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.

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

FY 2005. This program explores and addresses factors that perpetuate HIV transmission in the

reproductive age group (15-24 and 25+), and promotes the "Abstinence and Be faithful" strategy through

advocating for delaying sexual debut and 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. Through the

RSD, characters model risk reduction behaviors including seeking treatment of sexually transmitted

infections, and being faithful. The second component consists of reinforcement activities (RAs) that: a)

encourage communities to modify social norms and cultural practices which endorse multiple sexual

partners, b) provide support to people to change their behavior, and c) link people to existing and

forthcoming services. The RAs help to create community dialogue and diffuse stories about behavior

change modeled in the RSD.

Start up activities included stakeholder consultations, partner identification, gap analysis of HIV prevention

behavior change communication in Zambia, and development of a detailed plan to implement MARCH, in

Southern Province and later in Western Province. Formative assessment collected data on factors

influencing being faithful and informed a design workshop held in collaboration with Provincial Health Office

(PHO), Provincial and District AIDS task forces, HCP, Corridors of Hope and local NGOs working in

Southern Province. Workshop participants defined specific behavior change objectives to be addressed by

MARCH, and designed the universe of the RSD. Script-writing and RA workshops built capacity among

local writers, producers and actors to manage and produce both components of the project with partner

organizations. Writing and production is a continuous cyclical process that uses the innovative "Pathways

to Change" tools, unique to MARCH and ensure program consistency with behavioral theory and research.

In Southern Province, the RSD and the project itself is called Gama Cuulu, which means "facing life's

challenges head-on".

In FY 2006 the Gama Cuulu team developed six storylines revolving around a mix of characters just like

ordinary people such as farmers, housewives, students, and village elders. Each character models the

transition from an "unsafe" to a "safe behavior" over time, providing listeners with role models to emulate

and the inspiration to change. For example, Munyati, a farmer married to Mangalita, struggles to avoid

extra marital affairs but learns more about HIV, gets tested and overcomes social and personal barriers to

eventually remain faithful to his wife. Other storylines focus on partner reduction, modification of cultural

norms such as sexual cleansing, and use of HIV treatment services. The RSD went on air in September

2006 in the local language, Tonga, on four commercial and community radio stations and is broadcast

throughout the Southern Province. Listener responses suggest strongly that Gama Cuulu has found its

place in their lives as a source of information, education and rib-shaking humor every weekend: 40

episodes had been aired by early June 2007.

In FY 2006 and 2007, the RAs targeted community members directly through street theatre and peer

education activities in five districts of Southern Province, reaching a total of 11,200 people in the period

October 2006-March 2007. In the community street theatre activity, local drama groups wrote and publicly

performed plays based on RSD storylines and facilitated community dialogue focusing on locally-identified

risks and barriers to safe behaviors. Trained peer facilitators initiated discussion with small groups relating

to behavior changes modeled in the RSD and highlighting mediating variables such as psycho-social factors

and social norms. Peer educators also distributed Information, Education and Communication (IEC)

materials and referred participants to HIV and AIDS-related services. In FY 2007 MARCH started airing

Radio Reinforcement programs in which community members participate in on-air discussions about their

personal experiences related to the RSD content.

In FY 2007, MARCH rolled out RSD to Western Province with an adaptation workshop to tailor behavior

change objectives, the RSD, and RAs to the specific socio-cultural context and to involve of the Barotse

Royal Establishment, which rules over the Lozi kingdom of the local Lozi community. The project will

maintain a small office in Western Province and work with CDC and PHO to handle questions and build

rapport with the local community. The re-versioned Lozi language RSD will launch on community and state

radio stations and RAs will start, in October 2007.

In FY 2008, MARCH will continue in both provinces and intends to reach 100,000 individuals with activities

for HIV prevention through abstinence and being faithful and to train 150 individuals to promote HIV

prevention through abstinence and being faithful. Originally MARCH did not focus on abstinence since it

was well-covered by other programs. It will be highlighted in Gama Cuulu as two minor characters become

more central to the drama. Twaambo, a 16 year old school girl with a steady boyfriend, is delaying sexual

debut and is still a virgin. Mukabanji's personal perception of HIV risk will become more accurate and she

will model secondary abstinence. RAs will be developed to address abstinence behaviors.

Outcome evaluation will measure the effectiveness of the MARCH strategy in both Western and Southern

Provinces through a lagged quasi-experimental design. The first wave of baseline data was collected in FY

2006. The second wave of data collection will take place in September 2007 and the third survey will be

conducted in FY 2008.

In FY 2008, MARCH will add an abstinence component to its current program already addressing the "B"

and "C" of ABC. In Zambia, like in many African countries, discussing sexuality with ones own children is a

rare phenomenon. Children learn about sexuality from their aunties, uncles or peers. One of the goals of

the Families Matter is to equip parents with tools to help overcome barriers to parent-child discussion about

sexuality and sex risk factors.

In an attempt increase knowledge about sexual risks among adolescents ages 9-13 and increase delay

onset of sexual debut, MARCH will adopt and implement appropriate aspects of the Families Matter

Program to equip parents with tools to deliver primary prevention messages to their children. The program

Activity Narrative: will be designed to enhance protective parenting practices through working with two thousand parents to

build their knowledge, skills, comfort and confidence to discuss sexuality issues with their children. Focus

will be on raising awareness about sexual risks teens face in Zambia while encouraging general parenting

practices related to relationship building with their children and monitoring their children's movement to

discourage engagement in risky sexual behavior.

The program will begin by conducting formative data to provide baseline to inform how the program should

be implemented in Zambia and to provide benchmark for measuring program outcome effectiveness. The

program will be piloted in 2 sites in Livingstone district in Southern Province and 2 sites in Mongu district in

Western Province with intent for wider expansion the following year. Funding will be used to collect

formative data, implement the program such as obtain necessary office and work supplies, transportation,

coordinate parent training sessions and data collection on session outcome and hire additional staff to

implement the program.

The project plans to intensify activities in physically difficult to reach areas in Western Province as well as

conduct a formative assessment in Eastern Province, with intent of rolling out MARCH there. CDC is

already working with the PHO in Eastern Province so MARCH would add value to existing interventions.

Tulane University, through its sub-partner Media Support Solutions (MSS), has since 2006 been building

institutional capacity of Gama Cuulu project office in Livingstone, where both the Tonga and Lozi versions of

the RSD are recorded. Gama Cuulu is a registered local organization whose capacity is being built to soon

be one of the prime partners implementing prevention activities. MSS is assisting Gama Cuulu to put in

place a sustainability plan in which the first step will be to secure sponsorship for the Radio Reinforcement

Programs.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is a sub component of the MARCH program. It is linked to activities in counseling and testing

and ART services through the Southern Provincial Health Office activity with CDC, home based care

activities and HIV/TB activities. 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. However, MARCH also aims to advocate

for change in cultural practices that continue to expose individuals to HIV infection, to increase personal risk

perception for becoming infected with HIV, and to curtail alcohol abuse. These three topics will be the focus

of radio programs produced and disseminated by the MARCH HVOP activity.

In FY 2006 to FY 2007 the first phase of the project was implemented, with the development of the

storylines which revolve around a mix of characters who are like community members in the Southern

Province of Zambia. They are farmers, housewives, students, and village elders. Each character models a

transition from an "unsafe" to a "safe behavior" over time and thus provides people with a model from which

to draw inspiration to change. For example, Munyati, a farmer married to Mangalita, struggles to cut off his

extra marital affairs but learns more about HIV and overcomes several barriers to eventually remain faithful

to his wife. He learns to use condoms correctly and consistently and along the way, he and his wife will get

tested for HIV. Another example is Chali, a 22 year old street boy who engages in shoddy deals and drinks

alcohol excessively. His behaviour leads him to catching an STI, getting it treated, using condoms

consistently, reducing alcohol intake and finally taking responsibility over his family after his mother dies.

Other storylines focus on modification of certain cultural norms, and use of HIV treatment services to ensure

appropriate care and adherence to treatment.

In FY 2008 the project intends to continue airing the Tonga and Lozi Radio Reinforcement Discussions

where community members will participate and comment on their personal experiences in relation to the

subject matter in the Radio Serial Drama. Several such Radio RA programs have been aired in FY2007 and

received an overwhelming response prompting this to be a tentacle of the implementation strategy.

Airing of weekly episodes of the RSD in the local language, Tonga, which started in September 2006 has

continued on four radio stations. By the end of 2007, a total of 64 Episodes of the radio serial drama based

on research were aired out of a total of 88 that will have been written and recorded, ready for airing.

MARCH will continue writing episodes and producing the serial drama using Pathways to Change, 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 modeling and not messaging. The Tonga-language

drama will continue airing on both commercial and community radio stations and be transmitted throughout

the Southern Province. The project has also rolled-out MARCH to Western Province at full scale, with an

adaptation workshop to tailor the RSD, RAs and the key behavior change objectives to the specific socio-

cultural context of the Lozi community. A design and script writing workshop was held in FY 2007 and

through local consultation and formative research findings, the Southern province program has been

adapted to suit the Western province target audiences. Pilot episodes were developed and extensively pre-

tested prior to the team embarking of the production of the first 13 episodes. Airing of the drama is due to

start in October 2007.

The Lozi-language drama is to be aired on state and community radio stations throughout Western

Province. The drama will include a component targeting migrant fishermen and fish traders who frequent

the Zambezi River habours for fish orders. It will also deal with abstinence and/or delayed sexual debut

especially among girls that have undergone the traditional initiation called ‘Mwalanjo' in the Lozi local

language.

Building on implementation of activities in FY 2007, the MARCH program 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 such as male norms around the definition of virility, polygamy, sexual cleansing,

wife inheritance, dry sex and initiation ceremonies and will support accurate personal risk assessment for

becoming infected with HIV. Methods of prevention for positives will also be highlighted, and reduction of

alcohol abuse. With sustained behavior change the goal, community-based reinforcement activities will be

conducted that spur discussions among men and male social group leaders, and participants will be

encouraged to change their behavior to protect themselves from infection and from transmitting HIV and

other sexually transmitted infections to their sexual partners. 25,000 people will be reached through with

community level activities that promote 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 all districts of Southern and Western Provinces with radio access 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, Corridors

of Hope, and RAPIDS. 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

districts that will be implementing reinforcement activities. MARCH also works closely with Health

Communication Partnership (HCP) and Corridors of Hope II to learn from their experiences working in

Southern Province with communication activities.

Another area of emphasis may be male circumcision, common in some pockets of Western Province. The

idea will be to build on this ‘best practice' while encouraging correct and clinically safe circumcision of young

men. The project intends to intensify activities in physically difficult to reach areas in Western Province.

Increased funding for FY 2008 will enable the project to acquire reliable transport for conducting activities in

both Southern and Western Provinces.

Outcome evaluation will measure the effectiveness of the MARCH strategy in both Western and Southern

Provinces through a lagged quasi-experimental design. The first wave of baseline data was collected in FY

2006. The second wave of data collection will take place in September 2007 and the outcome survey will

Activity Narrative: be conducted in FY 2008. The program is routinely monitored through ongoing assessments of the RSD,

RAs and through community competitions to check on how popular the RSD is and also to ensure that the

communities are actively listening to the program.

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