SUMMARY:

The Southern African Clothing and Textile Workers Union (SACTWU) project has received PEPFAR

funding in previous years through a sub-agreement with the Solidarity Center, but in FY 2007, SACTWU

received direct PEPFAR funding. SACTWU has a well-structured training program, initiated in 1999, that

has evolved within the dynamics of the industry and includes basic facts on HIV, AIDS, abstinence, being

faithful and condom use. The major emphasis area of the activity is training. Target populations include

factory workers and people affected by HIV, HIV-infected adults, especially women, and the business

community.

BACKGROUND:

The Southern African Clothing and Textile Workers Union is South Africa's largest trade union organizing

textile and clothing workers. It also organizes footwear, leather and retail workers. Hence, SACTWU

members form part of the economically active population that has been identified as being the hardest hit by

the HIV and AIDS epidemic. Further, around 66% of SACTWU's membership is female, mostly between 20

and 60. The prevention program is a three-level training program that starts with a foundation phase on the

basic facts of HIV and AIDS, abstinence, being faithful and consistent and correct condom use (ABC). In FY

2008 the training will focus specifically on the issues of multiple concurrent partnerships, and

intergenerational sex. These facts are reinforced and strengthened with the intermediate and advanced

modules of training. The intermediate module deals with legal aspects and workplace policy development.

In the advanced module, delegates are trained to become trainers, lay counselors and home-based carers.

SACTWU also has an HIV and AIDS awareness workplace program where trainers take the training to floor

level in 30-minute sessions in the factories. The major emphasis of the workplace program is on prevention.

A particular focus of the SACTWU AIDS Program is to create greater gender equity in HIV and AIDS

programs and address male norms and behaviors.

SACTWU has a membership of approximately 110,000 members nationally. The SACTWU AIDS Project is

a national program that provides prevention and care services in five provinces: KwaZulu-Natal, Western

Cape, Gauteng, Eastern Cape and Free State. The SACTWU AIDS Project was initiated in 1998 and

developed a national comprehensive program, with an initial focus on prevention. It has matured over the

years to the point where it now has a well-structured comprehensive training program, provides "in house"

voluntary testing and counseling (VCT) services, access to a social worker in KwaZulu-Natal, runs income

generating workshops, provides a primary package of care through the VCT service, and provides home-

based care through its regional nurses and a home-based care network in KwaZulu-Natal. The nurses

provide some level of support in the home through home visits, but this activity is mainly implemented by

the home-based care network of 19 home-based carers who provide ongoing home-level support.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

The training program serves as an education program and addresses stigma and discrimination associated

with HIV status for all workers, shop-stewards, managers and healthcare staff within the industry nationally.

It also serves as an instigator for the demand for the care and treatment services offered through the

SACTWU AIDS Project, including counseling and testing, and antiretroviral treatment. With PEPFAR

funding SACTWU employs two trainers and a training coordinator fulltime to deliver all prevention programs

in-house and achieve set targets. This activity will aim to educate shop-stewards and workers within the

industry in the five provinces where the program is active and to address issues of HIV prevention, stigma

and discrimination by empowering the delegates and repeatedly reinforcing the facts on HIV. The basic

module emphasizes the ABC message of the South African government and aims to prevent new

infections. SACTWU also has an intermediate module that deals with the worker's rights and HIV as well as

development of workplace policies. Empowering individuals on their rights directly addresses the issue of

stigma and discrimination. Workplace training is done throughout the year, but with additional focus in April

and December. This training will be expanded in FY 2008 to cover additional sites and services added to

the program, including a focus on the issues of children (pediatric HIV care and treatment), and TB.

ACTIVITY 2: Condom Distribution:

The SACTWU AIDS program will distribute male and female condoms. One of the reasons why the

epidemic is more prevalent among women is the lack of power of women in the relationship, which impacts

on negotiating condom use. By making available the female condom SACTWU allows women additional

protection if the male partner refuses to wear a condom. The prevention training is complemented by

activities like the condom man campaign as well as using drama to reinforce the prevention message--this

helps to get HIV "out of the closet" and make it an interactive and informal discussion. The training focuses

on the correct and consistent use of condoms, as per Department of Health training guidelines.

PEPFAR funding will be used for human resources costs related to the prevention program. These activities

support the overall PEPFAR objectives of 7 million infections averted.

SUMMARY:

The Southern African Clothing and Textile Workers Union (SACTWU) project has received PEPFAR

funding in previous years through a sub-agreement with the Solidarity Center, but in FY 2007, SACTWU

received direct PEPFAR funding. SACTWU has a well-structured training program, initiated in 1999, that

has evolved within the dynamics of the industry and includes basic facts on HIV, AIDS, abstinence, being

faithful and condom use. The major emphasis area of the activity is training. Target populations include

factory workers and people affected by HIV, HIV-infected women and business/ community/ private sector.

BACKGROUND:

The Southern African Clothing and Textile Workers Union is South Africa's largest trade union organizing

textile and clothing workers. It also organizes footwear, leather and retail workers. Hence, SACTWU

members form part of the economically active population that has been identified as being the hardest hit by

the HIV and AIDS epidemic. Further, around 66% of SACTWU's membership is female. The prevention

program is a three-level training program that starts with a foundation phase on the basic facts of HIV and

AIDS, abstinence, being faithful and consistent and correct condom use (ABC). The FY 2008 the training

will focus specifically on the issues of multiple concurrent partnerships, and intergenerational sex. These

facts are reinforced and strengthened with the intermediate and advanced modules of training. The

intermediate module deals with legal aspects and workplace policy development. In the advanced module,

delegates are trained to become trainers, lay counselors and home-based carers. SACTWU also has an

HIV and AIDS awareness workplace program where trainers take the training to floor level in 30-minute

sessions in the factories.

SACTWU has a membership of approximately 110,000 members nationally. The SACTWU AIDS Project is

a national program that provides prevention and care services in five provinces: KwaZulu-Natal, Western

Cape, Gauteng, Eastern Cape and Free State. The SACTWU AIDS Project was initiated in 1998 and

developed a national comprehensive program, with an initial focus on prevention. It has matured over the

years to the point where it now has a well-structured comprehensive training program, provides "in house"

testing and counseling (CT) services, access to a social worker in KwaZulu-Natal, runs income generating

workshops, provides a primary package of care through the CT service, and provides home-based care

through its regional nurses and a home-based care network in KwaZulu-Natal. The nurses provide some

level of support in the home through home visits, but this activity is mainly implemented by the home-based

care network of 19 home-based carers who provide ongoing home-level support.

ACTIVITIES AND EXPECTED RESULTS:

SACTWU has not received PEPFAR funding for palliative care before. However, though the activities are

new, they support the current prevention, counseling and testing (CT) and ARV services components.

SACTWU has an existing care component for the program in KwaZulu-Natal. These include counseling and

therapeutic services on social problems to workers and their dependants within the industry to enhance

their social functioning; to provide psychosocial support to HIV-infected workers and their families, including

support groups; building capacity by running skills development workshops (e.g., food gardens, beadwork

skills, cooking, cushion-making skills, and candle making skills). These activities are geared as income

generating activities for participants.

In addition the FY 2008 funding provides for the palliative care of the ARV services program, including:

screening for pain and symptoms; screening for TB, STI and OI including the management of opportunistic

infections; cotrimoxazole prophylaxis; support groups for people on antiretroviral treatment, support groups

for those who are HIV-infected but not yet on treatment, integrated preventions services, including

prevention with positives and nutrition assessment, counseling and support.

The training programs involve skills transfer for income generation to the targeted participants. These

participants include HIV-infected members of SACTWU and their families. The training frequency is

expected to be once per month, lasting between 2 and 3 hours for each session.

For health workers, SACTWU has an in-house home-based care training program. There are 3 levels of

training: Phase 1 - 2 day theory, 2 day Practical; Phase 2 - Mentorship Program; and Phase 3 - Field

Assessment. The mentorship program is conducted at a step-down facility. The field assessments are

conducted by the regional nurse who assesses the home-based carers on their skills at the home of a

client. Once the assessments are complete the home-based carers are required to conduct 3 home visits on

their own. Once the home-based carers have successfully completed the 3 home visits they are given a

certificate of competency and are then deployed to provide service

With FY 2008 funding, these services will expand to the Western Cape, and possibly to other areas in the

geographic scope of the project.

The SACTWU activities support the PEPFAR 2-7-10 goals of reaching 10 million people with care.

SUMMARY:

This activity will provide access to comprehensive voluntary counseling and testing (CT) services in five

provinces with initial emphasis in KwaZulu Natal. The Southern African Clothing and Textile Workers Union

(SACTWU) program will provide training, support and supervision to CT counselors. SACTWU has five

existing CT sites and intends to establish two additional sites in KwaZulu-Natal and one site in Western

Cape, the two provinces with the largest union membership. Target populations include factory workers,

nurses and other healthcare workers. CT services will be on site at the factory health facility.

BACKGROUND:

The Southern African Clothing and Textile Workers Union is South Africa's largest trade union organizing

textile and clothing workers. It also organizes footwear, leather and retail workers. SACTWU members form

part of the economically active population that has been identified as hardest hit by the epidemic and, due

to work constraints, cannot access offsite CT services. Onsite services allows access to all employees

including the nearly 66% of SACTWU's membership which is female.

SACTWU has a membership of approximately 110,000 members nationally. The SACTWU AIDS Project is

a national program that provides services in five provinces, KwaZulu-Natal, Western Cape, Gauteng,

Eastern Cape and Free State. The SACTWU AIDS Project was initiated in 1998 and developed into a

national comprehensive program. Prior to FY 2007 SACTWU received PEPFAR funding as a sub-grant

from the Solidarity Center. The voluntary counseling and testing (CT) program was initiated in June 2002

and is ongoing nationally, and received PEPFAR funding in FY 2006 through the sub-agreement. In FY

2007, SACTWU became a prime partner and received direct funding to scale up services in KwaZulu-Natal.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Capacity Building for Counseling and Testing (CT) Services

This activity will provide access to workplace CT services for SACTWU members and their dependents who

are members of the communities in the five provinces, starting in KwaZulu-Natal. SACTWU has three

general settings for service delivery: (1) the clinic setting, (2) the regional office setting, and (3) stand-alone

sites within factory-based settings. This project, however, emphasizes is on the factory-based health facility

setting. The program also includes training, support and supervision of CT counselors using the National

Department of Health (NDOH) training model. PEPFAR funds will be used for human resources to employ

nurses and counselors who will provide CT services, infrastructure (minor refurbishment), procurement of

test kits, quality assurance using NDOH guidelines and supportive supervision and capacity development of

the counselors. The nurses will provide a rapid test while lay counselors will perform pre- and post-test

counseling. The site will be a down-referral site for ART and provide dispensing for antiretroviral treatment

(ART) and care/support services. Initiation of ART will be done in nearby hospital accredited ART sites.

SACTWU will train lay counselors to provide CT services. The target group for this activity is shop-stewards,

industry healthcare practitioners, and volunteers. The training includes pre- and post-training assessments.

ACTIVITY 2: Commodity Procurement

SACTWU will purchase rapid test kits and other expendable materials from a competitive pharmaceutical

supplier. Purchasing staff will make sure that the tests used are recommended by the NDOH. Quality

assurance testing will be done in compliance with national guidelines.

In FY 2008 SACTWU will expand the CT program to two new sites in KwaZulu-Natal. The national

campaign among clothing and textile workers will be increased significantly with the additional funding.

Community and Family members are also eligible for CT at the SACTWU sites.

The SACTWU activities contribute to the PEPFAR 2-7-10 goals.

SUMMARY:

The Southern African Clothing and Textile Workers Union (SACTWU) has a comprehensive HIV program

that has received PEPFAR funding in the past through a sub-agreement with the Solidarity Center. In FY

2007, SACTWU received direct PEPFAR funding for prevention, care and treatment activities, with the

prevention and care program focused in five provinces: KwaZulu-Natal, Western Cape, Gauteng, Eastern

Cape and Free State. The treatment program is currently limited to KwaZulu-Natal, but will add activities in

Free State and Western Cape in FY 2008. The emphasis areas are gender, human capacity development,

local organization capacity building, and workplace programs. The target population of the overall program

is factory workers.

BACKGROUND:

The Southern African Clothing and Textile Workers Union is South Africa's largest trade union supporting

textile and clothing workers. It also supports footwear, leather and retail workers. Hence, SACTWU

members form part of the employed population. SACTWU has a membership of approximately 110,000

members nationally, of which 66 percent is female.

The SACTWU AIDS Project is a national program that provides services in five provinces. The SACTWU

AIDS Project was initiated in 1998 and developed a national comprehensive program. It has matured over

the years to the point where it now has a well-structured comprehensive training program, provides in-

house voluntary and counseling services, provides access to a social worker in KwaZulu-Natal, runs income

-generating workshops, provides a primary package of care through the voluntary and counseling testing

service, and provides home-based care through its regional nurses and a home-based care network in

KwaZulu-Natal.

SACTWU initiated a pilot antiretroviral therapy program in the KwaZulu-Natal province as a public-private

partnership (PPP) with the Department of Health in FY 2007. SACTWU utilizes South African government

protocols. SACTWU has designed confidentiality protocols as well as client care flowcharts, and is working

closely with the King Edward VIII Hospital in Durban to ensure a formal confidential referral system via a

public-private partnership.

ACTIVITIES AND EXPECTED RESULTS:

SACTWU will contract medical practitioners to provide treatment services as per the South African

guidelines and eligibility criteria. Lay counselors or field workers will be employed (one per site) as well as

one contracted social worker per site to serve as part of the multidisciplinary team. The long-term goal will

be to develop a partnership with the public sector to replicate the model developed with the King Edward

Hospital where the clients are prepared for initiation of treatment (which includes laboratory tests, and

adherence counseling sessions), then referred to King Edward VIII Hospital for the initiation of treatment,

and then down referred back to SACTWU once stable. The South African government will provide the

antiretroviral drugs for the program. Patients will be identified for the program through the counseling and

testing program, in one established site and two new rural sites in KwaZulu-Natal. In addition, patients will

be referred from the existing SACTWU home-based care program, factories and the Bargaining Council

Clinic in KwaZulu-Natal. In partnership with the Dream Centre in Durban, patients will have access to step-

down care.

The aim in FY 2008 is to train shop-stewards and volunteers as home-based carers. This training will be

done in collaboration with a Belgian-based trade union (ABVV), which supports the clothing, textile and

leather sectors in Belgium. This is a long-standing cooperation relationship.

In FY 2008 this pilot will be expanded to two additional sites in KwaZulu-Natal. In addition to the two new

sites in KwaZulu-Natal, SACTWU will also add a site in the Free State (a mobile clinic), and one in the

Western Cape.

The services provided, beyond the standard counseling and testing, palliative care, and ART (as piloted in

KwaZulu-Natal), will be expanded to include a pediatric ART component. This will be done by strengthening

the family-centered approach to ensure that workers in the factories have the opportunity to bring their

children for HIV care and treatment. In addition the new site in Western Cape will focus specifically on

ensuring HIV care and treatment for TB patients (due to the high prevalence of TB in that area).

The SACTWU activities support the PEPFAR 2-7-10 goals.