SUMMARY:

HOPE worldwide South Africa (HWSA) will continue activities in abstinence and being faithful (AB) to

support the expansion of a comprehensive HIV prevention program through a skills-based, gender-focused

program for young boys and men and the promotion of AB messages for young people within designated

communities.

The activity targets children and youth (both in- and out-of-school), adults, parents, teachers, religious and

community leaders, mobile populations and non-governmental organizations (NGOs). The emphasis areas

for the project are gender addressing male norms and behaviors, reducing violence and coercion and

human capacity development. The target populations are adolescents and adults.

BACKGROUND:

The FY 2008 funded activities are part of an ongoing HIV prevention program of HWSA, funded by

PEPFAR since 2003. HWSA will continue its programs in Gauteng, KwaZulu-Natal, Western Cape and

Eastern Cape provinces to promote and strengthen abstinence and faithfulness prevention behaviors within

its community outreach efforts that include communities of faith. With FY 2008 funding, HWSA will expand

to new areas, and in particular to peri-urban and rural areas in South Africa, where the HIV prevalence is

high. HWSA has reached 300,000 individuals with A and AB messages through 32 faith-based

organizations (FBOs) and 73 schools, and other community-based awareness campaigns in 26 clinics and

hospitals through support groups. The HWSA prevention program is aligned to the South African

Government's (SAG) prevention strategy in its promotion of abstinence, fidelity and the correct and

consistent use of condoms (ABC) for sexually active youth at risk and older youth.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: AB Community Outreach

HWSA's AB program follows a standard Peer Educator model of training small groups of change agents,

through age-appropriate activities, to impact their immediate and broader communities. The first part of the

activity entails the establishment of an abstinence-based program for youth aged 10-14 years who have not

initiated sexual activity. The program educates children on the basic facts about HIV prevention and AIDS,

addresses stigma and discrimination and how to avoid and report abuse. The second part of the activity will

be targeted at the 15-24 year old age group and will establish an abstinence and fidelity-based approach

(AB) focusing on HIV prevention messages and AIDS awareness, the importance of abstinence in reducing

the transmission of HIV, the importance of delaying sexual activity until marriage, the development of skills

for practicing abstinence, and where appropriate secondary abstinence, personal self-esteem, the reduction

in the number of sexual partners, the importance of mutual faithfulness in reducing HIV transmission,

dangers of alcohol and substance abuse and the importance of HIV counseling and testing. The activity will

reach youth through school programs, faith-based organizations, recreational activities, health care services

and the workplace. HWSA will expand its services to new areas and focus on improving the quality of the

services offered based on lessons learned using PEPFAR funding. Key areas to be addressed include the

need to incorporate components on culture and personal leadership into the AB program

The HWSA program will also target out-of-school youth through youth clubs, community-based

organizations and sports groups. HWSA will provide full information regarding the correct and consistent

use of condoms and refer youth at risk of HIV infection to condom outlets and health facilities where

necessary as a way to reduce the risk of HIV infection for those who engage in risky behaviors. This

element of the program will be closely linked to HWSA's OP activity.

ACTIVITY 2: Men as Partners (MAP)

HWSA's MAP program is part of the national Men as Partners network initiated by Engender Health. The

MAP program creates community commitment and involvement in the reduction of violence against women

and children, community interventions that will challenge male norms and behavior about masculinity, early

sexual activity, multiple sexual partners and transactional sex for boys and men and will establish new

norms. FY 2008 funding will support school-based violence prevention programs, promote abstinence and

the development of skills for practicing abstinence and skills training for peer educators to promote HIV

counseling and testing. The MAP program will continue to build its public-private partnerships (with Coca

Cola, South African Airways and the National Department of Arts and Culture), which provide corporate

funding for workplace MAP workshops and awareness activities in the communities adjacent to these

companies. The MAP program will be modified to be age-appropriate for school children and older youth

reached by the school-based program. MAP project will focus on educating both young and older men to

respect and protect the rights of women and girl children. Lessons learned through program implementation

indicate the need for as a greater emphasis on gender issues in particular the vulnerability of girls and

young women and discourage sexual abuse, violence and coercion of women and girl children.

The activity will target young men aged 15-24 years and their communities. PEPFAR funding will be used to

maintain current staff of three coordinators, and eight peer educators.

ACTIVITY 3: Parent Empowerment

HWSA will scale up its Parent Empowerment program with FY 2008 funding. This activity started in FY

2006 and has been progressively scaled up in FY 2007. The need to scale up this activity and to empower

and capacitate parents, caregivers and guardians with skills to interact with children and youth about

sexuality and to create an enabling environment for AB messages has become increasingly evident over

the last program year. The scaling up of this activity will involve more sessions on personal growth; enhance

self awareness, personal values, and parenting skills. In addition much of the focus will be placed on

creating spaces where both youth and parents/caregivers are able to interact. Camps, child-parent days

and joint campaigns of youth Community Action Teams (CATs) and parent CATs will form a key part of this

component of the activity. Target audiences for this activity include parents of youth involved in the A

activities, members of FBOs and adults from the communities at large. The activity will also be linked to the

OVC program with a focus on empowering parents and guardians in vulnerable households and working

Activity Narrative: with granny-headed households. The practice and role-modeling of fidelity or partner reduction that forms a

part of the parenting activity will contribute to the number of beneficiaries reached through the indicator for

number reached with community outreach HIV prevention promoting AB. This activity will build on work

done with FBO networks and school governing bodies in FY 2007.

ACTIVITY 4: Sub-grant to Gateway for AB Prevention for In-school Youth

HWSA's new partnership with Gateway, an NGO working in rural communities of South Africa, will assist in

scaling up AB activities in areas where HWSA does not currently operate. As Gateway works predominantly

in schools with in-school youth, these activities will focus on including AB peer education, AB MAP activities

and the mobilization of Community Action Teams. The program will be expanded to new areas in Limpopo

Province (Musina, Duiwelskloof, Makhado, Lephalale, Modimolle, Bela-Bela, Vaalwater), North West

(Klerksdorp), Free State (Riebeekstad, Kroonstad, Welkom, Odendaalsrus, Ventersburg), KwaZulu-Natal

(Utrecht, Newcastle), Mpumalanga (Volksrust) and Northern Cape (Kimberly and Douglas). These

provinces have a high HIV prevalence according to the Human Sciences Research Council (HSRC)

research study. This strategic partnership will enable HWSA to expand its capacity to work in additional

areas through providing human resources and utilizing Gateway's established links and track record in the

new communities. HWSA will train Gateway staff on its Peer Education, AB and MAP curricula and provide

mentoring and coaching on a regular basis. This partnership will build on Gateway's success for 2006 in

which 338,464 individuals were reached. Gateway's work with youth has been funded by SAG grants and

other corporate sponsors.

These HWSA activities will contribute to the PEPFAR objectives of averting 7 million infections, and support

the USG PEPFAR Five-Year Strategy for South Africa by improving AB HIV prevention behaviors among

youth and adults.

SUMMARY:

HOPE worldwide South Africa (HWSA) will continue to scale up its activities in the other prevention program

area to support the expansion of a comprehensive HIV prevention program through a targeted program for

people living with HIV (PLHIV) and for most at risk populations. This activity targets people living with HIV

and AIDS, adults and mobile populations. The emphasis area for the project is gender, with a focus on

addressing male norms and behaviors and human capacity development through in-service and pre-service

training.

BACKGROUND:

The FY 2008 funded activities are part of an ongoing HIV prevention program of HWSA, funded by

PEPFAR since 2003. HWSA will continue its Other Prevention program activities in Gauteng, KwaZulu-

Natal, Western Cape and Eastern Cape provinces to promote and strengthen prevention with positive

interventions and prevention messages within its community outreach efforts. With FY 2008 funding, HWSA

will expand to new areas, and in particular to peri-urban and rural areas in South Africa. The HWSA

prevention program is aligned to the South African Government's (SAG) prevention strategy in its promotion

of abstinence, fidelity and the correct and consistent use of condoms (ABC).

ACTIVITY 1: Prevention with Positives

HWSA's Prevention with Positives (PwP) program is an integral part of HWSA's comprehensive approach to

care and support counseling and testing (CT) and prevention for vulnerable and at-risk populations. The

PwP program aims to provide HIV-infected individuals with supportive services, through group counseling,

that will assist participants to minimize the risk of infecting their sexual partners and re-infecting themselves.

The PwP activity has been run as part of HWSA's care and support program for a number of years but

became a priority for HWSA in FY 2007. Key interventions include educational counseling sessions on

disclosure and partner notification, partner reduction and fidelity, consistent and correct condom use, family

planning and treatment adherence. In addition, the program links with HWSA's CT services that offer both

partner testing and couple counseling. A key target group with this component of the activity will be the

identification of, interaction with, and support of discordant couples. The 75 established HWSA support

groups, with 15 to 20 members each, are located in five provincial sites in Gauteng, Mthatha, Port

Elizabeth, Durban and Cape Town. HWSA counselors co-facilitate group counseling and educational

sessions (with trained group members) and provide one-on-one support and referral services. The program

will pilot a new training for select support group members that enable them to become PwP mentors. These

mentors will serve as "buddies" for newly diagnosed support group members and their families, providing

them with intensive one-on-one counseling support and follow-up support. HWSA conducts all services in

consultation with the National Department of Health (NDOH), the National Association for People Living with

AIDS (NAPWA) and other PLHIV groups.

ACTIVITY 2: Condom Education and Distribution

HWSA prevention facilitators are posted at 45 partner clinics nationwide. These facilitators conduct weekly

educational sessions on basic HIV and AIDS information, prevention including, appropriate, correct and

consistent condom use. HWSA's partner clinics typically service a range of individuals including

adolescents aged 15-24. Adolescents will also be accessed through work done specifically with a youth

clinic in the Western Cape and with youth focused CBOs across the different program sites. This activity

also targets mobile populations in informal settlements through work done from the clinics situated in these

areas. This activity draws on HWSA's experience in its Men as Partners (MAP) programs and includes

sessions which address male norms and behaviors. The program also conducts educational sessions with

mobile populations at taxi ranks, bars (shebeens), and shopping centers and other targeted public areas.

During these sessions, counseling and testing for HIV and STIs is promoted, demonstrations are conducted

and condoms and informational materials are distributed. Condoms are accessed free from the South

African Department of Health. Prevention facilitators also provide counseling, referrals to counseling and

testing facilities, treatment, post-exposure prophylaxis and gender-based violence services. With PEPFAR

funding, facilitators and PwP mentors will receive new and refresher training on general HIV prevention,

condom promotion and usage and distribution.

With FY 2008 funding HWSA will seek to expand its OP activities and work towards creating best practice

models in both PwP and the promotion of the correct and consistent use of condoms. HWSA will also build

into its OP program lessons learnt from the abstinence and be faithful (AB), MAP and parenting

empowerment programs and to ensure linkages between these programs.

These HWSA activities will contribute to the PEPFAR objectives of averting 7 million infections, and support

the USG PEPFAR Five-Year Strategy for South Africa by improving OP HIV prevention behaviors among

youth and adults.

SUMMARY:

Hope worldwide South Africa (HWSA) will continue activities to provide and strengthen comprehensive care

and support of people living with HIV (PLHIV) and their families through community-based support groups

and home-based care (HBC) programs. Activities will use a family-centered approach and HWSA will

receive support from HPCA to strengthen clinical care services provided to its clients. The target

populations are PLHIV and their families and the emphasis area is increasing women's access to income

and productive resources, and human capacity development through in-service training.

BACKGROUND:

The activities described below are part of an ongoing Basic Care and Support program of HWSA, funded by

PEPFAR since FY 2004. HWSA and their community partners will implement all activities. The HWSA

project is managed through an umbrella agreement with PACT, Inc.

ACTIVITIES AND EXPECTED RESULTS:

HWSA collaborates with over 52 local government clinics to provide care and support services. HWSA has

established 52 support groups for PLHIV, most of which are integrated into the existing health care system.

In FY 2006, HWSA provided 5520 clients and 734 family members with palliative care services. Through a

sub-grant to the Soweto Hospice, HWSA has provided 609 home-based care (HBC) clients palliative care

services through HBC visits. HWSA has three separate activities in this program area. A family-centered

approach will be implemented to ensure that both clinical and supportive needs of HIV-infected adults,

children and family members, including OVC, are addressed. Care and support field staff will work in

tandem with OVC staff and volunteers. Both care and support and OVC activities at site level will be

centralized and managed by the site coordinator.

ACTIVITY 1: Support Groups

The first activity is to provide and strengthen comprehensive care and support of PLHIV through community

support groups. HWSA has reached over 6000 PLHIV through its 52 support groups to date. HWSA will

continue to facilitate 52 support groups in disadvantaged communities covering 5 national sites located in

the Gauteng province, Mthatha and Port Elizabeth in the Eastern Cape province, in Durban in KwaZulu-

Natal and in Cape Town in the Western Cape.

PLHIV support groups operate primarily out of local health facilities. The integration into DOH facilities will

help ensure government collaboration and facilitate access to appropriate clinical services for clients,

including ARV services. At clinics that do not provide ARVs the clients will be referred to appropriate SAG

hospitals or clinics. Facility staff will be trained to provide basic clinical services including screening for

symptoms and pain management. In addition, HWSA will work closely with provincial government to

collaborate and report on progress. New PLHIV referred to support groups will attend HWSA's basic HIV

and AIDS education course 'Living with Hope' in which clients meet with facilitators weekly over a period of

10-weeks.The course will be revised and updated to strengthen topics such as prevention with positives,

ARVs and adherence, and nutrition. Addressing prevention with HIV-infected individuals is an important part

of a comprehensive care strategy. Through healthy living and reduction of risk behaviors, these prevention

with positives interventions can substantially improve quality of life and reduce rates of HIV transmission.

The course will be disseminated as a training resource to key stakeholders, allowing for the scale-up of

community support groups. Selected PLHIV graduates of the course will be invited to assist with facilitation

of support groups as well as the course.

ACTIVITY 2: Home-based care services

The second activity is providing HBC for PLHIV. HWSA at all its sites will provide a range of HBC services

to clients, including psychosocial support, nutritional support, spiritual support, referrals, clinical support and

integrated prevention services. Levels of clinical support include screening for pain and symptoms,

screening for STIs and OIs with appropriate referral including referral for cotrimoxazole. HWSA will work

closely with government HBC efforts for necessary referrals and follow up.

Ongoing psychosocial and spiritual support will be offered to all clients and their family members with a

special focus on elderly female caregivers. Through wraparound programming, non-USG funded food

parcels sourced from partners such as Tiger Brands and supermarket outlets will be provided to needy

clients identified by staff and volunteers.

Income generation activities, supported by organizations such as Golden Cloud/Tiger brands, will support

livelihood strengthening and job creation. These activities will principally target HIV-infected and affected

women. Human capacity development at community level will be strengthened through training PLHIV in

facilitation of support groups, peer education, ART, facilitation skills and counseling. As a result, trained

PLHIV will facilitate support groups and other services to members. This will promote GIPA (Greater

Involvement of People Living with HIV and AIDS).

Home-based care sites will be strengthened with Nursing staff in all the sites. Nurses will then train staff,

volunteers and caregivers on pain, screening and basic symptoms management. HWSA will also

collaborate with hospices that are not PEPFAR funded to ensure greater reach, especially with clinical

services

Home-based carers will be trained by SAG-approved service providers in the government HBC training

program. The HBC program will continue to collaborate with a host of community partnerships in Hospices

and other HBC and community support organizations.

Ongoing training of staff on nutrition will be conducted by partners such as AED and Nestle. AED will also

train HWSA staff to conduct nutritional assessments of their clients and educate caregivers and their clients

on good nutrition and hygiene practices.

All HIV-infected individuals will receive at least one clinical service and one other category of palliative care

Activity Narrative: services. All family members of HIV-infected individuals and OVC will receive palliative care from at least

two of the five categories of service.

ACTIVITY 3: Providing care for caregivers

HWSA will train and educate caregivers on new developments in relation to HIV and AIDS. HWSA will

facilitate workshops, in partnership with HWSA's prevention program. HWSA will also strengthen referrals to

organizations providing debriefing sessions of caregivers. This activity will be facilitated through camps

and /or one-on-one counseling. Using non-PEPFAR funding, HWSA will also help to set up and strengthen

Income Generating Activities such as food gardening and sewing.

Through these activities, HWSA contributes to the PEPFAR goal of providing care to 10 million HIV-infected

and affected individuals. These activities also support the PEPFAR vision in South Africa as outlined in the

Five-Year Strategy by expanding local communities' capacity to deliver quality care for PLHIV in their

communities. In addition, HWSA will increase PLHIV access to government support systems and

strengthen linkages and referral systems with other social services such as Health and Social Development.

SUMMARY:

Hope worldwide South Africa (HWSA) will continue to strengthen and develop community orphans and

vulnerable Children (OVC) support groups, facilitate kids clubs, strengthen community child care forums,

train partner organizations and provide small sub-grants to community-based organizations (CBOs).

Primary target populations reached include OVC, youth, and people living with HIV and AIDS. The major

emphasis area for the program is training. There will also be a strong focus on educating boys and girls on

gender issues. HWSA will also embark on a strong prevention program for older OVC. Older OVC and their

families will also be assisted with income generating activities development through public-private

partnerships (PPPs).

BACKGROUND:

The OVC program is one of the five focus areas funded by PEPFAR since 2004. The program's main

objective is to strengthen and scale-up community-based interventions to provide comprehensive care and

improve the quality of life of OVC in areas where HWSA operates. The three activities described below

began in 2004 and will be strengthened and scaled-up in FY 2008. HWSA has a PPP with Coca Cola which

started in the Western Cape. HWSA will increase care and support of OVC and their families as outlined in

the South African Government (SAG) OVC National Plan of Action and National Strategic Plan. HWSA is an

active member of the National Action Committee for Children affected by Aids (NACCA) implemented

through Department of Social Development (DOSD) in collaboration with other departments to address the

OVC National Plan of Action. In FY 2006, HWSA reached almost 14,000 OVC across 4 provinces.

ACTIVITY 1: Training and Capacity Building

HWSA in partnership with ROSI (Regional OVC Support initiative), will continue to provide training to

NGOs, CBOs and FBOs in working with children and Psychosocial Support, Kids Clubs, Community Child

Care Forums, Basic Play skills, Basic Counseling for Children and support groups to partner organizations.

This partnership will enhance HWSA's capacity to offer quality training, enhance capacity of communities to

provide comprehensive care and support to orphans and help scale up the OVC reach across the country.

In FY 2008 ROSI will train HWSA site coordinators and fieldworkers who will then conduct training of other

organizations, Caregivers, Community Child Care Forums and Kids Club Leaders. ROSI trainers will follow

up on trained organizations and staff to observe implementation. HWSA continues to emphasize the

importance of youth participation in all its activities, and a key component of the Kids Clubs is that the

children themselves lead the discussions. To encourage child and youth participation, Kids Club leaders will

be trained on Basic HIV/AIDS and knowledge on how to run Kids Clubs (e.g. facilitation skills, lesson plans,

games etc.). During Kids Club Activities the HWSA fieldworkers observe, and then organize workshops to

help Kids Club Leaders improve their skills.

ROSI's expert on Child protection has sensitized HWSA managers on the need for the organization to

adhere to Child Protection. HWSA is drafting a Child Protection Policy which will ensure that all staff and

Caregivers working with OVC have been checked and qualify to work with OVC.

Caregivers and family members will be trained on succession planning, children's rights, child participation

and child protection. The Children Commission, in collaboration with HWSA and local police, conduct

annual campaigns on Children's Rights and Child Protection. These campaigns will be held in schools and

community centers and will educate OVC on their rights and responsibilities and help them identify and

address physical and sexual abuse issues.

ACTIVITY 2: Comprehensive OVC support

The OVC program will continue to provide comprehensive care and support to OVC and their families. OVC

are identified by the program through schools, referrals from Community Child Care Forums, Adults from

HWSA's Care and Support program. All OVC referred are assessed and registered on HWSA's database,

HWSA conducts baseline surveys when entering communities and establishes networks of service

providers and NGOs to facilitate referrals. Services such as access to education, social security grants,

health care, legal aid, targeted food, nutrition and psychosocial support will be provided to OVC through

activities Kids Clubs lead by trained OVC, Home Visits will be done by Caregivers to ensure OVC receive

comprehensive care. OVC will be counseled will be done by trained HWSA field workers, coordinators and

trained caregivers either one on one in groups. HWSA field workers, coordinators and caregivers will

educate OVC and refer others for services not provided directly by HWSA. OVC will receive ART treatment

and adherence support at the closest SAG accredited treatment site. In the Soweto area abused children

will be supported and referred for special treatment to Harriet Shezi Clinic in Soweto, where they will receive

psychosocial support and ART treatment. In addition, through HWSA's partnership with Tiger Brands (the

largest cereal producer in South Africa), local markets, churches and schools. With non-PEPFAR funds,

OVC will receive food parcels at least once a month; others may receive more regular food parcels

depending on the need. HWSA will provide a meal to every OVC during activities like Kids Clubs and

Support groups on a weekly basis. Various other services will be provided in partnership with the local

schools, women's groups, community and youth centers, clinics and government departments. For

example, ABSA a major South African banking group, is supporting Kids Clubs with educational and life

skills material with funding raised from the public through Special Campaigns for the purpose of assisting

OVC educational needs. HWSA's caregivers who do home visits then identify educational needs and

provide educational material to OVC identified as in need. This is supervised by coordinators and tracked

through HWSA's procurement procedures. Through the Kids Clubs and support groups, HWSA conducts

life skill activities, organize leadership camps, and provides one-on-one and group counseling to children

with special needs.

ACTIVITY 3: Sub-grants

NGOs such as VUKA and Emthonjeni will assist in scaling-up OVC activities in the areas where they

operate. The objective is to expand programs in rural areas of Eastern and Western Cape provinces. Sub-

grants will be awarded for OVC support to provide nutritional, psychosocial and material support. Technical

assistance will be provided on organizational capacity development where necessary to improve the care

and support of OVC. In addition, regular mentoring and feedback sessions will be held to review progress.

Activity Narrative:

ACTIVITY 4: Public-Private Partnership with Coca Cola

HWSA will pioneer a Vendor Employment Model for orphans and vulnerable children in South Africa.

Through a public-private partnership with Coca Cola, HWSA will explore a vendor economic support activity

for OVC/child-headed families and granny support groups. HWWSA has recruited 20 OVC and this number

will be increased in FY 2008. The children will be provided training in small business management, money

management and how to save and reinvest in their business. OVC will also be trained on basic business

skills, marketing and budgeting. In addition, psychosocial training, support and supervision will be provided

by HWSA. The necessary trolleys, uniforms, umbrellas and the first inventory of Coca-Cola will be provided

to the children. The Coca-Cola management assigned the children in the most appropriate areas where

they can sell Coca-Cola. This income generating activity will bring revenue autonomy and new skills into the

lives and homes of the OVC which will contribute to reducing the susceptibility of the OVC to HIV.

ACTIVITY 5: HIV Prevention and Gender Socialization

HWSA will use the funds as follows: a) To strengthen adolescent OVC program to focus on HIV Prevention

including reproductive health education. OVC face pressures to engage in risky sexual behavior like any

other adolescents, but their situation is magnified due to their increased vulnerability because of lack

adequate parental guidance. HWSA has undergone training on conducting prevention activities for

adolescent OVC to enhance their knowledge, skills and capacity to prevent HIV infection. HIV prevention

messages will be incorporated into Kids Clubs and Support group activities. Kids Club leaders, HWSA field

workers and coordinators who conduct Kids Clubs and support groups will all be trained on HIV prevention

messages for OVC. b) To integrate gender issues within the OVC program: While caregivers and

adolescent OVC (especially child-headed households) face serious challenges due to illnesses and

bereavement, the realities of gender inequalities and social norms contributes to their vulnerability. HWSA

Coordinators and fieldworkers, as well as Caregivers and members of CCFs will undergo training and

mentoring support on how to conducting gender socialization messages for adolescent OVC to enhance

their knowledge, skills and capacity and to build resilience to face gender related issues. Gender

socialization messages will be incorporated into Kids Clubs and Support group activities.

These Hope worldwide South Africa (HWSA) OVC support activities will contribute to the PEPFAR goal of

providing care and support to ten million people affected by HIV and AIDS including OVC and their families.

SUMMARY:

HOPE worldwide SA (HWSA) will use FY 2008 PEPFAR funds to continue its work in partnership with local

Departments of Health (DOH) to increase access to quality CT services at public sites in the Eastern Cape,

Gauteng, KwaZulu-Natal, and Western Cape provinces.

Counseling and testing (CT) targets adolescents from 15 - 24 years both in- and out-of-school through the

abstinence and being faithful (AB) program, adults from 25 years and over and nurses in the public sector.

The main emphasis areas for this CT activity are to increase gender equity in HIV and AIDS programs and

to build capacity at local organizations.

BACKGROUND:

CT is acknowledged within the international arena as an entry point to HIV prevention and AIDS care.

HWSA's CT strategies strengthen provincial government's capacity to manage counseling and testing

centers and so to create demand for the services. In addition, HWSA has developed 35 CT partner sites

around South Africa.

HWSA plans to use FY2008 funds to continue existing activities, but focusing on increasing the uptake of

CT services. Currently the uptake of CT services in South Africa is still predominantly by women and HWSA

will attempt to increase the number of males being tested and to promote couple and family counseling.

HWSA, in conjunction with Engender Health, developed the Men As Partners (MAP) program to increase

male involvement. HWSA's FY2008 CT strategy is to educate and sensitize men, women, and youth (in-

and out-of-school) about HIV and AIDS to increase CT uptakes. HWSA undertakes to train of male

counselors. The continued mentoring of counselors to ensure a high level of competency will remain

imperative.

HWSA, through PEPFAR-funded counseling activities, will, in FY 2008, build on successes achieved in FY

2006. HWSA provided CT services to 12,000 people in FY 2006, and CT is integrally linked with all other

programs at HWSA. If a client has tested HIV positive, the client is referred to care and support and the

children are referred to the orphans and vulnerable children (OVC) program. If the client has tested negative

the risk reduction plan is repeate to the client to encourage him/her to maintain their negative status.

The following factors will be considered and addressed to counter low male uptakes at CT sites: proxy

testing (using partner status as theirs); gender socialization; an unfriendly health care system; fear of dying;

and stigma. The partnership between HWSA and the departments of health has ensured the establishment

of a male clinic and a CT/MAP program to ensure education and sensitization on these factors.

Although uptakes of men are steadily rising, they still show a resistance to HIV testing. HWSA found that its

male-targeted campaigns tended to increase demand for testing by men.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1. Provision of CT

Pre- and post-test counseling will continue to be rendered at 30 existing DOH CT sites as a strategy for

preventing the further spread of HIV infection. Part of the HWSA FY2007 strategy will be to increase the

number of CT visits by men. Strategies to promote couple-oriented CT will be enhanced and referrals to

antiretroviral treatment centers increased to encourage the CT demand. HWSA CT continues to be

implemented as part of integrated healthcare services, directly linked to existing HIV care and treatment

services. HWSA will continue to support referrals from OVC and prevention activities and will continue to

refer clients testing positive to HWSA's support groups.

FY 2008 PEPFAR funding will be used to conduct, workshops and campaigns addressing constructive male

involvement in CT, gender-based violence and HIV and AIDS. Reduction of HIV and AIDS stigmatization,

staffing of new sites, and outreach to workplaces will be a focus of this activity.

ACTIVITY 2: Training CT Counselors

Ongoing emphasis will be laid on training more male counselors, to further capacitate CT counselors on

MAP methodologies and to equip the latter with skills to pre- and post- test counsel men. This supports

HWSA's strategy to reach more men. There will be a two-week CT training and orientation session to

capacitate counselors to run CT/MAP workshops. For newly appointed peer educators and CT counselors

there will be a 5-day Peer Education training course and a 10-day counseling course on CT protocols. In

addition, a MAP facilitator/trainer will be hired to engage CT counselors on how to involve men on HIV and

AIDS issues. HWSA also aims to capacitate counselors with adherence and couple counseling.

Regular assessments and mentoring of participants will take place during and after training. The latter

group's reach will be tracked. HWSA will examine the CT protocol and solicit feedback from the

trainer/learner assessor after each training session. HWSA activities in FY 2008 will include further training

of existing and new CT counselors with an emphasis on couple counseling, CT protocol, and CT training

and technical support of other CT organizations. In FY 2006, HWSA capacitated 100 CT counselors. HWSA

CT trainers will continue to provide their services to partner organizations while the use of international CT

protocols to ensure standardization of services will be ensured.

ACTIVITY 3: Expansion of CT Provision

HWSA will conduct community campaigns to promote the uptake of CT services and to reduce the stigma

associated with HIV testing. Trained community volunteers will conduct activities in workplaces, at

community meetings, and through door-to-door visits. Strategies to promote the uptake of CT services will

include providing information on CT, awareness-raising on the benefits of HIV testing, promoting couple

counseling, and marketing CT as an entry point for ARV treatment.

HWSA will use a mobile CT truck to provide CT services at educational campaigns and to provide CT

Activity Narrative: services in areas and/or sites that lack CT provision. HWSA will also ensure that two-way referral systems

between their OVC, prevention, care and treatment support programs are strengthened to ensure that

clients receive appropriate services as determined by their HIV status. HWSA will also advocate for the

provision of confidential and voluntary CT in the public sector.

HWSA has learnt that that counseling and testing works best if you take the services to - and involve the

communities. Activities like campaigns within the communities have been one of the successful methods

used to reach more community members, especially men who feel that clinics are unfriendly and

impersonal.

HWSA will maintain the 35 public and private sites from which HWSA CT program has been operating.

Introducing the MAP program at these sites will enhance the quality of the CT services provided, and

consequently, HWSA will reach more men. Efforts to engage private doctors as partners in the CT will

continue. HWSA will identify areas without CT service and attempt to extend HWSA coverage to these

areas by establishing new partnerships. The PEPFAR program contributed, through these partner sites, to

reach over 11,000 people through the CT services.

HWSA will also work very closely with South African prisons to increase the uptake of males who are

accessing CT services. HWSA will initially start work with the Johannesburg prison, which has given

approval for the provision of CT and training (protocol). This activity will (a) promote the benefits of CT

during peer education in all the medium security centers within the prison, and (b) promote referral of

inmates to counseling and testing. If tested positive the client will be referred to support groups. Inmates will

be identified and screened for training. The counseling and testing protocol will be used for counseling.

Inmates from Johannesburg prison will be trained to become counselors and a refresher course will be

done for those who were trained by other organizations.

Existing HWSA staff members will be trained on couple counseling and further training will be extended to

organizations that have already been trained by HWSA on counseling and testing.

These activities contribute to the PEPFAR goal of providing care and support to 10 million HIV-affected

individuals. Consistent with the USG Five Year Strategy for South Africa, these activities also strengthen

community demand for CT services; engaged communities on reducing the stigma associated with low CT

uptakes; strengthen partner capacities through training. Therefore, through these interventions HWSA CT

will strengthen community resolves on knowing their sero-status, promote and engage communities on

reducing the stigma associated with low uptakes at CT sites, promote and expand the partner network with

the goal of identifying additional resources for the sustainability of the program and identify and strengthen

partner capacities through training.