TAIWAN LOURDES ASSOCIATION

2009 ANNUAL WORK REPORT

BACKGROUND INFORMATION

HIV EDPIDEMIC DEVELOPMENT IN TAIWAN

The total numbers of HIV cases by December 31, 2009 were 18,378. 93% are male and 7% are female. The new cases in 2009 were 1,648. The major risk factors for transmission in 2009 were MSM (man have sex with man) with 924 new cases. The government provides Methadone treatment and free syringe; however, there are 177 new IDU (Intravenous Drug Users) cases in 2009.

89% of the HIV/AIDS population is from 20-49 years old. The people infected with HIV/AIDS are getting younger. It is important that the AIDS prevention education should start at school. The Ministry of Education needs to revise the student’s textbook to include AIDS education.

The government set up two MSM Health Centers in Central and South Taiwan. It aims to provide health services and AIDS prevention education to MSM group.   

TAIWAN LOURDES ASSOCIATION

Lourdes Association is a non-profit organization. It has its main office in Taipei (north ofTaiwan) and a branch office is in Taichung (central Taiwan). The PLWHA accounts for about 3/5 of HIV/AIDS population in these two areas. There are 15 staff members including 9 professional social workers, 5 coordinators for peer support and activities, and 1 accountant. We have 92 volunteers to assist various programs.

It is our goal to improve the quality of life of PLWHA through our various care and support services and programs. We advocate for human rights of PLWHA. We endeavor to eliminate discrimination against PLWHA through the educational programs.

IMPLEMENTATION OF THE SERVICES

People living with HIV/AIDS suffer from physical illness and the side effects of the treatment. They also endure the psychological and social difficulties because of discrimination and rejection. According to the survey of Lourdes Association, half of 429 interviewees suffer from the treatment side-effects, one out of three PLWHA feels lonely and has negative self-value. 10% of the interviewees experience discrimination from the medical personnel; more than 30% are not satisfied with the medical care service. However, the compliance, good doctor and patient relationship and social support network are the key factors for their psychosocial and spiritual life. 

We have learnt from our 12 years experience of working with PLWHA that the needs and problems of the PLWHA are involved with psi-psycho-social aspects. Therefore, the team of Lourdes Association evaluates their needs from the following aspects: basic life needs, knowledge on HIV/AIDS, emotional needs, social support, human rights, and special needs. It is our goal to improve their quality of life and basic human rights through case management. We liaison with the community resources to provide community care to them.

The services and programs Lourdes Association provided in 2009 were as follows:

(1)  Case Management

We provide care and support to the clients through regular contact and visit. We provide HIV information, liaison with organization for resources, organize support and self-development groups. In 2009, 318 cases were opened for those who had multiple needs. Social workers assessed the needs of the clients and made their care plans.

The basic information about those 382 opened cases is as follow:

Age: 24% were 21-30 years old, 39% were 31-40 years old and 27% were 41-50 years old. It shows that the middle age clients are increasing. The employment, care and housing needs of the middle age have become impending.

The drug addiction problem: 42% of our clients have drug addiction problems.

The following services were provided through the case management program:

Financial Aid: Some PLWHA did not have means to pay for rent, living expenses and medical expenses, especially those who had just been released from the prisons. We provided financial aid to clients in need for getting basic living needs. In 2009 the total amount of financial aid was US$32,495. 69% was given for living expenses, 22% was for rent and 7% was for medical care.

Residential Facilities: We have rented 5 houses with 14 beds to provide temporary accommodation to those who have housing needs. In 2009, 41 times people stayed in our residential facilities. The total of occupancy of our accommodation facilities is 1,183 days. The average stay of a client is for 29 days. The social workers provide financial aid and support during their stay in the accommodation facilities. A co-coordinator is appointed to provide meals, assistance in employment interview and doctor’s appointment for them.

Support through telephone: The social workers contact the clients regularly in order to giving support and respond to their immediate needs. In 2009, we made 2,223 times telephone calls.

Employment Services: We conducted a survey to 318 clients from October to November in 2009. It is found that one of their main concerns was unemployment. The statistics on the needs of our clients showed that 1,186 times/people have financial difficulties and 825 times/people have employment needs. It shows that the stable employment can secure their financial resources and quality of life. Therefore, in 2009 we assisted the 200 times/clients for employment seeking and interviews. 

Referral Services: We referred 212 times/clients to 18 other organizations for resources. The reasons for referral include financial aid, housing needs, human rights, medical care, employment, etc.

(2)  Counseling Services

We provide counseling services to the PLWHA and their families. In 2009, we provided 53 sessions of therapy to those who are more disturbed clients. 1,784 sessions of guidance/counseling were provided for giving support to the clients. We provided 674 times of information counseling to those who needed HIV, treatment and self-care information.

(3)  Outreach Services

We regularly visited HIV outpatient clinics and inpatient wards in AIDS hospitals. We provided HIV information and support to them. We also visited some clients at their homes when they were house-bound or needed support. In 2009 we visited 97 times/people at hospitals and homes.

(4) HIV/AIDS Information Services

Information services: We provided the services through telephone calls, e-mail, web message board and MSN. As the people infected with HIV are getting younger, web message board and MSN provides a good and confidential channel for them to communicate among themselves. The social workers and the coordinators (who are HIV Positive) reply to their questions about HIV test, treatment, policies on HIV issues and give them support. In 2009, we provided 914 times of information services on telephone and 893 times of information services on web message board. The output of web message board services was fewer than last year because we closed the message board services for 3 months for the technician to upgrade our system...

Educational Services: We invited health workers to our Drop-in Centers to provide information services to people infected with HIV. The public health workers came to Centers for 7 times and 102 people received the services.

(5)  Peer Support Services

Lourdes Association operates two Friendship Centers for PLWHA, one in Taipei and the other in Taichung. People infected with HIV/AIDS in Taiwan live a very isolated life. It is our goal that our HIV friends support each other through our various support programs and activities. 2,357 participants visited our Friendship Centers in 2009. Our HIV positive staff members and volunteers welcomed and chatted with them during their visits.

We provided the following programs in the Friendship Centers in 2009:  

Workshops: 11 workshops with topics related to treatment and self-care were organized with 184 participants.

Newly diagnosed gay men support group: We organized a small support group mainly for those newly diagnosed HIV positive people. They could share their experience of the difficulties they encounter and ask any questions of concern, such as treatment, disclosure of their status to friends, discrimination, etc. The support groups for newly diagnosed gay men have been very popular and well attended. They easily build up support among themselves and reduce the level of fears and isolation. We organized 30 sessions of support groups with 175 participants.

Middle Age Support Group: This group targets those over 45 years old heterosexual clients. They feel they are marginalized from the HIV young gay men, because they are not familiar with web services and have different interests from the younger generation. The support groups help them to gain mutual support and share their loneliness as they are aging. We organized 8 activities with 66 participants.

MSN support network: People infected with HIV/AIDS may access the MSN service at night. We train the co-coordinators who are HIV positive to provide peer support through MSN. We provided 41 times of MSN support network with 1,310 participants. The participants of this service have increased every year. Most of them were young gay men. MSN support network can overcome the difficulties of disclosure of status. The PLWHA who do not want to expose their identities may obtain support and information through this program.

Reading Group: We organized 18 sessions of a reading group with 170 participants. They read the books of “The New Manual for Life?and Courage and Freedom? They learned to be aware of their own emotions, accept uncertainty and to be free in spirit.     

Self-development workshops: The participants stay a weekend in a Catholic SpiritualCenter. The workshop aims to give spiritual care through deep sharing, meditation, painting, music and psychodrama. In 2009, we organized 2 workshops with 39 participants.

Recreational activities: We organized outings for a day or a weekend, meals together, special programs for festivals and Christmas. A total of 73 activities were organized with 776 participants. Usually the Christmas Party attracts most participants. Some HIV friends only participate in yearly Christmas Party to see other old friends.

Memorial services: Those HIV friends who have passed away are remembered by the workers and other HIV friends. We organized 3 memorial services with 62 participants.

AIDS CONFERNCE

We organized a Conference for PLWHA. The theme of the Conference is "Empowerment and Relationships" 102 PLWHA participated in it. An Australian and Hong Kong PLWHA who have many years working experience in HIV/AIDS organizations were invited as speakers. There are 9 seminars at the Conference. The topics include ownership of business, personal experience of being PLWHA, preparing for aging, recreational drugs, new HIV treatment, intimate relationships and yoga exercise. The Conference was very successful and fruitful. Those participates also elected the “the PLWHA of the year? The panel of the judge includes AIDS doctor, AIDS worker, PLWHAs. The PLWHA who has a positive attitude and happy life style was elected.

SERVICES FOR HIV DRUG USERS

According to the Department of Health, there were about 6,330 drug users infected with HIV/AIDS through sharing needles until December 31, 2009. They account for 34% HIV/AIDS population. The new cases of IDU have decreased. It shows that the methadone and needle exchange programs and education are effective.

About half of the HIV drug users are in prisons. There is an urgent need to work with HIV drug users when they are released from the prisons in order to avoid relapse into addiction and criminal activities. Many of them are rejected by their families for their offences and criminal records. Some of them have been in and out of the prisons for a couple of times. Most of them are from low social-economic families and have very low education achievement levels. The HIV drug users need support and social work intervention.

Lourdes Association provided case management and counseling services to the drug users.

(1)  Case Management for HIV Drug Users

In 2009 we had 140 clients who are drug users. Nearly all of them have criminal records and they were released from the prisons. Most of them are male. The basic information about the 140 clients is as follows:

Age: 9% were 21-30 years old, 78% were 31-50 years old and 12% were 51 plus. It shows most of the drug users were middle age.

The status of the clients: 92% were ex-prisoners, 3% were prisoners and 5% were the others.

The social workers assess their needs and try to obtain resources of treatment, housing, employment and referral for them. The following services were provided through the case management:

Financial aid: In 2009 we provided financial aid to clients in need for 539 times with a total amount of NT$588,261(US$18,566). 58% of the financial aid was used on living expenses, 35% on housing and 7% on medical expenses.

Housing project: We provide temporary shelters for HIV drug users. In 2009 we accommodated 20 drug users. The average length of stay was 68 days.

Support programs: We organized recreational activities for them. In 2009, 15 activities with 147 participants were organized.

(2)  Care and Support Services to the HIV Prisoners

Prisoners who are infected with HIV/AIDS are very isolated in the prisons. There is strong discrimination against HIV prisoners in the justice system. The HIV prisoners are segregated from other inmates and have very few activities and support. Therefore the prison visit is one of our major outreach services, and correspondence service is also provided. Sometimes, negotiating with prison officers on behalf of prisoners has been one of our most difficult tasks for the prison services.

Prison Visits: the social workers and volunteers regularly visited HIV prisoners in 22 prisons and detention centers. We provided HIV treatment, self-care information and tried to build up trust relationships with them. In 2009, 597 times/people made visits to the prisoners and detention centers.

Group Counseling for HIV Prisoners: The social workers and the therapist volunteers gave group counseling to three different stages of HIV prisoners: the newly diagnosed, preparing to leave prisoners and all the others. In 2009 we provided 298 times of group counseling with 10,164 participants. The social workers also provided 207 sessions of individual counseling.     

Correspondence Services: We provided information and gave support through letters. In 2009 we replied 169 letters to those prisoners.

(3)  Harm Reduction Support Groups

We use harm reduction perspectives to work HIV drug users. We help them to reduce the harm of drugs on themselves, their families and society while they are still under the drug influence. We explore drug issues, their relationships with drugs and families, emotional management, self-acceptance, etc. We also make referrals to methadone clinics and needle exchange programs. 83 Harm Reduction support groups were organized with 527 participants in 2009.

AIDS WORKERS WORKSHOP

Those workers who work with PLWHA need support among themselves for sharing their knowledge and skills on HIV/AIDS, and their experience of working with PLWHA. We organized 6 AIDS workers workshops with 101 participants.

PUBLICATION SERVICES

Lourdes Association is the only HIV organization which provides publication services to PLWHA in Taiwan.

Monthly Newsletter: We published 1,000 copies of a monthly newsletter with the latest HIV/AIDS information on treatment, self-care and government policies on HIV/AIDS. The Electronic Newsletters also were sent out by e-mail with 6,336 times/people.

Booklets: In 2009 we published the following booklets: "Compliance" with 3,000 copies; "HIV Information for Women" with 5,000 copies; "HIV Information" with 5,000 copies; "Annual Report" with 1,000 copies. All the publications were sent to the AIDS hospitals, prisoners, AIDS NGOs and PLWHA, and could be downloaded on our web site.

HIV/AIDS EDUCATION

Education is one of the methods to eliminate discrimination against HIV/AIDS. We are often invited to give training courses or talks on HIV transmission, caring for people living with HIV/AIDS and the skills of working with PLWHA. In 2009 we were invited to give 157 sessions of talks. The total participants were 8,618 which included health workers, social workers, prison guards, prisoners and students.

RESEARCH

We conducted two surveys: "The medical service for PWLHA in Taiwan" and "The Life Situation of PWLHA in Taiwan" 66 and 429 PLWHA participated in those two researches respectively.

OUTREACH WORK IN CHINA

In partnership with German Misereor, Sister Teresa Hsieh, the Board Member and Paul Hsu, the Director of Lourdes Association visited Xi-An, Shen-Yang and Ji-Lin Diocesan Social Service Centers and a Project for Beijing labor workers. They gave social work training to the Priests and staff members of the diocesan social service centers. They also gave training to those Sisters and lay people who worked with HIV/AIDS, child care and health care. The training is focused on the integration of service, faith and self-development.

STAFF MEMBERS TRAINING AND SUPERVISION

Attending training courses: The staff members are strongly encouraged to obtain on-going training. Each staff member averaged 40.6 hours in training courses. The courses included HIV treatment and counseling, social work treatment skills, group work, case management, psycho-social assessment, skills on computer software, public relationships, fundraising, etc. 

Supervision: The full-time supervisors give individual and group supervisions regularly. The social workers may obtain the knowledge, skills and support they need, especially the issues of emergency intervention, social work ethic, emotional and pressure management, and personal safety measures and efficiency in paperwork. In 2009, 238 times of individual supervision and 61 group supervisions were provided.

International Experience: It is very important to exchange experience of working HIV/AIDS with other countries. A social worker and a board member attended the Asia Pacific Conference on HIV/AIDS in Indonesia. Three social workers visited Drug Programs in Hong Kong. The former Health Minister of Swaziland visited Lourdes Association and shared with us their experience of working with HIV/AIDS.

VOLUNTEERS RECRUITMENT AND TRAINING

(1)  Volunteers Recruitment

We organized 4 volunteer recruitment training courses with 132 participants, but only 30 became volunteers. In our view, although the successful rate was low, those participants obtained accurate HIV information and accepted people living with HIV/AIDS through our training course. It can reduce the discrimination against PLWHA in society.

(2)  Volunteers Training and Supervision

We have 92 volunteers in 2009. The volunteers provide the services of administrative work, prison visits, correspondence service and assisting in activities. We organized 3 on-going training workshops with 46 participants and 3 group supervisions with 71 participants. The topics of the training cover HIV/AIDS policies and laws, ethics, self-awareness, empathy skills, emergency protection, etc.

(3) Buddy Service Volunteers

We have trained people living with HIV/AIDS as volunteers to provide buddy services. They have learned the skills of being helpers and about confidentiality. They provide one-to-one or two-to-one services. They share with the newly diagnosed HIV friends their own experience of overcoming the difficulties of becoming HIV positive. They also help the newly diagnosed PLWHA to build up support network. In 2009, 24 HIV friends were referred to the buddy service volunteers.