PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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:
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
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
CHOICES, Pact will provide technical assistance and support for organizational-capacity development to a
capacity of local organizations to focus on adults, Pact may also engage in some direct implementation of
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
system, and production of audio materials or radio programs with HIV-prevention information and behavior-
Although the results of the rapid assessment will be critical to program design, based on the EDHS data,
order to raise risk perceptions related to multiple/concurrent sexual partners, as well as transactional and
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
community conversations, identifying and training community leaders, or targeted use of media (e.g., radio,
Activity Narrative: concurrent partners. Interventions and trainings including A, B, and C approaches, 50 people trained, and
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
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.
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.
Continuing Activity: 17874
17874 17874.08 U.S. Agency for Pact, Inc. 7501 604.08 $125,000
Table 3.3.03: