Anke A. Ehrhardt, Ph.D.; Diane di Mauro, Ph.D.; Raymond Smith, Ph.D.; and the MAFLI team HIV Center Grand Rounds, March 17, HIV PREVENTION, GENDER, AND LEADERSHIP: THE M∙A∙C AIDS FUND FELLOWSHIP IN SOUTH AFRICA

The MAFLI Team HIV Center: Anke A. Ehrhardt (Principal Investigator), Diane di Mauro, Raymond Smith, Joyce Hunter, Linda Loffredo, Patricia Warne, Masud Rahman UCLA: Thomas Coates (Co-Principal Investigator), Laurie Bruns, Mushambi Mutuma HSRC: Vasu Reddy, Relebohile Moletsane, Kathleen Pithouse-Morgan, Lisa Wiebesiek 2 This program was supported by a grant from the M∙A∙C AIDS Fund to the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute

Leadership and HIV/AIDS Recommendations (1) Ensure sustainable funding for HIV/AIDS leadership development programmes. Promote and fund evaluation of leadership development programmes. Fund and implement scale-up of effective programmes. Develop initiatives to assist in transfer of leadership to countries and regions most affected. 3

Leadership and HIV/AIDS Recommendations (2) Increase the number of leadership programmes targeting those most at risk and most marginalized. Include a greater focus on a gender perspective. Coordinate programmes and ensure ongoing mentorship and support of trainees. Foster high-level leadership development in the HIV prevention field. 4

Leadership and HIV/AIDS Recommendations (3) Expand the role of universities in HIV/AIDS leadership development. Develop a clearing house for leadership development curricula, tools, and models. 5 Reference Szekeres, G., Coates, T.J., & Ehrhardt, A.A. (2008). Leadership development and HIV/AIDS. AIDS, 22(suppl 2),S24-S25.

Need for HIV Leadership in South Africa South Africa has 50 million people – one-sixth the U.S. population but over five times as many PLWHA South Africa’s 5.7 million PLWHA include 3.2 million women and 280,000 children. Among women 25-34, nearly one-third are HIV-positive. Adolescent girls are at particularly high risk. 6

Creating the M∙A∙C AIDS Fund Leadership Initiative (MAFLI) 7 The MAFLI was launched in 2007 by the HIV Center and the UCLA Program in Global Health with funding from the M∙A∙C AIDS Fund. The Human Sciences Research Council of South Africa (HSRC) became a partner in 2009.

Program Overview “A training program designed to cultivate emerging leaders in South Africa who will make a major contribution to reducing the spread of HIV by addressing the link between HIV/AIDS prevention and gender inequality.” Fellows: 4 cohorts from (N=46) Training: A two-month intensive, in-residence training program and development of an HIV prevention plan Implementation phase: Support for ten months of mentoring for prevention plan implementation in their communities

Recruitment and Selection A nationwide (South Africa) call for applications was issued via s, webpostings, and newspaper ads. The application included background information, personal statement, prevention plan proposal, and recommendations. All applicants were screened for leadership potential; innovation and feasibility of prevention plan; match with program. Final interviews were conducted by Selection/Advisory Board. 9

The MAFLI Fellows (N=46) 40 (87%) are women; more than 80% are Black, Coloured, or Indian. Most are ages 25 to 45 and hold a BA or MA. Fellows are from 7 of the 9 provinces of South Africa, especially KwaZulu-Natal (13) and Gauteng (11). Many focused on youth (15), community-based work (16), and higher education (7); also business, medicine, law and policy (8). 10

The MAFLI Training Curriculum Intensive, in-residence training of 8 weeks, starting with 2- week orientation: Knowledge-building sessions: HIV prevention; gender equity; human sexuality Skills-building sessions: leadership and management skills; values clarification; community site visits HIV Prevention Plan workshops: development of Fellows’ small-scale pilot projects and the skills to implement 11

MAFLI Fellows’ HIV Prevention Plans Prevention plans focus on a range of populations such as parents, LGBT youth, teachers, community leaders, and couples. Venues included prisons, soccer clubs, workplaces, churches, primary school, and colleges. Locations included townships, urban, periurban, and rural areas in 7 of the 9 South African provinces. 12

Implementation and Mentoring of Prevention Plans Fellows utilized HIV/AIDS knowledge and leadership skills gained in training. Fellows worked directly with host organizations in their communities. Mentors provided bi-weekly support, advice, and troubleshooting during plan enactment. The program provided funding for stipends and for plan implementation costs. 13

Romiela Pillay Johannesburg, Gauteng Project Manager at the MERSETA trade association Developed HIV/AIDS workplace programs in small- and medium-sized enterprises Trained client liaison officers to intervene with workforce Recognized by MERSETA and later by UNAIDS 14

Tshidi Maseko Katlehong, Gauteng Educational psychologist and Co-Founder/ Co-Director of Khanya Family Centre Conducted HIV and gender equity training with 33 staff and introduced HIV prevention services at Khanya Built strong relationships with government departments, schools and local VCCT clinics 15

Estelle Heideman & Tarryn Nell Bloemfontein, Free State Service providers at HIV Centre of University of the Free State Worked both with students and local farm workers Experienced career advancement at University of the Free State and have applied for continued funding 16

Building a MAFLI Network Goals: Extend reach and impact of the program Promote info. sharing, collaboration, technical assistance Form an SA-wide network on HIV prevention & gender Means: Program newsletter: Leadership Notes Online communications (e.g., website, Facebook, list-serv) In-person meetings (e.g., satellites at conferences) and Capstone Conference in February,

Keynote address by Justice Yvonne Mokgoro of the Constitutional Court of South Africa Panel presentations on leadership by MAFLI leaders Anke Ehrhardt and Thomas Coates, with Vasu Reddy Reflections on personal and professional growth by Fellows 18 Capstone Conference: Lessons in Leadership

At a poster discussion session, Fellows shared how they... Developed professionally and personally, Created new HIV prevention tools, Overcame major challenges, Continued their work beyond the project period. 19 Capstone Conference: Poster Discussion

Assessing the Impact of the MAFLI At an individual-level, the MAFLI increased or enhanced Confidence, self-efficacy, and leadership ability; World view and awareness; Exposure to and knowledge of HIV prevention research, interventions, and program practices; Competence to address HIV and AIDS in a professional capacity; Understanding of the impact of gender inequality and dynamics on the HIV epidemic; Understanding and acceptance of LGBT issues and people; Work skills (communication, presentation, training, facilitation skills, and project management); Professional opportunities and development. 20

Assessing the Impact of MAFLI At a community-level, the MAFLI enhanced/contributed to Capacity to provide tailored HIV/AIDS prevention knowledge and skills to groups not usually targeted by formal educational programs (parents, early childhood development practitioners, farm workers, small and medium-sized enterprises, etc.); Capacity to address HIV/AIDS within schools, communities, and workplaces; Capacity to provide comprehensive HIV-related information, services and support; Relationships between Fellows, their institutional sites and communities targeted; Development of various training manuals that can be used to train additional participants beyond the original target group. 21

Funding for project scale-up from the M∙A∙C AIDS Fund through HIVOS Expansion of the MAFLI Network Bridge to sustainability in South Africa: funding from M∙A∙C AIDS Fund ( ) 22 The MAFLI Program: Next Steps