Integrated Activity Flag: This activity is linked to Activity IDs 4497.08, 18709.08 and 9364.08.

Summary: Support will be provided to Promoteurs Objectif Zérosida (POZ) in order strengthen interpersonal

counseling and services to PLWHA 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 HIV counseling and testing with information dissemination and psycho-

social, care, support and treatment through its centers and outreach network. The primary emphasis of the

activity is to reduce HIV transmission among MSM, and those engaged in high-risk behavior, and to

minimize the impact of HIV within HIV-positive MSM 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,

and to reduce stigma and discrimination of MSM's 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: Promoteurs Objectif Zérosida (POZ) established a social center in Port-au-Prince in FY06 for

its clients, mainly MSM and PLWHA's and their families. This center addresses prevention, treatment and

Care issues for men who engage in high risk behavior, especially the MSM population. To minimize the

social impact of HIV infection among this target group, POZ provides comprehensive support including

prevention activities, behavior change and community outreach activities, messages for safer sex practices,

partner reduction, condom use, pre and post-test counseling, HIV tests, basics lab tests, treatment of STI,

OI, access to care through partnership with specialized NGO's and home visits.

Activities and Expected Results

Activity 1: The POZ Testing Care and Support Centers and in the 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. CDC's "HIV

Prevention within the Care and Treatment Setting" will be utilized. 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. POZ will work through their

established social network of MSM to develop an awareness campaign for the centers. In addition, as a way

to reach more MSM to refer them to the centers, the project team will visit groups not yet approached:

traditional healers, prisons, security agencies, NGO's. Advocacy and information of the center will also

occur within PEPFAR supported care and treatment centers to reduce MSM barriers to care due to stigma.

Activity 2: POZ will expand its prevention with MSMs. 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; and to move beyond awareness of HIV and prevention methods, and focus on

behavior change activities within this population. "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. Peers providing outreach

will visit night clubs, bars, areas where MSM engage in commercial sex, and other areas where MSMs

congregate; peers will meet monthly with the project coordinator and the community agents to discuss

methods of outreach, and improve peers outreach skills. During these encounters, outreach will be focused

on behavior change activities regarding reducing high risk behavior, correct and consistent condom use,

and encouraging clients to know their status. During outreach, POZ staff will refer clients to the POZ

centers for further counseling, CT, STI and syphilis diagnosis and treatment. 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.

EMPHASIS AREAS:

Development of Networks/Linkages/Referral Systems

Education/Communication/Information

Local Organization Development

TARGETS:

# of targeted condom service outlets: 10

# of individuals reached through community outreach that promotes HIV/AIDS prevention through other

behavior changes beyond Abstinence and/ or Being faithful: 5,500

# of individuals trained to promote HIV/AIDS prevention through other behavior changes beyond Abstinence

and/ or Being faithful: N/A

TARGET POPULTIONS:

MSM

KEY LEGISLATIVE ISSUES:

Reducing stigma

COVERAGE AREAS:

West and North Department

SUMMARY:. The project proposes to expand its best practices model of accompaniment to empower

people living with HIV/AIDS (PLWHA) in nine geographical areas of Haiti: West, South, North East, South

East and North and Grand-Anse, Artibonite, North East and Nippes. It will help to create and strengthen

grassroots groups of PLWHA and peers leaders to become more self supportive and therefore capable of

adopting safe sexual behaviors and contributing to the reduction of the current HIV rate. This project is an

expansion and continuation of a POZ model accompaniment of PLWHA and their families in which the

services will allow clients to learn appropriate coping strategies in a supportive environment. POZ will

continue to upgrade three palliative care sites that were launched last year: one located in Montrouis

integrated in a community CT clinic, two other integrated in MSM clinics.

BACKGROUND::

The HIV/AIDS epidemic has a tremendous impact on Haitian communities. There is an estimated 200,000

persons living with HIV/AIDS (PLWHA) 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

capacity of health staff and public awareness, strong stigma associated with the disease still exist and often

leaves PLWHA isolated from family and community support systems.

POZ opened its doors in Port-au-Prince, Haiti in 1995 with the mission to reduce the prevalence of HIV in

Haiti. It quickly developed into an institution that champions the cause of the PLWHA through advocacy,

awareness, and in particular PLWHA psychosocial support. POZ's major focus has been to implement

PLWHA support groups throughout the country. So far, over 50 support groups have been created in four

geographic areas with emphasis on empowering PLWHA to become spokesmen and women, and on

promoting positive attitude regarding care and treatment. Many organisations now use POZ-trained and

empowered PLWHA as facilitators in their programs. Four of these support groups have been reinforced to

become PLWHA associations with the capacity to manage funding, to provide palliative care services and to

participate in social mobilization and income generating activities. In addition POZ has been very active in

implementing activities to reduce stigma with focus on training health professionals and community leaders

in the fight against stigma. All health professionals in 25% of the sites have benefited from this training as

well as community leaders living around these sites using national guidelines and curricula that POZ has

developed in coordination with the Ministry of Health (MOH) and major stakeholders.

POZ has been managing four CT sites: one in Montrouis integrated with a model of community mobilization

and support services, two in Port-au-Prince and one in Cap Haïtien. One of the two in Port-au-Prince and

the one in Cap-Haitian are targeting Men having Sex with Men (MSM). With existing resources, the CT site

in Montrouis and the two MSM sites are being reinforced to provide clinical palliative care.

With Fiscal Year (FY) 2008 resources, POZ will continue to support the expansion of implementation of

PLWHA support groups around all the HIV sites to create a supportive environment for them to reduce

stigmatization, to promote positive attitudes, and to foster their adherence to treatment. To this end, POZ

will essentially play a lead role in building capacity at the sites to organize these support groups. POZ will

continue to reinforce the four existing PLWHA associations (1 in the South, 1 in the West and 2 in the North)

and will create two others in Grand'Anse and the South East. Each association will receive six types of

training: Advocacy, Leadership, Communication, Adherence / Commitment, Basic knowledge in HIV/AIDS,

Micro credit

POZ will continue to expand in coordination with the MOH departmental directorates the training of health

professionals and community leaders in stigma reduction ensuring that most of sites benefit from this

training thru a strategy of training of trainers. They will continue to strengthen the three palliative care sites

with a full package of clinical care in referral with ARV to ensure continuum of care.

ACTIVITY AND EXPECTED RESULTS

ACTIVITY 1: POZ will support training of 60 social workers and site managers on how to organize and

animate support groups for PLWHA and affected families enrolled at their sites POZ will also expand

training against stigmatization to reach 600 new health professionals in 20 sites and 300 community leaders

around the sites. For these trainings POZ will use the training of trainers use the national tools and

guidelines that they have developed in collaboration with MOH. Funding will be used to support training

logistic costs and supervision of support group activities. Funding will also be used to organize regular

departmental and local meetings on the progress of this program.

ACTIVITY 2: POZ will continue to provide technical assistance and financial support to help building

administrative and institutional capacity to six associations of PLWHA in the following areas: managing

small grants, project writing; organizational assessment, strategic planning meeting and program

development; partnership in mobilizations and support activities for advocacy and support of the PLWHA

ACTIVITY 3: POZ' will continue to strengthen its palliative care sites in Port au Prince, Montrouis, and Cap

Haitien to provide clinical and home based care to PLWAs enrolled at these sites. All will receive access to

laboratory, clinical, nutrition, psycho-social assessment and follow up services to prevent and to treat

opportunistic infection, malnutrition, to manage pain and symptoms, to monitor optimal time to provide

HAART and create a supportive environment for adherence to long term follow up and care. Funding will

be used to enhance infrastructure and strengthen both clinical and community staff in order to meet scale

up need with emphasis on nurses to play a greater role in providing clinical care. Through the community

personnel home based care will be reinforced around these sites to provide at PLWHA homes a package of

preventive care, counseling and education services. POZ will support around these sites support groups

and will provide technical oversight, supervision and monitoring of activities..

ACTIVITY 4: The International AIDS Candlelight Memorial is a yearly event that reaches millions of people

in Haiti since 2001. POZ is the sole coordinator of this event partnering with more than 50 NGO, local

grassroots, Christian churches, to bring awareness and support to PLWHA. Year 2009, POZ hopes to

conduct short training sessions for Candlelight coordinators to educate them about planning community

memorials, community mobilization, and advocacy. All members will grant seeds money to conduct this

event in their areas of mobile.

Activity 5: POZ will strengthen its capacity to plan, and supervise activities. Funding will be used to hire and

train new staff in psycho-social support and management. POZ will implement two regional offices: one in

Activity Narrative: the North and one in the South to provide proximity technical assistance.

TARGETS

•At least 3,000 PLWHA and affected families in targets areas will be supported and trained;

•Train 150 PLWHA on leadership, communication and basic HIV/AIDS facts;

•60 support groups and 40 groups for accompaniment and technical assistance established and from

across six (6) departments to meet monthly;

•Upgrading two (2) clinics to become official to deliver palliative care and create one (1) at Domus Mariae;

•1,500 patients treated for IO and others STI and MSM;

•2 million Christians, religious and community members reached during mass Candlelight event, and civic

gatherings;

•18 field agents to be trained for planning and organizing training sessions for PLWHA's in six (6)

departments;

•15 social workers trained to continue development and maintenance of local support group;

•Technical assistance to build up institutional capacity of 6 PLWHA associations in 6 departments;

•Economical support to families and PLWHA

Integrated Activity Flag: This activity is linked to Activity IDs 4497.08, 18709.08 and 5436.08.

Summary: POZ will conduct VCT in four sites of which two are stand-alone facilities in Port au Prince, one is

in a clinic in Montrouis (a high risk community serving as a rest area by long distance drivers) and the fourth

is a community health center located in Lafosette, an overpopulated, vulnerable area in Cap Haitian.

Activities in this program will be carried out to support expansion of comprehensive counseling and testing

services to high risks behavior groups such as men having sex with men (MSM), young adults in vocational

school, and communities along the routes of long distance drivers. Services in this project will include:

providing counseling during both pre and post testing; increasing outreach activities, including additional

field promoters to identify more clients among targeted groups, and supervising and training VCT

counselors for increasing quality of services. These services are in line with the national HIV/AIDS plan and

requested by the Ministry of Heath's (MOH) public teams.

Background: POZ began counseling and testing services in 2002 at the Centre of Education and

Counseling Services named CESAC, using a concept of integrated HIV/AIDS case management promoted

by POZ. Funded by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), these VCT activities

provided a continuum of community care service which has been very successful in getting people living

with HIV/AIDS (PLWHA) out of isolation and empowering them to live full lives. POZ has become a unique

institution in Haiti, providing services to a highly underserved population (MSM), in addition to their

community clinics. In 2004 the President's Emergency Plan for AIDS Relief (PEPFAR) provided funds to

procure test kits and medical materiel for laboratory screening. POZ will focus on the areas around Port au

Prince, Montrouis, and Cap Haitian where high risk behavior groups are meeting in order to promote the

VCT services.

Activities and Expected Results: POZ will perform two activities in this program area:

Activity 1: POZ will provide comprehensive counseling and testing services through both stand-alone

locations in Port au Prince, and integrated VCT service at the POZ community health centers in Montrouis

and Cap Haitian. Pre and post HIV test counseling will be provided by trained counselors at each center.

Blood samples will be drawn and the test conducted on-site with results given the same day. Individuals

who test positive will be registered for follow-up service. The follow-up counseling program will meet the

needs of PLWHA, their partner(s), family members, and friends. Services provided will include: follow-up

individual counseling, family counseling, partner notification, condom distribution, and support group

activities. Regular clients will be assigned a single counselor who will be responsible for managing his/her

case. While the majority of funding to support the centers will come from GFATM, PEPFAR will provide

testing kits, renovation of working space, laboratory equipment, energy power, two additional laboratory

technicians, and two field promoters to expand the services.

Activity 2: POZ will ensure the provision high quality HIV testing and counseling services to clients visiting

these centers by working with partners who will provide supervision and monitoring of services. With

PEPFAR funding, POZ expects to provide continuous training to counselors, monitor performance and

efficiency of services through supervision, and reinforce norms & procedures. POZ will start this activity in

2008 in concert with its partners. They include--GHESKIO, Partners in Health, Centre Domus Mariae, and a

to-be-determined partner.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of VCT services to

identify HIV positive persons and increase the number of persons receiving ARV treatment.

Targets

•4 outlets services providing counseling and testing according to national standards—two in Port au Prince

and one in Montrouis,

and one in Cap Haitien;

•4000 test and counseling sessions per year;

•25 counselors trained;

•24 supervision visits /year.

Emphasis Areas %

Community Mobilization/Participation20

Development of Network/Linkage/Referrals system10

Linkages with others sectors10

Local organization capacity Development30

Training30

Integrated Activity Flag: This activity is linked to Activity IDs 4497.08, 5436.08 and 9364.08.

SUMMARY: The purpose of this project is to reduce stigma and discrimination and the spread of HIV/AIDS

in five geographic areas of Haiti: It will help to create positive attitude amongst health service providers, the

traditional healers and the community have to create has environment more comfortable and supportive for

PLWHA.

BACKGROUND: A recent study carried out by an organization (Concern) highlighted the fact that infected

and affect are generally victims of stigmatization and discrimination on behalf of the health service

providers. The recommendation was thus to sensitize the health service providers to these two problems.

We thus propose to target 5 sites on the level of the 6 following departments (West, North, South, South

East, Grand Anse, and Nippes). On the level of these sites, we will sensitize all the health providers and

community leaders and traditional healers HIV/AIDS epidemic has a tremendous impact one the Haitian

communities. There is an estimated 200,000 persons living with HIV/AIDS (PLWHA) and 18,000 orphans of

whom very few have access to basics care and support services. In site of major efforts supported by public

and private groups to create and build up capacity of health staff and public awareness, strong stigma and

discrimination still associated with the disease still exist and often leaves PLWHA isolated from family and

community support systems. It has been well documented that to create an effective and sustained

response to HIV prevention, care, treatment and impact mitigation, stigma and discrimination must be

addressed. However, despite S&D being identified as an important factor in Haiti's epidemic--and is a core

component of the Ministry of Health's HIV prevention strategy--few resources have been earmarked

towards its mitigation. S&D and/or fear of S&D remain the main barriers to effective prevention and

treatment; yet the international community allocates the lion's share of its funding to ART. Speaking at last

year's AIDS conference in Toronto, Peter Piot, the executive director of UNAIDS, observed that stigma

together with human rights have been "relegated to the bottom of AIDS programmes…often with no

funding."

Also reported in many surveys, these negative attitudes often come from the health facilities personal itself

where the PLWHA ought to receive care and treatment. In addition, almost one (1) household on every

three (3) reported to consult a traditional healer when a member of the family become sick (EMMUS, 2000).

There is no gender difference and the proportion of household is equally significant in urban and rural

residence. It is also reported that late training course of chronic diseases such as AIDS cross the path of

traditional healers before they get to medical modern medicine, and quite often its too late. Since the

beginning of the AIDS epidemic to date, public and visible activities of traditional healers have been almost

non existent. There is no dialogue and few contacts between the two sectors delivering health care to the

population. Ratio traditional healer/Population in approximately 1/500 according to statistics and most of

beliefs, practices and farming representation carry on the causes of AIDS and HIV transmission are far

away different from what we know one modern medicine.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: To sensitize 300 health service providers (doctors, nurses, medical auxiliaries of the targeted

institutions on Stigmatization and Discrimination problems. According to the available curriculum, health

service providers will be sensitized during two days on the causes, the consequences of Stigmatization and

Discrimination.

ACTIVITY 2: To sensitize 150 members of the personnel staff of these institutions. Since the personnel

staff (guard, housewives, boilers etc....) is also directly in liaison with the patients, it will be sensitized during

one day.

ACTIVITY 3: To sensitize 300 traditional healers on the six focused departments. Culturally a very great

number of Haitians when sick, turn to the traditional healers, especially chronic disease. Some do it in

parallel, others in very first place. Considering their obvious importance in the chain of health care of the

patient, POZ thus proposes to sensitize them during two days, not only on the problems of the HIV/AIDS,

Stigmatization and Discrimination but also to encourage them to refer of all the received patients so that the

latter receive adapted and powerful care which their case requires.

ACTIVITY 4: To sensitize 300 popular leaders of the community. Since the PLWHA also undergo

Stigmatization and Discrimination coming from the members of the community and as the leaders have a

great influence on it and are well listening and their advice taken, POZ will conduct a one day session.

ACTIVITY 5: To set up at the level of each department, a surveillance committee of stigmatization and

discrimination cases. Being given that all the personnel of each institution targeted will have been sensitized

and that it will have been selected because of the existence of service of testing, therefore, groups of

support and even association of PLWHA, POZ will set up a committee of 4 members (1 PLWHA, 1 health

service provider, 1 member of the community and 1 person from the religious sector).

ACTIVITY 6: Media campaigns will consist of radio and TV spots, journalistic reports, banners or billboards

and brochures. Under the direction of the POZ manager communication officer Coordinator, and with the

technical assistance of CECOSIDA and others partners, the media strategies will be planned and

implemented in the three catchment areas. There will be large events with media coverage as well as

reinforcing messages regularly diffused throughout the communities radio/TV networks.

ACTIVITY 7: Support the development and capacity building of two associations of MSM in Cap-Haitian and

Port-au-Prince respectively. POZ will provide technical assistance and financial support to help building

administrative capacity to two associations of MSM. These will include: accompaniment for official state

recognition; setting-up a location for holding meetings and administrative procedures to manage funds;

conducting organizational assessment, strategic planning exercises and program development; small grants

for communication activities; partnership in mobilization activities.

SPECIFIC MONITORING AND ACTIVITIES EVALUATION

POZ will conduct the following monitoring and reporting activities in order to assess the progress of the

project, effectiveness of interventions and to update the donor one has regular basis;

•Monthly progress updates of project activities through email;

•Narrative Written quarterly carry forwards;

Activity Narrative: •Mid- term evaluation