The goal of IRCs program is to decrease new HIV infection through prevention activities and increase access to care and support for people infected and affected by HIV/AIDS in refugee camps and the surrounding rural communities located in Shimelba, MyAyni, and Adi Harush. The total population of the three camps is approx. 44,000 refugees. IRC activities will include training Administration for Refugee and Returnee Affairs, IRC health staff, and community-based providers on needs-assessed topics (e.g. diagnosis/management of opportunistic infections, clinical care for survivors of sexual assault, universal infection prevention, voluntary counseling and testing, prevention of mother-to-child transmission), and home-based palliative care). IRC will strengthen laboratory services to perform clinical tests needed for HIV care and treatment and provide reagents/materials to support testing and diagnosis of typical OIs. IRC will strengthen coordination mechanisms, promote a safe and confidential referral pathway, and build partner and community capacity through training and mentoring to increase access to quality health and psychosocial services for survivors of gender-based violence (GBV). IRC will support income-generating activities (IGA) and provide vocational and business skills trainings for PLWHA in all three camps. In all three camps, IRC plans to target youth with school-based HIV/AIDS education focusing on prevention of HIV/AIDS, as well as provide tutorial services for OVC where the need is identified. IRC has in place a monitoring system to report on program performance. The program supports the goals of the GOE and USG Partnership Framework and the Global Health Initiative.

IRC will provide home-based care to PLWHA and make palliative care kits available. IRC will also encourage PLWHA to join established support groups such as post-test clubs and PLWHA Associations. These groups will be used as an entry point to ensure that HIV-positive individuals receive the minimum package of clinical services including co-trimoxazole prophylaxis and that those eligible for ARV receive their medication and are properly treated. As IRC has found that many PLWHA lack adequate food supply and thus fail to comply with ARV despite the nutritional counseling they receive, IRC will also advocate for additional food rations with food distribution agencies.

IRCs OVC program in Shimelba and MyAyni Camps will seek to strengthen the range and availability of services for children living with PLWHA, at-risk of contracting HIV/AIDS, living without parental support, and/or exposed to sexual violence.

Community Support and CoordinationTrained SWs will provide psychosocial support to children at child friendly spaces (CFS), and will refer OVC to services as needed. IRC will provide information to younger and older OVC on AB through Sports for Life and Youth Action Kit discussions in the CFS.

SWs will conduct home visits to follow-up on identified OVC, especially for those living with PLWHA or who are HIV-positive. SWs will also accompany HIV-positive OVC to doctor appointments and adherence counseling, and will refer OVC to IRC education programs. In Shimelba, IRC will refer OVC requiring nutritional support to ARRA and provide food supplements for OVC on a needs basis. In MyAyni, IRC will implement a feeding program for children that are under group care. IRC will refer older OVC to vocational skills training, and will establish a scheme to support IGA for older OVC and OVC caregivers.

Increase Data Development and Use for Strategic PlanningIRC will use the inter agency child protection information management system to register at-risk children including OVC and to develop individual intervention plans for identified, assessed, and verified children.

Strengthen Systems/Government/PolicyTo strengthen the referral systems, IRC will regularly coordinate with UNHCR, ARRA, and community-based associations and will conduct training on child rights and protection for community leaders and service providers.

Family/Household StrengtheningIRC will provide material assistance for the construction of shelters for OVC and their caregivers and will build the capacity of caregivers/foster families through trainings. In MyAyni, IRC is working to identify families with the capacity to foster OVC who are currently in group care arrangement, and will continue this process in COP2012 and 2013.

Awareness-raising activities on abstinence will target young people ranging from 10-14 years old, while those on faithfulness will target married couples and sexually active young people aged 15 years and above. Messages will include abstinence and the need to delay sexual debut, the value of mutual faithfulness, and partner reduction. They will be tailored to address community norms that impact these behaviors, such as polygamous marriage, early marriage, and widow inheritance. IRC will also raise awareness on the relationship between GBV and HIV/AIDS.

Youth Health Clubs will distribute IEC materials on AB through mini-media. IRC Social Workers (SWs) will raise awareness on AB through regular coffee ceremonies, house-to-house visits, health education sessions, community wide campaigns and video shows in all three camps. SWs will be equipped with guidelines, training and training materials, job aids, and supervisory checklists on relevant topics to ensure effective outreach.

IRC employs the Community Conversations (CC) model developed by the United Nations Development Program (UNDP) as a basis for its own CC model. Led by a facilitator, communities participate in a series of small-group discussions to identify and explore factors fuelling the spread of HIV/AIDS in their community. Phase I of the CC process will focus on AB as a means of preventing HIV transmission. Group members will then be encouraged to develop and implement action plans to mitigate the effects of the disease in their communities. Phase II will focus on combating stigma and discrimination, and Phase III will focus on improving care and support for PLWHA. This process is expected to take two to three years in total. All eight CC groups in Shimelba have completed Phase I; seven CC groups have completed Phase I in MyAyni whereas four CC groups are still at Phase I. In Adi Harush, IRC will establish seven CC groups during COP2012. If all meetings are held according to plan, these groups are expected to complete Phase III during COP2013.

IRC currently conducts client-initiated counseling and testing (CT) services in Shimelba and MyAyni and surrounding host communities in IRC VCT centers located in ARRA Health Center compounds. To improve access, IRC will maintain community VCT centers in Adi Harush and in close proximity to existing community centers in Shimelba and MyAyni. In host communities, CT is conducted through an outreach VCT service twice per month. IRC will strengthen the integration of family planning services into VCT services at the centers, ensuring that both services are provided in the same location.

IRC will implement VCT services using the national testing algorithm, which includes a KHB, StatPak, and Unigold test; when the first test is positive, a client will be tested by all three tests. Each VCT center will include a laboratory equipped to ensure the cold chain is maintained. IRC will perform quality control for all testing to ensure that HIV rapid tests are in accordance with national and international standards. IRC will implement external quality assurance of HIV rapid tests by sending 10% of all negative tests, 100% of all positive tests, and 100% of all couple discordant tests to regional laboratories on a quarterly basis. In addition, twice a year, representatives from the Tigray Regional Health Bureau (TRHB) will conduct monitoring visits. IRC recognizes the importance of pre- and post-test counseling and conducts annual training for all counselors. During counseling sessions, counselors discuss risk reduction plans, partner referrals, sources of support, medical follow-up, and coping mechanisms. Counselors use checklists and give follow-up appointments when necessary.IRC will target MARPs, particularly CSWs for training and promote VCT and referral for clinical services including treatment of STI. IRC will refer sexual assault survivors to the ARRA Health Centers for clinical care and HIV CT services while encouraging survivors to seek timely assistance. To ensure quality of service, IRC will train ARRA health staff on clinical care for sexual assault survivors (CCSAS), ensuring at least one training a year for each camp during COP2012 and COP2013.

Activities will target sexually-active people aged 15 years and above who do not employ AB as means of prevention: those with multiple partners; mobile persons; those likely to engage sexually with one-time partners; and MARPs, particularly CSWs and at-risk youth. IRC will also promote proper and consistent condom use among HIV-positive women thereby addressing Prong II of the national PMTCT strategy.

Youth Health Clubs will distribute IEC materials and disseminate information via mini media on the correct and consistent use of condoms as a means of HIV/AIDS prevention. In all the camps, IRC will train newly formed Youth Health Club members on how to promote HIV prevention through condom use while those previously trained will receive refresher trainings during COP 12 and COP 13.

SWs will raise awareness on condom use through coffee ceremonies, household visits, health education sessions, and video shows. The CC process, as described in the HVAB section, also addresses condom use as a means of prevention. To investigate condom uptake by age and gender, IRC will map condom use at each distribution point. As a monitoring and evaluation strategy, IRC will conduct focus group discussions to assess the impact of awareness-raising activities on behavioral change related to condom use. An assessment of the CC methodology will also be done to extract best practices and lessons learned.

SWs will raise awareness through coffee discussions and house-to-house visits in MyAyni and Adi Harush on GBV prevention in relation to HIV/AIDS, available services, and the importance of seeking assistance. In Shimelba and MyAyni, IRC will continue implementing SASA! , an innovative prevention approach to ending violence against women and girls and HIV/AIDS.

IRC will raise awareness among MARPs specifically targeting CSWs on the referral system and train them to provide peer support, promote condom use, seek STI screening and treatment, and encourage other CSWs to access existing services. IRC will also work to decrease the commercial exploitation of women through alternative income generation. Outreach efforts will be supported by condom distributors in the camps and local communities.