1. PEPFAR-funded Programs Susan Purdin, RN, MPH Senior Technical Advisor, Reproductive Health Fourth Meeting of the IOM Committee for the Evaluation of PEPFAR September 15, 2005

2. 2 The International Rescue Committee Provides programming from the acute emergency to the post-conflict phase for persons affected by armed conflict, including refugee resettlement in the USA Beneficiary populations include: Refugees Internally Displaced Persons Returnees Communities hosting refugees and IDPs Returnee communities

3. 3 IRC’s international programming Social Schools Health Water & sanitation Gender-based violence Economic Livelihoods Governance & Rights Protection Civil society development

4. 4 Lack of attention to HIV for refugees 29 countries in Africa host more than 10,000 refugees UNHCR reviewed 22 national AIDS plans, only 10 include refugees in their program activities. In 23 states with approved GFATM proposals only 5 programs have included activities for refugees. Only 8 of 15 approved World Bank MAP projects have refugee-specific components

5. 5 Forced migration in conflict

6. 6 HIV vulnerability in conflict Consequences of displacementCharacteristics Multiple losses : deaths of family/friends, home, land, job/school Sadness, bereavement, depression Uncertain futureFatalism, desire to go home, short-term view Loss of legal status; rights; autonomyApathy, fear Dependence on camp routines and regulationsInsecurity, anxiety, loneliness Breakdown of family and social structures o increase in proportions of single men, women and child-headed households Suspicion, lack of trust, lack of respect ImpoverishmentHunger Loss of servicesPoor health, stress Suffered traumatic events: captivity, rape, torture, witnessed deaths, committed atrocities Numbness, guilt Lack of meaningful activityBoredom, aggression, frustration New influencesrisk-taking

7. 7 IRC implements primary health care programs in 20 countries All with some aspects of HIV programming Prevention Behavior change Blood safety & universal precautions Care & support Prevention & treatment of opportunistic infections Home-based care ART

8. 8 IRC’s HIV activities have been funded by CDC – Kenya – CDC/PEPFAR CIDA SV DFID EC ECHO Packard Foundation USAID – Uganda – USAID/PEPFAR USBPRM – Ethiopia, Uganda – BPRM/PEPFAR USOFDA UNFPA UNHCR

9. 9 Ethiopia – Sherkole Refugee Camp BeneficiariesFundingActivities RefugeesIDPsHostsTotal2004-20052005-2006 VCT 16,000010,00026,00095,00073,000

10. 10 Kenya SiteRefugees IDPsHostTotalFundingActivities Lokichoggio0041,551 2004- 2005 2005- 2006 BCC VCT PMTCT Care & Support ART M&E Non- PEPFAR 659,000 Kalakol0032,995 Kakuma86,1670111,506197,673

11. 11 Uganda SiteRefugees IDPsHostTotalFundingActivities Ikafe7,952010,46418,416 2004- 2005 2005- 2006 BCC VCT PMTCT Care & Support M&E 245,654 Kiryandongo15,812012,00027,812 Kitgum & Pader0291,5000 Karmoja00756,000

12. 12 Challenges identified Pressure to increase targets – and it seems that all they care about are the numbers – no interest in constraints, local community participation, etc – if your numbers are on target you are OK, if not, do not expect any additional funding (Ethiopia) Short notice from prime agency (PRM, AID) for PEPFAR reports (Kenya) – and – dual reporting to PEPFAR and prime agency (all) Interpersonal relationships between IRC and granting agency are key – in securing funds and in negotiating implementation and reporting requirements. Collecting data from sub-grantees on activities according to PEPFAR’ s reporting format (Uganda) Proportional allocation of funds is pre-established per program area. For example, 66% of Prevention funding must go to AB, which means that in Uganda condoms are almost completely cut from budgets and 10% of overall funding should go to OVCs, which means that these activities will have to be expanded at the expense of other program areas such as building institutional capacity and rehabilitation of facilities (Uganda)

13. 13 Future prospects BPRM representative based in Uganda is advocating for PEPFAR allocations for refugees in his countries: Cote d’Ivoire Kenya Rwanda Tanzania Uganda