C-Change seeks to contribute to the prevention of new HIV infections through the implementation of combination prevention in one of Swaziland's four administrative districts and to expand access to essential prevention services and commodities for chiefdoms in three community councils in the target region.

C-Change has supported the completion of Swaziland's strategy for social and behavior change communication (SBCC) for prevention, helped to strengthen the National Emergency Response Council on HIV/AIDS's (NERCHA) role as coordinator of the national response and has built the capacity of response agencies to integrate evidence-based, community informed planning in the design and implementation of prevention interventions. The lessons from these experiences would be brought to bear on C-Change's expanded efforts proposed for Swaziland, enabling faster start up and surer steps towards preventing new HIV infections. C-Change will contribute to the reduction in HIV incidence through:

1. strengthening of community service structures in one administrative region to integrate evidence-based, community-informed SBCC activities for HIV prevention

2. expanding access to essential prevention services and commodities in one urban and two rural councils within the same region

3. supporting the National Prevention Technical Working Group (TWG) to ensure that leadership of prevention efforts are well-coordinated

This intervention is linked to the sexual prevention objective in the Partnership Framework and intervention area ?coordinated and comprehensive approach to sexual prevention using social and behavioral change communication. It targets one of Swaziland's four administrative districts, covering 15-30 Chiefdoms. The program aims to reach 14,060 individuals aged 10 and older through a mix of SBCC approaches.

Gender is a cross-cutting issue for this activity, and gender analysis and gender equity promotion are integrated into all areas of programming. From abstinence to MCP reduction, gender differentiated messaging and possibly varied vehicles and venues may be required to reach the same behavioral objectives for females and males.

Women's Legal Rights: activities for building awareness of rights and protection of girls and young women against sexual abuse are integrated in activities to promote abstinence and in the training of CBOs, FBOs and traditional leaders.

Increasing Gender Equity: programming is designed to address gender equity including direct engagement with male norms and behaviors.

Male Norms: addressed explicitly in activities for males as secondary targets for abstinence promotion

C-Change's M&E Plan will consist of monthly data collection and aggregation; ongoing analysis; and quarterly reporting to PEPFAR, the Academy for Educational Development (AED) and community stakeholders. M&E for program will be led by one program officer and supported by M&E Specialist from AED, Washington.

A baseline on comprehensive knowledge of HIV prevention; attitudes; HIV-risk and prevention behaviors; and access to key prevention services and commodities will be undertaken in the communities targeted at the start and end of the intervention. In conjunction with other available country data, this baseline survey will provide formative data for the SBCC strategy.

A comprehensive set of indicators will be formulated to track and monitor program activities and impact. These will be monitored over the life of the program, collected at the end of discrete activities, aggregated on a monthly basis at program site level and reported to the country office for further aggregation, analysis and decision making. Data collection instruments and protocols will be developed with community input to ensure comprehension and ease of use. Where appropriate, instruments already developed for national coordination will be used and collection cycles aligned, again for ease of compliance. Reported data will be maintained in the country office and verified through periodic data audits at community level.

This intervention will work through structures at community level like kagogo centers, neighborhood care points, schools, churches, and indigenous community groups to enrich existing programs with activities for HIV prevention. Age appropriate, audience tailored communication activities will be introduced through trained community members in the Chiefdoms targeted.

The use of existing community structures increases the likelihood that the communities involved will be able to continue hosting program activities. The inclusion of community members and longstanding community institutions in the design and running of the program reinforce local ownership while the training and mentoring of residents helps to build community capacity for sustained implementation. Finally, by working with national and regional partners, the communities will be more likely to access those resources for ongoing advice and support

C-Change will infuse age appropriate sexuality education with integrated human rights and gender equity promotion into existing community program for youth ten years and older guided by a set curriculum and facilitated by trained adults affiliated with those community programs. C-Change will work with materials already under development in country, amending if needed, to include the components referenced. Adult facilitators will be recruited from FBOs, cultural leaders and existing CBOs. Education activities will be complemented by print media, edutainment videos and debates among young people.

Parents and guardians of children will be targeted as well with discussion and coaching sessions on parent-child communications around sexuality and healthy sexual development, information of sex abuse rights and supports for redress if needed. These sessions will be guided by set curriculum and trained facilitators, complemented by expert guest presenters.

Cultural leaders and the community at large will be mobilized to recognize and tackle social norms and environmental conditions that discourage abstinence or facilitate sexual abuse of children and adolescents. Activities include meetings hosted and facilitated by community leaders with support from trained facilitators.

There will be a print media campaign to promote and reinforce motivation to abstain targeting young people, parents and other adults built on information gathered through formative research.

Finally, refresher meetings on laws and policy governing the management of rape and sexual offenses will be convened for law enforcement personnel. These sessions will include links to medical and psychosocial supports for survivors. In turn, they will be expected to provide community talks on these laws, strengthening links to support for the community.

Considerable attention will be devoted to other sexual prevention activities. These include couples counseling for improved communication between partners, promotion of sex with one partner only and consistent use of condoms if having sex with more than one partner. Interpersonal communication activities will target young couples from the cohort generating the greatest numbers of new infections, people in relationships where work requires one partner to sleep away from home on a regular basis and couples who do not know their status.

Churches, traditional structures and PLWHA support groups will be strengthened to provide pre-marital and marital counseling for couples that addresses communication in relationships, testing and knowing HIV status, concurrent sexual partnerships, condom use (where appropriate) and HIV.

CBOs active in the community will be recruited and trained to lead community dialogues on the drivers of the epidemic in Swaziland with special attention to multiple concurrent partnerships. These sessions will employ multiple interactive formats, including edutainment through "movie-discussion nights" and community theatre. Discussions will be guided and videos drawn from regionally produced edudramas, such as Untold Stories. These activities will target the community at large and will be linked to prevention services through referrals, presentations by service providers or of provision of information on how to access services.

Support given to GKOS - NERCHA and the Swaziland National AIDS Programme (under the MOH) - will reinforce the growing leadership and coordination around prevention activities, including the reconstitution of a national Prevention TWG. The development of a national HIV prevention policy will be a key towards enhancing structural prevention elements.