SUMMARY:

Harvard School of Public Health (HSPH) contributes to PEPFAR prevention (AB and Other Prevention),

orphans and vulnerable children (OVC), and system/capacity building goals by providing training, technical

assistance, and materials development to government, non-governmental organizations (NGO), faith-based

organizations (FBO), corporate, and other organizations using peer education strategies through the Center

for the Support of Peer Education (CSPE). CSPE is the first academic center devoted to development and

continuing improvement of a sustainable national inter-sectoral peer education system. The emphasis area

will be gender, local organization capacity, development and training. The target population will be children,

youth, adults, HIV-affected families, teachers and religious leaders.

BACKGROUND:

This project is an expansion and institutionalization of peer education. Rutanang peer education is

consistently defined and implemented as including, among other characteristics, multiple-dose small-group

structured and facilitated discussions; informal influence; recognition and referral of those with further needs

(e.g., VCT, treatment, OVC); and advocacy.

ACTIVITIES AND EXPECTED RESULTS:

CSPE provides PEPFAR and non-PEPFAR partners with training and ongoing technical assistance and

assists with the development and adaptation of peer education materials and tools specifically focused on

the AB prevention in multiple settings. The Center will prepare and coordinate trainers (with accreditation

process initiated) from a variety of sectors and geographic areas. Partners will use evolving standardized

monitoring and evaluation tools to collect and share comparable data on program activities and outcomes.

All CSPE peer education AB activities and materials explicitly and intensively address the following areas of

interest: male norms and behaviors, sexual violence and coercion, stigma reduction, risk behaviors like

alcohol and substance abuse, across generational sex, multiple concurrent partnerships and maintaining

infected and affected children in school. Peer education focuses on Abstinence and Be Faithful prevention

messages for adolescents and adults. Prevention messaging will focus on abstinence for the youth aged 10

-14, delaying sexual debut and secondary abstinence for youth older than 14 years and reduction in multiple

and concurrent partners for youth at risk and those sexually active. Peer education having primary AB

prevention goals is also a means for early identification and referral to services of vulnerable children and

youth, and HSPH is pursuing strategies that enhance peer education as an advocacy tool to make

environments safer. Each of the foregoing content themes is explicitly addressed in the design of peer

education support systems, training of peer educators, and the content peer educators are trained to

deliver. AB activities are conducted through partners.

ACTIVITY 1: KwaZulu-Natal Department of Education

CSPE will train and support regional and district-level trainers and administrators in three of six districts to

provide supervision and oversight for high school-based peer education. More than 50 personnel from

NGOs, CBOs and FBOs serving KwaZulu-Natal will be trained and equipped to organize and supervise

peer education programs in 120 KwaZulu-Natal schools, working with teams of 15 peer educators per

school.

ACTIVITY 2: Catholic Institute of Education (CIE)

Three Catholic Institute of Education schools in KwaZulu-Natal will be assisted to develop integrated

models including primary prevention, services for OVC, workplace peer education for educators, and use of

school-trained peer educators in community settings. Integrated work in KwaZulu-Natal will promote an

intersectoral advocacy process involving policymakers and leaders from government departments and

public and private sector stakeholders. CSPE will support the expansion of peer education within the

national CIE network to an additional five schools in FY 2008. Maintenance of the current intervention in six

schools is a continued activity.

ACTIVITY 3: Eastern Cape Department of Education

Schools are receiving Rutanang-based peer education through Eastern Cape Department of Health

(ECDOE) tenders with Youth for Christ (YFC). This initiative predated YFC funding by Department of

Health/PEPFAR, uses ECDOE conditional grant funds, and specified the use of Rutanang in the tender.

CSPE maintains an ongoing consultative (at least two meetings/year) and monitoring and evaluation

training relationship with YFC.

ACTIVITY 4: Western Cape Education Department (WCED)

CSPE will support the implementation of peer education to a total of 100 high schools reaching 6,600

learners. A range of service providers working under the DOE umbrella receive at least two consultations

per year with CSPE staff, and additional trainings and consultations, including one for principals, are

planned.

ACTIVITY 5: Free State Education Department (FSED)

Strengthening the peer education called 'Radically Different Species' (RADS), the FSED adaptation of

Rutanang, CSPE will promote the integration of peer education into the scheduled curriculum, reaching

approximately 40 high schools and 2,000 learners. FY 2008 funding will ensure strengthen of monitoring

and evaluation ,for Department of Education provincial and district officials.

ACTIVITY 6: Mpumalanga Department of Education

In 2005, the Mpumalanga Department of Education (MPDOE) began using the RADS adaptation, and

HSPH training and technical assistance, to develop a province-wide peer education strategy. CSPE will

provide training and technical assistance to 30 MPDOE supervisory and M&E personnel, supporting

rigorous peer education programs in 30 schools reaching 1500 learners through training 6 PEs per school.

Activity Narrative:

ACTIVITY 7: Anglican Church of the Province of Southern Africa (ACSA)

CSPE is working with the Anglican Church of the Province of Southern Africa to tailor T&TA and materials

for AB activities in churches, religious schools, and FBO community outreach projects. Five diocese and 25

parishes with 5 coordinators; 50 supervisors and 150 peer educators reaching 50 youth per parish.

ACTIVITY 8: Faith-based Organizations

CSPE is also developing memoranda of understanding with three FBOs that provide school-based peer

education under PEPFAR funding to the Department of Health: Youth for Christ, with whom HSPH has a

long and productive relationship in the EC, the Muslim AIDS Program, and Scripture Union. HSPH will also

provide consultation to other large NGOS working in various parts of the country, including Hope

Worldwide.

ACTIVITY 9: Parent support

CSPE has identified the need to help and support parents to prevent high-risk behavior in their children.

Working through existing partnerships with organizations and structures capable of reaching parents

(schools and faith-based organizations); CSPE will develop, disseminate, and train on the use of parenting

workshop materials designed for low-literacy parents. In FY 2007 HSPH designed, piloted, evaluated, and

refined this package. In FY 2008 HSPH will begin a gradual, controlled rollout of this package to selected

partners.

ACTIVITY 10: CPSE Expansion

CSPE will divide its efforts between responding to specific partners and carrying proactive strategies to

improve peer education as a systems approach in a variety of settings and partners. CSPE will expand and

embark on a program to provide materials and advanced and targeted training to various audiences and

settings. Direct invitations to current partners make it easier for government employees to secure support

and budget to attend. CSPE will offer workshops at the University of the Witwatersrand and at provincial

sites. Training courses will be designed towards SAQA accreditation and contribute to improved rigor and

quality. This activity addresses both capacity building and systems strengthening goals. Training focus

areas include: (a) advanced peer educator training for a graduated system: supervisors and advocates; (b)

advanced communication skills for us in natural group encounters; (c) peer education for HIV and AIDS in

sport and recreation settings; and (d) peer educators as lay counselors: potential and limits.

In addition to contributing to PEPFAR annual and cumulative targets, long-term results of the HSPH project

will be the establishment of a sustainable integrated system supporting rigorous, measurable peer

education that increases the amount and quality of social interactions and skills acquisition concerning

norms, traditions, and behaviors that will help reduce the transmission of HIV.

SUMMARY:

Through the Center for the Support of Peer Education (CSPE), the Harvard School of Public Health (HSPH)

contributes to PEPFAR abstinence and be faithful (AB) and other prevention activities, support for orphans

and vulnerable children (OVC), and system/capacity building goals by providing training, technical

assistance, and materials development to government, non-governmental (NGOs), faith-based

organizations (FBOs), corporate and other organizations using peer education strategies. CSPE is the first

academic center devoted to developing and continuing improvement of a sustainable national inter-sectoral

peer education system. The major emphasis will be training with minor emphasis on policy and guidelines

and linkages with other sector and initiatives. Target populations include university students, adults,

teachers, HIV-affected families, out of school youth, business community/private sector, community and

religious leaders, program managers, South Africa-based volunteers, NGOs FBOs and CBOs.

BACKGROUND:

This project is an expansion and institutionalization of a five-year national consultative process developing

consensus on goals, essential elements and standards of practice for peer education programs, and

materials and tools (Rutanang) in wide circulation to improve how peer education is conducted in settings

including schools, FBOs, sport and recreation, clinics, and worksites. Rutanang peer education is

consistently defined and implemented as including, among other characteristics, multiple-dose small-group

structured and facilitated discussions; informal influence; recognition and referral of those with further needs

(e.g., voluntary counseling and testing (VCT), treatment, OVC); and advocacy. The first HSPH initiative in

workplace prevention activities was launched in 2005 with the South African Police Services and expanded

through collaboration with the South African Business Coalition on HIV/AIDS (SABCOHA) and the Wits

Business School (WBS). The latter is funded through the private sector, but adds to the expertise and

influence of CSPE and provides trained peer educators who are deployed in other settings in the

community.

ACTIVITIES AND EXPECTED RESULTS:

CSPE provides PEPFAR and non-PEPFAR partners with training and ongoing technical assistance and

assists with the development and adaptation of educational materials, tools, policy guidelines, linkages and

community mobilization, and strategic information focused on Other Prevention in multiple settings. All

CSPE activities and materials explicitly and intensively address the following issues: male norms and

behaviors, sexual violence and coercion, stigma reduction, and maintaining infected and affected children in

school. Peer education with adolescents and adults emphasizes delaying sexual debut, secondary

abstinence, and reduction in concurrent partners. Peer education, having primary Other Prevention goals, is

also a means for early identification and referral to services of vulnerable children and youth, and CSPE is

pursuing strategies that enhance peer education as an advocacy tool to make environments safer. Each of

the foregoing content themes is explicitly addressed in the design of peer education support systems,

training of peer educators, and the content peer educators are trained to deliver.

While CSPE's peer education focuses on teenagers and older youth, young adults, workers and families

through worksite programs and FBOs, it continues to emphasize the benefits and rewards of primary and

secondary abstinence, delay of sexual onset, and fidelity. However, for many populations (out-of-school

youth, some high school learners, university students, and adults) it is also necessary to address

information, attitudes and skills concerning reduction in number of concurrent partners, condom use for

those who are not abstinent, improved diagnosis and treatment of sexually transmitted infections (STIs),

and promotion of voluntary counseling and testing (VCT). Through CSPE's partners, target groups include

urban informal settlements, a focus on young women in their twenties and adult men who engage in risky

behaviors, an emphasis on partner reduction and delay in consecutive sexual partners. Through certain

partners there will be an increased involvement of people living with HIV (PLHIV). All of CSPE's activities

will enhance the integration on the role of alcohol in increasing risk behavior into programs for adults; youth

and high risk populations and continue to support a comprehensive ABC program.

In all settings, a persistent reconsideration of male roles and behavior, reductions in gender violence and

discrimination, and encouragement of participation in organizational governance are critical CSPE peer

education prevention strategies. Peer education activities at worksites also emphasize the roles audiences

play as parents, grandparents and guardians, and prepare them to promote abstinence and sexual safety

for their children.

ACTIVITY 1: Eastern Cape, Mpumalanga and Limpopo Department of Health

CSPE will conduct other prevention training for clinic-based staff at provincial and district level and provides

Training and Technical Assistance (T&TA), planning, M&E for peer education programs. The clinic-based

peer education program involves the selection and training of peer educators to reach youth from the

community through time-limited structured sessions. Clinic staff are selected and trained as supervisors

who will support and manage the peer educators.

ACTIVITY 2: South African Police Services (SAPS)

CSPE will develop materials and tools, provide ongoing T&TA, and assist with M&E as SAPS reconsiders

its original workplace program. Sixty peer educator supervisors and trainers from nine provinces will be

supported; each supervisor is responsible for an average of eight peer educators, and the number of SAPS

personnel expected to be reached by these peer educators is 9,600.

ACTIVITY 3: Eastern Cape, Free State and Western Cape Departments of Education - FET Sector

Peer education addresses other prevention in the Further Education and Training, Colleges sub-sector.

CSPE will work with management and education staff from selected campuses to develop and strategic

plan for the sectors HIV and AIDS response. This response includes peer education as a strategic

intervention. Educators and student counseling staff will manage and supervise the peer educators' work

with other students to implement a structured and rigorous intervention. CSPE will investigate providing

possible support for HIV and AIDS education for students (youth and adults) in Further Education and

Activity Narrative: Training (FET) institutions in the EC and WC province. Included in the above target explanation is

expansion of T&TA to the FET sector in Free State to selected multi-campus colleges and include situation

analysis, strategic planning and program design contributing to the sector response. This expansion phase

will include implementation of peer education as a workplace intervention and peer education as a

prevention strategy for students.

ACTIVITY 4: Worksite Programs

CSPE will provide planning, T&TA, materials development and M&E support to four public sector

departments or corporate entities. The project will target supervisors from selected sites and trainers for this

support; their work will involve prevention and promote the uptake of VCT as will as delay or consecutive

partners. A work place program will deploy educator teams to conduct other prevention activities throughout

the selected sites as well as some selected community outreach as part of workplace social responsibility

initiatives.

ACTIVITY 5: Sport and Recreation

In FY 2006 HSPH began articulating how peer education might be used to take advantage of the natural

appeal and access to youth of sports programs. HSPH has been working with GrassRoots Soccer and

Peace Players International (PPI) in Durban. Work involves the development of a sports oriented peer

education intervention that uses both the appeal of playing sport and the use of sports analogies to promote

prevention and behavior change. Sports NGOs are well placed in their linkages to schools as well as

community-based sports initiatives to embark on a peer education intervention where the coaches are

identified as supervisors in the program.

ACTIVITY 6: CPSE Expansion

As a Center CSPE will divide its efforts between responding to specific partners and carrying proactive

strategies to improve peer education as a systems approach in a variety of settings and partners. From

current efforts CSPE will expand and embark on a program to provide materials and advanced and targeted

training to various audiences and settings. Direct invitations to current partners make it easier for

government employees to secure support and budget to attend. These partners include DOE, DOH, HE and

FBOs among others. CSPE will offer workshops at Wits and at provincial sites. Training courses will be

designed towards SAQA accreditation and contribute to improved rigor and quality. This activity addresses

both capacity building and systems strengthening goals. Training focus areas include: Advanced PE

Training for a Graduated System: Supervisors and Advocates; Advanced communication skills for us in

natural group encounters; Peer education for HIV and AIDS in sport and recreation settings; and Peer

educators as lay counselors: Potential and limits.

In addition to contributing to PEPFAR goal of averting 7 million new HIV infections, long-term results of the

HSPH project will be the establishment of a sustainable integrated system supporting rigorous, measurable

peer education that increases the amount and quality of social interactions and skills acquisition concerning

norms, traditions, and behaviors that will help reduce the transmission of HIV.

SUMMARY:

Through the Center for the Support of Peer Education (CSPE), the Harvard School of Public Health (HSPH)

contributes to PEPFAR prevention (abstinence and being faithful (AB) and Other), orphans and vulnerable

children (OVC), and system/capacity building goals by providing training, technical assistance, and

materials development to government, NGOs, faith-based organizations (FBOs), corporate, and other

organizations using peer education strategies. CSPE is the first South African academic center devoted to

development and continuing improvement of a sustainable national inter-sectoral peer education system.

The major emphasis area for this activity is training with a minor focus on local organization capacity

development and policy and guidelines. The target populations are OVC, their caregivers, primary and

secondary school students, community and religious leaders, volunteers, teachers, CBOs, FBOs and

NGOs.

BACKGROUND:

This project is an expansion and institutionalization of a five-year national consultative process developing

consensus on goals, essential elements and standards of practice for peer education programs, and

materials and tools in wide circulation to improve how peer education is conducted (Rutanang). Rutanang

peer education is consistently defined and implemented as including, among other characteristics, multiple-

dose small-group structured and facilitated discussions; informal influence; recognition and referral of those

with further needs (e.g., voluntary counseling and testing (VCT), treatment, OVC); and advocacy.

ACTIVITIES AND EXPECTED RESULTS:

All CSPE OVC peer education activities and materials will explicitly and intensively address the following

areas of legislative interest: male norms and behaviors, sexual violence and coercion, stigma reduction, and

maintaining infected and affected children in school. Though focused on specific OVC needs, peer

education activities also emphasize delay of sexual debut, secondary abstinence, and reduction in

concurrent partners. Peer education to provide psychosocial support for OVC also seeks to promote

advocacy to make environments safer.

The OVC peer led intervention in FY 2008 will expand the initial pilot program (materials development,

design and pilot in FY 2007) for 14 - 16 year olds, in selected sites to be determined. The expansion will

target 5 OVC organizations, across 10 sites. This results in training of 30 adult supervisors; 30 peer

educators trained in implementation; and 120 OVC supported through a peer led intervention.

In FY 2008 CSPE will also conduct a situational analysis, materials development, training and

implementation of a pilot program for 5-10 year olds with selected partners yet to be identified. CSPE will

maintain support and mentoring to the sites that initiated the programs for 10-13 year olds and 14-16 year

olds in previous years.

NGOs and government departments addressing the urgent needs of South Africa's estimated one million

OVC face a critical shortage of professional capacity. Beyond necessary survival resources, OVC require

sustained psychosocial support, assistance with a variety of concrete coping skills, and effective education

to prevent behaviors that put them at risk of HIV infection and other threats to health and safety. Many OVC

do not understand these needs or seek this help, and will only receive it in environments that have their own

appeal and are protected from stigma and shame. They also need what all young people need: Social

activities that are fun and connect them with their peers, schools and churches, and communities.

Structured, time-limited, highly interactive groups with clear sequential educational objectives can provide

activities that get youth to laugh, and also help them acknowledge and express their grief and fears and

recognize their strengths and assets. Focused mutual-help groups also enable participants to experience

themselves as valued supporters for their peers while they are being helped themselves. Well-trained and

carefully supervised peer educators can plan and facilitate these groups, serve as role models of resilience,

and help OVC form a mutual support network to assist with maintaining school attendance and accessing

critical services.

Building on its ongoing PEPFAR-funded work to promote a sustainable intersectoral system of rigorous

peer education standards and practices, the Harvard School of Public Health will collaborate with six

PEPFAR-funded OVC service providers to develop, implement, assess, refine and disseminate tools and

materials, training and technical assistance packages, and monitoring and evaluation protocols for peer

education strategies to help OVC apply their own considerable strengths to the creation of sustainable

community-based supports. In late 2007 and in 2008, with materials field-tested and formative evaluation

complete, HSPH will implement systematic training and technical assistance in the use of these materials to

support OVC. We will also take advantage of national meetings and conferences to convene working

groups of OVC-serving partners for periodic feedback on how the materials are being used, and on needed

improvements and additions. Special attention will be paid to monitoring and evaluation processes,

including the tracking of group participants over time to assess their degree of effective coping.

Materials and models developed through this project will constitute much-needed resources to expand the

number of OVC for whom psychosocial support, with its positive effects on other OVC outcomes such as

retention in school and access to health services, will be available.

SUMMARY:

Through the Center for the Support of Peer Education (CSPE), the Harvard School of Public Health (HSPH)

contributes to PEPFAR prevention (AB and Other), OVC, and system/capacity building goals by providing

training, technical assistance, and materials development to government, NGOs, FBOs, corporate, and

other organizations using peer education strategies. CSPE is the linchpin of an unprecedented sustainable,

intersectoral national system delivering rigorous peer education in schools, FBOs and CBOs, clinics, sport

and recreation programs, higher education, and public and private sector workplaces. The major emphasis

area is training; minor emphasis areas are local organization capacity development and policy and

guidelines. The target populations are girls and boys, primary and secondary students, out-of-school youth,

adults, orphans and vulnerable children, HIV and AIDS affected families, the community, policy makers, and

CBOs, FBOs, NGOs and other implementing organizations.

BACKGROUND:

This project is an expansion and institutionalization of a five-year national consultative process developing

consensus on goals, essential elements and standards of practice for peer education programs, and

materials and tools in wide circulation to improve how peer education is conducted. Rutanang - meaning

"teaching one another" -- peer education is consistently defined and implemented as including, among other

characteristics, multiple-dose small-group structured and facilitated discussions; informal influence;

recognition and referral of those with further needs (e.g., CT, OVC); and advocacy.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1:

CSPE is especially designed to build capacity among PEPFAR and non-PEPFAR partners through training

and ongoing technical assistance and assists with the development and adaptation of educational materials,

tools, policy guidelines, linkages and community mobilization, and strategic information. The Center will

prepare and coordinate trainers (with accreditation process initiated) from a variety of sectors and

geographic areas. The CSPE model for rigorous peer education involves the training of a strong supervisory

structure (adults) who are responsible to support the teams of selected peer educator in a variety of settings

and structures in the efforts to implement peer led time limited structured prevention sessions with youth or

adults in work place settings. CSPE also provides TA to managers of peer education programs in their

efforts to improve peer education within a systems approach. Partners will use evolving standardized

monitoring and evaluation tools to collect and share comparable data on program activities and outcomes.

All CSPE materials explicitly and intensively address the following: male norms and behaviors; reducing

sexual violence and coercion; stigma reduction; and maintaining infected and affected children in school. By

its very nature, peer education also explicitly promotes democratic leadership development. Peer education,

as mentioned earlier, is consistently defined and implemented as including, among other characteristics,

multiple-dose small-group structured and facilitated discussions; informal influence; recognition and referral

of those with further needs (e.g., CT, OVC); and advocacy.

ACTIVITY 2:

CSPE will attempt to work with Learner Representative Councils and School Governing Bodies through the

schools program to articulate and evaluate the extent to which peer education programs contribute to active

participation in school governance. Peer education with adolescents and adults emphasizes delaying sexual

debut, secondary abstinence, and reduction in concurrent partners. Peer education also is a means for

early identification and referral to services of vulnerable children and youth, and CSPE is pursuing

strategies that enhance peer education as an advocacy tool to make environments safer. Each of the

foregoing content themes is explicitly addressed in design of peer education support systems, training of

peer educators, and content peer educators are trained to deliver.

The CSPE initiative strengthens an essential strategy currently used across South Africa, and indeed,

across the world, with little rigor and evaluation. A key CSPE goal is South African Qualification Authority

(SAQA) and other accreditation for programs, peer educator trainers and supervisors, and peer educators

themselves. CSPE policy and system strengthening activities also feature education of multisectoral

policymaking bodies, including National and Provincial Infectious Diseases Advisory Committees, unions,

and the business community.

ACTIVITY 3:

CSPE will also develop, refine, and implement standardized monitoring and evaluation (M&E) tools and

develop a database on peer education activities conducted by its partners. An annual conference of peer

education evaluators and researchers will be part of its ongoing program; the seeds for this collegial

approach to peer education measurement have been thoroughly sown in years of consensus-building and

networking. Additionally, expert peer educators and supervisors will convene at least once a year to develop

new tools and materials as needs are identified by practitioners in the field or researchers around the world.

An integral part of systems/capacity building is dissemination through training and technical assistance,

articles and publicity of our models and materials for psychosocial support of OVC and for workplace

programs in public and private sectors, especially components that focus on motivating and equipping

workers who are parents and guardians to engage in early and useful discussion and limit-setting with

children/teens on norms of abstinence and delay of sexual debut.

In addition to contributing to PEPFAR annual and cumulative targets, long-term results of the HSPH project

will be the establishment of a sustainable integrated system supporting rigorous, measurable peer

education that increases the amount and quality of social interactions and skills acquisition concerning

norms, traditions, and behaviors that will help reduce the transmission of HIV.