PLUS-UP: With the additional $ 270,000, CEDPA /PL will launch a prevention initiative with the Nigeria National Union of teachers as well as expand activities to two additional states- Taraba and Adamawa. The teachers initiative is a 3 pronged initiative that addresses HIV awareness and prevention by teachers for teachers; teachers ethics- coercive sexual relationships with students; teachers as role models to guide in-school youth peer AB prevention programs. Youth curricular will focus on building life skills such as negotiation and self esteem issues for youth especially girls, Primary target populations are in-school youth ( primary and secondary school) 10-19 and school teachers.

ACTIVITY DESCRIPTION This activity also relates to activities in HVCT (#6702, 6772), HBHC (# 6708, 6770, 6675), HTXS ( #6703, 6766, 6715,6678) HKID #( #6701, 6771, 6679), HVOP (# 6735, 6707), HVLAB (# 6709, 6767, 6680, 6716), PMTCT (# 6706,6768, 6699).

In COP 07, the Positive Living (PL) Abstinence and Be Faithful (AB) component will dovetail into the other prevention and palliative care programs to emphasize abstinence for youth and other unmarried persons, including delay of sexual debut; mutual faithfulness and partner reduction for sexually active adults. AB activities will be conducted at individual, family, school and community levels. 1.2 million People will be reached with AB interventions, 700,000 reached with abstinence (A) only, and 8000 trained as peer educators to facilitate and disseminate information for AB through a systematic community-based program. AB will be implemented in the 12 states of FCT, Bauchi, Edo, Kano, Anambra, Cross River, Lagos, Kogi, Rivers plus 2 new states where GHAIN will be working. This activity will include support to Anglican Church AIDS Program, National Supreme Council on Islamic Affairs, Association of Women Living with HIV/AIDS and Church of Christ In Nigeria.

‘Abstinence' messages will promote development of life skills for practicing abstinence; and adoption of social and community norms that support delaying sex until marriage, denounce cross-generational sex; transactional sex; rape, incest and other forced sexual activity. ‘Be faithful' programs will promote elimination of casual sexual partnerships; development of skills for sustaining marital fidelity; mutual faithfulness with uninfected partners; HIV counseling and testing for partners and couples that do not know their HIV status; endorsement of social and community norms, partner reduction, and marital fidelity by using strategies that respect and respond to local cultural customs and norms as described above. . CEDPA and GHAIN's curricula on abstinence will be adapted; and a curriculum for youth out-of-school will be developed.

Activities will also address sexual development, reproductive health and STIs during religious/school youth camps and conferences, one-on-one and group counseling and discussions. Clergy and Imams will be trained to reach people in faith-based settings, and integrate HIV prevention messages in routine activities e.g. bible studies and Tapsir sermons. Activities will be scaled-up through step-down training of peer educators to ensure easy and available access for youth. Religious and opinion leaders will facilitate debates and community planning sessions where issues on transmission and prevention of HIV e.g. marriage, and mutual fidelity will be discussed. PLWHAs working as model clients will share experiences and promote prevention among positives to address questions on discordance and positive living. Community capacity will be enhanced to address youth needs, promote open dialogue among religious leaders, adolescents and general community about HIV/AIDS and restore hope of PLWHAs by training the following categories as change agents. 1) Facilitators: 500 youth in and out of school; 250 religious leaders; 250 PLHAs; 2) Peer educators: 5,000 youth in and out of school; 1,400 religious leaders; 400 PLHAs. Parents and the general population will be reached through seminars, community debates and public media. Posters and pamphlets with targeted messages will be adopted and/or printed to enhance mastery of AB information and skills. The intensive community mobilization and sensitization activities will reach out to the currently underserved rural communities and PL will work to ensure there are adequate networks and linkages between outreach activities to GoN and USG sites where AIDS care and treatment are available.

CONTRIBUTION TO OVERALL PROGRAM AREA Scaling up of prevention, involvement of PLWHAs and youth, and encouraging peer educators to work together with community health care providers as planned under the PL

AB program will contribute directly to the interest of the US Global HIV/AIDS Strategy by reaching 1,908,000 people directly and 5,000,000 indirectly. The activities will stimulate demand for other HIV/AIDS related services offered by GoN and other USG partners throughout the 12 states where it will be implemented.

LINKS TO OTHER ACTIVITIES AB activities will be linked to HVCT (#6702, 6772), HBHC (# 6708, 6770, 6675), HTXS (#6703, 6766, 6715,6678) HKID #(#6701, 6771, 6679), HVOP (# 6735, 6707), HVLAB (# 6709, 6767, 6680, 6716), PMTCT (#6706,6768, 6699) and other services that will be provided at GHAIN, ACTION project, Harvard ART, and Positive Living VCT and PMTCT sites including government of Nigeria sites through cross referrals. High risk individuals will be referred to Society for Family Health service points for condoms services. Nigerian Network of Religious Leaders living with AIDS (NINERELA) will provide support for prevention among positives

POPULATION BEING TARGETED Activities will focus on young people aged 10-19 with "A" messages, youth and adults aged 15-49 with A and B messages. Though women focused, prevention activities will target men as strategic partners. Be Faithful activities will target clients of commercial sex workers with partner reduction messages.

KEY LEGISLATIVE ISSUES ADDRESSED This activity will promote a rights based approach to prevention among positives and other vulnerable members of society and equal, access to information and services; enlighten men on the special needs of women and youth; challenge the traditional gender norms of male dominance, female subservience and gender inequality in sexual relationships. Reduction of stigma and discrimination is also a key legislative issue to be addressed while activities will further contribute to demystifying stigma, denial and discrimination.

EMPHASES AREAS Prevention activities will emphasize community mobilization and participation, providing Information, Education and Communication materials, collaborating with other networks and service delivery points and advocating/lobbying for a conducive environment to prevent HIV infection. WRAP AROUND: Access to other prevention methods and palliative care will supplement the abstinence and be faithful messages by offering alternative strategies to the targeted population.

ACTIVITY DESCRIPTION This activity also relates to activities in HVCT (#6702, #6772), HBHC (# 6708, #6770, #6675), HTXS ( #6703, #6766, #6715, #6678) HKID #( #6701, #6771, #6679), HVAB (#6733, 6684), HVLAB (# 6709, #6767, #6680, 6716), PMTCT (#6706, #6768, #6699).

Condom and Other Prevention (HVOP) is a component of the comprehensive Positive Living (PL) program. Activities will emphasize provision of full and accurate information about correct and consistent condom use as a means of reducing but not eliminating the risk of transmitting HIV and other sexually transmitted infections (STIs), will support access to condoms for those at risk, and promote appropriate HIV prevention among known HIV positive partners. Information about correct and consistent use of condoms will be coupled with information about abstinence as the only effective method of eliminating risk of HIV infection; and the importance of HIV counseling and testing, partner reduction, and mutual faithfulness as methods of risk reduction. Referral for prevention of mother to child transmission (PMTCT) will be provided. Activities will be implemented in 12 states of FCT, Bauchi, Edo, Kano, Anambra, Cross River, Lagos, Kogi, Rivers plus 2 new states where GHAIN will be initiating services.

In COP 07, 300,000 persons will be directly provided with information and messages for correct and consistent condom use, 10,000,000 condoms will be distributed from 384 outlets targeting most at risk populations that include long distance truck drivers, migrant workers, out of school youth, people living with HIV/AIDS (PLWHA) and clients of commercial sex workers. 2400 adult peer facilitators (PFs) and educators (PEs) will be trained and based in collaborating NGOs and CBOs, to conduct one-on-one counseling; facilitate group discussions in homes, recreational areas, motor parks, market places and areas where young people usually congregate; and distribute IEC materials and condoms. PL will enable Primary Health Care facilities in communities to diagnose and treat STIs, while health workers will be trained on syndromic management of STIs where laboratories are not available. These facilities will serve as referral centers to which PFs and PEs will send clients for diagnosis and treatment of STIs. PFs and PEs will refer for testing and clinic based FP methods. PL will liaise with DFID and SFH to ensure the procurement of male condoms.

At the individual level PL will focus on peer education techniques that reinforce correct and consistent use of condoms, provide counseling on prevention and other RH services including dual protection to discordant couples, PLWHA, caregivers, and other family members; work with transport unions, social entertainment clubs, and market group associations that have access to large populations of out of school youth; promote mutual fidelity, and build self-esteem and confidence. PF and PEs will hold discussions with their peers focusing on prevention for positives during one-on-one and group discussions in support group meetings. Positive pregnant women will be counseled and referred to PMTCT centers like activities #6706, #6768, #6699. Community-wide prevention activities will involve dissemination of messages on prevention and stigma reduction during wedding receptions, naming ceremonies, age grade meetings, rallies, and youth clubs activities such as celebration of solidarity days. Existing media materials on prevention will be adapted and reproduced for distribution during the events.

COP 07 includes funding to the Anglican Church Nigeria Communion AIDS Control Program, Church of Christ in Nigeria, Association of Women Living with HIV/AIDS and National Supreme Council on Islamic Affairs through Ummah Support Group as sub recipients.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Condom and other prevention activities of Positive Living will contribute to PEPFAR 5 year strategic plan for Nigeria by reaching 300,000 persons with information and services on correct and consistent use of condom enhancing their abilities to adopt risk reduction measures that will contribute to averting new HIV infections. Nigeria has quite a number of discordant couples. PL will focus on keeping the negative spouse negative by teaching and encouraging couple to use condoms consistently and correctly. PL will focus on hard to reach populations for cultural or infrastructural reasons; and will therefore have a profound impact on underserved populations.

LINKS TO OTHER ACTIVITIES

This activity also relates to activities in HVCT (#6702, #6772), HBHC (# 6708, #6770, #6675), HTXS ( #6703, #6766, #6715, #6678) HKID #( #6701, #6771, #6679), HVAB (#6733, 6684), HVLAB (# 6709, #6767, #6680, 6716), PMTCT (#6706, #6768, #6699).

Government of Nigeria sites to improve access to HIV related services to underserved rural communities; Federal Ministry of Health (FMoH) and UNFPA for the purchase of female condoms. Linkages between peer educators, community health workers, religious leaders, and clergy, will be promoted.

TARGET POPULATIONS HVOP will be focused on most at risk populations of long distance truck drivers, migrant workers, out of school youth, people who are living with HIV/AIDS (PLWHA) and clients of commercial sex workers sexually active men, women, adult girls and boys in the general population. Prevention for positives will be a big feature targeting mainly discordant couples. Pregnant positive women will be mobilized and referred for PMTCT services.

KEY LEGISLATIVE ISSUES Key legislative issues addressed will include increasing gender equity in HIV programs; promote male norms and behaviors that encourage HIV prevention. Violence and coercion will reduction will be addressed through couple counseling for disclosure and collaboration with legal aid clinics.

EMPHASIS AREA Commodities procurement and supply particularly of female condoms will be an area of emphasis including Community mobilization; demand creation for HIV related services and training.

WRAP AROUND SERVICES The provision of other family planning and reproductive health services will complement the promotion of prevention particularly for positives.

ACTIVITY DESCRIPTION: This activity also relates to activities in HVCT (#6702, 6772), HTXS ( #6703, 6766, 6715,6678), HKID (#6701, 6771, 6679), HVOP (# 6735, 6707), HVAB (# 6733, 6684), HVLAB (# 6709, 6767, 6680, 6716), PMTCT (# 6706,6768, 6699) and TBHIV (#6700, 6765).

In COP07, Positive Living (PL) will provide community/home based palliative care (CHB-PC) services to 67,013 people living with HIV (PLWHACHB-PC will be implemented in 48 sites located in; Anambra, Edo, Federal Capital Territory (FCT), Lagos, Cross River, Kano, Akwa Ibom, Enugu, Kogi, Niger (Global HIV/AIDS Initiative Nigeria (GHAIN) states) , Bauchi and Rivers states (PL comprehensive sites). Services to be provided include: 30% effort on basic nursing care, assessment of signs and symptoms (including pain), prevention of malaria and opportunistic infections (OIs), palliative care medications, nutritional assessment; psychological care including adherence counseling, pain control; 20% effort on basic laboratory services; and 50%effort on Home Based Care (HBC) and Training, referral support for advanced management and ART.

CEDPA will implement the standardized GON/USG basic care package that will include; basic medical assessments of signs and symptoms, routine basic nursing care, nutritional assessment and counseling, identification of danger signs of common OIs, and referral for treatment, psychological and spiritual counseling, and referral to social services for education, food assistance and counseling and make appropriate referrals.. A basic care kit (consisting of ORS, ITN, water guard, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline, and GV) will be provided and when needed in accordance with the National PC guidelines and USG PC policy

Activities will be implemented at 2 levels: in GHAIN sites PL will support 52,503 clients with home-based care services and will be referred to GHAIN supported health facilities for HIV testing, ART, OI management and laboratory investigations. In the Rivers and Bauchi (8 comprehensive sites), PL will offer comprehensive palliative care services to 14,510 clients. We estimate that 20,104 (30% of 67,013) will require home-based nursing care. Of the 14,510 clients that will receive comprehensive palliative care, 5,000 will be from Bauchi, 3,420 from Rivers, and 1,000 from each of the GHAIN states. Affected family and community members are the secondary beneficiaries;

PL activities will involve health care providers at facility, community and home based levels( PLWHA, volunteers and family care givers) through 2 complementary approaches: outreach HBC volunteer program and the complementary medical services at referral centers based at community health posts including Primary Health Centers (PHC); support 20 community-based clinical facilities which will be upgraded to handle OI management, basic laboratory and prophylaxis services for PLWHA; train a total of 2,250 CHB-PC workers and 10,200 family members who will be given basic skills to provide continuous care and support. HBC volunteers will make regular home visits to PLWHA and their families providing HBC services. Medically qualified care coordinators will attend to and prescribe anti-biotics, start IVs, supervise volunteers who will be assigned designated care areas of operation to a maximum of 10 clients per volunteer. Through GHAIN, PL will collaborate with Howard University to train, community pharmacists, and trainers who will further train outreach workers (community health extension workers and patent medicine vendors).

SOPs, training manuals and materials will be adapted and updated to address identified gaps; ELICO maps model will be adopted to help HBC volunteers keep track of the individuals and families they visit, and follow-up. Community volunteers and PLWHAs will work as conduits to their families, support groups and communities for improved service delivery and reach out to the vulnerable people like orphans and widows.

CONTRIBUTIONS TO OVERALL PROGRAM AREA The planned community/home-based palliative care interventions will contribute to the overall C&S PEPFAR goal of mitigating the consequences of the epidemic by reaching 67,013 individuals with basic care and support services. PL working with Nigerian stakeholders, at all levels, (national, state, and local) will contribute to the sustenance of the interventions by helping to strengthen community systems to improve quality care for PLWHA and their families, build community-capacity to deliver palliative care by training a total of 2,250 community owned resource persons; and 10,200 family members, to care

and support PLWHA in their communities.

LINKS TO OTHER ACTIVITIES PL will establish strong linkages with USG partners in particular GHAIN, GoN and other stakeholders to provide a comprehensive care and support package for PLWHA and their families; establish linkages between HVCT (#6702, 6772) centers and care outlets to improve utilization of HTXS ( #6703, 6766, 6715,6678)services, enhance community participation in care for PLWHAs, and ensure quality of services. Wrap around activities including; social services, food and education assistance, and livelihood opportunities will be supported through referral linkages. In each of the states PL activities will be linked to prevention activities HVOP (# 6735, 6707), HVAB (# 6733, 6684),) as an integral part of the community-based palliative care program. As part of the services offered by HBC workers, linkages will be established with TB/HIV interventions TBHIV (#6700, 6765), PMTCT services (# 6706, 6768, 6699) and facilitate links to OVC (#6701, 6771, 6679), services in the communities.

POPULATIONS BEING TARGETED: The primary beneficiaries for the PL palliative care services are PLWHA, with an emphasis on women. Training will target community home-based care volunteers, family, members, professional health care workers, and CHEWS. Men will be targets for greater male involvement in CHB-PC.

KEY LEGISLATIVE ISSUES: through evidence based advocacy PL will advocate for reduced stigma and discrimination at all levels. This in turn will improve PLWHA quality of life and increase acceptance within the communities; PL interventions will encourage increased gender sensitivity in programming by targeting vulnerable young girls and women as well men involvement in care and support. PL will work with legal aids initiatives to develop as legal framework that will uphold the rights of people discriminated against as a result of HIV and AIDS such as widows, children and homosexuals.

EMPHASIS AREAS: Most of the activities have less than 50% effort/emphasis, the highest of these being training human resources, commodities supply and community mobilization.

The PLUS-UP funds will be used to: expand to 4 service outlets in 2 states - Taraba and Adamawa; train 350 community health workers; reach 7,000 PLWHA with home-based palliative care and 2,000 with comprehensive PL services; 500 PLWHA and their families with micro-credit finances.

ACTIVITY DESCRIPTION: In COP07, Positive Living (PL) is implementing a two pronged TB/HIV palliative care services: 1) CEDPA will provide comprehensive TB/HIV care services in 3 states- Imo, Benue and Bauchi reaching 200 PLWHA; and 2) home/community-based TB/HIV treatment care and support and referral for 4,108 PLWHAS in 11 GHAIN supported states- Anambra, Edo, Federal Capital Territory (FCT), Lagos, Cross River, Kano, Enugu, Kogi, Niger, Adamawa and Taraba. PL will therefore provide a total of 4,308 PLWHA with TB/HIV care and support services in a total of 24 sites located in 14 states. The TB/HIV component of Positive Living (PL) will address the increasing TB case load among HIV positive persons by increasing access to treatment and improving treatment outcomes. This activity will link TB and HIV prevention, care and treatment activities at the community and primary care level. All TB/HIV clients reached by CEDPA under the GHAIN arrangement will be counted as indirect targets.

The 24 CBOs will contribute to TBHIV care in the following ways: 1) Provide treatment support services through out treatment until cure; 2) Provide patient family and community education on TBHIV co-infection; 3) Complement case finding efforts of traditional facility based TB treatment programs; 4) Increase accountability of local health services to the community; 5; Lobby the state and local authorities for increased commitment to TBHIV control. 1,200 community health workers, home based care volunteers and peer educators will be trained to provide TB/HIV education, care and support including adherence to TB treatment regimens; family members (2 per PHA) will be given basic skills to provide continuous care and support. Four pilot community-based clinical facilities will be supported to handle TB management, basic laboratory and community services for HIV positive persons. This activity will ensure that 800 HIV positive persons and their family members are referred and supported to access routine screening for TB. It is anticipated that 200 HIV positive persons will require treatment for TB. Co-infected TB/HIV patients will be linked to medical services at GHAIN, other USG-funded health care facilities and DOTS centers. Communities will have increased knowledge on prevention and control of TBHIV and increased capacity to provide care and support for dually infected patients.

Partners and family members of HIV/TB patients will be counseled and referred for TB screening and linked to appropriate care and support services. TB/HIV activities will be integrated into ongoing palliative care program (HBHC #9839) and prevention programs (HVAB, and HV0P). HBC volunteers will be trained to recognize TB symptoms and danger signs, proper referral of PHAs for TB screens and treatment, home-based nursing care, infection control, follow-up and adherence counseling. Standard operating procedures, training manuals and IEC materials will be adapted and updated; ELICO maps model will be adopted to help HBC volunteers keep track of the individuals and families they visit, and follow-up. Project activities will be properly documentation at every stage of implementation.

Reprogramming 9/07: CEDPA will provide non-clinical services for each OVC supported by GHAIN in those communities where the two projects are active. The targets will be attributed to GHAIN, but the activity narratives will reflect that 2050 OVC will received $100 each of community oriented supports through CEDPA's activities.

ACTIVITY DESCRIPTION The Positive Living (PL) Orphans and Vulnerable Children (OVC) activity is a new activity that has come with the Plus Up funding. The PL OVC activities will follow guidelines set by the Nigerian OVC National Plan of Action and OGAC OVC Guidance to improve the quality of life of OVC in selected states in Nigeria. PL will identify and register OVC through a participatory assessment involving communities and the PHAs already enrolled in the PL. This assessment will also help to categorize problems faced by OVC their families and communities as well as current coping strategies. PL will provide definitions of the process of assessment and skills needed by the OVC within Nationally approved guidelines including the use of the National OVC vulnerability index developed by the GON to focus on the best interest of the child. The OVC component will support 1000 OVC with formal education, vocational training, basic health care, community engagement and opportunities to express themselves in their communities through a family centered approach. OVC will be reached in their homes and communities to maintain stability, care, predictability and protection. PL will work with already existing structures within the HBHC (#9839) component of to reach OVC. PL will collaborate with other stake holders such as the Federal Ministry of Women Affairs and Social Development, their State counterparts and other OVC stakeholders including the USG and their IPs in 4 states - Bauchi, Cross River, Edo and Kano for synergy.

Formal agreements will be made through negotiation with GoN and Faith-based organizations like the Church of Nigeria Anglican Communion AIDS Control Program (ACAP) and the Nigerian Supreme Council for Islamic Affairs (NSCIA) to place OVC especially girls in selected primary and secondary schools. PL will contribute some over head towards running the school in exchange for free tuition and the provision of other educational materials (uniforms, books) for OVC. Members of the Parents/Teachers Association (PTA) will be supported to recognize and respond to the academic needs of the OVC, support PTA levy waivers and provide psychological support. Children out of school, particularly those who are heads of households caring for sick parents and their siblings, will be facilitated to attend evening classes within the community; others will be enrolled for vocational training. OVC that complete vocational training will be given seed grants to purchase equipment as capital investments. PL in collaboration with Christian Aid and AIM Project will adapt a curriculum that equips OVC with life skills and age appropriate HIV/AIDS and sexuality/reproductive health information. PHA from support groups engaged by HBHC (#9839) will act as models for living positively and demystifying stigma and discrimination. Peer facilitators from PL prevention programs (HVOP, HVAB) will mentor and guide the children by counseling and engaging them in physical and social activities. The youth volunteers already trained by PL, will provide HIV/AIDS prevention information that focus on abstinence and be-faithful messages to their colleagues and siblings. Age appropriate prevention messages and education to prevent abuse will be shared. Sexually active youth will be provided with appropriate information on prevention and treatment of STIs. The children will be supported to share their acquired skills and knowledge with peers and siblings.

Two hundred (200) caregivers of OVC will be selected and trained to provide psychological and spiritual support to OVC; pediatric treatment adherence, nutrition counseling, diet and food preparation techniques; communicating with children and support healthy life decisions. Caregivers will be linked with USG supported sites to access other services for OVC. Caregivers will be given seed grants to set up group income generation activities to augment their household income, transportation to access services and support for OVC staying in schools and vocational trainings. HBC volunteers will be trained to carry out OVC related services such as to promote birth registration, nutritional assessments and counseling, monitoring immunization status of infants, support supervision of the caregivers and monitor OVC while assisting youth headed households in maintaining their homes. They will refer OVC for treatment of ailments, immunization, child welfare and wraparound services. Every HIV+ child will be given a preventive basic care kit. PL will negotiate for subsidized/free medical care for OVC at GoN and private health facilities not supported by the USG. HIV+ children will receive OI prophylaxis and linked to GHAIN, GoN and other USG sites for pediatric ART and treatment for advanced opportunistic

infections.

CONTRIBUTION TO OVERALL PROGRAM AREA The planned OVC interventions will contribute to the overall C&S PEPFAR goal of mitigating the consequences of the epidemic by reaching 1000 OVC with care and support services. PL working with all stakeholders, at all levels, (national, state, and local) will contribute to the sustenance of the interventions by helping to strengthen community systems to improve quality care for OVC, build community-capacity to of 200 caregivers to support OVC by training and providing seed grants.