The USG will initiate a comprehensive, multi-faceted prevention program to promote normative change and adoption of safer sexual behaviors, with the aim of reducing new HIV infections among general population adults, youth and high-risk groups. The prevention program will require concerted attention to the general population while concentrating on specific targeted populations such as youth (<15, 15-24) who represent 60 percent of the population, and the highest risk populations. The common practice of multiple concurrent partners (MCP) is an important driver. Additional key drivers of the epidemic include: high rates of unprotected sex, either low and or inconsistent condom use in sexual relationships, and low perception of risk, though data needs to be strengthened to better understanding the dynamics of the epidemic.

To avoid vertical programming and in order to achieve the maximum results with limited funds, it is important to focus efforts in an efficient, comprehensive and integrated manner. In terms of the implementation, USAID's prevention efforts will be split into two main projects and targeted interventions, this Community Based Prevention Project, and PROACTIVO targeting MARPs. A third mechanism, Social marketing for health, will support the other projects and ensure availability of commercial and generic condoms in Angola. A gender lens will be integrated into all activities, recognizing that cultural and gender norms may reinforce key drivers of the epidemic such as multiple concurrent partners and transactional sex.

Other key considerations for program design and implementation include undertaking a good epidemiologic analysis. This is especially critical for Angola, as there is little data and in-depth understanding of risk behaviors, groups and key drivers. Not only will this analysis help to identify critical areas, groups at higher risk, to some extent, it will also help with the market segmentation of BCC messages. The PLACE study will provide critical evidence for targeting services and messaging and will assist with the design of the various components of the community based response. Special efforts will be placed on training community health workers to engage in outreach for follow up of HIV+ people. The new community based prevention program which integrates the general population and youth packages has the following key objectives:

1) Supporting and developing an effective community based prevention response with an emphasis on BCC and creating critical linkages with the community;

2) Developing and implementing a comprehensive Life-skills curriculum at the primary and secondary school level;

3) Strengthening mass media efforts at the National and community level, to raise awareness, decrease stigma and discrimination and create demand for services, while emphasizing GBV;

4) Capacity building for the CBOs, Youth Centers, and other key community stakeholders such as FBOs and traditional leaders to implement comprehensive, community-based prevention programming.

Objective 1: Community based prevention activities will reach the general population with a strong focus on youth by improving individual's and communities understanding of the risks of HIV infection, scale - up HIV prevention and health promotion, and expand critical services, including condom programming and BCC/IEC messages. Community based activities will be linked to scaled up VCT, STI, PMTCT and other reproductive health services at various levels. Concerted efforts will be devoted to reducing alcohol use/abuse, as this is a known factor related to gender based violence, forced and/or unprotected sex.

In order to achieve successful delivery of these activities engagement of youth centers (i.e. Jangos), civil society, traditional leaders and the faith based community will be critical. Additionally, linkages to and promotion of related HIV clinical services are also a key component of this response. The Jangos will adopt a community approach leveraging and collaborating with the private sector and other influential actors in their respective communities such as schools, churches, and police. These new partnerships will allow for a comprehensive approach and will build linkages, referral and promotion for services, and re-orient the focus to interventions for transactional sex, and gender negotiation.

Program activities and messages will aim to increase individual's risk perception, BCC directed to the sexual networks that drive transmission; especially in high risk sexual encounters by HIV-positive persons, and include efforts to increase the age of sexual debut. The package of interventions will be based on evidence and use proven technologies and approaches. Interventions will be grounded in local culture to address epidemic drivers through clear, specific, consistent messages and behaviors and social norm change approaches, and to address underlying gender dynamics and norms.

Effective BCC efforts and messages need to be coordinated, and aim to reinforce messaging through: Mass media, community level capacity building, peer education, in/out-school youth and provision of reinforcing prevention messages within the clinical arenas of VCT and PMTCT. The interaction between national and local mass media, community mobilization, and interpersonal communication interventions and how to link them effectively while targeting specific populations with tailored messages will be important to address. Angola needs a reinvigorated and strategic BCC effort and the work of the USG at the community, individual and National level (providing support to the INLS) should help to support this.

Objective 2: Youth prevention will target boys and girls, in and out of school, with specific activities and messages to modify behaviors, values and cultural practices that put young men and women at risk of HIV. To support this intervention, an assessment of male and female norms and practices among youth (<15, 15-24) groups will be carried out to document cultural/sexual practices and vulnerabilities of boys and girls, and young men and women, providing a basis for comprehensive prevention activities, including the provision of youth friendly health services.

All of the youth focused interventions outlined in the Overview Narrative will be undertaken in collaboration with Ministry of Education, Ministry of Youth and Sports, Ministry of Health, specifically to:

Develop life skills curricula in schools, including sexuality and an emphasis on sexual harassment;

Improve school-based reproductive and sexual health services;

Engage parents and actively involve them in activities to support a healthy environment for their children;

Integrate other key components of school-based programming (see budget code narrative for more details).

Objective 3: The mass media components should include both community and national level efforts and include serial dramas, call-in shows, spots, billboards, print etc. and the use of role models (famous musicians or sport figures) to emphasize risk reduction prevention messages. All of these messages used in the community based BCC efforts should be aligned with the national campaigns, messages and use and/or adapt existing materials and resources when appropriate.

Currently, the INLS develops and implements national level informational and behavioral change with financial support from other donors. These efforts while, technically sound, are ad-hoc and lack innovation and varied means of delivery. It is envisioned that the USG will provide additional technical support, to re-invigorate the national BCC response with new and creative ideas and to improve coordination between the national and community levels to ensure consistent, high-quality materials, messaging and BCC activities. BCC interventions messages, approaches and materials targeting general population adults and youth will be revised on the basis of available data.

Objective 4: The community prevention program for youth and general populations provides capacity building to the Angolan government and civil society institutions and communities to plan and implement effective prevention interventions at the community level. The program promotes sustainability by engaging individuals, communities, and leadership to encourage ownership of activities and results. Key principles includes using resources effectively and strategically; achieving quality, scale and scope; strengthening systems; and using existing structures to ensure sustainability beyond PEPFAR. It aims to creating synergies through effective linkages with other partners, programs, and activities.

This project provides technical assistance and sub-granting to CSOs at the community level to implement effective prevention activities (mentioned above). Capacity building will be provided to CSOs and in the future to the Jangos and will include areas of organizational, technical and programmatic capacity. Additional training will focus on community health workers and traditional leaders who can disseminate information to their communities.

Interventions will complement the HVAB activities including:

BCC directed towards sexual networks that drive transmission, BCC and IEC messages, approaches and materials will be revised and reinvigorated based on available, new study data, and proposed assessments. Peer counseling protocols and messages will be revised by and will work to emphasize the four transmission routes (fluids) and individual risk behaviors.

Activities with the Jangos will focus on specifically tailored messages and customized activities to reach both in and out of school youth through both centers and outreach activities with an emphasis on gender norms, behaviors and vulnerability for HIV and will provide boys and girls with gender neutral skills such as computer- and language. Messages will include abstinence, secondary abstinence and fidelity components.

Develop life skills curricula, which include updated components on sexual education to include gender, GBV, and HIV/AIDS, specifically addressing teacher training, reduction of sexual harassment and abuse in the school environment, and provision of peer counseling in schools. New modules to add include girl's empowerment, safer sex negotiation skills, secondary abstinence, self-esteem building and related skills building. Components to emphasize for males include male norms, cultural peer pressure, men as "future partners." Promote the increased and on-going involvement of parents. Critically review teacher's role, both positively and negatively, existing and needed school based policies to protect students from sexual coercion and provide a systematic process for addressing these issues, and mandatory training for teachers.

Creation and support of innovative and creative AB related messages, campaigns, resources, materials. Examples include seeking to work with the private sector (i.e. the mining companies, cell phone providers, oil companies, etc.).

Cooperation and coordination with community leaders, parents and teachers and other groups and individuals on HIV prevention and BCC. Capacity building efforts for civil society will include technical support on BCC efforts focusing on A and B and related (i.e. gender and alcohol).

Interventions will complement the HVOP activities including:

All condoms and other prevention efforts, including B and C messaging, alcohol messages and gender related activities. Critical focus will be on interventions addressing reduction of MCP, and consistent and correct condom use, especially in high risk sexual encounters and by HIV-positive persons.

Small grants programs to work with community leaders, parents and teachers and other groups and individuals on HIV prevention, BCC. Capacity building efforts for civil society will include technical support on BCC efforts focusing OP and related (i.e. gender and alcohol).

Develop life skills curricula, which include updated components on sexual education to include gender, GBV, and HIV/AIDS, specifically addressing teacher training, reduction of sexual harassment and abuse in the school environment, and provision of peer counseling and condom distribution in schools. Improve school-based reproductive and sexual health services; promote youth-friendly health services, in partnership with the MOH and the provincial and municipal health services, including expansion of VCT, STI and follow-up referral for reproductive health services.

School-based programming will critically review the role of teachers, both positively and negatively, existing and needed school based policies to protect students from sexual coercion and provide a systematic process for addressing these issues, and mandatory training for teachers.

Also reach out of school youth and street youth with tailored messaging and activities

Activities in collaboration with the INLS will include the creation and support of innovative and creative promotion of HIV services and related BCC campaigns at the national level, including campaigns, resources, and materials. Examples include collaborating with the private sector, support of national efforts, specialized campaigns, one-off activities such as events for World AIDS Day, national testing day, events during Africa Cup, stigma and discrimination campaign.

Activities with the Jangos will focus on specifically tailored messages and customized activities to reach both in and out of school youth through both centers and outreach activities with an emphasis on gender norms, behaviors and vulnerability for HIV and will provide boys and girls with gender neutral skills such as computer- and language. Messages will include abstinence, secondary abstinence and fidelity components.