In FY10, DoD will support the Guyana Defense Force in its efforts to provide HIV prevention and care services to military members and their families. The GDF comprises approximately 2800 personnel. The eight military bases served by HIV program activities are Base Camp Ayanganna, Base Camp Stephenson, Coast Guard (Ramp Road and Kingston Seawall), Agriculture, Tacama, Seweyo, and Lethem.

In FY10, DoD will continue to support program activities in Injection Safety, Adult Care and Support, TB/HIV, and Laboratory Infrastructure. DoD will also commence support for Male Circumcision activities in FY10.

Laboratory equipment will be procured and GDF healthcare personnel will be trained to further increase capabilities in HIV, STI, and TB diagnosis. The enhanced capacity of GDF medical services will improve care and support of HIV-positive military members and families, and linkages with civilian health facilities for additional care and treatment services will be strengthened. Educational outreach will be carried out to inform GDF members about the benefits of male circumcision for HIV prevention, and male circumcision services will be linked and coordinated with HIV testing and counseling

DoD will support the human capacity development of GDF medical and laboratory personnel by funding training in injection safety and the handling and disposal of medical waste; training on TB case identification, diagnosis and appropriate referral for treatment; and training on the utilization of laboratory equipment and quality assurance.

In FY10, DoD PEPFAR will identify a TBD partner will support the Guyana Defense Force in the implementation of its HIV prevention activities with military members and their families. The GDF comprises approximately 2800 personnel. The eight military bases served by HIV program activities are Base Camp Ayanganna, Base Camp Stephenson, Coast Guard (Ramp Road and Kingston Seawall), Agriculture, Tacama, Seweyo, and Lethem.

In FY10, a TBD partner will continue to support HIV program activities in Sexual Prevention and Testing and Counseling, with increased emphasis on addressing substance abuse, stigma and discrimination, and gender. A TBD partner will also support Strategic Information and Health Systems Strengthening efforts for the GDF. By targeting military personnel, activities will support the Partnership Framework prevention goal of reducing HIV prevalence among high-risk populations and their clients.

Prevention activities will promote correct and consistent condom use and risk reduction through peer education, educational outreach, and sensitization events. Condoms will be made available in health facilities and other venues. Activities will address stigma and discrimination by promoting accepting attitudes toward people living with HIV/AIDS. Prevention activities will address alcohol and substance abuse through outreach and incorporation of substance abuse curriculum into existing prevention training. Sexual Prevention and Testing and Counseling activities will be closely linked and coordinated by promoting TC during outreach activities and by ensuring that all TC is accompanied by appropriate prevention interventions.

The GDF currently has a draft HIV policy under review. Upon approval of the policy, Health Systems Strengthening funding will support the effective implementation and dissemination of the HIV policy. Health Systems Strengthening activities will also encourage GDF participation in regional opportunities for military-to-military collaboration. In FY10, a TBD partner will support the GDF Strategic Information efforts to utilize data to inform program activities and strengthen monitoring and evaluation mechanisms.

Prevention outreach activities will address male norms and behaviors and address issues related to sexual violence and coercion. Possible partnership or collaboration with Ministries and other organizations addressing gender-based violence and gender inequalities will be explored. Increased efforts will be made to include military wives and families in HIV prevention and counseling and testing activities and to increase gender equity in access to HIV services.

Cost efficiency will be improved by increasing the capacity of GDF peer educators and testers and counselors to train other military personnel, and by leveraging resources provided by the Ministry of Health and National AIDS Programme Secretariat.

Monitoring and evaluation will be carried out according to national standards, utilizing mechanisms provided or recommended by the Ministry of Health and the National AIDS Programme Secretariat. Monitoring and quality assurance mechanisms may include refresher trainings and supportive supervision for peer educators and VCT providers, review and adaptation of curriculum and materials, and utilization of national standard reporting forms.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

HIV-infected members of the GDF have access to care and treatment through the St. Joseph Mercy Hospital where HIV-infected military members receive comprehensive care and support, including medical care, provision of antiretroviral therapy, and treatment of opportunistic infections, pain management, social support, nutritional vouchers and ART adherence education.

In FY10, program activities will support access of HIV-positive military members to HIV care and treatment services by strengthening linkages with civilian health facilities and services. Activities will seek the involvement of military chaplains in HIV/AIDS counseling and make other psychosocial support resources available to HIV-positive military members and their families. Military healthcare providers will be trained in prevention with positives activities to improve their ability to effectively counsel military members on healthy living, reduction of risk behaviors, partner notification, and adherence to ART. Efforts will be made to address stigma and discrimination by promoting accepting attitudes toward people living with HIV/AIDS.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity will provide HIV testing and counseling for those who seek to know their HIV status. In FY09, the TC site at Base Camp Seweyo located on the Soesdyke/Linden Highway was refurbished.

For FY10, activities will continue to strengthen the capacity of the Guyana Defence Force to provide accessible, confidential, and quality testing and counseling services. Twenty-five (25) individuals will undergo training or refresher training in TC. TC by trained counselors will be available at all four GDF locations: Base Camps Ayanganna, Stephenson, Ruimveldt and Seweyo. The mobile VCT unit will continue to reach outlying bases and units, and will be equipped with education materials on HIV, ART, STIs/OIs, and other prevention materials. The VCT vehicle will target remote, underserved regions to address barriers to VCT.

In support of the MOH, TC activities will link with prevention sensitization activities to educate participants and encourage testing. Efforts will be made to extend TC promotion activities to military wives and families. Counseling will be performed in accordance with national guidelines and will include targeted ABC messages, emphasize the reduction of risk behaviors, and address substance abuse and stigma and discrimination. Mechanisms to maintain anonymity of those tested and confidentiality of their test results will be put in place. TC activities will link with Adult Care and Treatment services through a referral system with the civilian health sector for follow-up care and treatment of HIV-positive individuals. Data collection and monitoring mechanisms will be supported.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity will support increased capacity within the GDF in the areas of surveillance, monitoring and evaluation (M&E), and analysis and utilization of strategic information. Funding will support improvement of the GDF health information management system. Existing data regarding risk behaviors from VCT intake forms will be analyzed to understand and target behavior change and other prevention activities. The GDF and USG country team will work to align the strategic information and M&E programs of the GDF and other PEPFAR partners.

In FY10, efforts will be made to improve health information management systems to manage data regarding HIV in the GDF and assure confidentiality and appropriate referrals. Data from a recent behavioral surveillance survey on HIV risk behavior among the GDF will be utilized to target HIV prevention interventions. The program manager will be trained in M&E to ensure proper reporting to PEPFAR. IT materials will be procured to support M&E of PEPFAR initiatives within the GDF.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity will strengthen the capacity of the GDF to plan, manage, and implement HIV programs by supporting GDF participation in regional opportunities for military-to-military collaboration. Opportunities for collaboration, such as regional conferences and workshops, will help reinforce military leadership's commitment to HIV activities and support the development of program management skills. Strategies for improving partnership with other government, NGO, and private entities working on HIV and health will be emphasized. Program activities will seek to secure military leadership endorsement of interventions addressing gender norms and substance abuse.

The GDF currently has a draft HIV policy under review. Upon approval of the policy, Health Systems Strengthening funding will support the effective implementation and dissemination of the HIV policy. Efforts will be made to strengthen military protocols that reduce stigma and discrimination and strengthen military commitment to supporting HIV-positive members.

Programming responding to yellow-lit activities- Guyana PEPFAR Interagency team has adopted OGAC Prevention Technical Working Group recommendations for the sexual prevention portfolio.

The GDF medical center at Base Camp Ayanganna began providing male circumcision (MC) services in March 2009. The service is provided free of charge to military members.

While there is interest in scaling up MC in the GDF, there is no available data on the current prevalence of MC in Guyana or in the GDF. Funding will support a rapid assessment of prevalence of MC and the acceptability of MC for HIV prevention in the GDF population. The assessment will compare self-reported MC status to physical exam and investigate determinants of MC status. Findings will be used to guide scale up of services and MC demand creation.

MC funds will also support education and outreach to GDF members on the benefits of male circumcision for HIV prevention. Sensitization will be carried out through oral presentations and information education communication materials. Activities will target all GDF ranks. Male circumcision services in the GDF will be provided according to national and international standards and recommendations. Supportive supervision and assistance with quality assurance in service delivery and follow-up will be sought from Georgetown hospital. Recipients of male circumcision services will be counseled on the need for abstinence from sexual activity during wound healing, wound care instructions and post-operative clinical assessments and care. Male circumcision activities will be linked with HIV testing and counseling services provided by trained testers and counselors at the VCT site at Camp Ayanganna.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

The purpose of this activity is to develop protocols in support of injection safety, reduce the number of unsafe and unnecessary injections through training and refresher training, and promote proper waste management techniques.

In FY10, DoD will continue to support the implementation of universal precautions in Guyana Defense Force (GDF) healthcare settings. Through the Guyana Safer Injection Project, the GDF's health care personnel will be trained in the areas of injection safety, handling sharp instruments, and handling and disposal of medical waste. Twenty (20) medics and lab personnel will be trained in safe blood drawing and handling techniques for sharp instruments and medical waste. Post Exposure Prophylaxis (PEP) protocols, already developed in the civilian sector through the National Care and Treatment Centre, will continue to be implemented to address occupational exposures that occur in military facilities. Occupational exposures will be tracked and reported. Following training, sites will receive essential commodities and supplies such as sharps containers and biohazard bags to ensure implementation of improved IP/IS practices. A national or commercial logistics system will be utilized for the provision of materials.

Programming responding to yellow-lit activities- Guyana PEPFAR Interagency team has adopted OGAC Prevention Technical Working Group recommendations for the sexual prevention portfolio.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity consists of prevention activities promoting partner reduction and the correct and consistent use of condoms in addition to addressing STIs, gender norms and other behavior change communication activities. Condoms procured through the Guyana National AIDS Programme Secretariat (NAPS) are made accessible to all members of the Guyana Defence Force.

In FY10, efforts will continue with GDF leadership and peer educators to increase the acceptability of condom social marketing within the GDF. Information education communication materials will be procured to support educational outreach efforts. Leadership and peer educators will be trained and encouraged to provide HIV/AIDS prevention education to their subordinates through seminars and workshop sessions in order to encourage HIV risk reduction. Condom dispensaries will be procured and supplied to all bases to be positioned in key areas of congregation and traffic (e.g. mess halls, restrooms, social areas/clubs, gym facilities, etc). Prevention messages throughout the military regions will focus on issues such as alcohol use, abstinence, fidelity, partner reduction, consistent and correct condom use, and correct knowledge of HIV transmission. Prevention activities will address male norms and behaviors and discourage violence and coercion. In FY09, the Minister of Human Services spoke with the senior officers about the Stamp Out campaign against domestic violence. In FY10, collaboration with Ministries and other organizations addressing gender-based violence and gender inequalities will be explored. In FY10, efforts will be made to extend prevention activities to include military wives and families. Prevention activities will also address stigma and discrimination by promoting accepting attitudes toward people living with HIV/AIDS.

In FY10, two events will be scheduled as part of the program's anniversary and the Guyana Defence Force's anniversary events, during which HIV/AIDS prevention activities, including peer educator presentations of ABC messages and distribution of IEC materials, will be held.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity will support the procurement of equipment and commodities to develop and strengthen laboratory systems and facilities in order to support STI and TB diagnosis and improve the capacity of the GDF to provide clinical care to HIV-positive military members.

In FY10, laboratory personnel will be trained in the utilization of laboratory equipment and data management. This activity will link with CT, TB, and care and treatment services by providing ancillary support for rapid HIV testing and STI and TB diagnosis. GDF laboratory technicians will be trained to parallel the skills and capabilities of laboratory technicians in civilian laboratories through assistance from the National Public Health Reference Laboratory.

THIS IS AN UPDATED, CONTINUING ACTIVITY INCLUDED FOR PARTNERSHIP FRAMEWORK PREPARATION.

This activity will support coordination between TB and HIV programs. Technical assistance for the development of training, educational resources, and guidelines for TB-HIV management will be provided by the Ministry of Health.

IN FY10, the GDF medical personnel will receive training on TB case identification, diagnosis and appropriate referral for treatment. The GDF will implement HIV testing and counseling for all TB patients and TB screening of all HIV-infected personnel. Necessary equipment and laboratory supplies will be purchased to support program area activities. This activity will link with laboratory infrastructure activities to strengthen TB diagnostic capabilities.