Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4979
Country/Region: Zambia
Year: 2007
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health Center for Communication Programs
Organizational Type: University
Funding Agency: USAID
Total Funding: $4,712,016

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $2,672,016

This activity links with Health Communication Partnership's (HCP) ongoing activities in HVOP (#8904), HBHC (#8902), HKID (#8903), and HTXS (#8901). HCP's AB activities also support both Zambian and the President's Emergency Plan for AIDS Relief (PEPFAR) goals through a comprehensive approach that promotes better health-seeking behavior. HCP facilitates synergistic networks among community organizations and the involvement of community leaders to ensure that activities are tailored to, informed by, and responsive to local needs. HCP draws on the expertise of JHU CCP expertise in formative research and evaluations of these programs. The 2003 study of language competency in Zambia has informed all HCP printed materials. HCP is working in 22 districts in nine provinces in close partnership with Peace Corps (#9629), PACT/Y-CHOICES (#8922), the IYF (#8899), PSI (#8925), RAPIDS (#8945), and the Zambian Government (GRZ). The "Helping Each Other Act Responsibly Together" (HEART) campaign was designed in 1999 specifically for youth and by youth, and informs young people about the Abstinence, Be faithful, and correct and consistent Condom use (ABC) approach to prevention. HEART program activities are based on yearly contests and peer education. The original design of the campaign was informed by surveys conducted in 1999, 2003 and focus groups held in 2005. Topics include the value of abstinence, delayed sexual debut for youth, adult-to-child communication, faithfulness, stigma and discrimination, the importance of knowing your status and getting tested, and positive male role modeling. HEART program activities will continue in FY 2007. HCP will continue to work with in- and out-of-school youth groups by engaging community-based organizations and by using the HEART Life Skills Toolkit to promote open discussion about risky behaviors and problem-solving skills and to build self-esteem. HCP will also continue to support Creative HEART—a community-based contest that promotes positive adult-child communication through mentoring relationships. The Creative HEART contests—first begun with FY 2005 funding—will expand their coverage area in districts where HCP currently has programs. Communities provide in-kind contributions of food, venue, transport, and lodging for contestants. Creative HEART is run jointly with the Ministry of Education. In total, the HEART campaign will reach 35,000 youth, 500 youth leaders, and 200 teachers with community outreach promoting AB. HCP also works with theater groups. HCP trained 20 theater members in health promotion through a two-week workshop in FY 2005 and is training theater groups in 21 districts in FY 2006. These actors/trainers developed skills to work with local theater groups to write and perform powerful and pertinent dramas promoting AB and facilitate discussions after the shows. Central themes addressed by these groups included rethinking gender norms—especially regarding sexual violence and exploitation of young girls and stigma reduction. In FY 2007, dramas will focus on peer pressure and delayed onset of sexual activity for youth, fidelity and partner-reduction for adults, and alcohol use as a contributing factor to risky behavior. The drama trainers will continue to serve as a resource to other USG-funded projects such as PACT/Y-CHOICES, PSI, and IYF, as well as other NGOs, UN agencies, and government organizations. In FY 2007, building on previous activities, drama productions will be scaled up in all nine provinces. To monitor and evaluate impact, HCP collects monthly reports from youth peer leaders and activity reports from the drama groups after each performance, recording the number of youth reached.

All HCP activities begin with formative research and are piloted with target populations before being launched. The Participatory Ethnographic Evaluation & Research (PEER) qualitative data collection conducted in FY 2006 will be used to design innovative, culturally appropriate "being faithful" interventions and messaging for geographically-remote, less-educated populations. HCP has a one-page guideline for consistent AB messaging, used for development and review of materials. All activities also consider existing gender roles with the goals of reducing violence, empowering young women to negotiate healthier choices, promoting partner communication and mutual decision-making, and male responsibility. HCP will also continue to fund the HIV Talkline. The HIV Talkline, implemented by Comprehensive HIV/AIDS Management Programme (CHAMP is a confidential, 24-hour, toll-free telephone line available in all 72 districts that provides information, counseling, advice, and referral services to the public. Full-time qualified nurse-counselors, all of whom are registered with the General Nursing Council, operate the HIV Talkline. They provide counseling and disseminate information on AB, CT, positive living, and discordant couples. With FY 2005 and FY 2006 funding, HCP has continued to aggressively promote HIV Talkline services through radio and television spots and outreach activities, which has led to a steady increase in caller demand. In FY 2007, 42,000 individuals will be reached with information on HIV services; messages will

continue to focus on confidential information and services offered through HIV Talkline. Outreach activities will place an emphasis on increasing the number of callers from rural areas, specially targeting the general adult population, PLWHA, and caregivers.

HCP has made strategic choices that underlie a commitment to ensure Zambian capacity, sustainability, and self-reliance, as well as the development of public opinion and norms supporting prevention activities. Trainings in proposal writing, activity design, and monitoring enable organizations to find local responses to local challenges. The choice of implementing activities is community-driven—not HCP-imposed—and requires community commitment through in-kind support. Youth have been trained to conduct most activities without assistance or incentives beyond the materials needed for the activity. Government ministries have been actively engaged in the development of Creative HEART contests, and in some places, have already institutionalized contests into their yearly programs.

HCP continues to play a key role on the NAC IEC TWG, collecting, harmonizing, and sharing national IEC materials. In FY 2006, HCP is supporting the development of the NAC Resource Center by compiling a database of all materials in Zambia. HCP continues to work with the Zambia Centre for Communication Programmes (ZCCP) in a technical advisory capacity. HCP will support ZCCP to develop their strategic approaches to AB and build their ability to design high quality BCC interventions. Supporting USG partners, HCP facilitates the adaptation and reproduction of IEC materials for partners' programs and plays a key role in promoting collaboration and coordination. HCP work plans are integrated into district and provincial plans, ensuring ownership and sustainability.

In FY 2007, plus up funding ($1.2 million) is being requested to allow HCP—in concert with the NAC and other key partners—to develop and produce a comprehensive multi-media campaign for TV, radio and print that promotes reduction of concurrent partnerships by raising risk awareness. This campaign will increase self-efficacy in avoiding risk and will reach over 4,000,000 individuals throughout Zambia. Impact of this campaign will be measured through population-based studies (baseline and end-of-project surveys). The total amount requested for this activity is $2,437,016.

With additional funds, HCP will also assist MOH, NAC, and MC delivery partners in developing and implementing a national MC awareness campaign that includes messages related to AB as part of the overall national MC campaign and male reproductive health kit.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $630,000

This activity links with the Health Communication Partnership's (HCP) activities in Abstinence/Be faithful (#8905), Palliative Care (#8902), OVC (#8903), and ARV Services (#8901). It also supports both the Zambian and the PEPFAR goals for appropriately targeting most at-risk populations (MARPs) with interventions promoting partner-reduction and condom use.

Community mobilization and behavior change communication—the foundation of HCP's strategy in Zambia—provide a comprehensive approach to promote better health-seeking behavior through interventions targeting MARPs in the 22 HCP-supported districts in all nine provinces. HCP draws on the expertise of Johns Hopkins University Center for Communication Programs' (JHU/CCP) worldwide experience including formative research and evaluations of these programs. For example, the 2003 study of Language Competency in Zambia has informed all HCP printed materials while the BRIDGE project baseline survey in Malawi provided valuable reference for building community efficacy in similar rural communities. HCP facilitates synergistic networks among community organizations and the involvement of community leadership structures to ensure that activities are responsive to local needs. Working within these community structures in close partnership with other US Government (USG) partners, HCP will promote HIV prevention through a balanced Abstinence, Be faithful, correct and consistent Condom use (ABC) approach. Special emphasis will be given to partner reduction, correct and consistent condom use, and promotion of knowing one's HIV status. Through this close collaboration with USG partners, HCP will ensure appropriate geographical coverage throughout the country, while avoiding duplication of efforts.

Building on work begun in late FY 2004, HIV/AIDS prevention interventions in FY 2007 will continue through peer leaders in the police, prisons, immigration services, and fishing populations. All 236 peer leaders, which include PLWHAs, have already been trained for these services. These peer leaders were provided with copies of the Zambia Uniformed Services HIV/AIDS Peer Leadership Manual developed during FY 2005, and have continued their work raising awareness, promoting CT, and developing PLWHA support groups in their service camps and surrounding areas.

In FY 2007, HCP will continue to support partners to develop program expansion action plans to be implemented by trained peer leaders at barracks. These activities will reach families of uniformed personnel and will emphasize knowledge of HIV status, correct and consistent condom use, provision of social support to those who are ill, and anti-stigma messaging. At prisons, similar activities will be implemented with inmates. HCP District Program Officers will also support similar efforts in fishing communities in Siavonga, Mpulungu, Chienge, and Mongu Districts through their links with the Fisheries Department Uniformed services. They will be encouraged to mainstream peer education activities into their barracks' HIV/AIDS educational programs and to strengthen activities targeted at the entire family. Uniformed services personnel were trained and provided materials to conduct activities without assistance or incentives beyond the materials needed for the activity. The Police, Prisons, Zambia Revenue Authority (ZRA) and Immigration services have integrated these activities into their plans. As a result of the training received, by July 2006, uniformed services peer leaders had counseled 7,808 people, 767 of whom went for testing. During FY 2007, HCP plans to reach 7,000 MARPs including uniformed personnel and their families, as well as those working in the fishing industry.

Furthermore, program messages on correct and consistent condom use will be complemented with in-depth information on behavior change and the development of respectful, gender-equitable relationships between men and women. Influential leaders will be encouraged to serve as role models for men in order to affect change in the male norms and behaviors that undermine risk avoidance efforts. HCP-trained community drama groups in remote, rural communities will continue to perform scripted drama and facilitate discussions on partner reduction, knowledge of HIV status, and stigma reduction.

As in FY 2006, HCP will continue to encourage peer leaders to conduct local screenings and facilitate discussions around three key videos: "Tikambe" (anti-stigma), "Mwana Wanga" (PMTCT), and "The Road to Hope" (ART). Available in three-to-five Zambian languages (depending on the series), more than 3,500 copies have been distributed throughout Zambia to government authorities, non-governmental organizations (NGO), and other stakeholders. Supporting the screening of these videos, televisions and VCRs

were placed in 180 health center public waiting rooms.

In order to better understand the risks around alcohol abuse and HIV/AIDS, HCP has conducted a Participatory Ethnographic Evaluation and Research (PEER) qualitative data collection in FY 2006 that will inform the development of innovative, culturally appropriate interventions and messaging about the role of alcohol abuse in risk-disinhibition. In FY 2007, HCP will support culturally appropriate interventions and messaging around the risks of alcohol abuse as related to HIV/AIDS.

With strategic communication approaches, HCP will support JHPIEGO's and PSI/ SFH initiatives to develop information on male circumcision ($90,000). In collaboration with partners and stakeholders, HCP will conduct formative research on messages for current and potential clients and the general population related to male circumcision. HCP will also begin developing technical information and educational materials for both the provider and the client, respectively. Materials will focus on acceptability, the importance of undergoing circumcision by a trained professional, risk-disinhibition, and post-procedure care.

All HCP activities begin with formative research and are piloted with target populations before being launched. They also consider existing gender roles with the goal of reducing violence, empowering women to negotiate for healthier choices, and promoting partner communication and mutual decision-making and male responsibility.

HCP's community mobilization efforts have focused on investing in the development of skills and capacity of individuals, neighborhood, and community-based organizations that promote positive health and social development. HCP has made strategic choices which underlie a commitment to ensure Zambian capacity, sustainability, and self-reliance and the development of public opinion and norms supporting other prevention activities. For example, trainings in proposal writing (for funds available locally), activity design, and monitoring can allow organizations to find local answers to local problems. The choice of implementing activities is individual or community-driven and requires community commitment through in-kind support.

HCP continues to play a key role on the National HIV/AIDS/STI/TB Council (NAC) Information, Education, and Communications (IEC) Technical Working Group, collecting, harmonizing, and sharing national IEC materials. In FY 2006, HCP is supporting the development of the NAC Resource Center by compiling a database of all HIV/AIDS IEC materials available in Zambia. HCP continues to work with the Zambia Centre for Communication Programmes (ZCCP), a local health communication NGO in a technical advisory capacity. HCP will support ZCCP in developing their strategic approaches to Other Prevention and will build its ability to develop high quality, behavior change communications interventions. With USG partners, HCP facilitates the adaptation and reproduction of IEC materials for their programs, playing a key role in promoting collaboration and coordination among partners.

Funding for Care: Adult Care and Support (HBHC): $335,000

This activity links with the Health Communication Partnership's (HCP) ongoing activities in Abstinence/ Be faithful (#8905), Other Prevention (#8904), Orphans and Vulnerable Children (#8903), and Treatment/ARV Services (#8901). It also supports the overall U.S. Government (USG) effort in promoting palliative and community-based care services and addresses both Zambian and the President's Emergency Plan for AIDS Relief (PEPFAR) goals for increasing public information and understanding of CT, Palliative Care, and Treatment, and improving the length and quality of life for people living with HIV/AIDS (PLWHA). In FY 2007, HCP will also continue to work closely with the following USG palliative and home-based care service providers: Catholic Relief Services (CRS)/SUCCESS (#9180), RAPIDS (#8946), Zambia Prevention, Care and Treatment Partnership (ZPCT) (#8884), Support for the HIV/AIDS Response in Zambia (SHARe) (#8908), Peace Corps (#9629), national and international stakeholders, PLWHA networks, faith-based organizations (FBOs), and other community groups.

Community mobilization and behavior change communication, the foundation of HCP's strategy in Zambia, provide a comprehensive approach to promoting better health seeking behavior nationally and within the 22 HCP-supported districts in each of the nine provinces. HCP draws on the expertise of Johns Hopkins University Center for Communications Programs' (JHU/CCP) worldwide experience including formative research and evaluations of these programs. For example, the 2003 study of Language Competency in Zambia has informed all HCP printed materials while the BRIDGE project baseline survey in Malawi provided valuable reference for building community efficacy in similar rural communities.

In FY 2005 and FY 2006, HCP developed a PLWHA and caregivers distance radio program, "Living and Loving," to communicate standardized messages to PLWHA, their families, and caregivers. The program was translated into seven local languages in addition to English. The 26-episode series, which is aired on Zambian National Broadcasting Corporation (ZNBC) and local radio stations, promotes discussion on a wide range of topics including positive living and staying healthy, how men can be caregivers, anti-retrovirals (ARVs), family support, nutrition, treatment of opportunistic infections (OIs), money management, stigma and discrimination, and treating PLWHA with respect. In FY 2007, HCP will develop new episodes to address psycho-social support, health and nutrition, income generation, and education, in addition to re-broadcasting episodes of particular pertinence. After the airing of each program listeners are encouraged to ask questions and provide feedback to HCP. HCP district staff will continue to support listener groups (selected from PLWHA care and support groups) to enable them increase their reach to over 25,000 PLWHA and their caregivers in 22 districts. By using HCP-produced program guides, group leaders will facilitate and head discussions on care, support, and positive living. HCP will continue to work with local communities, Neighborhood Health Committees (NHCs), and the Anti-Retroviral Therapy (ART) Unit of the Ministry of Health (MOH) to assume leadership and ownership of this activity, linking these groups with other support organizations to ensure sustainability.

In FY 2005, the Care and Compassion movement was developed and launched by the Zambia Interfaith Networking Group (ZINGO) with technical support from HCP. Counseling and education kits for religious and traditional leaders were adapted for use in Zambia. These kits enable leaders to initiate and implement care and support activities in their congregations and communities and strengthen their counseling skills. With HCP support, 276 core religious leaders from six religious bodies were trained in psychosocial counseling. As a result of their efforts, by July 2006, 15,000 congregants were counseled, 3,300 were tested, and 73,780 were reached with messages supporting community care to PLWHA and those affected by HIV/AIDS. By June 2006, 253 Care and Compassion groups had formed throughout the country.

In FY 2007, the Care and Compassion movement will focus on rural communities. An additional 110 religious leaders (five in each of the 22 districts) will expand efforts to ensure community-based action in support of those infected/affected by HIV/AIDS. As role models and through sermons, respectful relationships between men and women will be promoted. Their counseling and preaching will raise awareness and promote change of harmful male norms and behaviors that perpetuate inequitable relationships which make women most vulnerable to risk, stigma, and discrimination.

HCP will continue to promote local screenings of videos and facilitate discussions to raise awareness in three key areas: anti-stigma ("Tikambe"), PMTCT ("Mwana Wanga-My Child"), and ART ("The Road to Hope"). Available in three to five Zambian languages (depending on the series), more than 3,500 copies have been distributed throughout Zambia to government authorities, non-governmental organizations (NGOs), and other stakeholders. Supporting the screening of these videos, televisions and VCRs were placed in 180 health center general public waiting rooms.

At the end of FY 2005, 45,000 copies of the Positive Living Handbook were produced and distributed with a target audience of PLWHA, their caregivers, and OVC. This handbook is written for low literacy audiences and is designed to be the comprehensive and practical guide to positive living with HIV. It has become a regional standard for informing and engaging PLWHA. Due to an overwhelming response, various stakeholders, including the MOH, are reprinting 10,000 additional copies. In 2007 this handbook will be updated to reflect current drug regimens and additional treatment sites. Partners including MOH will be invited to join in the print run.

All activities begin with formative research and are piloted with target populations before being launched. The activities also take into account existing gender roles with the goal of reducing violence, empowering women to negotiate for healthier choices, and promoting partner communication/mutual decision-making and male responsibility.

HCP has made strategic choices which underlie a commitment to ensure Zambian capacity, sustainability, and self-reliance and the development of public opinion and norms supporting treatment and care. HCP's community mobilization efforts focus on capacity development of individuals, NHCs, and community-based organizations. For example, trainings in proposal writing (for funds available locally), activity design, and monitoring enable organizations to find local responses to local challenges. "Living and Loving" empowers the listeners; local radio personalities have been trained to interview PLWHA so that they can produce future programs on their own. Care and Compassion groups have emerged as a community response to a community problem. HCP plays a key role on the National AIDS Council (NAC) Information, Education, and Communication (IEC) Technical Working Group, which collects, harmonizes, and shares national IEC materials. In FY 2006, HCP is supporting the development of the NAC Resource Center by compiling a database of all HIV/AIDS IEC materials available in Zambia. In concert with USG partners, HCP facilitates the adaptation and reproduction of IEC materials for its programs, playing a key role in promoting collaboration and coordination among partners. HCP work plans are integrated into district and provincial plans, ensuring ownership and sustainability. Dramatically-discounted air time on ZNBC and local radio stations reflects the national and local ownership of "Living and Loving" and the Care and Compassion movement.

Funding for Care: Orphans and Vulnerable Children (HKID): $290,000

This activity links with the Health Communication Partnership's (HCP) ongoing activities in Abstinence/Be faithful (#8905), Other Prevention (#8904), Palliative Care (#8902), and Treatment/ARV Services (#8901). It also supports the U.S. Government (USG) partners providing orphan and vulnerable children (OVC) care and support services and addresses both Zambian and the President's Emergency Plan for AIDS Relief (PEPFAR) goals for increasing the number of orphans receiving care through community mobilization and the provision of quality information on educational, nutritional, and psychosocial support.

Community mobilization and behavior change communication, the foundation of HCP's strategy in Zambia, provide a comprehensive approach that promotes better health-seeking behavior through the support for and promotion of OVC services throughout the country. HCP draws on the expertise of Johns Hopkins University Center for Communication Programs' (JHU/CCP) worldwide experience including formative research and evaluations of these programs. For example, the 2003 study of Language Competency in Zambia has informed all HCP printed materials while the BRIDGE project baseline survey in Malawi provided valuable reference for building community efficacy in similar rural communities. In FY 2007, HCP will continue to take the lead in defining gaps in OVC materials and working with key partners/stakeholders to develop appropriate Information, Education, and Communication (IEC) materials. HCP will also continue to disseminate correct and consistent OVC information and referrals within the 22 HCP-supported districts in each of the nine provinces, indirectly reaching 33,000 OVC and their caregivers.

In FY 2007, HCP will take the lead in filling gaps in OVC IEC support materials, working in collaboration with the Ministry of Health, the National HIV/AIDS/STI/TB Council (NAC), and more than 15 different USG activities implementing OVC support activities throughout the country. Appropriate, practical, and user-friendly IEC resources will be developed, as requested of HCP by OVC partners such as RAPIDS (#8947), with the production and distribution coordinated by the request originator.

In FY 2005 and FY 2006, HCP developed a people living with HIV/AIDS (PLWHA) and caregivers radio distance program, "Living and Loving," to communicate standardized messages to PLWHA, their families, and caregivers. The program was translated into seven local languages in addition to English. The series of 26 episodes promotes discussion on many topics pertaining to OVC such as: psychosocial support, health and nutrition, income generation, stigma and discrimination, education, and social inclusion. During FY 2007, in collaboration with NAC and USG OVC partners, HCP will develop episodes addressing new issues in addition to re-broadcasting episodes of particular pertinence. Listeners are encouraged to ask questions and provide feedback. Those episodes which have been most popular, as noted by letters and requests from listeners and listener groups, will be reproduced on cassettes. HCP district staff will continue to provide support to listener groups to enable them to increase their reach to over 25,000 PLWHA and their caregivers in 22 districts. Leaders of each group will be elected and, using HCP-produced program guides, will facilitate and lead discussions on care, support, and positive living. "Living and Loving" empowers the listeners with information and hope; local radio personalities have been trained to interview PLWHA so that they can produce future programs on their own. Dramatically discounted or free air time on both the Zambia National Broadcasting Corporation (ZNBC) and local radio stations reflects the national and local ownership of "Living and Loving." HCP will continue to work with local communities, Neighborhood Health Committees (NHCs), and the Anti-retroviral Therapy (ART) Unit of the Ministry of Health to assume leadership and ownership of this activity, linking these organizations with other support organizations to ensure sustainability.

HCP will continue to promote local video screenings and facilitated discussions to raise awareness in three key areas: anti-stigma ("Tikambe"), PMTCT ("Mwana Wanga"), and ART ("The Road to Hope"). Available in three to five Zambian languages (depending on the series), more than 3,500 copies have been distributed throughout Zambia to government authorities (Ministries of Education, Health, Youth, Sport and Child Development), non-governmental organizations (NGOs), and other stakeholders. Supporting the screening of these videos, televisions and VCRs were placed in 180 health center public waiting rooms.

All activities begin with formative research and are piloted with target populations before

being launched. They also consider existing gender roles with the goal of reducing violence, empowering women to negotiate for healthier choices, and promoting partner communication/mutual decision-making, and male responsibility.

HCP‘s community mobilization efforts have focused on investing in the development of skills and capacity of individuals, NHCs, and community-based organizations (CBOs), promoting self-reliance, and supporting sustainability. HCP has made strategic choices which underlie a commitment to ensure Zambian capacity, sustainability, and self-reliance and the development of public opinion and norms supporting orphans and vulnerable children. For example, HCP supports the development and implementation of community-level action plans that promote positive health and social development and inclusiveness of and support for those infected or affected by HIV/AIDS. Trainings in proposal writing (for funds available locally), activity design, and monitoring enable organizations to find local responses to local challenges. Communities have responded to OVC needs by forming Care and Compassion groups. Training sessions for psychosocial counselors have inspired many to use their own initiative in response to local needs.

HCP continues to play a key role on the NAC IEC Technical Working Group, collecting, harmonizing, and sharing national IEC materials. In FY 2006, HCP is supporting the development of the NAC Resource Center by compiling a database of all HIV/AIDS IEC materials available in Zambia. With USG partners, HCP facilitates the adaptation and reproduction of IEC materials for their programs, playing a key role in promoting collaboration and coordination among partners. HCP work plans are integrated into district and provincial plans, ensuring ownership and continuity of activities.

Funding for Prevention: HIV Testing and Counseling (HVCT): $330,000

This activity is directly linked to Population Services International/Society for Family Health (SFH)), Health Communications Partnership (HCP), JHPIEGO, and Partnership for Supply Chain Systems (SCMS) male circumcision activities (MC) as well as indirectly to Ministry of Health (MOH), National AIDS Council (NAC), and USG implementing partner CT activities.

With additional funds, HCP will assist MOH, NAC, and MC service delivery partners in developing and implementing a national MC awareness campaign that includes messages regarding CT and stigma/discrimination reduction. Materials, as described below, will focus on the importance of knowing one's HIV status, risk-disinhibition, necessity of on-going safer sex practices, seeking MC and CT services from a trained professional, and post-procedural care. More specifically, components of the overall campaign will include development of a male reproductive health counseling kit with circumcision and other male reproductive health content, including CT information. This approach places MC and CT in the greater context of reproductive health and better ensures that clients receive clear counseling on how MC is and is not protective in acquiring HIV as well as the importance of knowing one's HIV status. This kit will be a practical counseling tool, accompanied by a more technically detailed male reproductive health handbook for service providers to use in pre- and post-counseling for clients seeking MC and CT services. Plus-up funds will enable wider coverage via the printing of an additional 2,500 kits. Complementing this MC/CT/male reproductive health kit will be a simple take-away brochure for use at CT and other sites that can be given out to those who test HIV negative so they may consider MC as a risk-reduction option with the understanding that it is still not 100% protective and that there is still need to practice safer sex behaviors (i.e., abstinence, delayed sexual debut, partner reduction, and condom use). Plus-up funds will enable wider coverage via the printing of an additional 20,000 copies.

Furthermore, HCP, in partnership with MOH and NAC, will develop and implement a press education/media meeting where experts will be invited to address the press on issues of MC, CT, and service availablility. The media will be given press kits (including a fact sheet) that have complete and correct information about the important role MC can play in HIV prevention and the importance of knowing one's HIV status. There will be presentations and clarifications from experts on all questions from the press as well as follow-up media analysis of press coverage. In partnership with the Zambia National Broadcast (ZNBC), HCP will air the above event on primetime television. HCP, with the plus-up funds, will also develop three one-minute television and radio spots focusing on disinhibition; the need to use a trained service provider; importance of knowing one's HIV status; and the advisability of MC for men who have tested negative. These spots will be pre-tested for effectiveness and adapted for radio, including translated into seven national languages. The spots will be aired for 16 weeks, twice per day, on ZNBC television and ZNBC Radio 1 and Radio 2, with alternating languages and themes. Local radio stations, that HCP has ongoing relationships with in all nine provinces, will also air radio messages in the appropriate language twice per day over 16 weeks. Finally, HCP will train 25 staff, in 22 districts in all nine provinces, who are working with nearly 900 communities to raise awareness and to correctly convey information about MC, including the importance of continuing safer sex, being faithful, and knowing one's HIV status. Safe motherhood action groups will also be encouraged to promote knowing one's HIV status and MC for men who have tested negative and for newborn male children. Traditional leaders will play a key role in all of HCP community-based activities. In provinces that implement MC as a traditional practice, HCP will actively engage traditional initiators in promotion of CT and safe and sterile service delivery, complementing training efforts of JHPIEGO, SFH, and MOH.

Table 3.3.09:

Funding for Treatment: Adult Treatment (HTXS): $455,000

This activity links with the Health Communication Partnership's (HCP) ongoing activities in Abstinence/Be Faithful (#8905), Other Prevention (#8904), Palliative Care (#8902), and Orphans and Vulnerable Children (#8903). It also supports the U.S. Government (USG) partners providing HIV care and treatment services and addresses both Zambian and the President's Emergency Plan for AIDS Relief (PEPFAR) goals of scaling-up antiretroviral therapy (ART) services by providing quality information on treatment, adherence, and positive living.

Community mobilization and behavior change communication, the foundation of HCP's strategy in Zambia, provide a comprehensive approach that promotes better health-seeking behavior through the support for and promotion of antiretroviral (ARV) treatment services throughout the country. HCP draws on the expertise of Johns Hopkins University Center for Communication Programs' (JHU/CCP) worldwide experience including formative research and evaluations of these programs. For example, the 2003 study of Language Competency in Zambia has informed all HCP printed materials. In FY 2007, HCP will continue to take the lead in assessing nationwide gaps in ART literacy materials, with appropriate development of new materials. HCP will also utilize currently available materials to expand its reach to new audiences.

In FY 2005 and FY 2006, HCP produced a three-part Preventing Mother-To-Child Transmission (PMTCT) video issued in five languages entitled "Mwana Wanga" (nearly 1500 copies), as well as the Positive Living Handbook (45,000 copies), and an ART video entitled "The Road to Hope." Demand for the Positive Living Handbook exceeded supply. In FY 2007, excerpted segments of "Mwana Wanga" and the "Road to Hope" will be broadcast on national radio and television to promote messages of knowing one's HIV status, ART adherence, and PMTCT. HCP will also monitor the use of the ART video, "Road to Hope," the anti-stigma video, "Tikambe," and the PMTCT video, "Mwana Wanga," along with other HCP distributed materials to ensure optimum utilization of these tools. In FY 2007, HCP will update the Positive Living handbook to reflect current drug regimens and additional treatment sites. HCP will coordinate with partners to determine the print run of the revised edition.

In FY 2007, HCP will target communication materials for children and adolescents infected with HIV/AIDS (as well as their counselors and caregivers), including information on pediatric ART. Through this approach, children and adolescents will learn about the importance of adhering to their regimens. Of the estimated 260,000 HIV-infected adolescents and children in Zambia, 56,000 are in need of treatment and an additional 28,000 will become eligible in the coming year. It is estimated that 13 percent or less of those in need of treatment are actually accessing it. HCP, in consultation with stakeholders, will conduct a needs assessment for pediatric treatment communication. HCP will use a consultative process to develop the priority materials and interventions needed for the key audiences of providers, parents/ caregivers, young children and adolescents.

Parents and other caregivers face issues of: knowing children's HIV status, getting treatment for their HIV-positive children, ensuring treatment adherence, disclosing of positive status to children in an age-appropriate way, and helping their children to cope with knowledge of a positive status.

Issues older children and adolescents face include coping after their status has been disclosed to them, adhering to and managing their own medications, and growing up with HIV— especially with regards to sex and sexuality. HCP will develop materials that promote sharing of feelings for children's support groups. All HCP-produced materials have input from the intended audience and are pre-tested for effectiveness.

At the service delivery level, providers need support in: counseling parents to get children tested and on treatment, counseling on adherence, preventing opportunistic illnesses and positive living, and counseling for parents on when and how to disclose positive status to their children. Service providers will also be key in assisting children to establish support groups. Materials addressing these issues will be developed in consultation with the Ministry of Health, the National HIV/AIDS/STI/TB Council (NAC), ART service delivery partners, PLWHA networks, the Centers for Disease Control and Prevention (CDC) (#9026), JHPIEGO (#9033), Zambia Prevention, Care, and Treatment Partnership (ZPCT)

(#8885), Centre for Infectious Disease Research in Zambia (CIDRZ) (#9000), Catholic Relief Services (CRS/SUCCESS) (#9182), and other stakeholders to reach consensus on appropriate and correct messages.

In FY 2004, HCP initiated and began to coordinate ART harmonization efforts. These efforts, in collaboration with the Ministry of Health and the NAC, brought together ART service delivery partners, PLWHA networks, and other stakeholders to review existing communication materials and reach country-wide consensus on appropriate, correct, and consistent treatment messaging. In FY 2007, HCP will conclude this extensive activity by developing a much-needed Zambian National ART Information, Education, and Communication (IEC) strategy as the Government of Zambia's treatment program continues to scale-up. Technical assistance begun in FY 2006 supporting the NAC to establish a resource center will continue in FY 2007.

HCP will collaborate with the U.S. Embassy Public Affairs Office, Ministry of Health, NAC, and the Ministry of Information to organize periodic orientations for journalists and reporters to encourage accurate and responsible reporting on issues of positive living and ART.

All HCP activities begin with formative research and are piloted with target audiences before being launched. HCP's IEC materials also support greater gender equity with a goal of empowering women to negotiate for healthier choices and promote partner communication, mutual decision-making, and male responsibility.

HCP has made strategic choices which underlie a commitment to ensure Zambian capacity, sustainability, and self-reliance and the development of public opinion and norms for ARV services. For example, as a result of the consultative and collaborative processes used in their development, there is significant government ‘ownership' of materials produced by the Ministry of Health and NAC. Zambia National Broadcasting Corporation (ZNBC) has aired "Tikambe" on national television free of charge and has significantly contributed to the airing of "Living and Loving," a radio program for PLWHA and their caregivers aired on national and community radio stations since December 2005. As a result, ZNBC has become known for the airing of health programs.

Subpartners Total: $100,000
Comprehensive HIV/AIDS Management Program: $100,000