HPI: 100% CUP

This is a continuing activity from FY07, but a new narrative is being provided for FY08 to reflect an improved

focus on provincial implementation.

Based on international best practices from Thailand, China and Indonesia, and upon FY07 advocacy work,

Health Policy Initiative (HPI) will pilot a 100% Condom Use Program (100% CUP) in Can Tho to increase

condom use among vulnerable groups with an emphasis on direct sex workers. Can Tho was selected

based on perceived support from provincial HIV/AIDS authorities and existing commitment to condom

provision. The 100% CUP program will be implemented through specific steps to build links between

provincial agencies; establish provincial partnership among police, health and local authorities, venues,

clients and sex workers; and link the program to ongoing HIV and STI services. In Can Tho sequential steps

will include: a) an MOU on 100% condom use signed by partner agencies; b) establishment of a provincial

management unit including the Provincial AIDS Center and law enforcement; c) elaboration of a strategic

plan with sectoral responsibilities, program targets, and M&E components; and d) development of a regular

reporting schedule.

One hundred percent Condom Use Programming is an integral part of the PEPFAR Vietnam 5-Year

Strategy and comprehensive ABC HIV prevention programs. Whereas many outreach programs target

either sex workers or potential clients, the 100% CUP is uniquely positioned to join these facets together

with the explicit cooperation of law enforcement, health authorities, and other stakeholders. This

collaboration will assist the PEPFAR team reach planned FY08 targets not only through outreach, but by

reducing the fear or arrest and stigmatization that causes sex workers and clients to avoid health seeking

behaviors.

A key lesson in the success of international 100% CUPs is that they must be implemented together with

other strategies such as appropriate and friendly health services, and that coverage must be

comprehensive to ensure that sex without condoms cannot be purchased in the province. The pilot 100%

CUP will be linked to existing PEPFAR activities and other donor interventions. HPI will ensure that

activities are coordinated with provincial HIV services, including outreach, positive prevention programs,

HIV counseling and testing, STI service, and clinical and community-based HIV care and treatment. These

linkages will facilitate the extension of the 100% CUP to non-venue-based sex workers. HPI will also link the

program with the legal clinic in Can Tho to ensure the clinic can provide assistance on legal matters arising

from the implementation of CUP (i.e., ensuring condom possession is not used as evidence of prostitution).

Populations targeted by the 100% CUP pilot include sex workers and their clients, those traditionally

marginalized by law enforcement and by social behavior standards. To effectively reach these often hidden

populations, HPI will develop a list of venues to ensure adequate coverage. Teams of public health worker

community representatives and police will be trained to liaise regularly with target venues and will be

responsible for monitoring and ensuring the compliance of venues with the program. Stakeholders will

receive training on condom use and 100% program guidelines and provisions. Review of existing condom

distribution networks and establishment of additional distribution networks will be coordinated with the TBD

PEPFAR condom social marketing partner. An identification card system for outreach workers, as outlined

in the Vietnam HIV/AIDS decree, will enable these individuals to conduct condom distribution without fear of

arrest. IEC activities for clients and sex workers will promote use of condoms in commercial sex and use of

condoms with non-commercial sex partners. Finally, incorporation of STI services into the program will

highlight the role of STI workers and physical examinations for sex workers and—if appropriate—contact

tracing to ascertain the sources of the infection and provide information to direct prevention efforts.

Piloting the 100% CUP in Can Tho will allow the Vietnam PEPFAR team to address gender issues including

male norms and behaviors and improve gender equity. By establishing policies that require condom use,

men will regularize condom use with commercial and non-commercial sex partners, and women will not be

subjected to pressures to engage in high risk unprotected sexual activity at the insistence of clients or

venue owners.

HPI: PwP training

This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major

updates to this activity since approval in the FY07 COP are:

• The core team of prevention trainers will be expanded from 120 to 200 in FY08, and refresher trainings will

be provided to the original trainers.

• The trainers will design and facilitate five workshops in each PEPFAR focus province to train

approximately 8,000 PLWHA in community outreach.

• An additional 25 condom service outlets will be supported, bringing the total to 60.

FY07 Activity Narrative:

Health Policy Initiative (HPI) leads PEPFAR partners' support for MOH prevention with positives

programming in Vietnam. PEPFAR will support HPI to develop prevention with positives training module

based on guidance from HHS/CDC HIV/AIDS Prevention Branch and OGAC, to establish a core of 120

PLWHA trainers on prevention with positives messaging. Three thousand and five hundred people will be

trained to promote HIV prevention messages.

These activities promote the Vietnam National HIV/AIDS Strategy, ensuring greater PLWHA involvement

and addressing stigma/discrimination reduction as outlined in the PEPFAR Vietnam 5-Year Strategy. This

activity targets PLWHA in geographic areas where the epidemic is the most severe. The interventions form

part of a structured approach that includes multiple exposures to prevention messages and links to other

relevant services including counseling and testing.

In collaboration with PLWHA groups, an HPI-trained team of 10 will develop and test prevention with

positives training module. The module will promote behavior change communication (BCC) through skills-

building to adopt safer behaviors employing a range of prevention methods. The module will teach life skills,

counseling (including referral for addiction treatment), and will address difficulties faced by women, and

male norms and behaviors. Specific interventions will address HIV re-infection and provide support for

PLWHA by providing clear referrals to the network model in the seven focus provinces.

The module will be used to develop a core group of 120 PLWHA prevention trainers. Drawn from existing

PLWHA groups, including Bright Futures, trainers will conduct workshops to build capacity among members

of one or more PLWHA groups from each of the seven focus provinces. This will also boost local

organization capacity as well as development of networks, linkages and referral systems. Trainers will

establish relationships with other service providers, including CT and outpatient clinic (OPC) sites, to enable

mutual referral among trainers and service providers. The 120 PLWHA prevention trainers will hold

workshops for PLWHA groups and other service providers in the seven focus provinces. Three workshops

in each province (total 21) will train 3500 participants to teach PLWHA abstinence or faithfulness or correct

and consistent condom use as appropriate, establish condom outlets, and mobilize communities to promote

safer behaviors. Condoms will be provided to groups and individuals as a component of the training on a

regular basis. A component of this activity will link with other Emergency Plan prevention activities to ensure

that PLHA groups are provided with regular and adequate supplies of condoms.

This is a continuing activity from FY07, where it was housed in OHPS. Due to shifting of OPHS activities, a

portion of this activity will be housed in HBHC in COP08.

• In FY08, Health Policy Initiative (HPI) will continue to support the HIV/AIDS legal centers that were set up

in 2005-06, with slight expansion in FY07. Attention will focus on providing quality services to clients and

building a client base in current centers, instead of spreading resources too thin for a small client base.

• In FY08, a pilot hotline to address legal issues of PLWHA will be tested.

• In FY08, HPI will focus on ensuring the rights of children in access to schooling and health facilities

through efforts in reduction of stigma and discrimination.

• HPI will continue to train new staff and provide refresher courses for current staff on legal issues pertaining

to PLWHA.

• HPI will continue to provide treatment literacy support initiated in 2005-06. HPI will work with other

PEPFAR partners and PLWHA support groups to ensure PLWHA have access to appropriate information.

• By April 2007 HPI conducted training for 50 individuals in policy development and 290 individuals in

reduction of stigma and discrimination.

• By April 2007 HPI established one legal center and one hotline and counseled 112 clients face to face and

a further 213 clients by telephone.

• By April 2007 HPI trained 180 PLWHA peer trainers in HIV treatment literacy.

• By April 2007 HPI provided 121 local organizations with technical assistance for HIV-related institutional

capacity building, including chapters of the Vietnam Lawyer's Association, the Ho Chi Minh Political

Academy, PLWHA groups and local NGOs.

• By April 2007 HPI provided support for the dissemination of information on the HIV/AIDS to 21 local NGOs

working on HIV/AIDS (5000 leaflets on the law distributed to agencies in the network).

• During FY07 HPI provided financial and technical assistance to a local NGO and the Ministry of Health

(MOH) to draft the HIV/AIDS Law which provides detailed guidelines on the implementation of the Law on

HIV/AIDS Prevention and Control. The Law was approved by the government of Vietnam on June 27, 2007.

• During FY06 HPI supported MOH's Department of Therapy in the development of national methadone

guidelines, and in FY07 HPI supported the implementation of an electronic patient monitoring information

system which links all six methadone pilot sites to the central level. In FY08, in collaboration with the

Vietnam Administration for HIV/AIDS Control (VAAC) and other partners, HPI will continue to support the

maintenance of this monitoring system, and subject to the approval of VAAC, HPI will help to expand this

system to new methadone sites in Vietnam.

FY07 Activity Narrative:

PEPFAR will support HPI to: build the capacity of 17 community-based organizations (CBOs) and develop

their ability to form a single network with other CBOs to advocate for the rights of PLWHA; provide legal aid

for PLWHA in seven focus provinces to ensure enforcement of the HIV/AIDS Law; support strategic

provincial planning for government of Vietnam (GVN) HIV/AIDS programs using the GOALS model in seven

focus provinces; and link with the Harvard training program to train 200 government cadres from 16

provinces.

Building on support in FY05 and FY06 to fledgling PLWHA CBOs in three focus provinces, HPI will expand

support to and build the network of 17 indigenous PLWHA CBOs (some existing, such as Bright Futures

chapters in focus provinces, and some to-be-determined) in all focus provinces and additional provinces.

These CBOs will receive technical and financial assistance (TA) through HIV-related institutional capacity

building. HPI will also support the development and expansion of an NGO network focusing on PLWHA

issues/rights. Via partnership with Community Mobilization Center for HIV/AIDS Control (VICOMC), HPI will

conduct four workshops targeting 150 PLWHA CBO staff. These workshops will enable PLWHA CBOs to

develop communication and management skills to strengthen advocacy activities. They will also enable

PLWHA CBOs to share best practices via the establishment of a national network of PLWHA organizations.

HPI will work closely with PLWHA-elected leaders representing the northern, central and southern regions

of Vietnam to liaise with the Communist Party, the National Assembly, relevant government ministries and

major donors to support the legal establishment of the PLWHA network. HPI will support this network to

conduct three regional meetings on general community mobilization with a focus on prevention, care and

treatment for PLWHA. Roughly 1500 PLWHA will participate in these workshops. The PLWHA network will

produce and disseminate a network newsletter on a monthly basis and an e-forum linking member groups

and will collate feedback for national policy makers on PLWHA needs.

HPI will also support the implementation of the impending HIV/AIDS Law at the provincial level in the seven

focus provinces. Support will assist the Vietnam Lawyer's Association to provide legal aid to PLWHA (see

HPI Palliative Care Basic) to advocate for themselves (key legislative issue: stigma and discrimination), in

conjunction with program monitoring by HPI staff on the enforcement of the law. In order to monitor the

efficacy of the HIV/AIDS Law, HPI will assess attitudes and practices of key policy makers, service

providers, employers and PLWHA to develop a monitoring tool to measure changes following the

dissemination of the Law (in select focus provinces). Lessons learned will be disseminated nationally at the

end of FY07 to assist policy makers in improving communication around and enforcement of the Law. HPI

will partner with the legal department of the Ministry of Health (MOH) to assist in disseminating findings. In

addition, HPI will support PLWHA organizations to report inconsistencies in implementation of the HIV/AIDS

Law.

This is a continuing activity from FY07, where it was housed in OHPS. Due to shifting of OPHS activities, a

portion of this activity will be housed in HKID in COP08.

In FY08:

• Health Policy Initiative (HPI) will continue to support the HIV/AIDS legal centers that were set up in 2005-

06, with slight expansion in FY07. Attention will focus on providing quality services to clients and building a

client base in current centers, instead of spreading resources too thin for a small client base.

• A pilot hotline to address legal issues of PLWHA will be tested.

• HPI will focus on ensuring the rights of children in access to schooling and health facilities through efforts

in reduction of stigma and discrimination.

• HPI will continue to train new staff and provide refresher course for current staff on legal issues pertaining

to PLWHA.

• HPI will continue to provide treatment literacy support initiated in 2005-06. HPI will work with other

PEPFAR partners and PLWHA support groups to ensure PLWHA have access to appropriate information.

By April 2007:

• HPI conducted training for 50 individuals in policy development and 290 individuals in reduction of stigma

and discrimination.

• HPI established one legal center and one hotline and counseled 112 clients face-to-face and a further 213

clients by telephone.

• HPI trained 180 PLWHA peer trainers in HIV treatment literacy.

• HPI provided 121 local organizations with technical assistance for HIV-related institutional capacity

building, including chapters of the Vietnam Lawyer's Association, the Ho Chi Minh Political Academy,

PLWHA groups and local NGOs.

• HPI provided support for the dissemination of information on the HIV/AIDS to 21 local NGOs working on

HIV/AIDS (5000 leaflets on the law distributed to agencies in the network).

• During FY07 HPI provided financial and technical assistance to a local NGO and the Ministry of Health

(MOH) to draft the HIV/AIDS Law, which provides detailed guidelines on the implementation of the Law on

HIV/AIDS Prevention and Control. The Law was approved by the government of Vietnam (GVN) on June

27, 2007.

FY07 Activity Narrative:

PEPFAR will support HPI to: build the capacity of 17 community-based organizations (CBOs) and develop

their ability to form a single network with other CBOs to advocate for the rights of PLWHA; provide legal aid

for PLWHA in seven focus provinces to ensure enforcement of the HIV/AIDS Law; support strategic

provincial planning for GVN HIV/AIDS programs using the GOALS model in seven focus provinces; and link

with the Harvard training program to train 200 government cadres from 16 provinces.

Building on support in FY05 and FY06 to fledgling PLWHA CBOs in three focus provinces, HPI will expand

support to and build the network of 17 indigenous PLWHA CBOs (some existing, such as Bright Futures

chapters in focus provinces, and some to-be-determined) in all focus provinces and additional provinces.

These CBOs will receive technical and financial assistance (TA) through HIV-related institutional capacity

building. HPI will also support the development and expansion of an NGO network focusing on PLWHA

issues/rights. Via partnership with Community Mobilization Center for HIV/AIDS Control (VICOMC), HPI will

conduct four workshops targeting 150 PLWHA CBO staff. These workshops will enable PLWHA CBOs to

develop communication and management skills to strengthen advocacy activities. They will also enable

PLWHA CBOs to share best practices via the establishment of a national network of PLWHA organizations.

HPI will work closely with PLWHA-elected leaders representing the northern, central and southern regions

of Vietnam to liaise with the Communist Party, the National Assembly, relevant government ministries and

major donors to support the legal establishment of the PLWHA network. HPI will support this network to

conduct three regional meetings on general community mobilization with a focus on prevention, care and

treatment for PLWHA. Roughly 1500 PLWHA will participate in these workshops. The PLWHA network will

produce and disseminate a network newsletter on a monthly basis and an e-forum linking member groups

and will collate feedback for national policy makers on PLWHA needs.

HPI will also support the implementation of the impending HIV/AIDS Law at the provincial level in the seven

focus provinces. Support will assist the Vietnam Lawyer's Association to provide legal aid to PLWHA (see

HPI Palliative Care Basic) to advocate for themselves (key legislative issue: stigma and discrimination), in

conjunction with program monitoring by HPI staff on the enforcement of the law. In order to monitor the

efficacy of the HIV/AIDS Law, HPI will assess attitudes and practices of key policy makers, service

providers, employers and PLWHA to develop a monitoring tool to measure changes following the

dissemination of the Law (in select focus provinces). Lessons learned will be disseminated nationally at the

end of FY07 to assist policy makers in improving communication around and enforcement of the Law. HPI

will partner with the legal department of the MOH to assist in disseminating findings. In addition, HPI will

support PLWHA organizations to report inconsistencies in implementation of the HIV/AIDS Law.

In conjunction with technical support for management and planning oversight provided via the

MOH/Vietnam Administration of HIV/AIDS Control (VAAC) cooperative agreement to provincial VAAC

offices, HPI will assist provincial health departments to use the GOALS model to make strategic resource

need and allocation decisions for HIV/AIDS programs in seven focus provinces. The GOALS model (not an

acronym) is a computer-based analysis model that allows program managers to manipulate human

resource and financial inputs to assess how effectively they address the local epidemic, based on various

indicators. The GOALS model has proven effective in Ho Chi Minh City Provincial AIDS Committee (HCMC

PAC) for financial and human resource planning and the development of the HCMC HIV/AIDS Action Plan,

and was requested by the MOH to be expanded to additional provinces during COP07 review sessions. HPI

will utilize experienced staff from the HCMC PAC and technical staff from HPI to train additional focus

provinces on the use of the GOALS model. Provinces will then produce HIV/AIDS action plans that

realistically estimate human and financial resource needs. Additional training and human resource needs

will be addressed in conjunction with support to the MOH/VAAC and HCMC PAC cooperative agreements

for program planning, monitoring and implementation.

Activity Narrative:

HPI will complement Harvard in the implementation of the HIV/AIDS policy training via the provision of TA

and logistical coordination of training (see Harvard Policy Activity). This activity will train incoming

Communist Party cadres who will take office following their induction as a complement to the UNAIDS

program, which will train existing Communist Party cadres.

These activities will contribute to the development of leadership capacity and sustainability as described in

the PEPFAR Vietnam 5-Year Strategy.

This is a continuing activity from FY07.

FY08 will be the final funding year for the dissemination of Analysis and Advocacy activities through Health

Policy Initiative (HPI). It is anticipated that sustained capacity for this activity will be developed and on-going

without further support from PEPFAR.

FY07 Activity Narrative:

In FY07, Health Policy Initiative (HPI) will continue the Analysis and Advocacy (A2) project funded in FY05

to advocate for the use of available data to formulate appropriate responses to the Vietnam HIV/AIDS

epidemic. Using Ho Chi Minh City (HCMC) and Haiphong as case studies, a model will be developed for the

use of information to inform HIV/AIDS policy development and resource allocation. With experience and

lessons learned from FY05, HPI aims to: 1) complete the development of the Goals Model and Asia

Epidemic Model interface and complete resource allocation analysis for Vietnam; 2) in collaboration with

Family Health International (FHI), present major outcome results by the end of FY06; 3) conduct workshops

in collaboration with FHI on the use of data from the integrated biologic and behavioral surveillance which

will provide updated findings on prevalence, behavior and coverage of the minimum package of services for

injection drug users, commercial sex workers, and men who have sex with men in the seven focus

provinces; 4) provide concrete programmatic implications to the USG team as well as to USG partners; 5)

collaborate with other international and local partners to continue supporting the Ministry of Health/Vietnam

Administration for HIV/AIDS Control (MOH/VAAC) in advocacy under the framework of A2 (this project will

utilize the strengths of both organizations for the appropriate use of data in policy-making and intervention

development); and 6) apply the A2 framework to advocacy activities in other focus provinces including

Hanoi, Quang Ninh, Can Tho and An Giang. The ultimate goal of this activity is to inform policy makers in

focus provinces and at the national level on the situation of the epidemic and resources needed to respond

appropriately and effectively to HIV/AIDS in Vietnam.

This is a continuing activity from FY07.

PEPFAR will support the Health Policy Initiative (HPI) to: develop an HIV/AIDS policy and program auditing

tool, which can be used to assess the compliance of HIV/AIDS related policies and practices to the

provisions of the law in all focus provinces and national partners responsible for local compliance with the

law; support the management capacity of PLWHA to receive and manage HIV/AIDS funding; and foster

involvement of a leading host country business in HIV/AIDS to begin working on public-private partnerships.

The first activity relates to the HIV/AIDS law. The law represents the most recent and powerful legal and

policy framework for HIV/AIDS in Vietnam. To date, HPI has been supporting legal awareness and services

with a focus on PLWHA. However, the law provides a range of measures which can support and increase

resources and ensure access to high quality HIV/AIDS services through greater sectoral involvement, in

particular by requiring the integration of HIV/AIDS into broader socio-economic development plans (Chapter

V, article 19, June 2007).

Currently, HPI activities in the COP07 focus on the development of legal clinics and legal

support/awareness through case work. The audit activity proposes to build on this and incorporate data

from the legal clinics and work with Vietnam's national AIDS control program staff and policy makers, health

care providers in the public and private sector, PLWHA groups, and the Vietnam Lawyers' Association to

develop an audit tool which will assess compliance with the provisions in the HIV/AIDS law, and support

provincial authorities and other HIV/AIDS actors to comply and implement the law.

In FY08 HPI will develop an HIV/AIDS policy and program auditing tool which will allow the law to be used

as a framework for monitoring and evaluation, and as a mechanism to support multi-sectoral involvement in

the HIV/AIDS response. The audit tool will be used to assess the compliance of HIV/AIDS-related policies

and practices to the provisions of the law in all focus provinces and national partners including the Ministry

of Justice, the Ministry of Health (MOH ) (legislation department) the Vietnam Lawyers' Association, the UN

(UNAIDS and UNDP) and Provincial People's committees, as it is these bodies which are responsible for

local compliance with the law. An advisory group will be established to develop indicators on which to frame

the audit tool. The tool will be developed using international best practices and will draw on HPI experience

of similar activities in Cambodia and Nepal. Once this tool has been developed it will be used to determine

the level of compliance of HIV/AIDS-related policies and practices in PEPFAR's eight focus provinces. The

methodology for implementation of the audit will include a policy review and key informant interviews at the

national and provincial levels. A final report will be developed for each province in addition to a national

HIV/AIDS legal auditing tool.

It is anticipated that results of applying the audit tool will include the integration of HIV/AIDS prevention,

care and treatment activities in socio-economic plans and development of provincial budget components for

these plans. Not only will this activity help to build capacity at the provincial level, it will also foster

sustainable planning and resource allocation by provinces.

The second activity is designed to support the management capacity of PLWHA to receive and manage

HIV/AIDS funding. The current legal environment restricts the capacity of PLWHA organizations to seek,

receive, and manage funding independently. Existing PLWHA groups in Vietnam are still nascent but have

demonstrated commitment to addressing HIV/AIDS issues. Until the legal environment changes, and in

order to support capacity development in the management and implementation of direct funding to PLWHA,

HPI proposes to support an existing NGO to act as an umbrella organization responsible for channeling

funding to the groups and increasing overall management capacity as implementing organizations. This will

help to build the capacity and sustainability of indigenous groups in Vietnam, including human resource and

financial management, strategic planning, and network strengthening. HPI will, in partnership with PLWHA

groups and NGOs, identify a suitable NGO to act as the implementing partner. PLWHA representatives

from 20 self-help groups (an estimated 100 people in total) and staff of the NGO will be trained in proposal

and project management, financial management, and transparency and accountability. HPI will provide an

initial series of small grants to pilot the model and support the group to seek funding from other agencies.

This activity is designed to address the specific needs voiced by PLWHA groups in regard to obtaining

funding, which they are able to manage as independently as the current legal environment allows. This

activity will also provide the necessary capacity development to enable a national PLWHA network to

exercise strong management capability when it is legally able to form.

The third activity is new and involves supporting the first public-private partnership for the Vietnam PEPFAR

team. It is designed to foster involvement of a leading host country business in HIV/AIDS. This activity fits

PEPFAR's Private Public Partnership technical working group's definition of, 'collaborative endeavors that

combine resources from the public sector with resources from the private sector to accomplish the goal of

HIV/AIDS prevention, care, and treatment.

HPI has developed informal links with the FPT Corporation, one of Vietnam's leading IT and mobile phone

companies, through a previous project in 2006 where HPI assisted in linking FPT with the Bright Futures

PLWHA network.

With the aim of strengthening the potential leadership role of FPT as a private sector actor in HIV/AIDS, HPI

will provide technical support and advice to FPT to develop a plan for the company in 2008 and 2009. This

will include a plan for how the company might integrate and incorporate HIV prevention and treatment, as

well as anti-stigma and discrimination messages through the use of mobile phone technology. FPT has an

established corporate social responsibility program and in our discussions with their representative they

have expressed interest in working on HIV/AIDS issues. However, they have no experience in the field and

are unclear how to leverage human and financial resources in this area. HPI will work with them to assess

the resources and potential they can bring to the field and develop a strategic plan for the company's

corporate social responsibility program. HPI will provide technical support to FPT to develop the following

deliverables:

a) Three-year strategic plan for FPT on HIV/AIDS, including a commitment to human and financial resource

allocation, which will equal the amount provided by PEPFAR.

b) Anti-stigma and discrimination campaigns implemented by FPT, using available resources and the IT

capacity of the company.

Activity Narrative: c) A core team of FPT personnel trained to develop a project utilizing the resources of the company to

deliver stigma and discrimination reduction messages to the general public.