There are an estimated 15,000 military personnel dispersed throughout Mozambique with the greatest concentrations in Maputo, Nampula, and Sofala provinces. However, the strategic concentration of troops is changing a lot due to the geo-political circumstances in some neighboring countries such as Malawi and Zimbabwe. The Mozambican Armed Forces (FADM) is divided into Army, Navy, and Air Force. Most military facilities are located in remote areas and some are stationed along some international borders for the aforementioned reasons. Enlisted recruits are trained in facilities located in districts with relatively good infrastructure and accessibility, which could increase their behavioral risk for HIV as they can easily access alcoholic beverages and commercial sex workers. In line with the Government of Mozambique National Accelerated HIV Prevention Strategy to implement evidence-based and comprehensive prevention interventions targeted towards the general population and most-at-risk populations (MARPs), the USG supported the FADM in completing the second round of the Behavioral and Prevalence Study within their personnel and have already supported the collection of data related to MC prevalence among young recruits. The collection of such information was critical to ensure evidence-based interventions targeting the armed forces. PSI will continue implementing general prevention activities as well as continue implementing biomedical prevention through MMC services, all in collaboration and coordination with other USG agencies, Mozambican Military Health and other partners implementing similar interventions. The main goal of these interventions is to continue assisting the FADMs effort to reduce HIV incidence among soldiers and their families and increase capacity.

PSI will work with the FADM to identify and produce a database of OVCs in all country. The database of childern identified will then be given to MIMAS as a central entity which provides the necessary support for these children. This activity will be coordinated with USAID as they are supporting MIMAS in all OVC related activities.

USG will support PSI to open one more MC site contributing to the scale-up efforts to offer the interventions to even more people.

The funding requested will enable PSI to maintain the two existing sites, open the new one, increase staff and the number of surgical beds in more demanding areas such as the Beira site. We are also expecting high numbers from the new site to opened in Chimoio as patients from here have to travel to Beira to access the services.

The target set for PSI is 10,000 males to be counseled, tested and circumcised.

Unprotected heterosexual sex is the primary route of HIV transmission among Mozambicans. A recent study conducted with Mozambicans between the ages of 15 and 24 found that only 33% of males and 29% of females reported using a condom during their last episode of sexual intercourse, suggesting that low rates of condom use may be a major factor in the spread of HIV. Multiple concurrent partners, stigmatization, gender inequality, and misinformation about HIV also impact the spread of HIV infection among the general population. Additional factors (e.g., mobility, sex workers, separation from family) contribute to the even higher prevalence of HIV among members of the Mozambique Armed Defense Forces (FADM). It is clear from these findings that developing effective risk reduction programs is critical to limiting new infections in Mozambique. The military population's age group ranges from 18 - 45+ years old. Based on this information and using the behavioral and prevalence study data, PSI will continue implementing activities that address the major drivers of the epidemic within the Mozambican military. Some of those are multiple concurrent partners, low condom use, heavy drinking, low CT. All aspects of risky behavior will be addressed and explored during peer education sessions and, funds will be allocated to PSI to implement this comprehensive program. The peer education program will have a particular piece targeting around 4000 recruits (men and women) during their military basic training. As they complete the training, it is expected that these new soldiers will be agents of behavior change within the barracks and in the communities surrounding the units where they will be assigned to serve. The military HIV focal points and their respective peer educators will work hard to promote HIV status disclosure among their peers. During prevention campaigns soldiers LHIV will give testimonies to fellow soldiers about their life. PSI will help the military to create alcohol free resource centers, equipped with entertainment devices/services (satelite TV, board games, music, etc), snaks and sodas available for sale. The HIV focal point/peer educators will talk about an HIV related theme everyday at the same time for one hour and, during this period all entertainment will stop so that people can focus on the presentations, explanations and participate on the discussions. GBV and sexual violence related topics will also be part of the discussion themes. HIV TC will be available in back rooms strategically located and arranged for that particular purpose. Murals, pamphlets and liflets will continue being painted, printed and distributed to all military members. In relation to GBV, the military code of conduct will be reviewed and distributed to all military members so that they are all aware of what the document says.

PSI will continue ensuring that the existing CT sites are well functioning, the counselors receive refresher courses to ensure reliable quality of testing, and IEC materials (printed and video) are available in each site and in all military bases. M&E tools will be in place. Mobile testing and counseling campaigns will be reinforced and increased to target military bases without local CT services. The remote bases and the training camps will be highly considered . During the campaigns and especially during each CT session, the counselors will be trained to assess information about the clients' status in regards to MC and, educate the ones that test negative about the advantages of the intervention. The testing will follow the national algorithm and HIV positive clients will continue being referred for care and treatment as usual. 2 CT campaigns are planned to occur and testing among military leadership will be encouraged. The PICT strategy will be introduced in all military health units. HIV status disclosure will be emphasized as well as discordant couples counseling. CT will continue being provided to young people (male and female) that are required to undergo medical check-ups in order to assess their ability/physical fitness for military basic training.

USG will continue funding Population Services International (PSI) to procure, buy and promote the use and distribution of the camouflage condom within the Mozambican Armed Forces. With the MMC scale up program, it is expected that condom distribution will increase due to the level of counseling that patients will go through before and after the intervention. Condoms will also be available in all MMC sites (fixed and mobile) as well as in all 71 military identified condom outlets.

Part of this funding will also support the training of peer educators to promote positive living strategies as well as discuss issues related to stigma and discrimination to encourage TC and disclosure. Therefore, peer educators will be trained to reinforce and intensify research-based communication aproaches to increase service utilization by creating an enabling environment, minimizing risky sexual behaviors.