Integrated Activity: This activity links to Activity IDs 10123.08 and 10667.08.

SUMMARY: CRS will coordinate with mobile teams of the Ministry of Health for making counseling and

testing available at all sites that receive dried food rations under Food Security Humanitarian Assistance

(FSHA program and the soon to be implemented Multi Year Program (MYAP) in the South, Nippes, Grande-

Anse departments. Once detected positive and registered at these sites, CRS will assist in the process of

referrals of all identified HIV+ pregnant women at sites that provide full PMTCT services.

BACKGROUND: For more than fifteen years, CRS has been one of the main implementers of the Food

Security Program. In that context, CRS has developed an important network of service delivery sites for the

implementation of the program, such as the one in the Southeast department. Meanwhile, due to growing

food insecurity, food supplementation has played a growing role for attracting pregnant women seeking for

ante-natal care services. Many ante-natal clinics served by CRS have a high attendance. Opt-Out

counseling and testing will be made available at these sites in close planning and coordination with public

VCT mobile teams that will be based at departmental level. Joint monthly planned plans will be developed

that will establish schedules of visits for each site. With the support of accompagnateurs and the community

health personnel of institutions that provide palliative care at community levels, such as those previously

listed, referrals of HIV+ pregnant women at full PMTCT sites will be carried out.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1. Support to 22 sites for helping the MOH mobile teams provide: (i) Opt-out Counseling and testing

to all pregnant women (ii) registration of HIV+ detected pregnant women

Activity 2. Active referral of all HIV+ pregnant women at full PMTCT service delivery sites where they will

receive the same package of services as listed above.

Targets -- Number of food outlets providing access to MoH mobile teams for PMTCT services: 22

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Integrated Activity: This activity links to Activity IDs 17930.08 and 10667.08.

SUMMARY:

This activity will provide a comprehensive package of community-based care and support for adults with

HIV/AIDS and will be integrated with existing clinical and government-supported programs providing

services in VCT, OVC, and PMTCT in the selected target area. Main emphasis areas include: community

mobilization, development of referral systems/linkages; information, education and communication, linkages

with other sectors, training and food nutrition support. Through this program, CRS will provide the physical,

nutritional, psychosocial, legal, and spiritual support to people living with HIV/AIDS (PLWHA). The primary

target population is PLWHA and their families. The geographic coverage area includes the Nippes, South,

Grande Anse, Artibonite, and Northwest Departments.

BACKGROUND:

This program will build on work CRS is slated to perform in community-based palliative care financed

through COP 2007. CRS will work in collaboration with the local Ministry of Health (MSPP) structures and

will coordinate with the Government of Haiti (GOH) hospitals on-going care and treatment programs across

five departments: North West, Artibonite, Nippes, Grand'Anse and South. Additionally, CRS will work

closely with 20 rural health centers and hospitals currently providing HIV services across these

departments. CRS will directly implement activities in the southern peninsula and will partner with other

community based organizations (CBOs) in Artibonite and Northwest. CRS will link activities with its Mother

and Child Health and Nutrition (MCHN) and HIV/TB feeding component of the multi-year assistance

program (MYAP) in the South, and COP 2008 funded OVC and TB programs slated for implementation in

the same five geographic areas. Volunteer community health workers (CHWs) participating in the MYAP

and volunteer PLWHA will be the primary providers of community-based palliative care. Additionally, the

program will focus on involving male volunteers in HIV support groups and home-based care activities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: CRS 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 with local

CBOs and other community 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 visit the CBO points

of services and to organize regular departmental coordination meetings between stakeholders.

Activity 2: Funding will be used to reinforce CRS and partner organizations' capacity to continue

strengthening in each of the five department served points of direct delivery of community services. These

points of service will be staffed with trained support and psycho-social staff, as well as with a facilitator 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.

CHWs participating in the MYAP will be linked to these points of services to build a bridge between the

points of service, sites, and the families. The community based information system which is being

developed and rolled out through CRS's points of service this year will be reinforced next year to get a good

track record of patients enrolled and of services offered.

Activity 3: To make services more accessible to PLWHA, CRS and its partners will identify other local CBOs

through which the community palliative care package could be expanded. Emphasis will be put on

identifying PLWHA's support groups and associations that are being expanded and reinforced, and on

grassroots organizations with relevant experience in providing support to PLWA or involved in other social

support services. CRS will use funding to provide these local CBOs with resources (financial, training, and

technical assistance) so that they can upgrade and become capable of offering community support services

in networking with HIV sites and other key stakeholders.

Activity 4: CRS and its partners will make a package of prevention, social support, and education services

available to PLWHA through the different points of services. They will distribute safe water products, and

drinking water bottles that will be procured through Supply Chain Management System (SCMS) to PLWHA.

They will also work with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and MOH

partners to distribute treated bed nets to PLWHA, pregnant women, and to children under five for malaria

prevention. Resources will be used to cover school fees for infected and affected children, a transit house

for PLWHA, lodging (should resources permit) based on a needs assessment. Staff from the points of

services and the MYAP community health workers will be trained through Institute Haitien de Santé

Communautaire (INSHAC) to provide education on best health practices and 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 towards infected family members.

Activity 5: Funding will be used to provide psychological and spiritual support to PLWHA by training local

authorities and religious leaders, and PLWHA groups on how to support PLWHA and their families.

Religious patients will also benefit from spiritual counseling from trained religious leaders. Community

leaders will receive guidance on how to protect the rights of affected families, particularly affected women,

and ensure that the will of PLWHA concerning disposition of their property and care for their children will be

addressed after they die.

ACTIVITY 6: CRS and partners will increase economic opportunities for PLWHA--particularly women-

headed households, widows, and pregnant women--by providing support for income generating activities.

PLWHA support groups will receive training in self-help group savings methodologies, project design and

management, organization, and small business skills. CRS will also assist support groups in the

development of bi-laws leading to their legal recognition as associations. CRS will seek linkages with micro-

finance institutions in the Development Alternative In Macrofinance and Small Enterprise (DAI/MSME)

network to improve access to micro-credit (key legislative issue: wrap around). Increased savings and

access to credit will improve the resiliency of PLWHA and their affected families by allowing them to build

up assets.

ACTIVITY 7: Activity seven will focus on providing nutritional support through linkages with Food for Peace

(FFP) Title II programs and public-private partnerships. Through CRS's Title II funded MYAP, CRS will

provide supplemental feeding rations to households with PLWHA enrolled in care and treatment based on

nutrition assessment. Targeting for supplemental feeding will prioritize: symptomatic PLWHA, PLWHA on

ARV treatment, PLWHA approaching end-of-life, and HIV infected mothers and children.

Activity 8: Through a partnership with Meds for Kids, CRS will procure a Ready-to-Use Therapeutic Food

(RUTF) called Medika Mamba (similar to Plumpy Nut) to severely malnourished PLWHA adults and

children. CRS will also procure a blended fortified flour specific to the nutritional needs of HIV+ pregnant

Activity Narrative: and lactating mothers and their children aged six to 24 months. CRS will be in charge of the distribution of

these foods to the various networks that will make them available to malnourished PLWHAs (adults and

children). This will be linked to the activities undertaken at the sites to assess and monitor the nutritional

status of PLWHA to educate and counsel PLWHA in nutrition, hygiene, and sanitation. All nutritional support

interventions will closely adhere to HIV nutrition guidelines established by WHO, FANTA, OGAC, HRSA,

and the Haitian MSPP.

EMPHASIS AREAS:

Training51-100%

Community mobilization 10-50%

Information, Education and Communication 10-50%

Linkages with other sectors 10-50%

Food/Nutrition support 51-100%

Development of referral systems/linkages 10-50%

TARGETS:

10 service outlets providing HIV-related palliative care

19,526 individuals provided with HIV-related palliative care

560 individuals trained to provide HIV palliative care

400 individuals trained in HIV-related stigma and discrimination reduction

TARGET POPULATIONS:

Community leaders, religious leaders; People living with HIV/AIDS; Caregivers; Widows; HIV-positive

pregnant women; other health care workers (CHWs); Community-based organizations (PLWHA support

groups/associations).

KEY LEGISLATIVE ISSUES:

Stigma and discrimination; gender; nutritional support; micro-finance

COVERAGE AREAS:

Nippes, South, Grande Anse, Artibonite, and Northwest Departments

SUMMARY:

This activity will provide a comprehensive package of community-based care and support for orphans and

vulnerable children (OVC) infected/affected by HIV and AIDS and will be integrated with existing clinical

programs providing services in voluntary counseling and testing (VCT), anti-retroviral therapy (ART) and

palliative care in the Nippes, South, Grande Anse, Artibonite, and Northwest Departments. Main emphasis

areas include: 1) Improving services to OVC, including addressing psychosocial needs, child rights

protection, and legal and economic support after the death of a parent; 2) improving OVC's access to health

services; 3) improving community capacity to address the needs of OVC's parents and foster families; and

4) linking institutions to communities. Areas of priority are: community mobilization/partnership, information,

education and training. CRS with health partner institutions will conduct activities in several communes of

the Nippes and South Departments. This activity will be closely integrated and managed within CRS's

Community Based Palliative Care activity to be implemented in the same geographic areas. Children of

people living with HIV (PLHIV) participating in the palliative care activity will be closely targeted. Food

support provided through Title II in the South will be linked to HIV affected families whose members will

include OVC.

BACKGROUND:

The CRS/OVC program has been working to improve the care and support offered to children and youth

affected by HIV/AIDS in five regions of Haiti since 2004 with the support of the President's Emergency Plan

for AIDS Relief (PEPFAR). In Fiscal Year (FY) 2007, CRS/OVC initiated a community-based approach in

several communes of the Nippes Department. During the FY 2008 funding period, CRS will expand

community support for OVC and ensure that children living in the communes of the Nippes, South, Grande

Anse, Artibonite and Northwest Departments have access to comprehensive HIV/AIDS services. CRS will

work in collaboration with local health structures currently providing clinical HIV services across the five

departments. CRS will work closely with 20 selected rural health centers currently providing HIV services in

the surrounding communities of Les Cayes, Miragoane, Jeremie, Gonaives, and Port-de-Paix. CRS will

implement activities through its community networks and through the Caritas/South youth network, a faith-

based organization. CRS through its partners' field trainers, its community health workers (CHWs) and

other human resources will help create links between the sites and the communities. Identifying and

monitoring the OVC infected with or affected by HIV/AIDS will be facilitated by zeroing in around the health

sites. CRS will provide a comprehensive package of education, access to health care and psychosocial

support in these areas. Particular attention will be paid to protecting the rights of and providing income-

generating opportunities to orphans, infected children and those living with people living with HIV/AIDS.

Additionally, selected communities will benefit from water/sanitation and infrastructure improvement

projects.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: CRS will improve psychosocial (PSS) services for OVC boys and girls aged eight to 18 years.

These children will be identified through the hospital-based pediatric services, PLWHA receiving palliative

care/ARV treatment at the selected partner health centers, as well as from their community outreach

programs throughout the Nippes and South Departments. OVC and their families and caregivers will receive

training in PSS from experienced staff and will receive counseling to help them manage and restore/build

self esteem, and develop social and coping skills. Family counseling will be accessible to targeted families

with limited coping capacity. Peer support groups will be formed, creating forums for OVC to express their

grief, doubts, and fears and build together hope for the future. Prevention messages will address specific

situations that these children face that make them more vulnerable than other children to becoming

infected.

Economic support will be extended in the form of income generation schemes such as animal raising, small

vegetable gardens, fruit transformation projects, etc. to children whose lost their parents to HIV/AIDS and

who are currently living with infected parents or caregivers.

ACTIVITY 2: CRS will ensure that OVC's access to health services is improved by increasing the capacity

of community members, especially caregivers, to care for HIV infected and affected children and by

enrolling OVC in primary health care services at the health center partner institutions.

Education assistance will be extended to OVC boys and girls. Children, ages six to 12 years old will benefit

from primary school support and youth from 15-18 years old scholarships of six months and one year to

attend a vocational/professional school.

Nutritional assistance will be provided to HIV affected families with OVC through the Title II funded MYAP in

the South Department. Orphaned OVC will continue to receive food support following the death of HIV

infected parents.

ACTIVITY 3: Field agents/trainers from the health centers partner institutions and community health workers

(CHWs) will be trained to sensitize and educate the general population about HIV/AIDS to reduce

discrimination and stigmatization and to promote respect for the rights of OVC and PLWHAs. Community

leaders, teachers, school directors, service providers and church leaders will also be trained in order to

reduce stigma experienced by PLWHAs, especially children. Community and foster care will be promoted.

Selected communities will benefit from water/sanitation and infrastructure rehabilitation projects.

ACTIVITY 4: CRS will continue to provide support to Caritas, a Catholic NGO, in the implementation of

their HIV/AIDS strategy, focalizing on OVC through training support for priests and program managers in

the care and support of OVC.

EMPHASIS AREAS:

Training/Education10-50%

Community mobilization10-50%

Information, Education and Communication 10-50%

Linkages with other sectors 10-50%

Local Organization Capacity Development 10-50%

Activity Narrative:

TARGETS:

TARGET:TARGET VALUE

Number of OVC served by OVC programs 5,000

Number of providers/caregivers trained in caring for OVC1,108

TARGET POPULATIONS:

Children and youth

Community leaders

Religious leaders

Community-based organizations

Faith-based organizations

KEY LEGISLATIVE ISSUES:

Stigma and discrimination

Education

Microfinance/Microcredit

Increasing girls' access to education

COVERAGE AREAS:

Nippes, South, Grande Anse, Artibonite, and Northwest Departments