THE ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

TITLE: Together We Can (TWC) Program

American Red Cross's Track 1 ABY program closes in June 2010. December 2008 marks the end of the

American Red Cross's (ARC) support of the TWC program in Kigoma, as the program moves to a higher

prevalence region. The project has seen considerable success. According to the THMIS (2007/08)

Kigoma's knowledge of HIV prevention methods is the second highest in the country for girls (62%), and the

third highest for boys (56%). Despite ARCs departure from Kigoma region, the Tanzanian Red Cross

Society (TRCS) continues to maintain a presence in Kigoma. Building on the strong volunteer capacity and

training developed through both the refugee relief operation and the TWC program, TWC will enjoy

continued exposure in the communities of Kigoma through the presence of trained peer educators (PEs),

coaches, and youth multipliers. In line with epidemiological trends and USG recommendations, ARC will

transfer its expertise, successes, and lessons-learned to four densely populated, high sero-prevalence

districts of Shinyanga region in FY09. To accommodate this shift to a more strategic area, TWC anticipates

a transition period between January and March of 2009. A PLACE-inspired methodology will be used to

rapidly gather information to facilitate strategic targeting and monitoring of higher risk youth and young adult

populations. In response to recent evidence, TWC is moving towards a peer education model which uses

community-based educators aged 17 or above. In addition, the TWC curriculum is in the process of an

adaptation that, building on new information regarding drivers of the epidemic in Tanzania, addresses risk

and protective factors such as transactional sex, sexual coercion, cross-generational sex, multiple

concurrent partnerships, individual risk planning, and gender equity. The curriculum will be finalized in time

for use in the new region.

Current strategies will be modified to increase youth-peer interaction through the curriculum's built-in series

of four take home assignments which include sharing key TWC messages, facts, and skills through the use

of: a decision making tool; a newly adapted pamphlet identifying risk factors for HIV infections; and referrals

and site-visits to local sexual and reproductive health services. Through an increased emphasis on out of

school youth and a targeted 50:50 in school to out of school breakdown in youth reached, ARC will develop

special training sessions incorporating facilitation and counseling skills to help PE's identify and work with

high-risk youth. ARC will enhance efforts to conduct follow-up interventions (FUI) through the roll-out of

guidelines to ensure FUI content matches the needs of local communities, based on district-specific

analysis from the pre/post-test database and qualitative feedback from youth. FY09 will see a minimum of

70% of all youth reached by the initial TWC curriculum also reached by one or more FUI.

Community Council and Town Hall Meetings will continue to address the needs of stakeholders and

community members, while encouraging an enabling environment for youth outreach. In addition, ARC will

scale up implementation of its three-day Adult Child Communication curriculum in partnership with Family

Health International (FHI) UJANA. These interventions all help to create supportive environments promoting

positive social and gender norms, and encourage healthy behavior choices and sustained behavior change.

Partnerships with Stradcom and T-Marc will continue to support mass media radio shows and marketing

campaigns in the new region, coordinated with listening and discussion groups for youth. Finally, leveraging

existing ARC funding, ARC is developing a broader integrated HIV program to utilize existing TRCS

capacity to develop home-based care (HBC) and support activities. Of the four TWC districts, two districts

will overlap with Pathfinder International's HBC activities. The remaining two districts will incorporate a

newly developed Red Cross HBC program, as well as free condom distribution through Red Cross

branches, linkages to counseling and testing, prevention programs for people living with HIV, and wrap

around programs including gardening, village community banking, and orphan and vulnerable children

programming. To date, TWC has reached over 425,000 youth with AB messages, and trained over 720

individuals. Volunteer retention rates exceed 95%.

*END ACTIVITY MODIFICATION*

At 3.2%, young men's zero-prevalence in Kigoma is higher than the national average. The percentage of

rural women who demonstrate comprehensive knowledge about HIV/AIDS in Tanzania is only 38% (DHS

2004). TRCS, a local organization established in 1962, has active offices in each of Kigoma's districts and

an established network of over 140 community-based HIV prevention volunteer peer educators uniquely

suited to reach remote areas of the country. ARC provides technical support to the TRCS and is a

recognized leader in the field of youth peer education, using a curriculum and methodology implemented by

the Red Cross movement in over 20 countries worldwide. Project messaging emphasizes life-skills in

abstinence and fidelity, and includes condom information and education for at-risk youth.

ACCOMPLISHMENTS: TWC has reached over 300,000 youth with AB messages, and trained 599

individuals (peer educators and field managers). Due to a systematic approach to refresher trainings and

incentives, volunteer retention rates exceed 95%. Increases in knowledge, accepting attitudes and self-

efficacy average over 82% (post- over pre-test scores in curriculum-based interventions). MEASURE

evaluation cited TWC as very strong in volunteer supervision systems, consistent skills-based messaging,

and high retention rates.

ACTIVITIES: The TWC project strengthens HIV related life skills for Tanzanian youth using multiple venues.

Groups of potential peer educators (PE's) are identified in the community based on age, education

(minimum of standard seven) and availability to work within the region from which they came. Once

selected, PEs are trained using participatory, skills-based, locally adapted interventions. Refresher trainings

and management meetings are held regularly. PEs also provide referral information to key services

provided in the region including VCT and STI treatment, thereby enhancing linkages to other partner

organizations and generating demand for these services. Referral manuals that list locally available youth

friendly services are kept up to date by the PEs. Graduated PEs host multiple training sessions to convey

the TWC curriculum to youth. Pairs of PE's facilitate these sessions for small groups of approximately 20

beneficiaries per workshop. Each youth participant in the workshop is responsible to communicate key

prevention messages via peer-to-peer outreach to ten of their peers as a ‘take-home assignment'. Youth

Activity Narrative: are encouraged to talk informally about issues that directly affect their life and health, drawing on knowledge

learned in training sessions. The final phase of the TWC project communicates prevention messaging

through the organization of ‘edutainment' events and through the production and dissemination of behavior

change materials (educational brochures, referral manuals, and support materials). Activities address

gender equity, norms and behaviors, stigma and discrimination, critical decision making skills, negotiating

abstinence, reduction of sexual partners, fidelity, and condom use. In line with recommendations from

MEASURE evaluation's recent process evaluation, TWC is refining follow-up strategies to increase the

booster effect on youth who have already completed the TWC curriculum. Workshop ‘graduates' will benefit

from two follow-up interventions 3-6 and 9-12 months after completion of the initial curriculum. To enhance

the community environment for the adoption of safer sexual practices, the TWC project holds town hall

meetings and hosts community councils at each key project site. Town hall meetings are designed to

inform, seek permission to conduct sexual education activities, and solicit direct involvement of adult

stakeholders. Councils are designed to encourage participation by adult stakeholders including parents,

teachers, and religious and secular community leaders from all sectors. Project staff works with local

community councils and organizations on day-to-day project implementation. Projects to date include;

planning TWC workshops in schools; consensus building on appropriate messaging for younger youth; in-

kind contributions to project activities; promoting TWC sessions via letters to parents; and offering feedback

after observing project activities.

LINKAGES: TWC collaborates with teachers, parents, local government task forces, FBO's, and CBO's to

ensure the direct involvement of adult community members in the fight against HIV/AIDS and the safer

reproductive lives of youth. TRCS works extensively with Emergency Plan and other donor funded NGO

partners and taskforces at the national, regional and community level through sharing of work-plans,

quarterly prevention partner meetings, and joint planning. This occurs through meetings and dialogue with

partners, and the sharing of curriculum and best practices. Common strategies and messages are

established and duplication of efforts is reduced, leading to a more efficient use of project resources. The

TWC project also shares best practices across countries where the program is in operation (Haiti and

Guyana) as well as through the Red Cross movement which is active in 185 countries. TWC is able to

provide referral information to the thousands of youth it reaches each month, thereby creating demand for

other Emergency Plan funded services such as STI treatment and VCT.

M&E: TWC uses data collection forms to track the number and nature of outreach and trainings as well as

town council meetings, media events, and refresher trainings, and utilizes a pre/post test tool to measure

knowledge gained through training sessions. Data is used for multi-level analysis to identify gaps in

understanding. When counting beneficiaries, a discount rate is applied to avoid double counting at large

scale events. Each type of activity has its own targets and is judged on its own objectives. This system

ensures that all outreach targets reported comply with the OGAC guidance. TWC will revise data collection

tools to harmonize with other PEPFAR AB and OP partners, and is currently active in prevention partner

meetings, volunteering M&E tools for review, and attending meetings to standardize tools. A written M&E

plan is currently in development, and will begin implementation no later than the receipt of FY 2008 funds.

Seven percent of the budget will be allocated to M&E.

SUSTAINAIBLITY: TWC's work through TRCS retains capacity in this local organization, which has been

working in Tanzanian communities since 1962. TRCS receives support from national chapters including the

Spanish, French, and Japanese Red Cross, and the Red Cross Federation. TRCS is currently seeking

funds from the Tanzanian government to expand chapter capacity throughout the country. The ARC will

continue to provide organizational development trainings and technical support for key areas (e.g.,

volunteer management and training, project planning, finance and compliance, monitoring and evaluation,

and curriculum adaptation). TWC also uses partnership building as a capacity-building tool, allowing the

TRCS to learn from and leverage each partner's expertise in HIV prevention, care, and treatment.

Targets:

TWC targets represent the number of individual youth multipliers and youth participants reached. These

figures are documented through the TWC HMIS on various forms and represent "A+B+C". (A= Youth

completing the TWC curriculum, B= Youth reached through Peer-to-peer outreach, and C= youth reached

through mass communication events.) Recognizing that youth reached through curriculum based

interventions may be reached through multiple other methods, a 50% discount rate has been applied to the

number of youth reached via the peer-to-peer outreach ("B") and the number of youth reached via

community mobilization/edutainment events ("C") to avoid double counting. In addition, community

mobilization activities have been modified to comply with the new OGAC standards, and are now only

counted for USAID if the event has fewer than 500 participants, although larger community events and

mass media broadcasts are still occurring.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13437

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13437 3472.08 U.S. Agency for American Red 6496 1508.08 Track 1.0 $587,731

International Cross

Development

9060 3472.07 U.S. Agency for American Red 4518 1508.07 ARC Track 1.0 $278,365

International Cross

Development

3472 3472.06 U.S. Agency for American Red 2874 1508.06 $844,027

International Cross

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

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: