Prevention component of the Ethiopian Orthodox Church Development and Interchurch Aid

Commission/IOCC HIV/AIDS Response

The International Orthodox Christian Charities (IOCC) conducts HIV prevention, care, and support activities

with the Ethiopian Orthodox Church's Development Inter Church Aid Commission (DICAC). The Ethiopian

Orthodox Church (EOC) has approximately 40 million faithful, over 500,000 clergy and a network of 40,000

parishes found throughout Ethiopia. DICAC operates in over 200 districts in the country. The Church

publicly declares that it has an obligation to mobilize human and material infrastructure for the national

response to HIV/AIDS and that it should strive to influence positive social change, care for those affected or

living with HIV/AIDS, promote abstinence and faithfulness and reduce stigma and discrimination. DICAC

uses peer education and interactive communication to reach these goals.

This is a continuing activity implemented by the IOCC with DICAC. The comprehensive HIV/AIDS activity

started in FY06 and provides a package of prevention modules to include peer education, public rallies,

information-education-communication (IEC) materials, media intervention and clergy training, all of which

interact to slow the spread of the epidemic. During the first half of FY07 alone, the partners reached almost

1.2 million individuals (54% women) with abstinence and be faithful (AB) messages and trained 6,700

persons in AB outreach approaches.

During FY08, the activity will operate in 140 districts in 28 dioceses. IOCC anticipates that several districts

will be transitioned to the status of "areas of higher HIV prevalence" using both antenatal care (ANC) and

Ethiopia Demographic and Health Survey (EDHS) data. This will allow communities at risk to be reached

with interactive and interpersonal communications utilizing AB messages. Similar AB approaches utilizing

interpersonal peer education and interactive communication will be conducted through Sunday schools, lay

counselors and 55 public rallies (five by the Patriarch and 50 by the Archbishops).

The communications strategy uses several approaches:

1) Interpersonal Peer Education: During FY05, DICAC implemented a youth prevention program through

the existing Sunday school structure, with 2,000 peer educators reaching 50,000 youth. In FY06 and FY07,

DICAC adapted the Youth Action Toolkit (YAK), produced by Johns Hopkins University/Health

Communications Partnership, for the Sunday school setting. In FY06, 80,000 youth were enrolled in YAK

activities at Sunday schools throughout the 100 districts. An additional 2,000 peer educators were trained or

retrained.

2) Interactive Communication and Public Rallies: In FY06 and FY07, DICAC supported interactive HIV-

prevention and stigma-reduction communications (i.e. Archbishop Rallies, Clergy outreach) within AB

prevention activities at the community level. These activities targeted community attitudes and social norms

of the congregation , including delay of sexual debut, return to abstinence, mutual fidelity, HIV burden

among young women, empathy for persons living with HIV/AIDS and identifying addressing misconceptions.

Interactive communication and mass rallies held by the Patriarch and his Archbishops played an important

role in catalyzing discussion on HIV/AIDS at the community level. These types of interventions will be

continued in FY08 with strategic emphasis on the vulnerability of young girls and sanctioning male behavior

in relation to multiple sexual partnerships and cross generational sex.

In FY05, IOCC/DICAC trained 100 clergy trainers who in turn trained 40,000 clergy and community

members on key AB issues. During FY06, 8,000 additional clergy and community members were trained,

bringing the total to 48,000 trained clergy in operation. These clergy discuss HIV prevention and stigma with

members of the congregation during community outreach and reach millions of individuals during the course

of one year. Discussions use church doctrine and clergy training materials to support improvements in risk

perception and AB approaches to HIV prevention by individuals and households. Trained clergy openly

encourage premarital voluntary counseling and testing (VCT) and support discordant couples and others

seeking advice, by referral to local service providers, on condoms, secondary prevention, care, and support

and ART. Lastly, a new module was incorporated into the training manual for clergy on the complementarity

between holy water and ART.

3) Pre-Service HIV/AIDS Curriculum in Theological Colleges: During FY05, the Ethiopian Orthodox Church,

with support from the IOCC, integrated HIV/AIDS modules into the core curriculum of eight clergy training

institutes and three theological colleges. During FY06 and FY07 further supportive supervision was

provided to these training institutes and colleges to ensure that the curriculum is effectively implemented. In

addition, clergy in training will perform an internship that includes community outreach during the summer

months in the regions. A section of that internship drew on lessons from the core curriculum.

Activities in FY08 will include the above three, as well as supportive supervision of district activities by the

Ethiopian Orthodox Church to ensure consistency, quality assurance and improvements in programmatic

performance against management indicators. This program will continue to use interpersonal

communication through Sunday school and clergy counseling. IOCC anticipates additional technical

assistance from the Johns Hopkins University Health Communications Partnership to implement the Youth

Action Toolkit to support risk reduction, improved knowledge of HIV/AIDS and adoption of AB practices.

Ninety-five thousand youths and young adults will be reached through Sunday Schools. Other strategies

include interactive communications and mass rallies with the Patriarch and Archbishops to support changes

in social norms and attitudes surrounding HIV/AIDS. The rallies draw on messages that emphasize

empowerment, support and empathy for those living with HIV/AIDS and HIV prevention through AB.

IOCC will continue to integrate the HIV/AIDS core curriculum into 18 clergy training institutes and three

theological colleges. Training through these outlets will reach 2,000 individuals. The maintenance of training

standards will be fostered through the modification of curricula on an as need basis, refresher courses and

regular reporting. The program will support in-service training for 10,000 clergy with follow-up from district

branch coordinators. IOCC will provide capacity building and exit strategy/planning with the Ethiopian

Orthodox Church/DICAC to support a multi-year transition of activities from IOCC to the Ethiopian Orthodox

Church, thus assuring sustainability of the program. This program will continue to provide IEC materials on

HIV prevention, care, and misconceptions regarding the Ethiopian Orthodox Church's stance on the

complementarities of holy water and ART will be distributed. These IEC messages and materials will be

reinforced by development and dissemination of new audio visual presentations. Community members and

Activity Narrative: PLWH trained as lay counselors to support community outreach will help disseminate these materials and

messages to the general population. These persons will function as messengers of hope to give public

testimony about their experiences with the program.

DICAC has supported the development of local community networks linking community organizations

offering HIV prevention, care, and treatment services. Efforts during FY05 allowed important partnerships to

be formed with local government, the Ethiopian Red Cross, PLWH associations and the Organization for

Social Services for AIDS. In FY08, the program will continue to support these networks with technical

assistance from DICAC staff in the regions. DICAC will cultivate additional partnerships with other

organizations active in interpersonal communications, including Population Service International, Population

Council, Family Guidance Association, World Food Program, and Action Aid.

Gender remains an underlying principle to DICAC and is given attention as a cross-cutting theme. Efforts to

increase participation of women in youth clubs, community-based discussion groups, income generating

activities, and counseling and training activities will continue. By the same token, steps will be taken to

increase male participation in the program at all levels in collaboration with Engender Health (12235). In

FY06, explicit female participation targets were raised to 50% for lay counselor and peer educator staffing

with satisfactory results. IOCC will maintain these targets in FY08.

In addition to the explicit multi-year planned transfer of responsibility from IOCC to the Ethiopian Orthodox

Church/DICAC, IOCC and DICAC will collaborate with the National Partnership Forum and the Inter Faith

Forum for Development and Dialogue and Action both to assure sustainability of this program as well as to

reinforce Ethiopia's faith-based organization response to the HIV/AIDS epidemic.

IOCC HIV/AIDS Response Mechanisms Project

The International Orthodox Christian Charities (IOCC) conducts HIV prevention, care, and support activities

with the Ethiopian Orthodox Church's Development Inter Church Aid Commission (DICAC).

The Ethiopian Orthodox Church (EOC) has approximately 40 million faithful, over 500,000 clergy and a

network of 40,000 parishes found throughout Ethiopia. DICAC operates in over 200 districts in the country.

The Church publicly declares that it has an obligation to mobilize human and material infrastructure for the

national response to HIV/AIDS and that it should strive to influence positive social change, care for those

affected by or living with HIV/AIDS, promote abstinence and faithfulness, and reduce stigma and

discrimination. DICAC uses peer education and interactive communication to reach these goals.

This is a continuing activity implemented by the IOCC with DICAC. IOCC/DICAC implements home-based

care (HBC) services in twelve dioceses and its income-generating activities and spiritual counseling support

services in 140 districts. In the first half of FY07 alone, IOCC/DICAC provided over 8,400 individuals (53%

women) with general HIV-related palliative care.

In FY08, IOCC/DICAC will reach 12,000 PLWH with care and support activities including income-generating

activities, HBC and spiritual counseling. IOCC uses volunteers drawn from local Orthodox congregations to

conduct home visits to clients who are bedridden or in the end-of-life stages of AIDS. These volunteers

conduct several activities at least twice each week, including: counseling both the client and their family;

providing basic physical and social care; serving as liaison for clergy to visit the home; referring patients to

medical services including ART (or in reverse, accepting ART beneficiaries from the public health system);

and leveraging nutritional support from the community including local businesses and hotels. The activities

planned at each district will continue in close collaboration with the local district HIV/AIDS Prevention and

Control Office (HAPCO) branch and other area stakeholders.

IOCC/DICAC encourages networking among groups to further strengthen the project's impact and

sustainability. Gender equality is an important cross-cutting theme of the IOCC/DICAC program. In FY08

the program will increase efforts to ensure increased female participation in youth clubs, advocacy groups,

community-based discussion groups, income-generating activities and counseling and training activities.

The program will maintain targets of no less than 50% female participation for income-generating activities

(IGA), lay counselor, and peer educator staffing. By the same token, steps will be taken to increase male

participation in the program at all levels in response to male partner initiatives in collaboration with the

EngenderHealth "Men as Partners" activity (ID 12232).

During 2008, IOCC/DICAC will provide HBC services to 3,000 PLWH and an estimated 12,000 family

members, reaching a total of 15,000 clients. HBC services will include nursing care; spiritual counseling;

referral of household contacts for VCT; screening for active TB and referral to local health facilities for

prescription of prophylaxis when appropriate; provision of insecticide-treated mosquito nets; education on

safe water and hygiene together with the provision of locally manufactured water treatment supplies;

nutrition counseling; adherence counseling; and education and encouragement of PLWH to seek HIV care

and treatment at health centers and hospitals.

In FY05, IOCC/DICAC developed a strategy aimed to improve the welfare and economic sustainability of

PLWH households with IGA. In FY08, IOCC/DICAC will extend IGA support to an additional 1,500 PLWH

and will indirectly support 6,000 family members. During FY08 the program will increase IGA start-up capital

from $90 to $136 per person to address the increased cost of commodities. IOCC/DICAC will foster

linkages so that PLWH enrolled in the program continue to receive regular follow-up guidance and technical

advice from their local HAPCO and agricultural office regarding selection and management of their IGA.

IOCC/DICAC will also support 5,625 PLWH with spiritual counseling through trained spiritual hope

counselors.

The Ethiopian Orthodox Church has taken a strong public stance against stigma and discrimination. This

will continue to be a key message in FY08 and will be widely disseminated at public rallies, through the

teachings of the church and trained clergy.

The International Orthodox Christian Charities (IOCC) conducts HIV prevention, care, and support activities

with the Ethiopian Orthodox Church's Development Inter Church Aid Commission (DICAC).

The Ethiopian Orthodox Church (EOC) has approximately 40 million faithful, over 500,000 clergy and a

network of 40,000 parishes found throughout Ethiopia. DICAC operates in over 200 districts in the country.

The Church publicly declares that it has an obligation to mobilize human and material infrastructure for the

national response to HIV/AIDS and that it should strive to influence positive social change, care for those

affected or living with HIV/AIDS, promote abstinence and faithfulness and reduce stigma and discrimination.

DICAC uses peer education and interactive communication to reach these goals.

This is a continuing activity implemented by the IOCC with EOC/DICAC that provides a package of services

to address the needs of orphans and vulnerable children. The package of services includes counseling by

trained lay counselors, training of guardians and provision of small grants for the start up of income

generating activities (IGA) to provide economic support.

In FY07, 2,000 new OVC and their households were enrolled in the IGA program that is expected to

indirectly improve the lives of approximately 8,000 OVC household members. These household members

benefit from the project's care and support components, including spiritual and practical counseling, start-up

capital, and education on nutrition and sanitation in the home. All OVC beneficiaries attended school, a

policy of the program that is reinforced through follow-up by lay counselors with guardians.

To increase program effectiveness and sustainability, IOCC increased networking and partnerships with

organizations such as the national, regional and local HIV/AIDS Prevention and Control Offices (HAPCO),

Red Cross, regional administration offices, Dawn of Hope and the Organization for Social Services for AIDS

(OSSA). In FY08, IOCC anticipates supporting 28 diocese equaling about 140 districts in the regions of

Addis Ababa, Amhara, Benishangul Gumuz, Oromiya, SNNP, and Tigray.

Additional resources in COP08 will be used to:

(1) Increase start-up capital from $90 to $136 provided to 3,000 additional OVC for income generating

activities. This is important in view of significant inflation in Ethiopia which was not anticipated in the last

budget. IOCC/DICAC will continue foster linkages so that OVC enrolled in the program continue to receive

regular follow-up guidance and technical advice from their local HAPCO and agricultural office regarding

selection and management of their IGA.

(2) Provide training to 360 new lay counselors. Lay counselors are required to follow-up and provide

guidance to the planned total of 6,500 OVC and their household members. The program currently has 240

lay counselors, a ratio of 23 OVC to one counselor. In FY08, this ratio will be reduced to 11 to 1 to enable

more frequent and better quality follow-up sessions; necessitating recruitment of an additional 360 lay

counselors.

(3) Provide funds to enable 75 OVC over 15 years of age to attend vocational training schools to receive

training that will better secure their future and make them productive and employable citizens. The program

will therefore provide funds to send three OVC from each of the 25 branch areas to vocational training

schools. This will include training in tailoring, metal work, woodworking and hairdressing. In addition, IOCC

will provide start-up equipment such as sewing machines and tools upon graduation.

In partnership with other PEPFAR Ethiopia OVC partners, this activity will work with the new PEPFAR

Annual Program Statement recipient to coordinate activities to achieve the most efficient use of resources

for OVC in the highest HIV/AIDS prevalence areas. This includes harmonization on indicators, reporting,

and OVC standards of care in line with Government of Ethiopia national guidelines and policies and OGAC

OVC Program Guidance, as well as achieving quality assurance in OVC programming. Data from the

Ethiopia Demographic and Health Survey (EDHS) 2005 and the results of USG Ethiopia mapping will used

to further identify geographic priority areas ranked highest for children affected by HIV/AIDS. As an exit

strategy IOCC focuses on strengthening the community and the diocesan partners to sustain the program.

Gender remains an underlying principle to DICAC and is given attention as a cross-cutting theme. Efforts to

increase participation of women in youth clubs, community-based discussion groups, income generating

activities and counseling and training activities will continue. By the same token, steps will be taken to

increase male participation in the program at all levels in collaboration with Engender Health (ID 12235). In

FY06, explicit female participation targets were raised to 50% for lay counselor and peer educator staffing,

with satisfactory results. IOCC will maintain these targets in FY08.

In addition to the explicit multi-year planned transfer of responsibility from IOCC to the Ethiopian Orthodox

Church/DICAC, IOCC and DICAC will collaborate with the National Partnership Forum and the Interfaith

Forum for Development Dialogue and Action both to assure sustainability of this program as well as to

reinforce Ethiopia's faith-based organization response to the HIV/AIDS epidemic.