Linked to Activities 9310, 10370.

SUMMARY: Health Policy Initiative (HPI) will assist the United States Government (USG) Team and the Ministry of Health (MOH) to identify key operational policy barriers which adversely affect the scale up of President's Emergency Plan for AIDS Relief (PEPFAR) and national HIV/AIDS programs, assessing the potential impacts of operational policy problems and how their resolution will improve PEPFAR and national performance. In addition, HPI will continue to reinforce capacity in the production and use of strategic information (SI) for effective resource and program planning.

BACKGROUND: Since 2001, HPI, in collaboration with national health officials, has played a leadership role in the production and dissemination of SI related to HIV/AIDS. Strategic information produced and disseminated includes: development of various models in understanding the epidemic and measuring its impact; secondary analysis of Demographic and Health Survey (DHS) II and III; secondary analysis of sentinel surveys, and other studies such as the AIDS Program Effort Index (API); the Maternal and Neonatal Program Index (MNPI); and the evaluation of the Global Fund's Country Coordinating Mechanism (CCM). These analyses have provided strategic information to support sound decision making.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: Dissemination and discussion of updated HIV/AIDS projections using the Estimantion and Projection Package (EPP) and Spectrum models (Demography - Demproj and AIDS Impact Model [AIM]). The EPP exercise will be carried out by UNAIDS; however, HPI will collaborate with UNAIDS to hold dissemination and discussion meetings with key stakeholders in Haiti. The objective is to ensure that future users of the data generated have a good understanding of the underlying assumptions and that they can use them appropriately for program planning. As HPI has access to the raw data used to provide the overall estimates, they will also carry out secondary analysis using DemProj to project the population of Haiti by regional departments by age and gender from demographic indicators published in the 1982 and the 2003 census and using EPP to produce estimates for each of the 10 departments and hence provide regional information never before available in Haiti.

Activity 2: Develop the Resource-Needs Model Application: The Resource-Needs Model (RNM) calculates the total resources needed for prevention, care, and orphan support for HIV/AIDS on a national level. The model contains three sub-models: the prevention model, which calculates the cost of specific prevention interventions; the care and treatment model, which estimates the cost of care and treatment programs, including home base care, palliative care, treatment of opportunistic infections, etc; and the orphan support model, which calculates the cost of interventions to support orphans and vulnerable children (OVC). As a result, information on the size of population target groups, unit cost of interventions, and program coverage will be available. In addition, HPI will raise the capacity of key stakeholders to use these elements for estimating the resources required to implement the National Strategic Framework.

Activity 3: Develop the Goals Model Application: The Goals model is intended to support strategic planning at the national level by providing a tool to link program goals and funding. The model can help answer several key questions: How much funding is required to achieve the goals of the strategic plan? What goals can be achieved with the available resources? What is the effect of alternate patterns of resource allocation on the achievement of program goals? The application for Haiti will help program managers to understand how funding levels and patterns can lead to reductions in HIV incidence and prevalence and improved coverage of treatment, care and support programs. In addition, HPI will enhance the capacity of program managers to gain a better understanding of the dynamics of funding and impact.

Activity 4: Secondary Analysis of the Demographic and Health Survey (DHS). The DHS is carried out and published in Haiti by Macro International in collaboration with Institut Haitien de l'Enfant (IHE). HPI will join this effort to disseminate and discuss the results with key stakeholders, including government authorities to better inform both policy and probram planning and development processes. Moreover, with the ante-natal clinic sero-survey and the DHS survey providing different estimates on the epidemic for the same indicators, more in-depth discussions are needed to enlighten consumers of the data

regarding contextual factors for the two surveys and the nuances of the interpretation of the data. Furthermore, there is a wealth of information from collected data which are frequently not published in the DHS manual. HPI will use a statistical package such as Statistical Package for the Social Sciences (SPSS) to perform, from the DHS database, secondary analyses (cross-tabulations) of the HIV/AIDS and of the Prevention of mother to child transmission (PMTCT) components to better understand the epidemiological profile of HIV/AIDS among the general population as well as the PMTCT situation.

Linked to Activities 10308 and 9312. SUMMARY: The Health Policy Initiative (HPI) seeks to improve the policy environment for the HIV and AIDS efforts by improving the implementation of national strategies and policies and by building the capacity of national, regional, and community-based organizations (CBOs) to lead a sustainable response to the HIV epidemic in Haiti.

BACKGROUND: The Health Policy Initiative Task Order 1 (HPI TO1) is a new program with the mandate to support the President's Emergency Plan For AIDS Relief (PEPFAR) goal of building sustainable local expertise to provide prevention, care, support and treatment in Haiti. HPI TO1 will provide practical and technical support for the implementation of HIV/AIDS programs through building capacity to address operational barriers which impede the implementation of laws, policies and programs. The HPI TO1 technical assistance will also strengthen the policy environment for HIV by supporting national and departmental leaders in developing and introducing new laws which protect the rights of people living with HIV/AIDS (PLWHA) and orphans and vulnerable children (OVC). HPI will work with faith-based groups (FBO) and with the private sector to reduce stigma and discrimination. In FY07, HPI will build the capacity of the Ministry of Health (MOH) to develop or clarify policies related to opt-out HIV testing and double orphans. These efforts will be realized in close collaboration with the MOH and other Government of Haiti (GOH) entities. HPI will collaborate with "Promoteurs de l'objectif ZEROSIDA" (POZ) and World Relief (WR) to implement several of these activities.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: HPI will collaborate with POZ and World Relief to improve the knowledge and attitudes of religious leaders and assist them to develop interventions to address S & D through church activities, sermons, and community outreach. HPI will work with POZ and WR to develop and adapt training materials and methodologies; POZ and World Relief will then train pastors in approximately 100 churches. Where feasible, we will bring pastors in the same regions together to discuss their successes and challenges and learn from each other. Anticipated results: Enhanced HIV/AIDS knowledge and decreased S & D among the FBO communities.

Activity 2: HPI will provide technical assistance (TA) to the MOH to reinforce the normative, planning and coordinating roles of the fight against HIV/AIDS. For example, HPI will support MOH in the development of a national anti-retroviral therapy (ART) SCALE-UP Plan, participate in the assessment of human resources (HR) needs for HIV/AIDS service delivery, and participate in the formulation of policies on crisis counseling and testing (CT) for victims of violence.

Activity 3: The GOH has recognized the need for an overarching law to protect the rights of HIV-positive people and those most at-risk for HIV in legal areas such as: opt-out or provider-initiated HIV testing; protection against S & D in the workplace, including job-protection policies for HIV+ personnel; inheritance rights of OVC; identifying who holds legal responsibility for dual (paternal/maternal) orphans; determining the necessary legal criteria for obtaining permission to test and care for OVC; law enforcement to protect OVC from trans-generational sex, resulting in increased risk for HIV/AIDS; addressing gender inequities in access to schooling and vocational training; and ensuring that HIV+ women have equal access to microfinance and income-generation programs. HPI, in collaboration with the MOH and other government and civil society stakeholders, will facilitate a series of consensus meetings to review conventions and laws adopted in other countries and, based on this review, provide technical assistance to legal advisors and parliamentarians to draft a National AIDS Law. HPI will support the involvement of PLWHAs, women and at-risk communities to participate in these stakeholder meetings (see Activity 2).

Activity 4: In coordination with capacity building for the Haitian Parliament and other stakeholders to develop a National AIDS Law, HPI will support capacity building for public and civil society organizations (e.g., ministries, police departments, women's groups, youth groups, business associations) to support passage of the National AIDS Law. HPI staff will conduct trainings with 10 organizations in advocacy and policy dialogue so that these groups can more effectively participate in national discussions about the law. Training will focus on increasing participants' knowledge about HIV/AIDS and the legal

and regulatory process in Haiti as well as building skills in developing advocacy messages for local and national policy makers to support the Law.

Activity 5: HPI, in collaboration with POZ, will train a core group of trainers who will conduct advocacy training with PLWHA networks in Port-au-Prince. The training of trainers (TOT) will be supported through small grants. HPI will ensure that women and other at-risk groups are included in these trainings. Participants will develop action plans to perform advocacy in their communities following the training. HPI will provide on-going technical assistance to these networks to address barriers identified by the trainees. Lessons learned from this activity will be incorporated into future training and barrier analysis for PLWHA networks in other departments of Haiti in FY08. Anticipated results: Strengthening the leadership of PLWHA networks and a greater involvement in policy decision making.

Activity 6: This activity will continue work started through the HPI Core-funded (FY 06) operational policy barriers analysis. The Core-funded activity will analyze key operational policy barriers that impede the scale-up of programs in a Program Area designated by the USG team and its partners (e.g., HIV testing and behavior change among uniformed personnel). The Core-funded activity will also identify corrective actions needed to address policy and program barriers. HPI Haiti staff and consultants will use field-support funds to address additional key operational policy barriers and work with multi-sectoral stakeholders to implement the corrective actions and reduce or remove operational policy barriers related to the program area.

TARGETS: • 3300 individuals (3000 church members, and 300 individuals of religious staff and religious leaders) trained in HIV related stigma and discrimination reduction • 340 individuals (40 members of PLHIV networks, 300 religious staff and religious leaders) trained in HIV-related institutional capacity building • 10 public and civil society organizations (e.g., ministries, police department, women's group, youth groups, and Private sector associations) provided with technical assistance for HIV-related policy development. • A National Coordination Plan is developed and approved by the AIDS Coordinating Control Unit (UCC) • A national AIDS law is formulated and trained parliamentarians, public/private sectors stakeholders conduct advocacy for the passage of the law.