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.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: The implementer has been changed from
TBD-Social marketing/BCI in the COP 2008 to PSI under a new cooperative agreement.
Interventions will target populations at highest risk of HIV - the drivers of the epidemic and/or bridge
populations. Most at risk populations (MARPs) in Cambodia include: Direct Sex Workers (DSWs-brothel
and non-brothel based); Indirect Sex Workers (IDSWs-entertainment workers engaged in sex work and/or
transactional sex); clients and "sweethearts" of sex workers; men who have sex with men (MSM), PLHA
(People Living with HIV/AIDS) and their sexual partners; DU/IDUs (Drug Users/Injective Drug Users);
mobile populations; and at-risk youth ages 15 - 24 years. PSI will prioritize individuals engaging in
overlapping risk behaviors.
Increased accessibility to condoms and behavior change activities for HIV/STI prevention will aim to cover
venues and hot spots in urban and peri-urban areas, prioritizing those areas in Cambodia with high rates of
HIV and high concentrations of MARPs including Sihanoukville, Phnom Penh, Kampong Chhnang,
Battambang, Kampot, Banteay Meanchey, Kampong Cham, and Siem Reap.
Quality of condom coverage, rather than volume, will be the primary measure of success for partners and
sales teams. Quality of coverage at high risk venues refers to targeted outlets that have point of sale and
promotional materials displayed and have the product on site or within 50 meters. Mapping will be
continually updated to reflect the evolving nature of outlets where MARPs congregate, and guide
implementation of activities and monitor coverage progress. PSI will leverage members of the United
Health Network (UHN) and other NGO networks to increase coverage of condoms by opening and
maintaining high-risk urban outlets where MARPs are known to congregate. PSI will employ a strategy of
intensive advocacy supported with targeted technical assistance to facilitate the distribution of public sector
condoms to serve the poorest and most vulnerable populations for HIV prevention and dual protection.
For targeted Behavior Change Intervention (BCI), PSI will target MARPs with the objective of promoting risk
reduction strategies including consistent condom use in higher risk sex situations and partner reduction
(e.g. decrease in commercial sex partners and fidelity). A targeted BCI for HIV prevention will achieve
behavior change objectives through two main approaches: 1) capacity building activities to support UHN
members and community based partners to implement high quality Interpersonal Behavior Change
Communication (iBCC) with target populations, and 2) filling a programming gap in HIV prevention in
Cambodia with male clients and "sweethearts" of IDSWs. PSI will provide training and on-going technical
assistance, working directly with staff and outreach workers of partner NGOs, to strengthen specific
capacities required to implement effective and targeted social marketing and behavior change interventions.
With the expectation that local NGOs will facilitate sustainable operations, UHN members will be the
primary drivers of BCI for the program. PSI will leverage and support local NGOs comprising the UHN to
enhance targeted HIV/AIDS prevention interventions. A key objective of this activity will be improved
capacity of UHN members to promote the use of health products and services though improved generic
communications utilizing a social marketing approach. The project will leverage the work of UHN members
that already reach populations engaging in high risk behaviors, such as IDU, PLHA, mobile populations,
SWs (Sex Workers), MSM, and at risk youth. UHN partners, with specific technical support and
commodities provided by PSI, will become the key program implementers of BCI for this project. Support
and materials will be tailored to the specific needs of target populations, with particular support going to
UHN members reaching individuals engaging in overlapping behaviors. As subsidies may be required to
carry out specific program activities, small grants will be administered to some members to fund additive
and additional activities related to enhanced iBCC and targeted product distribution.
The program will also build on current interventions targeting clients and will design and implement a
generic iBCC campaign, including targeted mass media and Interpersonal Communications (IPC), for HIV
prevention focused on clients and partners of IDSWs. IPC activities will take place in entertainment
establishments and beer gardens, while supportive mass media as a backdrop will provide consistency of
messages to large numbers of men. Activities targeting men will be enacted under close consultation and
collaboration with the National AIDS Authority (NAA) and will follow standard operating procedures. PSI will
also coordinate efforts with FHI or other organizations targeting clients of sex workers. To ensure that
donor resources are leveraged in a harmonious fashion, PSI will coordinate communication strategies by
ensuring all interventions comply with the Royal Government of Cambodia's Strategic Plan for HIV/AIDS
Prevention. This partnership will ensure interventions targeting specific MARPs have the full support and
input of government entities such as the NAA and the National Center for HIV/AIDS, Dermatology and
STDs (NCHADS), working groups, and bi-lateral and multi-lateral organizations to fill the gaps and improve
the quality of research.
The USAID-DFID social marketing/behavior change communications activity awarded to PSI includes DFID
providing the condoms. This collaborative effort will strengthen social marketing/behavior change
communication activities among donors, including Entwicklungsbank (KfW - the German Bank), UNFPA,
and the Global Fund. Wrap around funding includes integrated family planning (FP) interventions funded by
KFW with approximately US$1 million. With support from KFW, PSI will sell Social Marketing FP products
nationwide, including Oral Contraceptives, and provide support and training to private FP providers in
Kampong Thom and Kampot provinces. The program is intended to equip birth spacing (BS) providers with
the knowledge and skills to appropriately counsel their clients about their risk of STIs/HIV, prevention of
STIs and HIV and integrate BS messages in STI services while increasing access and demand for modern
FP methods nationally.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $580,000
Education
Water
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Under this program area, USG only supports activities for Injecting and Non-Injecting Drug Users (IDU/NIDU).
Cambodia has a concentrated epidemic with a 2008 estimated adult prevalence of 0.8%. Data is from a Consensus Workshop
held in June 2007 using the 2005 Cambodian Demographic and Health Survey (DHS), HIV Sentinel Surveillance (HSS), data from
the National Institute of Statistics, Behavioral Surveillance Survey (BSS), Integrated Biological and Behavioral Survey (IBBS) and
medical literature.
The HIV/AIDS epidemic is driven by men buying sex, with drug use as an added risk factor among many persons engaged in high
risk behaviors (MARPs). Small drug use surveys in urban areas indicate an alarming increase in drug use, including injecting. In
2004, 6% of non-injecting street children/youth who accepted counseling and testing were HIV+ while 31% of injectors tested
positive. A 2003 survey in a USG focus province showed 25% of direct female sex workers (FSW), 11% of military, 7% of male
casino workers, and 7% of indirect FSW used methamphetamines. Data from 2004 in Phnom Penh and Poipet reported injecting
drug users engaged in high-risk injection, selling blood to buy drugs, group sex (M/F), multiple partners, and transactional sex.
Males reported sex with men and women, and FSW. Forty percent of participants reported not always/never using condoms.
Amphetamine-type stimulants (ATS) are the most popular drugs with inhalants a major problem among street youth. Heroin is
inexpensive, very pure, and widely available in cities.
More recent data from a targeted survey among karaoke women with sweethearts reported that 83% have tried drugs, 7% have
ever injected drugs, and 20% have more than one sweetheart. ‘Sweethearts' can range from a similar age boy/girlfriend
relationship to a long-term client or ‘Ta-Ta' (literally grandfather, but actually ‘sugar daddy') who may not specifically pay for sex
but provides gifts and/or money. Data from a targeted survey among sexually active men with sweethearts reported that 18%
were married, 16% had more than one sweetheart, 85% paid for sex in the past 12 months, and 16% reported having ever tried
drugs, with less than 1% reporting ever injecting drugs.
A 2007 report by the National Authority for Combating Drugs (NACD) stated that existing estimates of the population size of illicit
drug users in Cambodia range from around 6,000 to 40,000, and within this group, 600 to 10,000 are injecting drug users (most of
whom are assumed to be heroin users). The official 2008 NACD estimate of drug users is around 6,000, while UN agencies
continue to believe its closer to 48,000. These ranges clearly illustrate the lack of reliable data on this population. Earlier this
year, the National Center for HIV/AIDS, Dermatology and STIs (NCHADS) conducted an IDU/NIDU population size estimate and
HIV prevalence survey; data from that survey are expected to be released by the end of calendar year 2008.
In 2008, methadone maintenance substitution therapy was initiated at the National Centre for Drug Dependence Treatment at the
Khmer Soviet Friendship Hospital in Phnom Penh with support from the Global Fund. This pilot methadone program will be
evaluated at one year, and if successful, will be expanded to reach more opioid dependent people who volunteer for the service.
Dispensing of methadone at different sites, including community based and mobile methadone clinics will be investigated pending
the results of the evaluation.
USG supported the development of the NACD's National Strategic Plan (NSP) for Illicit Drug Use Related HIV/AID which lays out
5 objectives: (1) to expand access to HIV (and associated infectious diseases) prevention information, services and commodities
for people who use illicit drugs, those at risk of illicit drug use, their sexual partners and families; (2) to expand access to HIV
(opportunistic infections and related infectious diseases) treatment, care and psychosocial support services for people who use
drugs; (3) to provide a range of options for treatment of drug dependence and associated mental illness using evidence-based
strategies; (4) to create an enabling environment (including related law, policy, quality surveillance, research, advocacy and
community engagement) which supports interventions to prevent and treat HIV and AIDS in illicit drug users; and (5) to develop
capacity of the Illicit Drugs Related HIV/AIDS working group, secretariat and implementing partners (including monitoring and
evaluation capacity). Funding for implementation of the strategic plan is being provided by multiple donors, including USG,
AusAID, SIDA, the Global Fund and several UN agencies.
Also in FY 2008, in collaboration with the NACD, the National Program for Mental Health, the Ministry of Social Affairs, WHO and
UNODC, the USG supported the development and distribution of an edition of the ‘Health Messenger', the only medical health
journal produced in Cambodia, on illicit drugs. Contents ranged from basic information on drugs (ATS, yama, etc.) to drug
dependency, rehabilitation, relapse and prevention. The journal was distributed to over 20,000 RGC health staff and NGOs.
In FY 2009, IDU/NIDU programming and messages will continue to be integrated into HIV prevention initiatives targeting MARPs.
Activities will include drug use prevention, harm reduction, addiction counseling, drug use support groups, needle and syringe
exchange (funded by the Global Fund and AusAID), and referrals to HIV and drug use care and treatment services. Awareness
raising and sensitization activities will target the broader community including key influential leaders, parents and local authorities
in order to promote awareness of drug-related HIV risk. Technical assistance will also continue to be provided to local
organizations and other stakeholders working with drug using MARPs, including training on topics dealing with ATS use and
methadone maintenance treatment. Local NGOs will continue to provide mobile VCT (Voluntary Counseling and Testing) and STI
(Sexually Transmitted Infection) services to DU/IDU populations, and OI/ART, clinical care, and supportive services to People
Living with HIV/AIDS drug users.
USG activities are implemented in collaboration with the NACD, the Ministry of Interior (MoI), UN agencies and other stakeholders
to implement, manage and monitor minimum standards in targeted drug rehabilitation centers and prisons. USG partners actively
participate on the Illicit Drugs related HIV/AIDS Working Group (DHAWG), co-chaired by NACD and the National AIDS Authority
(NAA). In 2009, AusAID will begin implementation of its HIV/AIDS Regional Program (HAARP) which aims to improve the quality
and effectiveness of harm reduction approaches in the region and scale-up harm reduction responses in Burma, Cambodia,
China, Laos and Vietnam. In Cambodia, HAARP will be implemented through four NGOs, three of which are funded by USG,
thus HAARP funds will increase the impact of USG activities among IDU/NIDU. USG also works with the RGC and other
stakeholders to increase public awareness about the impact of drug use and HIV prevention during national events, such as
International Day against Drug Abuse and Illicit Trafficking, World AIDS Day and the Water Festival.
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $607,865
Table 3.3.06:
PSI will employ an evidence-based approach to project implementation, with research and strategic
information forming a foundation for all program activities. Research and project monitoring and evaluation
employed for this project will focus on the production of timely, actionable data that project managers will
use to design and manage effective social marketing and behavior change interventions (BCI) for HIV. All
information is disseminated to program partners, the Royal Government of Cambodia (RGC), and other
institutions. PSI studies on high risk groups and behaviors provide complementary information to the
system of surveillance surveys under NCHADS. Three factors will ensure research results are optimized in
meeting programmatic needs: the involvement of project stakeholders and partners from the beginning to
the end of the research process; a focus on research that identifies factors that can be influenced by
program managers; and application of rigorous methodologies that lend credibility, acceptance, and use of
results to inform program interventions.
Table 3.3.17:
In FY 2009, PSI will strengthen NGO capacity through the United Health Network (UHN) initiative. Created
in 2002 with USAID funding, UHN has grown to 36 members, mostly local NGOs, whom PSI will assist in
social marketing of its health products and behavior change communications (BCC). The training includes
product related information (including proper storage) and selling techniques with the goal of increasing
access among at-risk communities served by the UHN members. These include, among others, commercial
sex workers, men who have sex with men, and vulnerable populations such as garment factory workers and
migrant workers.
In addition to selling the products, UHN members disseminate key BCC messages through their peer-
education and other outreach initiatives. PSI will continue to develop complementary BCC materials and
tools, train UHN members on their use and provide them with materials.
Additionally, PSI will contribute to public health system strengthening and policy formulation by being an
active member in several technical working groups including the National Condom Working Group and the
National AIDS Authority (NAA) Advocacy and Communication Working Group.
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Workplace Programs
Table 3.3.18:
