PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Adolescent girls, Early Marriage and Migration in Amhara Region and Addis Ababa
ACTIVITY UNCHANGED FROM FY2008
Amhara Region has the lowest age at marriage in the country, with 46% of girls marrying by 15 years. Most
of these vulnerable girls have not had sex before marriage and, in this population, the earlier a girl marries,
the earlier she has sex. Orphan girls are more likely to experience early marriage than non-orphans. In
addition, Amhara region has one of the highest rates of divorce in the world, with early marriage being a
predictor of divorce (Tilson and Larsen, 2000). A study by Population Council (PC) in low income areas of
Addis Ababa found that 45% of adolescent girls had migrated from rural areas; among the most common
reasons given for migration were education, work, and to escape early marriage (Erulkar et. al. 2006).
Though migrants hope for a better future in urban centers, many end up highly vulnerable, often in lowly
paid and exploitive domestic work or in sex work. Being economically vulnerable and socially isolated, such
girls and young women are highly vulnerable to forced or coerced sex, transactional sex for daily or periodic
support, and negative reproductive health outcomes, including HIV infection. Evidence suggests that girls
who marry early have increased risk of HIV infection, even compared to their unmarried sexually active
peers. A study in Kenya and Zambia revealed that married adolescent girls have 50% higher HIV rates
compared with unmarried sexually active girls. Married girls' high infection rates are related to more
frequent intercourse, almost no condom use, and husbands who are significantly older, more experienced,
and more likely to be HIV-positive compared with boyfriends of unmarried girls.
Few programs, especially OVC programs, have addressed the specific needs of married adolescent girls,
including the risk of migration, either escaping marriage or following divorce. Due to social and cultural
definitions of childhood, once a girl is married she is no longer considered a child regardless of her age or
stage of development. OVC programs working with communities to identify OVC need to take this issue into
consideration. This activity will assist OVC programs with meeting the specific needs of adolescent girls
who have migrated without adult supervision to urban centers most often to escape early marriage.
This activity will complement the continuing Population Council AB activity and will be undertaken in urban
and peri-urban areas of Bahir Dar, Gondar, Debre Markos, Dessie, and Addis Ababa with the latter three
being new sites during the current year. All districts are contiguous with the urban centers and along truck
routes, where many girls migrate. The objectives of this activity are 1) developing tools and training for OVC
programs on meeting the needs of adolescent girls experiencing or escaping from early marriage 2)
providing services and referrals to female OVC who have migrated to low income urban centers. Services
to be provided include emotional and social support from adult female mentors, non-formal education, HIV
prevention information, livelihoods training including financial literacy and entrepreneurship, and referrals to
post-rape counseling, health services, VCT, PMTCT, and ART. Population Council will partner with
economic growth programs specializing in livelihoods for vulnerable populations to provide guidance on
entrepreneurship training and employment strategies and resources. Linkages with programs addressing
exploitive child labor will be made to leverage experience and capacity.
In four urban areas of Amhara Region (Bahir Dar, Gondar, Debre Markos and Dessie) and Addis Ababa,
the activity will establish girls' groups for the most vulnerable, out-of-school, migrant girls, including
domestic workers. The groups, led by adult female mentors, will provide a safe space for girls to discuss
their problems, obtain peer support, and engage with supportive adults. Providing non-formal education to
girls in these groups will allow them to catch up with their interrupted or missed education. Different types of
livelihood skills training will be given to enable them to work and support themselves and therefore prevent
engaging in risky behavior for sustaining themselves.
Over 7500 of the most vulnerable migrant girls will be reached in FY08 through 100 trained female mentors.
Groups will be managed by the local ward administrations as well as local NGOs, to be identified. Site
selection will be done in collaboration with OVC programs to ensure maximum use of resources and avoid
duplication. Female mentors will serve a pivotal role in identifying needs, providing support, and making and
following up on referrals. The activity will build on lessons learned from the pilot project "Biruh
Tesfa" (Amharic for ‘Bright Future') program for vulnerable adolescent girls in the Mercato, area of Addis
Ababa. Through this pilot project, the most vulnerable urban girls are recruited house to house by female
mentors, who negotiate directly for the girls' participation with gatekeepers, including employers of domestic
workers.
Assistance to OVC programs will include provision of technical input on how to improve reach and depth of
services to adolescent girls who have migrated to urban and peri-urban areas. South-to-south exchanges
will be facilitated between OVC program and activities in Kenya that are addressing the impacts of early
marriage and migration of girls.
The activity will focus on vulnerable adolescent girls and therefore increase gender equity in HIV/AIDS
programs. The Population Council, through lessons learned from this program, will continue to lead
PEPFAR partners in enhancing programming directed to address the needs of vulnerable girls and young
women. The program will also include capacity building to partnering ward administration offices and local
NGOs to help them recognize the impacts of girls experiencing early marriage and how to address their
needs.
The activity will apply the recently drafted Standards of Services for OVC in Ethiopia and conform to the
PEPFAR Ethiopia Prevention Strategy of targeting high risk groups. Faith and community structures will be
engaged in identifying and providing support to adolescent girls their prospective husbands, their families
and communities that support early marriage. The program will link closely with Population Council's Safer
Marriage activity in the Amhara Region since that activity will focus on prevention of early marriage and
prevention of marital transmission of HIV through messages for the community, use of faith-based
structures at the community level and promoting faithfulness in marriage.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16680
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16680 5726.08 U.S. Agency for Population Council 7502 3789.08 $900,000
International
Development
10521 5726.07 U.S. Agency for Population Council 5518 3789.07 $800,000
5726 5726.06 U.S. Agency for Population Council 3789 3789.06 $500,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Preventing Early Marriage in Amhara Region
ACTIVITY UNCHANGED FROM FY2008:
FY 08 ACTIVITY NARRATIVE
Evidence suggests that girls who marry early have increased risk of HIV infection, even compared to their
unmarried, sexually active peers. A study in Kenya and Zambia revealed that married adolescent girls have
50% higher HIV rates compared with unmarried, sexually active girls. Married girls' high infection rates are
related to more frequent intercourse, almost no condom use, and husbands who are significantly older,
more experienced, and more likely to be HIV-positive compared with boyfriends of unmarried girls.
Amhara region has the lowest age at marriage in the country, with 46% of girls marrying by 15 years. Most
of these girls have not had sex before marriage and, in this population, the earlier a girl marries, the earlier
she has sex. In addition, Amhara region has one of the highest rates of divorce in the world, with early
marriage being a predictor of divorce (Tilson and Larsen, 2000). Data from the 2005 Ethiopian Demographic
and Health Survey (EDHS) highlights that the HIV epidemic is concentrated among ever-married women,
including young women. Ethiopian women who are divorced are a population highly affected by HIV, with
8.1% of divorced women HIV-positive, nationally.
The HIV epidemic in Ethiopia is concentrated in urban areas of the country; however, it disproportionately
affects migrants to urban areas, rather than natives. Many young women migrate to urban areas following
divorce, to pursue educational or livelihoods goals, or to escape early marriage. A study by Population
Council (PC) in low-income areas of Addis Ababa found that 45% of adolescent girls had migrated from
rural areas; among the most common reasons given for migration were education, work, and to escape
early marriage (Erulkar et al., 2006). Though migrants hope for a better future in urban centers, many end
up highly vulnerable, often in lowly paid and exploitive domestic work or in sex work. Being economically
vulnerable and socially isolated, such girls and young women are highly vulnerable to forced or coerced
sex, transactional sex for daily or periodic support, and negative reproductive health outcomes, including
HIV infection. Indeed, among young, urban women below the age of 30, 6.8% of migrants to the urban
center are HIV-positive compared to 2.8% of young women who are native to the urban area; likewise 16%
of urban women who are divorced and migrated to the area, are HIV-positive (PC tabulations of 2005
EDHS).
The gender, early marriage and HIV infection activity addresses the HIV risks associated with early
marriage, as well as those associated with divorce and migration. Communities often erroneously assume
that marrying girls off will prevent premarital sex and HIV infection. Understanding the HIV risks of marriage
and knowing each other's HIV status beforehand may help delay marriage, prevent transmission, and/or
foster long-term faithfulness. Delaying marriage may result in lower rates of divorce and related migration
following divorce. Few programs have addressed the HIV risk of pre-married and married adolescent girls,
including the risk of migration, either escaping marriage or following divorce. This activity implements
community awareness and premarital voluntary counseling and testing (VCT) interventions in Amhara to
promote later, safer, chosen marriage and marital fidelity. In view of unequal marital relationships, this
activity develops interventions encouraging married men to remain faithful. Key faith and community leaders
will reinforce these messages.
This expansion of a continuing activity will be undertaken in urban and peri-urban areas of Bahir Dar,
Gondar, Debre Markos, Dessie, and Addis Ababa; the latter are being new sites during the current year. All
districts are contiguous with the urban centers and along truck routes, where many girls migrate in the event
of divorce and where many husbands go on market days, often representing an opportunity for drinking
and/or engaging in extramarital relations. Strategies include: 1) educating communities on the risks
associated with early marriage, marital HIV transmission, and promoting faithfulness, 2) promoting
premarital VCT for engaged couples and VCT for married couples, and 3) supporting and educating married
adolescent girls and their husbands through clubs.
Religion is a powerful force in Ethiopia, and for many communities the church may be their only sustained
institutional contact. An additional 1,000 religious leaders will be trained through ‘Days of Dialogue,' to reach
congregations and community members with prevention messages, tailored to the nature of HIV risk in
Amhara. Over 1,000,000 individuals will be reached with prevention messages related to HIV, delaying
marriage, male norms and behaviors, faithfulness, and premarital VCT. During the current year, core
messages will integrate information on linkage between early marriage, divorce, migration, and vulnerability,
as well as male norms and risks associated with market days and other types of short-term movements.
Two hundred selected religious and community leaders from the new project sites will be trained as VCT
promoters to promote premarital VCT and refer couples to VCT sites. Clients testing positive will be
provided ongoing support and referral to existing care and support services.
This activity will establish married girls' clubs to reach over 15,000 married adolescent girls, providing
venues through which girls can receive information, advice, and social support, including in instances where
they feel their husbands pose HIV risk or when they are contemplating migration. The clubs will include
livelihood and mentoring opportunities, as well as informal education and HIV information and referral. In
collaboration with EngenderHealth's Male Norms Initiative, the activity will establish married men's clubs,
reaching 12,000 men, as a venue through which to discuss male roles and gender norms, gender-based
violence, and faithfulness, among others.
This activity will be part of the HVAB 10521 activity, but with more focus on the male behavior change and
will include condom promotion. This activity will be closely linked to Engender Health's Male Norms Initiative
in establishing men's clubs to promote faithfulness in marriage and creating a positive male role in gender
norms and gender-based violence; this will contribute to reduction of violence. The activity will also be
linked to counseling and testing programs through referrals for pre-marital VCT. The focus of the program
will be young girls (married and unmarried,) thereby addressing gender equity in HIV programming. It will
also increase the girls' access to income and productive resources through the informal education and
Activity Narrative: livelihood skills training that they receive through their clubs. The faith-based organizations, Amhara
Regional Youth & Sports Bureau, and other local organizations partnering with Population Council will have
their capacity built in through trainings directed at addressing the problem at the community level.
The program conforms to the PEPFAR Ethiopia Prevention Strategy of targeting high-risk groups; and uses
existing faith and community structures to reach the young women (especially those at risk of migration),
husbands or prospective husbands, their families, and communities that support early marriage.
Continuing Activity: 17875
17875 17875.08 U.S. Agency for Population Council 7502 3789.08 $313,000
Estimated amount of funding that is planned for Economic Strengthening $50,000
Estimated amount of funding that is planned for Education $50,000
Table 3.3.03:
COP08 NARRATIVE
to be provided include emotional and social support from adult female mentors, non-formal education, HIV-
Over 7500 of the most vulnerable migrant girls will be reached in COP08 through 100 trained female
mentors. Groups will be managed by the local ward administrations as well as local NGOs, to be identified.
Site selection will be done in collaboration with OVC programs to ensure maximum use of resources and
avoid duplication. Female mentors will serve a pivotal role in identifying needs, providing support, and
making and following up on referrals. The activity will build on lessons learned from the pilot project "Biruh
prevention of marital transmission of HIV through messages for the community, use of faith based
Continuing Activity: 18258
18258 18258.08 U.S. Agency for Population Council 7502 3789.08 $400,000
* Addressing male norms and behaviors
* Increasing women's legal rights
Health-related Wraparound Programs
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Economic Strengthening $135,000
Estimated amount of funding that is planned for Education $100,000
Table 3.3.13:
