Presentation to the Social Development Portfolio CommitteeGrace Matlhape

CEO: New loveLife Trust30 August 2011

History of loveLife (1)

1997-1999: Consensus among some civil society partners to initiate an HIV/AIDS prevention programme targeting youth in South Africa

MOU signed between the Kaiser Family Foundation and the South African government to create a large-scale HIV-prevention programme for youth

loveLife has been promoting healthy, HIV-free living among South African teenagers since 1999.

Tri-partite relationship established 2005 with significant funding from DOH and DSD.

History of loveLife (2)

Since inception loveLife has combined sustained nationwide multimedia with community-level outreach and support programmes

The 2004 evaluation of loveLife resulted in the scaling up of outreach and support and the scaling down of media campaign.

Thereafter the campaign continued to focus on addressing the individual and social drivers of the epidemic, with a specific new focus on structural factors, with 2008 seeing “Make Your Move” launched.

Functional organogram of loveLife

Geographic presence

Waterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornWaterberg / CapricornMopaneMopaneMopaneMopaneMopaneMopaneMopaneMopaneMopane

SekhukhuneSekhukhuneSekhukhuneSekhukhuneSekhukhuneSekhukhuneSekhukhuneSekhukhuneSekhukhune

BojanalaBojanalaBojanalaBojanalaBojanalaBojanalaBojanalaBojanalaBojanala

NkangalaNkangalaNkangalaNkangalaNkangalaNkangalaNkangalaNkangalaNkangala

Thabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo MofutsanyaneThabo Mofutsanyane

LejweleputswaLejweleputswaLejweleputswaLejweleputswaLejweleputswaLejweleputswaLejweleputswaLejweleputswaLejweleputswa

Gert SibandeGert SibandeGert SibandeGert SibandeGert SibandeGert SibandeGert SibandeGert SibandeGert Sibande

SiyandaSiyandaSiyandaSiyandaSiyandaSiyandaSiyandaSiyandaSiyanda

NamakwaNamakwaNamakwaNamakwaNamakwaNamakwaNamakwaNamakwaNamakwa

Boland/KarooBoland/KarooBoland/KarooBoland/KarooBoland/KarooBoland/KarooBoland/KarooBoland/KarooBoland/Karoo

Kruger ParkKruger ParkKruger ParkKruger ParkKruger ParkKruger ParkKruger ParkKruger ParkKruger Park

BizanaBizanaBizanaBizanaBizanaBizanaBizanaBizanaBizana

BophirimaBophirimaBophirimaBophirimaBophirimaBophirimaBophirimaBophirimaBophirima

CentralCentralCentralCentralCentralCentralCentralCentralCentral

Chris HaniChris HaniChris HaniChris HaniChris HaniChris HaniChris HaniChris HaniChris Hani

EhlanzeniEhlanzeniEhlanzeniEhlanzeniEhlanzeniEhlanzeniEhlanzeniEhlanzeniEhlanzeni

EthekwiniEthekwiniEthekwiniEthekwiniEthekwiniEthekwiniEthekwiniEthekwiniEthekwini

IlembeIlembeIlembeIlembeIlembeIlembeIlembeIlembeIlembe

JHB CentralJHB CentralJHB CentralJHB CentralJHB CentralJHB CentralJHB CentralJHB CentralJHB Central

KarooKarooKarooKarooKarooKarooKarooKarooKaroo

MetroMetroMetroMetroMetroMetroMetroMetroMetro

Motheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/XhariepMotheo/Xhariep

SedibengSedibengSedibengSedibengSedibengSedibengSedibengSedibengSedibeng

Southern CapeSouthern CapeSouthern CapeSouthern CapeSouthern CapeSouthern CapeSouthern CapeSouthern CapeSouthern Cape

UmtataUmtataUmtataUmtataUmtataUmtataUmtataUmtataUmtata

UthukelaUthukelaUthukelaUthukelaUthukelaUthukelaUthukelaUthukelaUthukela

VhembeVhembeVhembeVhembeVhembeVhembeVhembeVhembeVhembe

West CoastWest CoastWest CoastWest CoastWest CoastWest CoastWest CoastWest CoastWest Coast

WesternWesternWesternWesternWesternWesternWesternWesternWestern

ZululandZululandZululandZululandZululandZululandZululandZululandZululand

TshwaneTshwaneTshwaneTshwaneTshwaneTshwaneTshwaneTshwaneTshwane

Frances BaartFrances BaartFrances BaartFrances BaartFrances BaartFrances BaartFrances BaartFrances BaartFrances Baart

loveLife Partnership Schools loveLife Implementation Schools loveLife Partnership & Implementation Schools

PPA Sites

loveLife Regions

Kruger National Park

NAFCI ClinicsYouth CentresRegional OfficesFranchises

MAP LEGEND

Sustained Media: Radio, TV, Print, Web, and Mobile

loveLife Performance Summary

9,452* peer educators*2010: 1,447

groundBREAKERS, 8005 mpintshis

1,500,000 enrolments in educational programmes

Schools: 6,520

Youth Friendly Clinics: 532

NGO Community Partnerships: 330

loveLife Y-Centres: 18

loveLife Games

Youth Helpline

goGogetters: 500

Festivals & Events

760,102 calls to call centre

1,702,621 site event

participants

State of the epidemic: Why target youth?

Half our population is under 25

Main spike of infection is among youth

Source: HSRC National Survey (2008)

It’s about more than just knowledge

Condom use at last sex, by single year age bands for women

-20

-18

-16

-14

-12

-10

-8

-6

-4

-2

0

15 16 17 18 19 20 21 22 23 24

Age

Per

cen

tag

e p

oin

t d

evia

tio

n

fro

m p

eak

con

do

m u

se (

60%

)

Source: Pettifor et al (2004). HIV and sexual behaviour among young South Africans: A national survey of 15-24 year olds 2003., Reproductive Health Research Unit, University of Witwatersrand (secondary analysis)

An unequal society drives new infections

Young people are showing the way

We can halve incidence... again

Source: Thomas M. Rehle et al. (2010) “A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008”, PLoS ONE,1 June 2010, Volume 5, Issue 6, e11094.

13

How does loveLife fight HIV?

Individual/Behavioural: Address attitudinal and knowledge gaps in schools through massive outreach programmes.

Social change: Sustain media and youth leadership initiatives that entrench positive social norms.

Structural: Deliver youth friendly clinical services, psychosocial support, career guidance, school sport, and so on.

Bio-medical: Create demand for bio-medical prevention technologies while reducing the burden on the primary healthcare system.

14

A cluster of social & economic factors predict high risk behaviour

loveLife’s Theory of Change

Helplessness in the face of challenges

Individual

• LOW SELF-ESTEEM

• NO SENSE OF FUTURE

• UNCERTAIN IDENTITY

Social

• COERCION

• PEER PRESSURE

• LACK OF PARENTAL COMMUNICATION

• EXPECTATIONS OF WOMANHOOD

• MALE SENSE OF ENTITLEMENT

Perception of scant opportunity

Pressure to conform to negative social

norms

HIGH RISK TOLERANCE

Structural• POVERTY• LOW EDUCATION• MARGINALIZATION• INEQUALITY

Sense of constrained choices

Alignment to DSD Strategic priorities

Franchise17520%

loveLife Outlet

15518%

Y-Centre182%

Youth Friendly Clinic53260%

Total = 880

16

loveLife Annual Report 2010: All Sites

Figure 1: Sites by site typeSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: All Sites

EC FS GP KZN LP MP NW NC WC TOTAL

Franchise 22 15 7 29 16 28 21 28 9 175

loveLife Outlet 3 13 3 26 2 5 26 22 55 155

Y-Centre 3 2 1 3 2 2 2 1 2 18

Youth Friendly Clinic 98 44 74 55 97 49 41 31 43 532

GRAND TOTAL 126 74 85 113 117 84 90 82 109 880

Table 1: Sites table by province and typeSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: DSD Sites

Figure 2: DSD sites by region and typeSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: DSD Sites

Figure 3: DSD sites by typeSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: DSD sites by geo-type

loveLife Annual Report 2010: DSD groundBREAKERS

Female81955%

Male65745%

Figure 4: DSD groundBREAKERS by region showing M:F ratioSource: 2010 loveLife Monitoring Report

Total = 519

Male to Female Ratio of all groundBREAKERS

(n=1476)

loveLife Annual Report 2010: mpintshis

Figure 5: mpintshis by province showing M:F ratioSource: 2010 loveLife Monitoring Report

Female459757%

Male340843%

Total = 8,005

loveLife Annual Report 2010: mpintshis at DSD sites

Figure 6: DSD mpintshis by regionSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Schools

0

200

400

600

800

1000

1200978

500

679

10661166

684 678

353 416

Figure 7: Schools by province and typeSource: 2010 loveLife Monitoring Report

Total = 6,520

loveLife Annual Report 2010: Schools linked to DSD sites

Figure 8: Schools by loveLife RegionSource: 2010 loveLife Monitoring Report

Total number of schools linked to DSD sites

loveLife Annual Report 2010: In-school programmes

0 50000 100000 150000 200000 250000 300000 350000

Eastern Cape

Free State

Gauteng

Kwazulu-Natal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

No Province

226911

63845

135760

268497

300027

206319

96713

30236

180720

527

Figure 9: Total participants in loveLife programmes by provinceSource: 2010 loveLife Monitoring Report

Young people registered = 1,509,555

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

10-11Y 12-14 Y 15-17Y 18-20 Y >20Y

7%

44%

35%

11%

3%

11%

41%

33%

12%

3%

2009

2010

loveLife Annual Report 2010: Participant age distribution

Figure 10: Total participants in loveLife programmes by provinceSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Participants (DSD)

Figure 11: Registrations by region, DSD-funded sitesSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Site-based events (all)

Face-It/Interactive

Workshop Session

313012%

Mini-Championship/Le

ague Event492619%

Mpintshi Extravaganza

3311%

Other1991%

Talk/Presentation16650

63%

TBTF Site Event1007

4%

050000

100000150000200000250000300000350000400000450000

171472

10307779069

54163

446741

287445

112155

223054 221425

4020

Figure 12: Site events by type and participantsSource: 2010 loveLife Monitoring Report

Total participants = 1,702,621

loveLife Annual Report 2010: Site-based events (DSD)

Figure 13: Site events by type and participantsSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Born Free Dialogues

31

Total participants = 49,226

Figure 14: Participants in Born Free Dialogues: Parents vs. ChildrenSource: 2010 loveLife Monitoring Report

Parents

Children

loveLife Annual Report 2010: goGogetters and OVC

Total goGogetters = 465 Total OVC supported = 2,247

Figure 15: goGogetters and the children they support by provinceSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Call Centre

0

50000

100000

150000

200000

250000

Jan-Mar Apr-Jun Jul-Sep Oct-Dec

148894169450

224546 217212

7551797025

134331

112220

Total # of calls

# of counselling calls

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Jan-Mar Apr-Jun Jul-Sep Oct-Dec

8700

6411

7814

6863

1876 18622466

1742

Total # of calls

# of counselling calls

Youth Line: 760,102 calls in 2010 Parent Line: 29,788 calls in 2010

Figure 16: Calls to loveLife Youth Line and Parent LineSource: 2010 loveLife Monitoring Report

loveLife Annual Report 2010: Call Centre

Relationships28%

Pregnancy5%

Contraception1%

Sexual Abuse1%

Psychological6%

Sexual Issues3%

Career14%

loveLife Information

19%

Puberty and Adoloscence

4%

Sexual Transmited Infections

3%

Top2%

HIV&AIDS14%

Gauteng21%

Eastern Cape17%

Free State15%

KZN15%

Limpopo12%

North West9%

Mpumalanga6%

Western Cape3%

Northern Cape2%

Callers by Province Callers by reason for calling

Figure 17: Callers by province and reason for callingSource: 2010 loveLife Monitoring Report

What do we know prevents HIV?

METHOD EFFICACY COMPLEXITIES

Male Condoms 95 % when used consistently; (No RCT can be conducted for ethical reasons).

May not be used consistently & correctly; gender dynamics

Female condoms Estimated 95 % when used consistently &

correctly; currently the only female-controlled method of prevention

Low uptake; costly; conspicuous; unpopular; must be used correctly

and consistently.

Medical Male Circumcision

Shown to reduce female-male HIV transmission by approx. 60 %; 3 RCTs

confirm this; one-time procedure = cost effective.

Cultural issues; requires demand and uptake; concerns about behavioural

disinhibition.

STI treatment

Mixed evidence for efficacy in reducing HIV transmission; longitudinal studies support

syndromic management though RCTs show little evidence of efficacy.

Mixed evidence

Post-exposure prophylaxis Observational studies & animal studies suggest efficacy in preventing infection

after exposure to HIV

Access; requires adherence and awareness of protective effect of PEP.

Behavioural interventions have been shown to work

Participated in face-to-face HIV prevention programme1 (AOR: women 0.61 95% CI 0.43-0.85 & men 0.60 95% CI 0.40-0.89). Pettifor et al., “Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey”. AIDS 19:1525-1534.

In-school learners report less risky sexual behaviourless risky sexual behaviour and have lower rates of HIVlower rates of HIV than same-aged out of school peers. Hargreaves et al., “The association between school attendance, HIV infection and sexual behaviour in rural South Africa”. Journal of Epidemiological Community Health; 000;18;doi.10.1136/jech.2006.053827 (2007).

1 The programme under evaluation was loveLife.

Combination prevention is necessary

Multi-pronged interventions, none of which is 100% effective. All require the adoption of certain behaviours (adherence,

correct and consistent condom use, etc.) Growing consensus (cf. Lancet Series 2008) that we need to

combine our interventions:

“...to avoid risk compensation and to increase adherence, biomedical methods should be inextricably implemented together with behavioural interventions. Likewise, biomedical interventions, such as male circumcision, offer a unique opportunity for risk reduction counselling.” Padian et al., Lancet 2008

Significant inroads have already been made

Significant inroads have already been made

Preliminary findings of HSRC impact assessment

Study conducted by the Human Sciences Research Council; Funded by Kaiser Family Foundation

1. Most reported improved skills development and increased access to opportunity as a result of loveLife participation

2. Increased motivation and capacity to perceive and take opportunities after loveLife participation

3. Increased likelihood of safe sex4. Youth reported (1) learning healthy sexual behaviour (2)

practicing safe sex after participating in loveLife5. Youth reported positive thinking and ‘hope’

Upcoming evaluations of loveLife

• 2012: National Communication Survey (NCS) in partnership with Soul City and JHHESA:

• To examine whether public health communications programmes and messages have an impact in changing knowledge, attitudes, norms and behaviour with regard to HIV/AIDS and TB

• To be conducted across South Africa, sample of 10000 households• To be conducted in 2012

• 2012: Internal evaluation of loveLife groundBREAKER programme• 2011-12: Plans for baseline study and follow up evaluations of new Y-

Centre; and plans for assessment of impact of existing Y-Centres

What does SA get for investing in loveLife? A study of South African youth (15-24 years old) found that interaction with

loveLife face-to-face was had a 0.61 AOR “protective effect” (Pettifor et al. A national survey of 15-24 year-olds, AIDS 2005)

This means that participating in loveLife programmes makes young men and women around 40% less likely to contract HIV – a remarkable efficacy rate that is exceptionally cost effective.

2,500 temporary employment opportunities1

• Cash transfers to marginalized communities• Skills transfers affect long-term employability

1 goGogetters, groundBREAKERS, IDT Mpintshis, HWSETA learnerships – Monitoring2009 and 2010

2 VOSESA groundBREAKER Survey, 2007.

SA Youth Average groundBREAKERS before programme

groundBREAKERS after programme2

POST-MATRIC QUALIFICATION 6.1% 8% 47%

EMPLOYMENT 34% 12% 60%

loveLife has implemented at ever increasing scale

Participants: 450% increase over 5 years Schools: 127% increase over 5 years

Community Sites: 29% increase over 5 years

Source: loveLife Monitoring Reports 2006-2010

loveLife has increased efficiency levels dramatically

Source: loveLife Annual Reports 2006-2010

Who pays for lovelife?FUNDER DESCRIPTION OF PROJECT FOCUS AREA BUDGET

Bill and Melinda Gates Foundation

goGogetter programme National R4,716,731

Department of Health -National

National Call Centre, groundBREAKERS (n=622), National Youth Friendly Services, goGogetters (n=470), 523 clinical Sites, 18 Y-Centres, events and outreach into schools.

Primary Healthcare for HIV prevention R76,285 000

Department of Social Development -National

groundBREAKERS (n=525), national Outlet and Franchise programmes, national "mpintshi" initiative, events and outreach into schools.

Reach marginalized urban informal and deep

rural communitiesR42 595 000

Barloworld Youth leadership development National R333 333

Henry Kaiser Family Foundation

National evaluation of loveLife Evaluation R650,159

Ilembe Consortuim groundBREAKERS around ACSA – Durban Airport groundBREAKERS - KZN R209,099

Department of Social Development – North West

Additional mpintshis, groundBREAKERS, and goGogetters in selected areas in Northwest Province.

Extend loveLife's reach R3,150,000

FUNDER DESCRIPTION OF PROJECT FOCUS AREA Budget

National Lottery Distribution Trust Fund

"Cultcha Factories" in 18 marginalized communities; national "loveTrain" tour to railway stations across the country; Enviro Ys green economy programme; film-making for SABC including "I AM Mzansi"

Arts & Culture and Environment R17,339,660

Murray & RobertsRepairs, maintenance, and programme activity at loveLife Y-Centres Youth Centres R3,400,000

Royal Bafokeng

State-of-the-art loveLife Y-Centre in Luka Village and outreach into surrounding Bafokeng areas. Youth Centre R1,561,216

Department of Sports & Recreation-National

loveLIfe Games: events and outreach, coaches training, league formation, partnership model. Sports & Recreation R27,390,420

Deutscher Entwicklungsdienst Youth leadership development Youth Leadership

Development R695,804

United Nations Population Fund HCT Campaign roll-out and World Aids Day HCT R644,608

Other Funders Once-Off Donations, Advertisements National R1,545,196

Who pays for loveLife?

Expenditure breakdownEXPENDITURE FOR PERIOD JANUARY TO DECEMBER 2010

DOH DSR DSD

Support Costs 13,263,996 18% 4,157,716 14% 9,877,569 24%

Audit/Bank Charges/Insurance 600,328 236,385 369,650 Municipal/Rates/Licenses 399,605 68,643 314,163 Office Maintenance/Security/Cleaning/Repairs 1,010,813 302,540 589,370 Postage/Courier/Distribution 277,206 155,238 106,123 Rental-Premises/Equipment 915,263 129,366 643,073 Research/Consultancy/Project Management 792,728 225,237 421,274 Staff Costs 6,718,152 2,530,746 4,842,230

Stationery/Printing/Office Supplies 157,737 26,025 608,006 Telecommunications & IT 1,940,828 279,224 1,542,072 Trainings/Workshops/Events/Meetings 169,295 53,394 50,507 Travel/Accomodation/Transport 282,041 150,918 391,101

Programme Costs 58,466,383 81% 25,007,426 85% 30,469,319 76%

Media/Advertising/Merchandise 10,996,952 2,543,599 1,952,523 Postage/Courier/Distribution 780,351 479,928 539,686 Research/Consultancy/Project Management 1,646,083 475,583 70,654 Staff Costs 25,449,235 6,528,465 15,120,454 Stationery/Printing/Office Supplies 6,097,024 1,928,270 3,768,005 Telecommunications & IT 420,446 114,194 65,758 Trainings/Workshops/Events/Meetings 5,726,916 5,041,263 4,566,637

Travel/Accomodation/Transport 7,349,376 7,896,126 4,385,602

Capital Expenses 861,531 1% 245,000 1% -

Total Cost 72,591,910 100% 29,410,142 100% 40,346,888 100%

Thank youloveLifeTel +27 (0)11 523 1000 Fax +27 (0)11 523 100148 wierda rd west wierda valley sandton 2196P O Box 45 parklands 2121 south africatalk@lovelife.org.za www.mymsta.mobi www.lovelife.org.za