LEADERSHIP AND INVESTMENT IN FIGHTING AN EPIDEMIC (LIFE)
Proposed Joint Operating Plan of the U.S. Agency for International Development,
the U.S. Department of Health and Human Services, and the U.S. Department of
DefenseNovember 23, 1999

Table of Contents
Page
I. Introduction
A.

3
Geographic Focus

II. Program Elements
A.

Primary Prevention

4
6
7

Primary Prevention -- Civilian
1. Voluntary counseling and testing7

2. Social marketing8

3. Behavior change

8

4. Mother-to-child transmission

8

5. STD management8

6. Blood safety9

Primary Prevention – Military
1. Assessment

9

2. Regional specific military based education

9

3. Enhanced military education of African UN peacekeeper forces

10

Improving Community and Home Based Care and Treatment10

1. Care and treatment

11

2. Home and community based care and support

11

C.

Caring for Children Affected by AIDS

11

D.

Capacity and Infrastructure Development

12

1. Increasing political commitment13

2. Surveillance13

3. AIDS program strengthening

13

B.

III.

Managing and Monitoring the LIFE Initiative

13

IV.

Next Steps

13

A.

Country Level

13

B.

Global/Regional Level

14

C.

Milestones

14

V.

AnnexesA. Current USG HIV/AIDS Assistance in Target Countries and Regions

17

B: Activities Supported by the LIFE Initiative in Target African and Asian Countries

18

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

2

LEADERSHIP AND INVESTMENT IN FIGHTING AN EPIDEMIC (LIFE)
Proposed Joint USAID-USDHHS-USDOD Operating PlanI.

Introduction

On July 19, 1999, the Administration announced a new Initiative to address the global AIDS pandemic. This
Initiative is supported by an amendment to the Fiscal Year 2000 budget proposal signed by the President
and submitted to Congress for its consideration. A central feature of this LIFE Initiative is a $100 million
increase in US support for sub-Saharan African countries
and India, which are working to prevent the further
LIFE INITIATIVE’S GUIDING PRINCIPLES
spread of HIV and to care for those affected by thisdevastating disease. This additional funding is a critical
US agencies will apply the following principles tostep by the United States Government in recognizing thethe design and implementation of LIFE:
impact that AIDS continues to have on individuals,
families, communities and nations responding to theü Country ownership of the activities is essential.
imperative to do more. It is our hope that other nations
ü Initiative funding must complement existingand institutions will match this action.
programs and activities conducted abroad, asThis plan contains a framework of interventions,
grounded in a series of goals and objectives consistent
with those established for the international community incollaboration with the Joint United Nations Programme
on AIDS (UNAIDS). Specific activities and outcomes will
be delineated through dialogue with those African
nations and India that partner with the United States, aswell as with the multinational and community-based nongovernmental organizations that support the front line
fight against AIDS.

üwell as work within the context of national
HIV/AIDS strategic plans.
Leverage of and coordination with other
donors and organizations (including working
with the International Partnership against AIDS
in Africa) is critical.

ü

The number of collaborating USG agencies
and other partners in the fight against AIDS
must be increased.

üSupport for indigenous expertise andinstitutions in implementing program elements
must be emphasized.

The Initiative builds on the existing investment by the US
ü Information sharing must be two-way so as toin HIV/AIDS programs in Africa and India and involves anenhance opportunities to learn about newmodels that will assist US-based HIV programs
unprecedented collaboration between the United States
as well as to share US experiences abroad.
Agency for International Development (USAID), theDepartment of Health and Human Services (DHHS), andthe Department of Defense (DoD). USAID will have lead responsibility in the facilitation of coordinatedaction. The Initiative is a significant turning point in the United States Government fight against AIDS andwill contribute over the next 3 to 5 years to broad global targets that seek to reduce the transmission of HIV
by 25% and provide basic care and support services to at least 75% of infected persons.
The Initiative focuses on sub-Saharan Africa and India, which will be complemented by regional activities inwestern and southern Africa. The countries targeted represent those with the most severe epidemic, thehighest number of new infections, where the potential for impact is greatest, and where USG agencies are
already active.
The Initiative will contribute to the achievement of the goal’s articulated by UNAIDS and to the partnerships
necessary to that achievement. Yet curtailing this epidemic will require a significantly enhanced responseby the global community and cannot be viewed as just the responsibility of the US government. Therefore,
US partners involved in the LIFE Initiative will collaborate with UNAIDS and other international and local
agencies both to leverage additional resources from host countries, multilateral institutions, and the private
sector and to maximize coordination.
The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

3

Specific planning for activities and results under the LIFE initiative must be responsive toindividual country needs, existing efforts underway, and opportunities for intervention. As
a result, the actual scope of interventions will vary across countries and cannot be
determined in advance.

WORLDWIDE HIV/AIDS GOALSUNAIDS, in cooperation with its bilateral and multi-lateral partners, has laid out a series of international goals
for the next five years as described below. These goals represent the result of the total worldwide
contribution of resources and effort. The Administration seeks to work toward achieving these goals throughthe LIFE Initiative efforts.
ü
ü

ü

A.

The incidence of HIV infection will be reduced by 25% among 15-24 year olds by 2005. (Currently 2
million young adults are infected each year in sub-Saharan Africa.)
At least 75% of HIV infected persons will have access to basic care and support services at the homeand community levels, including drugs for common opportunistic infections (TB, pneumonia, anddiarrhea). (Currently, less than 1% of HIV infected persons have such access.)
Orphans will have access to education and food on an equal basis with their non-orphaned peers.

ü

By 2002, domestic and external resources available for HIV/AIDS efforts in Africa will have doubled to$300 million per year. (Currently, approximately $150 million per year is spent on HIV/AIDS prevention
in sub-Saharan Africa.)ü

By 2005, 50% of HIV infected pregnant women will have access to interventions to reduce mother-tochild HIV transmission. (Currently, less than 1% of HIV infected pregnant women have access to suchservices in sub-Saharan Africa.)

Geographic Focus
The initiative focuses on 14 target countries (13 in sub-Saharan Africa and India) as well as onregional activities in western and eastern/southern Africa. In each of these countries, there will becollaborative support from more than one federal agency. Countries were selected based on themagnitude of the epidemic, history of political commitment to fighting the epidemic, anticipated
receptivity to US assistance, and presence of existing US implementation mechanisms. Additional
criteria are presented below. DoD participation will be dependent on their availability of resources.

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

4

LIFE Countries *

USAID

DHHS

DoD***

Botswana

X**

X

X

Cote d’Ivoire

X**

X

Ethiopia
India

X
X

X
X

X

Kenya

X

X

X

MalawiX

X

X

Mozambique

X

X

Nigeria

X

X

Regional Programs (West Africa andEast/Southern Africa)
RwandaX

X

X

X

SenegalX

X

XSouth Africa

X

X

X

Tanzania

X

X

UgandaX

X

ZambiaX

X

Zimbabwe

X

X

X

X
X

*preliminary list – subject to change ** Botswana and Cote D’Ivoire to be covered by USAID regional
programs *** The DoD Regional Approach will also cover Benin, Mali, Ghana

TABLE 1—COUNTRY SELECTION CRITERIA
Criteria used to identify the above countries include the following:üüüThe magnitude of the epidemic
Country receptivity to assistance from US government
Country political commitment to fighting the AIDS epidemicüüüPotential for interventions and unique opportunities
Potential for impact
Potential for leveraging of other local and donor support

ü Existing U.S. Government implementation mechanisms

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5

II.

Program Elements

The initiative addresses four key program elements critical to fighting the AIDS pandemic: primaryprevention, improving community and home based care and treatment, caring for children affectedby AIDS, capacity and infrastructure development, and. Each of these elements must be
coordinated and integrated within an overall comprehensive response. To facilitate this coordination,
USAID missions will have the lead responsibility for facilitating inter-agency communication,
ensuring adequate dialogue with host nation agencies and organizations, and establishing a joint
country-specific implementation plan.
The design of the initiative will foster the expansion of current activities and provide support forevaluating and integrating more recently developed interventions (e.g. methods to reduce mother-tochild HIV transmission) that have not yet been incorporated into comprehensive programs. Although
the Initiative will not support all elements in every country, its funding must be coordinated andintegrated within an overall comprehensive response. Country programs will be tailored to theirneeds and existing efforts underway.

Program Element

Investment

A. Primary Prevention
1) Program Delivery and Other Activities

USAID: $25M

2) Technical Assistance and Training

DHHS:$13M

3) Prevention activities for African military and uniformed services

DoD:$10M
Subtotal: $48M

B. Improving Community and Home Based Care and Treatment

1) Program Delivery
2) Technical Assistance and Training

USAID: $14M
DHHS: $9M
Subtotal: $23M

C. Caring for Children Affected by AIDSUSAID: $10M

D. Capacity & Infrastructure Development
1) Increasing political commitment and strengthening AIDS programs

USAID: $6M

2) Surveillance

DHHS:$13M
Subtotal:$19M

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6

A.

Primary Prevention

The Global AIDS initiative focuses primarily on prevention ($48 million of $100 million) to slow—and
hopefully reverse—the trend of rising HIV infection rates in developing countries. The goal ofprimary prevention is to reduce the incidence of new HIV infections. Ninety percent of new
infections in the developing world derive from either sexual transmission (80%) or mother to childtransmission (10%), and another 5% from contaminated blood transfusions and infected needles.
Therefore, the primary prevention component of this initiative seeks to reduce these means oftransmission through the following activities (differentiation is made between civilian and military
prevention efforts, reflecting the mutually supportive yet distinct role of the Department of Defense
within this initiative):
Primary Prevention - Civilian
The program element of primary prevention has been broken down into four distinct, mutually
supportive activities.
Performance Measures for Primary Prevention
Within three years, monitoring systems will measure the combination of enhanced existing programs and the
additional “new” activities that are supported through the initiative. The following performance measures andtargets are expected. Actual baselines and targets will be determined for each country.
üdecrease in reported non-regular sex partners over the first yearüincrease in reported barrier method use with non-regular/regular sex partners

üdecrease in reported STD prevalence for men/womenü

decrease in HIV incidence rate in 15-24 year olds

ü decrease in perinatal infections

1) Voluntary Counseling and TestingCounseling sessions (both before and after the actual HIV test) offer an important opportunity
for intensive one-on-one prevention education for persons who test either positive or
negative.
This initiative will allow USAID and DHHS to assist to develop and implement locallyappropriate voluntary counseling and HIV testing services (see Annex B for a potential list of
countries that could make use of this assistance). DHHS will support this work by providing
critical technical assistance to ensure the quality and accuracy of HIV testing, identifying
methods to target high risk groups with VCT services, and assisting USAID with developing
linkages between VCT and health and social services.

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72) Social Marketing
The utilization of barrier methods (primarily male and female condoms) has proven to be an
essential element of HIV and STD prevention. Providing accurate information on theimportance of barrier method protection and reducing societal resistance to its use is an
essential prevention activity.
Therefore, this initiative will allow USAID to increase their social marketing efforts to improveaccess to barrier methods.
3) Behavior Change
In addition to broad community messages used to support the social marketing of barrier
protection, more individualized interventions are needed to effect actual changes in behavior.
Social marketing creates a more receptive attitude to the behavior change interventions,which build on that receptivity and promote individual acceptance and use of barrier
protection. In addition, efforts to reduce the stigma of HIV will be employed (using faithcommunities and other organizations of influence) in order to reduce resistance to getting
tested, informing partners and family if infected, and seeking help in obtaining HIV-related
care services.
Therefore, this initiative will allow USAID, DHHS and DOD to establish new or enhanced
behavior change activities countries and one regional area (see Annex B for a potential list of
countries that could make use of this assistance). The goal of each will be to expand
behavior change interventions, with specific targeting of youth and adult males.
4) Mother-to-Child HIV transmission
At least ten percent of new HIV infections are a result of transmission of HIV from mother tochild either during pregnancy or birth, or subsequently through breastfeeding. New
treatments offer tremendous promise in greatly reducing the likelihood of mother-to-childtransmission. However, significant barriers to their utilization remain, including low
percentages of HIV-positive mothers who get tested before birth, lack of training of healthcare providers in the use of the treatments, and cultural acceptance of preventative
medicine.
Therefore, this initiative will support USAID and DHHS to assist in implementing programs todesign and implement successful interventions to prevent mother-to-child transmission of
HIV. At these sites, USAID will provide support for screening of pregnant women, andtraining of maternal health providers. DHHS will also support this activity by identifying
barriers that exist for accessing these services and by monitoring the outcomes of theseinterventions on both infants and mothers.
5) STD Management
The successful prevention and treatment of sexually transmitted diseases (STDs) are
important strategies for reducing the incidence of HIV infections. Because STDs result frommany of the same behaviors that lead to HIV infection, efforts to prevent STDs are critical to
stopping HIV infections as well. In addition, untreated STDs significantly increase thelikelihood of infection by HIV upon exposure; therefore, identifying those with STDs andgetting them into treatment is also effective in reducing HIV infection rates.
Therefore, this initiative will support USAID and CDC to implement new or expand existing
STD prevention, diagnostic and treatment services.
The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

86) Blood Safety
HIV infection through the use of contaminated blood or blood products is a significant
problem in many poorer countries. However, implementation of modest screening, testing,training, and quality control programs can dramatically reduce this risk.
Therefore, this initiative will support DHHS in providing technical assistance on
implementation of programs to improve blood collection from volunteer donors, increase thequality of HIV testing of blood and ensure more appropriate use of blood transfusions.
Primary Prevention - MilitaryWith the availability of resources, the U.S. Department of Defense will support primary prevention
activities targeted at military and uniformed services in a number of countries. The sub-Saharanregion has been marred by decades of political strife that has resulted in numerous armed conflicts.
Many nations in the region maintain large military forces, and frequently deploy them outside theirown borders. Military personnel often become unwitting vectors of HIV from one part of Africa toanother. Therefore, efforts to increase awareness of individual HIV status and implementation ofeffective HIV prevention and education programs among military personnel are essential.
The program element of primary prevention for military personnel has been broken down into three
specific areas: assessment, education of indigenous military personnel, and education of UN
peacekeeping forces stationed in the region.
1) Assessment
Experience with AIDS prevention in the U.S. military provides a model for effective
intervention in African military populations. It has been demonstrated that assessment ofknowledge, attitudes, and behaviors, coupled with serial prevalence or incidence
measurements, can be done while maintaining confidentiality and with a high level ofvoluntary participation. The U.S. military population is exposed to multiple HIV subtypes
while on deployment; in response rapid diagnosis of HIV subtypes have already beendeveloped. There are a number of factors contributing to HIV risk. These include travel awayfrom home base, alcohol use, and economic means to use commercial sex workers.
Assessment of these components of HIV risk in African military populations will develop theregional profile to design and guide prevention activities.
2) Regional specific military-based education.
Based on findings of the assessments described above and through work with UNAIDS,
regional scientists, and African militaries, military-based education will be directed to four
specific African regions: East, South, West, and West-Central, respectively. The approach
will proceed by stages:
ü assessment of HIV prevalence and risk behaviors
ü development of a regional prevention planü implementation through training and development of infrastructureü evaluation of the effect of prevention
ü refinement and incorporation into the military culture for enduring impact
DoD will tailor its unique tri-service military education programs developed to prevent alcoholabuse and STDs, as well as the region-specific HIV prevention work by NGOs and USAID, to
African contexts. Anonymous serosurveys with risk behavior data collection will begin as
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9soon as feasible. In addition, locally developed or adapted interventions identified by USAID
or DHHS may also be utilized.
The initial round of serosurveys and risk behavior assessment will take a minimum of six
months. Assessment of HIV-1 subtypes in African military populations, with opportunity forfollow-up, will permit an evaluation of these factors in many different settings, ranging from avirtually single-subtype epidemic in Southern Africa to a highly complex mixture of subtypes
and recombinants in West Central Africa. A “train the trainer” approach that has been very
successful within the U.S. Air Force will be used. This training can occur simultaneously
within the different regions and will be completed within three months. All of these programs
will be coordinated with similar USAID activities (for example, education concerning
condoms, counseling, and testing of general populations).
3) Enhanced military education of African UN Peace-Keeper forces
African military personnel deployed far from their home base for long periods in conjunction
with UN peacekeeping activities may experience a different HIV risk profile than soldiers
remaining at home. In conjunction with the ongoing UN peace-keeping project to combat
HIV/AIDS, COL Peter Leenijes coordinated with the Ford Foundation, the Civil Military
Alliance, and the U.S. Military HIV Research Program to develop a special intervention
program targeted to the African military UN peace-keepers. The program was patterned on
one currently being piloted through the South African Army field units. The current project
involves five specific curriculum modules:
ü Defining HIV and its impact in the militaryü HIV Prevention
ü Substance Abuse, HIV, STDs
ü Risk Assessment and Prevention Strategies
ü Course Summary

B.

Improving Community and Home Based Care and Treatment
Performance Measures for Community and Home Based Care and Treatment

The following performance measures and targets are expected within three years:
ü

Increase in the percentage of local governments implementing care and support activitiesü

Increase in the number of primary health facilities providing quality prevention and treatment (i.e.
according to national guidelines) for opportunistic infections

ü

Increase in the number of households caring for persons living with HIV/AIDS that receive help indelivering that care from an institution or group outside the familyüIncrease in the percentage of dually infected (TB-HIV) persons who complete standard TB therapy within
12 months.

Currently in Sub-Saharan Africa and India, care and treatment for HIV infected persons and support
to their families is minimal. Less than 5% of persons know their HIV status and health careproviders do not have ready access to diagnose and treat HIV and the associated opportunistic
infections, let alone use of the latest “state of the art” antiviral treatment regimens. Ideally, there
should be a continuum between in-patient and community outpatient treatment, combined with
The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

10

psychosocial support services utilizing a wide range of community workers, including traditional
healers.
Even in the absence of antiretroviral drugs, there is much that can be done to improve the qualityand duration of LIFE for persons living with HIV/AIDS and their families within the developing
country setting. For instance, while the leading killer of AIDS patients in the developing world is TB,
through use of directly observed therapy regimens (DOTS), TB can be cured in HIV infected
persons, increasing the both the quality and duration of a person’s LIFE.
1. Care and Treatment
The Initiative seeks to provide medical and social services to HIV infected individuals, including
preventive therapy, and early diagnosis and effective treatment of AIDS-related diseases. Countries
will be assisted to implement locally appropriate programs to link people living with HIV or AIDS toprevention, care and support services. These individuals will be identified through enhanced
voluntary counseling and testing services (described above), to which they will be closely linked.
Pilot sites would be established to assess methods to improve TB and respiratory disease care in
HIV infected persons and to evaluate the applicability of U.S.-based early intervention care andtreatment models in a developing world setting (see Annex B for a potential list of countries that
could make use of this assistance).
2. Home and Community Based Care and Support
Through this initiative, countries will receive assistance in instituting home and community basedcare model programs. In addition, indicators for accurately measuring the impact of care services
will be developed. USAID will provide support for health provider training, establishing home andcommunity care models, and increasing the involvement of traditional healers. DHHS will focus ondeveloping treatment guidelines, creating training and curriculum materials, increasing the use of
DOTS, and linking psychosocial support services with improved biomedical interventions (see Annex
B for a potential list of countries that could make use of this assistance).

C.

Caring for Children Affected by AIDS
Performance Measures for Caring for Children Affected by AIDS
Within three years, expected performance measures and targets include:
3 Percent of households in high HIV prevalence communities with increased access to food.
3 Percent of households in high prevalence communities receiving assistance from
community based organizations.

Over eight million children under the age of 15 have lost their mother or both parents as a result of
HIV/AIDS. By the year 2000, there will be close to 32 million children who will have lost one or bothparents in the 19 of the African countries where HIV/AIDS is found in epidemic proportions. By theend of the next decade, this number will increase to 40 million. Despite the magnitude of this crisis,
services in developing countries for children orphaned by AIDS are extremely limited or nonexistent.

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11

Therefore, this initiative will support USAID to help countries take primary responsibility for activities
to assist children affected by AIDS and for their families, primarily through the use of Title II, Food forPeace programs. In addition, child survival funds not part of this initiative will be used to enhance
the scope of interventions directed at orphaned children in target countries.
Prior to this Initiative, USAID has supported a limited number of activities focusing on children
affected by HIV/AIDS. With supplemental funds appropriated by Congress for FY1999, interventions
are being developed and implemented in nine countries in Africa, three countries in Asia, and in
Haiti. In addition, since 1991, USAID’s Displaced Children and Orphans Fund (DCOF) has
supported AIDS orphans activities in Africa and is currently supporting community-based programs
in Zambia and Malawi. Through the use of Title II resources, USAID is currently supporting motherand child health programs, “food-for-work” interventions, and general relief programs.
The enormity of the problem makes it imperative that interventions are both effective and can bescaled-up to provide services to as many people as possible. A community-based approach willcontinue to be the focus of USAID activities. It is families and communities who are the front line of
the response to the impact of HIV/AIDS. All over Africa extended families are still absorbing mostorphans. However, in many places their capacity to do so is weakened by extreme poverty, lack ofaccess to services and the growing number of children in need. The most effective response is tostrengthen the capacities of families and communities in the geographic areas where HIV/AIDS has
made them especially vulnerable (see Annex B for a potential list of countries that could make use ofthis assistance).
The needs of children affected by AIDS, similar to those of other children living in extreme poverty,
include the need for food, clothing, shelter, schooling and health care. Childhood malnutrition ispotentially one of the most severe and lasting consequences of an adult death in the household.
Extended families caring for orphans – whether their family members are infected or not – struggle
to provide enough nourishment to the increasing number of children for whom they have become
responsible. Seeking to mitigate the impact of the AIDS epidemic on childhood nutrition is an
important area of vulnerability that must be addressed in a manner that is effective and provides themost benefit to families and to communities. In addition, the impact of using Title II resources will be
evaluated and the needs of very young children will be assessed.

D.

Capacity and Infrastructure Development
Performance Measures for Capacity and Infrastructure Development
The following performance measures and targets are expected within three years,:ü

increased number of HIV/AIDS/STD/TB information and service delivery points which meet minimum
quality standardsüsurveillance plans and survey designs in all focus countriesülab capacity for surveillance strengthenedü training of surveillance managers and key staff in country in at least 8 of the 12 countriesü

increased national AIDS control program capacity to plan, manage and evaluate national AIDS
programs,

Within the focus countries, it is critical that political commitment is increased and host country
capacity to implement effective interventions is strengthened, focusing on government, private
The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

12sector, NGOs and research institution capabilities. Key activities are to increase the use of accurate
HIV surveillance data to inform decisions on targeting of HIV/AIDS prevention and careinterventions, to measure the impact of these interventions, and to support new capabilities for thedelivery of care and services.
1.

Increasing Political Commitment

USAID will take the lead in countries and the regional program to implement activities to increase
national political commitment towards HIV/AIDS efforts. There will be extensive use of surveillancedata in this dialogue, derived from DHHS supported efforts.
2.

Surveillance

In all countries and regional programs, DHHS will take the lead in providing technical assistance andsupport to country health ministries to improve surveillance programs for HIV, TB and STDs. In
addition, new surveillance tools will also be tested and adapted for local application. USAID will
also provide funding for activities that will ensure close collaboration with key international partners,
such as UNAIDS, WHO and other multilateral and bilateral donors.
3.

AIDS Program Strengthening

The initiative will support expanded training and support for local NGOs and of government
personnel for HIV/AIDS program and service delivery.

III.

Managing and Monitoring the LIFE Initiative

To establish an active link between the initiative’s partners (US Agencies, UNAIDS, World Bank, EU,donors, etc.), a joint management and monitoring LIFE Initiative Task Force will be established.
This Task Force will be composed of designated focus point persons from each of the relevantFederal agencies. The Task Force will be convened under the auspices of ONAP, with secretariat
support provided by USAID. Additional members will be included as necessary (e.g. UNAIDS
representative). The Task Force will meet on a monthly basis over the next year, because of thewide range of issues that must be resolved in a timely way. After one year, meeting schedules canbe reviewed.
It is essential that the activities funded through the LIFE initiative build on existing resources andprograms in order to achieve the maximal coverage and impact. It should be recognized that it isdifficult to measure performance, which is attributable to discrete funding sources. Instead,monitoring systems will measure the impact of consolidated programs that have been established ineach country.

IV.

Next StepsA.

Country Level
The ultimate success of this initiative will depend on the scale, scope and quality of services
delivered in target countries, particularly at the community level. To achieve this, there must
be extensive dialogue and collaboration at country level with government, private sector,
non-governmental organizations, the faith community and community groups, especially
including persons living with HIV/AIDS and their care-givers. Some of the focus countries
already have established coordination mechanisms, which will be utilized wherever possible.

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13

However, joint country planning teams will also be formed over the next three to six months,
in order to work with USAID Missions, DHHS and other USG agencies, Host Country
Governments, etc, to finalize one to two year work plans, which will include more discrete
performance measures. It is also necessary to further examine what other bilateral andmultilateral donor are planning and to collaborate with local government, non-governmentalorganizations, persons living with HIV/AIDS, etc. to ensure that the program responds topriorities and existing gaps.
B

Global/Regional Level
At global and regional level, multiple partners must be engaged in a collaborative effort toleverage new resources, identify areas for cooperative efforts and areas for complementary
programs, and achieve consensus on measurements of performance. A series of“Partnership” meetings will occur over the next three to six months to assure the success of
this initiative. Examples of these “Partnership Meetings” are presented below.

Examples of Partnership Mtgs.

PurposeWashington-based African
Diplomatic Corps

To initiate dialogue for individual countries, which would lead to,improved collaborative efforts and mobilization of increased hostcountry resources and commitment.

U.S. AIDS Advocacy Groups

To increase awareness and garner support for the focus andactivities of the Initiative.

U.S.-based Faith Groups

To identify U.S. and international faith networks that will ultimately
create networks and support for prevention, counseling,
psychosocial support and care interventions in sub-Saharan Africa.

U.S. NGOs and CBOs

To provide support and collaborate with other African NGOs

U.S. and International Communities
of Persons Living with HIV/AIDS(NAPWA, GNP +, etc)

To ensure that PLWHA needs and priorities are met and to establish
processes so that host country PLWHA input is utilized optimally.

U.S. Teaching/Academic Institutions

To identify technical resources within the United States in order toexpand the technical assistance resource platform which will be
initiated in sub-Saharan Africa.

UNAIDS (including its seven cosponsors)

To link with the UNAIDS International Partnership for Africa.

Bilateral Donors

To identify gaps and areas for complementary programming inindividual countries

Multilateral Donors (EU, WorldBank)

To integrate country plans with overall prevention and care activities.

U.S. Diplomatic Corps

To coordinate with U.S. diplomatic AIDS initiatives

C.
1.

Milestones
Country notification and communication – November - January
Ø In December, USAID/DHHS is sending a formal cable to the USAID missions and embassies,

informing them about the final status of the LIFE initiative, country list, and next steps.
DHHS will communicate with its field sites and with embassies regarding establishing
NSDD-38 agreements. [Responsibility: USAID; DHHS].
Ø In the next month, ONAP will convene a meeting of all African ambassadors to the US to
discuss USAID and other programs, with discussion of LIFE [Responsibility: ONAP]
The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

14Ø In the next two months, USAID and DHHS will jointly commence communication with thecountry governments and respective stakeholders: government, multilateral and bilateral
donors, NGOs, communities affected, etc to set the stage for the planning process for the
LIFE initiative efforts. [Responsibility: USAID/DHHS]
2.

3.

Joint planning assessments – November – MarchØ In the next month, USAID with input from DHHS and ONAP, will issue guidance to the fieldon the planning parameters for the LIFE initiative activities. [USAID, with DHHS andONAP]
As part of this, the joint teams (USG, country) will review previously established country
profiles (US and donor response information). In close negotiations with countries, USAID,
DHHS will determine gaps and response needs to be enhanced. [Responsibility: USAID, withDHHS]Ø Within 6 months, all 14 countries and regional programs will have conducted a participatoryneeds assessment, identified current responses and gaps, and develop workplans.
[Responsibility: USAID and DHHS field staff will have primary responsibility, with USAID
lead coordinating role. Additional backup TA from Washington/Atlanta will be available.]
Strategies for implementation – Developed November onwards
Ø In the next 10 months, activities begin in all 14 countries and regional programs, with phasing

in of some countries for some activities. [Responsibility: All partners]
4.

Funding and Mechanisms
Ø USAID to accelerate its OYB process (e.g. allocations to missions) to allow access to fundingby missions.
Ø DHHS will develop NSDD-38 agreements with appropriate embassies.
Ø In the next two to six months, various mechanisms for implementation will be identified andused. These will vary by country. They include:-- USAID contractors: bilateral and field support-- USAID/DHHS grants and cooperative agreements to multilateral institutions: WHO,
WHO/AFRO, UNAIDS, UNICEF; possibility of others-- USAID/DHHS relationships with African institutions-- DHHS/USAID relationships with embassies-- Use of USAID contractors by DHHS (interagency agreement)-- Possibility of detailing DHHS personnel to USAID (to go to the field)-- DHHS Cooperative agreements with US based organizations-- Other
5.

Workshops and partnership meetings on parallel track – November onwards
Ø In the next 6-12 months, USAID will organize workshops to discuss technical issues (e.g.,

VCT, MTCT, care and support). These will include a broad mix of African, donor, and US
specific participation. [Responsibility: USAID; DHHS]•
November 23: USAID convened a working group of DHHS agencies (CDC and
HRSA), NORA organizations and USAID to discuss care and support issues.
•
December 6-7, 1999: Private meeting of the UN Secretary General to discuss withkey partners (donors, governments, NGOs, private sector) the International
Partnership against AIDS in Africa).
•
December 5-8: Paris AIDS conference to focus on AIDS care and support issues.

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

15

•

January 2000: WHO/AFRO is convening a meeting of all international and national
interested parties to discuss HIV/AIDS surveillance programs and issues.
•
February 2000: Meeting of the International Partnership Against AIDS in Africa.
•
July 2000: International AIDS conference in Durban.
Ø In the next 6 months, USAID will organize a series of key stakeholder meetings to discuss theinitiative (US based) [Responsibility: USAID]
Ø In one year’s time (approximately), USAID, with DHHS and ONAP, will convene a meetingof all of the partners to assess progress of implementation and to discuss ways to improve.
[Responsibility: USAID and DHHS]
6.

Coordination at the USG level: OngoingØ In the next month, ONAP will hold its first meeting of the working group of higher levelagency representatives to discuss progress and issues. This group will meet periodically toensure that the initiative is on track. [Responsibility: ONAP]Ø Throughout the next year, a coordination working group with USG agencies at the working
level will meet (USAID-CDC have been meeting informally; need to meet soon withexpanded group of other agencies.). [Responsibility: USAID to convene]Ø Over the next six months, four technical working groups around the four categories of the
LIFE initiative will be convened to help inform us about the set of issues and possible
interventions. Actual planning to be conducted at the field level. These groups will be time
limited. [Responsibility: USAID and DHHS]
7.

Indicators/milestones: OngoingØ Broad indicators and targets are already identified.
Ø Based on the joint planning teams and process, each country will develop its own set ofmonitoring and evaluation indicators, baselines, and targets.

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

16

ANNEX A: CURRENT USG HIV/AIDS ASSISTANCE IN TARGET COUNTRIES AND REGIONS.
COUNTRY

Primary Prevention

VCT

SM/
Procur
ement

BC/
SR

MTCT

Blood
Suppl/
nosoc
omial/OE

STD

Botswana
Cote d'Ivoire
Ethiopia
Kenya
MalawiMozambique
Nigeria
RwandaSenegalSouth Africa
Tanzania
UgandaZambiaTool
Dev.

CaringforChildren Affectedby AIDS*

Home and Community
Based
Care
and
Treatment*

Infrastructure and Capacity Development*

SupporttoAffected
Children

OI/TB/STD

Drug
SupplyPolicy/advoca
cy

H

H

H
U
U

U

Comm.
Mobiliza
tion

H
U
U
U,H
U

U
U
U,H
U,H

U
U
U
U
U
U
U
U
U
U
U

U
U
U,H
U
U
U
U
U
H
U
U
U

U,H

U,H

U
U
U
U

H
H
H
H

U
U
U,H
U,H

U,H
U
U
U

H
H
H
H
H

U

U

U
U

U
U

U
U
U
U

U
U
U
U

U
U

U
U

U
U

U,H
U

Home/
Comm.Based
Care

U
U
U

U
U
U

U

U

U
U,H
U

U
U
U,H
U
U,H

U,H
H
U

NGO
support

U
U
U
U
U
U
U
U
U
U
U
U

Training
and TA

Surveill

Multisectoral

H

H

U

U,H
U,H
U,H
U,H
U
U
U,H
U,H
U,H
U,H
H
U,H

H
U
U,H
U,H
U
U
U, H
U
H
H
H
U,H

U,H U
U
H
U
U
U,H
U
U,H
H
Zimbabwe
India
U
U
U
U
H
U
U
H
U
U
U,H
U,H
U,H
REGIONAL
WAFR/
(U)
U
(U)
U
U
U
U
(U)(H)
SAFR/EAFR
HEADQUARTERS
U
U
U
U
U
U
U
AID/W
Notes: * = Indicates additional DHHS agency involvement (e.g. HRSA, ACF, etc) that may not be reflected on the table( ) = indicates additional linkage between USAID regional program and Botswana and Cote D’Ivoire DHHS activities
VCT = voluntary counseling and testing; SM = social marketing; BC = behavior change; SR = stigma reduction; MTCT = mother-to-child transmission;
STD= sexually transmitted disease; OI = opportunistic infections; TB= tuberculosis; NS = nosocomial infection control; OE = occupational exposure
reduction
U = USAID H = DHHS

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

U
U
U
U
U
U,H

U
U

U

17

ANNEX B: ACTIVITIES SUPPORTED BY THE LIFE INITIATIVE IN TARGET AFRICAN AND ASIAN COUNTRIESCOUNTRY

Primary Prevention

VCT

SM/
Procurement

BC/ SR

MTCT

Botswana

H

H, D1

H

Cote d'Ivoire
Ethiopia
Kenya

H
U, H
U,H

H

MalawiMozambique
Nigeria
RwandaSenegalSouth Africa
Tanzania
UgandaU,H
U
U
U

Zambia

U,H

H
U, D2
U,H,D
1
U, D2
U
D1
U
U, D1
H, D1
U
U,H,
D2
U

U,H
U
U,H

U

U

U

U,H

Blood
Supp/
nosoc
omial/
OE

H(NS
U,H

U
U
U,H

H(NS
H

STD

CaringforChildren Affectedby AIDS**

Home and Community
Based
Care
and
Treatment**

Infrastructure and Capacity Development**

SupporttoAffected
Children**

OI/TB/STD

Home/
Comm.Based
Care**

Policy/advocacy**Comm.
Mobilization**

Drug
Supply

H

H

H

U

H
U
H

H
U
U,H

H

U

U
U
U
U
U,H

U*
U*
U*
U*

U

U*
U,H

U,H

U,H

U

U

U

U

H
U

U

Training
andTA**

Surveill***

Multisectoral

U

H

U

U

H
H,U
H,U

U

U
H
U

U
U

NGO
support
**

U
U
U
H
U
U,H

U
U

U
U

U,H

U
U
U
U

U
U
U
U

U,H

U

U
U

H,U
H,U
H, U
H,U
H,U
H
U,H
H

U
U

U
U

H

U,H
U
U, D2
U,H
U
U
H
U
Zimbabwe
India
U
U
U
U
U
H
U
(H)
U
U
U,H
REGIONAL
(U)
U
(U)
U
U
(U)(H)WAFR/
SAFR/EAFR
HEADQUARTERS
U
U
U
U
U
U
U
U
AID/W
Notes:* = Ongoing or potential Title II-“Food for Peace” countries.
** = Indicates additional DHHS agency involvement (e.g., HRSA, ACF, etc) that may not be reflected on the table*** = DOD will also implement specific surveillance activities in military populations in selected countries.
( ) = indicates additional linkage between USAID regional program and Botswana and Cote D’Ivoire DHHS activities
VCT = voluntary counseling and testing; SM = social marketing; BC = behavior change; SR = stigma reduction; MTCT = mother-to-child transmission;
STD= sexually transmitted disease; OI = opportunistic infections; TB= tuberculosis; NS = nosocomial infection control; OE = occupational exposure reduction
U = USAID H = DHHS D = DOD

The LIFE Initiative: Proposed Joint USAID-USDHHS-USDOD Operating Plan

18