SUMMARY:

PEPFAR funds will support the Department of Correctional Services (DCS) to raise awareness about the

prevention of HIV and progression to AIDS through the procurement of posters, pamphlets, videos/DVDs

and booklets. CDC South Africa (SA) will review posters prior to printing and distribution. The appointment

of six HIV and AIDS Management Area Coordinators (MACs) for the HIV and AIDS Offender Program, six

Regional Coordinators and six Management Area Coordinators for the HIV and AIDS Workplace (members)

Program as well as dieticians, on a contract basis of one year, will enhance the program implementation.

The HIV and AIDS coordinators will coordinate, monitor and evaluate all HIV and AIDS programs. The

emphasis areas for this program are workplace programs and reduction of violence and coercion. The

target population will include male and female offenders and people living with HIV (PLHIV).

BACKGROUND:

The Department of Correctional Services has two distinct HIV and AIDS programs that are currently being

implemented. It has a comprehensive HIV and AIDS Program for offenders for which a separate directorate

was established in 2004. It also has a separate HIV and AIDS workplace program for personnel.

Correctional officials are deployed in Correctional Centers, Community Corrections Offices, Management

Areas, Regional Offices, and the National Head Offices. The HIV and AIDS workplace program currently

resides under the Directorate for Human Resources Support and forms part of the Employee Wellness

Program. Raising awareness and the role of behavioral change including safe sex practices in prevention

among offenders and correctional officials forms a critical element of the comprehensive HIV and AIDS

Program in the Department of Correctional Services. The utilization of educational posters, pamphlets,

booklets, videos/DVDs, group activities, celebration of commemoration days raise awareness and

encourages safe practices by empowering participants with knowledge and distributing condoms.

Educational posters for offenders have previously been procured and distributed to the regions. Feedback

received from the regions with regard to the utilization of these posters was positive and encouraged

procurement of more educational material by Department of Correctional Services from accredited and

registered service providers. The educational material was utilized by the master peer educators and HIV

and AIDS coordinators during training and awareness raising sessions in Correctional Centers. The

appointment of HIV and AIDS MACs for offenders, whose function is to coordinate HIV and AIDS

comprehensive programs on contract basis, with funding received in 2004/2005 has proven to be

successful and has enhanced the implementation of HIV and AIDS programs and services at management

area level as well as at a correctional center level. It furthermore contributed to the fact that the human

resource capacity in at least five management areas was extended by converting the contract post to a

permanent post. Due to the shortage of human resources in the regions and at Management Area level,

and to ensure the implementation and management of HIV and AIDS programs and services for staff, it is

envisaged that the advertising of one year contract posts as indicated will add value to enhance and

broaden the involvement of staff in HIV and AIDS activities and services in the workplace.

ACTIVITIES AND EXPECTED RESULTS:

There are approximately 162,000 offenders (both sentenced and un-sentenced) incarcerated in 241

Correctional Centers managed by the DCS, and 36,879 offenders in community corrections programs. The

average offender population of a correctional center is approximately 4,000. In addition, DCS currently

employs approximately 41,000 persons. This program is designed so that every offender and every

correctional official will be exposed to ongoing information sessions and be involved in programs on HIV

and AIDS through awareness-raising sessions and behavioral change programs, and training of

professionals as well as offenders, and the changing of perceptions and behavior among correctional

officials and offenders.

ACTIVITY 1: Procurement and Distribution of Educational Material and Procurement of Relevant Behavioral

Programs

DCS will procure HIV and AIDS educational material that will be utilized during didactic training sessions,

small group sessions, bigger projects and behavioral programs and for both offenders and correctional

officials. These materials will be obtained through the Departmental procurement process. Offenders who

are trained as HIV and AIDS peer educators, social workers, health care professionals, psychologists,

chaplains and Employee Assistance Professionals provide prevention messages. The basic approach to

HIV prevention is through group or individual sessions with all offenders in the Correctional Centers where

information on abstinence, faithfulness and condom use is provided. The educational material will be

distributed to all Correctional Centers and the utilization thereof will be monitored by the management area

and correctional center coordinators. This activity is expected to reach individuals with relevant prevention

messages. An urgent need has been expressed by the HIV and AIDS Workplace program for members to

procure educational material. As explained in the background, the HIV and AIDS Workplace program

focuses on custodial officials in the Correctional Centers as well as staff employed in the National, Regional

and Management offices. JHU/CCP's Tsha Tsha materials are also used in some Correctional Centers to

supplement what has been produced by DCS.

ACTIVITY 2: Appointment of HIV and AIDS Management Area Coordinators and Regional Coordinators

PEPFAR funds will also support the appointment of six HIV and AIDS Management Area Coordinators.

These posts are intended to oversee the implementation of project activities. HIV and AIDS MACs are

responsible for monitoring and evaluation of all HIV and AIDS programs. They will coordinate with other

stakeholders, procure materials, and facilitate in-service and other training of staff and offenders as peer

educators and on awareness. Posts will also facilitate HIV and AIDS work sessions, coordinate meetings,

assist in gathering and tabulating required HIV and AIDS data and ensure that necessary reports and

documents are submitted to the Regional HIV and AIDS coordinators. PEPFAR funds will also now support

the appointment of six Regional HIV and AIDS Coordinators to assist with the management of HIV and

AIDS programs and services for staff. It is furthermore envisaged that six additional MACs, especially for

the bigger Management Areas, will be appointed to manage the HIV and AIDS program for staff. This has

not been covered in the FY 2007 COP.

ACTIVITY 3: Behavioral Change Programs

Activity Narrative:

It is important to ensure that correctional officials and offenders in correctional centers engage in

responsible behavior to mitigate the impact of HIV and AIDS and promote healthy living, abstinence,

faithfulness and condom use. It is envisaged that six behavior change campaigns for offenders (one in

every region) will be held. Behavior change programs will be developed on a scientific base through

researching and the utilization of external experts. Funds will be allocated to the regions to ensure the

implementation of these behavioral change programs, emphasizing responsible behavior. All the

Correctional Centers (including correctional officials and offenders) in a Management Area will be included

during the behavior change events and involved in more therapeutic programs or projects focusing on

responsible behavior. In order to ensure that international calendar events are commemorated in the

Department, such as Candle Light Ceremony and World AIDS Day, it is important to support the regions

financially to conduct behavior change activities as well as programs aimed at developing responsible

behavior around these special days for both staff and offenders. The awareness-raising sessions and

behavior change programs, as well as the development of behavioral programs, will be conducted by

external service providers who will be invited through the Departmental procurement processes. Offenders

will be capacitated with the necessary skills and knowledge on HIV and AIDS during these sessions.

ACTIVITY 4: Addressing Violence and Coercion

All offenders will be exposed to at least two group sessions led by the peer educators discussing gender

violence in the family. Social workers and Psychologists in the correctional centers will also provide one- on-

one counseling to inmates who are abusive. This activity will specifically target those inmates who are in the

pre-release centers or on parole.

The HIV prevention activities described in this section support the 2-7-10 PEPFAR goals by targeting a key

high risk population in South Africa, promoting HIV-awareness and preventive behaviors, responsible

sexual behavior and encouraging inmates and correctional officials to take a more active role in promoting

HIV prevention.

SUMMARY:

PEPFAR funds will be used by the National Department of Correctional Services (DCS) to provide basic

HIV and AIDS care and support to offenders and staff in DCS Correctional Centers in all nine provinces.

The major emphasis area for this program will be the training of personnel as facilitators on the

establishment and maintenance of support groups for infected and affected HIV and AIDS offenders in

Correctional Centers. Special emphasis will be placed on integrated preventions services, including

prevention with positives and behavior change as well as the management of psychosocial challenges.

Minor emphasis will be given to community mobilization and participation; development of

network/linkage/referral systems; information, education and communication; linkages with other sectors

and initiatives; and local organization capacity development. The target population will include men and

women offenders, people living with HIV (PLHIV), their caregivers and several most at-risk populations

(e.g., men who have sex with men, injection drug users and tattooing with contaminated instruments).

BACKGROUND:

The training will be provided by an identified service provider registered and accredited according to the

South African laws and contracted through the DCS procurement process. However, the actual services will

be carried out by both offenders and DCS members who have been trained. This activity is also one of the

National Department of Health's strategies aimed at promoting positive living among people who have

tested HIV-infected and integrate prevention services with those who seek to support one another and to

cope with their status. The activity will contribute to the core objective of the Department of Correctional

Services which is rehabilitation by enhancing a rational thinking among offenders and allowing them to take

charge of their own behavior and future.

Although the DCS is encouraging the establishment of care support groups in Correctional Centers, no

formal training was conducted to ensure that facilitators (personnel) are equipped with the necessary skills

and knowledge to establish and maintain these care support groups. Challenges have been previously

experienced whereby the support groups were without a skilled coordinator, and the concept of support

groups lost its meaning in terms of its objectives and core business. The establishment of support groups

for infected and / or affected members will also contribute positively towards creating an enabling and

conducive environment and will promote the Department's intentions to care and support members who

have to deal with the psychosocial impact of this epidemic. DCS will also encourage family members, where

possible, to be part of the support activities for PLHIV.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

FY 2008 funds will continue to support personnel that are aimed at strengthening the HIV and AIDS

Workplace Program. It is envisaged to train 180 members (at least 5 from each Centre of Excellence).

The activity will ensure gender balance by training both males and females as HIV and AIDS Support Group

Facilitators to establish and maintain support groups. Coverage will include the 36 Correctional Centers

identified as Centers of Excellence by the DCS in all six of its Regions which correspond with the nine

provinces of South Africa. The support group facilitators will consist of custodial officials, administrative

staff, professionals, etc to become comfortable with basic facts of HIV and AIDS and the support and care

of infected and / or affected members.

ACTIVITY 2: Provision of Care

The training of offenders in basic palliative care and support will continue. Trained offenders will provide

basic palliative care and support to other HIV-infected offenders. The basic palliative care activities will stem

from those provided by the DOH as adapted for prison use. Nutritional referral, personal care, counseling

(both pastoral and basic support), recognition of worsening condition such as increased pain or wasting,

knowledge of when to refer to clinical providers in the prison, treatment adherence, prevention (including

prevention with positives) and other holistic care activities as allowed (bathing, wound care). Screening for

TB, STI, and OIs with appropriate referral and follow-up will be emphasized. This will be done in

collaboration with the nurses at the prison since treatment for pain can only be done with a physician's

orders and under strict supervision. A two-day workshop will be conducted with care specialist to look at the

basic care package for offenders.

ACTIVITY 3: Care for Family Members

DCS will introduce a care and support package of family members of PLHIV to assist the individuals who

are about to be released. This will assist in the transition from incarceration to civil society while continuing

to be supportive of positive living behaviors. The training will include, promotion of family member CT,

coping mechanisms, referral and follow up to public sector facilities for the continuation of palliative care

services.

In all of the above activities, PLHIV will receive at least one clinical and one other category of palliative care

service. Palliative care to family members of PLHIV or OVC will be provided in at least two or the five

categories of palliative care services.

The Department of Correctional Services activities contribute to the PEPFAR objective of 2-7-10 by

increasing the number of people in care as well as preventing new infections.

SUMMARY:

PEPFAR funds will be used by the National Department of Correctional Services (DCS) to train professional

nurses in the management of tuberculosis (TB) and patients who are on the antiretroviral treatment (ART)

program. The major emphasis of this activity will be training, with minor emphasis on community

mobilization and participation; development of network/linkage/referral systems; information, education and

communication; linkages with other sectors and initiatives; and local organization capacity development.

The populations will include men and women of productive age, people living with HIV (PLHIV) and their

caregivers.

BACKGROUND:

This is an initial project. Currently there are about 635 professional nurses in the DCS. This project will train

about half of them to provide on-site primary healthcare services in the management of TB and for patients

who are on ART. South Africa has a fairly extensive and mobile correctional center population.

Overcrowding in Correctional Centers creates ideal conditions for the transmission of communicable

diseases such as TB.

ACTIVITY 1: Training of the Professional Nurses in the Management of TB

This is a continuation of the activity as indicated in COP FY 2007. A number of nurses have been trained in

the Management of TB. This has improved patient care in the Correctional Centers. Nurses that have not

been trained will be included in this training initiative. It is envisaged that the training will lay a firm

foundation for improved service delivery and the effective management of tuberculosis in Correctional

Centers.

ACTIVITY 2: Appointment of Communicable Disease Control Management Area Coordinators

A need has been identified to appoint 12 Communicable Disease Control Management Area Coordinators

on contract. The appointment of the above-mentioned officials will ensure improved Communicable Disease

Control. The Communicable Disease Control Coordinator will be responsible for the planning,

implementation, monitoring and evaluation of communicable diseases programs and services at a

Management Area level. They will also ensure program analysis, formulation and evaluation as well as

budgetary management for the program. They will further more liaise with relevant stakeholders at a

national, provincial, district and local level. These positions will be absorbed in the DCS establishment to

ensure continuation of services and programs.

ACTIVITY 3: TB/HIV Campaigns in Correctional Centers

TB/HIV campaigns will be held in all the 36 Centers of Excellence to raise awareness on the impact that this

epidemic has as well as to equip offenders and members with the necessary knowledge. This will add value

to the prevention and management of TB and HIV among offenders and members. It is envisaged that the

raising of awareness on TB will decrease the level of stigmatization and discrimination as well as to

encourage offenders who are on TB treatment to continue and finish their treatment. If offenders can be

made aware that having TB does not necessarily means you have HIV as well. Should the offender have

TB and HIV he must be made aware that TB is curable although HIV is not. The DOT support program will

also be encouraged and offenders will be motivated to have a DOT supporter.

SUMMARY:

PEPFAR funds will be used by the Department of Correctional Services (DCS) to increase the uptake of

members in HIV counseling and testing (CT) services in correctional centers as well as in other places of

work. The major emphasis area for this program will be awareness raising and accessing CT services, with

minor emphasis placed on mobilizing the incarcerated community and encouraging their participation;

information, education and communication; logistics; and strategic information. Target populations will

include offenders and DCS members (men and women of reproductive age, including people living with HIV

(PLHIV)), and most at-risk populations (e.g., men who have sex with men, injecting drug users). To increase

capacity, DCS will train nurses, social workers, psychologists, and spiritual care workers in counseling and

testing.

BACKGROUND:

This is an ongoing activity intended to initiate the establishment of voluntary counseling and testing (VCT) in

correctional centers. According to the National Department of Health protocols, only nurses can be trained

to give the rapid test. Social workers, psychologists, spiritual care workers and nurses, will be trained in pre-

and post-test counseling. Other professionals will play a role in the delivery of pre-, post-, and ongoing

counseling, which nursing personnel will be unable to do because of time constraints.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Counseling and Testing DCS members

Voluntary counseling and testing services will be made accessible to all DCS staff members at each

correctional center and where possible at other places of work (e.g., offices, etc). Employee Assistance

Practitioners (EAPs) will run campaigns in correctional facilities focusing on staff members and encouraging

them to be tested for HIV. In facilities where the correctional center clinics are not suitable to offer the

testing service, the EAP will collaborate with local NGOs to provide the CT services. Couple counseling will

also be strongly encouraged and the service will be made available to all DCS staff.

In order to ensure that CT services are enhanced and encouraged among members, a number of 24

regional CT roll-out campaigns will be held (at least four per region). The number of members who have

undergone CT is not known at this point in time as members are making use of external healthcare

providers (private doctors or health facilities) if they want to test for HIV.

ACTIVITY 2: CT Services for Offenders

With FY 2006 funds, nurses, social workers and psychologists working in prisons were trained in CT. Each

correctional facility will have confidential CT services. Peer educators will be used to encourage offenders to

use CT, as well as conduct other health campaigns in prisons. One-hundred and twenty CT roll-out

campaigns will be held in 120 correctional centers, especially targeting those centers where CT sites have

not yet been established.

These activities will contribute to both 7 million infections averted and 10 million people in care by promoting

and providing testing and counseling as an entry point for prevention, care, support and management of

HIV and AIDS.

SUMMARY:

FY 2008 PEPFAR funds will be used by the Department of Correctional Services (DCS) to establish and

accredit six more antiretroviral (ARV) treatment sites which will facilitate the comprehensive management of

HIV and AIDS. These six new sites, in addition to the nine already accredited, will ensure that there is one

accredited ARV treatment site per province. The major emphasis area for this program will be human

capacity development. The target population will include men and women offenders, people living with HIV

(PLHIV) and their caregivers, and several most at-risk populations (e.g., men who have sex with men,

injection drug users and tattooing with contaminated instruments).

BACKGROUND:

DCS currently has nine correctional centers that have been accredited as antiretroviral treatment (ART)

sites (Grootvlei Correctional Center in the Free State/Northern Cape Region, Pietermaritzburg Correctional

Centre and Qalakabusha Correctional Centre in KwaZulu-Natal Region, Kimberley, Groenpunt and

Kroonstad Correctional Centres in Free State/Northern Cape Region, St. Albans Correctional Centre in

Eastern Cape Region and Johannesburg Correctional Centre in Gauteng Region). Other than the nine

accredited ART centers, the DCS refers offenders to Department of Health public health facilities to access

ART. This program will encourage the establishment and accreditation to improve access for incarcerated

populations.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training of Personnel as ARV Project Managers

FY 2008 PEPFAR funds will be utilized to train DCS personnel as ART project managers. Training will

include management of ART services, plan development, budget planning, information and other

management systems. The trained personnel will ensure adequate facility and resource management of

ART service, in accordance with South African ART guidelines. At this point in time staff members are just

being trained to provide services to offenders.

ACTIVITY 2: Procurement of Information, Education and Communication Material

DCS will procure ART educational material that will be utilized during treatment literacy campaigns. The

educational material will be distributed to all correctional centers and the utilization thereof will be monitored

and recorded by the management area and correctional center coordinators. In addition to the distribution of

pamphlets, there will be treatment literacy education to enhance the understanding of adherence to the

offenders.

This activity contributes to the PEPFAR objective 2-7-10 by providing information on treatment to offenders,

and thereby increasing capacity to effectively provide HIV care and treatment services. These activities are

not at the site level but are more system strengthening activities and constitute what is considered ‘indirect'

support within the Correctional Services facilities. Therefore there are no direct targets for numbers of

people reached.

SUMMARY:

PEPFAR funds will be used by the Department of Correctional Services (DCS) to host a National HIV and

AIDS Conference in Correctional Services. The activity will focus on reviewing the progress of implementing

Comprehensive HIV and AIDS Programs for offenders and members, monitoring the implementation of

policies and on enhancing management involvement to strengthen the commitment and interventions. The

conference will be utilized to share best practices but also to evaluate the Department's goals and

objectives in line with the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP). It is

important that consultative discussions, through a conference, take place to ensure that new developments

in the field of HIV and AIDS are addressed and included in the mainstreaming of HIV and AIDS programs

and services at DCS. The major emphasis areas are monitoring, evaluation, and reporting, and the minor

emphasis areas are other strategic information (SI) activities. The activity primarily targets DCS members,

offenders, external stakeholders and other Southern African countries.

BACKGROUND:

The implementation of comprehensive HIV and AIDS programs and services has been prioritized by the

DCS. To ensure that implementation is taking place at an operational level, it is imperative to involve

management at all levels to discuss and outline future endeavors pertaining to HIV and AIDS programs in

the regions. In FY 2005, funding was allocated to host a National Conference on HIV and AIDS in the DCS.

However, due to various internal strategic challenges within the Department, it was proposed that the

conference be postponed to a later date. Holding the conference during 2009 will add value towards the

Department's objective to evaluate its progress with the implementation of HIV and AIDS programs and

services for offenders and members.

Monitoring and evaluation are ongoing activities aimed at ascertaining levels of compliance to policies,

procedures, and programs in correctional centers. The DCS has developed monitoring and evaluation tools

for HIV and AIDS programs. These tools will be implemented at all levels to determine compliance to

policies and procedures, the interpretation of these policies, as well as the status of the implementation of

the Comprehensive HIV and AIDS programs. All management and center coordinators received training in

2005 for similar purposes and this was useful.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Hosting of a National Conference on HIV and AIDS in the Department of Correctional

Services

The Department hopes to host a National Conference where best practices will be shared and the

Comprehensive HIV and AIDS Program for members and offenders be reviewed in line with the objectives

of the NSP. This conference will bring together internal and external stakeholders from around the country

as well as from other Southern African countries.

ACTIVITY 2: Monitoring and Evaluation (M&E)

M&E will be conducted using observational visits at various levels within the DCS to monitor the progress

and quality of program implementation. Regular progress reports will be submitted in terms of the South

African Public Finance Management Act. These will be used to collect ongoing data which will be analyzed

and fed back into the programs. Evaluation has been planned, but has not yet begun. These activities will

begin once the departmental M&E framework is approved.

All activities are in support of the USG South Africa Five-Year Strategy and in line with the South African

Government's policies, and contribute to PEPFAR's 2-7-10 goals by monitoring and providing data for

evaluation purposes on the effective rollout of HIV programs within the DCS.