One of the objectives of the 2005 PMTCT Drop-out Study was to ascertain the reasons that many women present at the labor and delivery ward late and do not receive a full dose of nevirapine. The findings found that many women present at the hospital late in labor to avoid a long wait in the waiting room, due to shortage of space and beds on the labor and delivery ward. Additionally, women raised concerns about the less than optimal degree of confidentiality allowed by the design of the ward. During an informal assessment of Georgetown Public Hospital Corporation's (GPHC) labor and delivery ward, it was found that there was ample space in the building, but due to the design and structure, entire sections of the ward could not be effectively utilized. To address these space shortages and design that inhibits guarantee of confidentiality in labor and delivery wards at Georgetown Public Hospital (GPHC) and other regional hospitals as identified by the MoH Maternal and Child Health Unit, USAID will provide support for infrastructural improvements to Labor and Delivery units, including include floor renovation and infrastructure, beds, fixtures, lockers for staff, upgrades, and supplies.

Targets

Target Target Value Not Applicable Number of service outlets providing the minimum package of  PMTCT services according to national and international standards Number of pregnant women who received HIV counseling and  testing for PMTCT and received their test results Number of HIV-infected pregnant women who received  antiretroviral prophylaxis for PMTCT in a PMTCT setting Number of health workers trained in the provision of PMTCT  services according to national and international standards

Target Populations: People living with HIV/AIDS Pregnant women HIV positive pregnant women

Coverage Areas Demerara-Mahaica (4)

Table 3.3.02: Program Planning Overview Program Area: Abstinence and Be Faithful Programs Budget Code: HVAB Program Area Code: 02 Total Planned Funding for Program Area: $ 1,936,860.00

Program Area Context:

The results of the PEPFAR-funded AIS which was completed in FY05 reveals that 74% of females and 64% males between the ages of 15 and 19 never had a sexual encounter, but among the 20-24 year olds there is a sharp decline to 48% and 21%, reporting the same behavior respectively. The findings imply that USG interventions should continue to encourage this population to remain abstinent, but to assist youth in a safe transition when appropriate to a faithful relationship. Additionally, among the 27% of sexually active women surveyed in age cohort 15-24, there is a reported 20% difference between urban and rural women, with a higher rate of sexual encounter reported in the last 12 months among urban women. Data also reveal that 16% of male youths aged 15-19 had 2+ partners in the last 12 months. In Guyana, the prevalence of multiple partners is a reality. In fact, having a variety of sexual partners is frequently said to be ‘natural' for men. The teaching that men are sexual beings begins in adolescence. Thus the expectations of men that they have multiple partners and acquire as much experience, as early as possible in adolescence encourage them to engage in risky sexual behavior. Hence it is imperative to target this population with "B" (fidelity and partner reduction) messages, and change male norms that support and encourage multiple partnering.

USG's AB activities directly support Guyana's National Strategic Plan for HIV/AIDS, since the Plan emphasizes the adoption of risk elimination practices by youth. Hence, support was provided to 9 indigenous NGOs/FBOs to reach youth with "AB" messages. All AB programs has been complemented by a national mass media campaign "Me to You: Reach One - Save One", implemented by the Ministry of Health that reached 86,000 youths in its first year. Another initiative, support for the Adolescent Health and Wellness Unit, resulted in the establishment of a network of 36 School Health Clubs that promoted abstinence and be faithful and responsible sexual behaviors. Interventions by Peace Corps volunteers and the Guyana Red Cross reached youths in the hinterland communities. In addition, the Roman Catholic Youth Office (RCYO) of the Diocese of Georgetown, with support from CRS private funds and the US Ambassador's Fund, conducted a training-of-trainers course to initiate the Diocese's Guyana Abstinence Program aimed at providing Guyanese youth the knowledge, confidence and skills to promote abstinence before marriage and fidelity in marriage

Based on these findings the Guyana program in FY 07 will continue to support the MOH, FBOs, and NGOs to encourage primary and secondary abstinence, delay of sexual debut, as well as the promotion of dignity and self-worth, discussion and education about drug and alcohol use, and the development of skills for practicing abstinence in schools, youth clubs, religious groups, and other organizations. While it is critical to educate women and young girls about safer sex practices, reproductive health, gender roles and the benefits of abstaining until marriage, it is equally critical to educate adult men and young boys so that the behaviors which fuel HIV transmission and other social and health challenges may be disrupted. "Be faithful" messages will complement abstinence messaging in groups of sexually active adults, sexually active youth over the age of 14 seeking support, and mobile populations such as miners; encouraging mutual fidelity and partner reduction. Interventions will also discourage cross-generational sex and multiple partners among adult males, since studies have shown that cross-generational sex contributes to considerably higher rates of infection among girls and young women than among same-aged male peers.

Given that myths, stigma and discrimination still exist and can hamper prevention, treatment and care efforts, communication approaches linked to reinforcement activities in order to educate, encourage safe behavior, and reduce stigma are highly warranted. Therefore, we will support the Ministry of Health "Me to You" program in collaboration with other partners, and the MARCH (Modeling and Reinforcement to Combat HIV/AIDS) strategy that promote the development of a non-discriminatory environment in addition to increasing community involvement in A and B program activities.

Howard Delafield International, a partner on the GHARP initiative will be responsible for development and production of all information education and communication materials to be used by the NGOs in their AB

outreach activities.

Program Area Target: Number of individuals reached through community outreach that promotes 38,970 HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that promotes 167,850 HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention programs 800 through abstinence and/or being faithful Table 3.3.02:

USAID will coordinate the HIV/AIDS portfolio, improve responsiveness to headquarters' reporting requirements, coordinate needed short-term technical assistance, oversee the overall implementation of PEPFAR in Guyana, and monitor program progress through site visits and periodic information assessments.

USAID program management for FY06 included overhead (partial payment of total USAID office costs, supplies, furniture, printers/copiers, communication facilities); one PHN Officer with responsibility as the Cognizant Technical Officer and HIV/AIDS Strategic Objective Team Leader; one Program Advisor with key responsibility and oversight on NGO coordination and development; two Global Health Fellows - one with responsibility for Strategic Information; one with responsibility to advise on AB and Other Prevention at the MOH; time-share of one FTE with responsibilities for program and EXO with responsibility for all three SOs; one driver); transportation (vehicle and maintenance, fuel, travel for meetings and trainings); program funds (miscellaneous expenses for SO cross-cutting issues at USAID, training funds for USAID staff, and travel for Global Health Fellow's travel for project implementation.

To deal with the increased number of partners and level of effort required to maintain such a significant portfolio, meet increased oversight needs, and respond to increasing contract and executive officer functions, in FY07 USAID will hire two additional staff: 1) An EXO assistant with key responsibilities for customs procedures, staffing logistics, and procurement paperwork, and 2) a Program Administrative Assistant who will also dedicate 50% of effort to NGO partner development. In addition, as per USAID guidance, time-share funding of any personnel is no longer permitted and as full payment of one driver will also be added, but the other two time-share positions from FY06 will not be funded through PEPFAR. All other program and management responsibilities will be maintained.