This is the continuation of FY06 AB focused prevention intervention in the Military. It also relates with activity ID 10579 (OP) improving HIV/AIDS/ STI/ TB prevention and care activities which is designed to address prevention other than AB. It also links with activity ID 10386 (AB) design and production of TA for MARCH. The objective of the intervention is to strengthen and integrate NDFE's prevention, care and treatment efforts for soldiers and their family members through AB activities employing the MARCH model.

Research conducted by Abebe, Yigeremu (August, 2003) to assess the HIV prevalence in 72,000 urban and rural male army recruits in Ethiopia which indicated that the prevalence is high among the armed force. The study showed that in urban recruits, overall HIV prevalence was 7.2%, ranging from 4.3% to 10.5% depending on region. In rural recruits, overall HIV prevalence was 3.8%, but the majorities were farmers (57%) and students (18%) with an HIV prevalence of 2.7% and 2.6%, respectively. (Higher) level of education in rural recruits was associated with HIV infection. Rural recruits of the Muslim religion were less likely to be HIV infected than recruits of the Orthodox Christian religion (odds ratio: 0.7, 95% confidence interval, 0.65-0.84). Urban and rural residents of Amhara region were at higher risk of HIV infection.

The Ethiopian armed force has come from all corner of the country and settled in a camp life, away from their family and friends. This group is the most at risk population and exposed for rural and urban hotspot that increase their risk of contracting HIV. Therefore; there is a need to have strong prevention intervention to reduce the prevalence of HIV among this group.

MARCH is a behavior change communications (BCC) strategy that promotes the adoption of HIV prevention behaviors and encourages community members to care for people living with PLWHA and children whose parents have died of AIDS. Addressing stigma and discrimination towards PLWHA, tackling the existing gender imbalances and the removal of stigma and discrimination is expected to contribute to reduction of risky behaviors and also encourage a comprehensive care and support on the part of the community, promote better service uptake and most specifically - abstinence and faithfulness among army members. There are two main components to the program: Entertainment as a vehicle for education (long running serialized printed dramas portraying role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level. Key to the edutainment component is the use of role models in the context of a storyline to provide information about change, to motivate the viewer, and to enhance a sense of self-efficacy. The second element involves reinforcing the message through interpersonal strategies like peer group discussions. Research shows that effective interventions are often personalized ones. The MARCH reinforcement activities try to personalize the behavior change intervention. The objective of the reinforcement activities include: applying message in the drama to their own lives, provide accurate information about HIV/AIDS and behavior change, provide an opportunity to practice new skills that may be required in avoiding infection and supporting those infected.

In FY04, FY05 and first quarter of FY06, NDFE has been implementing a Peer leadership strategy as one of its key reinforcement strategies for the Military. For the effective implementation of the peer leadership strategy 824 peer leader trainers and 3,700 peer leaders has been trained until the end of March 2006. In the first quarter of FY06, around 1,800 peer discussion groups has been organized in two divisions of the western Command (15th and 32nd ) and three divisions of the Northern command (21st, 23rd and 25th) and around 18, 000 members of the army have become direct beneficiaries of the program. Currently, Peer leaders use the peer leaders training manual as a guide to conduct their discussion and share the information with their peer discussion group and guide soldiers in applying the information to their own lives in order to reduce risk of infection, encourage members of the army living with the virus to live positively, support others within their unit and community who are trying to adopt healthier behaviors and reduce stigma suffered by those with HIV/AIDS.

As part of the Modeling component, the production of print serial drama in the form of comic booklet has been initiated in FY05. Three script writers, two cartoonists and one graphic designer had been employed and trained for the development of printed serial drama. A one year full storyline composed of 24 episodes has been developed until the end of the first quarter of FY06. The print serial drama will be launched in the second

quarter of FY06 and the peer leaders will start to use the comic strip with their peer discussion group. In FY06, the scope and depth of this program is being strengthened through collaboration with Johns Hopkins University Centers for Communication Program.

The human power capacity of NDFE has been strengthened at different levels to enable NDFE implement MARCH project effectively and efficiently. Twenty one Military Officers from the five commands have taken intensive project management training and around thirty military officers have also taken basic computer trainings in this regard.

In FY07 the MARCH project and its activities will be integrated with ART, VCT, STI, TBC,HIV/ AIDS activities by UCSD and DOD.

Working with this partner to reach these MARPs and the importance of establishing HIV/AIDS prevention, care and treatment office in NDFE are critical for the sustainability of the program.

Because of the structural adjustment at the NDFE set up, which has clearly helped us in designing the MARCH implementation mechanism to individual soldier level and the TA and close follow up of JHU/CCP, we are observing a number of improvements in utilizing funds and the human resource is well organized to rollout the activities.

As continuation of FY06 activities the following will be carried out in FY07: Training: - 2,085 peer leaders have to be trained in FY07 in order to strengthen the AB activities and reach more than 25,000 members of the army in the five commands. IEC/BCC materials and different formats production/distribution: producing and distributing a package of military specific IEC/BCC materials to the peer discussion groups augmenting the printed serial drama Monitoring and evaluation of the activities including supportive supervision.

Military Prevention Activities

This is the continuation of FY06 OP intervention in the Military. It links to improving HIV/AIDS/STI/TB Prevention and care activities (10578) and to design and production of TA for MARCH (10386 and 10388). The goal of intervention is to strengthen and integrate NDFE's prevention, care and treatment efforts for soldiers and their families through AB activities employing the MARCH model.

Research by Abebe, Yigeremu (August, 2003) to assess HIV prevalence in 72,000 urban and rural male army recruits found high rates of prevalence among the armed forces. Among urban recruits, overall HIV prevalence was 7.2%, ranging from 4.3 to 10.5%, depending on the geographical region. Among rural recruits, overall HIV prevalence was 3.8%, but this is influenced by the fact the majority were farmers (57%) and students (18%) with an HIV prevalence of 2.7% and 2.6%, respectively. (Rural recruits with higher educational levels showed higher prevalence. Rural Muslim recruits were less likely to be HIV+ than those of Orthodox faith. Amhara region, both urban and rural, displayed highest prevalence.

With regard to condom use, the study confirms that due to high mobility and separation from family, military personnel have multiple partnerships, usually with sex workers. According to a 2001 study, 81.2% of soldiers had sexual contact with commercial sex workers. The study further showed that 53.3% of the respondent used condom consistently while 29.2% did not use condoms at all (August 2003, Abebe, Yigeremu). Furthermore, the correct use of condoms is in question as it usually accompanies alcohol consumption.

The Ethiopian armed forces come from all corners of Ethiopia and live a camp life, away from their family, friends, and are highly mobile. They frequent rural and urban hotspots where infection risks are highest. There is a great need for strong prevention intervention to reduce the prevalence of HIV in this population.

MARCH is a behavior change communications (BCC) strategy that promotes adoption of positive preventive behaviors and encourages community members to care for PLWHA and children orphaned by the epidemic. In particular, this OP intervention will address problems related to stigma and discrimination towards PLWHA, promote consistent correct condom use and early STI treatment; and promote service uptake like VCT and ART within the military setting. The intervention seeks to reduce risky behaviors, encourages a comprehensive care and support approach in the community context, and promote better service uptake. There are two main components to the program: Entertainment as a vehicle for education (long-running serialized printed dramas portraying role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level. The first is a method of transmitting accurate information and mitigating misunderstanding or ignorance concerning HIV/AID, at the same time encouraging audiences to identify personally with the heroes or heroines who develop positive behaviors in the course of the stories. Research shows that effective interventions are often personalized ones and MARCH maximizes this aspect. The reinforcement activities, through peer discussion groups, encourage the audience to applying the dramatic messages to their own lives

Since FY04 the NDFE has been implementing a peer leadership strategy as a key strategy in the military community. By March 2006, 824 peer leader trainers and 3,700 peer leaders were trained In the first quarter of FY06, around 1,800 peer discussion groups has been organized in two divisions of the western Command (15th and 32nd ) and three divisions of the Northern command (21st, 23rd and 25th) reaching directly 18, 000 army members. Peer leaders use a leaders', training manual to guide their discussions and share information with their peer discussion group and to guide soldiers in applying the information to their own lives, in order to reduce risk of infection. Groups assist HIV+ members, to cope with living with the virus and encourage them to educate and support their peers.

In FY05 production of a serialized print serial drama in the form of comic booklet was begun. Three script writers, two cartoonists and one graphic designer were employed and trained for the content message. A one year full storyline composed of 24 episodes was

developed which ran through the first quarter of 2006. A second will be launched in the second quarter of FY06 and the peer leaders will begin using it in their peer discussion groups. In FY06, the scope and depth of this program is being strengthened through collaboration with Johns Hopkins University Centers for Communication Program.

The human capacity of NDFE has been strengthened at different levels to enable NDFE implement MARCH project effectively and efficiently. Twenty one Military Officers have taken intensive project management training and around thirty military officers have also taken basic computer trainings in this regard.

Improvements in performance and budget aspects have be achieved through structural adjustment at the NDFE, which have clearly helped adapt the MARCH methodology to individual soldier level; and by the TA and close follow up of JHU / CCP.

As continuation of FY06 activities: Training: - in FY07, additional 4,450 peer leaders will be trained in order to reach 100% of the army in the five commands; A total of 26,696 bi-weekly booklets will be produced monthly for 11,123 peer leaders and 2,225 peer leader trainers; To strengthen the IEC/BCC component of the program, funds will be allocated for development and distribution of military appropriate IEC/BCC materials to support the existing materials; The MARCH team offices opened in FY06 at the five commands will be equipped and furnished in FY07; and Monitoring and evaluation of the activities including supportive supervision will be enhanced