PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 21138
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21138 21138.08 U.S. Agency for World Learning 8560 8560.08 $50,000
International
Development
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $980,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Sexual Prevention - Abstinence and Be Faithful and Other Sexual Prevention
Overview
High-risk groups appear to be a principal driver of the HIV/AIDS epidemic in Angola and require special attention if the rate of HIV
transmission is to be slowed. The USG's strategic approach to prevention targets the general population, with a heavier
emphasis on most-at-risk populations, namely: in- and out-of-school youth, military personnel, truck drivers and commercial sex
workers (CSWs). HIV is transmitted primarily through multi-partner heterosexual encounters, with a male-to-female ratio of 0.8:1,
indicating that women are more likely to be infected than men. Angola's ANC data estimates HIV prevalence at 2.1% of the
population aged 15-49, and 2.6 % for the age group 15 - 24, with pockets of concentration along its borders with countries
affected by hyper-epidemics (for example, 9.4% in Cunene province, which shares a border with Namibia).
The recent 2005 TRaC study conducted by Population Services International (PSI) with USG support, shows that the mean age of
sexual debut is relatively young (15.03yrs) and the practice of multiple concurrent partnerships and support for several
households is common. Recent findings conducted by the National AIDS Institute (INLS) in collaboration with the USG through
the TRaC study shows that among youth aged 15-24 only 27% were able to correctly identify modes of prevention of HIV and
were able to refute misleading modes of transmission. Additional factors that increase the risk of contracting HIV include
intergenerational sexual activity and multiple partners (23% of youth reported having two or more partners in the last three
months), low condom use (55% of youth used a condom with their last casual partner, 37% with a non-married permanent partner
and 19% with a marital partner), and low risk perception (9% of youth classified themselves as being at high-risk of contracting
HIV). A 2006 INLS study showed that commercial sex workers have an estimated 26% prevalence rate. Similarly, more than half
of VCT clients reported not using a condom in the last three months, 35% reported sometimes using a condom, and 7% reported
always using a condom. Reported condom usage at last sex was 20%, condom use with a regular partner was slightly lower at
15%, while use with a casual partner (among those reported having a casual partner) was 30%. Of males tested for HIV at
voluntary (VCT) sites, 28% reported having concurrent partnerships. Concurrent partnerships coupled with low risk perception,
and very low condom usage increases the risk of the spread of HIV and other STIs.
Leveraging and Coordination
During the 27 years of civil conflict NGOs were the principal actors in the field of HIV/AIDS. These NGOs lacked infrastructure,
experienced personnel, reliable information, and opportunities for capacity building. The USG, working with the Government of
Angola (GoA) through the INLS, the Global Fund to fight HIV/AIDS, Malaria and Tuberculosis (GFATM), and UNICEF, has pulled
together an effective intervention to strengthening these NGOs.
Together with the INLS and the Ministry of Youth and Sports, the USG supports national information, education and
communication campaigns (IEC) around the prevention of HIV. The USG's partnership with the INLS, UNDP and the Brazilian
corporate partner Odebrecht sets favorable conditions for the distribution of USG purchased condoms and test kits. Odebrecht
stores 15 million non-branded USAID purchased condoms that are distributed in a targeted fashion by working with the Angolan
Business Alliance to use its network to ensure free condom availability to its employees and to other high-risk groups. Through
this partnership, an integrated system for effective logistics management and warehousing is being developed that works to
resolve the problems of condom distribution (see OHSS narrative). The GoA, USG and the UK Department for International
Development (DFID), in conjunction with the British Broadcasting Company, have provided strong social marketing programs for
condoms. The USG works closely with the GFATM to implement prevention activities, especially with high risk groups, using
Round Four funding ($86,120,215).
Current USG Support
The USG implementing partners, working together with other stakeholders in Angola, are making strong strides forward in
HIV/AIDS prevention. Specific current activities include:
•The USG supported the Jango Juvenil youth centre project to promote HIV/AIDS prevention and life skills through age-
appropriate messages targeting in- and out-of-school youth aged 15-24. The ‘Jangos' provide intensive HIV/AIDS prevention
education in a youth friendly, dynamic and accessible setting. There are five centers, each operated by a local partner NGO.
These local partners are also provided with continuous technical support, supervision, training and communication skills, as well
as technical assistance in organizational development, including project management and financial management skills. The
project serves a dual objective of allowing youth to acquire skills to make them more productive and provides an opportunity to
address their vulnerability towards HIV/AIDS through role play and counseling.
•The USG program promotes messaging on abstinence, fidelity and correct and consistent condom use (ABCs) among young
people aged 15-25 and educates young adults about the risk of STIs and HIV/AIDS through mass media campaigns, including a
weekly youth radio program. Youth peer educators managed by local partner NGOs are conducting interpersonal communication
(IPC) activities. Through PSI/Angola, the USG has developed comprehensive generic HIV/AIDS prevention materials for three
key target groups: 8- to 12-year-olds, 13- to 17-year-olds and 18- to 24-year-olds. These materials have been disseminated widely
throughout the Ministries of Health and Education and partner NGOs where they are tailored to meet the needs of each target
group. The USG has prepared a training manual for regional level health workers for an IEC campaign as well as provided training
to health workers from the Ministry of Health Provincial Health Department (DPS) Units in Luanda and Lunda Norte on stigma and
discrimination.
•A PEPFAR-funded social marketing campaign supports the INLS national strategic plan to combat STIs including HIV. The
campaign is focused on communications interventions in at-risk provinces, border areas, ports, major urban centers and along
transport routes. The "Legal" brand condom is highly subsidized and targeted to high-risk and vulnerable groups.
•The USG, through the DOD-funded Charles Drew University (CDU) prevention program, is working with the Angolan military in
the production of IEC materials. Charles Drew also supports interventions that reduce HIV transmission in most-at-risk
populations (i.e. commercial sex workers and their clients, long-distance trucker drivers, military and subsets of youth). These
interventions include ABC messaging, management of sexually transmitted infections, and programs that encourage healthy
behaviors, e.g. partner reduction. The USG is the primary donor addressing HIV transmission in the most at-risk population
groups and has worked with a local NGO MAFIKU in Cunene, organizing group activities with CSWs and outreach activities with
truckers along the borders. Outreach and training of educators include gender-equity messages and behaviors, and provide
guidance on how to work with men to address norms around violence, cross-generational, and transactional sex. The USG is
continuing to support the development of workplace initiatives through the EHSP, including those targeting health care workers to
deliver consistent prevention messages, and improved condom availability to workers and their families.
•A mass media campaign, a 20-minute radio broadcast airing on the national radio station during the military hour, includes a
radio drama based on a comic book, O Tropa Lunguka, promoting safe sexual behavior among military personnel.
USG FY09 Support
In FY09, the USGs prevention efforts will have a strategic focus on the provinces with the highest prevalence as well as those
which border neighboring countries. ABC messages, with a stronger gender focus, will be provided through outreach, training,
social marketing campaigns, and distribution of condoms. With the scale-up of strategic information (see SI section) providing
more data to inform programs, the USG may decide to revisit prevention efforts by shifting target provinces and populations.
Specific new and ongoing activities include:
•The PEPFAR public private partnership work will be strengthened to increase the level of corporate sponsorship the Banco
Fomento Angola provides to the "Jango" youth centers. This increased support will cover more of the operating costs and to allow
for expansion to additional provinces.
•Prevention efforts will continue at the five youth centers located in the provinces of Luanda, Huambo, Cunene, Huila and
Cabinda. Jango Juvenil activities will include debates, individual counseling, role play, skills-building classes (i.e. basic literacy,
crafts, electrical) and inter-personal communication outreach into the respective communities to reach youth not attending the
Jango Juvenils. PSI's AB approach will focus on gender sensitive key messages targeted to two age groups - those under 18
and those over 18 years of age. For under 18 youth, messages include promotion of delayed sexual debut, focusing on
empowering girls to resist pressure and sensitizing boys to refrain from pressuring girls. Delayed sexual debut communications
address the peer pressure faced by adolescents to prove themselves to their peers by becoming sexually active. For over-18
youth, promotion of fidelity and partner reduction will address the lack of self-efficacy of some youth to refuse sex with a new
partner. Activities will also include condom promotion for the sexually active.
•The social marketing component of the USG program delivered by PSI will be expanded to incorporate the following new
components in FY09:
- Improved training, more frequent monitoring and new education tools for activists;
- Increased IEC and BCC addressing stigma in communities and transactional and trans-generational sex;
- Strengthened gender aspects in lay counselor training;
- Improved coordination of the NGO forum together with ANASO and Global Fund to ensure that duplication of efforts is avoided;
- Incorporation of new TRaC information as well as follow-up qualitative research to review/update messages for CSWs and their
clients to motivate behavior change;
- Improved interactive educational materials, including picture codes, role-playing guidelines, risk assessment tools and debate
techniques that focus on individual risk assessment of behaviors in the Jango Juvenil Youth Centers;
- New behavioral research using TRaC methodology in men and young women (14 - 20) to review/update messages according
to key behavioral determinants;
- More prevention activities on men who have sex with men (MSM),truckers and native populations along the border areas,
specifically the border area of Cunene. Once CDC's BSS results are ready, PEPFAR partners will strengthen these activities with
the BSS results;
- Mapping on condom usage and risk. PSI will work with INLS and other agencies currently delivering condoms (e.g. UNICEF,
Global Fund, UNFPA) to assess condom use among high-risk groups and the general population;
- Prevention and treatment options will also be addressed by PSI through the use of radio programs, skits, and inter-personal
communications within the family and community.
•World Learning (WL) will take over the administration of the grants component of the Jangos project and will provide capacity
building for local NGOs that promote AB messages. Youth centers will partner with local health centers and offer on-site
counseling and testing for STIs and HIV. WL will promote the transition of financing of these NGOs and youth centers through
leveraging more banking and Global Fund support to cover the total costs of the Jangos, enabling them to expand to more
provinces. WL will continue to work with a consortium of human rights-based organizations that advocate for the availability of
services for people living with HIV/AIDS, their families, and communities. Working with local NGOs, WL increases awareness on
the right and importance of getting tested, provide information on testing sites and increase the number of people who know their
status.
•The DOD will continue its efforts with the Angolan Armed Forces (FAA) to promote the ABC approach. The target population,
young sexually active men, require prevention efforts that appropriately reflect the needs of the population. Charles Drew
University will train trainers, create educational materials (i.e. HIV prevention manuals, comic books, posters, informational
pamphlets) and assist the FAA in institutionalizing effective programs that motivate behavior change to reduce risky sexual
behavior among military personnel. To overcome the specific challenges presented in this population, educators are trained in
effective interactive teaching techniques and the implementation of an HIV intervention specifically designed for the Angolan
military. Training includes messages on gender equity and guidance on how to work with military men to address issues of
violence, cross-generational and transactional sex, and alcohol abuse.
•In addition to training military trainers, social marketing campaigns address the importance of VCT, fidelity, safe sex, reduction of
stigma and discriminating attitudes, as well as the promotion of tolerance and support for those affected.
•The USG will conduct a qualitative study to examine the feasibility of interventions in male circumcision.
AB Targets
2.1 Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence and/or
being faithful 90,000
2.2 Number of individuals trained to promote HIV/AIDS prevention programs through abstinence and/or being faithful 500
OP Targets
5.1 Number of targeted condom service outlets 2,000
5.2 Number of individuals reached through community outreach that promotes HIV/AIDS prevention through other behavior
change beyond abstinence and/or being faithful 25,000
5.3 Number of individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or
being faithful 500
Table 3.3.02:
Continuing Activity: 19163
19163 19163.08 U.S. Agency for World Learning 8560 8560.08 $260,000
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $100,000
The estimated number of people with tuberculosis (TB) in Angola has more than doubled between 1990-2006, from 21,380 to
47,231, and the TB prevalence is estimated to be 220/100,000 inhabitants (WHO, 2008). The DOTS strategy covers 116 of 164
municipalities, only 70% of the country, and lacks essential monitoring and evaluation (M&E) of patient registry, outcomes, and
program performance parameters.
Based on very limited data, the Ministry of Health (MoH) National TB Control Program (PNCT) estimates of HIV prevalence
among TB patients was up to 15% in 2007. Therefore, HIV infection is expected to be high in patients seen in TB clinical settings,
making these settings "high yield" for the identification of those patients with concomitant HIV infection and their referral for HIV
prevention, care and treatment. Although improving, there continues to be a need for more coordination and collaboration
between TB and HIV activities at all levels.
The national TB Control program submitted a round 8 Global Fund proposal that totalled $25,000,000 for five years. This
proposal has since been rejected. Since submission of the proposal, the PNCT organized a TB symposium where the national TB
strategic plan 2009-2013 was presented to an audience that included international donors, NGOs and other government
organization.
Among other needs, PNCT continues to experience significant obstacles. These include:
•Insufficient numbers or inadequately trained personnel to
oProvide HIV counseling and testing
oPerform M & E functions related to TB/HIV activities in TB facilities
oProvide referral and follow-up of HIV-infected TB patients
•Inadequately functioning M & E resulting in a significantly diminished capacity to
oPerform HIV surveillance among TB patients
oRecord and report program performance
oMonitor, forecast, procure, and manage lab reagents and drug stocks for the diagnosis and TB treatment of HIV-infected patients
Three non-governmental organizations (NGOs) receive funding from the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria
(GFATM) and the U.S. Agency for International Development (USAID) to implement TB and TB/HIV services in the public and
NGO sector: Catholic Relief Services (CRS) and CUAMM (CUAMM and the NGO LEPRA also receive support through other
funding sources). The U.S. Centers for Disease Control and Prevention (CDC) is not currently working with any local partners on
TB system strengthening, although discussions are in progress to work with the Dutch NGO, KNCV and possibly CUAMM and
LEPRA to establish sentinel surveillance and improve case detection, provider initiated HIV counseling and testing, and recording
and reporting of TB and HIV information for the purposes of M&E and routine surveillance.
The USG has funded the Essential Health Services Program (EHSP) since FY07, to address critical human resource problems
that limit the availability of TB treatment and referral, through training and supervision interventions, and the updating and
integration of TB testing protocols with HIV referral procedures. "Master trainers" were trained to provide oversight and
supervision in target areas. Additional TB/HIV activities include:
•Assisting the PNCT with updating and development of policy, and the adoption of a national HIV testing policy in TB facilities;
•Implementing HIV testing services at the Cunene and Huambo DOTS centers and TB screening in the USG-supported voluntary
counseling and testing (VCT) center in Luanda. Rapid HIV test kits, microscope, reagents and staff training are also being
provided.
Over the course of the past year, USG has made moderate strides in coordination efforts for HIV and TB collaboration between
the National AIDS Institute (INLS) and the Ministry of Health's National TB program. A CDC staff position, (to be seconded to one
of the two entities) will be hired in order to further facilitate this relationship. This position was programmed in the FY08 mini-COP
but remains vacant. CDC will continue to recruit for position in FY09 (see below). The purpose of secondement is to facilitate the
formation of a functional national TB/HIV collaborative entity between PNCT and INLS to oversee TB/HIV collaborative policies
and activities.
In order to address the USG TB/HIV priorities of human capacity building, technical assistance for the NTCP, improvement of
M&E functions, and the linkages between the activities being undertaken by USAID non-PEPFAR funding and other entities (e.g.,
GFATM, WB, NGO's), the USG will further strengthen the TB program by increasing the capacity of the NTCP and other NGOs
working with TB/HIV by supporting:
•The training of personnel in reporting and recording of TB information according to current guidelines, with a goal of eventually
transitioning to an already functional electronic TB register for this purpose, in order to facilitate HIV-infected TB patient
management, HIV surveillance in TB patients, and M&E of essential program functions and outcomes;
•The training of these personnel to serve as national trainers for a second tier of TB/HIV personnel in other facilities in the above
functions, but particularly in HIV counseling, testing, and referral of HIV-infected patients to appropriate health services;
•The strengthening of the PNCT program TB and HIV diagnostic capacity (including the capability to perform TB culture,
resistance testing for the detection of MDR/XDR TB) and the internal and external quality assurance of this capacity by supporting
central reference laboratory activities (see lab section);
•The facilitation and formation of a functional national TB/HIV collaborative entity between the PNCT and the INLS to oversee
TB/HIV collaborative policies and activities. Support for a specific USG-funded TB/HIV "focal point" staff position to be seconded
to either INLS or the PNTCT will continue from FY08 (see Management and staffing).
•The development and implementation of a TB/HIV sentinel surveillance system in collaboration with the PNCT and NGOs already
working in this program area.
Targets
There are no targets for this program area as all support will be technical assistance
Table 3.3.12:
