09.P.AB04: PSI - Be Faithful/Partner Reduction

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The geographical distribution of the project will be such that it will have a presence in Gaborone, Lobatse,

Mahalapye, Selibe-Phikwe, Palapye, Francistown, Maun, Kasane, Mabutsane and Ghanzi districts by the

end of FY2008 and will be implemented in all the above districts throughout FY2009. An increased amount

of support for community-level interventions will be required in FY2009, as 120 district-months of

implementation are planned compared to 74 district-months in FY2008.

The implementing partners for FY2009 are Humana People to People (Gaborone and Lobatse), AMEST

(Gaborone and Lobatse), Young Women Friendly Centre (Mahalapye), Ministers Fraternal (Mahalapye and

Selibe-Phikwe), Men Sex and AIDS (Selibe-Phikwe) and Itsoseng Banana (Palapye).

The specifications of projects in new districts will be agreed upon with District Multi Sectoral AIDS

Committees (DMSAC), although all projects are expected to follow a broadly similar approach. The

approach incorporates lessons learned from current interventions in Gaborone and Lobatse during FY2007,

regarding the need to broaden the scope of alcohol abuse related projects from their current, narrow focus

on shebeens. The approach also includes new methodologies which will be implemented as part of the

rollout of the national Multiple Concurrent Partners (MCP) campaign from FY2008. By the end of FY2008, it

is expected that PSI, in collaboration with the Youth Health Organization (YOHO), will have trained local

theatre groups in all project districts, and these groups will remain part of the project during FY2009.

Interpersonal communication (IPC) approaches will then be used to increase the ability and motivation of

youth and adults to reduce their number of sexual partners, use condoms correctly and consistently, and

drink responsibly. Social mobilization will continue at a reduced level to create an enabling local

environment for behavior change.

Mass media interventions focused on preventing HIV transmission by reducing MCP and alcohol abuse will

be modified in the following ways in FY2009:

The development, production and piloting of the second series of the planned television drama will occur

during FY2009. The television drama will incorporate key communication themes of the national MCP

campaign, as well as other national HIV prevention priorities, such as male circumcision.

There will be no new mass media activities on MCP, other than the television drama series, in FY2009.

PSI's involvement in mass media work on MCP will continue during this period, as part of the forthcoming

multi-stakeholder national MCP campaign led by National AIDS Coordinating Agency (NACA). The

President's Emergency Plan for AIDS Relief (PEPFAR) will support the national MCP campaign during

FY2009 through the community level interventions and the television series described above.

A limited number of mass media activities relating to alcohol abuse will be supported through FY2009.

Specific channels will be selected following assessment of the first phase of these activities during FY2008,

but may include billboards, booklets and events. Lessons learned from mass media alcohol interventions to

date will be applied; these include the need to stimulate more open debate about alcohol abuse and

HIV/AIDS, which will be addressed via the above mentioned activities.

From COP08:

This activity is a comprehensive social marketing and behavior change intervention focused on promoting

sexual partner reduction, particularly concurrent partner reduction, and faithfulness. Alcohol misuse and

abuse is one of the key mitigating factors that the campaign emphasizes.

In 2007, Population Services International (PSI) developed outreach materials focused on these issues for

use in small group settings and carried out a formative assessment in the initial target area (Lobatse

district). They worked with a local creative team to develop a branded campaign on partner reduction, but

based on feedback from stakeholders and target audience members, PSI plans additional changes before

roll-out. PSI developed a branded alcohol-HIV campaign, which they have begun to implement through

billboards, on radio, and in bars, shebeens, and discos in the Gaborone area. Humana People to People

conducted interpersonal outreach in both Gaborone and Lobatse. PSI also trained and supported 25 DJs,

musicians, and print media journalists to reinforce key themes related to alcohol risk reduction and partner

reduction/fidelity through their various means. Together, the partners reached about 400 people through

small group activities and 20,000 people through large scale promotional events.

PSI has planned a national 6-month awareness campaign focused on the risks of concurrent partnership

and is developing a short television drama (approximately 6-13 episodes) that will air in early 2008, which

will challenge norms related to multiple partnerships and promote those related to faithfulness through an

edutainment format with wide reach. These efforts will be supported by community outreach in Lobatse and

Gaborone districts, and by additional media efforts, such as radio talk shows and short radio spots. The

HIV risks associated with alcohol, particularly casual sex and poor or no condom use, are a core theme in

these efforts.

In 2008, PSI will continue and expand these activities. First, the mass media behavior change intervention

will continue on a national scale, including either 1-2 short television dramas or a continuation of the drama

initiated in coming months. The decision will depend on the success of the pilot drama. PSI also will launch

a new branded campaign focused on print, radio, and outdoor advertising. PSI will reinforce the themes

through community theater and through DJs and other popular performers, who weave the messages into

their performances and work; and radio call-in and talk shows. The two sub partners, Humana People to

People and African Methodist Episcopal Services Trust (AMEST), will expand the small group interpersonal

communication activities into secondary schools, churches, workplaces, drinking establishments, and other

sites as appropriate to the target communities. One outreach manual focuses on people 15-24, while

another focuses on older adults; PSI also will maintain sets of materials focused on alcohol and on multiple

partners, which partners will implement in the field in response to the target audience and setting. In all

cases, field officers will address issues related to alcohol and multiple and concurrent partnerships and

fidelity, but the degree of emphasis will vary. In 2008, PSI and its existing partners will also begin to identify

additional local partners in the target districts that can incorporate the small group activities into their work,

as part of their plan to expand the reach of those further. In total in 2008, PSI will take the interpersonal

activities to communities and villages across an estimated 10 districts.

Activity Narrative: Because these themes are still somewhat new for large scale social marketing and outreach in Botswana,

PSI will intensively monitor the implementation of these activities and the reactions to it. PSI will conduct its

regular program monitoring survey, which includes behavioral, attitudinal, and knowledge measures related

to partner reduction, fidelity, and alcohol.

PSI also will lead a public health evaluation of the interventions developed under this activity. In light of the

knowledge gap on how best to address multiple concurrent partnerships, PSI Botswana, working with a

reputable academic institution with experience in social research (e.g. PSI has had initial discussions with

the Poverty Action Lab of MIT, but the partner and the local co-investigator are both to be determined), will

conduct a randomized control trial to compare two approaches to addressing multiple and concurrent

partnerships. The first approach will provide an intervention that focuses on encouraging the target

population to reduce the number of sexual partners (such as by stressing the benefits of fidelity and/or the

risks associated with having multiple partners). The second intervention will focus on the pattern of sexual

relations, with an aim of discouraging the practice of having overlapping partners. Each of the treatments

will be delivered through an intensive combination of mass media (particularly outdoor advertising and local

radio programs), interpersonal communications (done in small groups and in one-on-one sessions), and

edutainment (with drama groups).

Villages would be randomized into the two treatment groups, with a third set of villages established as the

control arm, in order to ensure that outcomes were related to the treatments rather than to exposure to any

outside mass media efforts on multiple concurrent partnerships. Outcomes would primarily be subjective

(e.g., changes in self-reported patterns of sexual networks). Pending further discussion with collaborators

(including the GOB), some objective outcomes might be measurable (particularly biomarkers such as

pregnancy rates, STI rates, and/or seroprevalence rates at antenatal clinics or in other counseling and

testing sites). The budget for the research is estimated to be about $275,000 for the first of a planned two

year study. This is based on a preliminary design with an 80% power to detect a 5% difference between

groups, with 20 subjects in each of 300 clusters (i.e., a total of 6,000 interviewees per round).

Approximately $200,000 would go for field work costs, and $75,000 for research design, researcher time,

and other direct costs. In addition to a research partner from an international academic institution, PSI

plans to seek a partnership with a local researcher or academic group, particularly in the University of

Botswana (UB).

This activity has funds from both AB and C/OP program areas. The majority of funds are from the AB area

(75%, $1,500,000), because the effort will focus on faithfulness and partner reduction. The C/OP funds

support that part of the activity that highlights the risks associated with alcohol misuse and abuse (25%,

$500,000).

New/Continuing Activity: Continuing Activity

Continuing Activity: 17459

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17459 4535.08 HHS/Centers for Population 7768 5339.08 U62/CCU32522 $1,300,000

Disease Control & Services 2: Increasing

Prevention International Access to HIV

Confidential

Voluntary

Counseling and

Testing and

Enhancing

HIV/AIDS

Communications

, Prevention,

and Care in

Lesotho, South

Africa &

Swaziland

9921 4535.07 HHS/Centers for Population 5339 5339.07 $500,000

Disease Control & Services

Prevention International

4535 4535.06 U.S. Agency for Pact, Inc. 3371 1303.06 PACT $400,000

International

Development

Table 3.3.02:

09.P.OP04: PSI - Be Faithful/Partner Reduction

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The geographical distribution of the project will be such that it will have a presence in Gaborone, Lobatse,

Mahalapye, Selibe-Phikwe, Palapye, Francistown, Maun, Kasane, Mabutsane and Ghanzi districts by the

end of FY2008 and will be implemented in all the above districts throughout FY2009. An increased amount

of support for community-level interventions will be required in FY2009, as 120 district-months of

implementation are planned compared to 74 district-months in FY2008.

The implementing partners for FY2009 are Humana People to People (Gaborone and Lobatse), AMEST

(Gaborone and Lobatse), Young Women Friendly Centre (Mahalapye), Ministers Fraternal (Mahalapye and

Selibe-Phikwe), Men Sex and AIDS (Selibe-Phikwe) and Itsoseng Banana (Palapye).

The specifications of projects in new districts will be agreed upon with DMSACs, although all projects are

expected follow a broadly similar approach. The approach incorporates lessons learned from current

interventions in Gaborone and Lobatse during FY2007 regarding the need to broaden the scope of alcohol

abuse related projects from their current, narrow focus on shebeens. The approach also includes new

methodologies which will be implemented as part of the rollout of the national Multiple Concurrent Partners

(MCP) campaign from FY2008. By the end of FY2008, it is expected that PSI, in collaboration with YOHO,

will have trained local theatre groups in all project districts, and these groups will remain part of the project

during FY2009. Interpersonal communication (IPC) approaches will then be used to increase the ability and

motivation of youth and adults to reduce their number of sexual partners, use condoms correctly and

consistently, and drink responsibly. Social mobilization will continue at a reduced level to create an enabling

local environment for behavior change.

Mass media interventions focused on preventing HIV transmission by reducing MCP and alcohol abuse will

be modified in the following ways in FY2009:

The development, production and piloting of the second series of the planned television drama will occur

during FY2009. The television drama will incorporate key communication themes of the national MCP

campaign, as well as other national HIV prevention priorities, such as male circumcision.

There will be no new mass media activities on MCP, other than the television drama series, in FY2009.

PSI's involvement in mass media work on MCP will continue during this period, as part of the forthcoming

multi-stakeholder national MCP campaign led by NACA. PEPFAR will support the national MCP campaign

during FY2009 through the community level interventions and TV series described above.

A limited number of mass media activities relating to alcohol abuse will be supported through FY2009.

Specific channels will be selected following assessment of the first phase of these activities during FY2008,

but may include billboards, booklets and events. Lessons learned from mass media alcohol interventions to

date will be applied; these include the need to stimulate more open debate about alcohol abuse and

HIV/AIDS, which will be addressed via the above mentioned activities.

From COP08

This activity is a comprehensive social marketing and behavior change intervention focused on promoting

sexual partner reduction, particularly concurrent partner reduction, and faithfulness. Alcohol misuse and

abuse is one of the key mitigating factors that the campaign emphasizes.

In 2007, Population Services International (PSI) developed outreach materials focused on these issues for

use in small group settings and carried out a formative assessment in the initial target area (Lobatse

district). They worked with a local creative team to develop a branded campaign on partner reduction, but

based on feedback from stakeholders and target audience members, PSI plans additional changes before

roll-out. PSI developed a branded alcohol-HIV campaign, which they have begun to implement through

billboards, on radio, and in bars, shebeens, and discos in the Gaborone area. Humana People to People

conducted interpersonal outreach in both Gaborone and Lobatse. PSI also trained and supported 25 DJs,

musicians, and print media journalists to reinforce key themes related to alcohol risk reduction and partner

reduction/fidelity through their various means. Together, the partners reached about 400 people through

small group activities and 20,000 people through large scale promotional events.

PSI has planned a national 6-month awareness campaign focused on the risks of concurrent partnership

and is developing a short television drama (approximately 6-13 episodes) that will air in early 2008, which

will challenge norms related to multiple partnerships and promote those related to faithfulness through an

edutainment format with wide reach. These efforts will be supported by community outreach in Lobatse and

Gaborone districts, and by additional media efforts, such as radio talk shows and short radio spots. The HIV

risks associated with alcohol, particularly casual sex and poor or no condom use, are a core theme in these

efforts.

In 2008, PSI will continue and expand these activities. First, the mass media behavior change intervention

will continue on a national scale, including either 1-2 short television dramas or a continuation of the drama

initiated in coming months. The decision will depend on the success of the pilot drama. PSI also will launch

a new branded campaign focused on print, radio, and outdoor advertising. PSI will reinforce the themes

through community theater and through DJs and other popular performers, who weave the messages into

their performances and work; and radio call-in and talk shows. The two sub partners, Humana People to

People and African Methodist Episcopal Services Trust (AMEST), will expand the small group interpersonal

communication activities into secondary schools, churches, workplaces, drinking establishments, and other

sites as appropriate to the target communities. One outreach manual focuses on people 15-24, while

another focuses on older adults; PSI also will maintain sets of materials focused on alcohol and on multiple

partners, which partners will implement in the field in response to the target audience and setting. In all

cases, field officers will address issues related to alcohol and multiple and concurrent partnerships and

fidelity, but the degree of emphasis will vary. In 2008, PSI and its existing partners will also begin to identify

additional local partners in the target districts that can incorporate the small group activities into their work,

as part of their plan to expand the reach of those further. In total in 2008, PSI will take the interpersonal

activities to communities and villages across an estimated 10 districts.

Because these themes are still somewhat new for large scale social marketing and outreach in Botswana,

Activity Narrative: PSI will intensively monitor the implementation of these activities and the reactions to it. PSI will conduct its

regular program monitoring survey, which includes behavioral, attitudinal, and knowledge measures related

to partner reduction, fidelity, and alcohol.

PSI also will lead a public health evaluation of the interventions developed under this activity. In light of the

knowledge gap on how best to address multiple concurrent partnerships, PSI Botswana, working with a

reputable academic institution with experience in social research (e.g. PSI has had initial discussions with

the Poverty Action Lab of MIT, but the partner and the local co-investigator are both to be determined), will

conduct a randomized control trial to compare two approaches to addressing multiple and concurrent

partnerships. The first approach will provide an intervention that focuses on encouraging the target

population to reduce the number of sexual partners (such as by stressing the benefits of fidelity and/or the

risks associated with having multiple partners). The second intervention will focus on the pattern of sexual

relations, with an aim of discouraging the practice of having overlapping partners. Each of the treatments

will be delivered through an intensive combination of mass media (particularly outdoor advertising and local

radio programs), interpersonal communications (done in small groups and in one-on-one sessions), and

edutainment (with drama groups).

Villages would be randomized into the two treatment groups, with a third set of villages established as the

control arm, in order to ensure that outcomes were related to the treatments rather than to exposure to any

outside mass media efforts on multiple concurrent partnerships. Outcomes would primarily be subjective

(e.g., changes in self-reported patterns of sexual networks). Pending further discussion with collaborators

(including GOB), some objective outcomes might be measurable (particularly biomarkers such as

pregnancy rates, STI rates, and/or seroprevalence rates at antenatal clinics or in other counseling and

testing sites). The budget for the research is estimated to be about $275,000 for the first of a planned two

year study. This is based on a preliminary design with an 80% power to detect a 5% difference between

groups, with 20 subjects in each of 300 clusters (i.e., a total of 6,000 interviewees per round).

Approximately $200,000 would go for field work costs, and $75,000 for research design, researcher time,

and other direct costs. In addition to a research partner from an international academic institution, PSI

plans to seek a partnership with a local researcher or academic group, particularly in the University of

Botswana (UB).

This activity has funds from both AB and C/OP program areas. The majority of funds are from the AB area

(75%, $1,500,000), because the majority of effort will focus on faithfulness and partner reduction. The

C/OP funds support that part of the activity that highlights the risks associated with alcohol misuse and

abuse (25%, $500,000).

Condom Hotspot Distribution

Another part of PSI's work is distributing free condoms in rural area "hotspots" and educating distributors in

those communities on correct, consistent condom use. Approximately $75,000 of this entry is support to

PSI for this activity.

While PSI conducts social marketing for condoms in Botswana, they also support the free condom

distribution program led by GOB's MOH. In this activity, PSI will distribute Government free condoms to

approximately 500 non-traditional condom distribution sites across rural Botswana, in order to help make

condoms more available to such remote areas. Key sites include shebeens, small shops, bars, and other

strategic sites relevant to each community. PSI will identify a key individual in those sites who will serve as

the point of contact and condom promoter at that site. PSI will provide education to those individuals, to

help them be sources of accurate information about condoms in those communities and to promote the

correct, consistent use of condoms among sexually active people. PSI staff will visit these sites on a

regular basis, providing new supply of condoms and additional encouragement and education to the

condom promoters. About 3 million condoms will be distributed through this program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17460

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17460 11314.08 HHS/Centers for Population 7768 5339.08 U62/CCU32522 $500,000

Disease Control & Services 2: Increasing

Prevention International Access to HIV

Confidential

Voluntary

Counseling and

Testing and

Enhancing

HIV/AIDS

Communications

, Prevention,

and Care in

Lesotho, South

Africa &

Swaziland

11314 11314.07 HHS/Centers for Population 5339 5339.07 $200,000

Disease Control & Services

Prevention International

Table 3.3.03: