ACTIVITY UNCHANGED FROM FY 2009

ACTIVITY DESCRIPTION

The rate of economic growth in Sub-Saharan Africa has fallen by as much as four percent because of AIDS, and labor productivity has dropped 50% in the hardest hit countries. Some Sub-Saharan African countries will see a drop of 25% in their workforce by 2020 due to AIDS, and in some countries AIDS is already costing employers over 20% of their total earnings. HIV/AIDS is heavily impacting upon the workforce and the national and state economies of Nigeria. Nigeria's burden of care related to HIV and AIDS now ranks third in the world.

Nigeria, with a national HIV prevalence of 4.6% (HSS 2008) and HIV prevalence exceeding 5% in some states, would be characterized as having a concentrated epidemic. While Nigeria's prevalence is lower than its neighbouring countries, it nonetheless represents a higher number of infections, given the large population, Nigeria now has the highest number of HIV/AIDS -infected adults in West Africa and faces many challenges in tackling the epidemic, including poverty, lack of prevention, knowledge, lack of female empowerment, the vulnerability of youth with 60% of the population under 24, and strong stigma and discrimination against people living with and affected by HIV and AIDS.

HIV/AIDS is heavily impacting upon the workforce and the national and state economies of Nigeria. Nigeria's burden of care related to HIV and AIDS now ranks third in the world. With 66 million individuals participating in Nigeria's public and private sector labor force, the workplace is an ideal setting for effectively addressing HIV/AIDS through sensitization programs, prevention messages, and linkages to care and treatment for a large percentage of Nigerians infected and affected by HIV.

Since 2001, with initial funding from the US Department of Labor, AED implemented the SMARTWork Program in Nigeria to support workplace HIV/AIDS prevention education programs at the enterprise and national levels. Under the current USAID's PEPFAR project, AED is working in partnership with Nigerian Business Coalition Against AIDS (NIBUCAA) and five labor unions - the National Union of Chemical Footwear, Rubber, Leather and Non-Metallic Products Employees (NUCFRLANMPE), the National Union of Textile Garment & Tailoring Workers of Nigeria (NUTGTWN), the National Union of Road Transport Workers (NURTW), the National Union of Petroleum and the Natural Gas Workers (NUPENG), and the Senior Staff Association of Nigerian Universities (SSANU) to expand HIV/AIDS workplace anti-stigma and discrimination training, Abstinence, Be Faithful, and Condom (ABC) sensitization programs and HCT service delivery across sixteen states..

The overall goal of USAID/Nigeria - SMARTWork Program is to expand access to comprehensive high- quality prevention, care and support services to the working population by increasing local indigenous groups' capacity to implement these services in Nigeria while its objectives are:

1. To increase the technical, organizational and managerial capacity of local partners to deliver high quality HIV prevention, care and support services 2. To engage multiple public and private sector employers, including small and medium enterprises (SMEs) to develop and implement workplace HIV prevention programs 3. To promote healthy behavior change using workplace interventions to reduce the transmission of HIV/AIDS 4. To increase the uptake and accessibility of high-quality HIV counseling and testing (HCT) services through workplace (mobile and fixed) and government facilities. 5. To ensure greater uptake of care and treatment services through effective referral networks.

With the ultimate goal of sustainability and building partners' systems, a management and infrastructural audit of partners was conducted through the administration of a management questionnaire. Findings indicated that a lot of challenges bewildering the partners include lack of technical skill and competency, weak infrastructure, poor management information systems, absence of audit report and weak financial base to adequately support workplace HIV/AIDS programs. AED will continue to provide technical and organizational capacity building support in COP2010 to ensure that project partners have the systems

and technical expertise that clearly meets US government regulations, that each partner passes external audits and will have the ability to effectively compete for, and access, a US government funded agreement.

AED will continue to work with NIBUCAA and the unions to identify and prioritize critical capacity gaps and needs, as well as strengths and develop organizations specific capacity building targets and objectives in the action plans and periodically evaluate progress towards meeting objectives. Further efforts will also be made to strengthen the ability of the partners to conduct prevention and HCT scale up activities through direct technical assistance, mentoring during regularly conducted site visits; ongoing supervision; meetings to share lesson learned, problem solve and plan future activities.

In COP 2010, HTC strategies will continue to focus on providing HTC services for workers and their families and linking those who test positive to care, treatment and other appropriate HIV/AIDS services. AED will provide HTC services through two mobile HTC units, seven enterprises' clinics and six regional public hospitals. AED/SMARTWork will coordinate capacity building, infrastructure improvements and logistics management information systems (LMIS) in HTC sites to ensure quality service provision. Linkages will also be established and strengthened with other service providers in the referral network to ensure a continuum of care for HIV positive clients and families.

In partnership with NIBUCAA and five labor unions, the project will provide two models of HTC (client and provider-initiated HIV testing and counseling) implemented according to national testing protocols. AED and NIBUCAA will jointly manage and directly implement the HTC component of the project while the unions will mobilize workers and their families to access services. Additionally, AED will assist in tracking referrals of positive workers and family members into care and support.

In COP 2010, AED/SMARTWork will focus more on reaching the target populations with a minimum of three interventions in the workplace. Intervention strategies will promote sexual prevention through abstinence for unmarried individuals and fidelity for married individuals and those in long-term sexual partnerships. The risk and vulnerability of the target groups to HIV are propelled by behaviors like multiple sexual partnerships, drug/alcohol use and demographics associated with high mobility and long periods away from their families, limited access to health care services and condom availability. In addition, lack of information about risky behavior, risk perception and risk personalization may inadvertently put them at risk of STIs including HIV.

In COP 2010, SMARTWork partners (NIBUCAA, NUPENG, NURTW, NUTGTWN, SSANU and NUCFRLANMPE) will target employees and their family members with HIV prevention interventions on abstinence and/or being faithful and condoms; 75,000 individuals will be reached with HIV prevention

interventions that are primarily focused on abstinence and/or being faithful and 10,000 individuals with other HIV prevention interventions. AED will strengthen interactions and key referrals between health care facilities and the community as part of sexual prevention activities in the workplace programs. AED will work with the unions, the SMEs and enterprises to identify the right strategy and mix of interventions pooling from a broad range of identified best practices.

NIBUCAA conducted participatory needs assessment with each of the participating SMEs in COP 2009 prior to the launch of programmatic activities. AED and NIBUCAA will continue to provide technical support to all 85 enterprises (35 large enterprises and 50 SMEs) and financial support to the SMEs for workplace HIV prevention program implementation in COP 2010. AED and NIBUCAA will initiate and sustain regular meetings, promote resource and tool sharing and discuss barriers faced in program implementation with networks of individuals across SMEs. Each enterprise will conduct at least 1 community outreach during the period.

AED will continue to support partners through the process of condom procurement and storage, along with establishing stronger collaboration with Society for Family Health to ensure a consistent condom supply for 50 condom outlets established in COP 2009. AED will also provide necessary guidance to NIBUCAA and the five unions on distribution of relevant IEC/BCC materials to reinforce messages on abstinence, faithfulness and /or consistent and correct condom use. Dissemination strategies include distribution of materials at workshops, seminar, company-level presentations, special events like World AIDS Campaign, Workers Day, and integration of HIV/AIDS preventive messages into workplace newsletters, journals and other periodicals.

AED's workplace project is well positioned to address the unique needs of men and women in preventing and dealing with HIV. Gender plays an integral role in determining an individual's vulnerability to HIV infection, his or her ability to access care, support or treatment and the ability to cope with HIV when infected or affected. In Nigeria, HIV transmission and negative impacts of HIV in the country are fuelled by various factors that include gender inequities. The inequities are often not acknowledged or recognized, and, combined with other factors, poses a significant challenge in HIV programming in the workplace. Given the critical relationship between gender and effective HIV prevention, it has become imperative to incorporate gender considerations into workplace HIV programming.

Women are an increasing part of the formal workforce in developing countries and account for 61.5% of the adults living with HIV in Nigeria. Women and young girls are subject to all forms of sexual abuse, rape, forced sex and intimidations. They are sometimes infected as a result of gender-based violence in the workplace and elsewhere. Workplace education programs need to include gender-balance and gender-sensitive information both male and female workers, sometimes provided in separate sessions.

Female workers should have equal access to prevention education, care and support services. Efforts to attain gender equity in all aspects of the workplace include:

• Advocacy / lobbying initiative to spark policy changes to women empowerment via greater involvement in decision making concerning gender issues in workplaces. • Advocate for active participation of female representatives in HIV/AIDS committees, policy development, implementation and monitoring of individual enterprise HIV/AIDS programs. • Integrate gender sensitive HIV/AIDS prevention programs into every enterprise's HIV/AIDS activities. • Enhance the educational campaign targeted to labor unions, employers and government agencies to mainstream relevant gender issues in their workplace HIV/AIDS activitie • Promote female controlled methods such as female condoms that offer women more control in negotiating safe sex as well as prevention of STI including HIV and unplanned pregnancy.

AED will continue to work with the Federal Ministry of Labor, National Agency for the Control of AIDS, Nigeria Labor Congress and the Nigeria Employers' Consultative Association on advocacy and capacity building initiative to ensure that workplace effectively address the concerns of different at risk and vulnerable groups, sensitively address issue of stigma and discrimination and effectively monitor and evaluate their programs.

LINKAGES WITH OTHER PEPFAR ACTIVITY SMARTWork will continue to collaborate with other organizations including Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), GHAIN for care and treatment especially ART and PMTCT; Society for Family Health on condom logistics, the Supply Chain Management System project on HIV test kit logistics, JSI/MMIS on safe injection techniques for health workers in workplace clinics and regional hospitals.

POPULATION TARGETED The populations targeted are the Nigerian working population and union members.

KEY LEGISLATIVE ISSUES ADDRESSED Working with enterprises to develop effective policies will lead to an increased understanding of workplace HIV/AIDS prevention efforts and will assist in removing barriers toward HIV/AIDS prevention through ensuring workplace protection and guaranteed human rights of workers infected and /or affected by HIV/AIDS. AED hopes to work with other organizations to work on the National Assembly to pass the anti-stigma law.

COP 2010 PEPFAR ACTIVITY TARGETS:

PEPFAR Indicator P8.1.D: Number of the targeted population reached with individual and/or small group level preventive interventions that are based on evidence and/or meet the minimum standards required (10,000 individuals will be reached with individual and/or small group level preventive interventions that are based on evidence and/or meet the minimum standards required in COP 2010)

PEPFAR Indicator P8.2.D: Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required (75,000 individuals will be reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required in COP 2010)

PEPFAR Indicator P10.1.D: Number of enterprises implementing an HIV/AIDS workplace program, providing at least one of the 4 critical components (25 enterprises will implement HIV/AIDS workplace programs, providing at least one of the 4 critical components)

PEPFAR Indicator P10.2.D: Estimated number of people reached through work place programs (85,000 people will be reached through work place programs in COP 2010)

PEPFAR Indicator P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results (20,000 individuals will receive Testing and Counseling (T&C) services for HIV and their test results in COP 2010)

PEPFAR Indicator H2.3.D: Number of health care workers who successfully completed an in-service training program (60 health care workers will successfully complete an in-service training program on HTC in COP 2010)

None

None

ACTIVITY UNCHANGED FROM FY 2009

ACTIVITY DESCRIPTION:

In COP 2010, AED will continue to focus on strategic HIV prevention interventions targeted at reaching specific workplace populations. AED's activities (abstinence and/or being faithful) under sexual prevention are designed to support prevention among working adults and equip them with the skills and

information to promote prevention with their children and partners. AED/SMARTWork will focus more on reaching the target populations with a minimum of three interventions in the workplace as outlined in Nigeria's National Prevention Plan. Intervention strategies will promote sexual prevention through abstinence for unmarried individuals and fidelity for married individuals and those in long-term sexual partnerships.

Nigeria, with a national HIV prevalence of 4.6% (HSS 2008) and HIV prevalence exceeding 5% in some states, would be characterized as having a concentrated epidemic. With 66 million individuals participating in Nigeria's public and private sector labor force, the workplace is an ideal setting for effectively addressing HIV/AIDS through sensitization programs, prevention messages, and linkages to care and treatment for a large percentage of Nigerians infected and affected by HIV/AIDS.

IBBSS 2007 revealed that among predominantly male occupational groups (transport workers, armed forces and police), multiple partnerships are quite common while condom use with girlfriends was lowest with police (45%) and transport workers (45.4%). Although syphilis levels were low across the board (0.8%), the prevalence was highest among transport workers (1.7% according to the 2007 IBBSS). To reduce risky behavior, SMARTWork will continue to work with the National Union of Road Transport Workers (NURTW) including their motorcycle riders' unit who are predominantly youths to provide their members with HIV prevention interventions. Stereotypical characteristics of the workplace target audience include male dominance, physical strength, virility, and risk taking. Other associated risk factors, such as drug and alcohol use, play a role in diminishing inhibitions, and contribute to unsafe sexual behavior and sexual violence. The risk and vulnerability of the target groups to HIV are propelled by behaviors like multiple sexual partnerships, drug/alcohol use and demographics associated with high mobility and long periods away from their families, limited access to health care services and condom availability. In addition, lack of information about risky behavior, risk perception and risk personalization may inadvertently put them at risk of STIs including HIV.

AED will continue to pursue interventions that encourage youth to delay sexual debut till marriage, engage in secondary abstinence and reduce sexual risk taking while recognizing that abstinence is the only certain way to avoid sexually transmitted HIV infection. Interventions targeting sexually active adults at higher risk of HIV-infection will encourage behavior change to reduce the number of sexual partners (especially casual sexual partnerships) and promote marital fidelity. AED will reach out to PLHAs through promotion of their enrollment in and adherence to ART programs and/or promoting abstinence and consistent condom use with sexual partners to prevent re-infection.

In COP 2010, SMARTWork partners (NIBUCAA, NUPENG, NURTW, NUTGTWN, SSANU and NUCFRLANMPE) will target employees and their family members with HIV prevention interventions on

abstinence and/or being faithful; 75,000 individuals will be reached with HIV prevention interventions that are primarily focused on abstinence and/or being faithful. AED will strengthen interactions and key referrals between health care facilities and the community as part of sexual prevention activities in the workplace programs. AED will work with the unions, the SMEs and enterprises to identify the right strategy and mix of interventions pooling from a broad range of identified best practices.

AED will conduct community/enterprise awareness campaigns to clarify strategies and activities of the SMARTWork approach and educate the management of each enterprise. These meetings will take place prior to launching program activities in each establishment, in order to build awareness of HIV/AIDS issues and to answer any concerns participants may have. Enterprises and unions will be encouraged to undertake HIV/AIDS program outreach activities for their individual host communities where the enterprise is domiciled and reach out to the workers' family members with necessary information and education on HIV/AIDS. Capacity building activities may vary based on individual partner/enterprise needs but AED will support each enterprise and partner to conduct a series of two-day seminars for the community on abstinence and being faithful, interpersonal communications, community mobilization methods, peer education strategies and linking programs with counseling, testing and care and treatment centers as well as efforts at partner reduction and mutual fidelity Each enterprise will conduct at least 1 community outreach during the period.

AED/SMARTWork will continue to support each partner enterprise to establish a team whose members represent various aspects of the workplace and who share a commitment to addressing HIV/AIDS, with skills to "sell" the program to others in the workplace. The planning committee will include men and women from different departments and levels, as well as workers living with HIV/AIDS. The joint management-labor committee ensures that differences are taken into account and policies and programs can be developed that work for all areas of the workplace. AED will provide assistance in identifying the appropriate persons to represent the diverse interests and needs of workforce. In addition, AED will conduct a three-day capacity building training for members of the HIV/AIDS Planning Committee. The training will include all aspects of HIV/AIDS policy and program development and equip committee members with ability to play leading role in the management of the enterprise's HIV/AIDS workplace program.

AED will continue to provide technical support to the HIV/AIDS Planning Committee members of the enterprises to sensitize all the employees in the company's key locations about basic HIV/AIDS prevention and transmission information, voluntary counseling and testing, workplace issues related to stigma and discrimination, and mainstreaming HIV programs into workplace.

Peer educators will continue to conduct informal education and training activities for their co-workers.

AED will provide technical assistance to enterprises and unions in selecting appropriate staff to participate in a three-day peer educators training promoting HIV prevention through abstinence and/or being faithful. A proportion of staff in ratio of 10:1 peer educators will be reached through informal small groups and one-on-one interactions to discuss HIV/AIDS, teach safer sex practices, answer questions, distribute materials, and generally foster an environment of greater awareness and understanding about HIV/AIDS.

AED will continue to provide necessary guidance to NIBUCAA and the five unions on distribution of relevant IEC/BCC materials to reinforce messages on abstinence, faithfulness and /or consistent and correct condom use. AED will continue the distribution of extensive catalogue of behavior change tools and materials for the workplace that enables immediate implementation of activities and important leveraging of existing resources for use by the workers. Dissemination strategies include distribution of materials at workshops, seminar, company-level presentations, special events like World AIDS Campaign, Workers Day, and integration of HIV/AIDS preventive messages into workplace newsletters, journals and other periodicals.

AED/SMARTWork will continue to encourage parents to be active supporters of youths' health choices by addressing adults' knowledge, attitudes, communication and other parenting skills; and be part of an integrated approach in promoting a healthy lifestyle for young people. Youth focused awareness creation activities including lectures, drama and mascot will focus on behavior change, risk reduction and adoption of safer sex practices. AED will further assist the enterprises' developmental initiatives such as enterprise family days. Family days are often employer-sponsored events for employees to gather together with their families to celebrate the enterprise's yearly performance. During these family day events, trained peer educators will conduct HIV/AIDS education activities. AED will work with the partners to assist the HIV/AIDS Planning Committees at each enterprise level to make substantial input into the planning and implementation of the family days.

Greater Involvement of People Living with HIV/AIDS (GIPA) is critical to halting and reversing the HIV epidemic in Nigeria, AED-SMARTWork therefore will mainstream GIPA into workplace HIV/AIDS programs. Additionally, PLWHA have directly experienced factors that increase vulnerability to HIV infection, hence their involvement in program development and policy making will improve the relevance, acceptability and effectiveness of program. During workshops and trainings, the project will continue to collaborate with Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) through PLWHA's participation in workplace HIV/AIDS programs which ultimately will assist in changing perception and provide valuable experiences and knowledge sharing. Openly acknowledging their sero-status addresses myths and misconceptions about HIV/AIDS and PLWHAs as well as encourages infected workers to combat fear and shame by disclosing their status. PLWHA will also be advocates for the development of

HIV/AIDS policy as well as law and policy reforms. The partners and enterprises including the 50 SMEs will be encouraged to continue to engage qualified PLWHA in workplaces.

Additionally, reaching men who are in the majority in workplaces in Nigeria with HIV/AIDS messages is one of the innovative ways of dealing with HIV/AIDS pandemic particularly aiming at capacity building in healthy lifestyles skills, information gathering and sharing , monitoring the pandemic and establishing how men's behavior, attitudes and practices change over time.

LINKAGES WITH OTHER PEPFAR ACTIVITY SMARTWork will continue to collaborate with other organizations including Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), Society for Family Health on condom distribution, the Supply Chain Management System project on HIV test kit logistics, CEDPA on palliative care, JSI/MMIS on safe injection techniques for health workers in workplace clinics and regional hospitals.

POPULATION TARGETED The populations targeted are the Nigerian working population and union members.

COP 2010 PEPFAR ACTIVITY TARGETS:

PEPFAR Indicator P8.2.D: Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required (75,000 individuals will be reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required in COP 2010)

None