This is a new implementing mechanism.

PEPFAR Namibia will competitively award a single partner or consortium to promote normative change and adoption of safer sexual behaviors, with the aim of reducing new HIV infections among general population adults and youth. The new program will incorporate distinct activities in two sectors that will be closely coordinated by local partners during implementation: 1) media, and 2) comprehensive, community-based prevention. Activities under this award will provide coordinated social and behavior change communication and interventions to support sexual prevention, male circumcision (MC), HIV counseling and testing (CT), and prevention with HIV-infected persons.

This follow-on program responds to a headquarters review in March 2009 which found that many PEPFAR prevention interventions lack adequate structure and "dosage," and are limited in coverage to scattered sites across the country. Several existing prevention agreements that support media and community outreach are ending, including the NawaLife Trust agreement. This provides an opportunity to restructure the prevention portfolio to substantially enhance quality, geographic focus, and potential for impact.

The program will align with Government of Namibia (GRN) priorities and directly support the Prevention Thematic Area of the Partnership Framework, especially Objective 1 "Increase Social and Behavior Change focusing on the Key Drivers of the Epidemic." The recipient will participate in the Prevention TAC and implement activities falling within the national HIV prevention strategy.

The media component will be national in scope. This component will build capacity of the GRN to plan and manage an effective media program, while also providing implementation support for specific media campaigns and activities. The comprehensive community-based prevention component will focus on the northern zone of Namibia, which has the highest HIV prevalence and where two-thirds of the population resides. This component will build the capacity of regional and local-level GRN structures for program coordination and monitoring, while providing implementation support for a comprehensive, robust program of social and behavior change. Since USG resources are insufficient to provide national coverage of more intensive (and high cost) outreach and interpersonal approaches, implementation will focus selectively on priority regions and districts where the aim will be to provide "saturation" community- level coverage in conjunction with other PEPFAR and non-PEPFAR partners.

At the core of the strategy is support for effective implementation of an appropriate combination package that includes behavioral/social, bio-medical, and structural interventions with populations at high risk of infection in high incidence areas. These interventions will focus on: breaking the sexual networks that drive transmission; increasing consistent and correct condom use, especially in high risk sexual encounters and by HIV-positive persons; increasing the number of males who are circumcised; and increasing the age of sexual debut. The package of interventions will be based on evidence and use proven technologies and approaches. It will be grounded in local culture to address epidemic drivers through clear, specific, consistent messages and behavior and social norm change approaches.

A gender lens will be integrated into all activities, recognizing that cultural and gender norms reinforce key drivers of the epidemic such as multiple and concurrent partners and cross-generational and transactional sex. A high priority will be prevention for young adult women, who in Southern Africa have among the highest rates of HIV infection, together with efforts to influence norms, attitudes and behaviors of the adult

men who put them at risk.

The program will build capacity and leadership of the Namibian government and civil society institutions to plan and implement effective prevention interventions. The program will promote sustainability by engaging individuals, communities, and leadership in ways that enable them to feel ownership of activities and results. Key principles will include using resources effectively and strategically; achieving quality, scale and scope; strengthening systems; and using existing structures to ensure sustainability beyond PEPFAR. It will create synergies through effective linkages with other partners, programs, and activities.

Evaluation will focus on changes in individual behavior and social norms relating to rates of multiple concurrent partnerships, age mixing in sexual partnerships, transactional sex, condom use in different types of relationships, alcohol use related to high risk sex, sexual violence, as well as onset of sexual activity and secondary abstinence among youth. Evaluation efforts will seek to measure trends in estimated HIV incidence in program districts. The program will also assess the capacity of GRN leadership at various levels to use data and evidence for improved programming and to coordinate partners and institutions in a sustained effective prevention effort. USG Namibia will seek HQ support to design, fund and conduct a rigorous evaluation of this ambitious program.

This is a new follow-on activity.

This activity will build on COP09 demand creation activities with local partners in: 1) media, including related media campaigns, and 2) community outreach activities to support community mobilization.

In media and community outreach activities, the activity will initiate a comprehensive program to promote normative change and adoption of safer sexual behaviors, with the aim of reducing new HIV infections among general population adults and youth. Efforts will focus on refining existing materials, supporting events and promotions and additional language adaptations, and focusing on intensifying depth, breadth and dosage of HIV prevention activities and strengthening linkages to biomedical interventions.

In COP09 activities supported by Nawa Life Trust developed and implemented an umbrella communications and community outreach campaign to increase the overall uptake of HIV testing services in voluntary counseling and testing, the acceptance of provider-initiated counseling and testing, promoting acceptance of couples counseling and other models of HCT including outreach and mobile services. The key behavioral objectives were to mobilize persons that don't know their HIV status. Based on current findings from the implementation, this required increasing a sense of risk perception and decreasing fear of positive results among the target population as well as helping create convenient opportunities for testing. Activities were also structured to reinforce HIV prevention behaviours for those who complete HCT and are HIV negative.

In collaboration with various GRN and USG stakeholders, the recipient will target activities under this award to geographical focus areas where HIV counseling and testing coverage and access is below the national average.

1. Media activities will be coordinated with GRN and conducted on a national scale with the intent of supporting demand creation for HCT services.

2. Community outreach activities will build on past demand creation activities including related media campaigns and support to community mobilization. Efforts will be focused on refining existing materials, supporting events and promotions and additional language adaptations focusing on intensifying depth, breadth and dosage of HIV prevention activities and strengthening linkages to biomedical interventions.

Regular supportive supervision, distribution of standardized materials and monitoring visits will be undertaken by the USG and prime recipients to ensure that media and community outreach activities are being conducted to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions available and that data reporting is accurately reflecting progress against

PEPFAR indicators.

Sustainability components will include capacity building of local civil society and regional administrations to better coordinate and implement evidence-based HIV prevention strategies.

This is a new follow-on activity. This activity complements clinic-based investments in CIRC through other USG partners.

This activity consists of two main components: 1) promote normative change and adoption of safer sexual behaviors through media and community outreach activities associated with known epidemic drivers, and 2) build upon an existing MC communication strategy.

Background According to the NDHS (2006/07), approximately 21% of men aged 15-49 were circumcised by 2007. A total of 11% of the circumcisions were performed by a health worker at a health facility, while 4% were conducted by traditional health practitioners. 84% of the men were circumcised before the age 13. The available evidence does not show significant variations in the MC prevalence by age. Some variations were noted in the regions with estimates ranging from 6% in Caprivi to 57% in Omaheke.

1. This activity will promote normative change and adoption of safer sexual behaviors through media and community outreach activities associated with known epidemic drivers. Building on results of the Nawa Life Trust activities in COP09, local partners will conduct distinct media and community outreach activities that will support and reinforce normative changes associated with known epidemic drivers, including: multiple concurrent partnerships; inconsistent condom use; excessive alcohol use; intergenerational and transactional sex; and a lack of HIV testing and public awareness of HIV serostatus.

2. This activity will build upon an existing MC communication strategy, which includes demand creation strategies, informational campaigns for males and females to better understand the procedure, as well as positioning MC within the larger context of HIV prevention strategies to discourage inhibition. Expanding on basic materials developed or adapted to Namibia, the recipient will partners with other stakeholder to implement campaigns utilizing mass media. Local partners conducting media and community outreach activities supported under CIRC will participate in the National Male Circumcision Task Force. The task

force ensures a coordinated effort to develop and adapt non-clinical training, message development, and outreach models related to the promotion and demand creation of adult male circumcision.

The activity is closely aligned with the GRN's NSF priority of supporting advocacy strategy development and male circumcision campaigns to generate community acceptability and demand for MC.

Regular supportive supervision, distribution of standardized materials, and monitoring visits will be undertaken by the USG and its partners to ensure that media and community outreach activities are being conducted according to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions, and that data reporting accurately reflects progress against PEPFAR indicators.

Sustainability components will include capacity building of local civil society and regional administrations to better coordinate and implement evidence-based HIV prevention strategies.

This is a new follow-on activity.

The USG and GRN collaborated to detail known epidemic drivers in 2008/9.

PEPFAR Namibia will initiate a comprehensive program to promote normative change and adoption of safer sexual behaviors, with the aim of reducing new HIV infections among general population adults and youth. The award will provide coordinated social and behavior change communication and interventions to support sexual prevention, male circumcision (MC), HIV counseling and testing (CT), and prevention with HIV-infected persons. The new activity will incorporate distinct activities in two sectors that will be closely coordinated during implementation: 1) media; and 2) comprehensive, community-based prevention.

Media and community outreach activities will be closely coordinated.

1. Media activities will be on a national scale and will build capacity of the GRN to plan and manage an effective media program, while also providing implementation support for specific media campaigns and activities. Local partners conducting media activities will assess and adapt past campaign materials to address national audiences in selected areas of Namibia. Activities will continue to support the Ministry

of Information, Communication and Technology's (MICT) Take Control MCP program.

2. Community outreach will focus on the northern zone of Namibia which has the highest HIV prevalence and where two-thirds of the population resides. This component will build the capacity of regional and local-level GRN structures for program coordination and monitoring, while providing implementation support for a comprehensive, robust program of social and behavior change. Local partners conducting community outreach activities will adapt outreach materials and training guidelines previously developed under PEPFAR, strengthen community groups' implementation of structured prevention activities and implement a strengthened M&E system to support program management.

The behavioral change objectives include building skills for safe behaviors such as abstinence and delay of sexual debut, increasing perceptions of risk regarding multiple concurrent partnerships, increasing correct and consistent condom use, increasing risk perceptions of alcohol consumption, cross generational and transactional sex, and increasing positive attitudes for gender empowerment and male engagement.

Regular supportive supervision, distribution of standardized materials and monitoring visits will be undertaken by USG and prime recipients to ensure that media and community outreach activities are being conducted to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions available and that data reporting is accurately reflecting progress against PEPFAR indicators.

Sustainability components will include capacity building of local civil society and regional administrations to better coordinate and implement evidence-based HIV prevention strategies.

This is a new follow-on activity.

The new activity will incorporate distinct activities in two sectors that will be closely coordinated during implementation: 1) media; and 2) comprehensive, community-based prevention. PEPFAR Namibia will initiate a comprehensive program to promote normative change and adoption of safer sexual behaviors, with the aim of reducing new HIV infections among general population adults and youth. The award will provide coordinated social and behavior change communication and interventions to support sexual prevention, male circumcision (MC), HIV counseling and testing (CT), and prevention with HIV-infected

persons.

Building on results of the Nawa Life Trust activities in COP09 local partners will conduct distinct media and community outreach activities that will support and reinforce normative changes associated with known epidemic drivers including: multiple concurrent partnerships; inconsistent condom use; excessive alcohol use; intergenerational and transactional sex; and a lack of HIV testing and public awareness of HIV serostatus.

The USG and GRN collaborated to detail known epidemic drivers in 2008/9. Media and community outreach activities will be closely coordinated. Media activities will be on a national scale and will build capacity of the GRN to plan and manage an effective media program, while also providing implementation support for specific media campaigns and activities. Community outreach will focus on the northern zone of Namibia which has the highest HIV prevalence and where two-thirds of the population resides. This component will build the capacity of regional and local-level GRN structures for program coordination and monitoring, while providing implementation support for a comprehensive, robust program of social and behavior change.

The behavioral change objectives include building skills for safe behaviors such as abstinence and delay of sexual debut, increasing perceptions of risk regarding multiple concurrent partnerships, increasing correct and consistent condom use, increasing risk perceptions of alcohol consumption, cross generational and transactional sex, and increasing positive attitudes for gender empowerment and male engagement.

Local partners conducting media activities will assess and adapt past campaign materials to address national audiences in selected areas of Namibia and continue to support the Ministry of Information, Communication and Technology's (MICT) Take Control MCP program. Local partners conducting community outreach activities will adapt outreach materials and training guidelines previously developed under PEPFAR, strengthen community groups' implementation of structured prevention activities and implement a strengthened M&E system to support program management.

Regular supportive supervision, distribution of standardized materials and monitoring visits will be undertaken by USG and its partners to ensure that media and community outreach activities are being conducted to standards established by the GRN and USG, that linkages are strengthened to biomedical interventions available and that data reporting is accurately reflecting progress against PEPFAR indicators.

Sustainability components will include capacity building of local civil society and regional administrations

to better coordinate and implement evidence-based HIV prevention strategies.