In FY 08 KHANA will continue FY 07 activities in promoting abstinence and be faithful (AB) messages as

central approaches to its HIV prevention program. Under this program area, activities will target groups with

specific AB messages that emphasize key areas such as addressing male norms and behaviors, reducing

violence and coercion, and building gender equity. This activity will also include human and local

organization capacity building, with in-service training, and mentoring and monitoring to raise the capacity of

our partners and beneficiaries. Strategic information, in the form of project monitoring data, case studies,

best practices and lessons learned is collected regularly. In FY 08, KHANA wil ensure that a targeted

evaluation of this and other program areas is performed.

The activity will be carried out through focused prevention and integrated care and prevention programs.

The target population includes children from 10 years old, unmarried young people between the ages of 15

and 25, including OVC (in and out of school) and youth in the community. This activity will also be aimed at

married couples and PLHA (married and unmarried).

The target audiences are reached through peer outreach, group discussions, one-on-one counseling and

information materials, each specifically tailored to respond to the needs of the population. This activity will

include workshops to reinforce an understanding of the A and B approaches, messages, related lifeskills,

and interventions. As a result, the sub-partners are able to assess which intervention is most appropriate for

each audience, the most effective approaches to reach each population, and which messages have the

greatest impact.

The first component of this activity will focus on OVC and community youth from the age of 10 upwards.

KHANA will use a variety of activities, such as role plays, youth forums, events, outreach and group

discussions, to focus on providing essential information (e.g. on reproductive anatomy, sexuality, gender

and HIV, reproductive and sexual health) and provide them with the life skills and sense of responsibility to

make decisions. They will also refer youth who are already sexually active to relevant services.

KHANA will refine existing approaches for working with youth and ensure that NGOs have the required

capacity to respond to the specific needs of youth in their target areas. Activities to reach youth will be

conducted by trained peer educators through both outreach and facilitated discussion groups. All sub

partners supported to carry out these activities have experience in reaching communities and have existing

links to OVC and community youth through current prevention or care and support efforts.

The second component of this activity focuses on married couples, including couples where one or both

individuals are HIV positive or whose HIV status is unknown. Through a variety of interventions, KHANA will

focus on the importance of counseling and testing, fidelity, the role of religion, culture and society in sexual

relationships, the implications, and possible results of infidelity, gender and responsibility (such as the

responsibilities held by husbands and fathers and those held by wives and mothers), family planning, and

domestic violence. Women, in particular, will be given a greater understanding of their rights regarding their

bodies, decisions over sexual activity, and expectations of their husbands or partners' sexual behavior. In

addition, there will be emphasis on laws recently passed in Cambodia, on HIV/AIDS, domestic violence, and

adultery.

IEC will be modified and distributed that best serves the activities and the target groups listed above.

KHANA will work with other agencies, including USG partners, to share and modify IEC and behavior

change communication (BCC) materials and interventions that best deliver the A and B messages.

In FY 08, KHANA will repeat a workshop held in FY 07 on A, B, and C prevention approaches. This

workshop will include an examination of the methods used in the field, what has worked and what hasn't,

what modifications are required, and what revisions to the curriculum should be made. Training in A and B

interventions in terms of audience identification, appropriate messages, and methods of education will be

conducted to all relevant KHANA partners. These partners will then train their staff, home care teams, peer

educators, and volunteers in effective community-based messages and interventions.

Sub partners will receive regular support from KHANA in terms of workshop follow-up, technical support

visits, and training to ensure that their A and B activities are effective, inclusive of the target groups, and

efficiently monitored.

The results of these activities and the monitoring data they generate will be used to inform government

programs and other agencies operating HIV prevention activities (including USG partners) through lessons

learned forums, evaluations, and technical working groups.

In FY 08, KHANA will conduct Condoms and Other prevention activities as central features in its HIV

prevention program. Continuing on activities initiated in FY 07, KHANA will target groups with other

prevention messages that emphasize key areas such as addressing male norms and behaviors, reducing

violence and coercion, building gender equity, and prevention with positives. Strategic information, in the

form of project monitoring data, case studies, best practices and lessons learned will be collected regularly

and, since this is the last year of this current funding period, KHANA will ensure that a targeted evaluation of

this program area is performed.

In FY 08, KHANA will continue to work with men who have sex with men (MSM), indirect sex workers,

mobile populations and drug users. These groups are at high risk of HIV transmission and require specific

interventions. They still face the stigma and discrimination that affect their use of services, access to

information, and quality of life. KHANA will also promote positive prevention in their activities with PLHA and

their families and continue to work with sex workers. These populations remain at the center of the epidemic

and it is critical that they receive continued access to information, support, and services to prevent

resurgence in HIV prevalence.

It is vital that the most at risk populations (MARPs) come into contact with; service providers, brothel

owners, and the police, these groups are aware of the challenges MARPs face in accessing information and

services. These gatekeepers will be invited to regular meetings to sensitize them and to mobilize their

support in helping to reduce violence among and toward MARPs, helping them to access services and

information, and ensuring that they have safe spaces in which they can meet and support each other

without harassment.

In FY 08, KHANA will provide MARPs with in-depth participatory prevention approaches designed to build

confidence and skills so that these vulnerable individuals can practice less risky behavior. KHANA will

identify and train peer educators who will provide outreach services, referrals to VCT, STI and other health

services in addition to in-depth discussion groups where skills building and knowledge acquisition within a

peer group will enable individuals to understand risk and vulnerability and to modify behavior. Some at risk

individuals also face resistence from their own sexual partners in using condoms, so education interventions

on the correct and consistent use of condoms are always accompanied by exercises in risk reduction skills

building, negotiation, and building trust. In particular, considerable focus will be placed on women's

empowerment and their control over their sexual and reproductive health, and changing male behavioral

norms (including decreasing sexual activities with a non-spouse). Activities will be conducted by trained

peer educators through both outreach and facilitated discussion groups, using positive role models.

KHANA will organize IEC, awareness raising and advocacy events in HIV prevention, including drug-related

HIV prevention in collaboration with national and provincial stakeholders. KHANA will also hold social

gatherings for MARPs to strengthen cultures of solidarity and a sense of community in response to

HIV/AIDS and related issues, such as stigma and discrimination. Community involvement including parents,

faith-based institutions, and village chiefs will be crucial in organizing these events and facilitating the

delivery of prevention interventions at community level. KHANA partners will therefore organize community

mobilization meetings on a regular basis.

In FY 08, prevention for positives will continue to be a central focus. KHANA's peer education program will

encourage and train people with HIV (PLHA) to provide information through outreach and group discussion

to peers who might be positive. There will also be group discussions for positive people and their partners in

risk reduction skills building, negotiation skills, condom use and safer sex, and the benefits of VCT. Referral

mechanisms will be established and reinforced that overcome the obstacles that prevent people from

getting tested and all those referred to VCT will be invited to join pre and post test clubs for counseling and

prevention education.

In FY 08, KHANA will continue to train its partners and representatives of MARPs in prevention

interventions. While some training workshops will have general themes, such as BCC for prevention, others

will focus on specific issues such as prevention for positives or risk reduction among drug users. The

partners in turn will train home care team HCT, peer educators and facilitators to carry out the interventions

at household and community level.

KHANA's prevention activities are in direct agreement with the USG 5-year strategy for Cambodia where

prevention of HIV infection among MARPs is highlighted as critical to the continued lowering of HIV

transmission.

In FY 08, additional effort will be spent on ensuring that all eligible women in this project are referred to the

national PMTCT program and are encouraged to attend and receive all the services within it. For these

women, ANC services are often the entry point to PMTCT and therefore KHANA and its partners must work

closely with health centers, hospitals, birth attendants and organizations providing antenatal care, as well as

family members, to close the gap between ANC and HIV testing and the rest of the PMTCT process.

In order to ensure efficiency and cost effectiveness, KHANA and its partners will continue to collaborate with

other agencies (government departments, USG partners and others) to develop, modify and share BCC

materials and training resources in HIV prevention.

KHANA's USG-supported prevention activities are fully complimentary to the prevention activities carried

out with GFATM support. This support with KHANA will expand its activities into additional provinces and

reach a higher number of individuals, MARPs and the general population.

KHANA supports PLHA in the five categories specified by the USG: clinical/physical care, spiritual care,

psychological care, social care, and integrated prevention services. In FY 08, KHANA will continue to

routinely collect strategic information in the form of monitoring data, case studies, lessons learned and best

practices from our partners to be able to inform our programs, donors and government-led initiatives

(including the universal access targets).

In FY 08, KHANA will continue to provide comprehensive care and support in community and home-based

settings to its PLHA beneficiaries in 10 provinces. Building upon activities in FY 07, KHANA will continue to

support the Continuum of Care (CoC) model with our home-based care (HBC) focus and to ensure that

activities are cost effective.

KHANA will continue to support home care teams (HCT) that operate from local health centers. In order to

reach targets, these HCT will continue to make regular home visits to provide basic medical care to their

PLHA beneficiaries, reinforce efforts to refer them to relevant health services such as opportunistic infection

(OI), tuberculosis (TB), anti-retroviral (ARV) and PMTCT, and ensure that they can complete all forms of

treatment required. As access to anti-retroviral therapy (ART) increases, KHANA will step up efforts to

provide education on ARV side effects, living well on ARV, and ARV adherence and follow-up.

In addition to basic health care, KHANA and the HCT provide a comprehensive range of services to PLHA.

These include psychosocial support in the form of counseling and spiritual support.

It is also important that PLHA are referred to services that contribute to the care of their partners and

families and the quality of their lives. Therefore, referral mechanisms will be established or strengthened for

PMTCT, sexual reproductive health (SRH) services and to agencies and institutions that can offer PLHA

social and economic opportunities.

Positive prevention is also a part of this program area in that HCT provide counseling to PLHA to help them

maintain the quality of their lives and reduce the risk of onward transmission. Beneficial disclosure and

ethical partner notification will be encouraged at all times.

Friend Helps Friend (Mondol Mith Chuay Mith, MMM) Self Help Groups will continue to be supported under

this program area. These groups have proven to be effective environments to help PLHA cope with ARV

side-effects and treatment adherence, and to discuss issues that are important for the health and well being

of PLHA and their families, such as nutrition and positive prevention. HCT and CoC Coordinators will be

encouraged to engage with PLHA self-help groups to better understand the needs, concerns and

challenges faced by PLHA and to train the members in crucial issues such as ARV adherence and positive

prevention.

Training is still an important part of KHANA efforts under this program area. In FY 08, advanced integrated

care and prevention workshops will be facilitated by KHANA that cover the more complex and topical issues

involved with HBC, such as referral systems, ARV adherence, and nutrition and HIV. KHANA conducts

refresher trainings for HCT to improve and update their skills in delivering HBC and engaging in referral

systems.

KHANA partners will continue to conduct community meetings to reduce stigma and discrimination towards

PLHA and their families. They will also organize bi-annual community mobilization meetings, and meetings

with local authorities and faith-based institutions to determine the most effective responses to AIDS care at

the community level.

KHANA's program recognizes the challenge represented by a maturing epidemic, and focuses on providing

basic and AIDS health care through the CoC framework to increasing numbers of people requiring care and

support services, particularly in areas where the public health system is weak.

KHANA's HCT provide, or provide access to, a wide range of clinical, psychological, spiritual, and social

support interventions. As reliance on these teams increases and resources focus more on treatment,

KHANA will ensure that their team members will become proficient in referrals and increase their medical

support role to include monitoring of side effects and drug adherence.

Another challenge for KHANA's programs (for prevention and care) is access and uptake of VCT services.

VCT is a major element of the Royal Government of Cambodia (RGC's) Strategic Plans for HIV/AIDS and a

key element of the CoC. Access to VCT services remains limited in some areas of Cambodia, particularly in

sparsely populated areas of the country where transport costs are high. The system of referrals to and from

VCT also requires strengthening. KHANA's programs therefore seek to address the low utilization rates in

some sites and the limited referral success.

In FY 08, KHANA's income-generation activities will be more strategically defined so as to pose a

complimentary set of wraparound activities. The sub partners who have expertise in this area will continue

to provide income-generation activity opportunities for PLHA and PLHA families in the USG target areas.

In FY 08, Khmer HIV/AIDs NGO Alliance (KHANA) will continue to focus on HIV positive children as well as

children who are directly affected by HIV and AIDS in ten provinces. KHANA will address human and local

organization capacity development and in-service training, targeted evaluation, strategic information, and

food security.

In FY 08, KHANA will continue to provide basic medical care to OVC through the home care teams (HCT)

during home visits and will increase efforts to refer more OVC to other services such as vountary counseling

and testing (VCT), opportunistic infection (OI), tuberculosis (TB) and pediatric anti-retroviral therapy (ART).

OVC that are HIV positive and their caregivers will receive education and support from HCT to cope with the

side effects of ARV and to ensure treatment adherence and follow up.

Additional OVC will continue to be supported to attend school. HCT will also provide counseling and

psychological support to children infected and affected by HIV and their families and to refer eligible OVC to

appropriate vocational training opportunities. These children will be provided with information, education,

and communication (IEC) material when parents become terminally ill, preparation for foster care, memory

books and succession plans. Additional social services will also be available to reduce stigma and

discrimination towards OVC within communities and serve as platforms for HIV prevention education.

In FY 08, KHANA will organize community mobilization meetings, including the engagement of local faith-

based structures, such as pagodas and churches to help reduce the stigma and discrimination that is so

often experienced by OVC and their families and to encourage a community response to HIV/AIDS with

particular reference to OVC.

KHANA will conduct refresher training for HCT and care givers to improve their skills at delivering home

based care services for OVC. Partners design training based on needs of HCT including; responding to the

needs of OVC, child rights and child protection policy, school support, life skills, succession planning,

memory book development, seeking foster care, and pediatric ARV.

As specified in the 5-year strategy, KHANA will focus on the children and families affected by AIDS who

require medical care and psychosocial and economic support. KHANA's activities will directly address the

real or threatened prospects faced by these HIV-affected children of abandonment, stigma and

discrimination, exclusion from community activities and schooling, malnutrition, and exploitation, including

trafficking into commercial sex.

KHANA aims to improve the lives of these children by providing care and treatment, social support and legal

protection for them and their foster and extended families. KHANA will also strengthen the capacity of

families, communities, and non governmental organizations, community base organizations and faith base

organizations to care for OVC.

KHANA works closely with the World Food Program (WFP) to provide monthly food rations for OVC in all

USG supported provinces outside of Phnom Penh and Kandal.

In FY 08, KHANA will continue to be a member of the OVC National Task Force and contribute to technical

working groups working on OVC and service-related policy. The KHANA USG-funded activities with OVC

are complimentary to the KHANA OVC activities funded by the Global Fund and the European Union (EU).

The strategic information (SI) efforts of the Khmer HIV/AIDS NGO Alliance (KHANA) will benefit the national

response to HIV/AIDS as a whole. Monitoring data, lessons learned, and best practices will be shared with

and collected from all partners, target groups, other USG partners, the government of Cambodia, and local,

national, and international forums.

In FY 08, KHANA target populations are existing partners and other stakeholders, including government

institutions and other USG partners. They will be reached through training, as well as existing fora,

committees and working groups. Strategic information will also be shared internationally.

In FY 08, KHANA and its partners will continue to participate in international and national conferences,

exchange visits, and donor fact-finding missions. These will provide fora by which KHANA can distribute its

strategic information and also learn from the strategic information of others.

With FY 08 funds, KHANA's operational research priorities will be guided by national priorities and

government-led initiatives. KHANA's research associate will continue to work with the government

agencies, NGO partners, and other organizations to identify and address potential areas in research. As this

is the final year of this current funding program, it will be a suitable time to review KHANA's packages of

services and to assess whether they are effectively addressing the current priorities of the targeted

populations. To do this, target communities and the beneficiaries will be involved in the design and

implementation of evaluations and other research.

In FY 08, KHANA will focus on the emphasis areas of strengthening the systems of its partners and

promoting an enabling environment for HIV /AIDS activities by working with a range of actors in the

government, the UN community, donors, NGOs, and networks.

KHANA will continue to contribute to a coordinated response at the national level and will help to ensure

continuity and complimentary activities at provincial and community levels. In so doing, KHANA will continue

to support partner advocacy efforts at national, provincial and community levels and provide partners with

the tailored technical support they need to contribute to policy development, publications, and campaigns

aimed at reducing the impact of HIV/AIDS.

Populations targeted in this activity are civil society stakeholders, beneficiaries, donors and the national

government.

In seeking to reach targets for this program area, KHANA will organize awareness-raising and media work

during special events such as World AIDS Day, International Women's Day, Water Festival and others. This

will be carried out in collaboration with partners as this remains an effective way of mobilizing both

government and community support around specific themes.

In FY 08, KHANA will continue to build on its partners' technical, organizational, and institutional capacity

through a variety of methods, including workshops, follow-up and monitoring visits, one to one technical

support visits and mentoring to partner staff. Other approaches will include project reviews, tools

development, documentation, sharing lessons learned, and facilitating partner meetings to provide

additional ways of exposing NGOs to new approaches and best practices.

Building on FY 06 and FY 07 activities, KHANA will continue to concentrate on strengthening selected

partner NGOs as the lead NGOs within their province and as leaders within the HIV sector as whole .

In line with the USG 5-year strategy, KHANA will support policy and advocacy issues such as treatment

access, provision of counseling and testing, care and support for infected and affected, and prevention. In

particular, KHANA will actively participate in technical working groups including Care & Support, M&E,

Prevention, TB/HIV, and PMTCT to provide technical guidance on development and revision of policy,

protocols, and guidelines, and will support treatment advocacy and education efforts for PLHA groups.

An emphasis area for all of KHANA's programs is Gender particularly, increasing gender equity in HIV/AIDS

programs. In line with the 5-year strategy, in FY 08, KHANA will work closely with other stakeholders to

promote policy that facilitates access by women to antenatal care, skilled attendance at delivery and

postnatal care, PMTCT programs, and ARV treatment. Mother-to-child transmission is estimated to account

for nearly one-third of new HIV infections.

KHANA will continue to support MARPs with a view to strengthening the solidarity and networking capacity

of these groups to advocate for reduced stigma and discrimination and access to health services. For

example, KHANA will support CBO groups of PLHA, MSM, and SW to implement prevention and advocacy

activities, recognizing the significant progress made in skills development in leadership and management

among these groups.