The MARCH (Modeling and Reinforcement to Combat HIV/AIDS) Project has moved beyond the conceptual stage to the recording of several episodes of the radio serial drama (RSD) and the development of the activities to reinforce the behaviors being modeled through the drama. Preparations are underway for the launch of the RSD in October 2006. The overwhelming response to the countrywide field test of the pilot episode suggests that Merundoi, the RSD, reflects reality of life in Guyana and that embedded information on HIV/AIDS can be effective. Encouraged by these results, the MARCH Team has developed its RSD with a regional appeal to allow possible expansion into the Caribbean. The HIV/AIDS subject matter will be introduced gradually about three months into the drama. The project targets men and women, in-school students, out-of-school youth, and parents.

The 15-minute RSD will be aired twice a week on the popular FM station and repeated on the Voice of Guyana, a channel with a wider reach. An omnibus edition will be aired every Sunday. Efforts will be directed at ensuring countrywide reach through the use of community relay stations and Public Listening Sites (PLS). These PLS will target persons who do not have access to radios or who might not receive radio signals. CDs will be made available to person(s) in the community such as shopkeepers who have CD players and sound systems. The field test provided evidence of people's willingness to engage in spontaneous discussions about the issues being addressed in the RSD. The RSD will also reach the Guyanese Diaspora through webcast of the FM station.

Strategies must do more than provide information since theory and research suggest that behavioral interventions to prevent HIV/AIDS can be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present in the local environment. MARCH combines entertainment as a vehicle for education (long-running serialized dramas on radio that portray role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level (support from friends, family members, teachers and others can help people initiate behavior changes).

Data from other MARCH projects suggest that the strategy helps people overcome barriers to change. For example a mid-term assessment in Botswana showed that people who listened to the drama weekly (compared to others) were 1.6 times more likely to know abstinence and monogamy prevent HIV and 2 times less likely to report non-stigmatizing attitudes (e.g., not being afraid to be near a PLWHA).

The response to HIV/AIDS is increasingly conceptualized as a continuum between prevention and care, and the effects of stigma and discrimination can also be framed into this model. Formative research informed the selection of the behavioral objectives; abstinence/delayed initiation, parent and child communication, monogamy/fidelity, alcohol and drug use/drug reduction, access to care and treatment services/adherence, and reduction of stigma and discrimination.

Activities will focus on sexually abstinent adolescents in recognition that they have not received the same amount of attention as their sexually active peers. Activities will concentrate on increasing understanding of why some adolescents choose not to have sex in keeping with the trend toward identifying protective rather than risk factors that contribute to resiliency. The pertinent question will be: What have non-sexually active adolescents done right rather than what have their sexually active peers done wrong?

Additionally activities will focus on the power dynamics between men and women. Issues will include self-esteem, choice, coercion and violence. Emphasis will be placed on exposing the complexities of intergenerational sex since research now confirms that exploitative and intergenerational sex between older men, (Sugar Daddies) who are more likely to be infected with HIV than their younger counterparts. Fidelity information will target both married and single men to encourage them to consider why they have multiple partners and who their partners are.

The success of the MARCH strategy hinges on the development of community specific interpersonal reinforcement activities. Listening and Discussion Groups will comprise 10 to 15 persons who will be encouraged to listen to selected episodes from the RSD and

participate in a discussion around the behaviors and issues raised. Street Theatre/Drama will utilize actors/peer educators to dramatize social issue(s) that affect(s) particular communities and interact with community members to clarify issues around behavior change.

Selected content of the RSD will be infused into the Ministry of Education life skills based Health & Family Life Education (HFLE) curriculum that seeks to develop core skills - cognitive, social and coping. Infusion will fill an existing gap in the HFLE curriculum that serves only Grades 1 - 9. Emphasis will be placed on abstinence and delayed initiation in keeping with the Ministry of Education's policy regarding prevention. The capacity of the teachers will be built to structure a set of questions around a scene or episode in the RSD, to increase students' negotiation skills through role play and problem-based scenarios. This activity aims to revitalize the creative thinking of teachers and students by helping teachers to refine the outcome of the discussions into principles that will help students to apply learning to different situations.

A hotline will be established to field audience questions after the airing of each episode and a summary of the issues raised will be made available to the listening public via a monthly radio program facilitated by MARCH staff and members of the Project's Technical Advisory Committee. Those issues will be clarified for the benefit of the listening public. Health promoting school programs and health fairs will also form part of this activity, to reinforce the information modeled in the serial drama.

Based on experiences in other countries, it is expected that 345,000 persons (60% of the population) in Guyana will ever listen to the drama and 179,000 will follow it weekly. It is also anticipated that 3 million persons from the Caribbean will ever listen. It is expected that 66,000 youth will participate in group or school activities and 140,000 youth and adults will participate in community-wide activities to create a more supportive environment (e.g., adults who support youth in safer behaviors, safer social norms).

This request covers the second-year costs for the serial drama production and reinforcement activities, monitoring and evaluation activities for the MARCH approach, and efforts to Caribbean-ize Merundoi. This budget is in line with cost of current MARCH programs in Botswana and Zimbabwe. CDC GAP Guyana will partner with GHARP's NGO consortium, Peace Corps and the Ministry of Education to develop and pilot test reinforcement materials and conduct community-based reinforcement activities. Additional formative research will determine what youth and adults find appealing in dramas and will provide information that will enable MARCH staff to more fully understand barriers to behavior change. Evaluation data will also be collected.

The MARCH Project currently receives technical and administrative support through the CDC office in Guyana. In FY07, technical oversight will remain with CDC, administrative processes will be rapidly transitioned to a local institution. This transition will allow greater flexibility for staffing and procurement for the unique needs of the MARCH program.

The MARCH (Modeling and Reinforcement to Combat HIV/AIDS) Project will target female commercial sex workers (FCSW) and their clients, men who have sex with men (MSM), miners. MARCH will specifically address consistent and correct condom use, access to services and reduction of stigma and discrimination through the radio serial drama (RSD), Merundoi. The 15-minute RSD will be aired twice weekly beginning October 2006 on the popular FM station and repeated on the Voice of Guyana, a channel with a wider reach. An omnibus edition will be aired every Sunday. BSS and targeted prevalence surveys completed by USG/Guyana in 2005 identified key Most-At-Risk Populations (MARPS): sex workers, men who have sex with men, PLWHA, and "mobile" persons such as miners, loggers, sugar cane workers, transport industry workers, and migrants crossing the Brazil border. USG Guyana takes a public health approach to prevention, relying on both risk elimination and risk reduction, and our interventions with MARPS will follow the "ABC" model, with the emphasis on "BC." Partner reduction and mutual faithfulness are promoted through behavior change communications and interpersonal activities reinforcing safer sexual behaviors, and persons at elevated risk build skills in correct and consistent use of condoms. In our program communications we confirm that the only certain way to eliminate risk of HIV/STI infection is to abstain from sex.

Reaching the MARPS populations is a challenge, due to social and geographical barriers. Therefore, strong partnerships with individuals and organizations are being established to effectively reach and work with the MARPS "communities". MARCH will collaborate with USAID/GHARP and its beneficiary NGOs and Peace Corps to conduct interpersonal community activities to reinforce the behaviors being modeled in the RSD and support MARPS in their efforts to change their risk behaviors. Leaders in both the CSW and MSM communities identified during the BSS are currently supporting USG efforts to strengthen our prevention efforts and are being included as program implementers. A program targeting female commercial sex workers (FCSW) is currently being implemented with support from GHARP supported NGOs in Regions Four and Six. USG is working through outreach workers and peer educator (FCSW) to facilitate access to screening and treatment for HIV and other STIs, and access to condoms. Additionally one-on-one interaction through peers and outreach workers are being conducted. Plans are inn train to expand this program to Region Three and the mining communities, and train FCSW to target their clients. An MSM intervention is currently being developed. Qualitative data will be collected and the MSM program will be expanded.

The military is currently targeting border bases, recruits, officer cadets and ranks being deployed to outlying posts with information, education and communication (IEC) materials, safe sex information and condoms. Efforts will soon be directed at program, human capacity and infrastructural development and exploiting the potential to reach other disciplinary services.

Strong referral mechanisms to other care and treatment services and interventions are essential for example, referrals between USG/Guyana's ABY and OVC program areas will enable young persons engaging in risky behaviors to obtain needed HIV/STI counselling and testing and other HIV prevention services. Sexually active youth will be reached through Life Skills and Peer Leader Education programs and School Health Clubs.

An important component of our prevention program is services for PLWHA and their partners and families. Reinforcing "prevention for positives" and for sero-discordant couples will help PLWHA prevent secondary infection and further transmission of HIV. This program will also be implemented in the military.

MARCH will also target selected MARPS groups with information on monogamy and faithfulness. MARCH will seek to reduce the stigma and discrimination around FCSW and MSM to encourage them to adopt safer sexual practices and access services, including VCT and STI. M.A.R.C.H. (Modeling and Reinforcement to Combat HIV/AIDS) behavior change communication strategy will direct 33 percent of its resources to promoting appropriate care services for MARPS and correct as well as condom efficacy, correct and consistent condom use, implementing interpersonal community reinforcement activities aimed FCSW and their clients, MSM, and miners and reinforcing anti-stigma and discrimination information. It is estimated that 21,000 individuals from the MARPS will be reached through MARCH interpersonal community activities.

Targets

Target Target Value Not Applicable Number of targeted condom service outlets  Number of individuals reached through community outreach that 21,000
promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention 75
through other behavior change beyond abstinence and/or being faithful

Table 3.3.05: