SHARPER focuses on MARP and PLHIV populations in Ghana, appropriate given Ghanas relatively concentrated epidemic. The objectives of SHARPER are to increase knowledge, attitudes and practices of key health behaviors as well as increase utilization of quality HIV/AIDS related health services. Further, SHARPER strives to strengthen human and institutional capacity of MARP and PLHIV program implementers and coordination bodies. SHARPER is implemented in approximately 30 districts, which have been identified as areas with a concentration of MARP populations. The interventions are implemented through some 35 sub-grantees throughout the 30 districts mentioned above.

The HIV/AIDS prevention interventions for MARP and PLHIV focus primarily on the following key health behaviors: use condoms consistently and correctly; use non-oil based lubricants properly; get tested and know your result; disclose your HIV status to regular partners; promptly seek appropriate and effective treatment (including for STI); adhere to treatment (including ART, OIs and STIs); reduce your number of multiple and concurrent sexual partners; actively participate in program design and implementation; eat healthfully; protect yourself against infectious diseases such as TB, malaria and diarrhea. SHARPER, and her partners, focus their efforts on peer and small group education through which they reach community members with condom promotions, bar activations and cell-phone-based interventions.

Government partners and coordination bodies will be supported to strengthen their role in the national MARP program

PLHIV wellness centers and satellite clinics will be expanded in a systematic fashion, involving national and local coordinating authorities to cater for PLHIV. Wellness centers are similar to drop-in centers for key populations, which function as a first point of access to care. These centers form linkages through referrals with TC/STI services and other relevant health services such as PMTCT, OI and ART treatment and FP. Quality assurance of clinical and prevention activities are a continuous process, just as strengthening the linkages in a constant concern for improvement. In addition to strengthening this continuum of care, access to services will be improved through PLHIV groups or networks that will be trained and supported to institutionalize systematic AIDS case finding and subsequent enrollment into care services.

The project is increasing its effort to strengthen its sub-grantees to provide high-quality services to MARP and PLHIV and be reliable, transparent and efficient-partners. Through a time-series of assessments, NGO improvements in performance and the capability of their internal systems are measured. The result of this effort will be that Ghana has a critical mass of NGOs that can handle the scaling up of the national MARP response to a coverage that will be sufficient to reduce the number of new infections significantly, up to 50% in 2015 according to the National Strategic Plan. Given that the Global Fund is increasing its funding for MARP prevention interventions over 2013 and 2014, it is important that these efforts benefit also those NGO that are not USAID supported but are Global Fund recipients. This is done by developing a series of standard operating procedures that will be approved by the MARP TWG. The ongoing national MARP evaluation will measure performance will eventually measure performance of the MARP prevention response. The capacity building effort is also crucial for the USG to enter a new phase in the prevention program, where NGOs will either directly financed or through the GoG.

Through peer education, outreach, Helpline programs and provision of TC services, MSM, FSW, MSW, NPPs and PLHIV will be encouraged to disclose their HIV status to their regular partners. Close linkages have been between NGOs and clinical services through district based referral systems, with drop-in centers as a point of access to TC. A key activity is focusing on health care providers through stigma-reduction programs to ensure MARP-friendly" programming. Provider-initiated TC was introduced and will increasingly be provided for STI clients. Partner notification and couple TC is promoted in the Positive Health, Dignity and Prevention programs for people living with HIV.

Funding will be used to promote HIV/AIDS prevention and healthier behavior among MARP and PLHIV, through peer education programs, community events and telecommunication programs. Appropriate and consistent condom and lubricant use of will be promoted among male and female sex workers (MSW and FSW), their clients, their NPPs, MSM and their female partners and PLHIV, including distribution of condoms and lubricant, through peer educators. Dedicated Help Lines with specially trained telephone counselors for MSM and for FSWs that were started in 2008 will be scaled up, and a helpline for PLHIV will be piloted. An experiment with condom vending machines will be expended if the recently started pilot proves to be successful. Now that brothel-type sex work is becoming increasingly available, more emphasis will be put on introducing and institutionalizing 100% condom policies in those establishments.

Funding will be used for partner reduction activities among NPPs of CSWs and among the MSM population, using peer education and DJs at MSM trust parties. Substance abuse and most particular liquor use among MSM will become an additional focus of the program to reduce risky behaviors. There are no abstinence-only activities planned.