SUMMARY:

Living Hope (LH) provides a comprehensive HIV and AIDS awareness and prevention education program

with an emphasis on abstinence and fidelity in schools, churches, workplaces, and community centers. The

program is values-based and targets vulnerable and impoverished groups residing in the Western Cape

peninsula, including migrants from the Eastern Cape into the Ocean View, Masiphumelele, Capricorn and

Red Hill areas of the Western Cape. The program's emphasis is gender and human capacity development

through life skills education for children and youth on HIV prevention.

BACKGROUND:

LH Community Center is an indigenous South African faith-based organization (FBO) formed in 1999 in

direct response to the HIV and AIDS epidemic. LH's response to HIV has grown to include a comprehensive

approach to the pandemic including HIV prevention programs for children, youth and adults, a 22-bed

Hospice for HIV care, home-based care, and pre- and post-test counseling. The LH network includes five

branches in different communities, with partnerships through local churches, local Department of Health

(DOH), hospitals, schools, as well as DOH clinics.

The prevention program curriculum utilizes the Scripture Union's "Jika" and "Reach for Life" program and

Family Impact's 'Positive Parenting' course. The success of LH's program is due, in part, to the development

of partnerships with other community stakeholders and service providers. LH works with over eight primary

schools, seven churches, and several private organizations including Homestead, All Nations, OIL,

Desmond Tutu Foundation, Vrygrond Development Trust, New World Foundation, and Next Generation.

LH's PEPFAR-funded activities are a continuation and expansion of some of the first programs conducted

by LH such as after school life skills programs and community interventions held in the clinic in

Masiphumelele. FY 2008 funding will be used to expand geographical focus to include new areas in the

Western Cape such as Muizenberg, Red Hill, Fish Hoek, Simon's Town, Ocean View and False Bay.

FY 2008 funding will be used to provide life skills education, youth clubs for children and teens, outreach

activities to increase risk perception and behavior change for adults, and training and mentorship for local

churches. Other community-based organizations (CBOs) will be supported to undertake HIV prevention

activities.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

LH's life skills educators are recruited from local communities and attend a life skills workshop with a local

CBO called Think Twice as well as Scripture Union. Each life skills educator also attends the AIDS Training,

Information and Communication, Basic HIV and AIDS information course. Several other short courses are

conducted to sharpen the skills of life skill educators, such that they are able to communicate effectively

with children and to be creative in their presentation of the prevention program.

The life skills educators will be educated on the needs of diverse audiences including children, youth and

adults. The educators address abstinence for pre-teens and youth as well as delayed sexual debut. The life

skills educators will be provided with ongoing follow-up support and supervision from LH's Prevention

Coordinator. Regular meetings to evaluate progress and monitor activities will be held.

As LH continues to build relationships with community and religious leaders, it will conduct HIV prevention

education at LH facilities and partner churches, workplaces, schools, and community centers with a focus

on behavior change. The behavior change communication (BCC) focus on abstinence for youth aged 10-14

before they start sexual activity and AB for youth aged 15-24 to encourage them to adopt secondary

abstinence and reduction of number of sexual partners. Adult men will be educated on male norms and

values to discourage cross-generational sex and multiple concurrent partnerships. Youth at risk due to their

sexual behavior and adults will be provided with full information on correct and consistent condom use and

referred to condom service outlets. HIV outreach activities aim to prevent youth at risk and adults from

becoming HIV-infected by (1) increasing understanding about the nature of the disease; (2) increasing

understanding about how HIV can be prevented through abstinence, or delaying sexual debut, being faithful

and partner reduction; (3) increasing personal risk perception about HIV infection; and (4) reducing

stigmatization and discrimination against people living with HIV.

LH is aware of the influence of community leaders and encourages community leaders to become

advocates for HIV prevention through ongoing outreach activities and training. LH equips community and

religious leaders with teaching materials and encourages them to teach others about male norms and

behaviors as well as gender roles and equity to discourage discrimination, violence, coercion and abuse

against women and girl children. LH provides ongoing support as requested by various community leaders

and will be available for further awareness and education in local churches, businesses or community

centers upon request.

LH's prevention activities aim to provide comprehensive health-related courses with an emphasis on HIV

and AIDS risk perception and behavior change. This activity is designed to increase HIV risk perception and

knowledge of HIV and AIDS, with an emphasis on AB as the best means of preventing transmission. Within

the Be Faithful messages, there is a strong emphasis on sexual partner reduction, discouragement of cross-

generational sex and multiple concurrent sexual partnerships.

ACTIVITY 2: Outreach and Education

FY 2008 funds will be used to provide in-depth education and training in life skills and basic health topics

with an emphasis on HIV prevention. The adolescents under 14 years are targeted before they start

engaging in sexual behavior through the outreach and education designed to change behaviors and

attitudes to prevent HIV. This activity will be conducted through a partnership with local government, in

public schools as well as community churches in underprivileged communities such Masiphumelele,

Vrygrond Ocean View and Red Hill.

Activity Narrative: The HIV prevention messages will be disseminated in various places where youth congregate. Prevention

messages and structured curricula will be delivered through church sermons, public school assemblies in

underprivileged communities, youth and after-school kids clubs in these communities, and holiday clubs

during school holidays.

LH has implemented a life skills development program for children and youth-based on an abstinence value

system. Specific activities will include weekly children's and teen's clubs that incorporate life skills training to

encourage healthy life choices, including delaying sexual debut, abstinence until marriage for children

before they start to engage in sexual activity and faithfulness once married, and to enable youth to resist

sexual pressures. Women and girls will be empowered through these workshops to say no to premarital,

extramarital, and unprotected sex.

ACTIVITY 3: Referrals and Linkages

Adults and youth at risk and those who are sexually active will be encouraged to test for HIV and will be

provided with referrals for counseling and testing at clinics in Masiphumelele, Red Hill, Ocean View, Fish

Hoek, Simon's Town, Muizenberg, Seawinds and False Bay. LH's lay counselors will offer a comprehensive

basket of services to people based on their HIV status. These services include South African government

ARV treatment programs, clinical services, LH and other home-based care, hospice care and support

groups. If an adult or youth know their status to be HIV negative they will likely be more empowered to

protect their negative status through AB and partner reduction if already sexually active.

LH has developed a partnership with the City of Cape Town Clinic in Masiphumelele, Red Hill, Ocean View,

Fish Hoek, Simon's Town, Muizenberg, Seawinds and at False Bay Hospital where LH's lay counselors

conduct pre- and post-test counseling for CT clients with clinic staff conducting the rapid-tests. The client is

also offered a comprehensive list of services for follow-up care or support. Full information on correct and

consistent condom use will be provided to youth at risk and adults. For individuals who test positive, the

program will provide referrals to support groups to encourage positive living and will ensure treatment

access.

FY 2008 funds will be used to expand the HIV prevention programs by using social workers to help needy

children and their families. The communities where the prevention program is active have high rates of

unemployment and drug and alcohol abuse coupled with little or no access to social assistance. LH will

seek to fill this social service gap by providing at least one social worker for the prevention program to help

link needy families with appropriate government or non-government social services. The social worker will

also help in conflict resolution and linking vulnerable or abused children with the appropriate authorities. The

prevention program will also network with other area service providers in the area to help coordinate needs

with service delivery which will help reduce overlap and redundancy.

Integrating social services into the prevention program will help to strengthen LH's family-centered approach

and enable LH to work with all family members and referring them to the basket of services available to

them in the community in terms of HIV prevention and care.

SUMMARY:

Living Hope (LH) will provide in-patient hospice care and home-based care (HBC) for HIV-infected

individuals in the Western Cape peninsula. The program will also provide elements of the preventive care

package, post-test counseling and support groups for PLHIV. The emphasis areas include human

resources, training and the development of referral systems. The main target population is people living with

HIV.

BACKGROUND:

Living Hope Community Center is an indigenous South African FBO formed in 1999 in direct response to

the HIV and AIDS epidemic. The activities below are ongoing; PEPFAR funding for this activity began in

2005, helping to expand LH's reach into high risk communities with HBC, caring for caregivers and

providing hospice-based services and referrals.

LH is working in partnership with the False Bay Hospital by providing a lay counselor for PMTCT counseling

and support and with a local government clinic in Masiphumelele, Fish Hoek, Muizenberg, Ocean View,

Simon's Town, Red Hill and Seawinds Clinic where lay counselors assist in offering pre and post-test

counseling.

LH coordinates with the DOH to ensure that their care activities complement the HIV and AIDS strategy of

local government facilities and strengthening their prevention and care policies. With non-PEPFAR funds,

LH has also constructed a 22 bed hospice to care for HIV-infected patients referred by local hospitals and

HBC givers in the surrounding communities to offer culturally appropriate end-of-life care, symptom and

pain management, and referral for ART.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

All members of LH's HBC and hospice staff receive specialized training in palliative care including the basic

preventive care package. LH is working in partnership with the Palliative Association of South Africa to

develop a carefully managed, outcomes-based, training curriculum for their home-based caregivers. The

training modules and time frames are still under development but will be have the accreditation of the

Hospice Palliative Care Association (HPCA) and will be tailored for the needs of the caregivers. LH has had

negative experience with some of the other outsourced training programs so this provided the motivation to

tailor-make a training program.

LH will provide comprehensive HBC to people in four Western Cape communities - Masiphumelele, Ocean

View, Red Hill, and Muizenberg. This specifically includes people living with HIV (PLHIV) and their family

members. HBC caregiver visits incorporate nursing care, personal hygiene, HIV and AIDS education to

infected individuals and family members, screening for symptoms and pain and referral when treatment it is

unavailable through routine nursing care. All patients are assessed, referred for ART, TB, STI, OIs and are

provided with follow-up and ongoing care and support including the provision of DOTS and cotrimoxazole

when appropriate.

LH utilizes a family-centered approach to the provision of care. HBC caregivers spend time in the homes of

those who are ill and get to know the client's family, presenting an opportunity to provide training and

support to the family caregivers. This includes discussions on knowing one's HIV status and PMTCT for

pregnant women that will include safe infant feeding practices and family planning. This training and support

for the caregivers of PLWA and their families will include a comprehensive package of basic information

about caring for their family member, pain and symptom management and relief in the administration of

care. Preventive measures in home-based care are also covered. The hospice also provides ARV treatment

and clinical care for those eligible (treatment is procured and funded by the Western Cape DOH).

The HBC program will include services also provided by the Wound Dressing Clinics in Masiphumelele,

Muizenberg, and soon to be Ocean View Communities. The wound dressing clinics provide basic clinical

services one would find in drop-in clinics including dressing of wounds, treatment for basic injuries and

referrals to social or hospital services. These locations and services provide an effective means to establish

relationship with those individuals who are HIV-infected and need HBC or other services. It is also an

opportunity to encourage all individuals to get tested.

As part of the HBC activity a system will be established for the referral of HIV-infected individuals needing

holistic inpatient and/or hospice services (including those experiencing acute HIV-related illnesses,

including TB and other opportunistic infections) to LH's hospice or other appropriate healthcare institutions

for preventive care and symptom and pain management. A system will also be established for the referral

and follow up of ARV treatment-eligible patients to the nearest public health treatment site.

ACTIVITY 2: In-patient Hospice Care

LH will provide holistic in-patient care at their 22-bed hospice facility (20 of those beds are funded by

PEPFAR and are shorter term). The hospice is designed to provide palliative in-patient care to adults and

children over 12 with pain and symptom management such as those who are experiencing acute HIV-

related illnesses including TB, other opportunistic infections, and any other HIV and AIDS complication

requiring inpatient care. In addition to short-term hospice care, LH and its staff provide a place to die in

peace and dignity with psychosocial and culturally appropriate bereavement and spiritual support to the

patient as well as their family members.

The hospice is part of a network of care and support offered by LH that works in collaboration with

government and other NGO HIV and AIDS services in the area such as ART, counseling and testing and

clinical support including the basic package of care. LH also provides transportation for clients to access

any of the medical or care services required in the area from hospital care, clinical results or collecting the

ARVs for patients at the LH hospice.

Activity Narrative: ACTIVITY 3: Non-clinical Care and Support

As part of providing comprehensive palliative care, LH places an emphasis on meeting emotional and

spiritual needs. There are weekly support groups and one-on-one counseling available for HIV-infected

community members where they find acceptance, hope, encouragement and support needed to live a

productive and satisfying life. Those who attend are also coached in how to plan for their family members

who may be affected by an HIV-infected member of the household. LH's social workers link the OVC and

other vulnerable family members to social services, government grants where applicable, non-USG

nutritional support through temporary food parcel delivery, skills training, as well as ongoing emotional and

spiritual support.

ACTIVITY 4: Referrals & Linkages

The referrals system links HIV-infected people from initial pre and post-test counseling with LH lay

counselors to appropriate next level of service such as psychosocial support, home-based care,

government clinic or hospital services, PMTCT support or hospice care.

The LH Hospice receives and sends out referrals via partnerships with local area government hospitals and

clinics. Local hospitals refer clients to the hospice or home-based care program if the patient requires this

level of care. LH's social worker and chaplain are also called upon in many cases to visit or work with clients

from the government hospitals and clinics.

Home-based caregivers also refer and receive clients from local area hospitals or community members that

are aware of LH's service. Many times, clients looking for home-based care inquire about these services at

local hospitals and then the client is referred to Living Hope. Home-based carers are also being utilized in

area clinics to assist in wound care. They are learning as well as providing additional medical support in

these clinics. From this, better cooperation and referral linkages are made.

LH is in the process of developing a planned approach to South African Business inviting partnerships with

those businesses looking to fulfilling their social responsibility to reduce HIV infections in the workforce.

FY 2008 activities will be expanded to include an additional full day professional care staff to help provide a

broader level of clinical and medical services to clients in LH's home-based care programs. This service will

contribute to the holistic care and improve the basket of services to care clients. The geographic reach and

number of sites will remain the same although targets will increase due to improved 'family member'

indicator tracking and counting and more integration between the prevention program linking clients who

require the service to care providers.

In the above activities, PLHIV will receive at least one clinical and one other category of palliative care

service. Palliative care to family members of PLHIV or OVC will be provided in at least two or the five

categories of palliative care services.

This activity specifically contributes to the overall PEPFAR objectives of 2-7-10 by providing direct health

care, emotional and spiritual support or those who are HIV-infected and their families.