This program area has previously targeted recruits and ranks deploying overseas, but will be expanded to

include all ranks (enlisted and officer), reservists and dependents. DoD will enhance HIV/AIDS prevention

in the Guyanese Defense Force through continuing to train and support medical personnel and peer

educators to provide AB messages. Refresher training will also be provided. Activities will be extended

beyond Georgetown to outlying military posts where train-the-trainer programs will also be initiated.

Personnel in leadership positions will be trained and encouraged to provide prevention education to their

subordinates. Peer education will be supplemented through the distribution of HIV/AIDS prevention

literature. Peer education trainers will be supported in recruiting and training new peer educators. An

HIV/AIDS awareness day will be organized, coinciding with a national HIV/AIDS prevention activity. A

health fair with prevention messages, HIV counseling and testing as part of other health promotion (e.g.

cholesterol and nutrition) will be organized. In FY08, drama groups through edutainment, will be used to

reach out to military personnel and their families with messages promoting abstinence until marriage,

faithfulness to one's partner, and address issues of violence, especially sexual and spousal abuse.

Education regarding male norms will also be implemented.

Linkages into the civilian health sector for referral of HIV positive individuals will be maintained and

facilitated where possible (e.g. transportation to/from appointments, other palliative care). For FY08, a

vehicle for mobile VCT will be purchased, fueled and maintained. It will be equipped with education

materials on VCT, ART, STIs and stigma reduction. The mobile VCT will target not only remote,

underserved regions where GDF units are typically found, but also other regions where barriers to come to

VCT are present (e.g. dependent testing). Transportation assistance will be provided for HIV positive

members who require medical follow-up for care and treatment facilities. The mobile VCT will be used for

AB, other prevention and C & T activities

To strengthen education activities across AB and other prevention, computers, printers, USB devices, and

other supplies will be procured to support HIV/AIDS information management and distribution.

DoD will continue to assist implementation of universal precautions in the Guyana Defense Force (GDF)

healthcare settings. Through the Guyana Safer Injection Project, the GDF's health care personnel will be

trained in the areas of injection safety practices, handling and processing of sharp instruments, and

handling and disposal of medical waste. The implementation of Post Exposure Prophylaxis (PEP)

protocols, already developed in the civilian sector through the GUM clinic, will also be ensured for

occupational exposures that occur in military facilities. Tracking and reporting of occupational exposures

will also be performed. Following training, sites will receive essential commodities and supplies to ensure

implementation of improved IP/IS practices (e.g. procurement of sharps disposal containers, biohazard

bags and needle cutters through Initiatives).

Activity Narrative:Condoms are available through the Guyanese National AIDS Programme Secretariat

(NAPS) for members of the Guyanese Defense Force. Efforts will continue with GDF leadership to increase

the acceptability of condom social marketing within the GDF. Leadership will be trained and encouraged to

provide HIV/AIDS prevention education to their subordinates. Condom dispensaries will be procured and

supplied to all bases to be positioned in key areas of congregation and traffic (e.g. mess halls, restrooms,

social areas/clubs, gym facilities, etc). The drama group NGO will use edutainment to deliver messages

throughout the military regions on AB, partner reduction, consistent and correct use of condoms, correct

knowledge of HIV transmission, HIV counseling and testing, sexually transmitted infections (STI), stigma

reduction, the influence of alcohol on risk behavior and safe sex practices among others. Sensitivity to

issues surrounding stigma and discrimination will be emphasized. Information, education and

communication (IEC) materials promoting the above areas will be reproduced and distributed during the

drama tours. Materials to implement prevention initiatives within the GDF (e.g. projectors, screens,

billboards, flipcharts) will be procured. Condom pouches specifically designed to be worn on military

uniforms will be proposed to the GDF for implementation.

Linkages into the civilian health sector for referral of HIV positive individuals will be maintained and

facilitated where possible (e.g. transportation to/from appointments, other palliative care). For FY08, a

vehicle for mobile VCT will be purchased, fueled and maintained. It will be equipped with education

materials on VCT, ART, STIs and stigma reduction. The mobile VCT will target not only remote,

underserved regions where GDF units are typically found, but also other regions where barriers to come to

VCT are present (e.g. dependent testing). Transportation assistance will be provided for HIV positive

members who require medical follow-up for care and treatment facilities. The mobile VCT will be used for

AB, other prevention and C & T activities.

To strengthen education activities across AB and other prevention, computers, printers, USB devices, and

other supplies will be procured to support HIV/AIDS information management and distribution.

Male circumcision will be explored as a possibility for the GDF.

HIV-infected members of the GDF have access to care and treatment through the St. Joseph Mercy

Hospital where HIV-infected military members receive comprehensive palliative services that include

medical care, treatment of opportunistic infections, pain management, social support, nutritional vouchers

and ART adherence education. Additional palliative services for infected military members will be provided

through members in GDF units who will be trained using a curriculum (e.g. "stay healthy") focusing on

promotion of health and wellness, support in dealing with HIV symptomatology, depressive symptoms,

stigma and beliefs about the illness, adherence to ART and substance use. Capacity building and

involvement of military chaplain(s) in HIV/AIDS counseling, with emphasis on ministry skills relating to the

individual and the family, including marital relationships, parenting, and development of peer support

systems will be developed.

Military personnel are subjected to a high risk of TB and HIV as a result of the social situations they find

themselves in and the nature of their work. There has been a lag in emphasizing the diagnosis and

treatment of TB and other OIs in the GDF. GDF medical personnel will receive training on when to suspect

TB, the procedure for diagnosis (e.g. referral to Camp Ayanganno for sputum AFB smears) and treatment

(e.g. referral to Georgetown Chest Clinic), in HIV-infected individuals. Training, educational resources, and

guidelines for TB-HIV management will be provided by the Ministry of Health.

Counseling and testing (C&T) by trained counselors will be available at all four GDF locations: Base Camps

Ayanganna, Stephenson, and Ruimveldt, with plans to establish a VCT center at Seweyo base camp, and

in addition, refurbish other sites as necessary. In support of the MOH "Know Your Status" program,

personnel in leadership and peer educators will encourage GDF personnel to be tested for HIV. Counseling

will be performed in accordance with national guidelines and will include targeted ABC messages.

Reduction of stigma and discrimination will be emphasized, including implementation of mechanisms to

maintain the anonymity of those tested and the confidentiality of their test results. Linkages into the civilian

health sector for referral of HIV positive individuals will be maintained and facilitated where possible (e.g.

transportation to/from appointments, other palliative care). For FY08, a vehicle for mobile VCT will be

purchased, fueled and maintained. It will be equipped with education materials on VCT, ART, STIs and

stigma reduction. The mobile VCT will target not only remote, underserved regions where GDF units are

typically found, but also other regions where barriers to come to VCT are present (e.g. dependent testing).

Transportation assistance will be provided for HIV positive members who require medical follow-up for care

and treatment facilities. The mobile VCT will be used for AB, other prevention and C & T activities.

Given the current situation where military members are referred to a civilian private sector facility for

laboratory testing, and often at a fee, the goal for improving the GDF's ability to perform certain basic

diagnostic studies is crucial. Laboratory infrastructure will be established through the renovation and

equipment of an existing space at Camp Anyanganno. DoD laboratory personnel will perform technical

assistance visits to the GDF laboratory to provide training of personnel. Logistics mechanisms to sustain

laboratory capabilities will be initiated and maintained. In addition, GDF laboratory technicians will be

trained to parallel the skills and capabilities of laboratory technicians functioning in other civilian laboratories

of the same capacity.

DoD will continue to provide support for building capacity within the GDF in the areas of surveillance,

monitoring and evaluation (M&E) and analysis and use of strategic information. Improvements will be made

to the GDF health information management system, enabling it to provide both clinical and strategic

decision-enabling information in a timely manner. Existing data regarding risk behaviors from VCT intake

forms will be analyzed to understand and target behavior change and other prevention activities. The

program manager will be trained in M&E to ensure proper reporting to PEPFAR.

The goal for FY08 will be the development of an HIV military policy in the GDF. Through the provision of a

draft and visits/workshops guided by a U.S. DoD member knowledgeable in policy, the military central

management committee will be provided a proposed HIV military policy for the GDF. Designated high level

military leaders will be sent to the Defense International Medical Operations (DIMO) HIV Policy

Development Course at Brookes Air Force Base, Texas.

Two GDF health care providers will be sent to the Military International HIV Training Course in San Diego,

California where comprehensive training will provide a conceptual background and practical experience in

HIV management with antiretroviral therapy, management of common opportunistic infections, policies and

operational aspects of clinical and military management of HIV infected personnel and their families. HIV

diagnostics and laboratory diagnosis of parasitic diseases and opportunistic infections be taught. Vital

concepts and methods of epidemiology and biostatistics needed to address the critical public health issues

including surveillance, bias, confounding and study design, using and evaluating medical literature, and use

of vital statistics in research will be reviewed. Training and experience in database development,

maintenance, and data entry will be provided. Key elements of health communication messages and social

marketing efforts to promote HIV prevention, VCT, and destigmatization of people living with HIV/AIDS will

be presented. Individualized instruction on relevant software, and library and medical Internet searching

skills will be enhanced. Support will be provided for this individual to train other GDF military and healthcare

personnel to provide health care and support for HIV-infected personnel.

In FY08, DoD will hire a full time in country program manager who will oversee all DoD PEFAR funded

activities. Major duties of the program manager include serving as the principal advisor to the Military

Liaison Officer (MLO), Office of the Command Surgeon, United States Southern Command, and the DoD

HIV/AIDS Prevention Program (DHAPP) on HIV/AIDS activities in Guyana, coordinating with the other

implementing partners in country for information sharing and other issues. In addition, an administrative

assistant will be hired. These funds will also support costs incurred for travel and office supplies needed

for M & E. Embassy ICASS fees will also be included to cover contracts and other services.