USAID/Ethiopia is currently finalizing the procurement of a prime partner for the MULU Prevention Program for At-Risk Populations I (MULU I) program with the goal to increase HIV prevention coverage with emphasis on MARPs and highly vulnerable populations. This includes sex workers and their clients, men who have sex with men, young people, and others engaged in transactional sex in Amhara, Oromia, the SNNPR, Afar, Gambella, Tigray, Addis Ababa and Dire Dawa. The objective is to decrease the number of new HIV infections by reducing risks and vulnerability through: 1) Reducing behavioral risk factors among MARPs; 2) Improving the access and uptake of biomedical prevention services among MARPs; and 3) Strengthening community-level systems and structures to create enabling environments. MULU I will contribute to the PF national target of reducing new infections by 50% by 2014. As part of the USG realignment, CDC is in the process of transferring activities previously carried out under FHI/Amhara to MULU I. With regards to other prevention activities, interagency discussions will continue to establish the optimal programmatic setup. Asserting GHI principles, the program will strengthen the capacity of the GOE and civil society organizations to respond to the epidemics geographic variations and to implement the GOEs strategic plan for a multi-sectoral response to HIV/AIDS. Expected results are prevention service coverage for MARPs increased, GoE capacity strengthened in technical leadership and coordination. The M&E plans will be finalized when the work plan is developed. The program estimates the purchase or lease of seven vehicles. No COP12 funds are being requested for this project, the project will continue as described using pipeline funds.

The new USAID umbrella prevention program, MULU Prevention, will be implemented via two awards. MULU I (this award) will focus on comprehensive prevention for most-at-risk populations (MARPs) and other highly vulnerable populations in urban, peri-urban, and hot spot settings. MULU II will focus on HIV prevention in large-scale workplaces. The goal of MULU I is to reduce new HIV infections in Ethiopia through combination prevention with emphasis behavioral factors and evidence-based interventions to determine health-seeking and sexual behaviors of MARPs and highly vulnerable populations in Amhara, Oromia, the Southern Nations, Nationalities, and Peoples Region, Afar, Gambella and Tigray regions as well as Addis Ababa and Dire Dawa. Program activities will focus on communities adopting social and cultural norms, attitudes, and values that reduce vulnerability to HIV and improve reproductive health. Program activities will also be integrated with prevention components addressing substance abuse, gender-based violence, harmful traditional practices, stigma and discrimination. The program will strengthen the technical leadership and coordination capacity of Government of Ethiopia (GoE), communities and civil society organizations (CSOs) at different levels in order to respond to the epidemics geographic variations and to lead HIV prevention interventions determined by the epidemiology of new infections. The program will also ensure the access and availability of quality sexual and reproductive health services, along with improved policies and social norms, to better facilitate containment of new infections with direct benefit to vulnerable populations, including women and girls in urban areas. The program will follow the GoEs five-year plan objectives as well as the PEPFAR Partnership Framework for Ethiopia and will specifically contribute to two GOE targets: 1) 80% public and 60% non-public sector entities will establish units for mainstreaming HIV/AIDS and; 2) eleven regional partnership coordination forums and 750 district partnerships will be established or strengthened. As the mechanism is a TBD, the quality assurance and M&E plans will be finalized when the work plan is developed.

MULU-I will primarily target MARPs and other highly vulnerable populations in 200 towns to implement targeted testing. The project will use targeted mobile or outreach testing to reach key population and vulnerable population groups. MULU-I will coordinate with the Government of Ethiopia (GoE) and other partners to ensure effective referral linkages of tested positive cases to care and treatment services. MULUs mobile and outreach testing program will be implemented in towns which are not covered by other partners like Abt and TransACTION. HIV testing and counseling services will be linked to intensive behavioral interventions, peer education and other prevention packages. Peer educators typically refer MARPs and other vulnerable populations to public, private and mobile outreach testing outlets as appropriate. MULU-I may also incorporate some innovative approaches such as vouchers system to encourage at risk and vulnerable people to be tested in the private sector if that is preferred by the population group. To better facilitate access to HIV testing and referrals, the program will also use drop-in centers and STI screening and treatment facilities, where provider-initiated counseling and testing is employed as an alternative modality. Mulu-I will use the national testing algorithm, which recommends serial testing of three tests (screening, confirmatory and tie breaker). The program will closely work with Federal HAPCO, MoH and respective regional health bureaus to coordinate implementation, linkage and quality assurance of testing. The program will also collaborate with Federal HAPCO and PFSA to support the national quantification and supply chain for rapid test kits.

MULU I will reduce new HIV infections in Ethiopia through implementation of combination prevention. HVOP funds will contribute to the following results and associated outputs: 1) Prevent new HIV infections by reducing behavioral risk factors among most-at-risk populations and other highly vulnerable populations; 2) 80% of female sex workers in 200 towns reached with evidence- based interventions that meet minimum service package; 3) 300,000 other highly vulnerable populations (regular non-paying clients of sex workers, long distance drivers, at-risk youth, divorced/widowed women and people engaging in transactional sex and multiple concurrent partnerships reached; 4) 250 private and public health facilities supported to provide STI treatment for sexually-transmitted infections (STI), HCT and rape case management, along with reproductive health services; 5) Reduced percentage of men and women reporting on multiple concurrent partnership (MCP) and transactional sex engagement; 6) Three model sites established that demonstrate 100% condom use among sex workers especially with non-paying partners. Community systems and structures will be strengthened to support combination prevention; results include: 70-100 million condoms are distributed per year, 20,000 condoms outlets are established and/or maintained, Reduced proportion of people practicing MCP and transactional sex and 40,000 females engaged in transactional sex and male and female sex workers assisted with integrated economic assistance and HIV prevention services. Another objective is to increase the capacity of GOE to lead HIV prevention interventions based on the local epidemiology of new infections through: 1) Establishing a GOE national condom policy and strategy; 2) Support for Federal and seven regional offices to improve leadership and coordination capacity ; 3) A GOE system for tracking condom distribution and supply established and functioning.