Linked to Activities 10129, 10665, 8099, 9352, 9292, 9791, 10438.

SUMMARY: PLAN International activities will be implemented through Adult and Youth Peer Educators (YPEs). The North East Regional Department is near the Dominican Republic border. This department has the second highest prevalence rate of 2.7% (Haiti 2005 DHS) and a highly mobile population working. PLAN will continue to work with three main sub-partners--Centre pour le Développement et la Santé (CDS), Fondation Pour la Santé Reproductrice et l'Education Familiale (FOSREF) and Volontariat Pour le Développement d'Haïti (VDH) . The VDH will collaborate with the PEPFAR BCC cluster to refine training curriculum for training youth 10-24 years old and migrant populations. Since school children are not often segmented by age, because of late entry and high failure rates, topics will be designed to ensure appropriate abstinence and being faithful messages area targeted at 10-14 year olds and 15-24 year olds. In addition, efforts will be made to target out of school youth through the development of clubs using networks of consortium partners-FOSREF, VDH and CDS. PLAN will also work with its consortium partners to train migrants as adult peer educators to provide one on one education to their peers.

BACKGROUND: USG support to the Plan International Consortium's SHINE Project was initiated with a new award in FY 2006 as a result of a competitive process. The North East Regional Department has a population of approximately 300,000 persons comprised of six health districts (UCS). It is one of the most underserved and rural departments in Haiti with limited health facilities. As a result, there are multiple factors leading to high rates of HIV transmission. They include 1) a high level of mobility across the border contributing to prostitution and transactional/commercial sex including teen prostitution; 2) high levels of poverty ; 3) illiteracy affects 52% of the population ; 4) severe stigma prevents people from seeking to know their status and being willing to care for HIV positive family members. With minimal investments, PLAN has been able to mobilize its network to initiate cross border activities to promote behavior change among in and out of school youth. In FY 07, PLAN will expand to migrant populations. About 14% of this activity is funded through the OP budget

ACTIVITIES AND EXPECTED RESULTS: Activity 1: VDH will to provide training for all 100 YPEs (20 in school and 80 out of school) under the program. In addition, VDH will continue to manage 30 of these YPEs-- in its target commune of Ouanaminthe (10 in-school and 10 out-of-school in the city of Ouanaminthe plus another 10 out-of-school in the rural areas of the commune). FOSREF will manage the 30 YPEs in its target commune of Fort Liberté and Ouanaminthe. CDS will manage the 40 out-of-school YPEs in each of the other four communes (Ferrier, Capotille, Mont Organisé, and Carice). All the YPEs will operate either within their schools or their communities to discuss HIV/AIDS and stimulate self-risk assessments among their peers to help them develop behavior change strategies to manage their risk of infection. YPEs will provide counseling to their peers on abstinence, including secondary abstinence, personal risk assessment, reducing sexual partners and increasing negotiation skills. Referral linkages for STI treatment, other prevention, OVC programs, family planning services, CT, ART, care and support will be established for youth requiring these services. It is anticipated that each YPEs will reach about 30 peers through one on one sessions of small group meetings for a total of 2,400 youth being reached with abstinence and being faithful messages.

Activity 2: In 2007, YPEs will establish up to 10 Anti-AIDS clubs. Eight of the 10 clubs will target out of school youth. The clubs will be organized on the model currently being used by FOSREF which encourages youth to take ownership in planning and designing club activities. YPEs will organize periodic information sessions around key topics to promote abstinence and being faithful messages. These meetings will provide youth with a venue for discussing HIV topics such as risky behaviors, "sugar daddies", abstinence, secondary abstinence, fidelity, sexual health and hygiene, self esteem and gender, correcting myths around HIV transmission, and providing referrals to other prevention, CT, care or support services to reduce stigma and discrimination. The clubs will serve to reinforce positive behavior change and identify "youth champions" who can be role models for their peers to reduce HIV infection among youth. It is anticipated that up 250 youth will be reached through the Anti-AIDS clubs.

Activity 3: PLAN will provide peer education for adult migrant populations, especially men. The main themes that will be developed include sexual responsibility, high-risk sexual behaviors, fidelity, and the importance of VCT. About 100 migrants will be trained as peer educators who will conduct sensitization sessions bi-weekly for other migrants. Songs, sketches, mini-films, mimes, jingles will be produced and disseminated in public parks, public transportation stations, and other gathering places 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 migrants are frequent visitors. Key themes such as sexual responsibility for men, sexual violence against women, risk of concurrent partnerships, and advantages of fidelity will be discussed. Referrals to counseling and testing, other prevention, and care and treatment services will be provided.

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 9781, 10129, 10665, 11180.

SUMMARY: PLAN International activities will be implemented through Adult and Youth Peer Educators (YPEs). The North East Regional Department is near the Dominican Republic border. This department has the second highest prevalence rate of 2.7% (Haiti 2005 DHS) and a highly mobile population working. PLAN will continue to work with three main sub-partners--Centre pour le Développement et la Santé (CDS), Fondation Pour la Santé Reproductrice et l'Education Familiale (FOSREF) and Volontariat Pour le Développement d'Haïti (VDH) . The VDH will collaborate with the PEPFAR BCC cluster to refine training curriculum for training youth 10-24 years old and migrant populations. Since school children are not often segmented by age, because of late entry and high failure rates, topics will be designed to ensure appropriate abstinence and being faithful messages area targeted at 10-14 year olds and 15-24 year olds. In addition, efforts will be made to target out of school youth through the development of clubs using networks of consortium partners-FOSREF, VDH and CDS. PLAN will also work with its consortium partners to train migrants as adult peer educators to provide one on one education to their peers.

BACKGROUND: USG support to the Plan International Consortium's SHINE Project was initiated with a new award in FY 2006 as a result of a competitive process. The North East Regional Department has a population of approximately 300,000 persons comprised of six health districts (UCS). It is one of the most underserved and rural departments in Haiti with limited health facilities. As a result, there are multiple factors leading to high rates of HIV transmission. They include 1) a high level of mobility across the border contributing to prostitution and transactional/commercial sex including teen prostitution; 2) high levels of poverty ; 3) illiteracy affects 52% of the population ; 4) severe stigma prevents people from seeking to know their status and being willing to care for HIV positive family members. With minimal investments, PLAN has been able to mobilize its network to initiate cross border activities to promote behavior change among in and out of school youth. In FY 07, PLAN will expand to migrant populations. About 86% of this activity is funded through the AB budget

ACTIVITIES AND EXPECTED RESULTS: Activity 1: VDH will to provide training for all 100 YPEs (20 in school and 80 out of school) under the program. In addition, VDH will continue to manage 30 of these YPEs-- in its target commune of Ouanaminthe (10 in-school and 10 out-of-school in the city of Ouanaminthe plus another 10 out-of-school in the rural areas of the commune). FOSREF will manage the 30 YPEs in its target commune of Fort Liberté and Ouanaminthe. CDS will manage the 40 out-of-school YPEs in each of the other four communes (Ferrier, Capotille, Mont Organisé, and Carice). All the YPEs will operate either within their schools or their communities to discuss HIV/AIDS and stimulate self-risk assessments among their peers to help them develop behavior change strategies to manage their risk of infection. YPEs will provide counseling to their peers on negotiation skills, correct and consistent condom use, transactional and transgenerational sex, STI treatment, alcohol and drug abuse and the risk of concurrent partnerships. Referralsl to STI treatment, OVC programs, family planning services, CT, ART, care and support will be established for youth requiring these services. It is anticipated that each YPEs will reach about 30 peers through one on one session of small group meetings for a total of 600 youth being reached with condom and other prevention messages.

Activity 2: In 2007, YPEs will establish up to 10 Anti-AIDS clubs. Eight of the 10 clubs will target out of school youth. The clubs will be organized on the model currently being used by FOSREF which encourages youth to take ownership in planning and designing club activities. YPEs will organize periodic information sessions around key topics to promote correct and consistent condom use and STI treatment. These meetings will provide youth with a venue for discussing HIV topics such as risky behaviors, "sugar daddies", STIs, contraception, sexual health and hygiene, self esteem and gender, correct myths around HIV transmission, and providing referrals for CT, care or support services to reduce stigma and discrimination. The clubs will serve to reinforce positive behavior change and identify "youth champions" who can be role models for their peers to reduce HIV infection among youth. It is anticipated that up 250 youth will be reached through the Anti-AIDS clubs with prevention messages.

Activity 3: PLAN will provide peer education for adult migrant populations, especially men. The main themes that will be developed include sexual responsibility, high-risk sexual behaviors, correct and consistent condom use, STI treatment, and the importance of VCT. About 100 migrants will be trained as peer educators who will conduct sensitization sessions bi-weekly for other migrants. Songs, sketches, mini-films, mimes, jingles will be produced and disseminated in public parks, public transportation stations, and other gathering places 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 migrants are frequent visitors. Key themes such as sexual responsibility for men, sexual violence against women, risk of concurrent partnerships, and correct and consistent condom use will be discussed. Referrals to counseling and testing, and care and treatment services will be provided.

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 9781, 10665, 10111, 10124, 10110, 10123, 10109.

SUMMARY: This activity incorporates community-based psycho-social care and support of PLWHAs and their families in the North East Regional Department linked to institutional care for treatment of opportunistic infections (OI) and other clinical interventions. The psycho-social support activities will be conducted in partnership with Promoteurs Objectif ZEROSIDA (POZ) and will complement counseling and testing (CT) and palliative care health services furnished in partnership with Centres pour le Développement et la Santé (CDS) at hospitals and clinics in Fort Liberté, Ouanaminthe and Capotille as well as the new CT site to open during FY07 at Mont Organisé. This additional site will provide the communities of Mont Organisé and Carice with CT and HIV-related medical and psycho-social services. It will also complete the coverage of the Unité Communale de Santé (UCS) of Ouanaminthe (Ouanaminthe, Capotille, Mont Organisé, and Carice) and the UCS of Fort Liberté (Fort Liberté and Ferrier) with basic HIV services. There are three minor areas of emphasis in this program: Human Resources; Infrastructure; and Linkages/Other Sector Initiatives.

BACKGROUND: Plan Haïti is working with partners in the North East Regional Department to provide basic health, educational, and financial services for all residents in its zones of intervention. It will expand the palliative care services Plan Haiti provides through local non-governmental organization (NGO) partner CDS to include those that will be offered by local NGO partner POZ. This program will begin during FY06 and has the full support of the Departmental Health Directorate. It will strive towards gender equity in all its activities, particularly in terms of access to services, access to microfinance activities and a positive influence on cultural norms.

An evaluation of CDS's HIV services in 2005 showed that the two functioning CT sites lost about two-thirds of the newly diagnosed PLWHAs to follow-up. In FY07, Plan will invite sub-partner POZ to bring its successful work in PLWHA psycho-social support and reduction of stigmatization to the North East Department. POZ, in close collaboration with CDS staff, will begin three key services during FY06 through Plan's Stop HIV in North East (SHINE) Project: rapid, intensive support of newly-diagnosed sero-positive individuals (including pregnant women) at the CT sites; ongoing support for the PLWHAs and their families through drop-in Hope Centers near the CT sites in Ouanaminthe and Fort Liberté; and the initiation of PLWHA support groups in the vicinity of each CT site.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: Plan International, in collaboration with POZ, will support the logistical, technical and administrative capacity to deliver community palliative care in the North East by hiring social workers, strengthening the existing community workers network and expanding office space. Plan will also identify, assess and reinforce local community-based organizations (CBOs), particularly faith based organizations (FBOs), to expand services to the communities. Plan will coordinate with Family Health International (FHI) and Haitian Institute for Community Health (INHSAC) to train the community workers and to establish a supervisory structure using national guidelines and curricula. Plan will also contribute to the implementation of a community-based information system to track PLWHAs and monitor services.

Activity 2: In each department, Plan will develop linkages and a referral system with CT, Prevention of Mother-to-Child Transmission (PMTCT), clinical care and treatment sites where PLWHAs are identified and enrolled in clinical care and community services. Linkages will also be created with participating CBOs providing expanded access to community services for PLWHAs. Plan will work with MOH departmental staff and other local stakeholders to develop tools for this referral system. Plan will encourage and support regular departmental meetings to implement and monitor the system. These referral systems in the North East Department will be coordinated with palliative care services provided across the Dominican Republic (DR) border in Dajabon that are supported by USAID/DR in the Dajabon Hospital and in the surrounding communities through World Vision/DR and a Dominican NGO, CEPROSH.

Activity 3: Plan International will partner with POZ to expand and reinforce PLWHA support groups in the North East. The rapid, intensive support of newly-diagnosed sero-positive individuals initiated in FY06 under Project SHINE will continue at the three CT sites and a new CT site at Mont Organisé will begin providing services in FY07. An

estimated 125 persons will be offered these services during FY07. To the extent possible, POZ will use PLWHAs to deliver psycho-social support to their peers, a model which has been very effective in Port-au-Prince. The high level of stigmatization in the North East may hinder its implementation, since PLWHAs there have been reluctant to disclose their sero-status for fear of exclusion from mainstream society. Nevertheless, POZ's model in the Port-au-Prince area suggests that this fear can be overcome. Plan will support the structure of these groups according to national guidelines to maximize the effectiveness of their role in PLWHA HIV education, best health practices, adherence to treatment and stigma reduction. Plan will provide space and cover operational costs for these groups. Plan will train religious leaders and other community groups to engage their support for PLWHAs and their families. Activities with the PLWHA groups will be coordinated with similar intiatives carried out on the Dominican Republic (DR) side of the Haiti/Dominican border in Dajabon by a USAID/DR funded NGO, CEPROSH.

Activity 4: PLAN will distribute commodities for safe drinking water, e.g., water vessels, chlorine, hygiene kits. Plan will also work with Global Fund and MOH partners to distribute treated bed nets to PLWHAs for malaria prevention according to the national guidelines. PLAN will use its existing logistical system to distribute these commodities. The USG will procure the commodities thru SCMS.

Activity 5: Following an assessment to determine need, Plan will provide funding (if appropriate) in the North East for a transit house for PLWHAs to be located near the main ARV center. PLWHAs will also receive access to a micro-credit project (a pilot beginning towards the end of FY06) and up to $60 per family in other goods and services for those with specific needs. As PLWHAs reveal their sero-status and involve their families, more work will be centered on family members, particularly in training and psycho-social support as well as support for school fees or nutrition.

Activity 6: Nutritional support will also be provided by linking recipients to the United States Agency for International Development (USAID) Title II food assistance programs and to the World Food Program (WFP). Some resources will be used to buy local food for a limited time frame to address critical shortages. For this activity, Plan International team will work closely with the sites where the nutritional status of PLHWAs will be assessed and monitored and to detect those most vulnerable and in greatest need of food.

Linked to Activities 9781, 10129.

SUMMARY: Since virtually no HIV/AIDS related OVCs have been identified to date in the North East Regional Department due to a strong fear of stigmatization among the over 500 people living with HIV/AIDS (PLWHAs) already diagnosed, activities to find and support OVCs will center around those that involve a larger portion of the children in the zones. Working through its over 30 children's clubs, Plan Haïti will teach its youth leaders how to identify children under stress and then how to guide them to resolution through the use of games and crafts as play therapy. The clubs will also teach children about good citizenship, mutual caring and support, and encourage acceptance of vulnerable or already marginalized children. As PLWHAs become more comfortable with revealing their serostatus to their families, more direct OVC identification and support will then be initiated as well.

Sub-partners Fondation Pour la Santé Reproductrice et l'Education Familiale (FOSREF) and Volontariat Pour le Développement d'Haïti (VDH) will be tasked with the identification and mentoring of vulnerable youth in Fort Liberté and Ouanaminthe respectively. Activities will be expanded from the Unité Communale de Santé (UCS) of Fort Liberté (communes Fort Liberté and Ferrier) and the communes of Ouanaminthe and Capotille to also include the communes of Mont Organisé and Carice, which will then permit full coverage of the UCS of Ouanaminthe. There are three minor areas of emphasis in this program: Community Mobilization/Participation; Linkages/Other Sector Initiatives; and Strategic Information.

BACKGROUND: This program area is ongoing, having begun during FY06 with sub-partners Centres pour le Développement et la Santé (CDS), FOSREF, Promoteurs Objectif ZEROSIDA (POZ), and VDH, all local Non-Governmental Organization (NGOs). It has the full support of the District Sanitaire du Nord Est (DSNE), the local arm of the Ministry of Health (MOH). The program will strive towards gender equity in all its activities, particularly in terms of access to services and positive influencing of cultural norms.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: Since no HIV/AIDS related OVCs have been identified to date, Plan Haïti will begin with a more general approach to identify children under stress as well as teach community children about basic values that will help prevent discrimination and stigmatization. Using the over 30 children's clubs already established, it will enlist the help of a psychologist to train the club leaders to identify and support vulnerable children up to age 14 who show signs of stress. Using games, drama, and art, they will help these young people deal with their stress while encouraging good citizenship, and mutual support and acceptance to help promote non marginalizing behavior within the communities. The families of any OVCs identified will be invited to receive more direct services such as health care and support for school attendance.

FOSREF will work with the youth of Fort Liberté of the age of roughly 14 and older to identify any that are particularly vulnerable, orphaned, or otherwise demonstrate severe stress. These will be assigned to a mentor who will provide close, one-on-one support to help them learn how to solve problems and positively handle difficult situations. VDH will run a comparable program for the town of Ouanaminthe. About 40 youth are expected to be identified and enter the mentoring program during FY 2006 and another 40 during FY 2007.

Activity 2: While Plan Haïti throws the net widely at the community level and FOSREF and VDH support stressed youth in the more urban areas, POZ will work with the PLWHAs that it has brought into care from the Voluntary Counseling and Testing / Anti-retroviral (0VCT/ARV) sites (including the seropositive pregnant women in the PMTCT programs) to identify their OVC family members. POZ will also work with CDS staff to identify and support tuberculosis (TB) patients and their OVC children. As these PLWHA/TB patients become comfortable enough to share their illness (TB patients can confront stigmatization similar to PLWHAs), their children can then be directly supported along with them.

The consortium of Plan Haïti and its sub-partners will form a committee to determine the best method to manage the OVCs identified, i.e., which member should handle what, and what would be the best, most cost-effective package of services to offer. The package will be based on the principle of helping PLWHAs and their OVC offspring normalize their daily

life while particularly seeking ways to assure primary schooling for the younger children and professional training for the youth. Assuring primary health care for all the children/youth and family members will also be emphasized. The committee will then formalize a referral/counter-referral mechanism to assure that all OVCs, particularly the girls identified, are brought into care and that they receive the same services. A database will be designed and implemented; and it will be managed by the organization chosen as the lead. The club activities, the committee, the package of service definition, and the database with its system of referral/counter-referral are expected to be in place during FY 2006. Further refinement and the inclusion of more children are anticipated for FY 2007.

Areas of legislative interest include gender equity; influencing of cultural norms and behaviors among children and youth, wrap around services, and stigma and discrimination reduction via activities at the children's clubs and youth centers.

Funding from the President's Emergency Plan for AIDS Relief (PEPFAR) will be used to identify and support OVCs through the children's clubs as well as to run the mentoring program for vulnerable youth. Destigmatization will be particularly emphasized in this and in all program areas. Sustainability will be sought through the use of low-cost but effective interventions that will be designed to cover the most vulnerable members of the target population even if financial support should become limited. Plan International will seek to diversify its funding base, and encourage its sub-partners to do likewise, in order to avoid the sudden loss of financial support for which a programmatic adjustment could not be made. Lastly, the program will strive to build ongoing OVC support through the children's clubs as well as wider community involvement as the level of stigmatization declines. This program area is designed to help meet the PEPFAR goal of caring for 10 million persons impacted by HIV/AIDS. Activities for FY 06, the first year of the project, have not yet begun to be able to report on results.