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.
The Lift Above Poverty Organization LAPO Health and Partners Fight Against HIV/AIDS (LIFT) program is
envisioned as a 3-year $8 million partnership between LAPO Health and Partners for Development (PfD).
Together with local implementing agencies, the LIFT program will build a sustainable platform for HIV
prevention activities and provide direct service provision to orphans and vulnerable children (OVC) through
support groups of people living with HIV/AIDS (PLWHA) and OVC and their caregivers. The program will
train 500 individuals in promoting HIV/AIDS prevention through abstinence and/or being faithful (A&B).
LIFT's focus on HIV prevention and care for orphans addresses both causes and effects of the HIV
epidemic in Nigeria. HIV prevalence rates remain high due in part to risky and trans-generational sexual
practices. Many youth, especially young women, engage in transactional sex, and women head of
households often turn to commercial sex to support their families. There are three major target groups for
LIFT activities; PLWHAs, OVC caregivers and other affected persons, and OVCs. An anticipated 18,045
(7,000 male, 11,022 female) will be reached through community outreach that promotes HIV/AIDS
prevention through A&B. Through HIV prevention and micro credit activities to adult PLWHA and OVC, LIFT
will mitigate the role of poverty in increasing HIV/AIDS prevalence.
HIV prevention efforts have in the past primarily focused on HIV-negative individuals; however, changes in
the risk behaviors of HIV-infected individuals are likely to have larger effects on the spread of HIV than
comparable changes in the risk behaviors of HIV-negative individuals. These "Prevention for Positives"
efforts aim to prevent the spread of HIV to sex partners and infants born to HIV-infected mothers, as well as
to protect the health of infected individuals. Helping people living with HIV adopt safer behaviors is an
important part of a comprehensive prevention approach. Recognizing that HIV/AIDS care and treatment
settings serve as strategic entry points for reaching large numbers of HIV-infected people, in COP 09, LIFT
will continue to support a clinic-based, provider-delivered intervention to help HIV-infected patients prevent
the spread of HIV to their sex partners and children, and to help them protect their own health. LIFT will at
the same time provide a community based approach linking PLWHA in the communities to services at the
facilities.
LIFT will continue reaching adults with age and situation-appropriate A&B and condom and other prevention
(C&OP) messages, as well as specific prevention messaging and services targeting HIV positive persons in
support groups. Economic strengthening and peer education will be the key interventions that will tie
together all other interventions in a support group. LIFT will use income generating activities as a platform to
expand the delivery of HIV/AIDS prevention messages while increasing household and community
resources available for the care and support of PLWHA and OVC. Using grants to its local implementing
agencies (IAs), LIFT will issue micro-loans to borrower groups of PLWHA for income generating activities
and grants for individuals to complete skills-acquisition training. The borrowers groups at the community
level will act as a PLWHA support group as well as providing support to each other in their business efforts.
These small groups will serve as a platform for HIV/AIDS prevention activities and referral services.
LIFT will provide training to healthcare providers in selected sites to provide routine care and treatment to
HIV-positive patients and deliver important health information and preventive medical care, such as
treatment for sexually transmitted infections (STIs) and some family planning services. Healthcare providers
will be supported to assess each patient's risk and give targeted prevention recommendations that
encourage sex partners to get tested, disclose their HIV status to sex partners, abstain from sex or reduce
the number of sex partners or fidelity to one partner, consistently use condoms during sex, be aware of the
potential consequences of having sex without a condom, reduce alcohol use as it affects adherence and
increases risky behavior, and to adhere to antiretrovirals and other medication.
In addition to the clinical based prevention with positives messaging and services, LIFT will work through
support groups to provide a community based intervention that, in tandem with the facility based
intervention will provide a continuum of care for PLWHA and persons affected by AIDS (PABAs). The
community based interventions within the support groups, in accordance with the National Prevention
Strategy, will provide AB and C&OP activities in an integrated manner to reach individuals with a minimum
of three strategies. LIFT's suite of strategies for its AB interventions will target PLWHAs and their partners,
older OVC, and other youth in their communities with community awareness campaigns that will include
rallies and interpersonal communication, and peer education models using age peers among OVC, other
youth, and PLWHA. A curriculum based approach using Early Start Support Groups (ESSG), Young Life
Support Groups (YLSG) or Teen Life Support Groups (TLSG), as appropriate will be adopted for OVC.
Essential life skills trainings will be provided as part of this curriculum. Activities that address vulnerability
issues, especially for PLWHAs and older OVC, such as microfinance and skills acquisition will also be
adopted.
C&OP strategies will include interpersonal communications, referrals to counseling and testing, condom
messaging and distribution, balanced ABC messaging as appropriate, peer education models around
PLWHAs, OVC and other affected people, use of support groups as condom service outlets, referrals to
medical services, and linkage to microfinance and skills acquisition. Under the supervision of prevention
counselors, PLWHAs will be trained as peer educators to provide information, including STI counseling and
referrals to medical services to their peers within their microfinance support groups. LAPO and its IAs will
coordinate HIV/AIDS activities in the support groups through the use of trained HIV/AIDS prevention
counselors who will serve as discussion facilitators and expert references on topics related to HIV/AIDS
prevention for each of the target audiences in the support groups in which they work. Prevention
counselors will mentor peer educators among the PLWHA and OVC caregivers, who will disseminate A&B
prevention messages broadly in the community and refer support group members to additional services,
including HIV testing and counseling, prevention of mother-to-child transmission (PMTCT) services for
pregnant members, and other services.
The activity will address HIV risks for OVC and other youth, OVC care givers, and prevention from re-
infection for PLWHAs.
Contributions to Overall Program Strategy. This activity will contribute to the Emergency Plan Five-Year
Strategy in preventing new HIV infections among most at risk populations and vulnerable youth, especially
Activity Narrative: OVCs, as well as their care givers. HIV prevention programming will target the primary vectors of the
epidemic (PLWHAs) with various strategies and services to meet their needs and engender behavior
change. It is hoped that successes recorded in addressing this target population directly will engender a
reduction in the rate of new transmissions and significantly help to contain and control the epidemic
This activity is linked to treatment, care and support
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Increasing women's access to income and productive resources
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
USAID Nigeria is negotiating a new award which will provide integrated HIV prevention programming for a
targeted most-at-risk population of men who have sex with men (MSM). As is the practice when making
new awards, OGAC will be informed when the award is ready, and the partner(s) and targets will be
uploaded into COPRS. The proposed program will build and strengthen institutional and technical capacity
of five local MSM organizations in the FCT, Lagos, Cross Rivers, Rivers and Kano states to deliver high-
quality comprehensive AB prevention programs and services targeting Men having Sex with Men (MSM).
Lagos and FCT will be targeted to start programs in COP 09 with expansion to Rivers, Kano and Cross
River state planned for later years.
Nigeria with national prevalence of 3.4% (FMOH 2007) and prevalence exceeding 5% in some states has a
concentrated epidemic. HIV/AIDS prevalence of 3.7%, 3.5%, 3.1% amongst transport workers, police force
and armed forces and with prevalence of over 30% among female sex workers (IBBSS 2007), reveals
unequal distribution among different population subgroups. The highest prevalence amongst high risk
groups including MSMs at 13.5% emphasizes the need to target this particular group with HIV sensitization
programs, prevention messages, and linkages to care and treatment. IBBSS 2007 revealed that half of the
MSM surveyed could not correctly identify ways to prevent sexual transmission of HIV. Over 70% used oil
based lubricants. Multiple sexual partnerships (insertive and receptive) are common among MSM while over
50% engaged in transactional sex. MSM were not more likely to have used condom at last transactional
anal sex with a man (58%) compared to a non commercial sex partner (53%). Only 34% of reporting MSM
have ever been tested for HIV in Nigeria.
The proposed program will deliver HIV services as well as undertake multiple level capacity development
approach to simultaneously respond to unmet need for prevention, community based care and support HIV
services to MSM in Nigeria. Past efforts have worked through rather with MSM grassroots organizations
and services were provided under umbrella of most at risk population.
The new partner in COP09 will focus on MSM populations with a minimum of three interventions in the 5
states mentioned above. Intervention strategies will aim at reducing number of sexual partners, promoting
consistent condom use in all sexual acts, encouraging the use of water based lubricants, providing
adequate treatment of STIs and offering sex education.
Specific activities will entail building the capacity of indigenous MSM organizations to provide high quality
prevention programming that will bring about effective behavior change as it relates to reduction of multiple
sexual partners and transactional sex as well as with messages promoting fidelity, encouraging partner
reduction through risk reduction messages and personal risk perceptions skills; utilization of Peer Outreach
& Community Mobilization activities, establishing Condom/lubricant outlets, Community Centers, Online -
outreach and web resources, conducting trainings/Events and IEC materials development.
Activities will also focus on male and female partners of MSM who are at high risk owing to contextual
factors, with messages refined for each group. Activities to prevent transactional sex or protect MSM
involved in transactional sexual relationships will focus on skills based HIV education for vulnerable young
women and young men with broad based community care and support activities that facilitate access to
treatment and adherence counseling services for MSM. These interventions will be reinforced with mass
media activities that highlight importance of mutual fidelity, risk behavior reduction and safe sexual
practices. The program will concentrate activities in areas that will be identified through secondary analysis
of national behavioral data generated through the project SEARCH and NARHS PLUS survey.
The MARP prevention program will in COP 09 build capacity of local MSM networks to provide the minimum
package intervention for the MSM population groups. Technically this will entail familiarizing the
organizations with the minimum package modules and adopting a program approach that ensures delivery
of the package as stated by the National Prevention Plan.
The project anticipates reaching 28,000 MSM with AB messages and services and 22,000 MSM with
community and facility services including adherence and prevention with positive services for identified
positive MSM utilizing minimum package interventions that provide comprehensive balanced prevention
interventions. 17 outreach coordinators and 70 Peer educators will be trained in COP 09 to MSM population
in Lagos and FCT.
The new partner will document and disseminate best practices; successful and innovative approaches with
lessons learned and share these with their implementing agencies as well as other partners within the
PEPFAR program in Nigeria. In COP 09, particular interest on lessons learned will focus on effective
approaches for improving organizational and technical capacity of local lesbian, gay, bisexual,
transsexual/men who have sex with men organizations.
Implementation will be through local organizations whose capacities will have been built by the prime and
have been identified to have capacity for rapid scale up. Within the initial 6 months of implementation,
capacity-building for provision of prevention (AB) services for the groups will be carried out followed by
development of IEC materials for MSM. The overall programmatic intervention will be in line with national
priority plan and national prevention plan.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
The programs and activities implemented will fill critical gap in the reach of HIV interventions into
epidemiologically important population to better address gaps in coverage and to better address specific
behaviors within underserved populations. This MARP prevention program, delivered through implementing
agencies whose capacity has been built, will contribute to strengthening and expanding the capacity of the
GON's response to the HIV/AIDS epidemic and increasing the prospects of meeting the Emergency Plan's
goal of preventing 1,145,545 new infections.
LINKS TO OTHER ACTIVITIES
The AB and C/OP activities implemented under the proposed activity will be linked with care and support
Activity Narrative: activities, as well as with the other prevention partners.
POPULATIONS BEING TARGETED:
Populations targeted in these activities will include MSM and their partners (male and female).
KEY LEGISLATIVE ISSUES ADDRESSED:
Key legislative issues will address increasing equity and access to information and services for MSM.
EMPHASIS AREAS:
The service delivery component will focus on information, education, and communication in the community
and will build linkages with other sectors and initiatives.
Table 3.3.03:
This activity also links with prevention programs.
quality integrated programs and services targeting Men having Sex with Men (MSM). Lagos and FCT will
be targeted to start programs in COP 09 with expansion to Rivers, Kano and Cross River state planned for
later years.
Nigeria has a generalized national prevalence of 3.4% (FMOH 2007) and some states, with prevalence
exceeding 5%, represents a more concentrated epidemic. The higher prevalence rates amongst high risk
groups (to include MSMs at 13.5%) emphasizes the need to target this particular group with HIV
sensitization programs, prevention messages, and linkages to care and treatment. IBBSS 2007 revealed
that half of the MSM surveyed could not correctly identify ways to prevent sexual transmission of HIV. Over
70% used oil based lubricants. Multiple sexual partnerships (insertive and receptive) is common among
MSM while over 50% engaged in transactional sex. MSM were not more likely to have used condom at last
transactional anal sex with a man (58%) compared to a non commercial sex partner (53%). Only 34% of
reporting MSM have ever been tested for HIV in Nigeria.
Activities will focus on skills based HIV education for vulnerable young men with broad based community
care and support activities that facilitate access to treatment and adherence counseling services for HIV
positive MSM. The program will concentrate activities in areas that will be identified through secondary
analysis of national behavioral data generated through the project SEARCH and NARHS PLUS survey. The
package of care services provided to each PLWHA will include referrals for the provision of clinical services
with selected partner clinics that have been sensitized to the particular needs and concerns of sexual
minority groups. The program will also provide tailored supportive services including psychological,
spiritual, and prevention with positive activities delivered at the facility, community, and household (home
based care) levels in accordance with the PEPFAR and national care and support policies and guidelines.
While the overall project anticipates reaching 22,000 MSM with community and facility services including
adherence and prevention with positive services for identified positive MSM utilizing minimum package
interventions that provide comprehensive balanced prevention interventions.
behaviors within underserved populations. This MARP prevention and care program, delivered through
implementing agencies whose capacity has been built, will contribute to strengthening and expanding the
capacity of the GON's response to the HIV/AIDS epidemic and increasing the prospects of meeting the
Emergency Plan's goal of preventing 1,145,545 new infections.
The care and support activities implemented under the proposed activity will be linked with AB and C/OP
activities, as well as with the capacity building and policy related partners.
The service delivery component will focus on referrals, counseling and psychosocial supports as well as
treatment adherence guidance information and communication in the community and will build linkages with
other sectors and initiatives.
* Increasing gender equity in HIV/AIDS programs
Table 3.3.08:
