Uganda has a mature & generalised epidemic with a prevalence of 6.4 %. The epidemic is evolving and becoming more complex. Annual new infections are exceeding AIDS deaths; the epidemic is disproportionately affecting women; burden is shifting to adults and individuals in long standing relationships. According to the mode of transmission study, the major sources of HIV infection in Uganda include: multiple sexual partnerships (including partners) 37.3 %; Mutually Monogamous partnerships at 35.1%; Mother-to-Child at 18.1 %; Sex Work (Including partners, clients and partners of clients) at 8.7 %. Given current evidence from the sero behavioural survey and mode of transmission study, an expanded HIV Prevention programme will be implemented focusing on combination HIV prevention. This will include a mix of strategies and risk reduction approaches that use current epidemiological and programmatic evidence to target different audiences with simultaneous behavioral, biomedical, social normative and structural interventions that respond to local realities. This prevention programme is contributing to the NSP goal of reducing HIV incidence by 40 % by 2012.

In addition to reaching out to the young people and the general public, the programme will target those sections of the population where new HIV infections are originating from. . These include Most at Risk Populations (Fisher fork and their partners, Commercial Sex workers and their partners, internally displaced populations, uniformed personnel, Long distance track drivers, couples and those in long term relationships, discordant couples.

Uganda has a mature and generalised epidemic with a prevalence of 6.4%. Anecdotal reports indicate that new infections are rising annually. There have been shifts in epidemiological patterns, with new infections now occurring more in married and co-habiting couples than in youth, as was the case a few years ago. Available data and analyses highlight that sexual transmission accounts for 76% of all new infections, followed by mother to child transmission at 22%. Women, urban dwellers and those living in the conflict regions are the most severely affected. Of the adults in married and co-habiting relationships, forty percent of those who are HIV positive have an HIV negative spouse. The recently concluded mode of transmission study indicates that key drivers of the epidemic include: multiple concurrent sexual partnerships, discordance and non-disclosure among couples, low condom use, transactional sex, cross-generational sex, and relaxed sexual behaviors due to antiretroviral treatment (ART). The study also pointed to serious flaws in programming by government and its partners as most data generated over the years have not been utilized in designing new prevention interventions that address the current realities of the epidemic. For instance, although available evidence indicates that that medical male circumcision greatly reduces the risk of acquiring HIV among men, it has not been adopted nationally as a prevention strategy. Uganda has not yet reached consensus regarding the efficacy of the intervention and hence there is no government policy as yet. Public awareness and correct knowledge of the intervention also remains limited.

Despite the lack of strategic clarity, the demand for medical male circumcision has been high with the majority of those receiving services being adults. This activity will focus on addressing HIV prevention using a combination of biomedical and behavioural interventions targeted at adult populations. The activity will particularly aim to take to scale medical male circumcision as a critical HIV prevention strategy. Given the fact that there is no government policy as yet and public awareness is limited, activities will be focused on advocacy to access accurate information to the public, eliminate myths and foster general community appreciation of the strategy. A variety of communication strategies will be used including interactive mobile SMS messaging, mass media, community social networks, religious institutions and where possible outdoor advertising.

The program will also strive to train health workers and improving health facility preparedness to ensure that the intervention is undertaken with utmost professionalism and safety. This will entail rehabilitation and equipment of minor theatres and refurbishment of premises to create safe and spacious waiting areas. The program will also join other partners in their engagement with government to fast track the development and ratification of the national policy and guidelines to offer strategic direction to the intervention.

The activity will be complemented by sexual and other behavioral risk prevention activities will be geared towards increasing personal perception of risk of HIV transmission and utilization of prevention services through behavior change communication (BCC) programs to enable youth assess their risk for HIV infection, promote behaviors to reduce their risk and acquire skills to overcome and avoid risky behaviors.

Targets:

Number of locations providing MC surgery as part of the minimum package of MC for HIV prevention services within the reporting period 20

Number of males circumcised as part of the minimum package of MC for HIV prevention service 3500

Number of males circumcised as part of the minimum package of MC for HIV prevention service disaggregated by age

<5 years 500

5 -17 years 2,000

18+ years 1,000

Uganda has a mature and generalised epidemic with a prevalence of 6.4%. Anecdotal reports indicate that new infections are rising annually. There have been shifts in epidemiological patterns, with new infections now occurring more in married and co-habiting couples than in youth, as was the case a few years ago. Available data and analyses highlight that sexual transmission accounts for 76% of all new infections, followed by mother to child transmission at 22%. Women, urban dwellers and those living in the conflict regions are the most severely affected. Of the adults in married and co-habiting relationships, forty percent of those who are HIV positive have an HIV negative spouse. The recently concluded mode of transmission study indicates that key drivers of the epidemic include: multiple concurrent sexual partnerships, discordance and non-disclosure among couples, low condom use, transactional sex, cross-generational sex, and relaxed sexual behaviors due to antiretroviral treatment (ART). The study also pointed to serious flaws in programming by government and its partners as most data generated over the years have not been utilized in designing new prevention interventions that address the current realities of the epidemic. Consequently, populations at a higher risk of HIV infection are not served with the kind of services that they ideally need.

Based on the current evidence from the sero behavioural survey and mode of transmission study, USAID intends to launch an expanded and comprehensive HIV prevention programme to directly address the identified drivers of the epidemic using evidence based strategies. This will include a mix of strategies and risk reduction approaches that use current epidemiological and programmatic evidence to target different audiences with behavioral, social, normative and structural interventions that respond to local realities. The new program will build upon the progress and achievements realised through the five-year interventions implemented through centrally funded Track 1.0 partners. The program will contribute to the NSP goal of reducing HIV incidence by 40 % by 2012.

This activity will focus on promoting abstinence and mutual faithfulness among youth and adults in marriage and cohabiting relationships. With regard to adults, interventions will aim to consolidate approaches that increase personal awareness and responsibility, as well as risk perception. These will include among others, improvement in couple communication and trust, strengthening of traditional family and community networks and structures around the ethos of personal and social responsibility, further empowerment of women particularly enhancing their active role in family decisions, encouraging frank, open disclosure and discussion in situations where couples renege on their marital obligations and creating a sense of community, especially in urban areas to create a culture where individuals know each other, to facilitate mutual understanding and support. The program will also target behaviours and practices that heighten risk and exposure to HIV infection such as alcoholism and alcohol abuse, inappropriate gender and cultural norms, domestic violence, and the desire for quick solutions to personal needs which often breeds irrational sexual decision making. The program will further strengthen community based networks of volunteers such as PHA networks, religious leaders, women leaders, and youth associations to serve as enduring sources of HIV prevention information at community level. They will be facilitated to work with communities to challenge social and cultural norms that increase vulnerability and risk to HIV infection, in particular those regarding gender, power and sexuality. These community based volunteers will also serve as referral hubs directing people to facilities where essential services such as counselling and testing can be sought.

Besides reaching out to adult individuals in married and cohabiting relationships, the program will also target the youth with abstinence messages. The shifting of the epidemic to the older people presents an opportunity to consolidate HIV prevention among youth. Interventions under this program will directly target behaviours that increase risk among youth such as transactional and cross-generational sex, inappropriate and apathetic personal goals, low self esteem and efficacy as well as engagement in potentially risky relationships. Sexual and other behavioral risk prevention activities will be geared towards increasing personal perception of risk of HIV transmission and utilization of prevention services through behavior change communication (BCC) programs to enable youth assess their risk for HIV infection, promote behaviors to reduce their risk and acquire skills to overcome and avoid risky behaviors.

Other activities will include use of different communication channels (e.g. radio, drama, music, and TV) to help promote and reinforce positive behaviours; use of interpersonal communication to help individuals internalise the messages, HIV counselling and testing to enable individuals know their status and where applicable, engagement of the MOH and UAC on policy related matters.

Targets:

Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards:

10-14 years 100,000

15-24 years 800,000

25+ years 600,000

Uganda has a mature and generalised epidemic with a prevalence of 6.4%. Anecdotal reports indicate that new infections are rising annually. There have been shifts in epidemiological patterns, with new infections now occurring more in married and co-habiting couples than in youth, as was the case a few years ago. Available data and analyses highlight that sexual transmission accounts for 76% of all new infections, followed by mother to child transmission at 22%. Women, urban dwellers and those living in the conflict regions are the most severely affected. Of the adults in married and co-habiting relationships, forty percent of those who are HIV positive have an HIV negative spouse. The recently concluded mode of transmission study indicates that key drivers of the epidemic include: multiple concurrent sexual partnerships, discordance and non-disclosure among couples, low condom use, transactional sex, cross-generational sex, and relaxed sexual behaviors due to antiretroviral treatment (ART). The study also pointed to serious flaws in programming by government and its partners as most data generated over the years have not been utilized in designing new prevention interventions that address the current realities of the epidemic. Consequently, populations at a higher risk of HIV infection are not served with the kind of services that they ideally need.

Based on the current evidence from the sero behavioural survey and mode of transmission study, USAID intends to launch an expanded and comprehensive HIV prevention programme to directly address the identified drivers of the epidemic using evidence based strategies. This will include a mix of strategies and risk reduction approaches that use current epidemiological and programmatic evidence to target different audiences with behavioral, social, normative and structural interventions that respond to local realities. The program will contribute to the NSP goal of reducing HIV incidence by 40 % by 2012.

This activity will focus on addressing HIV prevention using a combination of biomedical and behavioural interventions targeted at adult populations with particular emphasis on those living and/or operating in high risk situations. These include fisher folk and their partners, commercial sex workers and their partners, internally displaced populations, uniformed personnel, long distance track drivers, individuals in multiple sexual relationships and discordant couples. The program will target behaviours and practices that heighten risk and exposure to HIV infection such as alcoholism and alcohol abuse, inappropriate gender and cultural norms, domestic violence, and the desire for quick solutions to personal needs which often breeds irrational sexual decision making. The program will further strengthen community based networks of volunteers such as PHA networks, women leaders, and community leaders to serve as enduring sources of HIV prevention information at community level. They will be facilitated to work with communities to challenge social and cultural norms that increase vulnerability and risk to HIV infection, in particular those regarding gender, power and sexuality. These community based volunteers will also serve as referral hubs directing people to facilities where essential services such as counselling and testing can be sought.

Sexual and other behavioral risk prevention activities will be geared towards increasing personal perception of risk of HIV transmission and utilization of prevention services through behavior change communication (BCC) programs to enable youth assess their risk for HIV infection, promote behaviors to reduce their risk and acquire skills to overcome and avoid risky behaviors. Other activities will include use of different communication channels (e.g. radio, drama, music, and TV) to help promote and reinforce positive behaviours; use of interpersonal communication to help individuals internalise the messages, and where applicable, engagement of the MOH and UAC on policy related matters.

Safe sex messages will be particularly emphasised to ensure that individuals make informed decisions. The program will facilitate expansion in access to and utilization of biomedical products such as condoms and family planning devices to minimise HIV transmission. Trained community volunteers will be facilitated to serve as sources of these devices at community level. In addition, the program will network with other USAID funded social marketing programs to ensure wide accessibility to condoms and family planning devices through the commercial sector.

Targets:

Number of the targeted population reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards:

10-14 years 0 15-24 years 100,000 25+ years 300,000