Document of The World Bank Report No: 65780-MG RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF SECOND MULTISECTORAL STI/HIV/AIDS PREVENTION PROJECT (CREDIT 4104-MAG) JULY 12, 2005 IN THE AMOUNT OF SDR 20.2 MILLION (US$30 MILLION EQUIVALENT) TO THE REPUBLIC OF MADAGASCAR December 23, 2011 ABBREVIATIONS AND ACRONYMS AIDS Acquired Immune Deficiency Syndrome ARV Antiretroviral CNLS Comité National de Lutte contre le SIDA (National AIDS Council) DCA Development Credit Agreement DHS Demographic and Health Survey ES Executive Secretary FAP Fond d’Appui à la Prevention (Fund for STI/HIV/AIDS prevention and care taking activities) FMA Financial Management Agency HIV Human Immunodeficiency Virus IBRD International Bank for Reconstruction and Development IDA International Development Association MSPP II Second Multi-sectoral STI/HIV/AIDS Prevention Project M&E Monitoring and Evaluation NGOs Non Governmental Organizations OP/BP Operational Policy/Bank Procedures PBC Performance Based Contracts PDO Project Development Objective PIU Project Implementation Unit PLWHA People Living With HIV/AIDS PMPS Projet Multisectoriel de la Prévention du SIDA SDR Standard Drawing Rights SHSDP Sustainable Health System Development Project STI Sexually Transmitted Infections SW Sex Workers TOR Terms of Reference Regional Vice President: Obiageli Katryn Ezekwesili Country Director: Haleh Z. Bridi Acting Sector Manager / Director: Jean Jacques de St. Antoine/ Ritva S. Reinikka Task Team Leader: Jumana Qamruddin 2 MADAGASCAR SECOND MULTISECTORAL STI/HIV/AIDS PREVENTION PROJECT P090615 CONTENTS A. SUMMARY ............................................................................................................... 4 B. PROJECT STATUS ................................................................................................. 4 C. PROPOSED CHANGES .......................................................................................... 6 D. APPRAISAL SUMMARY ..................................................................................... 10 E. ANNEX 1: ACTION PLAN (PLAN D’ACTION) MSPP II .............................. 12 F. ANNEX 2: RESULTS FRAMEWORK AND MONITORING.......................... 14 3 MADAGASCAR SECOND MULTISECTORAL STI/HIV/AIDS PREVENTION PROJECT RESTRUCTURING PAPER SUMMARY 1. The Second Multi-sectoral STI/HIV/AIDS Prevention Project (MSPP II) requires a Level 2 restructuring to address a number of key issues including: (i) inadequate targeting of at- risk groups; (ii) a weak health sector response; and (iii) insufficient availability and use of data for evidence-based decision-making. In addition, given delays due to the continuing political crisis in Madagascar, it is important to restructure the project to allow additional time to provide critically needed services to the population. In this context, and in line with the recommendations of the December 2008 mid-term review as well as the April and October 2011 supervision missions, the proposed restructuring includes: (a) eliminating the Fund for STI/HIV/AIDS Prevention and Care-Taking which was not effective in delivering key interventions to target populations, (b) increasing the health sector response by scaling- up contracting with NGOs for delivery of services directly to target populations, and (c) strengthening Monitoring and Evaluation (M&E) including better aligning project activities to intermediate and outcome indicators. In addition, the project closing date will be extended by one year to December 31, 2012 in order to consolidate achievements and measure the results of proposed changes. PROJECT STATUS 2. The Second Multisectoral STI/HIV/AIDS Prevention Project (MSPP II), a USD 30 million dollar IDA credit, was approved on July 12, 2005 and became effective on January 6, 2006. The original closing date of December 31, 2009 was extended once to the current closing date of December 31, 2011. Following the change in Government on March 17, 2009, the Bank's portfolio was subject to OP/BP 7.30, Dealing with De Facto Governments, whereby disbursements were put on hold. On humanitarian grounds, disbursements on certain key projects in Madagascar were allowed to resume as of November 10, 2009 (including Components 2, 4 and 5 of this operation). As of December 13, 2011, approximately SDR 17.5 million (USD 27.4 million equivalent) has been disbursed, representing 87 percent of the credit. 3. Despite the politically challenging environment, the project is currently rated Moderately Satisfactory on achievement of the PDO which indicates the steady positive progress made since the start of the crisis. While assessment of PDO outcome indicators is awaiting results of a large scale survey at the end of 2011, most of the intermediate indicators have already been achieved (with the exception of indicators related to Component 3, which has been suspended since 2008). Two indicators have already been met (HIV knowledge among youth; and number of sexual partners), and five are on track to be met. There is also a 4 positive downward trend in the indicator related to syphilis. As noted in the latest report of the External Verification Agency contracted under the Project, significant progress has been made during the first year of implementation of the Performance Based Contracts (PBC) with NGOs. These interventions focus on improving knowledge and promoting behavior change among target high-risk groups as well as providing a number of critical services, including testing and treatment. This progress on key intermediate indicators is a positive sign toward achieving the PDO. 4. Implementation progress and project management are rated Satisfactory. Safeguards are also currently rated Satisfactory based on adequate implementation of the medical waste management plan. Procurement and M&E are rated Satisfactory as well. 5. In December 2009, the closing date was extended to December 31, 2011 to allow time to complete activities due to delays stemming from the ongoing political crisis. At that time, as a result of governance and management issues, day-to-day management of the Project was transferred from the MSPP II project implementation unit (PIU) to the PIU of the Bank-financed Sustainable Health Systems Development Project (SHSDP), which is also currently responsible for managing and implementing funds from the African Development Bank, the Agence Française de Développement, the Global Fund, and the Government of Monaco. The SHSDP PIU has proven capacity and experience with Bank procurement and financial management procedures, as reflected by the high quality ratings in the interim unaudited financial reports and the unqualified annual audit reports. As a result of this change, the MSPP II PIU was dissolved generating important cost savings for the Project. 6. Financial Management was rated as Moderately Unsatisfactory due to ineligible expenditures under Component 3 (Fund for STI/HIV/AIDS Prevention and Care-Taking Activities) which were incurred as a result of poor book-keeping and accounting practices on the part of community-based organizations and poor supervision on the part of the Financial Management Agency (FMA). However, this rating has been upgraded to Moderately Satisfactory following submission of a proposed repayment plan by the Ministry of Finance for ineligible expenditures under the project (USD 745,569) and the payment of the first reimbursement tranche totaling USD 74,556 in August 2011. In all other areas of financial management the project has been rated Satisfactory. There are no outstanding audits. 7. A policy exception was obtained from the VP OPCS and the VP and Controller CTRLD on December 22, 2011 with respect to BP 10.02 Annex A, Actions that the Bank Takes in Respect to Noncompliance with Financial Management Requirements. Specifically, the exception was sought to enable the one-year extension of the closing date despite the outstanding ineligible expenditures under the Project. 5 PROPOSED CHANGES The proposed changes to each component are described below (please refer to action plan in annex A for details on activities): 8. Component 2 (Health Sector Response) will be strengthened with the inclusion of additional activities to reinforce the supply side of the fight against STI/HIV/AIDS, ensure a better targeting of the most-at risk groups and improve the care and treatment of People Living With HIV/AIDS (PLWHA). The Project is currently contracting NGOs to deliver health and HIV/AIDS related services directly to beneficiaries to better target at-risk groups and PLWHAs using consultant services firm contracts. These NGOs were put in place to focus on interventions for prevention and demand creation after an ineffective approach under Component 3 of the project delayed the implementation of those activities. Under the original project, Component 3 sought to finance all STI/HIV/AIDS prevention and care-taking sub projects submitted by community based organizations in conformity with a set of technical and financial criteria. This component will be eliminated under the project restructuring. However, prevention and treatment activities implemented by NGOs will continue to be financed through performance-based contracts under Component 2. The performance of the NGOs has so far been judged as satisfactory. The scope of work will be expanded and these contracts will be extended through the end of the proposed new project closing date. 9. Component 3 (Fund for STI/HIV/AIDS Prevention and Care-Taking) proved to be an ineffective instrument to target at-risk groups and support progress on achieving the key project indicators. Moreover, this component has suffered from governance issues as highlighted in a series of independent audits which in turn, identified a number of ineligible expenditures to be reimbursed by Government. As a result, Component 3 will be closed after outstanding eligible expenditures under the component have been paid. As a result, a FMA will no longer be needed to implement this component and the Designated Account B created to finance the FMA will also be closed. 10. Component 4 (Monitoring and Evaluation) will be strengthened through greater support to information systems and continued support to strengthening internal and external monitoring and verification mechanisms. More funds will be allocated to this component from Component 3. One other key challenge has been the insufficient use of program data for decision-making by the Executive Secretary (ES) of the National AIDS Committee and insufficient studies commissioned (e.g. biological/behavioral surveys) to enhance the overall evidence base on the epidemic. If actively pursued, strategic use of such data could serve as a dynamic tool to periodically adjust programs and activities, and ultimately strengthen the national response to combating the HIV/AIDS epidemic. In order to effectively improve access to information three studies will be conducted by the end of the project: i) Enquête Comportementale et Biologique to measure outcome level indicators; ii) Etude Chemo -sensibility to antibiotics – will be implemented by the World Health Organization Center from South Africa; and iii) Etude sur la stratégie de prise en charge 6 des infections sexuellement transmissible will be based on the results of the NGO interventions and the two studies above, to provide information for developing future approaches to combat HIV/AIDS on the national scale. 11. The Development Credit Agreement (DCA) will be amended and restated to reflect the relevant changes in the project as well as reference the updated General Conditions, the current Procurement Guidelines and the current Anti-Corruption Guidelines. (i) Results/Indicators 12. The PDO will remain unchanged. The Results Framework (see Annex 1) will be streamlined and certain indicators will be modified to reflect the strengthened focus on at risk groups and to rectify the existing disconnect between activities and intermediate and outcome indicators. Indicators that are no longer relevant or measurable will be eliminated. Key indicators have been amended to reflect project activities focusing on youth aged 15- 24 (by gender), military and sex workers in project areas. These targets have been amended based on the 2008/2009 Demographic and Health Survey (DHS). Moreover, activities targeting the truck driver population are being eliminated to avoid duplication of efforts given that the Global Fund is focusing on this high-risk group. This change is also reflected in the revised Results Framework. (ii) Institutional arrangements 13. Implementation, Financial Management and Procurement Arrangements: Project implementation, financial management and procurement arrangements will remain the same as under the original Project. The institutional arrangements per se will not change: the Executive Secretary will continue to assume a role of coordination, monitoring and evaluation and resource mobilization, while a PIU will be responsible for the day-to-day management of project activities. 14. The Conseil du Projet Multisectoriel de la Prévention du SIDA, the Project’s steering committee, will continue to function but given the elimination of Component 3, will no longer have the mandate to review grant requests funded under this component or review and approve the Fund manual. 15. Financial management functions will also continue to be undertaken by the PIU, which has considerable experience and a good track record in the implementation of Bank financial management procedures. All other financial management requirements will remain unchanged. 16. Procurement will be carried out in accordance with the World Bank’s “Guidelines: Procurement under IBRD Loans and IDA Credits� dated May 2004, revised in October 2006 and in May 2010, and “Guidelines: Selection and Employment of Consultants by World Bank Borrowers� dated May 2004, revised in October 2006 and May 2010. Moreover, the procurement threshold for Bank’s prior review will be raised to be in line with regional procurement thresholds. In addition, provision for a Procurement Agent for 7 the procurement of medical goods will be included to reflect the use of SALAMA, the national drug procurement agency for standard drugs and medical supplies. Selection of NGOs will continue to be based on quality and cost selection and contracts will be signed with the selected NGOs. (iii)Financing 17. Reallocation by component. A reallocation will be undertaken to allocate funds from the original Component 3 to strengthen the health sector response (Component 2), M&E (Component 4) and project management and capacity building (Component 5). Some funds will be also allocated to Component 1 to cover cost overruns of implemented activities. Table 1 presents the revised project costs by component. Table 1: Revised project Costs by Component (in SDR) Components/Activities Current Proposed (1) Harmonization, donor coordination, and 1.0 1.9 strategies (2) Support for health sector 2.4 8.1 response (3) Fund for STI/HIV/AIDS 11.1 4.8 Prevention and Care-Taking Activities (4) Monitoring and Evaluation 2.0 2.8 (5) Project management and 1.7 2.6 capacity building (6) Unallocated 2.0 0.0 TOTAL 20.2 20.2 18. Reallocation by category. Reallocation of the credit proceeds by disbursement category is outlined in Table 2. Category 1 (Goods and civil works) will be increased to allow for financing of additional goods critical for strengthening the supply side of the fight against STI/HIV/AIDS and improving the care and treatment of PLWHAs, including HIV and syphilis tests, blood transfusion and universal precaution supplies, male condoms, STI kits, ARVs, and medicines for treatment of opportunistic infections and prevention of mother to child transmission. Category 2 (Consultant services) will be increased to finance services related to strengthening information systems, undertaking HIV/AIDS related surveys and studies that will be commissioned to improve the evidence base on the epidemic as well as firm contracts with NGOs and the external verification firm. Category 4 (Operating Costs) will be increased to take into account the cost of implementation given that the project closing date is extended until December 31, 2012. Category 3 (Grants under Component 3) will be decreased given that this approach will be eliminated from the future activities of the project. 19. Disbursement arrangements. Designated Account A for the project will continue to be used. The ceiling of Designated Account A will be raised to US$1.5 million (previously US$1 million). The signatories include the National Director of the Project and the National Coordinator of the SHSDP PIU along with the Administrative and Financial Officer of the SHSDP PIU as an alternate signatory. Designated Account B used to finance 8 the FMA for implementation of Component 3 will be closed. Prior to closing, any remaining eligible expenses will be documented through submission of a withdrawal application for Designated Account B. The balance of Designated Account B, following documentation, will be refunded to IDA. 9 Table 2: Revised Disbursement Table Category of Expenditure Allocation % of Financing (SDR) Current Current Revised Current Revised (1) Goods and civil 2,700,000 6,700,000 100 100 works (2) Consultants’ 4,110,000 8,100,000 100 100 services, including training and audits (3) Grants 9,900,000 3,200,000 100% of 100% of (a) under Part C. 1 of amounts amounts the Project disbursed disbursed (4) Operating Costs 1,420,0000 2,200,000 100 100 (5) Unallocated 2,070,000 0 TOTAL 20,200,000 20,200,000 (v) Anti-Corruption Guidelines 20. ‘Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants’, dated October 15, 2006 and updated in January 2011, shall apply to the Project, with modifications as set out in the restated DCA. APPRAISAL SUMMARY 21. The current objective of the project remains valid. The restructuring will further strengthen the focus and effectiveness of the project by: a) eliminating the Fund for STI/HIV/AIDS Prevention and Care-Taking which was not effective in delivering key interventions to target populations, (b) increasing the health sector response through scaling-up contracting with NGOs for delivery of services, (c) strengthening M&E including better alignment of project activities with outcome indicators and (d) extending the project closing date by one year to December 31, 2012 in order to consolidate achievements and measure the results of proposed changes. 22. Safeguards: There are no changes to the safeguard classification and all safeguard implementation is rated Satisfactory. The Integrated Safeguard Data Sheet disclosed at the InfoShop on November 17, 2010 remains valid for the current restructuring. The implementation progress on the Medical Waste Management Plan is correctly reflected in the document. 23. Governance and Accountability: In order to ensure that the resources under the project continue to be protected in the current country context, governance and accountability 10 mechanisms have been proactively enhanced by the government and have been under implementation since 2010. These actions include: (i) strengthened internal verification mechanisms through intensified project supervision; (ii) strengthened external verification mechanisms through the recruitment of an external verification firm; (iii) contracts with NGOs to support delivery of services; and (iv) project implementation by a PIU that has proven to have high capacity and experience with Bank procurement and financial management procedures as demonstrated by excellent supervision reports, high quality interim financial reports and annual audit reports. 24. Risks: The risks continue to be the same as under the original project. However, an additional risk has arisen in the form of the on-going political situation which has delayed project restructuring and may delay implementation of remaining project activities. As a mitigation measure, in addition, to the strong governance and accountability mechanisms described above, the one -year extension of the closing date will allow sufficient time to satisfactorily complete and consolidate the project achievements. Therefore, the risk rating remains as Moderate. 11 ANNEX 1: Action Plan (Plan d’Action) MSPP II (through December 31, 2012) Xrate=USD 2000 Indicateurs/Résultat attendus Budget (USD) Besoin PU (reliquat CODE Activités principales Sous activités PMPS) (USD) indicateur de produit indicateur de résultat 2012 2012 HCD COMPOSANTE 1 : HARMONISATION, COORDINATION DES DONATEURS ET STRATEGIES 0 RSS COMPOSANTE 2 : SOUTIEN A LA REPONSE DU SECTEUR SANTE FACE AUX IST/VIH ET AMELIORATION DES OFFRES DE SERVICE MATERNELLE ET INFANTILE 1,498,774 RSS21 Sous composante 2. 1 : Acquisition des intrants de santé pour le dépistage du VIH 199,974 2,1,1, Acquisition des intrants de Achat de tests VIH et 1500 b/tes de 100 Determine acquises 1,500 111 166,327 santé pour la prise en charge des cons ommables 175 b/tes de 10 Retrocheck acquises 175 21 3,715 femmes enceintes et des 90 b/tes de 20 Unigold acquises 90 109 9,801 accouchés 35 b/tes de 100 tubes vacuitainers Pourcentage des jeunes, TDS et 35 33 1,158 acquises militaires dépistées au VIH 35b/tes de 100 aiguilles vacuitainers 35 25 872 acquises 1700b/tes de 50 paires de gant acquises 1,700 11 18,102 RSS24 Sous composante 2. 2: Amélioration de l’utilisation de service par les groupes les plus à risque VIH et des résultats attendus du Projet 1,228,000 - Nombre de jeunes/TDS/militaires 2,4,1, Recrutement d'ONG pour dépistés à la syphilis et ayant reçu le appuyer les partenaires Financement des ONGs pour rés ultat d'exécution du programme appuyer dans l'atteinte des 5 ONG recrutés -Nombre de jeunes/TDS/Militaires 5 200,000 1,000,000 IST/VIH dans l'atteinte des objectifs du projet IST/VIH dépistés au VIH et ayant reçu le objectifs du projet rés ultat -Nombre de préservatifs distribués Les interventions sur terrain suivent 2,4,2, Supervision des activités Supervision par superviseurs Nombre de supervision réalisées les méthodologies définies dans les 18 2000 144,000 des ONG dossiers des contrats Les interventions sur terrain suivent 2,4,3.Supervision des Supervision par UGP et Nombre de supervision réalisées les méthodologies définies dans les 21 2000 84,000 interventions sur terrain SE/CNLS dossiers des contrats RSS25 Sous composante 2.3: Contribution à la mise en œuvre du Plan de gestion des déchets : 15,000 2,5,1, Mis en œuvre du plan de Supervision et maintenance des Rapport de s upervision dis ponible X sites supervisés 8 1875 15,000 ges tion de déchets incinérateurs RSS26 Sous composante 2.4 : Amélioration de la qualité de prise en charge des PVVIH 55,800 2.6.1.Renforcement et Appui au fonctionnement des 47 Centres de Prise en charge des PVVIH fonctionnement du réseau de centres de prise en charge des Pourcentage de rapport de PEC reçu 47 50 28,200 financés pris e en charge PVVIH 2.6.2.Financement des .Financement des Ass ociations 3 associations de pris e en charge Au moins 60% des PVVIH ayant reçu Ass ociations de prise en charge de prise en charge 3 9200 27,600 financées un soutien psychosocial psychosociale psychosociale SUE COMPOSANTE 3: SUIVI EVALUATION 475,700 SUE 31 Sous composante 3.1. Suivi et supervision 44,000 Les supervsions sur terrain réalisées 2,1,6, Supervision des activités Supervision des activités de Les interventions des Formations Nombre de supervision réalisées 22 2000 44,000 relatives au programme IST/VIH santé sanitaires respectent les normes définies SUE 32 Sous composante 3,2, Etudes impact et évaluation 431,700 Recrutement d’un Agent 4,2,1, Recrutement d'une vérificateur indépendant pour le Le progrès des indicateurs relatifs Une Agence de vérification indépendante institution pour le suivi et suivi des progrès des aux interventions des ONG suivi 1 350,000 350,000 recruté évaluation des activités des ONG indicateurs relatifs aux activités régulièrement des ONG VIH et ONG Nutrition 4,2,2,Réalisation de l'évaluation 1 consultant international et 1 consultant Résultats de l'évaluation finale du 1 81,700 81,700 finale du PMPS II national recrutés PMPS II dis ponibles GDP COMPOSANTE 4: GESTION DU PROJET 425,526 GDP41 Sous composante 4,1: Service de consultant 10,780 Réalis ation de l'audit financier 4,1,1, Réalisation de l'audit Un cabinet recruté pour réaliser l'audit Rapport d'audit financier disponible 1 10,780 10,780 2012 GDP42 Sous composante 4,2: Fonctionnement du projet 414,746 Financement des charges de 4,2,1,Fonctionnement fonctionnement UGP et Paiement des charges de fonctionnement UGP et SE/CNLS fonctionnels 378,746 SE/CNLS Les interventions des ONG respectent 4,2,2,Recrutement des Recrutement des s uperviseurs Nombre de superviseurs recrutés les méthodologies définies dans les 3 1,000 36,000 supervis eurs des ONG des ONG, dossiers des contrats TOTAL 2,400,000 12 13 ANNEX 2: Results Framework and Monitoring MADAGASCAR: SECOND MULTISECTORAL STI/HIV/AIDS PREVENTION PROJECT Project Development Objective (PDO): Support GOM efforts to promote a multi-sectoral response to the HIV/AIDS crisis and to contain the spread of HIV/AIDS on its territory. Revised Project Development Objective: N/A D=Dropped Cumulative Target Resp. Core C=Continue Unit of Baseline Values Data Source/ PDO Level Results Indicators* Frequency for Data N= New Measure 2006 20091 End Methodology Coll. R=Revised (actual) 2012 Decrease in syphilis prevalence among C Percent 16.6%2 15.6%3 15% Every two Biological ES and SW. years surveillance PIU survey Percentage of respondents who can both D Percent M: 45.7% M: 57.3% N/A Every two Combined ES and correctly identify ways of preventing F: 45.1% F : 49.2% years Survey 2011- PIU the sexual transmission of HIV and 2012 reject major misconceptions about HIV transmission and prevention (by age group and gender). Percentage of targeted groups (Young R. Percent M: 66.8% M: 66.3% M : 68% Every two Combined ES and people aged 15-24 by gender, SW and F: 65.8% F : 62.6% F : 67% years Survey 2011- PIU military) who can cite three methods of SW: 60% SW: SW: 61% 2012 HIV/AIDS prevention Military: 58.9% Military: 53% Military: 57% 55.2% Percentage of people in high-risk groups Percent SW:44% SW: N/A Every two Behavioral ES and (SW, truck drivers, military), who reject D Truckers: 52.9% years surveillance PIU two major misconceptions about 56.3% Truckers: survey HIV/AIDS transmission. Military: 62% 84% Military: 88% Percentage of youth 15-24 exposed to Percent M: 72% M: 70.4% N/A Every two Behavioral ES and STI/HIV/AIDS communication D F:64% F:67% years surveillance PIU activities/products in the previous 6 survey months (by source of information). 1 Data is from 2009 surveys fielded in 2008. 2 Baseline data from Biological surveillance survey 2005. 3 Baseline data from Biological surveillance survey 2010. 14 Percentage of population aged 15-49 Percent M :15%4 M:25.5% N/A Every two Combined ES and who do not express discriminatory D F :15% F : 24% years Survey 2011- PIU attitudes towards PLWHA (by age and 2012 gender). Direct Project Beneficiaries, (number) N Number 234,069 1,417,515 1,929,774 Every year Project data ES and of which female (%) X Percent 63% 66% 64% PIU D=Dropped Cumulative Target C=Continue Values Resp. Core Intermediate Level Results Unit of Baseline Data Source/ N= New Frequency for Data Indicators* Measure 2006 2009 End Methodology R=Revised Coll. (actual) 2012 Percentage of men and women aged 15- Percent M:38.1%5 M:15.5%6 M: 20% Every five DHS INSTAT 49 who report having sex with a non- D F:16.8% F:2.1% F: 9% years regular partner in the last 12 months. Percentage of target7 population Percent M:34.2% M:40.4% M :45% Every two Combined ES and reporting the use of a condom in their R F:40.7% F:43.8% F :47% years Survey 2011- PIU last act of sexual intercourse with a 2012 non-regular sexual partner in the last 12 Military: Military: Military: months (%) 47.8% 63.6% 70% Percentage of men and women aged 15- Percent M:13.1% M:7.4%8 N/A Every five DHS INSTAT 49 reporting the use of a condom in D F:4.6% F:7.6% years their last act of sexual intercourse with a non-regular sexual partner in the last 12 months. Percentage of SW reporting the use of a Percent 79.4% 84.8% 86% Every two Combined ES and condom in their last act of sexual C years Survey 2011- PIU intercourse with a client. 2012 Percentage of truck drivers and military Percent 47.8% 63.6% N/A Every two Combined ES and reporting the use of a condom in their years Survey 2011- PIU last act of sexual intercourse with a D 2012 non-regular sexual partner in the last 12 months. Percentage of youth aged 15-24 that Percent M:7.7% M: M:20% Every two Combined ES and have received an HIV test in the last 12 F:8.7% 18% F :22% years Survey 2011- PIU months and who know their results (by N F: 2012 age and by gender). 21.2% 4 Baseline data from Behavioral surveillance survey in 2006. 5 Baseline data from DHS 2003/2004. 6 DHS 2008/2009 data on men and women aged 15-49 who report having more than two sexual partners in the last 12 months. 7 Defined as youth aged 15-24 by gender and military in project areas 8 DHS 2008/2009 data on men and women aged 15-49 having more than two sexual partners reporting the use of a condom in their last act of sexual intercourse. 15 Percentage of SW that have received an Percent SW:49.1% SW: SW: Every two Combined ES and HIV test in the last 12 months and who 59.6% 64% years Survey 2011- PIU N know their results. 2012 16 17