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AGAINST HIV/AIDS

AGAINST HIV/AIDS . A MULTICULTURAL CARIBBEAN UNITED AGAINST HIV/AIDS. HIV/AIDS IN THE CARIBBEAN:. FIGHTING BACK THROUGH MAINSTREAMING. Karl Theodore Health Economics Unit (HEU) The University of the West Indies Trinidad and Tobago Santo Domingo, March 5-7, 2004.

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AGAINST HIV/AIDS

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  1. AGAINST HIV/AIDS A MULTICULTURAL CARIBBEAN UNITED AGAINST HIV/AIDS HIV/AIDS IN THE CARIBBEAN: FIGHTING BACK THROUGH MAINSTREAMING Karl Theodore Health Economics Unit (HEU) The University of the West Indies Trinidad and Tobago Santo Domingo, March 5-7, 2004 Santo Domingo, March 5-7,2004

  2. TWO MAIN QUESTIONS The first obviously is why fight back against HIV/AIDS? Is it worth it? The second question is why mainstreaming of the fight back?

  3. Why Fight Back? • First, the epidemiological experience of HIV/AIDS suggests that this epidemic has the potential to annihilate the Caribbean. • Second, the economic calculations tell us that if the epidemic is not contained, by 2005 it will be destroying our national income base at the rate of around 5% per year. • The race: extinction vs economic annihilation

  4. MAINSTREAMING:UNAIDS DEFINITION Mainstreaming is an essential approach for expanding multi-sectoral responses to HIV/AIDS. Mainstreaming of HIV/AIDS is not an intervention per se. It constitutes a range of practical strategies for scaling up responses and addressing the developmental impacts of HIV and AIDS globally and regionally.

  5. UNAIDS DEFINITION(Cont’d) Through mainstreaming, government sectors, NGOs, private sector entities, church organizations, etc., can both meet the needs of their own workplace environment, as well as apply their comparative advantage to support specific aspects of national HIV/AIDS responses.

  6. AFRICA MULTI-COUNTRY DEFINITION Mainstreaming HIV/AIDS can be defined as the process of analyzing how HIV and AIDS impact on all sectors now and in the future, both internally and externally, to determine how each sector should respond based on its comparative advantage.

  7. UGANDA DEFINITION These (mainstreaming) plans should describe the comparative advantages and planned interventions of each ministry in the fight against HIV/AIDS, including the problem of orphans in Uganda. (Uganda AIDS Commission, 2002)

  8. TANZANIA DEFINITION In Tanzania,the concept of mainstreaming HIV/AIDS in practice has meant developing a community-led rights-based approach,where the community is encouraged to take the lead in bringing about AIDS competence. By promoting the role of the community,HIV/AIDS becomes fully mainstreamed into sustainable and relevant development plans.

  9. Mainstreaming – A Working Definitionfor the Caribbean In a nutshell, by mainstreaming we will mean locating the activities and services constituting the national and regional response to HIV/AIDS as far as possible within existing systems and structures, and funding the response substantially through normal channels.

  10. Five principles for introduction and implementation of HIV/AIDS mainstreaming. (UNAIDS) Clearly defined and focused entry point or theme National frame of reference Advocacy, sensitization and capacity building Distinction between two domains:internal and external Developing strategic partnerships based upon comparative advantage, cost effectiveness and collaboration.

  11. Modalities of Mainstreaming: The Caribbean Framework Caribbean Regional Strategic Plan of Action on HIV/AIDS, 2000 – 2004. This Plan of Action has become the model and the inspiration fornational strategic HIV/AIDS Plans across the region. The Pan Caribbean Partnership, PANCAP, is charged with responsibility for making the regional plan relevant to each country in the region . Essentially the Plan of Action identifies a number Priority Areas.

  12. The Priority Areas are listed as: a.      advocacy, policy development and legislation b.      support of people living with HIV/AIDS c.       prevention of HIV transmission, with a focus on youth d.      prevention of HIV transmission among vulnerable groups:- ·        men who have sex with men (MSM) ·        sex workers ·        prisoners ·        uniformed populations (military and police) ·        mobile populations ·        workplace populations e.       prevention of mother to child transmission of HIV, and orphan support; and f.        strengthening national and regional response capability

  13. Alignment with the Mainstreaming Experience of Africa? Based on the experience of countries on the African continent five“strategies” have been acknowledged: 1)the use of research and impact/predictive studies 2)the use of HIV/AIDS focal points 3)the use of training 4)influencing strategies,and 5)building structures for enabling high-level support

  14. COMPARING TWO APPROACHES This list is interesting because we can immediately align each of the items with at least two of the Priority Areas of the regional Plan of Action. In the case of the item not explicitly covered by the Plan of Action – the establishment of HIV/AIDS focal points in all stakeholder organizations – it is possible to interpret actions planned as Being covered under the existing Priority Areas

  15. MAINSTREAMING: The Caribbean Plan and the African Experience

  16. Mainstreaming: the financing implications In theory there are essentially four potential sources of financing the HIV/AIDS response: a)      domestic fiscal revenues b)      domestic private incomes c)      external bilateral assistance and d)      external multilateral assistance.

  17. FEASIBILITY OF REGIONAL RESPONSE National income year 2000 estimate of US$ 49.8 billion for the combined national income of the countries of the wider Caribbean Estimate of the annual cost of mounting a full-scale response to the epidemic in the wider region is close to US$ 300 million. Less than one percent!

  18. THREE CAVEATS The first is the extent of the income inequality across the region. A case for resource pooling. The second is the even greater income equality within countries. The third, given the obvious role of the public sector in a successful response to HIV/AIDS, is the near intractability of resource mobilization in many countries of the region.

  19. RESOURCE MOBILIZATION FOR MAINSTREAMING Two resource mobilization suggestions Begin by treating HIV/AIDS financing as an opportunity to improve the fiscal system in each of our countries. Invoke “crisis” status of HIV/AIDS funding by imposing a fight-back, awareness tax Ring fencing HIV/AIDS budget

  20. CONCLUDING REFLECTIONS Mainstreaming can have economic significance both in terms of impact and cost of response Caribbean response framework is ready for mainstreaming- but some resource pooling will be necessary Significant dependence on external funding of programs will not foster mainstreaming External funding - a way of buying time to put our house in order Main role of external support – neutralizing hostile market environment

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