This activity is related to activities in Other Prevention (MARCH) and AB Prevention (HCP, Corridors of Hope II, and RAPIDS)

The Modeling and Reinforcement to Combat HIV/AIDS (MARCH) project strategy in Zambia was initiated in fiscal year (FY) 2005. This program explores and addresses Zambian factors that continue to perpetuate HIV transmission in the reproductive age group and promotes the "Be faithful" strategy through advocating for fidelity. The first component is a radio serial drama (RSD) that provides listeners with authentic and realistic examples of people attempting to change risky behaviors associated with multiple and concurrent sexual partnerships that may lead to HIV infection and prompting people to rethink their own risk perceptions. Through the radio serial drama, behavior is modeled addressing risk reduction, sexually transmitted infections, and being faithful. The second component consists of community-based reinforcement activities (RA) that encourage communities to modify social norms and cultural practices that encourage multiple sexual partners and provide support to people to change their behavior, and lastly links people to existing and forthcoming services. The reinforcement activities are being implemented at the community level and aid in creating community dialogue and diffuse stories and messages in the serial radio drama. These two components of the behavior change strategy are entirely performed by local partners with technical assistance provided by the United States Government.

MARCH focuses on behavior change related to social norms that facilitate and continue to promote multiple sexual networks and concurrent sexual relationships. The behavior change objectives address issues around cultural practices and norms around the definition of a "Tonga Bull", a practice that accepts that men can have more than one sexual partner in Southern Province. Other practices are wife inheritance and sexual cleansing in both provinces that have been identified as risky in an HIV/AIDS era.

Data from projects in other countries suggest that MARCH encourages service use. A mid-term assessment survey for the Botswana project found that in comparison to other people, people who listened to the drama on a weekly basis had higher levels of knowledge, less stigmatizing attitudes, and were two times more likely to intend to get tested in the next three months. Qualitative data from Ethiopia suggests contribution to behavior change with evidence that participants from at least one discussion group went together for HIV testing. The project in Zambia will also measure the effectiveness of the MARCH strategy in both the Western and Southern provinces through a lagged quasi-experimental assessment design. The first wave of baseline data was collected in FY 2006. The second wave of data collection will be in FY 2007, after which point, the program will be commenced in the Western province.

Building from the formative assessments conducted in FY 2005, a design workshop was held in FY 2006 in collaboration with the Provincial and District AIDS task forces, HCP, Corridors of Hope and local NGOs working in HIV in Southern province. At this workshop, the universe of the RSD was set and the behavior change objectives to be addressed collectively identified. This was followed by script writing and RA workshops using data collected from the formative assessments. A team of local writers, producers and actors were recruited to manage and produce both components of the project. In Southern province, the project will be called Gama Cuulu, which means "facing life's challenges head-on". Tulane University through its sub-partner Media Support Solutions will in FY 2007 build institutional capacity or localization to establish the project as a local entity viable for sourcing and managing funding.

Building upon the foundation created in FY05 and FY06, MARCH will continue to writing episodes and producing the serial drama using "Pathways to Change", this is a set of MARCH tools which ensure consistency with behavioral theory and research on HIV and behavior in Zambia and ensures that behavior change is based on process and not messaging. The Tonga-language drama will continue airing on both commercial and community radio stations and be transmitted throughout the Southern Province and early development work for the Lozi program to be aired in Western Province will also commence. The drama has five interconnected storylines though the emphasis of the drama is on promoting "be faithful" messages.

In order to reach the communities at the grass root levels, the MARCH program has

employed community street theatre and peer groups outreach activities and in FY 2006, these were conducted in five districts of Southern Province. In the community street theatre activity, local drama groups reach various communities through drama, based on the radio drama storylines. The same drama groups have been trained on how to facilitate community discussion groups to ensure that behavior change is occurring according to the MARCH theoretical framework. After listening to the RSD, as evidenced in Ethiopia and Botswana, in FY 2007 the community, through the RAs, will initiate community dialogue and discussions which will culminate in the community identifying harmful social norms and solutions of addressing these norms collectively. In the context of the project in Zambia, the project will engage the communities to unpack their cultural beliefs around dry sex, polygamy, and male norms in this era of HIV/AIDS and promote faithfulness as a strategy that prevents HIV infection. The project will be the vehicle that drives and facilitates the behavior change process.

This program will receive $150,000 from the reprogrammed funds and will receive $100,000 from plus-up funds in FY07 which brings the total to $900,000 . The Modeling and Reinforcement to combat HIV/AIDS (MARCH) program was designed for roll out in both Southern and Western Provinces of Zambia, however rolling out into the Western Province has been hampered by lack of funds. With the additional plus up funds, MARCH will roll out the radio serial drama and reinforcement activities in 5 districts of Western province at full scale. Funds will be used to develop culturally appropriate serial drama messages for LOZI listeners, build relationship with stations in the area to air the drama and work with community to develop and implement reinforcement activities. It will also be necessary to maintain a small office space in Western Province to work with the CDC office in the Province to handle the questions and build rapport with the local community.

With these funds, the project will also duplicate and distribute 'living well with HIV/AIDS' materials to people accessing ART in both Western and Southern Provinces, link those newly diagnosed with HIV to accessible care in their area, link sexually abused children to services and highlight the need for healthy living while on ART. There will also be an emphasis on the benefits of responsible alcohol intake (not sure how are conceptualizing the implementation of this last piece. Gama Cuulu does not have capacity or technical expertise to do Palliative care but they can make referrals and link people to services).

This activity is a sub component of the MARCH program (HVAB #8815). It is linked to activities in counseling and testing HVCT (#9018), ART services through the new Southern Provincial Health Office activity with CDC, home based care activities (#9180 and # 8946), and HIV/TB activities (#9017 and #9046).

The Modeling and Reinforcement to Combat HIV/AIDS (MARCH) project in Zambia was initiated in FY 2005. This program explores and addresses cultural factors particular to Zambia that continue to perpetuate HIV transmission among married people. One overall strategy employed is to promote the "Be Faithful" strategy through advocating for fidelity (see activity #8815). However, MARCH also aims to advocate for change in cultural practices that continue to expose individuals to HIV infection, increase personal risk perception for becoming infected with HIV, and curtail alcohol abuse. These three topics will be the focus of radio messages produced and disseminated by the MARCH HVOP activity.

The overall MARCH program is comprised of two components. The first component is a Radio Serial Drama (RSD - modeling activity) that provides listeners with authentic and realistic examples of people attempting to change risky behaviors associated with multiple and concurrent sexual partnerships that may lead to HIV infection and prompting people to rethink their own risk perceptions. The second component consists of community-based reinforcement activities that encourage communities to modify social norms and cultural practices involving multiple sexual partners, provide support to people to change their behavior, and link people to existing and forthcoming services for HIV prevention, care, and treatment. The reinforcement activities are being implemented at the community level and inspire community dialogue and diffusion of messages through the RSD. These two components of the behavior change strategy are entirely conducted by local Zambian partners with technical assistance provided by the USG.

Building on formative assessments and design completed in 2006, the MARCH activity will continue to focus on behavior change and social norms. The activities will aim to modify cultural practices that continue to expose individuals to HIV infection, perpetuate low personal risk perception for becoming infected with HIV, and promote alcohol abuse in Southern and Western provinces. Messages of prevention for positives will also be highlighted. Cultural practices were identified through a formative assessment and design workshop; held in collaboration with the Provincial and District AIDS Task Forces of Southern Province. These practices include: male norms around the definition of virility, polygamy, sexual cleansing, wife inheritance, dry sex and initiation ceremonies that need to be modified in the era of HIV/AIDS. It is anticipated that the RSD focusing on these topics will reach 25,000 people with community outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful. In addition, 75 people will be trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful.

Through the RSD, communities in Southern Province will also be encouraged to seek HIV counseling and testing and linked to appropriate care services. Some of the services available are provided by USG partners, including the Southern Provincial Health Office (#9018), the Corridors of Hope II, and RAPIDS (#8944). HIV-positive individuals will be informed of and linked to ART services, palliative care, psychosocial counseling, and TB/HIV services through the availability of a map of services in the five districts that will be implementing reinforcement activities. MARCH also works closely with Health Communication Partnership (HCP) and Corridors of Hope to learn from their experiences working in Southern Province with communication activities.

Male norms that encourage men to have multiple sexual partners, concurrent partners, and discourage condom use will be addressed during RSD episodes. With sustained behavior change the goal, community-based reinforcement activities that spur discussions among men and male social group leaders will be conducted and participants will be encouraged to change their behavior to protect themselves from infection and transmitting HIV and other sexually transmitted infections to their sexual partners. Participants will also be encouraged to promote these messages among their peers.

In FY 2007, MARCH will continue writing episodes and producing the serial drama using Pathways to Change, this is a set of MARCH tools which ensure consistency with

behavioral theory and research on HIV and behavior in Zambia and ensures that behavior change is based on process and not messaging. The Tonga-language drama will continue airing on both commercial and community radio stations and be transmitted throughout the Southern Province and early development work for the Lozi program to be aired in Western Province will also commence. In Western Province, the early development work will include recruitment of a team of writers and producers, design workshops, script writing workshops and development of the drama universe. The drama has five interconnected storylines though the emphasis of the drama is on translating research findings into a real life story.