PACTO is designed to address the results of the INSIDA 2009 survey regarding prevalent risky behaviors and populations/age groups at risk, particularly the prevalent practice of multiple sexual partners and low condom use. PACTO focuses on the prevention of sexual transmission by designing and/or strengthening interventions that address behavioral, structural and biomedical aspects of prevention; increasing the perception of associated risks, creating demand and promoting appropriate use of clinical services for CT, PMTCT, VMMC, PP, screening and treatment for STIs and TB, and AIDS treatment. PACTO is also designed to facilitate the adoption of healthy behaviors, including HIV testing and condom use among the general population. PACTO's implementation efforts focus in the more densely populated urban and peri-urban areas of the three highest prevalence provinces where high risk behaviors are widespread, namely Maputo city and province and Gaza, which at 25%, is the province with the highest prevalence in the country. PACTO is also receiving $700,000 of GBV Initiative funds to intensify community dialogue on GBV and HIV prevention; increase understanding of, and disseminate laws related to GBV and promote referral to GBV services; promote use of the continuum of GBV prevention, care and support services and mobilize community action during the 16 Days of Activism Against GBV. JHU/CCP has developed innovative and sensitive monitoring of their activities, to track progress in implementation and achievement of results. PACTO FY12 request was reduced due to their AB pipeline. The mechanism will purchase 2 vehicles over its planned life, with a request for 1 vehicle to purchase in FY12. Vehicles are used for outreach and community HCT services.

These HVSI funds are intended to support the work PACTO is currently doing with the Center for Investigative Social Research in Manhica to collect and analyze HIV/AIDS behavioral data and monitor the effect of exposure to communication interventions on use of HIV services.

The major focus of this activity will be to develop a communication strategy that focuses on encouraging men 25 years and older to access VMMC. Experience in country and from the region shows that a sizeable proportion of the demand for VMMC services is in adolescent boys below the age of 15 and who are not the intended primary focus of PEPFAR adult circumcision activities. The proposed communication strategy will address this challenge, and strive for a more appropriate age mix of VMMC clients by targeting older men who are not currently accessing services. The strategy will be guided by qualitative formative research among communities in the targeted areas and developed in collaboration with MOH and implementing partners. Messages will focus on providing correct information regarding the advantages, wound care, and postoperative sexual abstinence, and will be concentrated around current service delivery sites. The overall goal is to guarantee an optimal age mix of the population seeking circumcision, to ensure impact for HIV prevention.

PACTO is a key USG partner implementing a combination prevention approach, using strong research based behavioral and structural approaches primarily. The goal of the prevention interventions supported through this activity is to achieve behavioral and normative change which create an enabling environment, critical for more responsible, less harmful attitudes and sexual behaviors among adults, youth and PLHIVs, their partners and families. The focus of the HIV prevention communication is on the high prevalence of Maputo City and Province and Gaza, in line with the USG strategic orientation . A primary emphasis is on discouraging the practice of multiple sexual partners , increasing the perception of its associated risks among individuals and communities and reaffirming the benefits of mutual fidelity between partners of known HIV status. The project continues to support the Andar Fora campaign, a comprehensive three-year national effort to address multiple partnerships and other risky sexual behaviors. Results from the mid-term evaluation of the campaign are positive, demonstrating reach and impact on risky sexual behaviors, and are being analyzed to design the next phases of the campaign. Alcohol abuse, male engagement, and constructive engagement of young adults have emerged as key factors to capitalize on in subsequent campaigns.

PACTO interventions, activities and materials developed also reflect other important findings from the INSIDA survey, supplemented by qualitative findings, including the need to improve comprehensive HIV knowledge, focusing on young women, and "breaking the silence" that surrounds HIV and contributes to increased stigma. PACTO 's approach relies on multi-pronged and reinforcing mass media and community level activities, using life skills based programs that harness the positive power of peer relations, and identifying positive role models for adults and young people. The PACTO project is coordinating its youth activities with USAID's education program, the Ministries of Education and Youth and Sports, to reach both youth in and out of schools, as a step towards creating structural and behavioral changes within the formal education sector and in the community. Ensuring a healthy and hopeful generaion is the overall emphasis of the activities geared to youth. Much of PACTO's work is with the central level AIDS commission (CNCS) and other ministries, and other communication implementing partners. Monitoring of behavioral outcome indicators is ongoing , through regular reporting, and assessments of reach and coverage through the various communication modalities used.

PACTO is a partner in the Combination Prevention demonstration project planned for Chokwe district, Gaza province, which is a GHI focus province. The project aims to reach high coverage levels for male circumcision, treatment, and PMTCT. PACTOs role will be the promotion of these services, CT, as well as the promotion of necessary risk reducing behaviors, including partner reduction, seeking CT, and correct and consistent condom use. This activity will take place only in the catchment area of the Chokwe demographic surveillance system. Gazas HIV prevalence is 29.9% among women 15-49 years compared with 16.8% of men. 26% of women reported having had a test in the last 12 months compared with only 10% of men.

This project focuses on sexually active adult men and women and discordant couples as key populations for prevention of sexual transmission in Mozambiques generalized epidemic. In such epidemic situations, reaching individuals who engage in multiple sexual partnerships, including transactional sex, and those who are HIV positive, represents important opportunities to reduce or prevent transmission of HIV to negative partners and spouses. As a result, this funding focus is on comprehensive programming of behavioral interventions among these population segments. As both individual perception of risk and condom use are very low throughout the country, this activity combines effective communication for behavior change, especially interpersonal communication and counseling for risk reduction, with increased condom availability and promotion to improve currently prevalent negative attitudes, and to increase consistent and correct condom use among sexually active adults, and discordant couples in the three highest prevalence provinces of Maputo, Maputo City and Gaza. The project has identified and will design interventions to address alcohol use, widely prevalent in the country, and is associated with increased risky sexual behavior and instances of gender based violence, all of which heighten the probability of HIV infection. The project supports local government priorities to develop a comprehensive national strategy to reduce alcohol consumption through a combination of approaches to address the policy enviroment, the private sector, and community and individual factors.

All behavioral interventions to reduce the risk of HIV transmission are linked to counseling and testing services, and will emphasize the importance of disclosure of HIV status between sexual partners, taking into consideration the potential need to mitigate issues of violence that may arise within a couple, as a result of disclosure. In line with a key finding and programmatic priority, the program will increase its efforts to promote reach men, both through channels known to be popular among men ( eg workplace, pool halls) as well as ANC and PMTCT clinics which can be critical entry points for male partner testing and positive prevention.

Funds will also be applied to addressing health care provider attitudes, and interpersonal skills, as critical interventions to increase utilization of preventive services by men and women alike. PACTO will continue to develop community level interventions that strenghten the understanding and practice of positive prevention by strengthening local CBOs who care for PLHIVs. Linkages and feasible referral mechanisms are built between community HIV/AIDS-related networks, CBO's and support groups, health facilities and other community services in order to facilitate Clinic-Community HIV/AIDS Services.