USAID/Ethiopia is currently in the process of finalizing the procurement for one prime partner to prioritize HIV prevention in large-scale workplace settings in the MULU Prevention Program for At-Risk Populations in Workplace (MULU II) program. The programs ultimate goal is to contribute to the national target of reducing new infections by 50% by 2014. This mechanism will also support the GoE efforts to implement the strategic plan for a multi-sectoral response. There are ongoing interagency discussions on possible areas of re-alignment applicable to this award to establish the optimal programmatic setup. Asserting GHI and PF principles, the program will strengthen employer capacity to develop HIV prevention program and services for employees. Program activities will center on HIV prevention communication and service models in large-scale workplaces and surrounding communities to reach such target populations as construction workers, long-distance truck drivers, etc. The program will develop HIV prevention policies and activities to support behavior change and will integrate HIV and reproductive health services into onsite educational and clinical services. The geographic focus includes Addis Ababa, Amhara, Oromia, SNNPR, Afar, Dire Dawa, Gambella, Harari, Benshangul and Tigray. By the end of five years, employers will gain greater capacity and tools to ensure employee health and integrated care services that support worker productivity and wellness. As the mechanism is a TBD, the M&E plans will be finalized when the work plan is developed. The program estimates the purchase or lease of 4 vehicles to assist with activity implementation. Though no COP12 funds are being requested for this project, the project will continue as described using pipeline funds.

The International Labor Organizations projections for 2015 reveal that as much as 8.5% of the labor force loss in Ethiopia will be due to HIV/AIDS deaths. The intended result of MULU II is strengthened workplace HIV prevention policies and activities for employees that support behavior change and that provide HIV and reproductive health services. The program will accomplish the following activities in 100 large-scale workplace settings in Ethiopia: 1) An equitable set of workplace policies communicated to all staff and properly implemented; 2) Ongoing formal and informal HIV/AIDS education for all staff; 3) Improved availability of condoms; 4) On/off-site services for diagnosis, treatment and management of sexually-transmitted diseases and HIV/AIDS voluntary testing, counseling, care and support services for employees and their families. MULU II will build upon other USAID investments in HIV/AIDS workplace programming and will coordinate with other entities such as GOE, private sector associations, and other donors in activity implementation. The program expects to reach 1 million workers and associated target populations with evidence-based interventions on individual and small group levels. Program activities will also support the development of workplace service mapping and referral directories as well as behavioral communication materials. The program will engage sector-based HIV/AIDS task forces, coalitions and associations, such as the National Business Collation against HIV/AIDS, the Ethiopian Horticulture Association, and the Ethiopian Transportation Association. Similarly, other sectors engaged in large-scale construction, including the Ministry of Water, the Ethiopian Roads Authority, and the Ethiopian Electric Power Corporation, will be targeted for mainstreaming of HIV prevention services in workplaces. As the mechanism is a TBD, the quality assurance and M&E will be finalized when the work plan is developed. However, the program plans to include a workplace baseline formative assessment on behavioral and prevention clinical services and also, an impact evaluation on effectiveness of interventions on self-reported behaviors and rate of STI occurrence.

MULU II will primarily target large-scale worksites in ten regions in Ethiopia to fully implement HIV testing services for employees, their families and target communities. The program will also reach out to test Most-At-Risk Populations (MARPs) and other highly vulnerable populations which are involved in the sexual network of worksites. HIV testing will be implemented within worksite clinics, mobile units and other outreach testing modalities. MULU II will coordinate with the Government of Ethiopia (GoE) and other partners to ensure effective referral linkages to care and treatment services. 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 II may also incorporate some innovative approaches such as vouchers system to encourage vulnerable workers to be tested out in the private sector if there is an issue of stigma and discrimination within the worksite clinic. 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 II 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. The program will also collaborate with Federal HAPCO and PFSA to support the national quantification and supply chain for rapid test kits.

The intended result of MULU II is strengthened worksite HIV prevention policies and activities for employees that support behavior change and more access to HIV and reproductive health services. The program will have a total of 100 large-scale worksites to implement its combination HIV prevention interventions. The project will target migratory workers, sex workers and transactional sex workers around large-scale worksites. The project will also target surrounding community in large-scale worksites which are involved in the sexual network of laborers and workers within and around large-scale worksites. The program will accomplish the following activities within and around worksites:

1) An equitable set of workplace policies communicated to all staff and properly implemented; 2) Ongoing formal and informal HIV/AIDS education for all staff; 3) improved availability of condoms; 4) On/off-site services for diagnosis, treatment and management of sexually-transmitted diseases and HIV/AIDS voluntary testing, counseling, care and support services for employees and their families. MULU II will build upon other USAID investments in HIV/AIDS workplace programming and will coordinate with other entities such as Ministry of Labor and Social Affairs (MoLSA), Federal HAPCO, trade unions, private sector associations, other donors and relevant GoE agencies. Expected outputs from HVOP funds include: Individual and small group evidence based behavioral intervention in 100 sites, 50 onsite worksites clinics will be supported to provide syndromic STI diagnosis and treatment, strengthening the capacity of large scale worksites to implement HIV prevention within their premises, and targeted condom distribution. About 25,000,000 condoms are expected to be distributed distributed and 50,000 STI cases will be identified and treated.