INTEGRATED ACTIVITY FLAG:

In addition to AB Activities, the Salvation Army is carrying out activities in the Basic Health Care and Support (#7551) and OVC (#7552) program areas.

SUMMARY:

The message of Abstinence and Be Faithful (AB) is promoted through two interventions: (1) Youth Mentors are equipped and resourced to deliver a values-based AB curriculum to youth in a school context or as part of a peer education group; and (2) Pastors are equipped to effectively promote AB to their congregations through integrating the message into standard church activities (sermons, funerals, groups of women, men, youth, etc.). The major emphasis area of this activity is information, education and communication of AB messages; and the minor area will be training and community mobilization in promoting AB as a lifestyle.

BACKGROUND:

The Salvation Army is an international Christian denomination with specific community programs to address all aspects of HIV and AIDS through community-based care and prevention programming: home-based care, provision of OVC psychosocial support, individual pre- and post-test counseling, clinical care of opportunistic infections, community counseling, and youth mobilization. Matsoho A Thuso is a care and prevention project that began in November 2004 with PEPFAR funding. Prevention activities focus on capacitating Salvation Army churches to address HIV prevention through training pastors and church volunteers to conduct outreach in churches, schools and the wider community. The project currently operates in 58 sites with Youth Mentors going to different schools to promote AB during the Life Orientation classes. This is done in conjunction with the Department of Education on local levels. Salvation Army also operates in 33 sites with Pastors promoting the message in churches and surrounding communities, in eight of South Africa's nine provinces, many of which are in rural and underserved areas.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training of Youth Mentors

Salvation Army will train South African volunteers as Youth Mentors. Youth Mentors are equipped to assist in the facilitation of Life Orientation lessons, to conduct school assemblies, and to lead peer support groups for youth who wish to commit to a lifestyle of abstinence before marriage. The curriculum used for this purpose contains 30 lesson plans complete with student activities that will assist youth in building the skills they need to pursue abstinence before marriage. These include development of the ability to attach consequences to actions, assertiveness and the ability to withstand peer pressure. The curriculum also challenges misperceptions about male norms and behaviors in order to assist in addressing issues related to gender. The learners are challenged to see that boys and girls have the same responsibility with regards to reducing the spread of HIV and AIDS. Girls are empowered with the necessary information and skills to delay their sexual debut even when they are pressured by their male counterparts. These lessons are planned to suit learners from higher primary to secondary school levels. Youth Mentors will be expected to represent the values of the program and act as role models to in-school youth. As of June 2006, 95 Youth Mentors have been trained to implement A and AB outreach activities in the school setting. FY 2007 funding will be used to train additional Youth Mentors and to increase the support and supervision provided to program volunteers to ensure the intensification of services.

ACTIVITY 2: AB Outreach in Schools/Peer settings

Youth Mentors will promote abstinence before marriage for children aged 14 and below, and abstinence before marriage and faithfulness within marriage to youth aged 15 and above in a school or peer group setting. The program will support the South African Government (SAG) lifeskills program in schools through providing AB prevention services throughout the country. Youth Mentors will be assigned to schools identified in collaboration with the SAG Department of Education for two terms. Each Youth Mentor will

conduct 30 lessons for each class. Lessons also include development of character and promotion of abstinence as a way of life. The curriculum also challenges misperceptions about male norms and behaviors. This has been a useful tool to address issues of gender equality and gender equity among the youth and the prevention programs are made accessible for both boys and girls. Initially it was planned that youth mentors would visit schools twice a week, however most schools have requested that Youth Mentors provide services daily. Youth Mentors will ensure that all OVC identified in schools are referred to the OVC program. As of June 2006, this activity has reached over 16,000 youth with A and AB messages.

ACTIVITY 3: Mobilization and Training of Church Leadership

The third activity is to mobilize church leadership (pastors) to effectively engage their congregations on issues of abstinence and faithfulness. Salvation Army will capacitate pastors to find positive language that extols the benefits of abstaining before marriage and being faithful within marriage, and to aid them in giving their congregations tools that will further reinforce the message. Pastors will be trained using a field-tested curriculum to introduce abstinence and faithfulness and related topics of character building into sermons, Bible Studies, groups of youth, men, women, etc. In the period ending June 2006, a total of 62 pastors were trained from 62 churches. In FY 2007 the project will train an additional cadre of pastors to intensify and expand service delivery. Project staff will provide supervision and support to pastors to ensure that prevention activities are being implemented in each church. Pastors will also be encouraged to take a leadership role supporting the care and support and OVC programs run by the Salvation Army. This will ensure that linkages are made between the different components of the project and will provide mentorship to the volunteers.

ACTIVITY 4: Outreach activities for congregation members

Pastors will exercise their influential status in communities to address the prevention of HIV through encouraging the adoption of A and B behaviors. Pastors will discuss the reduction of multiple and/or concurrent partners as a methodology to mitigate the spread of HIV in their communities. Anecdotal reports indicate that the corps/churches that are implementing the program demonstrated an increased awareness to the fact that benefits of prevention will be attained through Abstinence and Being Faithful. Pastors will disseminate values-based information and education in church and community gathering settings including at sermons, funerals, and during women's, men's and youth group activities.

Salvation Army's prevention activities will contribute to PEPFAR's goal of averting 7 million HIV infections among adults and youth.

INTEGRATED ACTIVITY FLAG: This activity relates to Salvation Army's activities in AB (#7550) and OVC (#7552). 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: The Salvation Army will provide through a trained cadre of volunteers home-based palliative care (HBC) to people living with HIV and AIDS in order to contribute to their quality of life, provide spiritual and psychological support to the client and their family, monitor the client's health, and facilitate access to clinical care. This activity will focus on training, in addition to community mobilization/participation and the development of network/linkages/referral systems.

BACKGROUND: The Salvation Army is an international Christian denomination that addresses all aspects of HIV and AIDS through community-based care and prevention programming: home-based care, provision of OVC psychosocial support, individualized pre- and post-test counseling, clinical care of opportunistic infection, community counseling, and youth mobilization. Matsoho A Thuso is a care and prevention model begun in November 2004 with PEPFAR funding. Palliative care activities focus on capacitating members of Salvation Army churches to provide psychological, social, spiritual and limited clinical support to people living with HIV and AIDS in their communities. The project currently operates in 50 sites in eight of South Africa's nine provinces, many of which are in rural and underserved areas. In FY 2007 Salvation Army will expand and enhance care activities through retraining of caregivers as well as providing a comprehensive range of services to the HBC clients.

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Training of Caregivers The main objective of the training is to increase skills in delivery of quality palliative care services including elements of the preventive care package. Utilizing the Salvation Army's extensive volunteer base, the Salvation Army will train and equip community members to carry out basic home-based care services. The training will be conducted by an accredited service provider with South Africa's Health and Welfare Sector Education and Training Authority. Each home-based caregiver will also receive a basic home-based care kit containing equipment such as gloves, disinfectant and bandages to ensure that they are able to provide an acceptable quality of care to people living with HIV and AIDS throughout the country while maintaining adequate precautions. In the first year of the project, a total of 101 caregivers have been trained to provide services. In order to intensify and improve the quality of services in FY 2007, additional caregivers will be trained. On-going mentoring and supervision will be provided by health facility staff and Salvation Army trainers to promote the retention of volunteers and to minimize burn-out. Increased participation by men will be encouraged in service delivery (key legislative area).

ACTIVITY 2: HBC Services Trained caregivers will identify clients in consultation with the community. Home visits will be conducted four times a month to provide clinical as well as social, psychological or spiritual services. Services provided will include elements of the preventive care package, assistance with bathing the client when s/he is unable to do so, tending to household duties when needed, providing spiritual and psychological support to the client and their family, and monitoring the client's status over time which will assist qualified health care providers in the management of opportunistic infections. A checklist with comprehensive palliative care services will be used to track the services rendered. Thus far Salvation Army has provided care and support to 538 HIV-infected individuals. In FY 2007 Salvation Army intends to intensify and expand services provided to HIV-infected individuals and their families. This activity will also contribute towards reducing stigma and discrimination against people living with HIV. The project aims to foster a culture of support and acceptance for people living with HIV and AIDS and their families by involving community members in care and support activities. Home-based care volunteers also make use of the opportunities given to address any misconceptions the family or the community may have about HIV and AIDS as well as applying the preventive care package. Family members of the HIV-infected individuals will also receive at least two support services (psychosocial, spiritual, etc) from the checklist of the services. Any OVC identified during HBC visits will be referred to the OVC program.

ACTIVITY 3: Strengthen Referrals Networks In order to ensure that HIV-infected individuals and their families receive appropriate care and support, Salvation Army will improve their linkages with other organizations, particularly in terms of increasing access to clinical care. Salvation Army will regularly map services available in each site and develop a formal referral system to other community health structures. This will ensure that beneficiaries are able to access services that are not provided by the Salvation Army (such as provision of ARVs). The patients will be referred and a proper follow-up will be made by home-based caregivers so that the program can track their progress and address any problems identified with the relevant authorities. The program will focus on strengthening relationships between caregivers and public clinics and hospitals in order to facilitate effective referrals and to provide additional support for volunteers from clinically trained professionals. In addition, Salvation Army will also explore partnerships with other private organizations and institutions in order to provide additional support for the program and to move towards ensuring the sustainability of activities. Monitoring and Evaluation (M&E) is an important component of this program and a comprehensive M&E structure has been set up to help track number of services provided by the caregivers as well as the progress made by patients.

The Salvation Army will use plus up funding to expand care and support services by increasing the set targets and as well as improving the quality of care provided. We will train additional Caregivers who will provide care to more clients, and we will also increase the scope of care provided. Plus-up funding will help The Salvation Army upscale the services and the targets. In addition, TSA will use the plus-up funding to add an additional activity: Wellness Program for Caregivers.

Activity 4: Wellness Program for Caregivers. The Salvation Army has identified the need to provide care and support services to caregivers to ensure that caregivers avoid burnout, receive care for medical conditions and are able to provide services to clients effectively. TSA will partner with local health facilities to offer on-going counseling and testing and health screening (for TB, diabetes etc.) to all caregivers. These screening services will be an entry point for further services from a specialized cadre of senior HBC service providers who will be trained to provide on-going HIV prevention education and counseling, debriefing services, run support groups for caregivers, provide support for clinic visits and adherance, counselling and referral for services related to gender-based violence and to assist with linking caregivers to income generation projects and with further educational opportunities. These interventions will assist in improving the health and well-being of caregivers and increase the sustainability of the program.

These activities contribute towards PEPFAR's goal of providing 10 million people with care including people living with HIV and AIDS and their families by increasing access and quality of care.

INTEGRATED ACTIVITY FLAG:

In addition to OVC activities, the Salvation Army also implements activities in AB (#7550) and Basic Health Care and Support (#7551).

SUMMARY:

The Salvation Army will provide OVC with a comprehensive range of services through the establishment of OVC Support Centers, which will offer psychosocial support, access to government grants for eligible OVC, school fee exemption, and referrals to other service providers such as social workers. Through leveraging community resources, trained community members will also facilitate access to feeding schemes and educational support (including assistance with uniforms and school materials). The major and minor emphasis area for this activity is training and building the capacity of the volunteer caregivers to respond more effectively to the needs of the OVC, community mobilization/participation and the development of networks, linkages and referral systems. Key target populations are OVC, families affected by HIV and AIDS, caregivers and volunteers.

BACKGROUND:

The Salvation Army is an international Christian denomination with specific community programs to address all aspects of HIV and AIDS through community-based care and prevention programming including home-based care, psychosocial support for OVC, individualized pre- and post-test counseling, clinical care for opportunistic infections, community counseling, and youth mobilization. Salvation Army developed Matsoho A Thuso, a care and prevention model in November 2004 with PEPFAR funding. This model includes care and support activities for OVC in accordance with South African Government (SAG) OVC policy. Salvation Army works to capacitate communities to care for OVC through training volunteers, offering outreach services and mobilizing community resources. The project currently operates in 70 sites in eight of South Africa's nine provinces, many of which are in rural and underserved areas. In FY 2007 Salvation Army will intensify and enhance OVC care and support activities through training new caregivers as well as retraining existing caregivers on a range of care and support services for OVC and their families.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

To respond to the needs of OVC, The Salvation Army has developed a training course for its community networks to establish and strengthen services for OVC. Volunteers attend a 5-day training course based on a collection of resources used practically in the field to equip them with skills to employ child-friendly interactive methodologies to identify and support OVC and to set up OVC Support Centers in their communities, providing children with a range of support services. The collection of resources that will be used includes practical exercises which cover the following topics: defining and identifying OVC, practical skills for care and support, establishing and managing an OVC support center,

understanding and accessing the SAG social support system, and basic monitoring and evaluation. Community volunteers are identified and profiled from local congregations and return to serve their communities after training increasing community support for OVC. Community volunteers will be provided with ongoing, on-site support and mentorship by skilled program staff. In the period ending June 2006, 85 volunteers were trained as OVC caregivers. In FY 2007 the Salvation Army will train additional caregivers to expand service delivery and enhance the quality of care provided through intensive supervision.

ACTIVITY 2: Establishment of OVC Support Centers

This activity involves the establishment of OVC Support Centers in communities where The Salvation Army already has a presence. Through extensive outreach to churches, community leaders and networks, community volunteers will inform the community of the establishment of the OVC Support Center and its services. As a result of this outreach, OVC will come to the OVC Support Center where their needs will be assessed and documented. OVC will then be provided with a comprehensive range of services based on each child's individual needs that include, but are not limited to, psychosocial support (primarily through child-friendly participatory approaches), building resilience, life skills and assistance in accessing SAG social support systems (including HIV prevention advocacy on behalf of OVC and their families). Volunteers will also negotiate with schools to help OVC obtain school-fee exemptions to ensure OVC have access to education. In addition, OVC will be linked to existing community resources for the provision of food, school uniforms and supplies. All outreach activities will be sensitive to gender and will address gender issues that arise in the equity of access to services through the routine monitoring of service data. Any imbalances detected will be addressed. In the period ending June 2006, Salvation Army provided services to just over 2000 OVC. FY 2007 funding will be used to intensify and enhance OVC services. Salvation Army will facilitate the referral system to ensure that the OVC have access to health and treatment services.

ACTIVITY 3: Establishment of referral networks and linkages

When volunteers identify cases they are not equipped to deal with, referrals will be made to relevant service providers such as child protection services, health care providers and social workers. The Salvation Army will form linkages and partnerships with existing specialized service providers such as social workers, police, child protection units and child health systems to improve and/or increase access to such services as well as to public and private institutions providing pediatric ARV treatment and services for HIV-infected children. Through utilizing established networks (such as women's groups, study groups, and Sunday School programs) and private and public sector partnerships, the Salvation Army will be able to access other community resources to further enhance OVC outreach initiatives. Reports on activities and data will be routinely forwarded to the local Departments of Social Development to share data and information contributing to national statistics of the OVC profiles the country and leveraging more support and resources for the OVC. This will improve the quality of service delivery and the services rendered and ensure that the program is in line with SAG policy, guidelines and priorities.

This activity will contribute to PEPFAR's goal of providing care and support to ten million people affected by HIV and AIDS including OVC and their families.