Linked to Activities 9326, 9364, 9322, 9346.

SUMMARY: Support will be provided to Promoteurs Objectif Zérosida (POZ) in order strengthen interpersonal counseling and services to PLWHAs and increase condoms and other prevention services to men who have sex with men (MSM). Activities will provide comprehensive psycho-social counseling and prevention services and STI treatment for those living in high risk situations and vulnerable to acquiring HIV/AIDS. POZ is in an excellent position to link voluntary testing with counseling, information dissemination and psycho-social, care, support and treatment through its centers and outreach network. The primary emphasis of the activity is to minimize the impact of HIV for those engaged in high-risk behavior by working through its center and community level activities. This year emphases will be put on: partner notification and referral services; support groups and empowerment activities; and greater involvement of the beneficiaries in promotional and educational activities. In addition, greater efforts will be made to strengthen linkages with PEPFAR supported ARV sites due to discrimination restricting, MSM access to HIV services. The activities will be carried out in some cities from west department (Port-au-Prince, Pétion-ville, Leogâne, Croix des Bouquets) and one city in North Department.Cap-Haitien.

Background In 2006, USG Haiti provided support to POZ to establish a social center in Port-au-Prince for its clients primarily targeting MSMs and PLWHAs and their families. This unique project is is one of the few centers that address prevention, treatment and care for high risk behavior among men, especially the MSM community. In order to minimize the social impact of HIV infection among this target group, POZ provides comprehensive support including prevention activities, messages for safer sex practices, partner reduction, condom use, pre and post-test counseling and basic lab tests for HIV, STI and other opportunistic infections. Through a combination of facility based care and community outreach activities, POZ provides a continuum of other prevention services by increasing partnerships with other specialized NGOs to provide home visits and related care to infected persons.

Activities and Expected Results Activity 1: The POZ Testing Care and Support Center will continue to provide a safe, confidential and comfortable environment where individuals can meet, come to ask questions, receive IEC material and condoms and be involved in discussion groups around HIV prevention, treatment and care issues. A trained counselor will provide prevention education to MSMs and PLWHA clients. A Resource Room will be upgraded and equipped with audio-visual and printed materials for conducting prevention activities at the center. The center will offer continuous counseling for the high risk group of men enrolled in the program. POZ will also continue pre and post test counseling and ensure confidential consultations on the complexities of HIV positive clients and the stigma and discrimination surrounding MSMs. A psychologist will assist the counselor in counseling and case management of MSMs and PLWHA clients. Special efforts will be made to assist high risk clients in developing personal risk reduction plans and practicing safe sexual behaviors. Under the palliative care activity, POZ has already developed a module to train PLWAs and persons affected by HIV/AIDS.

ACTIVITY 2: PEPFAR will intensify its assistance to MSMs given the high levels of risky sex among men. In order to create a demand for POZ services, a local advocacy NGO, "Grasadis" will be subcontracted to improved linkages between MSM clients to POZ centers. Efforts will be expanded to increase contacts within male groups in places such as clubs, men's associations, hotels, prisons and other places where men engage in high risk activities. "MSM" targeted materials will include: pamphlets and flip charts will cover a wide range of topics such as HIV transmission, personal risk assessment, signs and symptoms of STI and safe sex practices such correct condom use, and lubricants. Those groups will meet monthly with the project coordinator and the community agents and visit night clubs and bars where MSMs congregate. During these encounters, outreach will be done to discussions around reducing high risk behavior, condom use and encouraging clients to know their status. Building on its network of 100 peer educators, POZ will be mobilized to launch the campaign to increase risk reduction, prevention for positives and increase condom use among MSMs and PLWHAs. PEPFAR will support POZ to develop a discreet awareness campaign in local languages to promote the prevention, care and treatment provided by anonymous care center. The main themes for this campaign will

be: safe sex, partner reduction and consistent and correct condom use. During outreach, POZ staff will refer clients for further counseling, VCT, STI and syphilis diagnosis and treatment to its centers. HIV positive persons will be referred for ARV services and treatment of opportunistic infections. Prevention for positive will also be a key message for HIV positive clients. It is anticipated that 25,000 condoms will be distributed by POZ.

Linked to Activities 9327, 9364, 9333.

SUMMARY: The HIV/AIDS epidemic has a tremendous impact on Haitian communities. There is an estimated 250,000 persons living with HIV/AIDS (PLWHAs) and 18,000 orphans, of whom very few have access to basic care and support services. In spite of major efforts supported by public and private groups to create and build up capacity of health staff and public awareness, strong stigma associated with the disease still exists and often leaves PLWHAs isolated from family and community support systems. In addition, increased medical expenses combined with the inability to work, places an extreme economic burden on PLWHAs and their families. This activity will work towards reducing stigma and discrimination and the spread of HIV/AIDS in five regional departments of Haiti: the West, South, Nippes, North East and South East. It will also help to create and strengthen grassroots groups of PLWHAs and peer leaders to become more self-supporting and, therefore, better able to negotiate safe sexual behavior, thus contributing to a reduction in the current rate of HIV transmission.

BACKGROUND: This activity is an expansion and continuation of a POZ-developed model support program for PLWHAs and their families in which services are designed to help clients learn appropriate coping strategies in a supportive environment. Started in 2001 in two sites, Port-au-Prince and the semi-rural community of Montrouis, 60 Km from the capital, this initiative has been successfully expanded to other areas in the south of Haiti. With the President's Emergency Plan for AIDS Relief (PEPFAR) funding in FY07, this activity will be extended to approximately 31 sites in five geographical areas in order to provide direct psychological support to 9,500 PLHWAs and their families through PLWHA support groups and training sessions designed to promote positive attitudes and reduce stigma and risky behaviors. This activity will be part of the package of palliative care that these individuals will be receiving through the sites and community-based organizations in these departments.

Additionally, 1,500 other PLHWAs will get direct access to clinical and home-based care at two sites managed by POZ: Espoir, targeting men having sex with men (MSM) in Port-au-Prince, and the Community Center in Montrouis, providing services to a large community. These sites will be upgraded to become clinical care centers.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: At the request of and in coordination with the MOH Regional Directorates, POZ will conduct five (5) two-day training sessions for 150 PLWHA peer educators and counselors to provide them with orientation and education on basic HIV/AIDS facts, leadership, ARV adherence and the psychosocial support needs of PLWHAs. Each peer educator and counselor will then be responsible for training 50 PLWHAs in their respective communities to promote positive attitudes. POZ will support logistical costs for these peer educator training sessions, as well as for the cascade trainings. POZ has already developed a module for training PLWHAs and persons affected by HIV/AIDS which was used in 2005-2006 to train 100 PLWHA peer educators and counselors. This module is endorsed by the Ministry of Health. POZ will supervise the trained PLWHA peer educators and counselors in their respective communities and work places.

Activity 2: The second activity will train and supervise staff from community-based organizations (CBOs) in charge of implementing community palliative care support to organize and work with at least 50 support groups of PLWHAs (20 in each group) from across the 5 regional departments. These support groups will meet monthly to receive informational updates and share strategies for patient support. POZ will ensure follow-up supervision of the trained staff in organizing and implementing the support groups.

Activity 3: POZ will work with the primary CBOs receiving community palliative care support in at least 3 of the 5 targeted departments in order to transform the most advanced PLWHA support groups into a PLWHA association. POZ will provide the support groups with the logistical, technical and administrative capacity to manage resources and provide social support to PLWHAs and their families.

Activity 3: At the request of and in coordination with the MOH Regional Directorates, POZ will conduct eight (8) two-day training sessions for 300 health and support staff at 44 CT and ARV sites on the basics of HIV transmission and prevention, stigma and

discrimination, patient confidentiality, and issues relating to caring for caregivers (such as prevention of occupational exposure, post-exposure prophylaxis (PEP), stress and burnout). POZ will ensure follow-up supervision of the trained staff.

Activity 4: Additionally, the "Centre Espoir'' and the POZ's Community Center in Montrouis will be upgraded to provide a package of clinical and home based palliative care. This package will include opportunistic infection (OI) treatment and prophylaxis, nutrition assessment, counseling and support and outreach activities which will deliver at-home basic care and health education based on the national norms and guidelines. The two sites will be staffed with appropriate clinical and lab staff as well as community workers. POZ will coordinate with other USG partners to upgrade the lab capacity at these two sites.

Activity 5: The International AIDS Candlelight Memorial is a yearly event that has reached millions of people in Haiti since 2001. POZ has historically been the coordinator of this event, partnering with more than 36 non-governmental organizations (NGOs) and local grassroots organizations and Christian churches to bring awareness and support to PLWHAs. In 2007, POZ hopes to conduct short training sessions for Candlelight coordinators to educate them regarding planning community memorials, community mobilization, and advocacy. All members will receive seed money to conduct this event and mobilize other resources in their communities.

Targets for this activity include: • At least 2,000 PLWHAs and affected families will receive psychological support through support groups in targets areas.; • 150 PLWHA peer educators will be trained; • 7,500 PLWHAs trained by peer educators through cascade training • 50 PLWHA support groups established in 5 regional departments to meet monthly; • 300 health and support staff at 44 CT and ARV clinics trained to reduce stigma & discrimination; • 1,500 patients receiving clinical and home-based care at two sites • 2 million church and community members reached during mass candlelight event.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of palliative care as a way to improve quality of life and reduce rates of transmission.

Linked to Activities 9327, 9326, 9362.

SUMMARY: Activities are carried out to support expansion of comprehensive counseling and testing (CT) services to high risks behavior groups such as men who have sex with men (MSM), young adults in vocational school, and communities with long distance bus drivers. Services in this project will include pre- and post test counseling; HIV testing; increasing outreach activities such as using field promoters to identify clients among the targeted populations; supervision and training of counseling and testing (CT) counselors for increasing quality of services. These services support the national HIV/AIDS Plan and meet the approval of the Ministry of Heath (MOH).

Counseling and testing (CT) services began in 2002 at the center of education and counseling services named CESAC, a concept of integrated HIV/AIDS case management promoted by POZ. Funded initially by the Global Fund, these activities provided a continuum of community care services which have been successful in making people living with HIV/AIDS less isolated and empowering them to live positively. In FY 2004 the USG began procuring test kits and other supplies for laboratory screening. For this current activity, POZ will promote and implement the CT services in areas of Port au Prince and Montrouis where high risk behavior groups meet.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: POZ will provide comprehensive CT services through both stand-alone sites located in Port au Prince and an integrated CT service site at the POZ Community Health Center in Montrouis. Pre- and post-test counseling will be provided by trained counselors. HIV testing, using rapid test kits, will be conducted on-site and results provided the same day and individuals who test positive will be registered for follow-up service. The follow-up counseling program will meet the needs of people living with HIV/AIDS, their partner(s), family members, and friends. Services provided will include: follow-up individual counseling, family counseling, partner notification and support groups. Regular clients will be assigned a counselor responsible for managing their cases. While the operational costs of the centers will come from Global Fund, the USG will provide test kits, lab equipment, drugs, and support the establishment of a new lab, as well as the addition of a technician and two field promoters to expand the services.

Activity 2: POZ will provide high quality CT services to clients visiting these centers. With PEPFAR funding, POZ will strengthen and expand these services by providing continuing training to counselors, and by monitoring performance and efficiency of services. All training and refresher courses for VCT staff will be coordinated with the USG-supported CT training program funded under I-TECH/INHSAC.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of CT services in order to identify HIV positive persons and increase the number of persons receiving antiretroviral treatment.