This ongoing abstinence and being faithful (AB) prevention activity is designed to improve prevention, care,

and treatment activities related to HIV/AIDS, sexually transmitted infections (STI), and tuberculosis (TB) in

Addis Ababa University (AAU). A Knowledge, Attitudes, and Practices (KAP) study conducted at AAU in

2002 indicated that only a few respondents (22%) mentioned abstinence from sex as an effective protective

method. This attitude is one of the factors that puts youth at greater risk of contracting and/or transmitting

HIV—only 29% of survey respondents perceived themselves as at risk for acquiring HIV.

As students come to Addis Ababa from all corners of Ethiopia, factors such as maturity level, desire for new

experiences, peer pressure, absence of immediate parental control, change of environment, and a need to

"fit in," make them particularly vulnerable to HIV infection. In addition, they are exposed to various hot spots

surrounding the university campuses. AAU has 12 campuses within Addis Ababa and Debre-Zeit town (45

km east of the capital), encompassing a student population of about 32,000, an academic staff of about

3,000, and an administrative staff of about 2,000. Preventive behavior-change interventions that combine

activities to promote safer behaviors (including use of services) and help build students' ability to implement

the interventions are crucially important.

The aim of this project is to prevent and control HIV/AIDS within the entire university community (regular

and summer students, faculty, and administrative staff) through behavioral-change communication. It

focuses on improving HIV/AIDS/STI/TB prevention and care activities on the 12 campuses using the

MARCH model (Modeling and Reinforcement to Combat HIV/AIDS). MARCH is a behavior-change

communications (BCC) strategy that promotes behavioral changes that reduce the risk of HIV infection and

transmission, and encourages communities to use services to care for people living with HIV (PLWH) and

children orphaned by the epidemic.

There are two main components to the MARCH program: education through entertainment, and

interpersonal reinforcement. The entertainment component uses role models in a storyline to provide

information about, and model, behavior change; this motivates the audience and enhances a sense of self-

efficacy. Reinforcement activities use interpersonal strategies like peer-group discussions, with the objective

of group members applying messages from the drama to their own lives. The group discussions also

provide accurate information about HIV/AIDS and behavior change, provide opportunities to practice new

skills that may be required to avoid infection, and provide support to those infected. A serial drama is

distributed every two weeks, and follows the evolution of positive behavior change by role models; the serial

drama storyline forms a basis for peer-group discussions and other forms of interactive discussions.

Research shows that effective interventions are often personalized ones, so MARCH reinforcement

activities try to personalize the behavior-change intervention. The reinforcement activities aim to promote

audience internalization of positive behavior change through interactive discussion and opportunities to

practice new skills required to avoid infection and support PLWH. Printed serial dramas (PSD) are

published every two weeks and distributed among the students. Interactive reinforcement activities focus on

issues in the PSD and give students and staff support for behavior change. Reinforcement activities include

public debates, lectures, exhibitions, music concerts, live talk shows, plays, and sports competitions, which

give the student community opportunities to discuss the PSD.

In FY05, MARCH was begun on the main AAU campus and medical faculty; it was expanded to all AAU

campuses during FY06. In FY06, a total of 29,472 students were reached with a variety of MARCH

activities, including PSD, live theater programs created by AAU students and faculty, observation of World

AIDS Day, and an interactive MARCH website. The website has been visited by 12,700 students. One of

the most significant achievements of FY06 was the establishment of training curricula for selected students

to receive additional instruction toward obtaining a certificate. The certificate program is designed for

students who wish to go beyond a casual knowledge level and make HIV prevention part of their academic

and career skills.

In FY07 the MARCH project built on the achievements made in the previous fiscal years and accomplished

the following major activities: printed serial dramas (PSD), information-education-communications (IEC)

materials, a newsletter, poem book, fliers, posters, and banners were all produced and distributed to all

campuses of the university. The certificate curriculum was revised to make it more interactive and practical,

with six required modules, one optional module, and a practicum. Five hundred students were trained on

HIV/AIDS prevention, particularly on abstinence and being faithful (AB). Out of that group, 50 were retrained

and became reinforcement agents. The reinforcement agents conducted various interactive reinforcement

activities through which the project reached 30,000 university students and staff members. Technical

assistance from the Johns Hopkins University Center for Communications Programs (CCP) and CDC

helped the project to accelerate implementation of activities and achieve results. The University has also

built its capacity in financial and procurement procedures, which helped it to manage and accommodate

projects.

During FY08 the project will:

1) Strengthen the capacity of the campus liaison offices to implement MARCH fully in the university,

distribute PSD to students every two weeks, and augment IEC materials and student-led reinforcement

activities in which the entire university takes part to practice skills presented in the PSD

2) Conduct training for university students in HIV/AIDS prevention and reinforcement activities. From these

students, 200 reinforcement agents will be selected and retrained, using the revised certificate curriculum.

3) Produce and distribute 26 editions of the PSD

4) Undertake various reinforcement activities to personalize PSD messages through events such as drama,

music, exhibitions, quizzes, sport competitions, talk shows, lectures, etc.

5) Continue production and distribution of campus newsletters and other IEC materials

6) Explore possibilities for using AAU materials at other schools in Addis Ababa, including private

universities

7) Strengthen alliances between AAU and other Ethiopian universities, colleges, and high schools

8) Regularly maintain and upgrade MARCH websites to expand functionality for online interactive

discussion on printed serial dramas, other HIV-related fora, data collection, monitoring, and data analysis.

9) Conduct a process evaluation to identify major monitoring activities and assess early signs of behavior

change

AAU will also implement another area of intervention in FY08: the establishment of workplace HIV-

Activity Narrative: prevention and control programs at the 12 campuses of the university. This project will target all academic

and administrative staff with comprehensive HIV-prevention activities. The MARCH project at Addis Ababa

University primarily targets students, and the story lines in the PSD also address the problems which

students face in the fight against AIDS during their stay at the university. However, a 2005 report completed

in Ethiopia indicates that there is a high adult HIV prevalence rate, which indicates a need to focus on

targeting the adult population with HIV prevention information.

Therefore, this new workplace activity reaches academic and administrative staff at the university with an

intensive and comprehensive program to reduce risky behaviors and stigma and discrimination. It also

promotes: abstinence, being faithful, and correct and consistent condom use; service uptake (voluntary

counseling and testing and ART); and care for HIV-positive people.

Major workplace program activities will include:

1) Conducting a baseline assessment of HIV knowledge, attitudes, and practices (KAP) through an external

consultant

2) Developing or adopting HIV workplace policy, strategy, and implementation guidelines

3) Producing or adapting training manuals

4) Conducting BCC training for a selected focal person from each campus

5) Organizing various sensitization workshops and interactive fora

6) Producing IEC materials, including fliers, posters, banners, newspapers, and magazines

7) Building capacity for AAU staff anti-AIDS clubs with materials and technical support

8) Creating referral linkages for HIV/AIDS services within the university

9) Establishing an HIV resource corner at each faculties' library

10) Hiring and remunerating a project focal person at each campus of AAU for implementation

Since the PSD and reinforcement activities encompassed in MARCH are designed to reach the university

with a comprehensive ABC message, all targets will be counted under Other Prevention, though AB is a

significant part of the overall prevention intervention.

Supporting University Students with OP

This is a continuing non-AB focused activity from FY06, linked to AB activity with Addis Ababa University

students (5584) and to design and production of TA for MARCH (10386 and 10388).

AA November 2006 study on condom use among university and college students in Addis Ababa, including

Addis Ababa University (AAU) students, showed that only 34.5% of students believed that people can

protect themselves from HIV by using a condom correctly every time they have sex. Another interesting

finding of this survey is that only 3.9% of the students mentioned that condom use is the preferred method

of HIV prevention among young people. Another study at Jimma University in 2002, one of the local

universities with student-body characteristics similar to those at AAU, found that 60 (12.2%) of 490 students

were HIV-positive, with highest prevalence among third- and fourth-year students (i.e., those most

acquainted with the social environment). As students come to Addis Ababa from all corners of Ethiopia, a

number of factors make them particularly vulnerable to HIV infection including young age, desire for new

experiences, peer pressure and the desire to fit in, absence of immediate parental supervision, and change

of environment. In addition, the presence of entertainment facilities in the vicinity of the university campuses

that serve alcohol and have commercial sex workers creates an enabling environment for exposure to HIV.

AAU has twelve campuses within Addis Ababa and Debre-Zeit town (45 km east of the capital),

encompassing a student population of about 32,000, an academic staff of about 3,000, and administrative

staff of about 2,000. Preventive behavior-change interventions that combine activities to promote safer

behaviors (including use of services) and help build students' ability to implement the interventions are

crucially important.

The aim of this project is to prevent and control HIV/AIDS within the entire university community, including

regular and summer students, faculty, and administrative staff through behavioral change communication.

This Other Prevention activity promotes consistent, correct condom use, corrects misconceptions, tackles

stigma and discrimination towards people living with HIV (PLWH) and existing gender imbalances, alerts

students to the necessity of early treatment of sexually transmitted infections, and helps increase uptake of

services like voluntary counseling and testing (VCT) and ART. Its intent is to reduce risky behaviors and

encourage comprehensive care and support in the university and wider community by linking to other

services.

Modeling and Reinforcement to Combat HIV/AIDS (MARCH) is a behavior-change communications (BCC)

strategy that promotes behavioral changes that reduce the risk of HIV infection and transmission, and

encourages communities to use services to care for PLWH and children orphaned by the epidemic. There

are two main components to the MARCH program: education through entertainment, and interpersonal

reinforcement. The entertainment component uses role models in a storyline to provide information about

behavior change, to motivate the audience, and to enhance a sense of self-efficacy. Reinforcement

activities use interpersonal strategies like peer-group discussions, with the objective of having group

members apply messages from the drama to their own lives. The group discussions also provide accurate

information about HIV/AIDS and behavior change, provide opportunities to practice new skills that may be

required to avoid infection, and provide support to those infected. A serial drama is distributed every two

weeks, The storyline follows the evolution of positive behavior change by role models, forming a basis for

peer-group discussions and other forms of interactive discussions.

In FY05, MARCH began on the main AAU campus and medical faculty; it was expanded to all AAU

campuses in FY06, when a total of 29,472 students were reached with a variety of MARCH activities,

including live theater programs created by AAU students and faculty, and an interactive MARCH website.

The website has been visited by 12,700 students. One of the most significant achievements of FY06 was

the establishment of training curricula for selected students to receive additional instruction toward obtaining

a certificate. The certificate program is designed for students who wish to go beyond the level of casual

knowledge and make HIV-prevention part of their academic and career skills.

In FY07 the MARCH project built on the achievements made in the previous fiscal years and accomplished

the following major activities: printed serial dramas (PSD); information, education, and communication (IEC)

materials; a newsletter; poem book; and fliers, posters and banners were all produced and distributed to all

campuses of the university. The certificate curriculum was revised to make it more interactive and practical,

with six required modules, one optional module, and a practicum. Five hundred students were trained on

HIV/AIDS prevention, particularly on abstinence and being faithful (AB); of those, 50 were retrained and

became reinforcement agents. The reinforcement agents conducted various interactive reinforcement

activities in which the project reached 30,000 university students and staff members. Technical assistance

from the Johns Hopkins University Center for Communications Programs and CDC helped the project to

accelerate implementation of activities and achieve results. The university has also built its capacity in

financial and procurement procedures, which helped it to manage and accommodate projects.

During FY08 the project will:

1) Strengthen the capacity of the campus liaison offices to implement MARCH fully. The goal is to reach

35,000 students and 5,000 staff members by distributing PSD to 10,000 students every two weeks,

augmenting IEC materials, and offering student-led reinforcement activities, in which the entire university

takes part to practice skills presented in the PSD.

2) Conduct training for 250 students in certificate curriculum programs to qualify them to be reinforcement

agents and to conduct various interactive activities to reinforce messages from the PSD

3) Produce and distribute 26 editions of the PSD

4) Undertake various reinforcement activities to personalize PSD messages through events like drama,

music, exhibitions, quizzes, sport competitions, talk shows, lectures, etc.

5) Continue production and distribution of campus newsletters and other IEC materials

6) Explore possibilities for using AAU materials at other schools in Addis Ababa, including private

universities

7) Strengthen alliances between the university and other Ethiopian universities, colleges, and high schools

8) Regularly maintain and upgrade MARCH websites to expand functionality for online interactive

discussion on printed serial dramas, other HIV-related fora, data collection, and monitoring and data

analysis

9) Conduct a process evaluation to identify major monitoring activities and assess early signs of behavior

change

Activity Narrative:

AAU will also implement another area of intervention in FY08: the establishment of workplace HIV-

prevention and control programs at the 12 campuses of the university. This project will target all academic

and administrative staff of the university with comprehensive HIV prevention activities.

The MARCH project at AAU primarily targets students, and the storylines in the PSD also address the

problems which students face in the fight against AIDS during their stay at the university. However, a 2005

report completed in Ethiopia indicates that there is a high adult HIV-prevalence rate, which indicates the

need to focus on targeting the adult population with HIV-prevention information.

Therefore, this new workplace activity reaches academic and administrative staff at the university with an

intensive and comprehensive program to reduce risky behaviors, stigma and discrimination, and promote

abstinence, being faithful, and correct and consistent condom use, service uptake (VCT and ART), and care

for HIV-positive people.

Major workplace program activities will include:

1) Conduct baseline assessment of HIV knowledge, attitudes, and practices (KAP) through an external

consultant

2) Develop or adopt HIV workplace policy, strategy, and implementation guidelines

3) Produce or adapt training manual

4) Conduct BCC training for a selected focal person from each campus

5) Organize various sensitization workshops and interactive fora

6) Produce IEC materials, including fliers, posters, banners, newspapers, and magazines

7) Build capacity for AAU staff anti-AIDS clubs with materials and technical support

8) Create referral linkages with HIV/AIDS services within the university

9) Establish an HIV resource corner at each faculties' library

10) Hire and remunerate a project focal person at each campus of AAU to coordinate effectively and

efficiently the implementation of the workplace program activities.

Since the PSD and reinforcement activities encompassed in MARCH are designed to reach the university

with a comprehensive ABC message, all targets will be counted under Other Prevention, though AB is a

significant part of the overall prevention intervention.

This was a TBD. Addis Ababa University (AAU), one of the largest higher learning institutions in Africa, was

established at the end of the 1940s. AAU has twelve different campuses within Addis Ababa and Debrezeit

town (45 km south of Addis Ababa). The total number of students is estimated to be around 30,000 with

academic staff approximating 3,000. Addis Ababa University has entered in to a cooperative agreement

with CDC Ethiopia since 2004 to strengthen HIV/AIDS, STI and TB prevention, control, and treatment

efforts in the AAU. AAU has established an HIV/AIDS Prevention and Control Unit within the Vice

President's office for Graduate Students and Research. As the pioneer of higher education and as the

leading research center of the country, AAU is playing a substantial role in HIV/AIDS education, research,

awareness-raising and brining about behavioral change, as well as in devising new and improved methods

of combating the spread of the disease. Particularly the Department of Community Health has been playing

a leading role in providing technical assistance and coordinating a number of national research and public

health evaluations related to HIV/AIDS. The Department of Community Health has the required

organizational, technical and human resource capacity to implement this public health evaluation and other

similar programs. A complete reprogramming is, therefore,made from TBD/CDC activity # 187776 to AAU.

Justification:

This is a change of prime partner from TBD and to Addis Abeba University, which currently does have Co-

agreement with CDC/E & implementing other HIV/AIDS activities in the heath clinics/facilities/ of the

different campuses of the University . It is more cost effective to complememt and integrate these STI

activities in to the existing HIV/AIDS activies by the University and provide HIV prevention and friendly STI

services. Therefore, part of the CDC/TBD activity number 18710.08 to the amount of 100,000 USD is

reprogrammed to Addis abeba University to strengthen the STI service in the different Clinics under the

University .

HIV/AIDS (ART) Program Implementation Support

This is a continuing activity from FY05, FY06, and FY07.

Addis Ababa University (AAU), one of the seven institutions of higher learning with a medical school, is

located in Addis Ababa, the Federal capital of Ethiopia, and one of 11 regions of the country. AAU trains a

wide array of professionals, including different cadres of health workers and social scientists. Having

recognized that university students constitute a high-risk group that could be deeply affected by the

HIV/AIDS epidemic, AAU started to strengthen its response to HIV/AIDS-related activities in FY05/06/07

through support from PEPFAR Ethiopia. The university has taken measures to accelerate the

implementation of a comprehensive response to HIV/AIDS among the university community. It has

developed and disseminated an HIV/AIDS policy and established a university-wide structure to guide and

coordinate program implementation. AAU is also expanding its support to the national HIV/AIDS program,

including ART services. It is increasingly involved in various HIV/AIDS and related activities, both at national

and regional levels. This includes in-service training of health workers to meet the high human resource

needs to implement HIV/AIDS, tuberculosis (TB) and sexually transmitted infections (STI) program

activities.

In FY07 and FY08, AAU continues to expand voluntary counseling and testing (VCT) services in different

campuses and to strengthen prevention activities among students and staff. It will continue with the

mainstreaming of HIV/AIDS training in its graduate and undergraduate training programs in various

disciplines. A database for clinical patient monitoring that has been established in the AAU teaching hospital

will be used effectively. Guided by the HIV/AIDS Council, the HIV/AIDS-related projects and activities will be

implemented in a coordinated manner. The Office of the Associate Vice President will oversee HIV/AIDS

program activities in all 16 colleges and faculties of the university.

Different colleges, faculties, and departments of the university will be actively involved in HIV/AIDS activities

based on their areas of specialty and comparative advantages. The faculties of the Schools of Medicine,

Law, and Social Work, the Institute of Development Research, the Departments of Sociology and Social

Anthropology, the Center for Research and Training for Women in Development, and others will be

involved. The activities of each faculty and department will be coordinated so that the response of the

university is a unified one, with maximum impact on the epidemic, both university-wide and at the national

level. In addition to the national experience and the momentum gathered in Addis Ababa region, FY06/07

activities accord opportunities to AAU's efforts to scale up both its HIV/AIDS/STI/TB programs among

university students and staff and its support for the national program. However, a shortage of trained staff, a

lack of adequate technical support, and constraints with scientific evidence to guide policy and

programmatic decisions and activities will continue to pose major challenges to the national HIV/AIDS

program over the coming years. The complexity of the response to HIV/AIDS/STI/TB, including moral,

ethical, and technical implications of different interventions, calls for a strong technical support to the

national program. There is, therefore, a strong need for scaling up training at in-service and pre-service

levels, operations research, and national, regional, and international linkages and partnerships. These

programmatic needs can best be met by AAU in partnership with the Ethiopian Ministry of Health (MOH)

and through innovative alliances with similar national and international institutions. In FY08, in partnership

with Johns Hopkins' (JHU) Bloomberg School of Public Health, AAU will further consolidate and scale up

VCT service, expand prevention activities, and strengthen linkages to care and treatment for university

students. It will coordinate its program support with JHU and continue to provide technical assistance (TA)

to the MOH and four major regions of the country - Addis Ababa Administrative Council, Southern Nations,

Nationalities and Peoples Region, Gambella and Benishangul-Gumuz.

In FY08, AAU will strengthen its support for in-service training and direct TA to MOH and provide pre-

service training on HIV/AIDS, including ART. AAU will be involved in targeted evaluation of HIV/AIDS

program implementation and in national and regional activities related to data processing, documentation of

best practices, and dissemination of scientific information. AAU will collaborate with Johns Hopkins

University's Technical Support for the Ethiopia HIV/AIDS ART Initiative and Management Sciences for

Health, as well as undertake review meetings with other local universities and stakeholders. Through its

cooperative agreement with CDC Ethiopia, AAU will strengthen its engagement in managing its HIV/AIDS

program and its support to the national and regional programs and the health networks that deliver ART.

Using the funding support through this project and the direct TA from JHU, AAU will consolidate its technical

and managerial capacities that will, in the long-term, help the university to take over the technical support

currently provided by JHU and to ensure program sustainability.