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.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
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
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
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.
Years of mechanism: 2007
Understanding the Contribution of Concurrent Sexual Relationships to the HVI Epidemic
Rationale: The 2006 UDHS found that 36% of married women were in polygamous marriages an indicator
for concurrent relationships. In the same survey, 28% of men reported having had sex with two or more
partners in the preceding 12 months. The spread of sexually transmitted infections (STIs), including HIV, is
much more rapid under conditions of concurrent partnerships. The pattern of concurrency, the duration of
overlap, and the frequency of sexual relations with each partner, also have significant implications for the
spread of the epidemic. The high rates of concurrent relations suggested by the DHS needs to be
addressed as part of the prevention strategy for HIV in the country.
Objectives: This formative assessment will generate strategic information on factors that contribute to the
extent and pattern of concurrency in sexual partnerships. In addition, a formative assessment will examine
the ways in which legal, religious, or other institutional factors facilitate or inhibit the formation, maintenance,
and the ending of sexual relationships, and the prevalence of concurrency.
Design: A randomized, cross sectional population based survey is planned. Both quantitative and
qualitative methods including in-depth interviews and/or some focus groups will be used in this assessment.
Setting: (location: community, facility, etc.)
This will be a community based survey. The communities to be included in the survey will be selected using
results from the UDHS to ensure that there is representation of communities where concurrent relationships
are likely to be encountered. Participants: (In/exclusion criteria, sample size)
At the community level women and men 15-49 will be interviewed about their sexual relationships and
factors influencing the formation and sustenance of the relationships. The sample size will be determined to
allow for comparison of responses by age, sex, and socio economic status.
Methods: Study variables will include explanatory factors including individual-level variables (biological,
psychological, demographic, and socioeconomic); partnership-specific characteristics; and social, cultural,
and economic characteristics. The latter may include such factors as family influences, social networks,
characteristics of "sexual market places," community norms, cultural expectations such as bride wealth or
dowry, job and housing markets, and public policies.
Outcomes: The strategic information generated through this formative assessment will contribute to the
development of enhance STI and HIV-prevention interventions, particularly among most-at-risk populations
(MARPS). Lessons learned will inform ongoing activities through the Regional Outreach Addressing AIDS
through Development Strategies (ROADS) project and HIV prevention programming with MARPS along
high prevalence transport corridors in Uganda.
Timeline: (Total time of data collection) 1 year
The introduction of male circumcision (MC) as an HIV prevention measure requires that safety be
paramount. Working with traditional practitioners to integrate them into a comprehensive MC rollout and
scale up strategy leverages an established healthcare delivery system, particularly for rural Ugandans.
Family Health International (FHI) will partner with the Traditional and Modern Health Practitioners Together
Against AIDS (THETA), a local NGO which aims to improve the health of rural Ugandans by involving
traditional health practitioners through training in health education, counseling, and in community support
initiatives. FHI will work with THETA to develop and implement strategies for leveraging traditional MC
practices as an opportunity to provide a more comprehensive package of HIV prevention interventions and
reproductive health messages. It is anticipated that results of this pilot intervention will inform policy
dialogue for male circumcision in Uganda.
Based on the results of three randomized trials in South Africa, Kenya and Uganda, the WHO and UNAIDS
have issued a set of recommendations for the use of male circumcision in HIV prevention efforts. The
document concludes that the evidence that male circumcision reduces the sexual transmission of HIV from
women to men by 60% is compelling enough to recommend it as an efficacious intervention for HIV
prevention (WHO/UNAIDS, 2007) The document also recommends that programs be implemented in
populations where the prevalence of heterosexually transmitted HIV infection is high and male circumcision
rates are low. The HIV and MC situation in Uganda is precisely as described in the WHO/UNAIDS
In Uganda, traditional circumcisers play an important role as healers and opinion leaders. However,
traditional circumcisers may lack formal, medicalized training, may perform circumcisions in an un-sterile
environment, and may even increase the risk of blood-to-blood transmission of HIV by using the same
instrument for more than one young man during MC ceremonies. Despite medicalized training, A 1999
study in Uganda found that 90% of study participants were circumcised by traditional or religious ‘surgeons'
and only 10% had the procedure in a hospital or clinic. Given the severe shortage of trained medical
personnel and the apparent acceptance of traditional MC in Uganda, there are challenging ethical dilemmas
in not integrating traditional practitioners into a coordinated and comprehensive response. Because of the
insufficient health care services in rural communities, traditional circumcisers may need to be included in
training opportunities to promote HIV prevention through appropriate risk reduction counseling, referrals and
linkages to clinic-based MC procedures, mainly.
Despite the urgent need to provide safe, voluntary MC to those most at risk, significant challenges remain.
First, there is no unified training curriculum or surgical guidelines for those providing traditional MC
procedures. In the absence of a national standard, misunderstandings and mistrust may arise from
Western-trained physicians. One thing is clear - there is no integration of clinic-based and traditional MC
services in Uganda. Thus, the second challenge, little communication between the two healthcare delivery
systems, must be understood to develop an effective referral and counter-referral system. Third, traditional
practitioners may be the only provider in rural areas, and are often well respected members of society.
Their role as opinion leaders is critical in ensuring correct information and proper counseling are available to
their clients and communities. The critical issue of proper wound healing, for instance, is a major challenge
that traditional circumcisers might be well placed to address and reinforce. Finally, policy makers must
consider the safety and efficacy of traditional MC in determining their possible role in a national MC
Although little quantitative data on rates of complications from traditional circumcision in sub-Saharan Africa
exist, both scientific literature and media accounts document cases of advanced infection, stenosis,
necrosis, mutilation, and hemorrhage due to MC conducted by traditional practitioners. Working with
traditional practitioners to improve their knowledge and skills could greatly contribute to improved MC
outcomes as well as improving perceptions of MC as a safe procedure. FHI proposes to partner with the
THETA, to implement an intervention aimed at enhancing the capacity of traditional practitioners to support
safe circumcision, by providing information on safety, putting in place referrals links with clinical sites and
The activities will address both strategic information and programmatic needs. The combined approach will
provide decision makers with Uganda-specific data to inform a comprehensive MC strategy. The activities
will also facilitate more immediate improvements in HIV risk reduction and counseling by traditional
providers. Activities will be conducted in a phased approach with year one (Phase I) focusing on
documenting what is known about the capacity, scope, and outcomes of traditional circumcisers in Uganda.
Efforts in future years will build on the Phase I data and partnerships to operationalize and evaluate a
referral system and a skills/cultural exchange between traditional and clinic-based circumcisers.
The proposed Phase I activities are as follows:
1.Conduct a census of traditional circumcisers to determine their numbers, activity level, and location.
2.Conduct an assessment to determine the training needs of traditional circumcisers with regard to safety,
hygiene, and counseling.
3.Conduct a rapid assessment to explore the bi-directional assumptions and attitudes between traditional
and clinic-based providers, which will be useful for recommending a referral system.
4.Provide technical assistance to THETA and partners to support information and training for traditional
providers of MC, focusing on counseling, safety/hygiene, and risk reduction for men, both pre and post
operatively. The aim is to utilize MC as a vehicle to reach more men with SRH and HIV prevention
5.Develop and launch a pilot surveillance system to capture MC adverse events.
6.Compare rates of adverse outcomes between traditional and clinic-based circumcisers and synthesize
findings for policy dialogue and programmatic uptake.
This PEPFAR funded activity will generate strategic information on the potential role of traditional providers
in a wide scale male circumcision intervention. The knowledge generated will be translated into practical
applications in planning, policy making, program administration, and the support for quality, accessible male
circumcision services. Further, the activity will provide an important avenue for reaching more men and
adolescent boys with other reproductive health messages and HIV prevention interventions e.g. sexuality