The United Nations High Commissioner for Refugees (UNHCR) is working in partnership with the United States Government PRM (USG) to strengthen HIV/AIDS prevention programs for refugees residing in Zambia. UNHCR and its implementing partners began strengthening HIV/AIDS programs for refugees in Zambia in 2003. PEPFAR funding, which begun in 2006, enhanced the interventions with an emphasis on prevention. HIV/AIDS prevention and education campaigns conducted by host country governments need to be adapted to refugees, who speak different languages and have different cultural backgrounds. Refugees suffer trauma and violence, including sexual violence, during conflict and flight which destroys traditional community support structure and renders them vulnerable. Therefore, comprehensive HIV/AIDS prevention and care programs are tailored to this unique, high-risk population. UNHCR continues to spearhead prevention and health systems strengthening intervention in working with Implementing Partners (IP). These are World Vision International (WVI), Aktion Afrika Hilfe (AAH) in Kala and Mwange camps and Ministry of Community Development and Social Services (MCDSS) in Mayukwayukwa and Meheba settlements.

Refugees reside in the following geographic areas of Zambia: Kala Camp- Luapula Province, Mwange in Northern Province, Mayukwayukwa in the West and Meheba in the Northwestern Provinces. With ongoing repatriation, the Kala refugee population has reduced from 13,364 in October 2008 to the current (June 2009) 10,039 while Mwange is now at 11,630 from 15,207. Meheba settlement as at June 2009 has 15,977 refugees whilst Mayukwayukwa has 10,548, bringing the total camp based population to approximately 48,200.

UNHCR works with HIV/AIDS Interagency Task Forces established at each camp which comprise community representatives, , refugee leaders, and camp administration, as well as representatives from IP and UNHCR. The UNHCR also works with district and national HIV/AIDS programs to ensure they are operating under guidelines established for Zambia. Under 'one' United Nations (UN), UNHCR is part of the UN Joint team on HIV/AIDS.

The goal of UNHCR is to ensure that refugees, internally displaced persons (IDPs) and other peoples of concern (POCs) are protected. The overall strategic objective is to support and promote HIV/AIDS policies and programs to reduce morbidity and mortality and to enhance quality of life among refugees, IDPs, returnees and other POCs to UNHCR.

Specific objectives include:

To ensure that human rights of UNHCR's POCs are protected in HIV prevention, treatment, care and support programmes.

To coordinate, advocate for, and effectively integrate HIV policies and programs in a multi-sectoral approach for POCs by strengthening and expanding strategic partnerships with key stakeholders.

To reduce HIV transmission and morbidity through scaling up effective prevention interventions to UNHCR's POCs with an emphasis on community participation, especially among women, children and people with special needs, to ensure they have access to HIV prevention information and services.

To build and strengthen HIV knowledge and skills as well as to provide necessary technical tools to POCs and those staff working with them.

A consultant has been hired to serve as UNHCR's HIV/AIDS Technical Officer for all PEPFAR programs. The consultant assists all implementing partners to plan, implement, collect monthly data about their HIV/AIDS activities, and monitor progress towards reaching their targets. The Technical Officer undertakes a minimum of one monitoring visit per quarter to each of the four refugee sites. IPs submit reports on a quarterly basis and as per UNHCR requirements, financial reports are verified on-site before releasing subsequent installment to the IP. Quarterly meetings are scheduled in Lusaka to allow implementing partners to exchange experiences and new ideas.

Activities in each refugee site are spearheaded by an HIV/AIDS task force mainly comprising a cross section of refugees and staff working among them. They link up with clinics established in their locations as well as all groups involved in HIV/AIDS interventions. These clinics are linked to the country's district hospitals.

HIV/AIDS activities in FY 2009 focused on prevention and VCT. All four refugee sites have HIV and AIDS Task Forces. All planned targets were exceeded. Various age groups in the refugee settlements are able to confidently converse on HIV and AIDS prevention as a result of the information disseminated through PEER Educators, drama groups, Anti AIDS clubs and support groups. Statistics show that the number of people seeking VCT services has doubled. More and more people are accessing condoms for family planning and STI prevention which includes HIV. There are 89 condom distribution points against the planned 80. Prevalence rates have continued to be lower (on average 2.8%) that in the host community (14.3%).

Sexual Prevention and Counseling and Testing continue to be our main areas of focus with the inclusion of PMTCT. Gender and strengthening human resources for health will be cross cutting issues.

The refugees are involved in the design, implementation, and monitoring of the program to enhance effectiveness and ensure ownership of the program. Building the necessary HIV prevention skills in the youth and general population is particularly important in the refugee population, as these skills are transferable when refugees return to their countries of origin.

In FY2009, MOH trained 12 of their staff and 54 lay counselors to implement VCT. UNCHR, through its implementing partners established six more sites (Mayukwayukwa -two, Meheba -four) as VCT centers bringing the total to 15. Approximately 4,600 people tested for HIV and received their results.

The budget decreased from $100,000 in the previous year to $56,000 because MOH staff are trained in VCT. In FY2010, refugees will be made abreast of the VCT services available and the advantages to knowing one's HIV status. Lay counselors and peer educators will target 80 men with positive messages to access VCT. Ministry of Health (MOH) will train 36 Lay Counselors in Meheba and Mayukwayukwa settlements in mobile VCT. 4,600 people are targeted to test for HIV and receive their results. MOH will purchase laboratory supplies (test kits, needles, syringes and gloves) for HIV testing. VCT services include promotions through the VCT centers, information, education, and communications (IEC) programs through peer education; promoting condom distribution and Prevention of Mother to Child Transmission (PMTCT).

Prevention of Mother to Child Transmission (PMTCT) is part of VCT activities in Kala and Mwange camps. Except for one case where a pregnant woman did not want to test in fear of her husband in Kala camp, 99% of the women attending ante-natal clinic have tested and five out of 259, or 2%, came out positive. In the settlements, PMTCT is almost non-existent. UNHCR will work with MOH to ensure this service receives due attention. MOH will ensure every pregnant woman has access to HIV/STI screening and treatment and receive specific information on how to prevent mother-to-child transmission of HIV and other STIs. HIV-positive pregnant women will have access to ARVs and information on infant feeding alternatives.

UNHCR has established a referral system for HIV care and treatment in the camps and settlements for those who require further access to HIV/AIDS care and support outside of the provisions available in the camps. In FY 2010, the camps will continue to build broader networks among the organizations providing these services in nearby towns and a training session will be held for all camp/settlement staff to become aware of the referral services that are available for refugees.

In FY 2009, 200 adolescent girls attended 4-day youth camps that focused on their vulnerabilities and they reached 1800 more girls. 100 youths took part in sports activities that reinforced messages on HIV prevention. One hundred school age youth trained in life skills, equipping them for healthy decisions about HIV/AIDS. These in turn reached 3,600 fellow youths with HIV prevention messages. The community accessed IEC materials. Fifty school age youth were trained in assertiveness and decision making using the Stepping Stones approach and in-turn reached 1,800 school age youths.

FY 2010 will host 4-day youth camps targeting 120 adolescent girls on vulnerability of the girls to HIV infection. The girls will reach 360 more girls of the same age group with - comprehensive abstinence and be faithful messages. Sensitization messages will include transgenerational sex, vulnerable relationships like limited trust in marriages, and the reality and impact of concurrent multiple partners. Youth Sports Camps will target 200 school going children to promote HIV/AIDS awareness messages. Hundreds of adults and youths receive HIV/AIDS awareness messages through public matches by youth and drama performances during the breaks. 200 school age youth will participate in 3-day workshops on life skills training aimed at prominent school age youth and youth opinion leaders that can positively influence their peers to make healthy decisions when confronting matters of HIV/AIDS. Communities will receive reinforced HIV/AIDS prevention messages and behavior change through traditional village communication methods such as drama troops. Two troops per settlement will train and receive equipment. The refugees will access IEC materials in French, Portuguese, Swahili, and English. Eighty school age youth will be trained in assertiveness and decision making using the Stepping Stones approach. They in-turn will reach 180 school age youth throughout the year with HIV/AIDS abstinence and be faithful messages.

Programs will extend to the neighboring Zambian villages and communities, including anti-AIDS and sporting events. Approximately 8,500 people will be reached with HIV/AIDS prevention programs that promote abstinence and/or being faithful and 200 people will be trained to provide these programs.

In FY 2009, nearly 12,500 people received messages on HIV prevention through other behavior change. Seventy PEER Educators and key community leaders trained to promote behaviour change that is other than abstinence and being faithful. Eighty-nine condom outlets had a consistent supply of male and female condoms. Community members accessed culturally appropriate IEC materials.

In FY 2010, UNHCR continues to promote HIV/AIDS other prevention messages on behavior change that is beyond abstinence and /or being faithful to about 13,500 people. Thirty-six peer educators and sixty church/traditional community leaders will train to promote other behavior change. Peer educators will continue with community mobilization, sensitizing the community on safer sexual practices through abstinence, being faithful, and correct and consistent use of condoms while teaching peers how to hold discussions with their peers and advocate behaviors that promote prevention of HIV infection. Drama troops will be supported to continue actively disseminating HIV/AIDS messages. Discussions with the positives will bring to the fore the importance this group has in ensuring prevention of HIV infection. Information, education, and communication (IEC) materials will also be developed in languages like French, Swahili, and Portuguese. Drama, debate and awareness sessions will be conducted.

Community groups within the camp, such as people living with HIV/AIDS (PLWHA), will be supported to enhance their capacity to mitigate HIV/AIDS in their communities and ensure sustainability of activities. They will be trained in HIV/AIDS information, prevention, care, support, fundraising and community outreach. Stigma and discrimination will be incorporated into all training and outreach messages. Awareness programs will also include a call for communities to show compassion and support to people living with AIDS through community response. Approximately forty commercial sex workers will be trained in income generating activities (IGA) and facilitated to initiate the IGA.

Refugee women and girls will be targeted in sexual and gender based violence (SGBV) and reproductive health. Community groups will be sensitized on SGBV and psycho-social support to survivors of violence. Adolescent girls (60) and women (60) will be especially targeted.