USAID Nigeria has 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). 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. Heartland Alliance iwill focus on MSM populations with a minimum of three interventions in the 5 states mentioned above.

This activity also links with prevention programs. 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 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 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. Heartland Alliance 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 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.

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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 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. Heartland Alliance 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 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.

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). REDACTED. 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 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 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. Heartland Alliance 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 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.