INTEGRATED ACTIVITY FLAG: This activity is linked with activities described in the OVC (#7634) program area. WVSA also implements an OVC Care and Support programs as a sub-partner through PACT in FY 2007. WVSA will partner with Hospice Palliative Care Association of South Africa to ensure OVC and household members can care for themselves.

With existing PEPFAR funding WVSA focus on six project sites, selected based on high HIV/AIDS prevalence, existing Area Development Projects (ADPs), existence of basic HIV/AIDS programs, and potential for community participation. In addition to establishing a program of Interpersonal Therapy for Groups for 417 HVs (Home visitors) and creating community conversations, the project will integrate psychosocial support and advocacy into all programming to ensure adequate care is provided for care givers and volunteers currently in WVSA OVC programs.

SUMMARY: WVSA is expanding OVC care activities by increasing the coverage, scope, and quality of services. Emphasis areas are community mobilization/participation, training, Interpersonal therapy, psychosocial support and development of linkages and referral systems. Target populations are OVC and their families, HVs, FBOs, volunteers and primary care givers.

BACKGROUND: WVSA is a non-profit organization established in 1967 working in 14 ADPs in six provinces of the country, reaching over 42,000 children with holistic development support. WVSA has already identified and is providing community-led support to 3, 850 OVC in these ADP's. With PEPFAR funding this number will be increased to 10,000 children by the end of the project. By working with community partnerships through their CCC model, WVSA enhances their ability to prevent, mitigate and alleviate the impact of HIV and AIDS. Care at the home and community level is a strategy within the South African Government Strategic Plan.

WVSA will continue to strengthen access to integrated services as a part of a comprehensive care package for PLHIV and their families in Free State, Limpopo and Eastern Cape provinces. The activities reinforce and expand services provided by CBOs and government care programs, such as basic hygiene, wound care, screening for pain and symptoms, nutrition assessment and support, spiritual support, spiritual care, psychological care and promotion of the HIV preventive care package. With FY 2007 funding, WVSA will further institutionalize the program within government and CBOs, while also expanding its reach. WVSA will emphasize capacity building and local skills transfer, and will also stress gender sensitivity in counseling and community outreach, promote couple counseling, and assist HBC programs to develop strategies to alleviate the care burden on girls. In all activities, WVSA will ensure quality of community-based services, and identify/apply lessons learned.

ACTIVITIES AND EXPECTED RESULTS: Activity 1: Home based care program The majority of care workers (home visitors/HVs) in OVC programs are women (over 70%) while two thirds of the adult beneficiaries of the current home care programs are also women. In many cases, care workers may also be recognized as traditional healers. WVSA will work to increase the involvement of men in care-giving. As part of psychosocial support trainings, care workers will engage men by focusing on such topics as family violence, anger management, fathering and parenting skills. A stipend provided to care workers and volunteers through the HBC program is an important source of household income. Regular financial training seeks to improve the capacity and economic advancement of care workers in the program. In addition to the psychosocial support training 417 HVs will be trained on Palliative Community caregiver training by Hospice according to the accredited National minimum standards for palliative care training on Palliative Care for Community Caregivers and Resilience in Children and Caregivers. Some of the core models include basic hygiene, psychosocial support and community care.

Trained HVs provide a minimum standard of care focusing on physical, psychological, spiritual and social interventions. In addition to sharing integrated HIV-related palliative care messages with HIV-infected individuals and their families, care workers will use a family centered approach to client assessment. Based on need, clients are referred to clinic or hospital for pain management, treatment of OIs, family planning or other issues as

observed. Clients are also counseled on prevention for positives and family member are referred for counseling and testing. Outreach to the community and referrals are part of the HBC activities. An additional key activity of care workers is monitoring of adherence to TB and HIV treatment. Elements of the preventive care package for adults and children are also included during interaction between the care worker and the client. Special emphasis during training will ensure HVs have a comprehensive understanding of referrals and linkages with other services, including linkages with health and social welfare sectors for grants, legal aid, micro-finance, spiritual support, CT, ARV's, and FP

Activity 2: Psychosocial support training Identify and train supervisors and group leaders among home visitors. In districts where psychosocial support will be established, community group leaders will be trained to reach OVC, adults, and their households through psychosocial support groups. At each site qualified and trustworthy community members to guide support group activities will be identified. These community-based group leaders will lead weekly support sessions for the group members and conduct home visits to OVCs. At program outset, WV's Regional Psychosocial Advisor, based in Nairobi, will train supervisors as well as selected WVSA staff. The training curriculum is based on successful modules designed to address the particular needs of children and of adults, and will equip supervisors to train others in care of the carer. At all levels, care of the carer and wellness training will focus on psychosocial interventions, including assessment, basic counseling, group facilitation, and advocacy. Complementing health and nutrition lessons, training will ensure that all trainees are able to recognize general physical as well as psychosocial health problems associated with HIV/AIDS in children, and to make appropriate referrals to Child and Family Wellness clinics, Health Centers and PHC Centers as needed.

Support group meetings led by trained group leaders using interactive and participatory techniques will be held regularly with HVs and working with churches/FBOs, and CBOs, WV will invite community members to form psychosocial support groups. Group members will also be identified through assessment interviews and information provided by relevant community members. During these support group sessions, HVs and volunteers will learn to enhance coping skills to accomplish activities of daily living. Members will carry out tasks designed to enhance relationships and build self-esteem. Positive living is reinforced as group members develop emotional resilience. At the end of the project's first year, groups will be encouraged to continue meeting, with ongoing guidance from WV staff. The positive impacts of psychosocial support will extend to group members' households, and family members will benefit indirectly from the support group's first year of activities.

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Human Capacity Development. WVSA will conduct workshops utilizing the CABSA CoH curriculum for community leaders, FBOs and CBOs. A two-day Leaders Workshop will be held with leaders of all faiths from the targeted areas. The workshop will help religious leaders understand the urgency of the HIV and AIDS crisis, to address negative and discriminatory attitudes towards PLHIV and OVC and to work towards a compassionate and effective response to OVC care in their congregations and communities. These leaders will return to their congregations to identify members who will attend a four-day workshop focusing on best practice models for HIV prevention messages, care for OVC, home-based care, voluntary counseling and testing and advocacy for OVC issues at the local government level. WVSA will work with each FBO to develop an action plan to address OVC issues in their congregation and promote gender-sensitive attitudes in their communities. Trained congregation and FBO members will form Hope Teams. WVSA will support Hope Teams to implement action plans to protect and care for OVC and their families. Hope Teams will work closely with the CCC and the Department of Social Development (DoSD) at the provincial and district level. ACTIVITY 2: Community Mobilization/Participation. With FY 2007 funding, WVSA will assist targeted communities to establish structures to care for and support OVC. One element of an enabling environment for OVC support is the sustainability of CBO such as community care committees (CCCs). To this end WVSA has developed and will implement an organizational capacity building guide that includes self-assessment, training based on the assessment and follow-up support for CBOs. WVSA will support the provision of a package of services for OVC in the targeted communities, including educational, nutritional and psychosocial support. Following the DoSD model, WVSA will work with CCCs to mobilize an array of community stakeholders. A two-day community workshop will review activities already underway in the community, identify gaps, and select the appropriate CCC structure. WVSA will then train and support CCCs to carry out assessments to identify OVC according to the DoSD National Plan of Action and Policy Framework for OVC. WVSA and CCCs will recruit new Home Visitors (HV) who will identify OVC in their catchment area and visit them in their homes to assess their needs. CCCs will be encouraged to participate within the District Action Committee for Children Affected by HIV/AIDS (DACCA). Together with the CCC the HV will receive training on further modules that include Child Rights and Protection, health and nutrition, HIV prevention messages, life skills, psychosocial support and succession planning over a five day period. With WVSA support each identified OVC will receive a basic minimum package of services and support from HV ranging from direct material provision to greater livelihood security. ACTIVITY 3: Care and Support. Following the workshops for CCCs and HVs, each OVC will receive a basic minimum package of services, including child monitoring, child protection, psychosocial support, facilitating access to education and health care, basic nutrition training, HIV prevention messages, facilitating care for chronically ill adults and children (including pediatric treatment referrals), succession planning and supervised recreation. Direct support to OVC will include assistance to waive primary school fees, vocational training, school uniforms including shoes, books and supplies, facilitation with transport for age appropriate primary health care checkups and training of caregivers in food garden techniques. ACTIVITY 4: Local Organizational Capacity Development. WVSA has developed an Organizational Capacity Building (OCB) guide. The OCB process, to be introduced with PEPFAR funds, is an iterative one that begins with organizational self-assessment, followed by selected training based on the result of the assessment, and supplemented with additional follow-up support and mentoring. The training menu may include organization purpose and planning, structures and procedures, group dynamics, monitoring, evaluation and reporting, finance, and resource mobilization. WVSA will build the capacity of local organizations to effectively provide protection and care to OVCs and their families. ACTIVITY 5: Referrals and linkages. WVSA works closely with the Departments of Social Development, Health, Education as well as various NGOs, FBOs and CBOs. These linkages will be nurtured and expanded to ensure that OVC are continuously reached with a full package of care (education, age appropriate health care services, etc.) and referred when needed for appropriate ART treatment and care services.

Plus Up funds will be used to provide services to 1,000 additional OVC, specifically OVC adolescents. In addition to establishing a program of ‘community conversations', the project will integrate a gender component and advocacy into all programming activities. The aim of these new activities will be to build stronger, more gender-equitable

relationships with better communication between partners utilizing participatory learning to improve the health, well-being and economic resilience of adolescent OVC (Boys and Girls). Options to delay sexual activity will be emphasized. The following activities will be added: Activity 6: Community conversations. Facilitated community conversations will focus on raising awareness of social-economic and cultural inequalities that put women at a disadvantage and how this contributes to the spread of HIV/AIDS. Specifically, discussions will focus on how to strengthen the negotiating powers of women and girls in sexual relationships and on raising the awareness of men about the role they play in sexual relationships. This gender equality dialogue will emphasize the positive aspects of changing behaviors that increase the risk of becoming HIV-positive and utilize the most recent best practices. WVSA will benefit from participatory research conducted by WV that has demonstrated that these open and frank but sensitive "community conversations" will help cement new positive attitudes among youth and reduce gender-biased stereotypes. The majority of care workers (Home visitors/HV) in OVC programs are women (over 70%). WVSA will work to increase the involvement of men in care-giving of OVC. As part of the CCC (Community Care Coalition) trainings, HV's will engage men by focusing on such topics as family violence, anger management, fathering and parenting skills. Training materials will include discussion of power relations between girls and boys, women and men, and will give girls skills in refusal and negotiation. CoH training will also emphasize addressing gender from a standpoint of context and attitudes. Activity 7: Peer-support groups and Youth AIDS clubs. Using a participatory process, the OVC will identify role models (including positive deviants) to serve as the peer support leaders. The adolescents will form peer-education groups and these groups will form the critical catalysts for the community social discourse on healthy norms and avoidance of risk behavior. The anticipated outcome of this social discourse process is a re-emergence of AB as community norms and a reduction in the practice of harmful behaviors such as cross-generational sex, transactional sex, multiple casual sex partnerships, sexual coercion and violence, etc. Existing training materials and tools will be utilized drawing from the WV's experience in Uganda, Mozambique and Zambia. Partnerships with existing organisations with experience in adolescent programming will be explored and local organisations will be utelised where possible. Networking with key community stakeholders will be ensured by working through the already established CCC networks.