ACTIVITY UNCHANGED FROM FY 2008: The funding level for this activity in FY 2009 will remain the

same as in FY 2008. Narrative updates highlight progress, challenges, and achievements. This activity is

related to activities in Other Prevention Modeling and Reinforcement to Combat HIV/AIDS (MARCH) and

AB (HCP, Corridors of Hope II, and RAPIDS).

The Modeling and Reinforcement to Combat HIV/AIDS strategy was initiated in FY 2006 in Zambia. This

activity builds local capacity to address factors that perpetuate HIV transmission in the reproductive age

group (15-24 and 25+), and promotes the "Abstinence and Being faithful" (AB) strategy. One component is

a radio serial drama (RSD) that provides listeners with authentic, realistic examples of people attempting to

change HIV risk behaviors associated with multiple and concurrent sexual partnerships. The RSD is

supported by the second component, Reinforcement Activities (RAs), which create community dialogue

about behavior change modeled in the RSD and help communities to modify social norms and cultural

practices which sanction multiple sexual partners. This strategy highlights relevant norms and behavior,

such as transactional sex and sexual and domestic violence that contribute to HIV risk. RAs provide

support to people to change their individual behavior, through creation of an enabling social environment,

and link people to existing and forthcoming services. A third component that specifically addresses

abstinence is the Families Matter Program (FMP), which focuses on the role of parents in delivering primary

prevention messages to their children and promotes delayed sexual debut.

In FY 2009, MARCH will continue to implement RSDs and RAs in Southern and Western Provinces,

reaching 100,000 individuals with HIV/AIDS prevention through AB messages. Specific behaviors to be

modeled in the dramas will be identified in consultation with stakeholders and will relate to reduction of

multiple concurrent partnerships, parent-child communication, access to and use of HIV testing and

treatment services and prevention with positives. In the RAs community drama groups will continue to write

and publicly perform plays based on RSD storylines, and facilitate community dialogue focusing on locally-

identified risks and barriers to safe behaviors. Peer educators will continue to hold discussions with small

groups relating to behavior changes modeled in the RSD and highlight mediating variables such as psycho-

social factors and social and gender norms. They will distribute informational materials and refer

participants to HIV/AIDS-related services. Local partners will help set-up listening and discussion groups in

which participants can discuss the RSD content after hearing the program. A further 150 individuals will be

trained to promote HIV/AIDS prevention through AB.

The FMP will continue to equip parents with tools to deliver primary prevention messages to their children.

The program will enhance protective parenting practices by working with 2,000 parents (a sub-set of the

overall target) to build their knowledge, skills, comfort, and confidence to discuss sexuality issues with their

children, to build relationships, and to monitor their children's movement to discourage risky sexual

behavior. Sites in at least one rural district in each province will be added to those reached in FY 2008. As

part of the year two implementation of FMP, program monitoring which is key to understanding program

outcome will be adapted from the Kenya model and implemented.

Outcome data from FY 2008 will be used to adjust the RSD and RA components and the MARCH team will

conduct routine monitoring activities such as feedback sessions with listeners of the RSDs and participants

in the RAs. On-air competitions will assess the RSDs' appeal and help communities to actively engage with

the program. The FMP will be evaluated using protocols adapted from Kenya and other FMP-implementing

countries.

MARCH start-up activities included stakeholder consultations, partner identification, gap analysis of HIV

prevention behavior change communication in Zambia, formative research and development of a detailed

implementation plan. Orientation and training workshops built capacity among local writers, producers, and

actors to manage and produce RSDs and RAs. The MARCH team developed, wrote, and recorded scripts

revolving around key characters who modeled the transition from an "unsafe" to a "safe" behavior over time,

providing listeners with role models to emulate and the inspiration to change. Storylines focused on

faithfulness, partner reduction, modification of cultural norms such as sexual cleansing and gender norms

that condone extra-marital and multiple relationships, as well as use of HIV treatment services. Writing and

production was a continuous cyclical process that used the innovative "Pathways to Change" tools, unique

to MARCH, which ensure program consistency with behavioral theory and research. In September 2006

weekly episodes of the RSD, ‘Gama Cuulu', went on air in the local language, Tonga, on four radio stations

throughout Southern Province. One-hundred episodes had been aired by August 2008.

The RAs targeted community members directly through street theatre and peer education activities in five

districts of Southern Province, reaching a total of 44,473 people in the second half of FY 2006 and 64,829

people in the first half of FY 2007, exceeding the target of 50,000 for the period. Radio reinforcement

programs aired in which community members discussed their personal experiences related to RSD content.

In FY 2007 the project trained 60 new peer facilitators to add to the existing 130. Links with mobile

voluntary counseling and testing (VCT) providers ensured services were available to meet immediate

demand. Service providers included Corridors of Hope II, New Start Center, and Ministry of Health clinics.

In FY 2007 the program was initiated in Western Province: MARCH was tailored to the different socio-

cultural context by involving local stakeholders including the Barotse Royal Establishment, which rules over

the indigenous Lozi community. Local capacity was built through training for writers, producers, peer

educators, and drama group facilitators. Re-versioning of the RSD had started and RAs had been adapted

when the project was faced with the dual challenges of cultural sensitivities and logistical difficulties. The

only acceptable solution required a full MARCH office located in Western Province, where originally just a

limited presence had been envisaged. The RSD and RAs were temporarily halted and the local

organization set up to eventually manage MARCH changed its name from ‘Gama Cuulu' to ‘MARCH

Zambia', to reflect the broader scope of the project. In August 2008 full implementation of the RSD and

RAs in Western Province recommenced. The drama ‘Fala Mwa Lilangu', aired on two local community

radio stations, and on Namibian Broadcasting Corporation to cover the remote Sesheke district. It reflected

the context that pertains in Western Province, such as the migratory habits of plains dwellers who move to

higher ground in the rainy season. It targeted migrant fishermen and fish traders who frequent the Zambezi

Activity Narrative: river harbors. It addressed delayed sexual debut especially among girls who undergo traditional initiation

and modeled improved parent-child communication, including reference to male circumcision as a

protective practice.

In FY 2008, the MARCH program continued airing ‘Gama Cuulu' and ‘Fala Mwa Lilangu' and intensified

implementation of RAs. Through stakeholder consultation the objectives of the RSDs were adapted and

extended to build on existing storylines and characters. These included parent-child communication to link

with the FMP, couple VCT, and living with HIV status discordancy. The latter was informed by a visit to the

Zambia Emory HIV Research Project by the RSD team. A female character modeled secondary abstinence

in the context of reducing transactional sex and increasing economic independence for women. Other

storylines included prevention of mother-to-child transmission, living positively, modification of traditional

teachings around puberty and marriage, use of HIV treatment services, and advocacy by religious leaders.

Outcome evaluation measured the effectiveness of the MARCH strategy. The project has pre-post data for

outcomes in Southern Province with comparison data from Western Province. Baseline data was collected

in FY 2006. The second and third waves of data collection took place in September 2007 and October

2008.

In FY 2008, MARCH added the abstinence component FMP. In Zambia, as in many African countries,

discussing sexuality with one's own children is rare. Traditionally children learn about sexuality from their

aunts and uncles. Increased mobility and breakdown of the extended family prevents this so children often

learn incomplete or erroneous information from their peers instead. FMP aimed to equip parents with tools

to help overcome barriers to parent-child discussion about sexuality and sex risk factors. The program

began by conducting a community needs assessment, establishing community advisory boards, recruiting

and training staff, adapting and translating materials, and piloting activities and materials in two sites in

Livingstone district in Southern Province and two sites in Mongu district in Western Province. By the end of

the year implementation of FMP sessions had started in five week waves in the two districts. Baseline data

was collected with parents and children prior to the sessions starting, monitoring data collected during

implementation, and outcome data collected at the end of the sessions.

Since 2006 Tulane University, through its sub-partner Media Support Solutions (MSS), has built institutional

capacity of MARCH Zambia (formerly Gama Cuulu), a registered local organization, to be a prime partner

implementing prevention activities in Zambia. In FY 2008, the Tulane Mechanism ended and the sub-

partner MSS applied under the name Media Support Partnership (MSP) and won the award for continuing

the MARCH activities. MSP is assisting the MARCH Zambia program to put in place a sustainability plan in

which the first step has been to secure sponsorship in kind for the Radio Reinforcement programs. We will

explore strategies that enable partners to incorporate MARCH on an on-going basis in their existing

activities. $234,865 will be spent on Human Capacity Development to include staff retention, training, and

volunteer motivation. Key staff including management and creative personnel will be retained through a

combination of attractive pay packages, appropriate benefits and incentives such as training opportunities.

Volunteers and RA partners will be motivated through refresher training, frequent monitoring, participation in

radio programs and the provision of equipment such as bicycles.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $281,838

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

This activity is a sub-component of The Modeling and Reinforcement to Combat HIV/AIDS (MARCH)

program (HVAB #8815). It is linked to activities in counseling and testing HVCT (#9018), ART services

through the Southern Provincial Health Office (PHO) 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 strategy in Zambia was initiated in FY 2005. This activity addresses cultural factors particular to

Zambia that perpetuate HIV transmission. Part of the strategy promotes "Being Faithful" through advocating

for fidelity (see activity #8815). However, MARCH also aims to advocate for change in cultural practices

that expose individuals in the reproductive age group (15-24 and 25+) 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 serial dramas (RSDs) and reinforcement activities (RAs) produced and disseminated by the

MARCH activity.

In FY 2009, building on implementation of activities in FY 2008, the MARCH program will continue to focus

on behaviors and underlying risk factors relating to Other Prevention including condom use and male

circumcision. The activities will aim to modify cultural practices and norms that expose individuals to HIV

infection such as male norms around the definition of virility, polygamy, sexual cleansing, wife inheritance,

dry sex, sexual and domestic abuse, and initiation ceremonies. They will also support accurate personal

risk assessment for becoming infected with HIV. Methods of prevention for positives and reduction of

alcohol abuse will be highlighted. MARCH will continue writing, producing, and broadcasting local-language

RSDs in Southern and Western Provinces using Pathways to Change, a set of tools which both ensure

consistency with behavioral theory and research and guide content development of the RSD and RAs to

use a role modeling approach rather than messaging. With sustained behavior change the goal, community

-based RAs will be conducted that spur discussions among small groups of men and male social group

leaders, to integrate the new ways of behaving modeled in the RSDs in their lives, and to facilitate support

for individual and societal change. 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. Peer educators will provide informational materials and link individuals to services as appropriate.

About 25,000 people will be reached 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 RSDs, 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 and Western 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 RAs. Outcome data from FY 2008 will be used to inform

the RSDs and RAs as appropriate. Routine data collection on attendance and participation at RAs and

feedback sessions with RSD listeners will provide on-going monitoring data for program development and

assessment. On-air competitions and discussions will serve to monitor the appeal of the RSDs and

encourage active community engagement with the RSDs as well as enrolment in the RAs.

From FY 2006 to FY 2008, RSD storylines were developed which revolved around a mix of authentically-

drawn characters each of whom modeled a transition from an "unsafe" to a "safe behavior" over time and

thus provided listeners with a model from which to draw inspiration to change. For example, Chali was a 22

year old street boy engaged in shady deals who drank alcohol excessively, exposing himself to sexual risks.

His behavior led to him becoming infected with an STI, getting it treated, then using condoms consistently,

reducing alcohol intake, and finally taking responsibility for himself and his family after his mother died,

including getting tested and supporting another character living with AIDS. Other storylines focused on

modification of cultural norms that promote sexual cleansing for widows and widowers and introducing safer

ways of marking key rites of passage. Transitional characters also modeled seeking and use of HIV,

prevention of mother to child and tuberculosis treatment services with the aim of encouraging listeners to

seek appropriate care and adhere to treatment.

RAs included community street theatre performances followed by public discussions, and peer education

sessions with small groups. RAs addressed gender inequalities and gender-based violence by working with

traditional counselors to modify harmful traditional teachings around sex and marriage. Discussions were

tailored to address the reduction of violence and coercion and other social norms and behaviors.

Weekly episodes of the RSD, 'Gama Cuulu', in the Tonga local language of Southern Province started in

September 2006 on four radio stations. By August 2008, 100 episodes of the RSD had been aired. The

project also rolled-out in Western Province at full scale, with an adaptation workshop to tailor the key

behavior change objectives and the RSD and RAs to the specific socio-cultural context of the Lozi

community. A design and script-writing workshop was held in FY 2006 and through local consultation and

formative research findings, the Southern Province program was adapted to suit the Western Province

target audiences. Pilot episodes were developed and extensively pretested prior to the team embarking on

production of the first 13 episodes. Airing of the Lozi-language RSD, ‘Fala Mwa Lilangu', and full

implementation of the RAs was delayed until August 2008 to allow for a fully-fledged office and staff to be

established after localization of the Western Province program was demanded by stakeholders.

The Lozi-language drama was aired on two community radio stations as well as Namibian Broadcasting

Corporation to reach Sesheke District in the west. The drama included a component targeting migrant

fishermen and fish traders who frequent the Zambezi River harbors for fish orders. It addressed abstinence

and/or delayed sexual debut especially among girls that undergo traditional initiation called ‘Mwalanjo' in the

Lozi local language. Another area of emphasis was male circumcision, common in some pockets of

Western Province where statistics show that HIV infection rates are lowest in the entire country. The idea

was to build on this ‘best practice' while encouraging correct and clinically safe circumcision for young men.

Outcome evaluation has measured the effectiveness of the MARCH strategy. The project has pre-post data

for outcomes in Southern Province where activities had been implemented for two years by October 2008,

Activity Narrative: with comparison data from Western Province. Baseline data was collected in FY 2006. The second and

third waves of data collection took place in September 2007 and October 2008.

Capacity-building has been a core feature of the MARCH program. Since 2006 Tulane University, through

its sub-partner Media Support Solutions (MSS), has built institutional capacity of MARCH Zambia (formerly

Gama Cuulu), a registered local organization, to be a prime partner implementing prevention activities in

Zambia. In FY 2008, the Tulane Mechanism ended and the sub-partner MSS applied under the name

Media Support Partnership (MSP) and won the award for continuing the MARCH activities. MSP is assisting

the MARCH Zambia program to put in place a sustainability plan in which the first step has been to secure

sponsorship in kind for the radio reinforcement programs. We will explore strategies that enable partners to

incorporate MARCH on an on-going basis in their existing activities. $46,973 will be spent on Human

Capacity Development to include staff retention, training, and volunteer motivation. Key staff including

management and creative personnel will be retained through a combination of attractive pay packages,

appropriate benefits, and incentives such as training opportunities. For example, the Production Manager

improved the quality of the RSDs by implementing lessons learned about drama production, writing and

management from a study tour she made to the BBC in England. Volunteers and RA partners will be

motivated through refresher training, frequent monitoring, participation in radio programs and the provision

of equipment such as bicycles.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15572

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15572 6572.08 HHS/Centers for Tulane University 7187 3368.08 UTAP - $200,000

Disease Control & MSS/MARCH -

Prevention U62/CCU62241

0

8816 6572.07 HHS/Centers for Tulane University 4947 3368.07 UTAP - $100,000

Disease Control & MSS/MARCH -

Prevention U62/CCU62241

0

6572 6572.06 HHS/Centers for Tulane University 3368 3368.06 MARCH Project $299,600

Disease Control &

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $46,973

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03: