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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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.
Justification: Through the CR process it was discovered that PSI/SMA had a significant FY 06 pipeline for both VCT and Prevention (HVCT, HVAB and HVOP). In the past there have been concerns expressed by the COP technical review committee regarding the high cost of individual client testing at the community VCT Testing Centers (New Start) supported by SMA/PSI with funding, technical assistance and supervision. In addition, and as a result of increased monitoring by the USG, some performance issues have been identified. As a result of the above, a decision was made to move funding for FY 07 service delivery of community VCT to IntraHealth/The Capacity Project which already manages 5 of the 15 currently operating community VCT centers. Because of the remaining pipeline, it is not anticipated that SMA/PSI will need additional funding for FY 07 to maintain its prevention programs.
Cross-generational sex is the practice of older men having sex with young women and girls who need/want basic necessities and some extras such as food, rent, school fees, nice clothing, cosmetics, etc. This practice is a key factor driving infection rates among young women, whose infection rates are consistently higher than their male peers. Targeting young women and girls, their families and communities and the men with whom they are having sex will constitute a multi-faceted intervention with several USG implementing partners utilizing interpersonal and strategic communication, national and multi-media and provision of concrete income generation opportunities. Originally, Social Marketing Association (SMA) had planned to focus on the prevention strategies of abstinence and being faithful to reduce the occurrence of cross-generational sex working with young women and girls and their families in border communities. However, there has been a significant course correction in programming as a result of issues emerging from the USG Prevention Workshop in June 06 regarding expanding male involvement.
The Cross-Gen program will be modified with the addition of a new partner with gender expertise, substantially more involvement of community-based USG partners, more emphasis on the responsibility of men and the addition of a micro-credit component. SMA will now work with other USG implementing partners to support them in utilizing and integrating the findings of the formative research focusing on abstinence, secondary abstinence, fidelity, partner reduction and other prevention strategies as appropriate (see also Other Prevention), to identify and target young women and girls at risk for cross-gen/transactional sex as opposed to commercial sex, and to contribute to the strength of the overall Cross-Gen program through its comparative advantage and significant experience in working with border communities through Health Awareness Days and training. Targets: 15,000 young women and girls in their communities, 59,500 men through SMA's program targeting Namibia police and border officials (see also Other Prevention) and training 147 community-based partner staff and community members to promote HIV/AIDS prevention through abstinence, secondary abstinence, fidelity, and partner reduction. Programming will also leverage a formal relationship recently developed between PSI (SMA parent) and the African Union (AU) to address cross generational sex in 8 target countries across the continent. The goal of the Namibian component of the program ‘Wake Up Namibia' will be to increase understanding of the dangers of cross-generational sex by young women, their families and communities, to reduce societal acceptance of the practice to reduce peer pressure and to increase a young women's sense of self-worth and self-risk. During the first year, the program will explore opportunities to involve community counselors, church and community leaders, and school professionals to determine how best to support these young women and girls, e.g., micro credit, training for employment opportunities, and income-generation activities. In addition, "Being Faithful" SMA's HIV/AIDS prevention and education program with the Namibian police PolAction program will include components on cross-generational sex as an unacceptable practice and on the importance of faithfulness in marriage and committed relationships. Focus groups will be conducted with the police to further explore attitudes towards cross-generational sex and faithfulness. Workshops will be conducted with police HIV focal persons from all regions in order to develop an understanding of the issues surrounding faithfulness and commitment, the importance of communication within marriage, the sexual and legal rights of women and the practice of cross-generational sex. Facilitators will be drawn from the Legal Assistance Centre, the Council of Churches in Namibia and experts in the field of marital relations. Trainees will incorporate workshop information into their on-going work as peer educators in the regions. Materials will be developed to support these activities such as a peer educator handbook.
Internal economic migration, male norms and low socio-economic status of women, are drivers in multiple sexual partners and transactional sex/cross-generational "sugar daddy" relationships which are key factors in the spread of HIV infection in Namibia despite a relatively high awareness of HIV risk factors and prevention methods.
Social Marketing Assosciation (SMA) implements programs addressing these factors: Borders of Hope, working with most-at-risk-populations (MARPs), e.g., economic migrants, transport workers, informal traders, and commercial sex workers; PolAction working with the police and border officials; and Cross-Gen, working with young women and girls, their families and communities and the men with whom they have sex. The overall purpose of all of these programs is to move beyond awareness raising and education to developing an internalization of personal risk and assimilation of behavior change, through community mobilization and community based behavior change activities, targeting these populations to adopt one or more risk reducing behaviors such as secondary abstinence, faithfulness, partner reduction, condom use and counseling and testing (CT).
Originally, SMA had planned to focus on AB prevention strategies to reduce the occurrence of cross-generational sex (CGS) working with young women and girls and their families in border communities. Due to focus group formative research in FY06, the Cross-Gen program will be modified to be more conmprehensive in nature with the addition of a new partner with gender expertise, substantially more involvement of USG community partners, more emphasis on the responsibility of men and the addition of a micro-credit component (see Systems Strengthening). The program will involve a multi-faceted intervention with several USG implementing partners utilizing interpersonal and behavior change communication, national media and provision of concrete income generation opportunities. SMA will support other USG partners in utilizing and integrating the findings of the formative research focusing on comprehensive prevention strategies as appropriate (see also AB), to identify and target young women and girls at risk for cross gen/ transactional sex as opposed to commercial sex, and to contribute to the strength of the overall Cross-Gen program through its comparative advantage and significant experience of working with border communities with the Health Awareness Days (HAD) activity and training.
Activities include: 1) Working at borders, in, bars, police camps, secondary schools and with communities through the Traditional Authorities in high transit areas utilizing community-based health educator teams to conduct educational drama sessions, educational videos, question and answer sessions, condom demonstration and distribution (no demonstration or distribution in schools); 2) Training Traditional Authority council members on how to address behavior change from within their existing cultural structures; 3) Demand creation and referral services for CT, PMTCT and ART services utilizing local home based care and/or PLWHA support groups. Referral to CT will be monitored via client intake records at New Start Centers with the centers then monitoring onward referral to ART and PMTCT; 4) Development of messages and tools utilizing interpersonal and behavior change communication and national media to reach girls and young women, their families and communities and the older men with whom they have sex; 5) Building sustainable partnerhsips- JHU and DAPP comunity partners to identify high risk young women and girls, HAD training, and Project Hope income-generating activities offering an alternative to cross-gen sex/transactional; 6) Targeted social marketing of male condoms and MoHSS free condoms will also be distributed through SMA channels.
Targets: 59,500 MARPs through community and BC activities; 7,500 young women and girls and 60,000 men and community members through police and cross-gen activities and 700,000 condoms by social marketing.
PolAction, a workplace initiative with the Namibian police, begun in FY05. SMA will expand upon the lessons learned of PolAction. The police force is primarily comprised of men, providing the opportunity for addressing harmful male norms, gender violence and alcohol abuse by modifying their own behavior and supporting efforts to remedy these problems within the communities in which they service and promoting male involvement in PMTCT,
partner testing and ART.
Activities include: • Creating an enabling environment through the sensitization of high-ranking officers, by training and expert speaker seminars; • Edutainment teams conducting 5-7 hour edutainment sessions at all police stations, camps and bases across the country in an effort to bring the messages to the local level. Topics include balanced prevention, PMTCT, ART, CT, condoms, gender violence, alcohol abuse and addressing male involvement with an interactive booklet called "What can men do about HIV?" which explains male responsibility in decreasing the spread of HIV. • Weekly liasing by PolAction staff with the Gender Welfare department of the Namibian police. The team will advocate for high level commitment to improve reporting of gender violence and the functioning of the Women and Child Protection Unit to improve reporting to the database that Ministry of Gender Equality and Child Welfare (MGECW) maintains including monitored referral of victims of gender-based violence to health facilities, PEP, and counseling services. • Creating demand for testing and developing access strategies for CT, e.g., transportation to testing sites; • Free MoHSS condoms will also be distributed; • Supporting the development and implementation of an HIV/AIDS policy;
Many societal factors contribute to cross generational sex. SMA in partnership with JHU, the DAPP and Project Hope will focus on two key challenges in addressing cross generational sex in Namibia: 1. family and community acceptance of the practice. In FY06 SMA publicly opened the door on this subject through public service announcements (PSAs) and radio messaging targeting young women and girls and their families and older men; 2. engrained perceptions regarding masculinity which contribute to risk taking sexual behavior by men as men have been identified as both "the solution" and the origin of the problem.
In FY07 and based on focus group discussions, SMA will support partners to address: 1. Low levels of awareness among girls regarding the health risk involved with cross-gen sexual relationships; 2. Perceptions that pregnancy overshadows the threat of HIV; and 3. the belief that HIV infection is easily identifiable.
SMA will develop an interactive workbook for vulnerable girls combining information and guidance with culturally relevant examples. The workbook can be used in group or individual sessions. SMA CGS and PolAction teams will develop in partnership with USG community partners a "What can men do about HIV?" work booklet which will outline male responsibility in decreasing the spread of HIV. The content will challenge current notions of masculinity and illuminate the risks of CGS to men and their families.
Targets: 52,500 men (police, military and men in high transit areas), 15,000 vulnerable girls, 300,000 adults and young women through mass media campaign and, 100 stakeholders through consultative and sharing stakeholders' workshop.
Through the CR process it was discovered that PSI/SMA had a significant FY 06 pipeline for both VCT and Prevention (HVCT, HVAB and HVOP). In addition, and as a result of increased monitoring by the USG, some performance issues have been identified. Funding for FY 07 service delivery of community VCT is moved to IntraHealth/The Capacity Project which already manages 5 of the 15 currently operating community VCT centers.
Through the CR process it was discovered that PSI/SMA had a significant FY 06 pipeline for both VCT and Prevention (HVCT, HVAB and HVOP).(Funding reduced to 0 from $3,381,103.) As a result of continued USG support for the extension and expansion of C+T services, the New Start network has seen dramatic increases in client numbers- the total number of clients counseled and tested rose from 13,425 in 2004 to 31,061 clients in 2005. Average New Start client flow has grown to over 4,000 clients per month during FY 06. In response to this period of rapid expansion, The Social Marketing Association (SMA) proposes to consolidate existing C+T activities in 2007, and strategically focus on quality of service delivery. By strengthening the existing New Start C+T systems and operations, SMA aims to substantially increase C+T numbers at existing sites and when MoHSS mobile testing guidelines and rollout are approved. Quality service will mean complying with the national standards, regular supervision, regular refresher training, clear guidelines and protocols and above all attention to the psychosocial and referral needs of the clients. Quality service delivery will be complemented by aggressive demand creation initiatives, which will target men, particularly men as partners, and specific campaigns will be developed to address the current and significant gender imbalance. The New Start Centers' counseling sessions will be utilized as a platform to implement personal behavior change strategies, with emphasis on messages for reduction of partners, fidelity within partnerships and the issues surrounding discordant couples. PEPFAR funds will continue to leverage support from the Department for International Development (Dfid) for establishing PLWHA support groups at selected C&T sites.
SMA will continue provision of HIV counseling and testing through stand-alone centers, integrated hospital C+T services and mobile C+T, as and when approved by the MoHSS. FY 07 funding will support demand creation for C+T services through innovative mass-and-multi media campaigns; continued organizational and technical capacity building of local FBO/NGO partners. Discussions have already started with MOHSS to partner with SMA in developing regional referral networks through the existing structures in the community. A mapping exercise will be done of all the referral points in a region. The result will be a map that indicates: available services, their location and the service providers to provide choice for the clients. Networking with Regional HIV/AIDS Coordinating committees (RACOCS), leveraging EU support, and with NANASO, the AIDS NGO umbrella organization, referral directories reflecting regional level support services will be distributed at. VCT centers. Quality assurance will be monitored and evaluated through a variety of strategies, including regular supervision and records review, direct observation, mystery client surveys, suggestion book, exit interviews, and analysis of routine data. Staff will be trained to use new and updated monitoring tools and techniques.
SMA also aims to increase capacity and accountability among New Start franchise partners; key to this approach will be requiring the designation of a VCT focal person within each partner organization. New management and technical protocols have already been established, which place increased emphasis on recruiting and retaining professional staff, in order to enhance overall quality of service.
In support of its goal to counsel and test 65,000 new clients in 07, SMA will implement a behavior change communication strategy focusing on first time testers, couples and increased male testing. It is hoped that 95% of those tested will be first time testers and that the number of couples tested will at least double from 8% to 16%. SMA will work in partnership with the Ministry of Information and Broadcasting's (MIB) Take Control national media campaign and Nawa Life Trust/JHU to develop targeted messages promoting C+ T services utilizing mass and multi-media. New Start community radio programming will focus on male involvement in HIV prevention, services and partner reduction. Interpersonal communication prevention strategies will be implemented to reinforce behavior change among New Start clients. These strategies will include group education discussions and the use of visual aids, particularly flip charts in the counseling rooms.
SMA will more actively use community mobilization to bring first time testers to the centers with the aim of increasing risk perception and motivation among individuals and community groups to access services. Each VCT partner organization will have a dedicated community mobilizer and use SMA standardized community mobilizing practices. As a pilot
activity and until mobile outreach to rural areas is approved by the MoHSS, low income clients will be provided with transportation to selected centers twice monthly. SMA community mobilization teams will reach high risk groups through Health Awareness Days (HAD) which provide a unique opportunity to impart C+T information to those living in rural areas. SMA will also collaborate with JHU in areas where there are Community Action Forums (CAF) and VCT centers so that C+T mobilization activities can be carried out in coordination and conjunction with CAF activities (See Condoms and Other Prevention section), allowing for coordinated C+T message and information dissemination at a local/regional level.
With technical guidance and support from CDC, SMA has developed a MIS to capture and conduct analysis of New Start data There is a need to strengthen it to meet increasing demands of an expanded C+T program. The current Epi Info system will be upgraded to a more user-friendly and accessible "windows environment". The SMA MIS team will collaborate with the CDC and the Safe Injection Track 1 partner to obtain data from client intake records regarding interest in male circumcision.
SMA will continue as the overall coordinator of the New Start VCT partner network and provide technical assistance to build franchise partners' capacity to provide quality services.
With DFID support, SMA and its VCT partners have established 5 Tusano post-test clubs (PTC) in areas of high prevalence; Katima, Walvis Bay, Rundu, Katutura and Oshakati. With PEPFAR funding, SMA will conduct focus groups with PLWHA to determine what services would lead to a greater participation in post test clubs. A pilot activity will be initiated based on the formative research to meet the complex psycho-social support and palliative care needs of PLWHA. The pilot activity in the Walvis Bay MPC and the CAA Tonateni Center will be run and managed by specialist counselors who will provide clients with comprehensive information referrals and counseling on a preventive care package as well as individual and group counseling sessions on treatment and care options, disclosure, and risk reduction strategies following CDC "prevention with positives" model which will be adapted for community use in 07 by Nawa Life Trust/JHU. Additional counselors will be recruited and trained for the pilot post-test clubs initiative.
Through partnerships with the Legal Assistance Centre, Ibis, and Tusano PTC, the USG will leverage advocacy and media training for PLWHA members, which provides the tools and capacity allowing PLWHA to tackle stigma and discrimination at the grass roots level.
SMA will ensure a gendered approach to post-test service prevision by undertaking a qualitative needs assessment to identify the support needs of men and women. Future strategies to meet the gendered needs and perspectives of post-test clients are likely to include strengthening linkages with men and women's support and advocacy groups, conducting gender-specific counseling sessions, engaging men as partners for PMTCT, and reaching men in non-traditional settings (e.g. sports clubs).