Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3340
Country/Region: Uganda
Year: 2008
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: $8,580,487

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $800,000

This narrative has been updated and expanded and contains activities that are continued under AFFORD,

the Health Marketing Initiative. AFFORD is a Cooperative Agreement awarded to Johns Hopkins University

in October 2005 and has the following objectives: 1. Increase accessibility and affordability of HIV/AIDS,

reproductive health, child survival, and malaria products and services for Ugandans 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; 3. Strengthen/establish indigenous organization(s)

for 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. All six

partners are contributing to build an indigenous organization, the Uganda Health Marketing Group (UHMG),

which will possess the technical, managerial, and financial capacity to continue in the footsteps of AFFORD

at the end of the project. UHMG is currently categorized as a Not-For Profit Company, staffed and working

alongside the consortium partners. Key highlights of the program over the past year include distribution of

18 million condoms through 29,000 retail outlets, the communication of key health and HIV prevention to

over 200,000 people through community outreach and several interpersonal program approaches targeting

mainly most at risk populations (MARPS) including the military, migrant worker, commercial sex workers,

trucker, and fisherman folk at landing sites.

In FY07, AFFORD addressed various MARPs and the general audience with faithfulness/partner reduction

messages and activities to address gender stereotypes related to increasing HIV infection risks. AFFORD

used five approaches:

a) Peer educators (PE) program: During FY07, a total of 800 PE among Commercial Sex Workers (CSW),

their clients, the military (UPDF), the Uganda police and fishermen, were trained in collaboration with four

partner organizations working with MARPs. Embedded into the training were modules addressing gender

norms related to HIV risk behaviors. All support materials also pointed out existing gender and social norms

that increase men's risk of HIV infection. Through these program activities, 280,000 people were reached

using peer-to-peer interactions and community outreach. In FY08, AFFORD will continue to work with

MARPs, specifically the UPDF, police, truck drivers, fishermen associations, and organizations of CSWs, to

mainstream gender in their ongoing programs. For example, scale-up, reach more people, and establish

CSW drop-in centers where they can access a number of HIV/STI-related services.

AFFORD will increase the number of MARPs organizations it's working with from 6 to 8 and expand this

program to 6 new districts. Additionally refresher training for peer educators on gender and sexual violence

will be organized using films, interactive drama and support materials. AFFORD will continue to specifically

target men with gender positive messages from a male perspective (men-to-men).

AFFORD will also scale-up the ongoing experiential communication programs with Pulse (another AFFORD

partner) for security forces, military, and the police to also reach truckers and fishing communities. Our work

with WAWI will continue to integrate gender issues that increase sex workers' risk of HIV infection. As most

peer educators are exposed to gender violence on a regular basis, AFFORD will offer sexual violence

training for CSW peer educators in FY08. AFFORD will also ensure that the programs with five new CSW

organizations include the same gender mainstreaming as with WAWI and other MARPs organizations.

b) In FY07, 570 Popular Opinion Leaders (POLs) were trained in 13 districts. They have been trained by

AFFORD partner, Communication for Development Foundation Uganda (CDFU). Many of these community

POLs use messages about couple HIV testing, early treatment for STIs, as well as raise awareness about

gender issues to disassociate masculinity with higher risk behaviors and links between alcohol intake and

HIV; A total of 62,000 people were reached through this program.

AFFORD will continue working with CDFU to scale-up POL training from 13 districts in FY07 to 23 in FY08.

400 new POLs will be trained in interpersonal communications and community mobilization to address

socially constructed gender norms and behaviors that increase the risk of HIV transmission. These newly

trained POLs will reach 31,000 people resulting in a 50% increase in the number of people reached in

FY08. In FY08, AFFORD will also focus on strengthening this intervention through introduction of the HCP

African Transformation program model, which is a more in-depth skill-building model used to analyze

gender stereotypes and apply it within the POL strategy. Videos will be dubbed in 4 more local languages

and support materials translated. These video vignettes produced under the HCP "Be a Man Campaign" will

be used by POLs to initiate discussions about gender stereotypes/ masculinity stereotypes among

communities they are serving and also act as guidelines for community discussions under the Mango Tree.

In FY08, these video vignettes and materials developed through the "Be a Man" campaign will be integrated

in the POL training for the new 10 districts.

c) HIV Counseling and Testing (HCT) for Couples: AFFORD continues to strengthen the linkages to HCT

within the private sector where the health practitioners are expected to provide quality healthcare services

and products. The AFFORD gender strategy focuses on promoting HCT linkages for couples to increase

access to information about sexuality, disease, and reproduction through post-test clubs and other

psychosocial support groups. In FY08, AFFORD will continue to target couples as a unit of our gender

strategy to access an additional 100 clinics and continue to link these couples to other services like family

planning and palliative care.

d) The partnerships created with Uganda Breweries and Nile Breweries to raise awareness of links between

alcohol intake and STI/HIV/AIDS-related risk behaviors will be strengthened and the program expanded by

50%. The campaign called "The Responsible Living Campaign" creatively intersects brewery clients, bar

owners, as well as direct consumer activations and promotional materials with activities and messages

emphasizing the risks of alcohol abuse with regard to STI/HIV transmission. This is a demonstration of

public-private partnership as the breweries will be contributing some money to this effort.

e) AFFORD created the Good Life Campaign in FY07 which breaks down preventive health behaviors into

"simple, everyday activities" that can keep individuals, couples and households "healthy and save some

money" as a way to a "Good Life." Addressing all of AFFORD's health areas, living the Good Life with focus

on HIV risk perception, condom use, faithfulness, and partner reduction. The Good Life campaign was

launched through a highly popular TV, radio and experiential game show format with a strong couple

communication segment, encouraging couples to know more about each others opinions and knowledge of

the health topics in order to be a winning team. In FY07, The Good Life Show toured the country appearing

at over 200 locations in 20 districts and aired 24 TV episodes on 2 stations nationwide, while 120 radio

Activity Narrative: shows in 5 languages were aired on 11 local language stations. Various mini-campaigns on malaria, HIV

prevention, and health maintenance added to the mutually supporting media channels with community radio

shows, low literacy newsletters, and other print support materials. In FY08, AFFORD will continue to use the

Good Life campaign to address critical issues that drive the HIV epidemic in Uganda. Mass media will be

used to link to and reinforce the community interventions by highlighting activities, positive behaviors, and

using frequently asked questions from the field to create meaningful messages addressing risk perception,

self-efficacy, and gender issues driving people's behaviors.

In FY08, AFFORD will work in partnership with Raising Voices and the Young Empowered And Healthy

(YEAH) programs to scale-up communication activities through a mass media campaign to address HIV

prevention, gender and social norms within sexual relations. Through radio spots and print media, AFFORD

will continue to raise awareness on importance of reducing number of sexual partners, promote couple

communication, and encourage mutually respectful relationships. In FY08, AFFORD will also work with

religious leaders to send out strong messages, promoting mutual faithfulness/reduction of multiple sex

partners among couples and other women of reproductive health age; this will include orientation

workshops for religious leaders and development of materials targeting both couples. Religious leaders will

speak in a series of TV and radio spots promoting mutual fidelity, compassion towards HIV-positive partners

among discordant couples and the need to reduce stigma and gender violence around HIV prevention.

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

Health Communication Partnership (HCP) is a three-year USAID Associate Award for health communication

support in Uganda managed by the Johns Hopkins Bloomberg School of Public Health's Center for

Communication Programs, which was awarded in July 2007. HCP has been working in Uganda since July

2004, assisting the Uganda AIDS Commission to establish a national multi-channel communication initiative

for young people 15 - 24 years old called Young Empowered and Healthy (Y.E.A.H.). Y.E.A.H. is

managed by a partnership of Ugandan organizations led by Communication for Development Foundation

Uganda (CDFU), and has launched two multi-channel communication campaigns for young people. One -

the Something for Something Love campaign - discourages transactional and cross-generational sex, and

the other—the Be a Man campaign -promotes more gender equitable attitudes and behavior among men.

Both campaigns promote HIV/AIDS prevention through abstinence, partner reduction, faithfulness, and HIV

counseling and testing.

In FY 2006, Y.E.A.H. launched a weekly half-hour radio serial drama called "Rock Point 256", which won an

international award for excellence in HIV/AIDS communication in 2007, and has an estimated listnership of

30% among young 15 - 24 year olds, according to a survey conducted in three districts in 2006. During FY

2007, Y.E.A.H. reached more than 5 million young people through mass media and 46,000 through

community outreach promoting gender equitable relationships, faithfulness and partner reduction, open and

non-violent communication between intimate partners, and couple counseling and testing for HIV.

FY 2008 activities are a continuation of FY 2007 work and will have four components.

The first component is a further expansion of the Be a Man/Something for Something Love information,

education, and communication activities implemented in FY 2007. This includes a continuation of the award

-winning Rock Point 256 radio serial drama and comic books in five languages, radio spots, print materials,

as well as community outreach activities. Activities and media materials will include heightened attention on

alcohol consumption, responsible drinking and gender-based violence (GBV) as underlying factors in HIV

risk for young men. Additionally, the activities will integrate the strategies and approaches used in the

previous transactional sex campaign into the Be a Man campaign. The emphasis will be on social and

individual change to create an environment where alcohol, GBV, multiple sexual partners, and transactional

sex are no longer associated with manhood; where young people, especially men, recognize the

association between alcohol, violence and HIV; and where community resource persons, such as health

workers and peer educators are trained in alcohol counseling and abuse prevention and detection. HCP

will also work with the media and influential leaders at both national and community level to ensure that

leaders recognize GBV and alcohol abuse as underlying factors to HIV infection and speak out against it.

Additionally, HCP will work with the media to encourage portrayals of the underlying causes of HIV (GBV,

alcohol abuse, multiple sexual partners, and transactional sex) in a more serious and constructive manner.

HCP will reach an estimated five million young men and women through its radio programming.

The second component involves a continuation of training facilitators among men's groups at community

level, tertiary institutions and at work sites to facilitate interactive discussions using materials and tools

produced by the project. In doing so, HCP will adapt successful tools and approaches, including African

Transformation, a film-based documentary and community discussion facilitation guide for participatory

discussions, for use with young people. The adapted African Transformation will profile ordinary young

men, women, and couples who have broken gender stereotypes in their relationships, e.g. couples who

have tested together and shared their results with one another, young men who do not drink alcohol, and

young men who treat women as their equal. HCP will provide short courses and worksite seminars about

the relationship between GBV, alcohol and HIV for men at their work places and for nurses, midwives and

clinical officers as part of their clinical training. Men targeted through work places will include men in the

military, security guards, plantation and factory workers, and boda boda drivers. Additionally, HCP will work

with service delivery organizations that work with alcohol abuse prevention and treatment and GBV

prevention to develop and nurture a service provider working group to link Y.E.A.H. activities with HIV

counseling and testing, legal and social welfare, substance abuse treatment, and counseling services.

HCP will assist Y.E.A.H. to train 1,000 peer educators and community resource persons, and 20 health

workers in alcohol counseling. These peer educators and community resource persons will each counsel

30 young people, for a total of 20,000 young men and women reached through community outreach with

alcohol and HIV prevention information.

Through the third component, HCP will continue to provide technical assistance to the two prime indigenous

organizations, CDFU and Straight Talk Foundation (STF) to design, manage and evaluate multi-channel

communication for and by young people. HCP will also assist Y.E.A.H. to diversify funds and institutionalize

the strategies and programmatic concepts among key government and civil society partners. HCP will also

establish a distribution system and center through which health communication materials will be efficiently

marketed and distributed on behalf of Y.E.A.H.

The fourth component is monitoring and evaluating the effects of Y.E.A.H. information, education,

communication, and community mobilization activities. HCP will assist CDFU and STF to design and

conduct an assessment among young people aged 15-24 to determine whether or not there has been a

change in male gender norms, particularly in relation to GBV and alcohol abuse; whether the young men

have been exposed to the tools, materials and activities; and which ones specifically led to the greatest

change in their attitudes and behavior.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $300,000

During FY 2007, Health Communication Partnership (HCP) provided technical assistance to the newly

formed Male Circumcision task force , a joint MOH and UAC technical group, to develop and operationalize

a communication strategy for the distilling and dissemination of scientific and epidemiological data to the

general public to address information needs and misconceptions, as well as the design and implementation

of an information campaign for health professionals and leaders to provide basic information about male

circumcision (MC) as it relates to HIV prevention. While the MOH leadership is supportive of adding male

circumcision to the range of ABC+ tools for HIV prevention, others within the lay public and in political and

policy circles are less certain about the need to roll out services. In FY08, and depending on the success

of the campaign in increasing knowledge, understanding and acceptance of the effectiveness of MC, as well

as depending on policy decisions made by the GOU, HCP will intensify the public information campaign

(reach, exposure, content) and will provide assistance for the development of client education and

counseling materials, as pre and post operative counseling has been identified as a critical component of a

program to introduce medical male circumcision. If the government has decided to implement a full scale

male circumcision program, HCP will also assist the MOH and its male circumcision partners to develop job

aides for providers and other relevant client counseling materials. In addition, HCP will assist Young

Empowered and Healthy (Y.E.A.H.) programs to incorporate male circumcision information into its activities,

radio programming, and print materials.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,713,900

AFFORD is a CA awarded to Johns Hopkins University in October 2005, with the following objectives: 1.

Increase the accessibility and affordability of HIV/AIDS, RH, Child Survival and Malaria products and

services for Ugandans 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. 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. All six partners are contributing to build an indigenous

organization, the Uganda Health Marketing Group (UHMG), that will posses the technical, managerial and

financial capacity to continue in the footsteps of AFFORD at the end of the project. UHMG is currently

incorporated as a Not-For Profit Company, staffed and working alongside the consortium partners. Key

highlights of the program over the past year include distribution of 18 million condoms through 29,000 retail

outlets, communication of key health and HIV prevention to over 200,000 people through community

outreach and several interpersonal program approaches targeting mainly Most At Risk Groups (MARPS)

including the military, migrant workers, commercial sex workers, truckers, security forces, and fishermen.

This activity described under FY08 has three main components 1. Condom Social Marketing, 2.

Interpersonal behavior change communication, and 3. STI treatment.

1. AFFORD will continue direct condom promotion to MARPS (commercial sex workers, their clients,

truckers, fishermen, security agencies, and the police). In FY07 this activity was carried out in 4 districts and

will be scaled up by 50% in FY08 increasing the number of districts to 6. Target audiences will be

encouraged to use condoms consistently and referred to appropriate health services. Retail outlets

frequently used by these audience (e.g. bars and lodges) will be recruited to sell condoms and encourage

use. In FY07 bar and lodge owners were recruited to sell condoms and were oriented to provide information

on correct storage and use of condoms. In FY08, AFFORD wants to broaden the geographic reach of this

intervention and double the number of outlets recruited to 300. The expansion will increase from 19 districts

in FY07 to 39 in FY08. AFFORD will select interested bar and lodge owners to join a one-day training on

HIV/AIDS workplace activities, adapting a curriculum and print materials developed together with UPHOLD

during FY07, and complementing it with condom promotional materials. Incentives for attendance will

include hospitality training, provided by selected partners. In FY08, AFFORD will continue the distribution of

condoms, with plans to distribute 25 million condoms through 30,000 retail outlets. Its 150 Small Scale

Entrepreneurs will assist in getting condoms to hard to reach areas. 2. Interpersonal behavior change

communication (IPC) is will increase practical knowledge about HIV/STI prevention, to equip audiences with

skills to maintain healthy lifestyles, and modify/sustain positive behaviors. AFFORD will continue to carry

out IPC and plan to increase the number of the audience members reached directly from about 200,000 in

FY07 to 250,000 in FY08. AFFORD uses four primary approaches: The first approach will rely on

community mobilization and experiential marketing activities targeting MARPS including migrant workers,

fishermen, and security forces. Using music, film and drama coupled with interactive Q&A sessions hosted

by peers, the target audience will be challenged to look closely at high risk behavior. Key messages include

the correct and consistent use of condoms in risky sexual encounters, faithfulness and/or partner reduction,

the relationship of risky behaviors with gender stereotypes/masculinity, alcohol and drug use (including

sexual violence with e.g. commercial sex workers), the promotion of VCT and the importance of seeking

early treatment for STIs. AFFORD's partner PULSE Communications will lead this interpersonal community

intervention. The second communication approach works through institutions to reach the Uganda People's

Defense Forces (UPDF) and the Uganda Police (UP). Our programmes with them reached 240,000 people

in FY07, which is planned to increase to 360,000 in FY08. AFFORD will continue to support UPDF and UP

peer education re-training and super vision, VCT/STI service outreach embedded in drama and film shows,

and material development among other activities. The emphasis will be on activities promoting condom use,

faithfulness/partner reduction, early HIV testing and STI treatment and alerting about risk behaviors

including alcohol abuse and sexual violence (e.g., with commercial sex workers). The partnership created

with Uganda breweries and Nile Breweries in FY07 to raise awareness of links between alcohol in-take and

HIV/other STIs will be strengthened and the program expanded by 50%. The ‘Responsible Living

Campaign' targets brewery clients (bar owners) and consumers. The program emphasizes the dangers of

alcohol use in terms of impairment of judgment in relation to increased risky sexual behavior. They will be

supplied with STI kits for syndromic treatment of STI. Further emphasis will be put on including families and

members of the surrounding communities of UPDF and UP. The third approach will address CSW through

peer education (PE) and drop-in centers. AFFORD will steadily continue to scale up its work with CSWs in

partnership with Women at Work International (WAWI) to scale up to two new districts of Kabalore and

Jinja in FY08. In addition, five more organizations (TBD) will be recruited as partners to expand the work

from 4 districts to 9 (adding Gulu, Masaka Mukono, Iganga and Arua). These partners will address sex

workers and partners with PE activities, addressing HIV prevention skills, and sexual violence. Programs

will link CSW to STI/VCT services through outreach and to income generating activities such as condom

and other product sales as small scale entrepreneurs. In FY07 the CSW program developed two drop-in

centres for CSWs which provided safe havens off the street and opportunities to be exposed to PE,

educational materials and videos, and health service outreach. We will increase the number of drop-in

centres to 4 in FY08. Further support of the Uganda MARPS network, founded during AFFORD's FY07

Lessons Learned Workshop, will be crucial to identify more effective partners in HIV prevention with

MARPS. Support will be used to host the second annual meeting, exchange visits of successful

programming, and other activities developed by network members. The fourth communication approach will

involve 570 Popular Opinion leaders (POL) at the grassroots to educate members of their communities

about HIV/AIDS and serve as role models. They have been trained by AFFORD partner Communication for

Development Foundation Uganda (CDFU). Many of these community volunteers stem from HIV post test

clubs and are sensitively relaying messages about condom use among discordant couples, couple HIV

testing, early treatment for STIs, as well as raise awareness about gender issues and links between alcohol

intake and HIV. In FY08 AFFORD will carryout refresher training for the 570 POLs during which dialogue

regarding gender issues and other drivers of the epidemic will be revisited to refine the approach, based on

experiences on the ground. The POLs will reach an estimated target of 50,000 people through IPC through

FY08. 3. AFFORD addressed STI treatment in FY07 through recruiting 100 clinics as centres of excellence.

The essence of using existing clinics offering broad medical care to the general public was to reduce the

stigma of people accessing STIs treatment and other HIV/AIDS related activities. The centres have been

trained in STI diagnosis and treatment and offer HIV prevention IEC material as well as VCT to client. In

FY08, AFFORD will increase the number of clinics by an additional 100 in 10 more districts and train an

additional 500 service providers from pharmacies and drug shops in the syndromic treatment of STIs.

Further prevention activities include: A. Health Hotline: In 2007 AFFORD started to update its hotline

Activity Narrative: service for the general public from being an automated service where callers left recorded questions to a

hotline service that has a person responding to questions and concerns. Due to its anonymous nature it

quickly became a prime channel for HIV related questions. In 2008 AFFORD intends to upgrade this system

to a full computer-based call center with trained counselors in 5 local languages, referral guidelines and call

monitoring system. AFFORD intends to start wit 4 - 6 hours of operation initially, which can be slowly

expanded, and counselor numbers increased gradually throughout the year. B. AFFORD created the Good

Life Campaign in FY07 which breaks down preventive health behaviors into "simple, everyday activities"

that can keep individuals, couples and households "healthy and save some money" as a way to a "Good

Life." HIV messages focused on risk perception, condom use, faithfulness and partner reduction using a

highly popular TV, radio and experiential Gameshow format with a strong couple communication segment.

Various mini campaigns on malaria, HIV prevention and health maintenance added to the mutually

supporting media channels with a community radio shows, low literacy newsletters and other print support

materials. In FY08 AFFORD will continue to use the Good Life campaign to link to and reinforce its

community interventions by highlighting activities, positive behaviors and using FAQ from the field to create

meaningful messages addressing risk perception, self efficacy and gender issues driving people's

behaviors.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $250,000

Health Communication Partnership (HCP) is a three-year USAID Associate Award for health communication

support in Uganda managed by the Johns Hopkins Bloomberg School of Public Health's Center for

Communication Programs that was awarded in July, 2007. HCP has been working in Uganda since July,

2004, assisting the Uganda AIDS Commission to establish a national multi-channel communication initiative

for young people 15 - 24 years old called Young Empowered and Healthy (Y.E.A.H.). Y.E.A.H. is

managed by a partnership of Ugandan organizations led by Communication for Development Foundation

Uganda (CDFU), and has launched two multi-channel communication campaigns for young people—one

discouraging transactional and cross-generational sex, and the other—the Be a Man campaign--promoting

more gender equitable attitudes and behaviour among men. Both campaigns promote HIV/AIDS

prevention through abstinence, partner reduction, faithfulness, and HIV counseling and testing.

In 2005, Y.E.A.H. launched a weekly half-hour radio serial drama called "Rock Point 256", which won an

international award for excellence in HIV/AIDS communication in 2007, and has an estimated listenership of

30% among young 15 - 24 year olds, according to a survey conducted in three districts in 2006. During FY

2007, Y.E.A.H. reached more than 5 million young people through mass media and 46,000 through

community outreach promoting gender equitable relationships, faithfulness and partner reduction, open and

non-violent communication between intimate partners, couple counseling and testing for HIV.

In FY 2008, HCP will expand Y.E.A.H. activities as part of a new initiative targeting young people who are

HIV positive. This new focus is consistent with Uganda's HIV/AIDS National Strategic Plan 2007/2008 -

2011/2012 (NSP), and responds to findings from the HIV Seroprevalence Survey finding that a large

proportion of new infections occur among discordant partners and the need to strengthen programs

promoting prevention of transmission among people who are HIV positive. Y.E.A.H. will partner with groups

such as the Young Positives, the Pediatric Infectious Disease Center and the Mildmay Center Uganda to

work with young people who are HIV positive to improve disclosure of status to potential sexual partners

and consistent use of condoms among those who are already sexually active, as well as discouraging

alcohol abuse and encouraging gender equitable relationships.

HCP will work with a group of HIV positive young people to design and test communication and counseling

approaches that effectively increase disclosure of HIV status to sexual partners and consistent use of

condoms among this group. In developing these approaches, HCP will draw from successful approaches

used in Uganda or elsewhere in Africa. HCP will assist Y.E.A.H. to train counselors and peer educators to

provide counseling and education concerning prevention of transmission, and to prepare audio visual

materials for use by counselors, peer educators, and service providers with HIV-positive young people.

HCP will reinforce these interpersonal communication activities with mass media by incorporating HIV

positive role models and modeling positive prevention among HIV-positive young people in a realistic

manner. Counseling and education activities will also be extended to the young people's families, schools

and communities. HCP will explore the possibility of partnering with the Uganda Health Marketing Group to

distribute condoms among young positives.

HCP will evaluate the effectiveness of the approaches and assist Y.E.A.H. to share promising approaches

with stakeholders.

With Y.E.A.H., HCP plans to train 20 counselors and peer educators to promote prevention of transmission

among HIV-positive young people. Each counselor/peer educator is expected to counsel at least 50 young

people about positive prevention, for a total of 1,000 young people reached.

Funding for Care: Adult Care and Support (HBHC): $2,300,000

AFFORD is a CA awarded 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. All the six AFFORD partners are

contributing their unique skills towards the building of technical, managerial and financial capacity of

Uganda Health Marketing Group (UHMG) an indigenous organization to ensure sustainability the AFFORD

Health Marketing Initiative.. UHMG incorporated as a company limited by guarantee (not-for profit), is now

staffed and working alongside the consortium partners and taking the lead in marketing and distribution. In

the past year, the program distributed 18 million condoms through 29,000 retail outlets, communicated key

health and HIV prevention messages to over 200,000 people through community outreach and several

interpersonal program approaches targeting mainly most at risk groups (the military, migrant workers,

commercial sex workers, truckers, fishermen and people at landing sites). AFFORD integrates health

communication and social marketing techniques innovatively to change and sustain positive behaviors and

entices commercial sector participation to increase access to palliative care products and services.

Provision of palliative care products and services through the commercial sector and the Private Not For

Profit institutions is key in bringing palliative care to large numbers of PHA. A situation analysis of PHA

support groups showed that a large portion of PHA prefer to get palliative care products and services

through the private sector which they say offer better quality service and are more confidential. AFFORD

will continue to use a community based consumer-driven approach for the provision of preventive/palliative

care products to satisfy the needs of PHA through their preferred channels. In FY2007 AFFORD organized

training and orientation for over 500 clinics and 1000 drug shops on palliative care and the products

required to maintain a healthy life by PHA. A mutual referral was initiated among the service outlets to

identify, support and refer PHA that require information, products and services. Products for palliative care

were procured and distributed through trained outlets to PHA at subsidized prices. Using various channels

of communication, individuals and families were targeted and motivated to seek help an advice after testing

positive for HIV. The communication promoted palliative care products and services as well as simple steps

to stay healthy after testing positive. Print materials including an ART handbook for peer counselors, an

ART comic and brochure on palliative were developed, printed and distributed to the target.

In FY 08, AFFORD will consolidate and the scale up palliative care activities started in FY 07. The UHMG

product facility AFFORD started in the FY 07 aims at negotiating/brokering lower prices on high quality

palliative care products from private supplier by taking advantage of economies of scales. Interested

FBO/NGO/CBO in the private sector take advantage this facility to pass the price reduction benefits on to

their clients thus increasing access. In FY08, AFFORD will continue to run this facility to cover a range of

products including LLINS, water purification products and other pharmaceutical products essential for

maintaining good health among PHA.

AFFORD will continue to use traditional social marketing methods to distribute a range of high quality

palliative care products targeted at PHA through private commercial channels (drug shops, pharmacies,

clinics and midwifery's). This is based on the fact that HIV affects people are of all socioeconomic strata

including those that are able to pay and those not able to pay. AFFORD will principally target those able to

pay for the products and will work very closely with the private sector. Distribution of palliative care products

through the private sector helps in reducing stigma associated with accessing palliative care products from

a service delivery point which is dedicated for reaching PHA. In a drug shop, people just walk-in to purchase

palliative care products like any other customer.. These products are not specially packaged for PHA, they

are products used by the public. This eliminates the stigma associated with specially branded products.

The range of products to be provided in FY08 will include water purification product, Cotrimoxazole, the STI

kit, LLINs, condoms, multivitamins containing selenium, and acyclovir. It should be noted the palliative care

program will leverage the existence of products supported with child survival funds. These include Aquasafe

(water purification product), Zinkid (Zn) and RESTORS (ORS). Fluconazole is a life saving drug against

fungal meningitis in later stages of AIDS. Though it is relatively expensive, AFFORD plans to avail it through

selected specialized clinics and hospitals at a subsidy.

In FY 07 AFFORD established linkages with networks of PHA and service providers to enable PHA access

and utilize quality health products. In FY08 the work with networks and organizations will be consolidated.

AFFORD will work with National Forum For PHA Networks in Uganda (NAFOPHANU), Positive Men's

Union, Uganda Young Positives, National Community of Women Living with AIDS (NACWOLA), National

Guidance and Empowerment Network (NGEN)+ to procure and distribute palliative care products to its

members across the country. AFFORD will also work with organizations/associations of health workers to

improve the quality of care provided by their members. AFFORD will for example support the Uganda

Medical Association (UMA) an umbrella association of Ugandan Doctors to advocate for raising the

importance of palliative care to member clinicians. AFFORD will consolidate its work with the Uganda

Private Medical Practitioners Association (UPMPA) the association of medical Doctors in private practice.

UPMPA will identify, train and offer support supervision to an additional 300 Doctors in private practice.

These Doctors will be given support materials and linked to suppliers of palliative care products. AFFORD

will during FY08 scale up training and support supervision of members of Uganda Private Midwives

Association (UPMA). UPMA will be contracted to carryout the training and supervision of its members who

will thereafter be given support materials and likewise be linked to suppliers of palliative care products.

In FY2007 AFFORD developed 100 clinics as centres of excellence to offer HIV/AIDS, malaria, family

planning and child survival services. This is because existing clinics offering broad medical care to the

general public reduce the stigma of people coming in for palliative care and or STI treatment. The staffs of

these 100 centres have been trained in palliative care, HCT, STI diagnosis and treatment. They also

provide HIV prevention communication material and offer VCT to client visiting the clinic who would like to

know their status. In FY2008, AFFORD will develop an additional 100 clinics as centres of excellence in 10

more districts. In addition, AFFORD will also train 500 service providers working mainly in pharmacies and

drug shops in the syndromic treatment of STIs.

AFFORD has developed an umbrella logo (Orangie) under the Good life campaign used on all

communication vehicles and products as well being a symbol of certain services points. Under the Good

Activity Narrative: Life campaign, AFFORD will utilize various channels to raise awareness about palliative care, promote

products and service outlets. A total of 570 Popular Opinion Leaders (POL) have been trained on health

maintenance in HIV affected households and PHA including the correct and consistent use of appropriate

palliative care products. These community workers have been supplied with communication material

enabling them support PHA and strengthen the network model through effective referrals/linking of PHA to

service delivery points. In FY2008, communication material including brochures, flip charts, job aids and

health maintenance handbook will be re-produced to the work of POLs. The two 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 PHA to

access service providers displaying the Orangie logo. AFFORD will continue to mobilize PHA networks and

raise awareness on palliative care, increasing knowledge about benefits of palliative care products and

services through community activaties.

Family Planning will be integrated in palliative care activities and at service outlets and through all the

communication channels, PHA will be motivated to utilize dual protection if they engage in sex to prevent

pregnancy. Family Planning products will be made available through the private service delivery points.

AFFORD will support all these initiatives with mass media campaign aimed increasing awareness among

PHA that there are steps that one can take, products one can use and places that one can visit to make

their lives better. AFFORD will continue to 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 the

private sector channels.

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

This is a continuation from FY 2007. During FY2007, HCP received Plus Up funds to support the National

HIV counseling and testing (HCT) Coordinating Committee to design and implement a communication

campaign to promote couple counseling and testing and disclosure of HIV status, linked to HCT testing

days. During FY2008, HCP will continue to support the national HCT testing campaign, contributing to the

goal of reducing HIV prevalence by 25% stated in Uganda's HIV/AIDS National Strategic Plan 2007/8 -

2011/2012 (NSP).

According to the Uganda HIV/AIDS Sero-Behavioural Survey 2004-05 (HSBS), only 10 - 13% of men and

women have ever tested for HIV, although approximately 70% would like to test. The national HCT testing

campaign will make free testing and counseling services available on specific days throughout the year, and

would target cohabiting couples for testing. As more than 50% of cohabiting adults who are HIV-positive

have an HIV-negative partner, and most new infections are occurring within marriage (HSBS), this

intervention is aimed at protecting the uninfected partners in discordant relationships.

HCP will utilize a mixture of communication approaches to attract couples for HCT, and to promote

disclosure of HIV status among cohabiting partners, including mass media, client education and information,

and community outreach. Communication will target communities within easy access of HCT services.

HCP will also conduct assessments of the effectiveness of HCT communication that took place during

FY2007, to inform the design of HCT communication in FY2008.

It is anticipated that the HCT communication campaign will reach a minimum of 10 million adults throughout

Uganda through the mass media, and a minimum of 1,000 men and women per district with interpersonal

communication about HCT between 1 October 2008 and 30 September 2009.

HCP will strive to build the capacity of a Ugandan non-governmental partner and the Ministry of Health

AIDS Control Program to design and implement national HCT days coupled with communication and

education. In this way, the HCT campaign will become a sustainable activity of the Ministry of Health and

its HCT partners.

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

This activity is a continuation of activities implemented in FY2007. Health Communication Partnership

(HCP) has been providing technical assistance to the Joint Clinical Research Center (JCRC), the Ministry of

Health, and other HIV/AIDS treatment partners to improve the quality of anti-retroviral therapy (ART) client

education and adherence counseling, provide public education about ART, increase the uptake of HIV

services among children with HIV/AIDS, and reduce stigma and discrimination against people living with

HIV/AIDS. In FY 2006 and 2007, HCP has assisted JCRC to develop adherence counseling training

materials for community volunteers and clinical providers, design and launch a national pediatric ART

uptake campaign, and is developing a national campaign to combat stigma and discrimination.

In FY 2008, HCP will continue working with JCRC and other HIV/AIDS partners to implement a stigma

reduction campaign targeting stigma in health facilities, at community level, and in the media. Activities will

include interpersonal communication, training for community volunteers, community leaders, and media

personalities, as well as media materials. HCP will document and package community based stigma

reduction activities that are effective, and distribute these through the Uganda AIDS Commission

partnership of organizations working at community level.

According to qualitative studies, stigma is one of the main reasons given for not getting tested for HIV, and

for ART clients to stop taking their drugs. Stigma is also a major reason given by HIV-positive men and

women for not disclosing their HIV status to partners and for not using condoms. This activity aims to

improve uptake of HIV counseling and testing, to improve ART adherence, and to increase condom use by

reducing stigma associated with HIV/AIDS. According to Uganda's HIV/AIDS National Strategic Plan

2007/2008 - 2011/2012 (NSP), stigma is an underlying factor that must be addressed in order to reach

national goals for treatment and prevention.

HCP will provide technical assistance and training in strategic communication for JCRC, the Ministry of

Health AIDS Control Program, and other HIV/AIDS partners. Through these capacity building activities and

provision of communication tool kits, HCP will build a sustainable cadre of community facilitators who can

organize HIV/AIDS stigma reduction activities in other communities in future.

Funding for Health Systems Strengthening (OHSS): $216,587

During FY 2007, Health Communication Partnership (HCP) worked with local organizations and a joint MOH

and UAC Task Force to design an advocacy strategy intended for decision makers in the health, political,

media, and religious spheres. The overall purpose of the strategy was to provide epidemiological, cultural,

and cost data and arguments to support the MOH's intention to include medical male circumcision as an

effective prevention intervention within the country's ABC+ prevention program, and to provide these

leaders with the data and arguments necessary to properly inform their constituents and to effectively

address opponents. A particular aspect of the advocacy strategy involves the translation of the

epidemiological data into policy briefs that are accessible to a wide audience of policy makers, particularly

at national level.

Depending on the progress achieved in the campaign in 2007, and policy decisions made by the Ugandan

government, HCP will continue to provide technical assistance to the local advocacy partner identified in FY

2007 (likely the Makerere University School of Public Health) to strengthen its ability to design and manage

advocacy and communication programmes, specifically in support of male circumcision policy

implementation. HCP will assist the advocacy partner to evaluate male circumcision advocacy activities

and approaches conducted over the previous year, and build on successful approaches. If the government

of Uganda has decided to embark on a full-scale male circumcision programme, then the advocacy will be

increasingly targeted toward religious and cultural and community leaders at local level to support male

circumcision. HCP will assist the advocacy partner to reach a minimum of 10 religious, cultural, media

and/or local leaders in districts where male circumcision services are offered. Assuming male circumcision

is rolled out to 80 districts, HCP activities will reach a minimum of 8,000 local leaders ahead of the rollout to

facilitate acceptability and support.

Subpartners Total: $3,991,473
Palladium Group (formerly Futures Group): $2,000,000
Pulse Uganda: $500,000
Uganda Peoples Defence Forces: $100,000
Communication for Development Foundation - Uganda: $200,000
Women at Work International: $80,000
Uganda Health Marketing Group: $951,473
Uganda Police: $90,000
Media for Development Trust: $70,000