Round 6 grant: role of the Alliance Ukraine Support for HIV and AIDS Prevention, Treatment and Care for Most Vulnerable Populations in Ukraine 12 th Stakeholders’ meeting 23 rd of August, 2007 Andriy Klepikov Executive Director, International HIV/AIDS Alliance in Ukraine

OVERALL KEY PARAMETERS:  5-year programme Support for HIV and AIDS Prevention, Treatment and Care for Most Vulnerable Populations in Ukraine with maximum umbrella budget over 151 million USD for the period of August 2007 – July  Goal: To reduce HIV transmission and AIDS-related morbidity and mortality in Ukraine through interventions focused at most at-risk populations.  Approved budget for the 1 st phase (1 st of August 2007 – 31 st of July 2009) million USD.  Two non-governmental organisations became principal recipients of this programme – International HIV/AIDS Alliance in Ukraine and All-Ukrainian Network of People living with HIV/AIDS.  Budget split (Alliance Ukraine – 15.6 mln. USD, PLHA Network – nearly 14 mln. USD).

OBJECTIVES AND AREAS OF RESPONSIBILITY: Program has five objectives: Objective 1. To ensure adequate access to integrated prevention, treatment, care and support for marginalized populations (Alliance acting as a PR) Objective 2. To scale up comprehensive HIV care and treatment and ensure equitable access to services for IDUs and other vulnerable populations (Network acting as a PR) Objective 3. To expand access to comprehensive adherence counseling, psycho-social support and care for PLWHA (Network acting as a PR) Objective 4. To create a supportive environment for a sustainable and effective response to HIV/AIDS in Ukraine (Network and Alliance acting as co-PRs) Objective 5. To monitor and evaluate grant implementation and strengthen the national M&E system (Alliance and Network acting as co-PRs)

Consolidated phase I budget by program objectives (OB)

PROGRAM OVERSIGHT:  Country Coordination Mechanism (CCM) will provide the general coordination of Program implementation, including coordination of the requests for continued funding from the Implementing Country to the Global Fund, to be submitted before the end of Phase 1. It will also oversee and monitor the Program implementation. The National HIV/AIDS and TB Coordinating Council of Ukraine chaired by Vice-prime Minister of Ukraine Dmytro Tabachnik is playing the role of CCM in Ukraine.  There is a plan to set up the Project Conciliatory Group with the main responsibility to coordinate activities between two Principal Recipients to be formed by five constituencies: Alliance Ukraine, PLHA Network, NGO Coalition, Government of Ukraine, Parliament.  Stakeholders meetings will remain the key regular mechanism for the transparent programme accountability and broad coordination.

Objectives Alliance Ukraine is focusing on:  Objective 1: To ensure sufficient access to integrated prevention, treatment, care and support for vulnerable populations SDA 1: Community outreach for IDUs SDA 2: HIV/AIDS services in prisons SDA 3: Community outreach for FSWs SDA 4: Community outreach for MSM SDA 5: Prevention for street children  Objective 4: To create a supportive environment for a sustainable and efficient response to HIV and AIDS in Ukraine SDA 12: Strengthening of civil society and institutional capacity building to contribute to the response to the HIV epidemic Technical capacity building: Technical support provision Technical capacity building: Technical support provision Technical capacity building: Ensuring that AIDS service organizations have access to effective approaches and models of work Technical capacity building: Ensuring that AIDS service organizations have access to effective approaches and models of work  Objective 5: To monitor and evaluate grant implementation and strengthen the national M&E system SDA 14: Overall program monitoring and evaluation Maintenance and support of the M&E system Maintenance and support of the M&E system Carrying out surveys on programmatic activities in the sphere of prevention of HIV/AIDS Carrying out surveys on programmatic activities in the sphere of prevention of HIV/AIDS External evaluations of prevention programs and overall grant implementation External evaluations of prevention programs and overall grant implementation SDA 15: Strengthening the National M&E system Support capacity building for a national M&E system to implement monitoring and Support capacity building for a national M&E system to implement monitoring and evaluation of the national response to HIV/AIDS Support for the collection of national SGS data and national M&E indicators Support for the collection of national SGS data and national M&E indicators

Target Groups / Beneficiaries:  Injecting drug users;  Female sex workers;  Men who have sex with men;  Prisoners;  Street children aged years.

Phase I progam budget to be implemented by Alliance Ukraine Year budget break-down Year budget Q1Q2Q3Q4Year 2 Objective Number Objective formulation 1 To ensure sufficient access to integrated prevention, treatment, care and support for marginalized populations , , , , , ,38 4 To create a supportive environment for a sustainable and sufficient response to HIV/AIDS in Ukraine (in the part administered by Alliance, Ukraine as a PR) 0, , , ,00 5 To monitor and evaluate grant implementation and strengthen the national M&E system (in the part administered by Alliance, Ukraine as a PR) , , , , , ,16 N/A Management / PR Implementation Unit , , ,28 Summary period budget (in USD)

Key coverage indicator targets – end of year 2 of Program implementation IndicatorTodayTarget as of the end of year 2 Number and % of IDUs reached by HIV/AIDS prevention programs 123,140170,000 (52% of the estimated population) Number and % of FSWs reached by HIV/AIDS prevention programs 17,51023,000 (21% of the estimated population) Number and % of MSM reached by HIV/AIDS prevention programs 8,21613,800 (7,8% of the estimated population) Number and % of prisoners reached by HIV/AIDS prevention programs 36,57243,500 (27%) All IDUs and FSWs will receive the minimum package of prevention services (condom, syringe (if IDU) informational materials, consultation of a social worker and a referral to another specialist, depending on the client’s needs), and will also have access to VCT with rapid tests, STI diagnostics and treatment and services provided by mobile clinics.

Key impact indicator targets - end of year 5 of Program implementation Target as of the end of year 5 HIV prevalence among injecting drug users (weighted average for 6 oblasts) 30%26% HIV prevalence among female commercial sex workers (weighted average for 6 oblasts) 20%16% IDUs: safe injecting and sexual practices (Percentage of IDUs who report having adopted behaviours that reduce transmission of HIV, i.e. who both avoid sharing injecting equipment and use condoms in the last 12 months) 53%65% Percentage of MSM who report using condoms (Percentage of men reporting the use of a condom the last time they had anal sex with a male partner) 72%85% Percentage of CSWs who report using condoms (Percentage of female CSWs who report using a condom with their most recent client, of sex workers surveyed having had sex with any client in the last 12 months) 85%94%

Beginning of the program – first steps Open call for proposals of the projects on HIV/AIDS prevention among vulnerable groups has been conductedOpen call for proposals of the projects on HIV/AIDS prevention among vulnerable groups has been conducted –Open call for proposals of the projects has been announced on 3 July 2007 covering 13 areas, including HIV/AIDS prevention, rehabilitation of drug dependency, medico-social support of substitution maintenance therapy –130 project proposals have been received by 6 August 2007 –It is expected that project will be financed with $6,368,000, $1,730,000 coming from the budget of Round 6 –Significant increase in the budget for prevention programs among vulnerable groups is expected compared with the last year

Expected budget of the programs on HIV/AIDS prevention compared to the previous period

Expected budget of the programs on HIV/AIDS prevention compared to the previous period

Expected budget of the programs on HIV/AIDS prevention compared to the previous period

Expected budget of the programs on HIV/AIDS prevention compared to the previous period

Beginning of the program – first steps Negotiations are conducted and agreements are achieved on supplies of condoms, synergies and other products for prevention programs –USAID will provide 19,000,000 condoms in September 2007 –MoH (WB loan) will provide in 18,000,000 synergies and hygienic napkins as well as 11,000,000 condoms in January 2008 Preparations on implementation of STI component in prevention programs have been started –Negotiations with major stakeholders in this field are conducted. –Creation of the working group with MoH involvement for development and agreement of plans as well as invovlement of educational institutions to delivery of assistance with STI for vulnerable groups.

Round 1 to Round 6 complimentarity

Round 1 No-cost extension priorities  Drugs for substitution therapy  Support programmes for the ST clients  Support for ARV adherence  Administrative support

Addressing the challenges:  Harmonization with Round 6 programme, addressing potential funding gap between October 2008 – June  Build confidence that all the patients that will receive ARV treatment and PMTCT within the Round 1 framework will continue treatment after September 2008 with governmental funding.  Addressing programme and political challenges, particularly scaling up substitution maintenance treatment e.g. using methadone according with the Round 1 and Round 6 grant targets.  Setting effective STI programs for vulnerable groups linking medical facilities which provide STI care and NGOs which have access to those vulnerable groups.