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.
09.P.PM09: TBD - Expanding Counseling and Psychosocial Support for HIV-positive Pregnant Women,
their Spouses and Families
The Botswana Prevention of Mother to Child Transmission (PMTCT) program has made remarkable
progress in the last few years including expanding program uptake to more than 80% and decreasing MTCT
transmission rates to less than 7%. The program still faces a number of challenges, however, including:
-Community norms, values, and beliefs often make it difficult for women to implement the medical and
behavioral recommendations for the prevention of mother-to-child transmission (PMTCT). For example,
taking medication during pregnancy, using a breast milk substitute, or exclusively breastfeeding and then
early weaning are not normative practices for Batswana women. Many women are uncertain of the effect
these recommendations may have on their pregnancy and on their infant. Moreover, women may face
stigma and other social pressures if they follow their providers' PMTCT recommendations.
-Health providers are often overextended. HIV services have been added to existing responsibilities as the
number of nurses has declined over the years. In many settings, there are not enough nurses and midwives
to give needed medical and prevention information and support to patients.
-Follow up with HIV-positive women after delivery to address infant feeding, infant health, family planning,
and women's health has been difficult. Once women deliver, some do not return to the antenatal care (ANC)
or the maternal child health (MCH) clinics where they received PMTCT services.
The Counseling and Psychosocial Support Program was created to respond to these PMTCT challenges.
Recognizing that women need psychosocial support upon learning that they are HIV-positive, the Peer
Mothers Program provides peer support not only to help women accept their HIV status, but also to support
with prevention counseling and to assist clients to adhere to PMTCT recommendations. The program
supplements existing health services so that HIV-positive women and their infants receive comprehensive
care and are able to access the full range of services available to them, as well as carry out recommended
practices successfully.
In FY2009, a partner TBD will work closely with the Government of Botswana (GOB) to strengthen the
current activities and build a sustainable model for the rapid scale up of the Peer Mother's Program as
follows:
1. To provide counseling and psychosocial support to HIV-positive pregnant women and new mothers to
empower them to focus on and take responsibility for the health of their babies and their own health so that
pediatric and maternal outcomes are improved;
2. To assist HIV-positive women to access linkages and referral systems to bridge PMTCT and treatment
and care services to enable women and infants with AIDS-defining conditions access ARV therapy in a
timely manner;
3. To recruit and assist male partners to adopt positive and gender-equitable attitudes and behaviors and
reduce the risk and vulnerabilities of sexually transmitted infections;
4. To provide on-site technical assistance and supportive supervision, including a sustainable plan for
recruiting, training and evaluating newly recruited peer counselors, assessments, readiness preparation,
ongoing quality assurance of sites implementing the Peer Mothers Program, mentoring and orientation to
PMTCT and other appropriate health care delivery staff before and after a district or other health site begins
delivery of the Peer Mothers Program;
5. To provide a clear plan for quality assurance, routine monitoring and evaluation of activities over the life
of this five year project.
Planned measurable objectives:
1. The increase by five in the number of districts and sites providing counseling and psychosocial support
by the end of year one of the award.
2. The increase in the number of HIV-positive pregnant mothers provided with psychosocial support and
empowerment counseling and the assured knowledge transfer on issues they encounter in navigating the
PMTCT process, such as disclosure, stigma and discrimination, and risky sexual behavior, among other
things, from 2,000 to 3,000 by end of year one of the award.
3. The increase of male partners enrolled and active in PMTCT and other HIV prevention programs by 3000
4. The increase of current access rates to care programs by women and infants with AIDS defining
conditions from 21% to 25% in year one of the award.
5. The increase of anti-retroviral (ARV) therapy adherence rates for women and their infants identified in
PMTCT clinics from 70% to 75% in year one of the award.
Monitoring and evaluation:
An M&E system for the Program will be strengthened in order to enable monitoring and evaluation of
performance of the program and measurement of impact in reducing stigma and enhancing access to
psychosocial support.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $7,577,471
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine
tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS
Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and
an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of
pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program (PMTCT). The
Botswana 2007 Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall
trend appears to be decreasing from 37.4% in 2003.The Department of HIV/AIDS Prevention and Care reports that, as of the end
of July 2008, a total of 109,991 patients were receiving HAART, 97% of the 113,000 patients estimated to require treatment.
Challenges remain, however, with prevention, particularly the issue of multiple concurrent partnerships, alcohol abuse, nascent
civil society, and human capacity development.
A 2005 survey by Population Services International (PSI) of 15-24 year olds found that 43% of never-married respondents
reported never having sex (abstinence). Among sexually-active youth, however, 41% reported having sex with more than one
partner in the last 12 months. Nkosana's study of cross-generational sex in Gaborone (2006) found that of 600 senior secondary
students surveyed, 60% reported a friend or relative with an older boyfriend. Thirty eight percent reported they had been asked
by an older man to have sex with them. Twenty five percent of girls in the survey approached by an older man reported agreeing
to have sex with him.
HIV prevalence among girls and boys ages 10-14 years is 3.8% (BAIS II) and among the 15-19 year age group, prevalence was
3.1% (boys) and 9.8% (girls). This gender disparity continues into young adulthood, with approximately 26% of 20-24 year old
women HIV infected, and 9.8% of men of similar age infected. The Botswana AIDS Impact Survey II (BIAS II, 2005) estimates the
national HIV prevalence rates to be 17.1% (19.8% for females and 13.9% for males). Areas with high HIV infection rates for
females include Chobe (33.3%), Lobatse (30.6%), Francistown (29.4) and Selibe-Phikwe (27.2%).
Among adults, having multiple sexual partners is also a serious concern. A study of multiple concurrent partners (MCP) in
Botswana (Carter, et. al. 2007) found that 25% of 546 sexually active respondents surveyed in 2003 reported having sex with
someone else, while in a sexual relationship with a recent partner. Forty percent of these respondents reported suspecting that
their last partner had other partners. Kalichman (2007) found in a survey of 500 Batswana who knew they were HIV positive that
62% were sexually active and of those, 20% reported two or more sexual partners in the previous 3 months.
The National Operational Plan for Scaling Up HIV Prevention in Botswana 2008-2010
The Government of Botswana (GOB) has made a commitment to achieving the goal of "Zero New Infections by 2016". The
National Operational Plan for Scaling Up HIV Prevention in Botswana matches this vision with an aggressive prevention
implementation program, building on the National Strategic Framework that will fill the gaps in current programming and intensify,
unify and scale up the response to HIV/AIDS. The central pillar of the operational plan is the "minimum package," a set of
interventions, which if implemented simultaneously with sufficient reach, intensity, and duration, has the potential to reduce
dramatically further transmission of HIV in Botswana.
A set of five key interventions, namely prevention of sexual transmission, HIV counseling and testing, PMTCT, sexually
transmitted infections (STI) management, and prevention of blood borne transmission, defined by consensus cover the three most
common modes of HIV transmission: sexual, mother to child, and blood borne. Access to prevention services will be increased
through both supply (improve quality, diversify service delivery options, address gender inequalities, use evidence-informed
strategies) and demand (strategic communication and community interventions) approaches.
Linkages with Partners
During FY 2008, United States Government (USG) support went to different local and international non-governmental
organizations (NGOs) and the Ministries of Local Government, Health, Defence, Justice and Security, Labor and Home Affairs,
and Education. Together, these partners carried out a range of activities through community and mass media outreach to
promote the prevention of sexual transmission of HIV through abstinence, faithfulness, partner reduction, condom use and related
issues, like alcohol and gender equity.
PSI implemented a public health evaluation of two approaches to address MCP and also trained healthcare providers to
strengthen their knowledge, standardize information given to the public and provide skills on male circumcision (MC) procedures.
The Academy for Educational Development (AED) through the Capable Partners Program supported the organizational and
programmatic development of Makgabeneng and also partnered with the Botswana Business Coalition on AIDS (BBCA) to
provide Workplace HIV Prevention. Family Health International (FHI) provided life skills education to youth ages 10-17 in two
districts. Pathfinder was supported to provide a male-focused intervention in target districts, using local partners Humana People
to People (HPP), True Men and the Botswana Council of Churches. Support for Hope World Wide's project targeting children was
used for abstinence and life skills education. PEPFAR support to Constella was aimed at providing HIV prevention activities to
students at the University of Botswana (UB). Project Concern International (PCI) I helped integrate HIV prevention into palliative
care in collaboration with 15-20 civil society organizations (CSO).
A partnership with the Ministry of Education (MOE) supported the roll out of its new "life skills" materials to schools through out the
country. The Ministry of Local Government (MLG) partnership provided support to District Multi Sectoral AIDS Committees
(DMSAC) in five districts to carry out additional prevention activities. A partnership with the Botswana Defense Force (BDF)
provided technical assistance and support to BDF personnel and families with projects addressing HIV prevention and the Youth
Health Organization (YOHO) developed a network of youth-serving organizations with support from PEPFAR in 2008. A University
Partnership with Johns Hopkins started the Gender Initiative to Girls' Vulnerability to HIV in Botswana.
Linkages among Activities
In FY2008, Makgabaneng, the well known radio serial drama that has been on the air for five years, successfully implemented a
new model of community reinforcement activities in Tutume and Ghanzi districts, with the assistance of Humana People to People
and the Botswana National Youth Council (BNYC) who carried out school rallies, listening and discussion groups and supported
the utilization of a behavior change magazine for secondary students. As the MOE continued the roll-out of its new life skills
curriculum, the Peace Corp initiated a partnership with them to pilot test the placement of Peace Corp Volunteers in schools to
support implementation of the life skills programs and related HIV prevention activities. YOHO continued to implement the
prestigious, three-year PEPFAR New Partners Initiative (NPI) grant, which it won last year by expanding its theater, life skills and
"edutainment" activities, supporting affiliate youth organizations across the country, and strengthening its own organizational
capacity and systems with the help of AED.
FHI, new to Botswana in 2007, worked on hiring staff and developing contracts, work plans, budgets, and monitoring systems;
holding numerous stakeholder consultations; carrying out a formative needs assessment in two districts; and supporting behavior
change intervention training to its various local implementing partners. Those partners included the Botswana Network of AIDS
Service Organizations (BONASO), in addition to BNYC, HPP, the Botswana Network of People Living with AIDS (BONEPWA), the
Botswana Christian AIDS Intervention Program (BOCAIP) and Makgabaneng.
USG PEPFAR Review
The Botswana USG PEPFAR Team held Peer Portfolio Reviews (PPR) in June 2008. The participants represented the USG
agencies and Embassy offices implementing PEPFAR in Botswana: the DOD/Office of Defense Cooperation (ODC), Public Affairs
Section (PAS), Regional Health and Environment Office (REHO), HHS/Centers for Disease Control (CDC/BOTUSA), Peace
Corps, and USAID. The team reviewed the status of on-going and new PEPFAR activities for the period October 1, 2007 - March
31, 2008 and found most were on track for meeting planned targets. With USG assistance, there were notable achievements
mentioned, as well as challenges and recommendations for the future. Some of these for the Abstinence and Be Faithful (AB) and
Condoms and Other Prevention (OP) activities include:
• Partners were able to meet targets for both sexual prevention AB and OP community outreach through public and private sector
channels and consolidate and expand their programs. Key partners, such as Makgabaneng, FHI, YOHO, Pathfinder and PSI,
have improved their programs and more work with HPP, the MOE's Life Skills program, and BONASA will be needed.
• Discussions were helpful in pointing out areas where the AB/OP team should meet with Peace Corps, USAID and partners, such
as the MOE, to improve activities, possibly through holding interagency meetings with partners attending.
• The Peace Corps pointed out that volunteers are finding major shortfalls in condoms at the village and community levels.
• The Ministry of Health (MOH) is launching a major MC program aiming at 80% coverage in five years. Providing adequate
PEPFAR staff to work on this effort and building a USG MC team should be a priority.
Other HIV Prevention Activities
Several NGOs provide condoms and other prevention activities with PEPFAR support. PSI is funded to carry out a comprehensive
marketing and behavior change intervention focused on sexual partner reduction, particularly concurrent partner reduction,
faithfulness and alcohol misuse and abuse. Another part of PSI's work is distributing condoms in rural area "hotspots," including
approximately 500 non-traditional condom distribution sites across rural Botswana, and educating distributors in those
communities on correct, consistent condom use.
Other partners, although not directly distributing condoms, have a portion of the funds allocated to condoms and other prevention.
The Peace Corp Life Skills Program uses funds to provide OP prevention-related in-service training for volunteers. The
Prevention with Positives project supports technical assistance in positive prevention and alcohol-HIV issues for a limited set of
existing primary prevention interventions, some of which may not yet sufficiently target these issues.
The MLG funds activities that belong under OP such as sex worker out reach and the establishment condom distribution sites.
The Workplace HIV Prevention intervention carried out by the BBCA focuses on peer education training programs that actively
promote correct and consistent condom use and condom distribution, as well as address linkages between alcohol abuse and
HIV/AIDS. BBCA has targeted 200 work-based peer educators/counselors nationwide.
In an activity related to integration of prevention into palliative care, PCI targets both young orphans and vulnerable children. The
adolescents and people living with HIV/AIDS (PLWHA), many of whom are sexually-active, receive comprehensive HIV
prevention interventions to reflect their age-appropriate needs, including promotion of correct and consistent condom use and
alcohol use reduction. The Gender Initiative on Girls' Vulnerability to HIV uses a multi-component approach with a focus on the
most vulnerable girls engaged/not yet engaged in risky behaviors.
Makgabaneng also receives funds from the OP program area for its broad-based prevention radio serial drama. Constella's
activity targeting university students provides information and services about every HIV prevention method available, as many
students ages 18-30 are sexually active. The FHI-Youth focused community intervention will give sexually experienced
adolescents all the skills and tools necessary to remain free of HIV and unintended pregnancies, including provision and
discussion of condoms, and STI treatment. Pathfinder's male-focused prevention receives funds from C/OP to meet the needs of
sexually active adult men, focusing on condom use and alcohol abuse prevention.
Programs for Most at Risk Populations:
Only one specific activity focuses on HIV prevention interventions for Most At Risk Populations (MARP) in Botswana through local
civil society organizations. The target groups include sex workers, clients of sex workers, and women and girls in cross-
generational and/or transactional sex. The objective is to increase access to quality HIV/AIDS/STI prevention services for MARP
in Botswana and strengthen the linkages between these services and other critical HIV/AIDS related care and treatment services.
Table 3.3.02:
09.P.OP14: TBD - Expanding Counseling and Psychosocial Support for HIV-positive Pregnant Women,
Table 3.3.03:
