INTEGRATED ACTIVITY FLAG: This activity relates to AERDO's Activity Narratives for Orphans and

Vulnerable Children (OVC) and Palliative Care (PC) for Cooperative Agreement # 521-A-00-06-00013-00.

This activity is linked to activity ID 10111.08, 5411.08.

SUMMARY:

The proposed activities are to: 1) train community leaders, religious leaders and other influential persons to

clearly articulate traditional, community and faith-based values regarding HIV-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 children

and youth, community leaders, NGOs/PVOs, volunteers, men and women (including those of reproductive

age), out-of-school youth, religious leaders, public and private health care workers, and HIV-positive

children (5-14 years). Coverage area includes West, Northwest, North, South, Central Plateaue, Southeast,

and Artibonite.

BACKGROUND:

This activity is expanding on the current PEPFAR-funded COP 07 ABY activities carried out by AERDO in

Haiti. Each partner agency will work with the Haiti Ministry of Health (MOH) at the community level, and

WCDO will also coordinate with the MOH at the national level. Implementing the program are WCDO (lead

agency), SA, FOCAS and World Hope. FH will be a technical consultant. All are NGOs. WCDO and all sub

partners will disseminate accurate information regarding prevention, which we believe to be efficacious

toward behavioral changes. Religious leaders, community leaders and other influential persons will also be

mobilized and trained to provide support in making important life choices. All these activities will be

channeled through each agency's church and community-based networks. AB activities will be gender

balanced with at least 50% of the beneficiaries being female. Ensuring access to AB activities for females

will help to reinforce their capacity to manage and negotiate their sexuality. Women trained through Activity

1 will be encouraged to serve as mentors to younger girls.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Enable community leaders, religious leaders and other influential persons to clearly articulate

traditional, community and faith-based values regarding HIV-prevention. This target group will attend

training conferences designed to build their capacity using FH's "Abstain, Be Faithful," and as appropriate,

correct and consistent use of condoms (ABC), use of AIDS awareness curriculum, educational methods and

counseling techniques. AERDO will include all elements of ABC teaching in the adult education model, with

an emphasis on AB. Booklets summarizing the key concepts will be distributed to training participants.

Influential persons--teachers, community health workers, parents etc.--will be mobilized to refer youth,

including sex workers, for Voluntary Counseling and Testing (VCT) services. PEPFAR funds will be used to

recruit and train local leaders. This includes the print and distribution of the booklet summarizing key

concepts. During the current funding year, AERDO has been able to reach 1,353 individuals through this

activity.

ACTIVITY 2: Community and Religious Leaders trained in activity 1 will form Men's clubs and Couples clubs

within their church and local community network. This new activity will utilize the leader's ability to

implement the ABC curriculum using the adult education model. Groups will meet monthly and will focus on

messages of fidelity, partner reduction, appropriate messages to build skills in personal risk assessment,

improve couples communication, and referrals to CT. Each leader will form one group of 4 men or 3 couples

for a total of 300 groups formed, and 1500 reached.

ACTIVITY 3: Establish preventative HIV behavior change programs for children and youth. Drama and

music will be used to emphasize abstinence and behavior change for children and youth. Working with local

churches, promoters will train youth leaders in preventative HIV education using the World Relief "Choose

Life" manual. These youth leaders will, in turn, train other youth group members. Upon the successful

completion of the preventative education program, pledge cards will be provided, offering the youth

participants the opportunity to commit to abstinence. 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 community events--marches will be organized during

carnival, Memorial Day and International AIDS day to reach additional beneficiaries with messages about

HIV transmission and prevention. PEPFAR funds will be used to recruit youth into Youth-2-Youth (Y2Y)

groups and to conduct ABY programming. Funds will also be used for community events that will further

disseminate accurate information about HIV prevention. During the current funding year, AERDO has been

able to reach 18,193 individuals through this activity.

EMPHASIS AREAS:

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%)

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: 10,000

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

2,500

KEY LEGILATIVE AREAS:

In regard to the issues of U.S. Legislative interest, please note that for every activity, AERDO 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

Activity Narrative: reduced through the HIV/AIDS training on transmission and prevention which will demystify and

destigmatize the disease.

COVERAGE AREAS:

West, Northwest, North, South, Central Plateaue, Southeast, and Artibonite.

This activity is linked to activity ID 5238.08, 5411.08.

World Concern Development Organization (WCDO) will continue to establish and strengthen referral

systems for People Living with HIV/AIDS (PLWHA) in the West Department of Haiti to increase access to

services, expand current community situational analysis, scale-up community services available to PLWHA,

strengthen PLWHA associations, provide preventative care packages to PLWHA households, and

strengthen the economic coping capacities of households affected by HIV/AIDS. The emphasis areas are

community mobilization (major: 55%), development of network/linkages/referral systems (minor: 45%),

training (minor: 30%), food and nutrition (minor: 20%), local organization capacity development (minor:

30%), quality assurance (minor: 10%), and linkages with other sector initiatives (minor: 35%). The primary

target populations are PLWHA, HIV/AIDS-affected families, public sector hospitals and clinics, community-

based organizations, volunteers, women (including those of reproductive age), religious leaders, and public

and private health care workers. The coverage area is the West Department.

BACKGROUND:

In Fiscal Year (FY) 2007, the United States Government expanded the package of community palliative

care to PLWHA by channeling resources to each of the 10 departments through one community based

organization (CBO) that is in charge of planning and implementing this program in coordination with the

Ministry of Health (MOH) departmental directorate, local CBOs and grassroots organizations. The overall

strategy is to refer all PLWHAs enrolled in care at all HIV sites to the points of service put in place by the

CBOs in order to provide them with community and socio-economic support. World Concern Development

Organization (WCDO), the lead agency of the Association of Evangelical Relief and Development

Organizations (AERDO) HIV/AIDS Alliance (AHA) was given FY 2007 resources to serve as the central

CBO for the West Department where they expect to target about 10,000 PLWHA. WCDO has chosen to

channel resources and implement its activities primarily through three partners: CRWRC (spell out), SA

(spell out), and FOCAS (spell out) affiliated to AERDO.

Although the program has yet to be implemented because of FY 2007 funding delays, WCDO has worked

with the MOH, its three partners, and other key stakeholders to broaden guidelines which define the

package of community palliative care. They have also worked with different HIV sites in the West

Department where PLWHAs are being enrolled in care to establish the best strategies and mechanisms to

deliver the community care package. Based on these strategies, three points of services established

through WCDO and its partners will start providing community services soon.

With FY 2008 resources, WCDO will expand current activities to provide all PLWHA enrolled at the

voluntary counseling and testing (VCT), tuberculosis (TB)/HIV, preventing mother to child transmission

(PMTCT), clinical and anti-retroviral (ARV) services in the West Department 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. WCDO will continue

to work in coordination with its partners to focus on improving linkages 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 on connecting PLWHA to Title II food and

economic growth partners. Additionally, WCDO will work to link PLWHA with 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: WCDO and its partners 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

(particularly public hospitals and clinics), with local CBOs and other community resources through which

PLWHA and their children can access community services. They 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 PLWHAs and their

families to go to the CBO points of services and to organize regular departmental coordination meetings

between stakeholders.

Activity 2: Funding will be used to reinforce WCDO and its co-partners (CRWRC, SA and FOCAS) capacity

to continue strengthening their main points of direct delivery of community services throughout the West

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

PLWHAs, 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 WCDO and its co-partners this year will be reinforced next year to

establish a good track record of patients enrolled and services offered.

Activity 3: Next year WCDO will identify around its 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. WCDO will use

funding 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: WCDO will use funding to make available to PLWHA through the different points of services a

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

distribute to PLWHA safe water products, including drinking water bottles, they will procure through the

Supply Chain Management System. WDCO 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 according to national guidelines. 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 Institute Haitien de Santé

Communautaire (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: WCDO and its partners 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. WDCO

and its partners 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

Activity Narrative: to cover transportation and logistic costs to make the 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.

EMPHASIS AREAS:

Community mobilization (major: 55%), development of network/linkages/referral systems (minor: 20%),

training (minor: 20%), food and nutrition (minor: 15%), local organization capacity development (minor:

15%), and quality assurance (minor: 10%) linkages with other sector initiatives (minor: 25%)

TARGETS:

For the year ending September 30, 2008, AERDO seeks to reach the following targets: six service outlets

providing HIV-related palliative care; 10,000 individuals provided with HIV-related palliative care and 112

individuals trained to provide HIV-related palliative care.

The proposed activities in this narrative will enable households, families, churches and communities to

provide support to children orphaned or made vulnerable by HIV/AIDS. The Association of Evangelical

Relief and Development Organizations (AERDO) will work closely with local partners (including assigned

health centers) to develop community-based OVC support interventions that respond to their psychosocial

needs, strengthens the economic coping capacities of caregivers, links children and families to available

health and social services, provides food contributions, and trains caregivers and children in basic hygiene

and disease prevention. Trainings in and the use of curricula such as "Our Children" will serve to raise

awareness of OVC issues, reduce stigma, and empower communities to support and nurture OVC. The

emphasis areas include: community mobilization (major: 55%), training (minor: 20%), linkages with other

sectors and initiatives (minor: 20%), needs assessment (minor: 10%), quality assurance (minor: 10%),

strategic information (minor: 10%), local organizational capacity development (minor: 15%), and

food/nutrition (minor: 10%). The primary target populations are OVC, caregivers, people living with HIV and

AIDS, street children, faith-based organizations (FBOs), community-based organizations (CBOs),

volunteers, community leaders and religious leaders. The coverage area is the West Department.

BACKGROUND:

This activity is expanding on the current President's Emergency Program for AIDS Relief (PEPFAR)-funded

COP 2007 OVC activities carried out by AERDO in Haiti. Each partner agency will work with the Haiti

Ministry of Health (MOH) at the community level and WCDO will coordinate with the MOH at the national

level. Implementing the program are WCDO (lead agency), SA, WH, CRWRC, and FOCAS. WCDO and

implementing sub partners will bolster the economic abilities of OVC households through micro-credit and

activities will be monitored to ensure females are at least 50% of the beneficiaries. In addition, sensitization

trainings will highlight the unique needs and vulnerabilities of female OVC.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Enable community organizations (churches, FBOs and CBOs) to develop and maintain their

own OVC support programs. AERDO will identify the most appropriate churches, CBOs, and PLWHA

associations located around the PEPFAR-supported sites in the West to work as local partners. These

organizations, with mentoring by AERDO's technical staff, will visit the sites and make joint assessments of

the OVC at each site. The sites targeted in the West Department will include six (to be determined) from

the following list: Groupe Haitien d'etudes du Sarcome de Kaposi et des infections Opportunistes

(GHESKIO), Hopital de l'Universite d'Etat (HUEH), Hopital de Carrefour, Hopital Petits Freres et Soeurs,

International Child Care (ICC), Institute of Infectious Disease & Reproductive Health (IMIS), Grace

Children's Hospital and two other undetermined hospitals. PEPFAR funds will be used to recruit and train

local partners. During the current funding year, AERDO has enabled 80 local organizations to develop and

maintain their own OVC support programs.

ACTIVITY 2: Link children and families to essential health and social services where available. Select

essential health and social services, based on an assessment of need, will be provided to OVC. These may

include: psychosocial support for 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. Funding will also be used to support fees for health

services and drugs when necessary. AERDO will link counseling and testing (CT), PMTCT and anti-

retroviral (ARV) sites to orphanages and OVC households through a community-based network. Caregiver,

OVC, and parent of people living with HIV/AIDS (PLWHAs) will be supported to increase treatment

adherence. Mobile clinics in remote areas and rally posts will provide care and support to OVC.

ACTIVITY 3: Provide contributions of food to OVC. Local churches, CBOs, and FBOs will use local

contributions to meet the identified OVC's food needs to the extent possible. With FANTA guidance, OVC

will have routine clinical assessment of nutritional status especially children under five years, and dietary

assessments will be conducted to determine which OVC are most in need and explore ways to provide

them with nutritional support. Food by prescription at the clinics will address the needs of malnourished

OVC.

ACTIVITY 4: Train local volunteers to provide support and home visits to OVC. Three hundred trained

volunteers will visit HIV-affected caregiver and child-headed households on a regular basis to check on their

status. Efforts will be made to ensure that all pregnant women are referred for HIV testing and that the HIV-

positive women are enrolled in PMTCT services, including postpartum care. Newborns from the sero-

positive mothers will be referred to HIV/AIDS service delivery sites for testing, general pediatric care and

follow up, and enrolled in the OVC program. AERDO will document the visits made, the status of the OVC

households, and any resulting interventions. Family members not already tested for AIDS will be

encouraged to get tested. Midwives, as available, will be involved in the process of community based care.

Three hundred volunteers and 25 field staff will be trained in grief and trauma counseling to provide

psychosocial care during the home visits to OVC. During the current funding year, AERDO has reached

417 volunteers through this activity.

ACTIVITY 5: Train and support OVC caregivers. Community health issues such as prevention of HIV/AIDS,

malaria and cholera; clean water; sanitation; bed nets 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. This would include economic strengthening through trainings in basic business and

provisions of start-up capital to selected families. During the current funding period, AERDO has reached

1,455 caregivers through this activity.

ACTIVITY 6: Partner with Salesian to support Lakay, a program for street children. This partnership started

in FY 07 will: i) reinforce the training program, strengthen the behavior change and risk reduction of those

children, organize HIV-AIDS oriented entertainment activities at the school facility and outside of school to

reach street children not enrolled in school, provide psycho-social, access to health care and material

support to those vulnerable children. AERDO will link the children to collaborating ARV sites and ensure

that agreements reached with food programs will cover the Salesian Congregation.

As a gender issue, OVC female caregivers will have access to income and productive resources through

the availability of microfinance and income generation in the form of goat loans. Stigma and discrimination

will be reduced through sensitivity trainings provided to local organizations working with OVC, as well as

HIV/AIDS training on transmission and prevention which will demystify and destigmatize the disease.

[Legislative interest: note--for every activity, we will track the number of OVC who are female so that at least

Activity Narrative: 50% of the beneficiaries are girls].

A public/private partnership is possible because MedPharm is providing anti-parasite medications (valued at

US$5.288 per tablet) and Vitamin A supplements, so that OVC and their caregivers can receive this

treatment to boost their nutrition. In total, AERDO is providing a cost share of 52% for OVC activities.

These activities relate to the PEPFAR 2-7-10 goals by providing care and support to OVC and their

households. These activities will expand upon the Fiscal Year 2007 targets of 4,500 OVC served by OVC

programs and 900 providers/caretakers trained in caring for OVC. AERDO fully expects to reach these

targets by September 30, 2008.

EMPHASIS AREAS:

Community mobilization (major: 55%), training (minor: 20%), linkages with other sectors and initiatives

(minor: 20%), needs assessment (minor: 10%), quality assurance (minor: 10%), strategic information

(minor: 10%), local organizational capacity development (minor: 15%) and food/nutrition (minor: 10%)

TARGETS:

For the year ending September 30, 2009, AERDO plans on reaching the following targets: 1,700 caregivers

strengthened to support 5,000 OVC (50/50 male/female) affected by HIV/AIDS.