Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 604
Country/Region: Ethiopia
Year: 2009
Main Partner: Pact, Inc.
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $350,000

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $35,000

Prevention Activities in Gambella

ACTIVITY UNCHANGED FROM FY2008:

This activity is a continuation FY07 reprogrammed funds. In FY09, funds for this activity will be split evenly

across AB ($175,000) and OP ($175,000).

Gambella is the westernmost region of Ethiopia, bordering Sudan. The region is sparsely populated, with

2005 the Ethiopian Central Statistics Agency estimating a regional population of only 247,000, 80% of

whom live in rural areas. Pastoralism and agriculture are the major economic activities for the people of

Gambella. One of the major ethnic groups in Gambella is the Anuak people, who comprise of about 30% of

the region's population. The Anuak are considered to be ethnically, culturally, linguistically, historically and

religiously different from most other Ethiopians, and there have been ethnic conflicts in recent years in the

region, with significant tensions persisting.

The 2005 Demographic and Health Survey (DHS) revealed surprisingly high HIV prevalence of 6.0% in

Gambella region. Gambella's was the highest regional prevalence recorded by the DHS, and is nearly three

times the GoE's national single point prevalence of 2.2%. Behavioral data also reveals high levels of risk

behavior. Compared to other regions and the national average, men in Gambella reported high rates of

multiple partners, high-risk sex, lifetime sex partners, and having paid for sex. Women in Gambella reported

higher than average high risk sex. The draft Epidemiological Synthesis of HIV/AIDS in Ethiopia,

commissioned by HIV/AIDS Prevention and Control Office (HAPCO) and the World Bank, identify Gambella

as a "hotspot." Gambella's circumcision rate is the lowest in the country, with only 47% of men circumcised,

compared to a national rate of 93% for circumcision coverage. Furthermore, there are very few civil society

groups working on HIV in Gambella, and USG-supported prevention efforts in Gambella prior to COP07

reprogramming have been largely limited to work in the refugee camps on the Sudanese border. Pact is one

notable exception, as its' Track 1 ABY program has been active in four districts in Gambella since FY2006.

Through reprogramming funds, Pact will expand HIV prevention interventions focused on behavior change

to address the prevention needs of adults in Gambella. Building off of a similar approach to that of Y-

CHOICES, Pact will serve as a technical assistance and organizational capacity development support to a

selected number of local organizations that will carry out the prevention interventions in Gambella.

However, there is very limited civil society activity in Gambella, and depending on the presence and

capacity of local organizations to target adults, Pact may also engage in some direct implementation of

prevention services.

Because the region is quite different from many other parts of Ethiopia and there is little civil society

experience to draw from, a rapid assessment of prevention needs and local partners to work with will be

conducted. Some adaptation of Pact's established approaches in other regions of the country may be

necessary in order to be relevant to the populations in Gambella. Though largely rural, due to the disparate

population, initial prevention efforts will focus on the capital city, Gambella town, as well as other districts

where Y-CHOICES activities are already in place. Assessments for feasible means of outreach to rural

populations will be conducted. Needs assessments already conducted by the health network partner in

Gambella, Johns Hopkins University (JHU), will also be considered in program design.

Initial assessments of venues where HIV prevention efforts may be expanded include the use of public

transport and public transport workers, as they are the hub of nearly all mobility in the region and heavily

depended upon by the public. Transport workers and systems may be used to address social norms

contributing to HIV risk, to address HIV prevention directly and heighten risk perception among those using

public transport. Training transport workers to engage riders in dialogue about HIV while using the transport

system, production of audio materials or radio program with HIV prevention information and behavior

change messages are possible methods of addressing prevention in this widely used venue. Training and

support to help those engaged in transactional or commercial sex to enter the high-demand market of public

transport may also be explored as an alternative means of income for some high-risk and economically

vulnerable individuals. Additional platforms for prevention activities in addition to public transport will also be

assessed.

Although the results of the rapid assessment will be critical to program design, based on the DHS data,

some likely priorities are evident. Focusing on adult men and women, with a particular emphasis on men, in

order to raise risk perceptions related to multiple/concurrent sexual partners as well as transactional and

commercial sex appear to be key needs. Condom skills building and distribution in order to promote correct

and consistent condom use, particularly with non-marital or cohabitating partners, will be emphasized

(funded in OP). Peer education approaches will likely be used to raise individual risk perception among

adults. Beyond individual risk perception and skills building, community organizations will be challenged to

find forums to address community norms that heighten HIV risk. This may take place in the form of

community conversations, identifying and training community leaders, or targeted use of media (e.g, radio,

community drama, church sermons, etc.) for consistent messages that address harmful norms.

By addressing with new activities, Pact will also establish linkages between Y-CHOICES efforts and new

activities aimed at higher risk populations and adults. Public forums to raise awareness and challenge social

norms, community conversations, etc. will be implemented in concert with Y-CHOICES so that community

groups working to address particular populations have an opportunity to come together to develop

strategies to support one another and assure that the prevention needs of both youth and adults are

addressed.

As Pact will be addressing prevention comprehensively, targets for the adult populations reached will be

counted in OP, though there will be a significant emphasis on raising risk perceptions around multiple and

concurrent partners. Interventions and trainings including A, B, and C approaches, 50 people trained and

3,000 people reached. Pact will also establish a consistent definition of person "reached" as having received

some intensive dose of the intervention designed (e.g. completing a curriculum, multiple sessions with a

Activity Narrative: peer educator, etc) to assure that the focus of the intervention is on quality, leading to greater plausibility for

behavior change. As needs are assessed and approaches are tested in FY08, targets will be relatively

modest, with the expectation that capacity to reach larger segments of the population will increase with

time.

Expanding prevention activities into prevention is critical to the overall prevention strategy of addressing

prevention where new infections are occurring. A focus on high-prevalence urban populations with a an

emphasis on adults and high-risk populations represents a response to two recommendations made

through two technical assistance visits by members of OGAC's general population and most at risk

populations working groups. As the highest prevalence region in Ethiopia with almost no current prevention

efforts ongoing, this activity addresses a critical gap in Ethiopia's prevention needs.

With so few partners in Gambella, linkages between services will be essential, as there will be few other

organizations to reach this high prevalence population. Pact will establish a strong referral program for

counseling and testing with JHU, the care and treatment provider in Gambella managing CT sites at health

facilities. Connections with the new activity related to male circumcision by JHPIEGO will also be

established. As behavior change messages are a critical component of any male circumcision intervention,

the assessments Pact conducts and the information they provide will be an important link for MC activities.

An ongoing Nike Foundation program for Girls Empowerment will also be leveraged. Pact is also

implementing a USAID-funded peace project in Gambella called "Restoration of Community Stability in

Gambella." Lessons learned from this project in working in a heavily underserved region will be drawn upon

for stronger program design.

Although the assessment will reveal more specific populations to be targeted, sexually active adults with

multiple sexual partners will be targeted. Other high-risk populations such as sex workers and those

engaging in transactional sex may also be targeted depending on the results of the initial assessment.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18009

Continued Associated Activity Information

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

System ID System ID

18009 18009.08 U.S. Agency for Pact, Inc. 7501 604.08 $125,000

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $315,000

Prevention Activities in Gambella

ACTIVITY UNCHANGED FROM FY2008

FY 08 ACTIVITY NARRATIVE

This activity is a continuation of FY07 reprogrammed funds. In FY08, funds for this activity will be split

evenly across AB ($125,000) and Other Prevention (OP—$125,000).

Gambella is the westernmost region of Ethiopia, bordering Sudan. The region is sparsely populated; in

2005, the Ethiopian Central Statistics Agency estimated a regional population of only 247,000—80% of

whom live in rural areas. Pastoralism and agriculture are the major economic activities for the people of

Gambella. One of the major ethnic groups in Gambella is the Anuak people, who comprise approximately

30% of the region's population. The Anuak are considered to be ethnically, culturally, linguistically,

historically, and religiously different from most other Ethiopians, and there have been ethnic conflicts in

recent years in the region, with significant tensions persisting.

The 2005 Ethiopian Demographic and Health Survey (EDHS) revealed surprisingly high HIV prevalence of

6.0% in Gambella region. Gambella's was the highest regional prevalence recorded by the EDHS, and is

nearly three times the Government of Ethiopia's (GOE) national single-point prevalence of 2.1%. Behavioral

data also reveals high levels of risk behavior. Compared to other regions and the national average, men in

Gambella reported high rates of multiple partners, high-risk sex, lifetime sex partners, and having paid for

sex. Women in Gambella reported higher than average high-risk sex. The draft Epidemiological Synthesis

of HIV/AIDS in Ethiopia, commissioned by the HIV/AIDS Prevention and Control Office (HAPCO) and the

World Bank, identify Gambella as a "hotspot." Gambella's circumcision rate is the lowest in the country, with

only 47% of men circumcised, compared to a national rate of 93% for circumcision coverage. Furthermore,

there are very few civil society groups working on HIV in Gambella, and USG-supported prevention efforts

in Gambella prior to FY07 reprogramming have been largely limited to work in the refugee camps on the

Sudanese border. Pact is one notable exception, as its Track 1 ABY program has been active in four

districts in Gambella since FY06.

Through reprogramming funds, Pact will expand HIV-prevention interventions focused on behavior change

to address the prevention needs of adults in Gambella. Building off of a similar approach to that of Y-

CHOICES, Pact will provide technical assistance and support for organizational-capacity development to a

selected number of local organizations that will carry out the prevention interventions in Gambella.

However, there is very limited civil society activity in Gambella, and depending on the presence and

capacity of local organizations to focus on adults, Pact may also engage in some direct implementation of

prevention services.

Because the region is quite different from many other parts of Ethiopia and there is little civil society

experience to draw from, a rapid assessment of prevention needs and local partners to work with will be

conducted. Some adaptation of Pact's established approaches in other regions of the country may be

necessary in order to be relevant to the populations in Gambella. Though largely rural, due to the disparate

population, initial prevention efforts will focus on the capital city, Gambella town, as well as other districts

where Y-CHOICES activities are already in place. Assessments for feasible means of outreach to rural

populations will be conducted. Needs assessments already conducted by the health network partner in

Gambella, Johns Hopkins University (JHU), will also be considered in program design.

Initial assessments of venues where HIV-prevention efforts may be expanded include the use of public

transport and public transport workers, as they are the hub of nearly all mobility in the region and the public

depends heavily on them. Transport workers and systems may be used to address social norms

contributing to HIV risk, to address HIV prevention directly and heighten risk perception among those using

public transport. Training transport workers to engage riders in dialogue about HIV while using the transport

system, and production of audio materials or radio programs with HIV-prevention information and behavior-

change messages are possible methods of addressing prevention in this widely used venue. Training and

support to help those engaged in transactional or commercial sex to enter the high-demand market of public

transport may also be explored as an alternative means of income for some high-risk and economically

vulnerable individuals. Additional platforms for prevention activities in addition to public transport will also be

assessed.

Although the results of the rapid assessment will be critical to program design, based on the EDHS data,

some likely priorities are evident. Focusing on adult men and women, with a particular emphasis on men, in

order to raise risk perceptions related to multiple/concurrent sexual partners, as well as transactional and

commercial sex appear to be key needs. Condom skills building and distribution in order to promote correct

and consistent condom use, particularly with nonmarital or cohabitating partners, will be emphasized

(funded in OP). Peer education approaches will likely be used to raise individual risk-perception among

adults. Beyond individual risk-perception and skills building, community organizations will be challenged to

find forums to address community norms that heighten HIV risk. This may take place in the form of

community conversations, identifying and training community leaders, or targeted use of media (e.g., radio,

community drama, church sermons, etc.) for consistent messages that address harmful norms.

By addressing with new activities, Pact will also establish linkages between Y-CHOICES efforts and new

activities aimed at higher risk populations and adults. Public forums to raise awareness and challenge social

norms, community conversations, etc. will be implemented in concert with Y-CHOICES so that community

groups working to address particular populations have an opportunity to come together to develop

strategies to support one another and assure that the prevention needs of both youth and adults are

addressed.

As Pact will be addressing prevention comprehensively, targets for the adult populations reached will be

counted in OP, though there will be a significant emphasis on raising risk perceptions around multiple and

Activity Narrative: concurrent partners. Interventions and trainings including A, B, and C approaches, 50 people trained, and

3,000 people reached. Pact will also establish a consistent definition of person "reached" as having received

some intensive dose of the intervention designed (e.g., completing a curriculum, multiple sessions with a

peer educator) to assure that the focus of the intervention is on quality, leading to greater plausibility for

behavior change. As needs are assessed and approaches are tested in FY08, targets will be relatively

modest, with the expectation that capacity to reach larger segments of the population will increase with

time.

The overall strategy will address prevention where new infections are occurring. A focus on high-prevalence

urban populations, with a an emphasis on adults and high-risk populations, represents a response to two

recommendations made through two technical assistance visits by members of the Office of the Global

AIDS Coordinator's working groups on general population and most-at-risk populations. As Gambella is the

highest prevalence region in Ethiopia, with almost no current prevention efforts ongoing, this activity

addresses a critical gap in Ethiopia's prevention needs.

With so few partners in Gambella, linkages between services will be essential, as there will be few other

organizations to reach this high prevalence population. Pact will establish a strong referral program for

counseling and testing with Johns Hopkins University, the care and treatment provider in Gambella

managing counseling and testing sites at health facilities. Connections with the new activity related to male

circumcision by JHPIEGO will also be established. As behavior change messages are a critical component

of any male circumcision intervention, the assessments Pact conducts and the information it provides will be

an important link for MC activities. An ongoing Nike Foundation program for Girls Empowerment will also be

leveraged. Pact is also implementing a USAID-funded peace project in Gambella called "Restoration of

Community Stability in Gambella." Lessons learned from this project in working in a heavily underserved

region will be drawn upon for stronger program design.

Although the assessment will reveal more specific populations to be targeted, the focus will be on sexually

active adults with multiple sexual partners. Other high-risk populations, such as commercial sex workers

and those engaging in transactional sex, may also be addressed, depending on the results of the initial

assessment.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17874

Continued Associated Activity Information

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

System ID System ID

17874 17874.08 U.S. Agency for Pact, Inc. 7501 604.08 $125,000

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Subpartners Total: $0
Ethiopia Muslim Development Agency: NA
Ogaden Welfare and Development Association: NA
Rohi Weddu Pastoral Women Development Organization: NA