THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

The United Nations High Commissioner for Refugees (UNHCR) has been supporting HIV prevention and

treatment programs in Dadaab Refugee Camp since 2005 with PEPFAR funds. Dadaab Camp has an

estimated population of 173,409 with a 49.5 % female to male ratio. The UNHCR is responsible for the

protection of and the provision of assistance to refugees in close coordination and cooperation with other

agencies, namely: Government of Kenya, World Food Program, UNICEF, GTZ, CARE Kenya and the

National Council of Churches of Kenya (NCCK). There are three refugee camps in Dadaab (Ifo, Dagahaley

and Hagadera). These camps cover a total area of 50 square kilometers and are within an 18 km radius of

Dadaab Town. Each of these camps has a health facility providing preventive and curative outpatient

services as well as inpatient services. The HIV programs include HIV Testing and Counseling services

( VCT and PITC), Prevention of Mother to Child Transmission of HIV (PMTCT) , Condoms and Other

Prevention activities, Abstinence and Being Faithful program (ABY), Home Based Care (HBC), Orphans

and Vulnerable Children (OVC) and HIV Care and Treatment services. In FY 2008, UNHCR will continue to

support the expansion and consolidation of PMTCT program in the 3 health facilities within the camp as well

as the Dadaab Health Centre, and will provide HIV counseling and testing services to 2,000 pregnant

women and provide a complete course of ARV prophylaxis to 20 HIV + pregnant women. The program will

establish mechanisms for follow up and care of the HIV infected-exposed mother infant pairs through the

Comprehensive PMTCT framework, as well as bh strengthening postnatal care services at facility level to

include improved access to Family Planning services. The current package of care for the mother includes

regular follow up, linkage to family planning services, OI prophylaxis and counseling on correct infant

feeding practices; infant additional care activities include OI prophylaxis using Co-trimoxazole starting at six

weeks of age, and DBS for HIV- PCR (Early Infant HIV Diagnosis-EID). The program will target 20 HIV

exposed infants for DBS, and will work with the HIV/AIDS treatment program to ensure linkage to pediatric

HIV care services for all eligible infants. The program will support the training of 50 service providers on

PMTCT including lay counselors and Community Reproductive Health Volunteers. 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) in implementation of these activities. UNHCR will work in close

collaboration with CDC and other USG agencies for technical guidance on all Emergency Plan program

areas.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to PEPFAR goals for primary prevention and care by contributing 0.2% of overall

2008 Emergency Plan targets for Kenya in meeting the health needs of women in this special group

(refugee setting).

3. LINKS TO OTHER ACTIVITIES

This activity links to UNHCR activities in HIV ART and care services (#8962) and Counseling and Testing

services (#8980). The program will establish clear linkages to ensure that all HIV-positive pregnant women

and HIV infected infants' access HIV care and treatment services. The program will also encourage male

partner testing and will work with CT services to achieve this objective. Other related activities include

Abstinence and /Be Faithful UNHCR (#9215). 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).

4. POPULATIONS BEING TARGETED

This activity will target children less than five years, adolescents of reproductive age, adults, people living

with HIV/AIDS, pregnant women and Refugees/internally displaced persons. The refugee population

especially both men and women of reproductive age are vulnerable to HIV infection and its impact due to

their conflict-affected lives, disintegrated social network and rapid mobility. It will serve rural host

communities of the North Eastern Kenya.

5. KEY LEGISLATIVE ISSUES ADDRESSED / EMPHASIS AREAS

The emphasis areas include increasing gender equity in HIV/AIDS programs through provision of HIV

counseling and testing services to pregnant women and their partners, in-service training of service

providers on PMTCT using the nationally adopted WHO/CDC NASCOP PMTCT National Training

Curriculum, as well as wrap around programs in Family Planning, Malaria and Safe Motherhood activities as

part of the PMTCT package of care.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 50,000 young individuals and train 300 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 50,000 youth and

young adults and training 300 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 50,000 high-risk individuals and train 200 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 50,000 at risk

individuals, including positive prevention among people with HIV. 200 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 for at least 50 patients; 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. ACTIVITY DESCRIPTION

The United Nations High Commissioner for Refugees (UNHCR) will provide support services to 2,000

orphans and vulnerable children and train 200 caregivers in the Dadaab Refugee Camp in North Eastern

Province, Kenya. Others who will be trained will include 60 reproductive health motivators who will receive

an OVC orientation so that OVC support is incorporated into their broad RH education and outreach.

Dadaab, established in 1991, consists of three settlements (Ifo, Hagadera and Dagahare), and hosts an

estimated total of 173,000 refugees, including 153,000 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 estimate of 2300 HIV-infected refugees. UNHCR will build upon and expand HIV

Prevention and care activities being provided by its three major implementing partners, GTZ, National

Council of Churches of Kenya (NCCK), and CARE Kenya's Emergency and Refugee Operations (ERO).

There are currently approximately 1410 orphans, 351 unaccompanied minors and 3,784 persons with

disability. The OVC program will be implemented mainly by two partners; CARE and NCCK, and others as

UNHCR may consider appropriate. OVC will receive a package of services including as per the PEPFAR

and other UN guidelines, complementary to others services that are already provided through the overall

UNHCR refugee framework. An important element in this program is strengthening HIV prevention

education among OVC to equip them with life skills that would reduce their vulnerability to the risk of HIV

infection. Caregivers will be trained to strengthen the family support system and strong linkages will be

established between PLWHAs, HIV-infected children and health care services, including ensuring that

children and their parents or caregivers and other family members affected access appropriate care and

treatment. The scope of the current programs will be expanded to ensure that they provide a package of

essential services that qualify as primary direct support. All programs will work in close collaboration with

the District Children's Department and will follow guidelines provided by the parent ministry, alongside

PEPFAR and UNHCR guidelines.

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.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

UNHCR will contribute 0.4% of PEPFAR-Kenya country targets through providing primary direct support

services to 2000 OVC and training 200 caregivers to support OVC. HIV Prevention education will be

strongly integrated to the OVC program, both for the OVC as well as their caregivers.

3. LINKS TO OTHER ACTIVITIES

These activities will link to Abstinence/ Be Faithful (#9215), condoms and other prevention UNHCR (#9235)

and Counseling and Testing UNHCR (#8980), ARV services (#8982), Basic Health Care and Support

(#8736). The various implementing partners in Dadaab camp will work collaboratively under UNHCR

guidance to offer appropriate interventions to OVC and their caregivers.

4. POPULATIONS BEING TARGETED

This activity targets the Dadaab refugee community, specifically, their orphans and vulnerable children and

their caregivers, unaccompanied minors, older OVC, widows/widowers, HIV/AIDS affected families and

People Living with HIV/AIDS.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

This activity helps increasing gender equity in HIV/AIDS programs by ensuring the girl children have equal

access to services, and disaggregating data on girl children. It also addresses the wrap around issues of

food and education. 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are:

+ in FY 2008 UNHCR will implement a broader scope of counseling and testing approaches. This includes

mobile and other integrated outreach CT activities. UNHCR will facilitate the integration of HIV/AIDS service

at community level. In health facilities UNHCR will facilitate training and mentorship for health workers in all

clinical areas. This will lead to expansion of CT in health facilities. This support will be extended to the

nearby heath center and other government facilities in the neighboring areas.

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 Commissioner for Refugees (UNHCR) will support counseling and

testing services to 10,000 individuals, for whom 100 counselors and health workers will be trained in 5 sites.

They will be trained in VCT, PITC and couple CT and will work in the Dadaab Refugee Camp in North

Eastern Province, Kenya. The trained CT providers will provide CT services both in the static and mobile

VCT sites as well as in the health facilities in and around the camp. Dadaab Refugee Camp was

established in 1991 and consists of three settlements (Ifo, Hagadera and Dagahaley). 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 PITC 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.

N/A (exempt)