Regional (Africa and South East Asia) HIV and AIDS workshop: Focus on inclusive and integrated

1. Regional (Africa and South East Asia) HIV and AIDS workshop: Focus on inclusive and integrated HIV and AIDS services February 21-25, 2011, Bujumbura, Burundi Muriel Mac-Seing HIV and AIDS Technical Advisor

2. Let’s introduce and know about one another!

3. Workshop objectives • To reinforce sharing, in efforts to develop mechanisms for strategic exchanges between programmes and to refine HI’s strategy on HIV and AIDS • To outline and analyze lessons learnt and good practices on specific HIV and AIDS services promoted by HI projects • To understand the underlying rationales for a conceptual and implementing inclusive framework integrating HIV to SRH and GBV • To lay the ground for the elaboration of a guideline/handbook on disability inclusion within HIV programming (prevention, treatment, care and support) • To promote a sense of team spirit/belonging among the different HIV-related projects’ team members

4. Day 1 Introduction and objectives 8 HIV presentations per country Day 2 GBV presentation, Burundi Orientation training on GBV Day 3 Presentation preview of HIV and AIDS policy document and discussion Group work on cross disability inclusion into HIV programming Workshop preview Day 3 (continued) • Group work on cross disability inclusion into HIV programming • Cultural dinner with IEC material sharing Day 4 • Presentation of groups’ works Day 5 • Roundtable on scaling up of disability inclusion into HIV • Visit to Burundi partners • Evaluation of workshop

5. Rule settings for the workshop… yes we can!

6. Day 1 Morning • Kenya’s presentation • Ethiopia’s presentation, with discussion after 2nd presentations • Rwanda’s presentation • Vietnam’s presentation, with discussion after 2nd presentations Afternoon • Cambodia’s presentation • Mozambique’s presentation, with discussion after 2nd presentations • Somaliland/Puntland’s presentation • Regional Africa project’s presentation, with discussion after 2nd presentations

7. Day 2 Morning • GBV project presentation by Burundi • Orientation training on GBV linked to HIV and AIDS • Introduction • Concept and definition • Approaches and main strategies Afternoon • Continue with orientation training on GBV linked to HIV and AIDS • Linkages • Brainstorming • Group exercises • Ways forward In the evening, all are encouraged to attend a meeting regarding registration and abstract submission to ICASA in December 2011 in Addis Ababa

8. Day 3 Morning • Presentation of overview on HIV policy document in link with SRH and GBV • Discussion and plenary Afternoon • Group works on disability inclusion into HIV programming (PTCS) through different impairments: • Group 1: Visual impairments • Group 2: Hearing impairments • Group 3: Intellectual impairments • Group 4: Mental impairments

9. First, what are your ideas about the 1) linkages between HIV, SRH and GBV and 2) intersection between HIV and disability and why? Use meta-cards, drawings, etc. to express your ideas.

10. Presentation of highlights of HIV policy document (draft) Background • HIV and AIDS is one of the most disabling epidemics worldwide for a few decades now • As a development issues, HI started to work on HIV and AIDS in 1992 in Burundi. Kenya followed in 1996 • Primary rationales for working on HIV and AIDS are linked to the marked vulnerabilities of women and men with different impairments to the infection • PLHIV under ARV live longer and are more likely to develop temporary and/or chronic impairments due to the illness (HIV towards disability (and rehabilitation) linkage) • PLHIV taking ARV are most likely to develop temporary and/or chronic impairments (HIV towards disability (and rehabilitation) linkage) • PWD can become HIV positive (disability (and rehabilitation) towards HIV linkage)

11. Where HI currently works in HIV and AIDS: 8 countries in Africa and 3 in South East Asia

12. HIV situation worldwide

13. Women living with HIV worldwide Global feminization of HIV epidemic compounded in deeply rooted gender disparities

14. More specifically where HI worksData from UNAIDS 2009

15. Sexual and reproductive health (SRH): An overview Each year, there are 340 million new cases of syphilis, gonorrhoea, chlamydia and trichomoniasis occuring in men and women aged 15-49 Overall, STI prevalence rates continue to rise in most countries According to WHO, the Africa region accounts for 48% of MMR worldwide, with an average at 900 deaths/100,000 live births (450-1,500) MMR in Cambodia of 481, 405 in Lao PDR and 75 in Vietnam

16. SRH: An overview (continued) In the Sub-Sahara region, there is only 13% of contraception prevalence despite evident benefits of family planning and MNCH interventions; an average of 44% in the 3 SEA countries where HI works In the same region, 25% of unsafe abortions are among young women aged 15-19 (highest in the world) Most HIV infections are sexually transmitted or associated with pregnancy, childbirth or breastfeeding Furthermore HIV and SRH share root causes, including poverty, gender inequality and social marginalization of the most vulnerable populations

17. Rationales for integrating HIV with SRH Global Fund Practical Guide on the Integration (2009) Reduction of mortality from HIV and AIDS Reduction of unintended pregnancy and perinatal transmission (through PMTCT) Increase in people getting tested for HIV Expansion of the reach of programmes and services to more target groups Integration of services can reduce stigma and discrimination and increase access to and use of services Addressing also GBV can reduce risk for HIV

18. How can this look like… Global Fund Practical Guide on the Integration (2009)

19. Overview on GBV and HIV 1/3 women in the world has been raped, beaten or otherwise mistreated, usually by a family member or an intimate partner (Ellsberg and Heise, 2005)

20. Overview on GBV and HIV USAID website GBV puts women and girls at greater risk of HIV infection through multiple pathways (Campbell et al., 2008) Women survivors of rape are often reluctant to report crime because of the stigma associated with it and therefore do not receive any care of follow up, including PEP where it exists Women living with violent partners are less able to protect themselves from unsafe and coerced sex Women living with HIV are more likely to suffer violence as a result of their status, both from intimate partners, as well as family and community members In time of conflict and flight, women and girls (men and boys) may experience more violence, forced pregnancy, intentional HIV infection, abduction, sexual abuse and slavery or rape

21. How can this GBV and HIV be integrated? USAID Technical Brief on GBV and HIV (2010) With gender awareness-raising and strategies in HIV programming By addressing gender differences and inequalities that affect sexuality and HIV transmission and mitigation By building condom use negotiation skills among women and marginalized groups By increasing the availability of HIV prophylaxis in cases of rape Through development of laws/policies addressing gender disparities that positively impact gender norms, which can impact on pathways to HIV infection By training of health workers, counsellors, Courts, police and others on GBV and HIV and AIDS

22. Key facts on disability worldwide Around only 45 countries have anti-discrimination and other disability specific laws (Disabled World) Around 10% of the world population is disabled (WHO) More than 350 million women are disabled 20% of poorest people estimated to be disabled (WB) 3% and 1% adult literacy among adult men and women with disabilities respectively (UNDP) 90% of children with disabilities do not go to school (UNESCO) 30% of street youth have a disability (UNICEF) Persons with disabilities are up to 3 times more likely to be victims of physical and sexual abuse and rape (WB/Yale University) Disability recognized by UNAIDS in one of their Policy Brief (2009) Persons with disabilities part of vulnerable groups in UNAIDS new strategic plan (2010)

23. …In Africa, more than 100 million girls and women became disabled following female genital mutilation…

24. …Only ¼ of women with disabilities have access to work. They are two times less likely than their male counterparts to find employment…this leads topoverty which is one of the main drivers to HIV and GBV

25. Disability outlook

26. Intersection between disability, HIV and GBV Global survey on disability and HIV (World Bank/Groce N. 2004) All known risk factors to HIV and AIDS are present at an equal or greater rate among PWDs Adolescents and adults with disabilities as likely as non-disabled peers to be sexually active Homosexuality and bisexuality appear to be at the same rate among PWDs PWDs are as likely to use drugs and alcohol Women and men with disabilities are even more likely to be victims of violence or rape, although they are less likely to be able to obtain police intervention, legal protection and prophylactic care

27. Intersection between disability, HIV and GBV (continued) UNAIDS/WHO Policy Brief on Disability and HIV (2009) The UNCRPD does not explicitly refer to HIV or AIDS in the definition of disability. However: States are required to recognize that where persons living with HIV (with or without symptoms) have impairments which, in interaction with the environment, results in stigma, discrimination or other barriers to their participation – so they fall under the protection of the UNCRPD Risks to HIV infection among PWDs: Insufficient access to appropriate HIV prevention and support services Sexual violence Stigma, marginalization and discrimination Lack of knowledge and skills among service providers about disability issues

28. Intersection between disability and SRH WHO/UNFPA guidance note on SRH for PWDs (2009) Historically, PWDs have been denied information about SRH, as they are believed to be asexual PWDs have also been denied of the right to decide whether, when, and with whom to have a family PWDs often are subjected to forced sterilizations, abortions and marriages They are more likely to experience physical, emotional, and sexual violence and other forms of GBV They are likely to be infected with HIV and STIs There is a necessity to work towards inclusive services in different sectors

29. … Hence, in order to work towards Universal Access and respect of people’s right to access to health care, this needs to be considered…

30. Inclusive and integrated HIV services Source: Mac-Seing, M. (2010). From Africa to South East Asia: Handicap International’s work on HIV and AIDS. HI

31. Main target beneficiaries and populations Women, men and youth with different impairments and close relatives (family members) Women and men in their reproductive age Youth in and out of schools PLHIV and family OVC and relatives Other MARP groups, such as prisoners, sex workers, truck drivers, ethnic minorities Priority to start with disability inclusion approach and strategies integrated to HIV services (PTCS) with SRH and GBV…

32. Focus on disability inclusion into HIV programming (PTCS) Capacity building of health personnel Awareness-raising through peer education, mass sensitization, mass media, utilisation of IEC tools, theatres, group discussions, etc. Removal of barriers (communication and physical) Advocacy and lobbying for policy change Significant participation and involvement of PWDs and DPOs Evidence-based programming, through studies and research Throughout HIV prevention, treatment, care and support

33. Guideline for group work on cross-disability inclusion into HIV (PTCS) programming In a group of 6-7 people, please do the following for the whole afternoon With the selected impairment you have, systematically go through the HIV PTCS services and see how we can remove the following barriers: Communication Physical Environmental Please be specific in your solutions and clear in your presentation of your results

34. Day 4 Morning • Presentation of results of Group 1 • Presentation of results of Group 2 • Plenary and discussion Afternoon • Presentation of results of Group 3 • Presentation of results of Group 4 • Plenary and discussion

35. Day 5 Morning • Roundtable on how to scale up disability inclusion in HIV programming – guest speakers from: • Burundi National AIDS Authority • National Association of People Living with HIV • National Association of Organizations Working on the AIDS response • Presentation on technical supervision Afternoon • Visit to partners and know more about what they are doing: • National Association of People Living with HIV (RBP+) • National Association of Organizations Working on the AIDS Response (ABS) • National Association of Deaf of Burundi (ANSB) • Association working against SGBV (ADDF) • Evaluation of workshop

36. Thank you!