Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 8560
Country/Region: Angola
Year: 2009
Main Partner: World Learning Inc.
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $575,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $75,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 21138

Continued Associated Activity Information

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

System ID System ID

21138 21138.08 U.S. Agency for World Learning 8560 8560.08 $50,000

International

Development

Program Budget Code: 02 - HVAB Sexual Prevention: AB

Total Planned Funding for Program Budget Code: $980,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Sexual Prevention - Abstinence and Be Faithful and Other Sexual Prevention

Overview

High-risk groups appear to be a principal driver of the HIV/AIDS epidemic in Angola and require special attention if the rate of HIV

transmission is to be slowed. The USG's strategic approach to prevention targets the general population, with a heavier

emphasis on most-at-risk populations, namely: in- and out-of-school youth, military personnel, truck drivers and commercial sex

workers (CSWs). HIV is transmitted primarily through multi-partner heterosexual encounters, with a male-to-female ratio of 0.8:1,

indicating that women are more likely to be infected than men. Angola's ANC data estimates HIV prevalence at 2.1% of the

population aged 15-49, and 2.6 % for the age group 15 - 24, with pockets of concentration along its borders with countries

affected by hyper-epidemics (for example, 9.4% in Cunene province, which shares a border with Namibia).

The recent 2005 TRaC study conducted by Population Services International (PSI) with USG support, shows that the mean age of

sexual debut is relatively young (15.03yrs) and the practice of multiple concurrent partnerships and support for several

households is common. Recent findings conducted by the National AIDS Institute (INLS) in collaboration with the USG through

the TRaC study shows that among youth aged 15-24 only 27% were able to correctly identify modes of prevention of HIV and

were able to refute misleading modes of transmission. Additional factors that increase the risk of contracting HIV include

intergenerational sexual activity and multiple partners (23% of youth reported having two or more partners in the last three

months), low condom use (55% of youth used a condom with their last casual partner, 37% with a non-married permanent partner

and 19% with a marital partner), and low risk perception (9% of youth classified themselves as being at high-risk of contracting

HIV). A 2006 INLS study showed that commercial sex workers have an estimated 26% prevalence rate. Similarly, more than half

of VCT clients reported not using a condom in the last three months, 35% reported sometimes using a condom, and 7% reported

always using a condom. Reported condom usage at last sex was 20%, condom use with a regular partner was slightly lower at

15%, while use with a casual partner (among those reported having a casual partner) was 30%. Of males tested for HIV at

voluntary (VCT) sites, 28% reported having concurrent partnerships. Concurrent partnerships coupled with low risk perception,

and very low condom usage increases the risk of the spread of HIV and other STIs.

Leveraging and Coordination

During the 27 years of civil conflict NGOs were the principal actors in the field of HIV/AIDS. These NGOs lacked infrastructure,

experienced personnel, reliable information, and opportunities for capacity building. The USG, working with the Government of

Angola (GoA) through the INLS, the Global Fund to fight HIV/AIDS, Malaria and Tuberculosis (GFATM), and UNICEF, has pulled

together an effective intervention to strengthening these NGOs.

Together with the INLS and the Ministry of Youth and Sports, the USG supports national information, education and

communication campaigns (IEC) around the prevention of HIV. The USG's partnership with the INLS, UNDP and the Brazilian

corporate partner Odebrecht sets favorable conditions for the distribution of USG purchased condoms and test kits. Odebrecht

stores 15 million non-branded USAID purchased condoms that are distributed in a targeted fashion by working with the Angolan

Business Alliance to use its network to ensure free condom availability to its employees and to other high-risk groups. Through

this partnership, an integrated system for effective logistics management and warehousing is being developed that works to

resolve the problems of condom distribution (see OHSS narrative). The GoA, USG and the UK Department for International

Development (DFID), in conjunction with the British Broadcasting Company, have provided strong social marketing programs for

condoms. The USG works closely with the GFATM to implement prevention activities, especially with high risk groups, using

Round Four funding ($86,120,215).

Current USG Support

The USG implementing partners, working together with other stakeholders in Angola, are making strong strides forward in

HIV/AIDS prevention. Specific current activities include:

•The USG supported the Jango Juvenil youth centre project to promote HIV/AIDS prevention and life skills through age-

appropriate messages targeting in- and out-of-school youth aged 15-24. The ‘Jangos' provide intensive HIV/AIDS prevention

education in a youth friendly, dynamic and accessible setting. There are five centers, each operated by a local partner NGO.

These local partners are also provided with continuous technical support, supervision, training and communication skills, as well

as technical assistance in organizational development, including project management and financial management skills. The

project serves a dual objective of allowing youth to acquire skills to make them more productive and provides an opportunity to

address their vulnerability towards HIV/AIDS through role play and counseling.

•The USG program promotes messaging on abstinence, fidelity and correct and consistent condom use (ABCs) among young

people aged 15-25 and educates young adults about the risk of STIs and HIV/AIDS through mass media campaigns, including a

weekly youth radio program. Youth peer educators managed by local partner NGOs are conducting interpersonal communication

(IPC) activities. Through PSI/Angola, the USG has developed comprehensive generic HIV/AIDS prevention materials for three

key target groups: 8- to 12-year-olds, 13- to 17-year-olds and 18- to 24-year-olds. These materials have been disseminated widely

throughout the Ministries of Health and Education and partner NGOs where they are tailored to meet the needs of each target

group. The USG has prepared a training manual for regional level health workers for an IEC campaign as well as provided training

to health workers from the Ministry of Health Provincial Health Department (DPS) Units in Luanda and Lunda Norte on stigma and

discrimination.

•A PEPFAR-funded social marketing campaign supports the INLS national strategic plan to combat STIs including HIV. The

campaign is focused on communications interventions in at-risk provinces, border areas, ports, major urban centers and along

transport routes. The "Legal" brand condom is highly subsidized and targeted to high-risk and vulnerable groups.

•The USG, through the DOD-funded Charles Drew University (CDU) prevention program, is working with the Angolan military in

the production of IEC materials. Charles Drew also supports interventions that reduce HIV transmission in most-at-risk

populations (i.e. commercial sex workers and their clients, long-distance trucker drivers, military and subsets of youth). These

interventions include ABC messaging, management of sexually transmitted infections, and programs that encourage healthy

behaviors, e.g. partner reduction. The USG is the primary donor addressing HIV transmission in the most at-risk population

groups and has worked with a local NGO MAFIKU in Cunene, organizing group activities with CSWs and outreach activities with

truckers along the borders. Outreach and training of educators include gender-equity messages and behaviors, and provide

guidance on how to work with men to address norms around violence, cross-generational, and transactional sex. The USG is

continuing to support the development of workplace initiatives through the EHSP, including those targeting health care workers to

deliver consistent prevention messages, and improved condom availability to workers and their families.

•A mass media campaign, a 20-minute radio broadcast airing on the national radio station during the military hour, includes a

radio drama based on a comic book, O Tropa Lunguka, promoting safe sexual behavior among military personnel.

USG FY09 Support

In FY09, the USGs prevention efforts will have a strategic focus on the provinces with the highest prevalence as well as those

which border neighboring countries. ABC messages, with a stronger gender focus, will be provided through outreach, training,

social marketing campaigns, and distribution of condoms. With the scale-up of strategic information (see SI section) providing

more data to inform programs, the USG may decide to revisit prevention efforts by shifting target provinces and populations.

Specific new and ongoing activities include:

•The PEPFAR public private partnership work will be strengthened to increase the level of corporate sponsorship the Banco

Fomento Angola provides to the "Jango" youth centers. This increased support will cover more of the operating costs and to allow

for expansion to additional provinces.

•Prevention efforts will continue at the five youth centers located in the provinces of Luanda, Huambo, Cunene, Huila and

Cabinda. Jango Juvenil activities will include debates, individual counseling, role play, skills-building classes (i.e. basic literacy,

crafts, electrical) and inter-personal communication outreach into the respective communities to reach youth not attending the

Jango Juvenils. PSI's AB approach will focus on gender sensitive key messages targeted to two age groups - those under 18

and those over 18 years of age. For under 18 youth, messages include promotion of delayed sexual debut, focusing on

empowering girls to resist pressure and sensitizing boys to refrain from pressuring girls. Delayed sexual debut communications

address the peer pressure faced by adolescents to prove themselves to their peers by becoming sexually active. For over-18

youth, promotion of fidelity and partner reduction will address the lack of self-efficacy of some youth to refuse sex with a new

partner. Activities will also include condom promotion for the sexually active.

•The social marketing component of the USG program delivered by PSI will be expanded to incorporate the following new

components in FY09:

- Improved training, more frequent monitoring and new education tools for activists;

- Increased IEC and BCC addressing stigma in communities and transactional and trans-generational sex;

- Strengthened gender aspects in lay counselor training;

- Improved coordination of the NGO forum together with ANASO and Global Fund to ensure that duplication of efforts is avoided;

- Incorporation of new TRaC information as well as follow-up qualitative research to review/update messages for CSWs and their

clients to motivate behavior change;

- Improved interactive educational materials, including picture codes, role-playing guidelines, risk assessment tools and debate

techniques that focus on individual risk assessment of behaviors in the Jango Juvenil Youth Centers;

- New behavioral research using TRaC methodology in men and young women (14 - 20) to review/update messages according

to key behavioral determinants;

- More prevention activities on men who have sex with men (MSM),truckers and native populations along the border areas,

specifically the border area of Cunene. Once CDC's BSS results are ready, PEPFAR partners will strengthen these activities with

the BSS results;

- Mapping on condom usage and risk. PSI will work with INLS and other agencies currently delivering condoms (e.g. UNICEF,

Global Fund, UNFPA) to assess condom use among high-risk groups and the general population;

- Prevention and treatment options will also be addressed by PSI through the use of radio programs, skits, and inter-personal

communications within the family and community.

•World Learning (WL) will take over the administration of the grants component of the Jangos project and will provide capacity

building for local NGOs that promote AB messages. Youth centers will partner with local health centers and offer on-site

counseling and testing for STIs and HIV. WL will promote the transition of financing of these NGOs and youth centers through

leveraging more banking and Global Fund support to cover the total costs of the Jangos, enabling them to expand to more

provinces. WL will continue to work with a consortium of human rights-based organizations that advocate for the availability of

services for people living with HIV/AIDS, their families, and communities. Working with local NGOs, WL increases awareness on

the right and importance of getting tested, provide information on testing sites and increase the number of people who know their

status.

•The DOD will continue its efforts with the Angolan Armed Forces (FAA) to promote the ABC approach. The target population,

young sexually active men, require prevention efforts that appropriately reflect the needs of the population. Charles Drew

University will train trainers, create educational materials (i.e. HIV prevention manuals, comic books, posters, informational

pamphlets) and assist the FAA in institutionalizing effective programs that motivate behavior change to reduce risky sexual

behavior among military personnel. To overcome the specific challenges presented in this population, educators are trained in

effective interactive teaching techniques and the implementation of an HIV intervention specifically designed for the Angolan

military. Training includes messages on gender equity and guidance on how to work with military men to address issues of

violence, cross-generational and transactional sex, and alcohol abuse.

•In addition to training military trainers, social marketing campaigns address the importance of VCT, fidelity, safe sex, reduction of

stigma and discriminating attitudes, as well as the promotion of tolerance and support for those affected.

•The USG will conduct a qualitative study to examine the feasibility of interventions in male circumcision.

AB Targets

2.1 Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence and/or

being faithful 90,000

2.2 Number of individuals trained to promote HIV/AIDS prevention programs through abstinence and/or being faithful 500

OP Targets

5.1 Number of targeted condom service outlets 2,000

5.2 Number of individuals reached through community outreach that promotes HIV/AIDS prevention through other behavior

change beyond abstinence and/or being faithful 25,000

5.3 Number of individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or

being faithful 500

Table 3.3.02:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $450,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 19163

Continued Associated Activity Information

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

System ID System ID

19163 19163.08 U.S. Agency for World Learning 8560 8560.08 $260,000

International

Development

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $50,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 08 - HBHC Care: Adult Care and Support

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 09 - HTXS Treatment: Adult Treatment

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 10 - PDCS Care: Pediatric Care and Support

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment

Total Planned Funding for Program Budget Code: $0

Program Budget Code: 12 - HVTB Care: TB/HIV

Total Planned Funding for Program Budget Code: $100,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

The estimated number of people with tuberculosis (TB) in Angola has more than doubled between 1990-2006, from 21,380 to

47,231, and the TB prevalence is estimated to be 220/100,000 inhabitants (WHO, 2008). The DOTS strategy covers 116 of 164

municipalities, only 70% of the country, and lacks essential monitoring and evaluation (M&E) of patient registry, outcomes, and

program performance parameters.

Based on very limited data, the Ministry of Health (MoH) National TB Control Program (PNCT) estimates of HIV prevalence

among TB patients was up to 15% in 2007. Therefore, HIV infection is expected to be high in patients seen in TB clinical settings,

making these settings "high yield" for the identification of those patients with concomitant HIV infection and their referral for HIV

prevention, care and treatment. Although improving, there continues to be a need for more coordination and collaboration

between TB and HIV activities at all levels.

The national TB Control program submitted a round 8 Global Fund proposal that totalled $25,000,000 for five years. This

proposal has since been rejected. Since submission of the proposal, the PNCT organized a TB symposium where the national TB

strategic plan 2009-2013 was presented to an audience that included international donors, NGOs and other government

organization.

Among other needs, PNCT continues to experience significant obstacles. These include:

•Insufficient numbers or inadequately trained personnel to

oProvide HIV counseling and testing

oPerform M & E functions related to TB/HIV activities in TB facilities

oProvide referral and follow-up of HIV-infected TB patients

•Inadequately functioning M & E resulting in a significantly diminished capacity to

oPerform HIV surveillance among TB patients

oRecord and report program performance

oMonitor, forecast, procure, and manage lab reagents and drug stocks for the diagnosis and TB treatment of HIV-infected patients

Leveraging and Coordination

Three non-governmental organizations (NGOs) receive funding from the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria

(GFATM) and the U.S. Agency for International Development (USAID) to implement TB and TB/HIV services in the public and

NGO sector: Catholic Relief Services (CRS) and CUAMM (CUAMM and the NGO LEPRA also receive support through other

funding sources). The U.S. Centers for Disease Control and Prevention (CDC) is not currently working with any local partners on

TB system strengthening, although discussions are in progress to work with the Dutch NGO, KNCV and possibly CUAMM and

LEPRA to establish sentinel surveillance and improve case detection, provider initiated HIV counseling and testing, and recording

and reporting of TB and HIV information for the purposes of M&E and routine surveillance.

Current USG Support

The USG has funded the Essential Health Services Program (EHSP) since FY07, to address critical human resource problems

that limit the availability of TB treatment and referral, through training and supervision interventions, and the updating and

integration of TB testing protocols with HIV referral procedures. "Master trainers" were trained to provide oversight and

supervision in target areas. Additional TB/HIV activities include:

•Assisting the PNCT with updating and development of policy, and the adoption of a national HIV testing policy in TB facilities;

•Implementing HIV testing services at the Cunene and Huambo DOTS centers and TB screening in the USG-supported voluntary

counseling and testing (VCT) center in Luanda. Rapid HIV test kits, microscope, reagents and staff training are also being

provided.

Over the course of the past year, USG has made moderate strides in coordination efforts for HIV and TB collaboration between

the National AIDS Institute (INLS) and the Ministry of Health's National TB program. A CDC staff position, (to be seconded to one

of the two entities) will be hired in order to further facilitate this relationship. This position was programmed in the FY08 mini-COP

but remains vacant. CDC will continue to recruit for position in FY09 (see below). The purpose of secondement is to facilitate the

formation of a functional national TB/HIV collaborative entity between PNCT and INLS to oversee TB/HIV collaborative policies

and activities.

USG FY09 Support

In order to address the USG TB/HIV priorities of human capacity building, technical assistance for the NTCP, improvement of

M&E functions, and the linkages between the activities being undertaken by USAID non-PEPFAR funding and other entities (e.g.,

GFATM, WB, NGO's), the USG will further strengthen the TB program by increasing the capacity of the NTCP and other NGOs

working with TB/HIV by supporting:

•The training of personnel in reporting and recording of TB information according to current guidelines, with a goal of eventually

transitioning to an already functional electronic TB register for this purpose, in order to facilitate HIV-infected TB patient

management, HIV surveillance in TB patients, and M&E of essential program functions and outcomes;

•The training of these personnel to serve as national trainers for a second tier of TB/HIV personnel in other facilities in the above

functions, but particularly in HIV counseling, testing, and referral of HIV-infected patients to appropriate health services;

•The strengthening of the PNCT program TB and HIV diagnostic capacity (including the capability to perform TB culture,

resistance testing for the detection of MDR/XDR TB) and the internal and external quality assurance of this capacity by supporting

central reference laboratory activities (see lab section);

•The facilitation and formation of a functional national TB/HIV collaborative entity between the PNCT and the INLS to oversee

TB/HIV collaborative policies and activities. Support for a specific USG-funded TB/HIV "focal point" staff position to be seconded

to either INLS or the PNTCT will continue from FY08 (see Management and staffing).

•The development and implementation of a TB/HIV sentinel surveillance system in collaboration with the PNCT and NGOs already

working in this program area.

Targets

There are no targets for this program area as all support will be technical assistance

Table 3.3.12: