SUMMARY:

The activities in this country-funded concept paper are new, and represent both an expansion in geographic

and programmatic scope. Specifically, the proposed interventions entail:

(1) Scaling up core TWC activities through expansion to two new sites in Nippes and the North West

(2) Promoting parent/trusted adult -youth communication about healthy sexual behavior which has been

shown to serve as a protective factor for youth

BACKGROUND:

The existing Scaling-Up Together We Can (TWC) project uses three outreach strategies -curriculum-based

interventions, peer to peer outreach, and edutainment events - to provide Haitian youth with knowledge and

essential skills to avoid HIV infection. The primary target populations are primary and secondary students

and out-of-school youth including OVC, restavec (marginalized domestic servants), and street youth ages

10-24 with a focus on youth ages 15-19. TWC currently works through HRC branch offices in the following

seven geographic areas: Pétionville, Cité Soleil, Petite Goâve, Cap Haitian, Fort Liberté, Ounaminthe and

Anse-à-Pitres. Partnership building, capacity building of the Haitian Red Cross (HRC), and the engagement

of adult stakeholders such as parents and teachers are also key elements of the project in order to create

an enabling environment for youth outreach and community mobilization to occur.

Recommendations from "Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from

Developing Countries, UNAIDS Inter-agency Task Team on People (World Health Organization: Geneva,

2006) and continual review of the Haitian TWC program context, suggest that encouraging adult-child

communication on sex and contraception, working with others to strengthen and improve access to

condoms and quality of coverage in project areas, and partnering with USAID-funded agencies engaged in

mass media and other forms of BCC will better enable youth (and adults) to protect themselves against

HIV/AIDS. We will use the existing TWC network to implement these additional activities.

SUMMARY:

The activities in this country-funded concept paper are new, and represent both an expansion in geographic

and programmatic scope. Specifically, the proposed interventions entail:

(1) Increasing demand for and access to condoms by working with Population Services International (PSI),

communities and other partners to:

a) increase reliable supply of condoms through the local private and public sector outlets

b) supply free condoms through Together We Can (TWC) project activities including community

edutainment events

c) better integrate a Behavior Change Communication (BCC) approach around condoms into TWC

programming through disseminating Haitian Red Cross (HRC) Information Communication & Education

(IEC) materials in coordination and harmonization with partner organizations

BACKGROUND:

Recommendations from "Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from

Developing Countries, UNAIDS Inter-agency Task Team on People (World Health Organization: Geneva,

2006) and continual review of the Haitian TWC program context, suggest that encouraging adult-child

communication on sex and contraception, working with others to strengthen and improve access to

condoms and quality of coverage in project areas, and partnering with USAID-funded agencies engaged in

mass media and other forms of BCC will better enable youth (and adults) to protect themselves against

HIV/AIDS. We will use the existing TWC network to implement these additional activities as it is expanded

into two new geographical areas where condom coverage is under 50% while HIV prevalence is 1-3%. This

expansion includes a more complete TWC model that includes two new activities: adult-youth

communication training and reliable free condom distribution via trusted peer networks and other

interventions to improve condom supply.

ACTIVITIES AND EXPECTED RESULTS

Activity 1: Addition of condoms to current ABY program of condoms and improved BCC messaging around,

in order to increase the demand for and reliable supply of condoms in underserved project sites.

Since the program's inception, the American Red Cross and its implementing partner, the Haitian Red

Cross, have provided complete information to its youth beneficiaries in accordance with Emergency Plan

ABC guidance. In particular, the curriculum directly addresses multiple sex partners, and early sexual

initiation norms and behaviors. Additionally, activities on individual and peer attitudes towards condoms,

condom negotiation, and proper condom usage are built in. The TWC program is currently finalizing its

newly revised Haitian curriculum, which incorporates further enhancements including the addition of risk

factors relating to cross-generational and transactional sex, and greater emphasis on each youth participant

individually practicing self-efficacy building exercises linked to the use of condoms.

The new curriculum features referrals to condoms sales points combined with ‘take-home assignments'

where beneficiaries locate and visit these sales points and other reproductive and sexual health services in

their communities. However, research (specifically from PSI's MAP Survey) as well as feedback from

project participants and key informants have pointed to limited coverage, quality of coverage and access to

condoms as barriers to condom use, particularly in the rural communities it serves. The American Red

Cross proposes to enter into partnership with the main condom distributor in Haiti - PSI - to investigate the

demand and access issues in project areas, and agree upon area-specific strategies for condom distribution

that may include:

1) facilitating community meetings to determine appropriate actions and actors to ensure a regular local

supply of condoms

2) HRC TWC staff and peer educators monitoring and feeding back to PSI its own supply (where

applicable) and that of its referral sites (private sales points as well as free distribution venues) in project

areas

3) distributing free condoms during TWC events - curriculum-based training, community edutainment and

mobilization events, follow up events etc.

4) making free condoms available at Red Cross offices in target areas

ARC hopes to greatly enhance several protective factors for sexually active and high risk youth. At the

branch level, HRC will work with PSI to facilitate a planning process for the dissemination of condoms and

BCC materials (by conducting community meetings with the participation of community councils, HRC

branch staff, volunteers, and potential private sector and CSO partners who together can determine the

best approach for making condoms available to the community).

Additionally, Peer Educators (PE) will increase self-efficacy of TWC participants by providing reliable

sources for male condoms and BCC messages at TWC sessions, follow up activities, community

mobilization and edutainment events. Where needed, condoms will be distributed as part of a knowledge

and skill-building activity that advocates the twin TWC messages of risk reduction and risk elimination

through promoting ABC approaches to prevent HIV, STIs, and unintended pregnancy/parenthood. By doing

so, PEs, while typically at least 3 years older than the youth they target, will be promoting positive peer

norms and support for condom and contraceptive use, a positive determinant for condom use, and a

protective factors against HIV, STIs, and unintended pregnancy and parenthood.

Condom availability and distribution during TWC sessions and activities and through local Red Cross

branches enhances the deficient local supply as well as the perceived self-efficacy of participants to secure

condoms, thereby increasing uptake. Regular monitoring of both local condom supply, ruptures and

availability of youth friendly distribution points in our rural target areas will not only help our internal

distribution and referral system but also be communicated to PSI which will assist them and other partners

to respond to the 2006 MAP recommendation to improve monitoring. This feedback loop coupled with the

facilitation of community planning sessions through the HRC will enable PSI to identify or strengthen local

"point of sale" partners and social marketers for underserved rural regions.

SUMMARY

Activity Narrative:

This activity contributes to the Emergency Plan 2-7-10 goals by preventing new HIV infections among

Haitian youth and adults through the improvement of knowledge, attitudes, and skills pertaining to

HIV/AIDS, as well as access to services and commodities.

TARGETS:

Number of targeted condom service outlets at HRC branches

Over 610,000 condoms distributed to high-risk youth and adults.

*Please note that these numbers are IN ADDITION TO the number of beneficiaries reached in the COP08

central funded activity narrative through core TWC activities.

LEGISTLATIVE ISSUES

Activities in the proposed expansion branches will be implemented as described in the COP08 central

funded activity narrative (activities 1-3). These community-based activities will address the following issues

of legislative interest: gender equity, male norms and behaviors, female access to income and productive

resources, and stigma and discrimination. They will also benefit from additional condom outreach and

BCC/IEC materials if funding is secured for these interventions.