PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2010 2011
COP 2010 Overview Narrative
This is a new implementing mechanism which is a follow-on to the Population Services International (PSI)/Social Marketing Association (SMA) Corridor of HOPE program which comes to an end in March 2010. During the end of COP09, PEPFAR Namibia will competitively award a new program to strengthen HIV prevention services for the following most-at-risk populations (MARP): men who have sex with men (MSM), sex workers (SW) and clients of sex workers including truckers, seafarers and miners.
This new mechanism has three main components: 1) increased access to a comprehensive package of prevention services leading to reduced risk of HIV transmission among MSM, SW and clients of sex workers; 2) creation of an enabling environment for the provision of HIV services for these populations; and 3) increased organizational capacity of local stakeholders to develop, manage, and evaluate effective HIV prevention interventions for the target population.
This mechanism will fill an important gap in MARP programming in Namibia. Although commercial and male-to-male sex are not the source of most new HIV infections in Namibia, available data suggest that SW and MSM have some of the highest rates of HIV prevalence of any population sub-groups and remain important target audiences for prevention efforts. However, to date most prevention efforts have focused on awareness creation among youth and adults in the general population. The primary activity related to addressing higher-risk populations to date has been the SMA activity, but SMA also lacked a sharper focus on these most-at-risk groups.
The activity supports the prevention priorities of the Government of Namibia (GRN) as articulated in the draft National Strategic Framework for HIV/AIDS. The partner will participate in the Prevention Technical Advisory Committee (TAC) and work under the National Prevention Strategy currently under development. This program contributes to the draft USG Partnership Framework through the objective "Increased prevention programming for most at risk and vulnerable populations (MARP), including youth, sex workers, men who have sex with men, prisoners, truck drivers and other mobile populations."
Geographically, the new activity will, in collaboration with the GRN, establish selected high-risk areas in which to operate, specifically, those with a high density of MARP, high HIV prevalence and a thriving commercial sex industry.
A key focus of the program will be to identify and capacitate local organizations representing and serving MARP to operate in a cost-effective and accountable way and to develop the capacity of these groups and civil society to advocate for increased commitment by government and other stakeholders for improved HIV prevention, care and treatment services for MARP. By transferring technical knowledge and skills required to establish, operate and sustain these interventions to qualified indigenous organizations, and working with the GRN and stakeholders to create an enabling environment, USG will increase the likelihood of sustaining HIV prevention interventions with MARP in the future.
The program will address gender issues, recognizing that food insecurity, poverty and unemployment are among the reasons why women join the sex trade, and that power imbalances make it difficult for SW to insist on condom use with clients during paid sex.
During COP10, the USG will conduct research and surveillance regarding MARP including geographical mapping, size estimations, biomarker and behavioral surveys. The current Global Fund (GFATM) proposal includes support to NGOs working with MARP to collect qualitative and quantitative information to assess the size and behaviors of these groups. The USG will coordinate with these efforts and incorporate data in program design, planning and implementation. The mechanism will undertake additional formative and quantitative assessment to fill information gaps as needed.
The USG will work closely with the recipient to build M&E capacity of local partners and the GRN for program management of prevention for MARP, disaggregating beneficiary-level indicators by sex and category of MARP, and tracking data on planned coverage of interventions. Limited indicators exist to effectively monitor key accomplishments in the areas of policy development, organizational capacity building and creation of an enabling environment. The program will utilize indicators additional to the required PEPFAR indicators to monitor key accomplishments in these areas, based on global standards.
Delivery of comprehensive services to MARPs, including targeted HIV Counseling and testing services for MARP.
New Activity
Estimated Budget = Redacted
Policy and advocacy work around the areas of counseling and testing, making these services accessible and appropriate for MARPs.
Technical and organizational capacity building to local stakeholders to develop, manage, and evaluate effective HIV prevention interventions for the target populations.
ADDITIONAL DETAIL:
Counseling and Testing Services:
The program will establish and strengthen innovative and tailored models for delivering HCT testing in "MARP-friendly" settings to sex workers, clients and MSM, which may include mobile services, etc. in addition to different testing models including VCT, PITC and couples testing. Referral approaches for MARP populations to HIV counseling and testing in addition to care and treatment, given the high prevalence in these populations, should be further considered and strengthened. These linkages may also include referrals for circumcision, substance abuse treatment, PMTCT (including family planning), and post-exposure prophylaxis, tailored to the needs of each vulnerable group as appropriate. Sensitization of health care providers to provide MARP-friendly services will also be part of the package. The program will explore opportunities to bring mobile HIV testing services to locations that are convenient to MARP.
The new program will scale-up delivery of this package to MARP in priority program areas through collaboration with local organizations, including MARP-led organizations and the commercial sector. The program will use information derived from program monitoring to strengthen service delivery and to propose additional innovative approaches to reaching MARP with prevention services.
The partner will establish M&E systems to track referrals to HCT from IPC activities. Qualitative and quantitative reviews of where MARP access HCT services will be conducted to better focus technical assistance. This narrative links to other narratives in HVAB and HVOP.
Policy and Advocacy:
Namibia maintains policies and legislation that criminalize MARP and impede HIV prevention activities with MARP. Mobilization of key stakeholders, including government, civil society and members of targeted populations, is critical to create a legal, political and social environment where MARP can be reached with effective prevention programming. In the Namibian context, where sex between men and commercial sex remain illegal, HIV/AIDS programs must enlist the explicit cooperation of law enforcement, health authorities, and the political and religious communities, to reduce the fear of arrest and stigmatization that cause MARP to avoid health seeking behaviors.
The program will partner with MSM, SW and human rights organizations and networks, in spearheading advocacy for policies to reduce barriers to delivery of services. A range of local, national and regional stakeholders will be capacitated to assume leadership of advocacy efforts, so that this policy work is sustainable beyond the life of the project. The program will support stakeholders by ensuring timely and accurate use of data for policy work and advocacy, and for evidence-based decision making.
Organizational Capacity Building:
The transfer of knowledge and skills required to operate efficient, cost-effective, accountable and transparent organizations is essential to managing integrated interventions for MSM, SW and their clients. Moreover, solid organizational performance is core to the short and long-term success of scaling up interventions. Given the variable capacity among MSM and SW groups, the program will focus on meeting the particular organizational development needs of specific target organizations. Capacity-building will cover a broad range of substantive areas, ranging from advocacy to administration and finance, governance, leadership, management, networking, and strategic planning. Particular attention will be given to monitoring and evaluation, supportive supervision and quality assurance, given the importance of the quality of interventions to achieving successful behavior change.
Regular supportive supervision, distribution of standardized materials and monitoring visits will be undertaken by USG and prime recipients to ensure that outreach activities are being conducted to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions available and that data reporting is accurately reflecting progress against PEPFAR indicators.
Delivery of comprehensive services to MARPs, including the provision of outreach and education to reduce multiple and concurrent partnerships.
Design and implementation of relevant formative assessments to support program learning decision-making. This activity will complement size estimation and M&E efforts by UNAIDS, USG and GRN.
Technical and organizational capacity building to local stakeholders and organizations to develop, manage and evaluate effective HIV prevention interventions, focusing on partner reduction for the target population.
Gender:
In an effort to be responsive to concern over the incorporation of gender the recipient shall consider interventions to address male norms and health seeking behavior, intimate partner violence, alcohol abuse.
This new activity will support a comprehensive package of prevention services for most-at-risk populations (MARP), including supportive policy development, capacity building of local organizations and the GRN in addition to ensuring risk avoidance as a component among clients. This narrative links to other narratives in HVOP and HVCT. MSM and clients of sex workers are among the key populations targeted by this program. As one component of a comprehensive package for MARP, AB prevention funds will support outreach and education efforts to reduce multiple and concurrent partners among sex work clients and MSM.
Outreach and education on mutual monogamy and partner reduction:
Clients of sex workers in Namibia are frequently individuals who have migrated for work or are in occupations requiring that they spend long periods of time away from home. Seafarers, truckers, and miners especially are thought to be occupational groups that frequently purchase sex from SW; rough estimates suggest there may be 2,600 truckers and 2,000 seafarers in Namibia at any point in time. The risk factors for HIV among these migrant populations include unprotected sex with paid and casual partners, multiple concurrent partnerships, and low risk perception. While men in some occupations are easily identified as likely to engage in paid sex, other clients of sex workers are less readily identifiable as a risk group.
Innovative interpersonal communications (IPC) tools and materials will be used to increase risk perception and understanding of the potential impact of risky sexual behavior on their families, and to build skills needed to adopt responsible decisions and behaviors. The program will also emphasize the role of alcohol as a facilitating factor for risk behavior.
Formative Research:
Little formative research on male clients of sex workers exists in Namibia, but studies elsewhere indicate that the decision to pay for sex often begins at entertainment establishments such as bars and beer gardens that are frequented by sex workers. This decision is often influenced by peer pressure from friends and business partners, and by the loss of control owing to the influence of alcohol. Apart from their contact with sex workers, clients routinely report intercourse with wives, girlfriends, and casual acquaintances. In some countries, HIV interventions have reduced the proportion of men who visit sex workers, as well as the frequency of visits by those who continue to engage in commercial sex. The new program will conduct formative research to develop a profile of sex work clients in targeted areas and to identify entry points for program intervention, since vulnerabilities relating to HIV are often specific to each industry and sector. Research and assessment will build on the planned GRN/USG MARPS size estimation efforts.
Support to local organizations:
Strategies for reaching clients of sex workers who do not form a visible, coherent social group will include support to local community organizations for outreach in bars and entertainment establishments and other venues where men who frequent sex workers are to be found. The project will develop IPC interventions to engage target audiences in these settings, supported by educational materials about HIV. The program will develop mechanisms for supportive supervision of outreach staff, and will periodically undertake assessments to monitor trends in behavior among target populations.
Messages about reducing partners and patronage of sex workers for these high-risk men will be integrated within a comprehensive approach to risk reduction. Activities funded under HVAB form an important aspect of comprehensive HIV prevention activities associated with partner reduction and the promotion of mutual monogamy. Additional funding under HVOP is provided to support other methods of HIV prevention.
Regular supportive supervision, distribution of standardized materials and monitoring visits will be undertaken by USG and prime recipients to ensure that outreach activities are being conducted to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions available and that data reporting is accurately reflecting progress against PEPFAR indicators. Sustainability components will include capacity building of local civil society and regional administrations to better coordinate and implement evidence-based HIV prevention strategies.
Policy and advocacy work around the areas of sexual prevention, creation of an enabling environment, and making these services accessible and appropriate for MARPs.
Technical and organizational capacity building to local stakeholders and organizations to develop, manage and evaluate effective HIV prevention interventions, focusing on comprehensive prevention package for the target populations.
Delivery of services:
The program will incorporate linkages to "MARP-friendly" health services, especially referrals to HIV care and treatment, given high prevalence in these populations. These linkages may also include referrals for circumcision, substance abuse treatment, PMTCT (including family planning), and post-exposure prophylaxis tailored to the needs of each vulnerable group as appropriate. Sensitization of health care providers to provide MARP-friendly services will also be part of the package. The program will support the provision of Positive Health, Dignity and Prevention components in outreach programs.
The new program will scale-up delivery of this package to MARP in priority program areas through collaboration with local organizations, including MARP-led organizations. The program will use information derived from program monitoring to strengthen service delivery and to propose additional innovative approaches to reaching MARP with prevention services. This narrative links to other narratives in HVAB and HVCT.
Namibia maintains policies and legislation that criminalize MARP and impede HIV prevention activities with MARP. Mobilization of key stakeholders, including government, civil society, and members of targeted populations is critical to creating a legal, political, and social environment where MARP can be reached with effective prevention programming. In the Namibian context, where sex between men and commercial sex remain illegal, HIV/AIDS programs must enlist the explicit cooperation of law enforcement, health authorities, and the political and religious communities, to reduce the fear of arrest and stigmatization that cause MARP to avoid health seeking behaviors.
The program will partner with MSM, SW and human rights organizations and networks in spearheading advocacy for policies to reduce barriers to delivery of services. A range of local, national and regional stakeholders will be capacitated to assume leadership of advocacy efforts, so that this policy work is sustainable beyond the life of the project. The program will support stakeholders by ensuring timely and accurate use of data for policy work and advocacy, and for evidence-based decision making.
The transfer of knowledge and skills required to operate efficient, cost-effective, accountable and transparent organizations is essential to managing integrated interventions for MSM, SW and their clients. Moreover, solid organizational performance is core to the short and long-term success of scaling up interventions. Given the variable capacity among MSM and SW groups, the program will focus on meeting the particular organizational development needs of specific target organizations. Capacity-building will cover a broad range of substantive areas, ranging from advocacy to administration and finance, governance, leadership, management, networking and strategic planning. Particular attention will be given to monitoring and evaluation, supportive supervision and quality assurance, given the importance of the quality of interventions to achieving successful behavior change.
