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To Share and To Learn:. The Case For Canadians To Act Globally Against HIV/AIDS. International Affairs Directorate June, 2000. Introduction Goals of The Case For Canadians To Act Globally Against HIV/AIDS.

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to share and to learn

To Share and To Learn:

The Case For Canadians To Act Globally Against HIV/AIDS

International Affairs Directorate

June, 2000

International HIV/AIDS Toolkit

introduction goals of the case for canadians to act globally against hiv aids
IntroductionGoals of The Case For Canadians To Act Globally Against HIV/AIDS
  • To enhance your understanding of the enormity and devastating impact of the global epidemic.
  • To highlight how you can become involved.
  • To profile Canadian leaders in this area.
  • To highlight the benefits that will accrue to your organization as a result of taking an active role in international HIV/AIDS issues.

International HIV/AIDS Toolkit

the facts the global picture
The FactsThe Global Picture
  • 40 million people living with HIV/AIDS at the end of 2003
  • 5 million people newly infected with HIV in 2003
  • 3 million people died of AIDS in 2003
  • 95% of people living with HIV/AIDS live in developing countries
  • 90% do not know they are HIV-positive
  • Half of all new infections are in women

International HIV/AIDS Toolkit

sub saharan africa 26 6 million people living with hiv aids plwhiv aids
Sub-Saharan Africa: 26.6 million people living with HIV/AIDS (PLWHIV/AIDS)
  • Women 1.2 times more likely to be HIV-positive than men.
  • Home to 30% of PLWHIV/AIDS, but only 2% of the world population
  • AIDS is devastating economies and dramatically lowering life expectancy

Success Story: Senegal

By acting quickly to implement country-wide prevention education programs, Senegal has avoided a generalized epidemic.

International HIV/AIDS Toolkit

asia and the pacific 7 4 million plwhiv aids
Asia and the Pacific: 7.4 million PLWHIV/AIDS
  • Epidemic largely fueled by injection drug use and commercial sex
  • Significant local and regional epidemics in India
  • Emerging epidemics in highly populous countries: China, Indonesia, India

Success Story: Thailand

Through vigorous and early efforts to promote condom use in the commercial sex trade, Thailand turned around a limited epidemic, thus avoiding a generalized epidemic

International HIV/AIDS Toolkit

latin america and the caribbean 2 million plwhiv aids
Latin America and the Caribbean: 2 million PLWHIV/AIDS
  • Caribbean most affected region after Sub-Saharan Africa
  • Divergent regional modes of transmission
  • High levels of stigma and discrimination against vulnerable groups

Success Story: Brazil

Vigorous prevention efforts and universal access to treatment have helped Brazil contain and manage its epidemic.

International HIV/AIDS Toolkit

eastern europe and central asia 1 5 million plwhiav aids
Eastern Europe and Central Asia:1.5 million PLWHIAV/AIDS
  • Epidemic still exploding since the mid-1990s
  • Epidemic driven so far mostly by injection drug use

International HIV/AIDS Toolkit

middle east and northern africa 0 6 million plwhiv aids
Middle East and Northern Africa:0.6 million PLWHIV/AIDS
  • Very low prevalence rates
  • High level of stigma and denial

Success Story: Algeria

More substantial prevention programs are being developed to address the epidemic.

International HIV/AIDS Toolkit

industrialized countries 1 6 million plwhiv aids
Industrialized Countries:1.6 million PLWHIV/AIDS
  • Mortality rates continue to decrease due to access to treatment
  • Prevention activities not keeping pace with changes in epidemic

Success Story: Australia

Through coordinated prevention efforts and policy changes, the epidemic among gay men has been managed better than in other countries.

International HIV/AIDS Toolkit

the impact hiv aids burdens health care systems
The Impact HIV/AIDS Burdens Health Care Systems
  • In greatly affected countries, health care costs are increasing while the total availability of health care is dropping for everyone, especially the poor.
  • On average, the cost of treating a person living with HIV/AIDS for one year is equivalent to educating 10 primary school students for a year.

International HIV/AIDS Toolkit

the rationale canada has committed itself to help
The Rationale Canada Has Committed Itself To Help
  • The Canadian Strategy on HIV/AIDS calls on us to increase Canada’s participation in international HIV/AIDS activities and facilitate collaboration.
  • Canada supports the Convention on the Rights of the Child and the United Nations’ International Guidelines on HIV/AIDS and Human Rights.
  • In 2001 at the United Nations General Assembly, Canada will champion efforts to address the crisis of children affected by the HIV/AIDS epidemic.

International HIV/AIDS Toolkit

the rationale we are internationally recognized leaders
The Rationale We Are Internationally Recognized Leaders
  • Canada has a long and distinguished history as a diverse and outward-looking society, committed to providing significant humanitarian support.
  • Our work with NATO, our contribution to eliminating landmines and our role in the recent Kosovo crisis confirm our credibility and leadership abilities.
  • Our medical breakthroughs (e.g. 3TC) allow us to speak with an expert voice on a world stage.

International HIV/AIDS Toolkit

taking action share technical expertise
Taking ActionShare Technical Expertise
  • Canada’s reputation for excellence in HIV/AIDS issues ensures that our technical expertise is in great demand around the world.
  • Taking action could mean providing technical assistance to other Canadian organizations acting globally, international NGOs/ASOs, sponsors of large-scale or multi-disciplinary projects (e.g. CIDA, World Bank, Health Canada, UNAIDS).

International HIV/AIDS Toolkit

taking action build communities and their capacity
Taking ActionBuild Communities and Their Capacity
  • To prevent the continued spread of HIV and mitigate impact, investments must be made in communities to build their capacity to deal with the epidemic and sustain an effective response.
  • Program ideas include training in public awareness strategies, providing tools to engage the private sector, supporting advocacy groups, providing training in organizational development, and preparing sites for clinical trials of promising preventative measures.

International HIV/AIDS Toolkit

getting started embarking upon your own response
Getting StartedEmbarking Upon Your Own Response
  • Determine areas of strength or “comparative advantage”
  • Identify institutional readiness to undertake international HIV work
  • Understand the challenges that you will face
  • Determine senior management commitment to acting globally

International HIV/AIDS Toolkit

mobilizing for more focused advocacy

Mobilizing for More Focused Advocacy

The UNGASS Declaration of

Commitment

International HIV/AIDS Toolkit

declaration of commitment on hiv aids
Declaration of Commitment on HIV/AIDS
  • UN General Assembly Special Session (UNGASS) on HIV/AIDS – June 2001
  • Adopted unanimously by all 189 UN member states
  • A resolution of General Assembly, not a treaty or convention
    • Statement of intent: a plan governments say they are going to follow

International HIV/AIDS Toolkit

slide18
Leadership

Prevention

Care, support and treatment

Human rights

Reducing vulnerability

Children

Alleviating social and economic impact

Research and development

AIDS in conflict and disaster-affected regions

Resources

Follow-up

Declaration of Commitment on HIV/AIDSContains a preamble and a series of commitments divided into 11 areas

International HIV/AIDS Toolkit

why is the declaration important
Why is the Declaration important?
  • Sets real targets and deadlines
  • Constitutes unprecedented commitment by governments
  • More detailed blueprint than national AIDS strategies of most countries
  • Blueprint NGOs can use for advocacy and education, and to hold governments accountable

International HIV/AIDS Toolkit

strategies national state level
STRATEGIES (national, state level)
  • Disseminate Declaration widely
  • Analyze Declaration
    • Identify commitments that support existing advocacy
    • Identify commitments you can use to do new advocacy
  • Develop advocacy campaigns around commitments you select

International HIV/AIDS Toolkit

strategies
STRATEGIES
  • Hold your governments accountable for following through on the commitments
    • Ask how they plan to reach targets
    • Tell them what the priority commitments are
    • Call for action plan with timelines
    • Ask them how they plan to monitor implementation

International HIV/AIDS Toolkit

strategies1
STRATEGIES
  • Use Declaration to argue for more resources
  • Use the Declaration as benchmark
  • Develop strategies to monitor implementation
  • Lobby to be part of process
  • Build coalitions outside HIV/AIDS

International HIV/AIDS Toolkit

strategies aso level
STRATEGIES (ASO level)
  • Familiarize your organization with content of Declaration
  • Distribute copies in your community
  • Connect with other organizations that have used Declaration

International HIV/AIDS Toolkit

strategies2
STRATEGIES
  • Identify how Declaration relates to work already doing
  • Formally endorse Declaration
  • Use Declaration to support funding proposals
  • Share your experiences, lessons learned

International HIV/AIDS Toolkit

global resources available to address hiv aids
Global resources available to address HIV/AIDS
  • UNAIDS estimates we need about $US10 billion per year by 2005, then $US15 billion per year by 2007
  • Resources come from World Bank, Clinton Foundation, Bush Initiative, Global Fund and other bilateral and multilateral support.
  • 20-30% comes from domestic (personal, state, business) sources the rest from donor assistance
  • Abuja Declaration commits African countries to earmark 15% to health spending

International HIV/AIDS Toolkit

background
Background
  • The Global Fund is an international, independent public-private partnership designed to attract and manage significant new sums of money to finance the fight against AIDS, tuberculosis and malaria
  • Only developing countries can apply for funding
  • Countries are required to set up multi-sectoral country coordinating mechanisms where communities must be represented

International HIV/AIDS Toolkit

global fund
Global Fund
  • Independent, public/private partnerships

The Fund does not fall under the UN umbrella. It has autonomy and is structured to conduct its affairs in a business-like and transparent fashion.

  • Country driven, centrally accountable

The Fund defers to countries to design proposals based on local needs, but holds these to central standards of best practice and accountability.

  • Results based disbursement

Recipients must meet their milestones for the funds to keep flowing.

  • Fund Structure

The board is comprised of 18 voting members representing public donors, the private sector, recipient countries and civil society. The World Bank, WHO and UNAIDS are non-voting members

International HIV/AIDS Toolkit

approval rounds
Approval Rounds

International HIV/AIDS Toolkit

distribution by region
Distribution By Region

International HIV/AIDS Toolkit

by disease
By disease

International HIV/AIDS Toolkit

by type for activity
By Type for Activity

International HIV/AIDS Toolkit

by recipient
By Recipient

International HIV/AIDS Toolkit

global fund required revenue
Global Fund Required Revenue

New resources are needed and should not come from existing commitments to international development assistance.

  • 1.7 billion is needed for 2004, of which only 1.5 has been pledged
  • Needs for 2005 will total $3.6 billion based on a significant demand on resources for renewals and new proposal rounds
  • The Goal:
    • Donor Governments will cover 95%.
    • Private Foundations and corporations will cover 5%, including major philanthropic foundations and cash donations by private for-profit companies
    • Individuals will cover less than 1%

International HIV/AIDS Toolkit

equitable contribution 2002 4
Equitable Contribution (2002-4)

International HIV/AIDS Toolkit

shortcomings and risks
Shortcomings and Risks
  • Country Coordinating Mechanisms (CCMs) function poorly in some settings
  • Disbursement has been slow both by the Secretariat and Principle Recipients
  • Could lose momentum—Round 4 underfunded

International HIV/AIDS Toolkit

challenges
Challenges
  • Funding
  • Measurement of results
  • Vote for Communities
  • In-kind contributions

International HIV/AIDS Toolkit

fund the fund campaign
Fund the Fund campaign
  • Created in 2003, the “Fund the Fund” campaign is aimed at civil society organizations including non-governmental, community-based, people living with the diseases, faith-based and trade unions to promote their advocacy for increased investment in the Global Fund
  • It calls on nations to commit to annual contributions to the Global Fund based on the Equitable Contributions Framework (ECF): Each country’s contribution is based on that country’s gross domestic product (GDP)
  • Canada should contribute US$55 million in 2004 but has committed only US$25 million
  • In 2005 based on the ECF Canada should commit US$75 million but so far has pledged US$50 million

International HIV/AIDS Toolkit

for more information
For more information
  • Canadian Fund the Fund Campaign
    • http://ca.groups.yahoo.com/group/fundthefundcanada/
  • International Fund the Fund Campaign
    • www.fundthefund.org

International HIV/AIDS Toolkit

advocacy on access to treatment

Advocacy on Access to Treatment

International HIV/AIDS Toolkit

the obstacles
The obstacles
  • poor health infrastructures
  • the high cost of drugs
  • Inadequate political will

International HIV/AIDS Toolkit

the context
The Context
  • Epidemiology: More than 95% of PLWHIV/AIDS live in developing countries,
  • Per Capita Income: $25,732 in rich countries versus $440 in sub-Saharan Africa and $500 in South Asia,
  • Per Capita Health Spending: $1500 in North America vs. $204 in Africa and Asia,

International HIV/AIDS Toolkit

context
Context
  • Other priorities such as; clean water, adequate housing and nutrition, and decent schools and highways.
  • Other serious epidemics, such as tuberculosis and malaria
  • The Market for Drugs: Africa accounts for just 1%.

International HIV/AIDS Toolkit

poor health infrastructure
Poor Health Infrastructure
  • Too few clinics, hospital beds and laboratories.
  • Shortage of competent health care professionals.
  • lack of medical and laboratory equipment
  • Drug distribution systems are incomplete.
  • Adequate food, clean water,

International HIV/AIDS Toolkit

addressing the the high cost of drugs
Addressing the The High Cost of Drugs
  • Distribution Pipelines: United States-Venezuela Air Bridge
  • Bulk Buying: has reduced prices in the countries of the Caribbean
  • Technology Transfer: Building local infrastructure
  • Amendment to Canadian Patent Legislation to allow generic manufacturers to export cheaper drugs to countries in need

International HIV/AIDS Toolkit

international initiatives
International initiatives
  • WHO 3by5* -- provides technical assistance and standards concerning the scale up of treatment programs (*3 million on treatment by 2005)
  • Global Fund to Fight HIV/AIDS, TB and Malaria – provides financing to country-led initiatives
  • President’s Emergency Plan for AIDS Relief (PEPFAR) will spend US$15 billion over 5 years in 14 countries in the Caribbean and Africa to support AIDS projects
  • Clinton Foundation – works with governments to help finance projects using bilateral funding mechanisms

International HIV/AIDS Toolkit

global treatment access group gtag
Global Treatment Access Group (GTAG)
  • Increasing support to the Global Fund and other bilateral and multi-lateral mechanisms;
  • All trade agreements (including TRIPS, FTAA and others) must allow for the effective use of compulsory licenses for producing quality generic medicines for export to developing countries;
  • Official Development Assistance for health care infrastructure in developing countries should be increased.

International HIV/AIDS Toolkit

what is gtag
What is GTAG
  • GTAG is a working group of Canadian non-governmental organizations (NGO’s) sharing information and developing joint campaigning activities aimed at improving access to essential medicines and other aspects of care, treatment and support for people living with HIV/AIDS in developing countries
  • GTAG focuses its efforts on both the Canadian government and international actors

International HIV/AIDS Toolkit

what does gtag do
What does GTAG do?
  • The working group monitors and undertakes activities with respect to issues such as:
  • Canada’s positions in political and trade forums which affect access to essential medicine for treatment of HIV/AIDS and opportunistic infections
  • Canada’s contributions to global initiatives such as the Global Fund and Canada’s contributions to ODA and debt cancellation
  • CIDA policies and guidelines as they related to access to treatment
  • Prepares policy papers and public education information
  • Participates in national and international forums dealing with global access to treatment and health care
  • Letter writing campaigns, policy submissions and other actions directed at government policy makers in Canada and internationally

International HIV/AIDS Toolkit

how to become a member
How to become a member
  • NGO’s are encouraged to become members of GTAG
  • The NGO should designate a person who can represent it on GTAG and serve as the liaison between their organization and GTAG and be responsible for obtaining the necessary approval of their organization to participate in joint activities
  • No funding is available for GTAG’s work. Costs of participation and activities are borne by participating NGO’s
  • Contact Richard Elliott at the Canadian HIV/AIDS Legal Network. Telephone (416) 595-1666 or e-mail relliott@aidslaw.ca

International HIV/AIDS Toolkit

organizations canada
ORGANIZATIONS: CANADA
  • Canadian HIV/AIDS Legal Network
  • Canadian Treatment Advocates Council (CTAC)
  • Interagency Coalition on AIDS and Development (ICAD)
  • Médecins sans frontières / Doctors Without Borders Canada (MSF Canada)
  • Oxfam Canada
  • Canadian Labour Congress

International HIV/AIDS Toolkit

international organizations involved in access to treatment
International Organizations involved in access to treatment
  • Countries Consumer Project on Technology (CPT)
  • Health Global Access Project (GAP) Coalition
  • HIV & AIDS Treatment Action Campaign (TAC)
  • International Gay and Lesbian Human Rights Commission (IGLHRC)

International HIV/AIDS Toolkit

e mail discussion fora
E-mail discussion fora
  • Treatment Access Forum
    • www.hivnet.ch:8000/topics/treatment-access/
  • Pharm-Policy Mailing List
    • Lists.essential.org/mailman/listinfo/pharm-policy

International HIV/AIDS Toolkit

introduction to microbicides

Introduction to Microbicides

International HIV/AIDS Toolkit

what is a microbicide
What is a microbicide?
  • A microbicide is any substance that can substantially reduce transmission of sexually transmitted diseases (STDs) when applied in the vagina or the rectum
  • Like today’s spermicides, a microbicide could be produced in many forms:
      • Gels, creams, films, suppository, sponge, vaginal ring, or vaginal wipe

International HIV/AIDS Toolkit

what would they be like
What would they be like?
  • Some will also prevent pregnancy
  • Others will be microbicidal but not contraceptive
  • Many candidate products are broad spectrum reducing risk of some other STDs, in addition to HIV

International HIV/AIDS Toolkit

how effective will they be
How effective will they be?
  • First microbicides will be 50-60% protective
  • 2nd generation products will be 70-90%
  • should be promoted these adjunct or “back-up” to condoms, not as a replacement
  • use with harm reduction messages, such as:
    • Use a male or female condom every time you have sex; if you absolutely can’t use a condom, use a microbicide
    • Use a microbicide with your condom for added pleasure and protection

International HIV/AIDS Toolkit

how microbicides are developed
How microbicides are developed
  • Test existing substances for microbicidal potential
  • Explore novel compounds that either:
      • kill or disable the pathogen
      • boost vaginal/rectal defense systems
      • make a barrier to protect the vaginal/rectal walls
      • prevent infection from taking hold once the virus enters the body

International HIV/AIDS Toolkit

examples of products in development
Examples of products in Development
  • Carraguard
  • Savvy
  • BufferGel
  • Pro 2000
  • Invisible condom
  • Cellulose sulfate
  • Dextrine Sulfate

International HIV/AIDS Toolkit

numbers of products in development
Numbers of products in development

International HIV/AIDS Toolkit

development will require significant government investment
Development will require significant government investment

Large pharmaceutical companies have relatively

little interest in pursuing microbicides

  • perceived low profitability
  • liability concerns
  • lack of in-house expertise
  • uncertain regulatory environment

For the last 20 years, almost all funding for

contraceptive development and related research

has come from governments and foundations.

International HIV/AIDS Toolkit

the microbicide universe
The Microbicide Universe
  • 35 biotech companies
  • 44 non-profit research entities
  • 4 public-sector entities

International HIV/AIDS Toolkit

potential public health impact
Potential public health impact

If a…………….60% effective product

Offered to……..73 lower income countries

Is used by…….. 20% people reached by healthcare

during…………50% of sex acts when condoms isn't

= 2.5 million HIV infections averted in 3 years (including women, men and children)

By comparison:

People newly infected with HIV (2002)…. 5 mil

Women = 50% of newly infected = approx. 2.5 mil.

International HIV/AIDS Toolkit

the players
The players
  • Global Campaign for Microbicides (GCM)
  • International Partnership for Microbicides (IPM)
  • Canadian AIDS Society (CAS)
  • Microbicides Advocacy Group Network

(MAG-Net)

International HIV/AIDS Toolkit

how to become involved
How to become involved
  • Join MAG-Net and the Global Campaign for Microbicides
  • Get your organization to take on microbicides by raising awareness, taking on advocacy or community preparedness.
  • Visit the following web sites:
    • www.global-campaign.org
    • www.ipm-microbicides.org
    • www.microbicide.org
    • www.lifelube.org
    • www.cdnaids.ca

4) Sign up for the bi-weekly e-newsletter of the GCM at www.global-campaign.org

International HIV/AIDS Toolkit

introduction to h iv vaccines

Introduction to HIV Vaccines

International HIV/AIDS Toolkit

definition
Definition
  • A vaccine is a substance that teaches the body’s immune system to recognize and protect against a disease caused by an infectious agent.

International HIV/AIDS Toolkit

a vaccine primer
A vaccine primer
  • 200 years of vaccines
  • Common vaccines
  • Types of immunity: humoral (antibody) and cell-mediated
  • An ideal HIV vaccine
  • Preventative or therapeutic?
  • Vaccine development stages

International HIV/AIDS Toolkit

state of vaccine research
State of Vaccine Research
  • First trial in 1987
  • 30 products tested
  • 60 clinical trials
  • 2 phase III trials
  • 1% of global health R&D
  • In Canada, only AIDSVAX trial
  • $2.14 million in Canada on research

International HIV/AIDS Toolkit

state of canadian vaccine research
State of Canadian vaccine research
  • CANVAC
  • CIHR
  • CIDA grant to IAVI
  • Globally: a few pharmas, universities and governments
  • A narrow pipeline!

International HIV/AIDS Toolkit

impact on the epidemic
Impact on the epidemic

Low-efficacy:

  • Delivered to « high-risk » population
  • Level of awareness of vaccines
  • Level of trust of vaccines
  • Attitudes towards HIV/AIDS
  • Stigma & discrimination

International HIV/AIDS Toolkit

impact on the epidemic1
Impact on the epidemic

Low-efficacy (2)

  • Rates of coverage
  • Vaccine optimism
  • Combination prevention

High efficacy

  • Very similar issues!

No efficacy BUT still OK!

International HIV/AIDS Toolkit

who s who
Who’s Who
  • International AIDS Vaccine Initiative (IAVI)
  • Canadian AIDS Society (CAS)
  • Canadian HIV/AIDS Legal Network
  • Canadian Network for Vaccines and Immunotherapeutics (CANVAC)

International HIV/AIDS Toolkit

canadian hiv vaccines plan
Canadian HIV Vaccines Plan
  • 1) Ensuring Canada’s commitment to the development of HIV vaccines
  • 2) Ensuring public engagement
  • 3) Ensuring integrated strategic plans for HIV vaccine research and development
  • 4) Ensuring equitable vaccine access and delivery

International HIV/AIDS Toolkit

becoming involved
Becoming involved
  • Getting and disseminating information
  • Subscribing to IAVI Report or VAX
  • Advocating for vaccine development
  • Raising information in your community
  • Participating in development of Canadian HIV Vaccines Plan

International HIV/AIDS Toolkit

sources of information
Sources of Information
  • www.iavi.org IAVI Report, VAX
  • www.avac.org Handbook, reports
  • www.cdnaids.ca Basics, advocacy updates
  • www.aidslaw.ca Discussion paper, info sheets
  • www.icaso.org Primers
  • www.canvacc.org Vaccines, R&D

International HIV/AIDS Toolkit

overseas partnerships

Overseas Partnerships

International HIV/AIDS Toolkit

background1
Background
  • For many organizations getting involved in international HIV/AIDS as part of their work takes the form a partnership with another organization in a developing country.
  • Many opportunities exist for such partnerships, including twinning and internships

International HIV/AIDS Toolkit

what is twinning
What is twinning?
  • Twinning is a formal, substantive collaboration between two or more organizations anywhere in the world.
  • It is a process in which AIDS service organizations (ASOs), non-governmental organizations (NGOs), researchers and other institutions come together to contribute to each other’s work and to learn from each other’s experiences

International HIV/AIDS Toolkit

how do we organize an internship
How do we organize an internship?
  • ICAD can link organizations in Canada with similar organizations abroad. Consequently, each intern will be attached to a Canadian host agency two months - one month before and one month after the overseas placement. The overseas placement usually lasts between 5 to 6 months.
  • Internships are part of a Canadian International Development Agency (CIDA) program offering post-secondary graduates the opportunity to gain valuable international development work experience.
  • The Canadian host will be responsible for the recruitment and selection process.

International HIV/AIDS Toolkit

how do we find a partner
How do we find a partner?
  • Enter your organization in the Canadian HIV/AIDS Skills Database on ICAD’s web site
  • Visit the section on finding a twinning partner on the ICAD web site
  • Contact a development NGO in your community

International HIV/AIDS Toolkit

explore twinning
Explore Twinning
  • Generate the idea
  • Conduct a needs assessment and capacity assessment
  • Establish clear goals
  • Obtain organizational commitment
  • Identify who will be involved
  • Identify potential sources of funding
  • Identify potential partner
  • Discuss twinning with potential partner
  • Obtain agreement to proceed
  • Select the form of twinning

International HIV/AIDS Toolkit

plan and implement twinning
Plan and Implement Twinning
  • Prepare an outline of the twinning project
  • Obtain agreement on the outline
  • Prepare a detailed project plan
  • Obtain agreement on the plan
  • Obtain funding
  • Implement the project
  • Monitor and evaluate the project

International HIV/AIDS Toolkit