SUMMARY:

In FY 2008 The National Alliance of State and Territorial AIDS Directors (NASTAD) will continue to support

government-to-government twinning relationships between four South African provincial Departments of

Health AIDS Directorates and four U.S. state health department AIDS programs, resulting in bi-directional

exchange of expertise and improved capacity of provincial health systems. The primary emphasis area for

the activity is local organization capacity building, with secondary emphasis on community mobilization,

linkages with other sectors and initiatives, and policy and guidelines. The activity targets persons living with

HIV (PLHIV), policy-makers, teachers, public health workers, and faith-based organizations (FBOs).

BACKGROUND:

NASTAD is a U.S. non-governmental organization (NGO) with a membership of U.S. state health

department AIDS program directors whose positions are analogous in program responsibility to provincial

AIDS Directors in South Africa. NASTAD utilizes state AIDS program directors and their staff to engage in

twinning relationships with South African provincial and district staff, providing peer-based technical

assistance to increase program capacity. This project builds on a government-to-government twinning

relationship between the Massachusetts Department of Health AIDS Bureau and the Eastern Cape

Department of Health AIDS Directorate and the Eastern Cape PLHIV community that has been in existence

since 2000, and has been facilitated by South Africa Partners. NASTAD has been provided with PEPFAR

funding to expand these initiatives and to support three additional twinning relationships between California

and the Western Cape Department of Health (WCDOH), Indiana and Free State Province Department of

Health (FSDOH) and between Illinois and the Northern Cape Department of Health (NCDOH). NASTAD will

also assist Mpumalanga Provincial Department of Health (MDOH) and coordinate twinning with a U.S. state

to be determined.

ACTIVITIES AND EXPECTED RESULTS:

NASTAD will (1) maintain the existing four health department twinning relationships (2) add a fifth twinning

relationship with Mpumalanga province, and (3) enhance capacity of the provincial health departments by

promoting twinning relationships between U.S. state and South African provincial academic centers and

NGOs. This twinning activity will demonstrate best practices in the areas of community capacity building for

antiretroviral treatment (ART) roll-out and for prevention programs for PLHIV.

ACTIVITY 1: Training

NASTAD will train PLHIV in Eastern Cape, Free State, Northern Cape and Mpumalanga to form and

facilitate support groups for PLHIV to implement the Basic Care Package for PLHIV. This package includes:

acceptance of HIV status, disclosure, prevention with positives, and treatment of opportunistic infections

(with a special focus on TB/HIV co infection and the provision of cotrimoxazole), and ARV and adherence.

Addressing prevention with HIV-infected individuals is an important part of the NASTAD 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 goal of

these interventions is to prevent the spread of HIV to sex partners and infants born to HIV-infected mothers

and protect the health of infected individuals. Elements of the impact of nutrition and gender issues on HIV

status will be covered. NASTAD will foster twinning relationships between PLHIV groups in the US and

South Africa. There will be an exchange of training programs, building capacity of local institutions to

accredit and maintain these training programs, strengthening PLHIV support groups in each of the four

provinces where these programs will be institutionalized with the support of local universities and the

regional training centers. The aim is introduce care for PLHIV as soon as they are diagnosed as HIV-

infected. It will serve to bridge the continuum of care from testing to treatment and end of life care.

ACTIVITY 2: Support Groups and Counseling

iBhayi Living Centre: NASTAD and its sub-partners will continue to work closely with the MANEPHA (a

network of PLHIV), ECDOH, the EC Department of Social Development, and the Nelson Mandela Bay

Municipality to strengthen the reach and activities offered by the Centre. These will include the following: 1)

weekly support groups in all three NMBM Local Service Areas (LSAs), in partnership with local churches, to

provide a psychosocial support for PLHIV, and 2) continuation of monthly counseling sessions led by local

professionals at district level that provide important information and referrals for key areas (e.g. nutrition,

substance abuse, social grants, prevention with positives).

Activity 3:

NASTAD will integrate Prevention with Positives into the Basic Care Package for PLHIV. They will train

facilitators of the support groups on PwP and deliver these services through the support group facilitators

(employed by NASTAD) to deliver PwP training to PLHIV within support groups in EC, NC and FS

provinces.

SUMMARY:

In FY 2008, NASTAD will continue to support government-to-government twinning relationships between

four South African provincial Departments of Health AIDS Directorates and five U.S. state health

department AIDS programs, resulting in bi-directional exchange of expertise and improved capacity of

provincial health systems. The primary emphasis areas for the activity are local organization capacity

building and human resource strengthening with secondary emphasis on community mobilization, linkages

with other sectors and initiatives, and policy and guidelines. The activity targets persons living with HIV

(PLHIV), policy-makers, teachers, public health workers, and faith-based organizations (FBOs).

BACKGROUND:

NASTAD is a U.S. non-governmental organization (NGO) with a membership of U.S. state health

department AIDS program directors whose positions are analogous in program responsibility to provincial

AIDS Directors in South Africa. NASTAD utilizes state AIDS program directors and their staff to engage in

twinning relationships with South African provincial and district staff, providing peer-based technical

assistance to increase program capacity.

ACTIVITIES AND EXPECTED RESULTS:

In FY 2008, NASTAD and its partners will (1) maintain the existing four health department twinning

relationships; (2) add a fifth twinning relationship with Mpumalanga; and (3) enhance the network, linkages,

and referral capacity of the provincial health departments by promoting twinning relationships between U.S.

state and South African provincial academic centers and NGOs.

ACTIVITY 1: Capacity Building

Human resources are the backbone to the organizational structures, institutional arrangements and

strategies existing in South Africa. NASTAD will build capacity in leadership, strategic management and

program management in the areas of logistic and supply, finance, information management, collaboration

and partnership development, behavior change, community participation and NGO management. Provincial

DOHs require strong, dynamic HIV program leadership and well-trained program managers at the national

and district levels. Conditions and resources vary significantly among provinces. NASTAD will focus on core

content, skills and competencies that should underlie all programs NASTAD will enhance the twinning

relationships with its current provincial partners in South Africa utilizing an HIV leadership model to enhance

capacity at the provincial level. In addition, NASTAD will work with the provincial AIDS Directorate in

Northern Cape Province to continue providing peer education training to incarcerated populations in the

province and work with religious leaders to foster closer collaboration with the province.

ACTIVITY 2: Support of MANEPHA (Network of People Living with HIV and AIDS) - sustained growth in

Eastern Cape, and replication in Free State, Mpumalanga and Northern Cape.

NASTAD will continue to support and strengthen PLHIV advocacy groups with the following activities: 1)

support regular meetings of MANEPHA leadership structures (provincial network committee, coordinating

structure, health advocates, and district network committee); 2) organize the provincial summit to be held in

April 2008 that will include government and PLHIV representatives from across the Eastern Cape; 3)

provide introductory leadership and advocacy training for newly identified PLHIV leaders in all the

provinces; 4) provide capacity building sessions to strengthen existing leadership in the network, further

develop organizational functioning and develop skills and knowledge of network members; 5) increase

outreach at the District and Local Service Area (LSA) level targeted at reducing stigma, mobilizing

communities, and education about HIV-related services; and 6) further integrate MANEPHA activities into

those of the Provincial and District AIDS Councils.

In FY 2008 NASTAD will explore a potential relationship with the South African Institute for Health Care

Managers (SAIHCM). NASTAD is based in Washington, DC and is a member organization of U.S. state

health department HIV/AIDS directors. SAIHCM is a local professional association and alumni service to the

HIV and AIDS managers who participate in the PEPFAR-funded management development programs

offered by the Foundation for Professional Development (FPD). The activities would include an alumni

service, management and leadership development at centers, work place peer support systems and

mentorship. The target for this population is current district health system managers and students

undergoing pre-service training in this area. The program would improve effective and efficient delivery of

HIV/AIDS treatment and care through management development capacity building.

Strengthening HIV programming leadership at provincial and district level and the development of

advocacy, leadership and networking skills of people living with HIV (PLHIV) will assist in meeting

PEPFAR's strategic plans for HCD and 2-7-10 goals.