INTEGRATED ACTIVITY FLAG:

This activity also relates to activities in Basic Health Care and Support (#7538).

SUMMARY: Living Hope (LH) provides a comprehensive HIV and AIDS awareness and prevention education program with an emphasis on abstinence and fidelity in schools, churches, workplaces, and community centers. The program is values-based and aimed at vulnerable and impoverished groups residing in the Western Cape peninsula, including migrants from the Eastern Cape into the Ocean View, Masiphumelele, Red Hill areas of the Western Cape. The program's major emphasis is on information, education and communication, with minor emphases on training and the development of network/referral, linkages systems. Target populations include children and youth, adults, and community and religious leaders.

BACKGROUND: LH Community Center is an indigenous South African faith-based organization (FBO) formed in 1999 in direct response to the HIV and AIDS epidemic. LH's response since 1999 has developed to include a comprehensive approach to the pandemic including: HIV and AIDS prevention programs for children, youth and adults, a 22 bed Hospice for HIV care, home-based care, and pre and post-test counseling. The LH network includes five branches in different communities, with partnerships through local churches, local Department of Health (DOH), hospitals, schools, as well as DOH clinics.

The prevention program curriculum utilizes the Scripture Union's "Reach for Life" program and Family Impact's 'Positive Parenting'. The success of LH's program is due, in part, to the development of partnerships with other community stakeholders and service providers. LH works with over eight primary schools, three churches, Vrygrond Development Trust, New World Foundation, and Next Generation. LH's PEPFAR-funded activities are a continuation and expansion of some of the first programs conducted by LH such as after school life skills programs and community interventions held in the clinic in Masiphumelele.

With FY 2007 funding, LH will continue to provide life skills education, training clubs for children and teens, HIV and AIDS awareness workshops for adults, support groups for HIV-infected individuals and training and mentorship for local churches and other community-based organizations to undertake HIV and AIDS prevention.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development LH's life skills educators are recruited from local communities and attend a life skills workshop with a local community-based organization (CBO) called Think Twice. Trainees attend a morning training workshop and are given the fundamentals of the prevention programs. Each life skills educator receives a manual containing the complete program, information on child sexual abuse and an HIV and AIDS.

The life skills educators are given follow-up support and supervision from LH's Prevention Coordinator who regularly meets with them to evaluate progress and monitor their activities.

As LH continues to build relationships with community and religious leaders, LH will conduct HIV and AIDS Awareness courses at LH facilities, churches, work places, schools, and community centers with a focus on behavior change. HIV and AIDS awareness workshops are intended to prevent adults from becoming HIV-infected by (1) increased understanding about the nature of the disease; (2) increased understanding about how HIV can be prevented through abstinence and being faithful; (3) increase overall awareness about HIV and AIDS; (4) reducing stigmatization and discrimination against people living with HIV (PLHIV).

LH is aware of the influence of the community leaders and encourages community leaders

to become advocates for HIV and AIDS awareness and prevention. The community and religious leaders are equipped with teaching materials and encouraged to teach others in their areas of influence. LH provides ongoing support as requested by various community leaders and is available for further awareness and education in local churches, businesses or community centers upon request.

LH's prevention activities aim to provide comprehensive health-related courses with an emphasis on HIV and AIDS awareness and behavior change. This activity is specifically designed to create awareness and knowledge of HIV and AIDS, with an emphasis on abstinence, and being faithful as the best means of preventing transmission. Within the Be Faithful messages, there is a strong emphasis on partner reduction.

LH trains life skill educators from local communities to educate target populations on how to make healthy choices in life and also to teach on health-related topics with an emphasis on HIV and AIDS prevention. The training for these life skills educators is provided by a variety of accredited local colleges for high quality training. The life skills educators are being taught about the varying needs of different and varied audiences including children, youth and adults. The educators address abstinence for pre-teens and youth as well as delayed sexual debut. The Be Faithful message is aimed at older teens as well as adults to help encourage faithfulness to one partner and especially the reduction of concurrent sexual partners.

ACTIVITY 2: Outreach and Education The second prevention activity is to provide in-depth education and training in health-related topics with an emphasis on life skills and HIV issues. This activity targets children and is designed to change behaviors and attitudes in order to prevent HIV and AIDS. This activity is done through partnership with local government, in public schools as well as community churches in underprivileged communities such Masiphumelele, Vrygrond Ocean View and Red Hill.

These messages are delivered through church sermons, school wide assemblies in several public schools in underprivileged communities, the development of youth and after school kids clubs in these communities, and holiday clubs during Christmas and summer holidays.

LH has implemented a life skills development program for children and youth-based on an abstinence value system. Specific activities will include weekly children's and teen's clubs that incorporate life skills training to encourage healthy life choices, including abstinence until marriage and faithfulness once married, and to enable youth to resist sexual pressures. Women and girls will be empowered through these workshops to say no to premarital, extramarital, and unprotected sex.

ACTIVITY 3: Referrals and Linkages Adults and youth will be encouraged to take an HIV test and LH will provide referrals to counseling and testing (CT) programs at Nomzano Clinic in Masiphumelele. LH's lay counselors will offer a comprehensive basket of services to people based on their HIV status. These services include South African government ARV treatment programs, clinical services, LH and other home-based care, hospice care and support groups. If an adult and youth knows their status to be HIV negative they will likely be more empowered to protect that status through abstinence/being faithful and partner reduction if already sexually active.

LH has developed a partnership with the City of Cape Town Clinic in Masiphumelele and at False Bay Hospital where LH's lay counselors conduct pre- and post-test counseling for CT clients with clinic staff conducting the rapid-tests. The client is also offered a comprehensive list of services for follow-up care or support if the client chooses. For individuals who test positive, the program will provide referrals to support groups to encourage positive living and will ensure treatment access.

This activity will enable LH to reach hundreds of youth and adults with the abstinence and faithfulness messages. This feeds into the PEPFAR 2-7-10 goals of 7 million infections averted by helping adults and youth reduce risky sexual behavior.

INTEGRATED ACTIVITY FLAG:

This activity relates to Living Hope's (LH) activity in AB prevention (#7537). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations

SUMMARY:

LH will provide in-patient hospice care and home-based care (HBC) for HIV-infected individuals in the Western Cape peninsula. The program will also provide elements of the preventive care package, post-test counseling and support groups for PLHIV. The emphasis areas include human resources, training and the development of network/linkages/referral systems. Target populations include PLHIV and their affected families.

BACKGROUND:

Living Hope Community Center is an indigenous South African FBO formed in 1999 in direct response to the HIV and AIDS epidemic. The activities below are ongoing; PEPFAR funding for this activity began in 2005, helping to expand LH's reach into high risk communities with HBC, caring for caregivers and providing hospice-based services and referrals.

LH is working in partnership with the False Bay Hospital by providing a lay counselor for PMTCT counseling and support and with a local government clinic in Masiphumelele where lay counselors assist in offering pre and post-test counseling.

LH coordinates with the DOH to ensure that their care activities complement the HIV and AIDS strategy of local government facilities and strengthening their prevention and care policies. With non-PEPFAR funds, LH has also constructed a 22 bed hospice to care for HIV-infected patients referred by local hospitals and HBC givers in the surrounding communities to offer culturally appropriate end-of-life care, symptom and pain management, and referral for ART.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

All members of LH's HBC and hospice staff receive specialized training in palliative care including the basic preventive care package. Each HBC giver attends the four month full-time accredited DOH training over a period of 12 months. LH will continue to support the DOH in these training efforts with FY 2007 funding.

LH will provide comprehensive HBC to people in four Western Cape communities - Masiphumelele, Ocean View, Red Hill, and Muizenberg. This specifically includes People living with HIV (PLHIV), adults and children who are HIV-infected. The HBC visits incorporate nursing care, personal hygiene, HIV and AIDS education to infected individuals and family members, screening for symptoms and pain and referral when treatment it is unavailable through routine nursing care. All patients are assessed and referred for ART.

LH utilizes a family-centered approach to the provision of care. HBC caregivers spend time in the homes of those who are ill and get to know the client's family, presenting an opportunity to provide training and support to the family caregivers. This includes discussions on knowing one's HIV status and PMTCT for pregnant women. This training and support for the caregivers of OVC and PLHIV will include a comprehensive package of basic information about caring for their family member, pain and symptom management and relief in the administration of care. Preventive measures in home-based care are also covered. The hospice also provides ARV treatment and clinical care for those eligible (treatment is procured and funded by the Western Cape DOH).

The HBC activity also includes the services provided at the Wound Dressing Clinics in Masiphumelele, Muizenberg, and soon to be Ocean View Communities. These locations

and services provide an effective means to establish relationship with those individuals who are HIV-infected and need HBC or other services. It is also an opportunity to encourage all individuals to get tested.

As part of the HBC activity a system will be established for the referral of HIV-infected individuals needing holistic inpatient and/or hospice services (including those experiencing acute HIV-related illnesses, including TB and other opportunistic infections) to LH's hospice or other appropriate healthcare institutions for preventive care and symptom and pain management. A system will also be established for the referral and follow up of ARV treatment-eligible patients to the nearest public health treatment site.

ACTIVITY 2: In-patient Hospice Care

LH will provide holistic in-patient care at our 20 bed hospice facility. The hospice is specifically equipped and designed to care for adults, children and infants with pain and symptom management such as those who are experiencing acute HIV-related illnesses including TB and other opportunistic infections as well as any other HIV and AIDS complication requiring inpatient care. In addition to short-term hospice care, LH and its staff provide a place to die in peace and dignity with psychosocial and culturally appropriate spiritual support to the patient as well as their family members.

The hospice is part of a network of care and support offered by LH that works in collaboration with government and other NGO HIV and AIDS services in the area such as ART, counseling and testing and clinical support including the basic package of care. LH also provides transportation for clients to access any of the medical or care services required in the area from hospital care, clinical results or collecting the ARVs for patients at the LH hospice.

ACTIVITY 3: Non-clinical care and support

As part of providing comprehensive palliative care, LH places an emphasis on meeting emotional and spiritual needs. There are monthly support groups and one-on-one counseling available for HIV-infected community members where they find acceptance, hope, encouragement and support needed to live a productive and satisfying life. Those who attend are also coached in how to plan for their family members who may be affected by an HIV-infected member of the household. LH's social workers link the OVCs and other vulnerable family members to social services, government grants where applicable, non-USG nutritional support through garden projects or temporary food parcel delivery, skills training, as well as ongoing emotional and spiritual support.

ACTIVITY 4: Referrals & Linkages

The referrals system links HIV-infected people from initial pre and post-test counseling with LH lay counselors to appropriate next level of service such as psychosocial support, home-based care, government clinic or hospital services, PMTCT support or hospice care.

LH is in the process of developing a planned approach to South African Business inviting partnerships with those businesses looking to fulfilling their social responsibility to reduce HIV infections in the workforce.

All additional members of the HBC and Hospice staff are receiving specialized training in palliative care, including the basic package delivered by the provincial department of health. This will extend over a 12 month period as each HBC attends the 4 month full-time DOH training.

This activity specifically contributes to the overall PEPFAR objectives of 2-7-10 by providing direct health care, emotional and spiritual support or those who are HIV-infected and their families.