This activity narrative is a draft that will be revised upon award of the USAID Leadership Project, an extension to the John Snow Institute- Support to the HIV/AIDS Response (SHARe) project. Targets will be adjusted after award of the project, in collaboration with the partner.

USAID/Zambia's new Leadership project will support the Government of Zambia's (GRZ) multi-sectoral efforts to reduce the impact of HIV/AIDS through innovative approaches to engage Zambian leadership at all levels. The Leadership Project will build on lessons learned and successes from the previous SHARe project but represents a more cohesive and consolidated approach to engaging leadership at all levels in the fight against HIV/AIDS.

The Leadership Project will expand HIV/AIDS leadership and strengthen activities in AB Prevention for national and community leaders, industry heads, and young influential Zambians. AB Prevention programs will be increased through community-based organizations. The Leadership project will establish strong relationship and coordination with political, community, traditional and religious leaders to strengthen advocacy and activism skills. In addition, training/ and or technical assistance will be provided in HIV/AIDS advocacy and ambassadorship to Zambian leaders, enabling them to have a fuller understanding of the HIV/AIDS epidemic in Zambia, and how they can provide effective leadership in the national response and ensure consistency of messages.

The Leadership project will be key partners in promoting interventions that can offer protection against HIV/AIDS such as PMTCT and male circumcision, and in fighting stigma and discrimination against people living with HIV/AIDS. Additionally, the project will work with leaders to help mobilize Zambians to access TC services so that they know their HIV status and can make informed decisions regarding HIV prevention, including positive prevention, through AB interventions.

The Leadership project will continue to strengthen the capacity of NGOs, Provincial AIDS Task Forces (PATFs), District AIDS Task Forces (DATFs), and community-based organizations (CBO) to implement AB prevention programs while implementing comprehensive AB programs in workplaces and communities targeting adolescents, men, women, PLWHA, and most at- risk populations (MARPS).

The Leadership Project will develop innovative ways to engage communities to participate in testing and

counseling (TC) through community sensitization and mobile TC. Linkages will be made with organizations to access rapid test kits through the District Health Management Teams and Medical Stores Ltd in order to expand nationwide TC services. TC providers will link HIV positive clients to ART and palliative care services in their respective communities to ensure continuity of care.

Critical and valuable institutional capacity-building support will be provided to the NAC, PATFs and DATFs to help build systems and institutional capacity at the local levels to effectively respond to the HIV/AIDS epidemic. The project will work directly with the PATFs and DATFs to assess current functional capacity in responding to the HIV/AIDS epidemic and identify gaps. Its aim is to build sustainable programs, through strengthening technical and management capacities and mobilizing resources. Activities will include participatory analysis of current sustainability levels and development of sustainability plans.

Education venues will address HIV high risk behaviors among Most at-Risk Populations (MARPs) that go beyond AB and focus on partner reduction,(e.g., increase access to and availability of condom and their correct and consistent use, knowing one's status, screening and treatment of sexually transmitted, and referrals to male circumcision). The harmful role of alcohol abuse and gender based violence in HIV transmission will also be addressed through multi-level interventions.

The successful work undertaken by SHARe and efforts conducted with legal and regulatory bodies and NAC to improve and enforce laws and policies related to HIV/AIDS in creating enabling environments shall be enhanced. This project will engage leaders including Members of Parliament, community, religious and traditional leaders to highlight the importance of including gender-based violence awareness in broader AIDS prevention programs. Efforts to review, revise, and enforce policies and laws relating to sexual violence and women's property and inheritance rights; enhance women's access to legal assistance; and eliminate gender inequalities in civil and criminal codes will also be supported. In addition, steps to develop a substance abuse policy through the Ministry of Health (MOH) will move forward.

Reaching underserved rural communities with Testing and Counseling (TC) services is the primary focus of this activity which will link to other program areas including HVAB, OHPS, and HVOP. Creative ways will be sought to engage and connect the religious, traditional, political and women leaders to TC efforts in their respective communities. The project will focus on working with these leaders in promoting TC. This activity will increase TC through the provision of community-based TC which includes home based testing and mobile TC.

This activity will seek innovative ways to engage and connect communities to TC through community sensitization and mobile TC at traditional ceremonies and other social mobilization events. Members of Parliament, traditional leaders, industry heads, and young influential Zambians (musicians, artists, youth leaders) will be utilized to promote and advocate for increased TC uptake across communities and on increasing males involvement in TC.

Linkages will be made with organizations to access rapid test kits through the District Health Management Teams and Medical Stores Ltd in order to expand nationwide TC services. TC providers will link HIV positive clients to ART and palliative care services in their respective communities to ensure continuity of care. Community TC linkages will be formed with other USG programs including insecticide treated bed nets for malaria.

Couples TC will be highlighted, which has been shown to reduce transmission in sero-discordant couples and also encourages partner reduction and fidelity for partners who learn they are concordant negative. Furthermore, these services will also target specific communities most at risk.

Through the use of standardized logbooks, proficiency testing, regular on-site monitoring, supervision and limited retesting of a proportion of samples by a central laboratory, the quality of community-based TC will be assessed.

This activity will focus on providing critical and valuable institutional capacity-building support to the National AIDS Council (NAC), Provincial AIDS Taskforce (PATF) and the District AIDS Taskforce DATFs. Support will be given to NAC, PATF and DATF to help build systems and institutional capacity at the local levels to effectively respond to the HIV/AIDS epidemic. Working directly with the PATFs and DATFs the project will assess current functional capacity in responding to the HIV/AIDS epidemic and identify where gaps might exist for improvement. . Further, teams working at multiple levels will develop plans for implementing guided and evidence-based institutional strengthening, and monitor progress in organizational growth and development over time.

The project will work with NAC to build its capacity to develop an annual action plan and budget, and provide support for the Joint Annual Program Review (JAPR). Key technical staff will advise NAC in carrying out its mandate, as part of the sustainability strategy to transfer key technical competencies to counterparts in NAC.

Line ministries, civil society, and the private sector will assist in improving the multi-sectoral capacities to effectively respond to the HIV/AIDS epidemic. Requests will be made of national NGOs and institutions including the Zambia Interfaith Networking Group on HIV and AIDS (ZINGO), Network of People Living with HIV/AIDS (NZP) and National Royal Foundation of Zambia (NRF), to become involved in improve HIV/AIDS institutional capacities and to build sustainable programs .

Several issues will be addressed through this project's activities, some of which include: supporting efforts to review, revise, and enforce policies and laws relating to sexual violence and women's property and inheritance rights; enhancing women's access to legal assistance; and eliminate gender inequalities in civil and criminal codes. Activities will include, policy advocacy that targets policymakers and opinion leaders for adoption of legal protections for women and girls who have been victims of GBV; increasing access to legal aid; and increasing public awareness of the links between GBV and HIV/AIDS.

This activity will implement comprehensive and innovative AB programs in communities, targeting age, sex, and social habits. Religious, traditional, political and community leaders will be engaged to promote AB models that are responsive to local needs, and various groups of adults (e.g. sex workers and multiple concurrent partnerships), with the goal in mind of changing societal norms and attitudes. It will strengthen and expand the capacity of partners to implement AB programs that support the recently launched National Prevention Strategy and will focus on reduction of multiple concurrent partnerships (MCP), age disparate partnering, and the harmful role of alcohol abuse and gender based violence in HIV transmission. Men will be actively pursued to change harmful cultural practices that support behaviors that increase risk of HIV transmission.

Traditional religious and community leaders will facilitate dissemination of comprehensive AB messages during traditional ceremonies. Emphasis will be placed on fostering leadership at the national, district and community levels in the fight against HIV/AIDS. The activity will focus on working with Members of Parliament, traditional leaders, industry heads, and young influential Zambians (musicians, artists, youth leaders) to increase the reach of appropriate AB messages. As leaders they are encouraged to speak-out against practices that are known to fuel HIV transmission such as, multiple and concurrent partnerships, gender-based violence, and alcohol and substance abuse.

Community-based AB programs implemented by small CBO/FBO grantees and PATF's and DATF's coordinating AB activities at the provincial and district levels comprise this project. AB activities and messages will be incorporated into other prevention activities during World AIDS Day, VCT Day, and other commemorative events, through support to NAC, PATFs, DATFs, and the Zambia Interfaith Networking Group on HIV/AIDS (ZINGO).

Implementing Other Prevention activities to facilitate social change and reduce sexual transmission with a focus on religious, traditional, political, and community leaders is the focus of. Community involvement will ensure that the activities are responsive to local needs. Leaders from the at the local level will take the lead in promoting the discontinuance of harmful traditional and cultural practices such as widow cleansing, dry sex and early marriages. Participation of Most at Risk Populations (MARPS) and other vulnerable populations are essential to the development of other prevention interventions. MARPS and other vulnerable populations will be referred to other health services including family planning, primary health care as well as psycho- social and legal support, with special considerations to MARPS for post-exposure prophylaxis (PEP) due to increased risk of condom burst and rape. Peer education and outreach will be accompanied by risk reduction counseling with an emphasis placed on ensuring that those who test negative remain negative, and prevention with positives.

Other prevention strategies will focus on innovative community prevention programs in areas with high migrant populations, miners and market fish vendors and other most at risk populations. This project will provide education to address HIV high risk behaviors among MARPS that go beyond AB and focus on partner reduction, increase access to and availability of condom uses correctly and consistently, knowing one's status, screening and treatment of sexually transmitted, and referrals to male circumcision. The harmful role of alcohol abuse and gender-based violence in HIV transmission through multi level interventions will also be addressed.

Information on behavioral change will promote respectful relationships between men and women. Sites with high-risk groups will be linked to the Corridors of Hope III project and to socially marketed and free condoms through collaboration with the District Health Management Team and Society for Family Health.