Linked to Activities 9281, 9292, 10126, 10663, 9280.

SUMMARY: This activity is carried out to support continuation and expansion of a comprehensive HIV/AIDS program and to support interventions for youth and men at risk. The program is a continuation of a FY 2006 activity and is supported by the National AIDS Strategic Plan of the Ministry of Health (MOH). This activity is closely coordinated with Global Funded sites to avoid duplication. About 70% of this activity is funded through the OP budget.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: FOSREF will address the unmet needs of the sexually active youth particularly at community level. The USG will continue supporting three youth centers that were supported in FY 2006. The program will work in close collaboration with youth associations in the most marginalized areas around the centers and will train 250 youth as peer educators. The program will promote peer dialogue addressing themes such as: secondary abstinence, being faithful, perception of risk, partner reduction, negotiation skills, gender equity, self-esteem, and sexual violence. A Youth Coordinator will be hired to plan and design programs targeted to youth 15-24 years old. Peer educators messages will include themes such as secondary abstinence, being faithful, perception of risk, know your risk/know your status, and referrals to the FOSREF's youth centers for other prevention, STI treatment, VCT and other reproductive health services. Referrals to care, support and treatment services will also be provided, when needed.

Post-test clubs will also be established and similar messages as outlined above wil be discussed. Fifty street youth will be trained in the use of an adapted HIV/AIDS education material, elaborated by FOSREF. In order to reach other street youth, these youth will conduct skits and drama monthly to encourage safe sexual behaviors. Linking with activities with the BCC cluster, FOSREF will organize media programs to address themes against sexual violence, against "sugar daddies", promotion of secondary abstinence, being responsible, getting tested, and staying negative. Skits, jingles, radio talk shows with the community groups will be produced and coordinated with all prevention partners. The program will address social opportunities for the most vulnerable kids, including street kids and kids involved in gang activities. FOSREF will provide activities, such as basic short technical trainings in many technical fields (e.g. mechanics, handcrafting, floral arts, masonry, carpentry, sewing, arts-and-crafts, computers); elementary classes for literacy; and support for school reintegration of secondary school kids who have abandoned school. The program will link with rehabilitation programs for young girls, and also with other education and micro-finance programs supported by USAID/Haiti. 200,000 youth will receive abstinence and being faithful messages

Activity 2: FOSREF will provide peer education for fixed categories of men such as unemployed men. The main themes that will be developed include sexual responsibility, responsible parenthood and paternity, high-risk sexual behaviors, fidelity, and the importance of VCT. More than 200 men will be trained as peer educators who will conduct sensitization sessions monthly for other men. Songs, sketches, mini-films, mimes, jingles will be produced and disseminated in public parks, public transportation stations, in front of bars, brothels, on beaches, addressing themes on HIV/AIDS prevention. Sensitization activities will be organized during regional celebrations and during cockfights addressing the same themes. Community dialogues, debates and forums will be organized in areas and sites where men are frequent visitors, with media coverage of the debates by the community radio stations, addressing the same themes which will be coordinated with all prevention partners. The program will conduct interventions in the media, covering such key themes as sexual responsibility for men, sexual violence against women, risk of concurrent partnerships, and advantages of fidelity.

Monitoring and Evaluation of these activities including data collection, use, quality and feedback will also be a continued and focused effort in FY07

Linked to Activities 10126, 10663, 9280, 9322, 9346, 11059.

SUMMARY: This activity is carried out to support continuation and expansion of a comprehensive HIV/AIDS program for commercial sex workers (CSWs) and their clients, and to support interventions for youth and men at risk. The program is a continuation of a FY 2006 activity and is supported by the National AIDS Strategic Plan of the Ministry of Health (MOH). This activity is closely coordinated with Global Funded sites to avoid duplication. About 30% of this activity is funded through the AB budget.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: FOSREF will provide behavior change communication (BCC) messages to promote condoms and other prevention activities through seven "Lakay" CSW centers in the South, West, South East and West Departments. This will compliment the five centers funded by Global Fund. This activity will build on USG-supported FY 2006 results and will train 1,320 CSW peer educators and reach 27,500 CSWs and clients in brothels, hotels and bars. CSW outreach workers will conduct evening outreach activities to those who do not access the centers. During those contacts, they will distribute materials and brochures promoting safe sex to encourage safe sexual behavior among prostitutes and clients and facilitate interactive sessions so issues can be discussed in more depth. Sensitization sessions will also be conducted at the Lakay centers on various subjects including sexually transmitted infections (STI), consistent and correct condom use will all partners, "no condom-no sex" messages, negotiation skills, "know your risk/know your status" messages, dangers of alcohol and drugs, and "go get tested' messages. Community CSW Peer Educators will conduct visits to CSW at fixed points frequented by prostitutes. It is estimated that over 500,000 condoms will be distributed to more than 18,000 CSWs and clients. 60.000 CSWs will receive condom and other prevention messages

Activity 2: FOSREF will provide access to clinical and laboratory diagnosis and treatment of STIs to CSWs and their clients at the Lakay centers. CSWs will have access to trained physicians/gynecologists who will conduct gynecological examinations and lab tests. CSWs will receive treatment for STIs and other reproductive tract infections and will have access to family planning methods. It is estimated that more than 3,000 CSWs and their clients will be treated for STIs.

Activity 3: FOSREF will establish and support "The Other Choice" Social Clubs to provide alternative sources of income for CSW. A number of options, including computers, floral art/paper, dance, hair, beauty and skin care, sewing/embroidery, theater, and basic literacy courses will be available at the seven centers. CSWs attending the clubs will build skills, self-esteem, self-empowerment, and will learn about alternative ways to earn an income and abandon prostitution. The program will offer alternatives to prostitution with its links to micro-finance programs, general literacy programs and linkages with USAID programs. It is estimated that 11,000 CSWs will benefit from the "Other Choice" Social Club activities

Activity 4: FOSREF will address the unmet needs of the sexually active youth particularly at the community level. The USG will continue supporting three youth centers that were supported in FY 2006. The program will work in close collaboration with youth associations in the most marginalized areas around the centers and will train 250 youth as peer educators. A Youth Coordinator will be hired to plan and design programs targeted to youth 15-24 years old.

Peer educators messages will promote peer dialogue addressing themes such as perception of risk, negotiation skills, gender equity, self-esteem, correct and consistent condom use, alcohol and drugs, and sexual violence, and know your risk/know your status. Referrals to the FOSREF's youth centers for STI treatment, VCT and other reproductive health services will also be provided. Post-test clubs will also be established and the messages described above will be discussed during these meetings. In addition, fifty street youth will be trained in the use of an adapted HIV/AIDS curriculum, elaborated by FOSREF. In order to reach other street youth, monthy skits and dramas will be conducted to encourage safe sexual behaviors. Linking with activities with the BCC cluster, FOSREF will organize media programs to address themes against sexual violence, against "sugar daddies", consistent and correct condom use, and get tested and stay negative messages. Skits, jingles, a radio talk show with the community groups will be

produced and coordinated with other prevention partners. The program target the most vulnerable kids, including street kids and kids involved in gang activities, and refer them to FOSREF and other USG partners that support vocational training. For example, FOSREF will provide short technical trainings in many technical fields (e.g. mechanics, handcrafting, floral arts, masonry, carpentry, sewing, arts-and-crafts, computers); elementary classes for literacy; and support for school reintegration of secondary school kids who have abandoned school. The program will link with rehabilitation programs for young girls, and also with other education and micro-finance programs supported by USG/Haiti. 200,000 youth will receive condom and other prevention messages

Activity 5: FOSREF will provide peer education for fixed categories of men such as unemployed men. The main themes that will be developed include sexual responsibility, sexual violence against women, partner reduction, concurrent partnerships, alcohol and drug abuse, responsible parenthood and paternity, high-risk sexual behaviors, correct and consistent condom use, STI, and the importance of VCT. More than 200 men will be trained as peer educators who will conduct sensitization sessions monthly for other men. Songs, sketches, mini-films, mimes, jingles will be produced and disseminated in public parks, public transportation stations, in front of bars, brothels, and on beaches. Sensitization activities will be organized during regional celebrations and during cockfights addressing the same themes. Community dialogues, debates and forums will be organized in areas and sites where men are frequent visitors, with media coverage of the debates by the community radio stations, addressing the same themes which will be coordinated with other prevention partners. The program will conduct interventions in the media discussing similar messages. It is estimated the nearly 10,000 men will be provided with condoms.

Monitoring and Evaluation of these activities including data collection, use, quality and feedback will also be a continued and focused effort in FY07.

Linked to Activities 9281, 10663, 9280, 9326, 10108.

SUMMARY: FOSREF will expand palliative clinical and home-based care in three FOSREF counseling and testing (CT) sites that serve marginalized communities of the Port-au-Prince metropolitan area in the West Department of Haiti. This program will be integrated in the prevention and CT activities targeted at high risk groups, youths and prostitutes which FOSREF has been implementing for more than 5 years. This program will offer more comprehensive HIV services to these high risk groups. The target population of this program will be PLWHAs that are being detected at all FOSREF centers in the metropolitan area.

BACKGROUND: FOSREF has been implementing HIV prevention program targeted at youth and prostitutes for many years. Over the last 3 years, with resources from the Global Fund and President's Emergency Plan for AIDS Relief (PEPFAR), they have begun implementing a network of CT services, either as stand alone services or integrated into basic care, to complement their prevention activities. So far, they have a network of 17 functional CT sites throughout the country, with 11 of these sites in the metropolitan Port-au-Prince area. When PLWHAs detected at these sites are referred to other sites for clinical care services, they are lost to follow up. It is critical that FOSREF integrate palliative care in its network to provide a better continuum of care to PLWHAs and also as an incentive to encourage people to get tested. With FY06 resources, one CT site (Centre de Gynécologie Préventive et D'Education Familiale [CEGYPEF]/Port-au-Prince) in the metropolitan area will be upgraded to provide clinical palliative care.

With FY07 resources, FOSREF will reinforce the palliative care package at CEGYPEF/Port-au-Prince and will expand this package to two new sites: CEGYPEF/Delmas and CEGYPEF/Lalue. This package will include clinical and home-based care (HBC) services and will include networking with the other FOSREF CT sites in the area and with existing anti-retroviral (ARV) sites in the area where eligible PLWHAs are referred for anti-retroviral treatment (ART). FOSREF will develop linkages with the Association of Evangelical Relief and Development Organizations HIV/AIDS Alliance (or "the Alliance" AERDO), the main community-based organization (CBO) through which the USG will channel resources to provide community palliative care to PLWHAs in the West department.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: FOSREF will use funding to upgrade the three sites to assess the clinical status of patients and to provide opportunistic infection (OI) treatment and prophylaxis, nutritional assessments, counseling and support according to the national norms and protocols. This funding will also support long-term patient follow-up to determine the optimal time for beginning ART and to refer them to ARV sites, when appropriate. Efforts will be made through other partners to make available at these sites a processed food that could be distributed to malnourished PLWHAs with a food prescription. Each site will be staffed with a multi-disciplinary health-care team, including physicians, nurses, counselors, lab technicians and community health workers. FOSREF will make resources available at each site to cover transportation fees for PLWHAs to attend clinic visits. OI drugs will be provided by the United States Government (USG) thru the Partnership For Supply Chain Management (PFSCM). Dedicated staff will be hired at each site to adequately support monitoring and evaluation (M&E).

Activity 2: FOSREF will reinforce and expand its network of community workers around these three sites to deliver a package of care at home to PLWHAs enrolled at these sites. These community workers will be responsible for home visits in order to track patients and to provide counseling services regarding HIV prevention and best health practices, particularly related to safe drinking water, malaria prevention and nutrition. During home visits these community workers will assess basic care needs of the patients and will provide, as needed, pain killer as well as other symptomatic medicine, oral rehydration solutions (ORS) and micronutrients, according to the national guidelines. Commodities and drugs for this activity will be provided thru PFSCM.

Activity 3: FOSREF will build a system of reference and counter-reference with the ARV sites based in the metropolitan area to refer PLWHAs eligible for ARV. FOSREF will continue to offer tracking, adherence support and basic care at home for these ARV patients. In addition, FOSREF will link with the main CBO and local CBO to ensure that the

PLWHA enrolled in its palliative care and CT sites get access to psycho-social, nutrition and preventive care services at the community level.

Activity 4: FOSREF will reinforce its technical and logistic capacity to supervise day-to-day activities of the program and to coordinate with Haitian Group for the Study of Kaposi's sarcoma and Opportunistic Infections (GHESKIO) and Partners In Health (PIH) the training of the different categories of staff at the three sites in clinical and home based care using the national norms and protocols.

Activity 5: FOSREF will organize post-test Clubs and support groups for PLWHAs, involving HIV+ young people in decision-making for positive prevention. This will be done in coordination with the CBO in charge of supporting this activity as part of the package of community palliative care in the West department.

Linked to Activities 9281, 10126, 9280.

SUMMARY: This activity is carried out to intensify and expand FOSREF's program for orphans and vulnerable children. The primary emphasis areas for this activity are community mobilization/participation, information, education and communication, and training. Specific target populations include street kids, children affected or infected by HIV/AIDS. The activities will be carried out in four regional departments: the South, the South East, the Grande Anse and Nippes and particularly in the following cities (and their surroundings communes): Les Cayes, Jacmel, Jérémie, and Miragoane.

BACKGROUND: FOSREF has worked in the area of HIV/AIDS prevention for more than 10 years targeting youth in after-school clubs and drop-in centers that are operated in four regional departments in the country. Through these youth services, FOSREF has been able to identify children and youth who are HIV infected or from families where there is an HIV infected parent and has started an OVC component to their work. This current activity is a new program that will permit FOSREF to extend its OVC services in other departments of the country. This program will put special emphasis on key issues related to the OVCs, and will have a strong emphasis at community level.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: Peer Education for Street Kids: Training sessions for OVC peers will be organized at the youth centers of FOSREF in the 4 departments, in shelters, and meetings points and institutions working with street kids. These training sessions will cover interpersonal communication techniques, perception of risk level, negotiation skills, sexually transmitted infection (STI) and HIV/AIDS prevention and life skills. Activity 2: Provision of psychosocial and educational support: The program will provide psychosocial support to OVC at center level, in the families, and in the community as well as school fees for children age 5 to 18 years old and support for school materials and uniforms. Specific individual or group education sessions will be organized for OVC girls on self-esteem, negotiation skills and life skills. These sessions will be reinforced by psychological assistance for girls who might need it.

Activity 3: Weekly sessions of information and quarterly training for extended family members, members of the community, as well as providers to strengthen their capacities to provide protection, social support and care to OVC. Training sessions for OVC caretakers and providers at center level and at community level will emphasize coping with stigma and discrimination and caring for the HIV positive child.

Activity 4: Entertaining education sessions on different themes including HIV/AIDS prevention, fight against sexual violence, gender equity will be realized by social clubs within the FOSREF youth program. The FOSREF Youth Theater Clubs will be particularly implicated in the edutainment activities. These activities will be realized in the FOSREF youth centers in the areas of intervention of the project and also in shelters and meeting points for OVC. Development and production of educational materials for OVC will be a priority.

Activity 5: Clinical services for OVC: Basic clinical care for common diseases such as non complicated respiratory infections, diarrhea will be available in the 4 FOSREF youth centers, and a well-organized system of referrals of OVC presenting complicated diseases, at community and at institutional level. Immunization services will also be available for the OVCs.

Activity 6: Nutritional support for OVCs: The project will seek strong and close collaboration with specialized institutions such as Catholic Relief Services (CRS) and the World Food Program to strengthen the nutritional aspects of the program which will include dietary assessment, dietary counseling and multi-nutrient supplementation, as appropriate.

TARGETS: 300 information sessions on OVC needs will be organized in the community 10.000 community members will be reached and sensitized about OVC needs 96 education sessions for OVC will be organized 120 OVC peer educators will be trained

Linked to Activities 9281, 10126, 10663, 9362.

SUMMARY: This activity supports continuation and expansion of Foundation for Reproductive Health and Family Education's (FOSREF) comprehensive voluntary counseling and testing for HIV (VCT) program carried out in FY 2006 which included an organized testing and referral system for HIV-positive commercial sex workers (CSWs), HIV-positive youth, HIV-positive men, and HIV-positive pregnant women and also post-test clubs. The primary emphasis areas for these activities are training, human resource development and infrastructure development. Specific target populations include CSWs and their clients; youth aged 15 - 24 years, men, and pregnant women.

BACKGROUND: Activities targeting CSWs will be carried out in the USG-supported FOSREF centers in Petion-Ville, Cap-Haitien, Cayes, Ouanaminthe and Carrefour/Mariani, Jacmel, and Gonaives. Activities targeting youth will be carried out in 10 FOSREF youth centers located in seven of Haiti's 10 geographical departments: North, South, South East, Grande Anse, Artibonite, West, and North West. The FOSREF Centers are located in the eight largest cities of those departments, and will serve more than 200,000 youth. Activities targeting men will focus on specific sub-populations including men with multiple partners, men with high-risk sexual behavior, clients of prostitutes, and single men. These activities will be carried out in the following departments: West, particularly the metropolitan region; South; North; Nippes; North East; South East; and Artibonite. Program activities for pregnant women will be implemented in three FOSREF sites located in the metropolitan area and sub-urban, marginalized areas, of the West Department with an average HIV seroprevalence of 3 - 5.6%. The activities are a continuation of USG-supported FOSREF activities funded in FY06. Haiti's national HIV operational plan includes FOSREF's counseling and testing services.

ACTIVITY AND EXPECTED RESULTS: Activity 1: FOSREF will provide VCT services to CSWs in seven sites. The CSWs trained peers will be fully involved in the counseling process. FOSREF will promote VCT services and availability of mobile VCT services at fixed points of prostitution including brothels and bars. FORSEF will provide a constant supply of condoms at recruiting/gathering points for potential clients of prostitutes (e.g. bars, restaurants, bus stations, and garages). In addition, FORSEF will conduct HIV awareness sessions for the clients of CSWs in an effort to discourage them from engaging in high risk sexual behaviors. Those HIV-positive CSWs will be integrated in support activities that will promote positive prevention, care and support. HIV-positive CSWs also will be integrated into antiretroviral treatment (ART) programs or palliative care and support, as appropriate (See also: FOSREF Palliative Care narrative and ARV Services narrative). HIV-negative CSWs will be integrated in the Stay Negative program, and 100% condom use program, and will receive secondary abstinence messages. FY 2007 funding will support a total of 2,500 CT sessions among CSW.

Activity 2: FOSREF will enhance the delivery of VCT services to youth in its 10 specialized youth centers/clinics. VCT services will be delivered by trained youth facilitators/counselors. Youth aged 15 to 24 years will receive VCT-related services, integrated with other reproductive health services such as diagnosis and treatment of sexually transmitted infections (STIs). Both HIV-positive and HIV-negative youth will be integrated in post-test clubs which will function as psycho-social support groups. The VCT services will be supported by a community program organized by trained youth. An outreach network of youth facilitators will organize community activities that promote the VCT services and other related services among the youth. They will also promote post-test secondary abstinence, which is the key strategy of the Stay Negative program for HIV-negative youth. HIV-positive youth will also be referred to organized care and support services and antiretroviral treatment (ART). 4,500 youth will receive CT services with FY 2007 funding.

HIV-negative youth will be enrolled in post-test clubs to encourage them to maintain their negative serostatus. In addition, FOSREF will link its youth and VCT centers with existing Prevention of Mother-to-Child Transmission (PMTCT) and ART sites and will encourage youth to work as peer counselors, companions (accompaniers) for pregnant women, patients on ART, or people living with HIV/AIDS (PLWHA) receiving palliative care. These youths also will collaborate with community health workers at the HAART sites to help identify orphans and vulnerable children (OVCs). FOSREF youth centers also will counsel

youth referred by the "high risk sexually active program" for STI diagnosis and treatment, VCT services and post-test clubs services, and special services for victims of sexual violence Those services will be available in all the FOSREF youth centers. The program will also deliver mobile VCT services to youth in marginalized areas and in rural areas where there is no clinic available.

Activity 3: FOSREF will offer VCT services to CSW and their clients through mobile VCT services that travel to fixed points of commercial sex work including brothels and bars. FOSREF will maintain a constant availability of condoms at client recruiting/gathering points (bars, restaurants, bus stations, garages). In addition, FOSREF will conduct HIV awareness sessions with clients of CSWs in VCT sessions to encourage them to stop engaging in unsafe sexual behaviors. Clients of CSWs will receive also STIs diagnosis and treatment. FY 2007 funding will support a total of 2,000 CT sessions among clients of CSW.

Activity 4: FOSREF will counsel pregnant women regarding PMTCT during prenatal visits at its reproductive health Centers and will ensure that HIV+ women are formally enrolled in a PMTCT site in their community that offers a comprehensive package of PMTCT services. The information sessions will cover HIV counseling and testing during pregnancy for all pregnant mothers, and also for all women in the waiting rooms of those centers providing integrated sexual and reproductive health services. Key activities of the program will be: education and sensitization of all women attending the Centers (sessions of education will target mainly the pregnant women during prenatal clinic activities), education and sensitization sessions for clients in the community during outreach activities, and PTMCT club activities. Services provided will include: information and education; clinical VCT services; psychological and nutritional support; development of a strong referral system for HIV-positive mothers; and training. A total of 2,500 pregnant women will receive CT services.

All initial training and refresher training of VCT staff will be carried out in coordination with the USG-supported CT training program funded under I-TECH/INHSAC (see ITECH activity narrative for CT.)