STI/HIV/AIDS

• To raise awareness about STI/HIV/AIDS of 4000 men living in rural settlements that are especially poor in accessing health services,
• To encourage monogamy,

Cervical cancer and breast cancer

• By means of giving training about early diagnosis of cervical cancer and breast cancer, to 15-49 aged 6000 women and 4000 men, including influential family members and community leaders, who live in rural settlements that are especially poor in accessing health services,
• to ensure early diagnosis of breast cancer through self breast examination,
• to ensure early diagnosis of cervical cancer through identification of symptoms,
• to increase access to health services relating to early diagnosis of breast and cervical cancer,

Horizontal subject

• To increase awareness in the general public, especially among local authorities, community leaders and policy makers at the local level, about safe motherhood, family planning, STI/HIV/AIDS and early diagnosis of breast cancer and cervical cancer.

According to the data of 2003, Ardahan province is the 74 th province out of 81 provinces in Turkey from the perspective of socio-economic development. It is situated in Eastern Anatolia region, which is one of the most backward regions in the country. The population of Ardahan is 133.756 according to 2000 census. Nearly 70% of the population live in rural areas, while 30% live in urban areas. This is much lower than the average urbanization rate in Eastern Anatolia (53,05%) and average in Turkey (64,9%). High levels of migration are experienced out of the province. Annual population increase rate is %-20,22. Including the centre county there are six counties and 250 villages in Ardahan.

Traditional population structure is prevalent in the province. Compared to 15 years ago, more girls are being sent to secondary school, high school and university. The ratio of literate women to total population is %76,05. Even though this rate is lower than Turkey average, it is 10 points above the average in Eastern Anatolia . There are 29.320 women that are between 15-49 years in Ardahan.

The number of health workers in the province is insufficient. Even though there has to be 116 doctors as permanent staff in the health clinics (there are 24 health clinics in the county centres), there are only 26 doctors. On the other hand although there needs to be 207 midwives, there are only 34. In addition, even though 96 health officers are required, there are only 19. Also, while the clinics have 156 capacity, there are only 9. Moreover, most of the staff is employed at the urban areas. In addition, even though, there are 92 health homes in the villages, active ones are only 5 and only 7 midwives work at these homes. In the light of these data, it is not wrong to state that, the activities that are being carried out by Mother Child Health Programme (AÇSAP), is not able to reach larger parts of the population, especially the rural areas that are away from the city centres, due to insufficient number of personnel.

The average household number is 5,70. Even though this number is lower than Eastern Anatolia average, it is higher than Turkey average of 4,50. Although the exact number is not known, there are many polygamy marriages. In these types of households, the number of households goes as high as 10. The fertility rate in the provinces is 2,95, lower than Eastern Anatolia average of 3,92 and higher than Turkey average of 2,53.

20.18% of 15-49 years of age married women utilizes inter-uterus equipment, 4.76% oral contraceptives, %9.12 condoms and 4.14% other efficient methods. Meaning that only 38.2% use efficient methods. However, 80% of these live in province and county centres or settlements nearby these settlements. Even though with regards to family planning, compared to urban areas, people living in rural areas experience problems, present services are not able to reach rural areas. In the framework of AÇSAP trainings, if women are not able to be protected, men are advised to be protected. Nonetheless, men are unwilling to use protection methods in general. In rural areas, people do not have much information about family planning and inefficient methods are employed.

In the province women give birth at 3 state hospitals, 14 health clinics and 1 health centre. According to official records out of the women who have given birth, 87% has realised it at the hospitals, 4% under health team control and 9% at their homes. This 9% is being realised by traditional midwives, who has not received any training on health issues. Most of the births without health team are being realised in Göle County . Most people in the rural areas do not accept health teams. There are 627 women pregnant at present. According to the data obtained from Province Health Directorate, infant mortality rate is %0.22.

Average marriage age for women in Ardahan is between 18-24, and for men it is between 20-29. Unless there are major problems during pregnancy or the couples want to learn the gender of their babies, pregnant women do not recourse to health personnel. Especially in rural areas, ante-natal and post-natal care given by health personnel is at low levels. Women in rural areas employ traditional care methods during pre-natal and post-natal periods.

There is no brothel in the province. Yet, as it is one of our border provinces, many foreign sex workers enter the province illegally. In this framework, under unhealthy conditions at hotels, pubs and bars extra-matrimonial intercourse are being realised without any control or protection. 25% of men go to other provinces for this type of intercourse. Even though there is not any clear statistical data, it is known in the province that both young men and men at 40s experience this kind of sexual intercourse. There are no recorded HIV/AIDS cases in the province. Being not widespread, STI exists in the province. However, there are no data in hospital records as people prefer to be treated in other provinces in order no to face any discontent and not being excluded from the society. There is widespread lack of information regarding STI/HIV/AIDS in the provinces. And basically people do not care.

In line with the information provided above, there is much insufficiency of knowledge regarding family planning, safe motherhood and STI/HIV/AIDS, especially in the rural areas. Due to lack of knowledge, related methods are not employed and ante-natal and post-natal care is not being realised.

In this framework, as can be seen from the objectives and activities, a project which covers safe motherhood, family planning, STI/HIV/AIDS, a project which corresponds to Reproductive Health Programme's priorities and objectives is being proposed. The proposed project covers safe motherhood, family planning, STI/HIV/AIDS, early diagnosis of breast cancer and cervical cancer. The activities contain trainings and awareness raising campaigns regarding these issues. The rationale behind the activities is the lack of information and low levels of method usage identified in the general public, especially in the rural areas. The rationale behind the meetings with local authorities, policy makers and community leaders is to ensure improvement beyond the project in the long term through raising awareness in these circles.

The priority target group is the women and men, who are between 15-49 and who live in rural settlements, where health services cannot reach. In this framework, project aims to reach 6000 women and 4000 men. Moreover, through awareness raising (social marketing) campaign, the project targets to reach 20% of the population living in the centre county. The rationale behind the preference of 15-49 age group, is that people experience sexuality actively at these ages. It is known that AÇSAP's works are concentrated in the city centres and due to insufficiency of personnel, they can not reach rural areas, which cover 70% of the population. In accordance with this view, efforts within the scope of the project are concentrated on rural areas. Even though the activities are separate from that of AÇSAP's, it is complementary and the project will be realised with the support of this institution. The project has been deigned taking into account the conservative structure and abstention prevalent among the target group as well as the characteristics of rural and urban areas. Moreover, as literacy rate is 84,60& in the province, publications are widely made use of.

The priority target group is the women and men, who are between 15-49 and who live in rural settlements, where health services cannot reach. In this framework, project aims to reach 6000 women and 4000 men. Moreover, through awareness raising (social marketing) campaign, the project targets to reach 20% of the population living in the centre county. The rationale behind the preference of 15-49 age group, is that people experience sexuality actively at these ages. It is known that AÇSAP's works are concentrated in the city centres and due to insufficiency of personnel, they can not reach rural areas, which cover 70% of the population. In accordance with this view, efforts within the scope of the project are concentrated on rural areas. Even though the activities are separate from that of AÇSAP's, it is complementary and the project will be realised with the support of this institution. The project has been deigned taking into account the conservative structure and abstention prevalent among the target group as well as the characteristics of rural and urban areas. Moreover, as literacy rate is 84,60& in the province, publications are widely made use of.