The goal of this project is to prevent HIV infections in Gert Sibande, Mpumalanga by combine evidence based prevention programming targeting commercial sex workers (CSWs) and tavern patrons to reach 80% of CSWs in selected drinking places with comprehensive, evidence-based behavioral interventions to reduce high risk sexual behavior; ensure annual HIV testing of 90% of targeted CSWs; increase referral of CSWs to HIV care and support; implement Prevention with Positives; increase awareness of safer sex and alcohol use; and develop a project to be integrated into SAG services at provincial and district levels. When possible, indicators will be internationally recognized and derived from the PEPFAR Indicator Reference Guide. Standard data collection tools will be used to measure training and implementation outputs and outcomes, meetings will be conducted to discuss data and make data-driven decisions, information will be checked for accuracy and reliability, and audits will be conducted using established tools. HDA activities will be coordinated with Soul Citys Phuza Wize campaign to ensure resource efficiency. The project aligns with South Africas strategic plan and partnership framework, and supports PEPFAR and SAG goals of supporting country-led initiatives aimed at primary prevention of HIV infections. HDA has a track record of building the capacity of local organizations, and the Departments of Social Development and Education regard HDA as a key partner in the delivery of capacity-building initiatives. PSASA staff will be trained as trainers and receive management and technical support to scale up interventions. As part of the community mobilization strategy, HDA will pass developed training resources and capacity building interventions to local organizations.

Reliable data exists neither of the HIV prevalence, current HCT coverage, nor the size of the sex worker population in this geographic area. Using a model that employs community mobilization through peer education and outreach, HDA will provide community-based HIV counseling and testing (HCT), STI screening, appropriate referrals to HIV, STI care treatment and support (including mental health and substance abuse support) to CSWs working at drinking establishments, and their male clients/tavern patrons. All HVCT funding provided through this cooperative agreement will support provision of HCT for CSWs, a most at-risk population. This project aims to reach 80% of identified sex workers in the target area with HCT. CSW peer advocates will be employed to facilitate referral to appropriate care and treatment services. HDA will work with PEPFAR partners and DoH to establish referral systems to ensure ease of access and track and follow up on the service provided. . In FY2012, HDA aims to provide HCT and STI screening to 1000 persons (800 CSWs and 200 of their male clients). In FY2012, HDA will conduct bio-behavioral surveillance as part of the situational assessment to obtain baseline prevalence and risk behavior information. In 2012, this surveillance activity will sample 500 CSWs in Gerte Sibande district at a unit cost of $40.57 per study participant.

HDA has identified 5 target groups for this project: CSWs, male tavern patrons, tavern owners and managers, primary healthcare workers, and partnering CBOs. HDA's HCT activities will be complemented by sex worker peer advocates and male peer advocates trained through the One Man Can campaign, who will provide community mobilizations around HCT and STI screening services, distribute female and male condoms and risk reduction information to sex workers and male patrons at drinking establishments. CSWs identified through stakeholder engagement will participate in formal workshops and trainings (Stepping Stones Intervention) to examine attitudes towards gender and relationships, build on their knowledge of aspects of sexual health and HIV/AIDS, and develop skills to help them communicate their needs to others. The target for the Stepping Stones training in FY2012 is 600 CSWs. Of the CSWs participating in Stepping Stones, those who show leadership and an aptitude for peer education will be trained as peer advocates. The functions of peer advocates are to provide risk reduction education and condoms to their peers, support the practice of preventative behavior, and link CSWs to the primary health care system. HDA aims to train 80 CSW in FY2012 as peer advocates, who will in turn provide risk reduction information, support and materials to 6200 people in FY2012 . The One Man Can tools and materials will be adapted to provide men-to-men peer outreach in taverns to discuss alcohol use, violence, and masculinity to ensure a combination of behavior change strategies in drinking locations. 20 peer educators for the One Man Can component of this project will be trained in FY2012. HDA will hold training sessions for tavern owners and managers on how to support the project and CSWs frequenting their establishments as well as ensuring the availability of condoms. The buy-in and support from local health workers is crucial for the creation of a conducive environment in which CSWs able to practice risk reduction behavior and seek appropriate health services. In partnership with Department of Health, DHA will obtain buy-in and provide clinic health staff with information and sensitizations trainings on providing cooperative and friendly places for CSWs (and their sex partners), to obtain appropriate health services, and collect condoms and lubricants. DHA will work with PEPFAR partners and DoH to establish referral systems based on the standard HBC system for their peer educators to ensure ease of access and track and follow up on the service provided.