Integrated Activity Flag: This activity is linked to Activity IDs 10665.08, 11181.08 and 10129.08.

SUMMARY:

FY08 activities will maintain success with the one-to-one youth peer messages with high risk, out of school

and in school youth. Activities with migrant populations will be increased, Geographically, services will

expand into underserved rural areas not before reached through prevention programming. These activities

are split funded 20% OP, 80% AB.

BACKGROUND:

This program is ongoing, having begun during FY06. The program operates in the North East region of

Haiti, which has a population of 300,000 and is one of the most underserved and rural departments in Haiti.

As a result, this department faces multiple factors with regards to transmission of HIV including high rates of

mobility across the border contributing to prostitution and transactional sex; high levels of poverty; illiteracy

in more than half the residents; and stigma. The program is implemented through sub-partners: Centres

pour le Développement et la Santé (CDS) operating in rural Ouanaminthe; Fondation Pour la Santé

Reproductrice et l'Education Familiale (FOSREF) operating in urban Fort Liberte ; and Volontariat Pour le

Développement d'Haïti (VDH) operating in urban Ouanaminthe. For Fiscal Year (FY) 2008, VDH will work

with Promoteurs Objectif ZEROSIDA (POZ) to expand AB services into the more rural communes of Trou

du Nord, Terrier Rouge and Caracol in partnership with the Ministry of Education.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: PLAN will expand on its peer education for adult migrant populations (especially men) which

began in FY07, by adding more peer educators to target this population. The main themes addressed

include sexual responsibility, high-risk sexual behaviors, fidelity, and the importance of CT. An additional 50

migrants will be trained as peer educators who will conduct activity sessions bi-weekly for other migrants,

adding to the 100 trained in FY07. 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. 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, condom outlets, and care and treatment services will be provided.

Activity 2: Sub-Partners VDH and POZ will train additional Yuth Peer Educators (YPEs), focusing on rural

and underserved areas of Trou du Nord, Terrier Rouge and Caracol. YPEs will operate either within their

schools or their communities to implement HIV/AIDS activities that will 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, and reducing sexual partners. Referrals will be

made to STI treatments, CT, OVC programs, and condom outlets and family planning services when

appropriate. By the end of COP08 20 YPEs will be identified for the three rural communes. Each YPE is

expected to reach at least 30 of his or her peers (YPEs will be equally represented among the sexes). Thus,

among the total of 20 rural YPE's, and the 100 YPEs previously trained, 3600 youth will be reached with AB

messages.

Activity 3: New Anti-AIDS clubs will be established in rural underserved areas. These will follow the model

of the 10 clubs established in FY07 which was developed by FOSFER and 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 condom outlets when appropriate, 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 300 youth will be reached through the Anti-AIDS clubs.

Activity 4: FOSREF and VDH will also hold large group rallies twice a year in rural areas surrounding

patron saints days and special HIV/AIDS days (such as World AIDS Day). More frequent rallies and events

such as sports play-offs, theatrical presentations, etc. will be held in urban areas. The events will be run in

partnership with all the consortium members; and the organization assigned to the area will take the lead in

the coordination of all partner activities for the particular event. These rallies will have messages that

promote healthy behavior decisions in the direction of abstinence and/or being faithful. It is estimated that

20,000 individuals will be reached through rallies in COP08.

EMPHASIS AREAS:

Training

Information, Education, and Communication

Community Mobilization/Participation

Development of Networks

TARGETS:

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

abstinence (a subset of total reached with AB):

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

abstinence and/or being faithful: 7000

Number of individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful: 260

TARGET POPULATIONS;

Youth

Migrant Workers

Men

KEY LEGISLATIVE ISSUES:

Activity Narrative: Gender equality issues

Stigmatization of HIV/AIDS

COVERAGE AREAS:

Communes Fort Liberté, Ferrier, Ouanaminthe, Trou du Nord, Terrier Rouge, Caracol, Capotille, Mont

Organisé, and Carice.

Integrated Activity Flag: This activity is linked to Activity IDs 5234.08, 10665.08 and 10129.08.

SUMMARY: For COP 08, implementation of Project SHINE activities will continue in the North East

Department bordering the Dominican Republic. This department has the second highest prevalence rate of

2.7% (Haiti 2005 DHS) and a highly mobile population. An increasing focus for COP 08 is the expansion of

access in rural areas to other prevention methods. These methods not only complement the AB work that

will continue throughout the department but will expand to out of school youth through provision of other

prevention services within clubs and other venues. Plan will expand its work with migrant workers, through

its consortium partners and with agencies supported by USAID working in the Dominican Republic. These

activities are splint funded 20% OP, 80% AB.

BACKGROUND: USG support to the Plan International Consortium's Project SHINE was initiated with an

award in FY 2006 as a result of a competitive process. The North East Department has a population of

approximately 350,000 persons and covers 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 that affects 52% of the population; and 4) severe stigma prevents people from seeking to know

their status and being willing to care for HIV positive family members. With investments, Plan has been able

to establish partnerships and mobilize its network to initiate activities within the department as well as cross-

border activities to promote behavior change among in and out of school youth. During COP 08, the

increasing awareness and the reduction in stigma associated with HIV infection will result in increased

demand for HIV services. One of the prevention services predicted to increase is the demand for condoms,

both as a prevention strategy and where linked to increased demand for testing among sexually active

populations.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: PLAN will expand on its peer education for adult migrant populations (especially men) which

began in FY07, by adding more peer educators to target this population. The main themes addressed

include sexual responsibility, high-risk sexual behaviors, fidelity, and the importance of CT. An additional 50

migrants will be trained as peer educators who will conduct activity session's bi-weekly for other migrants,

adding to the 100 trained in FY07. 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. 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.

Activity 2: Sub-Partners VDH and POZ will train additional YPEs, focusing on rural and underserved areas

of Trou du Nord, Terrier Rouge and Caracol. YPEs will operate either within their schools or their

communities to implement HIV/AIDS activities that will help them develop behavior change strategies to

manage their risk of infection. YPEs will provide counseling to their peers on secondary abstinence,

personal risk assessment, reducing sexual partners, and correct and consistent condom use when

appropriate. Referrals will be made to STI treatments, CT, OVC programs, and family planning services

when appropriate. By the end of COP08 20 YPEs will be identified for the three rural communes. Each YPE

is expected to reach at least 15 of his or her peers (YPEs will be equally represented among the sexes).

Thus, among the total of 20 rural YPE's, and the 100 YPEs previously trained, 1800 youth will be reached

with OP messages.

Activity 3: New Anti-AIDS clubs will be established in rural underserved areas. These will follow the model

of the 10 clubs established in FY07 which was developed by FOSFER and encourages youth to take

ownership in planning and designing club activities. YPEs will organize periodic information sessions

around key topics to promote being faithful and consistent and correct condom use messages. These

meetings will provide youth with a venue for discussing HIV topics such as risky behaviors, "sugar daddies",

secondary abstinence, fidelity, sexual health and hygiene, self esteem and gender, correcting myths around

HIV transmission, and providing referrals 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 300 youth will be

reached through the Anti-AIDS clubs.

Activity 4: FOSREF and VDH will also hold large group rallies twice a year in rural areas surrounding

patron saints days and special HIV/AIDS days (such as World AIDS Day). More frequent rallies and events

such as sports play-offs, theatrical presentations, etc. will be held in urban areas. The events will be run in

partnership with all the consortium members; and the organization assigned to the area will take the lead in

the coordination of all partner activities for the particular event. It is estimated that 20,000 individuals will be

reached through rallies in COP08.

EMPHASIS AREAS:

Training

Information, Education, and Communication

Community Mobilization/Participation

Development of Networks

TARGETS:

# of targeted condom service outlets: N/A

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

behavior changes beyond Abstinence and/ or Being faithful: 2100

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

and/ or Being faithful: 70

TARGET POPULATIONS;

Youth

Migrant Workers

Men

KEY LEGISLATIVE ISSUES:

Gender equality issues

Stigmatization of HIV/AIDS

COVERAGE AREAS:

Communes Fort Liberté, Ferrier, Ouanaminthe, Trou du Nord, Terrier Rouge, Caracol, Capotille, Mont

Organisé, and Carice.

SUMMARY:

Plan International will continue to support the United States Government's (USG) effort to scale up

community palliative care services in the North East Department to people living with HIV/AIDS (PLWHA)

and their families. Plan International will build on the SHINE project they launched in Fiscal Year (FY) 2006

in this department. SHINE provides integrated prevention and community support services to PLWHA

through a partnership between key stakeholders (CDS, FOSREF, POZ and VDH). Plan will strengthen the

referral system between the CT, TB/HIV, PMTCT and treatment sites that are being expanded through this

department and the community based organizations (CBO) in order to offer a package of preventive care,

socio-economic, nutrition support, and spiritual care to enrolled PLWHA.

BACKGROUND:

Plan Haïti has been working for over 15 years with a variety of partners in the North East Department to

establish available basic health, educational, and financial services for all residents in its zones of

intervention. In FY 2006, Plan launched, with support from the President's Emergency Plan for AIDS Relief

(PEPFAR), the SHINE project in the North East Department. In partnership with MOH departmental

directorate and with CDS, VDH, FOSREF and POZ, SHINE expands HIV counseling and testing services

integrated with psycho-social support and prevention services to PLWHA.

In FY 2007, as the USG expanded the package of community palliative care to PLWHA, USG decided to

channel resources to those detected and enrolled in the North East Department through Plan International

building on their experience in implementing the SHINE project. The overall strategy is to create in the North

East Department through local CBOs, points of service where PLWHA enrolled at all HIV sites (CT, PMTC,

TB/HIV, clinical care and ARV) could be referred for nutrition, socio-economic and spiritual support services.

So far, Plan International has worked with the MOH, its SHINE partners, and other key stakeholders to

broaden guidelines which define the package of community palliative care and the best strategies and

mechanisms to start delivering it.

With FY 2008 resources, Plan International will focus on expanding current activities to provide all PLWHA

enrolled at the HIV sites with a more substantial package of community support as defined by the

guidelines. These activities will be implemented in a manner complimentary to current OVC programming

for a family centered approach. They will be implemented in linkages with those supported directly through

CDS to expand CT, PMTCT, TB/HIV programs (see CDS narratives) as well as through POZ to reinforce

psychological support through creating PLWHA support and associations and stigma reduction (see POZ

narratives). Plan will also strengthen links with HIV sites where PLWHA are enrolled in care, identifying

other local CBOs, grassroots organizations, and PLWHA associations through which resources could be

channeled to expand services and to connect PLWHA to Title II food, economic growth partners and church

groups to provide them with food, job and income generating activities, and spiritual support based on

needs assessment.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Plan International will continue to link PLWHA and infected/affected children living with

HIV/AIDS who have been detected and enrolled in VCT, PMTCT, clinical care and treatment sites with local

CBOs and other community resources through which PLWHA and their children can access community

services. Plan will build on referral tools and systems that they are being developed with existing

resources. FY 2008 funding will be used to continue strengthening this referral system by allocating

resources to cover transport fees for PLWHA and their families to go to CBO points of services and to

organize regular departmental coordination meetings between stakeholders.

Activity 2: Funding will be used to reinforce Plan International capacity to continue strengthening its main

points of direct delivery of community services throughout the North Eat Department. These points of

services will be adequately staffed with trained support and psycho-social staff, as well as with facilitators

who will continue to work with their counterpart at the sites to recruit PLWHA, establish their needs and

those of their families, including nutrition and socio-economic needs and to provide them with community

services. The community based information system which is being developed and rolled out through Plan

International's point of service this year will be reinforced next year to establish a good track record of

patients enrolled and services offered.

Activity 3: Plan International will identify around the HIV sites other local CBOs through which the

community palliative care package could be expanded. Emphasis will be put on identifying PLWHA support

groups and associations that are being expanded and reinforced and on grassroots organizations with

relevant experience in providing support to PLWHA or involved in other social support services. Funding will

be used to provide the aforementioned organizations with financial, training, and technical assistance to

upgrade them and make them capable of offering community support services in networking with the HIV

sites and other key stakeholders.

Activity 4: Plan will use funding to make available to PLWHA through the different points of service a

package of prevention, social support, and education services as directed by the guidelines. Plan will

distribute safe water products, including drinking water bottles, procured through the Supply Chain

Management System, to PLWHA. They will also work with the Global Fund to Fight AIDS, Tuberculosis and

Malaria and MOH partners to distribute treated bed nets to PLWHA, pregnant women, and children under

five for malaria prevention. Resources will used to cover school fees for infected and affected children, and

a transit house for PLWHA lodging (should resources permit) based on needs assessment. Staff from the

points of services will be trained through INSHAC to provide counseling on HIV prevention, including

couple and family counseling, in order to promote HIV testing within the family, reduce stigma, and to

promote positive attitudes toward infected person in the family.

Activity 5: Plan International and its network of local CBOs will continue to establish strong linkages with the

Title II food partners to make food available to PLWHA and their families based on nutrition needs

assessment established at the sites and the CBO points of services. This will complement efforts being

made at the sites to assess nutritional needs of PLWHA and to provide food as a prescription to those that

are malnourished. Plan International will link their points of service with church groups to provide spiritual

care to patients, particularly those enrolled in end of life care. They will also establish linkages with partners

involved in economic growth programs to enroll PLWHA in micro-credit and job creation activities. Funding

will be used to cover transportation and logistic costs to make food available at the points of services.

Funding will be used to train religious leaders and church groups to support PLWHA and their families and

to cover their transportation costs to visit PLWHA. Resources will also be used to provide guaranteed funds

to make micro-credit funds accessible to PLWHA.

TARGETS:

Number of people being tested in COP08: 44,000

Number of people testing positive: 1250

Number of people agreeing to seek palliative care services: 1000

Number of affected people being provided with palliative care services: 5000

Activity Narrative: Number of PLWHA support groups formed: 5

Number of PLWHAs offered microcredit: 100.

Number of PLWHA receiving water vessels and chlorine: 2000

Number of PLWHA receiving mosquito nets for malaria prevention 2500

SUMMARY:

During COP 2008, stigma reduction will continue to be the primary focus within the North East Department.

The involvement of communities in destigmatization activities will provide the impetus to identify and

support OVC in the North East Department. The program will expand from the 500 OVC supported in COP

2007 to 1000 in COP 2008. Project SHINE will work through a range of centers including the 30 children's

clubs supported by Plan Haiti, the youth clubs that Fondation Pour la Santé Reproductrice et l'Education

Familiale (FOSREF) and Volontariat Pour le Développement d'Haïti (VDH) will establish, and the work of

Promoteurs Objectif ZEROSIDA (POZ) in partnership with the Ministry of Health (MOH) in Trou du Nord,

Terrier Rouge and Caracol. Each agency will teach its youth leaders how to identify children under stress

and how to guide them to support using 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 people living with HIV/AIDS (PLWHA) become more comfortable with revealing

their serostatus to their families, more direct OVC identification and support will be initiated.

Sub-partners FOSREF and VDH will be tasked with identifying and mentoring 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. Project SHINE will initiate OVC activities in Trou du Nord, Terrier Rouge, and

Caracol. In addition to increasing the number of children being supported, the program will emphasize

community and municipal mobilization and participation, linkages/other sector initiatives, and strategic

information management to increase support for OVC.

BACKGROUND:

This program area is beginning its second year of operation and will build on experiences from COP 2007.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Plan Haiti will begin with a more general approach to identifying children under stress as well as

teaching communities and children about basic values that will help prevent discrimination and

stigmatization. Using the over 30 established children's clubs, Project SHINE will enlist the help of a

psychologist to train 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 stress while encouraging

good citizenship, and mutual support and acceptance to help promote non marginalizing behavior within the

communities. Plan Haiti will invite the families of any identified OVC to receive more direct services such

as health care and support for school attendance.

FOSREF will work with the youth of Fort Liberté 14 years and older to identify any that are particularly

vulnerable, orphaned, or otherwise demonstrate severe stress. VDH will do similar work in Ouaniminthe and

POZ in Trou du Nord. Each identified youth 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. Plan expects to

identify 40 additional youth in each area, which in addition to those identified in COP 2006 and COP 2007,

will result in the program supporting 200 youth.

Activity 2: Plan Haiti will work at the community level with FOSREF and VDH supporting stressed youth in

the urban areas. POZ will work with PLWHA brought into care through the Voluntary Counseling and

Testing/Anti-retroviral (VCT/ARV) sites (including the seropositive pregnant women in the PMTCT

programs) to identify their OVC family members. POZ will also work with Centres pour le Développement et

la Santé (CDS) staff to identify and support tuberculosis (TB) patients and their OVC children. As these

PLWHA/TB patients become comfortable enough to disclose their illness (TB patients can confront

stigmatization similar to PLWHA), their children will receive direct support while their parents receive

treatment. Plan Haiti will link OVC to MCH activities as well as immunization, Vitamin A supplementation,

growth curve monitoring, and de-worming. Whenever pediatric AIDS services are available at the Fort

Liberté Hospital, OVC from seropositive patients will be referred for early diagnosis and care and treatment.

The Plan led consortium and its sub-partners will form a committee to determine the best methods to

manage identified OVC (e.g. determining the most effective packages of services to provide and identifying

which member should provide those services). The package will be based on the principle of helping

PLWHA and their OVC offspring normalize their daily life while seeking ways to ensure primary schooling

for the younger children and professional training for the youth. Ensuring primary health care for all OVC

children/youth and family members will be emphasized. The committee will formalize a referral/counter-

referral mechanism to ensure that all OVC, particularly girls, receive care and they receive the same

services. Lastly, Plan will also link OVC and their families with food support from the World Food Program.

Activity 3: Expansion and management of the existing database will occur through COP 2008 under the

management of the lead OVC organization. Plan will use a variety of methods to track progress in this area

including, the committee, the package of services, and the database with its system of referral/counter-

referral. This will result in the inclusion of more children as identified through the different mechanisms.

Areas of legislative interest include gender equity, influencing 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 OVC through the children's clubs as well as to run the mentoring program for vulnerable youth.

Destigmatization will be particularly emphasized in all program areas. Sustainability will be sought through

the use of low-cost but effective interventions that are designed to cover the most vulnerable members of

the target population even if financial support should become limited. Plan 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 cannot 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 including OVC.

Targets:

Children identified through clubs and VCT centers: 1000

Providers/Caregivers trained in caring for OVC: 60

Target Populations:

HIV infected and affected children

Caregivers (of OVC and PLWHAs)

Activity Narrative: HIV/AIDS affected families

Orphans and Vulnerable children

Community based organization

Key Legislative issue:

Increasing gender equity in HIV AIDS

Stigma and discrimination

Food

Education

Microfinance/microcredit

Geographical coverage: North East