Linked to Activities 10111, 9353, 8157, 9781, 9292, 9791, 10438.

SUMMARY: The USG will provide support to World Concern for the Association of Evangelical Relief and Development Organizations (AERDO);s HIV/AIDS Alliance ("the Alliance") to: 1) Train community and religious leaders, volunteer health workers and teachers to clearly articulate traditional, community and faith-based values regarding prevention and 2) Establish preventative HIV education programs for children and youth. Trainings and prevention education programs based on abstinence and being faithful will raise awareness, reduce stigma, and empower beneficiaries to make good life choices. The emphasis areas are training (major: 60%), community mobilization (minor: 25%), linkage with other sectors (minor: 15%), information/education/communication (minor: 10%), quality assurance (minor: 10%) and strategic information (minor: 10%). The primary target populations are religious leaders, community leaders, other (volunteer) health care workers, teachers, children and youth, OVC, men and women, HIV-positive children (5-14 years), and out-of-school youth and restavek (domestic servant) children. The coverage area is the Artibonite, South, Southeast, West, North, and Central Regional Departments for the adult training component; and the West, South, Southeast and North Regional Departments for the HIV prevention education programs aimed at children and youth.

BACKGROUND: This activity is expanding on the current PEPFAR-funded FY 2006 Abstinence and Be Faithful for Youth (ABY) activities carried out by the Alliance in Haiti. Each of the partner institutions will work with the Haiti Ministry of Health (MOH) at the community level, and World Concern Development Organization (WCDO, the lead agency of the Alliance) will also coordinate with the MOH at the national level. Implementing the program are WCDO, Salvation Army (SA), Christian Reformed World Relief Committee (CRWRC), The Foundation of Compassionate American Samaritans (FOCAS) and World Hope (WH). Food for the Hungry (FH) will be a technical consultant. All are Non-Governmental Organizations (NGOs). The Alliance's current ABY activities are gender balanced with at least 50% of the beneficiaries being female. Access to ABY information will initially be targeted to women and girls in order to reinforce their capacity to manage and negotiate their sexuality. This will be done by strengthening the capacity of older women to mentor younger girls who will be enabled to become counselors to their peers through school or church activities. The Alliance will continue to challenge Haitian cultural, macho traditions and use discussion groups as well as family or parent retreats to give parents the tools they need to educate their children about HIV prevention and to ensure equity in transmission of values regarding abstinence to boys as well as girls. We will also promote traditional Abstinence and Be Faithful (AB) values which we believe to be efficacious toward behavioral changes, and promote interventions from religious leaders, as well as parents. All these activities will be channeled through each agency's church network in the Alliance.

ACTIVITIES AND EXPECTED RESULTS:

The Alliance will carry out two separate activities in this Program Area.

ACTIVITY 1: The first activity is to train community and religious leaders, volunteer health workers and teachers to clearly articulate traditional, community and faith-based values regarding prevention. They will attend conferences designed to build their capacity using FH's "Abstain, Be faithful" and, as appropriate, correct and consistent use of condoms (ABC) awareness curriculum, educational methods, counseling techniques and motivational interviewing. The Alliance will include all elements of ABC teaching in the adult education model, with an emphasis on AB. Each of the four trainings will last 4 hours. There will be 220 full training sessions each lasting two days, with an average of 25 participants for a total of 5,500 participants. We will use 4 staff trainers, who will each conduct an average of 15 days of training a month. Booklets summarizing the key concepts will be distributed to training participants. The Alliance will also raise awareness about the plight of restavek children and coercive sex among domestics, and the importance of using HIV/AIDS counseling services to reduce violence and coercion. Teachers, volunteers and health workers will be mobilized to refer youth, including sex workers, for Voluntary Counseling and Testing (VCT) services.

ACTIVITY 2. The second activity is to establish preventive HIV education programs using

drama and music to emphasize abstinence and behavior change for children and youth. Working with local churches, four promoters will each train 275 youth leaders in preventative HIV education using the World Relief "Choose Life" manual. These youth leaders will, in turn, train an additional ten youth group members, for a total of 3,025 youth. Upon the successful completion of the preventative education program, pledge cards will be provided, offering the youth participants the opportunity to commit to abstinence and faithfulness. Youth leaders and youth group members will also be encouraged to share the lessons learned with their parents and caregivers. In addition, promoters will give prevention messages at youth camps, and special events and marches will be organized during Memorial Day and International AIDS day to reach additional beneficiaries with messages about HIV transmission and prevention. Puppets shows an skits with HIV prevention messages will be conducted for OVC in orphanages and peer educations affected by HIV/AIDS will help teach fellow youth about prevention. Older women will be trained to become mentors to young women/girls who in turn can counsel their peers. Churches will empower parents to talk with their children about prevention. And finally, street children will be targeted for training and income generation activities to reduce coercion and violence. The total number of children reached via all activities is estimated to be 13,200.

In regard to the issues of U.S. Legislative interest, please note that for every activity, we will track the number of beneficiaries who are female so that at least 50% are girls, preferably higher. Male norms and behaviors are addressed in the A and B trainings, using peer educators. Stigma and discrimination will be reduced through the HIV/AIDS training on transmission and prevention which will demystify and destigmatize the disease. Community leaders will also raise awareness about cross-generational and transactional sex to reduce coercion and violence, and street children will be given training and income generation opportunities for their empowerment.

These activities relate to the PEPFAR 2-7-10 goals by increasing awareness about HIV/AIDS transmission and prevention, thereby helping to avert new infections. These activities will expand on the 39,874 people, as well as the 1,551 faith-based and community-based organizations and schools, who were trained last year, and the 2,489 youth groups reached with HIV education programs by the Alliance.

Linked to Activities 9352, 9353, 8157, 10124, 10110, 10123, 10129, 10108.

SUMMARY: World Concern, through the Association of Evangelical Relief and Development Organizations (AERDO), will support a holistic package of community palliative care services in the North and West departments of Haiti, emphasizing psychological, social, nutritional and preventive care support to PLWHAs and their families. End of life care to help the PLWHAs die with dignity and emotional support to rape victims will also be provided, as appropriate. The entry door for the program will be the voluntary counseling and testing (VCT) and treatment sites in these departments where PLWHAs are being detected and enrolled. AERDO will develop networks and linkages with these sites and other participating community-based organizations (CBO) to ensure a continuum of care to PLWHAs from the clinics to the communities. AERDO will reinforce the capacity of these CBOs to implement this program, which will be integrated with OVC activities to promote a family-centered approach. AERDO will coordinate with existing food programs to procure and distribute food commodities in order to address critical PLWHA needs. The World Concern Development Organization (WCDO) will also coordinate with the Ministry of Health (MOH) and other key stakeholders at the national level to standardize the package of community services and update the guidelines and training tools for this program. The primary target populations are PLWHA (half of them will be women), their families, private and public health care workers, volunteers, and local community-based organizations.

BACKGROUND: AERDO is an alliance of 5 faith-based non-governmental organizations (NGOs): WCDO, World Hope, Christian Reformed World Relief Committee (CRWRC), Salvation Army (SA) and The Foundation of Compassionate American Samaritans (FOCAS). With existing President's Plan for Emergency AIDS Relief (PEPFAR) and Global Fund resources, about 30,000 PLWAs have been receiving a continuum of counseling, clinical care and ART services in the North and West departments. With 06 resources, these services are being expanded, but lack integration into a comprehensive and well-structured package of community care. During FY 07, the number of PLWHAs needing care is expected to reach about 50,000. AERDO will provide community support to half of them

ACTIVITIES:

Activity 1: AERDO will meet with area partners, churches, CBOs, PLWHA associations, and health-care providers in the targeted communities to assess current services and to ensure that programs and services complement each other. The aim is to strengthen community capacity, not to supplant existing resources and systems. This assessment will identify needs and service gaps within the community, with the goal of providing a more comprehensive continuum of care to PLWHAs.

Activity 2: AERDO will hire social workers, increase the number of community workers and expand office space in the two MOH regional departments. AERDO will also identify and expand the capacity for local CBOs (at least 5 in each department), particularly faith-based organizations, in order to expand community services. AERDO will coordinate with Family Health International (FHI) and Haitian Institute for Community Health (INHSAC) to train the community workers and set up supervisory structures using national guidelines and curricula. AERDO will participate in the implementation of a community-based information system to track PLWHAs and to monitor services.

Activity 3: In each department, AERDO will establish referral systems and link PLWHAs detected and enrolled in VCT, PMTCT, clinical care and treatment sites with local CBOs and other community resources through which PLWHAs can access community services. AERDO will work with MOH departmental staff and other local stakeholders to develop tools for this referral system. AERDO CARE will encourage and support regular departmental meetings to implement and monitor the system.

Activity 4: In coordination with other organizations, AERDO will provide space and operational costs to expand and reinforce PLWHA support groups and structure these groups according to national guidelines. The support groups will provide PLWHAs with education on HIV, stigma reduction, adherence to treatment and best health practices. AERDO will train religious leaders and other community groups to engage their in support for PLWHAs and their families.

Activity 5: Working through the church network, CBOs, human rights groups and police officers, volunteers will identify approximately 375 rape victims and encourage them to seek medical help and emotional support. Support groups will be established for victims to share experiences and seek help from one another. They will be referred to counseling and testing (CT) sites in order to determine their serological status. Volunteers will be trained to give counseling in the support groups using World Relief's curriculum, "Facing AIDS Together" and "Choose Life" to help victims overcome the emotional trauma resulting from sexual coercion, and to promote themes such as secondary abstinence or faithfulness.

Activity 6: AERDO will distribute commodities for safe drinking water, e.g., water vessels, chlorine, hygiene kits. AERDO will also work with Global Fund and MOH partners to distribute treated bed nets to PLWHAs for malaria prevention according to the national guidelines. AERDO will support resources for setting up the distribution system for these commodities. The USG will procure the commodities thru Partnership For Supply Chain Management (PFSCM).

Activity 7: AERDO will fund a transit house for PLWHAs and locate it near an ARV center in each of the two departments. CARE will also support micro-credit activities in coordination with private or other NGO organizations involved in this activity. This support will complement other social support that is being provided through the OVC program and through the clinics such as transportation and school fees.

Activity 8: Nutritional support will also be provided by linking recipients to the USAID Title II food assistance programs and to the World Food Program (WFP). Some of the resources will be used to buy food on a limited basis during critical shortages. For this activity, the AERDO team will work closely with the sites where the nutritional status of PLWHAs will be assessed and monitored to detect those in greatest need of food.

Linked to Activities 9352, 10111, 8157, 10415.

SUMMARY: The proposed activities will enable households, families, churches and communities to support children orphaned or affected by HIV/AIDS. World Concern, working with the Association of Evangelical Relief and Development Organizations (AERDO) will work with partners in two departments, the North and West, to develop community-based support interventions which respond to OVC psychosocial needs, strengthen the economic coping ability of caregivers, link children and families to available health and social services, provide food contributions, and train caregivers and children in basic hygiene and disease prevention. Training sessions using curricula such as "Our Children" will serve to raise awareness of OVC issues, reduce stigma, and empower communities to support and nurture OVC. AERDO will partner with a Catholic organization, the Salesians, to support an existing street children program aimed at reducing risk behavior of street children, providing them with vocational training and faciliating access to HIV/AIDS services. The major emphasis area for this activity is community mobilization. The minor emphasis areas are training, linkages with other sectors and initiatives, needs assessment, quality assurance, strategic information, local organizational capacity development and food/nutrition. The target populations are OVC, caregivers (including people living with HIV/AIDS [PLWHA] caregivers), street children, faith-based organizations (FBOs), community-based organizations (CBOs), volunteers, community leaders and religious leaders. The coverage area is the West, and North departments.

BACKGROUND: This activity will expand on OVC activities carried out by AERDO in FY06 with the support of the President's Emergency Plan for AIDS Relief (PEPFAR). Each partner agency will work with the Ministry of Health (MOH) at the community level. World Concern Development Organization (WCDO) will also coordinate with the MOH at the national level. The following partners are implementing the program: WCDO, the Salvation Army, World Hope, Christian Reformed World Relief Committee, and the Foundation of Compassionate American Samaritans. All are Non-Governmental Organizations (NGOs).

AERDO will cover two important regional departments in terms of population size, HIV prevalence, and patient load. The West department, which includes Port-au-Prince, has 2 million inhabitants, about 40,000 patients enrolled in care, and some of Haiti's largest treatment facilities, including the University hospital and the Haitian Group for the Study of Kaposi's sarcoma and Opportunistic Infections (GHESKIO) network. The North includes Cap Haitian, Haiti's second largest city, with 2 million inhabitants and about 10,000 patients enrolled in care. While facility-based activities such as voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), palliative and anti-retroviral (ARV) have expanded rapidly in these two departments (59 sites in the West and 12 in the North), OVC services are extremely limited at most of the sites.

ACTIVITIES AND EXPECTED RESULTS: Acitivity 1: Identify the most appropriate churches, CBOs and PLWHA associations located around the PEPFAR-supported sites in the North and the West to work as local partners. These organizations, with mentoring by the AERDO technical staff, will visit the sites and make a joint assessment of the OVC situation at each site. The sites targeted in the West Department will include: GHESKIO, Hopital de l'UNiversité d'Etat (HUEH), Maternité Isaïe Jeanty, Hopital de Carrefour, Hopital Petits Frères et Soeurs, International Child Care (ICC), Institute of Infectious Disease & Reproductive Health (IMIS), Hopital Bernard Mews and Food for the Poor. In the North, Hopital Justinien, Centre La Fossette, Centre Fort St Michel, Hopital ST Jean Limbé, Hopital Grande Rivière du Nord et Hopital de Pignon will be targeted. The organizations expect to recruit at least 4,950 OVC. Each organization will make the necessary adjustments in terms of its physical setting and staffing level to establish service delivery points for OVC identified at the sites. Each organization will recruit a social worker to manage operations, organize delivery of services, and manage the information system. They will also use volunteers for service delivery. A core set of services will be provided by each collaborating partner, including: psychosocial support for the OVC, their families and caregivers; educational and nutritional support; transportation costs for access to health care, schools or other basic services; and support for birth registration. Additional services may be provided based on an assessment of specific needs within the community and the

capacity of the local partners. These services may include day-care center or canteen for OVC, placement services for children without family care, and cooperative activities.

Activity 2: Provide contributions of food. Local churches, CBOs and FBOs will use local contributions to meet the identified OVC food needs to the extent possible. AERDO, with the World Food Program (WFP), will conduct dietary assessments to determine which OVC are most in need and explore ways to provide them with nutritional support.

Activity 3: Run an active home visit program. 300 trained volunteers or social workers visit 660 HIV-affected caregiver and child-headed households on a weekly basis to check on their status. AERDO will document the visits made, status of the OVC household, and any resulting interventions. 450 volunteers and 25 field staff will be trained in grief and trauma counseling to provide psychosocial care during the home visits to 3,300 OVC.

Activity 4: Identify and train 1,000 caregivers in basic business skills, basic hygiene and disease prevention. Community health issues such as prevention of HIV/AIDS, malaria and cholera; clean water; sanitation; and personal hygiene will be addressed. Micro-finance training will be provided, based on existing programs. Once selected for the program, caregivers will participate in an intensive, two-day training session which will be followed-up by monthly meetings, monitoring and retraining as needed. Caregivers will be encouraged to create cooperative activities. Start-up capital will be provided on a pilot basis to those groups presenting the most viable ideas for an income-generating initiative.

Activity 5: Link children and families to essential health and social services where available, including microfinance support for creation of income generation activities and tie-ins to food assistance programs. Funding will be used to support fees for services and drugs when necessary. AERDO will link CT, PMTCT, and ARV sites to orphanages and OVC households through a community-based network. Mobile clinics in remote areas and rally posts will provide care and support to OVC. OVC will participate in immunization drives.

Activity 6: Partner with Salesian to support Lakay, a program for street children. This partnership will: (i) reinforce the training program and enhance the infrastructure for Salesian to better serve their current beneficiaries, (ii) strengthen the behavior change and risk reduction component of the curriculum, (iii) organize HIV/AIDS-oriented entertainment activities at the school facility and outside of school to reach street children not enrolled in school, (iv) establish a peer-training program for children to provide them with the necessary knowledge and skills to sensitize and educate their peers on HIV/AIDS issues, and (v) provide psycho-social, health-care and material support to a group of 59 HIV-positive children already enrolled by the Salesian. AERDO will link these children to collaborating ARV sites. AERDO will also ensure that agreements reached with food programs will cover the Salesian congregation.