PEPFAR in Zambia
January 28, 2023 marks the anniversary of President George W. Bush’s State of the Union address first announcing the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Twenty years later, the U.S. government, through PEPFAR, has helped not only save and improve millions of lives, but also transform the global HIV/AIDS response. PEPFAR was and is the largest commitment by any nation devoted to a single disease with nearly 6 billion dollars committed to Zambia since 2003. The end of HIV/AIDS as a public health threat by 2030 is an ambitious, but achievable goal. Through the work of PEPFAR, Zambia has exceeded UNAIDS HIV targets in treatment and viral suppression through close collaboration with the Zambian government, multilateral partners, civil society and faith-based organizations, and people living with HIV. Congratulations to the PEPFAR Zambia team on twenty years of service to Zambia’s national HIV response in partnership with the Zambian government.
Since 2004, the U.S. government through PEPFAR has provided support to Zambia’s national HIV response in partnership with the Government of the Republic of Zambia through the Ministry of Health (MOH) and National HIV/AIDS/STI/TB Council (NAC). In fiscal year 2022, Zambia received $401.6 million dollars from the US government for HIV prevention, treatment, care and support, and health systems strengthening in support of Zambia’s national HIV response. With this funding, the United States government supported over 1.2 million Zambians with lifesaving HIV medications, at no charge. Keeping people living with HIV on medication is a key component of preventing the spread of HIV.
PEPFAR Zambia has received over $5.9 billion dollars (estimated at over 102 billion ZMW) in support of the national Zambian HIV response. In just the last five years, PEPFAR Zambia has funded 21,126,301 HIV tests, supported more than 2 million voluntary medical male circumcisions, and provided support for more than 500,000 orphans, vulnerable children, and their caregivers in the last fiscal year. Today, PEPFAR Zambia supports over 1.2 million Zambians with lifesaving antiretroviral therapy, who if they continue to take their medicines can live long, healthy lives and prevent the spread of HIV.
As PEPFAR starts its 20th year of global support to end the HIV epidemic, Zambia will receive $402.6 million dollars to continue supporting the national HIV response with special focus on reaching those people living with HIV who have not yet begun treatment, including pediatrics, adolescents and young people and key populations. PEPFAR Zambia funds five U.S. government agencies in a single unified HIV responds strategy led by the US Ambassador to Zambia. These agencies are the US Centers for Disease Control and Prevention (CDC), Department of Defense HIV/AIDS Prevention Program (DHAPP), Department of State (DoS), and Peace Corps (PC), and United States Agency for International Development (USAID).
DREAMS Zambia
What is the PEPFAR-funded DREAMS program?
DREAMS is a global, public-private partnership between the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, ViiV Healthcare, and Gilead. This interagency program seeks to reduce new HIV infections in adolescent girls and young women (AGYW) between 10 and 24 years old across 15 sub-Saharan African countries. DREAMS is designed to meet the complex needs of adolescent girls and young women by helping them become more determined, resilient, empowered, AIDS-free, mentored, and safe.
Why Adolescent Girls and Young Women?
Globally, AGYW are the most vulnerable to new HIV infections, unplanned pregnancy, and sexual violence. In southern Africa, 79% of new HIV infections among 10 and 19-year-olds were among females.1 In Zambia, HIV prevalence among young people between 15 and 24 years old is 3.4% with a disproportionate burden on girls and young women (4.9%) as compared to their male age counterparts (1.8%). Sixty-nine percent of Zambian girls and young women have had sex by age 18 and 26% report their first sexual experience as coerced. 2,3 Additionally, 20.3% of adolescent girls and young having experienced sexual abuse during childhood.4 Such violence has immeasurable negative health and social consequences for girls and young women throughout their lives.
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1 UNAIDS 2019. Women and HIV – A spotlight on adolescent girls and young women.
2 Zambia Demographic and Health Survey (ZDHS) 2018.
3 Zambia Violence Against Children Survey (VACS) 2018.
4 Zambia VACS 2018.
DREAMS in Zambia
Since 2016, PEPFAR has steadily increased investment in DREAMS. As of 2020, PEPFAR invests $30 million per year in the DREAMS initiative in Zambia. Working across 14 districts in seven provinces, DREAMS Zambia targets the most vulnerable adolescent girls and young women in 77 health facility catchment zones with high HIV burdens. DREAMS Zambia has developed a unique model structured around DREAMS centers, where adolescent girls and young women meet in safe, confidential spaces to access a package of HIV prevention services tailored to their individual needs. These services include mentor-led safe spaces, gender-based violence care and support, HIV testing and counseling, family planning, pre-exposure prophylaxis, school scholarships, and economic strengthening. When combined with safe spaces, economic strengthening interventions, such as financial literacy and vocational training, can reduce the economic dependency that can lead to gender-based violence and sexual risk-taking behaviors.
DREAMS also works with adolescent girls’ and young women’s sexual partners, parents, schools, and communities. School-based HIV and violence prevention programs address gender and power relations and build prevention skills among youth. Community mobilization in DREAMS engages men and boys in community conversations about HIV, gender norms and sexuality to build community ownership of HIV risk reduction. These community-based interventions strengthen the supportive network necessary for girls and young women to thrive.
Since DREAMS inception, over 775,000 Zambian adolescent girls and young women have enrolled in the HIV prevention program, with nearly 725,000 completing at least one prevention service with support from DREAMS mentors. Girls and young women who have participated in DREAMS have demonstrated increased knowledge of healthy practices and behaviors that can reduce their risk of contracting HIV. Over time, DREAMS Zambia has observed improved use of modern contraceptive methods and pre-exposure prophylaxis through adolescent-friendly health services offered in DREAMS centers in partnership with government health facilities. Such prevention services are critical to reducing new HIV infections and achieving epidemic control in Zambia.
DREAMS also works with adolescent girls’ and young women’s sexual partners, parents, schools, and communities. School-based HIV and violence prevention programs address gender and power relations and build prevention skills among youth. Community mobilization in DREAMS engages men and boys in community conversations about HIV, gender norms and sexuality to build community ownership of HIV risk reduction. These community-based interventions strengthen the supportive network necessary for girls and young women to thrive.
Since DREAMS inception, over 775,000 Zambian adolescent girls and young women have enrolled in the HIV prevention program, with nearly 725,000 completing at least one prevention service with support from DREAMS mentors. Girls and young women who have participated in DREAMS have demonstrated increased knowledge of healthy practices and behaviors that can reduce their risk of contracting HIV. Over time, DREAMS Zambia has observed improved use of modern contraceptive methods and pre-exposure prophylaxis through adolescent-friendly health services offered in DREAMS centers in partnership with government health facilities. Such prevention services are critical to reducing new HIV infections and achieving epidemic control in Zambia.
PEPFAR in Action
PEPFAR Partners with Miss Zambia 2022 to Support Equity and Inclusion of Deaf and Hard-of-Hearing Adolescent Girls and Young Women
The United States government through the President’s Emergency Plan for AIDS Relief (PEPFAR) Zambia works to increase access to health services for all Zambians, including the most vulnerable and left behind, through HIV prevention, care and treatment education and linkage to health services. Commemorating the International Week of Deaf People 2022 themed “Building Inclusive Communities for All”, PEPFAR Zambia conducted outreach activities to engage eligible Deaf adolescent girls and young women (AGYW) through DREAMS and Rise Up! programs that are both designed to prevent the spread of HIV. Deaf AGYW in the Matero and Kanyama areas of Lusaka were invited to participate in an open house during which more than 60 AGYW from Deaf schools in Lusaka visited a DREAMS center or Rise Up! House. Going further, teams engaged Munali Secondary School where over 50 Deaf AGYW were educated of the services provided by DREAMS and Rise Up! programs, took part in HIV education activities and participated in a discussion on how PEPFAR programs can best accommodate Deaf AGYW. Building on her celebrity, PEPFAR Zambia partnered with Miss Zambia 2021/2022, advocate and role model, Ms. Natasha-Joan Mapulanga, whose platform and passion is sexual reproductive health rights and empowering AGYW. Ms. Mapulanga attended the event at Munali Secondary School, talked about her work in sexual reproductive health activism and encouraged the attendees to access the services provided through PEPFAR programming.
Notice of Funding Opportunity (NOFO): Scorecard for Community Led Monitoring
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Zambia in collaboration with the Government of the Republic of Zambia’s Ministry of Health (MOH) and the National HIV/AIDS/STI/TB Council (NAC) requests applications for an open competition from key population-led organizations to develop and implement a scorecard as part of PEPFAR Zambia’s efforts to strengthen community-led monitoring (CLM). The scorecard will assess the quality of and barriers to HIV prevention and treatment for key populations in Lusaka and Livingstone districts.
The proposed scorecard is a participatory monitoring tool aimed at engaging key populations to assess the availability and quality of HIV prevention and treatment services and track the implementation of actionable recommendations to facilitate improvements. The tool is participatory in nature as it brings together the service providers (MOH) and users (key populations) in a respectful way to jointly monitor and evaluate services provided at the health facilities and address identified barriers. The scorecard will be a CLM tool designed by and implemented by a key population-led organization.
Award Information:
Length of performance period: October 1, 2023, to September 30, 2024 (12 months)
Number of awards anticipated: 1 award
Award amount: Award may range up to the maximum of the Kwacha equivalent of $50,000 USD
Total available funding: Up to $$50,000 USD
Type of funding: FY2024/COP23 Allocated Funds
Anticipated program start date: October 1, 2023
Funding instrument type: Cooperative Agreement
Program performance period: Proposed programs should be completed no later than September 30, 2024.
The application deadline is June 30, 2023, by close of business.
Please apply for this opportunity at https://www.grants.gov/web/grants/search-grants.html?keywords=PEPFAR%20ZAMBIA
Opportunity number: PZ-CLM-SCORECARD-2024
Click here for additional information.
PEPFAR Small Grants Program Empowers Local Zambian Organizations to Combat HIV with 3.49 Million Kwacha Investment
The U.S. government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has identified twelve organizations as awardees of the 2022 PEPFAR Small Grants Program. The PEPFAR Small Grants Program was created to support the work of local community and civil society organizations. The annual funding provides grants in amounts between ZMW 155,200 ($10,000) and ZMW 388,000 ($25,000) to support community-led programs with activities that mitigate the spread of HIV for all populations including adolescent girls and young women and key populations, provide support to orphans and vulnerable children (OVC) and their households, and democracy and governance activities. The twelve organizations, inclusive of three youth-focused organizations and two organizations focused on key populations, are diverse in their missions and in the vulnerable communities they serve. Examples of the work these organizations will do with this funding include increasing access and equity in the delivery of comprehensive HIV services, combating HIV and AIDS stigma and discrimination, and empowerment to families through access to healthcare, parenting skills and household economic strengthening for primary caregivers of OVC. These grants will help strengthen the capacity of community and civil society organizations to deliver and support HIV-related services while improving community engagement.
Chargé d’Affairs, a.i. and Minister of Health Hold Joint Press Conference to Announce COP22 Approval
On April 7, 2022, Chargé d’Affairs, a.i., Martin Dale and the Honorable Minister of Health, Madam Sylvia Masebo, held a joint press conference to announce the approval of PEPFAR Zambia’s 2022 Country Operational Plan (COP), which will provide $402.6 million towards Zambia’s national HIV program. Chargé Dale used the press conference as an opportunity to highlight the 2022 country operational plans focus on adolescent girls and young women, pediatrics and key populations which require additional programmatic focus for Zambia to reach the goal of epidemic control. He also took the opportunity to recognize the Government of the Republic of Zambia, the Zambian Ministry of Health, civil society organizations representing young people, people living with HIV, key populations and faith-based communities, as well as international and national multilateral partners for their meaningful contributions and partnership throughout the COP22 planning process.
The Honorable Minister of Health, Madam Sylvia Masebo expressed her gratitude for the generosity of the American people and confirmed the Zambian government’s commitment to partnering with the American government. Chargé Dale told journalists from radio, television, and print media that the U.S. government had already invested more than $5.9 billion towards controlling HIV in Zambia over the past 19 years, demonstrating the commitment of the American people to a strong and healthy Zambia.
PEPFAR Zambia and the GIZ Join Hands for Young Women’s Empowerment in Zambia
PEPFAR Zambia’s USAID supported Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative produced 20,000 face masks, over 4,400 packs of reusable sanitary pads, and 4,000 cloth bags upon request and for procurement by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH. GIZ placed the order through the German-funded “Strengthening Girls’ Rights!” program, which aims to ensure that young people in Zambia are better able to protect themselves against HIV, teenage pregnancy, and gender-based violence. Produced by the young women in the DREAMS initiative, the nearly 30,000 cloth-based products were distributed with COVID-19 support kits for adolescents and young people, which also contained sanitizers, soap, and health information. Prior to the COVID-19 pandemic, the U.S. government had equipped 40 DREAMS centers across five provinces with sewing machines and supplies and trained the young women in the program to make and sell affordable, reusable menstrual pads in their communities. In response to COVID-19, the women adapted their sewing skills to craft and sell the cloth masks both within their communities and to others. In total, 4,450 support kits were handed over to the Ministry of Education and the Ministry of Health for distribution in schools and youth-friendly health facilities in six districts. Sixty schools and 62 health facilities were also supported with PPEs, hygiene products, and health information materials.
PEPFAR Zambia supports the 2022 Regional Adolescent Health Indaba (RAHi) for local and international youth advocates
PEPFAR Zambia opened the Inaugural Regional Adolescent Health Indaba (RAHi) under the theme “Closing the tap of new HIV infections through meaningful youth engagement, leadership and innovation on April 8-9, 2022. The RAHi attracted 300+ local and international youth delegates to discuss different health challenges affecting adolescents and young people as well as share best practices to promote access to quality healthcare services for adolescents and young people. The PEPFAR interagency team led discussions with youth delegates around pre-exposure prophylaxis (PrEP), condoms and STIs, HIV testing, gender-based violence, health service access for persons with disabilities, and adolescent friendly HIV treatment. PEPFAR Zambia sponsored youth delegates to attend the event and provided HIV testing as well as COVID vaccination stations for youth to access health services on-site. The next RAHi is set for February 2023 with Provincial Adolescent Health Indabas organized across the country for adolescents and young people to convene and draw together their experiences in promoting physical, mental and social well-being for youth in Zambia.
PEPFAR Implementing Agencies in Zambia
Useful Links
PEPFAR has invested more than $5.9 billion dollars in Zambia’s HIV response through the following U.S. government agencies:
- The United States President’s Emergency Plan for AIDS Relief
https://www.state.gov/pepfar/ - The United States Agency for International Development (USAID)
https://www.usaid.gov/zambia - U.S. Department of State
https://www.state.gov/ - U.S. Peace Corps Zambia
https://www.peacecorps.gov/zambia/ - Department of Defense (DoD)
http://health.mil/dhapp - Centers for Disease Control & Prevention (CDC)
https://www.cdc.gov/globalhivtb/where-we-work/zambia/zambia.html