TAIWAN LOURDES ASSOCIATION
2008 ANNUAL WORK REPORT
BACKGROUND INFORMATION
HIV EDPIDEMIC DEVELOPMENT IN TAIWAN
The total number of HIV cases by December 31, 2008 was 17,428. The new cases in 2008 were 2,601. The new cases have decreased every year since 2005. The ratio between female and male was 1:11. The main risk factors for transmission was 63% (10,493 cases) unsafe sex, 36% (6,007 cases) intravenous drug users. In 2005 there was an outbreak of transmission among drug users and about 3,000 drug users were infected with HIV. The government has quickly responded to the HIV transmission outbreak among drug users by introducing harm reduction programs. The government provides free methadone treatment and clean needles islandwide. Fortunately, the new HIV cases among drug users have decreased in the last couple of years. However, the HIV transmission among the gay men has increased in the last two years, because the focus and the resources of HIV prevention were targeted on drug users.
THE NEEDS OF CARE AND SUPPORT SERVICES IN TAIWAN FOR PEOPLE LIVING WITH HIV/AIDS (PLWHA) IN TAIWAN
The lion's share of the government's AIDS budget was spent on treatment and prevention. The budget on care and support programs is very little. The government provides free antiretroviral treatment to people living with HIV/AIDS (PLWHA), however the patients have to pay a small amount of the hospital administrative fees and share some medical bills. Poor PLWHA struggle with the living expenses, especially the drug users.
The PLWHA can hardly access social services because of discrimination and prejudice. The disability benefits do not include PLWHA. Therefore, the care and support of PLWHA completely depend on AIDS Non-government Organizations (NGOs). However, there are only 5 AIDS NGOs providing care and support to PLWHA which cannot fully respond to the vast needs of the PLWHA. The AIDS NGOs are under much pressure and workload as the number of new PLWHA has increased yearly.
The human rights of the PLWHA are violated. The government approved the laws of protecting the human rights of the PLWHA in 2006. However, the PLWHA still encounter rejection in education, medical, employment and residential care.
TAIWAN LOURDES ASSOCIATION
Taiwan Lourdes Association is a non-profit organization. It is our goal to improve the quality of life of PLWHA through our various care and support services and programs. Taiwan Lourdes Association has its main office inTaipei (north of Taiwan) 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 13 staff members including 9 professional social workers, 3 HIV positive co-ordinators for peer support and activities, and 1 accountant. We have 92 volunteers to assist various programs
IMPLEMENTATION OF THE SERVICES
The services and programs Taiwan Lourdes Association provided in 2008 were as follows:
(1) Case Management
We provide care and support to the clients through regular contact and visit, provide HIV information, liaison with organization for resources, organize support and self-development groups. In 2008 we contacted about 3,500 clients and 382 cases were opened for those who had multiple needs. Social workers assessed the needs of the clients and made their care plans.
The needs of the clients were as follows: Basic need (financial, housing, self-care, employment) accounted for 40%, HIV/AIDS information (HIV test, treatment, health) needs accounted for 15%, emotional need accounted for 17% and support need accounted for 24%. Human rights need accounted for 2%, the other issues (addiction, issuance, military service) accounted for 2%.
The need for employment in 2008 was 9% higher than that in 2007. It showed the impact of the global financial problem on PLHWA. The social workers needed to put more effort on getting resources of financial aid, employment and housing.
The basic information about those 382 opened cases is as follow:
Sex: 90% were male and 10% were female.
Age: 28% were 21-30 years old, 35% were 31-40 years old and 26% were 41-50 years old.
Location: 53% were from Taipei area and 40% were from Tai Chung area. That reflected the accessibility of our two offices in Taipei andTaichung.
The sources of the clients: 48% from themselves; 15% referrals from hospitals and public health workers; 10% from the prisoners or ex-prisoners; 7% from their families and friends; 7% from other organizations. The clients who asked for help by themselves had increased 6% comparing with last year. It showed that PLWHA broke through the stigma and asked for help. It also showed that our services were well recognized.
The status of the clients: 3% were prisoners, 43% were ex-prisoners and 54% were ordinary people.
The following services were provided through the case management program:
Financial Aid: some PLWHA did not have means to pay for insurance premium, rent or living expenses, especially those who had just been released from the prisons. We provided financial aid to clients in need for 942 times with a total amount of US$28,011. 70% for living expenses, 17% of the financial aid was for rent, and 11% for medical expenses.
Residential Facilities: we have houses with 15 beds to provide temporary accommodation to those who are rejected by the family or unemployed. 7 of those beds are for the drug users. 61 times people stayed in our residential facilities and 30% were drug users.
Referral Services: we referred 53 times clients to other organizations for resources. 70% of the referral was successfully completed. 66% of the referral was for financial aid, 23% was for housing needs. Only 3 clients agreed to make referral for employment. The need for employment was high, however, the clients usually refused to make referral because they wanted to keeping their status confidential.
(2) Counseling Services
We provided 77 sessions of therapy to those more disturbed clients. 1,743 session of guidance/counseling were provided for giving support to the clients. We provided 497 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 2008 we visited 773 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 2008, we provided 1,001 times of information services on telephone. Among them 60% were people infected with HIV and 40% were non-HIV people. We provided 1,493 times of information services on web message board.
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 10 times and 90 people received the services.
(5) Peer Support Services
Taiwan Lourdes Association operates two Friendship Centers for PLWHA, one in Taipei and the other in Taichung. People infected with HIV/AIDS inTaiwan live a very isolated life. It is our goal that our HIV friends support each other through our various support programs and activities. 2,750 participants visited our Friendship Centers in 2008. 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 2008:
Workshops: 13 workshops with topics related to treatment and self-care were organized with 106 participants.
Newly diagnosed 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. We organized 5 groups and 18 sessions of support groups have taken place.
Heterosexual support group: Since the majority of our services began users have been HIV positive gay men. We started a support group targeting heterosexual HIV positive. We organized 5 recreational activities with 32 participants.
MSN support network: People infected with HIV/AIDS may access the MSN service at night 2 times a month. We train the co-ordinators who are HIV positive to provide peer support through MSN. We provided 23 times of MSN support network with 553 participants. In 2008, the participants of this service had increased about 3.5 times more than last 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 24 sessions of reading group with 170 participants. They learn the skills of self-awareness and build up intimate and go forward with other relationships through commonly read books relating to self-development.
Self-development weekend residential workshops: It aims to give spiritual care through deep sharing, meditation, painting, music and psychodrama. We organized these workshops twice with 39 participants in a Catholic Spiritual Center.
Recreational activities: We organized outings for a day or a weekend, meals together, special programs for festivals and Christmas. A total of 52 activities were organized with 772 participants. Usually the Christmas Party attracts most participants with about 150 people. 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 4 memorial services with 65 participants.
Services for HIV Drug Users
According to the Department of Health, there are about 6,007 drug users infected with HIV/AIDS through sharing needles. 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. However, there are very few social care programs for HIV drug users in Taiwan. A couple of Christian organizations offer therapeutic communities of abstinence treatment based on the 12-steps theory. Most of the programs reject those people infected with HIV/AIDS.
Taiwan Lourdes Association provided case management and counseling services to the drug users as done for other clients.
(1) Case Management for HIV Drug Users
In 2008 among the opened 382 cases, 37% (140 cases) were HIV drug users. Most of the HIV drug users were released from the prisons. The basic information about the 140 opened cases:
Sex: 86% were male and 14% were female.
Age: 16% were 21-30 years old, 39% were 31-40 years old and 34% 41-50 years old. Mainly they were middle aged people.
The sources of the clients: 50% were from themselves; 19% were referrals from prisons and detention centers. The others were from hospitals, health workers, their friends and families, and other organizations.
The status of the clients: 95% were ex-prisoners and 5% were prisoners.
The social workers assess their needs and try to obtain resources of treatment, housing and employment for them. The following services were provided through the case management:
Financial aid: In 2008 we provided financial aid to clients in need for 942 times with a total amount of US$28,011. Among them, 64% (US$18,000) was aid to HIV drug users. 70% of the financial aid was used on living expenses, 20% on housing and 10% on medical expenses.
Housing project: We provide temporary shelters for HIV drug users. In 2008 we accommodated 18 drug users. The reasons they stayed in our accommodation facilities were: looking for jobs, enrolled in methadone programs and rejected by the families.
Support programs: We have Drop-in services for HIV drug users. 729 participants used this service.
(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 2008, 577 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 2008 we provided 297 times of group counseling with 7,777 participants. The social workers also provided 168 sessions of individual counseling.
Correspondence Services: We provided information and gave support through letters. In 2008 we replied 249 letters which was much higher than the number of 153 letters in 2007. It shows that correspondence served as a good means for information and support.
(3) Harm Reduction support groups
We work with drug users using harm reduction perspectives. We help them to reduce the harm of drugs on themselves, their families and society. We explore drug issues, their relationships with drugs and families, emotional management, self-acceptance, etc. We also make referrals to methadone and needle exchange programs. 77 Harm Reduction support groups were organized with 517 participants in 2008. The total numbers of people attending these groups were 68. Half of them enrolled in methadone programs. About 14 of them participated 5-9 times, 11 participated 10-20 times, and 2 participated more than 20 times.
Publication and Educational Services
(1) Publication Services
Taiwan Lourdes Association is the only organization which provides publication services to PLWHA.
Monthly Newsletter: We published 1,000 copies of a monthly newsletter with the latest HIV/AIDS information on treatment and self-care. The newsletters also are sent out by e-mail.
Booklets: In 2008 we published 2 new booklets of "Information for People Newly Diagnosed with HIV" and "The stories of people living with HIV/AIDS? All the publications were sent to the AIDS hospitals, prisoners, AIDS NGOs and PLWHA, and could be downloaded on our web site.
International HIV news: We translate latest international news on HIV epidemic and treatment development and send out the news through e-mail. We sent out 3,481 e-mails in 2008.
(2) HIV/AIDS Education
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 2008 we were invited to give 111 sessions of talks. The total participants were 7,571 which included health workers, social workers of social services, prison guards, prisoners and students.
Our social workers published 10 papers in journals, publications and international conferences. The topics of the papers cover case management for PLWHA, the peer support among PLWHA, working with drug users with HIV, human rights of PLWHA in Taiwan, etc.
Outreach Work in China
In partnership with German Misereor, Sister Teresa Hsieh, the Consultant and Paul Hsu, the Director of Taiwan Lourdes Association visited Xi-An, Shen-Yang and Ji-Lin Diocesan Social Service Centers for 4 weeks in 2008. 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.
Staff Members Training and Supervision
Attending training courses: The staff members are strongly encouraged to obtain on-going training. Each staff member averaged about 93 hours in training courses. The courses included counseling prior and after HIV test, counseling on loss, harm reduction psychotherapy, family therapy, group work, 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, personal safety measures and efficiency in paperwork. In 2008, 132 times of individual supervision and 55 group supervisions were provided.
Volunteers Recruitment and Training
(1) Volunteers Recruitment
We organized two volunteer recruitment training courses with 119 participants, but only 27 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.
(2) Volunteers Training and Supervision
We have 92 volunteers. The services the volunteers involve in are visiting HIV prisoners, administrative work, HIV prevention education, assistance in recreational activities. We organized 3 on-going training workshops with 58 participants and 4 group supervisions with 82 participants. The topics of the training cover suicidal prevention, and motivational interviewing methods.
(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 service. They share with the newly diagnosed HIV friends their own experience of overcoming the difficulties of becoming HIV positive. In 2008, 21 HIV friends were referred to the buddy service volunteers which were fewer than 2007. Probably some newly diagnosed HIV people join in our support group for newly diagnosed HIV positive and receive enough support in the group.