This program is an expansion of a COP06 activity (originally awarded to a different partner) that targets refugees in three camps, namely Dimma, Bonga, and Fugnido in Gambella region. No FY06 funds have been disbursed to this project because the change in partner has not yet been approved by Washington. The objective of this intervention is to reduce the transmission of HIV by promoting delayed onset of sexual activities, abstinence and faithfulness. This year, activities will be added in Kebribeyah camp in Somali region. The targeted population, which includes the surrounding host populations, is estimated to be 120,000 (64,000 refugees and 56,000 locals).

This proposal is programmatically linked to "Condoms and Other HIV Prevention Services for Refugees and Host Populations in Ethiopia" (COP ID 10529), "Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia" (COP ID 10527), "Assistance to Orphans and Vulnerable Children in Six Refugee Camps in Ethiopia" (COP ID 10530), "Palliative Care in Four Refugee Camps in Ethiopia" (COP ID 10572), and "Universal Precautions and Post Exposure Prophylaxis in Six Refugee Camps" (COP ID 10634).

This proposal has been developed in consultation with the Ethiopian Government's Agency for Refugee and Returnee Affairs (ARRA). Representatives from UNHCR and ARRA, along with staff from implementing agencies such as IRC spent the first half of 2006 conducting a gap analysis of HIV/AIDS programming in Ethiopia's seven refugee camps. Stakeholders identified the expanded activities that are the most critical, while emphasizing the need for establishing a minimum package of basic services that will be provided at each camp. Based on the current level of activities in the seven different camps, it was agreed that UNHCR would initiate activities in camps that did not yet have a strong prevention and/or counseling and testing foundation, while various implementing partners, namely IRC, would continue and expand work in camps where they had already established a foothold. All activities are coordinated closely with ARRA, who is responsible for providing basic health care services in each of the camps, as well as all other implementing partners. UNHCR has also developed a working relationship with the local HAPCO and will work with other PEPFAR partners in order to provide appropriate training to ARRA health clinic staff, as well as staff from other implementing partners.

In order to enable the community to prevent the spread of HIV through adapting and promoting protective behaviors, an integrated package of activities aimed at increasing knowledge, avoiding risky behaviors, promoting protective attitudes, developing safe practices and reducing stigma and discriminations among refugees and surrounding host populations is required. Under this project, the community will be mobilized through various activities to implement the "AB" principles - (Abstinence, Be faithful), as appropriate. Information, education and communication (IEC) and Behavior Change Communication (BCC) activities, being central to a successful HIV/AIDS prevention program, will be given a due emphasis in this project. IEC includes a variety of activities at different levels, from intensive person-to-person education to mass dissemination of information while BCC will be considered as a multi-level tool for promoting and sustaining risk-reducing behavior change in individuals and communities by distributing tailored messages in a variety of communication channels. Targeted IEC/BCC activities that rapidly increase knowledge, stimulate community dialogue, promote advocacy, reduce stigma and discrimination, and promote demands for prevention, care and support services in and around the camps will be implemented.

Creating these materials for the four refugee camps listed above will be a challenge as materials will have to be developed in six different local languages and will have to accommodate the different learning and communication styles to which each population will best respond. In addition to the difficulty posed by multiple languages, implementing programs in all three of the camps in Gambella, as well as Kebribeyah will require significant logistical inputs due to the often tenuous security situation in the camps. Intra- and inter- ethnic conflicts frequently erupt in the Gambella region, most notably with the ambush and murder of three ARRA officials in December 2003, just 10 miles outside of the town of Gambella. Therefore, all trips to Dimma and Fugnido camps must be made with an armed military escort, which brings considerable costs and requires additional logistical maneuverings just to carry out routine visits.

Although there are logistical and security challenges posed by working in Gambella, the

need for prevention activities is great. Evidence from ANC surveillance in Dimma and Fugnido suggests that the incidence of HIV infection in the region is 12.9% and 2.8%, respectively, while the national average for the rural population from the same study was 2.2%. Infection rates for syphilis in the two camps were also significantly higher than the national average. Therefore, the AB campaigns that are described below will fill a critical need for services in this community.

Implementing prevention programs in Kebribeyah, in the Somali regional state, will also pose its own set of challenges. Although this camp has housed displaced Somalis for over ten years, the level of services provided in Kebribeyah is much lower than in most other camps in the country. There are currently no prevention activities in Kebribeyah, and the region is challenged by a general lack of knowledge about HIV/AIDS and how it is transmitted, combined with the population engaging in risky behaviors including the abduction and rape of young girls, and most families practice at least some form of female genital mutilation in extremely unsanitary conditions. Since Kebribeyah camp abuts the town of the same name and there is a high level of interaction between the two populations, interventions will be targeted to both the refugees and the host community.

Under this project the following specific activities will be implemented: (1) Culturally appropriate IEC/BCC materials (posters, leaflets, brochures, billboards, etc) will be developed, adapted and produced in the local languages for use by refugees and the surrounding host communities. Messages that emphasize abstinence, delaying sexual activities until marriage, the importance of remaining faithful to a partner and adoption of social and community norms that support the AB principles will be vital components of the IEC/BCC materials. Stigma and discrimination against people infected and affected by HIV/AIDS and sexual and gender based violence issues will also be addressed these IEC/BCC activities. (2) Community conversations and coffee ceremony sessions to engage the community in discussions of HIV/AIDS problems and solutions will be conducted. (3) Mass HIV/AIDS educations using audiovisual materials will be implemented in all camps. (4) Peer educators (girls, boys, in and out of school children, etc) will be trained and peer educations supported technically and financially. (5) Anti-AIDS clubs will be organized and supported both in and out of the schools. (6) Mini media clubs will be organized and supported to prepare and stage educative and entertainment activities for the community. (7) As a part of soliciting supports from political, religious, and community leaders in the process of mobilizing the communities, advocacy workshops will be organized at national and regional levels. These workshops will be used as a platform where refugee issues are advocated to the government bodies for establishing integration of refugee HIV activities with the national programs, and involve religious and community leaders in the process of HIV prevention.

Universal Precautions and Post Exposure Prophylaxis in Six Refugee Camps

This is a new activity for FY07. The aim of this project is to enforce universal precautions for prevention of the transmission of HIV, which will include the use of post-exposure prophylaxis (PEP) kits for victims of rape and will be complemented by AB, OP and VCT components. Adherence to the principles of universal precautions to reduce medical transmission of HIV infection will be ensured through training of all camp health clinic staff.

This activity complements projects intended to provide prevention services to refugees living in the Bonga, Dimma and Fugnido refugee camps, located in Gambella region, as well as the Kebribeyah camp located in the Somali region, Sherkole camp in Benishangul-Gumuz region, and Shimelba camp in Tigray region. Services will be provided to all camp residents as well as the local host community who live in the surrounding communities. This proposal is programmatically linked to "HIV Prevention Services for Refugees and Host Populations in Ethiopia" (COP ID 10528), "Condoms and Other HIV Prevention Services for Refugees and Host Populations in Ethiopia" (COP ID 10529), "Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia" (COP ID 10527), "Assistance to Orphans and Vulnerable Children in Six Refugee Camps in Ethiopia" (COP ID 10497), and "Palliative Care in Four Refugee Camps in Ethiopia" (COP ID 10572).

This proposal has been developed in consultation with the Ethiopian Government's Agency for Refugee and Returnee Affairs (ARRA). Representatives from UNHCR and ARRA, along with staff from implementing agencies such as the International Rescue Committee (IRC) spent the first half of 2006 conducting a gap analysis of HIV/AIDS programming in Ethiopia's seven refugee camps. Stakeholders identified the expanded activities that are the most critical, while emphasizing the need for establishing a minimum package of basic services that will be provided at each camp. Based on the current level of activities in the seven different camps, it was agreed that UNHCR would initiate activities in camps that did not yet have a strong prevention and/or counseling and testing foundation, while various implementing partners, namely IRC, would continue and expand work in camps where they had already established a foothold. All activities are coordinated closely with ARRA, who is responsible for providing basic health care services in each of the camps, as well as all other implementing partners. UNHCR has also developed a working relationship with the local HAPCO and will work with other PEPFAR partners in order to provide appropriate training to ARRA health clinic staff, as well as staff from other implementing partners.

Universal Precautions Health clinics within the camps are staffed and administered by ARRA, and although they provide sufficient basic health services for the large camp populations, they are often under-resourced and do not have staff who have been adequately trained in universal precautions or post exposure prophylaxis. In addition, there are shortages of supplies like heavy duty gloves, aprons, masks and eye shields, and safety boxes for disposal of sharp materials are not available or are not properly utilized. Cleaning, disinfecting and sterilizing procedures are not up to the standard in some places, and most camps do not have incinerators on site.

Post Exposure Prophylaxis (PEP) is also required - both for health care workers who have possibly been exposed to HIV, as well as victims of rape and sexual violence. Due to the social stigma associated with rape and gender based violence, these incidents often go unreported and accurate incidence rates are not available for any of the camps. However, anecdotal evidence suggests that rape is a significant problem in all of the camps, especially in Kebribeyah in the Somali region of the country. Funding for this activity will be used for training of all health clinic workers, and linkages between other PEPFAR partners providing similar services in the region, including JHU and Intra health will be made. In addition, the staff of other NGOs who are providing services in the camps will be trained on the importance of rape reporting within 72 hours, in order to make use of the PEP kits. In addition, funds will be used for the sustainable supply of materials for universal precautions and PEP kits.

Logistical Considerations Creating appropriate interventions and training materials for all three of the camps in

Gambella, as well as Kebribeyah will require significant logistical inputs due to the often tenuous security situation in the camps. Intra- and inter- ethnic conflicts frequently erupt in the Gambella region, most notably with the ambush and murder of three ARRA officials in December 2003, just 10 miles outside of the town of Gambella. Therefore, all trips to Dimma and Fugnido camps must be made with an armed military escort, which brings considerable costs and requires additional logistical maneuverings just to carry out routine visits.

Although there are logistical and security challenges posed by working in Gambella, the need for prevention activities is great. Evidence from ANC surveillance in Dimma and Fugnido suggests that the incidence of HIV infection in the region is 12.9% and 2.8%, respectively, while the national average for the rural population from the same study was 2.2%. Infection rates for syphilis in the two camps were also significantly higher than the national average. Therefore, the UP and PEP materials and trainings are critical in order to stop the infection from spreading.

Implementing prevention programs in Kebribeyah, in the Somali regional state, will also pose its own set of challenges. Although this camp has housed displaced Somalis for over ten years, the level of services provided in Kebribeyah is much lower than in most other camps in the country. However, due to the high incidence of rape in the camp, there is a strong need for PEP and the associated training required for health clinic staff and community social/health workers.

Under this intervention, the following specific activities will be implemented in Bonga, Dimma, Fugnid, Kebribeyah, Sherkole and Shimelba camps: (1) Health workers will be trained on universal precautions and PEP administration for needle-stick accidents and sexual and gender based violence survivors; (2) Staff from other NGOs working in the camps will be trained in the reporting of rape within 72 hours; (3) Manuals and guidelines for universal precautions will be available for use by health staff in the health facilities; and (4) PEP kits, supplies and materials for universal precautions will be procured and distributed to all four camp health clinics.

Condoms and other HIV Prevention Services for Refugees and Host Populations in Ethiopia

This is an expansion of a COP06 activity (originally awarded to a different partner) that targeted refugees in Dimma, Bonga, and Fugnido camps in Gambella region. No FY06 funds have been disbursed to this project because the change in partner has not yet been approved by Washington. The aim of this project is to promote correct consistent condom use in four refugee camps. This year, activities will be extended to Kebribeyah camp in the Somali region.

The activity is programmatically linked to "HIV Prevention Services for Refugees and Host Populations in Ethiopia" (10528), "Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia" (10527), "Assistance to Orphans and Vulnerable Children in Six Refugee Camps in Ethiopia" (10530), "Palliative Care in Four Refugee Camps in Ethiopia" (10572), and "Universal Precautions and Post Exposure Prophylaxis in Six Refugee Camps" (10634).

The project was developed in consultation with the Government of Ethiopia Agency for Refugee and Returnee Affairs (ARRA). Representatives from UNHCR and ARRA, along with staff from implementing agencies such as IRC, spent the first half of 2006 conducting a gap analysis of HIV/AIDS provision in Ethiopia's seven refugee camps. Stakeholders identified the most critical gaps, while emphasizing the need for a minimum package of basic services at each camp. Based on the current level of activities in the camps, it was agreed that UNHCR would initiate activities in camps that did not yet have a strong prevention and/or counseling and testing foundation, while various implementing partners, namely IRC, would continue and expand work in camps where they had already established a foothold. All activities are coordinated closely with ARRA, which is responsible for providing basic health care services in the camps, and with other partners. UNHCR developed a working relationship with the local HAPCO and will work with other PEPFAR partners to provide appropriate training to ARRA health staff, as well as staff from other partners.

Key elements of condom programs are promotion to create and increase demand, and adequate and sustainable supply to the public in general and to targeted groups in particular. In refugee camps, the entire population is considered inherently at risk, due to transience, vulnerability to sexual exploitation, and lack of access to information.

Intensive condom promotion activities supported by appropriate IEC materials and increasing outlets will be undertaken in these camps. Syndromic management of STI according to the guidelines will be ensured.

Creating appropriate interventions and training materials for the four refugee camps listed above will be a challenge as materials will have to be in six languages and to accommodate the different learning and communication styles of each population. Furthermore, program implementation in all three Gambella camps, and Kebribeyah, will require significant logistical inputs due to the often tenuous security situation therein. Intra- and inter- ethnic conflicts frequently erupt in Gambella region, most notably with the ambush and murder of three ARRA officials in December 2003, just 10 miles outside Gambella. All trips to Dimma and Fugnido camps must be with armed military escort, which adds considerable cost and maneuverings simply to make routine visits.

Although there are logistical and security challenges posed by working in Gambella, the need for prevention activities is enormous. Evidence from ANC surveillance in Dimma and Fugnido suggests HIV+ prevalence of 12.9% and 2.8%, respectively, while the national average for the general rural population was 2.2%. Infection rates for syphilis in the two camps were also significantly higher than the national average. Therefore, the condom and other prevention activities described below will meet critical needs

Implementing prevention programs in Kebribeyah in Somali region, pose its own set of challenges. Although this camp has housed displaced Somalis for more than a decade, the level of services in Kebribeyah is much lower than in most other camps in Ethiopia. There are currently no prevention activities in Kebribeyah, and a general lack of knowledge of the virus and its transmission in a population engaged in risky behaviors, including abduction and rape of young girls. Condom usage is extremely low or nonexistent, so

promoting correct consistent condom use in this population will involve significant efforts using a host of mediums. Since Kebribeyah camp abuts the town of the same name and there is a high level of interaction between the two, interventions will be targeted to both refugees and the host community.

Under this intervention, the following specific activities will be implemented in Bonga, Dimma, Fugnido and Kebribeyah camps: (1) Condoms will be procured and distributed; (2) Condom outlets will be expanded; (3) Condom education supported with demonstrations using models will be intensified. (4) Community health workers, peer educators, community leaders and anti-AIDS club members will be trained to promote and distribute condoms; (5) Health care providers will be trained on syndromic management of STI; (6) Manuals and guidelines on syndromic management of STI will be made available in all four camps; (7) Essential drugs for syndromic treatment of STI will be procured and made available; (8) Adherence to the guideline for diagnosis and treatment of STI will be followed up, and STI treatment seen as an entry point for other prevention services; and (9) To monitor and evaluate progress of prevention and other programs, a comprehensive Knowledge, Attitude, Behavior and Practice (KABP) survey in all four camps will be conducted.

This is a new activity.

This proposal comprises the follow-on phase of a project intended to provide prevention and care services to refugees living in the Bonga, Dimma and Fugnido refugee camps, located in Gambella region, and Kebribeyah camp in Somali region. Services will be provided to all camp residents as well as the surrounding local host community.

The activity is programmatically linked to "HIV Prevention Services for Refugees and Host Populations in Ethiopia" (5739), "Condoms and Other HIV Prevention Services for Refugees and Host Populations in Ethiopia" (5786), "Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia" (5657), "Assistance to Orphans and Vulnerable Children in Six Refugee Camps in Ethiopia" (1049), and "Universal Precautions and Post Exposure Prophylaxis in Six Refugee Camps" (1022).

This proposal was developed in consultation with the Government of Ethiopia Agency for Refugee and Returnee Affairs (ARRA). Representatives from UNHCR and ARRA, along with staff from implementing agencies such as IRC spent the first half of 2006 conducting a gap analysis of HIV/AIDS programming in Ethiopia's seven refugee camps. Stakeholders identified the most critical gaps, while emphasizing the need for a minimum package of basic services to be provided at each camp. It should be noted that the entire refugee population is considered inherently at risk, due to their transient nature, their vulnerability to sexual exploitation, and their lack of access to information.

Logistical challenges:. Implementing programs in these regions will require significant logistical and material inputs due to the often tenuous security situation in the camps. Intra- and inter- ethnic conflicts frequently erupt in the Gambella region, most notably with the ambush and murder of three ARRA officials in December 2003, just 10 miles outside Gambella. All trips to Dimma and Fugnido camps must be made with armed military escort, which adds considerable costs and logistical maneuverings simply to make routine visits. Although the security situation in Kebribeyah is not as bad as in Gambella, this region is historically under resourced and lies in an area that is under threat of violence due to its proximity to Somalia and the frequent conflicts between the Ethiopian military and local rebel factions.

Statement of Need and Proposed Activities. Not all PLWHA need anti-retroviral treatment. However, all do need basic health care and support. This should include routine monitoring of disease progression, prophylaxis and treatment of opportunistic infections and complications of immune suppression. In refugee settings in Ethiopia, though the magnitude of HIV/AIDS problems is high, there is no comprehensive palliative care program that addresses the needs of people living with the virus. This project aims to strengthen basic health care services in general and the diagnosis and treatment of OI in particular for people living with HIV/AIDS in four refugee camps in Ethiopia through capacity building, training of health workers and provision of essential drugs for prevention and treatment of OI. Linkages will be made between with existing PEPFAR partners who are operating in the region, including JHU which is working in the health centers. Trainings for health center staff will be provided, and the basic palliative care package will be provided to all clients who have tested positive for HIV.

The existing tuberculosis program is also strengthened by providing technical assistance to health workers to adhere to the national guideline for implementation. Home-based care for AIDS patients will be introduced by training and supporting care providers from the community. The following are specific activities to be undertaken with this project: (1) Health workers will be trained on prophylaxis and management of OI, including tuberculosis. (2) Essential drugs for the management of OI (apart from those for tuberculosis) will be provided. (3) Health center staff will be trained in administering the basic palliative care package. (4) Basic palliative care packages will be procured and distributed to all HIV+ clients. 5) Referral linkages will be strengthened for management of neurological diseases associated with HIV/AIDS. (6) Symptom diagnosis and management of diseases associated with HIV/AIDS will be strengthened. (7) Tuberculosis control program run by each health facility in the camps will be

strengthened by providing technical supports to health workers.

The United Nations High Command for Refugees (UNHCR), in conjunction with its implementing partner, the International Rescue Committee (IRC), determined it would be most effective to develop a pilot OVC program in two refugee camps, Sherkole and Shimelba, before expanding the program to encompass other refugee camps and host communities in Ethiopia. Most of UNHCR's implementing partners do not have direct experience working with this sensitive population or with designing an OVC program. UNHCR/IRC determined that a pilot OVC project linked to a well-developed HIV/AIDS program would enable development of an effective program design and prevent discrimination against OVC in refugee camps. Based on successes and lessons learned, this project is expected to expand to other refugee sites. UNHCR, following OVC guidance from the Office of the Global AIDS Coordinator (OGAC), will develop pertinent program indicators and distinguish between direct-primary and indirect-supplemental services in semiannual and annual reports. UNHCR will be required to come up with an exit strategy to create smooth transition of the program from PEPFAR funding to community/UNHCR and government support. The number of OVC served by this program is reduced by half because only two camps will be targeted by the OVC pilot, rather than the seven initially proposed. In addition, it is not practical to conduct the pilot in the Gambella camps due to the imminent closings of Bonga and Dimma camps. This new intervention will provide OVC care and support in and around Shimelba and Sherkole refugee camps. Children who are vulnerable to HIV, and those orphaned due to AIDS, suffer social, emotional, and economic consequences. Their problems are not well addressed, especially in displacement settings—for example, there have been no programs addressing OVC needs in Ethiopian refugee settings, although reports and observations indicate a great problem. In FY07/08, through UNHCR, IRC will pilot a PEPFAR-supported OVC program in Shimelba and Sherkole refugee camps. Together, the IRC, the Government of Ethiopia's Administration for Refugees and Returnee Affairs (ARRA), and UNHCR Child Welfare Officers will work to identify children to be included in this group (PEPFAR criteria will be used). They will also strengthen activities supporting OVC and their families, with an emphasis on improving access to protection and social services, such as education and health. Under this pilot project, 175 Sudanese and Eritrean OVC refugees and the camp host populations will be supported by strengthening family and community capacity and providing skills training to older children. This proposal, which was developed with ARRA, is programmatically linked to HIV Prevention Services for Refugees and Host Populations in Ethiopia (5739), Condoms and Other HIV Prevention Services for Refugees and Host Populations in Ethiopia (5786), Voluntary Counseling and Testing Services for Refugees and Host Populations in Ethiopia (5657), Palliative Care in Four Refugee Camps in Ethiopia (1066), and Universal Precautions and Post-Exposure Prophylaxis in Six Refugee Camps (1022). IRC will engage members of the community (caregivers) to provide household support to OVC. This support may include preparing food (from the OVC' food rations) or fetching water or firewood. As they will no longer be responsible for these basic household duties, OVC will have more time to attend school or pursue other activities. Together with UNHCR and ARRA, IRC will identify OVC and their foster families. IRC Child Protection Officers and social workers will provide support and counseling to the caregivers and foster families to improve their ability to care and support for these children. It will be the responsibility of the Child Welfare Officers, together with the social workers, to monitor children in foster families and children who access child-friendly spaces for signs of neglect and abuse—making sure that children are referred to ARRA for medical care. Children will be monitored according to the USAID OVC criteria. IRC will identify youth who were formerly in a similar situation, or who are sympathetic to the situation of the current OVC, to work with community groups to identify and explore their beliefs and perceptions of OVC. The refugee community and religious leaders will be trained on how to work together as a community to support and nurture these children and protect them from HIV, and will be responsible for leading some behavior-change communication (BCC) campaigns. BCC strategies will be used to address the problems of stigma and discrimination and promote responsible behavior by youths and adults towards OVC. IRC will continue to integrate HIV education and anti-stigma discussions in IRC's informal education classes, primary school classes, gender-based violence (GBV) community discussions, at the ARRA health center and during outreach activities conducted by the IRC social workers. IRC Child Welfare Managers will be responsible for establishing and managing the OVC program. Their role will include strengthening relationships and links between UNHCR and ARRA to support the children and their families, monitoring foster families and the wellbeing of the children, and building refugee and IRC capacity. IRC Child Welfare Staff

will ensure that all staff working with OVC, including IRC's health, GBV, child welfare, and youth staff, ARRA's health staff, and UNHCR's staff, receive ongoing in-service trainings in child protection and OVC support. The IRC Child Welfare, ARRA, and UNHCR staff will hold monthly coordination meetings in between trainings to review cases for follow up and intervention. IRC will continue to strengthen referral links established between the ARRA health centers, UNHCR Welfare Officers, the regional hospitals, and the regional HAPCO offices.

Activities that will be implemented in Sherkole and Shimelba camps include: 1. Hire two Child Welfare Managers and one Child Welfare Officer; 2. Hire five refugee social workers for each camp; 3. Conduct one orientation training in child protection for IRC Child Welfare Managers, Officers, and refugee social workers; 4. Conduct quarterly in-service training for five refugee social workers for each camp; 5. Rehabilitate one child-friendly space in each camp; 6. Rehabilitate those homes of OVC that have security concerns—stigmatization and poor construction/lack of privacy can put OVCs at risk in the camps; 7. Identify and train foster care families; 8. Train OVC caregivers on how to care for children (i.e., nutrition, personal care); 9. Train religious and community leaders on child protection; 10. Purchase and make HIV educational materials (books, drama, videos) available for OVC; 11. Conduct one art competition in each camp, resulting in t-shirt creation with winning OVC/HIV message; 12. Provide nutritious snack for children accessing child-friendly spaces; and 13. Distribute condoms to older OVC. Through these activities, the project aims to reduce the suffering and improve the lives of 175 OVC. Based on successes and lessons learned, this pilot project could expand to other refugee sites. UNHCR, following OGAC OVC guidance, will develop pertinent program indicators and distinguish between direct primary and indirect supplemental services in semiannual and annual reports, indicating how they address gender equity in their programs. UNHCR will be required to come up with exit strategy to create smooth transition of the program from PEPFAR funding to community/UNHCR and government support. IRC Child Welfare Managers will be responsible for establishing and managing the OVC

The objective of this project is to provide voluntary counseling and testing services to approximately 30,000 Sudanese refugees and 20,000 members of the host community in Fugnido camp in the Gambella region, as well as over 20,000 Somali refugees in the Somali region. Since this proposal was submitted, the demographic of the refugee population within the country has shifted considerably. Nearly 23,000 refugees from Gambella region have been repatriated to South Sudan. In addition, it is now clear that the 16,000 refugees residing in the Kebribeyah camp in Somali region will not be able to repatriate any time soon (as originally was hoped), and that the number of Somali refugees in this region is growing quickly. A new camp, Teferiber, will open in this region, in order to accommodate the 10,000 refugees who have recently fled fighting in southern Somalia. In Fugnido, IEC/BCC activities that raise awareness and create demand for VCT service will be conducted. Community awareness raising activities, which will be implemented under AB and OP programs, will be linked to this VCT.

In the Somali region, IEC/BCC as well as AB and OP activities will be implemented with funding from IGAD and World Bank supported program. Counseling and testing will serve as a gateway to both prevention activities, as well as care and treatment services for clients who test positive. In addition, UNHCR will create linkages among existing PEPFAR partners who are operating in the region, including JHU which is operating in the health centers, in order to improve the level of service provided in the health center and to take advantage of additional government and regional resources.

The following are specific activities to be undertaken under this project: • Two new VCT centers will be established; one in Fugnido in Gambella region, and one VCT site for the Somali camps. • Counselors and other staff for the new VCT center will be recruited and trained. • VCT kits and consumable laboratory materials will be procured and supplied regularly. • A referral linkage to existing public health institutions will be established and made operational for PMTCT services. • Health workers will be trained on diagnostic counseling and testing • Monitoring and evaluation system of the VCT services will be put in place and implemented accordingly.

Monitoring the level of HIV infection and the trend is an integral component of a comprehensive HIV response. Data enables policy makers and planners to appreciate the magnitude of the problem, allocate resources as well as monitor effectiveness of interventions. Unfortunately in refugee setting in Ethiopia, there is a dire lack of HIV prevalence and behavioral data. Refugees have not been integrated in the national HIV sentinel surveillance nor community based surveys. The burden of HIV/AIDS among refugees is not understood.

Under this project, technical assistance and training will be provided to a cross section of implementing partners' staff members in Ethiopia through expert consultation, on site visits as well as meetings among others. On the job training and supervisory support will be strengthened. Fugnido, Teferiber and Kebribeyah will be supported to conduct ANC based sentinel surveillance using the ministry of health protocol and infrastructure. A time limited consultant will be hired to support health care providers and provide technical support to carry out sentinel surveillance.

Monitoring the level of HIV infection and the trend is an integral component of a comprehensive HIV response. Data enables policy makers and planners to appreciate the magnitude of the problem, allocate resources as well as monitor effectiveness of interventions. Unfortunately in refugee setting in Ethiopia, there is a dire lack of HIV prevalence and behavioral data. Refugees have not been integrated in the national HIV sentinel surveillance nor community based surveys. The burden of HIV/AIDS among refugees is not understood. However, data from routine health information system, voluntary counseling and testing services indicate that HIV/AIDS infection contributes to the burden of morbidity and mortality in refugee settings.

In 2007, PEPFAR approved a US$ 892,700 grant to strengthen HIV/AIDS response in refugee settings in Ethiopia. However, surveillance, monitoring and evaluation component of the program was not funded. Due to massive repatriation of refugee to south Sudan and an influx of refugees from Somalia, it has become essential to reprogram US$ 200,000 that was initially allocated for VCT services. We seek to set aside US$ 80,000 for strategic information.

Under this project, technical assistance and training will be provided to a cross section of implementing partners' staff members in Ethiopia through expert consultation, on site visits as well as meetings among others. On the job training and supervisory support will be strengthened. Fugnido and Kebribeya will be supported to conduct behavioral surveillance using the ministry of health protocol and infrastructure. A time limited consultant will be hired to support health care providers and provide technical support to carry out behavioral surveillance.

Targets

Target Target Value Not Applicable Number of indigenous organization provided with technical  assistance for HIV-related institutional capacity building; Number of local organizations provided with technical assistance for 7
strategic information activities Number of individuals trained in strategic information (includes 150
M&E, surveillance, and/or HMIS)

Table 3.3.13: