INTEGRATED ACTIVITY FLAG:

In addition to AB activities, the Health Policy Initiative (HPI) will carry out activities in Basic Health Care and Support (#7603), Strategic Information (#7605), Condoms and Other Prevention (#7606) and Policy Analysis and Systems Strengthening (#7604).

SUMMARY:

HPI is a follow-on to the POLICY Project funded by USAID. HPI is tasked with supporting the implementation of policies and programs to integrate gender, stigma and discrimination into USG programs. HPI will contribute to PEPFAR goals by providing technical assistance and capacity building to local partners at the national, provincial and community levels to identify and address the operational barriers that impede the expansion of HIV and AIDS programs. The project will work with faith-based organizations (FBOs), traditional leaders (TLs), and community-based organizations (CBOs) to develop and implement AB prevention messages and programs and to assist these organizations to systematically identifying program gaps and barriers to uptake or dissemination. Partners will target adults, youth, people affected by HIV and AIDS, community and religious leaders, CBOs and FBOs. Activities will focus on improving knowledge about HIV, behavior change to reduce risk, community mobilization and participation in HIV and AIDS related prevention programs. Emphasis areas are training in AB, with special focus on behavior change, and community mobilization and participation. The key legislative interest areas for training will address male norms and behaviors, and reduce gender-based violence and coercion, stigma and discrimination.

BACKGROUND:

HPI is a follow-on to POLICY Project with the focus on policy dialogue. HPI empowers new partners to participate in policy making process. With an additional focus on policy implementation, the initiative helps organizations translate policies, strategic plans, and operational guidelines into effective programs and services.

HPI will continue to build and strengthen the capacity of organizations and institutions across all sectors to design, implement, and evaluate comprehensive HIV and AIDS prevention, care, and support programs and policies. Project assistance focuses on improving multi-sectoral capacity and involvement in the country's national HIV and AIDS program by assisting different role players in developing and implementing effective advocacy strategies for HIV and AIDS; facilitating effective planning for HIV and AIDS programs; increasing the information used for policy and program development; and strengthening collaboration between government and civil society organizations (CSOs) and institutions working in HIV and AIDS.

The activities proposed under HPI will: 1) focus on the devolution of capacity building and training in AB programs to district level for TLs and to FBOs; 2) provide technical assistance to TLs and faith-leaders to ensure their training skills are used and appropriate prevention messages are being disseminated in communities; and 3) build the capacity of traditional and faith leaders to identify barriers to uptake or expansion of prevention programs. In this period HPI will also work in partnership with the South African National AIDS Council (SANAC) and the National House of Traditional Leaders. HPI will partner with SANAC to provide direct technical assistance to TL structures in South Africa.

Traditional Leaders: It is estimated that over 16 million people live in the rural areas that are under the jurisdiction of TLs. These TLs command respect and have significant influence on the day-to-day running of many rural/peri-urban communities. They are also key players in the governance structures of South Africa, particularly at the local level, and are therefore well placed to mobilize communities to access and use services. In 2001, a partnership between the National Department of Health (NDOH) and the Nelson Mandela Foundation (NMF) supported the formation of the National TLs' HIV and AIDS Forum and the development of a national strategy by TLs to address the challenges of HIV and AIDS. Building the organizational and technical capacity of the TLs' forum to implement their national HIV and AIDS prevention strategy and to undertake prevention programs at the community level are at the nascent stages of development.

Faith-Based Organizations: South Africa is a multi-faith country. FBOs are rooted in the community and are in a strong position to mobilize communities to address the challenge of HIV and AIDS. They can promote prevention strategies, mobilize communities against stigma and discrimination, and provide community-based care and support to people infected or affected by HIV and AIDS. The capacity of many FBOs to develop appropriate training materials or to design and implement effective programs varies considerably.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Traditional Leaders

HPI will conduct one three-day training workshop for 30 TLs in each of six provinces. There will be one workshop per province namely, Kwa-Zulu Natal, Eastern Cape, Mpumalanga, Free State, Limpopo and North West. The training will focus on the design, planning, and dissemination of successful AB prevention messages and will include strategies to reduce community level stigma and discrimination and raise awareness of the impact of gender-based violence on women's access to prevention programs. Trainees who are TLs will include AB prevention messages into one TLs' council meetings once a month. The training materials used throughout this activity will be developed by HPI. HPI will follow up with a subset of trainees to: 1) assess the activities carried out; 2) identify the challenges and opportunities TLs are experiencing in disseminating AB messages; and 3) provide technical assistance to the TLs to strengthen their skills in order to address implementation challenges.

ACTIVITY 2: Faith-Based Organizations

In partnership with the Seventh Day Adventist Church of South Africa, HPI will implement a national training program aimed at expanding AB prevention programs within this faith community. HPI will facilitate provincial training workshops of three days each for 30 HIV and AIDS committee members of the church in each of the nine provinces. Trainees will develop action plans to disseminate AB prevention messages and conduct prevention outreach activities within the church communities. HPI will follow up with a subset of those who participated in training to assess: 1) the degree to which participants were able to implement their action plans; 2) the challenges and opportunities trainees encounter in their community; and 3) to reinforce skills learned in the provincial training workshops in order to build a sustainable cadre of trainers.

The trainees for faith based organizations will be comprised of faith-based HIV and AIDS committee members and other members of the broader church community. Technical assistance will include the development of the training curriculum by HPI.

The activities outlined above will contribute towards meeting the vision outlined in the USG Five-Year PEPFAR Strategy for South Africa by mobilizing and training FBOs and TLs and equipping them with skills to promote AB prevention programs in their communities and churches.

INTEGRATED ACTIVITY FLAG:

In addition to the Condoms and Other Prevention activity, Health Policy Initiative (HPI) will also carry out activities in AB (#7602), Basic Care and Support (#7603), Strategic Information (#7605), and Policy Analyses and Systems Strengthening (#7604).

SUMMARY:

Several studies have shown a clear correlation between male circumcision (MC) and HIV prevalence. A four-country study in Africa by Auvert et al (2001) confirmed the population and individual-level association between HIV and the lack of male circumcision. Cross-sectional studies have demonstrated a willingness by men to undergo the procedure based on its presumed preventive effect. Three randomized-control trials were initiated in Kenya, Uganda and South Africa to assess to what extent circumcision intervention may have a protective effect against HIV acquisition in adult men. So far, results from one study in South Africa appear to confirm this hypothesis.

With FY 2007 funding HPI will convene a two-day workshop with national leaders from government, national and regional experts, and people living with HIV and AIDS and will draw on the work done by PHRU with nurses and HSRC with traditional healers. The workshop will form the basis of a policy analysis of the impact of pending South African legislation restricting male circumcision to medically defined conditions and for cultural practices. This activity will build on the work done by Perinatal HIV Research Unit (PHRU) (#7881) in comparing the feasibility and acceptability of alternative models of male circumcision and the Human Sciences Research Council (HSRC) (#7314) study of with traditional healers. In all three cases the activities will concentrate on policy issues surrounding circumcision within the South African context rather than on actual service delivery. The issues of legislative interest are male norms and behaviors, and stigma and discrimination.

BACKGROUND:

HPI is follow-on to the POLICY Project funded by USAID tasked with supporting the implementation of policies and programs to integrate gender, stigma and discrimination into USG programs. HPI will contribute to PEPFAR goals by providing technical assistance and capacity building to local partners at the national, provincial, and community levels to identify and address the operational barriers that impede the expansion of HIV and AIDS programs.

Researchers have cautioned that circumcision is not only a policy or health services issue. It embodies important cultural and religious beliefs in some communities, while there are cultural and religious issues surrounding the practice in other communities. It is also recognized that, for circumcision to be introduced as an intervention, many processes would have to be undertaken, including training of medical and traditional practitioners who conduct the majority of these procedures. If MC is confirmed by clinical trials to have a protective effect and is endorsed as a prevention strategy by major normative bodies such as the World Health Organization and UNAIDS, it will be critical for government and other key stakeholders to understand the implications of providing MC services within their prevention programs and for society as a whole.

In South Africa, male circumcision is a procedure that is usually done for cultural or religious reasons rather than for health benefits. This is seen among certain ethnic groups such as the Xhosa who routinely practice male circumcision as part of initiation to transition boys to manhood. In such cases the circumcision is done by traditional healers rather than by medically trained in a health facility. Since it is a surgical procedure, there are risks involved in traditional male circumcision. Partly in response to reports of adverse events surrounding traditional male circumcision, the South African Government is considering legislation to restrict circumcision to only medically defined conditions and for cultural practice.

ACTIVITY 1:

With FY 2007 PEPFAR funding, HPI will conduct a policy analysis of MC within the South

African context and convene a two-day workshop with national leaders from government, national and regional experts, and people living with HIV and AIDS and will draw on the work done by PHRU with nurses and HSRC with traditional healers who will be invited to a plenary sessions to present the scientific evidence and policy, public health, economic and cultural issues related to introducing MC as an HIV prevention strategy in South Africa. The analysis will examine the potential impact of pending South African legislation restricting circumcision to treating medical conditions and when it is part of culturally accepted practice. By bring into the dialogue the myriad of key stakeholders, such as traditional leaders, community groups, provincial authorities, and the medical establishment together, the analysis and workshop will support efforts to implement MC in a safe and culturally appropriate manner.

A report summarizing the policy analysis and the workshop be prepared and disseminated to all key stakeholders including the NDOH and other policymakers, the medical community, traditional healers, civil society groups.

The activities outlined above will contribute towards meeting the vision outlined in the USG Five-Year PEPFAR Strategy for South Africa by mobilizing and training faith-based organizations and traditional leaders and equipping them with skills to promote AB prevention programs in their communities and churches.

With the additional $50,000 reprogrammed into this activity from HSRC, all of the above dimensions of this activity will be enhanced and reach full potential.

INTEGRATED ACTIVITY FLAG:

This activity relates to The Health Policy Initiative activities in AB (#7602), Strategic Information (#7605), Condoms and Other Prevention (#7606) and Policy Analysis and Systems Strengthening (#7604). 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:

This activity is aimed at partnering with key civil society organizations focusing on mobilizing People Living with HIV and AIDS (PLHIV) to access basic preventive care services. The Health Policy Initiative Project (HPI) has technical expertise and existing nationally-recognized materials to support this activity which include 'To the Other Side of the Mountain - A Toolkit for People Living with HIV and AIDS in South Africa', 'National Support Group Guidelines', as well as materials to address stigma and discrimination at the individual and community levels. Emphasis will be placed on mitigating stigma and discrimination (key legislative area) and addressing gender inequalities (key legislative area) in palliative care.

BACKROUND:

The Health Policy Initiative (HPI) will provide technical assistance to PLHIV organizations to equip them with skills to mobilize and advocate for essential care and treatment support services, training on essential care messages and referrals for essential HIV and AIDS PMTCT, ART, opportunistic infection (OI) management (including TB) and counseling and testing (CT) services for its members and their families. The target populations for this activity are PLHIVs, their families, and community-based organizations. The major emphasis areas are local organization capacity development, with additional emphasis on community mobilization/participation and training. HPI will increase access to basic preventive care services under the umbrella of quality palliative care service delivery through a national roll-out of the Toolkit for People Living with HIV and AIDS. The Toolkit was developed in collaboration with PLHIV and the National Department of Health (NDOH) Chief Directorate on HIV and AIDS, Care and Support, STIs and TB. The process of developing the Toolkit was done though a series of national and provincial consultative meetings and workshops with PLHIV and other stakeholders representing government and other civil society organizations. The Toolkit was developed to address the needs of PLHIV in South Africa particularly in the areas of disclosure, rights, communication, facilitation, advocacy and mobilizing access to essential prevention, care and treatment services. This activity will also integrate psychosocial support to family members of people living with HIV and AIDS.

ACTIVITIES AND EXPECTED RESULTS:

HPI will provide capacity development for PLHIV organizations in South Africa to equip them with skills to mobilize and advocate for essential care and treatment support services, knowledge and awareness of essential prevention and basic preventive care interventions and the importance of mobilizing and referring for essential HIV and AIDS PMTCT, ART, OI management (including TB), family planning and CT services for its members and their families. This activity will focus on building the capacity of PLHIV organizations at the provincial and district levels to provide quality programs designed to meet the needs of people infected and affected by HIV and AIDS. These organizations work with the National Association of People Living with HIV and AIDS (NAPWA) and they will be selected through the provincial offices of NAPWA and provincial Departments of Health.

In FY 2007, HPI will provide training and technical support through nine provincial workshops for 30 participants per workshop per province who represents several community-based organizations providing community-based prevention and basic preventive care services, stigma and gender-based violence mitigation. The workshops will focus on providing participants with skill for stigma mitigation, messaging and mobilizing for access to evidence-based care interventions and skills in referring for essential HIV and

AIDS PMTCT, ART, OI management (including TB) and CT services for its members and their families. Training topics in the national curricula include advocacy skills, community group facilitation skills, skills which support disclosure of HIV status, mobilizing for essential care services including prevention strategies and prophylaxis and treatment for OIs, ART support, counseling on HIV prevention and behavioral change and provision of condoms; mobilizing for counseling and testing (CT) of family members; counseling in nutrition and personal hygiene; psychosocial support and mitigation of gender-related violence and mobilizing for PMTCT, ART, OI management (including TB), CT services and workplace interventions. This activity will strengthen the capacity of NGOs and CBOs which are messaging and mobilizing for basic preventive care services in South African communities. Follow-up from the workshops will be provided by PLHIV organizations at the provincial and district levels.

This activity addresses gender issues through the provision of basic HIV screening and care and prevention messaging to large numbers of male and female adult PLHIV, support for disclosure of HIV status and reduction of gender-based violence, involvement of males in the program, mobilization of community leaders for promoting community efforts against stigma and discrimination and for raising awareness regarding HIV prevention, care and treatment

The activities outlined above will contribute towards meeting the vision outlined in the USG Five-Year PEPFAR Strategy for South Africa by mobilizing PLHV organizations and individuals and equipping them with skills to promote that mitigate stigma and discrimination.

INTEGRATED ACTIVITY FLAG:

In addition to the activities in Strategic Information, the Health Policy Initiative (HPI) will also carry out activities in AB (#3014), Basic Health Care and Support (#3015), Condoms and Other Prevention (#6427) and Information Policy Analysis and Systems Strengthening (#3016).

SUMMARY:

The Health Policy Initiative (HPI) will carry out capacity building activities and provide technical support to ensure improved national and provincial level financial planning and effective resource allocation for HIV and AIDS. The target populations are host county government workers at national and provincial levels, with a specific focus on AIDS Control Program staff; and the emphasis area for this activity is other strategic information (SI) activities, to include healthcare financing and local organization capacity development.

BACKGROUND:

HPI is a follow-on project of the POLICY Project with the focus on policy dialogue. The Health Policy Initiative empowers new partners to participate in policymaking processes. With an additional focus on policy implementation, the initiative helps organizations translate policies, strategic plans, and operational guidelines into effective programs and services, especially for the poor and other underserved groups.

The HPI has significant expertise in providing assistance to governments and donors in planning and allocating future resources to manage national HIV and AIDS programs. This is an ongoing activity in South Africa, first initiated in 2001 with the collaboration of the National Department of Health (NDOH) and several other government departments. In 2004 and 2005, the activities were funded by PEPFAR and included provision of technical assistance and training for staff at the Health Financing and Economics Unit (HFEU) of the NDOH. HPI will continue to work in collaboration with the Health Economics Unit at the University of Cape Town and the HFEU to ensure continued support to the NDOH in preparing resource allocation and human capacity building plans in order to effectively implement the National HIV and AIDS strategy and operational plan.

The GOALS Model can serve as a useful tool for planning prevention interventions. The GOALS model is a computer model designed to support HIV and AIDS planning by linking expenditure on specific program interventions to coverage of the population in need and to program goals, such as infections averted and deaths averted. With prevalence rates still increasing steadily in South Africa, the USG Task Force has made it a priority to strengthen the prevention portfolio. The NDOH has also described 2006 as the year of prevention. The USG Task Force has asked HPI to update the GOALS model and make it specific to the South African context by incorporating data from recent South African studies. HPI will provide technical assistance to incorporate COP, Semi-Annual and Annual report information into the GOALS Model to identify gaps in budget allocations and providing information on what set of interventions can most effectively contribute to achieving the South Africa prevention target.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Resource Allocation

In this phase, HFEU staff previously trained in effective resource planning will form part of the core training team to roll this intervention out further. Training and technical assistance will be provided to HFEU trainers to conduct national and provincial training for technical working group members on resource allocation, the use of data for decision-making to prepare for the new National Comprehensive HIV and AIDS plan and human capacity needs for HIV and AIDS programming and financing.

HFEU staff will also be trained to use and teach staff at the provincial level on the use of the GOALS model to design programs, as well as allocate financial and human resources. HPI staff will follow-up throughout the year with the HFEU trainers to provide additional capacity building to roll-out the province-specific GOALS training.

ACTIVITY 2: Assistance to USG Prevention Planning

The USG Task Force has requested technical assistance from HPI to use the GOALS model again next year for planning the FY 2008 COP. The model will be updated with new information that is available in South Africa, such as the results of the male circumcision trials or the National Communication Survey, and then scenarios will be provided to USG to assist with decision making in the area of prevention.

This activity will contribute substantially towards meeting the vision outlined in the USG Five-Year Strategy for South Africa. It will contribute to reaching the goal of averting 7 million infections through improved planning and resource allocation.

INTEGRATED ACTIVITY FLAG: In addition to this activity, the Health Policy Initiative (HPI) will also carry out activities in AB (#7602), Basic Health Care and Support (#7603), Condoms and Other Prevention (#7606) and Strategic Information (#7605).

SUMMARY:

HPI will strengthen institutional capacity in public, private and civil society organizations to design and implement HIV and AIDS policies and programs. This activity will also focus on operational policy barriers which often result in poor planning, lack of access to services and ineffective ways of ensuring that resources are used in such a way that they achieve the greatest impact. The major emphasis area is policy and guidelines. The minor emphasis areas are community mobilization and training. Specific target populations for this activity are people living with HIV and AIDS, civil servants/host government workers, community-based organizations (CBOs), and other public health workers.

BACKGROUND:

HPI is a follow-on project of the POLICY Project with the focus on policy dialogue. HPI empowers new partners to participate in policymaking processes. With an additional focus on policy implementation, the initiative helps courtiers and organizations translate policies, strategic plans, and operational guidelines into effective programs and services, especially for the poor and other underserved groups.

HPI will continue to build and strengthen the capacity of organizations and institutions across all sectors to design, implement, and evaluate comprehensive HIV and AIDS prevention, care, and support programs and policies. HPI will focus on improving multi-sectoral capacity and involvement in the country's national HIV and AIDS and STI program by assisting different role players in developing and implementing effective advocacy strategies for HIV and AIDS; facilitating effective planning for HIV and AIDS programs; increasing the information used for policy and program development; and strengthening collaboration between government and civil society organizations (CSOs) and institutions working in HIV and AIDS.

Workplace Programs: HPI has provided support to the Postgraduate Diploma in the Management of HIV and AIDS in the World of Work since 2001. In FY 2005, PEPFAR funds supported the implementation of three modules called; Developing an HIV and AIDS Policy: Content, Process, Challenges and Implementation. More than 500 managers graduated from this program.

Building on this work, but with a new mandate to focus on policy and program implementation, HPI will randomly select 10 workplaces where participants of the diploma training are implementing workplace policies. HPI will assess the level of development of new workplace policies at these sites and provide technical assistance to strengthen the implementation of workplace policies.

The Department of Public Service and Administration, Government Workplace Policies: The South African Government (SAG) is the single largest employer in the country. The Department of Public Service and Administration (DPSA) has human resource oversight responsibilities for government employees. HPI developed "Managing HIV and AIDS in the Workplace: A Guide for Government Departments" as a capacity building guide to assist in the implementation of the Minimum Standards on HIV and AIDS. Thus far technical assistance for HIV and AIDS programming within the DPSA has mostly been done at the national level. HPI will provide technical assistance to four government departments in strengthening their skills to develop stigma and discrimination mitigation programs at provincial and district levels.

National Stigma Framework, Stigma Mitigation: Evidence from programs in South Africa suggests that unless stigma and discrimination is addressed, there is still fear associated with coming forward for HIV and AIDS testing and treatment. Since 2002, Center for the Study of AIDS (CSA) has implemented a project that focuses on HIV and AIDS stigma -- the Siyam'kela Project (meaning "to accept") -- in

partnership with Futures Group. To date, the project has been extremely successful in developing conceptual and theoretical tools to understand and mitigate HIV and AIDS stigma. This work has been used with government and civil society to inform stigma mitigation efforts, build capacity, develop advocacy messages and materials, and offer training and technical assistance around HIV and AIDS stigma. With FY 2007 funds, HPI will use tools developed through the Siyam'kela Project, such as the Stigma Resource Pack, to implement stigma mitigation programs across all the nine provinces of South Africa with particular emphasis on FBOs, people living with HIV and AIDS, and public servants. In addition, a group of media practitioners will be trained on how to address stigma through the media.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Workplace Programs

HPI will provide capacity building and technical assistance to graduates of the Stellenbosch University Postgraduate Diploma to strengthen the development and implementation of HIV and AIDS workplace policies and programs in their respective workplaces. HPI will select 10 workplace sites to conduct an assessment of the level to which workplace action plans have been put into place and the successes and challenges managers have experienced in implementing HIV workplace policies, and provide technical assistance to managers in these sites to revise policies, strengthen program components and implement workplace policies.

ACTIVITY 2: DPSA

In partnership with the DPSA, HPI will provide TA in facilitating and developing training materials such as workbooks to four government departments in four provinces to strengthen staff capacity to design and implementation of HIV and AIDS workplace programs in the public service.

ACTIVITY 3: Stigma Mitigation

Stigma and discrimination (key legislative issue) have had a negative impact on HIV and AIDS prevention in South Africa and have affected efforts to improve care and support for people living with HIV. This has been exacerbated by the lack of concepts and theoretical tools to understand and measure HIV and AIDS stigma and discrimination.

Through the ongoing implementation of the Siyam'kela Project, advocacy and capacity building for people living with HIV organizations and people living with HIV themselves to effectively advocate for stigma mitigation has occurred at national level. With FY 2007 funds, the Siyam'kela project will focus on providing technical assistance on stigma and discrimination, advocacy and mitigation to people living with HIV organizations and their members at both the provincial and district levels. Technical assistance will be provided to advocate at both national and provincial levels to for stigma mitigation.

ACTIVITY 4: Support to National Department of Health

The South African Government's AIDS Action Plan, a unit of the National Department of Health (NDOH), spearheaded a national capacity building process for the interfaith sector, in collaboration with the POLICY Project. An interfaith program, FBOs in HIV/AIDS Partnership (FOHAP), was established in early 2002. HPI will provide TA to three FOHAP structures in three provinces identified by the National Department of Health to strengthen their capacity to: 1) develop strategic plans for program implementation; and 2) provide institutional capacity building by facilitating governance and organizational development workshops to respond to the need for designing and implementing HIV and AIDS prevention programs.

The activities outlined above will contribute towards meeting the vision outlined in the USG Five Year PEPFAR Strategy for South Africa by building institutional capacity of workplace programs for FOHAP, DPSA and the University of Stellenbosch to help strengthen their HIV and AIDS workplace responses and stigma mitigation.