Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 328
Country/Region: South Africa
Year: 2008
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health Center for Communication Programs
Organizational Type: University
Funding Agency: USAID
Total Funding: $17,022,750

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $970,000

SUMMARY:

Johns Hopkins University/Center for Communication Programs (JHU/CCP), coordinates the work of 20

South African partners, provides technical assistance and capacity building to prevent HIV and AIDS

through a comprehensive HIV prevention program that addresses risky behaviors and the key drivers of the

epidemic in the general population through mass media and social mobilization. The target populations are:

youth, adults, people living with HIV (PLHIV), religious leaders, teachers, public health workers, and

community, faith-based and non-governmental organizations. Eleven partners working across South Africa

will support efforts to mobilize pregnant women and their male partners in support of PMTCT. Two mass

media programs are utilized to highlight themes relating to PMTCT guided by the findings of the 2006 South

African HIV/AIDS Communication Survey that found that 87% of all South Africans were reached with

messages dedicated to HIV prevention and living with HIV and AIDS by means of television and radio

programs.

BACKGROUND:

This is the first year that JHU/CCP is undertaking strategies using community-based mobilization and mass

media in support of PMTCT programs. Our approach recognizes the need to educate pregnant women and

their male partners (and discordant couples) concerning their right to PMTCT prior to delivery so that they

can make the best decision regarding their own sexual behaviors, know their HIV status, have access to

PMTCT services and understand the need for safe feeding practices that will reduce the risk of their

newborn from getting HIV. Through ensuring that women are counseled in advance of their rights to access

PMTCT services upholds the constitutional rights of women and their to access PMTCT services. The

evidence-based strategic message design identifies key theoretical and practical factors that influence

behavior, reinforcing the positive and minimizing the negative. Each activity below is designed to enhance

critical and creative thinking, contribute to changes in social norms, create social networks that support

individual change, build skills and improve decision-making. Eleven of the twenty South African partners will

incorporate social mobilization for PMTCT into their community mobilization and mass media activities.

ACTVITIES AND EXPECTED RESULTS:

ACTIVITY1: Community Mobilization

DramAidE places Health Promoters (HPs) living with HIV in 23 of the country's higher learning institutions.

The HPs use campus events to educate young female students and their male partners on PMTCT, to

undergo voluntary counseling and testing, and referrals to appropriate services on or in the vicinity of

tertiary institutions.

Mindset Health (MH), Health Workers Channel is located in more than 400 public clinics. It produces and

disseminates training materials for Health Care Workers that is expanded upon through an interactive web-

based training program. Its Public Health Channel sensitizes audiences through facilitated discussions

within public health centers on issues relating to PMTCT and encourages pregnant women to be tested for

HIV, obtain antiretrovirals for PMTCT and safe feeding practices. Mindset Health, a partnership between

Mindset Network, the Department of Health and Sentech, operates under the umbrella body of Mindset

Network, which is funded through a number of public-private partnerships, such as Standard Bank, Liberty

Life as well the Nelson Mandela Foundation.

The Community Health Media Trust (CHMT) is increasing the number of Treatment Literacy and Prevention

Practitioners (TLPPs) to 92 (72 funded by PEPFAR and 20 by the National Department of Health (NDOH))

who work in health centers serviced by MH in the Western Cape, Eastern Cape, KwaZulu-Natal, Free State

and Gauteng, to facilitate discussions with patients in general waiting rooms, prevention of mother-to-child

transmission (PMTCT), Antenatal (ANCs) and ART Clinics on PMTCT. In addition, these outreach workers

work with CBOs and support groups of people living with HIV to increase awareness of PMTCT.

Lesedi Lechabile and Mothusimpilo, who work with mobile populations in the mining areas of the Free State

and the North West, train their peer educators and clinical staff working in their mobile clinics to sensitize

pregnant women, their male partners and women engaging in transactional sex and those engaging in sex

work in areas surrounding the mines to be tested for HIV so that they can know their HIV status, access

PMTCT services and receive education on safe feeding practices.

The Valley Trust, working in rural KwaZulu-Natal, trains its peer educators and clinical staff in their mobile

clinics to encourage pregnant women to be tested for HIV, access PMTCT services and obtain information

on safe feeding practices. It also utilizes community events and activities to mobilize pregnant women and

their male partners around knowing their status, PMTCT and use safe feeding practices.

Lighthouse Foundation trains its peer educators and community facilitators to work in the 13 informal

settlements in the Madibeng District of the North West province to incorporate PMTCT into their community

outreach comprising door to door campaigns, HIV support group and men's support group in order to

mobilize pregnant women and their male partners to know their HIV status, be referred to PMTCT services

and educated on safe feeding practices.

LifeLine South Africa expands its innovative workplace approach from one informal settlement/rural area in

Gauteng and Limpopo provinces to include an informal settlement in the Free State, Northern Cape, and

Mpumalanga. This program works with management and employees in small and medium enterprises to

develop a comprehensive program that trains peer educators (PEs). As part of its workplace-based program

LifeLine provides pregnant women within these workplaces with counseling and testing so that they may be

referred for PMTCT services, while sensitizing male workers on PMTCT so that they can support their

partners. LifeLine works in partnership with the Small Business Associations and with the Farm Owners

Associations in the areas that they operate in.

The Department of Correctional Services, a PEPFAR partner, trains master trainers from the Department

that will train offenders within correctional facilities to provide peer education using the TshaTsha series to

promote HIV prevention. In male and female correctional facilities knowledge of HIV status and PMTCT are

addressed as key topics so that offenders can make appropriate decisions upon their release and

Activity Narrative: reintegration into society.

ACTIVITY 2: Mass media in support of Community Mobilization

ABC Ulwazi produces a radio talk show series tailored to 60 different community radio stations. Special

emphasis is on male norms and behaviors, partner reduction, and on PMTCT. Each episode will end with a

summary and clear messages on the topic discussed. Listeners' associations formed by local citizens have

facilitators' guides to carry out community outreach interventions related to the series themes.

JHU in a public-private partnership with the South African Broadcasting Corporation co-funds two TV

programs, nine local language radio programs and web support. Trailblazers, a community health show,

broadcasts 13 episodes highlighting individuals that provide models of positive behaviors for others to

emulate. A second season of the 26 episode TV drama (tentatively called Circles) deals with contextual

issues relating to social and cultural norms that inhibit and/or support positive male norms and behaviors,

including addressing the theme of male involvement in relation to PMTCT. Radio talk shows follow both

programs, providing additional information and stimulating community participation.

JHU/CCP contributes towards meeting PEPFAR goals by building the capacity of individuals and the social

networks through awareness, education and human support within the public health care system to support

pregnant women to prevent mother-to-child transmission of HIV. The results expected include: (1)

Contributing towards increasing the number of pregnant women accessing PMTCT services from the

current 17%; (2) Ensuring that greater numbers of pregnant women are aware of their HIV status and

enrolled into the national PMTCT program; (3) ART for treatment eligible pregnant women; (4) Essential

care for women and children in need of PMTCT; and (5) Safe feeding and nutritional practices. This

contributes to the goal of the National Strategic Plan for South Africa 2007 - 2011 by ensuring that 80% of

people living with HIV and their families have access to an appropriate package of treatment, care and

support services by 2011 through focusing on pregnant women and the wellness management of people

before they become eligible for ART.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $5,639,250

SUMMARY:

Over the next four years Johns Hopkins University/Center for Communication Programs (JHU/CCP) and its

20 South African (SA) partners will combine mass media with interpersonal community mobilization to bring

about heightened awareness of risk of HIV infection among general population to address sexual

partnerships and behaviors placing them at risk of HIV infection. With young people under 14, emphasis will

be on abstinence ("A") and delaying sexual debut (DSD). With people over 14 main focus will be on younger

girls and women aged 15-24 and men aged 25-49 and emphasis will be on faithfulness ("B"). "B"

messages focus on heightening perceptions of risk to HIV infection owing to sexual partnerships and

behaviors people engage in placing them at risk of HIV infection, namely: multiple and concurrent partners

(MCP), intergenerational/transactional sex (ITS), casual sex, violence and coercion, linkage between

alcohol and substance abuse and HIV, stigma and discrimination (SD). The target populations are youth,

people living with HIV (PLHIV), religious leaders, teachers and adults which will include the public health

workers, and community, faith-based and non-governmental organizations. The emphasis areas are

gender, human capacity development, strategic information, work place programs and wrap around

programs such as family planning and TB.

BACKGROUND:

JHU/CCP AB prevention initiatives are in their fifth year. Over the next four years all partners will prioritize

interventions to focus on men aged 25-49 and young girls and women aged 15-24, while addressing social

norms and values among youth below age 15. Interventions will impact on key drivers of the epidemic and

perception of risk in relation to sexual partnerships and behaviors including MCP, ITS and incorrect and

inconsistent condom use. Interventions are informed by qualitative research intervention undertaken by

JHU/CCP and its partner CADRE. The study found high-risk behaviors driving epidemic are determined by

social norms and values that include male attitudes and behaviors, alcohol and substance abuse;

population mobility and gender dynamics including gender-based violence (GBV). In hyper-endemic

situations where HIV prevalence exceeds 15% there is need to engage people to heighten perception of

risk while providing them with tools to enable them to manage risk of HIV infection by taking necessary

actions to address risk behaviors. JHU/CCP uses a social-ecology approach to communication that

combines power of interpersonal communication with mass media to engage and mobilize individuals

around sexual behavior and risk perception to HIV infection and influence social networks, communities and

societies to create enabling environment that allows them to reduce risk of HIV infection. Each activity is

designed to contribute towards change in social norms, create social networks that support individual

change, build skills, and improve decision making leading to safer sexual behavior.

ACTVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Young People 12-14

The Valley Trust (TVT) and Lighthouse Foundation (LF) will work with youth under 14 in primary and

secondary schools to encourage DSD and provide them with life skills to help reduce their risk to HIV

infection.

ACTIVITY 2: Mobilizing In- and Out-of-School Youth 15-24

Dance4Life (D4L), DramAIDE, TVT, Lesedi Lechabile (LL), LF and Community Health Media Trust (CHMT)

will work with youth in secondary schools using variety of approaches to train peer educators who will

establish HIV prevention, care and support clubs to act as entree to in-school youth. Among youth under 14,

the primary focus will be on DSD. Among youth over 14, the focus will be on messages relating to MCP,

ITS; correct and consistent condom use, male norms and behaviors, substance and alcohol abuse, gender-

based violence (GBV), risk perception and SD.

TVT, LF and LL will undertake interpersonal discussions, workshops and community events with out-of-

school youth to heighten perceptions of risk in relation to sexual partnerships and behaviors.

DramAidE's Health Promoters work in 23 tertiary institutions and use group meetings, individual

consultations, dorm visits, classroom instruction and community events to increase perceptions of risk in

relation to MCP, ITS, GBV, condom negotiation skills, STIs, male norms and behaviors, SD, sexual and

reproductive health (SRH) and risks of substance and alcohol abuse.

ACTIVITY 3: Mobilizing Adult Men and Women 15-49

Sonke Gender Justice (SGJ) supports partners to integrate Men as Partners approach to mobilize men on

responsible male behavior, substance and alcohol abuse and reduction of GBV. SGJ, LF, LL and TVT will

expand the number of men's clubs and health services to mobilize men, communities and traditional

structures around MCP, responsible male behavior, substance and alcohol abuse and reduction of GBV.

TVT, LF and Matchboxology (MB) will mobilize adult men and women using door-to-door campaigns,

taverns and taxi ranks, around MCP, ITS, male norms and behaviors, SD, and risks of substance and

alcohol abuse.

LifeLine SA and TVT will support workplace interventions and train PEs within small and medium

enterprises and on farms. MB will work with professional footballers and fan clubs. All workplace based

interventions will increase perceptions of risk in relation to MCP and ITS, GBV, SD, male norms and

behaviors and alcohol consumption and sexual behavior.

TVT and LF will engage with traditional leaders and healers to mobilize them to address cultural dimensions

of MCP, GBV, SD, male norms and behaviors and alcohol consumption.

TVT, LifeLine SA and LF will work with FBOs through activities to promote partner limitation, GBV and SRH.

Religious leaders will be trained and provided with appropriate communication materials to guide them.

Mindset Health Channel (MHC) has a Healthcare Worker Channel (HCWs) and a Patient Channel in more

than 400 public clinics. The HCW Channel trains health workers and its public health channel sensitizes

audiences on partner reduction, GBV, substance and alcohol abuse.

CHMT, will increase number of Treatment Literacy and Prevention Practitioners to 92 (72 funded by

PEPFAR and 20 by National Department of Health (NDOH) and facilitate discussion among patients in

Activity Narrative: general waiting rooms in MHC on topics relating to correct and consistent condom use, GBV, substance

and alcohol abuse, STIs and SRH. LF, TVT and Mothusimpilo will work with CHMT and MHC to facilitate

dialogues in clinics surrounding their areas.

LL and Mothusimpilo use PE and HCW in mining districts of North West and Free State to reach young

women at risk, including sex workers, through clinics, schools and community events to heighten risk

perceptions on sexual partnerships and behaviors that place them at risk of HIV infection including MCP,

ITS, GBV, SD, male norms and behaviors and risks of alcohol and substance abuse. Their programs are

linked to local mining companies who generally focus on male employees.

Department of Correctional Services (DCS) will expand their correctional facilities program from Limpopo

and North West to include Gauteng and Northern Cape. DCS uses TshaTsha TV drama series to train PEs

to heighten awareness of risks pertaining to sexual partnerships and behaviors that place them at risk of

HIV infection.

ACTIVITY 4: Mass Media Support for Community Mobilization

The 2006 national communications survey found that 76.7% of people had at least one television (TV) in

their households. 60% watch TV every day and 60% listen to radio every day. TshaTsha reached about

48% of population, while the treatment literacy program Siyanqoba - Beat It reached 27% and community

radio program Mind, Body Soul reached 6% of the population. TshaTsha is used to facilitate discussions

with people in schools, correctional facilities and community meetings around issues of risk of HIV infection,

ITS and MCP. However 16% of population was not reached by any media interventions partly due to

fragmentation of media environment in relation to audience preferences influenced by socio-economic

status and language. To address this, JHU/CCP will expand mass media program to include new platforms

such as cellular and internet technology and outdoor media that will complement radio and TV outreach. All

platforms will heighten awareness of risk among men aged 25-49 and young girls and women aged 15-24

in relation to sexual partnerships and behaviors including MCP, ITS and male attitudes and behavior.

ABC Ulwazi will produce a community radio talk show for 60 community radio stations using local

languages that are facilitated through listener associations. JHU has a public-private partnership with SA

Broadcasting Corporation to fund two TV programs supported by nine regional SABC language radio

programs and internet. A second season of TV drama Circles heighten perception of risk to HIV infection

through highlighting sexual partnerships and behaviors that place them at risk of HIV infection including

MCP and ITS. Trailblazers provide positive models.

MB in partnership with SA Professional Football Union and the Professional Soccer League will mobilize

prominent SA football players to provide messages through different mass media platforms to raise

awareness of risk concerning MCP, ITS, male behavior, GBV, alcohol and substance abuse, treatment of

STIs, as part of build up to 2010 Football World Cup.

A TBD outdoor media partner will work with JHU to develop messages for outdoor media to heighten

perceptions of risk in relation to sexual partnerships and behaviors that place people at risk of HIV infection

including MCP with low and inconsistent condom use. A TBD cellular telephone partner will use short

message services technology to address MCP, ITS, correct and consistent condom use, male norms and

behaviors and the risks of alcohol and substance abuse.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,600,000

SUMMARY:

Johns Hopkins University/Center for Communication Programs (JHU/CCP) and its 20 South African (SA)

partners are undertaking a concerted effort that utilizes a variety of communication channels, including

mass media and interpersonal community mobilization (CM). It aims at bringing about heightened urgency

of risk perception to HIV infection among the general population about sexual partnerships and behaviors

that place them at risk including multiple concurrent partners (MCP); intergenerational/transactional sex

(ITS); inconsistent and incorrect condom use; alcohol and substance abuse; and gender and gender-based

violence (GBV). The condom and other HIV prevention strategy is guided by qualitative studies that

investigated underlying behavioral causes of MCP and the 2006 SA HIV/AIDS Communication Survey that

investigated reach and impact of 19 mass media interventions on HIV prevention.

BACKGROUND:

Over the next four years partners will prioritize interventions focusing on men aged 25-49 and women aged

15-24. Interventions will impact on key drivers of the epidemic and people's risk perception about sexual

partnerships and behaviors including prevalence of MCP; ITS and incorrect and inconsistent condom use.

All interventions are informed through study which found that high risk behaviors driving epidemic are

determined through social norms and values that include male attitudes and behaviors, alcohol and

substance abuse; population mobility and gender dynamics including GBV. JHU/CCP and its partners

combines a social-ecology approach to communication with power of interpersonal communication with

mass media (including radio, television (TV), outdoor and cellular technology) to engage and mobilize

individuals around sexual behavior and perception of risk to HIV infection and influence social networks and

communities to create an enabling environment that allows them to reduce risk to HIV infection. Activities

will contribute towards changes in social norms, create social networks that support individual change, build

skills, and improve decision making leading to safer sexual behavior (SB).

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Mobilizing In- and Out-of-School Youth 15-24

Dance4Life (D4L), DramAidE, The Valley Trust (TVT), Lesedi Lechabile (LL), Lighthouse Foundation (LF)

and Community Health Media Trust (CHMT) will work with young people in secondary schools using variety

of approaches to train peer educators (PEs) to establish HIV prevention, care and support clubs to act as

entree to in-school youth. With youth over 14 messages relating to MCP, ITS, correct and consistent

condom use, male norms and behaviors, substance and alcohol abuse, GBV, risk perception, stigma and

discrimination (SD) will be given.

TVT, LF and LL will use interpersonal discussions, workshops and community events with out-of-school

youth to heighten their perceptions of risk about sexual partnerships and behavior including MCP, ITS,

correct and consistent condom use, male norms and behaviors, substance and alcohol abuse and GBV.

DramAidE's Health Promoters (HPs) work in 23 tertiary institutions. They use group meetings, individual

consultations, dorm visits, classroom instruction and community events to increase risk perceptions about

MCP, ITS, GBV, condom negotiation skills, sexually transmitted infections (STIs), male norms and

behaviors, SD, sexual and reproductive health (SRH) and risks of substance and alcohol abuse.

ACTIVITY 2: Mobilizing Adults 15-49

Sonke Gender Justice (SGJ) supports partners to integrate Men as Partners approach into their work to

mobilize men around responsible male behavior, correct and consistent condom use, substance and

alcohol abuse and reduction of GBV.

Sonke Gender Justice, LF, LL and TVT will expand number of men's clubs and men's health services to

mobilize men, communities and traditional structures around responsible male behavior, correct and

consistent condom use, substance and alcohol abuse and reduction of GBV. They will expand number of

men's clubs in Mpumalanga, NW and NC provinces to mobilize men, their communities and traditional

structures.

TVT, LF and Matchboxology (MB) will undertake CM interventions to mobilize adult men and women

through door-to-door campaigns, taverns and taxi ranks, around MCP, ITS, correct and consistent condom

usage, prevention with positives (PwP), GBV, male norms and behaviors, SD, and risks of substance and

alcohol abuse.

LifeLine SA and TVT will support workplace interventions by training PEs within small and medium

enterprises and on farms to mobilize employers and employees. MB will work with professional footballers

and fan clubs. All workplace-based interventions will increase perceptions of risk about MCP and ITS,

correct and consistent condom use, GBV, SD, male norms and behaviors and alcohol consumption.

TVT and LF will undertake community conversations with traditional leaders and healers s to mobilize them

in addressing cultural dimensions of MCP, inconsistent and incorrect condom usage, PwP, GBV, SD, male

norms and behaviors and alcohol consumption.

TVT, LifeLine SA and LF will work with faith-based organizations (FBOs) through activities to promote

partner limitation, correct and consistent condom usage, GBV and SRH. Religious leaders will be trained

and provided with appropriate communication materials to guide them.

Mindset Health Channel (MHC) has a Healthcare Worker Channel (HCWs) and a Patient Channel in more

than 400 public clinics. Its HCW Channel trains health workers and its public health channel sensitizes

audiences on partner reduction, correct and consistent condom usage, GBV, substance and alcohol abuse,

STIs, and SRH.

Community Health Media Trust (CHMT), will increase number of Treatment Literacy and Prevention

Practitioners (TLPPs) to 92 (72 funded by PEPFAR and 20 by National Department of Health (NDOH) and

facilitate discussion among patients in general waiting rooms in MHC on topics relating to correct and

consistent condom usage, GBV, substance and alcohol abuse, STIs and SRH. LF, TVT and Mothusimpilo

will work with CHMT and Mindset to facilitate dialogues in clinics surrounding their areas.

DramAidE, CHMT and LF will mobilize support groups and community-based organizations of people living

with HIV, in areas where they are working around PwP and in particular addressing correct and consistent

condom use; MCP, alcohol and substance abuse, STIs. LL and Mothusimpilo use PE and HCW in mining

districts of North West (NW) and Free State (FS) to reach young women at risk, including sex workers, in

clinics, schools and communities to address correct and consistent condom use, risk perceptions, ITS,

GBV, stigma and discrimination, male norms and behaviors and risks of alcohol and substance abuse. Their

programs are linked to local mining companies who focus on male employees.

Department of Correctional Services (DCS) will expand its correctional facilities program from Limpopo and

North West Province to include Gauteng and Northern Cape. DCS uses Tsha Tsha TV drama series, to

train its PEs to promote correct and consistent condom usage, GBV, SRH including that relating to same

sex SB.

Activity Narrative:

ACTIVITY 3: Mass Media Support for CM

2006 JHU/CCP national communications survey found that 76.7% of people had at least one television (TV)

in their households. 60% watch TV everyday and 60% listen to radio everyday. JHU/CCP supported drama,

Tsha Tsha reached 48% of population, treatment literacy program Siyanqoba - Beat It reached 27% and

community radio program Mind, Body Soul reached 6% of population. Tsha Tsha has been used to facilitate

discussions with people in schools, correctional facilities and community meetings around issues relating to

risk of HIV infection, ITS and multiple and concurrent partnerships. However 44% of population was not

reached by any of these due partly to fragmentation of media environment about audience preferences

influenced by socio-economic status and language. To address this issue, JHUCCP will expand its mass

media program to include new platforms such as cellular and internet technology and outdoor media that

complements radio and TV outreach work. All platforms will heighten awareness of risk among men aged

25-49 and young girls and women aged 15-24 about their sexual partnerships and behaviors including

MCP, low and inconsistent condom use and need for regular testing.

ABC Ulwazi will produce community radio talk show for 60 community radio stations using local languages

facilitated through listener associations.

JHU CCP has a public private partnership with SA Broadcasting Corporation (SABC) to fund two TV-

programs supported by nine regional SABC language radio programs and internet. A second season of TV

drama Circles will heighten peoples perception of risk to HIV infection by highlighting sexual partnerships

and behaviors that place people at risk of infection including MCP, and ITS.

MB in partnership with SA Professional Football Union and Professional Soccer League will mobilize

prominent SA football players to provide messages through different mass media platforms that emphasize

responsible male behavior including consistent and correct condom use, GBV, alcohol and substance

abuse, treatment of STIs, as part of build up to 2010 Football World Cup in SA.

A TBD outdoor media partner will work with JHU to develop messages for outdoor media to heighten

perceptions of risk about sexual partnerships and behaviors that place people at risk of HIV infection

including MCP with low and inconsistent condom use.

A TBD cell phone partner will use SMS technology to address MCP, ITS, correct and consistent condom

use, male norms and behaviors and risks of alcohol and substance abuse.

This activity contributes to reaching the 2-7-10 goals by training individuals to promote condom use and

other prevention messages and preventing 7 million new infections.

Funding for Care: Adult Care and Support (HBHC): $485,000

SUMMARY:

The Johns Hopkins University/Center for Communication Programs (JHU/CCP), coordinates the work of 20

South African partners, provides technical assistance and capacity building to prevent HIV and AIDS

through a comprehensive HIV prevention program that addresses risky behaviors and the key drivers of the

epidemic in the general population through mass media and social mobilization. Three partners working

across South Africa will support efforts around palliative care. The target populations are: youth, adults,

people living with HIV (PLHIV), religious leaders, teachers, public health workers, and community, faith-

based and non-governmental organizations.

BACKGROUND:

This is the second year that JHU/CCP will undertake strategies using community-based mobilization in

support of palliative care. Their approach recognizes the need to mobilize communities to provide care and

support for people living with HIV and their families throughout the continuum of illness. To achieve this,

medical practitioners and community-based organizations need to be capacitated so that they can respond

appropriately to the needs of patients.

ACTIVITY 1: Community Mobilization and Support for Palliative Care

Community Health Media Trust (CHMT), with PEPFAR funding, has developed a series of video and print

materials for people affected by and living with HIV, their caregivers and communities. PEPFAR funding

assists CHMT in the updating and community rollout of the series on palliative care including opportunistic

infections that will be used in group sessions and workshops. CHMT has 92 Treatment Literacy and

Prevention Practitioners (TLPPs), (72 funded by PEPFAR and 20 by the National Department of Health

(NDOH)), that train and mentor community-based organizations to use their treatment literacy materials and

provide training and counseling to organizations of PLHIV on palliative care. This intervention has received

National Department of Health (NDOH) accreditation. TLPPs also work with PLHIV within health care sites

to provide advice and guidance on palliative care that will be broadcast through Mindset's patient channel at

400 health facilities.

The Mindset Health Channel (MHC) provides direct information to health clinics, targeting patients in waiting

rooms with general information, and healthcare providers with technical and training information. To

broadcast current and accurate information on palliative care, JHU/CCP continues its collaboration with

MHC which, at the beginning of FY 2008, will be in more than 400 health facilities. Existing material will be

revised and updated, including treatment videos, web content and print materials in up to five languages for

healthcare workers at these sites. Materials developed through previous PEPFAR funding will be updated

as national guidelines and protocols change. CHMT TLPPs spend half their time with patients in ARV rollout

sites and downstream referral sites that have the MHC. Both Mindset and CHMT material have been

developed through public-private partnerships including business (MTN, Liberty Foundation and Sunday

Times) as well as assistance from government and parastatals (e.g. NDOH, SABC).

DramAidE utilizes Health Promoters In 23 Tertiary institutions in South Africa to provide information on

palliative care and support, including the treatment of opportunistic infections for tertiary students living with

HIV through the HIV support groups that they manage on tertiary campuses using the treatment literacy

series developed by CHMT.

The Valley Trust, working in KwaZulu-Natal, promotes and provides palliative care including clinical, social,

psychological care and prevention services to persons in need in the rural areas of KwaZulu-Natal through

its 15 mobile clinic sites and one fixed site. They train clinical personnel and peer educators in palliative

care using the treatment literacy series developed by CHMT that addresses the continuum of care and

support, including treatment for opportunistic infections as well as cotrimoxazole prophylaxis that will

support vulnerable women and mine workers.

Lesedi Lechabile and Mothusimpilo have 11 and 20 mobile clinics respectively, working in the mining areas

of the Free State and the North West Provinces that provide palliative care to persons living with HIV

through their mobile clinic sites. They train their clinical personnel and peer educators in palliative care

using the treatment literacy series developed by CHMT that addresses the continuum of care and support

including treatment for opportunistic infections that will support vulnerable women and mine workers.

Lighthouse Foundation trains its Peer Educators and Community Facilitators to work in the 13 informal

settlements in the Madibeng District of the North West Province to incorporate palliative care including the

treatment of opportunistic infections into their community outreach, comprising door to door campaigns and

their HIV support group based on the treatment literacy series developed by CHMT.

Funding for Care: TB/HIV (HVTB): $970,000

SUMMARY:

Johns Hopkins University Center for Communication Programs (JHU/CCP), coordinates the work of 20

South African partners and provides technical assistance and capacity building to mobilize and educate

communities and clinicians about the linkages between Tuberculosis (TB) and HIV. The focus is TB literacy,

and training clinicians through distance learning. The target populations for this activity are adult men and

women (including pregnant women) living with HIV (PLHIV), discordant couples, volunteers, public health

workers, and community-based, faith-based and non-governmental organizations. The major emphasis

area will be human capacity development and other activities will include community mobilization,

information, education and communication and training. Findings from the 2008 National HIV and AIDS

Communication Survey will help focus TB interventions and assist in improving understanding regarding TB

and its treatment. The survey will provide a valuable baseline to further develop present communication

interventions on TB.

BACKGROUND:

This is the first year that JHU/CCP will undertake community mobilization and mass media in support of

TB/HIV that builds upon the successful four year program and ongoing partnerships that have utilized

interpersonal communication and mass media in support of treatment literacy, adherence and clinician

training. Eight of the twenty partners that work with JHU/CCP will be engaged in work on TB/HIV including

the South African Broadcasting Corporation (SABC), Mindset Health Channel (MHC), Community Health

and Media Trust (CHMT), LifeLine, The Valley Trust (TVT), DramAidE, Lesedi Lechabile, Mothusimpilo,

Lighthouse foundation and ABC Ulwazi. The work will be in coordination with other PEPFAR funded

partners such as URC's TB TASCII Project and the National Department of Health (NDOH) TB Sub-

Directorate. All these interventions seek to undertake public awareness and education around the dual

epidemics of TB/HIV using interpersonal communication interventions and mass media. The awareness and

educational programs will be reinforced within health care facilities through interventions that provide more

human input into the care and support of TB patients in their interactions with the public health system and

upon their return to their communities. One of the weaknesses of the current care package is that patients

are only provided with verbal guidance on how to access health care services and there is very little follow-

up once they leave the health care facility. All community outreach workers will provide step-by-step

assistance to each individual patient and walk them through the health system. By providing one-on-one

assistance this will ensure that patients do not "get lost" which enhances the probability of them receiving

adequate care and support including accessing treatment. The same outreach workers will do home and

community follow-up to ensure that patients are compliant with their treatment regimens. It is anticipated

that this will ensure better initiation completion rate of treatment rates among TB patients.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community Mobilization

CHMT, with PEPFAR funding, has developed a series of video and print materials for people affected by

and living with HIV, their caregivers and communities that includes material on TB. PEPFAR funding assists

CHMT to revise and update the TB-HIV component of these materials. The materials are used in group

sessions and workshops facilitated by 92 Treatment Literacy and Prevention Practitioners (TLPPs) (72

funded by PEPFAR and 20 NDOH) within the TB and ART clinics where they encourage TB patients to be

tested for HIV and HIV patients to be screened for TB. The treatment literacy work of the TLPPs within

clinical settings task shifts the responsibility of the management of treatment literacy for patients living with

HIV from health practitioners thus freeing them up to provide to provide improved clinical services. TLPPs

provide capacity building and mentoring to local community-based organizations to use the treatment

literacy material in strengthening their support for people living with HIV. This intervention has received

National Department of Health (NDOH) approval.

The Mindset Health Channel (MHC) is a public-private partnership that provides information directly into

health clinics, targeting patients in waiting rooms with general information, and healthcare providers with

training and technical information. JHU/CCP continues its collaboration with MHC which, at the beginning of

FY 2008, will be in more than 400 health facilities. Existing material will be revised and updated, including

treatment videos, web content and print materials in up to five languages for healthcare workers at these

sites. CHMT treatment literacy practitioners spend half their time with patients in ARV rollout and

downstream referral sites that have the MHC.

Mindset uses its onsite access to clinicians to build their capacity to deliver quality TB services in line with

national protocols. This includes encouraging TB patients to be tested for HIV and for HIV patients to be

screened for TB, adherence messages for persons on treatment, treatment support education for families

and individuals supporting those on treatment. Other issues covered include prevention with positives with

emphasis on discordant couples. Information includes adherence for treatment.

Both Mindset and CHMT material have been developed through public-private partnerships including;

business (MTN, Liberty Foundation and Sunday Times) as well as assistance from government and

parastatals (e.g. NDOH, SABC).

DramAidE utilizes HIV-infected Health Promoters in 23 tertiary institutions in South Africa to undertake

community sensitization efforts among students on campuses using events such as World TB Day and

through their support groups of students living with HIV around the need to be screened for TB and

adherence to TB treatment.

Lesedi Lechabile and Mothusimpilo trains their peer educators working in mobile clinics and one static site

to provide counseling to vulnerable women, mine workers and people living with HIV on the need for TB

screening and treatment adherence in the mining districts of the Free State and North West Provinces.

They undertake community sensitization and mobilization around TB/HIV.

Lighthouse Foundation (LF) trains its peer educators and community facilitators to work in the 13 informal

settlements in the Madibeng District of the North West Province to undertake community sensitization

efforts using their door-to-door campaigns and community events. LF uses events such as World TB Day

Activity Narrative: and their support groups of students living with HIV to disseminate messages around the need to be

screened for TB and adherence to TB treatment.

ACTIVITY 2: Media support for community mobilization

ABC Ulwazi produces a radio talk show series tailored to 60 different community radio stations. Special

emphasis is on treatment adherence and establishing support systems for those people who have TB. Each

episode ends with a summary and clear messages on the topic discussed.

SABC continues the theme of treatment through two programs: Trailblazers, a 13 episode TV series

highlighting success stories including best practices in this area; and a new 26 episode adult TV drama

series. Both TV programs are accompanied by radio talk shows (on 9 local language stations) as well as

web-based content. The storylines focus on TB and HIV treatment and prevention with positives.

JHU/CCP contributes substantially towards meeting the vision outlined in the USG PEPFAR Five-Year

Strategy for South Africa by ensuring that 1) all persons who are screened for TB are tested for HIV and

that all persons living with HIV are screened for TB; 2) that TB patients and patients living with HIV have

access to TB/HIV services; 3) implementing joint TB/HIV information, education and communication

activities. By training individuals to deliver quality TB/HIV services this activity contributes to the PEPFAR

goal of putting two million HIV-infected people on treatment. This activity also contributes towards the

objectives of the National Strategic Plan for South Africa through ensuring that 80% of people have access

to appropriate treatment, care and support services through the effective management of TB and HIV

coinfection.

Funding for Care: Orphans and Vulnerable Children (HKID): $485,000

SUMMARY:

The Johns Hopkins University/Center for Communication Programs (JHU/CCP) will implement an orphans

and vulnerable children (OVC) intervention that builds networks of support around OVC, their caregivers

and educators. OVC will be assisted in accessing basic needs and psychosocial support. Proven

psychosocial models for supporting OVC will be used to build the capacity of organizations working with

OVC. The target populations for this program are OVC, people living with HIV, religious leaders, and

teachers and existing PEPFAR partners. The major emphasis area for the activity is local organization

capacity building.

BACKGROUND:

This program is now in its third year and focuses on using tools developed in past years to work with

communities, caregivers and OVC to implement appropriate responses which address a range of OVC

needs, including physical, social and emotional issues. DramAidE, The Valley Trust and the Anglican

church have worked with schools, FBOs and CBOs to identify OVC, who have received needed services.

This partner's activities to date include community mobilization for the provision of psychosocial and direct

support for OVC in communities. Direct support includes; home visits to OVC to monitor their progress,

referrals to social workers, tribal authorities, assisting in applying for the waiving of school fees for OVC

through the Department of Education, referrals to the Department of Social Development and the

Department of Home affairs for Child Support, Foster Care and Child Dependency grants. Support has also

focused on collaboration with local police and other community organizations to promote child protection.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Direct Support to OVC

The Valley Trust (TVT) works in the rural areas of KwaZulu-Natal and identifies and trains caregivers within

local communities to provide direct care and support to OVC. This includes protection from abuse and

exploitation and working with school officials to identify and work with OVC who are trained as Peer

educators within the school settings. Peer Educators identify and work with other OVC on creating safe

spaces and providing psychosocial support that that uses group recreational activities including music,

drama and sports to decrease social isolation. Peer Educators also provide support to OVC for

bereavement and compiling and maintaining memory boxes.

DramAidE Community facilitators (CFs) are trained to work in communities to assist OVC to gain access to

basic material needs and ongoing psychosocial support activities. In addition to providing direct assistance

to OVC, CFs work with communities, FBOs, NGOs, educators and caregivers to lay the foundation for

community action in support of these OVC.

Through these activities DramAidE and TVT strengthen the capacity of the communities to be able to

respond to the needs of and to develop a culture of care, nurture and support for OVC.

ACTIVITY 2: Technical Assistance (TA) for PEPFAR OVC Partners on Psychosocial Support

DramAidE provides training and technical assistance on psychosocial support to other PEPFAR OVC

partners. Creative, interactive and culturally appropriate activities to reach OVC, such as drama, storytelling

and workshops are used to equip and enhance existing PEPFAR OVC programs in responding to the

psychosocial needs of OVC and include HIV prevention interventions for OVC which are age appropriate.

Educators and caregivers are trained and provided with on-going support in implementing these programs.

The meaningful participation of affected children, OVC and youth is critical to the success and sustainability

of any effective intervention targeting OVC. To this end, OVC are consulted regarding their needs and are

involved in developing local support networks.

ACTIVITY 3: Communication Training

JHU/CCP and PEPFAR partner Soul City work together to provide communication training to assist

caregivers in developing tools and skills which will enhance their ability to provide more effective and

efficient services. Interpersonal communication skills training will be conducted, and a core set of materials

adapted from media programs, along with facilitator guides, will also be produced and distributed as part of

this activity.

These activities will contribute towards meeting the vision outlined in the USG Five Year Strategy for South

Africa, by providing care for children made vulnerable by HIV and AIDS through the expansion of

community capacity to deliver good quality care. In addition they increase OVC access to government

support systems, and strengthen linkages and referral systems to other social services such as health,

education and social welfare. The latter will be achieved through the establishment of child care forums with

all relevant stakeholders, including government departments that provide services to OVC; compilation of

directory of government and civil society services available for children and also through facilitation of

community conversations for OVC, pre-school practitioners, school governing bodies, community policing

forums, other stakeholders and youth caregivers to address stigma directed at OVC

JHU/CCP and its partners contribute towards the attainment of the National Strategic Plan target of

ensuring that 80% of people living with HIV and their families are provided with an appropriate package of

treatment, care and support through ensuring the effective implementation of policies and strategies that

mitigate the impact of HIV on orphans, vulnerable children and youth-headed households.

Activities implemented by JHU/CCP will contribute to the PEPFAR objective of providing care to 10 million

people, including OVC.

Funding for Prevention: HIV Testing and Counseling (HVCT): $1,697,500

SUMMARY:

Johns Hopkins University Center for Communication Programs (JHU/CCP) coordinates the work of 20

South African partners and provides technical assistance and capacity building to provide counseling and

testing (CT) using both mobile and fixed services through local NGOs and tertiary institutions. These

services will be promoted through the Mindset Health channel to both healthcare workers and patients. Key

areas of male norms and behaviors, partner limitation, correct and consistent condom usage, substance

and alcohol abuse, reducing violence and coercion and stigma and discrimination, form an integral part of

the CT interventions. The target populations for this activity are secondary school learners, university

students, patients in health care centers, celebrities and their fans, people living with HIV (PLHIV), out-of-

school youth, men who have sex with men (MSM), community leaders and healthcare providers. The major

emphasis areas are community mobilization and participation, and information, education and

communication, with additional emphasis on local capacity building across all activities. Findings from a

qualitative study on multiple concurrent partnerships and the National HIV and AIDS Communication

Survey, carried out in early 2006, will help focus on community perceptions of CT and help to determine

perceived needs in respect to CT communication interventions.

BACKGROUND:

This is the fourth year that JHU/CCP has undertaken counseling and testing activities. Eighteen of the 20

partner organizations work across all nine provinces of South Africa utilizing mass media and interpersonal

communication strategies in a variety of social settings aimed at creating a broad national social movement

that promotes counseling and testing as part of the broader national HIV prevention, treatment and care

strategy. Testing is promoted through mobile clinics and fixed sites operated by four partners and in

partnership with the public health system and other partners such as New Start. Counseling addresses

issues related to male norms and behaviors, violence and coercion, stigma and discrimination, alcohol and

substance abuse, and correct and consistent condom usage. All organizations carry out prevention with

positive living activities as part of their post-test counseling with HIV-infected individuals.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Social Mobilization for Testing

DramAidE, The Valley Trust, Lesedi Lechabile, Mothusimpilo, and Matchboxology support and promote CT

services targeting men, women, youth and the broader community at 85 mobile and fixed testing sites.

DramAidE's HIV positive Health Promoters (HPs) mobilizes tertiary students in 23 tertiary institutions across

South Africa to undergo CT. The Valley Trust (TVT), based in KwaZulu-Natal (KZN), promotes CT through

community outreach and mobilization activities targeting adult men and women in the rural areas of

KwaZulu-Natal at its 15 mobile and one fixed CT site. TVT promotes CT with youth aged 14 years and older

through its school Anti-AIDS clubs, and among adult men and women through community events and

traditional ceremonies, workplaces, taverns and faith based organizations.

Dance4Life promotes CT among youth older than 14 using dance, drama and drumming as part of their

prevention activities covering schools in the Eastern Cape, Western Cape, KwaZulu-Natal and Free State

provinces. Lesedi Lechabile and Mothusimpilo promote CT through activities undertaken at their mobile and

fixed sites to vulnerable women, youth and men in the mining areas of the Free State and the North West.

LifeLine promotes CT with workers in small and medium enterprises and farm workers in informal

settlements/rural areas in Gauteng, Free State, Northern Cape, Limpopo and Mpumalanga. This activity is

undertaken in partnership with the Small Business Association, farm owners and farm workers' unions.

Lighthouse, working in 13 informal settlements in the Madibeng District of the North West province,

promotes CT through its school Anti-AIDS club activities. The project encourages adult men, women and

out-of-school youth to undergo CT through their door-to-door campaigns and at community events,

traditional ceremonies, and gathering places like taverns and taxi ranks.

Matchboxology (MB) in partnership with the South African Professional Footballers Union (SAPFU) and the

Premier Soccer League (PSL) places 16 wellness coaches in 16 Premier Soccer League Clubs to mobilize

professional footballers and their fans to undergo CT. MB is a private sector firm that is responsible for the

Levis Red for Life Campaign that mobilizes celebrities around HIV.

Sonke Gender Justice (SGJ) will expand the number of men's clubs in Mpumalanga, North West and

Northern Cape to mobilize men participating in their male clubs to undergo CT. SGJ receives funding from

the Western Cape provincial government, the National Office on the Status of Women, a independent

foundations and United Nations agencies.

The PEPFAR partner, Department of Correctional Services (DCS), will expand their program from the

Limpopo and North West provinces to include Gauteng and the Northern Cape. The program with DCS

uses the TshaTsha TV drama series, to train their peer educators (PEs) to promote CT.

A "to be determined" (TBD) faith-based organization (FBO) will work with faith-based leaders to promote CT

to their communities.

A TBD partner will work with the indigenous communities living in the Northern Cape (the San and the Khoi)

to to promote CT as part of a broader effort to promote HIV prevention amongst this community.

A TBD partner will work with men who have sex with men (MSM), including male sex workers, to mobilize

this community to increase HIV prevention efforts including CT as part of a broader HIV prevention effort

targeting MSM in South Africa.

A TBD partner will work with cellular telephone providers in South Africa to utilize cellular technology to

encourage celebrities and other key personalities, through SMS technology, to participate in cellular and on-

line chat forums to promote CT.

Activity Narrative: ACTIVITY 2: Promoting CT in Health Centers

The Mindset Health Channel (MHC) broadcasts information to 400 health clinics. Patients in waiting rooms

are targeted with information on CT and HIV. The channel provides training and technical information to

healthcare workers (HCWs) using a multimedia approach that combines video, print and computer-based

interactive multimedia. Training on current CT guidelines (including strong linkages to HIV care and

services) are included. Mindset will also develop a video on provider-initiated testing and counseling (PITC).

The video will inform patients that the facility has a PITC policy and that the provider will test them for HIV

unless the patient refuses.

Community Health Media Trust (CHMT) works with MHC and with other community-based organizations

through its 92 Treatment Literacy and Prevention Practitioners (TLPPs). Seventy-two TLPPs are funded by

PEPFAR and 20 by the National Department of Health (NDOH). All TLPPs encourage CT in health centers

as an entry point into treatment while reinforcing HIV prevention to those who test negative.

ACTIVITY 3: Mass Media in Support of Community Mobilization

ABC Ulwazi produces a radio talk show series tailored to 60 different community radio stations with a

special emphasis on voluntary counseling and testing. Listeners' Associations formed by local citizens have

facilitators' guides to carry out community outreach interventions that mobilize local communities around

voluntary counseling and testing and encourage them to know their HIV status.

The South African Broadcasting Corporation plays a key support role by co-funding two TV programs with

radio (nine local language stations) and by providing web support. Trailblazers, a community health show,

will air 13 episodes highlighting individuals that provide models of positive behaviors for others to emulate.

A second season of a 26-episode TV drama deals with contextual issues relating to social and cultural

norms that inhibit and/or support positive male norms and behaviors, including positive examples that

promote counseling and testing and living positively. Radio talk shows follow both programs, providing

additional information and stimulating community participation.

MB and the South African Football Players' Union (SAFPU) and the Premier Soccer League (PSL) will

mobilize South African football players to be positive role models and to undergo public counseling and HIV

testing. Players will be encourage to promote messages relating to counseling and testing through in the

build up to the 2010 Football World Cup in South Africa.

JHU/CCP's work supports the vision outlined in the USG Five-Year Strategy for South Africa for expanding

CT services. CT is a critical entry point into an entire range of HIV services, including identifying HIV-

infected individuals for ART. These activities substantially contribute to the PEPFAR goal of providing 2

million people with treatment and averting 7 million new HIV infections. It also supports the HIV & AIDS and

STI Strategic Plan for South Africa's priority of establishing a national culture in which all people in South

Africa regularly seek voluntary counseling and testing. Establishing regular CT as a norm will contribute

towards reducing the number of HIV infections by 50% by 2011 and ensure that 80% of people living with

and affected by HIV have access to appropriate care and support and treatment.

Funding for Treatment: Adult Treatment (HTXS): $3,400,000

SUMMARY:

Johns Hopkins University Center for Communication Programs (JHU/CCP) coordinates the work of 20

South African partners and provides technical assistance and capacity building to mobilize and educate

communities and clinicians about ARV treatment. The focus is on pre-treatment literacy, adherence,

counseling, and training clinicians through distance learning. Target populations for this activity are adult

men and women (including pregnant women) living with HIV (PLHIV), discordant couples, volunteers, public

health workers, and community-based, faith-based and non-governmental organizations. The emphasis

areas for this activity are human capacity development, local organization capacity building and gender.

Findings from the National HIV and AIDS Communication Survey, carried out in early 2006, help focus on

community perceptions of treatment-related messages, their perceived needs for treatment literacy and the

amount of social capital invested in providing assistance in better understanding treatment and its uptake.

The survey provided a valuable baseline to further develop present communication interventions on

treatment.

BACKGROUND:

The JHU/CCP initiatives are in their third year, following successful programming and ongoing partnerships

in providing pre-treatment training, adherence counseling and clinician training. Twelve of the 20 partners

that JHU/CCP works with across South Africa are engaged in supporting work relating to pre-treatment

training and adherence counseling for people living with HIV. This intervention mobilizes communities

around treatment literacy and builds community preparedness by reaching several million people. Mindset

uses its onsite access to clinicians to build their capacity to deliver ART services in line with national

protocols. Treatment literacy includes pre-treatment training and adherence messages for persons on

treatment, treatment support education for families and individuals supporting those on treatment, and ART

preparedness education for communities and individuals who anticipate initiating treatment. Other issues

covered include prevention with positives with emphasis on discordant couples.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Community Mobilization

Community mobilization activities are implemented by a variety of partners. Community Health Media Trust

(CHMT), with PEPFAR funding, has developed a series of video and print materials for people affected by

and living with HIV, their caregivers and communities. PEPFAR funding assists CHMT in the community

rollout of these materials through group sessions and workshops. CHMT has 92 Treatment Literacy and

Prevention Practitioners (TLPPs), (72 funded by PEPFAR and 20 by the National Department of Health

(NDoH)), that train and mentor community-based organizations to use their treatment literacy materials to

provide pre-treatment training and adherence counseling to PLHIV. This intervention has received NDOH

accreditation. Treatment literacy practitioners also work with PLHIV on treatment literacy issues that are

broadcast through Mindset's patient channel at 400 health facilities.

The seven hours of treatment literacy videos developed by CHMT and Mindset for the public channel are a

major part of the support materials for the TLPPs (in addition to the materials developed previously by

CHMT). The materials also cover prevention with positives, male norms and behavior, and stigma and

discrimination.

The Valley Trust, as part of their rollout of antiretroviral treatment (ART), has a treatment literacy program

supported by the CHMT developed materials and their TLPPs. The Valley Trust also incorporates treatment

literacy into its workplace based program being undertaken in small and medium enterprises in several

communities in KwaZulu-Natal.

LifeLine works with small business associations as well as farmers and farm workers' associations in areas

surrounding one informal settlement in the Gauteng, Limpopo, Northern Cape, and Mpumalanga provinces,

to develop workplace programs, including prevention for positives, pre-treatment training and adherence

counseling. These programs focus on treatment preparedness and adherence for HIV-infected persons and

their treatment supporters (treatment buddies).

The Mindset Health Channel (MHC) provides information directly into health facilities, targeting patients in

waiting rooms with general information, and healthcare providers with technical and training information. To

broadcast current and accurate information on ARV treatment, JHU/CCP continues its collaboration with

MHC in more than 400 health facilities. Existing material will be revised and updated, including treatment

videos, web content and print materials in up to five languages for healthcare workers at these sites.

Materials developed through previous PEPFAR funding are also updated as national guidelines and

protocols change. CHMT treatment literacy practitioners spend half their time with patients in ARV rollout

and downstream referral sites that have the MHC.

Both Mindset and CHMT material have been developed through public-private partnerships including

business (MTN, Liberty Foundation and Sunday Times) as well as assistance from government and

parastatals (e.g. NDOH, and the national broadcaster, South African Broadcasting Corporation (SABC)).

DramAidE utilizes HIV positive Health Promoters in 23 tertiary institutions in South Africa to undertake

treatment literacy, including pre-treatment training and adherence counseling for tertiary students living with

HIV, using the treatment literacy series developed by CHMT. They work closely with government treatment

sites to fast-track students to initiate treatment early on.

Lesedi Lechabile and Mothusimpilo train their peer educators in treatment literacy using the treatment

literacy series developed by CHMT that addresses pre-treatment training and adherence counseling,

targeting vulnerable women and mine workers in the mining districts of North West and the Free State

provinces.

Lighthouse Foundation trains its peer educators and community facilitators to work in the 13 informal

settlements in the Madibeng District of the North West province. Training incorporates treatment literacy,

including pre-treatment training and adherence counseling, based on the treatment literacy series

Activity Narrative: developed by CHMT. These topics are included in their community outreach activities, comprising door to

door campaigns and HIV support groups.

Sonke Gender Justice undertakes treatment literacy, including pre-treatment training and adherence

counseling with people living with HIV in the areas surrounding the men's clubs that are to be expanded in

North West, Northern Cape and Limpopo provinces.

Matchboxology (MB), in partnership with the South African Professional Footballers Union and the

Professional Soccer League (PSL), provides treatment literacy training to football players who are living with

HIV including pre-treatment counseling and pre-adherence counseling. MB works closely with treatment

centers so that they can fast-track players to initiate treatment early on. Footballers will be mobilized to

promote treatment literacy in interaction with their supporters and as part of their social responsibility.

A partner, to be identified, will undertake treatment literacy, including prevention with positives, pre-

treatment training and adherence counseling in the areas of northern KwaZulu-Natal using the materials

developed by CHMT as part of their community outreach activities with people living with HIV.

ACTIVITY 2: Media Support for Community Mobilization

ABC Ulwazi produces a radio talk show series tailored to 60 community radio stations. Special emphasis is

on pre-treatment training and adherence counseling. Each episode ends with a summary and clear

messages on the topic discussed. Listeners' Associations formed by local citizens have facilitators' guides

to carry out community outreach interventions related to the series themes.

SABC continues the theme of treatment through two programs: Trailblazers, a 13 episode TV series

highlighting success stories including best practices in this area; and a second season of a 26 episode adult

TV drama series. Both TV programs are accompanied by radio talk shows (on 9 local language stations) as

well as web-based content. The storylines include a focus on treatment and prevention for positives.

JHU/CCP contributes towards meeting the vision outlined in the USG PEPFAR Task Force Five-Year

Strategy for South Africa by providing quality treatment literacy education to health providers, their patients

and communities. In addition JHU/CCP builds capacity of other organizations to utilize treatment literacy

materials to support work with people living with HIV on positive prevention and treatment literacy. By

training individuals to deliver quality ARV services and reaching South Africans with correct treatment

literacy messages, this activity contributes to the PEPFAR goal of putting two million HIV-infected people on

treatment. This activity also contributes towards achieving the National Strategic Plan of South Africa 2007 -

2011 target of ensuring that more than 80% of people living with HIV and their families are provided with an

appropriate package of treatment, care and support.

Funding for Strategic Information (HVSI): $776,000

SUMMARY:

Johns Hopkins University/Center for Communication Programs (JHU/CCP) coordinates the work of 20

South African partners and provides technical assistance and capacity building in communication activities

to prevent HIV, provide care and support, and increase treatment adherence and support. JHU/CCP also

undertakes program evaluation that aims to ensure that all communication activities undertaken by

JHU/CCP are responsive to emerging issues and the changing dynamics of the epidemic within the South

African context. The National HIV and AIDS Communication Survey, carried out in early 2006, serves as a

baseline for comparing overall PEPFAR and South African Government (SAG) communication goals and

objectives with a follow-up survey planned for 2008.

BACKGROUND:

JHU/CCP led the undertaking of the National HIV and AIDS Communication Survey in 2006 in partnership

with the National Department of Health (NDOH) through Khomanani, Soul City, Health and Development

Africa (HDA) and the Centre for AIDS Research and Evaluation (CADRE). The key objectives of this survey

were to develop an understanding of the overall HIV and AIDS communication environment; understand

communication gaps to inform future communication interventions; and determine the reach and

complementarities of national communication campaigns and their contribution to individual level

responses. This survey found that 87% of all South Africans were reached with messages dedicated to HIV

prevention and living with HIV and AIDS by means of television and radio programs.

In response to the identification of multiple concurrent partnerships as a risky behavior that fuels the

epidemic, JHU/CCP undertook a small qualitative study that aimed to unpack the underlying reasons for

multiple concurrent partnerships within a hyper-endemic scenario and the manner in which communication

can be mobilized to bring about behavioral and social changes. JHU/CCP provides technical support to its

partners to undertake programmatic evaluations that enable partners to align their activities to the needs of

the communities so that it is responsive to behavioral risk factors and key drivers of the epidemic within

communities. This ensures that programs are evidence based and continually respond to the changing

nature of the epidemic.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Strategic Partner Evaluations

In line with the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP), all project activities

should be evaluated so that they are responsive to the needs of the communities that they service.

JHU/CCP works with all 20 partners to evaluate their programs in consultation with evaluation experts that

at the same time provides these organizations with the necessary skills and capacity to undertake their own

strategic information activities as part of their ongoing project design and implementation.

In particular JHU/CCP supports the Community Health Media Trust (CHMT) to undertake an evaluation of

the impact of their Treatment Literacy and Prevention Practitioners (TLPPs) in providing care and support to

people living with HIV within public health clinics and the extent to which this task shifting contributes

towards improved care and support for patients living with HIV and non-HIV patients as well as investigate

their impact on prevention behaviors. The findings of this study will be used to engage national and

provincial health authorities on the manner in TLPPs can be used to task shift from health care workers and

provide optimal support to people living with HIV.

DramAidE employs young people living with HIV to act as Health Promoters on the campuses of tertiary

academic institutions. The study will examine the extent to which these Health Promoters have impacted on

the health and wellbeing of students and on the overall HIV policy and program being undertaken in tertiary

institutions. This study will be used to advocate with tertiary institutions for the integration of Health

Promoters as an integral component of their response to HIV.

ACTIVITY 2: Dissemination Workshops

HU/CCP will undertake the second National HIV and AIDS Communication Survey in follow-up to the first

survey in conducted in 2006. This survey will provide in-depth information about the communication

environment in South Africa as well as estimates of the separate and joint impact of various communication

interventions. The results of the study will be used to measure progress on program goals and to inform

future strategic planning for communication activities. In FY 2008, the main focus will be on the

dissemination of the findings through a series of workshops to more than 300 key policy and decision

makers throughout the country. The purpose of these workshops is to build national and local consensus on

the impact of communication interventions on HIV prevention, care and support, what has been achieved

through communication interventions and which program areas interventions need to be strengthened. In

addition, the findings from the 2008 survey will be compared to those from the 2006 survey to assess

changes in norms and behavior and the impact of various communication interventions.

Findings from the survey and discussion and processing of the findings in the dissemination workshops are,

taken together, effective ways to incorporate the role of most-at-risk populations and other populations that

contribute to the variation in the HIV and AIDS epidemic in South Africa. This is specifically where the tick

boxes in the tables on the following pages are relevant.

This activity will assist in making communication interventions across the different program areas more

effective by providing key data for decision making. This will contribute to the overall global PEPFAR goal of

averting 7 million new infections.

Activity 3: Capacity Building for Strategic Information

JHU/CCP partners will work with the University of KwaZulu-Natal, Centre for Cultural and Media Studies to

build the capacity of young South Africans in designing, implementing and monitoring strategic

communication interventions. This program capacitates students to undertake research that examines the

impact of communication interventions in relation to international standards.

Activity Narrative:

A media partner (partner to be determined) will work with South African media institutions including

journalists and editors to build their capacity in understanding, analyzing and reporting on HIV and AIDS

strategic information to improve media reporting on the state of the epidemic in South Africa.

Subpartners Total: $13,912,250
Applied Broadcasting Centre : $45,000
Anglican Church of Southern Africa: NA
Center for AIDS Development, Research, & Evaluation: $500,000
Department of Justice and Correctional Services - South Africa: $100,000
DramAidE: $1,375,000
Mindset Health: $2,350,000
South African Broadcasting Corporation: NA
The Valley Trust: NA
University of the Witwatersrand: NA
University of KwaZulu-Natal: NA
Pollution Environmental Community Development Energy and Resource Africa: NA
Dance4Life: $500,000
Lifeline: NA
Lutheran Church Lighthouse Foundation: NA
Lighthouse Trust: $500,000
Turntable Trust: $250,000
University of KwaZulu-Natal: $100,000
Winterveldt HIV And AIDS Project: $386,000
Valley Trust: $735,000
Sonke Gender Justice: $650,000
Luncedo Lwesive: $55,750
Motomoto Primary: $625,000
Lifeline: $800,000
South African Broadcasting Corporation: $1,900,000
Community Media Trust: $1,600,000
Zimeleni HBC: $65,500
Matchboxology: $650,000
Lesedi Lechabile: $575,000
University of the Witwatersrand: $75,000
University of the Witwatersrand: $75,000