Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4841
Country/Region: Uganda
Year: 2007
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health Center for Communication Programs
Organizational Type: University
Funding Agency: USAID
Total Funding: $7,600,000

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $450,000

This activity relates to activities in Condoms and Other Prevention (8439) and Palliative Care: Basic Health Care and Support (8440).

AFFORD is a Cooperative agreement awarded by USAID to Johns Hopkins University in October, 2005.

The AFFORD Health marketing initiative has the following objectives: 1. Increase the accessibility and affordability of HIV/AIDS, Reproductive health, Child Survival and Malaria Products and services for communities and families in Uganda using innovative private sector approache;. 2. Enhance knowledge and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviors and lifestyles within communities and families; 3. Strengthen/establish indigenous organization(s) for the sustainable and self sufficient delivery of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of six organizations, two international and four local. With sustainability being one of AFFORD's key results, all six partners are contributing their unique skills to set up an indigenous organization, the Uganda Health Marketing Group (UHMG), that will possess the Technical, Managerial and Financial capacity to continue in the footsteps of AFFORD at the end of the project. UHMG is currently fully staffed and is working alongside the consortium partners.

AFFORD took over the social marketing activities previously carried out by Population Services International (PSI). To date the program has achieved a seamless transition from PSI in the social marketing of three products including condoms without consumers feeling the impact of change of provider. Key highlights of the program after nine months of implementation include the distribution of 15 million condoms through over 20,000 outlets and the communication of key health and HIV prevention messages to over 100,000 people through community outreach programs targeting mainly most at risk groups including the military, migrant workers, commercial sex workers and truckers.

Gender and social norms are barriers to protective behavior change for HIV prevention and Uganda's recently developed Road Map for HIV Prevention highlights these issues as central in the fight against HIV/AID. In FY07, AFFORD will increasingly address gender and detrimental social norms through its varied HIV prevention communications activities. Working with mostly male target audiences like the Uganda Peoples Defense Force (UPDF), migrant workers in the agrarian sector and fishermen's associations, the program will use a variety of communication channels to examine, discuss and explore possibilities for change in existing gender and social norms which increase men's risk of HIV infection. Activities will be jointly designed and led by AFFORD staff and male Popular Opinion Leaders who have successfully adopted positive preventive behaviors and demonstrated strong commitment to countering gender and social norms that are harmful to the health and wellbeing of the community. Key areas to be addressed through these activities include existing concepts of masculinity and disassociating masculinity with higher risk behavior such as multiple sexual partners, excessive alcohol consumption, drug use, violence, gender violence etc. Community and peer outreach activities will promote couples communication and work with men on strategies for initiating discussions with their partner about HIV/AIDS prevention and couples counseling and testing. Activities will also focus on increasing men's sense of responsibility for protecting the health and wellbeing of their family and community through open communication and leadership and through modeling of positive preventive behaviors. These activities will also train them on how to reach out to younger men within their families and communities to discuss how current social and gender norms put them at higher risk of HIV infection and to support the next generation to emulate positive role models in this regard.

AFFORD, with its partner Communication for Development Foundation Uganda (CDFU), will train 200 popular opinion leaders at the grassroots. These actors will be provided with the skills and tools to effectively begin to shift gender and social norms to denounce forced sexual activity, discourage cross-generational sex, encourage reduction of partners and motivate communities to strengthen community sanctions against high risk behaviors. Gender training will also be a key component of this activity. UPDF commanders as well as other POLs working at the community level will be trained in social change techniques. In addition, 1000 peer educators will be trained through several workplace programs to reach over 50,000 men.

OGAC Reviews: #9188 (AFFORD) For this broad health initiative is there PMI buy-in and leverage?

AFFORD is an important implementing partner of the PMI here in Uganda. With PMI funds AFFORD has been distributing free nets through ANC clinics in the North and working with private providers to roll out the new MOH ACT guidelines in private sector. AFFORD coordinates PMI and PEPFAR activities in many ways including incorporating HIV prevention into PMI activities.

plus ups: Athough recent survey data highlight an increase in the number of recent, and lifetime sexual partnerships, particularly among men, there is not yet sufficient programmatic effort to reverse this trend, nor is the GOU leading a campaign on the scale of the Zero Grazing mobilization of the late 1980s. There are however smaller efforts, such as the Be a Man campaign, which can be amplified and can reach larger and larger numbers of men. AFFORD will complement Be a Man and work with men to realize the importance of reducing numbers of sexual partners, and to motivate them to change their attitudes and behavior toward casual sex, and build relationships on respect.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $1,100,000

This activity also relates to activities in Other Prevention, Counseling & Testing and Strategic Information. HCP's overall mission is to strengthen capacity and improve effectiveness of health and HIV/AIDS communication. This activity builds on and deepens the national YEAH communication initiative, particularly in its 2nd phase known as B a Man. This 2nd phase builds on "Something for Something Love" which continues alongside B a Man as both emphasize the male gender norms that underlie transactional sex. This 2nd phase has four components. The first component is a continuation of community mobilization and information, education & communication activities initiated during FY 06 to address male gender norms and expectations contributing to young people's increased vulnerability to HIV and AIDS. There will be a special focus on challenging male gender expectations, including concurrent multiple partnerships; discouraging alcohol abuse, gender based violence and transactional sex; encouraging faithfulness in marriage, HIV counseling and testing, disclosure of HIV status with sexual partners, and abstinence and partner reduction before marriage. Linguistically and culturally appropriate tools, media and materials that stimulate dialogue and personal reflection will be produced in consultation with a wide variety of organizations—faith based, local media, community based, government institutions, and other US government supported projects. The second component involves training peer educators and facilitators in workplaces and among men's groups at community level to facilitate interactive exercises and discussions, using materials and tools produced by the project. HCP will work with community & faith-based organizations and workplaces in five regions of the country to facilitate group exercises and debates around masculinity, alcohol abuse, fidelity and partner reduction, HIV counseling & testing and gender based violence. HCP will provide refresher training on alcohol abuse and gender based violence for the approximately 300 facilitators trained during FY06, and will train 200 additional facilitators during the reporting period. Each will be expected to facilitate at least 4 sessions with approximately 15 young men & women for a total of 30,000 reached. The third component involves strengthening the institutional capacity and sustainability of the Young Empowered and Healthy (YEAH) national communication initiative for young people. The focus will be on financial management and evaluation of communication programs. This is a continuation of work initiated in FY05 & 06. HCP will provide short training courses, and on-the-job mentoring and shadowing, including private sector volunteers, to reduce reliance on external technical assistance. The fourth component of this activity is monitoring and evaluating the effects of community outreach and mobilization activities. HCP will assist YEAH to design and conduct a population based assessment among young people 15 - 24 years old to determine whether or not there has been a change in male gender norms; and the extent to which young men have been exposed to tools, materials and activities.

OGAC Reviews: #9229 (HCP) It is unclear how PIASCY, UPHOLD and AFFORD interact as their activities and age groups targeted (secondary school and 15 + yrs) are overlapping and all are focused on National reach. Together these groups are receiving 4.8M this year in AB and an additional 3.2M in OP. Also it appears some of the activities may have been delayed - is there money in the pipeline for these activities. (4.7M FY06 AB and 3M OP FY06)

This question actually concerns the YEAH Initiative, not AFFORD, and how it relates to PIASCY and UPHOLD given that they all target similar age groups. PIASCY is a Ugandan presidential initiative, which the USG has helped to operationalize. We have done that through two bilateral mechanisms: one BEPS, just ended and a new partner will be awarded the ABE project. As education experts, BEPS/ABE have worked with the MOES structures to integrate PIASCY into teacher training and the Ugandan school system, by developing handbooks, counseling and guidance skills and training approaches. ABE will additionally operationalize PIASCY for the post primary school settings, which is new. UPHOLD is a district level implementation project and supports the roll out of PIASCY at district level. UPHOLD additionally promotes ABC information, messages and skills to out of school youth at district level. YEAH, like PIASCY, is a national initiative targeting the 15-24 year olds in after school settings, providing them with entertainment education opportunities (games, comic books, radio drama…) and molding attitudes that are gender equitable, and against transactional sex.

All three projects collaborate with each to ensure common messages are reinforcing,

complementary and provide greater reach. There are no major delays to report in this activity.

plus ups: The recent survey data which indicate that multiple sexual partners are on the increase, also highlight that this behavior is much more common among men. Qualitative and anecdotal data suggest that having several sexual partners is normative, expected and acceptable for men. The YEAH / Be a Man Initiative has been addressing norms of malehood and ideals of masculinity that underlie several risky behaviors, including violence by men against women. The initiative will intensify efforts to reach men with male to male approaches and to challenge and positively channel these norms to ultimately decrese potentially harmful sexual behaviors within the general population.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $150,000

MC plus ups: The Government of Uganda has recently included medical male circumcision in its National Strategic Plan, which is near finalization. The MOH and the Uganda AIDS Commission have formed a task force, and are planning a national dialogue to present study results from Uganda and answer questions and concerns. The USG Uganda team will support the GOU efforts as they become detailed. clear area of support is for improved public info and dissemination of correct info. The purpose is to increase understanding that MC is effective, that it is part of a comprehensive prevention package, which includes counseling and testing adn the promotion of safer sex practices, including partner reduction and consistent and correct condom use. JHUCCP will provide TA to the appropriate GOU partners identified to lead the sensitization efforts in the development of public information campaings, strategies, and messages.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,450,000

This activity also relates to activities in AB (9188) and Palliative Care: Basic Health Care and Support (8440). AFFORD is a Cooperative agreement awarded by USAID to Johns Hopkins University in October, 2005.

The AFFORD Health marketing initiative has the following objectives: 1. Increase the accessibility and affordability of HIV/AIDS, Reproductive health, Child Survival and Malaria Products and services for communities and families in Uganda using innovative private sector approaches. 2. Enhance knowledge and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviors and lifestyles within communities and families. 3. Strengthen/establish indigenous organization(s) for the sustainable and self sufficient delivery of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of six organizations, two international and four local. With sustainability being one of AFFORD's key results , all six partners are contributing their unique skills to set up an indigenous organization, the Uganda Health Marketing Group (UHMG), that will possess the Technical, Managerial and Financial capacity to continue in the footsteps of AFFORD at the end of the project. UHMG is currently fully staffed and is working alongside the consortium partners. AFFORD took over the social marketing activities previously carried out by Population Services International (PSI). To date the program has achieved a seamless transition from PSI in the social marketing of three products including condoms without consumers feeling the impact of change of provider. Key highlights of the program after nine months of implementation include the distribution of 15 million condoms through over 20,000 outlets and the communication of key health and HIV prevention messages to over 100,000 people through community outreach programs targeting mainly most at risk groups including the military, migrant workers, CSWs and truckers.

This activity has three major components. 1. Condom Social Marketing 2. Interpersonal Behavior Change Communication 3. STI treatment With FY07 funding the program will carry out direct condom promotion at locations with high incidence of risky behavior including truck stops, bars, lodges and landing sites for fishermen. Target audiences such as truckers, CSW and mobile populations will be encouraged to use condoms correctly and consistently. Retail outlets frequently used by the target (such as bars and lodges) will be recruited to sell condoms and the owners oriented to provide information on correct use and storage of condoms. Print material promoting condom use and highlighting location of availability will be distributed through these and other sites. Direct consumer activations using entertainment and drama skits will be used to stimulate discussion on the need for partner reduction and correct and consistent use of condoms with non-regular partners. Working with 11 national distributors and over 100 wholesalers nationwide, AFFORD plans to distribute 25 million condoms through 27,000 retail outlets.

Interpersonal behavior change communication is intended to change and sustain positive behaviors and to increase knowledge about ways to prevent HIV and STI transmission and equip the target with skills to maintain healthy lifestyles. AFFORD will carry out interpersonal communication using three primary approaches. The first approach will rely on community mobilization targeting at risk populations including migrant workers on tea and coffee plantations, fishermen in fishing communities and truckers. Using music, film and drama coupled with interactive question/answer sessions hosted by peers, the target audience will be challenged to look closely at behaviors which increase risk of HIV infection and will have an opportunity to interact with peer counselors in ways that give deeper understanding of the social, gender and economic issues associated with risky behaviors. Key messages to be delivered include the correct and consistent use of condom in risky sexual encounters, the importance of remaining faithful to one partner and/or reducing one's number of sexual partners, the promotion of VCT and the importance of seeking early treatment for STIs. AFFORD partners PULSE Communication and Tungase Cinema Group have in the past few months reached over 60,000 people in high risk locations across Uganda. It is expected that about 150,000 people will be reached in the same manner through this approach in FY07. Direct condom promotion and sales events will be organized alongside these community outreach programs. Bar and lodge owners around high risk locations will also be sensitized to support enter-education activities that are employed to promote correct and consistent condom use. The second communication

approach works through institutions to reach captive audiences who can be reached easily and. One major institution the program will be working with is the Uganda People's Defense Force (UPDF). AFFORD will support peer education training and other HIV prevention activities that educate the young men in the armed forces as well as members of the surrounding communities about the risk factors associated with HIV infection. These communication activities will also support and promote VCT. The armed forces will be encouraged to avoid risky sex or to correctly and consistently use of condoms and encouraged to seek early treatment for STIs. AFFORD will scale-up its work with CSWs through partnering with Women at Work International (WAWI), who will implement peer education activities, train CSWs in HIV prevention and condom negotiation skills. AFFORD will link these women to STI and VCT service sites and to other important wrap around initiatives such as income generation programs. The third communication approach will involve Communication for Development Foundation Uganda (CDFU), another AFFORD partner, who will train Popular Opinion Leaders (POLs) at the grassroots to educate members of their communities about HIV and serve as role models. Key messages will include condom use among discordant couples, early treatment for STIs, social and gender norms as well as raise awareness of the links between alcohol intake and HIV. In FY07 AFFORD plans to train and work with 200 POLs who will operate in over 60 sub-counties throughout the country reaching approximately 40,000 people.

Programming to raise awareness of links between alcohol intake and HIV and other STIs will also be addressed through partnering with two major breweries in Uganda, Uganda Breweries and Nile Breweries to implement a ‘responsible living' campaign. The breweries will carry HIV/AIDS prevention message on each bottle of beer and will support work with their client bars owners, as well as direct consumer activations, emphasizing the dangers of alcohol use in terms of inhibition and the increased potential of risky sexual behavior. AFFORD will also work with private sector service providers offering STI treatment to improve the quality of services offered and will socially market STI treatment kits. AFFORD will train 1000 service providers to offer syndromic treatment of STIs.

Through the activities described above, AFFORD will deliver 25 mil condoms through 27,000 retail outlets, and reach 200,000 people through community outreach.

*Plus up funding will expand activities to address links and risks between alcohol consumption and risky behavior that potentially leads to HIV infection, as well as increased violence particularly against women. AFFORD will work with breweries to raise awareness among bar goers and owners in key cities, towns and semi-rural trading centers. AFFORD will design and pilot approaches to reach dealers, brewers, and traders of the local brew in the relatively large informal sector. There is a potential for matching funds from the industry to increase the reach of this effort.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $200,000

This activity also relates to activities in Abstinence and Faithfulness, Counseling & Testing, Support for Orphans and Vulnerable Children and Strategic Information. HCP's overall mission is to strengthen capacity and improve effectiveness of health and HIV/AIDS communication. This activity works in tandem with HCP's abstinence and faithfulness program aimed at community mobilization, information, education and communication to change male gender norms associated with gender based violence, alcohol abuse, multiple sexual patners, and risk taking behaviour. The activity deepens the YEAH/ B a Man initiative with a special focus on highly vulnerable out of school young people: men in military service, young people in conflict affected areas, street children, adolescent orphans and vulnerable children, youth living in fishing villages and in stop-over towns along major transport corridors. YEAH/B a Man and the Saf T Stop regional transport corridor project will ensure strong linkages with each other and will coordinate activities and share materials. The activity will also work with HIV-positive young people to encourage abstinence; and disclosure of status and condom use among those who choose to become sexually active. The activity will have three components:

The first component involves adapting tools and materials developed for young people under the AB programming for use with highly vulnerable young people. Linguistically and culturally appropriate tools, media and materials that stimulate dialogue and personal reflection will be developed in consultation with a wide variety of organizations—faith based, local media, community based, government institutions, and other USG -supported projects—working with highly vulnerable young people. Representatives of the target populations will actively participate in the development of tools and materials.

The second component involves training peer educators and facilitators among youth groups in high risk communities, military services, and internally displaced camps to facilitate interactive exercises and discussions and interactive drama, using materials and tools produced by the project, to facilitate introspection and dialogue around masculinity, alcohol abuse, partner reduction, HIV counseling & testing, gender based violence, and condom use. HCP will train 120 facilitators and peer educators during the reporting period. Each will be expected to facilitate at least 4 sessions with approximately 15 young men & women for a total of 7,200 vulnerable young people reached.

The third component involves partnering with groups working with young people who are HIV positive to develop and implement a communication intervention to encourage disclosure to potential sexual partners and consistent condom use with sexual partners among HIV-positive young people. Approaches will assist young people who are HIV positive to deal with stigma and discrimination and may include activities to reduce stigma and discrimination among their un-infected peers. HCP will assist with the development of counseling and training materials for counselors and peer educators, will train counselors and peer educators in their use, and will assess their effectiveness. An estimated 20 peer educators and counselors will receive training and will, in turn, counsel and train 10 HIV-positive young people for a total of 200 HIV positive young people reached.

Funding for Care: Adult Care and Support (HBHC): $2,000,000

This activity relates to activities in Condoms and Other Prevention (8439) and Abstinence/ Be Faithful (9188). AFFORD is a Cooperative agreement awarded by USAID to Johns Hopkins University in October, 2005.

The AFFORD Health marketing initiative has the following objectives: 1. Increase the accessibility and affordability of HIV/AIDS, Reproductive health, Child Survival and Malaria Products and services for communities and families in Uganda using innovative private sector approache;. 2. Enhance knowledge and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviors and lifestyles within communities and families; 3. Strengthen/establish indigenous organization(s) for the sustainable and self sufficient delivery of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of six organizations, two international and four local. With sustainability being one of AFFORD's key results, all six partners are contributing their unique skills to set up an indigenous organization, the Uganda Health Marketing Group (UHMG), that will possess the Technical, Managerial and Financial capacity to continue in the footsteps of AFFORD at the end of the project. UHMG is currently fully staffed and is working alongside the consortium partners. AFFORD took over the social marketing activities previously carried out by Population Services International (PSI). To date the program has achieved a seamless transition from PSI in the social marketing of three products including condoms without consumers feeling the impact of change of provider. Key highlights of the program after nine months of implementation include the distribution of 15 million condoms through over 20,000 outlets and the communication of key health and HIV prevention messages to over 100,000 people through community outreach programs targeting mainly most at risk groups including the military, migrant workers, commercial sex workers and truckers.

The AFFORD project integrates health communication and social marketing techniques in an innovative way, intended to change and sustain positive behaviors and entice commercial private sector participation to increase access to palliative care products and services. The provision of a wide range of palliative care products and services through the private commercial sector and other private not for profit institutions is key in bringing palliative care to a large numbers of PLHAs. A preliminary situation analysis that engaged over 40 PLHA support groups in dialogue shows that a large proportion of PLHAs prefer to access palliative care products and services through private sector channels which in their opinion offer better quality services in more discrete settings. AFFORD will lead a community-based, consumer-driven approach to the provision of preventive/palliative care products which responds directly to needs defined by PLHAs themselves through their preferred channels.

In FY07, palliative care products will become increasingly available and accessible through a variety of private sector service delivery outlets in response to interest expressed by PLHA's to access products and services in the same way that other clients access general health products and services. AFFORD will engage in traditional social marketing of palliative care products by tapping into existing commercial distribution channels including private sector pharmacies, drug shops, midwiferies and clinics. Palliative care products will also be made more accessible to HIV/AIDS FBO/NGO/CBOs serving PLHAs through an innovative strategy recently implemented by AFFORD known as the virtual facility. The goal of the virtual facility is to negotiate/broker lower prices on high quality palliative care products with private sector suppliers by ensuring these suppliers a high volume of aggregate sales. Interested FBO/NGO/CBOs in the private sector are able to take advantage of the AFFORD coordinated economies of scale and pass the price reduction benefits on to their clients thus increasing access. In very little time, the virtual facility has become an attractive option for both private service providers and private sector suppliers, ensuring the continued market interest of the later and a reliable source of high quality palliative care products at reduced costs for the former. The range of palliative care products accessible through the two above mentioned strategies include, Cotrimoxazole, Water purification tablets, Condoms, LLINs, Multivitamin with essential minerals/ antioxidants, Fluconazole tablets, STI kits and family planning to name a few.

AFFORD has developed an umbrella logo for service delivery points, vehicles of communication and products provided by the program. Private sector service providers distributing AFFORD supported products, and having been trained by AFFORD in how to

best support patients to use these products correctly, will display this logo. An associated communication campaign will promote the service providers and the products offered through outlets sporting the quality logo. Health care providers to be trained in FY07 include: 1. Uganda Medical Practitioners Association - 500 Doctors will be trained in providing palliative care to PLHA's through their clinics; 2. Uganda Private Midwives Association - 400 midwives will be trained to provide palliative care treatment to PLHA's and 3. Pharmacists & Drug Shop Owners - 230 Pharmacies and 500 drug shop owners will be trained to provide palliative care. 200 Popular Opinion Leaders (POLs) and 100 Small Scale Entrepreneur's (SSEs) will also be trained on the importance of health maintenance strategies in HIV affected households and HIV positive individuals including the correct and consistent use of appropriate palliative care products. These community actors will be supplied with communication materials enabling them to effectively assume the role of resource persons to PLHAs and to strengthen the network model through effective referrals/linking of HIV positive individuals to service delivery sites. Other palliative care materials produced by AFFORD will include brochures, job aids, wall charts and a health maintenance handbook. These will be made available to all associated service delivery sites. Two already existing communication vehicles, ‘Everyday Health Matters' - a newsletter targeting consumers - and ‘Under the Mango Tree' - a community dialogue program recorded for community radio broadcast - will be used to encourage PLHAs to access service providers displaying the ‘good life' logo. Project partner PULSE will mobilize PLHA networks and carryout palliative care awareness raising, increasing knowledge about the benefits of palliative care products and services and linking PLHAs to high quality products and service delivery sites. Support groups will be encouraged to form cooperatives for bulk purchasing of palliative care products through the virtual facility at markedly reduced prices. AFFORD is also exploring with several PHA support programs the possibility of involving PLHA groups in the distribution of palliative care products supported by the program as a means of income generation. As Northern Uganda is presenting a relatively high prevalence area of HIV, AFFORD will continue to provide special support to internally displaced persons and communities affected by war in accessing palliative care products.

AFFORD will train 1200 service providers to support and promote the provision of palliative care products to PLHAs. The program will deliver the products through 3500 outlet reaching a estimated target of 210,000 PLHA accessing products through the efforts described above. AFFORD will work closely with CDC to ensure maximum synergy between the distribution of the free basic care package and AFFORD's social marketing approach working through private sector channels.

Funding for Care: TB/HIV (HVTB): $200,000

This activity is also related to ART, PMTCT+, and Counseling and Testing. HCP's overall mission is to strengthen capacity and improve effectiveness of health and HIV/AIDS communication. The communications strategy for TB/HIV collaboration in Uganda was developed by the MOH and partners, and launched in 2006. The program will be implemented through an operational plan at both the national and at district levels. In this activity, HCP will provide technical assistance to the Ministry of Health, the NTLP, STD/ACP, CBOs/NGOs and up to 6 districts to harmonize communication initiatives between TB and HIV, and to ensure that linkages between TB and HIV are realized. Support will cover advocacy, communication and social mobilization for the integration of TB/HIV activities at national, district and community levels,. At the national level, support will be provided to develop an operational plan with budget for district and national level implementation. It will also involve assisting the government to develop plans and tools to mobilize community based organizations, faith-based organizations, and other health providers and community agents to integrate TB prevention, diagnosis and treatment with HIV counseling and testing, home based care and support, and ART services. Districts will be supported to include TB/HIV communications strategies in their district operational plans and assist them to effectively target their messages. A selection of up to 6 districts to act as models will be made in consultation with the MOH. Ultimately, the activity will aim to increase referrals for TB diagnosis and treatment among PHAs at health facility and community levels, and to educate the public about TB prevention and treatment and its link with HIV.

Funding for Prevention: HIV Testing and Counseling (HVCT): $400,000

plus ups: Knowledge of one's HIV status may motivate individuals to protest themselves and others. 2004/05 survey data indicate that the vast majority of Ugandans have not been tested and therefore do not know their status. Although the proportion of women who have ever been tested has recently increased from 8% in 2000-01 to 15% in 2004-05, the proportion of men tested has remained constant at 12%. Johns Hopkins University will support the MOH's Know your Status campaign and will provide technical assistance to design the campaign, its materials and messages, as well as the holding of national testing days. Overall objectives of the campaign will be to increase numbers of couples testing together. Strategies will be developed to encourage and facilitate mutual disclosure of sero-status. It is anticipated that the campaign will directly contribute to reducing stigma and discrimination surrounding testing and disclosure. JHU will work closely with appropriate MOH departments with USG implementing partners working in the area of HIV counseling and testing.

Funding for Treatment: Adult Treatment (HTXS): $500,000

This activity also relates to activities in other prevention, and support for orphans and vulnerable children. HCP's overall mission is to strengthen capacity and improve effectiveness of health and HIV/AIDS communication. In this activity, HCP will work with the National ART Committee, the National AIDS Control Program and the Joint Clinical Research Center (JCRC) to design and implement information, education, communication, and community mobilization activities to address HIV/AIDS-related stigma, to improve ART adherence among adults and children, and to encourage preventive behaviors among people living with HIV and AIDS (PLHA). This activity is a continuation and expansion of activities begun in FY06 with JCRC, taking them to a national scale, and involving JCRC as well as other ART service providers. HCP will provide technical assistance to a working group of ART service providers under the auspices of the National AIDS Control Programme to design and implement community mobilization and communication activities that reach communities within 5 kilometers of sites providing ART services.

The activity has three components. The first component involves working with a national ART communication working group to agree on a common communication strategy, and to work with JCRC as the lead in ART communication to develop media materials and communication tools and materials for use by community counselors and clinic providers. HCP will assist with the development of materials, tools and approaches. JCRC will produce and distribute materials among partners. Activities and materials will focus on mobilizing communities to change discriminatory and stigmatizing practices, and support PLHA to access ART services and improve adherence. Through this activity, HCP will strengthen the capacity of JCRC to design and manage large scale communication strategies independently in future.

The second component involves working with JCRC and the National Working Group to train a cadre of national and zonal trainers who can provide training for community groups and faith based groups working in communities within 5 kilometres of ART service providers to facilitate groups discussions and exercises that raise awareness of and change stigmatizing and discriminatory attitudes and practices. Activities, materials, and tools will be developed with the involvement of PLHA, children with HIV/AIDS, and ART clients.

The third component involves assistance to ART service providers to better counsel clients about prevention. This will entail working with PLHA representatives, clinical providers, and counselors to design materials and counseling training for prevention among positives.

OGAC Reviews: AFFORD - 8438 - no ARV service provision - should it be in this section?

This is not an AFFORD activity but rather an HCP activity which supports community and individual level ART literacy and adherence activities and thus is appropriately placed in this section. OGAC requested us to subsume all JHU/CCP activities into one funding mechanism however the associated activities fall under several separate and distinct programs which seems to have caused some confusion for the reviewers.

Funding for Health Systems Strengthening (OHSS): $150,000

MC plus ups: The Government of Uganda has recently included medical male circumcision in its National Strategic Plan, which is near finalization. The MOH and the Uganda AIDS Commission have formed a task force, and are planning a national dialogue to present study results from Uganda and answer questions and concerns. The USG Uganda team will support the GOU efforts as they become detailed. clear area of support is for improved public info and dissemination of correct info. The purpose is to increase understanding that MC is effective, that it is part of a comprehensive prevention package, which includes counseling and testing adn the promotion of safer sex practices, including partner reduction and consistent and correct condom use. JHUCCP will provide TA to the appropriate GOU partners identified to lead the sensitization efforts in the development of public information campaings, strategies, and messages.

Subpartners Total: $2,881,378
Palladium Group (formerly Futures Group): $750,000
Pulse Uganda: $400,000
Uganda Peoples Defence Forces: $200,000
Communication for Development Foundation - Uganda: $735,000
Women at Work International: $80,000
Fenon Entertainment: $87,500
Straight Talk Foundation: $140,000
Media for Development Trust: $75,000
Mango Tree Orphan Support: $29,248
Media for Development International: $31,616
Aclaim Africa Limited: $303,814
iVAD International: $49,200