CARIBBEAN COALITION OF NATIONAL AIDS PROGAMME COORDINATORSPANCAP 9TH ANNUAL GENERAL MEETING National HIV/AIDS Country Report: Achievements, Issues and Challenges in the Implementation of National AIDS Programmes Dr. Kevin Harvey October 29, 2009
Background HIV in the Caribbean • Transmission: Primarily Heterosexual • 230,000 persons are currently living with HIV in the Caribbean region • The HIV/AIDS epidemic has left approximately 250,000 Caribbean children orphaned • Trinidad 2006, 20% HIV prevalence among MSM, 25% of whom regularly also have sex with women
Background – Cont’d As HIV continues to disproportionally affect vulnerable populations we thought it poignant to examine some of the issues taking place on a National level. Focus was directed at four critical areas: • Strategic Planning • Prevention • Treatment Care and Support • Monitoring and Evaluation (M&E)
Methodology • In September 2009, a survey instrument was disseminated to the CCNAPC membership which encompasses thirty four (34) countries in the French, Spanish, Dutch and English speaking Caribbean. • Questions were adapted from the UNAIDS Guidelines on Construction of Core Indicators 2010 Reporting. • Questionnaire was administered using an online survey instrument facilitating the ease of response.
SCOPE OF THE REPORT • This Report does not attempt to examine in depth all aspects of the four (4) topic areas. • It seeks to provide a snapshot of strides made by countries with respect to acknowledging and institutionalising policies and programmes, specifically with respect to youth and most-at-risk populations (MARPs). • It represents a report card on the performance of countries and can provide a baseline against which to measure future activities in these critical areas.
Multi-sectoral response to HIV Eighty percent (80%) of countries have adopted a national multi-sectoral approach to HIV
Behind the Data • Twenty percent (20%) of countries are still operating without or are in the process of developing a multi-sectoral approach. • Of those countries with a multi-sectoral strategy specific HIV budget for activities was available only in the areas of health, education, women and youth
Legal protection for the vulnerable Just over half (55%) of the countries had non-discrimination laws or regulations with specific protections for MARPs
Legal protection for the vulnerable • Protective laws and regulation focused overwhelmingly on women and young people. • There was limited or no focus on CSW, MSM or substance abusers.
Legal protection for the vulnerable There continues to be a significant gap in policies and legislation with respect to the inclusion and protection of vulnerable populations specifically men who have sex with men, sex workers, prisoners and migrant populations.
HIV Prevalence among female Sex Workers Caribbean Technical Expert Group 2004, Gebre et al 2006, UNAIDS 2007
Legal protection for the vulnerable Stigma continues to limit the effectiveness of interventions thus preserving a reservoir of the virus which will continue to transcend into the general population unless mechanisms can be found to provide the necessary prevention, treatment, care and support service to all MARPS. Policy and legislative changes must occur to ensure that needed HIV service reach those most in need.
Treatment Care and Support • Eighty six percent (86%) of countries have a policy or strategy promoting comprehensive HIV treatment, care and support inclusive of community-based care and psychosocial care. • With respect to addressing barriers facing MARPs the number were drastically lower. • Within the vulnerable groups greater attention was focused on women and young people (67%), with only 35% of countries addressing barriers facing people who trade sex for drugs.
Treatment Care and Support • In terms of actual services being implemented, out of a comprehensive listing of sixteen HIV treatment, care and support services recipients were asked to indicate whether they felt that most of the people in need of service had access to services. • Only in two areas; workplace or treatment referral systems through the workplace and HIV care and support in the workplace (including alternative working arrangements) did more than 50% of recipients agree that access to the majority was lacking.
Reproductive and sexual health education Twenty six percent (26%) of countries do not have a policy or strategy for promoting HIV related reproductive and sexual health education
Prevention While 70% of countries reported having a policy or strategy promoting HIV related reproductive and sexual health education for young people less than half (35%), actually had an education strategy targeting out of school youths.
Prevention With respect to MARPs about sixty five percent (65%) of respondents indicated that they did have a policy or strategy promoting information, education, communication and other preventative health interventions for this group.
Areas of focus and MARPS covered • Policies and strategies focus on: • Risk reduction information and HIV education • Stigma and discrimination reduction • Condom promotion • HIV testing and counselling • Reproductive health, and STI prevention and treatment • Strategies address HIV+, MSM, CSW and prison inmates populations • Lack of strategies towards drug abusers
Monitoring & Evaluation plan Fifty nine percent (59%) have a M&E Plan, while 41% do not or are in the process of development
Support for M&E Thirty five percent (35%) of countries have a budget, 35% in progress, 30% do not have M&E budgeted.
Monitor and Evaluation Units Forty one (41%) yes, 23% in progress, 36% none
Central National Database Fifty nine (59%) yes, 41% no.
Use of M&E data 60% of countries have been using M&E to inform their National AIDS Strategy, 57% used to determine resource allocation and 73% for Programmatic improvement.
In Closing Countries have made great strides with respect to scaling up of their National AIDS Programmes to meet the needs of a “generalised” epidemic. But the literature and research findings continue to show a disproportionate growth among specific interventions for MARPs.
Call to Action In order to effectively address the needs of those most-at-risk National AIDS Programmes will require targeted technical, financial and political support to redefine strategies to focus on mitigating the impact of the epidemic amongst those most affected -MARPS