NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

HIV/AIDS prevalence rates are typically higher among the military than the general populace. Soldiers are

usually young, single, and sexually active. They are often posted far away from home for extended periods,

and a variety of factors like stress and loneliness may increase their likelihood of engaging in casual sex.

Their steady income and higher status in the community provide them with access to alcohol and sex.

Reported condom use among the military population is low and inconsistent. The Malawi Defence Force

(MDF) first confronted HIV/AIDS in April 1996 at an internal workshop where officials openly agreed that

HIV/AIDS within the military was a major challenge that must be confronted. Mortality rates clearly indicate

that HIV/AIDS is a problem in the military, and the MDF itself clearly recognizes and accepts that HIV/AIDS

is a major problem among its ranks. There have been some positive recent developments within the MDF

that indicate a more serious commitment to addressing HIV/AIDS. Commitment at the highest levels at the

Malawian Ministry of Defense and MDF include drafting a HIV/AIDS policy which is ongoing; introduction of

an organic department to undertake HIV/AIDS both at the ministry and MDF level; increased efforts to

allocate a specific budget for HIV/AIDS programs; the MDF's enthusiasm to work with outside organizations

such as PSI/Malawi; the MDF's stated need to be included in national surveys; and active efforts to involve

the spouses of servicemen and women in Information Education Communication (IEC) programs.

Background

In 2007, DoD issued a Request for Application (RFA) for prevention work with the MDF. This contract was

recently awarded to PSI, who has begun implementation of a number of activities with FY 2006 funds. It is

expected that this award will be extended to include FY 2007 funds. With FY 2008 funds, DoD will issue

another RFA that will build on current activities being conducted by PSI with FY 2006 money. FY 2007 EP

funds will be split between Abstinence Be Faithful (AB) and Condoms and Other Prevention. Encouraging

AB messages among the MDF soldiers will help them change their behavior at home, and also during

deployment. Through these activities, soldiers will be encouraged to be faithful and abstain from sex, and

be educated about the importance of maintaining their negative status, as well as making positive

contributions to the military.

Once the RFA has been awarded, the new partner (TBD) will conduct a baseline assessment to determine

the success of previous interventions and determine whether alternate activities need to be developed. The

new partner is expected to conduct a TRaC (Tracking Results Continuously) survey in order to measure

reported levels of promoted behaviors and opportunity, availability, and motivation. The survey will

complement the previously conducted MDF KAP (Knowledge Attitude Practical) survey by providing

important data on segmentation and M and E. Also it is expected that the TBD partner will conduct

qualitative research for concept development and pre-testing intervention IEC materials. The partner will

evaluate the newly developed Voluntary Counseling and Testing (VCT) ‘Drop In' centers to ensure

uniformity and quality of services delivered. In order to measure the impact on key indicators a second

comprehensive tracking survey need to be conducted at the end of the program. Most of the AB

interventions for the Malawi Defense Force will focus on mutual faithfulness, partner reduction, and the risk

associated with concurrent partnerships.

Activity 1: Peer Education

This is linked to Activity 1 in DoD Condoms and Other Prevention (ID#10756) which will provide condoms

and messages about correct and consistent condom usage if soldiers cannot remain faithful to one partner.

This activity will focus on "B" messaging and work with soldiers to strengthen their commitment to one

partner and to understand the HIV risks associated with multiple (concurrent) partners. The soldiers will be

equipped with skills to reduce the number of sexual partners and practice mutual fidelity. In addition, critical

empowerment of young women in the MDF and surrounding communities to make positive decisions and

gain confidence in the area of AB will be supported through training and mentoring. Another key strategy

promoting AB will be the community/social mobilization capacity building activities through drama and

sensitization meetings. These activities aim to strengthen MDF units to respond to topical issues and

implement evidence based behavior change activities or facilitate extra generational intra-community

communications. These include advocacy on family HIV testing, religious leaders on issues of mutual

faithfulness, parents and teachers to change norms, and skills building for girls to reject intergenerational

sex.

The program will focus on messages of faithfulness to one partner and the development of pilot materials by

specially trained Peer Educators to impart correct and factual information on HIV/AIDS prevention and to

help mobilize and motivate members of the MDF to go for VCT. A target of 80 Peer Education Providers

and another 20 Trainer of Trainers (TOTs) is expected in 2008.

Activity 2: Targeted Outreach and Communication (TOC)

The TBD partner will assign a TOC team to conduct specially designed educational sessions with the MDF

as well as broader outreach activities in and around the military barracks. These events will include the use

of video and mobile video unit presentations and interpersonal communication (IPC) activities to reinforce

key behavior change objectives and to increase AB awareness and motivators for VCT. The TOC team will

utilize videos, short documentaries, and interactive discussions via a public address system and engage in

interpersonal communications to motivate for the adoption of positive behavior change, the importance of

knowing one's HIV status, and the value of remaining faithful to one partner and avoiding high-risk behavior.

With this team, it is estimated that 4,000 military personnel, spouses, and family members will be reached.

Activity Narrative: Activity 3: Drop in Center

AB activities with the MDF are closely linked to the Counselling and Testing and ART services . With FY

2004 and FY 2005 funds, the DoD HIV program under the Naval Health Research Center constructed and

equipped six VCT centers in six MDF barracks. Four of these centers have been approved by the Malawi

government to be ART distribution sites which serve both the military and civilians of the surrounding

communities, and MDF requested approval from the Ministry of Health (MoH) for the two most recently

constructed VCT centers to become ART distribution centers as well.

Activity 4: Media

The new partner will use previously developed media and develop new media campaigns as required.

These will include targeted, evidence-based HIV/AIDS prevention information, education, and

communications (IEC) materials and will work closely with the MDF to develop targeted, evidence-based

IEC materials to promote key behavior change objectives. Posters encouraging MDF members and their

families to seek VCT services and outlining benefits of HIV/AIDS prevention will be promoted; and video

documentaries, with emphasis on AB messaging using other leveraged funding, will be screened by the

TOC teams. Point of use items such as T-shirts and lapel pins will also be produced. These materials will

be designed to ensure their relevance to and understanding by the members of the MDF. The specific

results of the IEC materials will be increased knowledge of VCT sites and services offered, increased

awareness of the need for HIV testing, increased awareness of the importance of being faithful and

abstaining from casual sex, and increased knowledge on methods of HIV infection and prevention. To

ensure the desired outcome is achieved, all materials will be rigorously pre-tested with the MDF.

Activity 5: Monitoring and Evaluation

The current source of data existing for the MDF is from an internal KAP survey conducted within the army in

2002. On-going M and E is critical to determining the success of the program. The TBD partner will provide

M&E, using some or all of the following suggested indicators in consultation with MDF: social norms,

knowledge, self-efficacy, social support, beliefs, attitudes, locus of control, outcome norms, and subjective

norms. The indicators reflect opportunity, ability, and motivation factors. Even though the military are

classified as a "high-risk" group, there is no current national data that has tracked behaviors, knowledge,

and practices of MDF soldiers. The BSS does not provide any information on military.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15425

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15425 6418.08 Department of Project Concern 7136 3898.08 DOD GHAI $60,000

Defense International

10758 6418.07 Department of Malawi Defense 5581 3898.07 DOD GHAI $76,000

Defense Force

6418 6418.06 Department of Malawi Defense 3898 3898.06 $67,000

Defense Force

Table 3.3.02:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

This TBD activity will be a new RFA issued with FY 2008 EP funding to meet the needs for prevention

programming within Malawi's Defense Force (MDF). With FY 2006 funding, PSI won a one year contract

with the Department of Defense (DoD). In FY 2008, the winning bidder will have the opportunity to have a

two year contract with DoD.

Background

Because the MDF is a high risk group, activities are aimed at preventing HIV transmission through the

promotion of condom use and distribution, STI management, and messages/programs to reduce other risks

of persons engaged in high-risk behaviors. In addition, the USG through the TBD partner will support

community outreach sessions to promote the use of condoms by PLWHAs (including discordant couples)

and palliative care patients within the MDF. These messages will include correct and consistent use of

condoms.

HIV/AIDS prevalence rates are typically higher among the military than the general populace. Soldiers are

usually young, single,and sexually active. They are often posted far away from home for extended periods,

and a variety of factors like stress and loneliness may increase the likelihood of engaging in casual sex.

Their steady income and higher status in the community provide them with easy access to alcohol and sex.

Reported condom use among the military population is low and inconsistent. In FY 2008, USG will build on

current programs with MDF to provide prevention messages.

MDF still faces many challenges related to the provision of HIV-related services for its personnel. MDF

officials are concerned that Information, Education, Communication (IEC) materials from the National AIDS

Commission (NAC) do not address the particularities of MDF culture and have requested the development

and provision of IEC materials specifically target and address the concerns of military personnel.

With FY 2004 and FY 2005 non-EP-funds, the DoD HIV program under the Naval Health Research Center

constructed and equipped six VCT centers in six MDF barracks. Four of these centers have been approved

by the Malawi government to be ART distribution sites which serve both the military and civilians of the

surrounding communities. MDF has also requested approval from MOH for the two most recently

constructed VCT centers to become ART distribution centers. ARVs are provided by the MoH through the

Global Fund for AIDS, TB, and Malaria (GFATM) grant by the MoH and are distributed at the VCT sites.

They also issue free condoms to the soldiers. When DoD built the VCT centers, they included equipment

such as TVs, VCRs, digital cameras, computers, and printers that help in information, education,

communication, and data storage.

In 2007, DoD issued an RFA for prevention work with the MDF. A new RFA will be issued in FY 2008.

When the new RFA is awarded, the new partner (TBD) will conduct a baseline assessment to determine the

success of previous interventions and determine whether alternate activities need to be developed. A TRaC

(Tracking Results Continuously) survey will measure reported levels of promoted behaviors and opportunity,

availability, and motivation. The TRaC survey will complement the MDF KAP (Knowledge Attitude Practical)

survey by providing important data on segmentation, monitoring, and evaluation. Qualitative research will

also be used for concept development and pre-testing intervention IEC materials. Baseline and evaluation

rounds of mystery client visits will be undertaken at the VCT ‘Drop In' center to ensure conformity and

quality of services delivered. Mystery clients are designed to test or audit the effectiveness of a particular

service. In order to measure the impact on key indicators a second comprehensive tracking survey need to

be conducted at the end of the program.

Activity 1: Peer Education

This activity complements activity 1 in AB (ID# 6418) by providing ‘C' messages to soldiers in addition to A

and B messaging. Besides learning communication techniques and methods of HIV/AIDS prevention, the

peer educators will act as condom distribution agents to help ensure easy access to condoms within the

military and provide messages about correct and consistent condom usage.

It is expected that 20 Peer Educators, selected from all ranks of the MDF and covering one pilot site within

the MDF, will be trained as Peer Educators. With subsequent funding, this model will be replicated across

all units of the MDF. The Peer Educators identified to participate will complete an initial five day training

covering HIV/AIDS prevention, life skills, and general VCT information as well as communication techniques

developed by a partner TBD and counterparts in the MDF. TBD partner will facilitate the development of

the Peer Education manuals and support materials, and conduct the relevant training with the MDF. In

addition to educating colleagues about methods of HIV/AIDS prevention, the Peer Educators will be

provided with condoms for distribution to MDF members and their families to allow for on-going distribution

of condoms on a revolving fund basis. A target of 80 Peer Education Providers and another 20 TOTs is

expected in 2008.

Activity 2: Targeted Outreach and Communication (TOC)

The TBD partner will assign a TOC team as was previously done in FY 2007, to conduct specially designed

educational sessions with the MDF as well as broader outreach activities in and around the military

barracks. These events will include the use of video and mobile video unit presentations and IPC activities

to reinforce key behavior change objectives and to increase ‘C and OP' awareness and motivators for VCT.

Activity Narrative: The TOC team will utilize videos, short documentaries, and interactive discussions via a public address

system and engage in interpersonal communications to motivate for the adoption of positive behavior

change, especially for VCT services, and the correct and consistent use of condoms. With this team, it is

estimated that 4,000 military personnel, spouses, and family members will reached. The TOC team will act

as condom distribution agents ensuring enhanced targeted condom availability in high risk outlets and other

commercial outlets around the barracks as well as re-supplying Peer Educators.

Activity 3: Drop in Centers

Under this program, the TBD partner will work with the MDF to achieve its vision of ensuring that the

remaining four VCT centers be attached to, and integrated into, a broader information and education ‘Drop

In' centers which will include information resources such as radios, CD players, TVs, DVD players, IEC

reading materials, and computer access. This activity will be to roll out piloted activities at all VCT centers.

This will help ensure that these VCT sites are more welcoming and friendly and reduce the stigma and

discrimination related to going to an MDF VCT location. The MDF has the needed space and room for

creation of such a VCT Drop-In center. The MDF currently has six operational static VCT centers in six

units. Per MDF planning, there is a need to establish more VCT centers at the four remaining units in order

to adequately cover its ten key units. These drop in centers will be stocked with condoms which will be

made available and easily accessible to clients who visit the centers. The information resources described

above will capture the required information on correct and consistent use of condoms.

Activity 4: Media

Use of previously developed media and developing new media campaigns as required will be continued that

will include targeted, evidence-based HIV/AIDS prevention information, education, and communications

(IEC) materials will work closely with the MDF to develop targeted, evidence-based IEC materials to

promote key behavior change objectives. Posters encouraging MDF members and their families to seek

VCT services outlining benefits of HIV/AIDS prevention and video documentaries produced using other

leveraged funding will be screened by the TOC teams. Point of use items such as T-shirts and lapel pins

will also be produced. These materials will be designed to ensure their relevance to and understanding by

the members of the MDF targeted. The specific results of the IEC materials will be: increased knowledge of

VCT sites and services offered; increased awareness of the need for testing for HIV; increased knowledge

on methods of HIV infection and prevention, including correct and consistent condom use; -decreased

stigma and discrimination. A large focus will be given to the use of appropriate uniforms and insignia. To

ensure the desired outcome is achieved, all materials will be rigorously pre-tested with the MDF. Other

activities aimed at preventing HIV transmission will include purchase and promotion of condoms, STI

management, and messages/programs to reduce other risks of persons engaged in high-risk behaviors.

Activity 5: Monitoring and Evaluation

On-going M&E is critical to determining the success of the program. The TBD partner will provide M&E,

using some or all of the following suggested indicators in consultation with MDF: social norms, knowledge,

self-efficacy, social support, beliefs, attitudes, locus of control, outcome norms, and subjective norms. The

indicators reflect opportunity, ability, and motivation factors. It should be noted that though the military are

classified as a "high-risk" group, there is no current national data that has tracked behaviors, knowledge,

and practices of MDF soldiers. The BSS does not provide any information on military. The current source of

data existing for the MDF is from an internal KAP survey conducted within the army in 2002.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15426

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15426 6417.08 Department of Project Concern 7136 3898.08 DOD GHAI $58,000

Defense International

10757 6417.07 Department of Malawi Defense 5581 3898.07 DOD GHAI $39,000

Defense Force

6417 6417.06 Department of Malawi Defense 3898 3898.06 $33,000

Defense Force

Table 3.3.03: