1. LIST OF RELATED ACTIVITIES This activity relates to activities in Condoms and Other Prevention (#8874), Counseling and Testing (# 8976), and Abstinence and Being Faithful (#8989), (#8725).

2. ACTIVITY DESCRIPTION The Kenya Adolescent Reproductive Health Program (KARHP), implemented by Population Council FRONTIERS and PATH, is a multisectoral intervention with proven effectiveness in influencing HIV/AIDS knowledge, attitudes and behaviors that supports three Government of Kenya ministries: Education, (MOE); Gender, Sports, Culture & Social Services (MOGCSS); and Health (MOH). In 2007 with the institution of the Ministry of Youth Affairs, it will replace MOGCSS. The program supports the GOK ministries, both individually and through stimulating intersectoral collaboration, to integrate adolescent reproductive health (ARH) activities into their routine programs that promote abstinence and behavior change for youth. Ministry staff capacity is built using a "life skills" curriculum that has been developed by Frontiers and PATH. Their life skills curriculum was promoted by the Provincial Director of Education in Western province as the chosen curriculum for use throughout Western province. Over the past three years, the program has been introduced in two districts of Western Province, and then institutionalized and scaled up to cover all eight districts in the Province. In 2007, Frontiers will take the KAHRP methodology into an additional province to be selected following consultation with APHIA II partners and GOK. Guidance and counseling teachers in schools will promote HIV prevention and reproductive health information and services for adolescents in their routine work. Staff members are key implementers, working closely with peer educators, religious and civic leaders, other teachers and parents to enhance and sustain community acceptance. Currently Population Council and PATH are collaborating with the APHIA II program to introduce KARHP in two districts of Nyanza province and two districts of Eastern province where PATH will take the lead as the APHIA consortium member.

In 2007, it is expected that the project will train 800 teachers and Parent Teacher Association members in 50 schools and 50 Ministry of Education officials; 50 Social Development Advisors, and 50 MOH staff. In total, 1,000 people will be trained in communicating AB messages and 10,000 people reached.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This project aims at increasing knowledge of sexual and reproductive health issues using innovative approaches for public sector authorities to work not only with youth, but also with their parents, teachers and community leaders to improve HIV prevention through delayed sexual debut, secondary abstinence, and safer sexual practices among sexually active young people.

4. LINKS TO OTHER ACTIVITIES Through provision of reproductive health information to young people, this project increases the demand for reproductive health services such as VCT services and STI treatment. Key messages and activities are conveyed through existing community and religious structures, resulting in the strengthened capacities of local religious organizations, and community groups to address HIV risk through prevention and abstinence. The project activities will complement APHIA II project activities targeting in- and out-of-school youth and provision of youth friendly services at public health facilities (#8874), (# 8976), (#8989), (#8725).

5. POPULATIONS BEING TARGETED KARHP targets primarily girls and boys aged 10 to 14 years, and 15 to 19 years in primary schools, as well as unmarried out-of-school youth in the project communities. The project also reaches community and religious leaders, parents and local authority representatives.

6. KEY LEGISLATIVE ISSUES ADDRESSED Through the content of the life skills curriculum, group discussions and individual counseling sessions, the project will address gender equity, male norms and behavior, sexual violence and coercion, and stigma and discrimination. KARHP has continued to support MOE in developing the national schools curriculum on family life skills and HIV/AIDS, and development of the national Guidance and Counseling Policy for schools. It will also support the MOH to integrate KARHP activities in their yearly work plans to enable the Ministry to comprehensively address ARH issues. Through advocacy and lobbying at

the national level among the three ministries, ARH issues will be continually promoted as a priority by the ministries as they prepare their strategic plans.

7. EMPHASIS AREAS The life skills curriculum addresses issues of gender, stigma and discrimination. One of the primary gender issues in Kenya today is violence and coercion stemming from gender relations. By addressing these issues at an early age and forming adult mentors, the youth will have a better chance of developing good morals and high principles to live by.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8760), (#6983) and Abstinence and Be Faithful Activities (#8989).

2. ACTIVITY DESCRIPTION This project is based on previous research in Kisumu showing that married adolescents are at elevated risk of HIV infection over and above their sexually active counterparts. With sites in Rachuonyo and Homa Bay Districts, the project is using media messages through radio spots and drama to raise awareness on the HIV/RH risks associated with early marriage as well as marital transition of HIV and premarital voluntary counseling and testing (VCT). Local leaders, including church leaders, are trained as advocates so that they can pass HIV prevention and reproductive health (RH) messages through their routine activities in the community. In order to reach girls who are already married or girls at risk of early marriage, a local non-governmental organization (NGO) is training mentors to mobilize girls into clubs and reach them with HIV and RH information and referrals. In addition, young people and couples are referred to existing VCT sites, through a coupon system. In FY 2007, training and media activities will expand with additional radio messages and additional drama groups trained, while other activities continue to be implemented. Over the year, 350,000 people will be reached with radio spots raising awareness on early marriage, HIV, marital transmission and premarital VCT. Additional drama groups will be trained with 30,000 people reached through this approach. Thirty thousand community members will be reached with prevention messages through 110 trained church and civic leaders. One thousand couples will be referred for couples VCT and, of the 30,000 targeted populations reached, 5,000 girls will be reached through clubs. This year will include small-scale monitoring studies, including a study of the coupon subsidy system, as well as documentation of the project. In addition, Population Council field staff will be based in the project sites to monitoring ongoing activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The project raises awareness of HIV risk that adolescents face within marriage. Abstinence is promoted by emphasizing that marriage is not a safety zone from HIV-infection, encouraging adolescents and their families to delay marriage. The project promotes faithfulness within marriage and will contribute to preventing HIV transmission between discordant couples.

4. LINKS TO OTHER ACTIVITIES The project will create demand for VCT services being provided by Liverpool VCT and Care and APHIA II Nyanza and will make links to community activities in AB.

5. POPULATIONS BEING TARGETED 350,000 people will be reached with radio spots raising awareness, 30,000 community members will be reached with prevention messages through 110 existing, trained church and civic leaders. One thousand couples will be referred for couples VCT and 5,000 girls will be reached through clubs.

6. KEY LEGISLATIVE ISSUES ADDRESSED Power imbalances in sexual decision-making and the right of women to protect themselves from HIV infection, even within marriage, is emphasized. This activity will work toward increasing women's legal protection and addressing male norms and behaviors. Kenya is a signatory to the Rights of the Child that defines children as below 18 years and considers child marriage a human rights violation.

7. EMPHASIS AREAS The major emphasis of this activity will be community mobilization/participation in promotion of pre-marital VCT and VCT for newly married couples. Information, education and communication materials will be used to raise awareness of HIV risks associated with early marriage, including messages conveyed through the radio, through drama, and by community leaders. Community-level married girls clubs will support and empower newly married adolescent girls in their early stages of marriage.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in AB (#7022) and OP (#7025)

2. ACTIVITY DESCRIPTION The Population Council Frontiers in Reproductive Health (FRH) Project will expand activities to integrate counseling and testing services into existing family planning (FP) service outlets. Integration of CT into FP offers an opportunity for increasing availability and access to CT services since FP clients will conveniently be offered opportunities for CT. The Population Council will support the integration of CT into 20 FP Clinics and train 50 FP providers with a target to provide CT to 6,000 clients. The Population Council will monitor cost effectiveness of this integration to guide decision regarding further scale up. The Population Council FRH project has extensive experience in the design, implementation and evaluation of integrated models of reproductive health globally, including several projects in Kenya. FRH seeks to improve people's lives by enhancing services in family planning, safe motherhood, and other reproductive health areas. The FRH program conducts operations research (OR) in collaboration with developing-country organizations to design innovative interventions for improving services. One of the main goals is to communicate these research results so they can be utilized for program and policy development. FRH also works to build the capacity of local organizations to conduct operations research and utilize best practices that emerge from the studies. The Population Council, Frontiers in Reproductive Health Program in collaboration with the National Department of Health (DOH) (Maternal Child and Women's Health Directorate) and the Provincial DOH is currently undertaking a similar program in South Africa and has received support through the South African Emergency Plan country operational plan (COP). The proposal to integrate CT into FP is based on feasibility assessment that was conducted by the Kenya government in partnership a number of partners including JHPIEGO, CDC and FHI. Provision of CT services in FP outlets will be guided by national standards for CT service delivery and quality assurance. The program has intense social mobilization to inform potential FP clients about availability and benefits of CT services at FP sites. This integration will be implemented in Nairobi province, an area with a relatively high FP utilization rate where the benefits or shortcomings of this integration will be easily monitored and evaluated. Activities will include support for staff to implement the project, IEC efforts to inform FP clients about CT, training of doctors, nurses, clinical officers and family planning providers, workers in CT, quality assurance to ensure that high standards are maintained, and evaluation of this pilot effort.

3. CONTRIBUTIONS TO OVERALL PROGAM AREA This activity will contribute to the result of increased access to voluntary counseling and testing services. This activity also supports the National Strategy of the Ministry of Health to expand integrated HIV/FP services in Kenya. The target groups will be trained in counseling to inform clients about issues of HIV/AIDS and the need for knowing their status.

4. LINKS TO OTHER ACTIVITIES The activity creates demand for VCT services and will link to the VCT services at the health facility. More information will be given to clients and the community during community meetings with the local administration so that more messages and activities are conveyed through this community channel. The activity will also be linked to other Frontiers-Population Council activities in AB (#7022) and OP (#7025).

5. POPULATIONS BEING TARGETED General population will be targeted who will attend the facility for family planning services and also health facility staff, family planning clients and providers, doctors, clinical officers and nurses. These included men, women, adolescents and the community at large. Activities will be coordinated with National AIDS control program staff as well as with community based groups.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will work towards addressing the issue of stigma and discrimination faced by individuals with HIV/AIDS and their families.

7. EMPHASIS AREAS Major emphasis will be training and minor emphasis will be information, education and

communication materials which will be used as a part of community mobilization to raise awareness of knowing your HIV status.