SUMMARY:

The Kagiso Educational Television (Kagiso) PMTCT activity focuses on male involvement in the prevention

of mother-to-child transmission (PMTCT) to increase uptake of PMTCT through the expansion of a

grassroots campaign targeting community-based men's groups. The campaign aims to create male

awareness of PMTCT ensuring that men understand the implications of mother-to-child transmission

(MTCT) and can support and encourage their pregnant partners to uptake PMTCT services.

BACKGROUND:

Low uptake of PMTCT services remains a challenge to successful implementation. Although coverage of

PMTCT exceeds 80%, PMTCT uptake still hovers around 50%, indicating that the majority of women who

need PMTCT services are being missed. Reasons for low uptake vary from health systems issues to social

issues. Cultural and social values are prime factors, with fear of violence and abandonment from male

partners due to HIV disclosure often cited as the primary reason for choosing not to be tested during

antenatal care. Furthermore, many women assume that because they are faithful to their male partners,

they cannot be HIV-infected and choose not test for HIV during antenatal care. MTCT is also affected by

the cultural perceptions that breastfeeding is a practice adopted by model mothers and wives. Many HIV-

infected mothers report that they breastfeed in the presence of their husbands and mothers-in-law, but

formula feed when they are absent. These mothers are not aware that mixed feeding practices increase the

risk of vertical transmission.

Anecdotal evidence suggests that many men are afraid to undergo HIV testing and use their wives' HIV test

results as a proxy for determining their negative status. Conversely, when their wives test positive, they

often do not assume they are infected. These misconceptions contribute to vertical transmission of HIV, and

led to a joint decision by the USG Inter-Agency Task Force and the National Department of Health (NDOH)

to target the partners of pregnant women and to develop a PMTCT male involvement campaign targeting

grassroots men's groups.

Using FY 2006 PEPFAR funding, the grassroots male campaign was initiated. This campaign works directly

with non-governmental and community-based organizations, sports clubs, savings associations, faith-based

organizations and other men's groups at the community level to ensure HIV, AIDS and PMTCT information

transfer, and to address gender, stigma and masculinity in the context of South African culture and how it

relates to PMTCT.

Partners of women attending antenatal care are targeted by the campaign. The campaign aims to sensitize

men to issues relating to PMTCT, to create a platform from which to address cultural and gender issues that

impede the uptake of PMTCT.

FY 2008 funding will ensure expansion of the campaign to rural communities and will continue to target

male partners of women attending antenatal care and family planning clinics to facilitate their understanding

of HIV and AIDS and PMTCT issues, and to encourage them to get tested, "know their HIV status" and to

support their partners, even if their results are discordant. Efforts will be made to hold support groups for

men whose partners are in the PMTCT program, with a specific focus on the development of skills to reduce

stigma. In addition, Kagiso will link with the SAFPU (South African Football Players Union) to expand its

reach training the Union's HIV and AIDS facilitators, where they exist, and supporting the Union to select

and train facilitators where they do not exist. This project has a particular focus on the year 2010 when

South Africa hosts the Soccer World Cup.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Conducting workshops

Using FY 2008 funding, Kagiso will train male facilitators. Refresher training will be offered periodically.

Trained facilitators/community activists will be responsible for conducting ongoing workshops with different

male groups in their community. In each workshop or identified community activity, men will be taken

through a number of activities aimed at increasing awareness and understanding of PMTCT and then each

group of men will identify a community-based action or activity illustrating male support for PMTCT and

build on its outcomes. These actions may range from wearing T-shirts with emblems supporting PMTCT,

holding community meetings to address myths around PMTCT or encouraging men to go with their partners

to antenatal care and to be tested. With monitoring and ongoing support from the workshop facilitators, the

men will implement the activity in their communities. These activities will be developed and implemented by

the communities and will focus on creating support and awareness for PMTCT. Using FY 2008 funding, the

training curriculum will be accredited by the national accreditation board. This will ensure continued support

and sustainability. Capacity in the provincial departments of health will be built around health

communication by identifying community workers, volunteers or community health workers that are already

trained in PMTCT by offering the accredited community-based male involvement training as a way for these

community workers to continue their work and earn additional resources. This will extend the partnership

between USG and SA NDOH to a grassroots level. Using FY 2008 funding, Kagiso also seeks to deepen

productive relationships with national and provincial department of health initiatives such as MIPAA (Men in

Partnership Against AIDS) and WIPAA (Women in Partnership Against AIDS) identified in the previous year.

Having established public-private partnerships (PPPs) with appropriate companies as well as training

existing facilitators in fundraising, Kagiso will concentrate on establishing sustainability of these

organizations with FY 2008 funds. These activities will be done in collaboration with Soul City training and

outreach and the Soul Buddyz clubs throughout the country. Soul City is also a recipient of PEPFAR funds.

ACTIVITY 2: Media campaign rollout

Building on the project's success stories profiled in FY 2007, FY 2008 funding will be used to ensure scale

up and rollout of a media campaign entitled "Real Men Talking to Real Men." This campaign will draw on

successes of FY 2007 and will aim to reach a wider audience through broadcasting on both television and

radio. It will also leverage the hosting of the Soccer World Cup in South Africa in 2010 drawing on the

relationship with the South African Football Players Union. The media campaign will operate at two levels

Activity Narrative: with the mass media campaign being a targeted media burst. For example, in August, which is traditionally

"women's month," the messages could be differentiated by running a series of smart campaign commercials

on SABC radio stations and for one week on SABC TV; the second level could be community radio and

newspapers with a more specific messages drawing on the idea of Fathers to Fathers encouraging men at

a community level to support each other and their HIV-infected partners. This campaign will be linked with

community outreach through community radio, newspapers and other civil society initiatives to ensure that

communities, particularly men, have a platform to discuss issues raised by the campaign. In addition,

Kagiso will investigate digital storytelling and website channels and opportunities to provide skills and work

opportunities for young men and women.

ACTIVITY 3: Support groups.

In FY 2007, Kagiso targeted women attending antenatal care and pregnant HIV-infected women attending

support groups and encouraged them to bring their male partners to a discussion group. At the outset of the

partner discussion groups, all aspects of pregnancy, not just HIV and PMTCT, are discussed. Groups meet

regularly. Men are encouraged to attend antenatal care clinics with their partners and accept couple

counseling and testing. Men who want to be tested but who do not want to go to the clinic are referred to

alternative sites. The aim of the group sessions is to ensure the development of support networks for men

whose partners are enrolled in PMTCT programs, and to encourage improved support to their partners,

ensuring better uptake and adherence of PMTCT service delivery. Using FY 2008 funding, these groups will

be expanded geographically. The groups will be modeled on the highly successful mothers2mothers

initiative, although a different approach is being used to reach men. Men's groups will take place outside of

the health facility, at places where they are comfortable hanging out. These include sporting grounds,

churches, (through faith-based organizations) and informal stokvels (gatherings) or tavern associations.

ACTIVITY 4: Expansion

Funding will be used to expand the workshops and media campaign by linking the campaign with the South

African Football Players Association Union (SAFPU). By linking the male involvement in PMTCT campaign

to SAFPU, Kagiso will be able to reach at least 80,000 men and create greater awareness around HIV,

AIDS and PMTCT. In addition, this linkage will enable SAFPU the opportunity to strengthen the HIV

prevention campaign and to incorporate messages around PMTCT, thereby creating greater awareness

among their members.

This activity contributes to PEPFAR 2-7-10 goals by increasing awareness of HIV and AIDS, increasing

uptake of PMTCT, and reducing vertical transmission. Targeting men and ensuring men identify and

implement community-based activities in support of PMTCT will improve community-wide support for

PMTCT services. This activity will begin a process by which men begin to understand PMTCT. Increased

male involvement and community support for PMTCT will improve uptake of PMTCT service delivery,

contributing to the PEPFAR target of averting 7 million new infections.