This activity also relates to Project Concern International (PCI) activities in Other/Policy Analysis and

System Strengthening (PCI), Other Prevention (PCI), Other Prevention (JHPIEGO), Palliative Care Basic

Health Care and Support (PCI), Palliative Care Basic Health Care and Support (JHPIEGO), and Counseling

and Testing (PCI) and Orphans and Vulnerable Children (Belong for ZDF)

The first component of this activity involves supporting 30 Anti-AIDS youth groups in Zambia Defense Force

(ZDF) primary and secondary schools established in FY 2006 and FY 2007. The 30 schools which are on

military bases have been targeted for organizing children's clubs that include HIV/AIDS education and

programs on abstinence and anti-discrimination against people living with HIV/AIDS (PLWHA). The

purpose of the program is to inform, inspire, and challenge young people to choose to refrain from sex

before marriage or otherwise delay debut of sexual activity. The formation of these groups is in response to

numerous requests received by the ZDF from the students' parents to support such youth activities.

The first activity under this component is selection and reproduction of HIV/AIDS educational materials from

among those developed for use in Zambia through the Ministry of Health (MOH), National HIV/AIDS/STI/TB

Council (NAC), USG/PEPFAR-funded partners, Baptist Fellowship of Zambia (BFZ) or other sources. The

materials selected will be those promoting abstinence until marriage for youths who are not sexually active

and secondary virginity for those who are active. PCI will work with other USG AB partners and

stakeholders by attending monthly PST meetings and quarterly USG AB partner meetings (and other

coordinating mechanisms) this will be an opportunity to standardize training, IEC materials, prevention

messages, lessons learnt, and best practices.

The second activity will be refresher training of 100 teachers and patrons of Anti-AIDS youth groups in

mobilizing youth groups and integrating HIV/AIDS prevention and stigma reduction into their education

curricular. The training will equip teachers with skills for communicating age-specific messages that

encourage young people to avoid contracting HIV by abstaining from sex until marriage. Teenage sexuality,

virginity, gender-based violence, and life skills will be among the topics that will be covered.

The third activity under this component is to provide other logistic support (mainly stationery) for youth

group activities. All these activities will be implemented in close consultation and collaboration with the ZDF

education directorate. The goal of this program is to reach 7,500 youths with HIV/AIDS prevention

messages and promotion of abstinence, plus reduction of stigma and discrimination against PLWHA.

The next component of this program involves reaching out to military personnel and their families with

messages promoting abstinence until marriage and faithfulness to one's partner using chaplains from ZDF

and other uniformed services. In FY 2005, BFZ trained 63 chaplains and their assistants in HIV/AIDS

prevention, care, counseling, peer support, and palliative care. In FY 2006, 80 chaplains and their

assistants participated in training to build on the work done in FY 2005. This was to help the chaplains

integrate into their ministry and to the family and their communities, including the "True Love Waits" (TLW)

abstinence-based toolkit for use within the military setting. In FY 2007, training courses were provided to 80

chaplains to continue building on the aforementioned objectives, skills, and services to additional bases. To

carry out the TLW program, local TLW Clubs were established in twelve communities, and churches around

selected military bases. In FY 2008 TLW clubs will be established in four additional ZDF communities. The

chaplain initiative will continue the family support component aimed at stemming the spread and impact of

HIV/AIDS. 80 chaplains and their spouses will be trained to better identify and intervene in issues of

violence, especially sexual and spousal abuse. BFZ will give the chaplain additional tools to encourage and

support marital faithfulness. These tools include training in a program called "True Love Stays". BFZ will

also provide training to chaplains to start "Keep the Promise" support groups and conduct marriage

seminars targeting 100 married couples. Information, education and communication (IEC) materials

promoting abstinence, faithfulness, other prevention methods, stigma reduction, counseling and testing,

sexually transmitted infection (STI) management, and ART will be reproduced and distributed. The goal of

this program is to reach out to 8000 military personnel and their families with messages promoting

abstinence and being faithful.

The long-term sustainability of this program lies in the capacity which will be built through the training of

teachers, other Anti-AIDS youth group patrons, and chaplains to replicate, scale-up and manage youth-led

program in the future. As with other interventions with the ZDF, sustainability is promoted through an

emphasis on planning, implementing, and monitoring all activities with leadership from ZDF personnel

themselves, supported by PCI and other technical resources, as well as through capacity building through

training and through establishing and support ZDF-owned structures such as the drama groups and support

groups. In this area, training and mobilization of support from ZDF leadership has also proved very

effective at ensuring necessary support and involvement in HIV/AIDS-related programming and

intervention. In FY 2008, two leadership workshops will be conducted targeting 60 ZDF members.

This activity also relates to Project Concern International (PCI) activities in Other/Policy Analysis and

System Strengthening (PCI), Abstinence/be faithful (PCI), Palliative Care Basic Health Care and Support

(PCI) , Palliative Care Basic Health Care and Support (JHPIEGO), Counseling and Testing (PCI) and the

Orphans and Vulnerable Children (Belong for ZDF).

The first component is continued support to two existing drama groups and technical assistance in

developing HIV/AIDS-related scripts and performances. Since FY 2003, the drama groups, consisting of 39

members, have traveled to all 54 Zambia Defense Force (ZDF) facilities throughout the country spreading

messages on abstinence, faithfulness, and the correct and consistent use of condoms, HIV counseling and

testing, stigma reduction, the influence of alcohol on risk behavior, and other key messages identified

through regularly updated qualitative research with the target group to ensure continued maximum

relevance and acceptance.

Feedback from ZDF leadership, officers, and enlisted personnel alike indicates that the tours are extremely

well accepted and are effective at increasing HIV/AIDS-related knowledge and promoting positive behavior

change in ZDF personnel, their family members, and local communities surrounding the bases. Given the

isolated nature of many of the ZDF sites, these drama performances are often the only exposure many of

these communities, both military and civilian, have to HIV/AIDS prevention messages. In FY 2008, the

drama groups will continue to be supported to visit all the 54 ZDF units, camps and operational areas.

Some of these visits will be in conjunction with the mobile CT units as a means of pre-CT community

mobilization, and will reach an estimated 20,000 individuals.

The military is categorized as a high-risk group. According to a study conducted in 2004, about 30% of

military personnel reported having sex with multiple partners in the past 12 months, which is more than

three times higher than the general population rate, and condom use especially among those with multiple

partners was found to be very low. Therefore, PCI will support the ZDF in promoting change in gender

social norms that predispose women to HIV such as sexual violence and abuse. The plays will also promote

prevention methods such as correct and consistent condom use, along with promoting abstinence and

faithfulness. In FY 2007, the play developed by the drama groups focused on ART adherence, fidelity in

marriage, and excessive alcohol consumption.

CT, PMTCT and ART will continue to be key focus areas, in order to strengthen links with these USG-

supported activities of the ZDF. The performers will receive refresher training in Theatre for Development, a

locally adapted behavior change communication strategy developed in collaboration with the Open

University of Zambia. This method uses qualitative research methods together with performance arts such

as song, drama, poetry, and dance for a targeted audience. PCI will continue to measure the impact of the

drama tours (using pre-and post-exposure questionnaires as part of the intervention itself) to ensure quality

and effectiveness of the drama tours. The training also serves as an opportunity for ZDF participants to

conduct on-site qualitative research with the target population and to integrate current, key messages into

updated performances.

Information, education and communication (IEC) materials promoting abstinence, faithfulness, other

prevention methods, stigma reduction, counseling and testing, sexually transmitted infection (STI)

management, and ART will be reproduced and distributed during the drama tours, HIV/AIDS sensitization

tours by HIV/AIDS unit personnel and HIV+ personnel, mobile CT visits, monitoring visits, new recruit

training and other occasions. PCI is a member of the "Prevention of Sexual Transmission" group that has

recently been recognized by the National HIV/AIDS/STI/TB Council (NAC) as forum in one of their theme

groups. One role of this group is to ensure that all partners are giving consistent, evidence-based

messages which are approved by NAC.

The second component of this activity is to continue assisting in the mobilization of people living with

HIV/AIDS (PLWHA) to encourage their involvement in HIV/AIDS prevention activities. Whereas in 2003-

2004 there were no openly positive ZDF personnel participating in the HIV/AIDS prevention, care, and

support program, to date there are over 200 individuals associated with the ZDF actively participating in the

program through HIV/AIDS sensitization with their colleagues, peer education, and support group formation,

which has been initiated at five ZDF units. In order to promote sustainability of this activity, the ZDF has

established a new position at its national HIV/AIDS unit, filled by an openly-positive Major, to spearhead the

formation, guidance, and supportive supervision of support groups at individual ZDF sites. PCI will build on

this success through continued support for these activities and continued support for the formation of HIV-

positive support groups or post-test clubs at ZDF installations. PCI will provide training and technical

support to HIV-positive ZDF personnel in organizing and programming visits to 54 military units to promote

counseling and testing, ART, and stigma reduction. This group will also participate in HIV/AIDS leadership

workshops for 60 ZDF senior leaders, which have proved to be extremely successful at engaging ZDF

leadership and support at different levels for HIV/AIDS prevention activities in ZDF units.

In all prevention activities, the role of alcohol in the transmission of HIV will continue to receive emphasis.

Current training materials developed by PCI and the Defense Force Medical Services (DFMS), including the

peer leader training guides, educational videos ("Watch Out Soldier" and "HIV positive: No longer a death

sentence") and facilitation guides, and written educational materials already incorporate messages in this

regard and will be updated as needed. Awareness-raising by peer educators, PLWHA, the drama teams,

mobile and facility-based clinical staff, and the HIV/AIDS unit through ongoing tours, training of new recruits,

and training of pre-deployment personnel will also emphasize the impact of alcohol. Possible policy-level

interventions will be discussed and planned for especially at the leadership workshops and at the HIV/AIDS

Unit and DFMS levels. Lessons learned from local and international HIV/AIDS conferences, at which ZDF

is represented, will be incorporated as feasible into PCI's interventions.

As with other interventions involving the ZDF, sustainability will be promoted through an emphasis on

planning, implementing, and monitoring all activities with leadership from ZDF personnel themselves. PCI

and other technical resources will support these endeavors such as drama troupes and support groups. In

this area, training and mobilization of support from ZDF leadership has also proved very effective at

ensuring necessary support and involvement in HIV/AIDS-related programming and intervention. Most ZDF

sites are accessing free condoms through their respective DHMTs. DFMS has solicited for bicycles for

Peer educators from Zambia National Response to HIV/AIDS (ZANARA).

This activity also relates to Project Concern International (PCI) activities in Other Prevention Activities (PCI),

all Other/policy analysis and system strengthening relating to the Zambian Defense Force (ZDF) by PCI,

JHPIEGO and DOD, Abstinence/be faithful (PCI), PMTCT (JHPIEGO), Palliative Care Basic Health Care

(HBHC) and TB/HIV (JHPIEGO), Counseling and Testing (PCI), HIV/AIDS treatment/ARV services

(JHPIEGO), Condoms and Other Prevention (PCI and JHPIEGO) and Abstinence and Be Faithful (PCI).

This program aims to ensure that chronically ill HIV positive patients in the military health facilities receive

comprehensive HBHC services that include medical care, treatment of opportunistic infections, pain

management, psycho-social support, legal services, material support, nutritional supplement, referral and

adherence to anti-retroviral treatment (ART), and other HIV-related services. Through this activity, PCI will

support Defense Force Medical Services (DFMS) to provide quality HBHC services to HIV-positive patients

including ZDF members, their family members, and people living in the surrounding community. The ZDF

serves as the only source of such care for communities surrounding the base, given the remote nature of

most ZDF units.

PCI will support DFMS to undertake this comprehensive program in all 54 ZDF units in the nine provinces,

with a focus on 12 existing model sites (Maina Soko Military Hospital in Lusaka, ZAF Livingstone, Tag-

urgan Barracks in Ndola, ZNS Kitwe, Gondar Barracks in Chipata, Chindwin Barracks in Kabwe, ZNS Mbala

and ZNS Kamitonte in Solwezi, L85 in Lusaka, ZNS Luamfumu in Mansa, Luena Barracks in Kaoma, and

ZAF Mumbwa), and four additional model sites (to be established in FY 2008). This activity will be

integrated with other DOD-PCI and JHPIEGO activities, to ensure effective referrals between CT, TB/HIV,

STI, HBHC, ART and other services. Clients presenting with TB or STIs at the health facility are encouraged

to test for HIV and those that test positive are referred for pre- ART medical assessment including CD4

count and liver function tets at the nearest health facility with this capability. Clients that are commenced on

ART are closely monitored by community-based ART adherence supporters trained by JHPIEGO in FY

2006. Most of these clients are registered on HBHC and benefit from HBHC services provided by trained

HBHC care givers.

Capacity building will include formal and informal training for HIV/AIDS unit staff including the, HBHC

coordinators, HIV/AIDS unit coordinators, and ZDF caregivers. Logistical support to enable ongoing

supervision and monitoring of palliative care activities by the DFMS is provided, and linkages with

indigenous sources of technical support such as the Palliative Care Association of Zambia (PCAZ) have

been made in order to ensure that the ZDF has access to technical input, national palliative care guidelines,

and training packages adapted to their situation and needs.

In FY 2004 and FY 2005, 295 caregivers were trained. PCI's training of caregivers in comprehensive

palliative care was coordinated with PCAZ to ensure the consistency of the training and care services with

those of other USG-funded programs. An additional 140 caregivers were trained in FY 2006 and FY 2007.

These caregivers are actively involved at all 54 ZDF units in 9 provinces, responsible for identifying and

registering chronically ill patients both among military personnel and their families, as well as from non-

military populations in surrounding communities, providing community level care services in support of

families, and referring patients to DFMS or other health facilities for additional care and treatment services.

Adherence support for clients on ART has been added to the training modules in support of the expansion

of ART services at both ZDF and Ministry of Health (MOH) facilities. Caregivers are also trained to carryout

out a nutritional assessment of their clients. This is important in order to determine those who qualify for

nutritional support. In FY 2008 PCI will support the training of 80 additional caregivers in palliative care.

PCI will continue to make use of ZDF trainers who were trained by PCAZ in October 2006 in order to

promote sustainability of this activity. The quality of HBHC services will be closely monitored by two nurses

employed by PCI in FY 2007. A check list on minimum standards for HBHC developed by the National AIDS

Council will be used for monitoring.

PCI will continue to support the development and provision of HBHC kits for clients and their caregivers.

These HBHC kits have been evaluated in collaboration with the DFMS, Ministry of Health, and PCAZ and

include patient education materials relating to medicines, doses, nutrition, physical fitness, and referral

information printed in local languages. Care givers kits contain pain killers, anti-diarrhea medicine, anti-

fungal creams, multi vitamins, bleach, disinfectant, gloves wool and bandages The kits are refilled on a

monthly basis according to the number of patients reflected in the HBHC registers and monthly field reports.

In addition to clients' HBHC kits, PCI will continue procuring food supplements for clients who qualify

following an assessment of their nutritional status by a care provider. These include OVC, HIV-positive

lactating or pregnant women, and clients on ART will evidence of severe malnutrition. Material support to

the caregivers, such as bicycles, umbrellas, bags and shoes, will be provided as a means of facilitating their

work and motivating their continued participation.

In FY 2006 and FY 2007, PCI supported the training of 200 support group members in ZDF units using the

18 ZDF "stay healthy" master trainers who were trained in FY 2006 with support from the DOD twinning

program. In FY 2008, PCI will support the training of additional 20 "stay healthy" master trainers and 200

support group members. The effectiveness of training will continue to be assessed and monitored through

pre-and post-training tests, as well as with support from the twinning program. The workshops will focus on

promotion of health and wellness, with support in dealing with HIV symptomology, depressive symptoms,

stigma, and beliefs about illness, adherence to ART, behaviors, self-efficacy, and substance use. Positive

living materials developed by the Health Communication Partnership (HCP), the Academy for Educational

Development (AED)/USAID, and other local groups were reviewed by the DOD team for adaptation and will

be used under this activity.

Finally, through a partnership with the Baptist Fellowship of Zambia (BFZ), PCI will continue to support the

capacity building and involvement of military chaplains in HIV/AIDS counseling, with emphasis on ministry

skills relating to the individual and the family, including marital relationships, parenting, and development of

peer support systems. Training sessions also deal with child and spousal abuse, addictive behaviors,

management of family crisis, illness, death, trauma, and setting up family crisis services at a targeted

number of bases and their communities. In FY 2006, BFZ trained 63 military and police chaplains in

palliative care including spiritual counseling. They also provided on site technical assistance to 17

clergymen at ZAF Livingstone which is one of the model sites for palliative care and CT. In addition, they

reproduced an HIV/AIDS manual used in faith-based communities for use by the chaplains. In FY 2007, an

additional 80 chaplains and their assistants participated in training to build on the work done previously and

Activity Narrative: help the chaplains relate it to ministry for the family and their communities. In FY 2008, chaplains will be

supported to continue providing the above services to ZDF bases.

In order to ensure the sustainability of the activity, PCI works in close collaboration with the DFMS

HIV/AIDS unit, which has through PEPFAR support established a palliative care office, through which all

activities are planned, implemented and monitored. Sustainability is also promoted through ongoing

supportive supervision visits by HBC trainers, DFMS and PCI clinical staff, HIV/AIDS unit coordinators, and

PCI, in order to reinforce the training and to identify and address any performance and/or training gaps.

The target of this activity is to have 6000 people benefiting from HBHC services at the 12 model sites and

other ZDF medical sites. These are clients that will have been provided with HBHC services through

caregivers, military chaplins or support groups of PLWHAs.

This activity also relates to Project Concern International (PCI) activities in Other Prevention Activities,

Abstinence and Be Faithful, Palliative Care and Basic Health Care and support, Other/Policy Analysis and

system strengthening and JHPIEGO's activities for PMTCT, Palliative Care TB/HIV, Palliative Care and

Basic Health Care and support and HIV/AIDS treatment/ARV services and Other/Policy Analysis and

system strengthening.

Observation of previous Counseling and Testing (CT) activities and results from research supported by

(PCI) and PEPFAR (2005) reveal that military personnel may be more resistant to CT than the general

public. According to the research, although nearly seven in ten Zambia Defense Force (ZDF) personnel

know of the availability of VCT services in their camp/unit, only 10% have ever participated in VCT. This is

worrying in light of the relatively high risk behavior among military personnel and despite the fact that over

30% believe they might already be HIV infected. Military personnel are also hard-to-reach with static

services because military bases are scattered all over the country and many personnel are highly mobile or

are stationed in very secluded locales. The remoteness of ZDF units, relatively poor infrastructure, poor

linkages with national supply systems (e.g. of VCT kits), and the organizational isolation of the military, also

make providing CT services costly.

In FY 2008, PCI will continue its efforts to assist the ZDF through strategic and innovative approaches

developed through more than three years experience working with the ZDF in HIV/AIDS prevention, care

and support. The overall goal of this activity is to strengthen the capacity of the Defense Force Medical

Services (DFMS) to provide accessible, confidential, quality counseling and testing services. In FY 2005,

four model medical sites were strengthened to provide comprehensive HIV/AIDS services including

counseling and testing, anti-retroviral treatment, palliative care, and PMTCT services (in collaboration also

with PCI and JHPIEGO). In FY 2006 and FY 2007, eight additional model sites were established. While

these twelve sites (Maina Soko Military Hospital in Lusaka, ZAF Livingstone, Tag-urgan Barracks in Ndola,

ZNS Kitwe, Gondar Barracks in Chipata, Chindwin Barracks in Kabwe, ZNS Mbala, ZNS Kamitonte in

Solwezi, Luena barracks in Kaoma, ZAF Mumbwa, ZNS Luamfumu in Mansa, and L 85 in Lusaka ) maintain

the current services, four additional sites will be established in FY2008 to provide the same services,

targeting other areas where significant number of military personnel are stationed. Moreover, support for

basic levels of CT services will continue to be provided at 38 other ZDF units, who will have the opportunity

to visit and learn from the model sites.

Funding will cover procurement of necessary medical supplies and equipment and additional training for the

DFMS staff in the new sites. In order to promote sustainability, efforts will continue to be made to effectively

integrate the ZDF in the Ministry of Health (MOH) national HIV test kits supply system, in collaboration with

USAID's JSI/Deliver program. 20 DFMS staff will undergo training in counseling and testing, using national

guidelines, to ensure that all four sites have adequate human resources to provide high quality counseling

and testing services. In addition, 25 senior ZDF officers will be trained in CT to encourage senior officers to

access CT services. It has been observed that senior officers are shunning CT services because the staff

trained to provide this service are too junior to them. The rank structure in the military is such that it is

difficult for a soldier to counsel a senior officer. This training will therefore help to bridge this gap. Through a

sub-grant to the Baptist Fellowship of Zambia, 80 military chaplains who have received training in HIV/AIDS

counseling will be trained in HIV testing. Most clients would like to be tested for HIV by the person that they

have confided in during counseling. Training the chaplains in HIV testing will encourage individuals who

have great trust in the clergy, to know their HIV status. Confidentiality will also be safeguarded when the

chaplains are empowered to follow through HIV counseling with testing. HIV counseling training is facilitated

jointly by PCI and DFMS counselor trainers and local HIV counselor training organizations, such as Zambia

Counseling Council, Kara Counseling,MOH, and Chikankata AIDS Management and Training Services.

The HIV testing training will be facilitated by personnel from Maina Soko Military Hospital Virology

Laboratory in Lusaka, using national guidelines. In addition, 20 senior DFMS staff, mostly counselors

and/or supervisors from the new and existing model CT sites, will be targeted for training in supervision to

develop their skills in monitoring, managing, and evaluating HIV counseling and testing services; developing

linkage/referral networks for follow-up treatment and care in ART, TB, PMTCT and Palliative Care; and

ensuring quality standards for services in the comprehensive sites. The trained supervisors will serve to

reinforce CT training through ongoing supportive supervision visits and on-the-job training, and the

effectiveness of training will continue to be assessed and monitored through pre-and post-training tests.

The second component of this activity is to continue supporting the operation of two mobile CT units

established in FY 2006 which are operated by the DFMS with support from PCI. The first mobile unit was

launched on 14th August 2006. Response to the service has been excellent. Community mobilization

dramas and written materials are used to promote couple counseling and testing including issues such as

disclosure and discordance. Prior to the mobile CT units going out, an assessment of the proposed site is

undertaken to check on the catchment's population, existing referral services and to solicit support from the

local leadership. Existing referral services will be printed and shared with clients who come through for

counseling and testing. Clients who test positive will be referred to the local ZDF and other health facilities

for follow-up services. Referral services include, CD4, ART assessment, TB, PMTCT, STIs, OIs

management, Home Based care, spiritual support, Support groups for PLWHAs and psychosocial support.

PCI will work with referral centers to ensure that clients referred to them are tracked. This will help to

determine the effectiveness of the referral system. Clients who test negative are advised to go for a second

test after three months at the nearest CT facility to take care of the window period.

The mobile services will gradually increase their coverage to DFMS sites and surrounding communities

throughout the country, taking into account geographical coverage by static and mobile services, and

focused on remote, underserved regions where ZDF units are typically found. Funding will be used for

operation and maintenance of two vehicles, refresher training and logistical support for medical staff (a core

DFMS team and supplemental staff from the ZDF units in the areas targeted), community mobilization by

the ZDF drama teams, peer educators, and others, and procurement of HIV test kits (to supplement those

accessed through Zambia VCT Services) and other medical supplies. Updated and targeted education

materials on VCT, ART, sexually transmitted infections (STIs) and stigma reduction will be reproduced and

available at the counseling and testing sites. Other health services such as STI diagnosis and treatment or

reproductive health services will be included to overcome the stigma that would otherwise be associated

with a mobile service devoted solely to HIV counseling and testing. All mobile CT providers have been

trained in rapid HIV testing. A qualified laboratory technician/technologist carries out quality assurance on

10% of the samples from each counselor. In addition 10% of all samples are taken to Maina Soko Military

Activity Narrative: Hospital Laboratory for further quality assurance. PCI will continue to collaborate with other USG-funded

partners with experience in mobile CT, including SFH/New Start and CHAMP to assist DFMS in refining

operational procedures and guidelines to manage and maintain the effectiveness and efficiency of the

mobile services and its operations, particularly staffing, operational budgets, monitoring and evaluation,

quality assurance, outreach programs and educational materials. This will be made possible through

regular review meetings for key mobile CT providers.

The sustainability of this activity is by strengthening the capacity of the DFMS to plan, implement and

manage CT services with technical support. Capacity strengthening is achieved through joint planning,

assessments, and monitoring of activities, as well as through formal training of ZDF staff, on-the-job training

from experienced CT implementers from PCI and other partners, ensuring access by the ZDF to national

guidelines and policy, basic infrastructural support, and linking ZDF services with locally accessible sources

of resources and technical support (e.g. Zambia VCT Services). In FY 2006 and FY 2007, PCI supported

the registration of all ZDF VCT centers by Zambia VCT Services. This has allowed the centers to access

government HIV test kits and other services. Already, PCI has linked DFMS with the government Medical

Stores for provision of test kits for the mobile VCT program. This will also contribute greatly to the

sustainability of CT services.

The target of this activity is to have 6,000 people receiving counseling and testing at the 16 model sites and

other ZDF static VCT centers. The two mobile units will target an additional 3,000 people with counseling

and testing.

This activity also relates to all activities for the Zambian Defense Force (ZDF) conducted by Project

Concern International (PCI), JHPIEGO and DOD.

This activity is aimed primarily at further supporting and strengthening ZDF capacity in monitoring and

evaluation (M&E) and systems support. Funding for this activity will be used to assess and improve

communication systems in ZDF units to increase their capability in managing information, M&E and

situation analysis. This activity will also help to build on ongoing efforts to strengthen and systematize

linkages between Defense Force Medical Services (DFMS) facilities and the Ministry of Health District

Health Management Teams (DHMTs). These linkages are essential as they are proving helpful in allowing

the DFMS to benefit from technical and systems support, from drug supplies and medical supplies, and

from DHMT assistance in community mobilization of the civilian population. This is critical to the strategy for

promoting the longer-term sustainability in health care services managed by the DFMS.

To further strengthen DFMS capacity, computers, printers, UPS devices and other supplies will be procured

to support HIV/AIDS information management at four new model sites for ART, PMTCT, palliative care and

CT.

In FY 2006 ZDF appointed three program officers to help with HIV/AIDS data collection and management.

The three HIV/AIDS program officers from Zambia Army, Zambia Air Force and Zambia National Service

will be supported to undergo a short course in M&E offered by the University of Zambia (UNZA). This

training will build their skills in Health Management Information Systems (HMIS) including M&E data

collection, management and reporting. It is expected that following this training, the HIV/AIDS program

officers will have improved capacity to strengthen these areas in ZDF health facilities, and thus this

approach is also a means of building sustainable institutional capacity in this area.

To complement this effort, and building on previous workshops which served successfully to build capacity

as well as commitment to monitoring and reporting, 54 ZDF HIV/AIDS unit coordinators, 54 Ward masters

plus six central HIV/AIDS unit staff will undergo a refresher training in Monitoring and Evaluation, to

continue building their capacity to effectively monitor, supervise, and report on all HIV/AIDS-related

activities on their units. The workshop will be facilitated by PCI staff together with an M&E specialist from

the National AIDS Council (NAC) to maintain national standards. A significant ongoing challenge in terms

of monitoring progress in ZDF health services is getting feedback from the field units. In FY 2006, PCI

supported the training of Ward Masters from all the 54 ZDF units in Monitoring and Evaluation. The Ward

Masters are assisting the unit HIV/AIDS coordinators with data collection and compilation. It is expected

that annual refresher trainings in M&E will help to identify and jointly address constraints related to data

collection and dissemination, and will further raise awareness and commitment towards the importance of

regular data collection, monitoring and reporting and to increase the number of ZDF units that are

consistently submitting their monthly activity reports.

Funding will also be used to conduct initial facility surveys for the four model FY 2008 sites, in coordination

with DFMS and JHPIEGO, in order to plan effectively for establishing of these sites as model sites.

Supportive supervision tours of ZDF units, with leadership from the DFMS HIV/AIDS office (and including

the Director General Medical Services, who joins these monitoring tours from time to time with

DOD/PEPFAR support), will continue to be supported.

The emphasis in this program area is on sustainability of the efforts, through a focus on training and

systems support to build capacity within the ZDF, and in particular in those responsible at central and unit

levels for the design, implementation, monitoring and evaluation of HIV/AIDS related activities.

This activity also relates to all activities for the Zambian Defense Force (ZDF) conducted by Project

Concern International (PCI) JHPIEGO and DOD.

The goal of this activity is to build on the involvement of the Joint United Nations Program on HIV/AIDS

(UNAIDS) globally and in Zambia in strengthening the capacity of uniformed services personnel in

HIV/AIDS programming, through policy development and other technical assistance, with a particular focus

on UN peace keepers. The ZDF has been actively involved in peace keeping missions in the African

Region. The ZDF finalized the Defense Force HIV/AIDS policy in 2007 with technical assistance from

UNAIDS and the U.S. Government. During this workshop, the need to develop a policy on pre- and post-

deployment testing and effective prevention programs for personnel being deployed for peace keeping

missions and local border security operations was identified. Currently the ZDF relies on host government

or UN protocols for deployment procedures including HIV/AIDS pre-testing, post-testing and prevention

activities during deployment. There is also no restriction on the deployment period, which further

contributes to the vulnerability of military personnel and their families to HIV/AIDS infection.

PCI will work together with UNAIDS in strengthening the capacity of the ZDF in planning, developing,

implementing, monitoring and evaluating its HIV/AIDS program and toward its sustainability. In addition to

the Ministry of Defense (MOD), UNAIDS will also work with other government institutions which are involved

in the peacekeeping operations such as Ministry of Home Affairs.

To further strengthen ZDF capacity in addressing HIV/AIDS in its peace-keeping operations and local

border security operations, PCI and UNAIDS will work to strengthen peer education as a key component of

behavior change communication and in reducing stigma and discrimination. In FY 2008 PCI will support

refresher training of the 800 ZDF peer educators who were trained in FY 2004. The peer educators will also

be given logistical support to motivate them to effectively carry out HIV sensitization activities. The training

will help to build their capacity in communicating HIV prevention messages with their peers in the military

bases as well as during peacekeeping operations. In addition, PCI will collaborate with the UNAIDS in

targeting Zambian peacekeepers prior to deployment to other countries, including facilitating HIV/AIDS

sensitization workshops as part of the pre-deployment sessions, assuring the presence of peer educators

among the peacekeepers, and equipping them with educational materials.

PCI will continue to support gender mainstreaming throughout all programs, taking into account the special

environment in ZDF, and thus addressing masculinity perceptions, attitudes and risk behaviors amongst

male and female staff. Female peacekeepers will be targeted specifically, addressing their particular

situation as women and a minority. Further and importantly, the families of the peacekeepers, most often

the wives will be targeted as part of a multi pronged approach.

In order to strengthen the capacity of the ZDF to sustain its HIV/AIDS program, UNAIDS will continue to

assist the Defense Force Medical Service (DFMS) with resource mobilization including identification of other

potential indigenous partners for the ZDF HIV/AIDS programs, coordination of activities and trainings, and

coordination of partners such as other bi-lateral donors, the MOH, National AIDS Council, other UN

organizations. Building resource mobilization skills, strengthening policy development and implementation,

and increasing capacity to effectively plan and manage HIV/AIDS activities will support the sustainability of

the ZDF's HIV/AIDS activities which currently rely heavily on USG funding. The UNAIDS will also advise

the ZDF in conducting sensitization training, soliciting and dissemination of existing information, education

and communication (IEC) materials. Through all these activities, UNAIDS will ensure that the ZDF

HIV/AIDS program reflects the effective mainstreaming of AIDS and gender.

An additional component of this activity would be the family support unit. The ZDF has been supported by

PEPFAR funding and has requested assistance in the creation of a multidisciplinary clinic to include the

disciplines/programs in opportunistic infection management/prevention, palliative care, and post exposure

prophylaxis programs, among others. PCI having experience in working the DFMS units would assist in

expanding this activity and would partner with the DOD PEPFAR office to develop a joint ARV services/FSU

multidisciplinary clinic for Maina Soko HIV positive patients and their families. This activity will be linked to

the DOD system strengthening support.