Through accurate reporting, journalists highlight the perils of HIV/AIDS, as well as the consequences of stigma and denial. Journalists in Zambia are influential and are finally engaged -- after many years of silence -- in the HIV/AIDS dialogue, but they need to improve their standards to better engage in the HIV/AIDS dialogue. Current challenges of the Zambian journalism field include: pervasive inaccurate reporting (due to improper research or total lack of research), lack of follow-up to build upon stories that have had a positive impact, and the almost complete lack of photojournalism. In FY 2005 and FY 2006, the Public Affairs Section at the US Mission received PEPFAR funds to begin engaging journalists in the response to HIV/AIDS in Zambia. In FY 2005, through a twinning relationship between the American International Health Alliance (AIHA) and the Zambian Institute of Mass Communications Education (ZAMCOM), 60 Zambian print and electronic media journalists were trained in depth on AB strategies and messages. Two journalists from the FY 2005 session were awarded "best HIV/AIDS reporting" awards at a national contest (co-sponsored by the U.S. Embassy and the Media Institute of Southern Africa). A television journalist, who benefited from the FY 2005 PEPFAR media training, was recently singled out at the AIDS Conference in Toronto as an example of how broadcast media can shine a spotlight on PLWHA. Though progress has been made, there is still much room for improvement in how effectively Zambian journalists cover issues surrounding HIV/AIDS as media plays a vital role in educating the public and raising awareness of people's role in preventing the spread of HIV. Through PEPFAR support in FY 2005 and FY 2006, PAS has partnered with the Zambian Institute of Mass Communications Education Trust (ZAMCOM) to conduct in-service training for local journalists in areas ranging from technical to ethical HIV/AIDS reporting. ZAMCOM is peerless in Zambia; it is the only organization with the faculty, technology, and infrastructure to conduct such media training. Past performance indicates that ZAMCOM is more than up to the task. PAS proposes to continue the successful partnership between ZAMCOM and the American International Health Alliance (AIHA) Twinning Center, who will select an appropriately experienced U.S.-based partner to twin with ZAMCOM. As in past years, AIHA, partnering with ZAMCOM, will facilitate and manage the collaboration, which will occur through a training workshop to enhance human institutional capacity, knowledge-sharing, as well as field-based training. ZAMCOM will greatly benefit from the twinning relationship with a US-based partner who can provide the necessary assistance most needed by ZAMCOM. As partners, ZAMCOM and AIHA have worked closely on developing comprehensive work plans and media training strategies. Evaluations of the FY 2005 ZAMCOM training sessions indicate that the partnership has already yielded great successes. The proposed program for FY 2007 will support new and continued training for Zambian journalists, including rural journalists who are telling stories to audiences that often do not get their news from the national media. Feedback from the FY 2005 training sessions strongly called for an increase in the number and frequency of training sessions. Moreover, again as a result of FY 2005 feedback, the FY 2007 programs will include editors. Editors who have been cited by reporters as being uncooperative or difficult will be handpicked "invitees" to specific training sessions. The FY 2007 program will aim for—and build on—previous training outcomes. The trainings will be created to ensure that journalists gain a better understanding of HIV/AIDS issues and become fully knowledgeable about AB approaches, and how to communicate messages that help the public avoid risky behavior. Journalists will be given the tools to better promote abstinence among youth, fidelity and monogamous relationships. The trainings will strengthen the U.S. Mission's collegial relationship with ZAMCOM, and a deeper understanding about international and USG efforts to fight HIV/AIDS. Since reporters' stories are public documents, evaluation of the program yields immediate data in the number and tone of stories printed and/or broadcast. In FY 2007, ZAMCOM plans to partner with at least one Lusaka-based regional media and development NGO, to undertake content analysis of HIV/AIDS coverage and to monitor progress by trainees.

This activity links to CRS SUCCESS HBHC (#9180) and all other HBHC activities funded by USG Zambia.

USAID will continue to manage this twinning support for palliative care activity and channel funds for American International Health Alliance (AIHA) Twinning Center through HHS/HRSA. AIHA will provide south-south twinning support for Palliative Care in Zambia, in partnership with the African Palliative Care Association (APCA) and its local affiliate/sub-partner, the Palliative Care Association of Zambia (PCAZ), which will receive approximately 80% of these funds.

In FY 2005 and FY 2006, AIHA collaborated with APCA to provide technical assistance to the USG/Zambia mission and PCAZ through a series of assessment and mentoring visits. To date, AIHA, APCA, and PCAZ have reached a number of milestones. The PCAZ has a new, stronger management structure, led by a new National Coordinator with strong management and business development skills as well as palliative care experience. The PCAZ is now a larger, stronger membership organization. PCAZ helped develop a USG Joint Palliative Care strategy in 2005, and participates in the USG Zambia Palliative Care Forum. PCAZ has become a leader in taking palliative care for HIV/AIDS forward in the country. In late June 2006, APCA organized a study tour to Uganda for Ministry of Health (MOH), PCAZ, pharmaceutical board, and drug enforcement officials to learn about pain management and pain relief drugs (opiates). As a direct result, upon their return, the Zambian participants formed a National Pain Management Advocacy Team. They are now moving forward rapidly to advocate for new policy, guidelines, and regulatory change to permit the use of opiates more widely for pain relief in HIV/AIDS care.

Starting in FY 2006, AIHA will have a regional Palliative Care technical advisor posted in South Africa to support Zambia. AIHA and APCA staff will also make trips to Zambia as will AIHA twinning organizations to provide technical assistance for the development/refinement of business plans for PCAZ and the GRZ, to develop and conduct palliative training courses, and to assess progress in the area of palliative care in Zambia.

In FY 2007, AIHA and APCA will continue to strengthen the PCAZ secretariat and executive functions, making the PCAZ Board a more effective governing body. The partnership will also focus on strengthening PCAZ's role as a voluntary coordinating body for Zambian palliative care institutions and care givers. Particularly, the partnership will focus on the development of policy and advocacy skills within PCAZ, and capacity to facilitate and manage palliative care trainings for all professional levels of HIV/AIDS palliative care givers. Further, training will enable the PCAZ Secretariat to mobilize resources, including developing grant proposals and seeking funding from other sources, such as the Global Fund for AIDS, TB, and Malaria. Finally, PCAZ will implement the membership recruitment plan developed in FY 2006, and will also advertise to increase membership and associated dues. This is a means to develop sustainable revenue streams for the PCAZ, as part of its long-term business plan.

The APCA/AIHA partnership will continue to work together to strengthen PCAZ's ability to provide quality services, thus attracting members. The activities will include: (1) A training of trainers program in palliative care to scale-up and expand the program - eight participants out of all attendees will be trained further through clinical placements to become master trainers-of-trainers within six months; (2) a country specific advocacy workshop, focusing particularly on policies for pain medication procurement, prescription and availability for PLWHAs in the advanced stages of AIDS and on easing prohibitive Zambian drug enforcement practices that target pain medications; (3) adaptation and implementation of APCA standards of palliative care and outcome scale, revision of national training manuals and material based on the revised palliative care standards, and the development and implementation of M&E data collection tools to ensure adequate quality and access to palliative care; and (4) publication of a quarterly palliative care newsletter to keep members of medical and other caregiving communities informed of possible opportunities, new developments, and evidenced-based best practices. PCAZ will train 150 palliative care medical providers/caregivers in state-of-the-art palliative care for PLWHA.

To build sustainability, AIHA will continue to support twinning partnerships between US and regional palliative care organizations and PCAZ to strengthen local human and

organizational capacity in Palliative Care. AIHA will support regional palliative care premier institutions such as APCA (which includes the University of Cape Town, Sun Gardens Hospice in Pretoria, Hospice Uganda, and Zimbabwe Home-based Care programs). AIHA will collaborate with USG partners working on palliative care in Zambia (including SUCCESS, ZPCT, RAPIDS, PCI, JHPIEGO, and CDC partners) to provide mentoring, train palliative care health care providers and managers, develop palliative care courses and training programs, and facilitate technical information sharing.

This activity relates to UTH (#9043), SPHO (#8993), and Columbia University (#8993).

In cooperation with HRSA, the Centers for Disease Control and Prevention will manage this activity in Zambia. In 2006, American International Health Association focused on the identification and establishment of a partnership with the two pediatric ART centers of excellence. Efforts included communication with relevant stakeholders, including Columbia University, University Teaching Hospital (UTH) in Lusaka, and CDC. Based on these discussions and fact finding, AIHA posted an open solicitation to determine the bests-suited partner. The solicitation closed on 31 August, and AIHA has shared the selected partner with CDC/Zambia for concurrence. Once CDC approves the partner selected, the initial exchange visit to introduce the partnerships will be made. It is expected that this initial exchange visit, involving the United States partner to visit Zambia to meet with the Zambian partners, will occur in October 2006. At this point, the partners will discuss goals, objectives, and strategies of the partnership, and create the partnership work plan. In keeping with Twinning Center methodology, the partners will come together as equals to develop the partnership work plan, thereby ensuring buy-in from the partners and increasing the likelihood of sustainability once funding ends. Implementation of activities under the work plan is expected to begin before the end of 2006.

In 2007, the partnership will be active in carrying out the work plan goals and strengthening the structure and capacity of the pediatric centers of excellence. AIHA will continue to provide technical assistance, facilitation, and management to the partnership to scale-up ART services in Zambia by increasing the pharmaceutical service capacity at the two newly-established pediatric ART centers of excellence. Through a volunteer-driven partnership, 25 pharmacists will receive direct on-site technical assistance in organizing and managing a pharmacy in addition to acquiring necessary skills to address patient level management, adherence, adverse affects, and medication management trainings. Upon successful training of these pharmacists, AIHA anticipates an indirect beneficiary pool of an additional one-hundred pharmacists.

Additional focus areas will likely include systems development activities, patient booking and tracking, patient flow, patient records, case management, infection control procedures, and linkages between the clinics and with other HIV/AIDS resources in Zambia.

AIHA and the partnership (which includes UTH) will continue to work closely with CDC, Columbia University, and other relevant stakeholders to ensure that the activities are comprehensive and coordinated in order to promote sustainability. AIHA has been instrumental in increasing and strengthening palliative care in Zambia through its partnership with the Palliative Care Association of Zambia; this partner can be brought in as a resource for the pediatric AIDS treatment centers partnership. Further, AIHA intends on fostering south-south relationships within this partnership, possibly including the African Network for the Care of Children Affected by AIDS (ANECCA), to augment the technical assistance provided through the partnership.

This activity links with Project Concern International (PCI) and JHPIEGO's assistance to the Zambia Defense Force (ZDF) comprehensive HIV/AIDS care and treatment programs. Linked activities are OHPS (#9171), OHPS (#9087), OHPS (#9172), HLAB (# 9096), HVAB (#9170), HVOP (#8786), HVCT (#8785), HBPC (#8787), HTXS (#9089), HVSI (#8788), and MTCT (#9088).

Following a successful partnership and exchange program in FY 2005 and FY 2006, American International Health Alliance (AIHA) will continue to strengthen Defense Force Medical Services (DFMS) in FY 2007. The Learning Resource Center (LRC) opened in FY 2005 at the Maina Soko Military Hospital will continue to receive support in terms of maintaining the facility and keeping resources up to date and conducting library in-service training through twinning with civilian partners. This training will be conducted in conjunction with information resource specialists from University Teaching Hospital (UTH) and other Zambian institutions. This model and design of the LRC will be replicated and established at the Zambia Defense Force (ZDF) Nursing College; this will assist in capacity building of the institute and will support their teaching curricula which has integrated HIV/AIDS into routine nurses' education. Zambia Nursing Council curriculum will be used to maintain standards and strengthen collaboration with government systems. Newly trained ZDF nurses will go to serve in their 54 health units which are critically short of staff, thereby ensuring long term sustainability of palliative care and community health services.

Additionally, as ZDF health workers are routinely seconded to civilian facilities including UTH to supplement and augment the clinical services they provide, and provide critical services to the GRZ in times of natural disaster or disease outbreaks, improving the quality of ZDF nursing education will result in intersectoral improvements to the Zambian health system. By linking the ZDF Nursing School Learning Resource Center with pre-existing services established at Maina Soko, costs will be minimized and economies of scale introduced. Finally, funds under this activity will be used by AIHA to coordinate this activity with the overall twinning relationship established by DOD with the DFMS, as planned in activity #9172.