Detailed Mechanism Funding and Narrative

Years of mechanism: 2013 2014 2015 2016

Details for Mechanism ID: 16821
Country/Region: eSwatini
Year: 2013
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health
Organizational Type: University
Funding Agency: USAID
Total Funding: $320,000

The purpose of the JHU HC3 activity is to strengthen community systems and capacitate stakeholders to lead an effective HIV response including addressing the socio-cultural and gender norms that create barriers to service uptake and increase vulnerability. The primary focus of the community engagement will be to scale up all four prongs of PMTCT through a community lead process. This process will become the foundation for communities to address all aspects of the HIV response especially sexual prevention. Furthermore, addressing the norms, beliefs, and practices for PMTCT will result in reduced stigma and vulnerability for HIV in general. HC3 is aligned with the GOKS NSF extension 2014-2017 and falls squarely within the guiding principles and the core priority prevention strategies for Community engagement and ownership of HIV interventions. It will contribute to prevention outcomes including reduced exposure to HIV infection. HC3 will build on the existing decentralized coordination structure through the MTAD, reinforce CBO efforts, and actively link with other partners. The objectives are: 1)to create an enabling environment for PMTCT and sexual prevention by strengthening community capacity to use local and national information for community-based planning and monitoring of their HIV response; supporting a community process to maximize their assets and address barriers to prevention; and supporting a rights-based community approach to stigma reduction and norm change; 2)to improve access to and uptake of PMTCT and HIV prevention services by empowering communities to lead social and behavior change communication; strengthening the community based cadres; and strengthening linkages with CBOs and FBOs to promote uptake of services and healthier behaviors.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $50,000

1) The Health Communication Capacity Collaborative (HC3 ), is a globally competed cooperative agreement led by the Johns Hopkins University Center for Communication Programs (JHU-CCP), with a consortium of partners including MSH, NetHope, Ogilvy Public Relations, PSI, and Internews. HC3 will focus on strengthening in-country capacity to implement state-of-the art health communication and social change. The project will provide tailored, multi-level capacity strengthening to a range of indigenous implementers, as well as technical leadership in health communication.

2) The portfolio review identified a number of weaknesses in the sexual prevention program, including the need for greater focus on special vulnerabilities of and sexual reproductive health for youth, and more substantial engagement of communities to address the social, gender and cultural norms that create vulnerability to HIV infection including early sexual debut, intergenerational sex, multiple partnerships, SGBV sexual abuse and coerced sex, inconsistent condom use, lack of knowledge of status, and stigma around treatment.

3) OP and AB funds are combined for comprehensive sexual prevention programming. The purpose of the AB component is to strengthen community systems and capacitate stakeholders to lead an effective HIV response including addressing the socio-cultural and gender norms that increase vulnerability and create barriers to service uptake with particular attention to youth interventions. The objectives are : 1) to strengthen the capacity of communities to assess the current context, implement actions to address vulnerabilities and barriers to HIV services, and monitor progress; 2) empower communities to lead social and behavior change communication to address norms and promote service uptake; 3) in concert with other partners, strengthen the capacity of existing community cadres to address norms, stigma, and promote up-take of services; and strengthen linkages with community, FBOs, and HIV prevention treatment and care service providers.

- The strategies to achieve these objectives are in line with OGAC prevention guidance, , the HIV and AIDS coordination framework for the Ministry of Tinkhundla Administration and Development (MTAD), and the Swaziland National Strategic Framework. HC3 will focus their efforts in select chiefdoms working at the grass roots level through MTAD structures including the Chiefdom multi-sectoral HIV and AIDS Coordinating Committees (CHIMSHACC) that have the mandate to assure a coordinated and effective community led response. The CHIMSHACC include community representatives from the churches, health care providers, police, traditional healers, schools, agriculture extension workers, male, female and youth leaders etc. HC3 will provide technical assistance and support to the CHIMSHACCs and youth leaders to plan, implement and monitor interventions that will address the norms, vulnerabilities and barriers to service use, finding creative solutions and using local means to address gender norms, HIV related stigma and other barriers through community-led communication, peer support, and mobilization. HC3 will support community-based monitoring through participative approaches. Monitoring information will be used by the community for continuous program improvement.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $270,000

1) The Health Communication Capacity Collaborative (HC3 ), is a globally competed cooperative agreement led by the Johns Hopkins University Center for Communication Programs (JHU-CCP), with a consortium of partners including MSH, NetHope, Ogilvy Public Relations, PSI, and Internews. HC3 will focus on strengthening in-country capacity to implement state-of-the art health communication and social change. The project will provide tailored, multi-level capacity strengthening to a range of indigenous implementers, as well as technical leadership in health communication.

2) The portfolio review identified a number of weaknesses in the sexual prevention program, including the need for greater focus on special vulnerabilities of and sexual reproductive health for youth, targeted package of interventions for MARPS, and more substantial engagement of communities to address the social, gender and cultural norms that create vulnerability to HIV infection including intergenerational sex, multiple partnerships, SGBV sexual abuse and coerced sex, inconsistent condom use, lack of knowledge of status, and stigma around treatment.

3) OP and AB funds are combined for comprehensive sexual prevention programming. The purpose of the OP component is to strengthen community systems and capacitate stakeholders to lead an effective HIV response including addressing the socio-cultural and gender norms that increase vulnerability and create barriers to service uptake with particular attention to youth interventions and sex worker and LGBTI communities. The objectives are : 1) to strengthen the capacity of communities to assess the current context, implement actions to address vulnerabilities and barriers to HIV services, and monitor progress; 2) empower communities to lead social and behavior change communication to address norms and promote service uptake; 3) in concert with other partners, strengthen the capacity of existing community cadres to address norms, stigma, and promote up-take of services; and strengthen linkages with community, FBOs, and HIV prevention treatment and care service providers.

- The strategies to achieve these objectives are in line with OGAC prevention guidance, , the HIV and AIDS coordination framework for the Ministry of Tinkhundla Administration and Development (MTAD), and the Swaziland National Strategic Framework. HC3 will focus their efforts with two types of communities: 1) select chiefdoms: working at the grass roots level through MTAD structures including the Chiefdom multi-sectoral HIV and AIDS Coordinating Committees (CHIMSHACC) that have the mandate to assure a coordinated and effective community led response. The CHIMSHACC include community representatives from the churches, health care providers, police, traditional healers, schools, agriculture extension workers, male, female and youth leaders etc. 2) the LGBTI and sex worker communities. HC3 will provide technical assistance and support to the CHIMSHACCs and LGBTI/SW to plan, implement and monitor interventions that will address the norms, vulnerabilities and barriers to service use, finding creative solutions and using local means to address gender norms, HIV related stigma and other barriers through community-led communication, peer support, and mobilization.

- HC3 will support community-based monitoring through participative approaches. Monitoring information will be used by the community for continuous program improvement.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

1) The Health Communication Capacity Collaborative (HC3 ), is a globally competed cooperative agreement led by the Johns Hopkins University Center for Communication Programs (JHU-CCP), with a consortium of partners including Management Sciences for Health (MSH), NetHope, Ogilvy Public Relations, PSI, and Internews. HC3 will focus on strengthening in-country capacity to implement state-of-the art health communication and social change. The project will provide tailored, multi-level capacity strengthening to a range of indigenous implementers, as well as technical leadership in health communication The project will be characterized by a strong focus on implementation science, emphasizing rigorous evaluation, documentation, and diffusion

of effective practices.

2) The portfolio review identified a number of weaknesses in the Swaziland PMTCT program, including: low EID result pick-up rate for exposed infants; low uptake of ART among eligible women; low partner testing and involvement in PMTCT; poor re-testing rates among clients who initially test negative for HIV; high rates of transmission in children between 6 weeks and 2 years of age; and Weak referral linkages and follow up system & weak defaulter tracing mechanisms. Furthermore, the portfolio review identified community, cultural, and gender norms as key reasons for these weaknesses in the program.

The overall purpose of the PMTCT component in Swaziland is to strengthen the capacity of regional coordination committees and communities to increase the uptake of PMTCT in their areas through a community-led and owned process.

The objectives are : 1) to strengthen the capacity of communities to assess the current context, implement actions to address barriers to PMTCT ,and monitor progress; 2) empower communities to lead social and behavior change communication around PMTCT ; 3) in concert with other partners, strengthen the capacity of existing community cadres to address all 4 PMTCT prongs and promote up-take of services and strengthen linkages with community, FBOs, and PMTCT service providers.

3) The strategies to achieve these objectives are in line with OGAC prevention guidance, PMTCT guidance, the Swaziland National PMTCT acceleration plan, and the Global plan towards eliminating MTCT. It also builds on the UNAIDS promising practices in community engagement for the elimination of new infections. Most important these strategies will fill an important gap in PMTCT efforts in Swaziland.

- HC3 will provide technical assistance and support to the Ministry of Tinkhundla Administration and Development to strengthen the capacity of the region to coordinate regional and chiefdom level multisector response to HIV including PMTCT

- Provide technical assistance to key community leaders in the design and planning of interventions that will address the main barriers to PMTCT and follow-up. This will include finding creative solutions and using local means to address gender norms, HIV related stigma and other barriers through community-led communication, peer support, and mobilization.

- Supporting community-based monitoring through participative approaches that engage the community early and in all phases of the process. Monitoring information will be used by the community for continuous program improvement.

Cross Cutting Budget Categories and Known Amounts Total: $872,500
Gender: Gender Based Violence (GBV) $200,000
Gender: Gender Equality $200,000
Key Populations: FSW $300,000
Key Populations: MSM and TG $172,500
Key Issues Identified in Mechanism
Implement activities to change harmful gender norms & promote positive gender norms
Increase gender equity in HIV prevention, care, treatment and support
Family Planning