Transcript Document

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
• 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
• 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)
• 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
• 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
• Caribbean most affected region after SubSaharan 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.
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Eastern Europe and Central Asia:
1.5 million PLWHIAV/AIDS
• Epidemic still exploding since the mid1990s
• Epidemic driven so far mostly by
injection drug use
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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.
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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
• 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 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
• 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
• 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
• 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
• 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
The UNGASS Declaration of
Commitment
International HIV/AIDS Toolkit
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
Declaration of Commitment on
HIV/AIDS
Contains a preamble and a series of commitments
divided into 11 areas
– 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
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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
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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
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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
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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
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STRATEGIES (ASO level)
• Familiarize your organization with
content of Declaration
• Distribute copies in your community
• Connect with other organizations that
have used Declaration
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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
The Global Fund to fight
AIDS, Tuberculosis and
Malaria
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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
• 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
• 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
Rounds
Round 1
36
Approved
Amounts
565 million
Round 2
73
866 million
Round 3
61
623 million
Total
Countries
*121
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2,045 million
Distribution By Region
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By disease
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By Type for Activity
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By Recipient
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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)
Source of funds
% world
GDP
Eq. Co.
($5,945m)
Pledged
2002-4
Shortfall
2002-4
France
4%
248
294 m.
None
Germany
6%
356
50 m.
306
Italy
3%
207
200 m.
7
UK
4%
267
168 m.
99
Point Seven Group
3%
193
249 m.
None
United States
33%
1,933
825 m.
1,108
Canada
2%
129
75 m.
54
Japan
14%
807
200 m
607
(Denmark, Ireland, Netherlands,
Norway, Sweden)
International HIV/AIDS Toolkit
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
•
•
•
•
Funding
Measurement of results
Vote for Communities
In-kind contributions
International HIV/AIDS Toolkit
Fund the Fund campaign
• Created in 2003, the “Fund the Fund” campaign is
aimed at civil society organizations including nongovernmental, 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
• Canadian Fund the Fund Campaign
– http://ca.groups.yahoo.com/group/fundthef
undcanada/
• International Fund the Fund Campaign
– www.fundthefund.org
International HIV/AIDS Toolkit
Advocacy on Access to
Treatment
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The obstacles
• poor health infrastructures
• the high cost of drugs
• Inadequate political will
International HIV/AIDS Toolkit
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
• 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
• 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
• Distribution Pipelines: United StatesVenezuela 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
• 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)
• 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
• GTAG is a working group of Canadian nongovernmental 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
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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
• 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
[email protected]
International HIV/AIDS Toolkit
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
• 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)
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E-mail discussion fora
• Treatment Access Forum
– www.hivnet.ch:8000/topics/treatmentaccess/
• Pharm-Policy Mailing List
– Lists.essential.org/mailman/listinfo/pharmpolicy
International HIV/AIDS Toolkit
Introduction to
Microbicides
International HIV/AIDS Toolkit
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?
• 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?
• 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
• 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
•
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•
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•
Carraguard
Savvy
BufferGel
Pro 2000
Invisible condom
Cellulose sulfate
Dextrine Sulfate
International HIV/AIDS Toolkit
Numbers of products in
development
International HIV/AIDS Toolkit
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
• 35 biotech companies
• 44 non-profit research
entities
• 4 public-sector entities
International HIV/AIDS Toolkit
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
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•
•
•
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
1)
Join MAG-Net and the Global Campaign for Microbicides
2)
Get your organization to take on microbicides by raising awareness,
taking on advocacy or community preparedness.
3)
Visit the following web sites:
–
–
–
–
–
4)
www.global-campaign.org
www.ipm-microbicides.org
www.microbicide.org
www.lifelube.org
www.cdnaids.ca
Sign up for the bi-weekly e-newsletter of the GCM at www.globalcampaign.org
International HIV/AIDS Toolkit
Introduction to HIV Vaccines
International HIV/AIDS Toolkit
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
• 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
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•
•
•
•
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
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State of Canadian vaccine research
•
•
•
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CANVAC
CIHR
CIDA grant to IAVI
Globally: a few pharmas, universities
and governments
• A narrow pipeline!
International HIV/AIDS Toolkit
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 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
• 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
• 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
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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
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•
•
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www.iavi.org
www.avac.org
www.cdnaids.ca
www.aidslaw.ca
• www.icaso.org
• www.canvacc.org
IAVI Report, VAX
Handbook, reports
Basics, advocacy updates
Discussion paper, info
sheets
Primers
Vaccines, R&D
International HIV/AIDS Toolkit
Overseas Partnerships
International HIV/AIDS Toolkit
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?
• 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?
• 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 postsecondary 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?
• 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
• 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
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Plan and Implement Twinning
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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