N/A

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 02 - HVAB Sexual Prevention: AB

Total Planned Funding for Program Budget Code: $1,393,087

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

The 2006 ANC surveillance estimates DRC's HIV prevalence rate at 4.1%. DHS data from 2007 estimates the HIV prevalence

rate at 1.3% among the population between 15-49 years of age. The prevalence rate is higher among women (1.6%) than men

(0.9%). For women, those who are the most educated and wealthiest are at greatest risk (3.2% and 2.3%, respectively).

According to marital status, widowed women have the highest prevalence (9.3%). While nearly all women and men have heard of

AIDS, only 15% of women and 22% of men 15-49 years of age have complete knowledge of HIV/AIDS transmission and

prevention methods.

The epidemiological findings on HIV/AIDS in the DRC highlight three key findings: (1) the number of infected women is increasing;

(2) the epidemic is spreading to rural areas with Lodja and Karawa having the two highest prevalence rates among pregnant

women; and (3) the majority of new cases are diagnosed among people less than 24 years of age. Taken together, it is

increasingly evident that although the DRC is classified as a low prevalence country, there are concentrated epidemics in

geographic ‘hotspots' and among specific sub-populations throughout the country. The provincial capitals of Kasai Oriental,

Katanga and Kinshasa reveal prevalence rates of 24.5%, 23.3% and 18.4%, respectively among commercial sex workers.

Many prevalence hotspots are in areas where higher risk populations often congregate: border crossings, transport corridors,

ports, and regions with a large military presence. PNLS reports that HIV prevalence among commercial sex workers is 16.9%.

Nationally, truckers have 3.3% prevalence, but in Katanga (a USG focus province), long-haul truckers from southern African

countries have a 7.8% prevalence. The need for increased surveillance of hidden, high-risk populations remains; improved

surveillance would facilitate resource targeting and effective responses to the epidemic. Although there is little surveillance data

on high-risk groups, behavioral data supports a strategic focus on prevention with high-risk groups. Working with high-risk

populations helps the USG assure measurable impact on prevention in a resource limited environment.

Multiple/concurrent sex partners are common. The BSS positive indicates 37.3% of truckers reported having sex with non-regular,

non-cohabitating partners in the past 12 months. Miners are another targeted high risk group with 55% reporting two or more sex

partners in the last 12 months. Among the military, 32.9% report two or more sex partners in the last 12 months. HIV prevalence

rates among street children are unknown, however the proportions with multiple partners are shockingly high. According to the

BSS positive, 75.1% of street boys and 81.1% of street girls report two or more sexual partners.

Rates of exchanging sex for money are high, while rates of condom use are relatively low. About half of the transient men

surveyed said they had paid for sex in the past year. Condom use is low, with 26% reporting condom use during the last sexual

encounter with a CSW, 14% with occasional partners, and 4% with regular partners. Among truckers and the military, condom use

with non-regular partners is nearly 45%, but condom use with regular partners remains under 10% for both groups. The BSS

positive reports that 72% of CSW acknowledged using a condom with their last client.

Women and girls represent 52% of all HIV infections in DRC. Gender inequities, war, and instability have resulted in widespread

rape, sexual violence, and abuse. The horrifying level of violence against women in eastern Congo likely affects gender norms

overall in Congolese society. Addressing male norms, behaviors towards women, gender-based violence, and social norms

related to multiple/concurrent partnerships and transactional sex are key priorities for preventing new infections.

Among youth, 61% of young women and 56% of young men between 15-24 years of age have had sex before their 18th birthday.

Thirty-five percent of young women between 15-24 years of age report having had high risk sex in the past year, only 17%

reported using a condom. Among young men, 82% reported having had high risk sex in the past year and of those only 27% used

a condom. Cross generational sex is cited as a common occurrence in DRC with 13% of girls between 15-19 years of age

reported having sex in the past year with a man 10 or more years older. Prevention programs for youth and the general population

lack adequate investment and coverage. Behavioral data indicates a need for increased attention to high risk behaviors among

the general population. Key priorities include promoting the delay of sexual debut, reducing multiple and concurrent partners, and

addressing other social norms that increase HIV risk.

Challenges

A weak civil society and social taboos limit opportunities for organizations to engage in community dialogues around harmful

social norms and risky behaviors. The USG has limited resources to meet the prevention needs of millions of Congolese in the

general population. Given the limited funds for prevention in DRC, the USG will continue to prioritize targeted, comprehensive

prevention programs among persons engaging in high-risk behavior while also addressing risks for youth and the general

population.

Leveraging and Coordination

USG partners working with high risk groups and behavioral change communication (BCC) partners are also supported by the

Global Fund and the World Bank/MAP. As described previously, delays in implementation of MAP programming has resulted in

MAP prioritizing HIV work in health zones that have existing well-established World Bank support for other health programs. This

is expected to facilitate rapid roll out of BCC programs which will serve as a platform for effective national level programming

supported by the Global Fund and MAP.

Other USG activities implemented in common geographic areas are leveraged, such as the USAID-funded protection program

that aims to reduce the number of separated and abandoned children as well as assist victims of gender-based violence. USG

also works with DFID on their BCC programming in Kinshasa, including the use of DFID-developed materials.

Currently, USG provides limited support for prevention for discordant couples. By working with CT, PMTCT, and home-based care

programs, USG is expanding efforts to address this important population. The Global Fund and MAP are being encouraged to

address discordance. OVC programs will also help identify high-risk youth in need of comprehensive prevention services.

Current USG Support

With prevalence and behavioral data clearly delineating prevention needs among high-risk groups, targeting persons engaging in

high-risk behavior remains a key priority to DRC prevention efforts. The current program works with the communities to

disseminate balanced prevention messages that focus on both AB and OP as well as to discuss social norms that increase the

spread of HIV.

As part of BCC programming in Matadi, Bukavu, Lubumbashi, Kasumbalesa and Boma, a media campaign called "Je

m'engage" (‘I pledge') target youth to delay sexual debut. The campaign is reinforced among school aged youth through

interpersonal communication activities. The program mobilizes CBOs/FBOs to engage youth in activities and life skills building to

delay sexual debut and reduce the number of sexual partners. The program also attempts to empower parents and to engage

youth in dialogue about sex.

The "Je m'engage" campaign also uses mobile video units (MVU) to increase risk perception among adults. Community

screenings of MVUs are followed by question and answer sessions with trained facilitators. MVUs are accompanied by mobile

VCT units or provide referrals to VCT services. Community dialogue regarding transactional and trans-generational sex, alcohol

and drug abuse, coercion, and other harmful practices is also underway as part of the BCC program.

USG Public Diplomacy, through its Congo American Language Institute, has trained 500 secondary school English teachers from

five cities in HIV/AIDS awareness. These teachers will reach 165,000 students. The USG also drew in top Congolese musicians

to create a music CD and related documentary entitled "ABCD - Rien que la Vérité" ("Nothing but the Truth") and sparked much

needed public discourse on HIV/AIDS. The musicians performed a large concert in Kinshasa in May 2007, attracting many

important public figures with on-site VCT services.

USG supports the regional ROADS II to deliver prevention services at the DRC/Rwanda and the DRC/Burundi borders. The

ROADS II project targets CSWs, truckers, out-of-school youth, low income women, and government workers. The ROADS II

project uses the regionally branded ‘SafeTStop' to deliver coordinated messages and services to mobile populations along the

transport routes. The project is working with 10 transport associations to promote condom use, fidelity, partner reduction, C&T,

Sexually Transmitted Infection (STI) treatment seeking, care treatment for other infections, and stigma reduction, as well as

reduced gender-based violence and alcohol abuse. A mix of condom social marketing and free distributions is used. In addition,

programs are linked to the LifeWorks Partnership, which creates jobs for marginalized, vulnerable people in East and Central

Africa, including low-income women and CSWs.

The program strengthens campaigns initiated by community associations and youth groups called "clusters" to reduce alcohol

abuse and domestic violence among drivers and men in the community. Youth peer-educators are trained to provide HIV

prevention messages that promote AB behaviors, CT before marriage, and other protective behaviors. In collaboration with AFL-

CIO's Solidarity Center, ROADS II will train teachers in adult learning techniques in order to provide transportation workers with

skills and alternative activities in the evening. All of these activities will leverage other USG programs by linking clients to

programs where appropriate referral services are available.

Beyond the focus cities, individuals can access a toll-free HIV/AIDS Hotline "Ligne Verte" for HIV information and referral to the

nearest services. Hotline counselors are trained to answer questions and discuss personal risk reduction strategies. The hotline

receives 35,000 calls per month.

Congolese military personnel and their families are reached through community outreach and MVUs. Peer education programs

focus on reducing sexual coercion, transactional sex, and alcohol and drug abuse. The USG is also working with an association of

six mining companies through a GDA to improve access to prevention services for miners, both artisanal and professional, in

Katanga. The projects provide a prevention program for miners that include peer education, MVU, group discussion and referral to

testing. The GDA in Katanga leverages other USAID and private investments including education, democracy and governance,

civil society strengthening, microfinance, and other health services.

USG FY09 Support

With FY09 funds the following populations will continue to receive prevention services described above: school-aged youth and

adults in community forums in the five cities, church groups, transient men with money and other members of the community

along transport corridors, the military and their families, mining communities, OVC, and street youth. Future activities will also

focus on addressing risks around concurrent partnerships.

Building on the success of FY 07 efforts, the USG will create a more robust curriculum for addressing behavior change with an

English language program that reaches 165,000 school-aged youth. There will be opportunities to use the music CD entitled

"ABCD - Rien que la Vérité" to reinforce existing behavior change programs so that efforts are mutually reinforcing.

Additional activities aimed at involving musicians in prevention activities will help leverage the impact of the CD among youth and

other target audiences. The USG is also planning to create a serial drama for both radio and television targeting HIV behavior

change, and will involve the musicians who participated in the CD project. In addition to the programs for English teachers, PD will

expand the curriculum for secondary school teachers to include French language materials and teacher training.

With FY09 funds, the USG will continue to build on successful programming directed at high-risk groups with comprehensive ABC

messages through targeted, site-based interventions using a new integrated HIV bilateral program (mechanism TBD). The

comprehensive prevention programs in Lubumbashi, Matadi, and Bukavu will continue to focus on CSWs, truckers, miners, the

military, IDPs, and refugees. In addition, FY09 funds will support the expansion of the Lubumbashi HIV program through this

bilateral TBD mechanism in Kasumbalesa, Kolwezi, Kipushi and Likasi. These areas are located outside of Lubumbashi along a

major trucking route which starts in South Africa and travels north through Zimbabwe and Zambia into Lubumbashi through

Kasumbalesa. Continued expansion of programs to other ‘hotspot' areas and new high risk target groups, street youth, and

transient workforces, high risk in general population will be prioritized and determined by increased availability of funding, the

Compact Program and HIV prevalence rates. BCC activities among high-risk populations will be complemented with the targeted

social marketing of 10 million condoms annually. Referrals and linkages to VCT and STI services will continue.

ROADS II will support the activities already developed under the ROADS I program along the Rwanda/Bukavu border. A second

recreation center will be launched in 2009 at a truck stop in Uvira on the Burundi border to complement ongoing activities.

Continued support to GDA programs with mining companies will increase coverage of miners, a key high-risk population as part of

this new mechanism especially in Lubumbashi.

FY09 funds will also be used to continue support for the HIV Hotline's capacity. The referral directory service will be updated

annually.

USG will also expand efforts to reach the military with behavior change programming. Scaling up current HIV prevention activities

with the Congolese Armed Forces (FARDC) will contribute to a reduction in HIV/AIDS transmission among military personnel. The

DOD program will aim to increase personal HIV/AIDS risk perception and improve access to condoms among military personnel

and their families in conjunction with VCT scale-up efforts. These objectives will be achieved by training master trainers and peer

educators, by "troop level" HIV/AIDS prevention education and by behavior change communication.*

Table 3.3.02: