This document discusses enhancing engagement between PEPFAR and faith-based organizations and faith communities to help control the HIV epidemic. It notes that faith communities have significant influence and reach in sub-Saharan Africa, with high levels of worship attendance. PEPFAR and faith policies align in some areas like promoting HIV testing, treatment, prevention of gender-based violence, and male engagement. The document argues that faith-based organizations need to be optimally utilized to diagnose and treat well children and young adults with HIV, and that their engagement is essential to addressing the key gaps in controlling the epidemic.

1. Faith Communities and
HIV Epidemic Control:
Turning Influence into Impact

2. We need the
communities of
Faith engagement
in order to get the
HIV epidemic
under control

3. And we need to
ensure we are
optimally utilizing
the Faith Based
Organizations

4. The Lancet Special Issue on FBO Contributions to
Health Highlighted at World Bank Summit on
Religion and Sustainable Development, 2015
THE LANCET
6 July, 2015
An estimated 84% of the world’s
population is religiously affiliated. Faith
is a powerful force in the lives of
individuals and communities worldwide.
This Series argues that building on the
extensive experience, strengths, and
capacities of faith-based organizations
offers a unique opportunity to improve
health outcomes.

5. Engagement of Communities of Faith and Faith-Based
Organization in PEPFAR -The beginning of PEPFAR (2003)
and now
Faith Based
Organizations
with PEPFAR
Support
Faith Based
Organizations
with PEPFAR
Support
Communities
of Faith
supporting
Communities
with HIV
Communities
of Faith

6. 6
What IS PEPFAR and
What is it focus

7. PEPFAR PROGRAM RESULTS
Over 14 million women, men, and children on ART
Over 2.2 million babies born HIV-Free
Over 15 million voluntary medical male circumcisions
Over 6.4 million orphans, vulnerable children, and
caregivers provided with critical care and support
Over 65% of DREAMS districts with a 25-40%
decline in new HIV infections
Source: pepfar.gov, 2018

8. PEPFAR’s 3 Guiding Pillars
Accountability
Demonstrate
cost-effective
programming that
maximizes the
impact of every
dollar invested
Transparency
Demonstrate
increased
transparency with
validation and
sharing of all levels
of program data –
NOW AT SITE
LEVEL –
community and
facility
Impact
Demonstrate
sustained control of
the epidemic; save
lives and avert new
infections
Controlling the HIV
Pandemic
Active Program and Partner Management

9. PEPFAR Alignment to HIV
Burden

10. What have we
learned?
Dramatic impact is possible if:
The core policies are adopted quickly and
continuously evolving based on program
needs and gaps
AND we are in constant communication
with community and implementing
partners to make rapid improvements

11. Achieving Epidemic Control
Progress toward 90/90/90 in Adults
Source: Population-Based HIV Impact Assessments (PHIA) IMPACT Studies, 2016, 2017

12. Substantial declines in HIV infections in
young people and parents surviving in just
5 years
12

13. Dramatic increase in viral load suppression 2015 vs 2017
Namibia
73%

14. 14
BUT We have identified the key
gaps : we are NOT diagnosing
“healthy” children and young
adults with HIV and getting them
into treatment

15. LEADING TO : Who is and who isn’t virally suppressed
*Pooled data from Lesotho, Malawi, Namibia, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe
from PHIA projects.

16. 16
Dramatic increase in funding to
prevent infection in boys and
young men (VMMC) and girls
and young women (DREAMS)

17. HIV
VMMC
Condoms
PrEP
“Well” HIV
infected Men
HIV Dx and
ARV Tx
Young Women
DREAMS
Risk avoidance and reduction
Sexual violence prevention, PrEP
HIV
GAP : Prevention and treatment Services for Young
Men AND Adolescent Girls & Young Women
9-24 yo 25-35 yo
15-30 yo

18. HIV Prevalence by Age & Sex Swaziland

19. HIV Prevalence by age and sex
Malawi
Malawi PHIA, 2016

20. 20
Youth Bulge in Zambia as illustration of the future SSA
At the beginning of the Epidemic Today
Young Men Population: 781,000
Young Men PLHIV: 38,000
Young Women Population: 772,000
Young Women PLHIV: 66,000
Young Men Population: 1.6 million
Young Men PLHIV: 48,000
Young Women Population: 1.6 million
Young Women PLHIV: 77,000
Source: US Bureau of the Census , 2017 & UNAIDS, 2017

21. What is DREAMS?
Determined
Resilient
Empowered
AIDS-Free
Mentored
Safe

23. Our Priorities for Adolescent Girls
and Young Women
Keep them HIV FREE
Support them to:
• Stay in school
• Prevent early
pregnancies
• Prevent sexual violence
• Post violence care
• Reduce child marriage
Photo credit: USAID/Carole Douglis

24. DREAMS
Achievements

26. DREAMS Results
World AIDS Day, 2017
For the first time, the latest PEPFAR data show
significant declines in new HIV diagnoses among
adolescent girls and young women. In the 10 African
countries (63 districts) implementing DREAMS, the
majority (65%) of the highest-HIV-burden communities
or districts achieved a 25-40 percent or greater
decline in new HIV diagnoses among young
women. Importantly, new diagnoses declined in nearly
all DREAMS intervention districts.

27. DREAMS Programming Impact
Group by percent of districts in each country
with a greater than 25% decline
100% of
Districts
80% of
Districts <50% of
Districts

28. Districts with > than 25 % declines
(2/3rd)

29. Districts <25% declines (1/3rd)

30. •Comprehensive prevention interventions
work – most of the time in most of the
places for adolescents and young women
•We are sending teams into 6
countries—1 where all districts had a
>25% decline, 3 with mixed results, and 2
where all districts had a <25% decline
What we have learned and the
questions that remain

31. • Large urban areas vs. peri-urban or rural areas?
• Districts where secondary schooling is free?
• Less fidelity to the optimized program implementation?
• Cultural differences?
• Opportunities and options for young women?
• Differential VMMC and treatment coverage for young adult
men?
• Geographic coverage of DREAMS activities within DREAMS
districts?
Potential reasons why the impact
was less that are being explored

32. 32
Reaching HIV positive and
negative boys and girls through
our OVC programming :
constantly evolving the program
to meet the needs

33. Majority of Orphans Aged 10-17
Zimbabwe Trends over Time

34. OVC Programming Approach
• Focus on socio-economic, and health promotion and
access interventions, that reduce vulnerability, contribute to
prevention and risk avoidance goals, and support access
to and retention in treatment
• Provide family-centered, comprehensive care through case
management and routine monitoring
• Partner with FBOs, local communities and government
counterparts
• Ensure all HIV positive are supported, diagnosed,
treated and virally suppressed

35. • Promotion of HIV testing, including EID, and confirmatory HTS
• Referral to interventions focused on keeping adolescents HIV-free,
especially adolescent girls
• Coordination with NACS and EPI
• Facilitating uptake of and monitoring completion of health care
referrals
Healthy
• Supporting community and national level child protection/ GBV
prevention, including Violence Against Children Surveys
• Supporting clinic-based child abuse and GBV response services
• Succession planning and Permanency support
• Positive Parenting skills
Safe
• Facilitating group-based Household Economic Strengthening
activities, such as savings groups
• Supporting access to and uptake of social protection efforts
• Limited and temporary emergency cash
Stable
• Facilitating access to primary and secondary education
• Providing temporary school block grants to promote enrollment
and progression
• School-based psychosocial support and safety from violence
• Integrating cognitive development, attachment and stimulation into
HIV care & treatment
Schooled

36. 36
Malawi DREAMS Efficiency
Building on Synergies with the OVC Platform
Post violence
care
Social Assets
Community
mobilization and
norms change
Parenting
Programs 9-14
Case
management
services
9-17 year old AGYW = Target Group for Synergies
OVC DREAMS
Household Economic
Strengthening
Sexual Violence and HIV
prevention programming for
girls and boys 9-14
Parenting Programs
Case Management
School based GBV and
HIV Prevention
Programming
Condom Promotion and
Distribution
Sexual Violence and
HIV prevention
programming for girls 9
-14
Sexual and Reproductive
Health Services
Post Violence Care for
18+
PrEP
Education Support

37. Early Sexual Debut
AND
Sexual Violence
Are associated with
each other
AND
With risk for HIV

38. 38
Source: (VACS),
2016 *Data for Zimbabwe only available for 18-24 year old female
respondents.

39. 39
PMTCT

40. 40
15 Year Anniversary of PEPFAR’s Enactment
“Nelly lived in fear of stigma for
10 years until she connected
with a PEPFAR supported clinic
in 2005. Now, she is one of
over 14 million people receiving
lifesaving treatment with
PEPFAR support and has a
healthy baby, Charity – one of
the over 2.2 million babies born
HIV-free thanks to PEPFAR’s
assistance - who wants to be a
doctor when she grows up.”

41. 41
What is PEPFAR doing now towards EMTCT?
Source information here as necessary
•Since 2003, over 2.2 million infant infections
have been averted with PEPFAR support.
•To reach elimination we will need to:
– Continue to improve primary HIV prevention for AGYW,
– Increase attendance rates for antenatal care : together we must address the
formal and informal ANC fees in West and West Central Africa,
– Provide partner testing and PrEP for high risk pregnant/BF women,
– Improve retesting at delivery and during breastfeeding in high incidence
areas to detect seroconversion and provide immediate ART,

42. Since 2004, 2.2 million infant infections
averted with PEPFAR support

43. More pregnant women are receiving ART and entering
pregnancy on ART.

44. 44
Increasing prevention
of cervical cancer

45. Countries with the highest HIV prevalence in women have the
highest incidence of cervical cancer.
Women with HIV are 4-5 times more likely to develop
cervical cancer

46. Ending cervical cancer in HIV+
women at scale• Revised strategy will reduce cervical cancer risk by
95% in HIV-positive women
• PEPFAR support to include every-other-year
cervical cancer screening for HIV-positive women
over age 30, and
• HPV vaccination in younger girls and women LHIV
• Goal: Ensure all HIV-positive women over age 30 are
being screened and treated for pre-invasive cervical
lesions as rapidly as possible
46

47. Cervical cancer programs in
COP18
• Botswana, Lesotho, Malawi, Mozambique, Namibia,
Swaziland, Zambia, and Zimbabwe should plan for
expanded cervical cancer screening, initiating roll out at
high volume ART sites
• Teams should plan to scale up over time, and use a
hub-and-spoke model, referring women from smaller
sites to larger hub sites for screening, to reach all women
on ART with screening every other year.
47

48. 48
We have identified the key
program gaps
1. diagnosis of well children and
young adults – especially men
2. sexual violence of young girls

49. PEPFAR collaborations with FBOs
are not new
PEPFAR I.0
Community
Trust,
Palliative
& OVC
Care,
Stigma
reduction
2003-2008 2008-2013
PEPFAR 2.0
CONSULTATION
ON FBO ROLE
Focus on
sustaining
community and
country
leadership for
response,
OVC care
PEPFAR 3.0
FBOs
responded
to 90-90-90
pivot
2015 2017 2018
World Bank:
Religion &
Sustainable
Development:
Building
Partnerships
to End
Extreme
Poverty”
2014
Lancet
Series Faith
Based
Health
Providers
Seminal
Call to
Action
PEPFAR 3.0
CONSULTATION
ON FBO ROLE
Focus
on urgent
challenges-
Reaching the
vulnerable
(men, AGYW,
OVC) with
services and
prevention
PEPFAR 2017-2020
Strategy
Advancing HIV
Epidemic Control
Enhancing FBO
Engagement as a
key action step for
achieving epidemic
control
PEPFAR
COP 2018
Enhanced
Engagement for
reaching men & boys,
preventing violence
and HIV by avoiding
risk, pediatric and
adolescent treatment
PEPFAR/
UNAIDS
Strengthening
Faith
Community
Partnerships
for Fast Track

50. We need the
communities of Faith
engagement in
ensuring well children
and young adults are
diagnosed and treated

51. And ensure we are
optimally utilizing the Faith
Based Organizations –
with rapidly changing
demographics
(urbanization and 60% of
population under 20

52. In Sub-Saharan
Africa
communities are
engaged with
their churches

53. ACCESS: Worship Attendance,
Pew-Templeton:
“How often do you attend religious
services?”
Percentage

54. Enhancing
PEPFAR’s
Engagement
with FBOs and
Faith Communities

55. PEPFAR Strategy for Accelerating HIV/AIDS
Epidemic Control (2017-2020), 5 key actions
• Accelerate optimized HIV testing &
treatment - men <35
• Expand prevention for women <25 & men
<30 via DREAMS Partnership to reduce
incident HIV in Adolescent Girls and
Young Women, and VMMC
• Use health & cost data to increase impact
• Renew engagement with FBOs and the
private sector to accelerate epidemic
control
• Strengthen contributions by partner
governments in HIV/AIDS response

56. Faith Policies and PEPFAR
Priorities Have Areas that Align
EAM 2017 Sexual and Reproductive Health Policy
Statements
HIV & YOUTH (ages 10-35):
• Promote youth-parent interactions on sex and sexuality (3.8.6.3)
• Abstinence & fidelity are among the first line preventative measures
for transmission of HIV (3.9.5.1)
• Correct and consistent condom use during conjugal union reduces
transmission of HIV (3.9.5.2)

57. When FBO Policies and PEPFAR
Priorities Have Areas that Align
VIOLENCE
• The church stands strongly against & condemns
all forms of gender based violence (3.12.5.1)
• Build capacity of church to implement programs
of sexual GBV, targeting vulnerable groups

58. When FBO Policies and PEPFAR
Priorities Have Areas that Align
MALE ENGAGEMENT (3.12.6.1-4)
• Advocate for male involvement in all issues of sexual &
reproductive health (SRH)
• Engage with Government in service delivery to create
men-friendly facilities for engaging men in SRH
• Build capacity of men in and outside the church on issues
of Sexual and Reproductive health

59. • Emphasize awareness
• Preach abstinence and
teach prevention
• Promote self-esteem
• Promote HIV Testing
• Inform about and promote
treatment adherence
• Provide spiritual support
• Practice compassion
Churches as Influencers – Sermon Messages

60. Thank You!
We are poised to
make the impossible -
possible