Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 5139
Country/Region: Haiti
Year: 2007
Main Partner: Population Services International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $925,000

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $625,000

Linked to Activities 9346, 9281, 9260, 9273, 9327, 9937.

SUMMARY:Recent preliminary data from the DHS 2005 shows that condom use in Haiti has decreased. The data indicates that condom use among never-married women - 98% of whom are sexually active - is barely 30%. Condom use among 15-24 year old youth is even lower, putting them at risk to both HIV infection and unwanted pregnancy. The PSI/Haiti program will seek to ensure that condoms are widely available to these - and other - high-risk groups. The specific groups targeted under this program include: Commercial Sex Workers (CSW); youth (15-24yrs); and sexually active men in the general population (25-49yrs). PEPFAR will support: 1) strategic positioning of condom distribution to improve distribution of socially marketed condoms through the private sector; 2) improving coordination of condom distribution with the public sector; and 3) increasing demand and use of condoms among Most at Risk Persons (MARPS).

BACKGROUND: PSI/Haiti has a condom marketing and distribution program previously funded by PEPFAR. PSI seeks to provide affordable, high-quality condoms to segments of the population that are not effectively served by public and commercial sector sources. These condoms are branded and sold at highly-subsidized prices using commercial distribution systems across the country. PSI has partnered with UNFPA and other partners to support the Ministry of Health (MOH) in developing a national condom distribution system for targeted populations. PSI will also continue to work with the MOH and with other donors to reinforce branded communications campaigns aimed at increasing demand and addressing barriers to condom use.

ACTIVITIES & EXPECTED RESULTS: ACTIVITY 1: PEPFAR will support expansion of strategically positioned condom outlets to improve the effective distribution of socially market condoms to meet new and existing demand. In FY06, PSI supplied condoms for resale in about 450 outlets nationwide with sales of 4 million male condoms and 50,000 female condoms. In FY07, PSI will add an additional 150 condom outlets to its network for a total of 600 outlets nationwide.

In order to increase the number of access points, PSI is undertaking a Measuring Access and Performance (MAP) study. Special attention will be given to targeting outlets in departments with higher HIV prevalence rates such a in Nippes and the North Departments with rates at 3% each and in the Northeast with 2.7% HIV prevalence according to the 2005 DHS. In addition, PSI will enroll more large scale private distributors and will hire 4 additional sales agents for a total of 10 agents to be strategically deployed throughout the departments. They will be responsible for opening new outlets, coordinating promotional activities within their sales areas, monitoring sales, re-supplying distributors and monitoring quality assurance. During promotional events, agents will conduct condom demonstration sessions where messages about condom efficacy, risk reduction and correct and consistent condom use will be emphasized.

ACTIVITY 2: Support and technical assistance will be provided to improve coordination with public sector condom distribution. This assistance will improve the coordination of condom distribution with the public sector and ensure that all market segments - including people living with HIV/AIDS (PLWHA) - have access to condoms from the appropriate source. PEPFAR will support the development of networks and linkages between condom social marketing, the private sector, and the public sector (primarily UNFPA and the MOH) to increase condom distribution coverage and efficiency throughout Haiti.

PSI and UNFPA are working together to define in which settings/activities generic versus branded condoms are appropriate. VCT and STI clients using public health sites will receive free condoms supported by the MOH. Overtime, the health agent will refer the client to outlets stocking socially-marketed condoms for future supplies, as appropriate. Special emphasis will be placed on ensuring that free condoms are available to PLWHA either from public sector sites, or from NGO partners that work with PSI.

ACTIVITY 3: In 2007 PSI will combine condom social marketing and better audience targeting increase condom use among most at risk groups. PEPFAR will support scaling up, targeted condom and other prevention messages through behavior change communication (BCC) activities to improve personal risk assessment, partner reduction,

fidelity, prevention for positives, and correct and consistent condom use. Building on analyses of the 2005 DHS, PSI will target its condom and other prevention efforts among MAPRS and the general population as follows:

CSWs: In FY07, 100 peer educators (former and current CWS) will be trained to provide information to CSWs on reducing high risk behavior. Linkages will be made with FOSREF CSW program. PSI will a pilot a CSW intervention with street sex workers ("Trotteuses") posted at known streets in Port au Prince and other urban hot spots. Twice a week, a mobile video unit vehicle will target the "Trotteuses" with key prevention messages, including increasing condom use, referrals to VCT and STI services. It is anticipated that 50 street sex workers will be reached each month, and 20,000 CSW workers will be reached through this activity.

Youth: Working in collaboration with FOSREF, PSI currently has 100 peer educators working with in-school and out-of-school youth under a program branded Project SAJ. This program is funded by KfW and the Global Fund. PSI will use COP07 funds to expand this network of peer educators to 250, and extend their reach to Limbe, Pilate, and Plaisance. These 3 communes are located in the North where prevalence levels are higher than the national average and where FOSREF, VDH and other partners do not have a presence in these areas. Youth Peer Educator will provide IEC to their counterparts to delay sexual debut, practice safe sexual behaviors including condom use and assist in developing personal risk-reduction. Support will be provided to plan and organize education and entertainment activities such as sporting competitions, music, dance, and participative theatre as well as promotion activities during World AIDS Day (December 1), Halloween (Nov. 2), World Youth Day (Aug. 12), the Carnival, and other special occasions that draw crowds, especially youth in Haiti. It is estimated that the expanded peer educator activities will reach over 10,000 youth with age-appropriate messages on risk assessment, condoms and prevention.

Men and the General Population: Given that Haiti has a "mixed" epidemic, the social marketing program will strategically target condom prevention messages to both men and the general population. While many new infections are likely driven by most-at-risk populations including CSW, mobile workers, and out of school youth engaging in transactional sex, there are huge challenges to more strategically target men with multiple partners. Data from the 2005 DHS point to a feminization of the epidemic--indicating HIV transmission is moving beyond MARPS and into the general population. The feminization of the epidemic points to the need to better target men and young boys with messages to increase the correct and consistent condom use and reduce high risk sex. PEPFAR will support interventions that better target men with prevention messages which include personal risk assessment, partner reduction, condom use, intergenerational sex, gender based violence and women empowerment issues. In 2007, PSI will launch selected mass media campaigns and mass events targeted to men in the general population. It is anticipated that over 20,000 men will be reach through this activity.

TARGETS: • 6 million male condoms and 50,000 female condoms distributed to up to retail outlets

Funding for Testing: HIV Testing and Counseling (HVCT): $300,000

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