Transcript Update on the implementation of Ministerial decision

HIV and AIDS In the SADC Region
Dr Vitalis Goodwell Chipfakacha
Technical Advisor Capacity Building
and Mainstreaming HIV
SADC Secretariat
R
The combined population of the SADC
Member States is about 4% of the world
population
The region accounts for more than 37%
of people living with HIV.
It is estimated that between 11.7 and
18.8 million people of the region are
currently living with HIV
Statu
EPIDEMIC STATUS SADC REGION
• Epicenter
– SADC with 4% of the world pop carries
about 40% of HIV cases
– Contributed 40% of new cases in 2010
• Epidemic levels varies
– Ranges from .2% to >30%
– Ferminization of the epidemic very
significant
• Epidemic Maturity Varies
– Matured, maturing and less visible
DEFINTION OF TERMS
• RISK: determined by
individual behaviour
and situations
• VULNERABILITY: an
individual’s or
community’s
inability to control
their risk of
infection
• IMPACT: long-term
changes that HIV
and AIDS cause at
all levels
sadc
TYPES OF EPIDEMICS SADC REGION.
Epidemic concentrated - Transmission largely
among vulnerable groups and vulnerable group
interventions would reduce overall infection:
Madagascar, Mauritius, Seychelles and Zanzibar.
Epidemic generalized - Transmission primarily
outside vulnerable groups and would continue
despite effective vulnerable group interventions;
All 12 mainland states ;Angola, Botswana, DRC,
Lesotho, Malawi, Mozambique, Namibia, South
Africa, Swaziland, Tanzania,
Zambia and
Zimbabwe.
So why is HIV Higher in SADC Region?
• Low male circumcision rates
• Multiple concurrent partnerships
(“nyatsi,” “lishende,” “small house,”
“second office”... With inconsistent
condom use)
• Stigma/discrimination
• Weak laws/lack of enforcement of laws to
protect people esp. women, girls and
other vulnerable populations
• And various other factors, such as
relatively developed/highly mobile
societies, income inequality, gender
dynamics, "dry sex,” etc.
BIOLOGIGAL DRIVERS OF THE EPIDEMIC IN SADC
BIOLOGIGAL DRIVERS
– Low or incomplete male circumcision
– Sexually transmitted infection
– early age of sexual debut
– Partners viral load
– Blood transmission
– Surface are of genital organs
– Site of certain nerve sites with
affinity for HIV.
BEHAVIOURAL DRIVERS OF THE EPIDEMIC IN SADC
BEHAVIOURAL DRIVERS
– Incorrect and inconsistent and low
use of condoms
– Multiple and concurrent partners
– Alcohol and drug abuse
– Stigma and discrimination
– Transactional and commercial sex
– Personal knowledge of HIV status
SOCIAL DRIVERS OF THE EPIDEMIC IN SADC
SOCIAL DRIVERS
– Intergenerational sex
– Transactional sex
– Male dominated gender norms
– Sexual and gender based violence
– Erosion of traditional values
– Customary laws relating to polygamy
and other customs and rites that
negatively affect women.
STRUCTURAL DRIVERS OF THE EPIDEMIC IN SADC
STRUCTURAL DRIVERS
_Gender inequality
– Income disparities
– Migratory labour
– cross border migration
– Poverty and wealth
– Capital development projects
– Unequal access to prevention treatment
etc
– Late start on ART.
Applying and gender and human rights lens
when mainstreaming HIV
 Women 8 times more likely be infected
with HIV than men
 Women bear the burden of care for
orphans
 Gender-based discrimination hindering
access to Sexual & Reproductive Health
Services, justice, productive
resources….
Applying and gender and human rights lens
when mainstreaming HIV
Women’s vulnerability to HIV
further compounded by:
Harmful traditional or customary
practices affecting the
reproductive health of women and
children (such as early and forced
marriage);
Sexual violence;
Lack of legal capacity and
equality in family matters
SADC
SADC DEFINITION OF MAINSTREAMING
• Understand the impact of the epidemic on development and the
impact of development efforts on the epidemic, including the
aspects of development efforts that facilitate and mitigate the
spread of HIV
• Place the response to HIV and AIDS in the core agenda of all
sectors {public, NGO and private sectors} of all SADC Member
States, so that it is mainstreamed into their normal and routine
functions
• Use the comparative advantage of different stakeholders to put
in place strategies and programmes to address the epidemic
• Recognise the complementarity amongst stakeholders and their
mandates, as a pre-requisite for preventing duplication and
ensuring that resources are utilised optimally
Why Mainstreaming?
We must move from
treating the
symptoms to
treating the cause
This means dealing
with AIDS as a
development issue
Nothing less will be
effective!
Critical steps in the mainstreaming process
Know your
epidemic
Know your
response
Understand the
ministry
Strategy
formulation
• How does the
epidemic affect your
ministry?
•
• Who is affected in
the sector
(Employees etc)?
• What has your
ministry done for the
employees?
• Demographics
• What is the longer
term strategy?
• How has the
ministry responded
to
• Policies
• The Risk Scenarios:
How might the
sector contribute to
the spread of HIV
and AIDS, or
aggravate their
impact. (Internally
and externally)
• Mandates
• Planning process
• Job categories
• Who the
stakeholders?
• The Comparative
Advantage: How
can the ministry
reduce
susceptibility/vulner
ability t to HIV and
their impact
• Immediate actions
the sector can take
• Required budgets
and sources
• Linkages
• Results, indicators
Implement
M&E
• What kinds of
preparations are
needed for a
smooth take off of
the activities
• What is working or
not working and
why?
• When are we
implementing what
?
• Who is leading the
implementation
process
• Who will be
implementing what
Who will be the
implementing
partners if expertise
does not exist in the
ministry>
Sector Strategic Planning Process
• What results are
emerging:
Qualitatively and
quantitatively
• How are we
measuring the
results and what
assistance do we
need?
• Who is documenting
the results & how
are we feeding this
into the national
strategic information
system?
TERMINOLOGIES
• MAINSTREAMING IS A
MORE REFINED MULTISECTORAL APPROACH
TO THE FIGHT
AGAINST HIV AND
AIDS.
• COMPARATIVE
ADVANTAGES ARE
THE SKILLS AND
OPPORTUNITIES THE
SECTOR OFFERS.
In Sum, what mainstreaming is supposed to do?
SECRET TO SUCCESS OF MAINSTREAMING
 Target both the workplace and serviced populations with
responses, focusing on both policy change and
implementation
 Respond to the epidemic based on the comparative
advantages of the ministry and build partnerships for
implementation
 Emphasise mainstreaming with the ministry’s own
policies and
programmes and issues of sustainability
 Highlight the importance of continuous capacity building
for
integrated planning and implementation HIV strategies17
 Use evidence as a basis for responding to the epidemic
International commitments/Promises
GUIDING Principles
•
2000 Millenium Declaration (targets to 2015)
•
2001 UNGASS Declaration of Commitment
•
Maseru Declaration
•
2006 Abuja Declaration: Common Position on UA
•
2006 Political Declaration on UA (UNGA)
•
2010 Kampala Summit: UA commitment extended to 2015
•
2011 AU Consultative Process: Africa Common Position to HLM
•
2011 Political Declaration (targets to 2015)
•
2012 African Road Map
•
2013 Abuja +12
•
Post 2015 Landscape
2011 Political Declaration (targets to 2015)
Reduce sexual transmission of HIV by
50%
STATUS OF THE EPIDEMIC IN ESA
• In 2010, there were approximately 2.7 million new
infections in adults globally; 1,2 million of them were
in ESA.
• Decline in New Infections from 2001 to 2009:
– 3 countries achieved over 50%;
– 8 countries (including South Africa) achieved 3049%;
– 3 countries achieved10% or less;
– 1 country’s incidence increased by 4%.
• All countries need to achieve 50% decline from 2009
to 2015
Why Mainstreaming is sooo important now
than never before
WHY INVESTMENT FRAMEWORK?
 Decline in international funding begs for new
approach
 Major focus on efficiency, effectiveness and
sustainability in countries and by key partners
(World Bank, GFATM, USG, Gates, etc)
 Prominent in 2011 Political Declaration on AIDS
 Shared responsibility message critical
WH?
LINKAGES CSLTC AND
SADC APPROACHES.
• RIDSP
• SRH ESA
COMMITMENT
• NEW HIV STRATEGY
• M & E PROJECT
• New Food and
Agricultural strategy
• Maseru Declaration
• Minimum Standards
THANK YOU
MUITO OBRIGADO
MERCI BEAUCOUP
TATENDA