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Regional Review
CM
MY
CY
CMY
Buddhist Leadership
Initiative
UNICEF EAPRO
July 2009
Regional Review
Buddhist Leadership
Initiative
UNICEF EAPRO
July 2009
Cover photos:
(1) Focus Group Discussion with monks, BLI project in Xishuangbanna, Yunnan Province,
China: Unknown/UNICEF China, 2007
(2) Monks conduct life skills training at Keo Pan Ya School in Saphan Mo village,
Vientiane, Lao PDR: Jim Holmes/UNICEF Lao PDR
(3) Monks conduct an HIV education session using a participatory tool made of cloth and
cards in Khum Wat Kandal village, Raing Kersey commune, Battambang Province,
Cambodia: Udom Kong, UNICEF Cambodia, 2006
(4) Children doing their homework: Unknown/UNICEF Lao PDR
Contents
Acronyms
Acknowledgements
Executive Summary
v
vii
ix
1
1
2
4
5
5
5
11
11
11
12
13
Introduction
Key principles of the Regional Strategy
Regional Buddhist Leadership Initiative Monitoring and Evaluation Framework
Objectives of the multi-country review
CHAPTER 3: METHODOLOGY
15
15
15
16
18
20
20
21
21
23
23
24
Introduction
Trends in risk behaviours in the BLI countries
27
27
30
33
40
46
51
51
52
54
56
61
61
61
62
63
63
Endnotes
65
References
66
67
Acronyms
AIDS
ARV
Anti-Retroviral
BCC
BLI
EAPRO
FGD
HCMC
HIV
IEC
Lao PDR
MOLISA
NBA
NGO
Non-Governmental Organization
OVC
PLWHA
PPS
STI
Sexually-Transmitted Infection
UNICEF
VCCT
VNFF
Acknowledgements
The Buddhist Leadership Initiative (BLI) is a regional strategy for Buddhist involvement in
the response to HIV and AIDS in the Mekong Sub-region. Initiated by UNICEF East Asia and
the Pacific Regional Office (EAPRO) and Country Offices, the BLI was introduced in five
countries (Cambodia, China, Lao PDR, Myanmar and Viet Nam) of the Greater Mekong
Sub-region between 1998 and 2004.
The primary objective of the BLI is to mobilize Buddhist monks and nuns to lead their
communities in:
1. increasing access to care and support for adults and children living with HIV and AIDS
and children affected by AIDS;
2. increasing community acceptance of adults and children living with HIV and AIDS; and
3. building HIV resilience in communities, particularly among youth.
In 20062007, a multi-country review of the Buddhist Leadership Initiative was conducted by
the Country Offices under the guidance of UNICEF EAPRO to collect quantitative and
qualitative data and assess the impact of the BLI as a regional initiative.
This report presents the synthesis of the review undertaken in the five countries (Cambodia,
China, Lao PDR, Myanmar and Viet Nam) and the impact of the BLI as a regional initiative.
The report identifies achievements, and limitations of the BLI as well as lessons learnt.
Recommendations for strengthening and expanding the BLI interventions are included.
UNICEF EAPRO appreciates and acknowledges the contributions of Carol DSouza,
Consultant, for conducting the secondary data analysis of the five country reviews and
Shirley Mark Prabhu, HIV and AIDS Consultant, for providing additional technical inputs and
facilitating the completion of this report. Special thanks to Yoshimi Nishino, Regional HIV
Specialist and Wing-Sie Cheng, Regional HIV and AIDS Adviser, for their valuable
comments, regular guidance and direction to the regional review as a whole. The assistance
of Editha Venus-Maslang in editing the report is acknowledged.
UNICEF EAPRO appreciates and acknowledges all the contributions made by the Country
Offices (Cambodia, China, Lao PDR, Myanmar and Viet Nam) to the regional review. In
particular, our sincere gratitude to the following HIV and AIDS Chiefs/Specialists Ken
Legins and Wenqing Xu of UNICEF China, Verity Rushton of UNICEF Lao PDR, and Scott
Bamber of UNICEF Thailand, for their valuable comments and feedback.
We gratefully acknowledge the generous support provided by the Department for
International Development (DFID) United Kingdom.
vii
Executive Summary
Introduction
The mobilization of the faith-based organizations is increasingly acknowledged as a vital
part of the response to HIV and AIDS. The last few years have seen the flowering of faithbased organizations and networks working in HIV and AIDS in the East Asia and Pacific
region. The involvement and partnership with faith-based organizations are extremely
crucial to achieve the HIV commitments that countries have made.
As trusted and respected members of the society, religious leaders are listened to. Their
actions set an example. This can be especially instrumental in eradicating the stigma and
discrimination against people living with HIV and AIDS.1
In many places, a culture of silence surrounds HIV and AIDS. Religious leaders are uniquely
poised to break the silence by acknowledging suffering and reaching out with compassion
to the excluded and rejected. They have the power to end guilt, denial, stigma and discrimination
and open the way to reconciliation and hope, knowledge and healing, prevention and care.2
ix
xi
In China, the Home of Buddhist Light was launched as a model for care and support and
shared with the national level AIDS Prevention and Control authorities. The package of care
and support includes religious and group counselling with people living with AIDS and their
families: fund raising among Buddhists who attended religious services; income generation
activities for people with AIDS; educational classes on health and hygiene practices, self
help group activities, medical referrals for ill members of the support groups; and antidiscrimination activities among monks and in communities affected by AIDS.
In Cambodia, to promote greater community involvement in supporting people living with
HIV and affected families, contribution boxes are managed by the pagoda committees
established in each temple. The members of the pagoda committees are monks and
leaders from the surrounding communities. Using donations collected through the
contribution boxes and funding from UNICEF, pagoda committees are able to provide food
support, to facilitate childrens schooling as well as to provide access to medical care to the
most deprived families and children or families in crisis based on their needs. In 2007, about
2,100 children affected by HIV were supported with food and school materials.11 In Viet Nam,
with UNICEF assistance, about 1,000 CABA and PLWHA in BLI sites have benefited from
home-based and community-based care and palliative care.12
Enhanced support national Buddhist associations
In all the countries, the national Buddhist associations have actively supported HIV and AIDS
related work. In Lao PDR, 44% of respondents declared that they have been supported by
the National Buddhist Association in their HIV and AIDS prevention work and that providing
policy directives, letters or decrees have encouraged monks participation in HIV-related
activities. Further, the share of monks trained under the BLI who were supported by the
National Buddhist Association is significantly higher than that of untrained monks (62% vs.
26%). 80% of the monks in Ho Chi Minh City, Viet Nam agreed that the National Buddhist
Association supported the Provincial Buddhist Association in HIV and AIDS prevention work
by involving monks from the National Buddhist Association in National AIDS committees.
78% of the monks said that other support from the National Buddhist Association was in
providing policy directives, letters or decrees from the highest authority that encouraged
monks participation in HIV-related activities.
xii
In all four countries (Cambodia, China, Lao PDR and Viet Nam) for which quantitative
data are available in BLI and non-BLI sites, monks who received BLI training had better
knowledge of the relevance of Buddhist scriptures for reducing stigma and discrimination.
Increased involvement in prevention and stigma reduction programmes
Findings reveal that monks who received BLI training are much more likely to be involved in
prevention, stigma reduction programmes than monks who were not covered by the BLI.
The quantitative study for Cambodia found that a total of 35% of junior monks surveyed are
involved in reducing stigma and discrimination against PLWHA. A breakdown of trained and
untrained monks shows that 66% of monks who underwent BLI training had been involved
in promoting non-discriminatory attitudes towards PLWHA, compared to 27% of untrained
monks. Similarly, in China, a larger proportion of junior monks participated in activities
to reduce prejudice and discrimination against PLWHA in the exposed site than in the
non-exposed site. The Lao PDR is one of the few countries to develop a stigma reduction
communication campaign based on an appeal to Buddhist compassion. A major initiative in
2005 was the advocacy campaign Buddhist Compassion: Hope and Help for people with
HIV and AIDS. Also a poster art exhibition was designed to promote acceptance and
support for people living with HIV and AIDS. These included TV spots, posters, a special
edition of the Metta Dhamma Newsletter and a 2006 calendar.
Further, findings from the qualitative studies suggest that there is a widespread view that
monks should more frequently incorporate Buddhist scriptures into anti-discrimination
messages. In Cambodia, when the PLWHA were asked in FGDs about the most effective
methods of monks to reduce stigma, their response was preaching scriptures, especially the
Five Precepts in any traditional ceremony at home or at temple ceremonies.
Effective temple-based programmes
Findings of the multi-country review reveal that the most effective temple-based
programmes conducted by the monks were providing spiritual comfort (through meditation
and counselling) and material support (by providing shelter and income-generating
activities). The monks who were trained by the BLI provided counselling services compared
to non-BLI trained monks. In Viet Nam, the proportion of monks/nuns providing psychological/
spiritual counselling sessions on HIV and AIDS in the last 12 months was 41% in BLI sites,
compared to only 8% in the non-BLI sites. Many PLWHA remarked that they very much
appreciated the support provided by monks such as counselling, meditation, sermons and
compassion. In Viet Nam, 30% of monks and nuns in the BLI site had organized home visits
to care for PLWHA and their families in the past 12 months. The corresponding proportion
in the non-BLI sites is only 2%.
Increased engagement in IEC programmes
Compared to monks in the non-BLI sites, the monks in the sites where the BLI interventions
were undertaken have engaged in IEC activities which were aimed at reducing community
vulnerability to HIV. Monks were involved in the production of Buddhist educational
materials, putting up HIV and AIDS awareness posters, speaking on radio and TV about HIV,
contributing to Buddhist Initiative newsletters, distributing flyers with teaching about the
Buddhist principles in relation to HIV, using Buddhist IEC materials on HIV, community
education on HIV and youth related activities. In Cambodia, 5,000 copies of the booklet
entitled Monks and Society along with 5,000 copies of the Policy on Religious Leaders
involvement in HIV were printed.15 Findings in Cambodia, China and Viet Nam show that
little training on HIV occurs outside the BLI.
xiii
Challenges
The general community education on HIV provided by monks was found to be uneven in
terms of reach and impact and requires improvement. The knowledge of HIV prevention was
lower than that of HIV transmission modes. Findings from the survey reveal that there
remain misconceptions about the modes of transmission and prevention of HIV and AIDS,
which underscores the need for targeted education efforts to reduce misconceptions in the
community members. Further, stigma and discrimination remain serious barriers to
effective prevention efforts.
Some country studies (Lao PDR and Myanmar) noted the lack of support and encouragement
from senior monks and abbots for the participation of junior monks in BLI activities. The
evidence from the Cambodia, China and Viet Nam review show that monks have little
knowledge about local facilities that provide AIDS treatment and life skills, although the
corresponding shares are much lower for monks in the non-BLI sites.
The capacity of Buddhist monks in many countries was quite low in terms of education,
access to resources and management skills. Information exchange was limited by need for
translation and interpretation as most monks do not speak English in Cambodia, Thailand,
Lao PDR and China. Monks and nuns have struggled with new ideas like participatory
learning which is difficult to grasp as in the case of monks in Lao PDR. However, these
problems have lessened substantially over the life of the project.
In the BLI sites in all three countries, project management was among the least common
topics of training. The monks faced difficulty complying with project accounting and reporting
procedures which is quite alien to the traditional way of running activities in pagodas. Lack
of administrative and management skills such as project planning, proposal writing and
reporting was also seen.
The government has continued to support the work of the BLI in many ways. Although
constrained by local social, political and economic realities, the BLI has made progress in
countries.
In most of the countries, lack of financial support was reported as the main obstacle to
scaling up the programmes. The BLI requires more support and funding over the longer
term to achieve its goals.
xv
Recommendations
Training for the monks needs to place more focus on educating them about local facilities
that provide treatment for AIDS and opportunistic infections, so that monks can have a
greater impact on providing care and support for PLWHA by referring them to the correct
health facilities.
To raise the visibility of monks activities, the frequency of BLI interventions should be
increased. Specific interventions to be expanded are:
Teaching meditation and providing other spiritual support to PLWHA. Meditation training
and spiritual guidance are among the most effective and acceptable interventions for monks
to conduct, and therefore should be given priority.
Psychological counselling for HIV-positive persons and their families. More monks should
be trained in counselling to help PLWHA, people dying of AIDS, and their families cope
emotionally.
Outreach education activities. HIV prevention education to communities should be
expanded to reach a wider audience and should be adapted locally to address weaknesses
in community knowledge and attitudes.
Preaching tolerance and compassion towards PLWHA, using methods that have been
perceived positively by communities, such as the use of Buddhist scriptures in antidiscrimination messages, and the dissemination of IEC materials. Improving knowledge
and awareness of HIV and AIDS issues among the community is another (more indirect)
approach towards promoting non-discriminatory attitudes against PLWHA.
Supporting PLWHA self-help groups with materials, income-generating activities, space for
meetings, and shelter has proven to be beneficial to PLWHA and should be continued.
Monks should also engage in encouraging more PLWHA to join self-help groups.
Home visits to PLWHA. These interventions are crucial in supporting PLWHA emotionally
and spiritually, and in countering discrimination against them. PLWHA have found home
visits to be effective, provided that their confidentiality is protected. Collaboration with
social organizations may be an approach for increasing contact between monks and PLWHA.
xvi
In most cases, youth-targeted interventions are best tackled by educators other than monks.
However, monks can play a role in incorporating HIV and AIDS educational messages in
monastic schools and other classrooms where monks and nuns deliver lessons.
Additionally, monks can be trained to assist parents to positively influence and educate their
children on HIV and AIDS matters.
Moving forward
The Buddhist Leadership Initiative has demonstrated compassion to those infected and
affected, providing care and support and increasing HIV awareness. In addition, it has also
recognized the greater role in providing counselling and moral strength and guidance
to those infected with HIV and AIDS and using their influence to foster more care and
compassion within families and communities.
The contextual reality in each country in terms of HIV prevalence and morbidity, capacity and
resources of monks and nuns, along with the differing degrees of government involvement
has shaped the Buddhist response at national and local levels. In higher prevalence areas
monks are focusing on counselling, and assisting people living with HIV to access care and
treatment as in Cambodia and Viet Nam. In low prevalence countries like Lao PDR, Metta
Dhamma has had a particular focus on prevention activities for young people in schools
through Buddhist Life Skills.
There is greater scope within the BLI to expand prevention activities by addressing
weaknesses in community knowledge and attitudes. Given the nature of the HIV epidemic in
the region, long-term success in responding to the epidemic will require sustained progress in
reducing human rights violations associated with it, including gender inequality, stigma and
discrimination.
Although the BLI initiative has made considerable progress in all the five countries in
addressing many of the issues, there is a need for intensified action and calls for a greater
involvement of the monks, PLWHA, community members and project coordinators to
strengthen and expand the BLI.
xvii
The life of Buddha serves as an example for the role of the Sangha in supporting the community
to find solutions to suffering, as the following illustrates:
After attaining enlightenment, the Buddha did not remain seated under the Bodhi tree but took his
knowledge into the community and shared it with others. Once others had understood the Buddhas
teachings, which were aimed at preventing or alleviating the suffering of all sentinent beings, the Buddha
told his followers to take their knowledge and go out into the community and teach others. In this way,
the Buddha had established a team of workers (the Sangha) to assist him in his mission of spreading the
Dhamma to overcome suffering.
Source: UNICEF, A Buddhist Approach to HIV Prevention and AIDS Care A Training Manual for Monks, Nuns and Other
Buddhist Leaders, June 2006, pg 44.
Mongolia
China
China
(Yunnan)
Myanmar
Lao PDR
Thailand
Cambodia
Viet Nam
UNICEF EAPRO
UNICEF EAPRO
UNICEF EAPRO
2.1 Introduction
UNICEF developed the Regional Strategy
in January 2003 following a process of
review and consultation of the Buddhist
Leadership
Initiative
undertaken
in
November and December 2002 in Lao PDR,
Cambodia, Yunnan Prefecture in China and
Thailand.32 The purpose of the strategy was
to enable local Buddhist monks and nuns in
collaboration with key national Buddhist
institutions, and government agencies, to
implement a Buddhist response specific to
the needs of their national, provincial,
district and local situations.33 The strategy
was aimed at the long-term development of
Sangha capacity to address HIV.
The review of the Buddhist Leadership
Initiative in the four countries identified a
series of issues relevant to HIV that are
common to each country. The issues were
broadly classified under five major problem
headings:
1. Fear and discrimination in the community
keep HIV-positive people hidden and
scared to publicly disclose their HIV status.
2. Lack of support services for HIV-positive
people in the community.
3. Communities vulnerable to HIV due to
changing social circumstances.
4. Lack of resources in the Sangha to
address HIV problems.
5. Project management capacity.
A considerable amount of experience has
been developed by monks engaged in the
response to HIV in Thailand, Lao PDR, China
and Cambodia. Lessons have been learned
about what makes a programme effective
and what can lead to potential pitfalls.34
A Buddhist nun who attended a training course on Care and Support for CABA and PLWHA in
Viet Nam
I have gained a lot of new knowledge on HIV and skills on care and support for CABA and PLWHA. I am
more confident on what to do for these vulnerable people. I hope to receive more similar training
organized by Buddhist Association to improve my capacity in providing support for CABA and PLWHA.
Source: UNICEF EAPRO, Expansion and Consolidation of the Regional Buddhist Leadership Initiative in Cambodia,
Lao PDR and Vietnam 2006-2008, Final Report to the United Kingdom Committee for UNICEF, April 2008
UNICEF EAPRO
13
Methodology
3.2.2 China
The review was carried out in Xishuangbanna
Dai Peoples Autonomous Prefecture, located
on the southern border of Yunnan Province.
Specifically, the review covered Jinghong
City, which was the project site for the BLI,
and Menghai and Mengla Counties, which
were included as control, or non-exposed
or non-BLI sites.
3.2.1 Cambodia
The BLI covered 14 provinces Kampong
Thom, Sihanouk Ville, Takeo, Kampong
Cham, Stung Treng, Prey Veng, Kampong
Speu, Kampot, Pursat, Siem Reap, Phnom
Penh and Kampong Chhang. Out of the 14
provinces covered by the BLI, five provinces
were selected for the review: Kampong
Cham, Kampong Chhang, Phnom Penh,
Prey Veng and Takeo. Baseline data were
collected in two additional provinces, Svay
Rieng and Otdar Meanchey, where an
3.2.4 Myanmar
Although the original intent was to
implement the BLI nationwide, due to
political sensitivity to the nature of the BLI
programme, the BLI was eventually
implemented in Yangon and Mandalay
Division (as well as the outskirts of
Mandalay, including Sagaing). The review
was therefore conducted in Yangon and
Mandalay, with a focus on Mandalay where
there is an opportunity for expanding the
programme.
Countries
Implementation of
the BLI
China
Xishuangbanna Dai
Peoples Autonomous
Prefecture located on
the southern border of
Yunnan Province.
BLI sites
1
2
3
4
5
Kampong Cham
Kampong Chhang
Phnom Penh
Prey Veng
Takeo
Kampong Cham
Kampong Chhang
Phnom Penh
Prey Veng
Takeo
Jinghong City
(Non-exposed or control or
non-BLI sites)
(Exposed site)
Lao PDR
Vientiane Capital,
Savannakhet and
Champasak Provinces
(Exposed site)
(Control site)
Myanmar
Viet Nam
16
3.3.2.2 China
The BLI was only implemented in the
General Buddhist Temple of Jinghong City,
therefore, the temple and all four communities
that it serves were selected for the review.
Only one senior monk could be contacted
from the general temple, but this would not
provide statistically significant results, so
the review for China does not cover senior
monks. In the non-exposed sites, six
temples and their six communities were
selected at random. In addition to the
questionnaire survey, FGDs were held for
each of the target groups in both the
exposed and non-exposed sites.
18
3.4.2 China:
A total of 20 interviewers were hired in
Xishuangbanna. The criteria for selecting
interviewers for the study included
fluency of Dai and Chinese languages, basic
knowledge of HIV and AIDS, and having
both male and female investigators. All
interviewers were trained for the study
during 11 to 13 December 2006. The content
of the training included: the objectives of
the survey, the surveys principles and
methodologies, requirements of sampling,
techniques of self-introduction, how to ask
sensitive questions, getting familiar with
outlines of interviews and questionnaires,
techniques of group interviews/discussions,
recording practice, and quality control.
3.4.3 Lao PDR:
Interviewers were selected to conduct the
BLI review based on their experience with
data collection and/or knowledge about the
BLI in the country. It was important for
selected interviewers to be mature enough
to be able to contact and carry discussions
with senior and junior monks with ease. A
total of six interviewers were selected,
including two females. The training
addressed the following topics: briefing on
the BLI in Asia and in Lao PDR, the plan and
methodology for the review, methods of
interviewing and conducting focus group
discussions, familiarization of review tools
and field-testing, lessons learnt from
field-testing the review tools, and providing
detailed plans for data collection in selected
sites and fieldwork management.
3.4.5 Myanmar:
The interviewers were trained one month
prior to the start of the field survey at
Yangon. Interviewers for the qualitative
study were selected from Yangon based on
their experiences in conducting FGDs and
face-to-face interviews. The interviewers for
the quantitative component of the study
were from Mandalay.
3.4.6 Viet Nam:
The interviewers were selected on the basis
of their experiences working with communities
and monks/nuns. All interviewers were
trained on the objectives of the study,
Qualitative interviews
Myanmar
Since one big monastery did not give consent to conduct 8 FGDs were conducted in Mandalay among monks,
interviews after being selected, only 84 junior monks nuns, male youth, female youth, adult male community
could be interviewed (82% of the target).
members, adult female community members, male
PLWHA and female PLWHA.
Quantitative data could only be collected as baseline data
for the new site in Mandalay. Therefore the report does 8 FGDs were conducted in Yangon (same targets as
not contain any quantitative data on the existing BLI sites above)
in Myanmar.
Viet Nam
Junior monks
Cambodia
China
Lao PDR
Myanmar
Viet Nam
177
132
201
84
113
Senior monks
80
50
10
Community
members
585
825
300
70
401
PLWHA
302
75
79
101
BLI programme
coordinators
Total
1,151
241
625
UNICEF EAPRO
(provincial
coordinators)
966
627
19
Cambodia
China
Lao PDR
Myanmar
Viet Nam
Junior monks
32
18
12
33
32
Community members
24
38
31
32
32
48
30
29
32
32
PLWHA
48
25
31
32
Total
152
92
97
128
128
20
China
Only one senior monk could be contacted
from the general temple. Since this would
not provide statistically significant results,
the review for China does not cover senior
monks.
3.7.1 Cambodia
For senior monks, there were 80 successful
interviews and 141 unsuccessful attempts at
contact, mostly due to missed appointments.
The interviewers successfully reached 177
junior monks but were unable to contact 165
Myanmar
Due to political constraints, quantitative
data could only be collected as baseline data
for the new site in Mandalay. Therefore, this
report does not contain any quantitative
data on the existing BLI sites in Myanmar.
UNICEF EAPRO
21
Note:
The tables given in the report are not directly
comparable between countries because of
the
different
methodologies
used.
Specifically, the project and control groups
were sampled differently in each country.
For instance, in China, the BLI group (or the
22
4.1 Introduction
According to a UNAIDS estimate, 5 million
people were living with HIV in Asia in 2007,
including the 380,000 people who were
newly infected in that year.46 East Asia in
particular is witnessing one of the fastest
growing epidemics in the world, with 20%
more infections compared to 2001, higher
than most other regions.
The epidemics in Cambodia, Myanmar and
Thailand show declines in HIV prevalence
with national HIV prevalence in Cambodia
falling from 2% in 1998 to an estimated 0.9%
in 2006.
Despite the overall achievements in reversing
the HIV epidemic in Thailand, prevalence
among injecting drug users has remained
high. Similarly, recent studies show increasing
prevalence among men who have sex with
men (e.g. in Bangkok from 17% in 2003 to
28% in 2005).47 The estimated number of
adults and children living with HIV in
Cambodia decreased from 120,000 in 2001
to 75,000 in 2007. AIDS-related deaths also
declined from 14,000 in 2001 to 6,000 in
2007.48
In Viet Nam, the epidemic is growing at
particularly high rates. The estimated
numbers of people living with HIV have
increased from 160,000 in 2001 to 290,000 in
2007. Correspondingly, the HIV prevalence
rose from 0.3% to 0.5% within same period.
The estimated numbers of HIV-positive
women grew by more than 100%, from
37,000 in 2001 to 76,000 in 2007.49 In year
2006 2007, HIV prevalence among IDUs
was 34% in Ho Chi Minh City and 23.9 % in
Hanoi.50 Apart from antenatal women, other
key populations at higher risks include
injecting drug users (IDUs), female sex
China (N=825)
65%
52%
37%
Still drinking
91%
98%
89%
0%
0.2%
0%
0%
1%
1%
Still using
0%
0%
64%
61%
91%
94%
55%
77%
60%
21%
17%
28%
Every time
6%
6%
16%
Most of time
7%
7%
11%
Rarely
6%
9%
12%
Never
81%
76%
49%
To avoid pregnancy
43%
66%
59%
20%
26%
10%
34%
5%
1%
18%
13%
20%
Because I am married
46%
14%
36%
14%
32%
22%
16%
19%
5%
3%
4%
94%
67%
44%
Still injecting
and to increasing vulnerability of most-atrisk groups (sex workers and their clients,
men who have sex with men, injecting drug
users) and of migrants and other mobile
populations. HIV prevalence among MSM
and female sex workers (2001 & 2007) in
Vientiane was 1.1%.53
In Myanmar, the first case of HIV was
detected in 1988 while the first AIDS cases,
in 1991. The HIV prevalence in Myanmar
peaked at 0.94% in 2000. Since then, it has
24
UNICEF EAPRO
25
Per cent
100
Cambodia
90
China
80
Lao PDR
Myanmar
70
Viet Nam
60
50
40
30
20
10
Monks/nuns
Family
Friends
School teachers
Health workers
Brochure/posters
Newspapers
TV
Radio
Cambodia
(N=585)
China
(N=825)
Lao PDR
(N=300)
Myanmar
(N=70)
Viet Nam
(N=401)
100%
59%
67%
93%
83%
98%
59%
20%
88%
88%
Blood transfusion
99%
60%
71%
97%
93%
95%
58%
33%
84%
86%
Mosquito bites
17%
20%
12%
21%
16%
Kissing
2%
12%
74%
15%
5%
4%
16%
13%
3%
7%
74%
9%
7%
3%
28
Cambodia
(N=585)
China
(N=825)
Lao PDR
(N=300)
Viet Nam
(N=401)
95%
49%
71%
65%
99%
52%
66%
90%
94%
50%
38%
67%
63%
35%
98%
42%
39%
72%
35%
73%
30%
73%
40%
40%
1%
73%
19%
45%
UNICEF EAPRO
39%
30%
86%
49%
29
5.1.7.2 PLWHA
Among the 302 PLWHA interviewed in
Cambodia, 97% have had a test to confirm
their HIV status. Among them, 89% had it
because they had intended to take the test.
Among them, 61% of the PLWHA who
undertook the test were accompanied by a
spouse (30%), other family member (27%),
sibling (16%), project volunteer (15%), and
parent (10%).
In Myanmar, out of 79 PLWHA, two did not
respond to this question, while 77 PLWHA
stated having known their HIV status for an
average of two years. The longest duration
of awareness of HIV status was seven
years. All PLWHA have undergone a
confirmation test, and 14% were tested
without prior intention. 78% of the PLWHA
were accompanied to the testing centre,
most commonly by a spouse (22%) or
parent (20%).
5.1.8 Summary
The results from the findings in all five
countries show that interventions by monks
have helped increase the knowledge on HIV
and AIDS in the BLI sites compared to the
non-BLI sites. For instance, in China, the
share of community members in the BLI
site who know the correct methods of
transmission of HIV has nearly doubled than
that of the non-BLI sites.
As for the sources of knowledge, television
was the most commonly cited source of
knowledge and awareness of HIV and AIDS
in most countries. The radio is the key
source of information on HIV and AIDS for a
large share of communities surveyed in all
countries except for China.
Although the knowledge on correct means
of transmission among community members
is high among those who have heard of HIV
and AIDS, the percentages are much lower
among community members in China and
Lao PDR who had not heard of HIV and
AIDS. In addition, only a low percentage of
people in Lao PDR are aware about
the transmission by having multiple sex
partners and from mothers to babies. There
remain misconceptions about the modes of
30
China
(N=825)
Lao PDR
(N=300)
Viet Nam
(N=401)
Cambodia
(N=585)
Leave their children to study and play in the same class as a child 37%
who is known to have HIV or AIDS
63%
46%
85%
39%
66%
75%
94%
23%
53%
50%
88%
52%
51%
88%
96%
28%
51%
39%
64%
29%
63%
50%
90%
FGDs in Myanmar
47-year-old vendor (male) from Yangon, Myanmar
We are afraid because we know it is not curable
Female, youth session at Mandalay, Myanmar
I dont eat the snacks they make.
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Figure 2: Proportion of community members who would share objects with a PLWHA
Per cent
100
Cambodia
90
Lao PDR
80
Viet Nam
China
70
60
50
40
30
20
10
0
Plates
Spoons
Cushions
Mats
Bicycles
Figure 3: Share of community members who would treat a relative differently if they found out
that they were HIV-positive
Per cent
100
90
Cambodia
80
China
Lao PDR
70
Viet Nam
60
35
50
31
40
23
30
18
16
16
17
15
20
10
12
12
4
14
13
12
12
14
17
13
7
7
8
Mother
Father
Son
Daughter
11
32
Spouse
In-Laws
Other relatives
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Table 9: Monks engagement in IEC activities aimed at reducing community vulnerability to HIV
Activity
Cambodia
China
Viet Nam
Exposed group
N=35
N=47
N=33
Non-exposed group
(N=142)
(N=85)
(N=80)
Exposed group
37%
36%
27%
Non-exposed group
(9%)
(4%)
(2%)
Exposed group
34%
48%
33%
Non-exposed group
(17%)
(4%)
(4%)
Exposed group
49%
48%
55%
Non-exposed group
(27%)
(13%)
(21%)
Exposed group
11%
8%
0%
Non-exposed group
(6%)
(4%)
(6%)
Exposed group
6%
12%
0%
Non-Exposed group
(0%)
(4%)
(5%)
Exposed group
11%
28%
21%
Non-Exposed group
(4%)
(4%)
(0%)
Exposed group
20%
64%
46%
Non-Exposed group
(8%)
(9%)
(9%)
Exposed group
51%
48%
49%
Non-Exposed group
(13%)
(4%)
(9%)
Exposed group
43%
52%
46%
Non-exposed group
(17%)
(4%)
(5%)
Exposed group
60%
8%
52%
Non-exposed group
(20%)
(9%)
(8%)
Exposed group
43%
24%
18%
Non-exposed group
(13%)
(4%)
(11%)
Exposed group
63%
40%
12%
Non-exposed group
(25%)
(4%)
(9%)
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35
Monks and community leaders plan local temple based response in HIV and AIDS, Lao PDR.
36
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37
38
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39
5.3.6 Summary
The most common community education
programmes were distribution of flyers with
teachings of Buddhist principles, HIV and AIDS
awareness posters and Buddhist IEC materials
on HIV. The share of monks who took part in
the community education programmes was
higher than those in the non-BLI sites. In Lao
PDR, monks produced Buddhist Leadership
Initiative Newsletters to reach community
members in remote areas.
Results from the quantitative and qualitative
survey show that temple-based interventions
have played a major role in increasing
tolerance and sympathy toward PLWHA.
The community members supported monks
incorporating preventive messages in their
sermons.
Most of the community members surveyed
in the BLI sites in China were aware of
the monks conducting AIDS prevention
programmes in their communities and a
majority of them had participated in the
AIDS prevention programmes. In Lao PDR,
less than a third of the participants reported
having participated in HIV and AIDS related
activities conducted by monks/nuns in the
previous two years. The involvement of
40
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41
42
Challenges to counselling
During the FGDs with the community members in Cambodia, many respondents stated that counselling
could be very important but there are several challenges as follows:
The language used in the Buddhist scriptures is often difficult to understand for uneducated lay people.
The use of sex-related words does not befit monks.
Monks would be criticized by the public if they were to consult alone with a woman.
The monks affirmed to these challenges in their focus groups.
Perspectives from the community members in FGDs on monks counselling people with AIDS
If a monk talks about AIDS and sex, for example if he said AIDS is transmitted through sexual
intercourse, it is not accepted for Lao society to hear about that; but if a monk just does counselling on
how to avoid AIDS by saying about the fourth rule for five precepts, Yes it is very much acceptable, said
a local authority in a FGD in Champasak Province.
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43
44
Table 10: Other care and support services provided by junior monks to PLWHA
Type of support
Cambodia
(N=177)
China
(N=132)
Lao PDR
(N=201)
Myanmar
(N=83)
Viet Nam
(N=113)
25%
7%
6%
11%
31%
23%
6%
0%
1%
9%
11%
5%
4%
15%
32%
7%
8%
11%
16%
19%
2%
1%
7%
13%
14%
4%
3%
10%
15%
23%
7%
6%
11%
12%
25%
2%
1%
4%
7%
27%
2%
0%
1%
12%
29%
9%
4%
8%
21%
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47
48
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49
50
6.2.1 Introduction
Capacity building is a key strategy to
improve the professional competence of
monks/nuns and lay leaders to effectively
promote and sustain HIV prevention and
care programmes in the communities. This
section covers details on the training and
the types of training for monks/nuns,
monks/nuns satisfaction with training,
follow-up training on HIV and AIDS and the
support provided by senior monks.
6.1.6 Summary
In Cambodia, Myanmar and Viet Nam,
majority of the junior monks and nuns in the
site that underwent BLI training had a better
knowledge and understanding of HIV and
Table 11: Proportion of junior monks who received training on HIV and AIDS
Cambodia
(BLI sites)
N=151
Cambodia
China
(non-BLI sites) (BLI sites)
N=26
N=47
China
Viet Nam
(non-BLI sites) (BLI sites)
N=85
N=33
Viet Nam
(non-BLI sites)
N=80
33%
0%
87%
25%
43%
4%
100%
26%
100%
52
Cambodia
(BLI sites)
N=35
Cambodia
(non-BLI sites)
N=142
China
(BLI sites)
N=45
China
(non-BLI sites)
N=75
Lao PDR
(BLI sites)
N=176
Lao PDR
(non-BLI sites)
N=13
69%
14%
91%
27%
10%
0%
Behaviour change
51%
15%
27%
0%
5%
0%
63%
11%
80%
15%
11%
0%
49%
13%
71%
3%
5%
0%
51%
11%
62%
3%
6%
0%
37%
11%
20%
1%
2%
0%
Community
development and welfare
43%
8%
11%
1%
2%
0%
Life skills
34%
9%
40%
0%
12%
0%
31%
7%
29%
3%
5%
0%
Project management
26%
1%
7%
1%
2%
1. AIDS prevention
2. Basic facts about HIV and AIDS
3. The impact on HIV and AIDS on individuals
and communities and
4. Care and other support for people living
with HIV and AIDS
Among the total of 80 senior monks
interviewed in Cambodia, 66% had received
training on HIV and AIDS and Buddhist
Morality organized by their Provincial
Department of Cults and Religion. In Lao
PDR, 38% of the senior monks interviewed
were trained through the BLI.
Findings on the share of junior monks who
were trained on HIV and AIDS in the
Cambodia, China and Viet Nam sites are
reported in Table 11, by BLI and non-BLI
sites.
Findings from all three countries indicated
that little training on HIV occurs outside the
BLI. In Lao PDR only 13% of the 201 junior
monks surveyed had received training on
HIV and AIDS, all of whom were trained
through the BLI.
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53
Table 13: Knowledge of Buddhist scriptures to reduce stigma and discrimination (%)
Cambodia
(trained
monks)
N=35
Cambodia
(untrained
monks)
N=142
China
(BLI site)
N=47
China
(non-BLI
sites)
N=85
Lao PDR
(BLI sites)
N=176
Lao PDR
(non-BLI
sites)
N=13
Myanmar
(non-BLI)
N=85
Viet Nam
(BLI)
N=33
Viet Nam
(non-BLI)
N=80
63%
30%
60%
5%
40%
15%
51%
77%
38%
Table 14: Buddhist scriptures used in the past 12 months to promote non-discriminatory
attitudes towards PLWHA
China
Cambodia
Lao PDR
Myanmar
Viet Nam
Four Promavihara
30%
77%
75%
40%
43%
Metta Sutra
6%
38%
47%
62%
40%
Story of Supabuddha
3%
9%
7%
20%
27%
Potaghatessatera
0%
5%
9%
50%
49%
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Four Promavihara:
Metta Sutra:
Potaghatessatera:
Supabuddha:
The story of the leper who could see Dhamma, or the truth taught by Buddha
56
A group of Monks from three Wats/Pagodas from Kach Rotes, Boeung Chhouk, and Kampong Kau in Kampong
Preang commune, Cambodia are being trained on HIV Prevention and Care and Buddhist Principles.
UNICEF EAPRO
57
Table 15: Methods used by junior monks in the past 12 months to reduce stigma and discrimination
Activities conducted in the past 12 months
China
(N=33)
Cambodia
(N=62)
Lao PDR
(N=32)
Viet Nam
(N=34)
47%
76%
59%
63%
21%
58%
31%
63%
9%
60%
13%
59%
88%
37%
44%
31%
19%
52%
28%
47%
31%
77%
28%
59%
44%
61%
28%
35%
10%
40%
6%
58%
39%
39%
34%
29%
66%
50%
25%
23%
58
41%
3%
48%
6.4.5 Summary
A larger proportion of BLI trained monks/
nuns participated in activities to promote
non-discriminatory
attitudes
towards
PLWHA compared to non-BLI trained
monks/nuns. Further, BLI trained monks
were willing to share their plates, spoons,
cushions, mats and bicycles with PLWHA.
Fear of getting HIV and AIDS was stated as
the main reason provided by the monks
who felt uneasy sharing household objects
with PLWHA.
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62
7.5 Recommendations
In view of the findings and experiences
concerning the implementation of the BLI in
the Mekong region, country evaluation teams
have made the following recommendations
for strengthening and expanding the BLI.
7.5.1 Recommendations on the project
approach
Based on the success of the BLI, training
should be expanded to cover more temples
and, within each temple, engage more
monks and nuns. The training sessions
should include orientation training on
HIV and AIDS issues for novice monks.
Even in the existing BLI sites, a wider
engagement of monks may be needed.
In all five countries, monks training has
had a positive impact, both on the
knowledge of monks and on their
involvement in HIV and AIDS-related
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63
64
Preaching tolerance/compassion
towards PLWHA, using methods
that have been perceived positively
by communities, such as the use of
Buddhist
scriptures
in
antidiscrimination messages, and the
dissemination of IEC materials.
Endnotes
1
2
3
5
6
7
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
53
54
55
56
UNICEF, What religious leaders can do about HIV and AIDS Action for Children and Young People, UNICEF, World
Conference of Religions for Peace, UNAIDS, July 2004, pg 7
Ibid, pg 8
UNICEF, Faith-Motivated Actions on HIV and AIDS Prevention and Care for Children and Young people in South
Asia : A Regional Overview, December 2003, pg 20
UNICEF, EAPRO, Advancing the Regional Buddhist Leadership Initiative, Final Report to the Luxembourg National
Committee for UNICEF, March 2006, pg 4
UNICEF, The Buddhist Leadership Initiative, August 2003, pg 3
UNAIDS, UNAIDS, External Review, Mekong Subregion STD/HIV and AIDS Project, March 1999
UNICEF EAPRO, From Mekong Project to the Mekong Partnership & Beyond, The UNICEF Response to HIV and AIDS
in East Asia and the Pacific, 2001 2003, UNICEF EAPRO, September 2000
UNICEF EAPRO, Expansion and Consolidation of the Regional Buddhist Leadership Initiative in Cambodia, Lao
PDR and Vietnam 2006 2008, Final Report to the United Kingdom Committee for UNICEF, April 2008, pg 1
Ibid, pg 13
Ibid, pg 8
Ibid, pg 1
Ibid, pg 38
laymen of the monastery
Ibid, pg 10
Ibid
UNICEF, A Buddhist Approach to HIV Prevention and AIDS Care A Training Manual for Monks, Nuns and Other
Buddhist Leaders, June 2006, pg 47
Ibid, pg 54
UNICEF, Faith-Motivated Actions on HIV and AIDS Prevention and Care for Children and Young People in South
Asia: A Regional Overview, December 2003, pg 20
Ibid
UNICEF Thailand, A Study of the Sangha Metta Project, October 2003, pg 14
UNICEF, The Buddhist Leadership Initiative, August 2003, pg 3
UNICEF, Pamphlet titled UNICEF Responds to HIV and AIDS in East Asia and the Pacific, June 2002
UNICEF EAPRO, Expansion and Consolidation of the Regional Buddhist Leadership Initiative in Cambodia, Lao
PDR and Vietnam 2006 2008, Final Report to the United Kingdom Committee for UNICEF, April 2008, pg 6
UNICEF, Pamphlet titled UNICEF Responds to HIV and AIDS in East Asia and the Pacific, June 2002
Ibid
UNICEF, The Buddhist Leadership Initiative, August 2003, pg 8
Ibid
Ibid, pg 11
UNAIDS, UNICEF, Review of the Mekong Subregion STD/HIV/AIDS Project, Volume 11, March 1999
UNICEF, The Buddhist Leadership Initiative, August 2003, pg 9
Ibid, pg 11
UNICEF EAPRO. Strategy Monitoring and Evaluation Framework, Buddhist Leadership Initiative. January 2003, pg 1
Ibid
Ibid, pg 10
Ibid
Ibid
Ibid, pg 11
Ibid
Ibid
Ibid
Ibid
Ibid
Ibid
Ibid
Extending the Regional Buddhist Leadership Initiative, UNICEF Responding to the HIV and AIDS Epidemic, Second
Progress Report to the United Kingdom Committee for UNICEF, March 2006
UNAIDS, 2008 Report on the Global AIDS Epidemic, Geneva: UNAIDS
UNAIDS/WHO ( 2007 ) AIDS Epidemic Update, Geneva: UNAIDS
WHO, UNAIDS and UNICEF, Epidemiological Fact Sheet on HIV and AIDS: Cambodia, July 2008
WHO, UNAIDS and UNICEF, Epidemiological Fact Sheet on HIV and AIDS: Vietnam, July 2008
Ministry of Health, Vietnam, Results from the HIV/STI Integrated Biological and Behavioural Surveillance (IBBS) in
Vietnam, 2006
WHO, UNAIDS and UNICEF, Epidemiological Fact Sheet on HIV and AIDS: China, July 2008
WHO/UNAIDS, Epidemiological Fact Sheets on HIV and AIDS and Sexually Transmitted Infections, 2008
WHO, UNAIDS and UNICEF, Epidemiological Fact Sheet on HIV and AIDS: Myanmar, July 2008
WHO, UNAIDS, HIV and AIDS Programmes - Strengthening Health Services to Fight HIV and AIDS, Guidance on
Provider Initiated Testing and Counselling in Health Facilities, WHO, UNAIDS 2007
Report of the Commission on AIDS in Asia, Redefining AIDS in Asia: Crafting an Effective Response, Oxford
University Press, 2008
UNICEF EAPRO
65
References
Country evaluation reports:
Buddhist Leadership Initiative Programme: An Evaluation. Indochina Research Limited for UNICEF
Cambodia, May-June 2007.
The General Evaluation Report of the BLI Project in Xishuangbanna, Yunnan Province. UNICEF China
and Yunnan Institute for Drug Abuse, July 2007.
Report on Buddhist Leadership Initiative Evaluation in Lao Peoples Democratic Republic. UNICEF Lao
PDR, June 2007.
Assessment Report on Involvement of Buddhist Monks/Nuns in HIV-related activities. UNICEF Myanmar,
September 2007.
Evaluation of Activities on HIV/AIDS Prevention Related to BLI Project in Tra Vinh and Ho Chi Minh City.
UNICEF Viet Nam, September 2007.
Other references:
The Sangha Metta Project (November 2000), Evaluation Report Buddhist Monks and HIV & AIDS
Prevention and Care, The Sangha Metta Project
UNICEF EAPRO (April 2002), The Buddhist Leadership Initiative, Bangkok: UNICEF EAPRO
UNICEF EAPRO (June 2002), UNICEF responds to HIV/AIDS in East Asia and the Pacific, Bangkok:
UNICEF EAPRO
UNICEF EAPRO (January 2003), Strategy Monitoring and Evaluation Framework, Buddhist Leadership
Initiative, Bangkok: UNICEF East Asia and Pacific Regional Office
UNICEF ROSA ( December 2003), Faith-Motivated
UNICEF EAPRO, Sangha Metta Project (June 2006), A Buddhist Approach to HIV Prevention and AIDS
Care A Training Manual for Monks, Nuns and Other Buddhist Leaders, Bangkok: UNICEF EAPRO
UNICEF EAPRO ( October 2005), Scaling up the Regional Buddhist Leadership Initiative Final Progress
Report to the United Kingdom Committee for UNICEF, Bangkok, UNICEF EAPRO
UNICEF EAPRO (March 2006), Advancing the Regional Buddhist Leadership Initiative Final Report to
the Luxembourg National Committee for UNICEF, Bangkok: UNICEF EAPRO
Expansion and Consolidation of the Regional Buddhist Leadership Initiative in Cambodia, Lao PDR and
Viet Nam, 2006-8. Final Report to the United Kingdom Committee for UNICEF. UNICEF East Asia and
Pacific Regional Office, April 2008.
Survey Manual, BLI Evaluation. UNICEF East Asia and Pacific Regional Office.
UNICEF, WCRP, UNAIDS (July 2004), What Religious Leaders Can Do About HIV & AIDS Action for
Children and Young People, UNICEF, WCRP, UNAIDS
66
Annex:
General considerations
Introduction
Sampling strategies at all stages should be based on selection techniques where each
element has a known, and non-zero, probability of selection.
This means that at no stage of sampling should any sampling unit (province/district/
sub-district/community/temple/individual etc) be chosen for the study based on a non-probability
method. The probability method that should be used where information is available is
listing of the sampling units and then systematic sampling of the units. At each stage of the
sampling the degree of clustering should be minimized. This means that there should be
sufficient number of units selected at each stage to adequately represent the distribution of
units. Sampling strategies will need to be adjusted based on how the BLI has been
implemented in a particular context.
Select first level unit. This typically will be the province. All provinces where BLI
activities have been implemented should be included in the list. Provinces may be placed
in separate lists (strata) if there is an appropriate research reason. For example, there
may be a desire to compare those provinces that have strongly implemented BLI versus
those that have not strongly implemented the project. If strata are used the selection of
provinces from each list should be undertaken randomly. The number of provinces
selected should be maximized within the limitations of budget.
Select second level unit. If possible the second level unit should be temples in the
selected provinces where BLI activities have been undertaken. If it is necessary for
logistical reasons to have a second level unit that is at a higher level, for example, in the
case of districts, the same rules should be followed in selection as was undertaken for
provinces. That is, stratification can be used to create lists, but selection from within
strata should be random.
Selection of temples Irrespective of whether the temple is the second or third level of
sample selection, the selection of temples should be undertaken as follows. List all
temples in the higher level selected units (provinces/districts) where BLI activities have been
implemented. Randomly select the temples with the probability of selection equal to
the number of monks/nuns at the temple. This means bigger temples will have a
higher probability of selection than smaller temples. For the national sample, the
number of temples should be maximized. It is recommended that the minimum number
UNICEF EAPRO
67
of temples selected at the national level should be 20. If there are less than 20 temples
where BLI activities have been implemented then attempt to select all temples where BLI
activities have been implemented. If funding and budget allow more than 20 temples to
be selected this should be undertaken. The final number of temples selected will reflect
a balance between fieldwork logistics (e.g. budget, need to remain in area for a sufficient
period of time etc).
68
Selection of communities After a temple has been selected list those communities
which are served by the selected temple. If at least 20 temples have been selected, for
each selected temple randomly select one community this is served by the temple. This
will result in each temple having one associated community included in the sample. If
fewer temples are selected it will be necessary to increase the number of communities
associated with each temple that are selected. For example, if BLI has only been
implemented in 5 temples, than all five temples should be selected. Then, where
possible, a minimum of 4 communities per temple should be selected. To the extent
possible there should be a minimum of at least 20 communities included in the sample.
The communities should be selected based on the population of communities, with
larger communities having a higher probability of selection.
Selection of monks In selected temples the supervisor should request a list of all monks
in the temple. The list should be divided into two lists junior monks and senior monks.
The number of monks that needs to be selected from each group of monks will determine
the sampling interval. If there are 20 junior monks and 5 are required to be sampled, the
sampling frame would be 20/5=4. If the sampling interval includes a fraction then round
it down to the closest integer. Then randomly choose a number between 1 and the total
number of eligible monks and the number selected will indicate the number of the list of
the first monk who will be interviewed. Then from that number add the sampling
interval. That will be the second monk to be interviewed. For example, if there are 20
junior monks and the sampling interval is 4, and the starting number that is randomly
selected is 12 the monks to be selected are 12, 16, 20, 4 and 8. After selection of the
primary respondents, select another 40% (i.e. in this case two extra persons) to be used
as a replacement if the primary respondent cannot be interviewed. If the number of
monks in a temple does not equal the total number required, then interview all monks
available, and adjust the sample size in the next temple selected to make up the deficiency.
Selection of community members after a community has been selected the supervisor
should work with knowledgeable community members to update a list of all households
in the community. These households should include all households in the community
not just those that are officially part of the community (i.e. those that have household
registration). The required number of households should then be selected from the list.
Replacement households should then be selected randomly. Interviewers should be
provided with the addresses of sampled households and should contact those house
holds using the methods described in the following section. Replacement households
should only be used after all efforts have been made to contact primary households.
Sampling of PLHA Sampling of PLHA will have to be flexible and should be adjusted
according to how PLHA can be identified and how many are available to be interviewed.
Ideally, for communities that are served by a selected temple PLHA would be identified.
Then the methods of systematic random sampling from the list could be used, as
described above in the monks and community member sections, to select the required
numbers of PLHA to interview. As it is unlikely in most contexts to find sufficient PLHA
in any one community to meet sampling requirements, it may be necessary to include all
communities served by the selected temple in order to select the required number of
PLHA. Where the number of PLHA available does not meet the required number, all PLHA
available should be interviewed, and then the required numbers should be increased in
other sampling units. In some areas it may be necessary to use support groups or
self-help groups of PLHA to act as the sampling frame. Where these groups are directly
connected to BLI this strategy will limit the ability of the evaluation to assess the extent
to which BLI is reaching PLHA, so the strategy should only be used where other
approaches are not possible. If the support group includes both persons both exposed
and not exposed to BLI then this strategy of sample selection is acceptable.
Contact Sheets
Contact sheets have been developed for four of the groups to be sampled: Junior monks,
senior monks, community members and PLHA. The objectives of the contact sheets are: (1)
Allow the supervisor to control sampling procedures; and (2) provide the basis for
calculating response rates and refusal rates (both at the household and individual levels).
Therefore the contact sheets must be completed for all respondents (and in the communities,
all households) that are sampled. This means that there have to be completed contact forms
for all those units sampled, even if there is no completed interview.
The contact sheets must be retained and entered in the computer (with the appropriate
outcome code) in order to calculate response and refusal rates. These rates need to be
provided in the country report.
Use of the contact forms is explained in the following section.
IMPORTANT POINTS
The most important sampling unit is the temple where BLI activities have been undertaken.
Only those temples where BLI activities are undertaken will be eligible for selection
Communities that are selected should be those that view the sampled temple as serving
their communities.
Although temples are selected because they have been involved in BLI activities, it is very
important to note that monks, community members, and PLHA should not be selected
based on exposure to BLI activities. What we want is a representative sample of monks from
temples where BLI activities have been started, a representative sample of community
members from communities associated with temples where BLI activities have been
started, and a representative sample of PLHA from communities that are associated with
temples where BLI activities have been started.
Except for selection of eligible respondents within households, it is the responsibility of the
supervisor to undertake all sampling
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Place the temples in order (any order will do), with both the number of monks and the
cumulative number of monks recorded.
Based on the cumulative number of monks decide on the sampling interval. For example,
if the 20 temples contact 240 monks in total then the sampling interval is 240/number of
temples required, i.e. 240/4=60.
Randomly select a number between 1 and 240. This can easily be done by writing the
numbers 0 thru 9 on separate pieces of paper then randomly selecting a number, which
is taken as the first digit, then randomly selecting again for the second digit and so on.
From the listing of monks with the cumulative total find the temple associated with
the starting number. That is the first temple selected. For example, if the starting number
if 123, then find the temple in the list that included the cumulative number 123, then add
the 60 (the sampling interval), then find the temple associated with the number 183
(120+163) and that is the second temple selected, then add 60 to 183, to get the third
temple. Since this number 243 is greater than the total cumulative number of 240, we
start from the beginning of the list as if the list is a circle. That is, the number 243, can be
seen as number 3 (243-240). So the temple selected is that associated with number 3. The
final temple selected is that one associated with number 63 (3+60). The following table
illustrates this example.
Seq No
Temple Name
Number of Monks
Cumulative Number
Selected Number
12
12 (1-12)
17 (13-17)
21
38 (18-38)
42 (39-42)
27
69 (43-69)
13
82 (70-82)
88 (83-86)
93 (87-93)
34
127 (94-127)
10
134 (128-134)
11
12
146 (135-146)
12
149 (147-149)
13
156 (150-156)
14
160 (157-160)
15
168 (161-168)
16
22
190 (169-190)
17
196 (191-196)
18
15
211 (197-211)
19
20
231 (212-231)
20
240 (232-240)
Total
240
240
63
123
163
UNICEF EAPRO
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AW_UNICEF_AIDS_BLI.pdf
8/24/09
9:54:13 AM
Regional Review
CM
MY
CY
CMY
Buddhist Leadership
Initiative
UNICEF EAPRO
July 2009