The Guyana HIV/AIDS Reduction and Prevention Project (Prime: FHI) will support the GoG's ongoing HIV

prevention, care and treatment program by helping to establish the necessary health infrastructure systems

and improving provider skills so they can safely and effectively provide PMTCT with appropriate links to

follow-up services. FY08 will continue to focus on eliminating the large number of non-tested deliveries

occurring at L&D sites as was mentioned in the context adhering to new MOH SOPs and policy decisions

for PMTCT and for ensuring quality services. A new area of emphasis will see increased communication

and outreach to male partners.

GHARP will continue to strengthen human resource capacity by building capacity of PMTCT support groups

(including support packages for providers established in materials produced by CDC), strengthening MOH

capacity to manage PMTCT, train labor and delivery ward staff using CDC/FXB-developed materials on

protocols and procedures, post-exposure prophylaxis, safe obstetric practices, ARV prophylaxis issues and

post-birth counseling, including infant feeding counseling. Site support will include continued training,

provision of counseling support materials, operations manuals, infrastructure support as needed and quality

assurance, on-site mentoring, and monitoring/evaluation system support. A great deal of collaborative work

has resulted in as many as 12 ANC forms being streamlined into one paper-based, triplicate copy, ANC

form that includes all necessary PMTCT information which is processed through statistical unit of the MOH.

Further strengthening of this system will continue as well, keeping in mind such models as the CDC-

developed PMTCT-MS.

In FY07 FHI/GHARP conducted TOT for hospital setting; train labor and delivery ward staff from 5 L & D

sites using CDC/FXB-developed materials on protocols and procedures, post-exposure prophylaxis, safe

obstetric practices, ARV prophylaxis issues and post-birth counseling, including infant feeding counseling

and the newer MOH policy on opt-out testing in L&D wards. Recruitment and training for counselor/testers

took place to support the Labour and Delivery sites to adequately support the shift system at all Labour and

Delivery sites. The assessment conducted by GAP/CDC as well as FHI operational research in FY06

showed that there was a shortage of counselor/testers at several L and D sites. This resulted in mothers

having missed opportunities to be counseled and tested at L and D. Hence, all plans will continue to

support the increased personnel at these sites (all personnel were rolled over to MOH contracts upon COP

approval and award of funds in the first quarter of calendar year 2007).

The results of the qualitative PMTCT Drop-out Study found that the concept of discordant couples was not

widely understood among women who received PMTCT services, and many couples held the belief that a

woman's HIV status reflected her partner's status. In an effort to reinforce the concept of HIV discordance

among couples and increase the number of male partners who are tested, there was a focus in FY07 in

emphasizing the concept of discordance both during training of counselor/testers as well as during the

provision of PMTCT services.

With the staff transitioned from FHI to the MOH, GHARP will continue to technically support the process of

integrating PMTCT into MCH services through the safe motherhood program - focusing on the 5 prongs of

safe motherhood initiative that aims to reduce the illnesses and deaths among women of childbearing age.

In-service training will already begin to integrate the five prongs of safe motherhood as a first stage of the

process. During this transition period FHI will continue to conduct QA/QI follow up visits to clinical sites to

observe implementation of new skills and will collaborate with CDC/GAP and the MOH on a quality

assurance program for management of PMTCT sites, focusing on strategic information, commodities

management, and skills testing/training. (A draft tool has already been developed). This will enable staff at

every level of program operation to implement an effective QA/QI program to ensure maximum performance

and quality of all our interventions.

Specific Supported Activities will include:

1.) Continue the follow-up/ community outreach program. This will be achieved through the nurses based at

the health centers and linkages to NGOs and Palliative service providers.

2.) Provide training support as requested by MCH.

3.) Enhance the linkages between VCT, PMTCT, OI, STI and referral to ART and other technical areas.

4.) Review of PMTCT guidelines within the Safe Motherhood Program.

5.) Provide support for establishing links with overarching capacity develop and M&E and quality assurance

plans.

6.) Support the MOH/MCH in development and implementation of regular comprehensive review of the

program to identify and solve issues that affect implementation of the program.

7.) Enhance the uptake at primary care facilities through strategic blood collection at the health centers

through the use of mobile counseling and testing teams and MCH phlebotomists.

GHARP continues to achieve all, and exceed most, of its annual AB targets. In FY07, GHARP was also

able to review and revise technical standards: Abstinence and refusal skills manual, ‘Faith matters manual,'

which has been recognized as a best practice curriculum manual.

GHARP through FHI and the Caribbean Conference of Churches (CCC) will continue to technically support

12 NGOs/CBOs, including 4 FBOs to effectively implement Abstinence and Faithfulness prevention

programs for youth and adults alike in the ten Regions of Guyana.

In collaboration with its sub-partner the CCC, GHARP developed an abstinence and faithfulness manual

which is a sub-set of the Guyana "Body Works" tool called "Faith Matters" that is inclusive of all major

religions in Guyana (Christian, Hindu, and Islam). The NGOs/FBOs will continue to use this Peer Education

manual to conduct workshops on delayed sexual debut until marriage, refusal skills, secondary abstinence,

stigma and discrimination with religious and lay leaders, sermon development workshop with FBOs, and

capacity building of Faith Leaders to incorporate information on "AB", VCT and fidelity during marital & pre-

marital counseling. The pre-marital counseling support will aid in transitioning the couple to sexual activity

with responsible behavior, emphasizing fidelity. The primary objective is to avert HIV/AIDS infections by

encouraging behavior that will reduce the risk of infection.

To achieve our program objectives our efforts will be focused on creating an enabling environment for

positive behavior change. These activities will include promotion of the benefits of partner reduction,

increased family time, pre-and post marital counseling, and the promotion of individual, familial and societal

responsibilities. Training will also focus on cultural norms, gender issues, substance abuse, human

sexuality and domestic violence. Our FBOs will be integral partners in promoting this prevention strategy as

well as in counseling their members to access pre-marital counseling and testing.

There will also be targeted activities to encourage and support male involvement in FBO HIV/AIDS work.

Through our partnership with the religious organizations such as the Central Islamic Organization and Hope

Foundation, male constituents will be communicated directly to discourage cross-generational sex, and to

support and normalize fidelity, partner reduction and other behavior change. Men will also be targeted at

the workplaces and other sites where men congregate through our HIV/AIDS workplace programs to stress

male sexual and familial responsibility.

Our program will also encourage Guyanese leadership to promote partner reduction and faithfulness, and

denounce violence against women and girls, and design, implement, and evaluate a culturally relevant

intervention that prepares community leaders to guide community dialogue on sexual coercion, violence

against women and girls, partner reduction and faithfulness.

Community outreach activities with the NGOs will serve to support and reinforce the uptake of key

prevention behaviors among youth. Several local partners like Volunteer Youth Corps will engage youths

and stimulate community discussions, promote positive social values and social responsibility, removal of

misconceptions about sex and sexuality, and community mobilization approaches to youth empowerment.

Messages on abstinence are presently included in counseling and mentoring sessions as well as in peer

education outreaches. There are also community interventions which are designed for persons to be aware

of risky behaviors and in so doing eliminate or reduce those said behaviors. Young persons are especially

being given messages about self-worth, dignity and the necessary skills for practicing abstinence. They are

also informed of the risk associated with early sexual activity, sex outside of marriage, multiple partnerships

and cross generational sex, and are trained on alternatives such as healthy lifestyles and negotiation skills.

Howard Delafield Inc. (HDI) is a partner company on the GHARP initiative. This privately, women-owned

business has a successful history in public health marketing and communication development. Their

responsibility within AB will be to support the current communication and educational material ("All it Takes

is No" and "Pop Kook Kits") concepts by integrating them into community outreach media and inter-personal

communications. HDI will air and reprint materials developed in FY07; covering all costs of design,

development, pre-testing, production, reproduction and air/print dissemination. The continuation of the

appropriate female and male empowerment campaigns will be supported as will leveraging private sector

support and themes such as Herbal Essence and Lucozade (Sports Drink).

HDI also has strengths in building on private sector partnerships, and as such will be continuing to work with

beverage companies to address drinking and substance abuse as part of the abstinence program.

HDI will develop tailored messages on faithfulness for adoption by the National AIDS Program Secretariat

(NAPS) and reproduce, faithfulness materials (billboards, print, TV, and radio) as well as cover the

expenses of media coverage/airings. HDI will also produce tailored messages on faithfulness for different

religious organizations for distribution at a community level.

HDI will be tracking their own process indicators, but will not have direct targets as they contribute to

increasing access to care and in mobilizing the community. The actual service delivery targets are set

within the GHARP/FHI section as they have the overall responsibility to monitor and report on

USAID/GHARP overall program implementation.

Howard Delafield Inc. (HDI) is a small, privately owned business that is sub-contracted within the GHARP

consortium. By the time of the semi-annual report achievements include expansion of its partnership with

private sector distributors in order to make condoms available to high risk persons at nontraditional retail

outlets, establishment and sustainability of 848 condom non-traditional retail outlets, the development of

targeted promotion, distribution and "place" strategies for CSWs, MSMs, Miners and Loggers and PLWA's,

development and distribution of value packs for FSWs, including condoms and lubrication for use with

clients highlighting the importance of consistent and correct use of condoms, development of targeted

prevention interventions with the MSM community, innovative approaches to repackage condoms to appeal

to this population, and development and distribution of 600 value packs, including lubrications for MSMs.

HDI will continue to implement and monitor strategy to strengthen and expand partnerships with private

sector organizations with a special focus on MARP such as miners, loggers, transport workers (shipping,

river transport services, mini buses), including contractors of the primary organizations. HDI is also

responsible for continuing to maintain strategic distribution outlets for targeted distribution of condoms,

expanding the role of sales-promoters to include collection of informal data on the "pulse" of the community

in relation to the success of GHARP communication programs. Their condom marketing campaign will not

only generate demand for branded and un-branded condoms alike, but will increase access by high risk

persons to non-traditional condom sales outlets in mining and hinterland areas, and promote correct,

consistent use of condoms in most-at-risk populations. These populations will also receive prevention

education messages promoting being faithful and partner reduction as an important means of reducing

one's risk of HIV/AIDS/STI infection, with a focus on promoting responsible male behavior.

In addition, they will continue to cover all costs for design, field testing, production, reproduction, air-time,

print, and dissemination of communication material for bars/brothels/mobile populations and materials

focused on other prevention. HDI will build on the private sector's initiatives to conduct/implement joint

trade promotions with private sector condom distributors. Finally, HDI will produce, distribute ‘value

kits' (condoms, lubricants, cologne etc) for female sex workers.

FHI will maintain the responsibility for the overall cohesion of the GHARP project as the prime and will

continue to report financially and programmatically for the program.

In FY07 GHARP will achieve all, and exceed most, of its other prevention targets. GHARP also played a

critical technical role in the review and revision of technical standards of the National BCC Strategy.

GHARP will continue to use information from the BSS completed in 2005 to inform program design and

implementation, and will focus on customizing specific packages of services to meet each target MARP

needs for individualized prevention services. Sex workers will partner with outreach workers doing risk

reduction support. This target population will be reached with services promoting the desired behavior

change, including increased access to counseling and testing through MARP-friendly mobile VCT and STI

testing sites, a decrease in alcohol and drug intake through education and psychosocial support networks,

and, consistent and correct condom use with clients.

Vulnerability reduction and partner reduction activities for sex workers will include offering skills-building

opportunities to increase alternative income generation or employment options, in addition to condom

negotiation skills and strategies for avoiding violence (avoiding alcohol and drugs). Specific NGO

interventions are carried out by such groups as Artistes in Direct Support, Comforting Hearts, Lifeline, and

SwingStar. GHARP has been able to develop cue cards that have been pre-tested among CSW and are

used for group and individual peer education by the NGOs and CSW contacts who were trained as peer

educators. These same NGOs, linked to their points of contact within the target population, deliver

interactive sessions with a series of pre-tested tapes that have simple story-lines, just a few characters, and

walk the CSWs through different scenarios that educate and reinforce strong prevention behaviors and

practices. The same six NGOs have also self-selected themselves to target MSM. Only a few strong points

of contact exist within this target population and as such, the training of MSM to work within their own

network is critical until the community organizations are able to reach a wider population directly. Through

peer education and supportive referal for clinical and preventative services, men having sex with men will

be encouraged to adopt safer sexual behaviors such as condom use with clients and regular partners, a

reduction in the number of partners, and to increase their health seeking behaviors for STI/OI and HIV care

and treatment.

The six NGOs who are currently working with most at-risk populations will be providing HIV/AIDS/STI

prevention education, risk reduction counseling, and referrals for care and treatment to a recommended

network of services. The program will also work with MARP and PLWHA support groups and drop-in

centers that offer a supportive environment to reinforce behaviors that reduce risk of HIV transmission.

Miners will be provided a similar set of support services, customized to meet their own individual needs and

risk factors. This population will be encouraged to adopt safer sexual behaviors and to increase positive

health seeking behaviors. One very promising opportunity to promote the uptake of HIV/STI services by

miners and loggers is to offer malaria testing. Given the high level of concern among this population, this is

a possible way of encouraging these mobile, high risk men to access condoms and clinical services,

including HIV/STI counseling and testing.

Mobile services for VCT and STI syndromic management will be used wherever high risk populations are

present and access to services is limited. NGOs who are currently working in these areas will be providing

targeted prevention and risk reduction education to persons at high risk, as well as counseling, testing, and

appropriate referrals for care and treatment.

GHARP will support the development of prevention programs for positives and sero-discordant couples.

Through twinning, these programs will assist local PLWHA groups to increase their capacity to provide post

-test counseling for positives, and to conduct support groups for positive pregnant women (and provision of

family planning counseling and support), counseling for discordant couples, testing for the families of HIV+

persons, and support for family access to key health services.

Individualized prevention programs that include sensitization, education, peer counselor training, and

targeted materials development will be implemented to reach those high risk behaviors identified in the BSS

among the in and out-of-school youths, GuySuco workers, and uniformed services. The desired behavior

changes that will be promoted are all aimed at eliminating or reducing risk of transmitting or becoming HIV

infected, reducing alcohol and drug use; consistent and correct condom use where appropriate; promotion

of secondary abstinence; mutual monogamy and/or partner reduction (MSM primarily); increasing health

seeking behaviors and referrals; increasing correct knowledge of HIV transmission, and a decrease in the

levels of stigmatizing beliefs held by the groups.

In an effort to expand its reach to MARP, GHARP will utilize a number of interventions. Activities will

include targeted prevention education that is adapted to fit the risk reduction needs of specific MARP target

groups, increase access for STI treatment by offering MARP-friendly mobile syndromic management,

increase access for HIV/OI treatment by sensitizing clinical providers to issues of stigma and discrimination

and offering flexible clinic hours, aimed at establishing a friendlier setting for high risk persons to access

services. Special emphasis will also be placed on creating male friendly spaces where men will feel free to

be able to access HIV/AIDS/STI prevention services at times convenient to them and to speak with male

counselors in many instances. Promotion and training for staff on the expectation of service delivery that

emphasizes empathy will be implemented, which will foster thus exhibiting a certain degree of tolerance for

apparel and mannerisms, and will create a safe environment for all clients and their families. One partner

NGO, the Guyana Responsible Parenthood Association has been quite successful in building client-patient

relationships with high risk groups and expects to continue to see an increasing number of regular clients.

Also, staff from public and community based-HIV/AIDS programs in hinterland villages will be sensitized to

the specific needs of their clients and the increased need for anonymity in such an isolated setting. The

coordination with FXB and CIDA-supported STI, TB and ART centers will be integral so that those sites also

integrate a similar "MARP friendly" non-stigmatizing approach.

Additionally, GHARP will continue to build the capacity of NGOs to provide targeted prevention education to

specific MARP populations, and services to the most vulnerable populations that reinforce and support risk

reduction through behavior change. The project aims to strengthen local NGO managerial and technical

capacity to provide prevention programs and services for vulnerable populations through outreach, and

facilitate direct referral to clinical services in Georgetown.

Family Health International, as the prime partner for GHARP, provides technical support, monitoring and

data quality assurance, and program oversight implementation for the NGOs funded through the

Community Support & Development Services mechanism.

To date, GHARP continues to achieve all, and exceed most, targets.

The package of care that NGOs/FBOs provide includes all four aspects of essential palliative care services

and follows PEPFAR guidance. The clinical aspects of care are provided at the clinic level within the

community and the other three aspects are provided through a network of FBO/NGO partners that are

trained and supervised by GHARP. In some cases, FBO/NGO partners have been determined to possess

the necessary capacity to provide clinical care outside of the facility setting and are supported in delivering

such services. GHARP focuses on building the capacity of local service providers in an effort to facilitate

the transfer of skills and to improve and expand the range of services offered. All activities are being

developed and implemented in close collaboration with the MOH; with the network continually being

strengthened to provide home based counseling and testing or a direct referral to facility-based VCT, ART,

and OI/STI treatment provision. At sites where none of the aforementioned services are possible, the

patient is referred to the nearest site for clinical assessment, STI/OI screening, prophylaxis and treatment,

child immunization, nutrition hygiene counseling and reproductive health services. The reverse of these

referrals is witnessed when treatment sites call their palliative care coordinator within the facility, supported

by GFATM and the National AIDS Program, to register the client for palliative care services. This

coordinator then works with the client as well as available community-based HBC providers to ensure that

the client is not lost to follow-up.

FHI/GHARP will specifically focus on providing assistance as follows:

1.) Provide technical and management assistance and conduct monitoring of NGO progress through regular

field visits;

2.) Conduct quarterly mentoring site visits and conduct an annual assessment of NGO progress;

3.) Monitor, evaluate, and report of the implementation of palliative care programs.

In FY07 Cicatelli Associates Inc (CAI, sub-contractor under GHARP) will have achieved a Guyanese-led

HBC volunteer training program, successful implementation of quality control systems, development and

implementation of End of Life Care curriculum, computerization of home-based care reports, furthering

micro-enterprise opportunities for people living with HIV and their families, and completing the US-based NY

-Link twinning program with a critical mass of civil society care providers from Guyana.

PLWHA have been highly valuable contributors within HBC programs, and Cicatelli would like to continue

utilizing available PLWHA services in HBC. However, Cicatelli believes that it would be beneficial to utilize

PLWHAs in more than just the HBC area. Experience thus far in Guyana indicates that the incorporation of

PLWHAs in supportive workplaces has very good outcomes for both the workplace and the individual.

Cicatelli has had national/international success in PLWHA development which includes training PLWHAs for

enhanced outreach, navigation, peer mentoring (including adherence and secondary prevention), and as

recruiters in a new project called Social Networking (described below). Continuing to go from success to

success, is the innovative micro-enterprise program that was developed with the Institute of Private

Enterprise Development (IPED) and an indigenous furniture and art company called Liana Cane whereby

skills building and training for PLWHA is provided, with the possibility for future employment, as well as

training of current staff at the company and support for HIV/AIDS policy and workplace programming. In

FY07, Cicatelli expanded this model for working within the expanding field of trade and tourism industry as

well as training and employment programs with Habitat for Humanity and Victoria's Secret (through the local

manufacturer, Denmour Garments).

Cicatelli will continue to work with PLWHA associations and its palliative care program to link PLWHA to

these opportunities. Also, in FY06, Cicatelli initiated the very critical approach of focusing on the long-term

viability of HBC training by working with the Institute of Distance and Continuing Education to establish a

certification course for care providers. They will continue to work on strengthening this training course and

provide mentorship to the organization to effectively deliver the course.

In FY08, Cicatelli will therefore be specifically responsible for the following:

1.) Provide support and quality assurance to those we trained as trainers for volunteers in HBC certification

in ‘06

2.) Train providers on and support the process of introducing home-based VCT

3.) Implement HBC computerized reporting and referral system developed in ‘06

4.) Work with MOH to develop a national policy on pain management and hospice care

5.) Strengthen the quality assurance program for HBC jointly with MOH

6.) Continue working with nurse supervisors on their roles in HBC

7.) Integrate into MOH's HBC demonstration project using community health workers who provide home

based care for persons with diabetes and hypertension. At present, home based care is synonymous with

HIV; we would like to change that. This is an important strategy because by integrating services for persons

with chronic diseases such as diabetes and hypertension and HIV/AIDS, we can take some of the stigma

away and improve confidentiality measures.

8.) Continue working with NGOs to develop multidisciplinary teams and using PLWHAs as enhanced

outreach workers, navigators, etc.

9.) Support the MOH Case Navigation Demonstration Project. This is a project in which PLWHAs would be

employed and trained to navigate those testing positive in anonymous testing sites into treatment and care.

This project is necessary because there is no current follow up method to track those who are tested at VCT

centers and get positive test results. MOH has committed to hiring 4 PLWHAs to be employed as case

navigators working with anonymous testing and counseling sites with positive clients to assist them with

accessing treatment and care. MOH proposes hiring four PLWHAs in region three. Two of them would

work in the regional hospital, and two would work in the far end of region 3, in a satellite clinic. CAI would

develop jointly with MOH an implementation manual; training and supervisory curricula; and reporting,

tracking and evaluation tools. Based upon the success of this demonstration project, this model could be

implemented in all clinic sites in which case navigators could assist in all anonymous testing sites, assisting

those testing positive into treatment and care. This project would serve as a model for connecting

resources between MOH clinics and NGO VCT sites.

10.) Implement Social Networking, a CDC research to practice program which utilizes

"recruiters" (PLWHAs) to recruit friends from their social networks into testing. This is a very focused and

specific form of outreach to bring people into testing using people who have tested positive within the past 3

-6 months. Based upon preliminary findings, in areas of high incidence of HIV, the prevalence rate from

using Social Networks is 6 times the rate seen in publicly funded clinics. CAI is the CDC funded partner on

this program and we developed the training curriculum for Social Networking. We are currently training all

state HIV/AIDS health directors on this program. We would implement this program in three sites.

11.) Continue working with the people we are funding through IPED

12.) Continue working with the HIV+ women trained in crafts through Liana Cane

13.) Continue the partnership with Habitat for Humanity in Guyana. GFATM and WB will partner with

Cicatelli to fund Habitat for Humanity in Guyana up to $50,000 to develop low income housing for PLWHAs.

We would in addition provide funding to Habitat to provide skills training in carpentry and masonry for high

risk youth and young men living in households with PLWHAs, as well as PLWHAs.

15.) Partner with Victoria's Secret to provide employment slots for HIV positive and high risk women. We

would fund the establishment of a sewing training program and an employment readiness program prior to

the women being employed.

16.) Partner with the trade and tourism industry for the establishment of training and job-placement

programs for PLWHA in many of the hinterland regions where employment opportunities are very limited.

Family Health International, as the prime partner for GHARP, provides technical support, monitoring and

data quality assurance, and program oversight and will report on Cicatelli's program achievements.

GHARP continues to achieve its targets and has successfully built great capacity within indigenous

organizations to provide support for OVC. GHARP, through its NGO partners, will focus its energies on

increasing the reach of the OVC program through innovative means. Creative approaches are needed given

the relative low HIV prevalence in Guyana which suggests that the number of HIV/AIDS-related OVC is

small compared to OVC of all causes (HIV/AIDS OVC /OVC of all causes). GHARP will therefore focus its

energies, funding and technical assistance on didactic and on-site training/mentoring of OVC outreach

workers and organizations delivering OVC support. Critical areas of capacity building including a focus on

case-finding e.g. ART sites, PT/HBC centers, PMTCT, VCT, PLHA groups and community (drop-in) centers.

A significant role of GHARP will be in program oversight, monitoring and evaluation, reporting to USG,

networking, and technical backstopping.

In FY07 GHARP has achieved great strides in the field of counseling and testing, by completing the revision

of the Nationally-adopted C&T curriculum, revision of the National C&T protocol/SOP, development of first

National C&T guidelines, and surpassing its targets.

GHARP will increase the number of ARV referrals in FY08, and in order to do so will work diligently to

increase the access to and uptake of C&T services with an increased focus on reaching high-risk

populations. An extensive level of effort will be dedicated to mobilizing the populations to seek testing

through public, private, NOG/FBO, and PMTCT providers, in support of the MOH "Know Your Status"

program. Counselors will continue to be trained in the use of guidelines and provide ongoing follow-up

training in addition to basic counseling skills.

Direct service delivery of C&T has been successfully transitioned to MOH and NGO partners such as Hope

for All, Lifeline, Guyana Responsible Parenthood Association, Comforting Hearts, St. Francis Community

Developers, Hope Foundation, Linden Care Foundation, and Youth Challenge Guyana, but GHARP

continues to monitor, evaluate and report on C&T. In FY08, GHARP will continue to support NGOs/FBOs in

C&T service delivery and community mobilization by providing training, information management,

personnel, and management and support for the rapid testing teams. GHARP will also implement a Quality

Assurance/Quality Improvement (QA/QI) program to coordinate quality assurance programs with CDC/GAP

and the MOH to track counseling & rapid testing proficiency, training needs, and commodities management.

Tools for quality of counseling and testing have been developed and piloted at several VCT sites. GHARP,

in partnership with the MOH and CDC/GAP, will also dedicate a significant level of effort for the assurance

of efficient and appropriate data collection form development, oversight, and accurate reporting among all

partners.

To ensure a trained cadre of persons to support VCT activities, Counseling and Testing Training will be

institutionalized through the Institute of Distance and Continuing Education (IDCE), University of Guyana.

The IDCE program reaches a wide cross section of persons which will allow for C&T programs to be

afforded to persons in the regions.

In FY08, GHARP will continue to support the expansion of C&T services. Community organizations working

in remote, hinterland areas where the largest proportion of mining and timber industries operate, will

continue to provide mobile counseling and testing. GHARP will provide technical support and guidance to

increase uptake of these services by leading focus-group discussions to ensure that the organization's

service delivery matches the needs of the high-risk groups. Additional faith-based C&T services will be

supported, as requested by the Central Islamic Organization. A total of five mobile units will focus on

reaching the current demand from workplace, NGO/FBO, government, public, and high-risk/non-traditional

sites. Youth Challenge Guyana has already successfully transitioned to leading one of the mobile teams;

the other NGOs that will be chosen to manage the remaining mobile units are currently under review and a

transition plan is being developed. Efforts have been made with the mobile unit to initiate Community

Mobilization in hard-to-reach and high-risk populations. GHARP will continue to technically assist partners

to develop C&T expansion strategies in support of the National HIV/AIDS Strategy based on risk behavior

and prevalence information. All program expansion strategies will be developed in full support of the

National HIV/AIDS Strategy, conducted through a coordinated response with MOH, GFATM, and WB

programs, and based on risk behavior and prevalence information gleaned from FY05 targeted evaluations.

In FY08, GHARP will continue to focus on addressing barriers that ultimately prevent men from accessing

services by conducting a situation analysis and developing an action plan to address identified issues with

strategies to better provide services to men. GHARP will continue to promote opportunities for male access

to VCT through community based outreach and workplace programs, peer education, community

mobilization, and mass media, as well as targeted programs for sports clubs, interventions for minibus

drivers, and male clinics. Working with its NGO/FBO partners, GHARP will continue to encourage couples

counseling in an effort to reduce transmission in sero-discordant couples and encourage faithfulness in

concordant negative couples. Additionally, GHARP strategy will include home-based C&T for families of

orphans and vulnerable children, persons on treatment, and persons identified through the PMTCT

program.

GHARP will continue to focus on integration of C&T into the basic package of support services at health

facilities in FY07. Currently, strong referral links are being developed at PMTCT sites for family-centered

counseling and testing at out-patient clinics using the same C&T staff and rapid testing technology. Focus

will be placed in FY08 on strengthening the established referral system between C&T, treatment, home-

based care, OVC, and all other public and private service points. Integration of provider-initiated C&T at

sites delivering diagnosis and treatment for TB, STIs, and HIV will be done in coordination with CDC/FXB as

they continue to provide the majority of site-support for these clinics. C&T services will also be integrated

into the outpatient and medical clinics of selected facilities and to in-patient services to capture clients

already seeking health services.

Abstinence and faithfulness education will continue to be integrated into C&T service provision as is

protocol when discussing risk reduction practices during counseling sessions. Prevention programs for the

high risk groups identified and reached through counseling and testing will follow ABC guidance and will

serve as an integral part of the package of services delivered. Prevention messages and programs will also

be delivered during the community mobilization efforts.

GHARP will collaborate with NAPS to initiate a Care for the Caregivers (offloading) program for health care

providers. GHARP will facilitate the formation of a counselors' network for each geographical area by

providing forum for interaction. Quarterly VCT meetings have already started and will continue with

counselor/testers from all the regions except regions 1 and 8.

Howard Delafield Inc. (HDI) is a partner company on the GHARP initiative, with responsibility for public

health marketing and communication material development. Their responsibility will be to support

community acceptance and health service-seeking behavior.

In FY07, HDI will have successfully launched "strength" campaign that redefines male's norms with the

objective of encouraging male responsibility for C&T and partner disclosure, extended the male "strength"

campaign to include miners and loggers, leveraged mining and logging companies to support demand

creation and service utilization among their employees, leveraged beverage companies to address

responsible drinking in the context of risk reduction, continued media placement of multi media campaign

promoting C&T titled "Knowing is Better", which consists of four TV public information spots, two radio

spots, two posters and a magazine-style brochure, and expansion of S&D campaign. This final campaign

aims to include audio testimonials of persons living with HIV to increase their social value; profiles of

businesses, communities, and individuals who are advocates or "butterflies" to PLHAs as well as develop

"hero" booklets featuring famous persons living with HIV and audio/video testimonials from celebrities

infected or affected designed to address stigma and discrimination at a personal level (e.g. the Barbadian

singer Rupee).

HDI will develop and cover costs for printing and reproduction of community outreach C&T print, periodicals,

advertisements, and focus heavily on providing the public health system and civil society with the materials

and skills needed for interpersonal communication (IPC). Materials will be developed to reach specific

target groups such as youth, males, couples, and will be tailored for both clients and providers so that

messages are conveyed effectively and will service to assist health care professionals in providing accurate

information as well as influence individuals to change their behaviors.

HDI also has expertise and a track record of engaging the private sector to support HIV/AIDS prevention

initiatives. In collaboration with GHARP and the International Labor Organization (ILO), the workplace

programs have been rapidly scaled up since the inception of the project. Through the private sector

partnership program, more than twenty two companies have established workplace programs to help

reduce and prevent HIV/AIDS, reaching approximately 12,000 workers during the last program year, linking

more than 400 workers to VCT and 300 to PMTCT. Approximately 10 workplaces have also established

HIV/AIDS workplace policies. The program's success has also been bolstered through the strategic

cooperation with the USAID/GHARP Workplace Coordinator and the Guyana Representative of the ILO.

HDI works to bring private sector on board, foster workplace interest and commitment as well as provide

direct support, while the ILO collaborates by supporting workplace programs and policy development.

Howard Delafield will also work with GHARP and the private sector to stimulate demand for C&T through

the workplace programs. The GHARP workplace program officer will continue to promote onsite C&T for

employees using the GHARP mobile VCT team as well as referring persons to NGOs and other public

sector testing sites as part of the comprehensive approach to workplace intervention programs.

To date, GHARP has been able to accomplish significant strides in the area of strategic information capacity

building, quality assurance, and reduction of parallel systems. GHARP has completed the review of M&E

system for PMTCT and VCT, strengthened the NGO M&E systems (including QA/QI and data validation),

completed mapping of sex worker population at the national level, completed two rounds of BBSS among

sex workers in Guyana, completed BBSS among non-injection drug users, designed and implemented

QA/QI system for VCT, PMTCT and HBC, and provided support at the national level for M&E in capacity

building.

The same level of support is needed within the NGO/FBO sector, and as such, GHARP will assist partners

in developing M&E work plans to accompany annual work plans and longer-term strategies. Frequent,

routine field visits and on-sight technical guidance will be dedicated to all NGO/FBO partners. This will also

assist in the data quality assurance work needed under the GHARP program. GHARP will assist NGO/FBO

partners to develop programmatic databases for monitoring processes and outputs.

Support is also required in FY08 to support the roll out of the QA/QI program for the various program areas

thus ensuring that, all programs have in place the necessary tools and SOP and that the programs are

delivered according to available national guidelines.

In FY08, outside of continuing the system strengthening of M&E units, officers, and on-site follow-

up/mentoring; GHARP will be focusing on conducting the second round of BSS with MSM, GUYSUCO

employees, members of the armed services, and in and out of school youth. GHARP will obtain CAREC

IRB clearance. Also, GHARP will focus on transferring the capacity, systems, and technology necessary to

support high-level M&E of NGO grant performance to Community Support & Development Services. This

indigenous firm will need to possess the capacity to take on the current level of strategic information and

technical assistance support that GHARP currently provides for the local NGO consortium.

FHI/GHARP will continue to technically support, but not implement, the annual civil society work plan

development process of its current 20 NGO/FBO partners. This process requires a great deal of mentoring

as the responsibility is shifted to Community Support & Development Services, focusing on the continuum

of transferring capacity to indigenous organizations.

With civil society programs having only been concretely established in the last ten years, building their

technical as well and financial and administrative capacity is a daily commitment and requires a significant

dedication of human resources, time, attention, site visits, mentoring, conflict resolution, and responding to

immediate needs and demands of the organizations. Hence, NGO system strengthening will continue to be

a priority as the role these community-based organizations are playing is critical across the continuum of

prevention, care and support. FHI/GHARP will assist Community Support & Development Services to attain

critical benchmarks in program cycles (proposal development, implementation, quality assurance, reporting)

as well as to facilitate a rapid-scale up of management systems for new NGO/FBO partners that are now

receiving funds and reporting requirements from several different streams.

Management Science for Health is the prime partner within GHARP for provision of technical assistance for

supporting the capacity strengthening throughout the year for Ministries of the Government of Guyana that

are funded through World Bank, human resource development programs for leadership and management

skills-building, and most considerably to focus its technical assistance on increasing the capacity of

Community Support & Development Services (the successful indigenous organization who will take on

increasing responsibility for the technical, capacity building, and financial management of NGO grants in

Guyana. This will require assistance, mentoring, and provision of administrative, management, and policy

support needed within civil society.

MSH will strengthen the human resource system within civil society and ministries (Ministry of Education;

Ministry of Culture Youth and Sports; Ministry of Labor, Human Services and Social Security; Ministry of

Agriculture; Ministry of Ameridian Affairs; and the Ministry of Local Government and Regional Development)

to create conditions that foster retention, effective performance, and supportive supervision through

Leadership Development workshops by building effective teams to collaboratively identify challenges and

problem solve, and enhance their engagement in HIV/AIDS effort.

MSH will also increase multi-sector coordination and planning in support of the World Bank project, continue

efforts to mainstream HIV/AIDS in the aforementioned ministries through:

• A targeted program of direct technical assistance (HIV/AIDS skills development workshops for line

ministry focal persons, development of M&E plans, program management, planning and budgeting

workshop)

• Work to deepen the engagement of line ministries in HIV/AIDS work by enhancing prevention and work

place efforts

• Strengthening the implementation of two of the ministry programs with focused attention and increased on

-site support aimed at ensuring the implementation of the line ministry project

• Providing targeted short-term direct technical assistance as requested by the HSDU in support of the

planning, implementation, and reporting of GFATM.

• Provide targeted direct technical assistance, as needed, to strengthen the Regional AIDS Committees

Family Health International, as the prime partner for GHARP, provides technical support, monitoring and

data quality assurance, program oversight and will report on MSH's program achievements.

Howard Delafield Inc. (HDI) is a small, woman-owned business that is the lead partner for USAID/GHARP

in private sector programming and in creating an environment free of stigma and discrimination. HDI has

expertise and a track record of engaging the private sector to support HIV/AIDS initiatives to address issues

of stigma and discrimination as well as private sector partnerships and policy development.

Over the past years, HDI/GHARP has built from success to success in an escalating manner. Initially,

achievements included: Citizen's Bank sponsored a physician and pharmacist to host monthly clinics in

Bartica (Region 7) to treat and screen patients for HIV/AIDS and tuberculosis; GT&T, Lotto, and IPED

collaborated to offer loans to persons living with HIV/AIDS to start small enterprises; Companies sponsored

mass media events to promote tolerance and sensitivity for persons living with HIV/AIDS; Work places

began to provide on-site voluntary counseling and testing by partnering with NGOs who are trained to

provide such services; Partners such as Scotia Bank and Citizens Bank have been actively involved in

monthly "Dress Down Days", in which employees wear pins with supportive messages for PLWHA and

partner NGOs staff awareness booths to distribute HIV/AIDS information in an environment free from stigma

and discrimination; and Several other companies have provided exemplary education and training for

HIV/AIDS prevention for their employees through GHARP and its partner non-profit organizations.

Then, HDI, in collaboration with GHARP and the International Labor Organization (ILO), established a

private sector business coalition with over 25 businesses. This coalition has formed a Private Sector

Advisory Committee headed by chief executive officers and human resource directors from each partner

and working group sub-committees, which focus on identifying and securing resources from other private

sector organizations, NGOs, and donors. The Advisory Committee serves as a forum for private-sector

partners to share best practices with each other, to continue to create partnerships, and foster leadership to

prevent and reduce HIV/AIDS in the workplace and community.

From this point, HDI/GHARP progressed further, to being on track to achieve all FY07 targets. More than

12,000 workers in the Private Sector have been sensitized to HIV/AIDS as a workplace issue. The recently,

eleven members and staff of USAID/GHARP and the Private Sector Advisory Board attended the 2nd

Forum of the Pan Caribbean Business Coalition on HIV/ AIDS in Port of Spain, Trinidad. At this forum

GHARP's Private Sector Partnership Manager delivered a presentation which highlighted Guyana's

successful Public/Private Sector partnership program. In addition, during the month of June, a five (5)

person delegation comprising Private Sector and GHARP officials participated in a Global Business

Coalition on HIV/AIDS, Tuberculosis and Malaria organized technical session that examined "Opportunities

to respond across the supply chain through awareness, education and access", in New York. Efforts will

continue to intensify this year to ensure that more workplaces adopt policies and programs aimed at

heightening awareness of the dangers which the disease poses to skills retention in the productive sector.

HDI's focus in FY08 will be to provide the Coalition with technical assistance to leverage and build strong

relationships with other donors and partners to support the further establishment and strengthening of the

Coalition. HDI will also actively support the development of a plan that will integrate GHARP and the ILO

workplace programs as one program, to be sustained after the expiration of the GHARP contract. Technical

assistance will be provided to develop the skills of the Board members in areas of: leadership development,

targeted education and skills building for committee specific requirements, strategic planning, and

leveraging additional private sector input. HDI will work to strengthen the relationship with the Pan

Caribbean Business Coalition and also with the Global Business Coalition (GBC) on HIV/AIDS through a

formal co-branding (GBC) with the Guyana Business Coalition on HIV/AIDS.

Family Health International, as the prime partner for GHARP, provides technical support, monitoring and

data quality assurance, and program oversight and will report on HDI's program achievements.