The Strengthening Private Sector Services for Health (SPSS) Project is a new mechanism that is scheduled to begin in mid FY 10. The SPSS Project is designed to replace the he Partnership Project which ends on September 30, 2010. Consequently, the SPSS Project is expected to build upon implementation successes in the Partnership Project while continuing to strengthen private sector services for HIV prevention and palliative care for PLWHA.

The SPSS Project will be a multi-pronged initiative aimed at: reducing the rate of HIV infection in Zimbabwe through increasing the public's knowledge of HIV risks and alternatives; promoting sound behaviour change; reducing stigma towards those infected; enhancing access to HIV-related products and services, including testing and counselling and male circumcision; and, building the capacity of local policy makers and research and service providers to address the epidemic.

Although focusing on implementation within the private sector, the SPSS Project will support and strengthen the overall national response to HIV/AIDS. Implementation will be rooted in and based upon national policy, strategic, programmatic and research identified priorities. These include: improving the breadth and depth of Zimbabweans' knowledge about HIV/AIDS and promoting behaviours that prevent its spread and mitigate its impact, and significantly scaling-up HIV testing and counselling in order to increase the number of Zimbabweans who know their HIV status and are thus able to take appropriate actions such as personal risk reduction, Prevention of Mother to Child Transmission (PMTCT) and Antiretroviral Therapy (ART).

Activity areas include support for both prevention and palliative care and will expand the NGO-operated New Start and New Life networks that currently provide services to substantial numbers of Zimbabweans.

The existing New Life network provides care and support to about 200,000 continuing PLWHAs. This network offers both facility-based and outreach services. The project will provide the resources needed to expand community outreach services for PLWHAs and add home-based care support services to community-based operations supported by the NGO New Life network in a few pilot areas. In the pilot expansion areas, funds will support: the expansion of the NGO community outreach work force; service provider training; the production and distribution of communication materials for palliative care and home-based care.

The project will expand VCT services through the NGO-operated New Start network. Client-initiated counseling and testing, through both community outreach and static sites, has been growing. The project new activity will build upon this success and will increase both the number of VCT centers managed directly (under the New Start network), as well as those supported by other NGO organizations. Since community-outreach efforts now provide a larger portion of the total numbers accepting VCT, the project will expand community outreach activities and along with provider-initiated counseling and testing.

Expansion of VCT services is also planned among for mobile and vulnerable populations within which non-government outreach may increase the number of persons knowing their HIV status. A particular emphasis of the new activity will be to ensure that VCT is offered in firms or organizations with larger workforces and as part of a broader package of health services offered to employees. This expansion of VCT services is designed to contribute to the national goal of 80 percent of Zimbabweans knowing their HIV status.

Endorsed by the WHO and UNAIDS, male circumcision (MC) is now viewed by the Ministry of Health and Child Welfare (MOHCW) in Zimbabwe as an important new intervention to prevent against the heterosexual acquisition of HIV in men. In 2009, the MOHCW endorsed the launch of a pilot program to initiate male circumcision services in Zimbabwe with some technical assistance funded by PEPFAR and funding from an international NGO. Thus far, approximately 90 clinical care providers have been trained in MC procedures and more than 700 MC procedures have been conducted in four pilot sites. The project will help Zimbabwe scale-up MC service delivery from pilot areas to the broader service-delivery network, integrating MC services within facilities that provide routine clinical care. The project also will build the capacity of health care providers to offer safe MC service delivery, expand the availability of MC services and stimulate demand for MC through outreach efforts and health communications.

Sexual prevention in AB within the national mitigation program in Zimbabwe has begun to focus on the problem of concurrent sexual partnerships. In 2008, a study was commissioned to examine the prevalence and factors affecting concurrent sexual partnerships (CSP). The research found that, among sexually active Zimbabwean adults ages 1549 years, 11% (males: 15%, females: 6%) reported practicing MCP in the past month. Practice of MCP is higher among married/cohabiting males, 21% compared to married/cohabiting females, 5%. Among sexually active and never married females, 15% report practice of MCP in the past month compared to 10.3% never married sexually active men.

The findings from this research will be used to guide the design and implementation of a multimedia communications campaign and community outreach activities in an effort to reduce the prevalence of CSPs and promote being-faithful behaviors. A range of interpersonal communication (IPC) work aids will be developed, including highly illustrated flipcharts and drama themes to: guide the implementation of small group discussions in communities; enhance the quality of each IPC contact; and, reinforce key messages promoting reduction of CSPs. Multiple IPC channels (such as small group discussion, one on one discussions, street theatre and music) will be used to help define concurrent sexual partnerships and to explain why overlapping sexual partnerships increase the risk of HIV transmission in an interactive and participatory manner.

It is expected that this AB prevention will working in collaboration with the International Organization of Migration (IOM) to reach at risk populations which include former commercial farm workers and other mobile and vulnerable populations. IPC are also planned for rural growth points, farming and mining settlements, workplace, tertiary colleges and other areas with significant populations of older males and young females. Bearing in mind Zimbabwe's generalized HIV epidemic, the plan is to utilize mass media (using radio spots, television, posters, press and outdoor advertisements) to increase awareness and individual risk perception of CSPs and to complement IPC messages at community level.

In abstinence, the project will continue to train religious leaders to promote messages and enhance adolescent skills to delay sexual debut. The geographic focus of these efforts will be the rural areas of Masvingo and Midlands provinces. The project will also adapt current delayed sexual debut materials to reach adolescents ages 12-19 years and youth 20 - 24 years with a comprehensive interpersonal communication program to increase knowledge of reproductive health, sexual risks of cross generational sex, sexual violence and gender roles and adoption of relevant risk reduction strategies. This program will be implemented among disadvantaged populations such as displaced and disabled populations and former commercial farm workers' families.

To increase individuals' opportunity to use condoms, the project will work to continue to ensure that male condoms are widely available throughout the nation. This effort utilizes social marketing principles and will build upon the current direct distribution system and an indirect distribution network of wholesalers and stockists. It is expected that about 35% of the outlets will be alcohol distributors which will allow integration of condom availability with planned communication efforts that discuss the linkages of alcohol use with high-risk sex. In FY 09, social marketing resulted in over 63 million male condoms sold across the country. Of all male condoms distributed in FY09, 66% were social marketing and the remainder was public and commercial sector condoms.

The project will also support distribution of "Care" female condoms through carefully targeted outlets, especially in rural areas, peri-urban areas and growth points. It is anticipated that the project will continue to make female condoms available through a network of IPC agents and focused outlets in high risk areas targeting women in regular relationships, commercial sex workers (CSWs), PLHAs and discordant couples, young females in tertiary colleges, pregnant women and women in PMTCT programs. This type of focused marketing resulted in almost 2.5 million female condoms sold in FY09.

The overall strategy for the product delivery component will be to increase overall accessibility and availability of male and female condoms, with a special focus on high risk groups in Zimbabwe. The project will further efforts made to improve efficiency of the of the product delivery systems for male and female condoms and special focus will be on high risk outlets, that is, liquor outlets , tuck shops, hotels, brothels, guest houses/lodges, CSWs , Support Groups, and high risk priority areas, that is commercial farming areas, resettlement areas, growth points, border areas, mining areas, high density areas, rural areas and encampments.

Given the collapse of the commercial sector systems, the project will focus on strengthening direct distribution mechanisms, for maintaining high volume sales and overall product accessibility, until such a time that viable private sector alternative for product distribution re-emerge within formal commercial systems in Zimbabwe. However exploration of indirect product distribution through the private sector networks remains important as this could expand market coverage and reduce distribution costs if typical commercial options return to the marketplace. Thus the project will continue monitoring the economic environment for such positive developments. In the meantime the project will explore possibilities of establishing CBD channels as part of market approach to fill in the gaps being created by the collapse in the commercial sector channels. In addition the project will implement the public sector free condom distribution to fill any potential gaps in access to condoms within the total market.

The project will also develop a two pronged pricing strategy for local and foreign currency in light of the authorization to peg prices in foreign currency given by the central bank to selected retail and wholesale outlets. The female condom product area will continue focusing on scaling up the past years' geographic expansion of the care female condom initiative. Additionally, the project will continue strengthening existing distribution channels for the care female condoms, primarily the interpersonal communication channels, (hair salons, CSW groups, PLA groups and care and support organizations.

In sum, the project will build on the successes of previous social marketing efforts for male and female condoms to increase the availability and use of condoms in sexual prevention of HIV. New social marketing initiatives may include the introduction of different condom brands to better market to diverse segments of the Zimbabwean consumer population.

In Zimbabwe, about 80 percent of TB patients are also HIV positive; however, TB case detection rates are very low. In 2005, NGOs, in collaboration with the MOHCW, began integrating TB symptom screening for all HIV positive clients accessing counseling and testing services in private facilities. More than 300,000 Zimbabweans monthly receive HIV tests in 19 New Start static sites and through 23 New Start outreach teams. The project will support the integration of TB testing services within the VCT activities undertaken through the New Start network. Support will expand TB diagnostic services in both New Start and New Life centers (which provide post-test services for HIV-positive individuals) through refresher trainings in TB case finding, as well as trainings in sputum smear microscopy for existing and new laboratory staff. Clients receiving TB symptom screening and laboratory services in private facilities will be referred to TB treatment and care at public health facilities offering such services.