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Regional Review
Regional Review Buddhist Leadership Initiative
CM
MY
CY
CMY
Buddhist Leadership
Initiative
UNICEF EAPRO
July 2009
UNICEF EAPRO, July 2009
UNICEF East Asia and Pacific Regional Office

19 Phra Atit Road
Bangkok 10200
Tel: (66 2) 356 9499
Fax: (66 2) 280 7056
E-mail: eapro@unicef.org
Website: www.unicef.org/eapro
unite for children
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
Copyright UNICEF East Asia and Pacific Regional Office, 2009

Any part of this report may be freely reproduced with the appropriate acknowledgment
Design and layout: Keen Media (Thailand) Co., Ltd.

Printed in Thailand
ISBN: 978-974-685-111-4
19 Phra Atit Road
Bangkok 10200
Tel: (66 2) 356 9499
Fax: (66 2) 280 7056
Contents
Acronyms
Acknowledgements
Executive Summary
v
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CHAPTER 1: INTRODUCTION TO THE BUDDHIST LEADERSHIP INITIATIVE
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Buddhism in East Asia

Understanding HIV and AIDS from a Buddhist perspective
Buddhist Leadership Initiative (BLI) in the Greater Mekong Sub-region A regional approach
Objectives of the Regional Buddhist Leadership Initiative
Building on tradition
Sangha Metta Project provides technical assistance to Regional Buddhist Leadership Initiative
The initiation of the Buddhist Leadership Initiative in the Greater Mekong Sub-region
CHAPTER 2: BUDDHIST LEADERSHIP INITIATIVE STRATEGY FOR ACTION
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Introduction
Key principles of the Regional Strategy
Regional Buddhist Leadership Initiative Monitoring and Evaluation Framework
Objectives of the multi-country review
CHAPTER 3: METHODOLOGY
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Populations included in the study

Areas included in the study
Sampling design and sample sizes
Interviewer selection and training
Process of fieldwork
Data editing
Response and refusal rates
Limitations of the study
CHAPTER 4: HIV AND AIDS SITUATION IN THE BLI COUNTRIES AN OVERVIEW
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Introduction
Trends in risk behaviours in the BLI countries
CHAPTER 5: HOW DID BLI ENGENDER CHANGES IN THE COMMUNITY?
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Knowledge/awareness of HIV and AIDS

Reducing stigma and discrimination
Community responses to HIV education
Community response to care and support to PLWHA
Building and strengthening partnerships
CHAPTER 6: HOW DID BLI ENGENDER CHANGES IN THE MONKS/NUNS

AND THE SANGHAS?
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Enhancing the effectiveness and efficiency of Sangha response to HIV

Capacity building on HIV and AIDS
Promoting Buddhist scriptures to reduce stigma and discrimination
Promoting non-discriminatory attitudes towards PLWHA
CHAPTER 7: CONCLUSIONS AND RECOMMENDATIONS
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Experiences and lessons learned

Achievements of the BLI
Limitations of the BLI
Lessons learned
Recommendations
Endnotes
65
References
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Annex: Sampling methodology for the BLI
67
Acronyms
AIDS
Acquired Immuno Deficiency Syndrome
ARV
Anti-Retroviral
BCC
Behaviour Change Communication
BLI
Buddhist Leadership Initiative
EAPRO
East Asia and Pacific Regional Office, UNICEF
FGD
Focus Group Discussion
HCMC
Ho Chi Minh City
HIV
Human Immuno Deficiency Virus
IEC
Information, Education and Communication
Lao PDR
Lao Peoples Democratic Republic
MOLISA
Ministry of Labour, War Invalids and Social Affairs
NBA
National Buddhist Association
NGO
Non-Governmental Organization
OVC
Orphans and Vulnerable Children
PLWHA
People Living With HIV and AIDS
PPS
Probability Proportionate to Size
STI
Sexually-Transmitted Infection
UNICEF
United Nations Childrens Fund
VCCT
Voluntary and Confidential Counselling and Testing
VNFF
Viet Nam Fatherland Front
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
The Regional Buddhist Leadership Initiative (BLI)

The history of the Regional Buddhist Leadership Initiative goes back to the time when the
HIV and AIDS epidemic was rapidly gathering momentum in the sub-region and a multisectoral effort was urgently needed to effectively prevent the spread of the epidemic.
In the early 1990s, as people in communities in Northern Thailand began to fall sick and die
from HIV and AIDS, the Buddhist monks and nuns responded with a range of care and
prevention activities.3 Recognizing the value and applicability of their work, UNICEF began
supporting training for Thai monks on HIV and AIDS in 1997 and subsequently shared
lessons from Thailands long experience with Dai monks in Xishuangbanna, Yunnan, China
in 1999, followed by Cambodia (2000) and the Lao PDR (2001). The BLI was later initiated in
Viet Nam in 2002 and in Myanmar in 2003.
The Regional Buddhist Leadership Initiative was developed as part of the Mekong
Partnership Programme, with EAPRO support to Country Offices combining advocacy to
government and religious organizations at national level with funding and technical
assistance for monks and nuns at local level.4
Objectives of BLI
The Buddhist Leadership Initiative was designed to mobilize and enable Buddhist monks, nuns
and lay teachers in collaboration with key Buddhist institutions and government
agencies to lead community-level HIV and AIDS care and prevention, with a view to: increasing
access to care and support for adults and children living with HIV and AIDS and children
affected by AIDS; increasing community acceptance of adults and children living with HIV
and AIDS; and building HIV resilience in communities, especially among youth.5 Other
objectives of the BLI are to build capacity in monks and nuns and to manage the Initiative
effectively.
ix
The Regional BLI Approach to HIV and AIDS

The UNICEF Mekong Subregion STD/HIV and AIDS Project (Mekong Project) was
implemented from mid-1996 to end of 1999.6 Following the Mekong Project review, UNICEF
and its partners developed an HIV and AIDS strategy for 2001 2003. The strategy formed
the basis of the Mekong Partnership and Beyond Programme.7 UNICEF employed strategies
identified through its Mekong Partnership Programme, where lessons learnt from one
country were documented, adapted and applied within a cluster of geographically
proximate, culturally related countries.
The Regional Strategy and Evaluation Framework
In 2002 2003, UNICEF developed a Regional Strategy and Evaluation Framework, which
played a major role in providing guidance and direction to Country Office Programming.
Countries participating in the BLI were encouraged to adopt its objectives and monitor
achievements against these aims.
The Regional Strategy of 2003 had a strategic focus on care and support. Its purpose was to
lead religious leaders through a process of understanding the needs of people with HIV and
AIDS and the social dimensions of the problem to avoid the prohibitive or judgmental
approach to prevention.
UNICEF used a common orientation training approach in all countries in the Buddhist
Leadership Initiative. The approach has been documented in the training manual A
Buddhist Approach to HIV and AIDS Prevention and Care.
Multi-country review of BLI
A multi-country review (20062007) based on the Regional Monitoring and Evaluation
Framework was conducted by Country Offices under UNICEF EAPROs supervision to obtain
quantitative and qualitative data in the five BLI implementing countries. The review aimed
at: understanding and verifying the impact of services on beneficiaries and documenting the
findings at both country and regional levels; identifying programme strengths and weaknesses
and improving on them; identifying potential gaps between programme planning and
actual implementation; improving delivery mechanisms to become efficient and effective
and; obtaining lessons learnt and suggesting strategies in the context of multiple country
experiences for strengthening and scaling up the programmes.
The review targeted five population groups that were associated with the studys basic unit:
the temple. The targeted groups consisted of senior monks (defined as the head of a temple
or the monks belonging to the temples steering committee); junior monks and nuns,
PLWHA, members of communities served by the temple, and in some country reviews
(Cambodia and Lao PDR), the BLI programme coordinators.
Achievements/impacts of the BLI

The UNICEF Regional Buddhist Leadership Initiative grows from the heart of Buddhist
tradition and belief. Buddhist ideals like moderation, self-discipline and compassion are
valuable assets in HIV prevention and creating enabling environments for people with HIV
and AIDS.
Over the last decade, the impact of the Buddhist Leadership Initiative has been considerable
in all the five countries. UNICEF EAPRO and the Country Offices continued advocacy and
support for Buddhist involvement in the national AIDS programme has yielded results.
Monks and nuns in collaboration with key Buddhist institutions and government agencies
have been successful in leading community-level HIV and AIDS care and prevention. These
interventions have increased access to care and acceptance of people living with HIV and
AIDS and have contributed to building HIV resilience in communities.
x
BLI brings change to the communities

Increased knowledge of HIV and AIDS
HIV prevention education, IEC and other outreach activities performed by monks/nuns have
had a positive impact on communities, as knowledge of HIV and AIDS issues is greater
among community members in the BLI sites. In China, the greater efforts by monks in the
BLI sites on publicity for HIV prevention show that nearly twice (61%) as many people in the
BLI site had seen information on HIV and AIDS on brochures and posters compared to
non-BLI sites (32%).
Improved community understanding and acceptance of PLWHA
Concerted efforts were made to increase community understanding and acceptance of
people with HIV and AIDS based on Buddhist principles. The community respondents
acknowledged that the monks/nuns in their communities have been actively engaged in the
HIV and AIDS interventions and had contributed to care and support services for PLWHA in
the community. The types of activities that were appreciated by the community members
were monks preaching on compassion and tolerance towards PLWHA, visits by monks who
pray or perform ceremonies for PLWHA in the neighbourhood, provision of educational
materials on HIV spiritual support such as meditation, and the opportunity to participate in
the discussion on HIV and AIDS. In 2007, a total number of 2000 meditation booklets and
1000 meditation VCDs were distributed through the hospital self-help groups and temples in
the Lao PDR.8 In 2008, 15,000 copies of a booklet written for people living with HIV that
teaches adults to meditate, were reproduced and distributed for use in the programme in
Cambodia.9
Further, communities have shown a readiness and acceptance of BLI activities. Along with
PLWHA, community members were the most supportive stakeholders of HIV and AIDS
programmes conducted by monks. In Cambodia, during annual religious festivals, large
crowds gather at the pagodas. Monks have made use of these events to teach people about
HIV and AIDS through sermons promoting Buddhist compassion. As estimated 170,000
people from 13 provinces were reached with messages on non-discrimination, care and
support to people living with and affected by HIV and AIDS. These events included Khmer
New Year, the Water Festival, the Candle Light Memorial Celebration, World AIDS Day and
Pchum Ben Festival. Also 13,300 adolescents and school-going young people participated in
sessions on HIV prevention using Buddhist moral principles. One thousand copies of two
videos entitled Hope and Help and Giving a Hand were reproduced. The videos were
distributed to the 13 provinces to assist monks and provincial Departments on Cults and
Religions in their community education activities.10
Increased support and involvement of PLWHA
Among the approaches to support PLWHA, the formation of self-help groups is the most
common in all five countries. Additionally, providing PLWHA self-help groups with material
support, such as food and clothing was most popular in Viet Nam and Myanmar. The relatively
high degree of support that monks offer to self-help groups is reflected in the responses of
PLWHA. In Cambodia, most PLWHA (78%) interviewed belonged to a self-help group and
86% of these PLWHA responded that their group was supported by monks, who mostly
provide temple space and/or spiritual guidance and help with meditation. Programmes for
PLWHA include group discussions on health care, use of clean water/foods, and hygiene. A
large share of the PLWHA (87%) said they were very satisfied with the support that monks
provide to their group.
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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.
BLI engenders changes in the monks/nuns and the Sanghas

Improved knowledge and understanding of HIV and AIDS
Monks and nuns in the sites that underwent BLI training have a better knowledge and
understanding of HIV and AIDS issues. In Cambodia in 2006, 375 monks were trained as core
trainers on HIV prevention and care using Buddhist principles. The trainers then trained about
1,226 other monks, 634 achars13, 209 nuns and 587 village and commune chiefs.14 In China,
76% of the junior monks in the BLI site knew all the correct modes of HIV transmission,
whereas the share among junior monks was 51% in the non-BLI sites. In addition, trained
monks and nuns compared with untrained monks had better knowledge on prevention as
well as knowledge of local facilities providing treatment for HIV and AIDS. Since 1999, in the
General Temple, Jinghong City, the project has trained 600 monks from 40 Buddhist
temples. The 40 temples provide care information in communities covering around 100,000
community members. Over ten senior monks have been in charge of project activities.
HIV prevention was the most common topic of training for junior monks in the BLI sites in
China and Cambodia. In Lao PDR, the most widespread type of training was in life skills,
attended by nearly all of the 13% of the 201 junior monks in the BLI sites who were trained
under the BLI initiative. Another common topic in all three countries was HIV and AIDS
stigma and discrimination reduction.
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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
Improved acceptance and support of PLWHA

In Cambodia, an overwhelming majority (90%) of junior monks surveyed responded that
they would feel comfortable sitting next to a PLWHA of the same sex or tying a blessing
string on a PLWHA. Between 81% and 100% said that they would share household objects
with a fellow monk who was HIV positive. The few monks who would be uncomfortable
sharing objects with PLWHA attributed their attitudes to fear of getting infected.
In China, 77% of junior monks in the BLI site responded that they felt at ease when tying
blessing strings for PLWHA, compared to 47% in the non-BLI sites. Also, the rates of junior
monks in the BLI site who were willing to share their plates, spoons, cushions, mats and
bikes with PLWHA are 85%, 85%, 89%, 91% and 95% respectively, which are considerably
higher than the response rates of monks in the non-BLI sites (between 35% and 37%). The
main reason why the junior monks were willing to share their daily articles with PLWHA is
because this does not lead to infection. On the other hand, fear of contracting HIV was the
main explanation provided by the monks who felt uneasy sharing these items with PLWHA.
In Viet Nam, 55% of monks/nuns in the BLI site were involved in activities to reduce
discrimination against PLWHA, compared to 20% in the non-BLI sites. Of the junior monks
in the BLI sites, 95% had visited PLWHA in their homes. Among the efforts by the Sangha in
Lao PDR to develop direct contact with people living with HIV and AIDS in the community,
providing psychological counselling for PLWHA, both in groups and individually was the
most common.
Collaboration with health institutions
The temples and sanghas have worked with the health institutions to improve services
for PLWHA. Findings from the qualitative study in Myanmar indicate that the main types of
activities offered by monks to link PLWHA with the health sector were giving directions or
advice for contacting health facilities, and providing support to help the PLWHA access
health services. In addition, the temples have shown evidence of working in collaboration
with educational institutions and other civil society organizations.
Overall BLI achievements

The Buddhist response to HIV and AIDS has been accepted by governments, communities,
monks and nuns themselves. The role of the monks is better accepted at all levels now than
before. In Viet Nam, Cambodia, China, Myanmar and Lao PDR, the evidence that HIV-positive
people continue to seek and utilize counselling and care services at the pagoda/temple
indicates that they trust and appreciate the services.
In each of the countries, the BLI has been built on the strengths of the monks and nuns
and other religious leaders. It has encouraged the monks to move from their temples to
communities. One of the reasons why the Buddhist response has met with success in that it
provides an alternative to services that may be regarded by users as likely to be
condemnatory or even punitive.
Results from the multi-country survey show that BLI effectively supported monks training in
HIV and AIDS. Monks who received BLI training were more knowledgeable about HIV and AIDS
and exhibited less discriminatory attitudes towards people living with HIV. Furthermore, monks
who received BLI training were more likely to engage in prevention, care and support activities.
In addition, people living with HIV and AIDS participated in, and were satisfied with services
provided.
Furthermore, the Buddhist Leadership Project has served as an example for Muslim and
Christian communities in best practice sharing at conferences. In China, the success of the
BLI in Yunnan was documented and influenced the development of a Muslim AIDS initiative
in Ningxia Province in northern China.
xiv
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.
Interventions that have proven to be most effective and acceptable

Preaching non-discrimination messages and compassion towards PLWHA using Buddhist scriptures
and dissemination of IEC materials
Teaching meditation and spiritual guidance to PLWHA
Psychological counselling for HIV-positive persons and families
Supporting PLWHA self-help groups with materials, income-generating activities, shelter etc.
Home visits to PLWHA
xv
Areas for future action to include:

Increasing capacity monks, nuns, lay persons and others
Improving quality and increasing coverage of care and support for PLHIV and CABAs
Reducing stigma and discrimination against PLHIV and CABAs
Improving community participation especially among young people
Increasing community resilience to HIV, especially among young people
Expansion of multi-sectoral and inter-faith coordination
Developing policies/framework on religious organizations and HIV and AIDS and integration into
larger frameworks of community-based HIV programmes.
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
Introduction to the Buddhist

Leadership Initiative
1.1 Buddhism in East Asia

Buddhism is both a religious tradition and
philosophy based on the teachings of the
Buddha, Siddhartha Gautama, whose lifetime
is traditionally given as 566 to 486 BC.
From its origins in ancient India, Buddhism
spread to encompass most of South, Central
and East Asia, changing and evolving in the
process into three forms present in East Asia
today: Theravada Buddhism (Cambodia,
Thailand, Lao PDR, Myanmar, Yunnan in
China, some areas in Viet Nam) Mahayana
Buddhism (China and Viet Nam) and the form
of Buddhism known as Lamaism (Mongolia,
Tibet and other parts of China).
The Buddhas Four Noble Truths consist of:

1) suffering (Dukkha); 2) the cause of
suffering (Samudaya); 3) the cessation of
suffering (Nirodha); and 4) the path leading
to the cessation of suffering (Magga). They
provide an excellent framework for promoting
love, compassion and care and mobilizing
community support and acceptance of
people who are suffering from HIV and
AIDS. They also play a significant role in
demystifying the myths surrounding HIV and
AIDS and in creating an environment of
tolerance, respect and knowledge.
1.2.1 HIV and AIDS in the context of the

Four Noble Truths
The suffering (Dukka) related to HIV and

AIDS is not only physical but also emotional,
mental, economic, and social. In the First
Noble Truth, a broader understanding of the
widespread suffering of HIV and AIDS is
addressed. Additionally, it suggests why it is
important and appropriate for monks, nuns
and members of society at large to respond
to HIV and AIDS as a community issue and
not just a health issue restricted only to
those infected. It encourages them to relate
in a more personal way with those infected
and affected by HIV and AIDS and motivates
them to provide continuing support thereby
enhancing community understanding of
people living with HIV and AIDS.
The Buddha in his very first sermon after his

enlightenment declared: Birth is suffering,
ageing is suffering, disease is suffering,
death is suffering. This statement
constitutes the first of the Four Noble Truths
that make up the Buddhas most fundamental
teachings about universal suffering and
could serve as the context for a better
understanding of the sufferings and
challenges confronting people living with
HIV and AIDS, including their families and
communities.
The Second Noble Truth (Samudaya)

suggests the need to identify the underlying
causes of the suffering related to HIV and
AIDS in order to understand and eliminate
them. For many people living with HIV, it
remains a daily struggle to get adequate
medical treatment and care, to continue to
earn a living and keep a job, and to cope
with the isolation and shame imposed by
ongoing stigma and discrimination which
stem from ignorance of the modes of
transmission and nature of the HIV virus.
Originally introduced to the region around

the first century AD, Buddhism continues to
play an important role in East Asian society,
despite the challenges of globalization and
the political upheavals of the last few
decades.
1.2 Understanding HIV and AIDS

from a Buddhist perspective
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.
Therefore, it is extremely crucial to provide

accurate information to prevent fear, stigma
and discrimination against people living
with HIV and AIDS and to create an enabling
environment for them, their families and
communities.
The Third Noble Truth identifies the cessation
of suffering (Nirodha). After Enlightenment,
the Buddha surveyed the world to see to
whom he could teach the Dhamma and
thereby established a team of workers. In
the context of HIV and AIDS, the Third Noble
Truth relates to identifying existing
community resources and mobilizing the
entire community in working together
towards ending the suffering brought about
by HIV and AIDS. For example, schools or
youth groups could help in teaching
children about HIV and AIDS. The Buddha
taught that when people work together,
success and community harmony is easily
achieved. However, when there is disunity,
success is hard to attain.16
The Fourth Noble Truth identifies the path
leading to the cessation of the suffering
(Magga). The Noble Eightfold Path is the
path that leads to the cessation of suffering;
it entails Right Understanding, Right
Intention, Right Speech, Right Action, Right
Livelihood, Right Effort, Right Mindfulness
and Right Concentration. In order to end the
suffering related to HIV and AIDS, monks
and nuns can initiate activities on their own
or in collaboration with other individuals or
organizations. For example, if the problem

for the person living with HIV is an emotional
one caused by an inability to accept ones
status, then the temple and the monks can
become the resource in offering meditation
training and counselling. Or, if children of
people living with HIV face discrimination
from other children because of ignorance,
then the school can be the resource in
tacking stigma, with the monks providing
guidance and support.17
The Four Noble Truths and the Noble
Eightfold Path are central to HIV prevention
and can inform and inspire greater efforts
towards the creation of an enabling and
supportive environment for people living
with HIV and AIDS, their families and
communities.
1.3 Buddhist Leadership Initiative

(BLI) in the Greater Mekong
Sub-region A regional approach
The Buddhist Leadership Initiative was
initiated at a time when the HIV and AIDS
epidemic was rapidly gathering momentum
in the sub-region and a multi-sectoral effort
was urgently needed to effectively prevent
the spread of the epidemic.
In the early 1990s, as people in communities
of Northern Thailand began to fall sick and
die from AIDS, Buddhist monks responded
with a range of care and prevention
activities. The most well known of these was
Map showing countries where the Buddhist Leadership Initiative is implemented
Mongolia
China
China
(Yunnan)
Myanmar
Lao PDR
Thailand
Cambodia
Viet Nam
UNICEF EAPRO
the hospice of Wat Phra Baht Nam Phu

started in 1992 with the support of the
International Network of Engaged Buddhists
and AusAID. The Northern AIDS Prevention
and Care Program (NAPAC) was among the
first non-government organizations to see
the potential of monks involvement at
grassroots level and seek to develop this
with small grant funding, supporting 10
projects run by or with monks in 1993 4.18
strategies identified through its Mekong

Partnership Programme where knowledge
and experience learnt from one country
were documented, adapted and applied
within a cluster of geographically proximate,
culturally related countries.
In 1997, UNICEF Thailand funded Sangha

Metta, a Chiang Mai based NGO to train
monks in awareness raising, prevention
education, participatory social management
skills, as well as tolerance, acceptance and
spiritual support for people living with HIV
and AIDS. Using the Four Noble Truths as
the framework, the Sangha Metta has
trained over 2,500 monks and nuns. The
monks and nuns were able to apply their
new skills to meeting local needs and
day-to-day activities of their congregants.
They garnered the support of police, health
workers, teachers and other community
leaders to establish youth training camps,
income-generating activities for HIV-positive
women and other HIV and AIDS related
activities.19 Further from 1997 2003, a total
of 6,838 monks, nuns, novices, community
members, and youth have completed
project training courses.20
advocacy with national counterparts via

UNICEF Country Offices
technical assistance in training and

strategy development through a number
of international and national specialists
development and sharing of materials,

training curricula and manuals
Using Sangha Metta as a technical specialist

in training, the UNICEF East Asia and the
Pacific Regional Office (EAPRO) introduced
the BLI to Yunnan Province China (1998),
Cambodia (2000) and Lao PDR (2001), working
in close cooperation with governments and
national Buddhist associations. The BLI was
initiated in Viet Nam in 2002 and in
Myanmar in 2003.
The Regional Buddhist Leadership Initiative

aims to mobilize Buddhist monks, nuns and
lay teachers to lead their communities to:
The BLI was designed to mobilize and enable

Buddhist monks, nuns in collaboration with
key Buddhist institutions and government
agencies to lead community-level HIV and
AIDS care and prevention, with a view to
increasing access to care and acceptance of
people living with HIV and AIDS as well as
building HIV resilience in communities,
especially among youth.21 UNICEF employed
The strategies include:

provision of regional forums for sharing
experiences
Through the Regional Buddhist Leadership

Initiative, UNICEF has helped the Buddhist
response to HIV and AIDS prevention and
care in the Greater Mekong sub-region to grow
from a few isolated groups to committed
monks and nuns to a high-profile national
and sub regional-phenomenon in just a few
years.22
1.4 Objectives of the Regional

1. Increase access to care and support for

adults and children living with HIV and
AIDS and children affected by AIDS;
2. Increase community acceptance of adults
and children living with HIV and AIDS; and
3. Build HIV resilience in communities,
particularly among youth.
Other objectives of the BLI are to build
capacity in monks and nuns to address HIV
and AIDS issues, and to manage the
Initiative effectively.23
1.5 Building on tradition

The UNICEF Regional Buddhist Leadership
Initiative grows from the heart of Buddhist
tradition and belief. Buddhist ideals like
moderation, self-discipline and compassion
are valuable assets in HIV prevention and
creating enabling environments, for people
with HIV and AIDS.24
The traditional role of the temple as the
spiritual heart of the village provides many
opportunities for programming, for example:
1. Monks receive donations of food and
household goods, which can be shared
with families affected by HIV and AIDS.
2. During the Buddhist Lent (July October),
boys are ordained as novices for
meditation and spiritual instruction from
the monks. Those four months may
serve as a time to incorporate HIV and
AIDS awareness.
3. Temple schools provide education for
novices as well as for the poorest and for
orphaned and abandoned children
(including a growing number of children
affected by HIV and AIDS). A number of
these schools are including prevention
education in their curricula.
4. Religious festivals and temple fairs can
draw almost the whole community to the
temple. They are excellent times to
disseminate HIV and AIDS messages.
5. Some temples have built hospices and
refuges, providing both spiritual and
medical support, although for most, the
priority is overwhelmingly outreach and
community-based care.25
1.6 Sangha Metta Project provides

technical assistance to Regional
The Sangha Metta Project has been a source
of inspiration, training and other technical
assistance for the Buddhist Leadership
Initiative all over East Asia and Pacific.26
Sangha Metta training covers the following:
UNICEF EAPRO
awareness-raising; prevention education;

participatory social management skills and
tools; encouraging tolerance and compassion
for people affected by HIV and AIDS in the
community; and providing direct spiritual
and economic support to people and
families affected by HIV and AIDS.
In the training programmes, the participants
are taught to develop their understanding of
HIV and AIDS and the problems threatening
their community. HIV and AIDS is presented
within the framework of the Four Noble
Truths of Buddhism: suffering (Dukkha),
the cause of suffering (Samudaya) the
cessation of suffering (Nirodha) and the
path leading to cessation of suffering
(Magga). The participants explore the
suffering caused by HIV and AIDS and work
out solutions to these problems. When they
are back in their communities, the monks
and nuns apply these skills in a way that fits
in with local needs and makes use of the
available resources.27 Through the Buddhist
Leadership Initiative, the Sangha Metta
Project has provided training and advice for
monks and nuns in Cambodia, China, Viet
Nam, Lao PDR, Myanmar and Thailand.
1.7 The initiation of the Buddhist

Leadership Initiative in the Greater
Mekong Sub-region
1.7.1 Thailand
The history of the Buddhist Leadership
Initiative began in Thailand the first
country in the region to face a generalized
HIV and AIDS epidemic and to experience a
grassroots response from local Buddhist
leaders. This grassroots response grew up
in individual temples as abbots saw the
crisis unfold amongst the congregations
and has been recognized as a model for
Regional Buddhist Leadership Initiative.
Within Thailand, while active monks were
fully incorporated in the HIV and AIDS
response, their representation continued to
be largely at sub-provincial level and even
provincial level, as national bodies, such as
the Supreme Council of Sangha, continued
to view HIV and AIDS as marginal to their
concerns. From the inception of the
Buddhist Leadership Initiative, Thailand has

been a source of leadership rather than a
recipient.
As home to the UNICEF Thailand funded
Sangha Metta Project, Thailand leads the
way in modelling the grassroots response to
HIV and AIDS at community level, particularly
in North and North-East Thailand. The
Department of Religious Affairs and the
Sangha Government Council acknowledge
that monks and nuns have a role to play in
communities in relation to HIV prevention
and care. The Department of Religious
Affairs has funded HIV care projects in
temples.28 A formal network of Thai monks
working on HIV and AIDS titled Monks
Network on AIDS in Thailand was formed in
2004.
The Thailand experience shows that
innovative programmes led by NGOs can
force strong GO, NGO and CBO links with
PLWHA and other groups impacted by HIV
and AIDS.29 With the experiences gained
over the last decade, Thailand has continued
to be a valuable resource for the East Asia
and Pacific region, for study visits as well as
resource persons.
1.7.2 Cambodia
More than 90% of the population in
Cambodia is Buddhist. Pagodas are a
natural focal point for communities and
their needs. They have been providing
communities with a multitude of education
and health-related services for many years.
There are about 4,060 pagodas in Cambodia
with about 60,000 monks divided
in two distinct branches: Mahanykaya and
Thomayut. Many monks already act as
teachers and community leaders, providing
people in their communities with mental,
spiritual and social support.
UNICEF has supported the BLI activities in
Cambodia since 2000 as part of the Regional
Buddhist Initiative. UNICEFs main counterpart
is the Ministry of Cults and Religion, which
developed the National Policy on Religious
Response to HIV and AIDS (May 2002) in
conjunction with the countrys most senior
monks. The policy, the first of its kind in the
world, specifically calls upon religious
6
leaders to play a role in HIV and AIDS

through: educating themselves and their
communities on HIV and AIDS; reducing
discrimination against people with HIV;
improving access to care and support for
HIV-positive children and adults, maintaining
a multi-sectoral approach throughout.30
To date, the BLI programme has 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), including two provinces (Takeo
and Battambang) where the programme is
implemented through local faith-based
organizations. Within these 14 provinces,
BLI activities have been implemented in 45
districts, 188 communes, 886 villages and
387 pagodas.
1.7.3 China
The BLI foundations were originally laid in
1998 in Jinghong city, one county in
Xishuangbanna Dai Peoples Autonomous
Prefecture, which lies on the southern
frontier of Yunnan Province, bordering Lao
PDR and Myanmar. The Yunnan provincial
government has identified the programme
as an example of a culturally sensitive
model for HIV and AIDS prevention, care
and support. The project was then scaled-up
to Menghai and Mengla counties of
Xishuangbanna Prefecture in 2006, covering
all counties within the prefecture.
The total population of the prefecture is
993,000 of which 123,000 are migrants
without a Chinese residency card in the
prefecture. Xinshuanbanna has long
been influenced by Buddhist (Theravada)
cultures, thought and traditions. Overall,
there are 577 temples in the prefecture (201
in Jinghong, 125 in Menghai and 21 in
Mengla). Within the prefecture, there are
184 pagodas, 4,800 monks and over 300,000
registered Buddhists, who account for
one-third of the total population.
The success of the BLI in Yunnan was
documented and influenced the development
of a Muslim AIDS initiative in Ningxia
Province in northern China. Additional
initiatives among the Christian community
were initiated in Kunming, Yunnan, the

provincial capital, but they were discontinued
by the Bureau of Religious Affairs.
By the end of December 2006, 702 cases of HIV
and AIDS were reported in Xishuangbanna:
259 cases were found in Jinghong City: 185
cases were found in Menghai County: 63
cases were found in Mengla County. Of the
702 reported cases, 149 cases were among
migrant populations, and 49 cases were
among foreigners (from Myanmar, Lao PDR
and Thailand). The AIDS epidemic has
continued to increase every year. The building
of a highway from Jinghong to Chiang Mai
has brought large numbers of construction
workers to the region, and increasing
economic activity has contributed to an influx
of cross-border traffic.
The government office responsible for AIDS
Control in Xishuangbanna is the AIDS
Control Office of Xishuangbanna Prefecture
established in 1991. The office brings many
government departments together to
respond to the epidemic and has allowed for
multi-departmental cooperation for AIDS
prevention and control in Xishuangbanna.
These
government
structures
have
supported the UNICEF BLI programme in
Xishuangbanna Prefecture.
From 1997 to 2000, with support from
the UNICEF Yunnan Provincial Government
Cooperative
Project
on
HIV
and
AIDS Prevention, Care and Support,
Xishuangbanna developed the care and
support policies for the AIDS Control Office
of Xishuangbanna Prefecture. At that time
around 65 Buddhist monks received training
on HIV and AIDS and had the capacity to talk
about HIV and AIDS within communities,
but no follow-up actions were taken without
UNICEF support until July of 2003.
In July 2003 UNICEF funded the Buddhist
Association of Xishuangbanna to develop
the BLI pilot project in the General Temple of
Jinghong city based on a rapid needs
assessment among people living with HIV
and AIDS and an analysis of the resources
available through the Yunnan Buddhist
Association. The objectives of the strategy
of BLI project were developed and focused
UNICEF EAPRO
on care, support and anti-discrimination

education. In Xinshuangbanna, a self-help
group for people living with AIDS was
developed and three Homes of Buddhist
Light were established which currently
provide care and support to PLWHA and
their families. Prevention activities are
also conducted in the communities affected
by AIDS.
The Home of Buddhist Light was
launched as an advocacy initiative and as a
model for care and support. The package of
care and support includes: religious and
group counselling with people living with
AIDS and their families: fund-raising among
Buddhist who attended religious services;
income generation activities for people
living with AIDS (Mushrooms were grown
and a peacock farm was built at a
temple); educational classes on health and
hygiene practices, self-help group activities,
medical referrals for ill members of the
support groups; and anti-discrimination
activities among monks and in communities
affected by AIDS.
The Home of Buddhist Light care model
was developed over two years. IEC materials
were produced and the project was
documented as a good practice and
shared with national level AIDS Prevention
and Control authorities. In October and
November 2006, the Bureau of Ethnic
Minority Religious Affairs of Xishuangbanna
Government scaled up the Jinghong model
to Menghai County and Mengla County.
Since 1999, in the General Temple, the
project has trained 600 monks from 40
Buddhist temples. The 40 temples provide
care information in communities covering
around 100,000 community members. Over
ten senior monks have been in charge of
project activities.
1.7.4 Lao PDR
Approximately 75 % of the population of
Lao PDR are Buddhists in the Theravada
tradition. The bodies governing Buddhism
in Lao PDR are the Department of Religious
Affairs, within the Lao Front for National
Construction and the Lao Buddhist
Fellowship Organization.
In September 2001, UNICEF launched the

Buddhist Leadership Initiative in Lao PDR,
entitled the Metta Dhamma Project. The
Religious Department of the Lao Front for
National Construction and the National
Buddhist Association are UNICEF partners
in the BLI initiative in Lao PDR.31 The project
began with orientation trainings and study
visits and began to implement activities
from 2002. The Metta Dhamma project has
organized training for senior monks on HIV
and AIDS and the role of monks in reducing
the impact of the epidemic. Although monks
and nuns in Lao PDR have a low capacity
base, they have a high potential to influence
public opinion. For this reason capacity
building has been a strong feature of the
initial phase of the project.
Currently, monks are active in the care
and support of people living with HIV and
AIDS in three provinces: Savannakhet,
Champassak and Vientiane Capital. Monks
are involved in outreach and education to
communities and schools in four provinces:
Savannakhet, Champassak, Luang Prabang
and Vientiane Capital. With regard to the
low HIV prevalence status in Lao PDR, Metta
Dhamma has had a particular focus on
prevention activities for young people in
schools through Buddhist Life Skills. In
2007, concerns of children infected and
affected by HIV and AIDS were also
addressed through regular monthly
Buddhist life skills sessions and annual
camps. These provide affected youth aged
12 to 18 with skills to cope with HIV-related
problems including discrimination, grief and
loss, as well as ensuring peer social support.
1.7.5 Myanmar
More than 85% of the 54 million people
living in Myanmar are Buddhist. In most
communities, especially those located in
peri-urban areas, small towns and rural
areas, monasteries are the centre of
socio-culture activities. Monks retain a
significant influence on various aspects of
life in the communities. For instance, there
are more than 3,600 monasteries
throughout the country that provide access
to Monastic Education, where children from
low-income families can receive free
education in line with the government
8
schools curriculum. Another form of social

activity is the operation of small clinics or
hospitals in monasteries.
As of March 2006, there were 63,282
monasteries and 3,367 nunneries in
Myanmar, where over 540,000 monks and
novices and 43,000 nuns take refuge for the
Waso Lent. The Ministry of Religious Affairs
is responsible for all religious matters, while
the assessment of whether monks activities
lie within Theravada rules and disciplines is
the responsibility of bodies governed by the
monks themselves.
UNICEF EAPRO and Myanmar Country
Office began discussions on the Buddhist
Leadership Initiative with the Ministry of
Religious Affairs in April 2003. Subsequently,
UNICEF invited a consultant from Sangha
Metta in Thailand and the UNICEF regional
HIV Care and Support Officer to give a series
of lectures on The Buddhist response to
HIV and AIDS in the East-Asian Region to
student monks and laypersons at the
International Theravada University in Yangon,
State Sanga University in Mandalay and
Sitagu International Buddhist Academy in
Sagaing. The initial plan was to implement
the BLI through the International Theravada
Buddhist Mission University in Yangon and
Sitagu International Buddhist Academy
(Sagaing). However, due to the political and
cultural sensitivity of the project activities,
and strict rules and regulations that the
Universities should only teach literature
related to Buddhism, HIV-related messages
could not be incorporated in the Buddhist
Universities to reach monks nationwide.
The BLI activities were eventually
implemented in October 2004 through
Rattana Metta, a lay Buddhist organization.
Training on the Buddhist response to the
impacts of HIV and AIDS on Myanmar
society and citizens was organized in
November 2004, facilitated by the coordinator
of the Sangha Metta Project to help the
members of Rattana Metta better understand
the HIV and AIDS epidemic, to identify the
strategy for assisting the community in HIV
issues, and to develop the plans and activities
for HIV prevention, care and support.
Rattana Metta gradually began mobilizing

the community and Buddhist groups to be
involved in the HIV and AIDS response in
2005, and further expanded activities in May
2006. In addition to providing training and
dissemination of Theravada Buddhist HIV
and AIDS prevention messages, Rattana
Metta initiated care and support to PLWHA
and their affected families, including
orphans and vulnerable children (OVC) in
Yangon. Though the coverage was not
township-wide, the main prevention
activities were carried out in four townships
in Yangon (Alone, Mingalar Taungnyunt,
North Okkalapa, North Dagon), and two
townships in Mandalay (Chan Aye Thar Zan,
Chan Mya Thar Si). Through care and
support activities, 60 PLWHA and 120 OVC
received nutritional support, and 69 out of
the 120 OVC received educational support
in 2006.
1.7.6 Viet Nam
In Viet Nam, around 11% of the population are
Buddhist (10 million people are officially
registered as Buddhist). However, a far
greater number of people, although not
registered, frequently visit Buddhist temples
and participate in Buddhist ceremonies.
Vietnamese society and culture continue to be
strongly influenced by Buddhism.
UNICEF has been supporting the BLI
activities in Viet Nam since October 2002.
The main partners of this project have been
the Viet Nam Fatherland Front (VNFF),
the Vietnamese Buddhist Association of
Viet Nam, and the Ministry of Labour, Invalid
and Social Affairs (MOLISA).
In order to expand the role of Buddhism in
addressing HIV and AIDS prevention and
care in Viet Nam, four pagodas and
Buddhist clinics in Hanoi, Hue and Ho Chi
UNICEF EAPRO
Minh City (HCMC) were selected to pilot the

project. The selected pagodas and Buddhist
clinics were recommended by provincial
Buddhist Associations, based on the
commitment from monks and nuns in the
fight against HIV and AIDS and the availability
of human and financial resources for the
project.
Through various activities including HIV
prevention, psychological counselling, homebased care and support, herbal treatment,
and health care referrals, this initiative has
aimed to: 1) develop/pilot models of
pagoda-based care and support for people
infected and affected by HIV and AIDS,
especially children and teenagers; 2) raise
awareness/increase knowledge of Buddhist
leaders, monks and nuns and government
officers on HIV and AIDS and support and
care for children and families affected by
HIV and AIDS in communities; 3) further
introduce the BLI to Buddhist academies
and colleges throughout the country; 4)
replicate effective pagoda-based models to
other communities; 5) integrate BLI activities
into Buddhist Associations programmes;
and 7) involve different religions in BLI
activities.
The BLI in Viet Nam had increased the
access of thousands of people, including
PLWHA, families and children infected and
affected by HIV and AIDS, to pagoda-based
and community services in HIV and AIDS
prevention, counselling, care and support,
and activities fighting against stigma and
discrimination towards PLWHA. With the
support from the project, over 50 monks
and nuns were trained on BLI orientation,
counselling skills, and home-based care for
PLWHA. Plans are underway to expand the
BLI to two new sites, one in Danang City and
one in Tra Vinh province.

Strategy for Action
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
Accordingly the Buddhist Leadership

Initiative strategy has sought to incorporate
those lessons built on the hard efforts that
have been carried out with the hope that the
most effective interventions can be replicated,
and ineffective or deleterious activities can
be avoided.
2.2 Key principles of the Regional

Strategy
The Regional Strategy is based upon several
key principles as follows:
2.2.1 Government collaboration
The Buddhist Leadership Initiative will
involve representatives from the Department
of Religion or whichever government
department is responsible for the coordination
of religious institutions in the country. Sangha
will collaborate with these departmental
representatives and work with them to
engage both government and community
support for the programme activities.35
2.2.2 Community engagement
Sangha members involved in the Buddhist
Response will engage directly with
the community, especially with those HIVpositive members of the community. The
Sangha will be encouraged not to give
disproportionate attention to the development
of technical skills that might monopolize
their time and energy at the expense of
community engagement.36
2.2.3 Prevention, advocacy, care and support
The Buddhist Response will encourage the
Sangha to adopt a broad spread of activity
that involves input into prevention, advocacy
and care and support activities. Given the
proven effectiveness of Sangha involvement
in reducing discrimination through advocacy,
and in care and support activities, the
emphasis should be given to monks
developing these skills.37
2.2.4 Sangha as focal point

While other agencies and government
departments will collaborate on this
programme, the principal players will be
Sangha members (monks, nuns and
novices), who will be the primary group of
people involved in the programme and
engaged in every step of the planning and
implementation.38
2.2.5 Capacity building
UNICEF supports the principle of building
local capacity at each step of the process of
planning and implementation and will focus
on doing so amongst Sangha members and
relevant government staff.39
2.2.6 Planning for effective action
Inherent in the strategy is the need for
ongoing planning, monitoring and evaluation
to maximize the effectiveness of project
inputs. Planning appropriate responses is an
integral part of Sangha capacity building,
without which the sustainability of the
Initiative will be limited. Planning on an
annual basis also allows a degree of
flexibility, allowing project managers to alter
their approach if something is seen to be not
working.40
2.2.7 Engagement of nuns in the Buddhist
response
It is in the interest of all stakeholders in this
programme that initiatives to develop
Sangha effectiveness in responding to HIV
should include nuns. Although in some
places there are relatively few nuns, they
still have a great potential to enhance the
scope and effectiveness of Buddhist
interventions. Monks should recognize this
potential and be prepared to collaborate and
share with nuns some of the resources that
will be directed towards the Sangha for this
initiative.41
2.2.8 Involvement of people living with HIV
While Sangha members will be the primary
implementation body of the Buddhist
Leadership Initiative, the project managers
will consult with people living with HIV
throughout the programme. Representatives
from the HIV-positive community will
be encouraged to join the programme
management committee.42
12
2.2.9 Promote community-based care activities

UNICEF is opposed to the development and
maintenance of new hospice-type facilities
on the basis that they become unsustainable
and reduce community willingness to care
for HIV infected people in the community.
Instead UNICEF seeks to promote the care
of HIV infected and affected people by
members of their own community through
its support to the Buddhist Leadership
Initiative.43
2.3 Regional Buddhist Leadership

Initiative Monitoring and
Evaluation Framework
UNICEFs Regional Strategy and Monitoring
and Evaluation Framework for the Buddhist
Leadership Initiative was developed in 2002-3.
The Regional BLI Monitoring and Evaluation
Framework was disseminated to Country
Offices through a series of workshops, and
provided guidance and support for the
Initiative.44 The use of the Regional Strategy
and Monitoring and Evaluation Framework
has provided guiding principles and a menu
of ideas for local responses to many
countries in the region. The strategy has had
conscious focus on care and support,
designed to guide religious leaders to an
initial understanding of the situations and
history of people living with HIV and AIDS,
through their provision of care and support,
to a deeper understanding of prevention.45
The Monitoring and Evaluation Framework
formed the basis of a multi-country review
of the BLI, conducted by Country Offices
under EAPROs guidance in 2006-7. The
review sought to collect quantitative and
qualitative baseline data and assess the BLI
programme to date. Each of the five
countries produced a report of the review in
early 2008, focusing on the BLI interventions
and outcomes over the 12 months
preceding the review. This document
presents a synthesis of the five country
reports to review the impact of the BLI as a
regional initiative.
To identify potential gaps between

programme planning and actual
implementation.
In each of the five countries, the review of

the Buddhist Leadership Initiative was
conducted to address the following issues:
To improve delivery mechanisms to

become efficient and effective.
To understand and verify the impact of

services on beneficiaries and document
the findings at both country and regional
levels.
To obtain lessons learnt and suggest

strategies in the context of multiple
country experiences for strengthening
and scaling up the programme.
To identify programme strengths and

weaknesses and improve on them.
2.4 Objectives of the multi-country

review
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
The multi-country reviews of the BLI were

carried out based on a standardized
methodology developed by UNICEF and laid
out in a survey manual. Details of the
methodology used by each country are
provided in the next chapter.
expansion of the BLI programme is planned.

The review for Cambodia compared data for
monks who were trained under the BLI to
data for monks who were not trained by the
BLI (the non-exposed group) across the
seven provinces.
3.1 Populations included in the study
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.
The review targeted five population groups

that were associated with the studys basic
unit: the temple. The targeted groups
consisted of senior monks (defined as the
head of a temple or the monks belonging to
the temples steering committee); junior
monks and nuns, PLWHA, members of
communities served by the temple, and in
some country reviews (Cambodia and Lao
PDR), the BLI programme coordinators.
Provinces to be included in the review were

randomly chosen from a list of all the
provinces involved in the BLI programme. In
addition, provinces with sites for future BLI
programmes were also included in the
review, with baseline data collected for
these new sites. For each country, the
provinces selected for the review are listed
below:
3.2.3 Lao PDR

The BLI was implemented in nine
provinces (Vientiane Capital, Vientiane
Province, Sayaboury, Khammouane, Saravan,
Savannakhet, Champassak, Oudomxay and
Luang Prabhang Provinces since September
2001. For the review, five provinces were
randomly selected from three lists: Vientiane
Capital, Savannakhet and Champasak
Provinces as samples of areas where the BLI is
active; Luang Prabang, as a province where the
BLI is less active or newly-introduced; and
Bolikhamxay Province, where there is no BLI,
as a control site.
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.
3.2 Areas included in the study
Table 1: Areas selected for BLI review
Countries
Implementation of
the BLI
Cambodia The BLI covered 14

provinces in Cambodia.
Areas selected for

the BLI review
The BLI review was
undertaken in five of
the 14 provinces.
Baseline data was
collected from two
additional provinces
Svay Rieng and Otdar
Meanchey
China
Xishuangbanna Dai
Peoples Autonomous
Prefecture located on
the southern border of
Yunnan Province.
The BLI project site is

Jinghong City
BLI sites
1
2
3
4
5
Kampong Cham
Kampong Chhang
Phnom Penh
Prey Veng
Takeo
Monks who were trained

under the BLI
Non BLI sites

1
2
3
4
5
Kampong Cham
Kampong Chhang
Phnom Penh
Prey Veng
Takeo
Two additional provinces where

baseline data was collected were
Svay Rieng and Otdar Meanchey
Note: Monks who were

trained under the BLI is
the exposed group in the
BLI site
Note: Monks who were not

trained under the BLI is the
non-exposed group.
Jinghong City
Menghai and Megla counties
General Buddhist Temple

and all four communities
that the temple serves
(Non-exposed or control or
non-BLI sites)
(Exposed site)
Lao PDR
The BLI covered eight

provinces
Five provinces were

randomly selected from
three lists: Vientiane
Capital, Savannakhet,
Champasak Provinces
where the BLI is active
Vientiane Capital,
Savannakhet and
Champasak Provinces
Luang Prabang (newly introduced

sites where BLI is less active),
and Bolikhamxay Province (No
BLI interventions here)
(Exposed site)
(Control site)
Myanmar
The BLI was

implemented in Yangon
and Mandalay Division
(as well as outskirts of
Mandalay, including
Sagaing).
The BLI review was

undertaken in Yangon
and Mandalay
Yangon and Mandalay
Viet Nam
The BLI programme

was piloted in Hanoi,
Hue and Ho Chi Min
City.
The BLI review was

carried out in Ho Chi
Minh City.
Ho Chi Minh City

(BLI Site)
Ho Chi Minh City and Tra Vinh

Province
(Control Site)
Baseline data was

collected in two sites
where the BLI
expansion is planned:
one is Ho Chi Minh City
and One is Tra Vinh
Province.
3.2.5 Viet Nam

While the BLI programme was initially piloted
in Hanoi, Hue and Ho Chi Minh City, the
review was carried out in the Ho Chi Minh
City site. In addition, baseline data were
collected in two new sites where the BLI
expansion is planned: one in Ho Chi Minh
City and one in Tra Vinh Province. The latter
two sites were used as control sites for the
review.
16
3.3 Sampling design and sample sizes

Each country evaluation team conducted the
following types of review:
A quantitative and qualitative survey in

the selected provinces where the BLI has
been implemented;
A quantitative and qualitative baseline

survey in the new provinces selected for
expansion of the BLI, using the same
research tools as for the review in the
selected BLI provinces.
three provinces (Phnom Penh, Kampong

Cham, and Odtar Meanchey), and FGDs for
PLWHA were carried out in four provinces
(Phnom Penh, Kampong Cham, Takeo and
Svay Rieng).
3.3.1 Research tools

UNICEF designed the quantitative and
qualitative research tools used for the
review. For the qualitative study, UNICEF
provided the country teams with four focus
group discussion (FGD) guides: one for
monks and nuns, one for community
members, one specifically focused on the
youth in the communities; and one for
PLWHA. For the quantitative component of
the review, UNICEF provided the teams with
five questionnaires for face-to-face individual
interviews, with one questionnaire for each
of the groups (junior monks, senior monks,
PLWHA, community members and BLI
programme coordinators). All of the
research tools were translated into the
appropriate languages, with some further
testing conducted on the translated tools
where necessary.
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.
3.3.2 Sampling design

The review teams used a multi-stage
random sampling technique. In the first
stage, provinces were randomly selected
from the list of provinces where the BLI has
been implemented. From the selected
province, a subset of temples involved in
the BLI was randomly selected during the
second stage, using probability proportionate
to size (PPS) sampling. The third stage
consisted of random sampling from the
target population groups: junior monks,
senior monks, PLWHA and community
members. Details on the sampling
methodology for the study are provided in
the Annex.
3.3.2.1 Cambodia
A total of 1,025 quantitative interviews were
conducted in the five BLI provinces selected
at random, and 410 interviews were held in
the two new provinces. For the qualitative
studies, one FGD was held in each province
for the community members, except for
Phnom Penh, which held a FGD for adults
and a separate FGD for youth. Focus group
discussions for monks were conducted in
UNICEF EAPRO
3.3.2.3 Lao PDR

Sampling for the review was conducted as
suggested in the survey manual (see
Annex). To obtain qualitative information, 14
FGDs were carried out in Champasak
Province and Vientiane Capital, comprising
one FGD in each area for each target group
(adult males, adult females, youth aged 15
to 19 years, youth aged 20 to 24 years, male
PLWHA, female PLWHA, and monks).
3.3.2.4 Myanmar
The number of monasteries and the number
of junior monks in some of the monasteries
were small therefore fixed cluster size and
PPS sampling could not be carried out.
Instead, some small-sized monasteries
were combined into one cluster and 17
monks were selected per cluster using
disproportionate sampling. However, since
one big monastery did not give consent to
the interviews after being selected, only 84
junior monks could be interviewed (82% of
the target). Eight senior monks were selected
randomly. The PLWHA were selected using
convenient sampling. For security reasons,
the communities associated with the selected
monasteries could not be selected according
to the protocol. Instead, convenient
sampling was used to select 70 community
members from three areas: Yangon, Mandalay
and Taungyi.
17
In total, eight FGDs were conducted in

Mandalay (addressing monks, nuns, male
youth, female youth, adult male community
members, adult female community members,
male PLWHA and female PLWHA) and
eight FGDs in Yangon, targeting the same
population groups. 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.
3.3.2.5 Viet Nam
The monks/nuns and PLWHA were randomly
selected from the lists of target pagodas and
districts, respectively. Community members
were randomly selected from households
that in turn were systematically selected
from the registered list in the communes. In
addition to the face-to-face quantitative
interviews, eight FGDs were conducted in
each province (with the total 16 FGDs for the
two provinces), two in each province
for each target group (monks and nuns,
community members aged 15-24 years,
community members aged 25-49 years, and
PLWHA). All participants were selected for
the FGDs based on their awareness of HIV
prevention and care in the community, as
well as their willingness to cooperate and
participate in the study.
3.3.3 Sample sizes
Using the sampling design described above,
the five country studies ended up with the
sample sizes provided in Table 3 for the
quantitative component of the review.
Table 4 shows the total sample sizes for the
qualitative component of the review, namely
the focus group discussions.
3.4 Interviewer selection and training

3.4.1 Cambodia:
The fieldwork team was composed of a
director, managers, field managers,
supervisors, and quality control staff. In
total, 46 field interviewers, composed of
both male and female staff, were trained for
the project.
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,
Table 2 : Quantitative and qualitative interviews

Quantitative interviews
Qualitative interviews
Cambodia 1,025 quantitative interviews in the five provinces
One FGD was held in each province for community

members except Phnom Penh. An FGD for adult and an
FGD for youth were held in Phnom Penh.
410 interviews from the two new provinces.
FGDs for monks were conducted in three provinces

(Phnom Penh, Kampong Cham, and Odtar Meanchey)
FGDs for PLWHA were carried out in four provinces
(Phnom Penh, Kampong Cham, Takeo and Svey Rieng).
China
Quantitative interviews were undertaken
FGDs were held for each of the target group in both

exposed and non exposed sites.
966 interviews (exposed and non exposed sites)

Lao PDR
Quantitative interviews were undertaken
14 FGDs were carried out in Champasak Province and

Vientiane Capital, comprising one FGD in each area for
each target group (adult males, adult females, youth aged
15 to 19 years, youth aged 20 to 24 years, male PLWHA,
female PLWHA, and monks).
627 interviews (exposed and non exposed sites)
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
Monks and nuns and community members were randomly

8 FGDs were conducted in each province (with the total
selected for the lists of target pagodas and districts
16 FGDs for the two provinces), two in each province for
respectively.
each target group (monks and nuns, community
members aged 15 24 years, community members aged
Community members were randomly selected from
25 29 years, and PLWHA)
households that in turn were systematically selected from
the registered list of communes.
Table 3: Sample sizes for the quantitative surveys
Junior monks
Cambodia
China
Lao PDR
Myanmar
Viet Nam
177
132
201
84
113
(47 in exposed site; 85

in non-exp. sites)
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
(404 in exposed site;

421 in non-exp. sites)
(provincial
coordinators)
(the national project

coordinator)
966
627
19
Table 4: Sample sizes for the focus group discussions
Cambodia
China
Lao PDR
Myanmar
Viet Nam
Junior monks
32
18
12
33
32
Community members
24
38
31
32
32
Youth community members
48
30
29
32
32
PLWHA
48
25
31
32
Total
152
92
97
128
128
methodology and data collection, interviewing

skills, verification and performing role-play
for the interviews, and the sampling
methodology. The interviewers were provided
with guidelines for selecting the participants,
for the sample size and sampling method,
and on methods for approaching the
interviewees.
3.5 Process of fieldwork

3.5.1 Cambodia
The fieldwork was conducted from early
February to mid-March 2007. Field supervision
consisted of ensuring proper methods
for the selection of respondents and data
collection, and verifying recording practices.
Each field supervisor checked at least one
interview in its full duration per interviewer
per day. The supervisors also checked
research materials every day to plan for or
request technical support.
3.5.2 China
Supervisors and a technical expert inspected
and directed the investigators work at the
survey sites. Supervisors examined every
questionnaire and record carefully to check
for missing items, mistakes or conflicting
content in the questionnaire responses. All
the investigators summarized the progress
and plans for the next days activities on a
daily basis.
3.5.3 Lao PDR
The fieldwork for data collection underwent
the following process: training of interviewers,
submission of a detailed plan for approval,
20
informing the target sites on a timely basis

about conducting fieldwork in their area,
data collection and management, and data
gathering and double-checking for further
editing and computerization.
3.5.4 Viet Nam
The questionnaires were translated into
Vietnamese and used in this study after
checking for sensitivities. A technical
consultant trained every interviewer for the
fieldwork. All forms collected in the field
were verified by the consultant as quality
control for filling out the forms and conducting
the interviews.
3.6 Data editing

3.6.1 Cambodia
Supervision and quality control were carried
out on all the data collected. A complete
cross-check control was carried out on a
random sample of 30% of the questionnaire
responses.
3.6.2 China
Data from the questionnaire responses were
entered by staff using a database designed
by the BLI Evaluation Group. To ensure
quality control of the data entry, 10% of
questionnaires were chosen randomly to
check for errors. If inputting errors
comprised more than 1%, then the staff
would check and revise all the data
in the database against the original
questionnaires. The input from the focus
group discussions was summarized, sorted
and recorded into electronic version.
3.6.3 Lao PDR

The data were collected in NovemberDecember 2006, and were double-checked
every day by the supervisor/consultant who
accompanied the evaluation team in the
selected areas. A hired data imputer then
entered the data into the statistical
programme SPSS 13.0. Once computerized,
the data was sent to UNICEFs Bangkok
Office for cleaning and editing for further
use in report writing.
3.6.4 Myanmar
For the quantitative survey, contact forms
and interview forms were checked for
consistency, and were sorted in accordance
with residential area and date of interview.
Coding entries on the forms were rechecked
for completeness and consistency. Area
codes were given in accordance with postal
code numbers. The data were entered in
SPSS 13.0 by two trained data entry staff,
using prepared sets of data entry forms.
The staff checked for missing entries and
consistency by constructing frequency
tables and cross tabulations, and made
corrections by validation with the question
forms. For the FGDs, the taped and manual
notes used to transcribe the narrative data
were transformed into ethnographic files in
NVIVO software. Line, participant and
session codes were incorporated onto each
statement. Code numbers for the themes and
sub-themes code numbers were also set.
3.6.5 Viet Nam
A standard coding set was developed with
guidelines on data entering that was
consistent for both provinces. The data from
all questionnaires/sheets were computerized
using the Epi-Info programme. Analyses
were conducted using the EPI-INFO and SAS
software.
other junior monks, either due to missed

appointments or lack of availability during
the day. Among community members, there
were 585 successful interviews and 1,361
unsuccessful contacts, of which 178 were
refusals. Of the PLWHA, 302 were interviewed
and 600 were unsuccessfully contacted,
again mainly due to missed appointments.
3.7.2 Lao PDR
About 64% of respondents were able to
conduct interviews since the first contact. By
the second attempt, 20% of selected
populations were able to be interviewed and
16% had to schedule another time for the
interview due to their absence from the
selected households (working abroad,
studying in town or in Vientiane). There
were no cases of refusal to participate in this
study, partly due to good coordination with
the central, provincial coordinators and local
authorities.
3.7.3 Myanmar
One monastery selected for the junior
monks quantitative interviews refused to
respond to the questionnaire, rendering the
junior monks response rate to 82%. All other
sampled subjects from all study population
groups responded to the interviews. For the
FGDs, no respondent withdrew from the
interview during the process.
3.7.4 Viet Nam
No refusals were noted throughout the
study.
3.8 Limitations of the study
3.7 Response and refusal rates
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
exposed group) is the general temple area

in one city, whereas the exposed group in
Cambodia is composed of monks trained in
the BLI versus monks not trained in the BLI.
In Viet Nam, the exposed group is
composed of monks randomly selected
from a site where the BLI was implemented.
HIV and AIDS situation in

the BLI countries An overview
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
workers (FSWs), men who have sex with

men (MSM) and male military recruits.
In China, the HIV infection rate among
Chinas population is 0.1%. However, the
estimated annual reported HIV-positive
and AIDS cases in China have increased
exponentially from 492 in 1985 to 39,866 in
October 2007. The estimated number of
adults and children increased from 470,000
in 2001 to 700,000 by the end of December
2007. Further, AIDS-related deaths increased
from 15,000 in 2001 to 39,000 in 2007.51 In
2007, there were estimated 85,000 AIDS
cases and 50,000 new HIV infections.
By the end of October 2007, 71.3% of the
cumulative total of PLHIV was male and
28.7% was female. HIV infections have been
concentrated in the 20 to 39 age groups,
who account for 70% of the total AIDS
cases and 72% of the cumulative deaths.
HIV-infected populations have reportedly
been found in all 34 provinces (municipalities/
minority autonomous regions). However, as
of October 2007, the highest cumulative
number of HIV infections which accounts for
80.5% of the total reported cases came from
Yunnan Province, followed by Henan,
Guangxi, Xinjiang, Guangdong and
Sichuan.
In Lao PDR, the estimated number of people
living with HIV increased from 1,200 reported
in 2001 to 5,500 people in 2007. The number of
women infected with HIV increased from <500
in 2001 to 1,300 in 2007. The HIV prevalence
for adults (15-49) is now at 0.2%.52 The HIV
epidemic has been expanding with the
rapid socio-economic development and
the transformation of Lao PDR from a
landlocked to a land linked country. This
situation has further contributed to changing
sexual behaviour amongst young people
Table 5: Risk behaviours of community members aged 15 to 49 years

Cambodia (N=585)
China (N=825)
Viet Nam (N=401)
Have ever drunk alcohol
65%
52%
37%
Still drinking
91%
98%
89%
Have ever injected drugs
0%
0.2%
0%
0%
Have ever used non-injected drugs
1%
1%
Still using
0%
0%
Have ever had sexual intercourse
64%
61%
Still having sex
91%
94%
Had sexual contact in the last 12 months
55%
77%
60%
Used condom during the last sex
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%
To avoid sexually transmitted diseases generally
20%
26%
10%
To avoid HIV and AIDS infection
34%
5%
1%
Because I want to have children
18%
13%
20%
Because I am married
46%
14%
36%
Because I never thought of it
14%
32%
22%
Because I trust my partner
16%
19%
Had paid sex with someone in the last 12 months
5%
3%
4%
Did use condoms when had sex for money
94%
67%
44%
Still injecting
Frequency of use of condoms during sex in

the last 12 months:
Main reason for using condom:
Main reason for not using condom:
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
gradually declined reaching about 0.7% in

2007. Correspondingly, the estimated number
of people living with HIV dropped from
300,000 in 2001 to 240,000 in 2007.54 Of this
number, about 100,000 are women and
about 6,000 are children.
4.2 Trends in risk behaviours in

the BLI countries
In all countries, the survey asked community
members aged 15 49 years about their
activities related to risk behaviour, including

their consumption of alcohol, use of drugs,
and practice of unprotected sex.
Table 5 presents the results of all the
community members surveyed in both
project and control sites in Cambodia, China
and Viet Nam about risk-related behaviour.
4.2.1 Alcohol and injecting drug use
Findings in all three countries show that the
vast majority of the community members
who have ever drunk alcohol have continued
to drink. Almost none of the community
members interviewed have used injecting
drugs.
The responses to the same questions on risk
behaviour for Lao PDR suggest that the
percentages of smoking and drinking are
relatively low (32%), although as with the
table above, the responses may not be
reliable given the personal nature of the
questions. The quantitative findings for
Myanmar are only for the Mandalay site.
Here, 31% of the community members
interviewed have drunk alcohol, of which 90%
were still drinking. None of the community
members stated having had a history of
injection drug use; however, 6% said that
they had used non-injection drugs, though
no one was currently taking these drugs.
4.2.2 Practice of unprotected sex
In all three countries, less than a third of the
community members who are sexually
active used a condom the last time they had
sex. The most common reason given in
Cambodia and Viet Nam for not using
condom was being married. In China the
most frequently cited reason was because
UNICEF EAPRO
they had not thought of it. The main reason

provided for using condom in all three
countries was to avoid pregnancy. Of particular
concern is that among those who had paid
sex in the past 12 months, only 67% and
44% had used condoms in the China and
Viet Nam sites, respectively.
In Lao PDR, the share of community members
who had sex in the last 12 months was also
low (29%), although 73% of respondents are
in the reproductive period (15 45 years
old). Among the 6% of respondents who
reported having paid for sex in the last 12
months, there was 100% condom use.
In Myanmar, about two-thirds (63%) had a
history of sexual practice; out of them, 82%
still engage in sex. Regarding condom
usage, 33% of the sexually active persons
had used a condom during their last sexual
encounter. The main reasons they provided
for using condoms were to avoid STIs (53%)
and to avoid pregnancy (47%).
4.2.3 Summary
In relation to activities concerning risk
behaviours, findings for Cambodia, China
and Viet Nam show that the vast majority of
the community members who have ever
drunk alcohol continue to drink. Almost
none of the community members have
used injecting drugs. Further, in all three
countries, less than a third (21%, 17% and
28%, respectively) of the community
members who are sexually active used a
condom the last time they had sex. Of
particular concern is the fact that those who
had paid sex in the past twelve months, only
67% in China and 44% in Viet Nam had used
condoms.
25
How did BLI engender changes in

the community?
5.1 Knowledge/awareness of HIV

and AIDS
5.1.1 Introduction
The general awareness of HIV and AIDS
among the communities is high in all
countries. For instance, 99% of community
members surveyed in Cambodia and
Myanmar had heard of HIV and AIDS. Viet
Nam had more (98%) community members
who had heard about HIV and AIDS
compared to Lao PDR (84%) and China
(81%). The large difference in awareness of
HIV and AIDS between the BLI and non-BLI
sites (non-exposed) in China is to be noted.
In the BLI site, 94% of community members
had heard of HIV and AIDS, whereas only
68% of community members in the non-BLI
site had heard of HIV and AIDS.
5.1.2 Sources of knowledge/awareness of
HIV and AIDS
Television was the most common source of
knowledge and awareness of HIV and AIDS
in all country sites except for Lao PDR,
where radio was the most frequently cited
source. Radio is a key source of information
on HIV and AIDS for a large share of the
communities surveyed in all countries
except for China. Over half of the community
members surveyed in Myanmar and Viet
Nam had heard about HIV and AIDS through
newspapers, brochures/posters and friends.
At the focus group discussions in Champasak
Province in Lao PDR, community members
stated that they mostly got their information
on AIDS from Thai radio stations, where a
very famous Thai senior monk talks about
AIDS.
In terms of sources of HIV and AIDS knowledge
of surveyed community members from
exposed and non-exposed sites in China,
nearly twice as many people in the BLI site
(61%) compared to non-BLI sites (32%) had
seen information on HIV and AIDS from

brochures and posters. This could indicate
that monks in BLI than non-BLI sites had
exerted greater efforts in terms of promoting
HIV prevention.
5.1.3 Community members knowledge
about the transmission of HIV
To gauge the knowledge of community
members on HIV issues, the survey included
questions on how HIV can be transmitted.
The results for each country are provided in
Table 6 for all community members who
were interviewed, both in the BLI and
non-BLI sites.
In all the five countries, the knowledge on
correct means of transmission (shaded in
blue) among community members is high
among those who have heard of HIV and
AIDS. It is to be noted that the percentages
for China and Lao PDR are much lower
than for other countries as almost 20% of
community members surveyed in these
countries had not heard of HIV and AIDS. In
addition, only a low percentage of people in
Lao PDR stated that AIDS could be transmitted
by having multiple sex partners (20%) and
from mothers to babies (33%).
5.1.4 Misconceptions about the modes of
transmission of HIV and AIDS
Findings from the survey reveal that there
remain misconceptions about the modes of
transmission of HIV and AIDS. Community
members (between 12% and 21% see
Table 6) in Lao PDR and Myanmar thought
mosquito bites were a mode of transmission
for HIV. In Lao PDR and to a lesser extent in
Myanmar, there are misconceptions that
kissing, shaking hands and sharing plates
with HIV-positive persons can lead to
infection. These findings underscore areas
and countries that need targeted education
efforts to reduce misconceptions amongst
community members.
Figure 1: Sources of knowledge/awareness of HIV and AIDS
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
Table 6: Community members knowledge about the transmission of HIV

HIV can be transmitted by:
Cambodia
(N=585)
China
(N=825)
Lao PDR
(N=300)
Myanmar
(N=70)
Viet Nam
(N=401)
Having sexual intercourse
100%
59%
67%
93%
83%
Having multiple sexual partners
98%
59%
20%
88%
88%
Blood transfusion
99%
60%
71%
97%
93%
From mothers to babies
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%
Shaking hands with HIV-positive persons 3%

Sharing plates with HIV-positive persons
3%
In China, the share of community members

in the BLI site who know the correct mode of
transmission of HIV is nearly double the
figure in the non-BLI sites. In Viet Nam,
there are no significant differences in the
knowledge of HIV transmission between
communities in the BLI and non-BLI sites.
Community members in both sites provided
a high rate of accurate responses on the
correct modes of HIV transmission.
28
5.1.5 Community members knowledge

about the prevention of HIV
The findings in Table 7 show that community
members are less knowledgeable about
prevention than they are about transmission,
particularly in China, Lao PDR and Viet Nam.
The misconception that mosquito bites can
transmit HIV and AIDS is again found
in China (67%) and Lao PDR (63%).
Furthermore, the proportions of community
Table 7: Community members knowledge about the prevention of HIV

Infection with the HIV virus can be avoided by:
Cambodia
(N=585)
China
(N=825)
Lao PDR
(N=300)
Viet Nam
(N=401)
Not having sex
95%
49%
71%
65%
Using condoms when having sex
99%
52%
66%
90%
Always using sterile/new needles/injection equipment
94%
50%
Avoiding mosquito bites
38%
67%
63%
35%
Having only one sexual partner
98%
42%
39%
72%
Not sharing any objects with HIV-positive persons
35%
73%
Not kissing anyone
30%
73%
40%
40%
Eating good food
1%
73%
19%
45%
members in China who believe that not

sharing objects with PLWHA (73%), not
kissing anyone (73%) and eating good food
(73%) are means of avoiding HIV transmission
is remarkably high.
5.1.6 Can HIV and AIDS be cured?
The proportions of community members
who responded accurately that HIV and
AIDS cannot be cured varied across
countries: Cambodia (96%); China (69%);
Lao PDR (54%); Myanmar (67%); and Viet
Nam (90%). The same is true for those who
believed that a healthy-looking person can
be HIV-positive: Cambodia (82%); China
(8%); Lao PDR (37%); Myanmar (70%); and
Viet Nam (90%). These figures highlight the
need to strengthen and expand HIV
education programmes in China, Lao PDR
and Myanmar.
5.1.7 Testing for HIV Infection
5.1.7.1 Community members
Of the total 585 community members
surveyed in Cambodia, 18% have been
tested for HIV. Of those who have not been
tested, 82% would be willing to be tested
(86% of youth). Of the 86 people who would
not want to be tested, 69% reasoned that
they are not at risk of HIV infection; a few
noted that it was not important to know
(13%), and they are afraid of needles (12%).
Conversely, of those who were willing to be
tested, 49% said that it is possible they are
UNICEF EAPRO
39%
30%
86%
49%
HIV-positive and 46% would do so because it

is necessary.
Among the 300 community members
surveyed in Lao PDR, about 40% declared
that they have been tested for HIV, and 41%
of those not yet tested were willing to take a
test. The main reasons for their willingness
were that: 1) it is possible that they are
HIV-positive, 2) it is necessary, and 3) they
were afraid to transmit HIV to their children.
Those who were not willing to be tested
gave the following top three reasons: 1)
there is no risk of HIV infection, 2) it is
expensive to have the test, and 3) they may
be discriminated against as a result of
having been tested.
The findings for Myanmar show that, of the
total 70 community respondents, 71% have
never been tested. Among them, 60% were
not willing to take the test, with not being at
risk of HIV as the most commonly cited
reason.
In Viet Nam, 10% of community members
had been tested for HIV; namely 17% in Ho
Chi Minh City (HCMC) and 4% in Tra Vinh.
Among community members who have not
yet been tested, 80% in Tra Vinh and 74% in
HCMC were willing to take the HIV test. The
main reasons for their willingness were that
it was necessary and that it is routine to have
the test.
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
transmission of HIV and AIDS. Community

members (between 12% and 20%) in all
countries thought that mosquito bites were
a mode of transmission for HIV. There are
also misconceptions that kissing, shaking
hands and sharing plates with HIV-positive
persons can lead to infection. In addition,
community members are less knowledgeable
about prevention than they are about modes
of transmission particularly in China, Lao
PDR and Viet Nam. These findings underscore
areas that need targeted education efforts to
reduce misconceptions and reduce risk of
HIV transmission in community members.
Findings in all countries show that only a
low percentage of the community members
have been tested for HIV. Strengthening
the monks/nuns involvement with the
community in planning and designing of
programmes is necessary. Furthermore,
reduction of stigma and discrimination,
negative reactions to disclosure and linking
prevention, treatment and care programmes
will increase the uptake of HIV counselling
and testing services. Greater knowledge of
HIV status is critical to expanding access to
HIV treatment, care and support in a timely
manner and offers people with HIV an
opportunity to receive information and tools
to prevent HIV transmission to others.55
5.2 Reducing stigma and

discrimination
5.2.1 Introduction
HIV-related stigma and discrimination
against people infected and affected with/by
HIV continues to affect their access to
employment, housing, insurance, social
services, education and health care.56 This
section highlights the attitudes of community
members towards PLWHA in the five
countries.
5.2.2 General attitude of community members
towards PLWHA
Regarding community attitudes towards
PLWHA in general, Table 8 presents some
findings on the willingness of community
members to have various types of contact
with PLWHA. The results show that there is
significant discrimination against PLWHA in
Table 8: Attitudes of community members towards PLWHA
Share of community members who are willing to:
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%
Welcome people with HIV or AIDS in own house
39%
66%
75%
94%
Rent out a house to a person with HIV or AIDS
23%
53%
50%
88%
Sell food to a person with HIV or AIDS
52%
51%
88%
96%
Buy or take food offered by an HIV-positive person
28%
51%
39%
64%
Visit a market stall run by an HIV-positive person
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.
Lao PDR, Viet Nam and particularly in China,

while community attitudes in the Cambodia
sites are more positive towards PLWHA.
knew a PLWHA, the contact was mostly

because the PLWHA was a friend, neighbour
or relative.
Findings from the quantitative survey show

that 85% of the community members in
Cambodia and only 37% in China were
willing to leave their children to study and
play in the same class as a child who is
known to have HIV and AIDS. Also 64% in
Cambodia, 28% in China and 39% in
Viet Nam were willing to buy or take
food offered by an HIV-positive person.
Nonetheless, while the FGDs supported this
finding that most community members
had positive attitudes towards PLWHA,
some discriminatory attitudes were also
expressed.
5.2.3 Sharing objects with PLWHA

Figure 2 shows that most of the community
members in Cambodia would be willing to
share plates, spoons, cushions, mats and
bicycles with a person infected with HIV. For
China, Lao PDR and Viet Nam, the figures
are somewhat lower, averaging 35%, 55%
and 49% respectively across all five items.
During the FGDs in Myanmar, the community

members discussed contact with and
attitude towards PLWHA. Some participants
said although they did not have contact with
PLWHA, they were afraid of getting infected
by them. Among community members who
UNICEF EAPRO
In all four countries, more community

members would be willing to share a bicycle
with a PLWHA than a food utensil or
bedding item. Except for China, where
community members in the BLI site were
slightly more likely to share objects with
PLWHA than those in the non-BLI sites (e.g.
43% vs. 31% would share a bicycle with a
PLWHA) there are no significant differences
in attitudes between community members
in BLI and non-BLI sites.
31
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
5.2.4 Attitude to a relative living with HIV

Findings in Figure 3 show that the attitude of
the community members toward PLWHA
also depends on their relationship with the
infected person. In Cambodia, Lao PDR and
Viet Nam, the PLWHA are more likely to be
discriminated more by distant relatives than
by close relatives. There is no significant
difference in attitudes between BLI and
non-BLI survey respondents.
5.2.4.1 Reasons for treating PLWHA differently
In Cambodia, Lao PDR and Myanmar, the
main reasons given by community members
for treating PLWHA differently were fear of
getting infected with HIV, and being upset or
angry with them. In Cambodia and
Myanmar, the third most frequent response
was not knowing how to deal with PLWHA
(13% and 20% of respondents, respectively).
5.2.4.2 Reasons for treating PLWHA in the
same manner
The reasons provided by the community
members (Cambodia, Lao PDR and
Myanmar) who said they would treat
PLWHA in the same manner as they would
treat anyone else were sympathy, love/
affection, and responsibility/obligation. In
Myanmar, 13% of respondents said that
Buddhist teachings were a reason for not
treating PLWHA differently, while the
corresponding figure for Cambodia was less
than 1%.
5.2.5 Summary
Findings show that there is significant
discrimination against PLWHA in Lao PDR,
Viet Nam and particularly in China, while
community attitudes in Cambodia are more
positive towards PLWHA.
One of the main reasons given for treating
PLWHA differently was fear of getting infected
with HIV. Except for China, community
members in Cambodia, Lao PDR and Viet
Nam were more willing to share a bicycle
with a PLWHA than a food utensil or
bedding item. The community members
also said that they did not know how to deal
with PLWHA. In Myanmar, respondents
cited Buddhist teachings as reason for not
treating PLWHA differently. The findings
UNICEF EAPRO
point out to the urgent need for monks/nuns

to plan and implement programmes that
address the actionable causes of stigma, i.e.,
lack of awareness of stigma and discrimination
and their negative consequences, fear of
acquiring HIV through casual contact, and
linking behaviour that is considered
immoral or improper.
5.3 Community responses to HIV

education
5.3.1 Introduction
Monks and nuns have worked towards
reducing the vulnerability of their local
communities to the HIV epidemic. Section
5.3 focuses on the development and
dissemination of IEC materials by monks,
temple-based interventions to promote
community resilience, community participation
and response to monks AIDS prevention,
protection and care outreach programmes
and impact on monks involvement in youth
activities.
While a large share of monks across
the samples had conducted IEC and other
outreach activities to promote HIV prevention
in their communities, interventions targeting
youth or addressing risk behaviours were
considerably less frequent.
5.3.2 Development and dissemination of IEC
materials
The share of junior monks involved in
various IEC activities aimed at reducing the
vulnerability of their communities to HIV are
given in Table 9. Shares for the exposed
groups as well as for the non-exposed
groups (in italics and parentheses) are
presented.
Findings show that the monks in Cambodia
were mostly involved in community
education (60%) and youth related activities.
The share of trained monks involved in
these activities is much higher than that of
untrained monks.
In the exposed site in China, the most
common activities performed by the monks
include the distribution of flyers with
teachings of Buddhist principles, HIV and
33
Table 9: Monks engagement in IEC activities aimed at reducing community vulnerability to HIV
Activity
Participated in the production of materials on

Buddhist educational messages about HIV
Presented HIV and AIDS awareness videos
e.g. With Hope and Help
Put up HIV and AIDS awareness posters
Spoken on radio about HIV
Spoken on TV about HIV
Contributed to Buddhist Initiative newsletters
Distributed material (flyers) with teachings

about the Buddhists Principles in relation to HIV
Used Buddhist IEC materials on HIV
Distributed printed Buddhists teachings

HIV-IEC materials
Gave community education on HIV
Participated in or led HIV activities aimed at

youths
Involvement with temple-based youth groups
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%)
AIDS awareness posters and Buddhist IEC

materials on HIV. In the non-BLI sites, less
than 10% of the monks were involved in any
of the IEC activities aimed at reducing
community vulnerability to HIV, with the
exception of putting HIV and AIDS
awareness posters. Putting up HIV and AIDS
awareness posters is also most common
among the monks surveyed in Lao PDR and
in Viet Nam (although less than 10% of
monks in Lao PDR were involved in IEC
activities). In Lao PDR, to reach community
members in remote areas, many of the
34
monks surveyed had contributed to

producing Buddhist Initiative Newsletters,
while some had given community education
on HIV and AIDS using Buddhist IEC
materials. A few noted having spoken on
television about HIV and AIDS, but none had
spoken about these issues on radio in the
preceding 12 months.
Also, a large share of monks in the BLI
site in Viet Nam took part in community
education on HIV using Buddhist materials
on HIV. The majority of the monks/nuns
in the non-BLI sites in Viet Nam did not

participate in activities that seek to reduce
community vulnerability to HIV during the
previous 12 months.
TV message on Buddhism and

HIV and AIDS
Buddhism teaches us to be
compassionate, loving and fair...
Give people with HIV an opportunity.
Credit: UNICEF Lao PDR
In Myanmar, among the 84 junior monks

surveyed in Mandalay, 13% responded that
they participated in activities to reduce
community vulnerability to HIV by distributing
pamphlets, posters and videos of HIV-related
materials, as well as producing and presenting
educational materials. Again, among the 11
junior monks who participated in these
activities, putting up HIV and AIDS awareness
posters (55%) and being involved with
temple-based youth groups (46%) were the
activities most frequently cited.
Responses from the interviews with senior
monks indicated that out of the eight
monasteries surveyed in Myanmar, six were
involved in the production of educational
materials related to HIV, including brochures,
posters and audio-visual materials. Five of
the six senior monks stated that the main
targets for the education materials were
junior monks at the monastery and visitors
to the temple.
5.3.3 Temple-based interventions to
promote community resilience
For temple-based interventions on promoting
community resilience, participants who took
part in the FGDs in Cambodia cited activities
namely: preaching, holding youth meetings,
and diffusing promotional materials.
In China, the quantitative study results
indicate that 87% of the community
members in the exposed site had attended
monks sermons on increasing tolerance
and sympathy towards PLWHA, compared
UNICEF EAPRO
to 76% in the non-exposed sites. However

in China, the results of focus group
discussions reveal that only a small share
(three out of 19) of the community members
surveyed had participated in AIDS
prevention and care activities organized in
temples. None of the youth who participated
in the focus groups had attended the same.
In the non-exposed project sites, neither the
adult nor youth community members
surveyed had attended AIDS prevention and
care activities organized in temples.
During the FGDs held in Lao PDR, all
community members responded positively
about the role of local temples as the centre
of cultural and social events.
Participant from a womens FGD

in Vientiane, Lao PDR
In our temple we have seen Lao
Youth Union coming to organize
educational workshop on HIV and
AIDS led by our abbot; and
sometimes we observed that PLWHA
also come to meet the monks to seek
advice or do meditation.
In the FGDs in Myanmar, the leadership role

of religious persons regarding HIV-related
activities was discussed further by community
members in both Yangon and Mandalay.
Many discussants said that the possibility of
monks assuming a leading role in templebased activities would depend on the senior
monks approval and guidance.
Furthermore, most participants who took
part in the FGDs supported monks
incorporating HIV prevention messages in
their sermons. Monks and community
members who participated in the FGDs
suggested three different approaches that
the monks could adopt to conduct templebased activities on HIV prevention: 1) monks
themselves initiate ideas and implement the
activities, 2) monks implement the activities
based on community requests, or 3) monks
organize/supervise/support the activities to
be implemented by other organizations.
35
Monks and community leaders plan local temple based response in HIV and AIDS, Lao PDR.
Credit: UNICEF Lao PDR
47-year-old vendor (male), Yangon

If Buddha Dhamma is used to admonish someone, it would be like a preventive message to those who
have not been infected yet, while for those already infected, it would be like relieving the suffering. If one
breeds good attitude, one could die with merit and one can get a better afterlife. Goodwill may cause good
consequence. Monks can teach or preach people to have good mind and will.
38-year-old Government staff (male), Yangon
Only if social organizations request monks to include HIV issues in their sermons should monks do it.
35-year-old carpenter (male) Yangon
It would be very good if meditation centres could be arranged for the PLWHA. It would be better if social
organizations could support their needs while monks could offer instruction. These will help PLWHA a lot.
5.3.4 Community participation and response

to AIDS prevention, protection and care
outreach programmes
Findings from the quantitative study show
that only 11% of the community members
interviewed in Cambodia were aware of any
HIV-related programmes conducted by
monks in their community. Among these
community members, 84% said that
monks/nuns have been more actively
36
engaged during the previous two years

(2006 2007). 67% responded that
monks/nuns have contributed to care and
support services for PLWHA in the community.
Among the 64 interviewees who were aware
of monks activities, 31 (5% of the total
sample) have participated in HIV-related
programmes
conducted
by
monks.
According to them, they had mostly listened
to monks preaching on compassion (94%),
FGDs in China Participation in AIDS prevention activities

Seven out of 10 monks surveyed in the BLI project site participated in outreach programmes for AIDS
prevention and care organized by Home of Buddhist Light. All the community members surveyed in the
BLI site said that they had participated in AIDS prevention programmes organized by senior monks in their
villages. Senior monks gathered community members in meetings and taught them by use of wall charts
about the transmitting channels of AIDS, non-transmitting channels of AIDS and HIV prevention. The senior
monks also asked workers from health agencies to teach community members about condom use and to
distribute condoms. In the non-BLI sites, none of the surveyed junior monks or community members said that
they attended outreach programmes on AIDS prevention and care organized by Buddhist temples.
had been educated about HIV and AIDS

(87%), and had participated in discussion
about HIV and AIDS facilitated by monks or
had been visited by monks who prayed for
PLWHA in the neighbourhood (77%). 90%
of the community members were very
satisfied with the monks activities.
None of the adult and youth community
members who participated in the FGDs
in Cambodia had ever participated in
discussions regarding HIV and AIDS by a
Buddhist monk or a nun. However, some of
the community members mentioned having
joined discussions facilitated by NGOs or
health centre staff.
In China, most of the community members
(85%) surveyed in the BLI sites were aware
of the monks conducting AIDS prevention
activities in their communities. Moreover,
63% of these community members had
participated in AIDS prevention activities
conducted by monks sometime during the
preceding two years. In the non-BLI sites,
only 23% of community members surveyed
knew of AIDS prevention activities that were
conducted by monks.
Among the nine PLWHA surveyed, three had
attended monks preaching by use of
Buddhist scriptures for AIDS prevention and
four had been invited by monks to attend
meetings to tell community members of
their own experiences.
In Lao PDR, about 10% of the 31 community
members surveyed were aware of some
monks or nuns activities related to HIV and
AIDS in the communities, and 13 out of 31
UNICEF EAPRO
community members acknowledged that

monks/nuns in their community have
been actively engaged in HIV and AIDS
interventions in the previous two years.
Less than a third (eight out of 31) of the
participants reported having participated in
HIV and AIDS related activities conducted by
monks and nuns in the last two years.
Among those, six people had listened to
monks teaching about being more tolerant
and compassionate toward people with HIV
and AIDS; five people reported receiving
education about HIV and AIDS; and four
people had participated in discussions
about HIV and AIDS and in youth activities
facilitated by monks. Moreover, three to five
people reported being taught meditation,
being visited by monks who prayed or
performed ceremonies to help people with
HIV in the neighbourhood, receiving HIV
educational materials and hearing monks
messages on HIV via the media. About 75%
of respondents expressed satisfaction with
those services. The remaining community
members were not satisfied about those
services mainly because of two reasons:
the methodology was not appropriate and
information was limited.
The involvement of monks in community
prevention outreach interventions in
Myanmar has been sparse. Only 17% of the
junior monks have participated in prevention
outreach, mostly by using life skills methods
to educate youth on HIV prevention; while 7%
had also undertaken other youth prevention
interventions. Also, only three out of the 70
community members had either listened to
monks teaching about compassion and
37
42-year-old monk from Mandalay

It is good to have more knowledge about HIV. If monks remind us about this issue even superficially, the
community will remember. So, if we talk, it will be effective. Thus, monks should know all about HIV
and AIDS.
tolerance towards PLWHA, been educated by

monks about HIV and AIDS, or received HIVrelated education materials distributed by
monks. In FGDs, monks discussed their willingness to learn more about HIV and AIDS
so that they could incorporate these issues
in their sermons and work in outreach activities through lay organizations.
About 14% of community respondents in
Myanmar were aware of the programmes of
monks and nuns targeting PLWHA. This
proportion was higher than that of the
previous two years (10%) indicating that
awareness of the monk/nuns activities on
HIV has increased.
The FGDS for communities for Myanmar
revealed more positive than negative
attitudes concerning the involvement of
monks in HIV-related programmes. The
positive attitudes were particularly related
to the potential for monks to provide spiritual
support, such as meditation. Negative
attitudes on the monks involvement in HIV
and AIDS work were not common, but those
that were expressed revolved mainly
around the opinion that HIV and AIDS is a
social issue that should be tackled by social
organizations, not by monks.
In Viet Nam, a high proportion (77%) of
community members surveyed thought that
monks or nuns should participate in HIV
prevention and care. The types of activities
that most community members felt monks
should be involved in were teaching
meditation (88%), teaching tolerance and
38
compassion towards PLWHA (87%), and

providing care and support for HIV-positive
children.
5.3.5 Impact on youth activities
In Cambodia, the youth focus group
discussions described the outreach
activities in schools as effective. The youth
said that the educational messages they
received most often were on HIV and AIDS
prevention and VCCT. Care and support are
communicated less often, as these activities
are mainly targeted at the general community.
All groups found HIV-related education and
communication activities to be very useful.
However, the FGD youth participants felt
that monks, nuns or lay-preachers are not
effective to help youth with HIV and AIDS
issues. They suggested that monks should
spend more time visiting PLWHA and
spreading the message of non-discrimination
against PLWHA through scriptures.
The FGDS among youth in Cambodia
confirmed that their parents and close
relatives have more influence on their lives
than religious persons. Most community
members noted this fact in their focus group
discussions. This was also confirmed by
monks in their focus groups, with nearly all
saying that only a few young people come
to them for advice or help. However, some
youth stated that their older relatives and
parents would get advice from monks, and
would use it to educate them. Therefore, the
clergy have an indirect role on youth if there
is a direct family involvement.
Adolescents participate in an HIV education

session in Kampong Speu Province.
In Lao PDR, the monks who were interviewed

reported having used participatory methods
or life skills approaches to discuss with
youth and teach them about HIV and AIDS.
Activities include meditation and developing
a range of youth-friendly Buddhist teachings
that address the issues related to young
people. During the FGDs the community
members gave examples of HIV-related
educational activities that have taken place
in the temples, targeting youth and linking
with youth groups. However, as with China
and Cambodia, the lack of interest from
youth was cited as a limitation to the
effectiveness of these activities.
Credit: Udom Kong, UNICEF Cambodia 2006
In China, it was found that only 28% of youth

participated in AIDS prevention programmes
in the BLI sites, and this share was not
significantly higher than in the non-BLI sites.
In the BLI sites, monks who were engaged in
youth-specific programmes ranged between
12% and 30%, depending on the type of
programme such as participatory or life
skills for teenagers. All FGD community
participants including youth mentioned
receiving brochures on AIDS prevention
from monks, which none of the FGD
community participants in non-BLI sites had
received. Further, none among the FGD
youth participants had attended AIDS
prevention and care activities held in
temples in the BLI sites. Also, none of
the youth surveyed in the non-BLI sites
attended AIDS prevention and care activities
organized in temples.
Furthermore, the Focus Group Discussions
for youth in China show that in the aspect
of AIDS care, 11 out of 13 adolescents
interviewed in the BLI site thought it was
useful for monks to provide care for PLWHA
& AIDS patients. The participants said that
the establishment of Home of Buddhist
Light helps PLWHA both materially and
spiritually. As for AIDS prevention, 10 out of
the 13 adolescents thought it was not useful
for monks to participate in prevention
activities, because monks are not doctors
and what they say is not professional. This
viewpoint was expressed both in the BLI
and non-BLI sites.
UNICEF EAPRO
Statement from the Womens

FGD in Lao PDR
In our temple we have seen Lao
Youth Union coming to organize
educational workshop on HIV and
AIDS led by our abbot; and sometimes
we observed that PLWHA also come
to meet the monks to seek advice or
do meditation.
In Myanmar, only 17% of monks had used

life skills methods to teach youth in schools
or temples, and 7% had used participatory
methods and other activities to teach youth
about HIV and AIDS. Monks at the FGDs in
Yangon stated that they preferred young
monks to conduct programmes so that
youth could relate better to them.
Compared to the other countries, a larger
share of monks in Viet Nam had participated
in HIV-prevention programmes targeting
youth. For instance, 42% of the junior monks
surveyed in the BLI site had used participatory
methods for discussions with youth or
PLWHA, and 40% had used life skills methods
to teach youth in schools, communities
or temples. In the non-BLI sites, the
corresponding figures were 13% and 26%.
Over 90% of the monks who offered
counselling in the BLI sites provided
sessions for men, women including youth
with HIV.
39
Monk providing support to the community.
Credit: UNICEF Cambodia
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
monks in community prevention outreach

interventions in Myanmar has been sparse.
The community members had listened
to monks preaching on compassion and
tolerance, had been educated on HIV and
AIDS, and had participated in discussion on
HIV and AIDS facilitated by monks or been
visited by monks who prayed for PLWHA in
the community.
In Cambodia, the FGD youth participants felt
that monks, nuns or lay preachers are not
effective to help youth with HIV and AIDS
issues. In China, none of the youth who
participated in the FGDs had attended AIDS
prevention and care activities in the temples
in the BLI sites. Compared to other
countries, a large share of monks in Viet
Nam had participated in HIV-prevention
programmes targeting youth.
5.4 Community response to care

and support to PLWHA
5.4.1 Introduction
This section provides an overview of the
role that monks and nuns have played in
providing care and support to PLWHA to
reduce the emotional, physical and economic
difficulties that they face.
26 year-old dependent female PLWHA from Yangon, Myanmar

When I attended the gathering at Yadana Metta, I met with nuns. They preached
sermons and taught to do meditation.
30 year-old glass technician male PLWHA from Mandalay, Myanmar
STD team arranged visit to monasteries two times. At Yankin Hill, monk taught
meditation. I found one female PLWHA like us there.
5.4.2 Temple-based interventions for PLWHA

According to the focus group discussions
with monks in Cambodia, the most common
temple-based activities are teaching
PLWHAs to meditate, giving occasional
material assistance with funding from
NGOs, and in few cases, inviting PLWHA to
participate in regular meetings held by the
monks at the pagoda. On an average, monks
conducted six HIV-related programmes in
the temples every month. However, these
programmes are conducted by only a small
share of monks who have been trained by
the BLI (no more than three out of 62
monks).
From the results of the junior monks FGDs
in China, it is interesting to note that
although all the junior monks are aware that
the General Buddhist Temple organizes
programmes for PLWHA, junior monks have
rarely participated in providing PLWHA with
direct support. A possible reason for this is
the consideration of the BLI project to
keep the identities of PLWHA secret, and
consequently only senior monks participate
in specific programmes to provide care and
support for PLWHA.
In Lao PDR, of the 54 PLWHA who have been
economically affected, 59% said that they
have received support from monks. Among
those receiving support from monks, 88%
reported having been taught meditation by
the monks to reduce their suffering. Over
25% had been provided with support for
income-generating programmes. Among
them 56% were very satisfied, 27% were
sufficiently satisfied, 6% have had little
satisfaction. One PLWHA claimed to be
not satisfied at all, though no reason
was provided. The income-generating
programmes included providing space for
UNICEF EAPRO
selling flowers in temple areas, and providing

small grants or scholarships for temples
and boys.
In the FGDs in Myanmar, PLWHA from both
Yangon and Mandalay noted that the majority
of the monastery-based programmes were
focused on meditation.
Besides meditation, another supportive
programme for PLWHA was providing
meeting space and shelter. Participants from
the FGDs for PLWHA from Yangon and
Mandalay also mentioned visiting clinics
that were located inside monasteries to seek
medicine or treatment.
The findings for Myanmar point to very few
monastery-based interventions of monks to
provide care and support for PLWHA. None
of the community members interviewed
mentioned being aware of monastery-based
monks programmes which provide care for
PLWHA. However, the community members
indicated that they would be accepting if
there were such activities.
5.4.3 Counselling services
Findings from the quantitative survey
for Cambodia suggest that providing
counselling services for PLWHA is not
frequent among monks. Of the 177 junior
monks surveyed, only 23% had provided
HIV and AIDS counselling sessions in the
previous 12 months. In addition, it is to be
noted that 46% of the monks who were
trained by the BLI provided counselling to
PLWHA in comparison to untrained monks
(18%). Despite the low share of monks who
provide counselling, their services appear to
have attained a wide coverage in the
Cambodia sites.
41
Perspectives from the community members in FGDs in Lao PDR on monks

counselling people with AIDS
As Lao people mainly respect Buddhist religion, they will follow whatever the monk
advises. If a monk becomes a counsellor on HIV and AIDS, it will be a wonderful job to
help people avoid catching AIDS, reducing stigma and discrimination toward PLWHA,
and/or making people understand and support people dying of AIDS, said a woman
in an FGD in Vientiane.
29-year-old PLHA male from Yangon

I know a monk that I respect too much. He is very smart and famous. He is also
educated. One day when I met him, he said I looked thin. I disclosed my status then
and said I did not know what to do. He gave me suggestions that are good for me. He
also suggested that I inform my wife. I collected books from him and gave them to my
wife and told her what to do step by step as per the monk's advice. I don't know about
counselling. But my wife has accepted gradually. She was lucky. She did not have the
virus. She encouraged me much when I became weak.
Counselling services were also found to be

infrequent in China. In the BLI sites, only 9%
of the surveyed junior monks provided
counselling services on HIV and AIDS in
2006, and none of the surveyed junior
monks in non-BLI sites provided those
services in 2006.
In Viet Nam, the proportion of monks/nuns

providing psychological/spiritual counselling
sessions on HIV and AIDS in the previous 12
months was 41% in the BLI sites, compared
to only 8% in the non-BLI sites.
In China, counselling services were found to

be infrequent. Only 9% of the junior monks
provided counselling services on HIV and
AIDS in 2006 in the BLI sites. However, none
of the surveyed junior monks provided
services in the non-BLI sites in 2006. The
people who came for counselling were
mainly male AIDS patients and children who
were affected by AIDS. A possible reason for
the low proportions is that only monks with
senior ranks (who are older than 20 years
and have official titles of Buddhist monk or
chiefs of temples) and monks who have
received counselling training are allowed to
provide counselling for PLWHA. Most of the
monks who were surveyed in the China sites
were less than 20 years and did not have
official titles of Buddhist monks or chiefs
of temples.
5.4.4 PLWHAs response to counselling

services
In Cambodia, 84% of the 233 PLWHA
surveyed noted that they had been offered
assistance for emotional coping. Of this,
25% of the PLWHA said that they had been
offered assistance for emotional coping by
relatives. Temples and monks followed
Among the nine PLWHA surveyed in the

China site, four had been counselled by
monks. One of them had been counselled
once, two PLWHA sought counselling once
every six months, and the fourth person
attended counselling once every month.
Two PLWHA said that they were satisfied
and another two were very satisfied.
In Lao PDR, only 27 out of 201 junior monks

are active in providing counselling services
for HIV-positive people and their families.
However, many junior monks reported
having attended the training course on
counselling for PLWHA. In Myanmar, 13% of
the monks had provided counselling services
to HIV-positive men and women in the
preceding 12 months.
42
second, having offered assistance to 22% of

PLWHA. 21% of the PLWHA mentioned
NGOs.
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.
In view of the importance of providing

counselling to help PLWHA with emotional
coping, the Metta Dhamma Project in Lao
PDR has planned to broaden its scope of
response to include more temples, encourage
monks to become more actively engaged as
counsellors for people with AIDS and their
families, and to promote wide community
awareness of the social role of monks and
their importance in the response to HIV
and AIDS.
During the FGDs in Mandalay, Myanmar,
most PLWHA reported having gone to
monks for psychological support rather than
community members. Many PLWHA
remarked that they very much appreciated
the support provided by monks such
as counselling, meditation, sermons and
compassion.
Quantitative results in Myanmar showed
that only one of the 80 PLWHA interviewed
received
counselling
from
monks.
Nonetheless, the services provided by
monks have mostly consisted of other types
of psychological support. Most common
types of psychological support were home
visits, prayer and being taught meditation
by monks or nuns. In all, 16% of the PLWHA
surveyed had received some form of
psychological support from monks or nuns.
UNICEF EAPRO
In Viet Nam, over 90% of the monks and

nuns who offered counselling in the BLI
sites provided sessions for men, women
and youth with HIV. In the BLI sites, 25% of
the monks and nuns met with the PLWHA
groups once a week. The monks/nuns
surveyed in the BLI site were more engaged
in counselling for PLWHA and their families
in the last 12 months than monks/nuns in
the non-BLI sites in HCMC and in Tra Vinh
Province (39% compared to 3% and 10%
respectively).
5.4.5 Home visits
Many respondents in the FGDs held in
Cambodia wished that monks were more
active in visiting PLWHA. In the FGDs
conducted among monks, the monks
remarked that visiting PLWHA in the
community is not a very frequent activity.
Major obstacles faced by monks to care and
support for PLWHA in Cambodia were:
Lack of material support
Lack of support from senior monks
Lack of motivation for monks to spend
their time in home visits to PLWHA
Among the nine PLWHA surveyed in the
China sites, four said that monks had visited
their homes.
43
Maintaining confidentiality during home visits

Findings point out that, while communities generally have a positive perception of home visits, confidentiality
for PLWHAs should be maintained.
In the focus group discussions conducted in Myanmar, the PLWHA expressed positive attitudes towards
monks conducting visit to their homes. However, the PLWHA expressed concerns about confidentiality.
36-year-old male PLWHA bicycle workshop worker from Yangon:
Some people would not like home visit by monks or talks about HIV. Another issue is preaching of monk
at home might let neighbours to know about HIV status because houses are very small and close to one
another.
36-year-old male electrician from Mandalay:
It would need time to accept home visit like this because we are living closely with neighbours. Just within
the family, we can easily accept on preaching and teaching by monks
In Lao PDR, the proportion of home visits is

considerably higher. About 21% of the 75
PLWHA interviewed recalled being visited
by monks at their home for meditation,
praying, teaching sermons about HIV and
AIDS and compassion, receiving educational
materials or traditional medicines and
encouraging them to go to the hospital
when necessary. The PLWHA who had
received home visits responded that they
met with monks at least once a month. 93%
of the PLWHA who received home visits
were satisfied with the services.
In Myanmar, 10% of the 83 monks surveyed
responded that they carried out home visits
to care for PLWHA and families affected by
HIV and AIDS. 100% of PLWHA reported that
praying was the most frequent action/
activity carried out during home visits. This
was followed by teaching meditation. 85%
of PLWHA reported that monks taught
meditation during home visits.
44
in the responses of PLWHA. In Cambodia,

most PLWHA (78%) interviewed belong to a
self-help group and 86% of these PLWHA
responded that their group was supported
by monks, mostly by providing temple
space and/or spiritual guidance and help
with meditation. Programmes include group
discussions on health care, use of clean
water/foods, and hygiene. A large share
of the PLWHA (87%) said they were very
satisfied with the support that monks
provide to their group. The 302 PLWHAs
who were interviewed suggested more
donations (34%), medicine and food (32%)
and materials and money for doing business
(31%) in order to support their needs for
the future.
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 previous
12 months. The corresponding proportion in
the non-BLI sites is only 2%.
In China, all junior monks in the exposed

site were aware that the General Temple has
helped PLWHA establish Homes of Buddhist
Light Self-Help Groups, and has supported
PLWHA in these groups. For example, the
General Temple helped the PLWHA families
to raise peacocks as a self-help programme
during times of difficulties. The surveyed
monks said that local temples in non
BLI sites did not implement supporting
programmes for PLWHA.
5.4.6 Monks support to self-help groups

(SHGs)/support group
The relatively high degree of support that
monks offer to self-help groups is reflected
In China, among the nine PLWHA surveyed,

seven had joined a self-help group that is
supported by monks. Of these, three PLWHA
took part in group events held once a month
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)
Providing PLWHA self-help groups with

material support (food, clothing, etc)
25%
7%
6%
11%
31%
Providing PLWHA self-help groups with

income-generating activities
23%
6%
0%
1%
9%
11%
5%
4%
15%
Providing PLWHA self-help groups

meeting space, shelter and refuge
Providing PLWHA self-help groups
spiritual support-meditation training,
spiritual guidance
32%
7%
8%
11%
16%
Palliative care for those dying of AIDS
19%
2%
1%
7%
13%
Hospital visits for PLWHA
14%
4%
3%
10%
15%
Provision or organizing food or other

material support for individual PLWHA
23%
7%
6%
11%
12%
Taking care of children whose parents

are ill because of HIV or AIDS
25%
2%
1%
4%
7%
Care of orphans whose parents died due

to HIV or AIDS
27%
2%
0%
1%
12%
Mobilizing communities in PLWHA care

and support
29%
9%
4%
8%
and three attended the groups on a quarterly

basis. Five of them expressed being very
satisfied with the support that monks
provided to their group.
In Lao PDR, 77% of interviewed PLWHA
reported belonging to a self-help group in
their area. 63% of the PLWHA who attended
these groups received support from monks.
Most of the PLWHA (59%) said that their
groups met on a monthly basis while the
other groups met twice a year. The PLWHA
reported that their groups organized
meetings only once or twice a year due to
financial constraints.
In Viet Nam, only 35% of the PLWHA
interviewed in Ho Chi Minh City (HCMC)
belonged to a support group for HIV-positive
people. Of the respondents who attended
self-help and support groups, 39% reported
that Buddhist monks supported their
groups, and 60% of these people were
sufficiently satisfied with the monks support.
Awareness of the monks involvement in
self-help groups for PLWHA is high among
the communities in the project site. In the
interviews conducted with community
UNICEF EAPRO
21%
members in HCMC, about 83% were aware

that monks in their area supported self-help
groups for PLWHA.
5.4.7 Other services to PLWHA
Table 10 provides an overview of other
types of services that all junior monks
surveyed have provided to care for and
support PLWHA.
The findings indicate that among
programmes to support PLWHA, self-help
groups are the most common approaches in
all five countries. Additionally, providing
PLWHA self-help groups with material
support, such as food and clothing was the
most popular in Viet Nam and Myanmar.
In Cambodia, nearly a third of all monks
interviewed have provided PLWHA self-help
groups with spiritual support, whether
through meditation training or spiritual
guidance. However, there has been very
little palliative care provided to people dying
with AIDS, particularly among monks in
China, Lao PDR and Myanmar. Also, care of
orphans and other children affected by AIDS
is another programme that very few monks
45
from these three countries were involved in.

Monks who were involved in the care of
children orphaned by HIV and AIDS is
significantly higher in Cambodia (27%) and
Viet Nam (12%).
Many monks in Myanmar particularly those
in Yangon, said that other programmes to
provide care and support for PLWHA included
preaching for people dying of AIDS,
encouraging them to meditate, and helping
grieving family members through preaching.
Monks also used preaching to strive
towards improved health conditions for
PLWHA, using Buddhist scriptures including
Bauzzen Suttra, Four Noble Truths, and
Metta Sutra. Some discussants pointed out
that monks preaching could be applied not
only towards reducing discrimination, but
also towards raising donations for PLWHA.
5.4.8 Summary
The most common temple-based activities
are teaching PLWHAs to meditate, support
to income-generating programmes, giving
occasional material assistance with funding
from NGOs and inviting PLWHA to participate
in regular meetings held by the monks at the
pagoda.
Counselling services were found to be
infrequent in Cambodia and China. However,
the percentage of trained monks providing
counselling to PLWHA was much higher
than untrained monks in China.
In Cambodia PLWHA noted that they had
been offered assistance for emotional
coping. In Myanmar, most PLWHA reported
having gone to monks for psychological
support. Support such as counselling,
meditation, sermons and compassion were
much appreciated by the PLWHA. In Viet
Nam, monks/nuns surveyed in the BLI site
were more engaged in counselling for
PLWHA and their families in the preceding
12 months than monks/nuns in the non-BLI
sites. Also, challenges to counselling were
highlighted. Home visits were appreciated
by the PLWHA. Maintaining confidentiality
was highlighted as one of the important
concerns during home visits.
Self-help groups are the most common
approaches in all five countries to support
46
PLWHA. The PLWHA expressed satisfaction

with the support that monks provided to
their self-help groups. The support by
monks include providing temple space and/or
spiritual guidance, help with meditation and
income-generating programmes.
Palliative care for people dying with AIDS,
particularly among monks in China, Lao PDR
and Myanmar requires to be strengthened.
In addition, care of orphans and other
children affected by AIDS needs attention.
5.5 Building and strengthening

partnerships
5.5.1 Introduction
This section highlights the role played by
the temples/Sanghas, National and Provisional
Buddhist Association to support and
strengthen the Buddhist Leadership
Initiative. Extensive efforts were made to
collaborate with the health sector and other
institutions. Plans to scale up programmes
and challenges faced by the temples/
Sanghas are included here.
5.5.2 Temple plays an enhanced role in the
community
In Cambodia, among the 80 monks
interviewed, one-third said that their temple
was active or very active, while 11% said
that their temple was not at all active. Only
23% of senior monks stated that their local
temple had produced any educational
material on HIV, with Phnom Penh and Prey
Veng being most active and producing
educational material on HIV (about 40%
for both).
In China, the General Temple of
Xishuangbanna, Home of Buddhist Light
in Xishuangbanna and the project officers
are responsible for designing and executing
project activities in Jinghong, Menghai and
Mengla. AIDS control offices in the project
sites help the local Home of Buddhist
Light to implement project activities.
Meanwhile, groups of Buddhist Associations
in townships, towns and village Buddhist
temples are responsible for routine project
work.
In Lao PDR, in relation to the overall role of
temples in HIV and AIDS activities, 32% of
the 50 senior monk respondents in the five

provinces considered their temple active or
very active, while 32% of the monks
responded that their temple was not active.
Based on the responses of the senior monks,
the areas with the highest level of temple
activity are Vientiane, Savannakhet and in
particular, Champasak.
5.5.3 National and Provincial Buddhist
Association support BLI
In Cambodia, five of the seven provincial
coordinators stated that the National
Buddhist Association has actively supported
HIV and AIDS related work. Six provincial
coordinators responded that the provincial
Buddhist Associations have demonstrated
support for HIV and AIDS work. Similarly,
the six provincial coordinators mentioned
that the Department of Religious Affairs is
supportive of the temples and monks HIV
and AIDS activities.
Half the senior monks mentioned that they
have been supported in their HIV and AIDS
work by the National Buddhist Association.
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%).
A higher proportion of monks (68%) feel
supported by their Provincial Buddhist
Association and by their District Buddhist
Association.
In China, the BLI project management is
carried out by the Buddhist Association of
Xishuangbanna Prefecture, Yunnan Buddhist
University in Xishuangbanna and Buddhist
Associations in the project sites. The leading
organizations in the BLI project include the
Yunnan Provincial AIDS Control Office, the
Bureau of Ethnic Minority Religious Affairs
of Xishuangbanna and the AIDS Control
Office of Xishuangbanna Prefecture. These
three organizations are responsible for
leadership and coordination of the BLI.
The project management team in Lao PDR
was organized with support from the Lao Front
for National Construction, the government
department tasked with overseeing the
activities of Buddhist Associations, in close
UNICEF EAPRO
collaboration with other sectors, particularly

with key health personnel, the Lao Youth
Union and the National and Provincial
Committees for the Control of AIDS. In Lao
PDR 44% of respondents declared that they
have been supported by the National
Buddhist Association in their HIV and AIDS
prevention work by providing policy
directives, letters or decrees that encouraged
monks participation in HIV-related activities.
In Viet Nam, the BLI management has been
carried out by the Viet Nam Fatherland Front
(VNFF), provincial and city level Fatherland
Fronts, UNICEF, Buddhist Associations and
pagodas. The VNFF was the acting project
manager for most of the projects course,
providing direct support to target pagodas
in project planning, implementation
and evaluation. Since 2006, the provincial
Fatherland Fronts in Tra Vinh and
HCMC have taken over as the BLI project
managers.
80% of the monks in HCMC 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.
Other support from the National Buddhist
Association was in providing policy
directives, letters or decrees of the highest
authority, encouraging monks participation
in HIV-related activities (78%). At the
provincial level, 67% of senior monks in
HCMC said that their Sangha has been
supported in HIV and AIDS prevention work
by the Provincial Buddhist Association. The
most widespread forms of support were
enabling their participation in discussions at
Buddhist Association meetings (83%), and
highlighting the Sangha activities as an
agenda item at meetings of the Buddhist
Association (83%).
5.5.4 Collaboration with the health sector
In Cambodia, nearly half of the senior
monks (45%) interviewed stated that their
temples/Sangha has worked with health
institutions (health centres, district health
centres, and hospitals). In their focus
groups, most PLWHA stated knowing that
47
they have the right to access health and

educational services, including rights to
receive HIV treatment from public hospitals,
to consult with a doctor, to receive free
treatment or medicines from public hospitals,
and to complain to a court if any doctor or
school staff discriminates against them.
In Lao PDR, 24% of the PLWHA who were
interviewed reported having been encouraged
to go to hospitals to seek treatment.
Moreover, during their stay in the hospitals,
many PLWHA reported receiving visits by
monks who were relatives. In China, four
out of the nine PLWHA surveyed had been
referred by monks to healthcare facilities.
Two of the eight senior monks interviewed
in Myanmar had stated that there are
linkages between their monasteries and
health facilities such as Township Hospitals
and local STI teams. Findings from the
qualitative study indicate that the main
types of activities offered by monks to link
PLWHA with the health sector were giving
directions or advice for contacting health
facilities, and providing support to help the
PLWHA access health services.
The study in Viet Nam found that there were
only activities by monks and nuns to
establish linkages with the health sector in
the previous 12 months in HCMC, not in Tra
Vinh. 64% of the monks/nuns in the BLI site
in HCMC had visited PLWHA in hospitals,
compared to 3% of monks and nuns in the
non-BLI site in the same city. Similarly, the
proportion of monks/nuns doing palliative
care for those dying of AIDS in HCMC was
higher in the project site than in the control
site (33% and 10% respectively).
5.5.5 Sangha extends partnership with other
institutions
Concerning their collaboration with other
institutions in Cambodia, 49% of senior monks
responded that Sangha has collaborated with
educational institutions. On health issues,
45% of monks said that their temple has
worked with health institutions. 61% of
monks said that their Sangha has worked
with civil society organizations such as
national NGOs on HIV and AIDS issues.
48
58% of the senior monks (or of their Sangha)

belong to an AIDS committee. Of the 46
AIDS Committees, 25 are at the village level,
14 are at the district level, four are at the
provincial level, and three are national.
In Lao PDR, the temples have shown
evidence of working in collaboration with
some other organizations, though only a
few are HIV and AIDS institutions (36%). The
most common responses provided for
collaborating organizations were Metta
Dhamma, the Lao Front for National
Construction, the health sector, the Lao
Youth Union and the District Sangha
Council.
Over a third (38%) of the 19 temples
surveyed are included in HIV and AIDS
committees, with every level represented
among the responses (one at the national
level, eight at the provincial level, seven at
the district level, and three at the village
level). Majority of senior monks (64%) said
that their Sangha members meet with HIV
and AIDS committee one to three times
annually.
In Myanmar, 50% of monasteries have
collaborated with a health institution, and
three of the monasteries have worked with
civil society institutions on HIV-related
programmes. Most of the collaborating
organizations were national NGOs and other
Buddhist Organizations, while community
based organizations and local NGOs
were also indicated as collaborating
organizations. Three monasteries were part
of an AIDS committee, with one each at the
provincial, district and local levels. Two out
of the three committees included members
from the Ministry of Health.
In Viet Nam, 60% of the senior monks
interviewed in HCMC confirmed that the
Provincial Buddhist Association was a part of
an AIDS Committee, while the corresponding
proportion in Tra Vinh was only 20%.
5.5.6 Sangha Scale up plans and resource
mobilization
Two-thirds of the senior monks interviewed
in Cambodia affirmed that their Sangha had
plans to scale up HIV and AIDS programmes

in the near future. There were plans to train
more monks, nuns and Buddhist laity
through the BLI. Moreover, in six out of the
seven provinces, there were plans to
increase the number of temples supported
by the BLI.
However, only 25% said that their temple
had a budget to scale-up programmes. By
and large, senior monks perceived that the
biggest challenge to scaling was the lack of
financial support.
All 17 monks who actually have a specific
budget for BLI activities assigned to their
temple/Sangha knew the exact budget. In
eight cases, the money was given by an
unspecified NGO, in four cases the direct
source is UNICEF, while in three cases the
money was provided by the provincial
programme coordinator. Seven out of 17
senior monks reported delays in payments,
with the average delay being three to four
weeks. 59% of the senior monks surveyed
kept record of accounts. Accounts are kept
in 62% of cases by a senior monk,
followed by a specifically commissioned
monk (17%). Half of the Sanghas have been
audited.
In Lao PDR, nearly half of the senior monks
interviewed (48%) said that they had plans
for future HIV and AIDS programmes and
18% responded that they had a budget
allocated and assigned for conducting BLI
activities. 64% responded that the Sanghas
expenditure was audited. The known
sources of funding for HIV and AIDS
programmes are from the Centre for HIV
and AIDS and STI services, the Ministry of
Health, and the Metta Dhamma project
supported by UNICEF. However, only few
monks knew the annual expenses and most
were unsure about the amount spent.
In Myanmar, two monasteries of the eight
monasteries surveyed in Mandalay had
future plans to scale up HIV-related
programmes. A senior monk from one of
these two monasteries responded that it
has many plans for future HIV-related
programmes, including training, scaling up
UNICEF EAPRO
existing interventions, community outreach,

care and support, youth education, family
support
and
producing
educational
materials.
Lack of financial support was reported as the
main obstacle to scaling up the programmes.
Two monasteries have accounting books to
record expenditures. The head of the monks
(abbot) is responsible for accounting as well
as auditing. The senior monks responded that
there has been no past linkage with
the National AIDS programme manager
regarding HIV-related programmes.
The Buddhist Association in Viet Nam
planned to scale up HIV and AIDS activities
in the near future to the new sites in Tra Vinh
and HCMC, with 50% and 70% of senior
monks in these sites reporting plans
for scaling up. The most common plans
reported include training more monks/nuns,
providing more food and other materials for
PLWHA, and expanding areas of activities.
Senior monks reported that the most
difficult challenges to scaling up the
activities in Tra Vinh and HCMC were lack of
financial support, reported by 20% and 50%
of respondents in Tra Vinh and HCMC
respectively. Other challenges, mentioned
by 20% of the senior monks in both sites,
were the lack of technical support and the
lack of motivation of monks and nuns to be
involved in HIV and AIDS programmes.
5.5.7 Summary
Findings in Cambodia, China and Lao PDR
show that temples have been active or very
active in HIV and AIDS programmes.
National Buddhist Associations have
demonstrated support for HIV and AIDS
work in all countries. The National Buddhist
Associations in Lao PDR and Viet Nam have
assisted in providing policy directives,
letters or decrees encouraging monks
participation in HIV-related activities.
Temples/Sanghas have built linkages with
the health institutions. The support to
PLWHA range from providing directions,
support or advice to contact health care
facilities, awareness on the right to access
49
health and educational services, including

right to receive HIV treatment in public
hospitals and to complain to a court if any
doctor or school staff discriminates them.
Sanghas have shown evidence of working
in collaboration with education institutions,
health institutions and civil society
organizations on HIV-related programmes.
50
Many of the temples/monasteries in almost

all countries belong to AIDS committees at
provincial, district or local levels.
Although Sanghas had plans to scale up
their HIV and AIDS programmes, lack of
financial support was reported as one of the
main obstacles.
How did BLI engender changes in

the monks/nuns and the
Sanghas?
6.1 Enhancing the effectiveness
and efficiency of Sangha response
to HIV
6.1.1 Introduction
To increase the effectiveness and efficiency
of the Sangha to respond to issues of HIV
and AIDS, the survey questionnaire included
questions relating to the general knowledge
of HIV and AIDS, including HIV transmission
and prevention and the HIV-related training
that the monks and nuns had undergone.
The aim of these questions was to evaluate
the capacity of the Sangha to respond to HIV
in their communities. This section focuses
on the HIV and AIDS awareness of monks
and nuns including their knowledge of the
transmission and of local treatment
facilities, and prevention of HIV.
6.1.2 Awareness of HIV and AIDS
In Cambodia, all but one of the 177 junior
monks interviewed had heard of HIV and
AIDS. All monks surveyed in the BLI site in
China had heard of HIV and AIDS, compared
to 82% of monks in the non-BLI sites. The
majority of monks surveyed in Myanmar
were aware of HIV and AIDS.
6.1.3 Knowledge of the transmission of HIV
In Cambodia, between 95% and 100% of
junior monks responded correctly to the
most common ways of HIV transmission
(sex, multiple partners, blood transfusion,
and mother-to-child). In China, majority of
the junior monks in the BLI site (76%) knew
all the correct modes of HIV transmission;
whereas among monks in the non-BLI sites,
the share was much lower (51%).
In Myanmar, more than 72% of junior monks
responded correctly about the modes of HIV
transmission. However, there remain some
misconceptions that mosquito bites and
personal contact can transmit the virus.
In Viet Nam, junior monks and nuns in the

site that underwent BLI training have a
better knowledge and understanding of HIV
and AIDS issues than those in the other
sites, though the difference is not great. For
instance, 98% of monks and nuns in the BLI
site knew that blood transfusion was a
means of transmitting AIDS, compared to
86% of monks and nuns in the non-BLI sites.
6.1.4 Knowledge on the prevention of HIV
infection
In Cambodia, between 96% and 100% of 177
junior monks knew the correct ways of HIV
prevention. However, 35% of all junior
monks surveyed responded that not sharing
any objects with a PLWHA was a means of
preventing HIV infection. Interestingly,
the training that the junior monks had
undergone did not make a difference
to these responses. In terms of monks
knowledge of HIV prevention in China,
monks in the BLI site again had better
knowledge than those in the non-BLI sites.
For example, 85% of monks in the BLI sites
knew that condom use was a means of
preventing HIV infection, compared to 60%
of monks in the non-BLI sites. Overall,
however the knowledge of HIV prevention
was lower than that of HIV transmission
modes. In particular, a significant share of
monks had the misconception that not
sharing objects with an HIV-positive person
was a way of preventing HIV infection (64%
of monks in the BLI-sites compared to 37%
in the non-BLI sites).
6.1.5 Awareness on local treatment facilities
In Cambodia, 41% or less than half of the
177 junior monks knew of any facility
providing ARV or drugs for opportunistic
infections.
However,
trained
monks
compared with untrained monks had better
knowledge of local facilities providing
treatment for HIV and AIDS (63%) or
treatment for opportunistic infections (57%).

In China, one of the weaknesses of the
monks capacity to respond to HIV was their
limited awareness of local AIDS treatment
facilities. Only 32% of the junior monks
surveyed in the BLI site knew of any health
service facility that provides drugs to treat
HIV and AIDS patients, and only 23% knew
of any facility that provides drugs to treat
opportunistic infections to PLWHA. While
the corresponding shares are much lower
for monks in the non-BLI sites. Only 1.4%
knew of any health facility that provides
drugs to treat HIV and AIDS patients and
treat opportunistic infections among PLWHA.
This limited knowledge of local treatment
facilities presents a clear constraint to the
monks ability to provide care and support
to PLWHA in their communities.
AIDS issues compared to the non-BLI sites.

The knowledge of HIV prevention was much
lower than that of HIV transmission modes.
The findings highlight the importance
of strengthening HIV prevention training to
correct such misconceptions.
In Viet Nam the monks awareness of

nearby health facilities for treating PLWHA
was low, though it was higher in the BLI site
than in the non-BLI sites. Specifically, 39% of
junior monks and 52% of junior nuns in
the BLI site knew of health facilities that
provided anti-retroviral drugs (ARVs) and
health facilities that treated opportunistic
infections for people with HIV and AIDS. The
corresponding figures for monks and nuns
in the non-BLI sites were 9% and 17%
respectively.
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
Findings reveal that the monks awareness

of local AIDS treatment facilities is low.
Training for monks/nuns and lay leaders
need to include knowledge on the local
health services to help strengthen links
between communities and public health
treatment facilities to increase community
members access to HIV prevention, treatment
and care services.
6.2 Capacity building on HIV and

AIDS
6.2.2 Training on HIV and AIDS

From interviews with senior monks, junior
monks and provincial coordinators, the
main topics covered during the BLI training
sessions were:
Table 11: Proportion of junior monks who received training on HIV and AIDS
% who have ever

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%
Of those who received 70%

training, % who
received BLI training
52
Table 12: Type of training received by junior monks
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
HIV and AIDS prevention
69%
14%
91%
27%
10%
0%
Behaviour change
51%
15%
27%
0%
5%
0%
HIV and AIDS stigma and

discrimination
reduction
63%
11%
80%
15%
11%
0%
HIV and AIDS care and

support
49%
13%
71%
3%
5%
0%
HIV and AIDS counselling
51%
11%
62%
3%
6%
0%
Home visiting skills
37%
11%
20%
1%
2%
0%
Community
development and welfare
43%
8%
11%
1%
2%
0%
Life skills
34%
9%
40%
0%
12%
0%
Drug user care and counselling
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.
UNICEF EAPRO
In Myanmar, quantitative data were only

collected in the new site in Mandalay where
the BLI interventions have not yet been
undertaken. The survey results revealed
that HIV-related training was found in two
monasteries with a frequency of three to four
training sessions, although the BLI has not
been initiated in these monasteries. In each
training session, the number of participants
(monks/nuns) ranged from 12 to 36.
6.2.3 Type of training received by junior
monks
As Table 12 indicates, HIV prevention was
the most common topic of training for
junior monks in the BLI sites in China and
Cambodia. In Lao PDR, the most widespread
type of training was in life skills, attended by
nearly all of the 13% of the 201 junior monks
in the BLI sites who were trained under the
BLI initiative. Another common topic in all
three countries was HIV and AIDS stigma and
discrimination reduction. In the BLI sites in all
three countries, project management was
among the least common topics of training.
In the BLI site in Viet Nam, 18% of the 33
monks and nuns surveyed were trained in
palliative care for people dying of AIDS. Of
these six monks who received training in
palliative care, four were trained through the
BLI.
53
6.2.4 Monks/nuns satisfaction with training

Most of the junior monks from Cambodia
who underwent training declared themselves
to be very satisfied (67%) or satisfied (19%)
with the training. Satisfaction is particularly
high with BLI-trained monks, among whom
82% were very satisfied.
In China, 51% of the trained monks in the BLI
site reported being satisfied with the
trainings, while 39% said they were very
satisfied with the training. Monks rates of
satisfaction with trainings in the BLI site are
higher than those in the non-BLI sites.
A high proportion (85%) of monks/nuns in
the BLI site in Viet Nam was satisfied with
the outcomes of the training.
6.2.5 Follow-up training on HIV and AIDS
In China, there has been very little follow-up
training on HIV and AIDS. In the BLI site,
only 23% of the surveyed junior monks
attended follow-up training and 9% of them
attended study visits.
Among the 27 junior monks in Lao PDR who
had participated in various courses, 96%
responded to having had follow-up training,
and 37% had gone on study tours. Four
monks had visited activities of other temples
in their own city; five had visited activities of
temples in other parts of the country and one
had attended a study tour abroad.
In Viet Nam, nearly half of them (46%) had
received follow-up training, and 62% had
gone on study tours related to HIV and
AIDS, a much higher share than that of
monks/nuns in non-BLI sites (13% in HCMC
and 2% in Tra Vinh).
6.2.6 Encouragement from senior monks
From the total sample of 177 junior monks
in Cambodia, 59% said they are encouraged
by their abbot and senior monks to deliver
the message about HIV and AIDS they have
learnt. This percentage increased to 89% for
the BLI-trained monks in Cambodia. The
interviewees who said they were not
encouraged cited the following reasons: 1)
abbots and senior monks do not offer
opportunities, 2) abbots and senior monks
do not understand about HIV and AIDS and
54
3) abbots and senior monks are generally

unsupportive. About 20% of those interviewed
cited each of the three reasons.
Only 21% of junior monks in Lao PDR
reported being encouraged by senior monks
and abbots in delivering HIV and AIDS
messages. The most common reason cited
by monks in Lao PDR was that abbots and
senior monks do not understand HIV and
AIDS issues (31%).
Most of the junior monks (85%) surveyed
in the BLI site in Viet Nam reported being
encouraged by the abbot and the senior
monks in delivering the HIV and AIDS
messages they have learned.
6.2.7 Summary
Findings showed that most of the monks
surveyed in Cambodia, China and Viet Nam
received training on HIV and AIDS through
the Buddhist Leadership Initiative. Most
common topics of training were HIV
prevention, life skills and stigma and
discrimination reduction. Project management
was among the least common topics of
training. Monks/nuns were satisfied with the
training. While there have been follow up
trainings in Lao PDR and Viet Nam, it is
necessary to build in additional follow up
programmes in all countries to reinforce the
training received by the monks/nuns.
6.3 Promoting Buddhist scriptures

to reduce stigma and discrimination
6.3.1 Introduction
This section provides details on the monks
knowledge of Buddhist scriptures to reduce
stigma and discrimination, most effective
scripture to promote non-discriminatory
attitude and reduce suffering of PLWHA.
6.3.2 Knowledge of Buddhist scriptures to
reduce stigma and discrimination
The junior monks were asked whether they
knew of Buddhist scriptures that were
particularly relevant for stigma and
discrimination, which could be used for
delivering HIV and AIDS messages to reduce
the community members prejudice and
discrimination against PLWHA. Table 13
presents the results for all countries.
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%
In all four countries 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.
6.3.3 Mostly frequently used Buddhist
scriptures
The most frequently used Buddhist
scriptures in the previous 12 months for
reducing stigma and discrimination in the
communities towards PLWHA for all junior
monks surveyed are provided for each
country in Table 14.
Findings showed that the Four Promavihara
is the most commonly used scripture to
fight discrimination in three of the five
countries. In Myanmar, the Metta Sutra
was used more frequently. In Viet Nam,
the Potaghatessatera was the scripture
most commonly used by monks in antidiscrimination messages. Supabuddha was
used mostly in Viet Nam and Myanmar.
In all four countries for which quantitative
data is available in both BLI and non-BLI
sites, monks who received BLI training had
better knowledge of the relevance of
Buddhist scriptures for reducing stigma and
discrimination. The findings demonstrate
that the BLI training has been effective in
UNICEF EAPRO
increasing the knowledge of junior monks

on Buddhist scriptures. Therefore similar
trainings could be used to reduce community
members discrimination against PLWHA.
6.3.4 Most effective scripture to promote
non-discriminatory attitudes
In China, 32% of the junior monks who used
scriptures to promote non-discriminatory
attitudes thought that the Four Promavihara
is the most effective scripture for this
purpose. 76% of the junior monks in Lao PDR
were in agreement with this perspective.
Junior monks (61%) in Myanmar expressed
Metta Sutra as the most effective scripture
followed by Four Promovihara, which
was selected by 19% of respondents. The
viewpoint of monks in Viet Nam was
divided between the Four Promavihara
(31%) and the Potaghatessatera (30%).
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.
The respondents felt that this has not been
done enough.
55
Four Promavihara:
Meditation on the four sublime states:

loving kindness, compassion, appreciative joy and equanimity.
Metta Sutra:
Teachings on loving kindness
Potaghatessatera:
The story of Buddha tending to a sick monk
Supabuddha:
The story of the leper who could see Dhamma, or the truth taught by Buddha
6.3.5 Buddhist scripture to reduce suffering

of PLWHA
During the FGDs held in Myanmar, many
participants especially monks and nuns
from Mandalay and community members
and youth from Yangon said that Buddhist
teachings should be applied to reduce the
suffering of PLWHA. Some participants (in
particular, nuns from Mandalay) suggested
targeting not only those suffering from HIV
and AIDS but from any kind of disease, and
therefore using Buddhist teachings for
non-discriminatory
attitudes
towards
anyone suffering from disease. Another
suggestion was to give support specifically
to PLWHA. In both Yangon and Mandalay,
monks and PLWHA expressed that stigma
reduction activities can and should be linked
with the Buddhist way of teaching.
6.3.6 Summary
In all four countries (Cambodia, China, Lao
PDR and Viet Nam), monks who received
BLI training had better knowledge of the
relevance of Buddhist scriptures for
reducing stigma and discrimination. Further
findings from the review indicate that
monks who received BLI training are much
more likely to be involved in stigma and
discrimination programmes than monks
who were not covered by the BLI.
The main activity undertaken by the monks
is using the teachings of Buddhist Scriptures
in messages to promote tolerance and
reduce discriminatory attitudes in their
communities. Also, qualitative studies
suggest that there is a widespread view
that monks should more frequently
incorporate Buddhist scriptures into
anti-discrimination messages.
56
6.4 Promoting non-discriminatory

attitudes towards PLWHA
6.4.1 Introduction
This section highlights monks/nuns
involvement in reducing stigma &
discrimination and attitude towards PLWHA.
6.4.2 Reducing stigma and discrimination
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.
Of the 201 junior monks surveyed in Lao
PDR, 16% had participated in activities to
reduce stigma and discrimination in the past
12 months. While preaching by using
Buddhist scriptures proved to be the most
common activity in this regard, other
frequently cited activities were distributing
HIV and AIDS awareness pamphlets and
showing videos related to support and care
for PLWHA. In Viet Nam, the share of monks
and nuns who participated in activities to
lessen discrimination against HIV-positive
people is significantly greater among those
in the BLI site (54%) than those in the nonBLI sites (20%). Only 11 out of 84 (13%) of
the junior monks surveyed in Myanmar are
involved in activities to reduce stigma and
discrimination.
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.
Credit: Wat Noreat Peaceful Children, March 2006
40-year-old tailor (female) from Mandalay

Preaching not to abandon; instead, monks/nuns should encourage and be kind-hearted
towards a patient.
22-year-old monk, Yangon

Even during the life of Buddha, he showed an example by taking care of a sick monk (Gilana Sangha). After that,
because of Buddha's preaching using this example, many monks reached the higher level. We can use this
teaching to convince one to show sympathy and talk kindly to suffering people. We ourselves will treat
people better if we encounter people who are suffering. If we treat people with sympathy and kindness, these
deeds will be reciprocated. So does bad treatment. Leaders should also show an example first and only then will
others follow him.
6.4.3 Attitude towards PLWHA

In Cambodia, an overwhelming majority
(90%) of junior monks surveyed responded
that they would feel comfortable sitting
next to a PLWHA of the same sex or tying a
blessing string on a PLWHA. Between 81%
and 100% said that they would share
household objects with a fellow monk who
was HIV positive. The few monks who would
be uncomfortable sharing objects with
PLWHA attributed their attitudes to fear of
getting infected.
to share their plates, spoons, cushions, mats

and bikes with PLWHA are 85%, 85%, 89%,
91% and 95% respectively, which are
considerably higher than the response rates
of monks in the non-BLI sites (between 35%
and 37%). The main reason why the junior
monks were willing to share their daily
articles with PLWHA is because this does not
lead to infection. On the other hand, fear of
contracting HIV was the main explanation
provided by the monks who felt uneasy
sharing these items with PLWHA.
In China, 77% of junior monks in the BLI site

responded that they felt at ease when tying
blessing strings for PLWHA, compared to
47% in the non-BLI sites. Also, the rates of
junior monks in the BLI site who were willing
During focus group discussions in the China

sites, all the surveyed junior monks in BLI
site said that they do not discriminate
against PLWHA, and that people infected
with HIV need their help and care. In
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)
Preaching by using Buddhist Scriptures
47%
76%
59%
63%
Tying blessing strings or pouring holy water on

HIV-positive people so others can see you are not
afraid to be near them
21%
58%
31%
63%
Visiting people living with HIV/ADS at their home
9%
60%
13%
59%
Distributing HIV/ADS awareness pamphlets or

booklets to promote acceptance and compassion
towards PLWHA
88%
37%
44%
31%
Integrating the reduction of stigma in the classroom

activities that are delivered by monks and nuns
19%
52%
28%
47%
Collecting money for OVC or/and PLWHA through

charity/donation/assistance boxes in the temple
31%
77%
28%
59%
Conducting community based activities on the

reduction of stigma and discrimination towards
people living with HIV/ADS
44%
61%
28%
35%
Inviting a HIV-positive person to a meeting

allowing him/her to speak of their experiences to
community members
10%
40%
6%
58%
Showing with hope and help videos or any others

related to care and support videos
39%
39%
34%
29%
Displaying HIV/ADS awareness posters to promote

acceptance and compassion towards PLWHA
66%
50%
Participating in HIV/ADS awareness local radio

programmes to promote acceptance and
compassion towards PLWHA
25%
23%
contrast, a small number of junior monks in

the non-BLI sites said in FGDs that people
got AIDS because they do not pay attention
to their own behaviour. After drinking alcohol,
they went out to do bad things and got
infected with AIDS. Good people have
families and children. They do not have this
kind of disease.
In Viet Nam, a greater proportion of monks/
nuns in Ho Chi Minh City (HCMC), both in
the BLI sites (69%) and in the non-BLI sites
(63%), felt comfortable sitting or standing
close to a person of the same sex who had
HIV or AIDS, as compared to the proportion
of monks/nuns in Tra Vinh (30%). However, a
greater proportion of monks/nuns in the BLI
sites were willing to share plates, spoons,
cushions, and bicycles with fellow
58
41%
3%
48%
monks/nuns who are HIV positive than those

in the non-BLI sites. For instance, 91% of
monks and nuns were willing to share a
bicycle with fellow monks and nuns with
HIV and AIDS, compared to 67% and 48% in
the non-BLI sites in HCMC and in Tra Vinh.
As with the monks surveyed in China and
Cambodia, the main reasons provided for
feeling uncomfortable to share the objects
was fear of getting HIV and AIDS (19% in the
project site, 54% in the non-BLI site in Tra
Vinh, and 53% in the non-BLI site in HCMC).
In Myanmar, among the 11 out of the 84
monks, all but one had used Buddhist
scriptures in preaching and had tied
blessing strings or poured holy water on
HIV-positive people to set an example of
non-discrimination.
6.4.4 Contact with PLWHA

The monks/nuns have initiated programmes
that involve establishing direct contact
with PLWHA in the communities. These
programmes were organized to address
discrimination against PLWHA in the
communities.
PLWHA in their homes. Among the efforts

by the Sangha in Lao PDR to develop direct
contact with people living with HIV and
AIDS in the community, the most common
was providing psychological counselling for
PLWHA, both in groups and individually.
Findings for Cambodia revealed that just

over a third of the monks surveyed had
engaged with PLWHA in the course of the
previous year. The most frequently cited
activity was encouraging PLWHA (38% of
junior monks). Visits to the homes of the
PLWHA and their families were carried out
by 33% of junior monks. Here again, trained
monks were much more likely to have made
home visits than untrained monks (57% and
27% respectively).
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.
In Viet Nam, 55% of monks/nuns in the BLI

site were involved in activities to reduce
discrimination against PLWHA, compared to
20% in the non-BLI sites. Of the junior
monks in the BLI sites, 95% had visited
Again, monks/nuns in the BLI sites

developed direct contact with PLWHA
and were involved in activities to reduce
discrimination against PLWHA in the
communities.
UNICEF EAPRO
59
Conclusions and recommendations
7.1 Experiences and lessons learned

The experiences and lessons learned from
implementing the BLI, detailed in this
section, are gathered from the five country
reports, which in turn derived their
information from interviews with stakeholders
(monks, PLWHA, community members
and project coordinators) and existing
documents.
HIV-prevention education, IEC and

other outreach activities performed
by monks have had a positive impact
on communities, as knowledge of HIV
and AIDS issues is greater among
community members in the BLI than
in the non-BLI sites.
Communities have shown a readiness

and acceptance of BLI activities.
Along with PLWHA, community
members were the most supportive
stakeholders of HIV and AIDS
activities conducted by monks.
7.2 Achievements of the BLI
Overall, the country evaluation studies all

conclude that the training for the monks
conducted through the BLI has had a
significant impact on the knowledge of
monks on HIV and AIDS issues and on
their involvement in the response to HIV.
As evidenced by the results of monks in
BLI sites versus non-BLI sites (or trained
monks versus non-trained monks, in the
case of Cambodia):
Training has improved the knowledge

of monks on the prevention and
transmission of HIV and AIDS
Training has increased the knowledge

and use of Buddhist scriptures by
monks to mitigate stigma and
discrimination from the communities
against PLWHA.
The HIV and AIDS activities conducted

by the monks have had the following
positive impact on their communities:
Compared to monks in the nonexposed sites, monks in the BLI site

have more visibility in their
communities regarding activities to
promote non-discriminatory attitudes,
including preaching and spreading
the message of Buddhist scriptures.
The monks involvement in HIV and AIDS

issues has also demonstrated positive
impact on PLWHA:
Some country evaluation studies

found that monks were effective in
establishing contact with PLWHA. For
instance, in Cambodia, 90% of the
PLWHA surveyed had been involved
in activities with monks over the
preceding two years.
PLWHA reported that the most effective

activities conducted by the monks
were providing spiritual comfort
(through meditation and counselling)
and material support (by providing
shelter
and
income-generating
activities).
The positive experiences of the BLI project

management are as follows:
Through the BLI activities, more and

more senior level monks have been
informed of the potential for religious
persons to be involved in HIV and
AIDS issues and have an impact.
In general, the senior monks in all

countries reported that their Sanghas
were well-supported by National and
Provincial Buddhist Associations.
Successful collaboration with other
institutions has particularly contributed
to the success of the programme in
Lao PDR.
For instance, the findings for

Cambodia reveal that the proportion
of monks who would not share
objects with a PLWHA is no lower
among trained monks than among
untrained monks.
The monks activities with PLWHA had

the following shortcomings:
7.3 Limitations of the BLI
Some country studies (in particular, 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 commitment from religious leaders

is crucial for success of the BLI.
However, as senior monks in
Myanmar were reluctant to implement
the BLI, these activities were carried
out through lay Buddhist organizations.
The scope of the BLI has been limited,

as few monks have been trained in
this programme, particularly in China
and Lao PDR. Only 13% of the 201
monks surveyed in Lao PDR had
received BLI training.
The evidence from the Cambodia,

China and Viet Nam reviews 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.
62
Some weaknesses in the activities that

have targeted communities are:
On the whole, the BLI activities do not

seem to be very frequent or visible.
For instance, less than 15% of
community members interviewed in
Cambodia, Lao PDR and Myanmar
were aware of monks being engaged
in HIV-related activities in their
communities.
Monks HIV education interventions

appear to have had an uneven impact
on communities. In some cases,
community attitudes do not differ
from those in non-BLI sites, and
important misconceptions remain
about general knowledge on HIV
and AIDS.
In Lao PDR, only 21% of junior monks

recalled being encouraged by senior
monks; the rest stated that senior
monks presented obstacles to
delivering the HIV and AIDS messages
they had learned.
The impact of training on monks capacity

has been limited in the following ways:
Despite training, some discriminatory

attitudes against PLWHA persist
among monks (although the overall
results point to more positive
attitudes among monks in BLI sites).
Only a small share of the monks

surveyed in some countries (Cambodia,
China, Myanmar, Viet Nam) had
made direct contact with PLWHA. In
Cambodia, many of the PLWHA
interviewed expressed that they
wished monks were more active in
visiting them in their homes.
BLI project management has faced the

following challenges that have limited
current and future activities of the
programme:
Political reluctance to implement

activities in Myanmar and Viet Nam
has delayed the implementation of
the BLI, and has hampered its scope.
In addition, as the government did
not provide approval for the
quantitative survey component of the
study, the review for Myanmar has
faced sampling limitations.
Lack of financial support is the

biggest challenge to implementing
plans for scaling up the BLI activities
in Cambodia and Lao PDR.
activities; therefore the scale-up of

training for monks is warranted.
The programme should draw on

effective cooperation with education and
health authorities, as well as with the
Buddhist Associations at all levels, to
help attain the programmes goals.
It is recommended that programme be

advocated to high-ranking government
officials from central, provincial and
community levels, to raise their
awareness of the social role of monks,
and to garner verbal and financial
support for expanding the coverage of
BLI activities. High-level monks may be
in a good position to initiate the advocacy
to government officials.
Closer collaboration with local community

leaders is recommended, to engage
communities more effectively in the HIV
and AIDS activities that monks
participate in.
Senior monks should be trained on ways

to deal with project management and
planning issues; and the positive
outcomes of the programme should be
advocated to them to strengthen
commitment from religious leaders.
Future activities should undergo regular

monitoring and evaluation. The baseline
data that have been collected should be
reported back to the implementing
partners of the BLI and used for project
monitoring to improve the delivery and
reach of activities. Further data collection
efforts should also target information on
the total coverage of each activity and on
the supervision of activities. Data should
also be collected on the financial
management of the study, so as to
estimate the cost and impact of the BLI in
each country.
7.4 Lessons learned

Overall, there is some consensus between
community and monks on what activities
are appropriate to be conducted by monks:
promoting compassion and tolerance
towards PLWHA teaching about general HIV
and AIDS issues, meditation and other
spiritual support, providing material
assistance (foods, mosquito nets, and mats);
celebrating the funerals of AIDS victims; and
encouraging the community to contribute to
the needs of PLWHA.
Conversely, many community members
and monks expressed their opinions that
activities such as education about sex and
HIV and AIDS, or individual counselling with
a woman are viewed as inappropriate for
monks to conduct and may face resistance.
Moreover, the majority of community
members and monks interviewed perceived
monks activities targeting youth as less
effective than activities that reach out to the
general community.
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
UNICEF EAPRO
7.5.2 Recommendations on the project

activities
Training for the monks needs to place
more focus on educating them about
local facilities that provide treatment for
63
Improving knowledge and awareness

of HIV and AIDS issues among the
community is another (more indirect)
approach towards promoting nondiscriminatory attitudes against
PLWHA.
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 activities should be
increased. Specific activities to be
expanded are:
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.
64
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.
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.
Supporting PLWHA self-help

groups with materials, incomegenerating 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.
In most cases, youth-targeted

activities 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.
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, 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
Ibid
Ibid, pg 11
UNAIDS, UNICEF, Review of the Mekong Subregion STD/HIV/AIDS Project, Volume 11, March 1999
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:
Sampling methodology for the BLI

(Chapter 3 of the BLI Review survey manual)
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.
Model sampling scheme

1
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
Sampling with probability of selection proportional to the size of the population

(PPS) At several stages of sampling PPS sampling may be required especially for the
selection of temples, and in some instances selection of communities. An example of how
to do this form of selection is shown below.
Assume that we have 20 temples in a province where BLI activities have been implemented.
Also assume that our sampling strategy requires that we select 4 of these temples.
UNICEF EAPRO
69
Undertake the following steps.

1 Obtain information on the number of monks in each temple.
70
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
Temples 1, 5, 8, and 15 selected
UNICEF EAPRO
71
AW_UNICEF_AIDS_BLI.pdf
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9:54:13 AM
Regional Review
Regional Review Buddhist Leadership Initiative
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Buddhist Leadership
Initiative
UNICEF EAPRO
July 2009
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19 Phra Atit Road
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Fax: (66 2) 280 7056
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Regional Review Buddhist Leadership Initiative

UNICEF EAPRO, July 2009

UNICEF East Asia and Pacific Regional Office

Copyright UNICEF East Asia and Pacific Regional Office, 2009

Design and layout: Keen Media (Thailand) Co., Ltd.

CHAPTER 1: INTRODUCTION TO THE BUDDHIST LEADERSHIP INITIATIVE

Buddhism in East Asia

CHAPTER 2: BUDDHIST LEADERSHIP INITIATIVE STRATEGY FOR ACTION

Populations included in the study

CHAPTER 4: HIV AND AIDS SITUATION IN THE BLI COUNTRIES AN OVERVIEW

CHAPTER 5: HOW DID BLI ENGENDER CHANGES IN THE COMMUNITY?

Knowledge/awareness of HIV and AIDS

CHAPTER 6: HOW DID BLI ENGENDER CHANGES IN THE MONKS/NUNS

Enhancing the effectiveness and efficiency of Sangha response to HIV

CHAPTER 7: CONCLUSIONS AND RECOMMENDATIONS

Experiences and lessons learned

Annex: Sampling methodology for the BLI

Acquired Immuno Deficiency Syndrome

Behaviour Change Communication

Buddhist Leadership Initiative

East Asia and Pacific Regional Office, UNICEF

Focus Group Discussion

Ho Chi Minh City

Human Immuno Deficiency Virus

Information, Education and Communication

Lao Peoples Democratic Republic

Ministry of Labour, War Invalids and Social Affairs

National Buddhist Association

Orphans and Vulnerable Children

People Living With HIV and AIDS

Probability Proportionate to Size

United Nations Childrens Fund

Voluntary and Confidential Counselling and Testing

Viet Nam Fatherland Front

The Regional Buddhist Leadership Initiative (BLI)

The Regional BLI Approach to HIV and AIDS

Achievements/impacts of the BLI

BLI brings change to the communities

BLI engenders changes in the monks/nuns and the Sanghas

Improved acceptance and support of PLWHA

Overall BLI achievements

Interventions that have proven to be most effective and acceptable

Areas for future action to include:

Introduction to the Buddhist

1.1 Buddhism in East Asia

The Buddhas Four Noble Truths consist of:

1.2.1 HIV and AIDS in the context of the

The suffering (Dukka) related to HIV and

The Buddha in his very first sermon after his

The Second Noble Truth (Samudaya)

Originally introduced to the region around

1.2 Understanding HIV and AIDS

Therefore, it is extremely crucial to provide

organizations. For example, if the problem

1.3 Buddhist Leadership Initiative

Buddhist Leadership Initiative

Map showing countries where the Buddhist Leadership Initiative is implemented

the hospice of Wat Phra Baht Nam Phu

strategies identified through its Mekong

In 1997, UNICEF Thailand funded Sangha

advocacy with national counterparts via

technical assistance in training and

development and sharing of materials,