PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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.
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.
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.
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.
Communication Programs that was awarded in July, 2007. HCP has been working in Uganda since July,
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
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.
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.
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.
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.
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.