Reaching Youth and Women

This is a continuing and expanding activity from FY07 with new activities.

Johns Hopkins University/Health Communications Partnership (JHU/HCP) will continue their existing youth

activities under the Youth Action Kit, Beacon Schools, and Sports for Life, while developing new prevention

interventions to reach adults, especially women in university and workplace settings. These activities are

linked to JHU/HCP's activity under HVOP.

The Beacon Schools program seeks to provide basic life skills and knowledge about HIV prevention through

an interactive curriculum for young adolescents aged 10-12. The program was launched in January 2006 in

158 primary schools in the Oromiya Region and ten administrative regions of Addis Ababa. Currently, the

number of Beacon Schools has increased to 546, reaching nearly half a million youth. The program has

been actively embraced by the Ministry of Education and since it is run through the primary school system,

it has proved to be a highly cost-effective and sustainable program focused on abstinence and fidelity.

The overall objectives in 2008 will be to reach 60% of all schools in seven urban hotspots (Addis Ababa,

Adama/Nazareth, Jimma, Dire Dawa, Mekele, Bahir Dar and Dessie.) with the Beacon Schools program. In

addition to strengthening the Beacon Schools Program in the existing 120 schools in the Addis Ababa

region with refresher trainings, HCP will introduce the Beacon Schools program into the approximately 230

Sports for Life (SFL) schools (program for 7th and 8th graders) in the above seven urban areas. This will

permit students in these 230 schools to participate for four continuous years in an HIV-prevention program.

HCP will also strengthen partnerships with districts, regional educational officers, World Learning, the

Ethiopian Orthodox Church, and World Vision to expand the Beacon and Sports for Life programs to 455

additional schools through other PEPFAR partners. In total, HCP aims to reach 420,000 young people and

train 4,500 individuals through the Beacon Schools program in 2008.

HCP and its initial partner, the Ministry of Youth and Sports, launched Sport for Life (SFL) in June 2004 and

as of June 2007 the program was in over 1,660 schools throughout Ethiopia. The SFL program targets in-

school youth aged 12 - 15 in grades 7 and 8. This AB program encourages youth to use their creative and

athletic talents to develop life skills and reduce their HIV/AIDS risk. Because the vast majority of students

who participate in SFL are not sexually active, the program promotes basic skill building, such as decision-

making, communication with parents, preparing for the future, and delaying sexual debut.

In FY08, HCP will focus on strengthening its SFL program in the same seven hotspot cities identified above

by working with parents, teachers, and Urban Advisory Committees to promote sustainability and ownership

of the SFL activities. Following the Beacon program's successful integration into the school system, HCP

and the Addis Ababa Education Office will formally integrate SFL into the 7th and 8th grade curriculum.

HCP in partnership with the Ethiopia Football Federation will launch sports and HIV-prevention activities for

older adolescents ages 13-17 years old (of which about 40% have already left school) in the seven target

cities. In 2008, HCP aims to reach 650,000 youth and train 4,700 individuals through the SFL program.

HCP's overall approach to scaling up will continue through new partners and transferring complete program

ownership to them with in a one year period. The International Rescue Committee, CRS and Pact, all active

in the Youth Action Kit (YAK) program, have expressed interest in reinforcing their programs by introducing

SFL. Geneva Global, YMCA, and Forum for Street Children, are also interested in integrating SFL into their

activities.

To increase parental involvement and raise awareness of HIV risk among the general population, HCP will

introduce the Parents' Passport to catalyze greater parental support and involvement in their children's

adolescent development. Building on the success of the Youth Passport, a vital SFL component, HCP and

its partners will develop a Parents' Passport to encourage parents to learn the hard facts about AIDS in

Ethiopia, including the frequency of transactional and cross generational sex, the emotional and physical

cost of FGM, alcohol and chat use and other high risk behaviors. To complement the face-to-face

information sharing, SFL in partnership with the Addis Ababa Educational Mass-Media agency will include a

second 30-minute weekly radio program aimed at capturing and broadcasting the voice of youth engaged in

SFL. The program will focus attention on the "tough" transitional issues many youth face once they leave

school after eighth grade.

In addition to these two youth-focused activities, HCP will continue to expand the Youth Action Kit (YAK)

program. YAK is a participatory prevention program for young people between the ages of 15-22 years that

builds life skills, encourages emotional development and the use of creative talents to fight AIDS. It

promotes HIV-preventive behaviors such as abstinence, mutual fidelity, negotiation, emotional control, and

personal reflection around values and goals. The targets for this comprehensive ABC activity can be found

under JHU/HCP in the HVOP section. HCP launched YAK in September 2004 through the Ethiopian Youth

Network and is currently implemented by the Ethiopian Orthodox Church, Save the Children, CRS and Pact.

HCP's approach is to train partner staff, who in turn, implements programs through youth groups and

schools. After 6-10 months of effort, when a youth club has met its goals, it is certified as a "Champion." To

date YAK has been implemented in 75 schools and 1,324 out-of-school clubs and Sunday schools. A total

of 155 of these clubs are in the seven hotspot areas.

A March 2007 YAK evaluation documented major changes in attitudes and behavior among program

participants. The percentage of youth who discussed HIV/AIDS with their parents increased by 19.2%.

Attitudes towards abstinence improved with the percentage of youth who believed that secondary

abstinence is possible increasing by 6.7%. The proportion of participants who reported testing for HIV

increased by 27%. In 2008, HCP will launch the YAK Level II "Tsehay" ("Sun") Program in the same seven

urban hot spots areas to advance youth clubs that have already achieved champion status. The YAK

evaluation showed that these clubs are eager to become more engaged in community outreach and

possess the human resources to do so. The goal of the Level II program is to further assist the

transformation of youth groups into frontline community leaders.

HCP completed a field test of the "Tsehay" program in 15 clubs in Bahir Dar, Jimma and Makele in the first

half of 2007. The results to date have been promising and HCP will build upon the successes to reach the

most vulnerable youth. In response to the 2005 EDHS findings, the program will refocus efforts on bringing

group activities and peer counselling to hard-to-reach neighbourhoods and out-of-school youth. During the

Activity Narrative: initial design of the YAK program, HCP used the Media and Materials Clearinghouse (MMC) at JHU, to

review and capture the best prevention activities from 20 programs across Africa. HCP will return to the

MMC and other resources to review prevention work carried out with high risk populations to compile an

activity core for the Level II "Tsehay" program. HCP plans to encourage clubs to conduct more CT

campaigns, especially with outreach efforts to reach sex workers and at-risk youth. The YAK program will

introduce a "Let's Talk" component which will use short dramatic stories and skits during club meetings and

street festivals to capture the interest of participants. Trained facilitators would initiate discussions designed

to "break the silence" around themes such as transactional sex.

HCP anticipates that there will be several overlapping areas between the Level II "Tsehay" program and the

new "Adult Prevention Kit". HCP will include information about partner reduction, fidelity, GBV and condom

use in the new module-based curriculum for adults. Based on the success of the YAK materials, HCP will

use their MMC at JHU to adapt, create, and test a collection of modules which can be used to target a

number of different at-risk populations - adults in the workplace, women attending universities, and women

and men engaged in transactional sex and/or maintaining multiple sexual partners.

The Adult Prevention Kit will consist of two basic components: "core activities" which will respond to the

common or universal needs of vulnerable, at-risk groups and "electives" - activities designed to respond

appropriately to the concerns and/or risk perceptions of specific target groups. In order to insure rapid

adaptation and deployment of the curriculum, HCP will initially field test a common version of the kit with

women in university and workplace settings. The program will focus on populations reporting higher-risk sex

in urban areas, including never-married women and women with a secondary or higher education. HCP

anticipates that this kit will be considerably shorter than either YAK or SFL - perhaps taking six to eight

sessions to complete. HCP will field test the new adult curriculum at 25 factories and seven universities in

Addis Ababa, Adama/Nazareth, Jimma, Dire Dawa, Mekele, Bahir Dar and Dessie. JHU/HCP will

collaborate closely with Abt Associates, and Addis Ababa University to ensure that interventions are not

duplicative in nature. For more information about the adult curriculum and activities, please see the

JHU/HCP activities under the HVOP section. Targets for the adult-focused activities can be found in the

HVOP narrative.

Reaching Youth and Women

Johns Hopkins University (JHU)/Health Communication Partnership (HCP) will continue their existing

comprehensive youth activities under the Youth Action Kit, while adopting new prevention interventions to

reach adults, especially women in university and workplace settings. This is a continuing and expanding

activity from FY07.

HCP will continue to expand the Youth Action Kit (YAK) program. YAK is a participatory prevention program

for young people between the ages of 15-22; it builds life skills, encourages emotional development, and

provides comprehensive information about HIV prevention. It promotes HIV-preventive behaviors such as

abstinence, mutual fidelity, correct and consistent condom use, negotiation skills, emotional control, and

personal reflection around values and goals. HCP launched YAK in September 2004 through the Ethiopian

Youth Network and is currently partnering with the Ethiopian Orthodox Church, Save the Children, Catholic

Relief Services and Pact Ethiopia to implement the program. HCP's approach is to train partner staff, who in

turn implement programs through youth groups and schools. After 6-10 months of effort, when a youth club

has met its goals, it is certified as a "Champion." To date partners have implemented YAK in 75 schools and

1,324 out-of-school clubs and Sunday schools. A total of 155 of these clubs are in the seven target hotspot

areas - Addis Ababa, Adama/Nazareth, Jimma, Dire Dawa, Mekele, Bahir Dar and Dessie.

In 2008, HCP will launch the YAK Level II "Tsehay" ("Sun") Program in these seven urban hotspots to

advance youth clubs that have already achieved champion status. HCP plans to train 2,400 individuals and

reach an estimated 800,000 young people with the YAK prevention program in 2008. The YAK evaluation

showed that these clubs are eager to become more engaged in community outreach and possess the

human resources to do so. The goal of the Level II program is to further assist the transformation of youth

groups into frontline community leaders and to strengthen the sense of individual responsibility in the fight

against HIV/AIDS. HCP completed a field test of the "Tsehay" program in 15 clubs in Bahir Dar, Jimma, and

Makele in the first half of 2007. The results to date have been promising and HCP will build upon these

successes to reach the most vulnerable youth. In response to the 2005 Ethiopian Demographic and Health

Survey (EDHS) findings, the program will refocus efforts on bringing group activities and peer counselling to

hard-to-reach neighbourhoods and out-of-school youth. During the initial design of the YAK program, HCP

used the Media and Materials Clearinghouse (MMC) at JHU to review and capture the best prevention

activities from 20 programs across Africa. HCP will return to the MMC and other resources to review

prevention work carried out with high-risk populations to compile an activity core for the Level II "Tsehay"

program. HCP plans to encourage clubs to conduct more counselling and testing CT campaigns, especially

with outreach efforts to reach commercial sex workers and at-risk youth. The YAK program will introduce a

"Let's Talk" component which will use short dramatic stories and skits during club meetings and street

festivals to capture the interest of participants. Trained facilitators will then initiate discussions designed to

"break the silence" around themes such as transactional sex that should, at this point, be common

knowledge in Ethiopia.

In addition to the expanded youth activities, HCP will begin addressing the HIV-prevention needs of adults.

The keystone of this program will be the "Adult Prevention Kit" which will be designed to insure that

participants thoroughly understand the dynamics and dangers of high-risk situations and have the skills to

protect themselves. This program will train 2,500 individuals to reach an estimated 28,500 adults with

comprehensive HIV-prevention messages and tools. The Adult Prevention Kit will consist of two basic

components: "core activities" which will respond to the common or universal needs of vulnerable, at-risk

groups and "elective activities" designed to respond appropriately to the concerns and/or risk perceptions of

specific target groups. HCP will use the MMC at JHU to adapt, create, and test a collection of modules

which can be used with a number of different at-risk populations - adults in the workplace, women attending

universities, and women and men engaged in transactional sex and/or maintaining multiple sexual partners.

In order to ensure rapid adaptation and deployment of the materials, HCP will initially field test a common

version of the kit with women in university and workplace settings. Given the limited free time available to

university and working women, HCP anticipates that this kit will be considerably shorter than either YAK or

Sports for Life - perhaps taking 6-8 sessions to complete.

HCP will develop and test approaches to engage husbands, boyfriends and co-workers (such as truck

drivers linked to factories) of university and working women. At least two of the kit's activities will aim to

catalyze dialogue between women and men about gender and HIV and promote gender-equitable behavior

among men. During the development of these activities, HCP will work closely with the Male Norms

Initiative to incorporate appropriate messaging on male behavior and norms. HCP will also build on the

results from their recent Gender Equitable Men (GEM) research which looked at Ethiopian men's views on

violence against women, condom use, and homosexuality, among other topics. As with the YAK program, a

baseline assessment will be conducted to record changes in attitudes, knowledge, and behaviors over the

course of the intervention.

HCP will also create an adult passport to encourage personal reflection and decision-making specifically

around issues of coercion and exploitation. The adult passport will contain a "Red Card" to directly

challenge social norms and push the limits of acceptable behavior. The red card is similar to the one used in

soccer matches, except that women will be encouraged to use the card in any situation in which they feel

uneasy. The success of the "Red Card" in Madagascar, which has a social dynamic similar to Ethiopia,

demonstrated that a civil rights movement is simmering just below the surface of a traditional society. The

passport will also contain "Red Pages" which provide a "personal risk assessment tool" and negotiation

techniques to use in high-risk situations. These tools go directly to the heart of cross-generational sex and

the lack of gender equality in Ethiopia.

The Adult Program will engage certified peer counselors to reach each cohort of 25-30 women. These peer

counselors will be role models who are prepared to make significant service contributions. They will

participate in a three-day course and work with university counseling offices and CT clinics towards

certification over a six-month period. Certified peer counselors will be equipped to act in the most difficult

situations. Peer counselors will provide guidance and support to young women who test either positive or

negative. Little work has been done on the best way(s) to seize the opportunity that a negative test result

presents. HCP will develop tools that facilitate the implementation of risk-reduction strategies for university

and working women, as well as other vulnerable populations such as commercial sex workers and their

clients. HCP will work with the HIV/AIDS Prevention and Control Office (HAPCO), the Federal Ministry of

Activity Narrative: Health (MOH) and PEPFAR partners to insure that certification of the peer counselors is recognized across

Ethiopia.

HCP will launch the "Adult Prevention Kit" in partnership with local nongovernmental organizations and

companies in the seven university towns. HCP will collaborate closely with JHU/HCP and the MARCH

(Modeling and Reinforcement to Combat HIV/AIDS)project to complement and reinforce the existing and

any future MARCH materials or approaches being used at Addis Ababa University. HCP will collaborate

closely with all PEPFAR partners, especially Abt Associates, working with the private sector on HIV/AIDS

activities. The 25 target factories will be selected in collaboration with HAPCO and USAID. Special efforts

will be given to reaching women who work in flower farms/agro-industries in proximity to urban hotspots.

HCP will identify a series of events which link networks of university women and those in the workplace with

young women active in the YAK program in order to create a broader sense of collective efficacy, solidarity,

and purpose. These events will be positioned to project an image of Ethiopian women as thoughtful, strong,

and responsible. Events will be reinforced through mass media coverage. Examples of such activities

include an annual community outreach awards ceremony to recognize individuals and groups that have

taken exceptional steps to provide leadership and community service in HIV prevention and workplace

coverage certification for those companies where 85% of the female employees have participated in the

prevention program. Both the YAK and Adult Prevention Kit programs support the Government of Ethiopia's

Accelerated Access to HIV/AIDS Prevention, care, and Treatment in Ethiopia: Road Map, 2007-2008 which

aims to increase prevention efforts directed at vulnerable youth and women.