1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8980), Condoms and Other Prevention (#9235).

2. ACTIVITY DESCRIPTION The United Nations High Commissioner for Refugees (UNHCR) will provide targeted Abstinence/ Be Faithful behavioral interventions to 30,000 young individuals and train 200 people to deliver these interventions at the Dadaab Refugee Camp in North Eastern Province, Kenya. These include 60 reproductive health motivators will be retrained on HIV Prevention education so that this is incorporated into their RH education. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating a generalized epidemic and providing estimates of 2300 HIV-infected refugees. UNHCR will build on care activities being provided by its three implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO). The AB program will be implemented mainly by two partners; CARE and NCCK. CARE will target youth in schools and will train thirty teachers from both the camp and the host population and support them in delivering interventions in school. This will be further boosted by supporting HIV prevention clubs in schools and training peer educators. NCCK, the lead agency in community mobilization, education and information on HIV in Dadaab will use multiple approaches to strengthen behavior change among young people in Dadaab. It will develop age-appropriate and culturally sensitive IEC material and distribute these widely. It will also expand access to a two-year World Space radio intervention to increase the number of youth enrolling in listening clubs as well as motivating their sustained participation. Youth involvement will be enhanced through participatory approaches such as Magnet Theater. Humanitarian aid workers will also be targeted through workplace programs. These workers work in isolation from their families for long periods of time and are vulnerable to concurrent and multiple sexual partnerships. In 2000, UNHCR and its three partners initiated HIV prevention, care and support services on a limited scale. These partners depend on UNHCR for 80-95% of their Dadaab program funding. Financial constraints have prevented UNHCR to meet the increasing demand for a comprehensive HIV program, and additional funding and technical support are necessary to expand the scope and quality of existing services. Targets are modest because of the extreme remoteness of these areas, and the challenges associated with conducting activities in the refugee camp and the slow start up expected in initiating programs in the first year of funding. UNHCR will work in close collaboration with CDC and other USG agencies for technical guidance on all Emergency Plan program areas.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to providing comprehensive AB education and life skills to 30,000 youth and young adults and training 200 people.

4. LINKS TO OTHER ACTIVITIES These activities will link to condoms and other prevention UNHCR (#9235) and Counseling and Testing UNHCR (#8980). Populations in Dadaab will be segmented for appropriate interventions and served under OP and CT programs as need be. The various implementing partners in Dadaab camp will work collaboratively under UNHCR guidance to offer appropriate interventions to young people including young married persons.

5. POPULATIONS BEING TARGETED This activity targets the children and youth from the Dadaab refugee and local population of that North Eastern Kenya region including youth in school at primary and secondary levels. It will also target out-of-school youth and refugees in the camp. It also targets community leaders, religious leaders, volunteers and teachers. These populations are vulnerable to HIV infection and its impact due to their conflict-affected lives, disintegrated social network and rapid mobility. Program managers and humanitarian aid workers are also targeted for increased training to improve HIV prevention knowledge and improved perceptions on Abstinence and Faithfulness.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to addressing male norms and behavior

and increasing gender equity in HIV/AIDS programs. It will focus on reducing violence and coercion especially as it affects young refugee girls and women. It will also contribute to addressing stigma and discrimination, a rampant problem among the refugees and host population.

7. EMPHASIS AREAS This activity includes major emphasis in community mobilization and participation. It will have a minor emphasis on human resources, information education and communication, quality assurance and supportive supervision as well as training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Be Faithful Programs (#9215), Counseling and Testing (#8980), Palliative Care: Basic Health Care and Support (#8736) and HIV/AIDS Treatment: ARV Services (#8982).

2. ACTIVITY DESCRIPTION The United Nations High Commissioner for Refugees (UNHCR) will provide condoms and targeted other prevention activities to 25,000 high-risk individuals and train people to deliver these interventions at the Dadaab Refugee Camp in North Eastern Province, Kenya. 100 condom outlets, including community-based distributors and Reproductive health community volunteers will serve as distribution points. This activity will aim to strengthen condom promotion through increasing the number of condom outlets. 60 nurses/midwives drawn from all clinics will receive training on safer sexual behavior including correct and consistent condom use. Community based distributors will enhance social marketing of condoms, increase demand and supply. Information, education and communication targeted specific groups will be adapted to local languages. 90 health care providers will be trained on post exposure prophylaxis owing to the high levels of sexual violence. STI refresher training will also be provided. An important focus of this activity will be Positive Prevention. While general prevention education and campaigns will focus on the general population of mainly uninfected individuals, special efforts will be put to the small segment of the population who have HIV and are therefore potentially very high risk individuals in transmitting HIV. Linking up with the counseling and testing activities, Positive Prevention interventions will ensure that there are targeted behavioral interventions for individuals with HIV, that unintended pregnancies are prevented among women with HIV, that there is active STI screening and treatment for individuals with HIV, that there is significant leadership by individuals with HIV in positive prevention and that most importantly, individuals with HIV access care and ART treatment to reduce viral load and reduce the risk of HIV transmission. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating a generalized epidemic and providing estimates of 2300 HIV-infected refugees. UNHCR will work with its three implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO). These partners depend on UNHCR for 80-95% of their Dadaab program funding. Financial constraints have prevented UNHCR to meet the increasing demand for a comprehensive HIV program, and additional funding and technical support are necessary to expand the scope and quality of existing services. Targets are modest because of the extreme remoteness of these areas, logistical camp challenges and the slow start up expected in initiating programs in the first project period. UNHCR will work in close collaboration with CDC and other USG agencies for technical guidance on all Emergency Plan program areas.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to providing comprehensive AB education and life skills to 25,000 at risk individuals, including positive prevention among people with HIV. 150 people will be trained to deliver services. 100 condom outlets will be established.

4. LINKS TO OTHER ACTIVITIES These activities will link to Abstinence and /Be Faithful UNHCR (#9215) and Counseling and Testing UNHCR (#8980) as younger youth will be served under the AB program, while those requiring counseling and testing will be served under CT. Persons needing care and treatment for opportunistic infections or ART care will be referred to Palliative Care: Basic Health Care and Support (#8736) and Treatment: ARV Services (#8982).

5. POPULATIONS BEING TARGETED This activity targets adult men and women as well as Special populations including refugees and out of school youth. It also targets program, community and religious leaders, volunteers and teachers. These populations are vulnerable to HIV infection and its impact due to their conflict-affected lives, disintegrated social network and rapid mobility. This program will also work with community and faith based organizations including NGOs and implementing agencies. It will serve rural host communities of the North Eastern Kenya.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues including increasing gender equity in HIV/AIDS programs, addressing male norms and behavior and reducing violence and coercion, especially among young refugee girls and women. These activities will help address stigma and discrimination among the refugees and host population.

7. EMPHASIS AREAS This activity includes major emphasis in community mobilization and minor emphases on human resources, information education and communication, and training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence / Be Faithful (#9215), Condoms and Other Prevention (#9235), Counseling and Testing (#8980), and ARV Services (#8982).

2. ACTIVITY DESCRIPTION The United Nations High Commissioner for Refugees (UNHCR) will support expanded palliative care services to 100 HIV-infected individuals at Dadaab Refugee Camp in North Eastern Province, Kenya, targeting both refugees and the local population. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating a generalized epidemic and providing estimates of 2300 HIV-infected refugees. UNHCR will support a package of services that includes clinical evaluation and laboratory monitoring, provision of cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional support and improved access to safe drinking water and malaria prevention interventions; 10 health care workers will also be trained to provide palliative care services using national guidelines. This will include training in diagnostic counseling and testing to improve/increase provider-initiated testing and subsequently increase patient enrolment into HIV care. UNHCR will build on established care activities currently being provided by its three implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya, for people with HIV at refugee camp hospitals and health centers. UNHCR will expand care programs by providing technical support, supporting staff salaries, training staff, conducting laboratory evaluation, and providing adherence counseling and monitoring.

In 2000, UNHCR and its three partners initiated HIV prevention, care and support services on a limited scale. These partners depend on UNHCR for 80-95% of their Dadaab program funding. GTZ provides health and nutrition services, the NCCK supports community-based reproductive health and HIV/AIDS education, and CARE assists with water, sanitation and education services. Financial constraints have prevented UNHCR to meet the increasing demand for a comprehensive HIV program, and additional funding and technical support are necessary to expand the scope and quality of existing services. UNHCR will work in close collaboration with CDC and other USG agencies for technical guidance on all Emergency Plan program areas.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to expansion of access to palliative care services for people with HIV, strengthened human resource capacity to deliver care, and a strengthened referral network.

4. LINKS TO OTHER ACTIVITIES These activities will link to prevention and treatment services provided by UNHCR Abstinence / Be Faithful (#9215), Condoms and Other Prevention (#9235), Counseling and Testing (#8980), and ARV Services (#8982), and to coordination of ARV scale up supported through National AIDS and STD Control Program.

5. POPULATIONS BEING TARGETED This activity targets the refugees and local populations, especially people living with HIV/AIDS. These populations are vulnerable to HIV infection and its impact due to their conflict-affected lives, disintegrated social network and rapid mobility. Humanitarian aid workers are also targeted for increased training to improve HIV clinical knowledge and skills.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to provision of care and treatment for refugee populations and stigma and discrimination.

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, human resources, local organization capacity building, community mobilization, quality assurance and supportive supervision, logistics, and training.

1. LIST OF RELATED ACTIVITIES This activity is related to AB [#9215], OP [#9235] , Basic Care and support [#8736] and ARV services [#8982]

2. ACITIVITY DESCRIPTION IN FY 2007 The United Nations High Commission for Refugees (UNHCR) will support counseling and testing services to 1,500 individuals and train 12 counselors to serve in the Dadaab Refugee Camp in North Eastern Province, Kenya. These counselors will provide VCT services in the 3 camps of Dadaab. Additionally 10 health care workers will receive DTC training in accordance with national and international standards. Dadaab Refugee Camp was established in 1991 and consists of three settlements (Ifo, Hagadera and Dagahare). It hosts 140,000 Somali refugees and 20,000 Kenyans of the Somali tribe. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating that there a generalized epidemic in the camp. From these statistics, it is estimated that there are 2300 HIV-infected refugees in the camp. UNHCR has been coordinating health care services in the camp in collaboration with other partners, notably GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya. Heath providers trained in DTC will provide services in the refugee camp hospitals and health centers. Activities will be conducted in close collaboration with the Ministry of Health personnel to ensure compliance with MOH guidelines as well as to provide logistical support on the ground. CDC will provide technical support to this activity through conducting site and service assessments and providing training for counselors through a CDC-designated training agency. Owing to the low uptake of CT services in Dadaab, intensive community mobilization will be carried out in conjunction with other activities funded under PEPFAR including OP and AB. Community outreach activities for primary health care will be integrated so that CT services are seen as an integral part of heath care delivery.

3. CONTRIBUTION TO OVERALL PROGRAM AREA. The activity will contribute less than 1% of the USG supported CT services in Kenya in FY 2007. However, the refugee population is considered to be a vulnerable to HIV/AIDS because of the poverty and the unstable lifestyle. Secondly, there has been insecurity in northern Kenya and Somalia. This means that services are not readily available or accessible. Kenya, with the support of friendly governments and international agencies, have an obligation to provide comprehensive health care to refugees and other displaced persons. Those who will be found to be HIV positive will be referred to care and treatment facilities.

4. LINKS TO OTHER ACTIVITIES. UNHCR has been working with various sub-partners in Dadaab, in the provision of health services. In FY 2007, it will continue with this trend, by supporting the sub-partners to provide different components of the HIV/AIDS interventions. This activity will therefore be linked to AB[#9215], OP[#9235], Palliative Care[#8736] and ARV services[#8982].

5. POPULATIONS BEING TARGETED. This activity will target the entire population in the refugee camp. This includes adults, youth and children. It will also include refugees and migrant workers

6. KEY LEGISLATIVE ISSUES ADDRESSED. By targeting the entire population, the activity will address issues of gender equity and stigma.

7. EMPHASIS AREAS. The activity will emphasize community mobilization and capacity building of local organizations. To a lesser extent they will focus on training, production of IEC materials and development of networks

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence / Be Faithful (#9215), Condoms and Other Prevention (#9235), Counseling and Testing (#8980), and Pallative Care: Basic Health Care and Support (#8736).

2. ACTIVITY DESCRIPTION The United Nations High Commissioner for Refugees (UNHCR) will support antiretroviral treatment services to 30 individuals with advanced HIV infection at Dadaab Refugee Camp in North Eastern Province, Kenya; additionally 10 health care workers will receive ART training in accordance with national guidelines. Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts 140,000 Somali refugees and 20,000 Kenyan Somali. Each camp has a hospital and three satellite health centers. Sentinel surveillance activities in 2005 reported a 1.4% HIV seroprevalence among ANC clinic attendees, 1.7% among STI patients, indicating a generalized epidemic and providing estimates of 2,300 HIV-infected refugees. UNHCR will build on care activities being provided by its three implementing partners, GTZ, National Council of Churches of Kenya (NCCK), and CARE Kenya, for people with HIV at refugee camp hospitals and health centers to provide local treatment. Activities will be conducted in close collaboration with the Provincial ART Officer responsible for North Eastern Province. UNHCR will establish ART programs by providing technical support, supporting staff salaries, training staff, conducting laboratory evaluation, and providing adherence counseling and monitoring. ARVs will be supplied to the sites through the USG central distribution system.

In 2000, UNHCR and its three partners initiated HIV prevention, care and support services on a limited scale. These partners depend on UNHCR for 80-95% of their Dadaab program funding. GTZ provides health and nutrition services, the NCCK supports community-based reproductive health and HIV/AIDS education, and CARE assists with water, sanitation and education services. Financial constraints have prevented UNHCR to meet the increasing demand for a comprehensive HIV program, and additional funding and technical support are necessary to expand the scope and quality of existing services. Targets are modest because of the extreme remoteness of these areas, and the challenges associated with conducting activities in the refugee camp. UNHCR will work in close collaboration with CDC and other USG agencies for technical guidance on all Emergency Plan program areas.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to expansion of access to ARV treatment for clinically qualified HIV-positive patients, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral network for provision of ARV treatment.

4. LINKS TO OTHER ACTIVITIES These activities will link to other prevention and care services provided by UNHCR, and to coordination of ARV scale up supported through National AIDS and STD Control Program.

5. POPULATIONS BEING TARGETED This activity targets the refugees and local populations, especially people living with HIV/AIDS. These populations are vulnerable to HIV infection and its impact due to their conflict-affected lives, disintegrated social network and rapid mobility. Humanitarian aid workers are also targeted for increased training to improve HIV clinical knowledge and skills.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to provision of care and treatment for refugee populations and stigma and discrimination.

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, human resources, local organization capacity building, community mobilization, quality assurance and supportive supervision, logistics, and training.