Pathfinder is active in a broad range of HIV-related interventions in Mozambique. In FY 2010, Pathfinder will be initiating new activities to establish a replicable model for reaching students at pre-service institutions with HIV prevention, testing, care and treatment, while building on existing HIV activities among incarcerated populations; Pathfinder is uniquely positioned to reach this most-at-risk population in Mozambique.

The objectives of the pre-service institutions project are to increase the number of pre-service students in intra- and extracurricular HIV prevention activities, including information on TB and opportunistic infections; increase the number of pre-service students, faculty, and staff that use prevention services and commodities such as counseling and testing, condoms; increase the number of preservice students, faculty and staff referred for care, treatment, and support; and strengthen the capacity of the respective ministries to manage HIV prevention activities within pre-service institutions. These objectives fall under the Partnership Framework goal to reduce new HIV infections in Mozambique where use of behavior change communication campaigns with emphasize on gender dynamics and increased access to counseling and testing are employed. While the goal of this project is to work nationally, FY 2009 activities focused on preservice institutions for health and education in Nampula and Maputo.

While the goal of this project is to work nationally, the first year of this project is focused on pre-service institutions for health and education in Nampula and Maputo. In FY 2010, additional funds will be provided to expand to other provinces per guidance from Ministry of Education and Culture (MEC) and the MOH. Wraparound activities will be developed in family planning through other USG agreements with Pathfinder (Strengthening Communities through Intergrated Programs). The target populations are students and faculty at pre-service institutions.

The key contribution to health systems strengthening is in preventing HIV tranmission among students attending government pre-service institutions thereby diminishing the loss of future teachers and health workers. Emphasis is on educating current faculty who are in a position to support the pre-service system through their own behavior and mentoring of students regarding health related decisions.

Under the cross-cutting programs and key issues, this implementing mechanims' activities address human resources for health and education. One of the activities planned is conducting "The We Are Together Campaign" where teachers commit to developing egalitarian teacher-student relationships. In preparation for this campaign, faculty undergo training that includes use of participatory teaching methods and tools; information around healthy lifestyles, HIV prevention, TB, OIs and STIs; and how to deal with problems when initiating behavior change among students. Another activity led by faculty is establishing a formal mentoring program where teachers will be challenged to look at their own behaviors and beliefs. Approximately 10% of faculty at each institution will be identified as leads for this program. In order to support the use of current information, a technical resource center will be established at each institution. Activities for students include the piloting of a self-directed learning package for students living off campus focused on health decision-making and prevention. Another activity will be preparing students as peer educators and developing support groups. The peer educators will be mentored by faculty. BCC materials, use of media and public events will be employed, promoting HIV prevention and CT as well as addressing factors that increase vulnerability to HIV such as gender inequity, intergenerational sex, multiple concurrent partners. In FY 2010, a plan for achieving cost efficiency will be developed. The implementing mechanism plans to use a 3 pronged approach beginning with monitoring performance followed by securing buy-in and mid-course corrections leading to evaluating impact to guide project management and improvement. This will be achieved through the monitoring of outcome indicators to evaluate program effectiveness and impact, provincial-level meetings to assess progress, lessons learned and solutions; comprehensive reviews at the end of years 2&3 and use of an internal program monitoring system for monitoring basic operations. Data collected will be analyzed and reports provided to stakeholders especially the MOH and MOEC. Gender will be mainstreamed within all activities including addressing barriers to preventative behavior change, maximizing young women's participation and using Pathfinder's experiences in gaining male involvement.

In FY 2010 Pathfinder will also support HIV services for incarcerated populations and prison guards in Mozambique. HIV is a significant health threat to prison populations. HIV infection, hepatitis, TB and STI present significant challenges for prison and public health authorities since prevention measures are rarely provided in these settings. In FY 2010 Pathfinder will build on prior activities and expand services in line with USG priorities based on the Partnership Framework goal to reduce new HIV infections through comprehensive prevention interventions, including prevention activities and increased access to HIV CT for MARPs. Pathfinder will support prevention interventions in prison settings through implementation of a risk reduction and motivational counseling project with prisoners just about to be released, and will also support implementation of activities for prisoners included in the National Strategy for Accelerated Prevention of HIV Infection operational plan.

This activity will directly contribute to the following goals of the Partnership Framework:

Goal 1: Reduce new HIV infections in Mozambique by getting to know the HIV status and expanding access to confidential HIV counselling and testing (Obj 1.3) Goal 2: Strengthen the Mozambican health system, including human resources for health and social welfare in key areas to support HIV prevention, care and treatment goals.

Most of the pre-service institutions students are young people below 25 years old. Including staff and faculty, these groups correspond to more than 15,000 people who represent the future workforce for both health and education. Also these are strategic sectors to ensure sustainability of the National Health and Educational Systems as well as the development of the country in order to reduce the poverty. Between 2000-2010, it is estimated that 13% of teachers and 15% of HCW will have ceased working and/or died due to HIV complications. Roughly half of pre-service students are female and most are between the ages of 17-29; because the risk of contracting HIV is up to 3 times greater for females and those aged 15-29 account for half of the total HIV infections in Mozambique, intervening at the pre-service level could avert many new infections. VCT Centers at pre-service Institutions could play an important role in

providing the full spectrum of services for youth, integrating many of health issues that affect these groups as well as promoting gender-sensitive, youth friendly, optimizing personnel and potentially becoming an integrates site for internships. In those cases, a CT center can meet the need for testing services for youth following these main principles: providers have a respectful, non-judgemental attitude; the facility has a strong privacy and confidentiality policy; environment is comfortable and non- threatening; and fees are waived for all clients.

For FY 2010 Pathfinder will operate CTH sites in 1 pre-service institutions in Nampula with potential expansion to Beira, Zambezia and Maputo in 2011. Three pre-services institutions will be covered for education sector, 2 in Nampula and 1 in Maputo Province.

Prevention and testing of teachers and health workers for HIV is critical to maintaining a healthy

workforce. While systematically there are activities focused on existing health workers, there has not

been a system of prevention, care or treatment for health and education preservice institutions. The

activities under this budget code are focused on increasing the number of preservice students reaching in

intra- and extracurricular HIV prevention activities, including information on TB and opportunistic

infections; increasing the number of preservice students, faculty, and staff that use prevention services

and commodities such as counseling and testing, condoms; increasing the number of preservice

students, faculty and staff referred for care, treatment, and support; and strengthening the capacity of the

respective ministries to manage HIV prevention activities within preservice institutions. The activities

under this budget code and those under counseling and testing are complementary. These objectives fall

under the Partnership Framework goal to reduce new HIV infections, through use of BCC campaigns with

emphasis on gender dynamics and increased access to counseling and testing. In FY 2010, additional

funds will be provided to expand to other provinces per guidance from MEC and MOH. The MOH has

recently hired a technical advisor for workplace safety to coordinate and direct all workplace programs

supported by the donors and GOM. These activities would be part of the workplace safety portfolio and

coordination.

In many countries including Mozambique, HIV is a significant health threat to prison populations. HIV infection, hepatitis, TB and STIs present significant challenges for prison and public health authorities

since prevention measures are rarely provided in these settings. The risk of contracting infections behind bars is increased due to risk behaviors, including sexual coercion and the continuation and initiation of injection drug use, but prevention measures are rarely provided in prisons. HIV in this most-at-risk population may also impact the generalized epidemic in Mozambique, through linkages between incarcerated populations and communities (e.g. through prisoner release programs).

In FY 2010 Pathfinder will support prevention interventions in Mozambican prisons settings through implementation of a risk reduction and motivational counseling project with prisoners just about to be released. The partner will also support implementation of activities for prisoners included in the National Strategy for Accelerated Prevention of HIV Infection operational plan. Key activities for FY 2010 include: 1) Adaptation and implementation of an individual risk reduction package; 2) Ensure access to services for reduction of HIV and STI transmission through support for specific elements of the prisons operation plan, including trainings and IEC materials; 3) Scale up access to HIV counseling and testing, with linkages to care and treatment; 4) Coordinate prevention activities in prisons through support for specific elements of the prisons operation plan, including HIV epidemiologic surveillance, M&E, and regional educational exchange visits; 5) Advocacy activities, including development of partnerships between the government and civil society organizations for prevention activities in prisons and advocacy to make condoms available in prisons.