This is a new activity which will focus on highly vulnerable orphans and other vulnerable children on the street or those in danger of going on the street. The activity was initially funded through DCOF for an initial period of three years after which this funding will not be available.

The devastating impact of the HIV/AIDS pandemic on families and communities has resulted in many children remaining without adequate adult care. This has resulted in many children ending on the street. It is estimated that there are 13,000 children who live on the street country-wide. Children initially take to the streets in search of an income through vending, car-guarding, begging or stealing; or they may be raising funds to take home as a contribution to (or even the sole source of) family income. Children use the street as a source of income face a lot of dangers such as substance abuse, sexual abuse, delinquency and crime. All these dangers make it less and less likely that these children will want to go home and if they do they are unlikely to be accepted there if they do go. The majority of children who take to the streets are boys. For girls facing similar neglect and abuse, the streets are even more dangerous, as many end up in prostitution. Even if they avoid the streets, they are vulnerable to sexual abuse, early pregnancy, STIs and HIV/AIDS at home.

Children on the street are less likely to attend school, and are exposed to violence, physical, sexual, and verbal abuse; other threats to their physical health, including substance abuse. The need to support themselves makes street children more likely to engage in high-risk behaviors, leaving them vulnerable to HIV/AIDS. For most of these children, their emotional well-being - their sense of identity and self-worth, of being important to society - also suffers greatly through life on the streets. Without assistance, the future security of these children is seriously jeopardized, a cycle of poverty and vulnerability is perpetuated, and the productivity and viability of future generations and society overall are threatened.

PCI will seek to address the needs of the children on the street, in centers which keep which who are withdrawn from the street and those children who are in danger of ending up on the street due to the conditions at home. Further, PCI will ensure that activities that are implemented in FY07 increase the effectiveness, impact, and sustainability of interventions to street children or children at risk of ending on the street. The first activity that will be implemented is aimed at reducing the number of children ending up on the street. To achieve this, PCI will establish an early warning system at community level to identify families whose children may end up on the street. Community awareness should therefore play a major role in the implementation of this activity. PCI will link up with other organizations such as the government, non-governmental organizations, and the private sector firms in tackling this problem. The prevention campaign will have a strong public awareness component to discourage the public from giving children on the street money, food and other support, thereby making living on the street a less attractive option for at risk children. The public should instead be encouraged to make contributions to centers that take care of street children. PCI should identify local partners with skills to work both at family and community levels, which is missing in the current award. PCI will also ensure that children on the street, in the centers and in households with children who are likely to end on the street are provided with high quality services.

PCI will also increase the capacity of local organizations In order to ensure sustainability of interventions to street children and at risk children. Although PCI is now working with 18 local organizations from the initial nine partners, most of these organizations cannot implement activities without external technical and financial support. Without a follow-on award, the progress so far made with these organizations will not be sustained. To achieve greater sustainability, at least 50 percent of the total project budget will go to local partners in the first year, 60 percent in the second year and 70 percent in the third and final year.

PCI will in addition to increasing the capacity of local implementing partners also strengthen the Ministry Community Development and Social Services (MCDSS), which is responsible for dealing with the problem of street children and other vulnerable children. Once the capacity of MCDSS is strengthened, it will be able to provide leadership to all stakeholders involved in dealing with the problem of street children. In addition MCDSS will be able to coordinate all street children interventions, select local organizations to

implement activities, and monitor and evaluate interventions on street children. PCI will work with MCDSS to develop guidelines and standards of care and support for children on the street and centers and handover the implementation of this activity to the MCDSS. This is necessary because MCDSS has both technical and financial challenges in playing its role, and only by strengthening its capacity can interventions be sustainable in the long-term. Currently, this role is being played by PCI.

In order to ensure program quality and effectiveness PCI will develop a strong monitoring system that is able to track all the children being reached through the program. The current monitoring system cannot track the total number of individual children being reached by the program. It is only able to track the number of services provided to children. Once this system is developed and tested, PCI should install it in the Ministry of Community Development and Social Services and Ministry of Sport, Youth and Child Development at the national level and at the district level in Lusaka, Livingstone, and the Copperbelt and train staff in how to use the system.

Targets

Target Target Value Not Applicable Number of OVC served by OVC programs 5,000
Number of providers/caregivers trained in caring for OVC 200

Table 3.3.09: Program Planning Overview Program Area: Counseling and Testing Budget Code: HVCT Program Area Code: 09 Total Planned Funding for Program Area: $ 20,421,394.00

Program Area Context:

Counseling and Testing (CT) is key to the US Government's (USG) Five-Year Strategy, representing an important link between prevention programs and referral of HIV positive persons and their families for services. Voluntary counseling and testing (VCT) services began in 1999 as a Ministry of Health initiative supported through the National AIDS Council. USG efforts are coordinated through this national body, which oversees all VCT activities in the country, including those conducted by government and non-governmental organizations (NGOs). By working within the Government of the Republic of Zambia (GRZ) program, USG is both building capacity and ensuring future sustainability.

In support of the national CT program, great progress has been made in scaling-up CT services nationwide. Zambia started with 22 sites, and now has approximately 560 CT sites, representing all 72 districts. Furthermore, an estimated 327,000 will be tested in FY 2006, a substantial increase from 268,000 in 2005. In March 2006, GRZ issued national HIV CT guidelines, calling for routine, opt-out HIV testing and use of finger-prick when appropriate in all clinical and community-based health service settings where HIV is prevalent and where anti-retroviral therapy (ART) is available. These guidelines encourage using rapid HIV tests, and emphasize that testing be voluntary and based on informed consent. Health care workers (HCWs), including lay counselors, are trained in CT and initiate testing in a variety of clinical settings, such as tuberculosis (TB), sexually transmitted infection (STI), and ante-natal (ANC) clinics as well as in private mining and agribusiness companies and within communities. At the community level, lay counselors are being trained by local organizations to advise couples to be tested and to disclose their status with their partners, especially among discordant couples. In FY 2006, GRZ conducted the first national VCT Day to increase access to VCT services and encourage testing across the country. Currently, USG supports 62 districts, representing 86% of the population.

Additionally, the German Development Bank and USG are supporting a network of branded private sector clinics, both stand-alone and mobile, to serve persons unable or unwilling to access public sector CT sites. The branded network approach assists in developing national VCT capacity and demand for VCT through coordinated efforts to educate Zambians about the benefits of knowing one's HIV status. Other CT sites include private and public sector workplace programs as well as CT programs in military facilities and among the defense forces.

USG's CT program also targets most-at-risk populations to ensure that these individuals have access to CT services. For example, to serve discordant couples, partners have increased efforts to offer couples CT, including the development of a procedures manual for couples CT and a multi-media demand-creation campaign to increase the number of couples accessing CT. Another illustration is the effort to increase access to CT in the education sector; USG supported the Ministry of Education (MOE) in developing capacity to administer CT services amongst their 61,000 employees, mostly teachers. To serve mobile populations, sex workers, and truckers, USG will provide CT services along borders and high-transit corridors. Finally, to increase pediatric HIV testing, USG is training counselors in best practices for child and family HIV testing, sensitizing communities about pediatric HIV, and providing psychosocial support and follow-up to children living with HIV/AIDS and their care givers.

Despite these many efforts, CT expansion, especially in rural, remote areas, continues to face many challenges as revealed in the 2005 Zambia Sexual Behavior Survey in which only 13% of Zambians know their HIV status. Examples of these obstacles include: weak logistics system to distribute HIV test kits to CT sites, limited availability of CT staff, and gender inequities in access to CT services. Therefore, in FY 2007, USG will support 454 CT sites to provide mobile, static, and community-based CT services; it is estimated that 286,696 persons will receive CT services this year. For hard-to-reach populations, USG is supporting CT outreach services in peri-urban and rural areas, including assistance in provision of home-based CT (door-to-door).

Moreover, USG will expand its efforts in the following areas: training people living with HIV/AIDS (PLWHA) to advocate for CT; developing information, education, and communication (IEC) materials; mobilizing communities to increase demand for CT; training CT facility staff in commodity management; increasing access to CT in workplace programs; strengthening the national military referral laboratory and hospital in Lusaka to offer quality CT services. Moreover, in coordination with GRZ, USG partners have strategically selected catchment areas to avoid duplication of resources; this process is coordinated through the District Health Management Teams. USG partners will also continue providing referrals for care and treatment following CT, including post-test counseling; partners have established referral networks to link individuals to services in their geographic coverage areas.

In FY 2007, USG will procure HIV test kits, in collaboration with GRZ, Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (GFATM), and Japanese International Cooperation Agency (JICA). USG's HIV test kit contribution will represent approximately 1,616,952 tests or 50% of all HIV tests conducted in FY 2007 (this includes confirmatory, tie-breaker, and tests performed by the National Blood Transfusion Services). Three types of HIV test kits will be procured through the Partnership for Supply Chain Management Systems (SCMS): screening (Determine), confirmatory (currently Genie II, switching to Unigold), and tie-breaker (currently Bionor, switching to Bioline). The procurement process is closely linked with the development of a rigorous logistics management information system and the use of software to monitor stock levels in order to ensure an uninterrupted supply of HIV test kits. For this reason, JSI/DELIVER will assist GRZ and other key stakeholders in developing forecasting and quantification skills, provide timely consumption data, and strengthen the national HIV test kit supply chain.

With an increased focus on strategic CT interventions, such as increasing the number of CT providers, procuring HIV test kits, expanding mobile CT services for hard-to-reach populations, and strengthening referral networks for prevention, treatment, and care services, USG is well positioned to contribute to the Emergency Plan's global 2-7-10 goals and to achieve the USG Five-Year Strategy objectives.

Program Area Target: Number of service outlets providing counseling and testing according to 418 national and international standards Number of individuals who received counseling and testing for HIV and 294,696 received their test results (including TB) Number of individuals trained in counseling and testing according to national 3,288 and international standards

Table 3.3.09: