SUMMARY:

USAID and CDC will support the National Department of Health (NDOH) to create and lead an HIV

prevention consultative core action group (or "Action Tank"). The purpose of the Action Tank will be to help

the South African government (SAG) accelerate the scale-up of HIV prevention through an inclusive, broad-

based process to develop comprehensive, coordinated, evidence-based, target-driven national prevention

implementation strategy. The group is slated as an "action tank" because in addition to providing expert

advice and recommendations, its primary purpose is to facilitate large scale prevention action under NDOH

leadership. The establishment of the Action Tank will be done through an active and participatory approach

that will engage key stakeholders and facilitate the alignment of prevention actions based on understanding

the SA HIV epidemic.

The creation of the Action Tank will be a multi-tiered process that will progressively strengthen the capacity

and engage the leadership of the NDOH and other key actors. This may include: a rapid prevention

program situation analysis, identification of challenges and barriers to effective scaled-up prevention

programming, identification of programming gaps and best practices, development of a plan to focus

strategic implementation for maximum results, and an on-going process for prevention program evaluation

and utilization of new information. The process will engage stakeholders and other donors in order to

achieve consensus on the implementation strategy.

BACKGROUND:

South Africa is the most affected country in the world, with an estimated 5.7 million HIV-infected people and

an estimated 530,000 new infections annually. While there is some indication that the prevalence may be

starting to decline (from 29% in 2005 to 28% in 2007 in antenatal clinics), the continued rate of new

infections, the increasing numbers of patients on treatment and ever growing numbers of orphans and

vulnerable children result in an incontrovertible burden on the South African health, social, and economic

systems. There is an urgent need for effective prevention programs at a national scale and that can be

sustained by the SAG and civil society for the long term.

Former South African President Mbeki provided little leadership to prevent the spread of this epidemic. In

addition, the previous Minister of Health did not make HIV programming a priority, did not encourage

coordinated action, and criticized donor-supported HIV programs. In stark contrast to most PEPFAR focus

countries, donors, including the USG, have not played a direct, major role in strategy or policy formulation in

recent years. However, the change in national leadership and the new Minister of Health offer an

opportunity to help the SAG shift the prevention paradigm. The NDOH has placed prevention among the

high priorities in HIV programming and seems to be open to developing a robust partnership for prevention.

The SAG emphasized the need for an integrated, inter-departmental approach to dealing with the pandemic

and this will be an important component of a strategic implementation action plan.

The examples of successful prevention programs around the globe, such as Cambodia, Senegal, Kenya,

Zimbabwe, India, and Haiti that have seen significant changes in social norms and individual sexual

behavior all have the common denominator of high level political support and engagement. These examples

demonstrate that barriers to scaled-up prevention efforts can be overcome through evidence-informed

action.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Capacity and Consensus Building

Together with the NDOH, the USG will help support an inclusive process, bringing together multiple sectors,

key donors and actors, and ensuring strong participation by civil society, affected communities, and people

living with HIV, to garner consensus on the state of current prevention programs in relation to the epidemic,

identification of program gaps and best practices, and develop a comprehensive implementation strategy for

the HIV prevention. Engaging the NDOH in the PEPFAR prevention program stock-taking exercise will be a

part of this process.

ACTIVITY 2: Creating the Action Tank

USAID and CDC will work closely with the NDOH to facilitate the creation of a core group, the Action Tank

and establish its terms of reference. It is expected that the Action Tank, led by the NDOH, will facilitate the

implementation of the National HIV prevention plan, will work with international and national technical

agencies, and national, provincial, and district level HIV authorities to assess HIV prevention scale-up on an

ongoing basis, and identify factors that impede program expansion. In the long term, the Action Tank may

facilitate the initiation of joint reviews of the HIV prevention program and support the revision of the

prevention implementation plan as needed, based on epidemiologic trends, evaluation findings, and the

emergence of new prevention tools.

ACTIVITY 3: Action Tank Actions

Based on the Action Tank terms of reference and the needs of the NDOH, the Action Tank may support the

following types of processes to facilitate a coordinated, evidence-based national scale up of prevention

programs under the leadership of the NDOH:

-Establishment of clear achievable targets for the prevention program: Using available information and

research findings, the Action Tank, with technical assistance, may help the NDOH establish concrete

measurable indicators for HIV prevention including coverage, intensity of prevention efforts, and outcome

and impact of the HIV prevention program.

-Effective utilization of HIV prevention information: South Africa has strong HIV and behavioral surveillance

systems, high quality data from population-based surveys, and information from a variety of quantitative and

qualitative research activities; the drivers of the epidemic are clearly understood and outlined in the HIV

Activity Narrative: and AIDS and STI National Strategic Plan. The Action Tank might help the NDOH take on a more robust

leadership in assuring that all actors (in the public and private sectors) clearly understand this information,

including HIV prevalence and incidence, the sources of new HIV infections, the size and characteristics of

groups most at risk, important sources of HIV-related vulnerability (e.g., drug and alcohol use, cultural

norms, social, economic, etc.), and how to use this information to continually refine the prevention response

and fill gaps. The Action Tank may also help the NDOH identify gaps in HIV prevention information that

could be filled through research or action research.

-Addressing factors that increase vulnerability: The Action Tank might assist the NDOH to develop an

advocacy and/or action plan to address the broader social, cultural, and structural issues that increase

vulnerability to HIV transmission. This may involve assuring greater synergy between and among

governmental departments, and identifying priority policy actions.

-Improved integration of HIV prevention with treatment and other clinical services: The Action Tank might

assist the NDOH in developing activities to assure real field-level integration of prevention with HIV, TB, and

STI treatment programs, and explore methods to encourage integration of HIV prevention in other service

delivery settings.

This activity contributes to the PEPFAR goals and objectives by strengthening the prevention portfolio and

developing a coordinated national framework in which to implement prevention in South Africa. This will

contribute to reducing new infections.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03: