This document outlines a health promotion program to prevent HIV/AIDS using the PRECEDE-PROCEED framework. It begins with an introduction and objectives. Baseline data is presented on the target population which shows some risky behaviors. A needs assessment is then conducted using the PRECEDE components which examine social, epidemiological, behavioral, educational, and policy factors. Objectives are set and a program is designed which includes awareness activities, condom demonstrations, and monitoring. The program aims to increase knowledge of HIV prevention and promote safe sexual practices to reduce new HIV cases in the target area by 50% by 2022.

1. Health Promotion and Education program in
prevention and control of HIV/AIDS
using PRECEDE-PROCEED framework
BY :
Arjun Hamal - 588
Shirshak Shahi - 621
1

2. Presentation Introduction
• Total slide no of slides : 37
• Time of Presentation : 20 minutes
• Queries : you will get 10 min for ask question
2

3. Objective of the presentation
To share planning of health education program on prevention
of HIV/AIDS so as to develop presentation skills.
3

4. Contents
 Introduction
 Framework PRECEDE/PROCEED
 Baseline information
 PRECEDE
• Social Assessment
• Epidemiological Assessment
• Behavioral and Environmental Assessment
• Educational Assessment
• Administrative and policy assessment
 PROCEED
• Program design
• Resource assessment
• Objectives
• Detail plan of action
• Implementation of the program
• Monitoring and evaluation of the program
4

5. HIV is retrovirus that causes acquired immune deficiency syndrome
(AIDS), AIDS is a condition in humans in which the immune system
begins to fall leading to life threatening opportunistic infections.
Mode of Transmission
• Direct contact of a mucous membrane or the bloodstream with a
bodily fluid containing HIV, such as blood, semen, vaginal fluid,
seminal fluid, and breast milk.
• Anal, vaginal or oral sex
• Blood transfusion
• From mother to baby during childbirth,
• Sharing of contaminated syringes and needle.
Introduction
5

6.  Major signs are:
• Wt. loss > 10 % of body weight.
• Chronic diarrhea for more than 1 month.
• Prolonged fever of more than 1 month.
 Minor signs are:
• Persistent cough for more than 1 month
• Generalized pruritic dermatitis.
• History of herpes zoster.
• Oropharyngeal candidiasis.
• Generalized lymphadenopathy
6

7. Baseline information
from Bandipur rural municipality, Ward-4. Tanahun
• Total households: 852
• Total Populations:4321
Major ethnic group
• Gurung-51.2%
• Newar- 23.3%
• Brahamin /Chhettri -19.1%
• Others- 6.4%
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8. 8

9. Social Assessment
• Decreased self reliance/ Confident/low self esteem
• Reduced community participation
• Unemployment rate increase ultimately( ↓ 𝐺𝐷𝑃 2-3%)
• Lower quality of life
• Living with social Discriminate and stigma
• Increase expenditure to treatment
• School (80%) and job absenteeism (62%) among HIV infected
• Illiteracy in total population 26%
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10. Epidemiological assessment
National scenario
Key population are as follows
• People who inject drugs 4%
• Sex workers and their clients 13%
• Men who have sex with men and transgender 9%
• Male labor migrants and their wives
• Prison inmate
• HIV prevalence among adult population in the country is below 1%
• People living with HIV in Nepal: 31020
• Majority is adult 15-49 years people : 22812 (alive 21148)
• Children : 1192
source NCASC.gov.np
10

11. In Bandipur Rural Municipality
• PLWHA: 8 which is less than about 2 percent of total
population
• Majority in adult : 75 % (6 number)
• Children : 25 % (2 number)
• History of Multiple sex partner among PLWHA: 37.5 % (male
25% and female 12.5%)
• History of labor migration among PLWHA 75% (6 male). High
prevalence among migrants. (especially who work in India)
11

12. Behavior and Environmental Assessment
Significant behavioral factors:
 practice of using condom Among (15-49) WRA population 2%
Poor health care utilization ( people don’t know the available
services and also they don’t want to go checkup while they back
to from Labor migration)
Multiple sex partner - 12%
Currently on ART - 75%
Poor ANC check up ( coverage only 22%)
Unsafe sex with female sex workers. (migrant worker)
12

13. Environmental factors:
• Poor Accessibility / Availability the health services
• Unsupported family and community
• Acceptability of condoms by partners
• Availability of comprehensive sex education
(Comprehensive sex education include : knowing that consistent use of condoms during sexual
intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV,
Knowing that a healthy-looking person can have HIV and rejecting the two most common that a healthy-
looking person can have HIV, and rejecting the two most common local misconception about
transmission or prevention of HIV.)
13

14. Prioritized behavior for health education intervention: unsafe sex and incorrect use
of condom.
score : 1- Very low, 2 – low, 3- neither low nor high, 4 high, 5- high
Behavioral prioritization
Behavior Important Changeability Total score
Unfaithful with
partner/(Multiple sexual
partner)
4 3 6
unsafe sex / incorrect
correct use of condom
4 4 8
Health care utilization
during ( ANC )
2 3 5
14

15. Educational Assessment
Predisposing factors: Knowledge, attitude, behavior which are related to HIV/AIDS.
• Heard about HIV/AIDS: women- 81% and men- 98%
• HIV: communicable- 70% and non-communicable 30%
• Transmission of HIV/AIDS : unsafe sex- 60%, infected Blood transfusion- 15%, IV drugs
or Syringe sharing – 10%, Handshaking- 35%, mosquito bite- 50%
• Prevention: possible- 65%, not possible – 20% and not known- 15%
• Availability of treatment (ART): Government health facility- 45%, Private hospitals
and clinic 30 % and don’t know 25%
• Forty five percent know that correct use of condom can prevent HIV transmission.
• Treatment cost : Totally free- 15%, partially take cost- 30%, take cost- 50% and don’t
know-5%
• Only 5% people know PMTCT.
• Two % people heard the term HTC and ART.
• Only 2% of adolescence use condom.
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16. Educational Assessment
Reinforcing Factors:
• Health and sex education on HIV/AIDS and STD not integrated with
school education, Mothers group meeting session not conducting
effectively.
• Partner support: Avoiding use of condoms (region-reduce sexual
pleasure)
• Availability of effective awareness program in HIV/AIDS is lacking.
16

17. Educational Assessment
Enabling Factors:
• Service availability on Health facility, structure of service providing are
poor.
• Skills of use of condom poor
• Community perception: (community people believes HIV related behavior,
prevention and treatment is individual matter.)
• Absence of Awareness and education program through media and exposure
to the media
• Counseling on safe sex not available
• Health Worker have poor counseling skills
17

18. Administrative and policy assessment
Nepal health policy 2071 has strongly supported to HE program.
• Free HTC and distribution of ARV drugs.
However,
• No health education focal person on Bandipur rural municipality and
HE and sexual education is often ignored by all sector.
• Poor logistic and poor skilled human resource.
• No health education corner in HP.
• No any private supportive organizations and programs.
18

19. Health education program design
• Goal
Improve health related quality of life attributes by HIV/AIDS in Bandipur
RM ward 4 of Tanahun District.
• Program objective
Reduce the incidence of HIV by 50 percent at the end of 2022 by health
education program.
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20. Behavioral objectives:
• To change unsafe sex behavior of 70 % population after three years of
health education program on safe sex and correct use of condom.
• To promote sexual practices with their spouse only of 80% of
population after three years of health education program on safe
sexual practices.
• To explore the available health services to all people of Bandipur after
three years of health education program on HIV/AIDS.
20

21. Educational Objectives
• To develop knowledge and skills of reproductive age group people of
correct use of condom.
• To promote the importance of safe sexual practices.
• To aware people to have sex with multiple sex partners.
• To develop knowledge about the causes of HIV/AIDS and its
prevention.
21

22. Organizational and policy objectives
• To create environment to conduct and run the mothers group meeting
regularly from the end of the year2022.
• To develop the knowledge among health workers and FCHVs on safe
sex and correct use of condom.
• To establish Health Education corner at local health facility and all
schools of Bandipur by the end of the year 2022.
22

23. Resource Assessment
Resource source
IEC materials HO/Local health facility
Human resource HO/Local health facility
Funding Bandipur RM office and EO
Infrastructure Local community
23

24. Program design
24

25. Planning matrix
Objectives Activities Indicators/Targets Means of verification
Overall goal
Improve health related Qol of
people attributed by
HIV/AIDS in Bandipur rural
municipality in Tanahun
district.
HE program on safe sexual
practices.
Human development index
(HDI)
Rural municipality health
profile, health facilities
reports and Education
profiles
Program objectives
Reduce incidence of HIV by
half i.e. 50%
HE program on safe sexual
practices.
• 70% of the local people
will have the knowledge
about the proper use of
condom.
• 80% of the local people
will know about safe sex
practices.
Rural municipality ward -4
post survey after the
program.
25

26. Objectives activities Indicators/target Means of verification
• To develop knowledge
and skills of
reproductive age group
people of correct use
of condom.
• To promote the
importance of safe
sexual practices.
• To aware people to
have sex with multiple
sex partners.
• To develop knowledge
about the causes of
HIV/AIDS and its
prevention.
• Meeting and discussion
about safe sexual
practices and its
importance with health
workers, FCHVs /health
workers/ local
leaders/peoples
• Discuss about cause
and prevention of
HIV/AIDS with local
people.
• Demonstration on
correct techniques of
use of condom.
• 85% participants can
describe about the
importance of safe sex
practices.
• 90% participants know
about the proper use
of condoms.
• 70% of the participants
will be aware of having
sex with multiple sex
partners.
• 90% participants can
describe about causes
and preventions of
HIV/AIDS.
Pretest and post surveys.
26

27. Detail plan of action
27

28. Activities Target group Methods/Media Resource
persons
Date , time and
Venue
Remar
ks
Meeting and
discussion on
HIV/AIDS and
Safe sex
practice,
FCHVs, health workers,
formal and informal leaders
and teachers, social workers
Group discussion
/Flip
chart/electronic
medias.
Focal person
of HIV/AIDS
District/RM
Bandipur RM, ward-
4 office hall
2019 April 1 and
April 2
Mini –
lecture on
HIV/AIDS
• Adolescents.
• Local leaders and school
teachers.
• Members from CBOs,
Youth clubs and NGOs.
• FCHVs and members of
mothers group
• Mini lectures
• Group
discussions
• Posters
• Pamphlets
• Flip charts
• Video show
• HIV/AIDS
focal
person /HP
In-charge,
Bandipur RM, ward-
4 office hall
2019 April 15- Jun
30
28

29. Activities Target group Methods/Media Resource
persons
Date , time and
Venue
Remar
ks
Role Play • Adolescents.
• Local leaders and school
teachers.
• Members from CBOs,
Youth clubs and NGOs.
• FCHVs and members of
mothers group
• Role play
• Mike
• Posters
• pamphlets
FCHVs
students
Health post
health workers
All the village and
town of ward no.4
2019 July 15 10 to
October 30
Wall painting
through out the
all popular
places of Ward
no 4
Community people Wall painting Painter by
hired
All popular places
of ward no.4
2019 nov 1 to
2020 jan.
29

30. Activities Target group Methods/Media Resource
persons
Date , time and
Venue
Remar
ks
Radio
comprehensive
health education
program on safe
sex practice and
HIV/AIDS
All community
people
Interview
Audio tape/Radio
Short Add type audio
message
Communicati
on team
• Radio Bandipur
• 2019 april to
2022 december
Mothers group
discussion on
multiple sex
partner, HIV/AIDS
and prevention
All mothers
groups of ward
Group discussion
Role play
FCHVS
HP staffs
• Each village of
ward -4
30

31. Activities Target group Methods/Med
ia
Resource
persons
Date , time and
Venue
Rema
rks
Demonstra
tion on
correct use
of condom
Adolescence people
Mothers group
Community peoples
Group
discussion
Demonstration
FCHV of
each areas
All village
meeting halls
2020 January 1
to end of 2022.
31

32. Risk Management
Risks Risk Management
The willingness of the community may
decrease during the program
Community will be involved in all stages
of the program: planning,
implementation and evaluation
Seasonal busyness of local people Program will be conducted in off time.
32

33. Implementation of the program
It is the process of putting the plan of action into operation. Health
education program on HIV/AIDS is implemented by using the
following strategies:
• Building commitments
• Training of human resources
• Mobilizing & utilizing resources
• Organizing community
• Monitoring of the program
• Supervision
33

34. Monitoring of the program
It will be done by;
• Observing the working situation.
• Interviewing the field workers and community people.
• Reviewing the reports and records.
• There will be one monitoring and evaluation sub-committee for the program.
• The members will be deputy mayor of the rural municipality and ward
chairperson, health post in charge , one target group representative and one
RM health coordinator representative.
• The focal person for the program monitors and advise where required, and will
ensure that there is good accountability and also act as process facilitator.
• The committee will monitor the program two time a month.
• Each monitoring will produce a report and the monitoring findings will be
utilized to modify and strengthen the health education program. 34

35. Evaluation of the program
Done at all level of program phases
• Process evaluation :Evaluation of implementation of detail
plan of action and educational objectives and indicators.
• Impact Evaluation :Behavioral change regarding the safe sex
and correct use of condom; increase in KAP HIV/AIDS; and
how they behave with HIV positive etc. will be taken as the
major indicators.
• Outcome evaluation :Evaluation of social indicators and
objectives
35

36. 36

37. Reference
• Ministry of health, Nepal, New ERA, and ICF 2017. Nepal
Demographic And Health survey 2016 Kathmandu, Nepal
• MOHP, DOHS Nepal, Annual report 2072/73 Kathmandu Nepal
• Sapkota SP. and Pahari D. A test book of Health promotion and
Education
• Websites:
• http://www.ncasc.gov.np/WAD2018/FACTSHEET-2018-
FINAL/Factsheet-2018-final.pdf
• http://library.nhrc.gov.np:8080/nhrc/bitstream/handle/12345678
9/411/244.PDF?sequence=1
37