Supporting University Students with AB

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This is a continuing abstinence and being faithful (AB) activity from FY08, linked to OP activity with Addis

Ababa University (AAU) students and Expansion of Wegen National AIDS Talk line and MARCH Model

Activities. 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).

The release of new HIV surveillance data has resulted in a new understanding of the nature of HIV

epidemic in Ethiopia. In 2007, the single-point estimate for HIV prevalence for adults 15-49 was 2.2%, with

an urban rural difference of 7.7% versus 0.9%. All local universities are based at the capital cities or sub-

cities of the regional states. These new estimates reflect a consistent pattern, observed in both antenatal

clinic (ANC) surveillance and the 2005 Ethiopia Demographic and Health Survey (EDHS), of a nearly nine-

fold higher HIV prevalence in urban settings than in rural settings. Rural HIV prevalence is concentrated

primarily along transport corridors and in peri-urban settings. The formative assessment conducted on

university students also showed that there is a knowledge, attitude and practice gap among this audience.

In line with the analysis of HIV concentration in urban settings, MARCH project HIV prevention program

continue to focus at most-at risk populations, including university students. 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 (45km 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 sexual behaviors

(including improved health care seeking behavior for HIV/AIDS) 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

intervention. This AB focused program promotes abstinence and being faithful prevention 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 entertaining comic print serial

dramas, and interpersonal reinforcement. The entertainment component uses role models in a storyline to

provide information about AB and other prevention, 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 printed and distributed every month, 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 among the university community.

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. Interactive

reinforcement activities focus on issues in the PSD and give students and staff support for behavior change.

The AB focused reinforcement activities include public debates, lectures, exhibitions, music concerts, live

talk shows, drama, movies, plays, and sports competitions, which give the student community opportunities

to discuss on the PSD.

During FY05, 06, 07, and 08 MARCH was implemented in the main AAU campus and medical faculty; it

was also expanded to all AAU campuses during these periods. The project reaches 30,000 university

students and 3000 staff members through a variety of MARCH activities, including PSD, live theater

programs performed by AAU students and faculty employees, observation of World AIDS Day, and an

interactive MARCH website. A certificate training curricula program was established and selected students

participated to have better knowledge and skill to go beyond a casual knowledge level and make HIV

prevention part of their academic and career skill. In FY07, 225 students were trained based on the newly

established and revised curricula program and they organized different reinforcement activities including

sport competition, dramas, quiz on HIV/AIDS, card plays based on models and characters in the print serial

dramas that promote abstinences and faithfulness and the uptake of care and treatment services.

In general, up to FY08, the MARCH project accomplished major activities including the production and

distribution of printed serial dramas (PSD) and different information-education-communications (IEC)

materials such as newsletters, poem books, fliers, posters, and banners. These materials were 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).

AAU is also in the process of implementing workplace HIV/AIDS interventions to reach university academic

and administrative employees. AAU conducted continuous panel discussions with both the academic and

administrative staff and the out come so far has been very positive. In FY09, AAU is planning to build the

capacity of all faculties to create better infrastructure for the implementation of the project. AAU will conduct

Activity Narrative: situational analysis to design and implement employee tailored behavioral change communication

interventions.

During the past period of MARCH program implementation in AAU, it is learnt that the production of printed

serial drama every two weeks was difficult. The production of PSDs adjusted from two weeks to a month

and this will help to have enough time and space to the limited number of designers and cartoonists to do

their job. As the PSD production extended to every month, it is true that gap will be created on peer group

discussions every two weeks, however in COP09 gaps created is filled by different linked reinforcement

activities including staged dramas, poem and play presentation, penal discussions and quizzes. MARCH

program in the AAU will ensure information communication materials enclosure of service availability and

access.

So far, there is no cure or vaccine for HIV, the only alternative as a vaccine that we have at hand is

promoting and addressing messages geared towards averting new HIV infection, and hence MARCH will

continue to be a tool for our prevention programs to bring sustainable behavioral change and to bring a

change in behavior and to personalize models in the PSD, MARCH will continue with the appropriate

dosage, intensity and coverage. We are observing early signs of behavioral change among the university

students, after the introduction of the MARCH program, students are talking and discussing with their peers,

partners and family members about the voluntary testing and counseling, and asking information about

treatment and care services.

During FY09 among other things, the project will:

1.Strengthen the capacity of the campus liaison offices to implement MARCH with appropriate dosage,

intensity and coverage fully in the university;

2.The Print serial drama will be produced every month. Peer groups will conduct peer group discussions

every two weeks alternating PSD with student-led linked reinforcement activities.

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

students, 250 reinforcement agents will be selected and refreshed, using the revised certificate curriculum.

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

music, exhibitions, quizzes, sport competitions, talk shows, lectures, card plays, documentary films etc.

5.Continue production and distribution of campus newsletters and other IEC materials and ensure the

enclosure information regarding VCT service accessibility, referral linkages of care and treatment services

6.Explore possibilities for leveraging experiences in organizing different reinforcement activities of the

Federal Police and Ethiopia National defense Force, private universities using AAU materials at other

schools in Addis Ababa, including

7.Regularly maintain and upgrade MARCH websites to expand functionality for online interaction

8.Data collection, monitoring, and data analysis. Collect information to conduct a process evaluation to

identify major monitoring activities and assess early signs of behavior change.

9.Strengthening of workplace HIV prevention and control programs at the 12 campuses of the university.

This activity will target all academic and administrative staff with comprehensive HIV-prevention activities.

Major workplace program activities will include:-

•Developing and implementing employee tailored behavioral communication materials such as posters, bill

boards, IEC materials, fliers, magazines, newspapers and will conduct various programs that conduct HIV

education through entertainment. These will be based on the baseline assessment.

•Conducting BCC training for a selected focal person from each campus;

•Building capacity for AAU staff anti-AIDS clubs with materials and technical support;

•Creating referral linkages for HIV/AIDS services within the university; and establishing HIV resource

centers at each faculty's library.

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

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

AB is a significant part of the overall prevention intervention.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.02:

HIV Prevention Activities with University Students

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Substantive changes were made in the COP 08 Narrative and are as follows:

This is a continuing non-AB focused activity from FY08, linked to AB activity with Addis Ababa University

students and Expansion of Wegen National AIDS Talk line and MARCH Model Activities.

A 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.

All local universities are based at the capital cities or sub-cities of the regional states.

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, 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

intervention. This Other Prevention activity promotes consistent and 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 month;

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.

During FY05, 06, 07, and 08 MARCH was implemented in the main AAU campus and medical faculty; it

was also expanded to all AAU campuses during these periods. The project reaches 30,000 university

students and 3000 staff members through a variety of MARCH activities, including PSD, live theater

programs performed by AAU students and faculty employees, observation of World AIDS Day, and an

interactive MARCH website. Training curricula was established and selected students participated to have

better knowledge and skill to go beyond a casual knowledge level and make HIV prevention part of their

academic and career skill. 225 students trained based on the newly established and revised curricula

program and they organized different reinforcement activities including open air sport games, plays,

dramas, quiz on HIV/AIDS, card plays based on models and characters in the print serial dramas that

promote abstinences and faithfulness and the uptake of care and treatment services.

In general, up to FY08, the MARCH project accomplished the following major activities including the

production and distribution of printed serial dramas (PSD), different information-education-communications

(IEC) materials such as newsletters, poem books, fliers, posters, and banners. These materials were

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).

During the past period of MARCH program implementation in AAU, it is learnt that the production of printed

serial drama every two weeks was difficult. The production of PSDs adjusted from two weeks to a month

and this will help to have enough time and space to the limited number of designers and cartoonists to do

their job. As the PSD production extended to every month, it is true that gap will be created on peer group

discussions every two weeks, however in COP09 gaps created is filled by different linked reinforcement

activities including staged dramas, poem and play presentation, penal discussions and quizzes. MARCH

program in the AAU will ensure information communication materials enclosure of service availability and

access.

So far, there is no cure or vaccine for HIV, the only alternative as a vaccine that we have at hand is

promoting and addressing messages geared towards averting new HIV infection, and hence MARCH will

Activity Narrative: continue to be a tool for our prevention programs to bring sustainable behavioral change and to bring a

change in behavior and to personalize models in the PSD, MARCH will continue with the appropriate

dosage, intensity and coverage. We are observing early signs of behavioral change among the university

students, after the introduction of the MARCH program, students are talking and discussing with their peers,

partners and family members about the voluntary testing and counseling, and asking information about

treatment and care services.

AAU is also in the process of implementing workplace HIV/AIDS intervention to reach university academic

and administrative employees. So far AAU conducted continuous penal discussions with both the academic

and administrative staff and the out come was very positive. In FY09 AAU is planning to build the capacity

of all faculties to create better infrastructure for the implementation of the project. AAU will conduct

situational analysis to design and implement employee tailored behavioral change communication

interventions.

During FY09 among other things, the project will:

1.Strengthen the capacity of the campus liaison offices to implement MARCH with appropriate dosage

intensity and coverage fully in the university;

2.The Print serial drama will be produced every month. Peer groups will conduct peer group discussions

every two weeks alternating PSD with student-led linked reinforcement activities.

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

students, 250 reinforcement agents will be selected and retrained, using the revised certificate curriculum.

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

music, exhibitions, quizzes, sport competitions, talk shows, lectures, card plays, documentary films etc.

5.Continue production and distribution of campus newsletters and other IEC materials and insure the

enclosure information regarding VCT service accessibility, referral linkages of care and treatment services

6.Explore possibilities for leveraging experiences of organizing different reinforcement activities to the

Federal Police and Ethiopia National defense Force, private universities using AAU materials at other

schools in Addis Ababa, including

7.Regularly maintain and upgrade MARCH websites to expand functionality for online interactive

8.Data collection, monitoring, and data analysis. Collect information to conduct a process evaluation to

identify major monitoring activities and assess early signs of behavior change.

9.Strengthening of workplace HIV prevention and control programs at the 12 campuses of the university.

This activity will target all academic and administrative staff with comprehensive HIV-prevention activities.

Major workplace program activities will include:-

•Based on the baseline assessment ,develop and implement employee tailored behavioral communication

materials such as posters, bill boards, IEC materials, fliers, magazines, newspapers and will conduct

various program that conducts HIV education through entertainment;

•Conducting BCC training for a selected focal person from each campus;

•Building capacity for AAU staff anti-AIDS clubs with materials and technical support;

•Creating referral linkages for HIV/AIDS services within the university; and establishing HIV resource

centers at each faculty's library.

10. Strengthen the implementation of prevention of urban-rural transmission of HIV/AIDS. Students will be

equipped with the appropriate training and skills to teach empower their community better respond to HIV

when students return back for vacation. To help students better achieve the plan manual or guide line will

be developed to direct all actions to bring the same result.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16692

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16692 5766.08 HHS/Centers for Addis Ababa 7507 494.08 Strengthening $85,000

Disease Control & University HIV/AIDS, STI &

Prevention TB Prevention,

Control &

Treatment

Activities

10554 5766.07 HHS/Centers for Addis Ababa 5525 494.07 $10,000

Disease Control & University

Prevention

5766 5766.06 HHS/Centers for Addis Ababa 3755 494.06 $20,000

Disease Control & University

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $10,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

ACTIVITY UNCHANGED FROM FY2008

This is a continuation of activity from FY08. 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, TB and sexually transmitted infections (STI) program

activities.

AAU 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. 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, public health evaluations and basic program evaluations, 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 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 regions of the country - Addis Ababa City

Administration, Southern Nations Nationalities and Peoples Region, Gambella and Benshangul-Gumuz.

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 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

(JHU-THSEHAI) and Management Sciences for Health (MSH), as well as undertake planning and review

meetings with other local universities and stakeholders as appropriate. 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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16693

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16693 5670.08 HHS/Centers for Addis Ababa 7507 494.08 Strengthening $140,000

Disease Control & University HIV/AIDS, STI &

Prevention TB Prevention,

Control &

Treatment

Activities

10550 5670.07 HHS/Centers for Addis Ababa 5525 494.07 $100,000

Disease Control & University

Prevention

5670 5670.06 HHS/Centers for Addis Ababa 3755 494.06 $100,000

Disease Control & University

Prevention

Table 3.3.09: