Noted April 16, 2008:

Funding for Family Matters parent-child communication activities is being split between:

1. The originally identified partner, CDC (fomerly identified in COP08 as TBD CDC), which will provide

translation and technical assistance, and

2. AB implementing partner Hope Worldwide, which will pilot implementation.

The USG/Cote d'Ivoire program supports comprehensive HIV/AIDS prevention interventions targeting the

general population and specific sub-populations in urban and rural areas across the country.

Primary HIV prevention priorities include behavior change to delay sexual debut and promote life skills with

positive gender roles for in- and out-of-school children and youth; a decrease in cross-generational and

coerced sexual relationships; the promotion of fidelity coupled with HIV testing within sexual partnerships;

decreased hospital-related infection through expanded blood-safety and injection-safety programs; and risk

reduction among high-risk populations.

In FY07, PEPFAR is reinforcing and expanding effective programs and introducing new interventions to

affect pervasive behaviors and attitudes in the general population and high-risk behaviors among identified

groups. Targeting of interventions responds to available data, with continued concentrations in the urban

South (Abidjan, San Pedro) and prioritizing of other high-prevalence areas through local sub-grants and

coordinated site selection.

Abstinence and Be Faithful (AB) components target adult men and women as well as youth. These include

working with women and girls to emphasize linkages to prevention of mother-to-child transmission

(PMTCT), working with men and boys to promote messages about gender equity and violence, and working

with children and youth through life-skills and Sports for Life programs. All sexually active target populations

receive messages about the importance of HIV counseling and testing.

Based on lessons learned, available data, and the new National Strategic HIV/AIDS Plan 2006-2010, the

USG focuses on the following prevention priorities: (1) locally appropriate responses to address major

sources of new infections, (2) expanded reach of behavior change communication (BCC) messages

through mass-media and community-level outreach campaigns, (3) support of local religious, professional,

and other networks that influence community values, (4) research to assess and refine prevention

approaches, (5) innovative strategies for promoting delay of sexual debut and partner reduction, and (6)

secondary HIV prevention for HIV-infected individuals and sero-discordant couples.

The USG currently funds 12 prime partners in prevention, of which 10 have multiple sub-partners

(NGO/CBO/FBOs). Among the prime partners are two government agencies, six international NGOs, and

three local NGOs. Sub-partners work at the community level to promote delayed sexual debut, partner

reduction, correct and consistent condom use, increased HIV knowledge and awareness, decreased HIV

stigma, and greater uptake of HIV testing and counseling, including couples and family testing.

These areas will continue to be priorities in FY08, with an added focus on identifying effective activities and

assessing the impact of programs. In the AB program area, particular emphasis will be placed on involving

parents in the promotion of delay of sexual debut and secondary abstinence as critical elements in multi-

component intervention programs to improve adolescents' sexual and reproductive health. In FY08, the

USG will fund a partner to adapt, implement, and evaluate a parent/child communication program that was

developed, implemented, and evaluated in the United States. The evidence-based intervention curriculum

targets parents or guardians of 9- to 12-year olds, bringing them together in small groups to promote

positive parenting practices and more effective parent/child communication about sexuality and sexual risk

reduction. An adaptation of the U.S. curriculum has been implemented in Kenya, and preliminary analysis

from a recent assessment, 15 months post-intervention, indicates a sustained positive effect in terms of

parenting and communication skills reported separately by participants and their children.

The partner will plan the intervention, including adaptations of the curriculum and evaluation of its impact,

with the Ministry of Health, the Ministry of the Fight Against AIDS, and other relevant HIV prevention

stakeholders. With direction from this group, PEPFAR partners will approach parents and community and

religious leaders in selected communities to determine their interest in implementing the program. The lead

partner will then implement and evaluate the program with several PEPFAR prime and sub-partners at the

community level. If the adapted program is determined to be effective, the partner will plan national scale-up

by multiple prime partners in FY09.

The partner will report to the USG strategic information team quarterly program results and ad hoc

requested program data. To help build and strengthen a unified national M&E system, the partner will

participate in quarterly SI meetings and will implement decisions taken during these meetings.

The USG/Cote d'Ivoire program supports comprehensive HIV/AIDS prevention interventions targeting the

general population and specific sub-populations in urban and rural areas across the country.

Primary HIV prevention priorities include behavior change to delay sexual debut and promote life skills with

positive gender roles for in- and out-of-school children and youth; a decrease in cross-generational and

coerced sexual relationships; the promotion of fidelity coupled with HIV testing within sexual partnerships;

decreased hospital-related infection through expanded blood-safety and injection-safety programs; and risk

reduction among high-risk populations.

In FY07, PEPFAR is reinforcing and expanding effective programs and introducing new interventions to

affect pervasive behaviors and attitudes in the general population and high-risk behaviors among identified

groups. Targeting of interventions responds to available data, with continued concentrations in the urban

South (Abidjan, San Pedro) and prioritizing of other high-prevalence areas through local sub-grants and

coordinated site selection.

Abstinence and Be Faithful (AB) components target adult men and women as well as youth. These include

working with women and girls to emphasize linkages to prevention of mother-to-child transmission

(PMTCT), working with men and boys to promote messages about gender equity and violence, and working

with children and youth through life-skills and Sports for Life programs. All sexually active target populations

receive messages about the importance of HIV counseling and testing.

Based on lessons learned, available data, and the new National Strategic HIV/AIDS Plan 2006-2010, the

USG focuses on the following prevention priorities: (1) locally appropriate responses to address major

sources of new infections, (2) expanded reach of behavior change communication (BCC) messages

through mass-media and community-level outreach campaigns, (3) support of local religious, professional,

and other networks that influence community values, (4) research to assess and refine prevention

approaches, (5) innovative strategies for promoting delay of sexual debut and partner reduction, and (6)

secondary HIV prevention for HIV-infected individuals and sero-discordant couples.

The USG currently funds 12 prime partners in prevention, of which 10 have multiple sub-partners

(NGO/CBO/FBOs). Among the prime partners are two government agencies, six international NGOs, and

three local NGOs. Sub-partners work at the community level to promote delayed sexual debut, partner

reduction, correct and consistent condom use, increased HIV knowledge and awareness, decreased HIV

stigma, and greater uptake of HIV testing and counseling, including couples and family testing.

In FY08, these priority areas will continue with an added focus on improving the overall quality of activities

and assessing the impact of programs. To achieve this goal, the USG will use AB and Condoms and Other

Prevention funds to support a partner to address prevention program quality and coordination by

determining and promoting best practices, assuring coverage and eliminating duplication among partners

and sub-partners, and strengthening capacity of partners and sub-partners through a standardized system

of capacity building. The partner will work with the Ministry of the Fight Against AIDS (MLS) to map where

community-level interventions coordinated by PEPFAR prime partners are being conducted, the proposed

content and fidelity to content of those interventions, and the proportion of target populations reached.

Interventions determined to be best practices from this exercise and from new programs evaluated (Men as

Partners) will be standardized, and all sub-partners working with relevant populations will be trained and

funded to implement them.

In addition, the partner carrying out the present activity will work with the MLS to collate and evaluate the

capacity-building tools used by all PEPFAR prime partners with their sub-partners. Based on the findings,

the partner will develop a national system for sub-partner capacity development, supervision, data

collection, monitoring, and evaluation, which all prime partners will then adopt as a standardized national

approach.

Within Cote d'Ivoire's adult HIV prevalence of 4.7%, women are more than twice as likely as men to be HIV-

positive, 6.4% vs. 2.9% (National AIDS Indicator Survey, 2005). Although no incidence surveys have been

done, the prevalence data by age group suggests that a large proportion of new infections are occurring in

women ages 20-34 years. HIV prevalence among women is 0.4% in 15- to 19-year-olds and increases to

4.5% for ages 20-24, 7.5% for ages 25-29, and 14.9% for ages 30-34 (almost triple the 5.6% rate among

men in that age group).

Efforts to target HIV intervention activities for groups that are vulnerable, marginalized, and at highest risk of

HIV infection, such as commercial sex workers, are under way in Cote d'Ivoire (FHI, PSI). However, little is

known about the characteristics, risk behaviors, and potential points of intervention of women in the general

population who may be at high risk but do not identify themselves as sex workers, such as women who

engage in transactional sex or inconsistent sex work. Identifying high-risk groups among women in the

general population and understanding their risk factors related to HIV are critical steps toward providing

appropriate prevention interventions to improve program effectiveness and meet the needs of the target

audience.

In FY08, the USG will fund a partner to conduct an assessment of HIV prevalence and risk factors among

women ages 20-34, potentially using surrogate markers such as CD4 count as an indicator of "recent

infection." Steps needed to conduct the assessment include (1) a qualitative assessment through desk

review, (2) key informant interviews and focus-group discussions to help determine the scope and

objectives of the main assessment, and (3) a cluster sample survey. Potential key informants and focus-

group participants include women recently diagnosed with HIV, female college students, female domestic

workers, women in small trades, and members of the general public.

The initial formative assessment will help determine the target population, locations, and sampling strategy

of the main assessment. A cluster sample survey with behavioral and biologic markers is one potential

methodology. The study will examine the demographic and socioeconomic characteristics, HIV status,

related risk behaviors, and access to health care among representative women. Data will help determine

how HIV prevention and care programs should target these women and identify intervention and entry

points.

Biological and behavioral data will be collected among at least 500 women in Cote d'Ivoire. As part of the

data-collection process, participants will receive educational information and discuss their personal risk

behaviors and how to keep themselves from becoming HIV-infected or transmitting HIV to their partners.

Participants will also be referred to counseling and testing services and available care and treatment

programs their area.

The implementing partner will work in collaboration with the Ministry of Health staff, who will initiate a

stakeholders meeting for input as the survey is developed. Special emphasis will be placed on ensuring

confidentiality and anonymity of study participants.

While the USG Cote d'Ivoire supports a wide range of HIV/AIDS prevention activities for the general

population as well as many highly vulnerable sub-populations, little is known about the number of Ivorian

men who have sex with men (MSM), their HIV prevalence rates, or their HIV-related risk behaviors.

Limited research from other countries suggests that anal sex, a very high-risk behavior for HIV transmission

(Vittinghoff et al, 1999), may be more prevalent in Africa than commonly assumed (Brody & Potterat, 2003).

There is also evidence that some African men have sex with both men and women (Brody & Potterat,

2003), suggesting potentially complex networks of HIV transmission. Findings from recent studies in Kenya,

Senegal, Uganda, and South Africa suggest an urgent need to implement targeted prevention and

treatment programs for MSM populations. Obtaining information on HIV prevalence and related risk

behaviors among Ivorian MSM and their male and female sex partners is an essential first step toward

designing and implementing effective and targeted prevention and care programs for this vulnerable and

underserved sub-group.

In FY08, PEPFAR will fund a partner to conduct an assessment of HIV prevalence and risk behaviors

among MSM in Abidjan, including MSM who engage in transactional sex. An initial qualitative assessment

through desk review, key informant interviews, and focus-group discussions will help determine the scope

and objectives of the main assessment. Potential key informants and focus-group participants will include

MSM, bar/hotel owners, law enforcement officers, and health officials.

Based on the initial formative assessment, a study using the respondent-driven sampling method will

examine the demographic and socio-economic characteristics of MSM in Abidjan, their HIV prevalence, HIV

risk behaviors, access to health care, and health care-seeking behaviors. Biological and behavioral data will

be collected from at least 300 MSM in Abidjan, with special emphasis on ensuring confidentiality and

anonymity of study participants. As part of the data-collection process, participants will receive educational

information and discuss their personal risk behaviors and how to keep themselves from becoming HIV-

infected or transmitting HIV to their partners. Participants will also be referred to counseling and testing

programs and, if necessary, care and treatment programs available in their area.

Study results will help determine how HIV prevention and care programs should target this population.

The partner will work in collaboration with the Ministry of Health, RIP + (the national network of PLWHA

organizations), and the Ministry of the Fight against AIDS, which will provide official support for this

assessment.

The USG/Cote d'Ivoire program supports comprehensive HIV/AIDS prevention interventions targeting the

general population and specific sub-populations in urban and rural areas across the country.

Primary HIV prevention priorities include behavior change to delay sexual debut and promote life skills with

positive gender roles for in- and out-of-school children and youth; a decrease in cross-generational and

coerced sexual relationships; the promotion of fidelity coupled with HIV testing within sexual partnerships;

decreased hospital-related infection through expanded blood-safety and injection-safety programs; and risk

reduction among high-risk populations.

In FY07, PEPFAR is reinforcing and expanding effective programs and introducing new interventions to

affect pervasive behaviors and attitudes in the general population and high-risk behaviors among identified

groups. Targeting of interventions responds to available data, with continued concentrations in the urban

South (Abidjan, San Pedro) and prioritizing of other high-prevalence areas through local sub-grants and

coordinated site selection.

Abstinence and Be Faithful (AB) components target adult men and women as well as youth. These include

working with women and girls to emphasize linkages to prevention of mother-to-child transmission

(PMTCT), working with men and boys to promote messages about gender equity and violence, and working

with children and youth through life-skills and Sports for Life programs. All sexually active target populations

receive messages about the importance of HIV counseling and testing.

Based on lessons learned, available data, and the new National Strategic HIV/AIDS Plan 2006-2010, the

USG focuses on the following prevention priorities: (1) locally appropriate responses to address major

sources of new infections, (2) expanded reach of behavior change communication (BCC) messages

through mass-media and community-level outreach campaigns, (3) support of local religious, professional,

and other networks that influence community values, (4) research to assess and refine prevention

approaches, (5) innovative strategies for promoting delay of sexual debut and partner reduction, and (6)

secondary HIV prevention for HIV-infected individuals and sero-discordant couples.

The USG currently funds 12 prime partners in prevention, of which 10 have multiple sub-partners

(NGO/CBO/FBOs). Among the prime partners are two government agencies, six international NGOs, and

three local NGOs. Sub-partners work at the community level to promote delayed sexual debut, partner

reduction, correct and consistent condom use, increased HIV knowledge and awareness, decreased HIV

stigma, and greater uptake of HIV testing and counseling, including couples and family testing.

In FY08, these priority areas will continue with an added focus on improving the overall quality of activities

and assessing the impact of programs. To achieve this goal, the USG will use Condoms and Other

Prevention and AB funds to support a partner to address prevention program quality and coordination by

determining and promoting best practices, assuring coverage and eliminating duplication among partners

and sub-partners, and strengthening capacity of partners and sub-partners through a standardized system

of capacity building. The partner will work with the Ministry of the Fight Against AIDS (MLS) to map where

community-level interventions coordinated by PEPFAR prime partners are being conducted, the proposed

content and fidelity to content of those interventions, and the proportion of target populations reached.

Interventions determined to be best practices from this exercise and from new programs evaluated as noted

in AB activities #17138 (parent/child) and #16526 (Men as Partners) will be standardized, and all sub-

partners working with relevant populations will be trained and funded to implement them.

In addition, the partner carrying out the present activity will work with the MLS to collate and evaluate the

capacity-building tools used by all PEPFAR prime partners with their sub-partners. Based on the findings,

the partner will develop a national system for sub-partner capacity development, supervision, data

collection, monitoring, and evaluation, which all prime partners will then adopt as a standardized national

approach.

The partner will report to the USG strategic information team quarterly program results and ad hoc

requested program data. To help build and strengthen a unified national M&E system, the partner will

participate in quarterly SI meetings and will implement decisions taken during these meetings.

Deleted.