Regional strategy supporting the national strategic plans of countries

1. Regional strategy supporting the national strategic plans of countries Managing Change in Small Islands Room 203 – 204 Monday 21 July 2014 Dr. Jason Leo Iane Mitchell CEO-OSSHHM 20th IAC Melbourne

2. Overview • Brief Pacific introduction • Historical overview Pacific response • HIV epidemic status 4 decades later • Lessons learnt • The change-Shared agenda

3. The Pacific in focus

5. The Pacific in focus • 22 Countries in the Pacific • 21 smaller Pacific Island Countries and Territories • Population size 67(2011) – 850,000 (2013) • Religious and cultural diversity • Third of the world’s languages • 21 systems and governments to work with • Country support provided regionally

6. History and Evolution of the Regional Response to HIV ‘A PERIOD OF FOUR DECADES’

7. Regional Response: 1st Decade 1980-1989 • HIV is a non-issue for Pacific • Focus more on public awareness • Response driven by government • First case of HIV diagnosed 1984 1 6 1 1985

8. Regional Response:2nd Decade 1990-1999 • Country leaders met to discuss the potential threat of HIV to PICTS • HIV response treated as an emergency in many countries • Engagement with national traditional and religious leaders

9. Regional Response: 3rd Decade 2000-2009 2002 • Pacific forum leaders acknowledge HIV as an important development issue 2004 • Endorsement of the Pacific Regional Strategy on HIV/AIDS (2004–2008) 2008 • Endorsement of the Pacific Regional Strategy against STIs and HIV (2009-2013). • Developed by Gov, NGO sectors and regional development partners

10. Pacific Regional Strategy on HIV/AIDS (2004–2008) • Pacific Regional Strategic Implementation Plan (PRSIP I) • 8-thematic areas organised into 4 components: • Leadership and governance • Access to quality services • Regional coordination • Programme management • Scaling up of regional support to facilitate growing national efforts • Largely government focused and driven • Resourcing: Global fund, AusAID, NZaid, ADB and French funding • Emerging evidence for HIV & STI

11. Pacific Regional Strategy on HIV and other STIs(2009-2013) • PRSIP II framework to respond to STIs & HIV nationally and regionally • 6 Thematic areas (consistent with country NSPs): • Prevention programmes(MSM, SW, Seafarers, servicemen) • HIV and STI diagnosis (focus on STI and HIV) • Continuum of care, treatment and support systems and services (focus on STI and HIV) • Leadership and enabling environment • Strategic information and communication • Governance and coordination (Govt and NGO) • Regional division of labor supporting national responses • Resourcing: Global Fund R7 and the Response fund, minimal national resources • Greater emphasis in CBO and community engagement

12. Partners working together-PRSIP II

13. Regional Response:4th decade 2010 + 2013 • Major funding mechanism for PRSIP II (GF and RF) came to an end • Regional STI & HIV strategy ended • Many countries left with little to no technical and financial support regionally • Consultations for the development next regional response begins

14. Two regional strategies later • Greater engagement with communities in planning and implementation of strategies and programmes nationally • Greater evidence emerging • HIV focused in the general population – SGS x 2 • Key population- challenging stereotypes • Few countries beginning to repeal draconian laws particularly around MSM • Fiji, PNG and Palau have standalone HIV legislation • Other countries continue to reform in support of enabling environments • Prohibitive laws still exist MSM/TG, SWs and drug use

15. HIV epidemic status 4 decades later

16. Lessons learnt 3 decades later • Need to link HIV, STI, gender, sexual and reproductive health programmes. • Social research to inform policy and programming. • Better evidence of the critical role that social, cultural and religious factors have on the effective implementation of: • HIV, STI and SRH programmes for all sectors of the community • Need for more country-focused and country-led strategic planning. • Greater engagement with other key population.

17. Rationale for a change in approach • Need for a strategic document to guide PICTs in responding to SRH issues as a whole. • Document should not prescribe a one size fits all approach but should be an overarching guidance document. • Stronger linkages/integration between HIV/STI and SRH. • Need for comprehensive approach which addresses the complexities of SRH. • Greater focus on most-at-risk and vulnerable populations.

18. Modifying the approach Extensive consultations: • Ministers & Directors of Health • National and regional stakeholders • Key populations • MSM/TG • M&F SWs • PLHIV • People living with disabilities • Youth • Women • Others

20. Conclusion The change: • Move from 2 decades of disease focused approach • Shared agenda hopes to improve access to comprehensive SRH for ALL The challenge: • regional and national resources continue to decline (human and financial) What of the shared agenda? How do we carry on from here?

21. Acknowledgements: • Ms. Michelle O’Connor and Dr. DennieIniakwala-Secretariat of the Pacific Community-various slides • To the Australian Aid programme and ASHM for their ongoing support and for supporting my involvement in this programme

22. References • SPC, 2005, Pacific regional strategy on HIV/AIDS [2004-2008], Noumea, 2005. • SPC, 2012, Pacific HIV Report 2012, Noumea, New Caledonia: Secretariat of the Pacific Community. • History and Evolution of PRSIP: Adapted from the Presentations at the Development of Shared Agenda Consultation meetings‘Making Waves’ PPT made by Dr. DennieIniakwala, HIV&STI Team Leader, Health Protection Programme, Public Health Division, SPC Nadiand Guam, March 2013. • The Pacific Sexual Health and Wellbeing Shared Agenda 2015 – 2019, PPT presentation made Ms. Michelle O’Connor at the Directors of Health meeting, Nadi April, 2014.