1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Be Faithful Activities (#6943), Condoms and Other Prevention (#6948), Counseling and Testing, (#8746).

2. ACTIVITY DESCRIPTION The Institute of Tropical Medicine (ITM) will continue to assess a comprehensive youth intervention program in the Asembo and Gem areas of Nyanza Province, which has the highest HIV prevalence rates in the country. In Kisumu, the capital of Nyanza Province, a previous ITM study found very high rates of HIV infection among young women. Young women, aged 15 to 19 years, had a 23% HIV prevalence rate in contrast to their male counterparts with a 3.5% prevalence. A multi component program targeting adolescents directly and through their families and the community, was begun in 2002 to adapt evidence based interventions an African rural setting and to test these interventions in order to assess their effectiveness in reducing HIV and STI infection and teen pregnancy. In this project, 4,000 youth and 3,000 parents will be reached with targeted HIV prevention messages and fifteen people trained.

Activities promoting abstinence and delay of sexual debut in young people have been key in a multi-component intervention program to improve adolescents' sexual and reproductive health. This comprehensive youth intervention program includes two AB activities. One activity being conducted by ITM is the implementation of a "Families Matter" curriculum targeting parents or guardians of 9 to 12 year olds. It is an adaptation of "Parents Matter" curriculum which CDC has evaluated in the US. The program brings together small groups of parents and aims to promote positive parenting practices and improve effective communication about sexuality and sexual risk reduction between parents and their children. Preliminary analysis of a recent assessment of Families Matter, 15 months post-intervention, seems to indicate a sustained positive effect in terms of parenting and communication skills reported by participants and their children separately. To date, parents, community and religious leaders in Asembo and Gem are very supportive of this approach of enabling parents to take a more active role in HIV prevention for their adolescent children. The program has been scaled-up and 1,800 families have participated in the intervention so far. Another activity is an abstinence based curriculum targeting school-going children aged 10 to 14 years old. "Healthy choices for a better future" is an adaptation of "Making A Difference", a curriculum that was selected by CDC as an effective intervention. The adapted curriculum has been piloted, and ITM is currently developing a proposal to evaluate this component as well. Efforts to change the social norms which contribute to this high risk for young girls are part of this intervention. The project has also found that the lack of skills and employment opportunities contributes to high risk behavior among girls and boys, so one aspect of the project is the provision of vocational skills and opportunities for income generating activities for these youth.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This project will contribute to the Kenya Five-Year Strategy which focuses on HIV prevention in youth, since the primary target group is young people, including children aged 10 to 14. Targets in this project will contribution to HIV infections averted through reaching 4,000 youth and 3,000 parents and training 15 community leaders.

4. LINKS TO OTHER ACTIVITIES This activity will be linked to KEMRI AB activity (#6943), KEMRI OP activities in Kisumu (#6948) and ITM CT activities (#8746). KEMRI and ITM work together on this program and KEMRI provides the bulk of the human resource who implement this program. Referral linkages between these programs have also been established.

5. POPULATIONS BEING TARGETED The primary population being targeted is primarily a rural community including both in-school and out-of-school youth. Ages of youth targeted range from 10 to the early 20's. Age-appropriate curricula are used with each group. In addition, their parents and family members, mainly men and women of reproductive age, and HIV/AIDS affected families are targeted. Community and religious leaders as well as volunteers are targeted by the project. The project will work with teachers in in-school programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED This project will have a strong gender component, including increasing young women's

access to income and productive resources, addressing male norms and behaviors and increasing gender equity in HIV/AIDS programs.

7. EMPHASIS AREAS The primary emphasis area is human resources, as the project has a large staff needed to implement and assess the impact of these interventions. IEC activities to educate the youth and their parents about abstinence and faithfulness as well as training are minor emphasis. The project will train implementers and provide very close Quality Assurance, Quality improvement and Supportive Supervision in the curricula adaptation process.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Be Faithful Programs (#6903) and Counseling and Testing (#8746), (#6941).

2. ACTIVITY DESCRIPTION This activity is being implemented by the Institute of Tropical Medicine (ITM) in collaboration with Family Health Options Kenya, a local partner. ITM is already implementing a project targeting youth, their families, and the local community in several rural areas of Nyanza province. In June 2006, ITM expanded its activities to Kisumu town to target young vulnerable women, including sex workers, with HIV prevention and care services. Free health services are offered at an integrated clinic, including management of STIs, HIV testing and ART for HIV-positive clients. A network of peer educators is being established to promote safer sex practices. Towards the end of 2006, ITM, in collaboration with CDC and the Kenya Medical Research Institute, plans to conduct a needs assessment and baseline survey of HIV, STI and associated risk behavior. The findings of this assessment will be used to refine the interventions; Nyanza Province is the area of Kenya with the highest HIV incidence and prevalence, and therefore this activity with highly at-risk populations is of great urgency. In this project, 700 women will be reached with targeted HIV prevention messages. ITM will also integrate an alcohol and HIV prevention initiative that will reach 500 men. 20 people will be trained to deliver this intervention and 10 condom outlets will be established.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This project will contribute to the Kenya Five-Year Strategy which focuses on HIV prevention in youth, as the primary target group will be young women. Targets in this project will contribution to HIV infections averted among 700 at-risk young women and 500 young men. 10 condom outlets will be established and 20 people trained to deliver this intervention.

4. LINKS TO OTHER ACTIVITIES This activity will be linked to KEMRI CT activity (#6941) implemented by other CDC partners in Kisumu (KEMRI) and will be linked to the Institute of Tropical Medicine AB activity (#6903) and CT activity (#8746) already being implemented by ITM in Nyanza province.

5. POPULATIONS BEING TARGETED Young male and female adults, both those already engaged in CSW and out-of-school young girls and women living in the environs of Kisumu who are vulnerable to beginning CSW, will be targeted by these activities. This project will also work with PLWHAs and a mainly most at risk populations including commercial sex workers. Important entry points to this work will be through targeting brothel owners, community leaders and community as well as NGO organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED This project will have a strong gender component, including increasing women's access to income and productive resources as an alternative to engaging in full time or part time commercial sex work. Services will be provided to these women, including detection and treatment of both HIV and other STIs, counseling for behavior change, and services to help these vulnerable young women with alternate sources of employment and income. This will also address gender equity in HIV/AIDS programs and male norms and behavior through targeting at risk men. Stigma and discrimination will be addressed through these efforts.

7. EMPHASIS AREAS The main emphasis area covered by this activity is Human resources. Minor emphases include the development and implementation of Information, Education and Communication activities, conducting needs assessment, training and providing quality assurance, quality improvement and supportive supervision.

This will support an expansion of existing 07 COP activities implemented by the Institute of Tropical Medicine (ITM)'s Pambazuko project. The expansion will cover additional areas of Kisumu hotspots targeting young vulnerable women, including sex workers and their clients. It will also target at-risk men, including MSM. An important addition to this

intervention will be provision of lubricant gels alongside condom promotion to increase condom use, efficiency and acceptability. This expanded activity will also provide interventions for Positive Prevention among positive people and their partners including linkages to partner counseling and testing, increased access to treatment of STIs for HIV-positive patients and their partners and an active involvement of PLWHA in spearheading PWP activities. There will also be increased support to the sub-partner, Family Health Options Kenya to allow the project develop an autonomous management structure through co-location with the implementing agency.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in AB (#6903) and OP (#6904).

2. ACTIVITY DESCRIPTION The Institute of Tropical Medicine (ITM) has a long international history of operational research on HIV in Africa including Kenya. In previous years, they have received Emergency Plan funds, through CDC, for the implementation of AB and OP activities in Nyanza Province, the region that has the highest HIV prevalence in Kenya. The main of strength of ITM has been their work with youth in HIV prevention and evaluation. In FY 2007 they will continue to work with youth to support HIV in prevention, but they will also carry out specific CT activities in the same region. This includes maintaining two stand-alone VCT sites and facilitating mobile VCT services in areas where VCT services are not available. Mobile VCT will be provided in markets, beaches, near schools and during community events. Mobile VCT will be preceded with extensive community mobilization and awareness creation. In the past, ITM has facilitated the establishment of support groups for HIV positive youth. In FY 2007 these established groups will be used to disseminate information about CT in the community. This will improve uptake of CT services as well as reduce HIV-related stigma in the area. All these efforts should lead to at least 3000 being counseled and tested for HIV. This will require an additional six counselors to be trained, both for the stand-alone and the mobile VCT services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA As stated above, Nyanza province has the highest HIV prevalence in Kenya. The Kenya Demographic and Health Survey of 2003 showed that majority of the HIV positive Kenyans (including those in Nyanza) do not know their HIV status. Despite the relatively small numbers of people projected to receive CT services in FY 07, by working with the youth, ITM will be working towards achievement of national CT targets. They will also be working towards the realization of Kenya's five-year strategy of preventing infections among the youth. But apart from this longer term contribution, ITM will promote greater access to comprehensive HIV/AIDS care, through increased knowledge of status.

4. LINKS TO OTHER ACTIVITIES This activity will be linked to AB (#6903) and OP (#6904) activities implemented by the Institute of Tropical Medicine in Nyanza province. Personnel that carry out community mobilization can pool resources to maximize the benefit. Also, the OP and AB activities can be used to increased uptake of CT.

5. POPULATIONS BEING TARGETED The primary population being targeted is rural youth, including both in-school and out-of-school youth. Ages of youth targeted range from 13 to the early 20's. In addition, their parents and community and religious leaders are targeted by the project.

6. KEY LEGISLATIVE ISSUES ADDRESSED This project will have a strong gender component, including increasing young women's access to income and productive resources. The activity will also facilitate stigma reduction through community mobilization and through widespread CT activities.

7. EMPHASIS AREAS. The primary emphasis area is human resources, as the project has a large staff needed to implement and assess the impact of these interventions. Community mobilization to change social norms which encourage delay in sexual debut is also an important component of this project, along with IEC activities to educate the youth and their parents about abstinence, faithfulness and safer sex practices.