AIDS: M&E and Human Rights

1. AIDS: M&E and Human Rights

2. Overview • Information versus privacy • Necessity of M&E • Key human rights issues • Finding a balance

3. There is an increased understanding of the AIDS in Asia • The principal modes of HIV transmission • HIV is generally concentrated among certain populations. • Infections appear first among IDUs, SWs and Clients, and MSM, but then it spreads to wives and children • The driving forces of Asian epidemics • sharing of needles during Injecting Drug Use – kick-starts and accelerates the epidemic • unprotected Commercial sex – gives it range and power • Sexual networking among Asian men markedly higher than women • Projections into the future based on various scenarios indicate that the spread could be slowing

4. Functions of Frameworks for M&E • Roadmap to program planning, monitoring and evaluation • Delineate clear pathways to program goals & objectives • Define relationships between program inputs, processes, outputs, and outcomes • Describe how program factors interact with external context (environmental factors) • Lead to sound implementation and good M&E plans

5. Frameworks and Indicators • Understand how indicators are linked to frameworks • Describe how to operationalize indicators • Identify the role of indicators at different levels (national, sub-national, project) and the linkages between them • List sources of indicators that are international standards • Select indicators and define indicators for an M&E plan

6. M&E system and plan • Theoretical Basis: Global Fund and UNAIDS Guidelines • Routine Reporting: reporting tool, financial & narrative • Surveillance System: • Repeat biological and behavioural surveys • Facility surveys • Research: • Evaluations of existing interventions • Evaluations of new interventions • Other Research: to inform programme development & planning • Overall System: Flowchart and database, M&E plan, Log frames with indicators

7. Indicators provide critical M&E data at every level (and stage) of program implementation • Inputs, Process • Was the program carried out as planned? • How well was it carried out? • Outputs, Results • Did the expected change occur? • How much change occurred? • Outcome, Impact • Has the outcome changed in desired direction? • Does the change signal program “success”?

8. Issues for M&E practitioners • Challenge of identifying trends and changes • Comparability of samples • Ensuring methodological consistency (documentation, staff turnover) • Attributing changes to programmes and interventions (impossible) • Role of stakeholders / programme managers in interpretation of findings • Consider how to optimise the data and investment in research (e.g. advanced analysis)

9. Limitations All indicators have limitations, even those commonly used: • Blood safety: cannot monitor private facilities adequately • Sexual behavior(e.g. condom use, number of partners): self reporting bias • Sero-surveillance: get biased population (pregnant women and other populations) • Population-based HIV prevalence: refusal bias , sampling bias

10. Particular HIV/AIDS Issues Prevention • Quality of reporting of sensitive behaviors • Identifying size of most-at-risk population Voluntary Counseling and Testing • Measuring impact • Quality of services • Service cascade

11. Particular HIV/AIDS Issues Care and Support • Little M&E experience • Often community-based • Minimum care standards • Integration with TB-tracking referrals ARV • Patient-level tracking systems • Adherence

12. Stigma and Discrimination • Definitions • Measurement tools – validity in different contexts • Selection bias – only disclosed PLWHA observed • Psychosocial support measurement • Ethical & methodological issues in data collection • Sensitive data, public perceptions

13. IFRC Code of Conduct, Principle 2: “aid is given regardless of the race, creed, or nationality of the recipients and without adverse distinction of any kind. Aid priorities are calculated on the basis of need alone” • Good Humanitarian Donorship Initiative: “humanitarian action should be guided by… impartiality… without discrimination between or within affected populations” Human Rights and Humanitarian Principles

14. Human rights instruments are aspirational • It is not always possible for governments to adopt policies that respect all human rights at all times • But it is possible to incorporate a human rights dimension into planning and operations Facing Trade-Offs in Practice

15. Starts with a vulnerability and needs assessment • Provides non-discriminatory assistance that is: • (i) available • (ii) accessible • (iii) acceptable • (iv) adaptable Human Rights as a Framework in AIDS programming

16. Rights issues PLWA organizations Confidentiality Stigma Exclusion from family and community Loss of livelihoods

17. Balancing M&E and Rights • General public communication on AIDS • Staff Training • Communication with PLWA • Engagement with PLWA organizations • Consistency in M&E procedures • Management of information/confidentiality

18. Moving forward • Behavioral surveys are necessary for identifying and characterizing the risk factors. • M&E helps identify effective interventions which can bring down new infections effectively have been demonstrated. • Countries understand the need for information and are starting to generate more data and fill data gaps. • Stronger health system support for treatment and PMTCT programs results in fast scale up. • Social environment changing across the region: communication regarding AIDS and perceptions of PLWA remains necessary and a continual requirement for effective national programs

19. What needs to be done next? • Understand the characteristics of the epidemic and tailor the response. • AIDS should get to the top of the agenda for activists and social reformers • It provides a platform for civil society no other movement was able to provide earlier. • Focus on programs that produce impact and results, and do not spend limited funds on low impact interventions. • Coverage and scale up is the key - Attempt and attain more than 80% coverage of populations who need prevention and treatment services. • In the long term, • impact mitigation is the key • special focus on vulnerable groups • AIDS related stigma and discrimination should be addressed through a variety of channels