Implemented by a consortium of local organizations led by the Society for Family Health (SFH) with three key results: to deliver a set of interventions to reduce HIV transmission; to strengthen MARP-led organizations to advocate and implement public health interventions; and to support an enabling environment for MARP-led advocacy, networking and partnership with the Government of Namibia.

The program targets sex workers (SW), clients of SW and men who have sex with men (MSM). The program is implemented in ten urban areas across the country with a high density of MARP and high HIV prevalence rates. Under-served populations are linked with MARP-led community systems. MARP face barriers to care including punitive laws, stigma and discrimination. Namibias five-year National Strategic Framework includes priorities for MARP.

A core set of interventions for SW, clients of SW and MSM will be delivered. Capacity-building of MARP-led civil society organizations to plan, implement and monitor the delivery of a core set of interventions will occur. Strengthening the enabling environment for MARP programming, through collaboration with the Ministry of Health and Social Services, Members of Parliament, and local CSO, will facilitate domestic scale-up and sustain of HIV prevention, care and treatment services and other legal and social services. Interventions are costed annually and serve as a benchmark.

The program supports the GHI by promoting access to services by under-served populations; supporting domestic institutions to advocate and recognize health needs of MARP communities; and establishing networks to transition and sustain investments. Core costs for MARP-led advocacy and service delivery will not be supported by GRN.

No procurement of motor vehicles is expected.

This is a new budget code which supports transition. Under the HBHC budget code, Society for Family Health (SFH) will utilize COP13 funding to complete the following objective: Improve access for key populations (KP) to the continuum of care and treatment for timely ART initiation and maintenance on ART. KP targeted by this program includes commercial sex workers (CSW), clients of CSW and men who have sex with men (MSM).

SFH will conduct programming in operational sites noted in the implementation mechanism narrative through local KP-led organizations and sexual and reproductive health (including HIV) service providers the Namibian Planned Parenthood Association and the Ministry of Health and Social Services (MOHSS).

This activity's strategy to transition over time is to support a mix of KP-led local organizations and MOHSS (where possible) over the course of the next five (5) years. Transition of KP-related activities presents a significant challenge to the USG due to criminalization of CSW and MSM-related practices in Namibia. KP continues to experience discrimination and stigmatization resulting in barriers to health and social services. Advocacy activities are underway in activities linked to HVOP to strengthen the enabling environment for KP programming in Namibia.

SFH will provide technical assistance (TA) and limited grant resources to local KP-led organizations to reduce barriers to care and treatment faced by KP. This activity will support post-HIV counseling and testing (HCT) activities where HIV sero-positive KP are identified. Activities will include the following: 1) Provide TA to clinical service providers to improve accessibility by KP to HIV care and treatment services; 2) Strengthen linkages between HIV risk reduction interventions and HCT services to HIV care and treatment services; 3) Provide TA to community-based KP-participatory groups to incorporate evidence-based outreach services and client retention interventions; and 4) Support quality monitoring and evaluation (M&E) to advance program approaches and fill gaps in knowledge on priority KP-related care and treatment issues.

SFH collaborates and jointly delivers this activity with the MOHSS. This narrative is linked to activities under HVOP, HVCT, and HVSI. Cross-cutting activities include Human Resources for Health/In-service Training and estimated funding is estimated at $35,000. No vehicle procurement, construction or renovation is planned for COP13.

Under this budget code support to the M&E Advisor will continue to provide technical assistance for the capacity development of M&E of MARP-led organizations and networks to operationalize standard M&E systems (with emphasis on HIV prevention) and increase the use of data analysis for HIV prevention program in ten geographic areas of operation by the program.

Core components include:

Increased organizational capacity of local stakeholders to develop, implement and evaluate effective HIV prevention and health interventions. The transfer of knowledge and skills required to operate efficient, cost-effective, accountable and transparent organizations managing the implementation of the integrated interventions for MSM, SW and their clients is a core component of the program.

Strengthening the enabling environment for the provision of health services to MARP: This will be accomplished by developing, strengthening, and supporting MSM and SW advocates and networks to assume leadership in the policy process; working with stakeholders, including uniformed services and the government; and collecting data for evidence-based decision-making and advocacy.

M&E activities are aligned with GRN and international standards and systems. Costs represent an M&E Advisor based at SFH and associated operational costs to provide routine project support and engagement with the relevant GRN offices.

This activity links with activities funded under HVOP and HVCT.

Strengthening HIV Prevention for MARP will continue activities under this budget code to establish and strengthen innovative and tailored models for delivering HIV counseling and testing (HCT) in MARP-friendly settings to sex workers (SW), their clients and men who have sex with men (MSM). The program prioritizes mobile and outreach HCT approaches to ensure that MARP overcome stigma and discrimination. Referral approaches for MARP, including STI suspects in selected high-volume facilities, to both voluntary and provider-initiated HCT sites is underway and will continue to be strengthened. The project is providing enhanced risk reduction counseling for MARP groups with linkages for referrals for medical male circumcision, substance abuse treatment, PMTCT (including family planning), and post-exposure prophylaxis, tailored to the needs of each target group.

The bulk of current HCT programming represents general population approaches through integrated service delivery sites in health facilities and outreach based on primary health care service packages. This activity will work with national, regional and district stakeholders to utilize alternative models which have been demonstrated to access clandestine and hard-to-reach populations with HIV testing. This may include extended hour HCT services in specific NGO clinics, mobile, moonlight and targeted testing for focus populations in areas of operation. Activities will be coordinated with stakeholders to leverage their expertise and utilization of available HCT personnel and commodities where available.

Sensitization of health care providers to provide MARP-friendly services will continue to be part of the intervention package. The program will continue to explore opportunities to bring mobile HIV testing services to locations that are convenient to MARP.

The program will continue to scale-up delivery of the intervention package to MARP in the ten priority program areas through collaboration with local organizations, including MARP-led organizations and the commercial sector. The program will continue to use information derived from program monitoring to strengthen service delivery and will propose additional innovative approaches to reaching MARP with prevention services.

The Strengthening HIV Prevention for MARP IM has established M&E systems to track referrals to HCT from interpersonal communication activities. Qualitative and quantitative reviews of where MARP access HCT services will continue to be conducted to better focus technical assistance.

This narrative links to other activities in HVOP and HVSI.

Strenghtening HIV Prevention for MARP will continue activities under this budget code to support linkages to MARP-friendly health services, especially a package of HIV prevention services and referrals to HIV care and treatment, given high HIV prevalence among these populations.

A core set of interventions will be delivered, either directly or through referrals, including risk reduction counseling, peer education and outreach/referral and condom/lubricant promotion and distribution. Linkages to services include referrals to male circumcision, substance abuse treatment, HIV care and treatment such as PMTCT (including family planning), and post-exposure prophylaxis tailored to the needs of different MARP. Routine STI assessment, treatment (by partner country health services), and referral to risk reduction remains an integral part of the package of services. Sensitization of health care providers will remain a key component of the program. Activities will train current health care workers interacting with MARP and STI suspects and, in parallel, provide a basis for national level training to be transitioned to the Ministry of Health and Social Services to promote long term capacity. The program will continue to work through collaboration with local organizations, including MARP-led organizations and use information derived from program monitoring to strengthen service delivery and propose additional innovative approaches to reaching MARP with prevention services.

Increased attention to enrolling STI suspects appearing in high volume public health facilities in risk reduction counseling will occur with the intent of receiving HCT and post-test services for both sero-negative and sero-positive individuals.

This narrative links to other narratives in HVCT and HVSI.

Organizational Capacity Building: Given the variable capacity among MSM and SW-led organizations, the program will continue focusing on meeting the particular organizational development needs of specific target organizations. Capacity-building covers a broad range of substantive areas, ranging from advocacy to administration and finance, governance, leadership, management, networking and strategic planning. Particular attention will continue to be given to M&E, supportive supervision and quality assurance, given the importance of the quality of interventions to achieving successful behavior change.

Policy and Advocacy: 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 prevention and treatment programs must enlist the explicit cooperation of law enforcement, health authorities and the political and religious communities to reduce fear of arrest and stigmatization that cause MARP to avoid health seeking behaviors.

The program will continue to partner with MSM and SW-led organizations such as the Legal Assistance Centre and MARP-led networks in spearheading advocacy for policies to reduce barriers to delivery of services. A range of local, national and regional stakeholders such as traditional leaders, Regional Governors and Members of Parliament will continue to be capacitated to assume leadership of advocacy efforts, to sustain policy work beyond the life of the project.