Addressing the HIV and AIDS epidemic in Khayelitsha

LifeLine/Childline Western Cape aspires towards instilling hope, nurturing healing and growth, and promoting healthy living and emotional wellness by providing a safe place, and hearing the voices of those it serves. The organisation journeys with people from all walks of life through the trauma and challenges they experience, as well as the possibilities and solutions available to them in a mutual quest for a happier, richer life for all South Africans.

OVERVIEW

LifeLine/Childline Western Cape's HIV and AIDS programme aims at mitigating the effects of the HIV and AIDS epidemic in Khayelitsha. This programme entails:

• Voluntary counselling & testing as well as compliance and adherence counselling and support services for antiretroviral (ARV) treatment programmes.
• Psychological support and care for people living with HIV, specifically targeting the youth, young mothers and women.
• Prevention of mother to child transmission (PMTCT) intervention.
• Nutritional advice and support.
• Training in income generating activities.
• Community mobilisation and education to collectively overcome stigma and discrimination.
• Prevention and awareness raising campaigns.

Programme activities are implemented by 52 specifically trained and selected lay counsellors, who receive regular mentoring, supervision and debriefing from programme management and professional psychologists. The HIV and AIDS programme operates from 15 government clinics and hospitals in Khayelitsha. This is an ongoing programme, and is implemented in close partnership with the Western Cape Provincial Department of Health. It aims to provide a comprehensive HIV and AIDS lay counselling and PMTCT programme in Khayelitsha

WHAT WE LIKE ABOUT THIS PROJECT

• Lifeline/Childline Western Cape model is an integrated and comprehensive response to the HIV and AIDS epidemic that takes account of socio-economic as well as medical dimensions of the disease, and incorporates activities on education and awareness raising, care and support as well as prevention and management of the epidemic.
• LifeLine/Childline works in close partnership with various organisations, which are active in the sector of HIV and AIDS in Khayelitsha, including government clinics and NGO forums. This contributes to increasing overall programme coordination, effectiveness as well as increasing government capacity for service delivery.
• The organisation conducts reputable, specialist training programmes for counsellors. Lifeline/Childline selects lay counsellors for contract positions based on a strict evaluation of their suitability.

EXPECTED LIFE CHANGE

The project budget of R 200,000 is a portion of a larger intervention calculated at R 4,291,853 for a one year period. The programme is on-going and most of the additional funding has already been secured. An investment of R 200,000 will contribute to carrying out a year-long comprehensive intervention in Khayelitsha. Approximately 75,000 people, including direct and indirect beneficiaries, will benefit from the intervention. Among those:

• 35,000 people will be tested and receive pre- and post-test counselling;
• 10,000 people living with HIV and AIDS will benefit from ongoing supportive counselling;
• 5,000 people living with AIDS will receive ARV adherence counselling and support.
• 12,500 mothers will benefit from a Mother-to-Child Transmission Programme.
• 575 men and women living with HIV/AIDS will benefit from extra income from food gardens and beading activities.
• 38,000 people will be informed and educated on HIV/AIDS through community outreach and awareness raising campaigns.

The estimated direct life change is R57 per person.

NEED

South Africa, with an estimated 5.7 million infected people, has the largest HIV-positive population in the world. According to the South African Department of Health, women account for approximately 55% of HIV positive people. Women in the age group 25-29 are the worst affected with prevalence rates as high as 40%. The national average of HIV-positive women attending antenatal clinics in 2005 was 30.2%. The long incubation period between infection and illness means that infected persons may infect many others without realising it.

While HIV and AIDS prevalence in Cape Town and the Western Cape as a whole is lower than the national average, infection rates in Khayelitsha are only marginally lower than the national average. Khayelitsha is a deeply impoverished area where many households rely on casual work, subsistence gardening or trading, old age pensions or mutual borrowing and assistance for survival. The impact of HIV has stretched these survival strategies to breaking point in many cases.

STRATEGY

Through its HIV and AIDS Programme in Khayelitsha, LifeLine/Childline Western Cape will mitigate the psychosocial and economic impact of the pandemic by implementing effective and accessible prevention, care and support services in order to improve health and emotional wellness.

The LifeLine/Childline holistic approach includes:

• Creating a safe and secure environment for people to explore their fears and concerns and other HIV/AIDS-related issues.
• 52 specially trained lay-counsellors providing psychosocial support and care for people living with HIV/AIDS to assist them to come to terms with the implications of having a life-threatening disease and to live positively.
• Promoting, encouraging and supporting voluntary, confidential testing so that greater numbers of community members know their status. HIV-negative individuals are given the guidance to avoid infection and HIV-positive individuals are offered support services that will help them maintain their health and emotional well-being.
• Promoting, encouraging and supporting compliance and adherence to ARV programmes.
• Assisting to reduce the chances of transmission of HIV from mother-to-child (the PMTCT Programme).
• Providing nutritional advice and support.
• Providing training in - and support for- income-generating activities (in the form of food gardens and beadwork projects).
• Conducting widespread community outreach, education and awareness campaigns to ensure that communities are knowledgeable and well-informed about HIV and AIDS, and are more sensitive and willing to support those living with HIV.

ACTION PLAN

Preparation

The programme is already well established and functioning at 15 public hospitals and clinics in Khayelitsha

Implementation

• 28 lay counsellors conduct daily voluntary counselling and testing (VCT) services.
• 28 lay counsellors conduct daily on-going supportive HIV and AIDS lay counselling.
• 24 lay counsellors perform daily adherence counselling and default tracing. Nine individual face-to-face counselling sessions are provided to prepare clients for embarking on ARV treatment.
• 28 lay counsellors carry out a daily PMTCT Programme, which includes six individual face-to-face counselling sessions as well as making milk formula available to mothers.
• Every month, 60 support groups are led by 15 lay counsellors in 8-week cycles. Members will meet weekly. Of these, 40 are general support groups and 20 are adherence support groups.
• One specialised contract employee support the establishment of new food gardens at clinics and will train beneficiaries in food gardening techniques.
• An experienced craft-worker train beneficiaries in quality bead-work. Markets for these products will be secured.
• Daily and weekly education sessions are held in the waiting rooms of day hospitals and clinics.
• On request community outreach are implemented at community centres and youth facilities.
• 12 media campaigns will be conducted, including the distribution of information materials and condoms.
• All 52 lay-counsellors are provided with clinical supervision from a psychologist twice a month. Lifeline/Childline also provide ongoing supervision, mentoring and support to these counsellors.
• The lay counsellors are offered monthly training opportunities according to the requirements of the Department of Health.

Monitoring and Evaluation

LifeLine/Childline?s HIV and AIDS Programme is subject to extensive monitoring in order to assess its performance and quality of service. An important part of the process is the supervision of lay counsellors, both at individual and group level. The purpose of supervision is to allow the counsellor to debrief and discuss each case, as well as to assess the need for therapy. The strategy for monitoring and measuring impact includes:

• Accurate record keeping with statistics of cases and services rendered.
• Quarterly qualitative and quantitative reviews of indicators, such as the VCT and mother-to-child transmission statistics monthly reports; CD4 counts; and feedback from support group participants.
• The programme manager conducts regular site visits to the targeted clinics and hospitals.
• An extensive year-end programme evaluation.

ORGANISATION ASSESSMENT

LifeLine/Childline Western Cape is a well established organisation with a clear expression of its purpose and values, which come through strongly in its supervision, counselling and training efforts. The organisation is highly recognised by counselling experts, and it plays a very active role in coordinating government, NGOs and community groups, which helps to increase the effectiveness of its efforts.

The organisation is run by a team of experienced professionals, which follow very clear governance and monitoring structures to ensure a high quality service. The organisation is currently implementing a succession plan for the Executive Director in order to broaden management and organisational knowledge. The structure of the organisation is excellent, producing transparent programme and financial management processes, with minimal project risks.

RISK PROFILE

Key Strengths

• Concept: The Lifeline/Childline Western Cape model is a holistic and comprehensive response to the HIV and AIDS epidemic. Dynamic partnerships with community-based organisations, NGOs and government structures provide the ground for increased coordination and efficiency.
• Design: This project relies on solid, long-term relationships with the Department of Health, which ensures programme alignment with government policies as well as an enforcement of government capacity for service delivery.
• Capability: The programme is directly managed by a highly experienced individual with extensive counselling and management know-how, and is regarded as an expert in the field of HIV/AIDS in Cape Town. All project lay-counsellors undergo comprehensive, focused and highly recognised training which ensures consistency in approach and quality of service.
• Control: LifeLine/Childline has a very structured approach to monitoring performance at all programme levels: beneficiaries, counsellors as well as overall programme objectives. This ensures that programme rationale is consistent and effective, and potential issues are identified in time to be managed.
• Sustainability: Strong anecdotal evidence suggests that support groups are a cost-effective and powerful mechanism to support, empower and educate people living with HIV and AIDS. LifeLine/Childline?s open door policy and ongoing availability at hospitals and clinics provides a good support platform for lasting impact in the lives of the beneficiaries. Lay counsellors are specially trained and selected members of the community, who will act as ?multiplicators? of the effect of the project in their personal and social circles.

Key Risks - Low

• Concept: A market strategy for income?generation through bead-work has not been developed yet, which raises questions on sustainability and profitability of the programme. LifeLine/Childline however, will conduct formal research on viability and opportunity identification for this activity. In the interim, the organisation has established partnerships with specialised organisations, to which beneficiaries are referred should they want to establish consolidated income-generation projects.