1. LIST OF RELATED ACTIVITIES This activity relates to [#7012] and [#6971] activities in the System Strengthening / Policy program, as well as [#7004] in the ARV Services and [#7005] in Palliative Care: Basic Health Care and Support program areas.

2. ACTIVITY DESCRIPTION The 2005 Kenya Health Workers Survey identified stigma and discrimination against HIV/AIDS patients among health workers as a prevalent problem including treatment of HIV infected patients by health workers, but also attitudes about HIV/AIDS within the health care community. One in ten providers felt that health workers should have the right to refuse to care for AIDS patients. Nearly one third of those surveyed had never taken an HIV test, and cited lack of confidentiality and stigma as factors. In addition, the survey disclosed that many health workers refused to seek on site post-exposure prophylaxis again due to lack of confidentiality and fear of stigma by their colleagues.

Health workers represent a critical interface between patients and the medical care system, and there is an urgent need to address this issue at the health facility level. With PEPFAR support, this activity will focus on reduction of stigma and discrimination against patients as well as medical professionals in health care settings.

A consultant or consultants will work with key medical professional associations including Kenya Medical Association (KMA), Nursing Council of Kenya, the National AIDS and STI Control Program (NASCOP) and networks of PLWHA to develop a standardized approach to HIV/AIDS stigma and discrimination reduction at the health facility level. This plan will be informed by the 2005 Kenya Health Worker Survey and will incorporate proven tools and approaches that address stigma and discrimination by health workers. The plan will be disseminated to senior high and mid-level health managers drawn from public and private health facilities in all eight provinces. Participants will be assisted to adapt the plan for implementation in their facilities. This activity will be undertaken in conjunction with the Health Policy Initiative (HPI) activity to assist in developing an association and support groups for medical professionals living with HIV/AIDS.

In the second component of this activity, the consultant will work with stakeholders to design appropriate information, education and communication materials on HIV/AIDS stigma reduction in the health care setting. PEPFAR support will be utilized to design, print and disseminate 20,000 brochures targeting 5,000 health care providers in both public and private health facilities across the country. Messages will also be developed to target users of public health facilities on their right to equal treatment and health care services. These messages will lead to increased awareness and reduction of stigma and discrimination in health care settings and among health care providers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will enhance the capacity of health care managers and providers to address stigma and discrimination of HIV infected patients and health workers in health care settings. The activity will also mobilize the general public and especially PLWHA to demand equal treatment in health care facilities, and lead to improved HIV/AIDS services for medical professionals living with AIDS.

4. LINKS TO OTHER ACTIVITIES This activity is linked to the CDC-KMTC activity that involves the development of brief stigma reduction training materials targeting health workers and their integration in all in-service training activities. Reduction of stigma in the health care setting will also support the scale up of prevention, care and treatment of HIV infected persons in NASCOP activities. Messaging on non-discriminatory treatment in health care facilities for PLWHA also links to work undertaken by Internews's Local Voices project to develop responsible HIV/AIDS reporting by TV, radio and print journalists.

5. POPULATIONS BEING TARGETED This activity targets public and private health care providers, other MOH staff, people living with HIV/AIDS, and the general public.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses the reduction of stigma and discrimination of HIV infected persons

in the health care setting.

7. EMPHASIS AREAS This activity will focus on training and providing information, education and communication to target groups, as well as and mobilizing community and PLWHA participation to reduce HIV/AIDS stigma in the health care setting.

Management and staffing funds allocated to the Department of State / Africa Bureau will support costs associated with interagency coordination as a service to the overall U.S. Mission and the Emergency Plan in Kenya. After the inception of the Emergency Plan, Kenya became the first focus country to identify the need for a country coordinator to help implement the Emergency Plan. In 2006 a PEPFAR Coordination Office (PCO) was established as a permanent part of the U.S. Embassy. The PCO currently consists of the Country Coordinator, Deputy Country Coordinator, and an Administrative Assistant. As in past years, the Country Coordinator, Deputy Country Coordinator, and Administrative Assistant receive their salaries and benefits under USAID's management and staffing funding mechanism.

In FY 2007, the Department of State / Africa Bureau management and staffing budget will continue to support administrative and logistical functions of the PCO. The PCO staff will expand to include a PEPFAR Information Specialist and a second, part-time Administrative Assistant. The Information Specialist will work closely with the Country Coordinator and the Embassy's Public Affairs Section to raise the profile of PEPFAR's activities in Kenya and to ensure that PEPFAR successes are presented to the local media in an accurate and timely fashion. OGAC's request for the Kenya Country Coordinator to provide technical support to other Emergency Plan countries and to OGAC's public affairs team necessitates an additional, part-time Administrative Assistant to manage logistics for these activities. The FY 2007 PCO budget will also support costs for interagency technical team stakeholders' meetings, interagency team retreats, as well as costs related to the Country Coordinator's assistance to other PEPFAR countries. This year, we will also fund the Embassy Public Affairs Section to develop a press kit, host press events, and create a PEPFAR brand in Kenya.

Plus up: Funds will be programmed for the following critical changes / additions to the staff complement in the office responsible for coordinating the $367 million dollar Kenya program. A UNAIDS secondee to assist with improved external relations / donor coordination as well as optimizing opportunities presented by VIP visits including CoDels, StafDels, media tours, etc. will be accepted at a total cost of approximately $275,000. A position of COP database manager will be created as an EFM / FSN hire. Many of the detailed, COPRS functions currently performed by the deputy country coordinator will be re-assigned to this position to allow the deputy to focus more on programmatic priorities including public-private partnerships and the planned Youth Prevention Initiative. Estimated cost is $75,000. PEPFAR/Kenya increasingly attracts highly-skilled pre- and post-graduate university students interested in both supporting the program and learning by exposure to it. $25,000 is requested to support miscellaneous costs associated with accepting these valuable "staff-extenders."

"Cost of Doing Business" Assessment The cost of doing business associated with the PEPFAR Coordination Office under the Department of State / Africa Bureau includes ICASS charges. This estimate is based on the current office mix of one direct-hire American, one local-hire American, and one locally employed staff member.

Table 3.3.15: