The following activity is newly proposed for FY 2008. This activity will be linked to the CDC activity with

Southern Province Health Office for Palliative care TB/HIV.

In FY 2008, CDC will work with a DAPP in Zambia to expand HIV prevention, care, and treatment programs

among migrant and non-migrant farm workers in Southern Province. In FY 2006 and FY 2007, a public

health evaluation was conducted among migrant and non-migrant farm workers in Southern Province to

estimate HIV prevalence and incidence and sexual behaviors that are associated with HIV infections.

Preliminary results show that migrant workers, the families that they leave behind in their hometowns, and

the temporary families that they are likely to establish in their place of work are all in need of specific HIV

prevention interventions. Additionally, people living in areas that cater to large influxes of migrant workers

need to be targeted with specific HIV interventions. The complete results from the baseline survey will be

available in time to inform the tailoring of appropriate prevention activities.

Migrant workers, mobile populations, their families, and the people they live among while they are working

are prone to experience social environments that cultivate risky behaviors for HIV and STI transmission and

acquisition. Activities through this funding mechanism will focus on encouraging behavior change by

producing materials and targeted messages, working with peer educators and/or trained clinical providers to

educate the target populations about the risks of STIs, creating a personal awareness of one's risks for

becoming infected with HIV, understanding the importance of attending VCT regularly, the importance of

correct and consistent condom use, and the importance of reducing the number of sexual partners.

Approximately 5,000 individuals will be reached through 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. Eight (8) condom outlets will be established to distribute condoms to migrant workers and

their partners in conjunction with education sessions.

The majority of people will be reached through education sessions for adult men and women that cover a

range of topics including: basic facts about HIV and STIs, understanding the CD4 count, antiretroviral

therapy (ART) and immunosuppression, practice talking with a spouse about sex, STIs, attending couples

counseling, and ways to seek out friends and family who are living with HIV to be open to them and

encourage them to have good nutrition, adhere to treatment regimens, and prevent further transmission of

HIV. These activities are expected to promote behavior change and combat stigma. An additional

important component of the activities will be to establish condom outlets and procure condoms for

distribution at major access points for migrant workers and their partners and train them on consistent and

correct use. Persons in prostitution and who exchange sex for money and/or goods with multiple or

concurrent sex partners are known to frequent areas where migrant workers live and activities are needed

to empower them to use condoms with their clients. Additional activities may include organizing recreational

activities to provide workers with alternative meeting places other than at bars, working with widows to

ensure that they are tested for HIV and receive appropriate care, and.

In order to ensure sustainability of the program and to promote lasting behavior change, the partner will

work with the Provincial and District Health Offices in Southern Province and work within their strategic

framework for activities in FY 2008. Additionally, many large farms in Southern Province have established

basic HIV programs for their workers and the partner will work through these programs to create the

capacity for their expansion and garner support from their head management offices.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

Development Aid People to People (DAPP) in Zambia has been operating since 1986. The mission of

DAPP in Zambia is to implement projects that will give people knowledge, skills, and tools that will empower

them and their families to face the challenges of everyday life and to improve their quality of life. Through

this funding mechanism, DAPP in Zambia in cooperation with Humana People to People plan to continue

with their collaborative program called Total Control of the Epidemic (TCE) that began in FY 2006. This

DAPP program is an innovative, grassroots, one-on-one communication, and mobilization strategy for HIV

prevention and behavior change. These programs implement voluntary counseling and testing (VCT) on a

house-to-house basis in conjunction with personalized counseling for HIV/AIDS prevention and behavior

change, and referrals for care and treatment services.

The overall objective of the TCE program seeks to mobilize communities to take control of the epidemic.

One large rural area in the Mazabuka district of Southern Province was identified in FY 2006 as the initial

target area. Funds for FY 2006 were awarded in September 2006. Thus far, 55 local resident people have

been trained as field officers to promote HIV/AIDS prevention through other behavior change beyond

abstinence and/or being faithful. It is anticipated that an additional 7,500 people will be tested for HIV/AIDS

and receive their results in FY 2008 and an additional 100 people will be trained in counseling and testing

according to national and international standards .

In addition to providing VCT for households, field officers are trained to talk to people about preventing

mother to child transmission (PMTCT) services, basic health care and support services, and antiretroviral

therapy (ART) services that are available in the district and they can tailor services based on the person's

HIV-related needs. Appropriate referrals will be made to services such as VCT, ART, PMTCT, and

community networks and initiatives. It is anticipated that 600 people who are enrolled in ART will be

identified through the house-to-house program and will receive prevention for positives counseling. DAPP in

Zambia hopes these practices will become institutionalized as habits as this will ensure adherence to ART

during and after the mobilization campaign. In FY 2008, approximately 1000 pregnant women are expected

to receive HIV CT for PMTCT and receive their results. Approximately 500 people will be referred for TB

treatment Another 20,000 individuals are targeted to be reached through community outreach that promotes

HIV/AIDS prevention through other behavior change beyond abstinence and/or be faithful.

This program is essential for providing VCT to people at a grassroots level. Efforts are made to contact

hard-to-reach people in their homes including adults, adolescents, children, pregnant women, people living

with HIV/AIDS where they may be most comfortable talking about HIV and learning of their HIV status. A

large benefit of this program is that house-to-house VCT can be strategically positioned to reach husband

and wife couples with couples counseling or entire families with family counseling. Follow-up visits to people

who would benefit from extra time with a counselor can also be made. Additionally, people will receive

pertinent information about HIV/AIDS services available in their community and how to access them. The

United States Government (USG) programs of PMTCT, ART, and basic health care and support will benefit

from the referrals that will be made to them. This program will work closely with the Southern Provincial

Health Office, SPHO (CDC to insert activity #) and in future years can be scaled-up to include other areas of

the Southern Province

There is a mobile population of fishermen living in this area along riverbanks and islands in the Kafue River

flats. Specific methods have been developed to reach these people by boats and their partners, including

persons in prostitution and persons who exchange sex for money and/or other goods. Given the need to

reach people in a mobile fashion and that boats will be used to reach some people, the cost per person

tested for HIV in this activity may be greater than for other activities. Teachers and religious leaders from

the targeted areas are also reached for CT and approached to support the program. Orphans and

vulnerable children living in this area are also targeted with CT and other appropriate referrals.

In its first year of operation, TCE established a formal agreement with the Ministry of Health in Mazabuka

District for obtaining test kits and supplies for CT which will continue in FY 2008. The district health office

will also conduct quality assurance monitoring to ensure that testing is carried out according to standards

and results are accurate. Work is also ongoing with the district health office to ensure that DAPP operated

in collaboration with their plans for scaling up CT programs in order to reach more people who live in rural

areas. TCE programs are naturally sustainable following the three years of formal implementation by

DAPP. The formal program is anticipated to run through FY 2008 and during this time, capacity is built in

individuals and communities to take action in the fight against HIV/AIDS. A component of the third and final

year for TCE in this area will be to turn activities over to the Ministry and encourage people who have

shown dedication to the program to continue with the work. Individuals who have been trained through the

program are from within the community where they are working and will continue to impart their knowledge

and experiences to members of their communities for many years to come. They will be seen as role

models and experts in HIV/AIDS in their communities and are often approached by community members for

support regarding HIV/AIDS.

In FY 2008, DAPP will continue their program called "Total Control of the Epidemic" to reach people living in

Mazabuka with personalized HIV messages and counseling. Field officers trained by DAPP are currently

living among rural communities in order to ensure that everyone in the community learns to take

responsibility of their own HIV status and is working towards preventing new HIV infections and seeking

care and treatment for people who are already infected with HIV. With additional funding in FY 2008,

additional field officers will be trained and the program will be scaled-up to reach more rural communities

from the current 9 wards to an additional 3 wards of Mazabuka district.

Targets set for this activity cover a period ending September 30, 2009.