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  1. HIV/AIDS Policy: A global perspective

  2. Eastern Europe Ed Shaw

  3. Eastern Europe and Central Asia2005 • 1.5 m people living with HIV in Eastern Europe and Central Asia • 220 000 people newly infected • 53 000 adults and children lost thier lives (twice as many as 2003) • 21 000 out of 160 000 in need of Antiretroviral received treatment • World Health Organisation – ‘AIDS Epidemic Update 2001’ – 28th Nov 2001 • Eastern Europe had the fastest growing Epidemic in the world, in some cases increasing 15-fold in just 3 years

  4. What has been done? The speed with which the HIV epidemic is growing in Eastern Europe and Central Asia is alarming, and it is essential that governments across the world continue to provide leadership and support in the fight against HIV. With the information and experience which already exists in helping to prevent HIV transmission, it would be a tragedy if we did not incorporate the things that we have already learned in other parts of the world which have been heavily impacted by the virus. Experience has shown us what we need to do - what we need now is the leadership to make it happen. (Thomas Yocum from the Terrence Higgins Trust)

  5. AFFECTING THE YOUNG • 55% of those diagnosed with HIV in the Ukraine are between 20 and 30 • 25 % of those diagnosed with HIV in the Ukraine are younger than 20 • 60% of those diagnosed with HIV in Belarus are between 15 and 24 • 80% of those infected with HIV by drug use in Russia are below 30

  6. Why so young? Drug Use • 70% of those diagnosed with HIV in EE and CA were infected due to drug use Unsafe Sex • 45% of those diagnosed with HIV in Belarus and Moldova infected due to unsafe sex • 30% of those diagnosed with HIV in Ukraine infected due to unsafe sex • Increase in female sufferers • Increase in mother to child cases

  7. Given that 80% of those infected in Eastern Europe are young people, there is an urgent need for a massive and comprehensive response to reduce the vulnerability of young people and empower them to become active partners in the fight against Aids. If no action is taken, we will be faced with a larger Aids epidemic that risks crippling the region's social and economic development and undermining national security (Lars O Kallings, special envoy of the UN Secretary-General for HIV/AIDS in Eastern Europe)

  8. UNAIDS – ‘Training Workshop on Legal and Ethical Issues Related to HIV/AIDS’ – Moscow, Russia - 1998 • Objective: to create a team of lawyers able to pass/carry out legislation for HIV prevention, treatment and care. • Policies included: • Educating Lawyers to specialise on HIV/AIDS cases • Legal aid clinic • Counselling services • Expansion of existing laws with emphasis on HIV/AIDS • Sex/Drug education in high schools • Supportive legislation for sex/drug use in prisons • HIV and drug use courses for military personnel • Enforcing human rights as a response to HIV prevention • Courses on drug users for police and politicians • Media campaign

  9. World Bank, 2003 – Denial Syndrome • Russia’s budget is just 1% of Britain but problem is 20x larger • Initiative to raise political commitment • Finance to increase from 300m USD to 1.5bn USD

  10. Programmes, resources, and needs of HIV prevention NGOs – January 2006 • Origin of NGO Budget International Aid (33%) International Private Charities (31%) Home country government (14%) • NGO Budget consumption Needle Exchange (48%) Peer education (28%) Secondary prevention services (24%) HIV testing (8%) Condom distribution (4%) Mass media coverage (4%) • Barriers as citied by NGO Funding (72%) Government indifference (52%) Cultural Stigma (36%)

  11. What needs to be done? • Political Commitment • Rise in Home Country Governmental Aid • Increase in HIV/AIDS awareness • Mass media coverage • Education • Health clinics: HIV testing, condom distribution and Needle exchange

  12. Southeast Region:India and Thailand Shohei Kawakita and Matluba Sherzamonova

  13. Facts about HIV/AIDS in South-East Region Resource: World Health Organizationhttp://www.searo.who.int/en/Section10/Section18/Section348_9917.htm

  14. Amount of national funds spent by governments from domestic sources for AIDS in South-East Region Resource: UNAIDS http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp

  15. A case Study from India

  16. Year the epidemic was recognized as emerging. The time line of the epidemic- how it has spread over time across our region/population

  17. National AIDS Policy

  18. A case Study from Thailand

  19. References (Region) • World Health Organizationhttp://www.searo.who.int/en/Section10/Section18/Section348_9917.htm • UNAIDS http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp (India) • National Aids Policy// www.indeanembassy.org /policy/AIDS/Infro.html • Gate charity helps Indian fight NIV/AIDS .Toronto Star, Canada-24 Oct 2006 • Business Standard , India-31 Oct-2006 • A geographical perspective on HIV/AIDS in India , by Gosh, Jayati • Geographical review , 0016-7428,January 1, 2002, Vol.92,Issue 1 • AIDS.In search of social solution.Published by 3rd world Net Work TWN (Thailand) • Resource: Cornea,G.A.ed(2002): AIDS, Public Policy and Child-Well-Being,(Chapter 12) • UNICEF, Innocenti Research Center

  20. The Americas Sylvia Dickinson

  21. Basic Regional Data • Cumulative total of 1,388,810 cases of AIDS in the Americas • 25,423 were paediatric cases • A total of 716,499 cumulative deaths Courtest of PAHO: http://www.paho.org/English/AD/FCH/AI/Bulletin_AIDS_Surveillance_June_2004.pdf

  22. WHO Regional Policy Positions • Universal access to comprehensive care for HIV/AIDS/STI • Evidence-based health promotion and HIV/STI prevention affected groups including • Gender-sensitive policies and programs accommodating: • Different roles • Unequal power relationships • STI prevention, control, and education • Health as a human right

  23. A case study:Hispanics/Latinos in the US

  24. Courtesy CDC 2003

  25. Who manages policy in the US? • Centre for Disease Control • Policy developed in 1999 • Published in 2001 - most current • except for September 2006 Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Healthcare Settings. • Targeted Education and Testing • Limited to high risk populations • …”should ideally recommend testing to all clients”…regardless of HIV Hazard Rate • Mandatory testing in ‘high risk’ settings • High risk determined by setting and behaviour

  26. Designated High Risk Settings

  27. At risk population comparison Mexico United States Mexico

  28. Observations • Epidemic profile has changed • Increase in new infections, particularly among minority populations • Targeted education and testing no longer reach populations with highest rates of new infection • Revise approach to reach Hispanic/Latino population • Revise high risk settings and behaviours • Acknowledge/address cultural and gender differences that may hinder awareness • Gain access to illegal migration population

  29. MAINSTREAMING HIV/AIDS: A CASE OF SUB-SAHARAN AFRICA Bupe Mulaga and Robert Lihawa

  30. INTRODUCTION • Sub-Saharan Africa accounts for just 10% of the world’s population but is a home of more than 60% of all people living with HIV (25.8 million www.uncids.org 2005) • In most African countries, HIV/AIDS is seen as a cross cutting issue, thus it is common to argue that policy and programming responses to this epidemic need to be holistic in approach if we are to curb the epidemic.

  31. Over the past ten years, many governments in Africa, together with their trading partners, have tried to mainstream HIV/AIDS in development policies. (e.g. UNDP in Malawi) • Mainstreaming HIV/AIDS means: • The absorption of HIV/AIDS prevention, care and mitigation into the regular process of planning, budgeting, implementation, and monitoring and evaluation of programs and projects inside the organization and in its relationship with others. • It implies awareness, throughout all sectors, of the implications of HIV/AIDS for individuals, households, groups, organizations and government. (Analysis CARE Programme)

  32. Key principles: • Identifying focus entry points • Working within existing structuresstrategies • Working to the sectors comparative advantage • Identifying strategic partners (UNDP in Malawi

  33. PROGRESS SO FAR • What has happened so far leaves a lot to be desired. • Countries such as Uganda have been able to control the spread of HIV/AIDS. • Prevalence rate has dropped from 20% to 6% (highest drop in SSA). • This has been mainly due to significant change in sexual behavior and increased level of political commitment. • Uganda is the first country to develop a multisectoral response to HIV/AIDS, hence its success.

  34. How different countries in Africa are affected: • HIV prevalence vary greatly between African countries • Somalia and Senegal, prevalence rate is under 1% of adult population • South Africa, Zambia, Zimbabwe, Malawi around 15-20% • Botswana and Lesotho 24% and 23% respectively • Swaziland 33% • West Africa less affected, relatively low in Nigeria 3.9%

  35. HIV/AIDS AND LIVELIHOODSExperience in Mainstreaming from Malawi • The Malawi Growth and Development Strategy (MGDS) is the overarching strategy for Malawi for the next five years, from 2006/07 to 2010/2011 fiscal years. • The purpose of the MGDS is to serve as a single reference document for policy makers in Government; the Private Sector; Civil Society Organizations; Donors and Cooperating Partners on socio-economic growth and development priorities for Malawi.

  36. The MGDS is centered on achieving strong and sustainable economic growth, building a healthy and educated human resource base, and protecting and empowering the vulnerable. The pre-requisites for good performance of the strategy are infrastructure development and good governance. • The MGDS is based on six thematic areas namely; sustainable economic growth; social protection; social development; management and prevention of nutrition disorders and HIV and AIDS; infrastructure development; and improved governance.

  37. Throughout Sub Saharan Africa, the two-way relationship between HIV epidemic and economic /food security is undeniable CARE’s experience has shown that successful programming must take this relationship into consideration.

  38. COUNTRY SITUATION ANALYSIS • Coordination: The National Aids Commission (Led by a Multisectoral Board of commissioners, Principal Secretaries of the HIV/AIDS, Mulitsectoral District AIDs Committees, and Civil society forums etc

  39. Donor Support and Coordination: • Malawi has achieved greater gains in donor harmonization. • Malawi is also undergoing a decentralization process and currently, there are inadequate /weak systems in financial management and procurement

  40. The UNDP which was established in 1992 has tried to strengthen the understanding of the epidemic as a development issue. • Thus one of its strategic programme areas is mainstreaming HIV in villages, self help schemes, food security schemes, distribution of ARV’s etc.

  41. Challenges • Weak public-private partnership link • Unemployment (poverty) • No monitoring mechanisms to evaluate success (funds diverted) • Stigma at most work places • Exclusion of gender issues in many development policies

  42. WHAT NEEDS TO BE DONE • Increased funding • Improved targeting of women, girls and other marginalized groups to enhance their access to available HIV related services • Meeting the human resources capacity needs especially in key government ministries with special focus on health sector • Addressing the triple threat of HIV, poverty and food security findings of the MPRS review, needs to be analyzed in order to influence policy • Improved and harmonized monitoring on how well community grants support prioritized interventions • Domestic commitment e.g. Uganda case • Reduce stigmatization, especially in work places • Enhance public private partnerships