Ethiopian Orthodox Church Comprehensive HIV/AIDS Activity (AB)

This is a continuing activity from FY06. As of June 2006, the partner received 100% of FY06 funds and is on track according to the original targets and workplan. IOCC conducts HIV prevention and care and support activities with the Ethiopian Orthodox Church (EOC): the Development Inter Church Aid Commission (DICAC). It relates to activities Community and Home-based Care for PLWHA (10513) and Community and Home-based Care for OVC (10511).

The Ethiopian Orthodox Church has approximately 40 million faithful, over 500,000 clergy and a network of parishes found throughout Ethiopia. DICAC operates in 100 districts in the country. The Church publicly declares that it has an obligation to mobilize human and material infrastructure for the national response to HIV/AIDS and that it should strive to influence positive social change, care for those affected or living with HIV/AIDS, promote abstinence and faithfulness and reduce stigma and discrimination. DICAC utilizes peer education and interactive communication to reach these goals.

During COP07, the activity will operate in 100 districts in 20 Dioceses. We anticipate that several districts will be transitioned to areas of higher HIV prevalence using both ANC and EDHS data. This will allow communities at risk to be reached with interactive and interpersonal communications utilizing AB messages. Similar AB approaches utilizing interpersonal peer education and interactive communication will be conducted through Sunday schools, para-counselors and 44 public rallies (4 by the Patriarch and 40 by the Archbishops).

In COP06, PEPFAR Ethiopia supported International Orthodox Christian Charities (IOCC) to work in partnership with the development arm of the Ethiopian Orthodox Church, (DICAC), to utilize and mobilize the strong Orthodox network towards reinforcing HIV AB prevention messages.

Interpersonal Peer Education: In COP06, DICAC focused on building its youth and general HIV prevention and risk reduction programs. During COP05 the youth prevention program was implemented through the existing Sunday school structure and 2,000 Peer Educators reached 50,000 youth biweekly. DICAC has adapted the Youth Action Toolkit (YAK), produced by Health Communications Partnership, for the Sunday school setting. In COP06, 80,000 youth were enrolled in YAK activities at Sunday schools throughout the 100 districts. An additional 2,000 Peer Educators were trained or retrained.

Interactive Communication and Public Rallies: In COP06, DICAC supported interactive HIV prevention and stigma reduction communications (i.e. Archbishop Rallies, Clergy outreach) within AB prevention activities at the community level. These activities targeted community attitudes and social norms of the congregation including delay of sexual debut, return to abstinence, mutual fidelity, HIV burden among young women, empathy for persons living with HIV/AIDS and identifying addressing misconceptions. Interactive communication and mass rallies held by the Patriarch and his Archbishops played an important role in catalyzing discussion on HIV/AIDS at the community level. These types of interventions will be continued in COP07 with strategic emphasis on the vulnerability of young girls and sanctioning male behavior in relation to multiple sexual partnerships and cross generational sex.

In addition to mass rallies, IOCC/DICAC provided intense training to 100 clergy trainers for cascade training to 40,000 clergy and community members up to the end of COP05. During COP06, 8,000 additional clergy and community members were trained, bringing the total to 48,000 trained clergy in operation. These clergy discuss HIV prevention and stigma with members of the congregation during community outreach and reach millions of individuals during the course of one year. Discussions utilize church doctrine and clergy training materials to support improvements in risk perception and AB approaches to HIV prevention by individuals and households. Trained clergy openly encourage premarital VCT and support discordant couples and others seeking advice, by referral to local service providers, on condoms, secondary prevention, care and support and ART.

Pre-Service HIV/AIDS Curriculum in Theological Colleges: During COP05, the Ethiopian Orthodox Church, with support from the IOCC, integrated HIV/AIDS modules into the core

curriculum of eight clergy training institutes and three theological colleges. During COP06 and COP07 further supportive supervision will be provided to these training institutes and colleges to ensure that the curriculum is effectively implemented. In addition, clergy in training will perform an internship that includes community outreach during the summer months in the regions. A section of that internship will draw on lessons from the core curriculum.

Activities in COP07 will include: (1) Supportive supervision of district activities by the Ethiopian Orthodox Church to ensure consistency, quality assurance and improvements in programmatic performance against management indicators;

(2) Continued integration and supervision of HIV/AIDS core curriculum into eight clergy training institutes and three theological colleges. Training through these outlets will reach 1,000 individuals;

(3) Utilization of interpersonal communication through Sunday School and clergy counseling. IOCC anticipates additional technical assistance from Health Communications Partnership to implement the Youth Action Toolkit to support risk reduction, improved knowledge of HIV/AIDS and adoption of AB practices. Eighty thousand youth and young adults will be reached through Sunday Schools;

(4) Interactive communications and mass rallies with the Patriarch and Archbishops to support changes in social norms and attitudes surrounding HIV/AIDS. The rallies draw on messages that emphasize empowerment, support and empathy for those living with HIV/AIDS and HIV prevention through AB;

(5) In-service training of 8,000 clergy with follow-up from district branch coordinators;

(6) Capacity building and exit strategy/planning of IOCC with the Ethiopian Orthodox Church (DICAC) to support a multi-year transition of activities to the Ethiopian Orthodox Church;

(7) IEC materials on HIV prevention, care and misconceptions regarding the Ethiopian Orthodox Church's stance on the complementarities of Holy Water and ART will be distributed; and

(8) Utilization of community members and persons living with HIV/AIDS trained as para-counselors to support community outreach to the general population.

DICAC has supported the development of local community networks linking community organizations offering HIV prevention, care and treatment services. Effort during COP05 allowed important partnerships to be formed with local government, the Ethiopian Red Cross, PLWHA Associations and the Organization for Social Services for AIDS. These networks will continue to be supported with technical assistance from DICAC staff in the regions.

Gender remains an underlying principle to DICAC and is given attention as a cross cutting theme. Efforts to increase participation of women in youth clubs, community-based discussion groups and counseling and training activities will continue. In COP06, explicit female participation targets were raised to 50 percent for Para Counselor and Peer Educator staffing. These targets will be maintained in COP07. Sustainability of the DICAC program and Faith-based Organization FBO response will be emphasized through the Federal National Partnership Forum and through the Inter Faith Forum for Development and Dialogue for Action.

IOCC HIV/AIDS Response Mechanisms Project

This is a continuing activity from FY04-FY06. As of June 2006, the partner received 100% of FY06 funds and is on track regarding 05/06 targets and workplan. We propose increased funding based on achievements to date.

This activity is linked to the IOCC OVC (5591), Ethiopian Orthodox Church Comprehensive HIV/AIDS activity AB (5592), Care and Support Contract Palliative Care (5616), Care and Support Contract (TB/HIV) (5749), Care and Support Contract counseling and testing (5654), ART Service Expansion at Health Center Level, PMTCT/Health Centers and Communities (5586).

The IOCC will work in partnership with the development arm of the Ethiopian Orthodox Church (EOC) to use the strong Orthodox network towards reinforcing HIV AB prevention messages this The EOC has approximately 40 million faithful, over 500,000 clergy and a network of parishes that can be found throughout Ethiopia. The IOCC-EOC partnership operates in 100 woredas in five regions. The EOC publicly declares it has an obligation and duty to mobilize its human and material infrastructure to lead the HIV/AIDS campaign in Ethiopia, and that it should strive to influence social change, caring for PLWHA, promoting abstinence and faithfulness, reducing stigma and discrimination and educating Ethiopian society on the facts about HIV/AIDS. This activity is one component of a broader continuum of care for those receiving clinic-based nutritional support.

In COP07, IOCC/DICAC will reach 11,500 PLWHA with care and support activities including IGA, HBC and spiritual counseling. IOCC utilizes volunteers drawn from local Orthodox congregations to conduct home visits to clients who are bedridden or in the end-of-life stages of AIDS to conduct several activities at least twice each week including: counseling client and family, providing basic physical and social care, serving as liaison for clergy to visit the home, referring patients to medical services including ART, and leveraging nutritional support from the community including local businesses and hotels.The activities planned at each project Woreda will continue t in close collaboration with the local Woreda HAPCO branch and other area stakeholders. Networking among groups will be encouraged to further strengthen the project's impact and sustainability. Gender equality is an important cross cutting theme of the IOCC/DICAC program in COP07 and efforts will be made to ensure increased female participation in youth clubs, advocacy groups, community-based discussion groups and counseling and training activities. During COP06 a 50% female participation target was set for IGA schemes, for OVC and for para counselor and peer educator staffing. A 70% target for female participation in IGA schemes for PLWHA was also in place. These will be maintained in COP07.

Since FY05 IOCC implemented HBC services by trained providers. 1,500 PLWHA benefited from this, involving 80 volunteers during 2006. During 2007 IOCC/DICA will provide HBC services to 6,000 PLWHA. HBC will include nursing care, spiritual counseling, referral of household contacts for VCT, screening for active TB, education on safe water and hygiene, nutrition counseling, adherence counseling, education and encouragement of PLWHA to seek HIV care and treatment at health centers and hospitals

In COP05, IOCC/DICAC developed a strategy aimed to improve the welfare and economic sustainability of PLWHA households with income generating activities (IGA). In COP06 1,000 new PLWHA were enrolled in the IGA program for ART patients, with emphasis on those HIV positive women who are heads of households. In COP06 4,000 PLWHA household members were supported with start-up capital and training for income generation activities, PLWHA self-help support groups, spiritual counseling and home based care services.

In COP07, IOCC/DICAC will extend IGA support to an additional 1,000 PLWHA and will indirectly support 4,000 family members. During FY07 IOCC will increase IGA start-up capital from $90 to $115 per person to address increased cost of commodities.

PLWHA will continue to receive regular follow-up guidance and technical advice from their local HAPCO and agricultural office regarding selection and management of their IGA. IOCC will also support 4,500 PLWHA with spiritual counseling through trained spiritual para counselors. IOCC implements HBC services in eight woredas, and its IGA and

spiritual counseling support services in 100 woredas. . The EOC has taken a strong public stance against stigma and discrimination. This will continue to be a key message in COP07 and will be widely disseminated at public rallies, through the teachings of the church and trained clergy.

IOCC HIV/AIDS Response Mechanisms Project This is a continuing activity from FY05 and FY06. Funding will be increased based on the achievements from COP05 and partial results from COP06. This activity is linked to Ethiopian Orthodox Church Comprehensive HIV/AIDS Activity (#5592 AB) and IOCC HIV/AIDS Response Mechanisms Project (#5593 palliative care). To date, IOCC has received 100% of FY06 funding. This activity is on schedule per workplan. Summary of FYO6 Accomplishments: In FY06, PEPFAR Ethiopia supported International Orthodox Christian Charities (IOCC) to work in partnership with the development arm of the Ethiopian Orthodox Church (EOC), and the Development Inter Church Aid Commission (DICAC), to utilize and mobilize the strong Orthodox network to reinforce HIV prevention efforts in Ethiopia and to expand community-based care and support of orphans and vulnerable children. The Orthodox Church has some 40 million followers, over 500,000 clergy and a network of parishes that are found throughout all regions of Ethiopia. In FY06, 2,000 new OVC households were enrolled in the income-generating activities program that will improve the lives of approximately 8,000 OVC household members. These household members benefit from the project's care and support components, including spiritual and practical counseling, start-up capital, and education on nutrition and sanitation in the home. The quality and availability of counseling services to both beneficiaries and the public at large was improved during FY06 with 60 new counselors being identified and trained. All OVC beneficiaries attended school. The IOCC/DICAC PEPFAR Ethiopia program reached approximately 20% of the country and operates in 100 woredas in 5 regions. IOCC's increased networking and partnerships accounted for achieving greater effectiveness and sustainability. Organizations such as HAPCO, Red Cross, regional administration offices, Dawn of Hope and the Organization for Social Services for AIDS (OSSA) provided assistance to the IOCC/DICAC program.

During COP07, gender will continue to be given maximum attention as a cross cutting theme of the IOCC/DICAC program. Efforts will be made to ensure increased female participation in youth clubs, advocacy groups, community-based discussion groups, counseling and training activities, and the use of program indicators on the percentage of women's participation reinforce this approach. During COP06, the criteria for hiring of counselors, trainers, HBC providers and Peer Educators strongly encouraged female and PLWHA applicants. This will continue in COP07. IOCC Ethiopia will continue to integrate different faiths into its work, through participation in the National HAPCO Partnership Forum and the Inter-Faith Forum. The activities planned by each project district will be undertaken in close collaboration with the local HIV/AIDS Prevention and Control Office (HAPCO) branches and other stakeholders in the area.

Additional resources in FY07 will be utilized for: (1) An increase in start-up capital from $92 to $115 provided to the 2,000 additional OVC for income generating activities. This is important in view of significant inflation in Ethiopia which was not anticipated in the last budget. (2) Provide training to 240 new para counselors. Para counselors are required to follow-up and provide guidance to 5,500 OVC and their household members regularly. The program currently has 240 Para counselors, a ratio of 23 OVC: 1 counselor. In FY07 this ratio will be reduce to 11:1 to enable more frequent and better quality follow-up sessions; necessitating recruitment of an additional 240 para counselors. (3) Provide funds to enable 40 OVC aged 15+ to attend vocational training schools. There is no element in the COP06 program that addresses the need for OVC to receive training that will better secure their future and make them productive and employable citizens. The program will provide funds to send two OVC from each of the 20 branch areas to vocational training schools. This would include training in tailoring, metal work, woodworking and hairdressing. In addition, IOCC would provide start-up equipment such as sewing machines and tools upon graduation.

In partnership with other PEPFAR Ethiopia OVC partners, this activity will work with the new PEPFAR APS recipient to coordinate activities to achieve most efficient use of resources for OVC in the highest HIV/AIDS prevalence areas. This includes harmonization on indicators, reporting, and OVC standards of care in line with Government of Ethiopia national guidelines and policies and OGAC OVC Program Guidance, as well as achieving quality assurance in OVC programming. Data from the EDHS 2005 and the results of USG Ethiopia mapping will used to further identify geographic priority areas ranked highest for

children affected by HIV/AIDS. As an exit strategy IOCC focuses on strengthening the community and the diocesan partners to sustain the program.