TAIWAN LOURDES ASSOCIATION
2013 ANNUAL WORK REPORT
BACKGROUND INFORMATION
HIV EPIDEMIC DEVELOPMENT IN TAIWAN
The total numbers of HIV cases by December 31, 2013 were 26,475. 93.36% are male and 6.64% are female. The new cases in 2013 were 2,243 which account for the top 3 highest record ever. The major risk factors for transmission in 2013 were MSM (man who have sex with man) with 1,788 new cases. The government provides Methadone treatment and free syringe as harm reduction strategies and successfully lowers the new IDU (Intravenous Drug Users) cases to 39 in 2013. Compared to 2012, other than the IDU cases, all the statistics above are increased and the new cases hit the 3rd record high in the Taiwan epidemic history.
92.30% of the HIV/AIDS population is between 20-49 years old. The people infected with HIV/AIDS are getting younger and the main risk factor is through unsafe sex. It is important that the HIV/AIDS prevention educations should start early at school. The Ministry of Education needs to revise the students’ textbook to include the AIDS education.
Taiwan LOURDES ASSOCIATION
Taiwan Lourdes Association is a non-profit organization. It has its main office in Taipei (North of Taiwan) and a branch office in Taichung (Central Taiwan). The PLWHA accounts for about 3/5 of HIV/AIDS population in these two areas. There are 21 staffs work at Taiwan Lourdes Association, including 13 professional social workers, 6 coordinators for peer support and activities, 1 assistance and 1 accountant. We have 169 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 not only suffer from physical illness and the side effects of the treatment, but also endures the psychological and social difficulties because of discrimination and rejection. We have learned from our experience of working with PLWHA and find out that the needs and problems of the PLWHA are involved with psi-psycho-social aspects. Therefore, the teams of Taiwan Lourdes Association’s professional social workers evaluate their needs from the following aspects: 1) Basic life needs, 2) Knowledge on HIV/AIDS, 3) Emotional needs, 4) Social support, 5) Human rights, and 6) Special needs. It is our goal to improve their quality of life and basic human rights through case management and liaison with the community resources to provide community care to them.
The services and programs Taiwan Lourdes Association provided in 2012 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 2013, there were total of 6,799 people times simple cases opened, 75% of which were satisfied and 21% of which remand open for further services. There were 71 cases (4%) of which switched to multiple-needs cases. In 2013, 296 cases were opened for those who had multiple needs. Social workers assessed the needs of the clients and establish their care plans. There were 150 cases remained from last annual year and 130 cases were closed. The reasons for closed cases were 56% needs has been satisfied, 28% lost contacts,10% were in prison and 6% were dead.
The basic information about those 296 opened cases is as follow:
Gender & Age: 88.5% of our clients were male and 11.5% were female. 25% were 21-30 years old, 32% were 31-40 years old and 37% were 41-50 years old. It shows that the middle age clients and younger age clients are increasing, in addition, the older age group is increasing as well. Therefore the ageing problem is starting to become an important issue for our clients. The employment, care and housing needs of the older age have become impending. On the other hand, the younger age group are mostly MSM, therefore the school safer sex education and HIV/AIDS prevention are desperately need to be increased. In addition, the increase of younger age clients had raise our awareness about the epidemic among younger generation.
The drug addiction problem: 45.7% of our clients have drug addiction problems. 70% of our clients had the experience in using recreational drugs.
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 of many kinds including rent, medical or meals expenses to clients in need for getting basic living needs. In 2013 the total people times of financial aid were 1,179 and total amount of financial aid was US$48,672 (US$1=NTD29). 40% was given for living expenses, 12% was for rent, 5% was for medical care and 40% was for shelter house and 3% are others.
Residential Facilities: We have rented 5 different locations with 16 beds to provide temporary accommodation to those who have housing needs (including one exclusively for female). In 2013, 46 people stayed in our residential facilities with the total of occupancy of our accommodation facilities of 138 people times. The average stay of a client is 92 days with the residential rate of nearly 87%. 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. The total amount of meals delivery were 7,118 times and 836 times of social workers visits and 750 times of one by one counseling.
Support through telephone: The social workers contact the clients regularly in order to giving support and respond to their immediate needs. In 2013, we made 1,403 times telephone calls and 641 on line counseling.
Employment Services: The stability of employment can secure their financial resources and quality of life. Therefore, in 2013 we assisted 143 times/clients for employment opportunities seeking and interviews.
Referral Services: The reasons for referral include financial aid, housing needs, human rights, medical care, employment, etc. In 2013 we referred 70 times/clients to 16 other organizations for resources connection, human rights and others.
(2) Counseling Services
We provide counseling services to the PLWHA and their families. In 2013, we provided 22 sessions of therapy to those who are more disturbed clients. 2,044 sessions of guidance/counseling were provided for giving support to the clients. We provided 1,421 times of information counseling to those who needed HIV, treatment and self-care information.
(3) Outreach Services
In 2013 we visited 469 times/people at hospitals and homes. We regularly visited HIV outpatient clinics and inpatient wards in AIDS hospitals (106 times). We provided HIV information and support to those in need. We also visited clients at prisons (257 times) with total of 4,784 people times and mail respond for 415 times. Other locations (106 times) including local government health department or public spaces for clients who do not want to be exposed.
(4) HIV/AIDS Information Services
Information services: We provided the services through telephone calls, e-mail, web message board and Wednesday on-line chat room. As the people infected with HIV are getting younger, web bulletin board and Wednesday on-line chat room provides a good and confidential channel for them to communicate among themselves or the professionals. The social workers and the peer coordinators (who are HIV Positive) reply to their questions about HIV test, treatment, policies on HIV issues and give them support. In 2013, the on-line chat room and e-mail reply served 884 people times, we also provided 1,453 times (988were positive and 465 were negative) of information services on telephone and 103,575 click times of information services on web bulletin board. The output of telephone and web message board services were both increased than last year.
Educational Services: We invited health care workers to our Friendship Centers to provide information services to people infected with HIV. The public health workers came to Centers for 19 times and 551 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 can support each other through our various supporting programs and activities. 3,233 participants (1,038 were IDU) visited our Friendship Centers in 2013. 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 2013:
Workshops: 8 workshops with topics related to treatment and self-care were launched with 147 participants.
Newly diagnosed gay men support group: We launched 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 their 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 launched 42 sessions of support groups with 246 participants. Both numbers are gradually increased then last year.
Middle Age Support Group: This group targets those over 45 years old MSM 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 12 activities with 108 people times participants.
Wednesday on-line 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 on-line chat room system. We provided 48 times of MSN support network with 884 participants. We also start to invite famous people like doctor or well known PLWHA to be the honor guest for the chat room. The participants of this service have decreased this year due to the renewal of our chat room system and the newly introduced APP social network system. Most of the participants were young gay men. On-line 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.
Self-development workshops: The participants stay a weekend in a Catholic Spiritual Center. The workshop aims to give spiritual care through deep sharing, meditation, painting, music and psychodrama. In 2013, we launched 1 workshop with 20 participants.
HIV community social gathering: We work closely with the hospitals in Taipei, Taoyuan and Taichung to form the social group for PLWHA can get to know each other, sharing their life experience and support each other. We total organized 19 social gathering with 551 participants.
HIV peer training and empowerment group: We cooperated with Taipei government health department CDC to provide training programs for HIV peers, offer them the self-care skills, knowledge on HIV and communication skills courses. There are total of 10 times with 135 people times participants. Most of the participants had become peers support volunteers. They had reached out to 286 newly diagnosed cases and participate in 22 different educational advocacy events.
Love to smile women support group: In Taiwan, most of the HIV infected females does not have much support from the government or from other NGOs, therefore, Taiwan Lourdes Association continue to coordinate the women support group in 2013. We held 9 session of women support group gathering with 7 participants. Due to various reasons the support group are now temporary stopped but will be restart again in the following years. .
Recreational activities: We organized outings for a day, single mingle or a weekend getaway, meals together, special programs for festivals and Christmas. A total of 96 activities were launched with 1,357 participants. Usually the Christmas Party attracts most participants. Some HIV friends only participate in yearly Christmas Party to see other old friends.
Memorial services: To show those HIV friends who have passed away were remembered by the workers and other HIV friends. We organized 1 memorial services with10 participants.
(6) Female Shelter House
Started from Feb. 2012, Taiwan Lourdes Association established a new shelter house for HIV infected females. Including Taipei and Taichung, there are 3 units available. There are total of 2 clients take advantage of this new service and with total of 175 days on average and 4 times of house meetings and one-on-one counseling. Every week the life care peer will visit the shelter house and prepare some nutrition supplies and needed materials to maintain the clients’ health and assist them to gain a stable life style and be independent. Due to funding problems, the service been stop this year.
HAPPY LIFE AIDS CONFERNCE
We organized a Happy Life Conference for PLWHA. The theme of the Conference is "Positive, be positive" and 102 PLWHA from different region in Taiwan and 12 professional health care providers participated in it. 4 professional experts from different fields who have many years working experience in HIV/AIDS organizations were invited as speakers, including Laurindo Garcia from Philippine and Yosuke Takaku from Japan. The topics include how to deal with difficult emotions, personal experience of being PLWHA and disclosure, preparing for aging, new HIV/HCV/HBV treatment and co-infection. The Conference was very successful. Three of the participants who have a positive attitude and healthy life style were also elected as the "The Happy Life PLWHA of the Year" .
SERVICES FOR HIV DRUG USERS
According to the Department of Health, there were about 6,686 drug users infected with HIV/AIDS through sharing needles until December 31, 2012. They account for 27.58% 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 before 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 2013 we had 172 clients (44.8% of the total 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 172 clients is as follows:
Age: 7% were 21-30 years old, 80% were 31-50 years old and 13% were 51 years old and above. It shows most of the drug users were middle age.
The status of the clients: 90% were ex-prisoners, 5% 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.
(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 17 different prisons and detention centers. We provided HIV treatment, self-care information and tried to build up trust relationships with them. In 2013, 257 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 the others. In 2013 we provided 195 times of group counseling with 4,784 participants. The social workers also provided 250 sessions of individual counseling.
Correspondence Services: We provided information and gave support through letters. In 2013 we replied 415 letters to those prisoners.
(3) Harm Reduction Support Groups
In order to help the HIV infected IDU group to regain their dignity and health, Taiwan Lourdes Association held the IDU harm reduction support group 4 times a month. Teach these clients the ideas of “harm reduction” and motivate their drives to be productive or protective to themselves or others. We use harm reduction perspectives to serve with HIV drug users. We help them to reduce the harm of drugs on themselves, their families and society while they are still under the influence of drug. 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. 51 Harm Reduction support groups were organized with 498 participants in 2013.
AIDS WORKERS WORKSHOP
Workers who work with PLWHA need support among themselves for sharing their knowledge, experiences and skills on HIV/AIDS, and their experience of working with PLWHA. We organized 46 AIDS workers workshops with 413 participants.We also organized 9 sessions of specialized workshops in different hospitals to help the local case managers, public health workers and social workers. There are total of 232 participants involved.
PUBLICATION SERVICES
Lourdes Association is the one of the few HIV organization which provides publication services to PLWHA in Taiwan.
Monthly Newsletter: We published 1,000 copies every month 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 9,372 times/people.
Booklets and Flyers: In 2013 we published the following booklets: “Taiwan Lourdes Association Annual Report” with 2,000 copies; “The Harm Reduction for Recreational Drugs” with 1,000 copies; “2013 ARV treatment guideliner” with 2,000 copies; “2013 The Art of Disclosure” with 2,000 copies; “Taiwan ARVs medication poster” with 500 copies; “I Want to Tell you – Female HIV” with 5,000 copies; In addition, we published a “Semi-year Report” with 2,000 copies , and all of the booklet and flyers could be downloaded on our web site.
Taiwan Lourdes Association have 33 different online booklets for free online reading and download. The total download times for 2013 are 57,447 times. The most popular online booklet is “HIV/AIDS positive families”, accounted for 14,033 times of downloads. It shows that the need and support for positives’ families had become more and more important than before. In addition, in year 2013, Taiwan Lourdes Association published 8 different articles in international conference or communities’ journal, in order to share our experiences with other organizations or workers in this field.
HIV/AIDS EDUCATION
Education is one of the most important methods to eliminate discriminations and stigmas against HIV/AIDS. We are often been invited to give training courses or talks on HIV transmission and prevention, caring for people living with HIV/AIDS and the skills of working with PLWHA. In 2013 we were invited to give more than hundred sessions of speeches. The total participants were 11,754 which included health workers, social workers, prison guards, prisoners and students.
ADVOCACY AND CREATIVE ACTIVITIES
In 2013, Taiwan Lourdes Association had cooperated with other organizations and participated in some HIV/AIDS related advocacy groups including Long-term Care Supervision Alliances and HIV/AIDS Action Coalition. These two groups are both dedicated in fighting the basic human rights for HIV infected people or people who are in need.
Taiwan Lourdes Association also launched a PLWHA group name “Positive League”. By using the empowerment, action research and social diffusion theory as the base of researching methods to recruit the HIV infected gay men who possess the leadership qualities. Through various operations like real life practices and internet exercises etc. to build up their voices, excited their powers and abilities to break through the limitation and fears of coming out. Starting from how to recruit HIV positive gay men to participate in this project and induced them to invest more concerns toward the subjects like AIDS/HIV policies and preventions. Through the processes of weakening awareness and action involvements, establishing the practical knowledge in the related fields. Hoping to influence other HIV infected people and the society with the Positive League’s course of action and personal life story.
Taiwan Lourdes Association also held the 30th International Candlelight Memorial at Taichung City with 50 people participated in this event ( due to the weather). We also participated in the Taipei, Taichung and Kaohsiung LGBT parade and try to raise the HIV/AIDS prevention awareness to the public.
RESEARCH
We conducted one survey: “The Living Situation of PWLHA in Taiwan” 417 PLWHA were participated in this research respectively. 90% were male and the female account for 10% of the survey. Main age group were 31 to 40 years old (44%). 142 were prisoners and 275 were people from the society. We found in the survey that most of the PLWHA still facing serious disclosure issue but the trend had turn from the family to the society or working place. On the other dimension, the lack of pressure release had become another important issue. PLWHA started to avoiding or looking for abnormal channels when dealing with pressure which leads to negative influences toward their health. Taiwan Lourdes Association will continue our services in helping PLWHA to deal with these issues as our future developments.
OUTREACH WORK IN CHINA
a. The 2nd year Taiwan Lourdes Association continue to improving the evaluation skills and knowledge, including the needs evaluation, resource connection and referral skill of the HIV case management for the HIV/AIDS health care providers. In order to make Caritas Shengjing Social Center of Liaoning in Shenyang become the key role in the local service network, we invited all the HIV/AIDS related organizations to participate in a workshop to discuss the difficult cases in practical practice. Establish the understanding of resources with each other and open the window for direct communication.
Concerning about the peer empowerment, we continue to implement the first year's courses, deepening the companionship, the group leading skills and the related moral in services. In regards of the program of case management, the IT engineer has already finished 50% of the structures. We are expecting the program and training can be complete at the 3rd year. The leader of the courses had helped all the participants to gain the most benefits from the class through various activities and method according to the participants’ level of knowledge.
Concerning about the establish of HIV/AIDS center, due to the human power of Caritas Shengjing Social Center of Liaoning in Shenyang and the limited resources from the international fundation, the menpower of the center will be downsized. In addition, many of the social workers been resigned and replaced with consultants which might be weaker in the referall services. Therefore, the establishment of the center might have some diffculties but the important key role in playing the HIV/AIDS services will still can not be neglected.
b. At the 2nd year, Xian remain to host a three days partner and family therapy workshop, in addition, we provide one additional professional supervisory course for senior health care providers. Through the activities experience instruction method to emphasize the importance of both practical and theory are deeply welcomed by the participants. This year, we also focus on the details explanations of system concept, development concept and the forward outlook; successfully increase the passion of the participants toward the therapy method. It also provides the participants to have a more complete concept toward the partner and family therapy. There will still need more practice for the participants to fully implement the theories and skills into its daily services.
c. Based on the first year basic course of marriage and family consulting, this following year we start to focus on the domestic violence resources network systematic establishment and review. This year’s workshop are hosted by the Teenager social center in Ningjin, beside the participants from last year, we also invited staffs from local women focus NGO, Fathers from Shandong and other care providers in order to expend the domestic violence prevention network. In addition, we enhance their skills in how to recognize and react toward domestic violence through the gender inequality understanding and stigma reducing activities.
d. Due to the visit time of the 2nd year are during the summer vacation for school and universities, we will postponed the plan for school speech to the 3rd years. We will schedule next year's objective activities time during the school season and arrange speeches and students workshop accordingly, in order to deliver our HIV/AIDS service and case management related knowledge to the students and expands its professional vision and ability to see the potential services possibilities toward their future service works.
STAFF MEMBERS TRAINING AND SUPERVISION
Attending training courses: The staffs of Taiwan Lourdes Association are strongly encouraged to obtain on-going training. There are total of 1042.5 hours of training courses. Each staff member averaged training courses is 55 hours. 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 2013, 106 times of individual supervision and 126 group supervisions were provided.
International Experience: It is very important to exchange HIV/AIDS field working experience with other countries. Three social workers and peer coordinators visited total of 10 different organizations in HIV related fields located in China and Hong Kong shared and learned experience of working with HIV/AIDS. 2 staff members attended the ICAAP at Bangkok, Thailand to exchange their working experience with other health care provider from around the globe.
VOLUNTEERS RECRUITMENT AND TRAINING
(1) Volunteers Recruitment
We partnered with United Hospital and organized 4 volunteer recruitment training courses with 103 participants. The 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 169 volunteers remained in 2013. The volunteers provide the services of administrative work, prison visits, correspondence service and assisting in activities. We organized 8 on-going training workshops and group supervisions with 107 participants. The topics of the training cover HIV/AIDS policies and laws, ethics, self-awareness, empathy skills, emergency protection, etc.
(3) Peer Buddy Service Volunteers
We have trained people living with HIV/AIDS as volunteers to provide buddy services. There are now total of 2 peer buddy volunteers in our association. They have learned the skills of being helpers and about confidentiality. They provide one-by-one or two-by-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 2013, 5 HIV friends were referred to the peer buddy service volunteers.