HARPIN will carry out sexual prevention (AB/C&OP) and PMTCT programming in the Niger Delta and build the Financial and Management capacity of Pro-Health and other organizations. The objectives of the HIV/AIDS Reduction Program In the Niger Delta (HARPIN) program are to increase the knowledge of prevention of HIV transmission by 10% in target communities, to increase HCT uptake by 10% among the people of Cross Rivers and Rivers state over a 3 year period, to reduce stigma and discrimination associated with HIV/AIDS by 10%, and also to build the financial and management systems capacity of Pro Health International (PHI) and its partners to provide more effective HIV/AIDS programming. The above objectives will be achieved by providing Peer Education using a minimum of three (3) intervention packages to reach in and out of school youth within the ages of 15 and 24. In addition, there will be a Peer led intervention for People Living with HIV/AIDS using a combination of three (3) minimum packages as a means of reducing transmission. Also, a PMTCT program will be carried out to address cross generational transmission of the virus from mother to child.

The abstinence and be-faithful (AB) program area will target in-school and out-of-school youths with peer education on HIV/AIDS and reproductive health. Following training of trainers on Peer Education with use of UNICEF/SFH manuals, youths will be carefully selected and trained as peer educators who will reach out to their peers with HIV prevention messaging. This will be reinforced with small group discussions and formation of health clubs or Community-based organizations. This combination of interventions will make up the minimum package for youth. Existing Community Based Organizations will also be collaborated with for continual program implementation and sustainability.

The HARPIN Condoms and Other Prevention program will target PLWHAs with peer education and emphasis on prevention with positives. This program area is designed to identify and reduce HIV/AIDS stigma and discrimination in the Niger-Delta. HARPIN will collaborate and network with PLWHA support groups and other CBOs to carry out these activities. They will be reached using a Peer Education approach. In addition, stigma reduction activities will be carried out as a means of providing an enabling environment for sustainable behavior change.

HARPIN Prevention of Mother-to-Child Transmission of HIV will target pregnant women. Women in reproductive age groups and their male partners will be secondary targets. The PMTCT program will be based on the WHO four pronged approach. This thematic area is designed to identify pregnant women who are HIV positive (through HCT) and prevent mother-to-child transmission through ARV prophylaxis, proper infant feeding and family planning. Other activities include provision of general health education, nutrition and adherence counseling and health promotions. HARPIN PMTCT program is facility-based (Primary Healthcare Facilities), but with a strong community-based component especially in collaboration with TBAs (to refer their clients for HCT). HARPIN will collaborate with trained HCWs, PLWHA lay counselors, volunteers with strong stakeholders' advocacy for program implementation and sustainability. Early infant diagnosis will aid the early detection of positive infants and subsequent treatment.

HARPIN strategic plan will involve the use of combination prevention intervetnions which will target the individual, the individual's community and the socio-cultural/socio-economic milieu for both sexual prevention and PMTCT.

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The Condoms & Other Prevention program is a peer led program which will target high risk/highly vulnerable populations identified by the NARHS Plus with HIV prevention and behavior change interventions in line with the National Prevention Plan. These target populations include PLWHA, Uniformed services men (Nigeria Police Force) and widows. The overall approach for these target cohorts focuses on reaching the individual with Prevention messages aimed at sustainable behavior change, addressing community norms and practices, and creating the appropriate socio-economic/socio-cultural milieu for sustainable behavior change.

Using the 'Prevention with Positives' approach, capacity building of the PLWHA will target individual behavior to reduce new infections, re-infection and promote positive and healthy lifestyle. These behavioral changes include delayed sexual debut, secondary abstinence, partner reduction, mutual fidelity for married couples, self stigma reduction, correct and consistent use of condoms, non-sexual risk reduction and positive/healthy lifestyle. The socio-economic milieu will be targeted through economic strengthening to reduce the economic vulnerability of individuals. The community framework will be targeted using stigma and discrimination reduction strategies. These strategies will address socio-cultural norms and practices in the community that fuel sexual transmission of HIV within PLWHA and even to the uninfected population.Training of Trainers will provide a capacity platform for the trainers to gain the requisite knowledge and skills for training support group Peer Educators. A yearly retraining will provide program staff the opportunity of being current on innovations and advances in Behaviour Change Communication especially as it concerns community based 'Prevention With Positives'. Volunteer PETs will be trained concurrently as a means of building a pool of trained personnel to avoid burnout. Volunteer training will also aid in building local technical capacity for future program implementation. Advocacy and Roll Out will be achieved through community mapping techniques, mobilization of PLWHAs, visits to stakeholders, advocacy meetings, PLWHA tracing and necessary approvals from respective authorities. Using a Peer led approach, Training of PLWHA Peer Educators will be carried out for 2-3 members of each support group using an adapted CDC PWP manual. Best practice strategies like use of audio visual materials and other interactive learning techniques will facilitate a greater knowledge gain. Peer Education for PLWHAs will be Support Group based and form the fulcrum activity for the PWP program. Picture codes and other message sensitive IEC materials will be provided with the reaching of PLWHAs to increase the transfer of knowledge from Peer Educator to their Peers. Peers and Peer Educators will have access to the Toll Free Telephony backup. Incentives will be provided to outstanding support groups.

Widows will be targeted with messages that will encourage Abstinence or Being Faithful based on the preference of the widow to either remain single or be re-married. The behavoural objectives will include secondary abstinence, partner reduction, mutual fidelity, avoidance of risky behaviours and improved self-esteem. Community structures including women associations and groups will be targeted using advocacy and community mobilization techniques in reducing the stigma and discrimination often associated with widowhood. Wife inheritance, widow disinheritance and other harmful socio-cultural practices will be targeted using advocacy tools in a bid to address the socio-cultural milieu of the widows. Partnerships will be fostered with FIDA and other legal frameworks involved in providing legal support to widows as a means of addressing the rights issues associated with widowhood. Capacity building in small scale businesses with the provision of skills aquisition and micro-credit will aid the economic vulnerability that is prevalent with widows.

Due to the high level of the Stigma and Discrimination in the South South Region, a multi-level approach will be adopted. This will include:

Intrapersonal Level

Interpersonal Level

Organizational/Institutional Level

Community Level and

Governmental/Structural Level.

At the intrapersonal level, internalization of stigma results in low self esteem and self isolation. Formation of support groups has been identified as a strong factor in the reduction of intrapersonal stigma. These support groups through their various activities will improve PLWHA's identity and self esteem, their coping skills as well as their social integration.

Interventions at the interpersonal level aim at modifying the affected persons' environment. These interventions deal with the impact of social support and social networks on health status and behaviours. They aim to establish relationships between members of the person's interpersonal environment in order to have them share ways to restore or promote their health. Using Community Based Rehabilitation Strategies like engaging PLWHAs in Economic Strengthening Activities will help to rehabilitate delinquent PLWHAs, equalize their opportunities within the community, and provide a sound basis for social integration. Also, providing linkages to palliative care and support services provides a basis for the improvement of the health status of the individual PLWHA, thus improving the likelihood of social integration.

Interventions at the organization/institutional level aim at organizational change to modify health and stigma related aspects of an organization. The institutionalization of Workplace Programs that improve the conditions of PLWHAs in the workplace is a best practice that will help in reducing stigma. Components of workplace programs include winning the support of the owners and managers of the organizations thus creating a trustful environment; advocacy and mobilization of personnel for anti-stigma activities; creation and enforcement of policies that improve the working conditions of PLWHA e.g health benefits, job security for PLWHA, mainstreaming of HCT and ARVs into benefits; education on PLWHAs workers rights, formation of support groups within the organization etc. In addition, greater involvement of PLWHAs (GIPA) is another strategy that will reduce workplace stigma.

Community Level interventions seek to reduce stigma within specific community groups. Some of the specific community groups that will be targeted in the HARPIN program will include religious communities, educational communities like secondary schools, tribal/ethnic communities etc. The primary focus will be to provide sensitization and improve knowledge about HIV/AIDS thereby providing facts that counter false assumptions on which stigma is based. Using the 'contact' strategy, HARPIN will reduce stigma and discrimination by airing actual testimonials by PLWHAs as TV commercials. Alongside, anti-stigma activities will be mainstreamed into all other HARPIN activities as a means of leveraging on already available structures and resources. Advocacy visits will be carried out to key gatekeepers and influencers who will in turn influence their respective communities to imbibe non-stigmatizing and non-discriminatory acts against PLWHA.

Governmental and structural interventions to reduce stigma and discrimination against PLWHA will focus on the strengthening of the role of SACA within the states. Legal and policy interventions will provide sensitization visits to legislative, legal and law enforcement bodies.

All of these will form composite stigma and discrimination reduction strategy that will further address the unacceptably high rate of stigma and discrimination against PLWHA in the Niger Delta. Therefore, the three interventions for the C&OP program include Peer Education(fulcrum activitiy), Stigma reduction ( provides an enabling environment for sustainable behavior change) and IGA which addresses the socio-economic milieu by interupting the vicious cycle of poverty and increased risk of transmission.

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