INTEGRATED ACTIVITY FLAG:

The Abstinence and Being Faithful activities are linked to the Condoms and Other Prevention (#8252) program area and to CT (#8255).

SUMMARY:

LifeLine's two major components of the Abstinence and Being Faithful (AB) program area include community outreach and mobilization around the designated hot spots and throughout Bojanala District in the North West (NW) province and HIV prevention activities at the areas populated with individuals with high risk behaviors (hot spot) and the LifeLine centre in Rustenburg, also in the North West province.

The major emphasis area is information, education, and communication conducted with target populations and the minor emphasis areas are local organization capacity development, community mobilization/participation and training.

Target populations include boys and girls, particularly with respect to abstinence-based activities, and men and women, especially of reproductive age. In a generalized epidemic such as the one in South Africa, the project targets the general population, though ongoing effort to reach high-risk populations to be emphasized.

BACKGROUND:

Lifeline is affiliated with LifeLine Southern Africa (which covers the Southern African countries) and in turn is affiliated with LifeLine International. Annual affiliation is based on performance and adherence to standards. Lifeline Rustenburg has a close working relationship with the National Office - they are informed with regard to all projects and services run by LifeLine Rustenburg. Biannual consultative meetings are held and quarterly reports submitted.

LifeLine Rustenburg has been operational since May 1991 and serves an area of approximately 200 kilometer radius. Main activities are: personal empowerment and life skills training, especially among youth in the district; drop-in counseling service during office hours as well as private interview counseling by appointment; HIV and AIDS counseling services in health facilities and local communities; provision of training for specialized HIV and AIDS counselors among health workers in several surrounding communities, health facilities, hospitals and mobile units; establishing a partnership with the provincial Department of Health through which Lifeline Rustenburg trains, supplies, and supervises 200 counselors at 147 health clinics throughout the Bojanala District; crisis team services on a 24-hour basis providing 24-hour call number available throughout the country; assistance with the establishment of LifeLine centers in Mafikeng in North West and in Botswana; provision of training to home-based caregivers in counseling skills and personal development for many organizations; and capacity building of other NGO/CBO's by providing training on HIV and AIDS counseling, care and support. This project also has the support of two U.S. volunteers (key legislative issue) based in the North West Lifeline office.

The AB activity is new but harnesses the activities and work of other ongoing projects, namely, the Community Counselor Project, especially with respect to community mobilization and outreach.

The South African Government (SAG), specifically the Bojanala District Department of Health in the North West, identifies the priority areas for program implementation in collaboration with LifeLine and supports and contributes to a sustained and broad-based community mobilization and outreach effort through public health facilities, schools, other government outlets, and media.

Informal partners in these activities include local businesses, Radio Mafisa, local taxi associations, mining corporations and others, who provide support for our community mobilization and outreach effort.

The AB messages and HIV prevention activities address gender issues and gender dynamics directly, encouraging target populations to examine gender roles in society. Many prevention modules require that male and female participants to be separated to encourage discussion of sensitive issues and LifeLine will continue with this approach. The program activities also emphasize, within the context of Abstinence and Being Faithful, AB changing male norms and behaviors and altering the norm of violence against women in society.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community Mobilization and Outreach

LifeLine will work with the community at Bojanala District in North West to transform male norms and behaviors in order to reduce violence and sexual coercion which is rife in the community, and a major driver of the HIV epidemic. The community mobilization and outreach effort seeks to ensure the general public receives the necessary information targeted towards behavior change. Mobile units will be used to reach high numbers of the community. During the mobile visits in the area, communities will be engaged in activities with AB messages. Activities will also be held at the LifeLine office for the communities living closer to the LifeLine Center. Internationally recognized and researched appropriate messages will focus mostly on abstinence or delayed sexual debut, for younger audience. This will also include encouraging youth that is already sexually active to consider secondary abstinence. These activities strive to influence behavior change in the form of increased abstinence and delayed sexual debut, commitment to one partner at one time, and general social norm transformation.

Messages for the older youth and adult population will focus mostly on reduction of sexual partners and will encourage non-concurrent sexual relationships. The HIV prevention activities, conducted in the area surrounding the hot spots and LifeLine centre will be conducted by LifeLine community outreach volunteers, at least half of whom are People Living with HIV or AIDS (PLHIV) and men. Workshops of between one and five days will be conducted. These will utilize a variety of techniques and a participatory methodology.

Six stipend-earning community outreach volunteers, with the help of the Project Manager, will conduct the awareness campaigns and workshops. Funds are used for stipends and salaries, training, workshops, and research for material and program development, community outreach efforts such as pamphlets and radio time, and the administration of the mobile unit.

Sustainability occurs in the form of persistently pursuing ongoing funding for the project, from PEPFAR and the SAG. Equipment purchased for the project will not need to be replaced for many years to come.

Human capacity development, in the form of training, is ongoing throughout the project for the community outreach volunteers in order to ensure their motivation and proficiency in carrying out the activities. Peace Corps volunteers also help with development, planning, training and implementation of the activities.

Results for this activity will contribute to PEPFAR's objectives of averting 7 million HIV infections.

INTEGRATED ACTIVITY FLAG:

This Condoms and Other Prevention activities are linked to the AB (#8271) and CT (#8255) program areas.

SUMMARY:

The three major components of Lifeline's activities in this program area include condom provision at specified sites, community outreach and mobilization around the designated areas populated with individuals with high risk behavior (hot spots) and throughout Bojanala District in North West province and HIV prevention activities at the areas highly populated with individuals with high risk behaviors and the LifeLine centre in Rustenburg, also in the North West.

The major emphasis area is information, education, and communication conducted with target populations and the minor emphasis area of community mobilization/participation and training. Specific target populations include boys and girls above the age of fifteen and men and women of reproductive age. In a generalized epidemic such as the one in South Africa, the project targets the general population, though ongoing effort to reach high-risk populations through targeting the general population should be emphasized.

BACKGROUND:

Lifeline Rustenburg is affiliated with LifeLine Southern Africa (which covers the Southern African countries) and which, in turn, is affiliated with LifeLine International. Affiliation is awarded annually based on maintenance of standards, adherence to policy and procedures and acceptable performance in areas of service. Lifeline Rustenburg has a close working relationship with the National Office - they are informed with regard to all projects and services run by LifeLine Rustenburg. Biannual consultative meetings are held and quarterly reports submitted.

LifeLine Rustenburg has been operational since May 1991 and serves an area of approximately 200 kilometer radius. Main activities include personal empowerment and life skills training, especially among youth in the district; drop-in counseling service during office hours from Monday to Friday; private interview counseling by appointment and crisis team services on a 24 hour basis; HIV and AIDS counseling services in health facilities in communities and local communities; training specialized HIV and AIDS counselors among health workers in a number of different communities, health facilities, hospitals and mobile units; establishment of a partnership with the North West Department of Health (LifeLine trains, supplies and supervises 200 counselors at 147 health clinics throughout the Bojanala District; a 24 hour telephone HIV and AIDS counseling services - a share call number available throughout the country; assistance with the establishment of LifeLine centers in Mafikeng in North West and in Botswana; Training home-based caregivers in counseling skills and personal development for many organizations; and capacity building of lay counselors of other non-governmental and community-based organizations on HIV and AIDS counseling, care and support.

The condoms and other prevention activity is new but harnesses the activities and work of other ongoing projects, namely, the Community Counselor Project, especially with respect to community mobilization and outreach.

The Bojanala District Department of Health in the North West selects the hot spots in collaboration with LifeLine and supports and contributes to a sustained and broad-based community mobilization and outreach effort through public health facilities, schools, other government outlets, and media. Informal partners in these activities include local businesses, Radio Mafisa, local taxi associations, mining corporations and other organizations that provide support for LifeLine's community mobilization and outreach efforts.

The condom and other prevention messages and activities address gender issues and gender dynamics directly, encouraging target populations to examine gender roles in society. Many prevention modules require male and female participants to be separated in order to delve into specific issues, and this is the approach LifeLine will continue with. The

program activities also emphasize, within the context of correct and consistent condom use, changing male norms and behaviors and altering the norm of violence against women in society.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community Mobilization and Outreach

LifeLine will work with the Bojanala District in the North West community to transform norms, behaviors and attitudes to make them fully aware of HIV prevention methods, including correct and consistent condom use in order to reduce HIV infection rates. The community mobilization and outreach effort seeks to ensure the general public receives necessary information targeted towards attitude and behavior change around high risk behaviors. Mobile units will be used to reach high numbers of individuals within the community. During the mobile visits, communities will be engaged in activities around the use of condom and other prevention messages. Activities will also be held at the LifeLine offices. Messages will focus mostly on safer sexual practices, correct and consistent use of condoms, and use of condoms in long-term relationships. The HIV prevention activities, conducted in the area surrounding the hot spots, LifeLine centre and other specified sites will be conducted by LifeLine community outreach volunteers, at least half of whom are people living with HIV (PLHIV) and men. Workshops of between one and three days will be conducted. They will utilize variety of techniques and a participatory methodology. These activities strive to influence behavior change in the form of increased correct and consistent condom usage. Activities include such topics as attitude towards use of condoms, cultural and religious issues, female condom, discordant couples and condom use.

Two stipend-earning community outreach volunteers, with the help of the project manager, conduct the activities. PEPFAR funds will be used for stipends and salaries, training, workshops, and research for material and program development, community outreach efforts such as pamphlets and radio time, and the administration of the mobile unit.

Sustainability occurs in the form of persistently pursuing ongoing funding for the project, from PEPFAR and SAG. Equipment purchased for the project need not be replaced for many years to come.

Human capacity development, in the form of training, is ongoing throughout the project for the community outreach volunteers in order to ensure their motivation and proficiency in carrying out the activities. Peace Corps volunteers also help with training, organizing and implementation of the activities.

Results for this activity will contribute to PEPFAR's objectives of averting 7 million new HIV infections.

INTEGRATED ACTIVITY FLAG:

The activity relates to LifeLine's activities in AB (#8271), Condoms and Other Prevention (#8252), and Counseling and Testing (#8255). 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:

LifeLine's activities in the Palliative Care includes three components; the referral of those testing positive for HIV, the Counseling and Testing unit to local FBOs/CBOs, to access care and support, supervision and mentoring of delivery of palliative care services by the sub-grant receiving FBOs/CBOs, receiving sub-grants and capacity building in the form of training of lay counselors on HIV and AIDS, care and support to support partner FBOs/CBOs by LifeLine Rustenburg.

The major emphasis area is local organization capacity development and the minor emphasis areas including training, the development of network/linkages/referral system, and information, education and communication. Target populations include people living with HIV and AIDS and HIV and AIDS Affected Families, and community-based organizations and faith-based organizations.

BACKGROUND:

LifeLine Rustenburg is a non-governmental, non-profit, community-based organization that has three main areas of service to the community, namely, the provision of: (1) Primary mental health counseling and emotional crisis intervention services in frontline support of the formal government and private sector mental health services; (2) HIV and AIDS related counseling, CT, education, awareness, empowerment and other services in support of efforts to combat the spread of the disease and to empower those already infected to be able to lead productive lives; and (3) Life skills and empowerment training services in support of people and capacity building.

LifeLine Rustenburg is affiliated with LifeLine Southern Africa (which covers the Southern African countries) and in turn is affiliated with LifeLine International. Affiliation is awarded annually based on maintenance of standards, adherence to policy and procedures and acceptable performance in areas of service. Lifeline Rustenburg has a close working relationship with the National Office - they are informed with regard to all projects and services run by LifeLine Rustenburg. Biannual consultative meetings are held and quarterly reports submitted.

LifeLine Rustenburg has been operational since May 1991 and serves an area of approximately 200 kilometer radius. Main activities are: Personal empowerment and life skills training, especially amongst youth in the district; Drop-in counseling service during office hours from Monday to Friday; as well as Private interview counseling by appointment and crisis team services on a 24 hour basis; Providing counseling services in health facilities and local communities; Training specialized HIV& AIDS counselors among health workers in a number of different communities, health facilities, hospitals and mobile units; Establishing a partnership with the provincial Department of Health through which LifeLine Rustenburg trains, supplies, and supervises counselors at health clinics throughout the Bojanala District. Presently LifeLine service 147 health facilities with 200 counselors, providing 24 hour telephone HIV and AIDS counseling services - a share call number available throughout the country. Other activities include assisting with the establishment of LifeLine centers in Mafikeng in North West province and Botswana; training home-based caregivers in counseling skills and personal development for many organizations; and assisting with capacity building of lay counselor of other NGO/CBOs on HIV and AIDS, care and support.

ACTIVITY AND EXPECTED RESULTS:

ACTIVITY 1: Palliative Care and Support

The Bojanala District Department of Health in North West province, in conjunction with LifeLine Rustenburg, will select the partner FBOs/CBOs already doing work in the area of palliative care to provide the care and support services. The identified partner FBOs/CBOs will receive capacity building and technical support from LifeLine and the NWDOH.

LifeLine will conduct the initial counseling and testing and screening for pain and symptoms, then the clients and/or their family members will be referred to partner FBOs/CBOs for ongoing care and support. The partner FBOs/CBOs, which are still to be determined, implement the Palliative Care services while LifeLine provides capacity building and referral system support services. The DOH, through the public health system will provide rudimentary clinical services to People Living with HIV and/or AIDS (PLHIV) that are receiving Palliative Care services from the FBOs/CBOs. Palliative care includes screening for symptoms indicative opportunistic infections (OIs) and other HIV-related illnesses; individualized counseling on HIV prevention and behavioral change (AB for adolescents and ABC for adults); routine follow -up to determine the optimal time to start the anti-retroviral therapy (ART); prevention of OIs such as TB; alleviation of HIV related symptoms and management of pain; nutrition and personal hygiene counseling; psychosocial support for students (including support for disclosure of status) and support for adherence to TB and ART. The program area increases access to services for PLHIV, especially women who are disproportionately affected by HIV in South Africa (key legislative area), and their families.

PEPFAR funding will be used to fund the three full time LifeLine trainers to conduct capacity building activities with partner FBOs/CBOs and to cover operational costs and to purchase the mobile units, providing CT and prevention programs, will be used to reach high numbers of the community. Sub-grants go to FBOs/CBOs on a monthly basis to pay for service delivery e.g. home-based care services; provided the FBO/CBO fulfils its reporting and expenditure obligations to LifeLine, i.e. with an adequate proportion dedicated to service delivery. Funds are also to be spent to ensure an efficient and effective referral system between LifeLine, the public health system, and the partner FBOs/CBOs.

The palliative care program area is set-up to foster sustainability such that partner FBOs/CBOs receive organizational capacity building from LifeLine in order to ensure their programs and organizations are sustainable. Partner FBOs/CBOs, by the end of the project, will have the skills and expertise necessary to do fundraising for their own sustainability and to provide technically sound services without the support of LifeLine.

The managers, staff, and volunteers of the organization undergo training in the form of human capacity development. Peace Corps volunteers (key legislative area) allocated to assist LifeLine will also help with development, training, assessment and research.

The expected results will contribute to PEPFAR 2-7-10 goals by ensuring people living with HIV and AIDS receive care and support and fostering a network that ensures PLHIV have a gateway to treatment.

INTEGRATED ACTIVITY FLAG:

This activity is linked to LifeLine Rustenburg activities described in AB (#8271), Condoms and Other Prevention (#8252), and Basic Health Care and Support (#8253) program areas.

SUMMARY:

LifeLine Rustenberg will utilize mobile units to enable counselors and nurses to provide voluntary counseling and testing (VCT) services in Bojanala district in North West province. Clients will receive a group HIV information session, individual pre-test counseling, followed by a rapid test using serial testing algorithm as recommended by National Department of Health (NDOH). Finally a post-test counseling session will be done with individual clients with further referrals provided, if necessary. VCT sessions via the mobile unit will take place at designated areas populated with individuals with high risk behaviors. VCT sessions will follow strict policies of informed consent and confidentiality. The above activity also includes couple HIV counseling and testing.

The major emphasis area is information, education, and communication with training, community mobilization/participation and the development of network/linkages/referral systems as minor emphasis areas.

Target populations include men and women, boys and girls with the proper consent for VCT. Though they are not targeted directly, the project hopes to reach out to certain most at-risk populations, including sex workers, truck drivers, and mobile populations.

BACKGROUND:

LifeLine Rustenburg, a new PEPFAR partner, is a non-governmental, non-profit, community-based organization that has four main areas of service to the community, namely, the provision of: (1) primary mental health counseling and emotional crisis intervention services in frontline support of the formal government and private sector mental health services; (2) HIV and AIDS related counseling, VCT, education, awareness, empowerment and other services in support of efforts to combat the spread of HIV and to empower those already infected to lead productive lives; and (3) life skills and empowerment training services in support of individual and community upliftment and capacity building.

LifeLine Rustenburg is affiliated with LifeLine Southern Africa which, in turn, is affiliated with LifeLine International. Affiliation is awarded annually, based on maintenance of standards, adherence to policy and procedures and acceptable performance in areas of service. LifeLine Rustenburg has a close working relationship with the national office - they are informed on all projects and services run by LifeLine Rustenburg. Biannual consultative meetings are held and quarterly reports submitted.

LifeLine Rustenburg has been operational since May 1991 and serves an area of approximately 200 kilometer radius. Main activities are: (1) personal empowerment and life skills training, especially among youth in the district; (2) drop-in counseling service during office hours from Monday to Friday and private interview counseling by appointment; (3) provision of counseling services in health facilities and local communities; (4) training on specialized HIV and AIDS counseling for health workers from a variety of communities, health facilities, hospitals and mobile units; (5) establishment of a partnership with the North West Department of Health through which LifeLine Rustenburg trains, supplies, and supervises 200 counselors at 147 health clinics throughout the Bojanala District; (6) crisis team services on a 24-hour basis, where a share call number is available throughout the country; (7) support in establishment of LifeLine centers in Mafikeng in North West and in Botswana; (8) training provided to home-based caregivers in counseling skills; and (9) support to capacity building of lay counselors of other NGO/CBOs on HIV and AIDS counseling, care and support.

Lifeline Rustenburg's major CT activity includes the selection of the areas populated with individuals with high risk behaviors for community-based VCT. This will be conducted in conjunction with the Bojanala District Department of Health (DOH). LifeLine will report to

the Department of Health on its activities which will be consistent to the SAG protocols.

LifeLine Rustenburg will also address issues of stigma and discrimination to increase uptake of VCT. Gender issues are addressed such that counseling and testing improves access to services for men and women. Statistics show that less men participate in VCT at public health facilities than women. Pre- and post-test counseling sessions enable individuals to examine their role as a male or female and are encouraged to outline a plan of action for behavior change to prevent HIV infection.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Voluntary Counseling and Testing

LifeLine will provide an easily accessible VCT service targeted towards the communities around Rustenburg and Bojanala District. The aim is to increase individual's knowledge of personal HIV status and when necessary, refer infected and affected individuals to appropriate care and support services. The VCT effort seeks to ensure that the general public has easy access to necessary information, counseling and testing, and required referrals for HIV services. Services will focus on group information sessions, individual or couple pre-test counseling sessions, which include informed consent, testing and confirmatory testing where necessary, and finally individual or couple post-test counseling sessions with required referrals for HIV and other services. VCT services will be available at the LifeLine center for members of the local communities. Mobile units will be staffed by three nurses and eight counselors who will conduct VCT in hard-to-reach areas.

Sustainability is achieved by persistently pursuing ongoing funding for the project, from PEPFAR and the South African Government. Equipment purchased for the project will not need to be replaced for many years to come. Salaries and other costs can be sustained through increased corporate training.

Human capacity development takes place in a variety of self development courses; is carried out in the form of preliminary and ongoing training such that the services provided are of the highest quality and proficiency.

LifeLine's counseling and testing activity will contribute to PEPFAR objectives by averting 7 million new HIV infections and caring for people living with HIV and AIDS.