SUMMARY:

This activity is a component of a comprehensive prevention education, care and treatment program for

small to medium enterprises (SMEs) with 20-200 employees and other workplaces in South Africa. It

includes activities in CT, ARV Drugs, ARV Services, Policy Analysis and Systems Strengthening, and

Condoms and Other Prevention.

Background:

The South African Business Coalition (SABCOHA) will implement through the Vender Chain Management

and BizAids sub-partnerships. The major emphasis for this program will be the development of a workplace

program, with minor emphasis given to community mobilization and participation; training and linkages with

other sectors and initiatives and development of information, education and communication materials. The

target population will include adults (men and women of reproductive age), truck drivers, factory workers,

the business community and HIV/AIDS affected families. The project will focus on gender by addressing

male norms and behaviors, issues associated with violence and coercion and stigma and discrimination (all

key US legislative issues).

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Vendor Chain

Vendor Chain Management will make use of the SABCOHA HIV/AIDS Toolkit methodology which has a

component on workplace prevention programmes. During the capacity building of companies, there will be

training of managers, steering committees and HIV Coordinators on prevention. It will be one of the major

components of the program as it will cut across at all levels of the company. The approach used will include

the education in terms of workshops, information in terms of materials which will be provided during the

various sessions as well as various communication channels include audio-visuals. In addition, an

assessment to determine needs and risk profile of company(gender, age, socio-cultural aspects) will be

conducted. This will assist in determining how prevention programs can be tailored to meet companies'

needs. Companies will also be linked to external service agencies for continuous support after the direct

capacity building intervention. A particular focus of the company workshops will be on the B component of

the AB messaging.

Activity 2: Project Promote

Through Project Promote the current private sector partners in the cleaning and hygiene sectors will receive

support on IEC material and programme messages to be included in in-house HIV/ AIDS company training

that focuses on issues such as the be faithful messages highlighting the significant risk of having concurrent

partners as well as issues of stigma and discrimination within the workplace. The contract cleaning

industry is almost 60% female and as such gender issues will also be covered in the materials provided to

companies for dissemination. Current private sector partners of Project Promote combined employ over 30

000 cleaners. Through internal company trainers and as part of the partners ongoing workplace programs,

Project Promote aims that its private partners will reach at least half of these employees over a 5 year

period. During FY 2008 Project Promote aims to facilitate the training of 3800 cleaners.

Activity 3: BizAIDS

The Micro Enterprise sector in South Africa is enormous. Developed by the International Executive Services

Corps (IESC) BizAIDS mainstreams HIV and AIDS issues within broader operational and strategic issues

for micro enterprises. BizAIDS is a tested strategy in mitigating the economic impact of HIV and AIDS and

other unplanned risks on micro-enterprises.

In a 15 hour programme, at minimal cost to the business owner, they will acquire business management;

health (HIV) and legal knowledge in managing their business better, thereby reducing risk and to ensure

that to continue to operate in the face of risk and to generate income. The aim of the SABCOHA response

will be to expand on BizAIDS Project as a core strategic initiative and to include VCT as well as treatment

and care to the core projects and through the BizAIDS project, the aim is to train 2500 people over the next

5 years. As the BizAIDS progamme links to with the vendor chain programme the same treatment and care

model will be used. While numbers are based on an average of 500 micro-enterprises per year to be

serviced each year over 5 years, it is possible that the treatment and care components can be extended to

include spouses and dependents should funds allow. The BizAIDS programme will have access to 500

Microenterprises per annum. On Average these enterprises have approximately 5 employees each with an

additional 5 family members being influenced by the enterprise itself.

This activity will directly contribute to PEPFAR's goal of preventing 7 million new infections. These activities

support the USG Five-Year Strategy for South Africa by expanding and improving quality AB prevention

programs.

SUMMARY:

This activity is a component of a comprehensive prevention education, care and treatment program for

small to medium enterprises (SMEs) with 20-200 employees and other workplaces in South Africa.

Activities and Expected Results:

Activity 1: Project Promote

Project Promote is a public private partnership established in 2006, between the South African Department

of Health (NDOH), SABCOHA and the cleaning industry through Prestige Group, Fidelity Supercare, Steiner

Group and BidAIR to as part of broader prevention programmes to provide an efficient and effective

mechanism for condom distribution. Project Promote directly supports the NDOH in terms of extending

condom distribution services through non traditional outlets. There is a national task team made up of

representatives from each of the partners managed by SABCOHA, through a consulting organization

Genlem projects that has worked in HIV and AIDS programmes within the cleaning industry for over 3

years. Currently Private sector infrastructure including personnel (trainers, supervisors and cleaners) are

provided at no cost to the project, where SABCOHA funds the progamme management and the department

of health procures, quality assures and delivers the condoms to the primary distribution sites free of charge.

Primary distribution sites are actual Private Sector regional offices of each of the partners. Project Promote

reports directly into the provincial and national departments of health using department of health approved

M&E systems based largely on the Logistics Information System supported by USAID including LMIS

sheets and Bin card. The interest in Project Promote shown by government and Private sector partners

has lead to a far greater demand than originally envisaged and Project promote plans to have 43

operational Primary distribution sites in year one. Distribution mechanisms varying according to Private

sector partner infrastructure, but the broad range of models enable project promote to access SME's

otherwise difficult to reach over large geographical regions. In addition to this the project has begun

supporting a community distribution programme whereby cleaners themselves are used as community

distributors. Operationally over 5 years, Project Promote needs to be maintained and grow by at least 10

new primary distribution sites per year from year 2. Currently 8 of the 9 provinces are fully operational with

Limpopo to be brought on in year 1 as part of the SABCOHA SME programme. This component of the

programme will feed directly into the supply chain strategy and micro-enterprise strategy encouraging

condom distribution through those mechanisms as well. It is anticipated that the SMME's reached through

the Vendor-Chain Programme and the BizAIDS Programme will also be serviced by Project Promote. In

addition to this as part of year one Project Promote will, based on systems currently used by the

Department of Health streamline its operations through the development of and investment in greater IT

technology and systems which will allow the programme to more effectively monitor the 43 sites in year one.

On average the 43 sites are expected to distribute an accumulated total of 600 000 male condoms per

month. These additional 10 sites for year 2 will bring the total number of sites to 53, with an additional 600

000 condoms distributed per month.

Activity 2: BizAids

BizAIDS through a network of small business associations and training providers will facilitate the transfer of

skills to the informal sector. Skilled facilitators lead workshops of 18 - 20 business owners through topics

ranging from: 1) understanding and identifying risks of HIV and other health risks; 2) protecting employees

who are both HIV positive and negative; 3) providing HIV/AIDS legal/community resource directory; 4)

increasing HIV/AIDS awareness through messages of abstinence, being faithful and using a condom; 5)

ysing tools such as a SWOT (Strengths, Weaknesses, Opportunities, Threats in mitigating risk posed by

unforeseen events.

By providing education on key strategies for preventing HIV infection and promoting healthy behavior

change among workforce populations, including appropriate use of condoms, and by distributing condoms

to a large population of workers the SABCOHA workplace program will directly contribute to PEPFAR's goal

of preventing seven million new infections. Through education on prevention messages and the

distribution of male and female condoms, this program will also support the prevention goals outlined in the

USG Five-Year Strategy for South Africa.

SUMMARY:

This activity is a component of a comprehensive prevention education, care and treatment program for

small to medium enterprises (SMEs) with 20-200 employees and other workplaces in South Africa.

BACKGROUND:

SABCOHA program PEPFAR funds will be used to identify HIV-infected individuals as noted in the Vendor

Chain and BizAIDS programs below. The major area of emphasis is Workplace Programs. Minor areas of

emphasis include Community Mobilization/Participation, and Information, Education and communication.

Specific target populations include Male and Female adults, Truckers, and the Business Community. The

care component of this SABCOHA initiative will initially be implemented in at least three provinces namely:

Gauteng, Mpumalanga and KwaZulu Natal. The SABCOHA Vendor Chain and BizAIDS counseling and

testing (CT) programs will identify HIV-infected individuals will be referred into pre- ARV treatment (ART)

services.

The Vendor Chain and BizAIDS components of the existing SABCOHA program will begin a CT and CARE

component that will identify HIV-positive individuals and ensure that they are enrolled in care services until

eligible for treatment. Through its program, SABCOHA will work with the existing infrastructure, and ensure

that newly identified HIV-positive individuals will take advantage of the holistic education, testing, and

treatment program for the employed sector.

Once an HIV-positive individual has been identified, it is the aim of the Vendor chain program to ensure

adequate transition to care. Most of the HIV-positive individuals will be referred to one of the 440

established South African Department of Health (DoH) comprehensive care management and treatment

sites as well as any other sites identified throughout the country. It is critical however that adequate referral

is undertaken. To enable the referral, a specific referral path to a treatment site, adequate and close to the

testing site is identified before testing. Patients tested HIV-positive are referred with the DoH or any other

identified site's accepted referral information. In additional the CD4 count performed at the time of testing is

referred to the treatment site. By referring most patients to government sites this program will leverage the

available funding, infrastructure, personnel, ART and laboratory testing from Government. SABCOHA

estimates that it will provide Pre-HAART services to approximately 2,100 people in the first year.

ACTIVITIES AND EXPECTED RESULTS:

ACTITY 1: identification of HIV positive individuals who are not treatment eligible and ensuring that they

receive the appropriate care

After undergoing VCT, The Vender Chain and Biz AIDS components of the existing SABCOHA program will

refer HIV positive individuals to general practitioners within the established GP Network. The general

practitioners will provide treatment for opportunistic infections, a minimum of 3 visits during the course of the

year to monitor disease progression, laboratory services; prophylaxis or treatment for TB and Health Risk

Management services to each patient. Health care providers will provide patients with pamphlets on signs

and symptoms of disease progression. This will ensure patient awareness of disease progression.

SABCOHA's care activities will contribute to the PEPFAR 2-7-10 goals by identifying HIV-infected

individuals for care, and ensuring they get the appropriate care until they are treatment eligible. This will

contribute to the PEPFAR vision outlined in the Five-Year Strategy for South Africa by expanding access to,

and availability and quality of care services.

SUMMARY:

SABCOHA program PEPFAR funds will be used to identify HIV-infected individuals as noted in the Vendor

Chain and BizAIDS programs below. VCT is used as a prevention mechanism to promote abstinence, be

faithful and to use condoms, as well as an entry-point in to ARV treatment. It is also an essential tool for

fighting stigma and discrimination. The major area of emphasis is Workplace Programs. Minor areas of

emphasis include Community Mobilization/Participation, and Information, Education and communication..

Specific target populations include Male and Female adults, Truckers, and the Business Community.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Vendor Chain

Vendor Chain Management - the businesses that have been offered capacity building though the

development of a workplace - will be offered VCT during the second phase of the programme. VCT will be

offered to all employees of participating businesses.

Activity 2: BizAIDS

BizAIDS activities will ensure that VCT is provided in a training workshop setting.

Activity 3: SABCOHA will use the contracted Disease Management service provider for the provision of

counseling and testing.

Linkages with other services providers and public hospitals will be explored to maximize the manner in

which the intervention can reach the target group effectively and efficiently, as need arises.

The counseling and testing interventions will be conducted by a sub-partner and that will facilitate the

implementation of VCT services to communities that would not otherwise be able to access testing. The.

FY 2008 funding will ensure that employed populations have access to counseling and testing services in

the workplace. SABCOHA will primarily use On-site VCT and provide counseling and testing at the site of

the SME. All sites will be inspected for suitability for testing: e.g. privacy for employees, accessibility,

hygiene. A communication campaign informing employees about the testing date is undertaken before the

testing dates. Such communication is linked into the prevention ABC education. Prior and on the date of

testing, the eligible individuals undergo an education session which includes motivational messaging on the

benefits and procedures of HIV testing.

Information on organizations which provide support will be given to the employees. Referrals for HIV

positive individuals will be done for PreHAART and treatment related services, which will be offered by an

contracted Treatment service provider.

SABCOHA's VCT activities will contribute to the PEPFAR 2-7-10 goals by identifying HIV-infected

individuals for care, treatment and preventing infection in those who are HIV-negative. This will contribute

to the PEPFAR vision outlined in the Five-Year Strategy for South Africa by expanding access to, and

availability and quality of VCT services.

SABCOHA, will have identified a treatment partner to assist in the implementation of the treatment

component of the program.

The treatment component of this SABCOHA initiative will initially be implemented in at least three provinces

namely: Gauteng, Mpumalanga and KwaZulu Natal. The SABCOHA Vendor Chain and BizAIDS

counseling and testing (CT) programs will identify HIV-infected individuals will be referred into ARV

treatment (ART) services. The major area of emphasis is commodity procurement. The minor areas of

emphasis include Development of Network/Linkages/Referral Systems and Training. The primary target

group for these activities are men and women of reproductive age who are employed in small, medium

enterprises, truck drivers, factory workers.

The Vendor Chain and BizAIDS components of the existing SABCOHA program will begin a CT component

that will identify HIV-positive individuals. These individuals will have access to Treatment/ARV Drug

network.

ACTIVITIES AND EXPECTED RESULTS:

Activity 1: Procuring and Supplying ARV Drugs

SABCOHA will be responsible for establishing systems to procure and supply ARV Drugs for its treatment

sites and ensure that there are no drug stock-outs on any drugs despite global shortages in stavudine and

lamivudine. PEPFAR funds will be used for the procurement and distribution of ARV drugs to HIV positive

individuals who are unable to access government facilities by ensuring that they are provided via a network

of trained general practitioners. A system will be set up where the ARV prescriptions are forwarded to a

pharmacy, which handles all the procurement, logistical and pharmaceutical management, dispensing and

distribution of ARVs for this project. The drugs will then be delivered to the treatment sites via an

independent courier company on a weekly basis. Treatment sites receive batches of drugs for multiple

patients with drugs labeled and dispensed on a patient-named basis. Drugs are then securely stored at the

side and dispensed to the patient on a monthly basis. Where sites are able to harness the capacity of a

pharmacist, direct procurement will be facilitated.

SABCOHA's activities in this program area directly contributing to the 2-7-10 goal of ensuring access to

treatment for two million people. SABCOHA will support the PEPFAR vision outlined in the Five-Year

Strategy for South Africa by expanding access to ART services for this program's target audience, building

capacity for ART service delivery and increasing the demand for an acceptance of ARV treatment.

The Vendor Chain and BizAIDS components of the existing SABCOHA program will begin a CT component

that will identify HIV-positive individuals. Through its counseling and testing program, SABCOHA will work

with the existing infrastructure, and ensure that newly identified HIV-positive individuals will take advantage

of the holistic education, testing, and treatment program for the employed sector.

Once an HIV-positive individual has been identified, it is the aim of the Vendor chain program to ensure

adequate transition to care. Most of the HIV-positive individuals will be referred to one of the 440

established South African Department of Health (DoH) comprehensive care management and treatment

sites as well as any other sites identified throughout the country. It is critical however that adequate referral

is undertaken. To enable the referral, a specific referral path to a treatment site, adequate and close to the

testing site is identified before testing. Patients tested HIV-positive are referred with the DoH or any other

identified site's accepted referral information. In additional the CD4 count performed at the time of testing is

referred to the treatment site. By referring most patients to government sites this program will leverage the

available funding, infrastructure, personnel, ART and laboratory testing from Government. SABCOHA

estimates that it will provide Pre-HAART services to approximately 2,100 people in the first year.

For SABCOHA-identified HIV-positive individuals who do not live or work near one of the established DOH

sites, SABCOHA will establish a network of private general practitioners who can provide treatment, care

and support services to the employed population with no access to health care insurance. SABCOHA

estimates that (in the first year) of this initiative approximately 190 patients will use the general practitioner

network.

ACTIVITIES AND EXPECTED RESULTS:

Activity1: Expansion of treatment services

SABCOHA will use FY 2008 PEPFAR funds to accelerate the implementation of the national rollout plan at

government sites in partnership with the National Department of Health (NDOH).

All of the HIV-positive patients will be maintained through a model that enables primary healthcare providers

to communicate directly with HIV experts.

SABCOHA will ensure that each ART patient at a SABCOHA supported facilities receives a minimum

package of ART services, including clinical and pathology monitoring, and adherence counseling. There will

be follow-up of all defaulting patients. Adherence activities will include a focus on reducing stigma and

encouraging disclosure in order to enhance drug compliance and to improve patient retention.

Providing comprehensive treatment services in a workplace setting will contribute to the PEPFAR 2-7-10

goals. These activities will also support the care and treatment objectives laid out in the USG Five-Year

Plan for South Africa.

The South African Business Coalition (SABCOHA) will implement through the Vender Chain Management

and BizAids sub-partnerships. The major emphasis for this program will be the development of a workplace

program, with minor emphasis given to community mobilization and participation; training and linkages with

other sectors and initiatives and development of information, education and communication materials. The

target population will include adults (men and women of reproductive age), truck drivers, factory workers,

the business community and HIV/AIDS affected families. The project will focus on gender by addressing

male norms and behaviors, issues associated with violence and coercion and stigma and discrimination (all

key US legislative issues).

Activities and expected results:

Activity 1: Vendor Chain

In the Vendor chain program, during the capacity building of companies, there will be discussions on the

HIV and AIDS workplace policy, procedures and human resources (HR) issues. This will result in drafting of

policies with the participating companies and in ensuring that the HIV and AIDS programs can be linked to

the existing company systems without unnecessary duplication of work and/or roles.

Managers will be trained on Stigma and Discrimination as part of the Management training.

One of the components will include the discussions on the HIV/AIDS Workplace policy, procedures and HR

issues specifically relating to performance management, compensation, industrial relations and the

management of incapacity and disability in accordance with the Code of Good Practice, ensuring a non-

discriminatory work environment . This will also include managing misconceptions and prejudice and the

development of supportive relationships amongst employees.

Activity 2: Peer Education

In offering HIV-related education, counseling and support in the workplace, peer educators are in many

respects at the coalface of the epidemic. SABCOHA will also strengthen the existing Peer Education

forums in the 5 provinces where they exist.

Using FY 2008 PEPFAR funding, the trained HIV Coordinators and peer educators in the vendor chain

program will be linked to the strengthened and fully functional peer education forums. As the Vendor Chain

Programme unfolds in other provinces, SABCOHA will develop more Peer Education forums.

Activity 3: BizAids

A personal participant handbook forms the basis personal plans of action to mitigate against the risk of

HIV/AIDS and its potential for disruption of small business. BizAIDS training materials have been developed

in English. Research has found that small businesses owners prefer to have the training delivered in

English as they believe the language of business is English. Trainers switch to the vernacular when

translating areas of uncertainty. Training handouts include information on HIV/AIDS prevention,

abstinence/be faithful, VCT & Treatment options and guidance on how to link into local business, treatment

and legal assistance services. These materials come from strategic partners such as the Khomonani

campaign (the communication campaign implemented by the South African Department of Health, The

AIDS Law Project and Metropolitan Health. Linking the business owner, their employees and family to VCT

and treatment is the next necessary link.

Providing effective prevention messages and leadership education to employer associations, business,

worker representatives and union members in a cross-section of South African industry will contribute to

PEPFAR's goal of preventing 7 million new infections. The activities described here will also support the

prevention objectives identified in the USG Five-Year Strategy for South Africa.