The program goal is to increase healthy behaviors in order to reduce HIV/AIDS transmission among MARPs (most-at-risk populations) and other vulnerable populations. These healthy behaviors include increased condom use, reduced number of sexual partners, and increased access to HIV testing.

The PrevenSida project was designed to increase the capacities of local (in Managua, Chinandega, Chontales, Granada, Leon, Masaya, Rivas, and Región Autónoma Atlántico Norte/Región Autónoma Atlántico Sur) NGOs working on HIV/AIDS to provide prevention services for people living with HIV (PLHIV) and MARPs. By doing this, NGOs will be increasingly involved in the national response to HIV/AIDS. These NGOs are receiving intensive training in financial, administrative, and technical aspects to improve the quality of the services they provide to their peers. At the end of the project in 2015, at least 20 NGOs will be able to continue providing these services with high-quality technical standards and managing funds from different funding sources in a transparent and accountable way.

Other results include reducing stigma and discrimination of MARPs and PLHIV and improving access to and quality of HIV/AIDS prevention services for MARPs from NGO service providers.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? No

At the community/NGO level, the project will promote the organizationof Support groups using peers and involving MARPS. These groups will work on training for community counselors, educational activities for PLWA, home visits, ARV treatment follow-up including promoting adherence to ARV treatment, corordination with the MOH, psychological support, depression prevention, reduction of stigma and discrimination at community level, behavior change communication, nutrition, family counseling and HIV prevention messages,

Currently there are eight alternative centers that provide VCT and perform other laboratory testes. The project will support NGOs laboratories to improve their quality. They are: Fundacion Xochiquetzal, Profamilia, Si Mujer, CEPRESI, CEPS, XILONEM, Womens Center of Masaya, and IXCHEN. These alternative centers will have theircapacity improved to assure quality in VCT provision.

The NGOs that work in HIV prevention for MARPS play an important role in the decision making processesfor policy development. To effectively perform this role, NGO staff require capacity building to be able totake appropriate action to bring about needed policy change orto reaffirm support of existing policies and programs.The PrevenSida program will support NGOs to improve the quality of their involvement in national, local and departmental dialogue. This support includes: helping NGOs to network and coalesce around common objective and goals, sharing data and information, institutional strengthening, and providing financial resources.For a national response to HIV/AIDS that is comprehensive and integrated, all actors involved must actstrategically: recognizing the health-epidemiological context (status of the epidemic with itsanalysis, interpretation, surveillance, and monitoring and evaluation based on the management ofknowledge generated by these activities), complying with the legal framework (current national laws andcommitments to HIV and AIDS with a human rights approach), working with multi-sector vision (MINSA-sectorrectory-and inter-sector-CONISIDA), with greater knowledge and technical security (state of the art in bestpractices in AIDS prevention), and in an organized manner to strengthen their participation (coverage withactive MARPS participation in strong and representative organizations). These organizations will intervenemore effectively if they know what is happening in terms of the epidemic and the response at national andregional level, key players, what they do, why they do it, where and with whom they do in order to improvetheir opportunities to contribute, produce and receive benefits in the national response. They willmore easily understand why they must work with allies and according to national plans and strategieswhose activities are designed and implemented in a consensual manner and in cooperation with otherpartner organizations. Strategies for improving the participation of NGOs representing MARPS and PLHIV will includeimprovements in the processes of strategic information collection, dissemination, bridging information gapsand the establishment of an M&E system. Through sub partner CIES this project will build a critical mass of professionals and technicians in the service of national wellbeing, leading to an educated society, inclusive and egalitarian, with a propensity for solidarity which contributes to the pursuit of development and wellbeing.

The approach to capacity building is structured holistically to encourage an enablingenvironment, ensuring appropriate policies and norms and assuring that national systems and structures arecapable of managing the local HIV prevention systems. Capacity building activities are framedaround the larger goal of unlocking local skills and equipping partners to address both immediate HIVprevention needs (in terms of tools, materials and human resources) and long-term system development.Through focused training and mentorship to empower health and education managers, the PrevenSidaprogram contributes to the continuity of the HIV prevention program through capacity building activities which bring together partners from the civil society.The NGO personnel (100 health workers at managerial level) will receive training and mentoring on a combination of organizational fundamentals such as clear mission and vision,, planning, network structure, solid financial and management practices, flexibility and adaptation to environmental changes, innovation, commitment to leadership and relationships. The project will provide the NGOs with the skills to develop the structures to strengthen their financial management processes, a necessary component for the sustainability of any organization. By providing the NGOs with the tools necessary to improve their financial tracking, budgeting, management, as well as linking them with funding sources, they will in turn be more able to attract and receive future funding from other sources, further increasing sustainability past the life of the project.The participating NGOs will have the opportunity to gain and share abilities and competencies with highlevel TA providers, using methodologies and pedagogical knowledge where the participant will developskills in technical and financial administrative management, strategic and operative planning, networking,monitoring and evaluation (M&E), knowledge of the legal framework, management change and usingtechnology for planning, learning, implementing and management. Not only will these skills enhance theirabilities to run their organizations and scale up their prevention efforts, but they will also increase theirability to report on their results achieved. This will allow the NGOs to present their efficiencies andsuccesses more comprehensively to donors, strengthening their fundraising capabilities. The program will also contribute to HSS by training 500 health care workers from the NGOs: 200 in outreach with MARPS, 30 in testing and counseling and 70 in adult care and support.

Implementation activities at the NGO level include developing operating agreements that describethe roles and responsibilities of all partners in VCT services and ensuring funding mechanisms;conducting training for counselors, counseling supervisors and site staff; and procuring HIV test kits.NGO/technical partner laboratory personnel will establish an inventory, distribution and storage systemfor rapid HIV test kits as well as an HIV testing quality control procedure, to be implemented incollaboration with the national program.NGOs that are conducting BCC activities or counselors and VCT site coordinators need to be trained ininterpersonal skills to ensure potential clients understand the meaning of their decision to obtain VCT;assess their risk; adopt positive behavior changes; become aware of care and support services within theirlocality (as described for the national level but limited to the district/province/NGO catchment area). NGOmonitoring and evaluation plans and tools will be developed that provide relevant information to manageVCT services that are consistent with national-level plans. Site-level monitoring activities will includemeasures for service performance, service use, service delivery, adherence toprotocols and confidentiality, staff performance and program effectiveness. These site-level processindicators may be reported but they should also be used as a tool for service delivery management.Furthermore, NGOs must develop or adopt ongoing counseling and testing quality assurance measures.Other models to expand the reach of VCT include mobile VCT which offers temporary, rotating servicesfor hard-to-reach groups such as injecting drug users, sex workers and truck drivers with the benefits ofimproved access for populations not using stand-alone services or for rural populations. The use of mobileunits increases VCT access and education activities for HIV/AIDS prevention. The project will perform 10,000 VCT services to MARPS throught the subgrants with NGOS.

A key focus of the PrevenSida program is to help NGOs identify, customize, implement and scale-upthe best practices in HIV prevention that are already available but under-utilized, rather than creating newmaterials or programs. The emphasis of HIV prevention strategies is to link to the expanding network of HIV support services and ensure that prevention messages are coordinated to facilitate the development of the broader HIV response and create linkages with services. The project will help NGOs assess existing outlets for HIV prevention information, to improve the quality and content of messages, and expand their coverage. PrevenSida will work with partners at the local level to lead the development of innovative approaches to reach target audiences, drawing on best examples from within Nicaragua as well as other HIV endemic settings. The medium and message must be gender-sensitive and chosen carefully to ensure that the correct target audience is reached, particularly when attempting to reach groups such as MSM, FSWs, or urban youth. The program will assist NGOs to explore low-cost/high-impact media initiatives and explore partnerships with the private sector. In order to sustain long-term behavior change and promote HIV prevention, it will be necessary to address the incorrect and inequitable beliefs and attitudes of men and adolescents which contribute to sexual transmission of HIV. The PrevenSida program will work with men, including educators, traditional leaders, business owners, and fathers to involve them in creating messages targeting men and young men to address the behaviors which facilitate HIV transmission, including intergenerational and transactional sexual relationships, multiple concurrent partnerships and sexual violence. The program will work with communities to identify strong male role models from various backgrounds to support young men to adopt positive behaviors to keep themselves and their partners healthy. This component is one of the most important of the Prevensida project and it is implemented through subgrants with at leas 20 NGOS that using peer approach are direct providers of these services. The basic package of preventive services includes: peer BCC, VCT, condom distribution, reterral to STI services, referral to drug prevention and treatment programs, referral to other MOH services (HIV services, family planning, ARV treatment, nutrition, chronic disease programs, etc), alcohol and drugs prevention, vocational training, women's shelters, etc.