HIV/AID prevalence is at 6% among adults aged 15-49 in Uganda. The rate is higher among women at 8%,

compared to the 5% among men, according to the HIV/AIDS Sero-behavioural survey 2004-2005. The

same survey reports a high prevalence in North Central Region of 8%, second only to the Central Region

and Kampala with 9%. The leading factors for the epidemic in Northern Uganda are can be described as the

consequences of social economic factors. These factors include the conflict in the North, which has

hindered delivery of HIV/AIDS services to displaced communities. One indicator of this hindrance is the that

UDHS, in 2006, found that only 20% of women and 39% of men had a comprehensive understanding of

HIV/AIDS. Over twenty years of camp life has eroded traditional community cohesiveness resulting in

hardships, idleness, and poverty. The IDPs have developed a number of adverse coping strategies. Some

of these include the exchange of sex for money or materials for survival among women, and excessive

alcohol consumption among men. 60-70% of all camp households produce some type of alcohol and 75%

of men in camps drink alcohol, many of whom become intoxicated on a regular basis. Alcohol brewing is by

far the major income generating activity for impoverished homes and will continue to expand unless other

alternatives are sought. Substance misuse influences sexual behavior and many people under the

influence of alcohol engage in unsafe sex with multiple sexual relationships. This risky behavior increases

the risk of contracting HIV and other STIs. Violence against women is also linked with substance abuse.

IMC health staff report that they handle many cases of alcohol related SGBV. According to the Uganda

Demographic Health Survey 2006, 78% of women reported having been beaten by their husbands while

they were under the influence of alcohol.

The proposed project will tackle the neglected problem of substance abuse as one of the leading causes of

the HIV epidemic and GBV in Northern Uganda. The project will be implemented in 3 sub-counties

(Puranga, Atanga, and Pajule) in the Pader District. IMC will implement community-based education and

awareness raising aimed at changing attitudes to substance abuse and reducing new cases of substance

abusers through media, drama, video shows, door to door visits, impromptu discussions, and other IEC

materials like booklets, playing cards, and posters. BCC campaigns will be conducted, targeting specific at-

risk populations, like out of school youth, single women, bar owners, and men within trading centers. IMC, in

collaboration with local partners including the DDHS and CBOs, will support the return and reintegration

process in Northern Uganda by training and supporting social workers to provide treatment and

rehabilitation services for substances abusers and their families. IMC will also provide education to law

enforcement agencies and community health workers on the appropriate management and referral of

substance abusers. HIV/AIDS and GBV awareness will be integrated into substance abuse education

campaigns, drama, and other community outreach programs. Village health teams will be trained and

supported to provide comprehensive HIV/AIDS knowledge and to carry out STI and GBV prevention

activities. The PHAs will be mobilized and supported to participate in HIV/AIDS/GBV/Substance awareness

activities. Condom promotion campaigns will be conducted, targeting substance abusers and other at-risk

groups so that they practice safer sex. Condom dispensers will be established at trading centres, health

centres and with other key players in the community, such as elders, LC leaders, and youth leaders, to

increase community accessibility. Existing health centres in the sub-counties of operation will integrate

HIV/AIDS counseling and testing, STI screening and management, and GBV-related health services. This

will be done though training of Health Workers, providing the drugs and related supplies or establishing

mechanisms for referral to other health centres or hospitals that to provide these services.

This effort will also indirectly benefit entire communities as alcohol will be less readily available and will

therefore reduce associated social and health ailments.

Schools will also be a major target in the effort to change attitudes of students against substance abuse.

School programmes will include seminars, debates, and life skills and will provide information on the risks

associated with substance abuse, such as HIV/AIDS, STIs, GBV, poverty and other social ills.

Schoolteachers will have to be trained on substance abuse/HIV/GBV/STIs in order to support the students

to carry out these activities. Recreational activities will serve as the foundation for out-of-school youth

programs.

This is a continuation from FY07 activities and the narratives have not changed

This activity compliments activity 8393-Orphans and Vulnerable Children. Over the last year, the USG

through the US Embassy Small Grants Office successfully administered a similar activity that awarded

grants to community groups providing care and support for Orphans and Vulnerable Children.

This activity will use the same model to fund grass roots organizations in underserved areas to provide care

and support to PHAS. Projects could include small income generating activities for women's HIV/AIDS

networks or enhancements for rural health clinics.

This is a continuation of FY07 activities and the narratives have not changed.

This activity compliments activity 8394- Palliative Care: Basic Health Care and Support. It is to support

grassroots programs in the delivery of HIV/AIDS services. Financial and technical support will be given to

community and faith-based projects providing HIV/AIDS services at the grassroots level. The focus will be

on community support to orphans and people living with HIV/AIDS.

Over the last fiscal year, this activity has funded 22 projects in underserved communities around Uganda.

Orphans and vulnerable children have benefited from vocational training, school upgrades, rural-based

health clinic construction, and clean water projects.

This year, the Embassy will continue to identify and fund similar projects designed and implemented at the

grass roots level.

The State Department's Small Grants Project will provide funds to the Fort Portal Dioceses for the provision

of 13 rainwater harvest tanks for 13 rural health centers in the Fort Portal Diocese. The water tanks will

ensure safe and clean water to PHAs and OVC being treated and cared for in the 13 health centers. The

13 health centers provide VCT, PMTCT, treatment of OIs, dispensing of septrin tablest to HIV+ clients and

dispensing of ARVs to AIDS patients.

Coordination of the PEPFAR Uganda Program: The US Ambassador, as the head of the US Mission in

Kampala, manages the overall PEPFAR country program. Working through the Executive Committee and

Coordinator, the Ambassador provides leadership for USG interagency coordination, and gives policy,

strategic, and budgetary guidance for achieving the overall PEPFAR goals. The Coordinator, who reports

to the Deputy Chief of Mission and Ambassador, is the overall and primary liaison with the Government of

Uganda and other AIDS development partners regarding PEPFAR and also coordinates PEPFAR public

affairs communications to better inform the American and Ugandan people about the program's goals and

successes.

PEPFAR Coordinator's Office. The PEPFAR Coordinator's Office within the Uganda US Mission was

established in February 2006, when the first Country Coordinator joined the Department of State. A

PEPFAR Program Assistant was subsequently hired in March 2007. The PEPFAR Coordinator reports

directly to the Deputy Chief of Mission and the Ambassador and is responsible for the day-to-day

management and coordination of the PEPFAR Program in Uganda.

Given the considerable growth of the Uganda PEPFAR Program, the Country Team and the Executive

Committee agreed that in FY08, the PEPFAR Coordinator's Office will recruit and hire a Program Manager

and a Communications Officer (both positions will be contracted through USAID). The Program Manager

will support the Coordinator in the day-to-day programmatic operations and liaison with OGAC, freeing the

Coordinator to focus more on public diplomacy, donor coordination, and national HIV/AIDS strategy

development. The Communications Officer will work closely with the Public Affairs Officers or designated

point persons from State and other USG agencies to develop and implement a comprehensive PEPFAR

communication strategy. The hiring of a Strategic Information Liaison, who supports the overall PEPFAR

Uganda program, was approved for FY07. Reporting to the Coordinator, the SI Liaison will work closely

with the SI Advisors from CDC and USAID. Co-location of these team members is under consideration but

no final agreements have been reached. As space is also an issue at the Chancery, co-locating the

Coordinator's Office either with Peace Corps or Walter Reed is currently being considered.

Small Grants Program: State manages a PEPFAR small grants program that includes funding for orphans

and vulnerable children and palliative care. This program is overseen by the Political Officer who reports to

the Deputy Chief of Mission and complements the Ambassador's Self Help and Democracy Grants Funds.

Initially the PEPFAR small grants program was managed by the same person who oversaw the

Ambassador's Self Help Program but after a detailed workload assessment, the Mission decided to hire an

EFM specifically tasked to manage the PEPFAR small grants program in tandem with the manager of the

Ambassador's Self Help and Democracy Grants Funds. All the small grants programs are under the

purview of the Political Officer. To facilitate coordination, the Political Officer has liaised closely with the

PEPFAR Coordinator. The new Small Grants Manager will report to the Political Officer. Additional

systems will be put in place to ensure coordination between the small grants program and the Coordinator's

Office. In addition, the Program Manager in the Coordinator's Office will provide systematic technical

support, particularly in monitoring and evaluation, to the small grants recipients.

Refugee Program: PEPFAR also funds HIV/AIDS prevention and care programs for refugee populations,

managed by the Bureau for Population, Refugees, and Population (PRM). The primary liaison is PRM's

Refugee Coordinator who sits in the Chancery. Once the Program Manager in the Coordinator's Office is in

place, s/he will provide technical support, particularly in monitoring and evaluation, to the implementers of

the refugee HIV/AIDS programs, in close consultation with the Refugee Coordinator.

The Department of State ICASS bill for FY07 was $177,836. It is estimated that there will be an increase of

$548 to support the additional position in FY08.