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.
Years of mechanism: 2008 2009
The overall goal of this activity is to decrease new HIV infections through male circumcision in the Rwanda
Defense Forces (RDF) by providing training and capacity building to perform the procedure safely.
Circumcision will be offered as a part of an expanded approach to reduce HIV infections in conjunction with
other prevention programs including AB messaging, TC, treatment for other sexually transmitted infections,
promotion of safer-sex practices and condom distribution.
The WHO and UNAIDS recommended that male circumcision (MC) be made available in countries highly
affected by HIV/AIDS to help reduce transmission of the virus through heterosexual sex. According to final
data from two NIH-funded studies conducted in Uganda and Kenya, routine male circumcision could reduce
a man's risk of HIV infection through heterosexual sex by 65%. According to the WHO, implementing
circumcision programs in sub-Saharan Africa could prevent about 5.7 million new HIV cases and three
million deaths during the next two decades if combined with other prevention activities, such as condom
use, responsible behavior, and knowing your and your partner's HIV status. WHO is encouraging access to
no-cost male circumcision to countries in Southern and East Africa where HIV rates are high and
circumcision rates are low. These countries are being asked to consider adopting male circumcision as "an
important and urgent" health priority, with the target group being boys and men ages 13 to 30.
In FY 2007, several questions were added to a mini-DHS and service provision assessment to assess the
acceptability of MC and readiness of clinical services and staff to safely perform the procedure in Rwanda.
In FY 2008, proposed activities will include correct communication and messaging to the population that the
benefits accrue over time and that MC does not provide complete protection. It is critical that the Rwandan
military know that even if circumcised, one can still contract and transmit HIV. Therefore, circumcised men
should continue to practice abstinence, have fewer sex partners and use condoms.
The communication approaches will occur at the national level through media campaigns that encourage
safe male circumcision as part of a complete approach to prevention, as well as local and inter-personal
communication strategies. Attention will be paid to the socio-cultural context, human rights and ethical
principles, health services strengthening, training, development of national policy on MC, gender
implications, service delivery and evaluation. Conducting MC in the Rwandan military is considered vital
since the members are predominately male, typically young, highly mobile and are considered a high risk
group. MC will be offered to HIV-negative soldiers on a voluntary basis.
Preliminary results from a study being conducted in Uganda and presented earlier this month to UNAIDS
and WHO officials found that HIV-positive men undergoing circumcision might be more likely to transmit the
virus to their female partners, if they have sex before the circumcision wounds have healed. Special
attention will therefore be placed on pre- and post- circumcision counseling to reduce the likelihood of
transmission during this crucial time period after the procedure.
DOD will work with the MOH to create a policy that recognizes circumcision as an effective HIV prevention
method alongside the ABC strategy and ensures that this service is provided to the public in a safe manner.
Likewise, the DOD will sensitize soldiers to practice abstinence, reduce sexual partners, or use a condom
during sex even after circumcision. It is important to prevent the perception that it is okay to engage in risky
sexual behavior after being circumcised.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16954
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16954 16954.08 Department of US Department of 6331 131.08 DOD Rwanda $200,000
Defense Defense Office
Table 3.3.03:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
1. Activities have been elaborated
2. This activity has been moved from HVOP in FY 2009 to CIRC
The overall goal of this activity is to decrease new HIV infections in the Rwanda Defense Forces (RDF)
through the expansion of male circumcision (MC) services with emphasis that MC be offered as part of an
expanded approach to reduce HIV infections in conjunction with other prevention programs, including HIV
testing and counseling, treatment for other sexually transmitted infections, promotion of safer-sex practices
and condom distribution. MC will not replace other known methods of HIV prevention and will be considered
as part of a comprehensive HIV prevention package.
The World Health Organization (WHO) and UNAIDS recommend that male circumcision (MC) be made
available in countries highly affected by HIV/AIDS to help reduce transmission of the virus through
heterosexual sex. According to published studies conducted in Uganda and Kenya, routine MC could
reduce a man's risk of HIV infection through heterosexual sex by 65%. According to WHO, implementing
MC programs in sub-Saharan Africa could prevent about 5.7 million new HIV cases and three million deaths
during the next two decades if combined with condom usage, responsible behavior, and knowing the HIV
status of one's partner. WHO encourages countries in Southern and Eastern Africa where HIV rates are
high and circumcision rates are low to provide access to no-cost MC, for men aged 13-30 and to consider
adopting MC as "an important and urgent" health priority. Rwanda would benefit from MC as an additional
HIV prevention strategy because it has a low male circumcision rate (2-5%) and a generalized HIV epidemic
(3.1%).
PEPFAR has worked closely with the Rwanda Ministry of Health (MOH) and other donors in a national task
force to develop policy that recognizes the MC as an effective HIV prevention method alongside the ABC
strategy. The MOH has also requested donor support for the initiation of MC services beginning with the
Rwanda military (one of Rwanda's most at-risk populations). Conducting MC in the Rwanda military is
considered vital since the military is predominately male, typically young, highly mobile and is considered a
high risk group.
In FY 2008, the Department of Defense (DoD) prioritized the training of enough health providers to perform
a sufficient amount of circumcisions to have the kind of public health impact needed to reduce the incidence
and prevalence of HIV in the Rwanda Defense Forces (RDF). Furthermore, the DoD emphasized the need
for the provision of safe male circumcision practices, which includes ensuring that MC-provider training
needs are met, and that access to post-circumcision care, the ability to manage and report adverse events,
and a system of risk compensation are in place prior to commencing the MC activity in the RDF.
In FY 2009, these activities will continue. Additional programming will include MC communication and
messaging to the general population encouraging safe MC as part of a complete approach to prevention,
emphasizing that the benefits accrue over time, and that MC does not provide complete protection. This
activity will utilize interpersonal communication strategies as well as local- and national-level mass media
campaigns and will be attentive to socio-cultural context, human rights and ethical principles, health
services strengthening, training, gender implications, service delivery and evaluation.
These activities address the key legislative issues on gender, particularly with respect to male norms and
stigma reduction. Additionally, prioritizing prevention efforts on the military is a key strategy of both PEPFAR
and the Government of Rwanda as reflected in the Rwanda PEPFAR Five-Year Strategy.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.07:
Under the Rwanda Defense Force (RDF), there are a total of three military hospitals and five brigade clinics
throughout the country. DoD and the Directorate of Military Services (DMS) works together to promote HIV
prevention, care and treatment among members of the Rwanda Defense Forces (RDF). While many
soldiers practice sexual abstinence and fidelity, their living situation, mobility and age increase their
vulnerability to contracting HIV. The estimated HIV prevalence in the RDF is 4.5% (from where) and,
consequently, the PEPFAR five-year strategy highlights the military as a high-risk group.
In FY 2009, DoD will continue to strengthen the capacity of the RDF through periodic TA visits from the
Department of HIV/AIDS Prevention Program (DHAPP) and through collaboration with clinical partners and
the RDF (Rwanda Defense Forces). The first component of this activity involves providing four to five short-
term TA visits from DHAPP headquarters prevention specialists to support the RDF health providers with
prevention, clinical management, diagnosis and treatment of HIV/AIDS. More specifically, DoD will reinforce
referral mechanisms between military voluntary counseling and testing (VCT) sites and prevention, care
and treatment services. DoD will also improve the integration and linkages between facility based and
community based services. Through periodic TA, DoD will provide technical and institutional expertise to
Drew University and to the RDF to strengthen their capacity to manage and improve clinical activities in
Prevention of Mother-To-Child Transmission (PMTCT), TB/HIV, Basic care and Support, testing and
counseling (TC), and Anti-Retroviral Therapy (ART). In addition, TA will enable the RDF and Drew
University to improve their performance and promotion of professional medical staff providing HIV/AIDS
care and treatment.
Drew University is working to ensure that Rwandan Defense Forces (RDF), their family members and
communities surrounding the military installations have equitable access to a high quality, sustainable
continuum of care through HIV and AIDS services. Specifically in FY 2009, this TA will help military health
providers improve treatment of OIs, STI and TB among HIV infected military personnel and civilians
receiving care at military facilities. In addition, this targeted TA will strive to increase treatment adherence.
To address mental health issues related to HIV infection this TA will also improve the quality of psychosocial
support services and build capacity treatment of mental ill-health in PLHIV receiving treatment and care at
military health sites.
This activity contributes to the USG Five-Year Strategy and the GOR care and treatment plan for scaling-up
prevention and treatment services, building on existing services and ensuring quality and equitable access
to HIV treatment in an expanded number of sites/districts.
Continuing Activity: 16981
16981 16981.08 Department of US Department of 6331 131.08 DOD Rwanda $259,756
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Education $35,000
Table 3.3.18:
With PEPFAR funding, the DOD Coordinator position began in FY 2006 and continued in FY 2009.
Responsibilities for the DOD Coordinator are broad and include management, coordination, and support of
all DOD EP activities in Rwanda. In addition, this funding supports technical TA to DOD partners with
development, M&E of new and existing programs. Additionally, these funds support travel, training,
workshops and equipment.
Continuing Activity: 12913
12913 2802.08 Department of US Department of 6331 131.08 DOD Rwanda $100,000
7267 2802.07 Department of US Department of 4359 131.07 DOD Rwanda $100,000
2802 2802.06 Department of US Department of 2573 131.06 DOD Program $30,000
Defense Defense Mgt
Table 3.3.19:
