SUMMARY:

The PEPFAR-funded Abstinence and Being Faithful activity described in this FY 2008 COP harnesses the

activities and work of other ongoing projects, namely, the Community Counselor Project, especially with

respect to community mobilization and outreach. It also benefits from contributions from other donors such

as Anglo Platinum Mines, which has committed to three-years of cost-sharing. In particular, Anglo Platinum

Mines are funding a vehicle to be used in the mining areas and covering traveling costs and stipends for a

nurse and driver. Relationships formed with local government and municipal departments will assist to

ensure the continuity of the project. The 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 and the LifeLine centre in Rustenburg.

The AB messages and HIV prevention activities address gender issues and gender dynamics directly,

encouraging target populations to examine gender roles in society. Emphasis areas include gender

addressing male norms and behaviors, and reducing violence and coercion as well as human capacity

development. Target populations include boys and girls (aged 10-14); adolescents; and adult men and

women, especially of reproductive age. In a generalized epidemic such as the one in South Africa, the

project targets the general population; thus the project will also reach groups such as persons who engage

in transactional sex, but who do not identify as persons in sex work, discordant couples, people living with

HIV, and orphans and vulnerable children.

BACKGROUND:

LifeLine Rustenburg is a non-governmental, non-profit, community-based organization affiliated to LifeLine

Southern Africa which in turn is affiliated to LifeLine International. Affiliation is awarded annually based on

maintenance of standards, adherence to policy and procedures and acceptable performance in areas of

service. Operational since 1991, LifeLine focuses on counseling and crisis intervention services; provision

of life skills training; capacity building for community-based organizations; voluntary counseling and testing

(VCT) and HIV prevention activities. To date LifeLine has implemented a community counselor project

(CCP) that provided counselors to 150 health facilities in Bojanala; established a non-medical VCT site;

provided 24-hour counseling service via a national counseling line; and provided training to numerous other

organizations. FY 2008 plans for the project include placing counselors at all health facilities in the Bojanala

District; supplying mobile VCT; conducting referrals for care to HIV persons; and promoting HIV prevention

throughout the Bojanala District of the North West Province.

The South African Government, specifically the Bojanala District Department of Health in the North West

province, supports and contributes to a sustained and broad-based community mobilization and outreach

effort in public health facilities, schools, other government outlets, and through media. Informal partners

include local businesses, Radio Mafisa, local taxi associations, mining corporations and others, who provide

support for our community mobilization and outreach efforts. In particular, Mafisa Radio Station provides an

hour timeslot weekly for Lifeline to discuss and debate on topics related to HIV and AIDS education. The

local taxi associations agreed, in FY 2006, to paste Lifeline stickers on their vehicles and to participate in

prevention campaigns.

Many prevention modules require male and female participants to be separated in order to delve into

specific issues. This is the approach LifeLine will continue to use during education and training sessions in

the FY 2008 period. The program activities also emphasize changing male norms and behaviors, promoting

one-partner relationships and altering the norm of violence against women in society. A hot spot is defined

as an area that has a high rate of traffic of vulnerable persons; for example, taxi ranks and the mining

hostels. The LifeLine hot spots are currently located in the Bojanala region, with one hot spot identified in

each sub-district. In COP FY 2007, PEPFAR enabled LifeLine to work in eight such hot spots, with the

target for COP FY 2008 being 12 hot spots.

ACTIVITIES AND EXPECTED RESULTS:

Four activities will be covered in this program area. For youth, particular emphasis is placed on abstinence

and delayed sexual debut based activities. Contact is made during school hours with education sessions

and at the end of the school day when leaving the premises. After school activities (i.e. sports, youth and

church clubs, etc.) are utilized especially to reach the out-of-school youth. Men and women, especially of

reproductive age, are initially reached at the hot spots, and thereafter encouraged to join more intensive

education sessions. They are also contacted at evening and weekend activities such as men's and/or

women's clubs/groups, church groups, "stokvel" meetings, etc. In a generalized epidemic such as the one in

South Africa, the project targets the general population. This will also include encouraging sexually active

youth to consider secondary abstinence. Messages for the older youth and adult population will focus

mostly on reduction of number of sexual partners and will discourage multiple and concurrent sexual

relationships as well as cross-generational sex. LifeLine will also work with the traditional leaders and

community to transform male norms and behaviors in order to reduce violence and sexual coercion, which

is rife in the community.

ACTIVITY 1: Community Mobilization

The community mobilization and outreach efforts seek to ensure that the general public receives the

necessary information targeted towards behavior change. Eight community outreach volunteers and four

trainers will conduct the HIV prevention activities in areas surrounding the hot spots, which are visited bi-

monthly. Education is provided in plenary sessions, as well as focus group education and discussion.

Education topics highlight behavior change; attitudes; cultural, legal, gender, alcohol and substance in

young people as a risk factor, and other issues; multiple partners; same sex partners; and cross-

generational sexual partners. The pros and cons of abstinence, benefits of later sexual debut, and one

partner relationships will be highlighted to people who are not yet sexually active. For persons already

sexually active emphasis will be on faithfulness, one partner relationships and secondary abstinence where

relevant. All prevention activities are target and language group sensitive i.e. each target group receives

relevant information and education specific to the age, culture or other dynamic of the group. Some of the

LifeLine activities are conducted at the lifeline offices while others take place within the communities.

Activity Narrative: ACTIVITY 2. Capacity Building

Human capacity development requires ongoing trainings throughout the project for the community outreach

volunteers in order to ensure their motivation, competency and proficiency in carrying out the activities.

Peace Corps volunteers help with training where required. Bi-annual training as an incentive that ensures

retention of staff in the service. Training is conducted on monthly basis as an in-service kind of training.

Workshops of five-days duration aimed at behavior change will be conducted for community members.

These are presented three times per annum per hot spot. Workshops will be held one day a week over a

five week period, with the same participants in groups of 10-20 persons. An evaluation session will be held

three months after completion of each workshop to measure behavior change. A variety of techniques and

participatory methodologies are used. Topics cover basic life skills, behavior patterns, sexuality,

reproductive health, morals and values, choices, consequences and responsibilities, substance abuse,

multiple, concurrent, same sex and cross generation partners, and HIV topics. 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 related to gender issues. The workshops

are facilitated by LifeLine trainers.

These activities will contribute to PEPFAR 2-7-10 goals of averting HIV infections through promoting

Abstinence and Be Faithful prevention activities among the general population and youth.

SUMMARY:

LifeLine's OP activity harnesses the activities and work of its other ongoing projects, such as the

Community Counselor Project, especially with respect to community mobilization and outreach. It also

benefits from contributions from other donors such as Anglo Platinum Mines, which has committed to three

years of cost-sharing. In particular, they are funding a vehicle to be used in the mining areas and covering

traveling costs and stipends for a nurse and driver. Relationships formed with local government and

municipal departments will help ensure the continuity of the project. Salaries and other costs can be

sustained through increased corporate training and workplace programs bringing in substantial revenue for

LifeLine. The two major components of the program area include condom provision with education at

specified sites as well as community outreach and mobilization. Emphasis is on information, education,

dialogue, and HIV prevention activities carried out around the designated hot spots, throughout Bojanala

District and the LifeLine centre in Rustenburg. The OP messages and activities address gender issues and

gender dynamics directly, encouraging target populations to examine gender roles in society. Emphasis

areas for this activity focus on gender by addressing male norms and behaviors and reducing violence and

coercion around the designated hot spots and throughout Bojanala District and the LifeLine centre in

Rustenburg. A "hotspot" is defined as an area that has a high rate of traffic of vulnerable persons; for

example, taxi ranks and the mining hostels. The target groups for the OP messages are males and females

from 15 years and older, including people living with HIV (PLHIV), discordant couples, pregnant women,

persons who engage in transactional sex but who do not identify as persons in sex work, and mobile

populations. Target groups are located in the identified hotspot areas. The LifeLine hot spots are currently

located in the Bojanala region, with two hot spots identified in each sub-district. In FY 2007, LifeLine

operated eight such hot spots. With FY 2008 PEPFAR support, LifeLine will expand its reach by an

additional 4 hot spots, yielding support given to a total of 12 hot spots in the North West Province.

BACKGROUND:

LifeLine Rustenburg is a non-governmental, non-profit, community-based organization, affiliated to LifeLine

Southern Africa and 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 been operational since 1991, and serves an area of approximately 200 square kilometers.

LifeLine Rustenberg has a close working relationship with the National Office, which is informed about

projects and services run by LifeLine Rustenburg. Bi-annual consultative meetings are held and quarterly

reports are submitted to the main office by LifeLine Rustenburg.

LifeLine focuses on counseling and crisis intervention services, provision of life skills and personal

development training, capacity building for less established community-based organizations (CBOs),

counseling and testing (CT) and prevention activities. To date, LifeLine has implemented a community

counselor project (CCP) which, in partnership with the provincial department of health, provides counselors

to 150 health facilities in Bojanala, has established a non-medical CT site, provides 24 hour counseling

service via a national counseling line, and has provided training to numerous other organizations. Future

plans for the project are to place counselors at all health facilities, supply mobile CT, support and care to

HIV-infected and affected persons and HIV and AIDS prevention services to rural and other under-serviced

communities throughout the Bojanala District. Care and support activities will be provided through ongoing

partnerships with other CBOs and FBOs (faith-based organizations) with expertise in these areas.

The South African Government, specifically the Bojanala District Department of Health, supports and

contributes to a sustained and broad-based community mobilization and outreach effort in public health

facilities, schools, other government outlets, and through media. Informal partners include local businesses,

Radio Mafisa, local taxi associations, mining corporations and others, who provide support for LifeLine's

community mobilization and outreach efforts. In particular, Mafisa Radio Station provides an hour timeslot

weekly for LifeLine to discuss and debate on topics related to HIV and AIDS education, and the local taxi

associations agreed, in 2006, to paste LifeLine stickers on their vehicles and to participate in condom-use

campaigns.

In LifeLine's community outreach and education, many prevention modules require male and female

participants to be separated in order to delve into specific issues. LifeLine will continue to use this approach

during education and training sessions in FY 2008. The program activities also emphasize changing male

norms and behaviors, discouraging cross-generational partners, promoting one-partner relationships and

altering the norm of violence against women in society.

ACTIVITIES AND EXPECTED RESULTS:

Four activities will be covered in this program area. Messages for younger audiences will focus mostly on

abstinence or delayed sexual debut. This will also include encouraging sexually active youth to consider

secondary abstinence. Messages for the older youth and adult population will focus mostly on reduction in

the number of sexual partners and will encourage non-concurrent sexual relationships. LifeLine will also

promote the consistent and correct condom use. LifeLine will also work with the traditional leaders and

community to transform male norms and behaviors in order to reduce violence and sexual coercion, and

discourage cross-generational sex, which is rife in the community.

ACTIVITY 1: Mobile Counseling and Testing and Health Education Services

LifeLine uses two mobile units to reach high numbers of adolescents and adults in the community. The staff

within each mobile unit consists of: two Counselors, two Community Outreach officials, and one Nurse.

Currently the mobile covers five sub districts in the Bojanala region, and each of these five sub-districts

features a minimum of two hot spots. The mobile unit services each hotspot for approximately seven hours

a day, and a hotspot is revisited on a bi-monthly basis. The main aim of the mobile service is to increase

accessibility, create awareness, and provide education and training on issues relating to HIV and AIDS

prevention within the community. The mobile units provide Counseling and Testing (CT) services, offering a

full range of CT services as well as prevention interventions. During the mobile visits, communities are

educated on correct and consistent use of condoms, as part of a comprehensive ABC prevention program.

Community members who test positive at the mobile unit are referred to the nearest hospital so that they

can be enrolled in treatment, care and support programs.

Activity Narrative:

ACTIVITY 2: Community Mobilization

The community mobilization and outreach efforts seek to ensure that the general public receives the

necessary information targeted towards behavior change. The HIV prevention activities, conducted in the

area surrounding the hot spots, will be conducted by eight LifeLine community outreach volunteers and

trainers. Education is provided in plenary sessions, as well as focus group education and discussion.

Education topics highlight behavior and attitudes concerning: cultural, legal, gender, alcohol and substance

abuse in young people as a risk factors, and other related social issues; multiple partners and cross-

generational partnerships; and, for persons over 15, correct and consistent condom use. All prevention

activities are target and language group sensitive (i.e. each target group receives relevant information and

education specific to the age, culture or other dynamic of the group). Some activities are also conducted at

the LifeLine offices. Individuals who live close to the LifeLine offices can access services at the LifeLine

center. Activities at the LifeLine center are conducted by LifeLine community outreach volunteers and four

trainers.

ACTIVITY 3: Capacity Building

Human capacity development requires ongoing trainings throughout the project. In-service training will be

provided for the community outreach volunteers. This will ensure sustained motivation, competency and

proficiency in carrying out LifeLine's HIV prevention activities. Peace Corps volunteers often assist with

training, as needed. Bi-annual training for new personnel ensures project retention while monthly in-service

training promotes staff retention. Workshops aimed at community members will also be conducted. These

workshops are 2-days in duration, and are aimed at achieving behavior change with respect of safer sex

practices. FY 2008 funding will ensure that these workshops will be conducted once a month per hotspot.

The workshops will be held one day a week over a two week period, with the same participants. Each

workshop will accommodate groups of 10-20 persons. A variety of techniques and participatory

methodologies will be used. Topics cover basic life skills, HIV and AIDS general and prevention education,

correct and consistent use of condoms, concurrent, same sex and cross general partners. The workshops

will be facilitated by LifeLine trainers. In order to access behavior change and retention of information, a

follow-up evaluation session will be held three months after completion of each workshop.

These activities will contribute to PEPFAR 2-7-10 goals of averting HIV infections through promoting

Condom and Other Prevention behaviors among the general population and youth.

SUMMARY:

LifeLine's activities in Palliative Care/Basic Health Care & Support involve sub-grantees who have prior

home-based care services and protocol training in line with SAG policies and guidelines. Activities include

the following three components: 1) referral of HIV-infected individuals from the Counseling and Testing unit

to local faith-based and community-based organizations (FBOs/CBOs) for follow-up; 2) Supervision of the

delivery of palliative care services by LifeLine's second-tier sub-grantees (FBOs/CBOs); and 3. Capacity

building in the form of training to support LifeLine's sub-partner FBOs/CBOs.

The Bojanala District Department of Health in North West province assists LifeLine with capacity building

and supervision of the FBOs/CBOs. The program increases access to services for PLHIV, especially

women and their families, who are disproportionately HIV-infected in South Africa.

Emphasis areas for this PEPFAR supported program are human capacity development and local

organizational capacity development. The target populations adolescents aged 15 -24 and adults and also

include most at risk populations namely, mobile population, non injecting drug users, persons who engage

in transactional sex, but who do not identify as persons in sex work, people living with HIV and AIDS

(PLHIV), and HIV and AIDS affected families.

BACKGROUND:

LifeLine Rustenburg is a non-governmental, non-profit, community-based organization, affiliated to LifeLine

Southern Africa which in turn is affiliated to 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 been operational since 1991, and serves an area of approximately 200

kilometers radius. A close working relationship exits with the National Office -which is informed about

projects and services run by LifeLine Rustenburg. Bi-annual consultative meetings are held and quarterly

reports are submitted to the main office by LifeLine Rustenburg.

LifeLine focuses on counseling and crisis intervention services; provision of life skills and personal

development training; capacity building for less established CBOs; CT (counseling and testing) and

prevention activities with regards to HIV and AIDS. To date, LifeLine has implemented a CCP (community

counselor project) which provides counselors to 150 health facilities in Bojanala (in partnership with

Provincial Department of Health), established a non medical CT site, provide 24 hour counseling service via

a national counseling line, and have provided training to numerous other organizations. Future plans for the

project is to place counselors at all health facilities; supply mobile (outreach) CT; support and care to HIV-

infected individuals and other affected persons; and, HIV and AIDS prevention services to rural and other

under serviced communities throughout the Bojanala District of the North West province. Care and support

activities will be provided through ongoing partnerships with other CBOs/FBOs with expertise in these

areas.

FY 2007 funds were provided to LifeLine to work in 8 such hot spots. FY 2008 PEPFAR funding will be used

to expand the number of hotspots to increase care coverage. The target groups for the Care activities

messages are PLHIV located in the identified hot spots within Northwest province. A hot spot is defined as

an area that has a high rate of traffic of vulnerable persons; for example, taxi ranks and the mining hostels.

The LifeLine hot spots are currently located in the Bojanala region, with 2 hot spots identified in each sub-

district.

ACTIVITIES AND EXPECTED RESULTS:

After initial CT services are provided, clients and/or their family members will be referred to LifeLine's sub-

grantee FBOs/CBOs for ongoing care and support. Counseling and testing is the entry point to care and

support. The care component will be linked to CT services. After initial testing, clients and/or their family

members are referred to the nearest sub-grantee FBO/CBO for ongoing care and support.

ACTIVITY 1: Palliative Care and Support Services

The sub-partner, i.e. the FBOs/ CBOs, carry out the palliative care services. Each sub-partner provides

service delivery in at least two of the five required categories i.e. clinical, psychological, spiritual care, social

care and prevention services. This minimum package includes screening and referral for opportunistic

infections including the provision of cotrimoxazole, screening and referral for TB, psychosocial counseling,

wellness/healthy living education, monitoring and referral, home-based care, advice and assistance on

welfare issues and applications for welfare grants, and hospice and end-of-life care for terminally-ill patients.

Through the public health system, the North West Department of Health will provide rudimentary clinical

services to PLHIV that are receiving palliative care services from the sub-grantee FBOs/CBOs. LifeLine

monitors that activities are carried out as per subpartner agreements.

ACTIVITY 2: Local Organization Capacity Building

LifeLine provides capacity building to sub-partners and strengthens the referral system. The palliative care

program is set-up to foster sustainability to enable the sub-partner FBOs/CBOs to receive organizational

capacity building from LifeLine. PEPFAR funding will support in-service training activities conducted by four

LifeLine trainers targeting members of the sub-partner FBOs/CBOs. Training consists of workshops of five

days covering topics relevant to administrative and financial systems By the end of the project, these

FBOs/CBOs will have the skills and expertise necessary to do fundraising for their own sustainability and to

provide proficient services without the technical support of LifeLine. Peace Corps volunteers help with

development, training, assessment and monitoring of the project activities.

In the above activities, to be counted as having received palliative care service, all HIV-infected clients will

receive at least one clinical service and one non-clinical service and family members will receive service in

at least two categories of palliative care.

These activities will contribute to 2-7-10 PEPFAR goal by ensuring PLHIV receive adequate care and

support. Its efforts to strengthen referral networks also ensure PLHIV have greater access to treatment.

Activity Narrative: SUMMARY:

SUMMARY:

This project benefits from contributions from other donors such as Anglo Platinum Mines, which has

committed to three-years of cost sharing. In particular, they are funding a vehicle that will used in the mining

areas, and covering traveling costs and stipends for a nurse and driver. Through the mobile unit operation,

counselors and nurses provide counseling and testing services. Willing clients receive a group HIV

information session, individual pre-test counseling, followed by a rapid test with an accompanying verifying

test, finally a post-test counseling session with further referrals, if necessary. Counseling and testing

sessions occur at designated hot spots where the mobile unit is operating and follows strict policies of

informed consent and confidentiality. This project also includes couple counseling and testing.

Target populations include men and women, boys and girls, discordant couples, pregnant women, persons

living with HIV, young people who are sexually active, mobile populations and people who engage in

transactional sex but who do not identify as persons in sex work. Though they are not targeted directly, the

project hopes to reach out to most-at-risk populations including sex workers, truck drivers, and mobile

populations, by targeting the general population.

Relationships formed with local government and municipal departments will assist to ensure the continuity

of the project. Equipment purchased for the project in the first year will not need to be replaced for many

years. Salaries and other costs can be sustained through increased corporate training and workplace

programs that garner substantial revenue for LifeLine.

BACKGROUND:

LifeLine Rustenburg is a non-governmental, non-profit, community based organization, affiliated to LifeLine

Southern Africa, and to 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 been operational since 1991. The organization serves an area of approximately 200

kilometers radius. LifeLine Rustenberg works closely with the National Office, who are informed about

projects and services run by LifeLine Rustenburg. Bi-annual consultative meetings are held and LifeLine

Rustenburg submits quarterly reports to the main office.

LifeLine focuses on counseling and crisis intervention services, provision of life skills and personal

development training, capacity building for less established community-based organizations (CBOs),

voluntary counseling and testing (VCT), and HIV prevention. To date, the organization has implemented a

community counselor project (CCP) that provides counselors to 150 health facilities in Bojanala (in

partnership with North West Department of Health). LifeLine Rustenburg has also established a non-

medical CT site, provided 24-hour counseling service via a national counseling line, and trained staff at

numerous other organizations. Future plans for the project is to place counselors at all health facilities,

supply mobile (outreach) CT, support and care to HIV persons and other affected persons, and to provide

HIV prevention services to rural and other under-served communities throughout the Bojanala District of the

North West province. Care and support activities will be provided through ongoing partnerships with other

CBOs and FBOs with expertise in these areas.

During the COP 2007 period, LifeLine Rustenburg used PEPFAR funds to establish a mobile CT operation.

The mobile unit and counselors at public health facilities provide CT services throughout the Bojanala

District of the North West province. The target groups for the abstinence and being faithful (AB) prevention

messages are males and females, 10 years and older, located in the identified hot spots in the province. A

hot spot is defined as an area that has a high rate of traffic of vulnerable persons; for example, taxi ranks

and the mining hostels. The LifeLine hot spots are currently located in the Bojanala region, and one hot spot

has been identified in each sub-district. PEPFAR FY 2007 enabled LifeLine to work in seven such hotspots,

although the target for FY 2008 is 12 hot spots.

ACTIVITIES AND EXPECTED RESULTS:

LifeLine will continue to provide accessible CT services that promote increased knowledge of personal HIV

status. This service will facilitate access to care and support for HIV-infected and affected individuals. This

Mobile CT Unit seeks to ensure the public has easy access to necessary information, counseling and

testing, and prompt referrals for other relevant services. CT services offered are: pre-counseling group

information sessions; individual or couple pre-test counseling inclusive of informed consent; testing and

confirmatory testing, where necessary; and finally individual or couple post-test counseling sessions with

required referrals. Mobile units will be used to improve access in hard to reach communities. CT services

will also be available at the LifeLine centre for neighboring communities. Four nurses and 12 counselors

conduct counseling and testing services through two mobile units that service 12 hot spots. All people who

test positive are referred to treatment and care services.

Through CT, access to services for men and women will improve and gender issues are addressed

accordingly. Statistics show that more women undergo CT at public health facilities. Pre- and post-test

counseling sessions enable test-takers to examine their gender role as individuals and are encouraged to

outline a plan of action for behavior change to prevent HIV infection.

Human capacity development activities through preliminary and ongoing training ensure sustainability. This

ensures that the services are of the high quality and provided by competent staff. LifeLine will report to the

National Department of Health on its activities and will comply with South African legislation in carrying out

its services.