The overall goal of the ATEP-Health program is to improve HIV/AIDS prevention and support services in the regions where it is currently active. Specific objectives include: (1) providing need-based capacity building to at least 12 selected local NGOs; (2) mainstreaming HIV/AIDS policy and programming in 50 ATEP lead clients workplaces as well as in ATEP's office; (3) increasing awareness on HIV/AIDS prevention for 50,000 ATEP program beneficiaries; (4) strengthening the referral system for HIV/AIDS counseling and testing (HCT), involving at least 7,500 ATEP targeted beneficiaries including migrant and seasonal workers; (5) increasing condom promotion and distribution to ATEP's beneficiaries; and (6) improving income generation activities for at least 3,000 OVC caregivers, PLWHAA and young adolescents across ATEP's beneficiary pool in the four sectors.

The USAID-ATEP Health program encompasses 4 regions (Amhara, Tigray, Oromia and SNNPR) and 34 woredas. The project's target population includes workers of the project's lead coffee, oilseed, and horticultural clients and their households. The project's indirect beneficiaries include a large number of migrant seasonal workers, especially in the oilseed and coffee growing areas. The project aims to reach a total of 70,000 beneficiaries.

The intervention areas are characterized by booming business centers and larger production areas attracting a high influx of seasonal/migrant workers during the peak harvest periods. Notably, in these areas workers are equipped with basic awareness of HIV/AIDS, reproductive health and other sexually transmitted infection; however, behavioral changes have not transferred to the context of workplace mainstreaming. Health services are lacking the proper structures to provide needed assistance as well. The project will target these weakened areas and provide necessary support and training. Program beneficiaries will be referred to nearby health institutions so that HCT uptake can be handled by equipped health institutions. Furthermore, the program will collaborate with local health organizations to strengthen health systems.

The program addresses two cross-cutting areas income generation and gender. The ATEP Health program and subgrantees will work with producer cooperatives to strengthen income generation activities and improve livelihoods for members of the cooperatives and their families. Special effort will be made to address gender gaps in accessing HIV/AIDS prevention, care and support services for ATEP beneficiaries. Since women play a lead role in facilitating access to other family members to health care and other social services, ATEP-Health will also assist households in providing HIV/AIDS prevention, care and support services in coordination with a selected local NGO. These strategies will be made practical by strengthening the referral linkages amongst service providers involved in HIV/AIDS prevention, care and support.

This program will ensure sustainability by strengthening community-based delivery of HIV/AIDS prevention, care and support for the following reasons, among others: (1) capacity building of the selected local NGO partners is expected to remain a local endeavor once the partnership is created by the project; (2) the working linkages created by the project between the communities, the local NGOs and the local and regional health authorities will increase available capacity to better address HIV/AIDS related issues as a unit rather than individually, ensuring a long term partnership; (3) This partnership will also serve to create a platform for ensuring a continuous dialogue for addressing HIV/AIDS related issues at the community level; (4) providing HIV/AIDS prevention, care and support in the workplace environment will improve workers' productivity and enterprise benefits that should in turn encourage the continuous mainstreaming of HIV/AIDS policies in the existing organizations.

For an effective monitoring and evaluation plan, a baseline knowledge attitudes and practices (KAP) assessment will be conducted at the beginning of this program, and findings from subsequent program monitoring and evaluation activities will be compared with the KAP assessment. Monitoring services provided to the targeted beneficiaries is mandatory to meet the pre-designed goals and objectives of this program. This will be expressed through reporting, review meetings and site visits. Selected USAID-ATEP field health advisers and M&E specialists will play key roles in carrying out effective monitoring activities with the local NGOs. Each sub-partner, in coordination with the assigned field health advisors, will facilitate review meetings with peer educators and lead client HIV/AIDS committee members, stakeholders and donor organization on a quarterly and annual basis. Furthermore, the project will use Fintrac's proprietary software, CIRIS, to monitor results. Evaluation of this award will be conducted at the end of the two year project period and results will be compared with the KAP assessment findings.

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Top priority actions: To address OVC group, USAID ATEP Health sector will work on the following top priorities, community support and coordination and family/household strengthening.

Strategies to address the above selected top priorities: a) Community support and coordination: The major strategies to meet this selected priority area are mainly strengthening community and facility level bidirectional referral linkages. The community level referral linkage will be made practical through a series of steps (i.e. selection and mapping of services provider organizations; organizing sensitization workshops on the importance and process of referral linkage; formation of referral steering committee; and assigning roles and responsibilities for the volunteer committee and building the capacity of the referral committee). b) Family/household strengthening: 1) increasing awareness level on HIV/AIDS prevention, care and support service provision, VCT, treatment, ART, PMTCT; 2) trainings on home based care services provisions (management of OI at home level, counseling on ART adherence, nutrition preparation, environmental and personal hygiene etc); 3) economical strengthening by engaging family members in IGA, establishing linkages with local micro-finance institutions, and engaging them in different vocational trainings and increasing access to markets. c) Target sub-populations: OVCs between age ranges of 1 -17 years (both sexes) will be addressed in all impact regions and woredas. d) Type of services given in existing program: In the existing USAID ATEP HIV/AIDS prevention and support program OVCs are addressed indirectly by supporting their guardians with income generating activities. e) Successes and challenges: Our current approach/budget is not comprehensive to address other packages for OVCs like basic education including early childhood development, health care services, food and nutrition including safe infant food and weaning diet, legal support etc.

This program covers four major areas already targeted in 2009. The number of woredas will increase from 34 to 45 as the number of beneficiaries increases from 50,000 to 70,000 due to expanded program areas: horticulture, coffee, oilseeds and leather, hides and skin (HSL) sectors. Beneficiaries are women of reproductive age group (15-49) and are mostly employed in the horticulture sector. These workers or members/employees of the four sectors are mostly in the lower educational bracket and possess insufficient funds to cover basic household needs and work away from home. With minimal knowledge of sexually transmitted diseases, including HIV/AIDS, the working partners are at risk for engaging in risky behaviors in their workplace.

Intervention areas: AB outreach will target a total of 70,000 beneficiaries, 3,500 peer educators (including the existing 2,000 trained peer educators from 2009 and 1,500 newly added peer educators for 2010). These peer educators will transfer information about delaying sexual initiation, condom use, promoting supportive cultural practices towards AB, and promoting open discussion about faithfulness with partners. They will also reach out to their peers in their respective work places. IEC/BCC material production and dissemination and youth oriented media coverage will also be considered.

Literacy, low knowledge on HIV/AIDS prevention, socio cultural factors, gender inequality, and mobility play key factors targeted by this intervention. For example, the peer to peer education program can increase HIV/AIDS prevention awareness. It will also ensure gender equity and equality, increase condom accessibility and utilization, increase VCT and ART uptake and accessibility to care and support services. Working with partners and guardians to promote open discussion also targets the socio cultural driving factors.

AB can be integrated with VCT, condom promotion and distribution, ART, PMTCT, STI prevention and treatment, and care and support services. The integration level will range from community to facility level referral linkages.

USAID ATEP addresses thousands of migrant seasonal workers in Amhara and Oromia regions (oilseeds and coffee sectors). These in include men who move from their homes to distant places in search of seasonal work (the majority of beneficiaries) and seasonal commercial sex workers. Sexual prevention is mandatory to curve the spread of HIV/AIDS among these groups. An estimated 20,000 target groups will be addressed in OP covering four major intervention areas. The number of woredas will increase from 34 to 45 in 2010. Amhara, Tigray and Oromia regions have a large influx of seasonal workers, especially during the harvesting periods. OP will also address the program's other at risk population.

The major interventions in OP include condom promotion and distribution, STI management and increasing HIV/AIDS prevention awareness levels among the targeted beneficiaries. The awareness rising activity will include: a) establishing a peer group for target clients b) producing and distributing IEC/BCC materials for beneficiaries c) conducting HIV/AIDS campaigns seasonally for migrant seasonal workers and d) Increase condom promotion and education.

The harmonization of program components with national guidelines is also important to ensure quality of the program.

OP will be integrated with CT, ART, PMTCT, care and support, and STI management services.