Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 8616
Country/Region: Uganda
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $90,587

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $90,587

Through a COMFORCE contracting mechanism this Senior Technical Advisor based at PREFA, will continue her work previously funded through JHPIEGO to strengthening PREFA's capacities in multiple areas related to PMTCT. Specifically, the principle emphasis areas addressed by this support are in training, local organization capacity development, strategic information, and policies and guidelines. The PMTCT technical advisor has a broad technical assistance scope of work that covers building the technical, administrative, and managerial capacity of the NGO, improving quality assurance, accessibility and overall increase in uptake and follow-up of PMTCT services at PREFA facilities.

Table 3.3.02: Program Planning Overview Program Area: Abstinence and Be Faithful Programs Budget Code: HVAB Program Area Code: 02 Total Planned Funding for Program Area: $ 14,012,126.00

Program Area Context:

As sexual transmission remains the key driver of HIV transmission in Uganda, USG supports a strong focus on Abstinence and Being Faithful (AB) as part of USG's comprehensive HIV/AIDS program. In FYO7, USG partners will consolidate their AB educational and counseling efforts to and strengthen their comprehensive prevention planning to reach youth and the general population appropriately. The Government of Uganda (GOU) has renewed its emphasis on HIV prevention and declared 2006 the "Year of Prevention". This renewed commitment to prevention is grounded in evidence showing that HIV prevalence and incidence rates are stabilizing, rather than declining. The Uganda HIV/AIDS Sero-Behavioural Survey (USHBS) reveals a 6.4 percent HIV prevalence among the adult population. USHBS data, combined with the Ministry of Health (MOH's) estimated 135,000 new infections in the last year, has fueled concern that Uganda's success to date could be threatened. As a result, the GOU formed a National HIV Prevention Committee to identify priority issues strategies, and actions. The Committee also commissioned special reviews to establish the current drivers of the epidemic and launched a Road Map to accelerate prevention by focusing on the main drivers. UHSBS results and other data point to sexual transmission as the predominant mode of HIV transmission in Uganda, and the key driver as high risk sex (defined as multiple concurrent partners and unprotected sex). GOU prevention priorities, identified in response to the studies, include behavior change for risk reduction and risk avoidance, counseling and testing, PMTCT, integration of HIV prevention into care and treatment, post exposure prophylaxis, condom availability, prevention of STIs and promotion of protective social norms. The National HIV Prevention Working Group will be tasked with developing a comprehensive prevention strategy that includes these priority areas. The GOU's development partners have also pledged their support to increased prevention programming, particularly through the Partnership Fund. In FY07, USG is supporting comprehensive prevention programming across its program areas and implementing partners. These activities will be aligned with the Road Map for Accelerated HIV Prevention, as well as global OGAC guidance in prevention programming. Specifically, USG will support HIV prevention strategies that target youth, the general population (particularly men), and high risk groups, and those that address the social and gender norms underlying risky sexual behavior. The USG portfolio includes comprehensive ABC programming approaches that are balanced differently as they are applied and tailored to specific groups, behaviors, and underlying factors. Recently available evidence shows both positive and negative trends in AB behavior. Women, especially young women, are increasingly delaying the age at first sex. However, this trend is not as clear among young men. Data also show that 50 percent of never married men and 64 percent of never married women aged 15-24 have never had sex. In view of these positive trends among young people toward delayed debut and increased abstinence, USG in FY07 will consolidate and strengthen its existing abstinence programs among young people 10-19 year olds, through a combination of school-based and out of school programs, media, and community approaches. Programs will continue to support the Ministry of Education and Sports to reach more students in primary schools USG will also support the roll out of President Museveni's PIASCY initiative to the post-primary students and educational institutions, with a strong teacher training component, and age appropriate comprehensive prevention messages, skills, and activities. In addition to this institution-based approach to HIV prevention, USG will support a large number of civil society and faith-based organizations working at community level to reach out of school youth through peer education, information, education, and communication approaches, drama, and local radio programming. Approaches and activities to reach higher risk youth will be programmed under the AB and OP program areas to ensure that their particular vulnerabilities and behaviors are appropriately addressed. USG will also support the Ministry of Gender, Labor and Social Development (which is also the youth ministry) to strengthen its ties with civil society through a mechanism of grants to local NGOs. Also, a number of partners will intensify programs in university populations, where there is anecdotal evidence of increased transactional and cross generational sex and alcohol abuse, all behaviors which increase HIV transmission risk. On the negative side, an MOH conducted trend analysis shows that certain positive behaviors are sliding

backward from the late 1980s. In particular, there is an increase in casual sex, an increase in multiple partners, and a recent decrease in men's condom use with casual partners. According to a secondary analysis of faithfulness data, 88 percent of men are not lifetime faithful, compared to 56 percent of women, and only 10 percent of couples. A burden of disease analysis of the UHSBS data finds that multiple partners and genital herpes are two key drivers. In addition, a BED assay found that, compared to those with one sex partner in the last 12 months prior to the survey (recent faithfulness), those with two+ sex partners had twice the risk of acquiring HIV. All of the studies demonstrate clear gender disparities cutting across risky behaviors, with men more commonly engaging in sex earlier and with more partners. Given these results, USG objectives within the AB program area includes an increasingly strong focus on the critical role of partner reduction, faithfulness, and the underlying gender disparities that sanction this behavior. Recognizing the importance of the data on male behavior, particularly multiple partners, several of the USG's Track 1.0 AB/Y grantees have incorporated messages for men in their programming and have coordinated with the USG-supported "B a Man" campaign for assistance in working with men, training of group facilitators, and developing appropriate communication materials. In FY07, USG supported partners will intensify educational and counseling efforts in community outreach, counseling and testing programs, and work-based activities. These efforts will increase understanding of the behaviors and practices that reduce the risk of HIV infection.

Program Area Target: Number of individuals reached through community outreach that promotes 3,638,951 HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that promotes 8,080,411 HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention programs 35,198 through abstinence and/or being faithful

Table 3.3.02: