Pre-bidders workshops ; 12th October 2011 CIVIL SOCIETY FUND Strengthening civil society for improved HIV/AIDS and OVC service delivery in Uganda RFA # 11-001: Reduction Of New HIV Infections Through Enhanced Community Engagement In Combination HIV Prevention Pre-bidders workshops ; 12th October 2011

WORKSHOP OBJECTIVES Orient potential applicants on the RFA 11-001 requirements Share the national HIV Prevention Strategy; Orient stakeholders about combination HIV Prevention and its package in the context of Uganda; Discuss approaches for supporting convergence of partners and joint planning and partnerships frameworks for the 6 districts;  

EXPECTED WORKSHOP OUTPUTS Improved understanding the RFA 11-001 requirements to enable them write appropriate concept papers/proposals Improved understanding of the national HIV Prevention Strategy, and combination HIV Prevention including its package in the context of Uganda;  Orient stakeholders on the design and methodology for the Combination HIV Prevention pilot program;   Suggested approaches for supporting convergence of partners and joint planning and partnerships frameworks for the 6 districts;

  ..Expanding and doing HIV prevention better …. UGANDA NATIONAL HIV PREVENTION STRATEGY ..Expanding and doing HIV prevention better ….

BACKGROUND Uganda’s HIV epidemic is mature, and generalised Recent evidence shows that the epidemic has evolved – risk factors and drivers as well as population groups most affected have changed in recent years Although various HIV Prevention Interventions have piloted / implemented for 25 yrs, Uganda still has a run away epidemic Over 124,000 new HIV Infections in 2009 New Infections exceeding AIDS deaths by about X2 New Infections exceed annual ART enrolment by X3 HIV prevention is one of the priorities of the NDP (2010 -15)

TRENDS IN HIV PREVALENCE About 731,000 potential new infection over next five years if status quo is maintained. Of these about 112,000 would be among children

HETEROGENEITY OF HIV BURDEN Very High HIV Prevalence Sex Workers, Partners of Sex workers, Individuals with history of same sex. Fishing communities Average HIV Prevalence Antenatal women, Boda boda cyclists, Plantation workers Relatively low HIV Prevalence University Students Majority of new infections sexually transmitted 37% multiple partnerships HIV discordant monogamous Sex work and networks Majority of sexual transmission among individuals over 25 years MTCT about 20-25% infections Negligible blood borne infections

SOCIAL/STRUCTURAL DRIVERS OF HIV Socio-cultural drivers Harmful cultural beliefs/practices e.g. polygamy, widow inheritance, courtship rape, rites of passage, Gender Norms SGBV, multiple partnerships among men, Permissiveness among women, Masculinity among men Socio-Economic Poverty/wealth, Dependency , mobility Human rights violations especially for women/girls access to justice- weak enforcement of existing laws Inequities in access to health services Stigma and Discrimination

WHY NEW HIV INFECTIONS REMAIN HIGH.... Current HIV Prevention not always aligned to epidemic drivers: Relevant sexual behaviours. i.e. multiple concurrent partnerships, transactional sex, etc Low coverage of male circumcision Socio-cultural and gender norms often neglected Coverage of key HIV prevention services still sub-optimal to make public health impact Over 60% of adults never tested for HIV Over 40% of antenatal mothers no access to PMTCT Almost three-quarters of adult men not circumcised Over half of risky sex not protected with condoms Quality of HIV prevention services not optimal

CONSIDERATIONS IN THE NEW STRATEGY Aligning HIV prevention efforts to drivers of the HIV/AIDS epidemic Target population groups with the highest risk of new infections Central theme of the new strategy is Combination HIV prevention approaches using proven interventions Minimum HIV prevention packages for the general population and specific groups brought to critical coverage Alignment to NDP NSP, HSSIP – i.e. the strategy to implement the HIV prevention component in these frameworks / strategic plans

  THE NATIONAL HIV PREVENTION STRATEGY

MISSION & VISION Mission The strategy is to serve as a resource to stakeholders to strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections Vision “Uganda where new HIV infections are rare, and where everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

MISSION Mission The strategy is to serve as a resource to stakeholders to strengthen planning, implementation, coordination, and monitoring of HIV prevention programmes to significantly reduce new infections Vision “Uganda where new HIV infections are rare, and where everyone regardless of age, gender, ethnicity or socio-economic status has uninterrupted access to high quality and effective HIV prevention services free from stigma and discrimination”.

GOAL To reduce new HIV infections by 30% based on the baseline of 2009 which would result in 40% reduction of the projected number of new HIV infections in 2015, in line with the targets in the NDP To reduce MTCT Rate reduced from 29% to less than 10% by 2015 40% 40% Reduction in new infections based on projected 2015 levels Equivalent to 30% reduction based on 2009 estimates of new infections IR declines from 0.74 to 0.46 /100PYs 178,930 New HIV Infections averted

OUTCOMES BY 2015 New HIV Infections Reduced by 30% from 2009 levels (i.e. 40% of projected new infections in2015) Increased coverage, and utilization of HIV prevention services Increased adoption of safer sexual behaviors and reduced risky behaviors A strengthened & sustainable enabling environment that mitigates underlying factors that drive the HIV epidemic Achieving a more coordinated HIV prevention response at all levels Strengthened information systems for HIV prevention

PRIORITIES FOR HIV PREVENTION To adequately address the key drivers Scale up priority HIV prevention services i.e. PMTCT, HCT, SMC, ART for HIV Prevention and Condom use Reduce "unsafe sex" i.e. multiple and concurrent partnerships, early debut, cross generational , transactional and, casual sex Make "unsafe sex" safer through condom promotion and increased male circumcision.  Reduce gender/socio-cultural/structural constructs that facilitate sexual transmission of HIV  Improved Coordination and M&E for HIV Prevention

PRIORITY POPULATION GROUPS General Population with a strategic shift to adults, married and previously married individuals, wealthy and working adults Residents of high prevalence / high risk locations e.g. urban residents, high HIV prevalence regions, transport corridors, boarder crossings, fish landing sites etc Most-at-risk population groups, especially sex workers and their partners, long-distance truckers, fish-mongers, men in military service, Vulnerable population groups e.g. victims of rape and sexual violence, non-infected partners of individuals in HIV sero-discordant relationships, widows, etc PLHIV

MINIMUM PACKAGE OF SERVICES FOR GENERAL POPULATION Core Components: PMTCT Male circumcision HIV counseling and testing Antiretroviral Therapy Condom promotion BCC integrated into existing structures (religious institutions, work places, school, etc) focusing on multiple partnerships etc Complimentary Components: IEC Messages and social norms reinforced through mass media STI screening and treatment Blood Transfusion Safety and Infection Control Supporting policy and advocacy

MINIMUM PACKAGE OF SERVICES FOR MARPs Community-based peer education and outreach Risk reduction counseling (peer, outreach or in clinic settings) Condom promotion and distribution HIV counseling and testing STI screening and treatment Family planning and SRH services Post Exposure Prophylaxis HIV care and treatment Access to health/social services Structural issues (community mobilization initiatives and policy level initiatives, including those which address stigma and discrimination)

IMPLEMENTATION STRATEGY Combination HIV Prevention Referral linkages, Integration of services, Health Systems Strengthening Realignment of funding priorities Increased domestic and external resources, Fund HIV Prevention as a key and cross-cutting component of the NDP Improved Coordination Multisectoral response, Health sector, Line Ministries, LGs Monitoring and Evaluation Results-based, Strengthening of M&E systems, Alignment of M&E systems, Improved reporting and surveillance, systems Impact evaluation, Resource tracking, Improved information management and sharing

  INTRODUCTION TO RFA 11-001

INTRODUCTION TO RFA 11-001 HIV/AIDS epidemic in Uganda , goal and purpose  The HIV Prevention Strategy Combination HIV Prevention with emphasis on behavioural and structural interventions The community engagement concept Eligible CSOs CBOs; cultural/religious institutions; NGOs; networks and NNGOs. principal recipients must have district presence of 3 years consortiums. 6 focus districts  UGX 26 billion in a period of 36 months.

OBJECTIVES OF THE RFA The objectives for this RFA mirror those stipulated in the National Prevention Strategy. These include: To empower individuals and communities to effectively demand for quality HIV/AIDS services and to demand for inclusive delivery of these services. To increase adoption of safer sexual behaviors/practices To create a sustainable enabling environment that mitigates the underlying socio-cultural, gender based and other structural drivers of the HIV epidemic To achieve a well coordinated HIV prevention response

EXPECTED OUTCOMES OF THE RFA Higher Level Outcomes Increased demand for and utilization of HIV prevention and care services in the targeted districts Increased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and women Improved community perception of the benefits of sustained behavior change. Well coordinated HIV prevention efforts at national, district and community level.

EXPECTED OUTCOMES OF THE RFA Lower Level Outcomes Increased proportion of adults who have ever received HCT and know at least two benefits of testing. Increased proportion of infected mothers and the exposed infants accessing a minimum package of PMTCT Reduced recent multiple concurrent partners among men and women in the targeted communities Increased average age for marriage or sexual debut for individuals especially youth in the targeted communities Increased proportion of risky sexual acts/encounters that are consistently protected by condoms

EXPECTED OUTCOMES OF THE RFA Lower Level Outcomes (cont..) Increased percentage of women who make decisions about their sexual and reproductive health rights independently or jointly with their partners Reduction of percentage of women who experience sexual violence Improved involvement of men in community based HIV prevention interventions Functional referral mechanisms/systems among the community and facility HIV/AIDS services

THE 4 KNOWS Know Your Epidemic Know Your Context Know Your Response Analysis of data on prevalence and incidence to prioritize populations and geographic areas that are most at risk for HIV. Know Your Context Data to contextualize the epidemic. Ensure cultural relevance. Know Your Response Tracking the epidemiological alignment, scope, coverage and effectiveness of prevention efforts. Know Your Costs Knowing what is spent, and what the output for investment is; prioritizing interventions based on cost-effectiveness.

COMBINATION HIV PREVENTION   COMBINATION HIV PREVENTION

COMBINATION HIV PREVENTION The National HIV Prevention Strategy for Uganda calls for a strategic shift towards Combination HIV Prevention Definition (UNAIDS ) “The strategic, simultaneous use of different classes of prevention activities (biomedical, behavioral, social/ structural) that operates on multiple levels (individual, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership, and engagement of affected communities.”

BIOMEDICAL ART treatment for eligible patients and PreP Safe Male Circumcision PMTCT Home-based HIV Testing HIV Testing (routine/opt-out) linked to ART and behavioral change programs TLC Family planning STI-screening and treatment of MARPs & PLHIV Safe syringes

BEHAVIORAL Condom Use Promotion Programs Peer education HIV prevention programs addressing condom use, concurrency, age-mixing and transactional sex targeting high risk groups Couple counseling Disclosure promotion programs Delay sexual onset Adherence to ART support programs Positives Counseling Programs Positive Health Dignity and Prevention (PHDP) Abstinence and Faithfulness programs

SOCIAL/STRUCTURAL Micro credit programs to support women’s economic situation Creating Demand for HIV Prevention Services Programs GBV prevention programs Conditional Cash Transfers Women Empowerment Programs PLHIV programs addressing stigma Addressing widow inheritance Human Rights and Empowerment Interventions for Sex Workers, IDU’s Easing access to care for Sex Workers, IDU’s

BENEFITS OF THE RIGHT COMBINATION Several HIV interventions have a proven, but partial efficacy In combination a synergy effect can occur between different interventions, which increases the effectiveness of all of the interventions when delivered together. According to the local epidemiology we will have a tailor made HIV prevention program for the area The tailor made approach adds effectiveness, high risk individuals and groups are targeted first to avert most new HIV infections Tailor made combined intervention taking place at the same time in the same place to a defined standard are know to be more effective. Efficacy is what’s shown in Randomized Clinical Trials. It’s the result you get while implementing an intervention. As you all know there’s no one solution that works everywhere and for everyone.

  COMMUNITY ENGAGEMENT

COMMUNITY ENGAGEMENT DEFINITION Community engagement is the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.(adapted from Fawcett et al, 1995) Different levels at which one engages with people:- * Inform * Consult * Involve * Collaborate * Empower N.B: Different situations require the use of different levels of engagement  

COMMUNITY ENGAGEMENT PRINCIPLES Empowering the people to make decisions, raise question & problems and be part of the solution The rules of engagement between the target beneficiaries and the supporting agency need to be clarified Should be participatory (need awareness before this can be acted upon) Should include both men and women Focus on the power dynamics (women empowerment) Community ownership Accountability

BENEFITS OF COMMUNITY ENGAGEMENT of engaging the community:- the development of sustained, community-focused and led interventions Use of explicit methodologies that engage people in discussion and collective action on the factors that influence risk and vulnerability to HIV in their particular communities. The development and/or strengthening of strategic partnerships and coalitions that help mobilize resources and influence systems, change relationships and serve as catalysts for changing policies, programs and practices.

Innovative interventions in the following:- AREA OF FOCUS AND SUGGESTED INTERVENTIONS Innovative interventions in the following:- Communication for social and individual behavior change Gender norms and harmful social cultural practices  Coordination, collaboration, strategic partnerships networks and referrals Cross cutting issues Engage with district and any other relevant Capacity building interventions for communities and selected duty bearers.  

NOTES Consortiums -leverage resources and avoid duplication of efforts. Procurement restrictions Niche/comparative advantage Coverage of target populations

  Building Strategic Partnerships, Linkages and Referrals – The role of the various stakeholders in the district

Strategies for strengthening partnership, linkages & referrals Establishing terms and conditions of partnership Ensuring clarity of roles of all partners Ensuring regular meetings of the partners Ensuring transparency and accountability in the partnerships Strengthening forums for partnership development Strengthening the capacity of service providers to manage referrals

OVERVIEW OF THE M&E SECTION   OVERVIEW OF THE M&E SECTION

OVERVIEW OF THE M&E SECTION The M&E section has three main components; The M&E Matrix The M&E Narrative 3. The M&E Resources 4. The CSF M&E System

THE M&E MATRIX Builds on the log frame and provides the following details: Overall Objective – what your project intends to contribute to. Outcome-desired change/ result that your project aims to achieve Outputs - immediate results of project activities Performance indicators (within prevention strategy framework) and respective baselines and targets Means of Verification (MOV) - Data sources Frequency of data collection for each indicator 7. Responsible person /entity for data collection for each indicator 8. Frequency of data analysis and use for each indicator 9. Responsible person /entity for data analysis for each indicator

THE NARRATIVE SECTION Explain precisely the how, what, who, when and where regarding; Data collection Data storage Data analysis, reporting and utilization Other monitoring processes Data quality assurance M&E capacity building Monitoring external, uncontrollable factors

M&E RESOURCES Provide a sufficient M&E budget (10 – 15% of the total project budget) cater for:- Full-time M&E personnel to carry out M&E functions Equipment for data capture, storage, processing and reporting e.g. computers, internet Short-term M&E resources e.g. consultants, data entrants M&E activities including data collection, analysis, storage, reporting, review meetings, trainings, assessments, tools production, field monitoring visits and the like.

The CSF M&E System Data collection tools: CSF has standardized data collection tools fro capturing HCT, HIV prevention, PMTCT, that are used by all the sub grantees. The sub grantees will therefore be required to adopt the available data collection tools. Reporting formats: CSF has standardized reporting formats for quarterly, semi annual and annual reports. All sub grantees are supposed to abide by the reporting timelines An online database: CSF has an online database for capturing sub grantee data and all are required to enter their data in this database. Indicators: CSF has standardized indicators that all sub grantees are required report against.

TARGET AND DENOMINATOR TABLE CATEGORY (CSW, PHA, Fisher folk etc) District Female Male Total Sub county Parish Age (Years) Target Denominator 10-14 15-24 ≥25

EXPECTED OUTCOMES OF THE RFA Higher Level Outcomes Increased demand for and utilization of HIV prevention and care services in the targeted districts Increased adoption of safer sexual behaviors /practices and reduced risky behavior among targeted men and women Improved community perception of the benefits of sustained behavior change. Well coordinated HIV prevention efforts at national, district and community level.

EXPECTED OUTCOMES OF THE RFA Lower Level Outcomes Increased proportion of adults who have ever received HCT and know at least two benefits of testing. Increased proportion of infected mothers and the exposed infants accessing a minimum package of PMTCT Reduced recent multiple concurrent partners among men and women in the targeted communities Increased average age for marriage or sexual debut for individuals especially youth in the targeted communities Increased proportion of risky sexual acts/encounters that are consistently protected by condoms

EXPECTED OUTCOMES OF THE RFA Lower Level Outcomes (cont..) Increased percentage of women who make decisions about their sexual and reproductive health rights independently or jointly with their partners Reduction of percentage of women who experience sexual violence Improved involvement of men in community based HIV prevention interventions Functional referral mechanisms/systems among the community and facility HIV/AIDS services

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