from local NGOs, the majority were from the BPS district offices. This was followed almost immediately in all three districts by mapping and data collection. Population Council staff assisted in this process in North Sumatra, but were not present in Riau or Jakarta. Data collection was still in process at the time of writing this report, but certain lessons have already been learned. In technical terms, the biggest problem was a failure to properly specify inclusion and exclusion criteria, but this can be easily rectified. There was also some difficulty with access to populations. A sampling issue beyond the control of BPS is the political and security climate. Many areas are currently experiencing a “crackdown” on activities such as prostitution. These crackdowns (razia) can be very localized, but can nonetheless have a significant impact on our ability to select respondents according to the sample frame. Overall, it is clear that more effort will be needed in training in the crucial issues around sampling and respondent selection, including in how to record unexpected events that may influence the interpretation of data. Many operational issues have surfaced during the trials, some of them with budgetary implications. For example the budget did not include any significant operational funding for the mapping process. However, with mobile populations, mapping can require a huge amount of travel. In retrospect, it would have made more sense to separate the budget for the field

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trial and the follow-up districts so that the lessons learned in the field trial could be more easily taken into account in the follow-up work. One further issue should be noted. The surveillance team in North Jakarta faced a very hostile initial reaction from the local neighborhood chief in one large brothel complex, the gist of which was that survey teams have been coming here to question “his girls” year after year, but nothing ever changes. The purpose of surveillance may initially be to demonstrate the need for interventions and to lobby for resources, but one round of data should be sufficient for this. The question remains as to what extent should we continue to intrude on people’s privacy (and take their blood) if the data generated contribute nothing to their wellbeing. IDU and MSM To allow BPS to gain experience in behavioral surveillance in the more accessible groups first, it was decided that behavioral surveillance among IDUs and MSM would be carried out by UI, which had for several years conducted BSS under the HAPP project, and had conducted a single round among waria and IDUs in Jakarta in 2000. BSS was planned for IDUs in Jakarta, Bandung and Surabaya, and among MSM in Jakarta, Surabaya and Batam. The MSM BSS in Jakarta forms part of a larger sero-survey discussed at greater length below. Miscommunication within the ASA office led to some early problems with BSS among these groups, particularly MSM, concerning mapping. UI’s sub-agreement was therefore amended to include proper mapping, and this has now been carried out in Jakarta, Batam and Surabaya and is underway in Bandung. In the mapping process, it has become clear that the original targets set for BSS for MSM (200 each of waria, male sex workers and gays) will not easily be met in Batam. In Surabaya, there is no massage-parlor based male sex industry, and it has been decided that the MSW and gay groups should be combined and the distinction between them made at the analysis stage, depending on reported commercial sex behavior. The IDU mapping has proven difficult, largely because of the extraordinary level of attention being given to “narkoba” in the national media—most of the rhetoric speaks of strict punitive measures against drug users as well as dealers. Understandably, users are suspicious of outsiders asking questions, and it is even reported that drug users are informing on one another for cash payments. The UI team appears to have done very well in gaining the trust of key informants and of gaining access to IDUs in Surabaya, where there is currently no intervention. However, under the current circumstances, the quality of the data that will be generated is questionable, and there is a real possibility that the surveillance activity will increase the crackdown effect. The surveillance and IDU teams are currently evaluating whether to go ahead with BSS among IDU in Surabaya this year. The MSM study This quarter saw the bulk of the activity on the survey of HIV, syphilis and related behaviors among men who have sex with men in Jakarta. During this period, training of field workers

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was completed and data collection begun. By the end of June, data had been collected from 252 waria (target 250) and 272 male sex workers (target 300). The data collection in these two groups was remarkably smooth. Data collection in the third group, self-recognized homosexuals and bisexuals, is currently underway. After an early misunderstanding about compensation was ironed out, cooperation with Dinas Kesehatan DKI, who provided the blood collectors for the study, has been good. The interview team, which included transvestites and former male sex workers, has proven dedicated and hardworking. The study supervisors—provided by UI—lack the training or field experience to run a study of this nature to international standards without extremely tight supervision, and ASA staff (in particular, consultant Phillippe Girault) have therefore been involved in every step of this study on a daily basis to maintain the quality of data collection. The early results of the study are alarming, but should be kept confidential until they can be properly disseminated to the affected groups, to CDC and to the KPAD. Although we have no reason to doubt the quality of our laboratory procedures, we would also like to delay wider publication of the results until quality control on a sub-set of samples has been performed at the University of California, San Francisco. A high proportion of male sex workers have collected their test results, but the proportion of waria presenting for their results has been much lower (fewer than 10%). Under the study protocol, free treatment for syphilis is available only until 16 August 2002. Since treating active syphilis is considered an absolute priority, ASA’s waria collaborators have been asked to begin actively encouraging waria to come in for their syphilis results even if they do not want to receive their HIV results. ASA has also arranged to provide transport money for waria who come back for their second and third rounds of treatment. Because ASA feels that active use of the results of this study in planning appropriate interventions is of paramount importance, plans are underway for an RRF with ASA’s waria cooperating institution, Srikandi, so that the waria community can be actively involved in the process. Review of the sero-surveillance system In order to plan appropriate support for sero-surveillance, ASA commissioned a review of the sero-surveillance system for HIV in Indonesia. The review was undertaken by ASA consultant Dr. Penny Miller, in close collaboration with CDC (led by CDC staff member Dr. Naning). It involved a review of surveillance guidelines, records and procedures at central level, direct observation of implementation of surveillance at provincial level, and a review of information technology within the sub-directorate. Because the timetable for surveillance activities is set at the district level, the review was divided into two phases. Implementation has been observed in one district (in East Java); another two observational visits are planned for the second phase, which will be completed in

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the next quarter. The bulk of the review was completed in this quarter. A very comprehensive draft interim report is available, but the major conclusions are as follows:

• Overall, Indonesia has a high level of activity in HIV surveillance, most of it is in appropriate risk groups, and the technical and sample handling procedures are largely adequate. However, there is some misunderstanding about what constitutes sentinel surveillance, especially in the areas of sampling, numbers of people tested and methods of testing.

• There is a disconnect between the central and the implementing levels. This disconnect works in both directions. Standard operating procedures determined at the central level are not always followed at the district level, while districts often fail to report the results of surveillance to the central level.

• Capacity to analyze and use data appropriately is poor at all levels. There is very little understanding of trend analysis, and in several cases major trends in HIV infection have been missed because data have been inappropriately analyzed or poorly reported.

• There are virtually no mechanisms to ensure that data generated by the surveillance system are used for advocacy, integrated into intervention planning or used in any other constructive way at the district level. Even at the national level, data use has historically been very poor, although that is beginning to change.

• The surveillance system is legally and financially in a very precarious situation. Reagents are provided at the central level, but all other resources must be provided at the local level. In some cases, these resources are provided largely because local authorities wish to identify HIV positive individuals. Such case-finding is in contradiction to national guidelines, but remains widespread. It is possible that if it were eradicated, local support for HIV surveillance would evaporate with it. A stronger legal and financial basis for a minimum national surveillance system is urgently needed.

The interim report has been presented to the national surveillance working group, and their comments will be taken into account before finalizing the report. ASA will plan its support for strengthened second generation surveillance on the basis of the report’s recommendations, and in collaboration with CDC and other major donors such as AusAID. Strengthening the ethical basis of HIV sentinel surveillance Some provinces in Indonesia continue to conduct HIV sentinel surveillance as case-finding exercises, recruiting subjects perceived to be at higher risk of infection, and using linked approaches so the identities of people who test positive are known by authorities. This practice is more common in marginal populations (e.g. sex workers, IDUs, and prison populations) but may also be an issue in the military. In April and May 2002 four regional workshops were conducted in collaboration with the Directorate of Communicable Disease Control (CDC) to strengthen the ethical basis of sentinel surveillance activities at the provincial level. The workshops adapted the curriculum and resources used in two national workshops in 2001. Conducted in Indonesian by a team of facilitators experienced in surveillance, the participants included health department staff, members of provincial AIDS committees, the Indonesian Red Cross and NGOs.

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Dates Location Provinces No. of participants

2–3 April 2002 Jakarta West Java, DKI Jakarta, Central Java, East Java

37

9–10 April 2002 Batam Riau 37

16–17 April 2002 Medan South Sumatra, North Sumatra 36

7–8 May 2002 Jayapura North Sulawesi, Maluku, Irian Jaya 34 The workshops have contributed to a more open public debate regarding case-finding methods in sentinel surveillance and to making sure the debate is better-informed. Although this is an important step forward, it is important to be realistic about the progress on this issue: while there are still powerful political individuals and groups at both provincial and district levels who are supporting case-finding, particularly amongst female sex workers, it is likely to continue. Population size estimation One of the weaknesses in planning adequate interventions and in monitoring their success throughout the region and indeed the world is our ignorance about the size of the populations at higher risk for HIV. Family Health International, with funding from USAID/ANE, has begun to address this issue by trying to develop appropriate tools for the estimation of population size. This process began with a regional workshop held in Bali in April 2002. While there were participants from nine countries, the largest contingent was from Indonesia, with one participant each from CDC, LitBangKes and BPS. Participants from the Indonesian offices of USAID and ASA/FHI were also present. The workshop discussed a number of possible methods for size estimation, and engaged in hand-on exercises illustrating each method. At the end of the meeting, each country developed a workplan to take this work forward. The lead in Indonesia was taken by Sigit Priohutomo of CDC. He has already presented the results of the workshop to the national surveillance working group and to a national surveillance meeting held in Ciloto in June. A sub-group, which includes ASA staff member Pandu Riono, has been designated to take this work forward. ASA has proposed to the sub-directorate that a process to develop a new national estimate of HIV infection be initiated. The goal would be to develop an estimate in time for a national report that would be presented at a cabinet meeting in November and launched publicly for World AIDS Day, 1 December. UNAIDS and WHO in Geneva have expressed strong support for this process and would be active participants if the sub-directorate agrees to take it forward.

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Strengthening data use at the local level One of the issues that has been reinforced by the findings of the surveillance review is that even where data are available, they are rarely used to guide decisions about HIV prevention programming. ASA, under RP 3 and RP 4, has been working to build capacity to use data more effectively to guide decisions, through a series of capacity-building meetings for KPADs and regional partners. The meetings, which have now been held in North Sulawesi, Papua, East Java, DKI Jakarta, North Sumatra and Riau are described more fully under RP4. Capacity building for data use is being implemented by the Population Council. Although ASA feels that sufficient guidance on needs was given, the Population Council prepared unsuitable materials which also totally ignored locally relevant data. Once ASA staff made their feelings known to the Population Council, a dramatic improvement in performance and materials was reported, and the response from KPADs and their partners has been positive. The workshops covered the general principles of data analysis and interpretation and their use in program planning. Follow-up meetings will actually go through the exercise of collecting, analyzing and using local data. It is expected that these will be planned as soon as BSS data are available, at least in the three trial provinces. RP 4: Strengthened Capacity of Local Organizations to Plan, Finance, Manage and Coordinate HIV/STI Responses Capacity building for KPADs The focus this quarter was on the provision of workshops to build capacity and develop competencies within KPADs, leading up to the drafting of the strategic plans and annual workplans. The workshop is delivered in each province in two phases. The first phase aims to develop competencies surrounding the HIV/AIDS program concept, epidemiology, risk factors, social impact, data collection from different sectors, and analysis and interpretation of data. The four-day workshop also covered KPAD functions and responsibilities with regard to the HIV/AIDS prevention and care program, and the principles of an integrated approach to HIV/AIDS. The workshop was facilitated by ASA partners RTI, the Population Council and Atma Jaya, and has been delivered at province level in all 10 provinces. It has also been delivered in all ASA Program districts in North Sulawesi, Papua, North Sumatra, East Java and DKI Jakarta, and in three of the four program districts in Riau. The remaining districts are scheduled to complete the first phase by the end of August. The outcome of each workshop was an action plan for dissemination to the executive and the legislature in each region.

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Capacity Building Workshops for KPAD

Dates Location Provinces No. of participants

23–26 April Manado North Sulawesi 32 (3 KPADs)

30 April–3 May Jayapura Papua 34 (4 KPADs)

13–16 May Medan North Sumatra 31 (3 KPADs)

4–7 June Jakarta DKI Jakarta 22 (6 KPADs)

11–14 June Batam Riau 33 (4 KPADs)

18–21 June Surabaya E Java 52 (5 KPADs) Plans were also made this quarter for the second phase, which will focus on the development of a strategic plan and a comprehensive annual action plan in each district. Capacity building for IAs A Pre-Jump Start workshop was held in Maluku, with the aim of encouraging the establishment of relationships between district-level KPADs and between KPADs and sectoral offices, NGOs and CBOs. The outcome of this workshop was a series of three-month workplans for identifying local issues concerning HIV/AIDS and developing a shared perception on an HIV/AIDS framework for each area. The participants represented the provincial-level KPAD of Maluku as well as the KPADs of Ambon and Maluku Tenggara districts, and four local NGOs: LPPM from Ambon and Tiara, Bethesda and Ilwiory from Maluku Tenggara. This quarter, current and potential IAs underwent two different modules aimed at building competencies and identifying mentoring needs for each IA. The first of these, focusing on institutional strengthening, was facilitated by Business Dynamics, who will initiate the mentoring activities. REMDEC, meanwhile, provided training in project-based financial management and accounting systems for participants from 10 IAs in DKI Jakarta. Participants had the opportunity to try out the accounting system software developed by REMDEC, which proved easy to apply and use. The level of delivery was set too high, however, and REMDEC is currently revising the module for delivery in other regions. This program will resume in July and is scheduled to finish by the end of September.

Dates Location Training/Provinces No. of participants

3–5 April 2002 Maluku Pre-Jump Start/Maluku 40

13-16 May Jayapura Institutional Strengthening/Papua 24

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Dates Location Training/Provinces No. of participants

13-17 May Jakarta Financial Management & Accounting/DKI Jakarta

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10-13 June Manado Institutional Strengthening/North Sulawesi 30

18-21 June Jakarta Institutional Strengthening/DKI Jakarta 27 An expert in Institutional Strengthening on HIV/AIDS for the Church was appointed to assist the ASA Program in Papua. RP 5: Increased Leveraging of Non-Program Programmatic Interventions and Financial Resources Private Sector Module Development Yayasan Kusuma Buana, in collaboration with TBCA and ASA, continued work on the modules for worksite programs on HIV/AIDS prevention. This is intended for delivery by NGOs (in the first instance, Yayasan Utama in Riau) to private companies. The modules will provide the client company with a sustainable program that they can integrate with their existing health program, while the NGO provides technical assistance. Modules have been developed on advocacy, training skills, worker education, technical assistance, IEC materials and condom use; they are close to completion but some minor revisions are needed. The first pilot activity—a TOT for 16 Yayasan Utama staff—took place on 22 April–1 May, facilitated by YKB, TBCA and ASA. There have been some problems with scaling up YKB’s role from that of implementer to trainer, and technical assistance has been required from other experts. Preliminary plans were made during this quarter to expand the TOT into other ASA Program provinces, with the first “cluster” consisting of six NGOs from Eastern Indonesia. Private Sector Participation A number of companies have been approached, and at least two have expressed interest. One Caltex contractor has confirmed and training is scheduled for August. Because of a Government regulation that disqualifies diagnosis or treatment of STI-related diseases under the government health insurance program, efforts have been concentrated on foreign and multinational companies that have a policy on HIV/AIDS, rather than domestic companies whose employees are covered by the Government scheme. ASA has also hosted executive luncheons for AMCHAM and Nike to solicit support for the establishment of an Indonesian Business Commission on AIDS, and further meetings are being arranged with Global Alliance, Citibank and the Rotary Club. The Indonesian Coalition on Health, an organization active both in government and the private sector, has offered its assistance to ASA, and this is currently being pursued.

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SUPPORTING ACTIVITIES 3. ASA/FHI MANAGEMENT AND STAFFING Management During this quarter, several major activities were organized with the specific objective of improving the overall management of the ASA Program. FHI Internal Review On 6–10 May 2002 a team from FHI Headquarters and the Asian Regional Office led by Dr. Peter Lamptey, President of the FHI AIDS Institute, conducted a comprehensive review of the ASA Program. The major issues included in the review were program implementation status; technical strategies; impact monitoring and project monitoring and evaluation; program management and staffing; ASA partners; subagreement design, review and management; and financial management. Specific findings and recommendations for each of these areas were delineated in the final report. The ASA Program has taken immediate action on the majority of these recommendations and will follow through with the remainder over the next several months. The final report of the review and a written response by the ASA Program are available separately.

Subproject Proposal Development One major area identified within the internal review and requiring immediate action was proposal development. Though well into the second year of the Program, actual interventions in the field remain limited, and a major realignment of effort was warranted. To prepare for this, a four-day training course in proposal development and writing was held in late May with the assistance of the FHI Asian Regional Office for all ASA staff, including the program staff at the provincial and district levels. The training included practical exercises in determining goals, strategies and appropriate activities, as well as budgeting and monitoring and evaluation. During this quarter, ASA has also experimented with a variety of methods to assist local NGOs in developing proposals of sufficient quality to receive funding. In East Java and Riau, workshops were organized wherein a team from ASA Jakarta, with assistance from the provincial ASA staff, worked intensively with groups of local NGOs to determine comprehensive strategies for each area, and identify roles and responsibilities for individual organizations. In Papua, one-on-one assistance was provided to individual NGOs. The proposal review process also underwent experimentation, with joint review meetings between the Program Unit and the Technical Unit proving to be the most effective. Currently, over 60 subproject proposals are in development, and ASA has set a target of at least 35 signed, new subagreements by 30 September 2002.

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Year 3 Workplan Work has also commenced on the planning for Year 3 of the Program. The Program Management Unit has already identified partner organizations and their specific roles in each of the 10 target provinces, and the Technical Unit has determined what kind of technical assistance and support activities will need to be organized at the national level. The Finance Unit is in the early stages of allocating funding and negotiating a final budget. A draft of the Workplan will be finished by 1 August 2002, with the final version ready for submission to USAID on 1 September 2002.

Monitoring System With the recruitment of a dedicated Monitoring and Evaluation Officer early in this quarter, work on the development of a comprehensive monitoring system has recommenced after having stalled earlier in the year. A very simple yet effective system is the goal. Each subproject, whether funded by subagreement, RRF, task order, or direct funding, will have an assigned project monitor, designated within the funding document. This ASA staff member will be responsible for monitoring each subproject at least once a month, and will provide a written status report (using a standard format) to the Monitoring and Evaluation Officer, who will compile the information and share it with all relevant parties, including USAID. Work on developing an overall subproject database, standard recording formats, reporting pathways, and a written scope of work for the project monitor has continued throughout the quarter. The system will be piloted in two provinces in July and August, before expansion projectwide. Appropriate training in monitoring for both ASA staff and local NGOs is also being considered.

Staffing During this quarter the following full-time staff were hired:

Irene Sirait FSW Specialist 1 April 2002 Gita Kencana Provincial Officer, North Sumatra 1 April 2002 Pandu Riono Surveillance Specialist 1 April 2002 Hilda Eveline District Officer, Sorong, Papua 1 April 2002 Maddie Thanos Executive Secretary 1 May 2002

The following changes in position also occurred: Tris Priandari Administrative Assistant, Program Management Unit (formerly

Receptionist) Anna Manyokori District Officer, Merauke, Papua (former Secretary, Papua)

Several prospective staff members started their three-month probationary period during this quarter: Raden Wibowo Provincial Officer, Central Java 1 April 2002 Riza Sulistya Receptionist 22 April 2002

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Kharisma Monitoring and Evaluation Officer 1 May 2002 Andreas Wasito Provincial Officer, South Sumatra 26 June 2002 Consultants The ASA Program received technical assistance from the following consultants during this quarter:

• Abby Ruddick has continued her work on developing a strategy for advocacy within the ASA Program, including identifying issues and appropriate TA and planning the necessary training for ASA staff and selected district KPAD. She has also facilitated the development of comprehensive programs and individual subagreements throughout the ASA provinces. (61 days)

• Penny Miller assisted ASA and the Directorate for CDC in conducting the national HIV sentinel surveillance system, including reporting back to the national working group; she also provided technical supervision to regional workshops on sentinel surveillance and related ethical issues. (41 days)

• Tony McMullen provided technical assistance in training for strategy building for STI clinics, development of training materials for puskesmas, and situational assessments in Palembang and Riau. (61 days)

• Anthony Pramualratna (14 days) and Nurudin (10 days) from Thailand provided short term technical assistance during the pilot training of the private sector leveraging in Riau in April; and Stephanie Pirolo (12 days) assisted in the preparation and revision of the modules used in the training.

• Phillppe Girault continued to provide technical assistance for the development of MSM subagreements and was instrumental in coordinating the implementation of the MSM study. (30 days)

• Sarah Huffam (9 days) has recently begun a three-month consultancy to review and suggest a strategy for improvements in the STI clinical services in Papua.

• Sally Wellesley (3 days) provided report writing and editing expertise for the development of the previous quarterly report.

• Made Setiawan and Ferry Kamil continued to provide part time technical assistance to the IDU component and were active in proposal development and training during this quarter.

• Gede Ngurah Surya finished his assignment concerning the organization and facilitation of the ethical surveillance workshops this quarter, and also provided assistance to the Program Management Unit on proposal development.

• Siti Nurdjaja Saltief was hired to begin work on the development of a network for PLWA in Papua.

• Joedo Prohartono provided help in the strategy assessment of FSW activities with Yayasan Kusuma Buana in Mangga Besar, Jakarta.

• The MSM study required a significant number of consultants during this quarter, including blood collectors Bambang Wibowo, Kardin, Kasmay, Sulaiman Susanto, Wahyu Winarto; networking and respondent recruitment consultants Stephen, M. Juharto, and Deddy Gunawan; and clinical services consultants Dr. Maya Trisiswati and Erdini Angriani.

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• Dr. Atiek Anarati and Dr. Kimmy Ampera continued to provide excellent assistance in assessing STI services, training of STI facilities in Merauke, and providing practical clinical expertise to other selected STI clinics.

• Dr. Ninik Sukartini also continued to assist Dr. Elizabeth Donegan in the assessment and training for STI laboratories, and in several laboratory test evaluations.

• Several consultants were involved in the development of modules to support the private sector leveraging training including Annisa Sahid, Tetty, Adi Sasongko, Yeremais Wutun, Yani Mulyani, Ira Atmosukoto, Alfita Moelyadi and Ari Wibowo.

• Rio Helmi began his work on the development of a photographic exhibition devoted to PLWA, which will be ready for World AIDS Day 2002.

• Titin Sri Redjeki is providing technical assistance to Bandungwangi to improve their management systems and develop a subproject proposal.

• Berchmans Mau Bria began his assistance in Papua to organize a network with religious groups that would support HIV/AIDS prevention.

• Dasih Aries Listyani is providing assistance to Yapepa to revise the module on HIV/AIDS that will be integrated into the school curriculum in Mareuke.

• Dr. Ade Chandra has been hired to assist Dr. Sarah Huffam in her assessment of the STI clinics in Papua, and will continue to work with ASA in developing training for HIV/AIDS care and support with the PLKM in Makassar.

• Danny Yatim also continued to provide assistance to the BCC unit in module development and facilitating training during the project director workshops in Yogyakarta.

Visitors

The program also received assistance from the following international visitors this quarter:

• Robert Baden, FHI ARO, visited twice during the quarter, from 8–12 April to

provide direct assistance and training to the ASA C&G unit on contracts and grants, and from 27–31 May to assist in the training for proposal writing for ASA staff.

• Elizabeth Donegan, UCSF, visited from 20 April to 5 May to continue her assessment of STI laboratories, and to help prepare and coordinate the MSM study.

• Dave Burrows (21–26 April, 27–31 May and 24–28 June), Vanessa Gstrein (27–31 May) and Annie Malcolm (21–27 June) from the Burnet Institute visited several times to design and negotiate amendments to their Partner Agreement, and to plan appropriate IDU interventions with ASA.

• Ton Smit (23–26 April and 27–31 May) and Umesh Sharma (21–26 April, 27–31 May, and 24–28 June) from AHRN also visited to design and negotiate an amendment to their Partner Agreement, and to plan coordinated IDU interventions.

• From 5–11 June, FHI organized an Internal Review of the ASA Program by Peter Lamptey, Peter Mwarogo (FHI Uganda), Steve Mills, and Ladda from FHI ARO.

• Nancy Jamieson, FHI ARO, provided assistance during the Management of Outreach Workshop in Yogyakarta from 14–25 May.

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• Training for ASA staff in proposal writing was held in Jakarta from 27–31 May with the assistance of Tony Bondurant, Chutima, and Siripon from FHI ARO.

• Erik Van Pragg from FHI Headquarters provided technical assistance during the development of national guidelines for care and support from 5–14 June, during the national meeting in Jakarta.

• Neil Brenden, FHI ARO, completed a brief supervision and management support visit from 11–14 June.

4. PRODUCTS AND MATERIALS PRODUCED THIS QUARTER The products and materials produced this quarter by the ASA Program include:

• Promotional materials for BSS respondents: - cap for males - purse for females - leaflet

• Promotional materials for the MSM study respondents:

- flyers – 2 - posters – 2 - t-shirt - shopping bag

• Public Service Announcements: Television (5 titles)

• Public Service Announcements: Radio (6 titles)

• Assessment of the Sero-surveillance System for HIV in Indonesia. Progress Report. ASA Program and the Subdirectorate for AIDS and STIs. May 2002.

• IEC Materials Quick Review Report. Studio Driya Media. Bandung. April 2002.

5. MAJOR ACTIVITIES PLANNED FOR THE NEXT QUARTER

The major activities planned for the next quarter, July to September 2002, include:

• Subagreement Development. Over 70 subproject proposals are in various stages of development at present, with at least 35 targeted for completion by September.

• Workplan Year 3 Development. The workplan will be drafted by the end of June and

reviewed in Jakarta by a team from FHI ARO in mid-August before being finalized for submission to USAID on 1 September 2002.

• Capacity Building Workshops. Workshops will continue this quarter in Central Java,

West Java, North Sumatra and South Sumatra, focusing on financial management for NGOs (with ASA Partner, REMDEC), and on strengthening the overall management of NGOs (with Business Dynamics).

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• MSM Study. Data collection will be finished by mid July, followed by data analysis.

Dissemination will begin with each of the various target groups as soon as preliminary results are available.

• BSS Study. Data collection in the three pilot provinces will be completed in July,

followed by data analysis and review; and preparations will commence for the expansion of the study into the other seven provinces in October.

• Private Sector Leveraging Training. Rehearsals of the training modules will continue

with ASA and Yayasan Kusuma Buana in Jakarta and with Yayasan Utama in Riau, before YU begin the actual interventions with private sector companies in September. YKB will also organize the first regional training in workplace programs for NGOs in eastern Indonesia, also in September.

• Prevention Marketing. Production of materials for below the line campaign with DKT

will begin this quarter. The HIV/AIDS prevention spots will continue to be aired on TVRI and TPI, and the radio spots will continue on 20 stations in five major cities as planned. The print ads will also continue in selected tabloids and newspaper in the same five cities.

• STI Clinical Services. Training in STI clinical management will be organized for

selected clinics associated with ASA in Riau, Papua and North Sulawesi during August and September. Training for doctors and midwives in STI and HIV/AIDS will also be organized in Papua and Riau in September. Approximately 20 clinics associated with ASA will join a workshop in Jakarta to finalize proposals for subagreements in early August.

• Care and Support of PLWA. Spiritia will be organizing a 10 day working visit to

Papua in July to strengthen the local network of PLWA and provide advocacy to local government officials and NGOs concerning appropriate strategies for care and support of PLWA.

• Workshop for Harm Reduction Implementing Agencies Network. The workshop will

be held on 5–7 August in Jakarta to determine organizational structure and develop basic strategies. Included in the workshop will be NGOs, government agencies, local puskesmas and other stakeholders working with IDUs.

• Voluntary Counseling and Testing. A meeting on VCT will be held in September for

the counselor working group in Jakarta and the surrounding areas to socialize the concept of VCT and discuss a presentation by a local NGO in Bali on their experience with VCT.

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GLOSSARY

AHRN Asian Harm Reduction Network AMCHAM American Chamber of Trade ARO Asia Regional Office ASA Program Aksi Stop AIDS Program BCC Behavior Change and Communication BPS Badan Pusat Statistik (Central Bureau of Statistics) BSS Behavior Surveillance Survey CBO Community-based Organization CDC and EH (Directorate of) Communicable Disease Control and Environmental

Health CHRUI Center of Health Research, University of Indonesia DepKes Departemen Kesehatan (Ministry of Health) DepSos Departemen Sosial (Ministry of Social Affairs) DKI Jakarta Daerah Khusus Ibukota Jakarta (the provincial-level administrative

unit covering Jakarta) DK Dinas Kesehatan (Province/Municipality District Office of the MoH) DKT Social Marketing Program DPRD Dewan Perwakilan Rakyat Daerah (Local Legislatureors) FGD Focal Group Discussions FHI Family Health International FSW Female Sex Workers GOI Government of Indonesia HDI Howard Delafield International HIV Human Immunodeficiency Virus IA Implementing Agency ICAAP International Congress on AIDS in Asia and the Pacific IDU Injecting Drugs Users IEC Information, Education and Communication ILOM Indigenous Leader Outreach Model KADINKES Kepala Dinas Kesehatan (Chief of District Health Department Office) Kabupaten District KPAD

Komisi Penanggulangan AIDS Daerah (Regional AIDS Prevention AIDS Commission)

LitBangKes Ministry of Health Research and Development Center MoH Ministry of Health MSM Men who have Sex with Men MSW Male Sex Worker narkoba narkotika dan bahan berbahaya (narcotics and dangerous substances) NGO Non -Governmental Organization P2M&PL Dit. Jen. Pemberantasan Penyakit Menular dan Penyehatan

Lingkungan (Directorate of Communicable Diseases CenterControl and Environmental Health)

PATH Program for Appropriate Technology in Health PKBI Perkumpulan Keluarga Berencana Indonesia

(Indonesian Parenthood Planning Foundation) PKPM Atma Jaya

Pusat Kajian Pengembangan Masyarakat Atma Jaya (Community Development Research Center for Societal Development Studies, Atma Jaya)

PLWA People Living With AIDS puskesmas Pusat Kesehatan Masyarakat (Community Health Center) REMDEC Result Management and Development Consultant RP Result Package RRF Rapid Response Fund RSCM

Rumah Sakit Cipto Mangunkusumo (Cipto Mangunkusumo Hospital)

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RTI Research Triangle Institute STI Sexually Transmitted Infection TBCA Thailand Business Coalition on AIDS TOT Training of Trainers UCSF University of California, San Francisco UI University of Indonesia VCT Voluntary counseling and testing Waria Male Transvestite WHO World Health Organization YAPEPA

Yayasan Peduli Perempuan dan Anak (Foundation for Women and Children)

YKB Yayasan Kusuma Buana (Kusuma Buana Foundation) YKB Jayapura

Yayasan Kesehatan Bethesda (Bethesda Health Foundation)-Jayapura

YPI Yayasan Pelita Ilmu YU Yayasan Utama (First Foundation)