Ivoirian women are twice as likely to contract HIV as men; the risk disparity is eight-fold among young women. In the face of this feminized epidemic, health services remain vastly underused as a channel for reaching those most at-risk, as well as their partners and families, with high-quality, gender-sensitive HIV/AIDS prevention and care services.

The PEPFAR Cote d'Ivoire team is funding EngenderHealth to draw on its extensive international experience and expertise to help pilot and evaluate approaches to improve the uptake, quality, and inclusive reach of HIV/AIDS and other health services for girls and women, with a view to identifying cost-effective best practices that can be scaled up nationwide.

Funding is requested in the PMTCT, HVAB, HVOP, and OHSS budget codes to build on EngenderHealth's FY 2009 technical and financial assistance to the family-planning association AIBEF and the local PLWHA association Femmes Actives de Cote d'Ivoire to implement integrated sexual and reproductive health-HIV (SRH-HIV) activities at health facilities and to implement, evaluate, and scale up Men as Partners (MAP), a program designed to address attitudes and behaviors that adversely affect the health of men and women and to link gender equity, male involvement, and improved health for men and women.

With FY 2010 funding, EngenderHealth will continue to work with AIBEF and Femmes Actives, in collaboration with relevant ministries and other implementing partners, in and around seven AIBEF clinics in San Pedro, Daloa, Treichville, and Yopougon to:

Implement peer-to-peer education at PMTCT sites that includes partner referral for HIV testing through PMTCT services

Pilot and evaluate an effective referral mechanism for seropositive women delivering at health centers

Build capacity at supported health clinics for the provision of youth-friendly services, with a focus on young women and girls

Train health clinic staff in stigma reduction

Conduct a situational analysis at PMTCT sites to better understand, and develop approaches to overcome, male reluctance to seek services

Train health center staff and community stakeholders in MAP approaches to gender-transformative HIV prevention.

Provide technical assistance to community organizations and PEPFAR implementing partners to incorporate intimate partner communication and negotiation skills for young men in their HIV prevention activities.

Organize MAP events in the communities around four supported health clinics, designed to change community members' attitudes and knowledge related to gender norms and HIV prevention.

Train health center staff data quality assurance and data use for decision making

While EngenderHealth's work will focus on technical assistance to identify promising approaches, its activities will also, between October 2009 and September 2011, reach 2,100 girls and young women with HIV prevention behavior change communication, provide psychosocial support for 156 women, reach 100 men with small-group/individual outreach that explicitly addresses norms on masculinity and gender equity, provide HIV testing for at least 400 male partners, train 64 people in Other Prevention approaches, and train 31 health staff in data quality assurance and data for decision making approaches.

EngenderHealth will strive to ensure that local ownership and sustainability are built into the approaches it develops, using processes such as:

? Informational meetings to brief community and national/regional/district Ministry of Health officials about the project's objectives and activities and to disseminate project results.

? Participation by representatives from local PLWHA networks, community organizations, and program managers, doctors, nurses, and social workers from health facilities in all planning and training activities.

? Planning meetings with district health officials and CBO/NGO program managers to coordinate project activities, select health personnel to be trained, and ensure inclusion of project interventions in health district plans.

Activities will contribute to the key issues of family planning and safe motherhood, by supporting integration of HIV and family planning activities to ensure that PMTCT services are available; addressing male norms and behaviors, through MAP; end-of-program evaluation, through evaluation of pilot programs and other activities; and military populations, as MAP is conducted with the uniformed services in collaboration with PSI (and a follow-on awardee).

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The PEPFAR Cote d'Ivoire team is funding EngenderHealth to draw on its extensive international experience and expertise to help pilot and evaluate approaches to improve the uptake, quality, and inclusive reach of HIV/AIDS and other health services for girls and women, with a view to identifying cost-effective best practices that can be scaled up nationwide.

Funding for prevention of sexual transmission (HVOP and HVAB) is intended to build on and extend EngenderHealth's FY 2009 technical and financial assistance to the family-planning association AIBEF and the local PLWHA association Femmes Actives de Cote d'Ivoire to implement, evaluate, and scale up Men as Partners (MAP), a program designed to address attitudes and behaviors that adversely affect the health of men and women and to link gender equity, male involvement, and improved health for men and women.

MAP recognizes the importance of partnership between women and men, as well as the crucial need to reach out to men with services and education that enable them to share in the responsibility for health. To address this, EngenderHealth established its MAP program in 1996. Through its groundbreaking work, this program works with men to play constructive roles in promoting gender equity and health in their families and communities. EngenderHealth works with individuals, communities, health care providers, and national health systems to enhance men's awareness and support for their partners' health choices, increase men's access to comprehensive health services, and mobilize men to take an active stand for gender equity and against gender-based violence. EngenderHealth has developed MAP programs in 15 countries in Africa, Asia, Latin America, and the United States.

The MAP approach consists of workshops in which men and mixed groups explore gender roles and are trained as peer educators to promote gender equality in their community. The program challenges contemporary gender roles that equate manliness with a range of risky behaviors, such as violence, alcohol use, multiple sex partners, and domination over women. MAP addresses both the HIV epidemic and violence against women within a comprehensive framework for recognizing and dealing with the complexities of how gender roles affect men's and women's lives. The intervention combines a community-based participatory group approach with interactive educational activities. Preliminary evaluations of the program in South Africa indicate that the program is a promising intervention for HIV prevention.

In FY 2008, the USG CI program funded EngenderHealth, Care International, and Hope Worldwide to adapt the MAP program for the Ivoirian context, in collaboration with relevant ministries, HIV and health-sector partners, and other donors.

With FY 2009 funding, EngenderHealth is working with JHU/CCP and the Ministry of AIDS (MLS) to ensure that adapted MAP materials are validated and included in national communications strategies. EngenderHealth is also supporting scale-up of the MAP program by building the capacity of new MAP partners, including the Ministry of Education and Ministry of Defense, to implement the MAP program. MAP workshops are mobilizing participants to promote behavioral change among their peers and within the communities where they live. These efforts are supported by large-scale community events and campaigns.

EngenderHealth is working with local organizations and stakeholders to distribute MAP BCC materials and to promote and distribute condoms at MAP community events. EngenderHealth is also providing technical support to partners for evaluating MAP activities using a modified version of the Gender Equity Male (GEM) Scale.

With FY 2010, EngenderHealth will continue and expand on these activities, including:

Helping to organize community MAP events around four supported health clinics designed to change community member's attitudes and knowledge related to gender norms and HIV prevention

Building capacity at seven AIBEF clinics for the provision of youth-friendly services, with a focus on young women and girls. Training in Other Prevention approaches will be provided for at least 32 individuals per year through September 2011.

Providing technical assistance to community organizations and PEPFAR implementing partners to incorporate intimate partner communication and negotiation skills for young men in their HIV prevention activities.

Between October 2009 and September 2011, sexual-prevention activities will reach 2,100 girls and young women with HIV prevention behavior change communication, reach 100 men with small-group/individual outreach that explicitly addresses norms on masculinity and gender equity, and train 64 people in Other Prevention approaches.

The PEPFAR Cote d'Ivoire team is funding EngenderHealth to draw on its extensive international experience and expertise to help pilot and evaluate approaches to improve the uptake, quality, and inclusive reach of HIV/AIDS and other health services for girls and women, with a view to identifying cost-effective best practices that can be scaled up nationwide.

Funding in the PMTCT budget code is intended to build on and enlarge EngenderHealth's FY 2009 technical and financial assistance to the family-planning association AIBEF and the local PLWHA association Femmes Actives de Cote d'Ivoire to design, implement, and evaluate integrated sexual and reproductive health-HIV (SRH-HIV) activities at 10 health facilities in the East Central region, including capacity building for positive prevention, prevention of unintended pregnancies, stigma reduction, and service-demand generation.

With FY 2010 funding, EngenderHealth will continue to work with AIBEF and Femmes Actives, in collaboration with relevant ministries and other implementing partners, in and around AIBEF clinics in San Pedro, Daloa, Treichville, and Yopougon to:

Implement peer-to-peer education at four PMTCT sites that includes partner referral for HIV testing through PMTCT services. Activities will include HIV testing for at least 200 male partners per year through September 2011.

Pilot and evaluate an effective referral mechanism for seropositive women delivering at health centers

Train health clinic staff in stigma reduction to ensure that they are aware of stigmatizing beliefs and behaviors and are able to create a welcoming environment for women seeking PMTCT services

Conduct a situational analysis at two PMTCT sites to better understand, and develop approaches to overcome, male reluctance to seek services