NOTE: This is a new activity.

INTEGRATED ACTIVITY FLAG: VCT, Basic Health care and Support; Food supplementation. This activity

is linked to activity ID 12363.08, 8155.08, 10655.08.

SUMMARY: World Vision International will coordinate with mobile teams of the Ministry of Health for making

counseling and testing available at all sites that receive dried food rations under the FSHA program and the

soon to be implemented MYAP, i.e.: the island of La Gonave, the Central Plateau and some areas of the

Artibonite health department. Once detected positive and registered at these sites, World Vision will assist

in the process of referrals of all identified HIV+ pregnant women at sites that provide full PMTCT services.

BACKGROUND: For more than seven years, World Vision has been one of the main implementers of the

Food Security Program. In that context, World Vision has developed an important network of service

delivery sites for the implementation of the program, at their previously listed target areas. Meanwhile, due

to growing food insecurity, food supplementation has played a growing role for attracting pregnant women

seeking for ante-natal care services. Many ante-natal clinics served by World Vision have a high

attendance. Opt-Out counseling and testing will be made available at these sites in close planning and

coordination with public VCT mobile teams that will be based at departmental level. Joint monthly planned

plans will be developed that will establish schedules of visits for each site. With the support of

accompagnateurs and the community health personnel of institutions that provide palliative care at

community levels, such as those previously listed, referrals of HIV+ pregnant women at full PMTCT sites will

be carried out.

ACTIVITIES AND EXPECTED RESULTS

Activity 1. Support to 25 sites for the provision of : (i) Opt-out Counseling and testing to all pregnant women

(ii) registration of these pregnant women

Activity 2. Active referral of all HIV+ pregnant women to full PMTCT service delivery sites where they will

receive the same package of services as listed above.

Targets - September 2009

- Number of service outlets providing the minimum package of PMTCT/CT services: 0

- Number of pregnant women who received HIV counseling and testing for PMTCT and received their test

results: 8,000

- Number of pregnant women referred at full PMTCT service delivery sites: 175

This activity is linked to activity ID 18065.08. 12363.08, 8155.08, 18065.08.

SUMMARY: This intervention is designed to improve the well-being and quality of life of people living with

HIV/AIDS (PLWHA) living in the areas of VCT/PMTCT/ARV sites supported by the PEPFAR program where

World Vision implements programs. World Vision will provide a package of community palliative care

services that will be integrated with OVC services to offer a comprehensive range of services based on a

family-centered approach. The program will reach 6,000 PLWHA and their families by September 2008 and

8,000 by September 2009. The interventions will take place in that part of the West Department not covered

by World Concern Development Organization (WCDO) and its partners, and in part of the Central Plateau

Department not covered by Partners in Health (PIH). Community palliative care support will be provided by

WCDO which serves as the chief community based organization (CBO).

BACKGROUND: This intervention is the extension of the President's Emergency Plan for AIDS Relief

(PEPFAR)-funded SAFENET Plus program approved in Fiscal Year (FY) 2006. SAFENET Plus targets

OVC who receive care and support to improve their well-being and quality of life. Through this program,

World Vision will support the United States Government's (USG) efforts to expand the package of

community palliative care to PLWHA by channeling resources to each of the 10 departments through a

main CBO which is in charge of planning and implementing this program in coordination with the Ministry of

Health (MOH) departmental directorate, local CBOs, and grassroots organizations.

Three nongovernmental organizations (NGOs) will implement the project: World Vision, acting as a principal

recipient; Save the Children, acting as a sub-recipient; and Management and Resources for Community

Health (MARCH), acting as a sub-recipient. Activities will be carried out in World Vision's Area Development

Projects (ADP) and in the intervention areas of the sub-recipients. The SAFENET Plus program will work

with HIV sites where PLWHA are identified to enroll them in community palliative care in integration with

OVC's program activities.

ACTIVITIES AND EXPECTED RESULTS.

Activity 1: Funding will be used to reinforce World Vision and its partners' capacity to strengthen their chief

points of direct community service delivery. These points of services will be adequately staffed with trained

support and psycho-social staff, as well as with a facilitator who will continue to work with their site

counterpart to recruit PLWHA, establish their needs and those of their families, and to provide community

services. The community based information system which is being developed and rolled out through CBOs

this year, will be reinforced next year to establish a good record of patient enrollment and services offered.

Activity 2: World Vision and its partners will continue to establish a link with HIV sites located in their

catchment areas to identify PLWHA and to provide a basic package of services through their points of

service. Sites in the West include: Hopital de Petit Goave, Centre de Sante Croix des Bouquets, Centre

Mennonite Crx des Bouquets, POZ et Clinique St Paul Montrouis, SADA (Matheux, Belanger), Pierre

Payen. Additional sites, located in the Center Department include Maissade, Mirebalais, Saut-d'Eau,

Savanette, Thomassique, and Thomazeau. Services will include distribution of safe water products, and

drinking water bottles procured through SCMS. World Vision, in coordination with the Global Fund to Fight

AIDS, Tuberculosis and Malaria (GFATM) and Ministry of Health partners, will also deliver treated bed nets

to PLWHA, and pregnant women and children under five for malaria prevention. World Vision will use

resources to cover school fees for infected and affected children, transit house for PLWHA, and lodging

(should resources permitted) based on needs assessment. INSHAC will train points of service staff to

provide counseling on HIV prevention, including couple and family counseling, in order to promote HIV

testing within the family, reduce stigma and to promote positive attitudes towards infected family members.

Activity 3: World Vision and its partners will continue to establish strong links with Title II Food partners to

make food available to PLWHA and their families based on nutrition needs assessment established at the

sites and the CBO points of services. This will complement efforts being made at the sites to assess the

nutrition needs of PLWHA and to provide food as a prescription to the malnourished. World Vision and its

partners will link their points of service with church groups to provide spiritual care to patients, particularly

those enrolled in end of live care. They will also establish relationships with partners involved in economic

growth programs to enroll PLWHA in micro-credit and job creation activities. Funding will be used to cover

transportation and logistic costs to make food available at the points of services. Funding will be used to

train religious leaders and church groups to support PLWHA and their families and to cover transportation

costs to visit PLWHA. Resources will also be used to provide guaranteed funds to make micro-credit funds

accessible to PLWHA.

EMPHASIS AREAS:

Community mobilization (major: 55%), development of network/linkages/referral systems (minor: 20%),

training (minor: 20%), food and nutrition (minor: 15%), local organization capacity development (minor:

15%) and quality assurance (minor: 10%) linkages with other sector initiatives (minor: 25%)

TARGETS:

Number of health professionals trained: 60

Number of PLWAs enrolled in community palliative care: 8,000

SUMMARY. Haiti's HIV/AIDS crisis is poised to rob a generation of young people of their parents, their

childhood and a normal transition to adulthood with parental guidance and care. Because of AIDS, orphans

have lost their parent(s) and many more are at risk of losing them. To address the needs of these orphans

and other children made vulnerable by HIV, a consortium of organizations including World Vision (WV),

Management Resources for Community Health (MARCH), and Save the Children (SC) has proposed the

SAFENET1 Plus Program. The managed care concept which Safenet represents will target orphans and

other vulnerable children and enroll them into a package of services that will reach 9000 children by

September 2009.

Background. The SAFENET Plus program's primary goal is to improve the well-being and quality of life of

OVC and other children made vulnerable by HIV. These children will be formally enrolled and offered a

package of services that combine the reach and power of proven medical and social interventions, care and

support of 9000 enrolled orphans and vulnerable children (OVC) by September 2009. Besides OVC, the

project will seek to improve the well-being and quality of life of people living with AIDS. To achieve this, the

consortium will build on the extensive community infrastructure of SC and WV already reaching 355,000

people and MARCH's community-based services to 250,000 people in the Central and West Departments,

to provide this package. Current involvement with families and communities will facilitate enrollment of

target groups and a quick scale-up. The technical capacity of civil society organizations will be improved for

better care and support to target groups. The resilience of HIV/AIDS-affected families will improve through

increased access to livelihood and food security. Gender equity, stigma reduction, advocacy, partnership

with people living with HIV/AIDS (PLWHA) associations, and multi-sectoral approaches will enhance

sustainability of interventions in the two departments.

ACTIVITIES AND EXPECTED RESULTS. Little information is available to determine the best options for

OVC in Haiti, but it is known that a large number (at least 25%) fall under the "vulnerable" category. About

15% of this subgroup consists of single or double orphans, and estimates show that 48% of them may be

related to HIV .2 SAFENET Plus will expand services and support of OVC families, focusing on

psychosocial support while providing key interventions to orphans in Central and West Departments and the

most vulnerable in both departments. To achieve this, SAFENET Plus will build on child sponsorship

programs in the Central Department and La Gonâve. With community support, staff will conduct a needs

assessment to identify/enroll OVC and their families, and to understand the local "safety net" in place.

Activity 1. Provision of a wide net of psychosocial support to children and youth in their communities

through clubs and other recreational and supportive activities. These will be located within well-established

community structures, such as schools, churches, or community centers to facilitate long-term sustainability.

A modest sum of money will be invested in the activities so that the community can eventually take them on

at little cost. Club leaders, especially youth from within the communities, will be taught simple art, music, or

drama projects that they can implement at little cost. Proven effective measures such as drawing and

drama will be used to help enrolled children confront and resolve difficult situations in their lives. Each

enrolled OVC will receive at least one home visit by the field animator or the social worker. However, OVC

with specific problems (recent loss of a parent, chronic illness, pregnancy, etc.) will be visited as often as

necessary. An OVC service package will be provided to enrollees .

Activity 2. For children in orphanages, SAFENET Plus will seek out opportunities to involve them and youth

in community-based activities wherever possible. These activities will have the goal of social integration and

development of life skills needed to transition OVC out of institutions to socially integrated living, and will

work with orphanage staff to apply approaches wherever appropriate and feasible. The initial geographic

focus for this program will be in the West Department where there are many functioning orphanages.

SAFENET Plus will work with them specifically on issues related to child protection, children rights,

psychosocial support, and basic health care training, including personal hygiene.

Activity 3. Provision of health care, social services, and support to education. The package includes: 1) an

enrollment card and identification; 2) psychosocial counseling; 3) psychosocial support for caregivers; 4)

payment for school fees and/or educational materials; 5) referral to basic health care services and ARV

services for pediatric HIV/AIDS. (Facilities managed by the partners will be first to provide this care.); 6)

training of teachers, parents, community leaders, teachers and caregivers of OVC; 7) health and sexual

education; 8) referral to Abstinence and Healthy Choices for Youth (ABY) for older OVC and; 9) linkage with

economic development activities to provide job opportunities for the oldest OVCs or the most needy parents

of OVCs.

Gender Equity: The score system used to enroll the OVCs gives some priority to girls. However, the

enrolled OVCs will be given the same opportunities without any difference related to gender. However, a

particular focus will be put on women-headed households as children may be more vulnerable because of

economic deprivation.

Sustainability will be addressed by developing a sense of empowerment for community to provide more

supportive care and support environment for OVC. This will be achieved through training of care givers, with

the ultimate goal being to develop permanent community capacity for cohesive community response on

behalf of affected households. This will translate into heightened community and social mobilization, with

advocacy at all levels to leverage community and institutional inputs across sectors.

Expected results. This program contributes to the overall world-wide PEPFAR objectives by identifying

individuals who are made vulnerable by HIV and providing them with support services, thus ensuring a

better quality of life.

Targets.

Number of service outlets providing OVC-related services: 11

Number of OVC receiving care and support: 9000 (September 2009); 10000 (September 2010)

Number of individuals trained to provide OVC care and support: 1700. (Sept 09); 2200 (Sept 2010)

Emphasis areas:

Development of networks/linkages/Referral systems 30%

Education, Health and Psychosocial support 40%

Linkages with other sectors/initiatives 20%

Training 10%

Target Populations:

HIV infected and affected children

Caregivers (of OVC and PLWHAs)

Activity Narrative: HIV/AIDS affected families

Orphans and Vulnerable children

Community based organizations

Key Legislative issue:

Increasing gender equity in HIV AIDS

Stigma and discrimination

Food

Education

Microfinance/microcredit

Coverage areas : Central and West departments