BROTHERS FOR LIFE Provincial rollout KZN report.pages

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					Brothers For Life Provincial roll out dialogue KZN

Date: 08 – 09 April 10

Venue: Riverside Hotel and Spa, Athlone

Introduction

It was the second time that a Brothers For Life (B4L) consultative dialogue was held in
KZN. The first one was held late last year (2009) and this particular workshop served as
a follow up and an update of what has happened in the provinces so far regarding B4L.
Beside the overall aim of Increasing the capacity of the Provincial Men’s sector in the
fight against HIV/AIDS the platform was also used strategically to strengthen the KZN
mens sector and also look closely on how the local and the provincial AIDS structures
are suppose to be constituted and the roles that they are expected to play in the fight
against HIV/AIDS in the province and how they can link and utilise B4L campaign. An
opportunity was also taken to speak more about the Medical Male Circumcision (MMC)
what does it mean, after the call made by Inkosi Goodwill Zwelithini and also look at
the HIV testing and Counselling Campaign (HCT).

This forum also gave a chance to other stakeholders who were attending for the first
time a chance to have an understand about B4L, AIDS Councils and more information
about the HCT and MMC campaigns including the province’s flagship programme and
it was very useful to have Inkosi TR Khumalo as she explained some of the
misunderstanding that have happened re-consultation of Amakhosi on doing work
with them or working in their areas.

The dialogue was mainly attended by the KZN men’s sector; local and provincial AIDS
council and delegates from them government. Also present were delegates from
COSATU, the religious sector and the traditional healers. We were official welcomed by
the chairman of the KZN mens sector Mr. Rabi Gobind and in his welcome he briefly
spoke about how he got to know about B4L and the “battles” that he had to fight with
people in order for B4L to given a proper platform in SANAC men’s sector. He was
happy that finally B4L is will be more active and the communities and the benefits will
soon be realized.

Summary

The first presentations were by Mr. Themba Ndabandaba from KZN Department of
Health where he presented about the Medical Male Circumcision (MMC) and the HIV
Testing and Counselling (HTC) campaign. His fist presentation was on the MMC and
these are some of the key issues that he covered during his presentations

The Back ground of MMC
  •   This was embarked on after the King’s Call in December 2009 / NDOH and
      SANAC

  •   Formation of task team led by the HOD

  •   Provide programmatic and operational guidance on the integrated male
      circumcision intervention in KwaZulu-Natal.

  •   Consensus that MC will be offered as part of an integrated HIV prevention
      approach

  •   Draft guidelines developed by the task team

  •   Implementation plan done and finalised

  Some FACT on MMC includes:

  •   HIV reduction proven beyond doubt

  •   No definite evidence of male to female reduction or MSM

  •   Complete removal of the foreskin

  •   Failure to abstain for 6 weeks post circumcision increases the risk of
      transmission of HIV

  •   Biological explanations

         –   The foreskin has high concentrations of target cells that are very
             susceptible to HIV infection

         –   The underside of the foreskin is susceptible to micro tears and trauma
             during sexual intercourse that provides an entry point for HIV infection

         –   After complete MC, the skin of the penis thickens and becomes a
             stronger barrier to HIV infection

  •   Indirect benefit to women by reduction of the number of men who HIV-infected

  •   High acceptability of MC in SA

KZN SCENARIO

  •   Approximately 4,3M males, 1.8M of the age group 15-49yrs

  •   Acceptance rate of 80%

         –   1,867,030 adults as part of the catch-up programme

  •   Jews, Muslims and some ethnic groups excluded
   •   Adult MC to span span over a 5 year incremental period

   •   10% of adults in Y (186 703 males), 30% in Y2, 50% in Y3, 80% in Y4, and 100%
       Y5

   •   Current costing of 87M for adult MC and 12M for neonatal MC

PROPOSED MODEL

Phased in approach, commencing 1st April 2010

Short term (Year 1)

          –   Minimum of 1 facility/ district

          –   FACILITIES IDENTIFIED AND TARGETS SET

          –   Circumcision camp per district

   •   Medium / Long Term (Y2-5)

          –   Capacitation of remaining health facilities

          –   Camps

          –   NGO sites

   •   Phases not mutually exclusive

   •   Both the short term and the medium/long-term phases to emphasise the
       continued scaling-up of neonatal MC within maternal and child care services

MINIMUM CRITERIA FOR MC FACILITIES

   •   MC FACILITIES WILL BE WHERE

          –   Minor surgery is performed, under fully hygienic and aseptic conditions;

          –   Appropriate resuscitation equipment is available;

          –   Staff are appropriately trained and competent

          –   Sterilisation facilities and infection control exist

          –   Facilities for rest and recovery are available before patients are sent home

   •   Where these minimum criteria are not met, the health facilities will need to be
       improved so that they are able to deliver at least the minimum package of MMC
       services to clients

Minimum package for MMC services
   •   HIV testing and counselling (HTC) / PICT and risks and benefits of MC

   •   Active exclusion of symptomatic STIs – syndromic management

   •   Provision and promotion of male and female condoms

   •   Counselling on risk reduction and safer sex

   •   Education and counselling on FP, pregnancy, maternal health and prevention of
       vertical transmission (PVT)

   •   MMC performed according to the Clinical Manual/guidelines for MMC under
       local anaesthesia

   •   Assuring that proper referral systems and linkages are in place between various
       Health facilities

   •   Counselling on improving gender norms

   •   Counselling on providing awareness on violence against women

   •   Male sexuality

   •   Identification and reduction of co-factors like alcohol and substance abuse

   •   Informed consent

   •   Performing MC under general anaesthesia is not encouraged

Background to HCT Campaign

Objectives:

   •   The HIV counseling and testing programme seeks to:

   •   Create an enabling environment that promotes universal access to safe, effective
       and good quality HCT services;

   •   Encourage individuals, couples, families, and communities to test for HIV in the
       interests of their own health;

   •   Promote support for positive living, healthy lifestyles and good nutrition;

   •   Encourage and support the voluntary disclosure of HIV status and to minimise
       stigma;

   •   Facilitate referral and access to prevention, treatment, care and support services
       following HIV testing;
   •   Facilitate and promote integration of HCT with family planning (FP), tuberculosis
       (TB), sexually transmitted infections (STIs), and other communicable and non-
       communicable diseases; and

   •   Integrate affordable, feasible, accessible, safe, and sustainable HCT services into
       the health system

Circumstances for HIV testing

   •   Individuals and couples

   •   Pregnant mothers for PMTCT

   •   Clinical diagnosis

   •   Research and other screening purposes

   •   Domestic violence and sexual assault

   •   PEP

   •   Court order

   •   Abandoned babies

   •   Pre requisite for MMC

Types of HCT

   •   CICT (VCT) – Client Initiated Counselling and Testing

   •   PICT – Provider Initiated Counselling and Testing

Core Ethical principles

   •   Counselling

   •   Informed consent

          –    VCT (CICT)

          –    PICT

   •   Illiteracy: right thumb

   •   Inability to make a decision

          –    Adults: National Health Act

          –    Children: Children’s Act
   •   Confidentiality and privacy

   •   Shared confidentiality

   •   Non discrimination

   •   Infection control

HIV Counselling and Testing for Children

   •   IN THE BEST INTEREST OF THE CHILD

   •   Counselling

   •   Informed consent

   •   Testing

   •   Confidentiality

   •   Considers relevant legislation

          –   Children’s Act, No. 38 of 2005

                 •   Regulations on Sections 130-132

   •   PCR testing

          –   For children<18 months

HIV Counselling and testing of special populations

   •   Pregnant mothers: PMTCT: PICT

   •   PEP: exposure at work

   •   Survivors of sexual assault: PEP

   •   Alleged sexual offenders

   •   Male and female prisoners



On day two the focus was on developing plans on how to roll out the B4L campaign in
Province and the plan will be informed by the current and future activities planned for
each district. A brief on the planned KZN mens symposium was given before the
districts went into commissions to deliberate about their plans.

              PROPOSED PROVINCIAL MEN’S SECTOR CONFERENCE
BACKGROUND

The Office of the Premier invited men, ONE per District and HIV Coordinators in
ALL Districts at Protea hotel on the 23-24 October 2009. The different
stakeholders on HIV & AIDS were invited to do presentation to the Men’s Sector.
The Interim Committee for Men’s Sector was elected and they were given a task
to:

    1. Establish a Men’s Structure from Ward level, District, and Provincial level.

    2. Draft a Constitution and register Men’s Sector as an NPO.

All this to be done before the 30th April 2010.

PROPOSED DATES:
          03-04 June 2010

PROPOSED VENUE:
          Pietermaritzburg or Durban.

THEME:
      
      “Charge a man to lead in a change”


      
     
      OR


      
     “KZN Men to lead the Change to do more for South Africa”

OBJECTIVES

    1. To ensure, facilitate, enable all the implementation of our Government
       NSP (2007-2011) within all Wards in KZN.

    2. To encourage leadership in man.

    3. To strengthen the Men’s Sector Structure in all levels.

    4. To plan, coordinate, and monitor HIV & AIDS Strategy.



DELEGATES:
         10 per District X 11= 110+Interim Committee.

INVITEES
    Office of the Premier


      
     HIV & AIDS Coordinators (22)


      
     Brothers For Life

      
      SANAC Men’s Sector Leadership


      
      Amakhosi




PROPOSED PROGRAMME

DAY ONE

TIME                      ACTIVITY                  FACILITATOR
09h00-10h00               Registration              Sifiso Mthethwa
10h00-10h15               Opening Remarks           Prof. N Gqaleni
10h15-10h45               Update KZN Men’s Sector   Rabi Gobind
10h45-11h15               Update SANAC              Bob Phato
11h15-11h45               Brothers For Life         Mandla Ndlovu
11h45-12h15               Flagship Programme &      Dr. F Ndlovu
                          HCT Campaign
12h15-12h45               Men & Sexual Health       Dr P Ramlachan
12h45-13h30               LUNCH
13H30-14H00               Role of Men’s Sector &    DoH
                          Male Medical
                          Circumcision
14h00-14h15               Credentials               Sifiso Mthethwa
14h15—14h30               Break
14h30-16h00               Constitution


    DAY TWO
TIME                         ACTIVITY                       FACILITATOR
08h30-09h00                  Recap
09h00-09h30                  Resolutions
09h30-10h30                  Elections
10h30-11h30                  Premier’s Address


Below are district plans

DISTRICT PLANNING

   A. Ethekwini District

   1. How will we integrate HCT into the Districts plans?

      •   The district council plan to be linked to the municipal IDP and the budget
          process.

      •   Mainstreaming HCT e.g. all events according to Health calendar

      •   Special days e.g. – mens day (6 Dec), Health Lifestyle day

      •   Premarital counseling should include couple testing together and HCT for
          couples

      •   Partnerships with FBO’s and traditional healers

      •   Promote intersect oral collaboration through existing structures using men
          as role models



   2. How will we integrate MMC promotion into district plans?

      •   Replicate the National/ Provincial strategy of MMC implementation at wards
          level

      •   Using the above event we also promote MMC e.g. camps either religious,
          sporting or social and other social events in the community



   3. How will we integrated B4L training and use of toolkit?

      •   Training of master trainers’ eThekwini e.g. 50 master trainers to cover the
          100 wards we have.

      •   Request financial from local AIDS council, Province as a service provider
   •   Sustain B4L by integrating their programme as part of men’s sector
       programme.



4. How will we integrate the district plan with the flagship plans?

   •   In each ward there should be a representative from the mens’ sector



5. How are going to mobilize resources?

   •   Use mobilisation use existing resources e.g. involvement of business, NGO,
       religious organisations etc. for funding, motivate national men’s sector to
       apply for global funding



6. How are going to report to our stakeholders?

   •   Regular report back meetings

   •   Using local media for local update



7. Who are the people responsible in our district?

   •   The district mens sector committee



8. How do we move from here to implementation?

   •   Records of the previous plans

   •   Reports back from allocated duties and accountability at a regular M & E
       meeting



B. UMgungundlovu district

   1. How will we integrate HCT into the Districts plans?

       •   Mobilise men from churches, NGO’s/ FBO’s, Government department and
           in the community at large to go for testing under the auspices of HCT
           rather than VCT alone capitalizing on the district’s slogan “ Through our
           culture we can prevent HIV infection”
   2. How will we integrate MMC promotion into district plans?

      •   Take advantage of existence of park homes in some health facilities and
          encourage men to visit such facilities for health services with the view of
          them volunteering for MMC.

   3. How will we integrated B4L training and use of toolkit?

      •   Mens programme will be aligned with B4L training, expectations placing
          special emphasis on nutrition and health education.

   4. How will we integrate the district plan with the flagship plans?

      •   District coordinator of HIV/AIDS will be facilitating stakeholders’
          multisectoral forum with the view of supporting mens sector agenda.

   5. How are going to mobilize resources?

      •   District men’s organisation to be registered as an NPO first

      •   Develop appropriate business plan for funding

   6. How are going to report to our stakeholders?

      •   Activities that are happening in the wards (85) and (7) municipalities will
          be reported to the district men’s sector where different stakeholders from
          government, civil, society and NGO’s sit.

   7. Who are the people responsible in our district?

      •   Local coordinators responsible for wards and in turn the district
          coordinators are responsible for both the municipalities and the districts

   8. How do we move from here to implementation?

      •   Identify people who will take the programme forward

      •   Build their capacity on B4L

      •   Develop monitoring and evaluation tool at district level that can tie in
          with the district AIDS councils’ plan.

C. ILembe District

   1. How will we integrate HCT into the Districts plans?

      •   Work with NGO’s , CBO, FBO to conduct door to door promoting HCT
          campaign
   •   Encouraging men to go for testing informing them about their closest
       testing site



2. How will we integrate MMC promotion into district plans?

   •   Men’s structures to reach out to the youth.

   •   Men in partnership with Amakhosi, traditional health practitioners and
       government departments.

   •   Mobilising men from ward level, targeting public places, taxi ranks,
       taverns and workplaces

3. How will we integrated B4L training and use of toolkit?

   •   Train the district structure

   •   TOT of sub-districts who will in turn train peer education to work in
       wards



4. How will we integrate the district plan with the flagship plans?

   •   Men to have representatives in district, ward and local task teams
       meeting




5. How are going to mobilize resources?

   •   Mens structure business plans to be presented to district mayor, local
       municipalities, Government departments business fraternity

6. How are going to report to our stakeholders?

   •   Organise sub-district men’s Imbizo and present district HCT plans

   •   Regular meetings – preferable bi-monthly of district mens’ structure

   •   District mens structure to report to the provincial structure and local
       structure will filter the information down to the wards and izigodi
       zamakhosi

   •   Emails circulate minutes.
   7. Who are the people responsible in our district?

      •   District mens sector chair person

      •   Local structures chairperson

      •   Two district HIV Coordinators

   8. How do we move from here to implementation?

      •   Presentation of the MS plan to prominent leaders e.g. district, local
          municipalities and business fraternity




D. Sisonke District

   1. How will we integrate HCT into the Districts plans?

      •   Invite all stakeholders within the district like NPO’s, traditional leaders,
          traditional healers and political leadership.

      •   Arrange meetings in all local municipalities in order to make sure that
          information reaches all wards.

      •   Arrange a campaign per local clinic

   2. How will we integrate MMC promotion into district plans?

      •   Arrange meeting per ward to mobilize men to circumcise

   3. How will we integrated B4L training and use of toolkit?

      •   B4L toolkit will be used in existing district programmes

   4. How will we integrate the district plan with the flagship plans?

      •   We will work together with them in order to make sure that the men are
          not left behind

   5. How are going to mobilize resources?

      •   All stake holder will hold meetings

   6. How are going to report to our stakeholders?

      •
  7. Who are the people responsible in our district?

  8. How do we move from here to implementation?




E. Umkhayakude District



     1. How will we integrate HCT into the Districts plans?

     •   Invite all stakeholders within the district, NPO, traditional leaders,
         traditional healers, political leadership and etc.

     •   Convene meetings in all municipalities to ensure that information reach
         all wards

     •   Hold a campaign per local clinic



     2. How will we integrate MMC promotion into district plans?

     •   Convene meeting in all ward to mobilise men for circumcision

     3. How will we integrated B4L training and use of toolkit?

     •   B4L toolkit will help us in our existing training in our district.

     4. How will we integrate the district plan with the flagship plans?

     •   We will work with them in order to make sure that men are not left
         behind

     5. How are going to mobilize resources?

     •

     6. How are going to report to our stakeholders?

     •   All stake holders will hold meetings to report

     7. Who are the people responsible in our district?

     •   All leaders within the districts will be responsible
     8. How do we move from here to implementation?

     •   We will do monitoring and evaluation



F. Thukela-Majuba Districts



     1. How will we integrate HCT into the Districts plans?

     •   Social mobilisation to create awareness in the following areas Churches,
         Schools, Taverns, sports recreation centers, pension pay point, Imbizo
         Zesizwe, Taxi ranks and trucks stop sites

     2. How will we integrate MMC promotion into district plans?

     •   Awareness campaigns around MMC procedures and requirements of
         certificate of fitness in clinics, pregnant mothers, support groups,
         schools, tribal authority structures and local media

     3. How will we integrated B4L training and use of toolkit?

     •   Establish and workshop mens sector committees from the ward level up
         to the District level, traditional council, youth and church structures

     4. How will we integrate the district plan with the flagship plans?

     •   District men’s sector representatives to be part of the district flagship
         committee. Local municipality and ward level.

     •   Link flagship with traditional leadership structures at all levels



     5. How are going to mobilize resources?

     •   All department, business sector, traditional leaders, traditional healers,
         academics, youth sector, NGO’s, FBO and CBO’s

     6. How are we going to report to our stakeholders?

     •   By following the district mens sector communication plan – mens sector
         to report to the AIDS council

     7. Who are the people responsible in our district?

         • District men’s sector , department of health, department of rural
           development, district municipality HIV/AIDS coordinator
      8. How do we move from here to implementation?

      •   Establish and strengthen men’s structure s from ward level – local
          municipality level up to district municipality level. Integrating HCT and
          MMC into Brothers For Life activities.



G. Ugu District



   1. How will we integrate HCT into the Districts plans?

      •   Establish mens sector forum by 14 May 2010, 2 NGO rep per local
          municipality

      •   Develop district plans by 31 May 2010

      •   Have HCT and MMC as planned programme of the mens sector

      •   NN to coordinate integration of SSC, HCT into mens sector programme

      •   Present men’s sector plan to Ugu district AIDS Council (UDAC) to mobilise
          political and administrative support and fast track implementation.

   2. How will we integrate MMC promotion into district plans?

      •   Same as above however will use SSC to promote in households on their
          day to day activities.

   3. How will we integrated B4L training and use of toolkit?

      •   Conduct B4L toolkit induction/workshop to mens sector

      •   Ward reps workshop training

      •   Ugu district to provide secretariat and technical support

      •   Conduct induction/presentation to UDAC to mobilise political and
          administrative support

   4. How will we integrate the district plan with the flagship plans?

      •   Mens sector rep to be represented in the ward-rooms to advocates for
          mens issues

   5. How are going to mobilize resources?
      •   Developing a plan on how to engage municipalities, provincial
          departments, private sector and other potential funders/donors

   6. How are we going to report to our stakeholders?

      •   District meeting once every 2 months, local meetings once every two
          months, ward meetings every months

      •   Local print and electronic media

      •   Municipal publications

   7. Who are the people responsible in our district?

      •   Mens sector representative – Mboniseni V. Khumalo 073 211 0594 and
          Nhlanhla S. Ndlovu – 072 099 6124

      •   District Municipality coordinator – 039 688 5875

   8. How do we move from here to implementation?



H. Uthungulu District

   1. How will we integrate HCT into the Districts plans?

      •   District men’s sector must cascade the information about the programme
          to the local municipalities down to the wards, roping traditional leaders,
          Ngo’s traditional leaders, traditional practitioners.

   2. How will we integrate MMC promotion into district plans?

      •   There must be a district launch of the HCT and MMC programmes and
          males will be mobilising through stakeholders for MMC.

      •   MMC was launched in the district in Ngwelezane

   3. How will we integrated B4L training and use of toolkit?

      •   Group local municipalities together for training – uMhlathuze and
          Mbonambi, uMthojaneni and Ntambanana, uMlalazi and iNkandla

      •   15 per Local will be trained, targets a CHAMPIONS, CDW’s, Traditional
          practitioners and leaders and reps from Amakhosi.

      •   These people are then going to train the community under the
          supervision of the district men council

   4. How will we integrate the district plan with the flagship plans?
   •   We will introduce ourselves to the district flagship committee and take
       part in their programme because they are ward based and deal with
       statistics in issues like MMC and others

5. How are going to mobilize resources?

   •   Using local newspapers, Bay TV, radio stations (IKORA FM), Business
       sector.

   •   Campaigns (awareness) at schools and other areas where pamphlets
       will be distributed to scholars through the department

6. How are we going to report to our stakeholders?

   •   With all the mens sector programmes we will build a good relationship
       with DAC and follow their reporting process.

7. Who are the people responsible in our district?

   •   Mens district committee will be responsible , together with stakeholders

8. How do we move from here to implementation?
I.   Zululand District

     Proposed integrated plan



     Programmes         Activity             Time Frame           Responsible
                        description                               person
     HIV counseling and Lease with local      May 2010            District municipality
     testing            health facilities to
                        have special time                         MP Zulu
                        for attending male
                        patience once a
                        month                21 April 2010

                         Encourage fathers
                         to visit health
                         facilities with their
                         families
     Medical Male        Education on the      10 April 2010      District Flagship
     Circumcision        concept               (Majomela event)   chairperson

                         Integrate with      May and June 10      Chairperson’s
                         district flagship                         forum MP Zulu
                         task team

                         Taxi associations

                         Traditional
                         authorities

                         Churches and
                         communities
     Communication       Zululand and        May, June and July Myaka Cyril
     plan                Ukhozi FM,          10
                         Traditional                            MP Zulu
                         structures
                         campaigns and
                         community
                         meetings, churches,
                         youth and schools
Brothers For Life  Mass meeting of      July 10            B4L, Cyril, MP Zulu
trainings          men at the centre
                   for training and use
                   toolkit
People responsible Integrated business                     Representatives
per district       people,                                 from NGO’s,
                   municipalities                          CBO’s, Chairperson
                   Government                              ZDAC HIV/AIDS
                   Department, police,                     coordinator
                   traditional healers,
                   tourism
Move from plan to Meeting with Cyril 21/04/10
implementation     on
                                        May
                   Revive mens sector
                   by including
                   influential members
                                        June – August 10
                   from former MIPAA

                    Old age soccer
                    clubs and pay
                    points

                    Workshop for care
                    givers and
                    volunteers from
                    various
                    organisation

                    Visiting Clinics –
                    letter to be sent to
                    mens clinics to
                    inform them about
                    the mens sector

                    Strengthen HIV/
                    AIDS support
                    groups and widow/
                    widowers OVC’s
   Update of the KZN men’s sector



   •   Established mens sector committee district (11 Health District) then ward based

   •   22 District established

   •   Constitution is in a draft form need committee to meet and discuss before
       provincial conference

   •   Will register as a Nonprofit organisation after constitution approved

   •   Accelerated efforts to reach remaining 9 health district – need transport and
       other resources for facilitation

   •   Draft plan of action was to have been submitted to local AIDS Council – April –
       May established District committee at & health districts

   Challenges of KZN mens sector so far

   •   Lack of funds and resources

   •   Collaboration with other partners i.e. flagship , war room structure at ward and
       local government level

   •   Men sectors need to start activities




Conclusion



The dialogue was very successful because of the balanced representation of the
delegates, the participation, presentations made, the commitment of the participants,
dedication of the mens sector, the support from the government and the openness of
the traditional leadership and the traditional healers. The province has long been
waiting for the follow and it came at the right time more especially after the call for
MMC. The KZN mens sectors recommitted themselves in making a difference in the
fight against HIV/AIDS and they already have plans underway to start working.



The second day helped in making delegates to exactly see what role and how are they
going to play it within the province in supporting government campaigns and how best
they can use B4L for that. The promise by the Premier’s office in continuing giving the
mens sector support in achieving their objectives further boosted their commitment.
The fact that the labour federation also shared with us their plans on how they will be
working with men on HIV/AIDS issues strongly suggest that everyone present in the
dialogue have started internalizing the way forward. The men’s sector will take a
leadership in the planned conference and they will share their ideas with the office of
premier

				
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