ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Funds will be used to continue to implement the activities as indicated in FY 2008. Of the FY 2008 activities

that have not been implemented, we anticipate implementation to take place by February 2009. Once the

systematic framework has been implemented, FY 2009 funds will be used to develop specific activities that

address gaps in service delivery for sex-workers and other most at risk groups.

----------------------

SUMMARY:

As part of an integrated approach addressing most at risk populations (MARPs), this activity focuses on the

development of a strategic and systematic framework to deliver HIV Prevention to Persons Engaged in High

-Risk Behaviors (PHPEHRB). Groups that are acknowledged to be core transmitters in South Africa, even

within a generalized epidemic, are: migrant populations, persons engaging in commercial and transactional

sex, members of the uniformed services and persons working along transport corridors. This activity aims to

develop a strategic and systematic framework to deliver HIV prevention messages to these target groups. In

addition, funding will be used to facilitate the development of national referral networks and linkages

focusing on HIV counseling and testing, behavior change interventions and referral to treatment, care and

support services for commercial sex workers (CSWs), men who have sex with men (MSMs) and alcohol

abusing population of South Africa. The major emphasis area for this activity is the development of linkages

with other sectors and initiatives in order to develop a systematic framework. Minor emphasis areas include

community mobilization/participation; development of networks, linkages and referrals and information,

education and communication. The target population is high-risk vulnerable groups, including CSWs,

MSMs, substance abusing populations, including alcohol, and migrant workers.

BACKGROUND:

Although this activity appeared in the FY 2007 COP, activities have not yet been implemented and it is a

new activity with the partner. Detailed scope of the activity is to be determined in collaboration with the

South African PEPFAR Prevention Technical Working Group and the global PHPEHRB Technical Working

Group. Discussions are currently underway with the PHPEHRB Technical Working Group and it is

anticipated that a more specific scope of work will be available in November 2007. The unspent FY 2007

and a portion of FY 2008 funding will be used to conduct a mapping activity that will provide additional

qualitative information, mapping and size estimates to inform program design and measure coverage.

ACTIVITY 1: Mapping

FY 2007 and FY 2008 will be used to conduct a mapping exercise of persons engaged in high risk

behaviors. The purpose of this mapping exercise is to identify specific needs for most at risk groups both in

terms of geographic hot spots and magnitude of key groups. This will be an important entry point to

engaging existing partners as well as new partners to expand their work with these populations (which often

requires distinct approaches. This activity will be initiated with FY 2007 funding and FY 2008 funding will be

used to expand the mapping exercise and plan for expansion of interventions.

ACTIVITY 2: Development of a systematic framework

In collaboration with other donors, the National and Provincial Department of Health, the PEPFAR

PHPEHRB Technical Working Group, and non-governmental organizations (NGOs), FY 2008 funding will

be used to identify gaps in delivery of HIV prevention to PHPEHRB. The identification of gaps will be based

on the findings of the mapping exercise above. A national plan that addresses challenges in implementation

of HIV prevention to at risk populations will be developed. The framework/national plan will focus on the

implementation of behavior change interventions, and the development of networks and linkages suitable

for most-at-risk populations. In order to develop the systemic framework, a national consultative forum will

take place to identify groups working with PHPEHRB. At this forum the results of the mapping activity will be

presented and a comprehensive strategy focused on providing sufficient coverage of at risk populations will

be developed. The consultative forum will ensure participation of government and non-government

agencies in the development of a national framework for working with high risk groups in the context of HIV.

ACTIVITY 3: Implementation of specific interventions targeting most-at risk populations

Based on the findings of the mapping activity (Activity 1) and the development of the systemic framework

(Activity 2); FY 2008 funding will be used to support groups working with people engaged in high risk

behaviors. FY 2008 funding will be used to expand coverage and intensify HIV prevention programs for

migrant populations, persons engaging in commercial and transactional sex, injection and non-injection

drug users, men who have sex with men, members of the uniformed services and persons working along

transport corridors.

ACTIVITY 4: HIV and alcohol interventions

Alcohol abuse has been identified as a substantial risk factor for HIV transmission. Recognizing that

irresponsible alcohol use can contribute to a range of social harms, including sexual risk behavior that can

lead to HIV infection, FY 2007 PEPFAR funding, was used to provide the South African PEPFAR task team

with information for the development of a PEPFAR strategy aimed at addressing alcohol and HIV. The

Medical Research Council (MRC) will present the findings of this report to the South African PEPFAR team

in March 2008. Based on these findings, PEPFAR funds will be used to develop an intervention that will

promote responsible drinking and the adoption of HIV preventive behavior. Drinking venues (bars, taverns,

shebeens) are identified as ideal venues in which to implement such interventions, since they are locations

in which: (a) casual sexual partners are met; (b) sexual risk behaviors are initiated and/or take place; and

(c) patrons are a "captive audience" for health promotion and similar interventions. In addition, this activity

Activity Narrative: will address gender, because shebeen/tavern "culture" is often associated with interpersonal and gender-

based violence and sexual assault, some of which is associated with HIV infection. It would be a missed

opportunity to not also consider reducing alcohol-related violence as part of the intervention. In addition,

activities will be implemented to include alcohol education in interventions targeting youth, adults in the

general population and most-at-risk groups.

This activity will contribute PEPFAR 2-7-10 goals by preventing infections in PHPEHRB and encouraging

HIV counseling and testing, and appropriate referral to treatment, care and support services. In addition,

this activity will enable the South African USG PEPFAR team to scale programs serving most at risk

populations, including, but not limited to CSWs and alcohol abusing populations.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14281

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14281 10991.08 HHS/Centers for To Be Determined 6763 5678.08 TBD-MARPs

Disease Control &

Prevention

10991 10991.07 HHS/Centers for To Be Determined 5678 5678.07 TBD

Disease Control &

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

* 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: