NEW/REPLACEMENT NARRATIVE

This PHE activity, Changing Gender Norms that Support HIV Risk Behaviors, Among Men in Namibia, was

approved for inclusion in the COP. The PHE tracking ID associated with this activity is NA.07.0214.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.03:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, EngenderHealth will work with its local partner, LL/CL, in the following ways:

1. Selecting the partners who have most effectively integrated ME in their programs and work with them

more intensively to ensure that they can "graduate" and serve as in-country resources.

2. Identify the next tier of 8-10 partners who are most interested in focusing on ME and ensure that they

receive the TA and support to integrate ME in their current programs. These would be programs that would

have the best chance to "graduate" in the coming year. Another important criterion for selecting these

organizations would be that they are specifically focusing on one or more MARP or other categories.

3. Identify partners working with girls/women on gender issues and develop a joint, pilot project testing

"gender-alignment" strategies (working with both men and women jointly on gender issues).

4. Ensuring that male engagement and gender are mainstreamed into existing PEPFAR HIV and AIDS

prevention, care, and treatment programs through the provision of technical assistance, mentoring, and

supervision.

Please review the activity narrative from COP08:

Noted April 22, 2008: This funding will be allocated to USAID Namibia SOAG.

This activity is a continuation of a program of activities initiated under the FY07 COP (ref: FY074442.08)

and supports the OGAC global initiative on gender. Harmful male norms and behaviors and a lack of

positive, societal and family roles for boys and men were identified by USG/Namibia implementing partners

during the development of the FY07 COP and for follow-on activities under the FY08 COP as some of the

leading challenges in dealing with long-term behavior change in Namibia. Specific issues include

widespread prevalence of intimate partner violence, sexual assault, and child abuse throughout the country

as well as widespread abuse of alcohol which fuels violence and sexual coercion. Masculine norms support

and perpetuate male infidelity, transactional sex and cross generational sex and between older men and

younger girls is common. Lower rates of male participation in HIV/AIDS care and treatment services,

especially in PMTCT, C&T and ART, mean that men do not receive much needed services. The Namibia

National Medium Term Plan (MTPIII) 2004-2009 acknowledges these challenges and includes interventions

targeting gender inequality and violence and alcohol abuse.

In FY07, the Ministry of Health and Social Service (MOHSS), Ministry of Gender Equity and Child Welfare

(MGECW), Ministry of Safety and Security (MOSS), and Ministry of Defense (MOD) formed a Men and

HIV/AIDS steering committee, and took a leadership role in the mainstreaming of gender throughout their

sectors and for USG-supported clinical, community-based and media-driven interventions. This signaled a

strong start for the Men and HIV/AIDS initiative, and a unique opportunity for inter-ministerial ownership and

engagement in a movement which will influence in a sustainable manner deeply rooted Namibian male

norms and behaviors impacting HIV/AIDS. The Men and HIV/AIDS initiative in Namibia had three

components: a national strategy that employs an intensive and coordinated approach to addressing male

norms and behaviors that can increase HIV/STI risk; the provision of technical assistance (TA) to

implementing partners applying evidence-based approaches to integrate into existing programs and to

develop innovative programs; and an evaluation component that investigates the effect of gender

mainstreaming programming on self-reported behaviors. EngenderHealth (Engender) and Instituto

Promundo (IP) will facilitate the first two components; PATH the evaluation component. An interagency

USG gender task force in Namibia supports and coordinates all of these activities and the program receive

valuable support from the OGAC gender team.

The Men and HIV/AIDS technical approach is based on the evidence-based best practice program, Men as

Partners (MAP), developed and tested by Engender in sub-Saharan Africa and the Indian subcontinent.

MAP employs group and community education, and service delivery and advocacy approaches to promote

the constructive role men can play in preventing HIV, and improving care and treatment if they understand

the importance of gender equity issues and safe health practices via behavior modeling in their families and

communities. MAP programmatic approaches have been evaluated and have shown an increase in men

accessing services, supporting their partners' health choices, increased condom use and decrease in

reported STI symptoms.

To date, the Men and HIV/AIDS initiative has had a strong start. In collaboration with the inter-Ministerial

task force, Engender and IP developed a TA support plan and have initiated gender mainstreaming capacity

building activities within prevention, care and treatment activities with more than 30 PEPFAR-implementing

partners. Several partners were designated as key in-country resources in different areas (information,

education, communication (IEC) development, group education, training, and service delivery). The partners

are diverse, including FBOs and CBOs, and these partners engage many different groups of men, including

young men, religious leaders, teachers and soldiers. In addition, PATH has finalized the evaluation protocol

and is initiating the baseline study.

With FY07 re-programmed and plus up funds, additional monies were allocated to support a number of Men

and HIV/AIDS activities: to the MOHSS for a national Men and HIV/AIDS conference, to the MOD and

MOSS for mainstreaming gender throughout the uniformed services peer education programs; and to the

Ministry of Information and Broadcasting (MIB) to weave supporting messages throughout its national

HIV/AIDS mass media campaign, Take Control. Engender/IP received additional country funding for TA and

to hire a gender expert to coordinate the initiative in country.

In FY08, USG will strengthen and expand the Men and HIV/AIDS initiative. Engender and IP will continue to

focus on the providing TA to in-country partners. One of the USG's top priorities in strategic planning and

Activity Narrative: TA for implementation will be assisting partners to make choices based on optimizing the feasibility and

effectiveness of interventions and their potential for sustainability and scale-up. Another priority will be

strengthening the national and regional networks to discuss challenges and lessons learned in gender

mainstreaming. The initiative will support selected networks to implement joint activities at the local and

regional levels to advocate for male involvement in HIV. As feasible, these will be linked to global events

that focus on issues related to gender and HIV and AIDS: e.g., 16 days of activism, Father's Day, and World

AIDS Day.

Issues and behaviors to be targeted in FY08 include alcohol use and abuse, multiple concurrent partners,

transactional sex, condom use, and male violence. Building on partnerships with private and public sector

organizations, the initiative will continue to mobilize social capital to focus on the issue of male involvement

in HIV. This year, a specific focus will be on identifying ways that additional private sector organizations

including workplace programs can

be mobilized to work with the network of partners already involved in Namibia's Men and HIV/AIDS

initiative. In addition, advocacy work will be continued with the government to ensure that male engagement

principles and approaches are integrated into government initiatives related to HIV/AIDS.

Overall during FY 2008-09, the USG/Namibia will ensure that a male engagement lens is applied to all

aspects of programming from program design and implementation to monitoring and evaluation. Technical

assistance will focus on further building the capacity of in-country partners including those listed above to

serve as resources through ongoing mentoring and supervision to ensure that male engagement is

mainstreamed into existing HIV and AIDS prevention, care, and treatment programs. Ongoing supervision

and monitoring will be provided in a variety of ways: through joint program design, implementation, and

training; in-country field visits and discussions on ways to address challenges, and feedback through email

and phone discussions with a core group of partners and in-country resources. One key area of focus will

be TA related to Behavior Change Communication (BCC) (activity 12342.08) with the aim of making sure

that partners not only effectively transfer knowledge to men about risky behaviors and safer behaviors, but

that the men are equipped to change their behaviors and are supported to do so by environmental factors.

BCC TA to USG partners will take the form of mentoring and on-the-job learning, and will be aimed at

strengthening the overall quality of their BCC programming, including design, implementation, quality

assurance and monitoring and evaluation (activity 16501.08). Another key area will be addressing alcohol

use and its relationship to unsafe health practices, and the Men and HIV/AIDS initiative will drawn on TA

and support from the comprehensive alcohol program (activity 17057.08).

The initiative will reinforce existing mass media activities such as the Take Control campaign by working

closely with Nawa Life Trust (NLT), which has been the key IEC partner during FY 2007 under the Men and

HIV/AIDS initiative and has ensured that all materials that are developed are consistent with the Take

Control campaigns. Gender partners will incorporate the Take Control guide packs developed by NLT into

gender mainstreaming activities (activity 5690.08, 4048.08).

The Men and HIV/AIDS quality assurance plan is designed to remain effective and relevant if needs evolve.

Each project staff person will be responsible for working with, following up and providing feedback to a small

group of in-country partners. This allows the provision quality, timely feedback and TA to a large group of

PEPFAR partners. The staff person seconded to this project during FY08 will continue to play a key role in

making sure that quality assurance and supervision at the country level and on the project team is strong.

This staffer will receive continued supervisory and on-the-job support to ensure that the PEPFAR partners

are getting the assistance they require for impacting male norms and behaviors.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16123

Continued Associated Activity Information

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

System ID System ID

16123 8030.08 U.S. Agency for Engender Health 7649 7649.08 TBD $0

International (EngenderHealt

Development h)

8030 8030.07 U.S. Agency for Engender Health 4442 4442.07 ACQUIRE $315,582

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $250,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03: