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
Preventing Mother to Child Transmission of HIV for Sudanese and Eritrean Refugees
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
IRC is currently providing PMTC services to Sherkole Refugee Camp in the Benishangul-Gumuz region and
Shimelba Refugee Camp in Tigray. IRC will expand the geographic scope of this activity in FY09 to cover
refugee and host community pregnant women who test positive in My Ayni Refugee Camp, which opened in
May 2008 to accommodate the continued influx of Eritrean asylum seekers entering Ethiopia. In addition,
IRC will provide transport and per diem funds for women in the host communities surrounding both
Shimelba and My Ayni who test positive and are referred to the Shire health facility for treatment. Including
host community beneficiaries is a critical aspect of refugee assistance programming. Because treatment
services are not yet available in Shimelba or My Ayni, positive pregnant women are referred to facilities in
Shire for services (approximately three hours away). Due to their mandate to serve refugees, the
Government of Ethiopia's Administration for Refugee and Returnee Affairs is unable to provide support for
host community women who are referred for services leading to a high loss to follow-up rate for these
women as they cannot afford to make the trip without assistance. To date, My Ayni hosts a temporary clinic
providing basic health care, but does not have the capacity to provide VCT or PMTCT services. This
activity links directly to IRC's PEPFAR-funded VCT program that also has plans to expand services to My
Ayni during FY09.
Per current ARRA protocols, dual therapy will be administered in place of Nevirapine as ART becomes
available in the camps. ART and dual therapy services are currently available in Sherkole Refugee Camp,
but are not yet available in Shimelba or My Ayni refugee camps. However, single-dose Nevirapine is
available in Shimelba camp. IRC has been working with the Tigray Regional Health Bureau and providing
training through the University of Washington/I-TECH to bring ART and dual therapy to Shimelba. High staff
turnover and the isolated location of the camp have delayed implementation of those services to date.
COP08 ACTIVITY NARRATIVE
The proposed project is a new component of the International Rescue Committee's (IRC) current PEPFAR-
funded project, which provides counseling and testing (CT) services to refugees living in camp settings and
the surrounding host communities. IRC's CT project was initiated in October 2004 in Sherkole Camp (in the
Benishangul-Gumuz region) and in 2007 in Shimelba Camp (in the Tigray region). In FY08, IRC is
proposing to expand PMTCT activities in both camps and host communities, in coordination with ARRA and
the United Nations High Commission for Refugees (UNHCR).
IRC coordinates its activities closely with UNHCR, the Government of Ethiopia's (GOE) Agency for
Returnee and Refugee Affairs (ARRA), regional, zonal, and district-level governments, and the Ethiopian
HIV/AIDS Prevention and Control Office (HAPCO).
IRC encourages women and healthcare providers to know the woman's status before delivery, with the
intent of reducing the risk of HIV transmission by administering Nevirapine to the pregnant woman and the
newborn.
Since 2006, IRC has provided capacity-building training of relevant ARRA health staff in the Sherkole
refugee camp, for PMTCT, including the Maternal and Child Health (MCH) department. From January 2007
to date, 294 pregnant women have been tested, with one woman testing positive. In FY07, in collaboration
with Johns Hopkins University (JHU) and the Assosa Regional Hospital, IRC will make Nevirapine available
in the Sherkole ARRA MCH clinic.
In Shimelba, since the opening of the voluntary counseling and testing (VCT) center on July 2, 2007, IRC
has provided CT services to 75 pregnant women; three of whom have tested positive and have been
referred to Shire Regional Hospital for follow up. IRC, in collaboration with University of Washington/I-
TECH, will provide PMTCT training to ARRA health staff in FY0,7with the intent of providing greater PMTCT
services to the refugees. In FY08, these services will be continued and expanded to include Nevirapine.
In FY08, IRC will provide refresher trainings for traditional birth attendants and ARRA community-health
volunteers to provide them with the skills to counsel and encourage pregnant women to be tested for HIV so
that they may have access to ART.
The outreach services are designed to communicate openly with the community about HIV, with the hope of
reducing the associated fear, stigma, and discrimination. In both camps, IRC will target and tailor behavior-
change communication (BCC) messages specifically for pregnant mothers and their partners. The
messaging will strive to increase maternal understanding of the purpose and benefits of knowing their HIV
status for their own health and for the health of their unborn baby, the importance of using Nevirapine to
prevent transmission of HIV from mother to child during delivery, and the importance of partner testing.
Condoms and other methods of family planning will be provided to women coming for antenatal care (ANC)
services.
IRC will continue to coordinate with the Gender-Based Violence (GBV) and Education teams to integrate
HIV education, including preventing mother-to-child transmission of HIV and anti-stigma discussions, in
IRC's informal education classes, primary school classes, and GBV community discussions at the ARRA
health center and during outreach activities conducted by the IRC social workers.
In light of the repatriation and resettlement of refugees from both camps, more interventions are planned to
engage community and religious leaders, women, and youth in health-education activities on HIV/AIDS and
VCT issues to raise the awareness of as many refugees as possible prior to their return to Sudan or
resettlement to the US. The program as outlined is based on the current situation, demographics, and
population in the refugee camps, but it is likely that the situation will change in one year, as the mobility,
influx of new refugees, and voluntary repatriation of current refugees cannot be predetermined.
Activity Narrative: In Sherkole and Shimelba Camps and host communities, FY08 PMTCT activities and strategies will include:
ensuring the availability of, access to, and use of Nevirapine and ART therapy for refugee and host
community women; providing Nevirapine to HIV-positive mothers and newborns; and providing commodities
management training and support to relevant ARRA health staff to ensure that Nevirapine stock-outs do not
occur. In addition, IRC will continue to build the capacity of VCT center staff and ARRA health staff through
ongoing in-service trainings on PMTCT and Nevirapine administration, referrals, counseling, and
opportunistic infections management. IRC will also provide refresher training to traditional birth attendants
and community health workers who can mobilize the women in the community. Finally, IRC will maintain
good relations and continue to strengthen referral links established between the VCT centers, the ARRA
health centers, the regional hospitals, the post-test clubs, and the regional HAPCO offices, and with JHU
and I-TECH for technical support and training.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18625
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18625 18625.08 Department of International 7516 649.08 $74,649
State / Population, Rescue
Refugees, and Committee
Migration
Emphasis Areas
Health-related Wraparound Programs
* Malaria (PMI)
* TB
Refugees/Internally Displaced Persons
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Prevention/Abstinence/Be Faithful Activities for Sudanese and Eritrean Refugees
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
In FY09 IRC will initiate abstinence and be faithful activities as described in COP08 in My Ayni Refugee
Camp, which opened in the Tigray region in May 2008 to accommodate the continued influx of Eritrean
asylum seekers entering Ethiopia. My Ayni is currently home to approximately 4000 refugees with about
400 more arriving each month. While resettlement out of Shimelba is expected to begin in 2009, some
additional resources are needed to initiate AB programs in the new camp. Continued repatriation of
Sudanese refugees out of Sherkole Refugee Camp has reduced the camp size. However, plans for
consolidation of the two remaining camps housing Sudanese refugees (Fugnido in Gambella and Sherkole
in Benishangul-Gumuz) are not yet final, making it difficult to predict how many refugees will ultimately be
served by AB programs in Sherkole for FY09. This program is directly linked to IRC's VCT services, which
will also be expanded to My Ayni in FY09. Otherwise this activity remains unchanged from COP 08.
In an effort to provide more reliable data on numbers reached through community outreach (to avoid double
counting) IRC developed more exact targets using an age-focused approach and assuming attendance at
one outreach session per individual reported. Targets were developed using current camp populations
minus those under five years of age. Abstinence activities will focus on individuals who are pre-sexually
active (5-14 years); be faithful activities are focused on adults with partners (14+ years); and other
prevention activities will focus on anybody who might be sexually active (14+ years).
International Rescue Committee
Related Activities: This project is programmatically linked to Counseling and Testing for Sudanese and
Eritrean Refugees (10561) and Condoms and Other Prevention Activities for Sudanese and Eritrean
Refugees (10646).
The proposed project is a continuation of the International Rescue Committee's (IRC) current PEPFAR-
funded project, which provides current counseling and testing (CT) services to refugees living in camp
settings and the surrounding host communities. IRC's CT project was initiated in October 2004 in Sherkole
Camp (in the Benishangul-Gumuz region) and in 2007 in Shimelba Camp (in the Tigray region). For FY08,
IRC is proposing to continue its current Abstinence/Be Faithful (AB) activities in both camps and host
communities.
IRC coordinates its activities closely with the United Nations High Commission for Refugees (UNHCR), the
Government of Ethiopia's Agency for Returnee and Refugee Affairs (ARRA). IRC has established
relationships with Johns Hopkins University (JHU) and the University of Washington/I-TECH for technical
support and training, and with the Ethiopian HIV/AIDS Prevention and Control Office (HAPCO) which
provides training to field staff.
Outreach and Awareness-Raising
IRC provides CT and HIV/AIDS awareness and education through strategic behavior-change
communication (BCC) campaigns and community group discussions. Messaging will promote
understanding among at-risk populations of the importance of abstinence in reducing the transmission of
HIV, the importance of delaying one's sexual debut until marriage, life skills for practicing abstinence, and
faithfulness to one's partner within a marriage. The campaigns will focus on at-risk groups, including those
who travel and are away from their families for extended periods, women who engage in commercial sex
work (both in and out of the camp), women who are vulnerable to sexual exploitation due to their living
conditions, former and current military combatants, and adolescents. The campaigns will address prevalent
gender inequalities and male norms which encourage risky behaviors.
The awareness-raising activities will contribute to the comprehensive IRC strategy of mainstreaming HIV
information through its program sectors, including Education and Community services and the new gender-
based violence (GBV) services for the refugee population. The integration of three IRC programs leverages
the prevention, counseling, and testing campaign in the camp. The refugees are hearing similar HIV
messages from a greater number of sources in their surroundings, thus increasing their awareness of their
risk, their need to address current male norms that are spreading HIV, and the need to engage in safer
behavior practices.
IRC's information-education-communications (IEC) and BCC materials (e.g., posters, leaflets, billboards)
will be designed in collaboration with the refugee and local communities to ensure relevance and
appropriateness. These will be distributed to CT clients and placed in strategic locations where they can be
seen by both the focus populations and the population at large. IEC materials will reinforce project outreach
activities and ensure further AB education of the targeted population. IRC will also investigate additional
venues to disseminate sexually transmitted infections ( STI) and HIV/AIDS messages and to illustrate
behavior-change options.
In conducting discussions with the camp and host communities in Sherkole and camp community in
Shimelba, IRC will use the Community Conversations model developed by the United Nations Development
Program (UNDP). Community Conversations was introduced in Sherkole Camp in 2006. With the
assistance of a facilitator, communities engage in discussions to: create a deeper understanding of
HIV/AIDS; to identify and explore factors fueling the spread of HIV/AIDS in their respective contexts; and to
reach decisions and take action to mitigate the effects of the disease in their communities. Those actions
may include abstaining from premarital sexual activities and addressing gender inequalities and male norms
which encourage the spread of HIV.
In FY07, IRC trained 35 HIV/AIDS refugee social workers and youth peer educators in Sherkole Camp to
facilitate this innovative strategy. In FY08, the Community Conversations strategy will be expanded to
Activity Narrative: Shimelba Camp if it proves to be successful with the refugees in Sherkole Camp.
IRC will continue to coordinate with the GBV and Education teams to integrate AB promotion activities in
IRC's informal education classes, primary school classes, GBV community discussions at the ARRA health
center, and in outreach activities conducted by the IRC social workers.
voluntary counseling and testing (VCT) issues to raise the awareness of as many refugees as possible
before their return to Sudan or resettlement to the USA.
Anti-AIDS Clubs and Peer Educators
In FY08, IRC will continue to provide support for the youth anti-AIDS clubs in Sherkole Camp, the host
community in the Benishangul-Gumuz Region, and in Shimelba Camp in the Tigray Region. IRC will also
support four peer-education groups (one adult and three youth). The anti-AIDS clubs and peer educators
are actively educating youth and adults on HIV/AIDS and STI using a peer-to-peer model of information-
sharing. IRC will provide the anti-AIDS clubs and the peer educators with additional training to increase their
community mobilization capacity. In Shimelba, IRC will focus on strengthening the anti-AIDS club and
encouraging the participation of females.
In FY08, IRC's CT activities and strategies will include the continuation of the Community Conversations in
Sherkole Camp and the host community, with the expectation that they will be incorporated into the
HIV/AIDS program in the Shimelba Camp. Refugee community and religious leaders will be targeted for
participation and leadership in HIV/AIDS awareness-raising and anti-stigma activities. Groups at risk for HIV
will be involved in discussions to encourage their understanding of their risk and to promote the AB
message. Informal education sessions on AB prevention will be held in alternative basic education centers,
accelerated learning classes, refugee primary schools, GBV sessions, and the ARRA clinic. Life-skills
sessions, video presentations, and other activities will be used to reach the out-of-school youth. IRC will
continue to provide technical and material assistance and support to youth and adult peer-education groups
and youth anti-AIDS clubs in the refugee camps and surrounding communities. IEC materials on HIV
prevention and AIDS will be distributed in the camp and to host community outreach centers.
Continuing Activity: 16707
16707 10600.08 Department of International 7516 649.08 $92,460
10600 10600.07 Department of International 5536 649.07 $96,219
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Table 3.3.02:
Condoms and other Prevention Activities for Sudanese and Eritrean Refugees
In FY09 IRC will initiate HIV prevention activities as described in COP08 in My Ayni Refugee Camp, which
opened in the Tigray region in May 2008 to accommodate the continued influx of Eritrean asylum seekers
entering Ethiopia. My Ayni is currently home to approximately 4000 refugees with about 400 new arrivals
each month. While resettlement out of Shimelba is expected to begin in 2009, some additional resources
are needed to initiate OP programs in the new camp. Continued repatriation of Sudanese refugees out of
Sherkole Refugee Camp has reduced the camp size. However, plans for consolidation of the two remaining
camps housing Sudanese refugees (Fugnido in Gambella Regional State and Sherkole in Benishangul-
Gumuz Regional State) are not yet final, making it difficult to predict how many refugees will ultimately be
served by OP programs in Sherkole for FY09. This program is directly linked to IRC's VCT services, which
In addition, in an effort to provide more reliable data on numbers reached through community outreach (to
avoid double counting) IRC developed more exact targets using an age-focused approach and assuming
attendance at one outreach session per individual reported. Targets were developed using current camp
populations minus those under five years of age. Abstinence activities will focus on individuals who are pre-
sexually active (5-14 years); be faithful activities are focused on adults with partners (14+ years); and other
The proposed project is a continuation of the International Rescue Committee's (IRC ) current PEPFAR-
IRC is proposing to continue its current Condoms and Other Prevention activities in both camps and host
communities. This project is programmatically linked to Counseling and Testing for Sudanese and Eritrean
Refugees (10561) and Abstinence/Be Faithful Activities for Sudanese and Eritrean Refugees (10600).
IRC coordinates its activities closely with United Nations High Commission for Refugees (UNHCR) and the
understanding among the target populations of the importance of abstinence in reducing the transmission of
seen by both the focus populations and the population at large. These materials will reinforce the project
outreach activities and provide a further resource for the targeted communities to understand and eventually
use the available CT services.
reach decisions and take action (such as using a condom or practicing abstinence and faithfulness) to
mitigate the effects of the disease in their communities. In FY07, IRC trained 35 HIV/AIDS refugee social
workers and youth peer educators in Sherkole Camp to facilitate this innovative strategy. In FY08, the
Community Conversations strategy will be expanded to Shimelba Camp.
Activity Narrative: before their return to Sudan or resettlement to the USA.
Anti-Aids Clubs and Peer Educators
support three peer-education groups (two in Sherkole/Benishangul-Gumuz and one in Shimelba). The anti-
AIDS clubs and peer educators are actively educating youth and adults on HIV/AIDS and sexually
transmitted infections (STI) using a peer-to-peer model of information-sharing. IRC will provide the peer
educators and anti-AIDS clubs with additional training to increase their community mobilization capacity. In
Shimelba, IRC will focus on strengthening the anti-AIDS club and encouraging the participation of females.
Condom Distribution
In addition to community awareness-raising activities targeting HIV prevention, free condoms will be
supplied to condom-distribution sites located within Sherkole and Shimelba Camps and within the local host
population. Condom distributors will also receive training on proper use and storage of condoms.
IRC's 2008 HVOP continuation strategy in Sherkole and Shimelba Camps and host communities will
include providing universal precaution (UP)supplies and training on UP to the IRC-supported outreach and
static camp CT centers. The strategy will increase availability and access to condoms. It will also introduce
condom distributors to condom-negotiation training and the proper use, storage, and disposal of condoms.
Community Conversations in Sherkole Camp and the host community will be continued and introduced to
the HIV/AIDS program in the Shimelba Camp. Behavior-change discussions on HIV/AIDS, life skills, and
condom-negotiation skills will be held with at-risk groups and out-of-school youth. There will be HIV/AIDS
awareness sessions in informal education sessions, alternative basic education centers, accelerated
learning classes, the primary school, GBV discussion groups, and at the ARRA health center throughout the
year. Refugee community leaders and religious leaders will be targeted for HIV/AIDS awareness-raising
activities that encourage life choices and healthy norms that minimize individual risk to HIV. IRC will
continue to provide technical and material assistance as needed for the youth and adult peer-education
groups and youth anti-AIDS clubs in both the refugee and the local host communities
Continuing Activity: 16708
16708 10646.08 Department of International 7516 649.08 $43,545
10646 10646.07 Department of International 5536 649.07 $30,000
Table 3.3.03:
Care and Support Activities for Sudanese and Eritrean Refugees
ACTIVITY UNCHANGED FROM FY2008
This activity is unchanged from FY08. IRC determined that it does not currently have the capacity to
expand its care and support activities to My Agni Refugee Camp, which opened in May 2008 to
accommodate the continued influx of Eritrean asylum seekers entering Ethiopia. To date, My Agni hosts a
temporary clinic providing basic health care, but does not have the capacity to provide other services. IRC
intends to focus on initiating AB and OP outreach activities as well as OVC, VCT and PMTCT services in
FY09 with the hope of building enough capacity to initiate care and support services in My Agni in 2010.
During program design it was determined that FY08 targets were set too high given the actual number of
PLWH in the camps and host communities. FY09 targets have been reduced to reflect this reality. FY07
VCT results indicate that 81 individuals tested positive (15 in Shekel and 66 in Shim Elba), but not all of
these individuals require (d) palliative care. Because the number of individuals requiring care is reduced
there is an expected reduction in the number of individuals trained to provide HIV-related palliative care
(assuming a 1:2 ratio of care providers to care recipients).
COP08 NARRATIVE FOR THIS ACTIVITY:
This new activity works into the International Rescue Committee's (IRC) current PEPFAR-funded project,
which provides prevention and counseling and testing (CT) services to refugees living in Shekel and Shim
Elba Refugee camps and the surrounding host communities.
IRC's HIV prevention and CT project was initiated in October 2004 in Shekel Camp (in the Benishangul-
Gumuz region) and in 2007 in Shim Elba Camp (in the Tigray region). For FY08, IRC is proposing to
continue its prevention and CT activities with a strategic plan to expand its continuum of care to include care
-and-support activities in both camps and host communities.
Government of Ethiopia's (GOE) Agency for Returnee and Refugee Affairs (ARRA), and the Ethiopian
HIV/AIDS Prevention and Control Office (HAPCO), and has established relationships with Johns Hopkins
University and the University of Washington/I-TECH for technical support and training. This proposal was
developed in consultation with the GOE/ARRA.
IRC provides CT and HIV/AIDS awareness and education through strategic, behavior-change
communication (BCC) campaigns and community group discussions. In FY07, IRC trained 35 HIV/AIDS
refugee social workers and youth peer educators in Shekel Camp to facilitate the Community Conversations
model developed by the United Nations Development Program (UNDP). The BCC campaigns and
Community Conversation strategy target youth 'at risk' and adult community groups to identify and explore
factors fuelling the spread of HIV/AIDS in their respective contexts and to reach decisions and take action
(e.g., abstaining from sexual activities before marriage and addressing gender inequalities, sexual taboos,
and male norms which encourage the spread of HIV) to mitigate the effects of HIV and the stigma that
comes with being identified as HIV-positive in their communities. In FY08, the Community Conversations
strategy will be expanded to Shim Elba Camp.
Since FY05, IRC has provided HIV prevention, scaling up over time to include CT services and referrals for
assessment and wraparound care to local regional hospitals. While this program aspect has been
successful and well-received by the communities, there is no next step for those who have tested positive.
In FY08, IRC plans to expand its HIV program by providing care and support for people living with HIV
(PLWH), thereby providing a continuum of care for refugees and host communities. Since HIV testing began
in 2005 in Shekel Camp, IRC has provided counseling and testing to 3,324 clients; 1,671 refugees (970
males, 701 females), and 1,653 host-community individuals (1,023 males, 630 females). To date, 60
individuals have tested positive; 19 refugees (11 males, eight females) and 41 host community individuals
(12 males and 29 females), and 24 refugees have been referred to the Assisi Regional Hospital for
wraparound care and monitoring. Eight are receiving ART therapy and 16 are being monitored.
HIV testing in Shim Elba Camp began on July 2, 2007. In the first month, 364 clients (98 females and 258
males) received counseling and testing (343 were refugees, 13 host-community residents). Within the first
month, 13 people were found to be HIV-positive; eight males and five females of whom 11 are refugees
(seven males, four females) and two are from the local community (one male, one female). All have been
referred by ARRA to the Shire Regional Hospital for wraparound care and monitoring.
In FY08 IRC will hire a full-time counselor, who will provide counseling and support to individuals and their
families, assist in developing and supporting refugee PLWH groups, strengthen and expand community-
based PLWH groups, and build referral networks to improve access to information, education, and support
IRC plans to recruit a short-term consultant to begin the Care and Support program. S/he will establish and
strengthen referral networks to Johns Hopkins University (JHU) and the University of Washington/I-TECH
program, both of which provide technical support, training, and mentoring to the regional hospitals for ART
and opportunistic infections (OI) treatment. This consultant will then hand over an established program to
the full-time counselor.
FY08 will involve increasing strategic, community-awareness-raising activities, which promote the benefit of
knowing one's status through CT and communicating positive messages about living with HIV to reduce
stigmatization, with the intended effect of promoting responsible behavior.
Activity Narrative: IRC will focus on increasing the capacity of PLWH groups and communities to care for individuals from
diagnosis through end-of-life, and enable the groups to engage in advocacy, networking, and caring for HIV-
positive persons. PLWH individuals and groups will be supported to participate in training on home-based
care, nutritional counseling, and healthy life strategies. PLWH will receive preventive-care packages which
will include condoms, long-lasting insecticide nets (LLIN) in malaria-endemic areas, TB screening, and
education on safe water and personal hygiene.
HIV education and anti-stigma discussions in IRC's informal education classes, primary school classes,
GBV community discussions, at the ARRA health center, and during outreach activities conducted by the
IRC social workers.
voluntary counseling and testing (VCT) issues. The program is based on the current situation,
demographics, and population in the refugee camps, but it is likely that the situation will change in one year,
as mobility, the influx of new refugees, and voluntary repatriation of current refugees cannot be
predetermined.
To support the new Care and Support services, IRC will continue to build the capacity of psychosocial
counselors, CT center staff, and ARRA health staff through: ongoing in-service trainings to support palliative
care and treatment; and strengthening referrals between the CT centers, the ARRA health centers, the
regional hospitals and affiliated universities, the post-test clubs, the PLWH associations, and the regional
HIV/AIDS Prevention and Control Office (HAPCO) offices for effective wraparound care and support.
Monthly coordination meetings will be held between the counselors, CT staff and ARRA health clinic to
review cases for follow-up and intervention. IRC will continue to strengthen referral links established
between the VCT centers, the ARRA health centers, the regional hospitals, the post-test clubs, and the
regional HAPCO offices.
Continuing Activity: 18102
18102 18102.08 Department of International 7516 649.08 $186,621
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.08:
Orphans and Vulnerable Children support for Sudanese and Eritrean Refugees
There are increasing numbers of vulnerable children appearing in Sherkole, Shimelba and My Ayni Refugee
Camps. While child-friendly spaces have been provided as a platform for identifying and providing services
to OVC, extra assistance, including specialized psychosocial support, is needed for work on individual case
loads. In Sherkole camp, located in the Benishangul-Gumuz region, there are unaccompanied minors
arriving from Darfur requiring specialized psychosocial support, while revalidation in Shimelba camp,
located in northern Tigray, revealed a much higher than expected number of unaccompanied minors as well
as increasing drug and alcohol abuse by minors in the camp. My Ayni camp, opened in May 2008 in Tigray
to accommodate the continued influx of Eritrean refugees, hosts the same population as Shimelba refugee
camp. The high ratio of males to females within the general refugee population of these two camps (roughly
75% to 25%) is also reflected in gender ratios for minors and increases risk of SGBV (against young boys
as well as girls) and of the exploitation of unaccompanied minors (e.g., forced labor; physical, mental and
sexual abuse; stealing of rations).
In FY09 IRC will expand geographic coverage of services detailed in FY08 to My Ayni Refugee Camp. In
addition, IRC will expand services to provide an expert trainer and continued expert technical assistance
(professional counselor/psychologist/psychiatrist) for national staff and refugee social workers to address
unique psychosocial needs of vulnerable children in the camps. Coordination among key partners has been
a challenge, especially in Shimelba. Child Protection Coordination Groups formed in Shimelba and Sherkole
have helped address problems including sub-par health care services for referred children and difficulties
with ration distribution. To assist in identifying vulnerable children and understanding the core principles of
working with OVC within the host community, IRC will develop and implement an awareness raising
program with host community teachers and community-based organizations.
COP08 NARRATIVE
which provides prevention and counseling and testing (CT) services to refugees living in Sherkole and
Shimelba Refugee camps and the surrounding host communities.
IRC's HIV prevention and CT project was initiated in October 2004 in Sherkole Camp (in the Benishangul-
Gumuz region) and in 2007 in Shimelba Camp (in the Tigray region). For FY08, IRC is proposing to
continue its current activities with a strategic plan to expand its efforts to include activities for Orphans and
Vulnerable Children (OVC) in both camps and host communities.
IRC coordinates its activities closely with United Nations High Commission for Refugees (UNHCR), the
HIV/AIDS Prevention and Control Office (HAPCO). IRC has also established relationships with Johns
Hopkins University (JHU) and the University of Washington/I-TECH for technical support and training.
assessment and wraparound care to local regional hospitals. While this programmatic aspect has been
successful and well-received by the communities, IRC has recognized a need for a more comprehensive
HIV program. Support to OVC is one notable gap in the Sherkole and Shimelba refugee sites, with no single
program addressing the particular needs of these children. IRC will collaborate with ARRA and UNHCR
child-protection officers to strengthen activities supporting OVC, with emphasis placed on improving access
to protection and social services, such as education and health.
In FY08, IRC will introduce the Community Conversations model developed by the United Nations
Development Program (UNDP) in Shimelba Camp. The Community Conversations strategy will work with
community groups to identify and explore their beliefs and perceptions of OVC in the camp and how to work
together as a community to support these children and protect them from HIV.
IRC intends to improve the overall protection and support of OVC through increased access to services.
Safe spaces will be established for OVC in the camps. These safe spaces will be staffed with refugee social
workers trained in best practices for child care and psychosocial counseling. They will provide psychosocial
support and informal education to children, which will include life skills, basic personal care, and HIV
information, including preventive measures such as AB. As a result of the poor nutritional status of most
OVC in the camps, the child-friendly spaces will provide a nutritional snack to children accessing the
centers.
Counselors will monitor the children who access the child-friendly space and provide regular status updates
to the IRC child-protection officers. The social workers will also be trained to provide support and counseling
to the caregivers and foster families with whom the children live to improve their ability to care for these
children. Condoms will be provided to 'at risk' youth, as will information about CT services.
IRC child-protection managers will be hired to support and strengthen programs, monitor the well-being of
children, address the needs of OVC and their families (caregivers or foster families).
IRC child protection staff will ensure that all staff working with OVC, including IRC health, gender-based
violence, child-protection, and youth staff, ARRA health staff, UNHCR staff, receive on-going in-service
trainings in child protection and OVC support. IRC will also identify and train volunteers as OVC service
providers.
In the camp, monthly coordination meetings will be held between the IRC child-protection officers, ARRA
staff and UNHCR to review cases for follow up and intervention. IRC will continue to strengthen referral
links established between the ARRA health centers, UNHCR protection officers, the regional hospitals, and
Activity Narrative: the regional HAPCO offices.
In the first year, it is expected that 200 OVC will receive primary, direct benefits from this program and an
additional 100 children will receive supplemental support through the IRC program.
The program as outlined is based on the current situation, demographics, and population in the refugee
camps, but it is likely that the situation will change in one year as the mobility, influx of new refugees, and
voluntary repatriation of current refugees cannot be predetermined.
In the host communities, IRC will mirror the activities implemented in the camp. IRC will provide support for
OVC to ensure that they have access to services and provide training to foster families and care-givers. The
child-protection officers will work to build capacity and strengthen coordination between UNHCR, ARRA,
and IRC in the camps, and between IRC and district health bureau and HAPCO officials in the host
community, to support a long-term program that provides care and support of these children.
Continuing Activity: 18177
18177 18177.08 Department of International 7516 649.08 $93,311
Estimated amount of funding that is planned for Education $18,000
Table 3.3.13:
Counseling and Testing for Sudanese and Eritrean Refugees
THIS ACTIVITY HAS BEEN MODIFIED FROM COP08 IN THE FOLLOWING WAYS:
IRC currently provides VCT services to refugee and host community populations in Sherkole Refugee
Camp in the Benishangul-Gumuz region and Shimelba Refugee Camp in Tigray. In FY07, JHU cited the
Sherkole VCT center as an exemplary VCT site for quality control and service delivery. In addition, IRC
developed and rolled out a new database improving data storage, data security, data analysis, and
consistency and completeness of reports.
In FY09 IRC will expand geographic coverage of this activity to initiate VCT services in My Ayni Refugee
Camp, which opened in May 2008 to accommodate the continued influx of Eritrean asylum seekers entering
Ethiopia, and surrounding host communities. The current camp population (as of October 2008) is
approximately 4000 refugees with about 400 more individuals arriving monthly. To date, My Ayni hosts a
temporary clinic providing basic health care, but does not have the capacity to provide VCT services. Funds
in excess of FY08 levels will allow for construction of a confidential VCT center in My Ayni, enabling
refugees and host community members to receive counseling and testing for HIV without traveling 2-4
hours to the next closest testing facility. This activity links directly with IRC's PMTCT, AB and OP programs
that will also expand to My Ayni in FY09. IRC will continue to build on its coordination with ARRA health
officers in the camps as well as other PEPFAR partners and health networks outside the camp. Otherwise,
this activity remains unchanged from FY08.
IRC is proposing to continue its CT activities in both camps and host communities. This project is
programmatically linked to Abstinence/Be Faithful Activities for Sudanese and Eritrean Refugees (10600)
and Condoms and Other Prevention Activities for Sudanese and Eritrean Refugees (10646).
Voluntary Counseling and Testing (VCT)
The provision of CT services has been well received by both the refugee and host populations in the
Benishangul-Gumuz region. IRC offers CT services via a static site integrated into the Sherkole Camp
health center, which is managed by ARRA, and through outreach CT services to the surrounding host
communities. Patients presenting with sexually transmitted infections (STI) and tuberculosis (TB) are also
referred by ARRA for CT. There are plans to strengthen this referral and begin provider-initiated testing in
FY08.
HIV testing began in Sherkole Camp on April 12, 2005. As of July 27, 2007, IRC had tested and counseled
a total of 3,324 clients—1,671 refugees (970 males, 701 females), of whom 19 refugees (11 males, eight
females) tested positive. In the four outreach sites within the local host community, IRC has tested 1,653
individuals (1,023 males, 630 females), of whom 41 individuals (12 males and 29 females) tested positive.
Eighty three percent of those infected are between 20-39 years of age.
IRC has worked with ARRA and the regional hospital in Assosa to develop a strong and effective referral
system between the CT center and those sites. This system enables HIV-positive clients to access the
necessary medical and follow-up services they require. This includes cotrimoxazole prophylaxis and other
opportunistic infection (OI) treatment; CD4 count monitoring; ART; and psychosocial support. HIV-positive
clients are also closely monitored for tuberculosis co-infection. To date, 24 refugees have been referred for
wraparound care and monitoring; eight are receiving ART and 16 are being monitored.
CT services were highly sought-after by the refugees in Shimelba Camp. The results of knowledge,
attitudes, and practices surveys conducted by IRC in 2003 and 2004 revealed that 92.8% of the refugees
surveyed wished to know their HIV status. HIV testing in Shimelba Camp began on July 2, 2007. In the first
month, 364 clients (98 females and 258 males) received counseling and testing (343 were refugees, 13
host community). Within the first month, 13 people were found to be HIV-positive; eight males and five
females, of whom 11 are refugees (seven males, four females) and two are from the local community (one
male, one female). All have been referred by ARRA to the Shire regional hospital for wraparound care and
monitoring.
The CT center in Shimelba Camp is integrated into the ARRA health center, and was established using
lessons learned from IRC's experience in Sherkole Camp. For example, in Shimelba Camp, IRC
immediately established a referral system for TB and STI patients and quality-control testing with the
regional hospital. In FY07, IRC encouraged greater referrals from ARRA for at-risk clients and worked with
the IRC gender-based violence (GBV) team to provide testing to women seeking medical assistance after
rape.
IRC will continue to coordinate with the GBV and Education teams to integrate HIV education and anti-
stigma discussions in IRC informal education classes, primary school classes, GBV community discussions
at the ARRA health center, and in outreach activities conducted by the IRC social workers.
All activities of the Sherkole and Shimelba Camp CT centers and mobile outreach activities meet and
Activity Narrative: perform according to Ethiopian national CT guidelines and procedures.
Support and Outreach Activities:
change communication (BCC) messages specifically for the refugees and host communities. The
messaging will strive to increase community understanding of the purpose and benefits of knowing their HIV
status through CT, and to promote to the host community the static CT centers and the CT outreach
services in the four mobile sites around Sherkole Camp.
IRC will continue to develop innovative, interactive CT awareness and education activities. Specifically, IRC
will use the Community Conversations model developed by the United Nations Development Program
(UNDP). Community Conversations was introduced in Sherkole Camp in 2006. With the assistance of a
facilitator, communities engage in discussions to: create a deeper understanding of HIV/AIDS; to identify
and explore factors fueling the spread of HIV/AIDS in their respective contexts; and to reach decisions and
take action (such as knowing one's status through CT) to mitigate the effects of the disease in their
community. In FY07, IRC trained 35 HIV/AIDS refugee social workers and youth peer-educators in Sherkole
Camp to facilitate this innovative strategy. It is expected that the Community Conversations strategy will be
expanded to Shimelba Camp in FY08, if it proves to be successful with the refugees in Sherkole Camp.
In Sherkole, all CT clients are encouraged to join the "New life after test" post-test club. With facilitation from
the IRC CT staff, the club provides support for CT clients and promotes CT services to others in the camp.
HIV-positive clients from the local community are referred to IRC's local partner, the Tesfa Bilichat
Association, based in Assosa, for further social support. To date, the Tesfa Bilichat has provided material
and monetary support to one HIV-positive person from the host community who was tested by IRC.
In Shimelba Camp, a post-test club was established in FY07, and referral networks and linkages were
strengthened with local health authorities and facilities for follow-up medical and wraparound services. In
FY08, IRC will continue to support the post-test club and to nurture cohesive relationships with partners,
including the local association for people living with HIV/AIDS (PLWH).
In Sherkole and Shimelba Camps and host communities, IRC's FY08 HVCT activities and strategies will
continue to offer and promote quality, static and mobile CT services to both refugees and members of the
host communities. They will also ensure availability of, access to, and use of ART therapy and referral
services with the regional hospitals for all HIV-positive clients. These activities will be conducted in
coordination with ARRA. To support the CT services, IRC will continue to build the capacity of CT center
staff and ARRA health staff through ongoing in-service trainings on provider-initiated CT, referrals,
counseling and OI management. IRC will continue to strengthen referral links established between the CT
centers, the ARRA health centers. New collaborations with Johns Hopkins University (JHU) and the
University of Washington/I-TECH will include technical support, training, and mentoring to ARRA, the
regional hospitals, the post-test clubs, the PLWH associations and the regional HAPCO offices for effective
wraparound care and support.
FY08 will involve increasing strategic, community-awareness-raising activities which promote the benefit of
stigmatization. The intended effect of these activities is to promote responsible behavior. Clients attending
CT services will have access to condoms and information about post-test clubs and local, community PLWH
associations which are supported by IRC. IRC CT staff and ARRA health clinic staff will meet monthly to
review and coordinate performance and outcomes. IRC will continue to strengthen referral links established
Continuing Activity: 16709
16709 5606.08 Department of International 7516 649.08 $130,635
10561 5606.07 Department of International 5536 649.07 $150,000
5606 5606.06 Department of International 3768 649.06 $75,000
Construction/Renovation
Table 3.3.14:
