Epidemiological update

1. Opportunities for Cross-Border ProgrammingThe Baltic Sea ‘Network of Excellence’ ProjectUSAID SOTA courseOctober 8, 2002

2. Epidemiological update • UNAIDS has declared Eastern Europe and Central Asia a priority region for HIV/AIDS response.

3. Regional Approaches to an HIV Response are crucial: • Patterns of HIV spread are regional phenomena • Collective responsibility between nations needs facilitating • Key stakeholders at country level need to be involved in regional planning.

4. The ‘Network of Excellence’ Project… • Regional project operating in 5 sites: • Estonia • Latvia • Lithuania • St Petersburg, Russia • Kaliningrad, Russia • Supports goals of BSI Action Plan, adopted by the five sites, with international support: • HIV prevention among IDUs • STI prevention and care focusing on vulnerable groups • Health promotion among vulnerable youth.

5. Priority areas revealed by assessments: • youth workshops; • sex worker interventions. St Petersburg • Expanded harm reduction services; • National and Region-wide training center for youth peer educators. • IDU harm reduction and rehabilitation models • Training of family doctors to provide services to young IDU • Parents against drugs support groups • Methodological and IEC materials Exchange. Estonia Latvia Lithuania • Twinning for scaling up health systems responses; • Focus on teenage rehabilitation and drug prevention, links with youth leisure/sports centers in resource poor settings – twinning Klaipeda-Kaliningrad; • Local support for data collection in Klaipeda. Kaliningrad • IT support for information dissemination.

6. Elements of “Regionality” within the Project • Regional Advisory Committee (RAC) • Exchange of information and expertise = cross-border linkages throughout • Beginnings of a regional Knowledge Management System • Encourage effective strategic thinking • Development of replicable best practices

7. The Regional Advisory Committee • Elected representatives from each of the five sites plus other major stakeholders/donors in the region • Provides input into program design and funding allocation; • Provides a framework for strategic planning and advocacy for the region as a whole, to attract further donor support.

8. Small Grants – Latvia, Estonia • Estonia • 3 subagreements funded • Two youth interventions = 510 youth trained in 34 workshops • One SW intervention • Latvia • 2 subagreements funded • Youth peer education training materials -- now in draft • IDU outreach work -- Over 3,000 outreach IDU contacts in greater Riga

9. Small Grants - Lithuania • 2 subagreements funded • Lithuania AIDS Center – information dissemination – • 8 e-bulletins issued and widely disseminated • 2 issues of Between Us published • Klaipeda – youth center and outreach – • Equipment for youth center procured

10. Small Grants - Kaliningrad • 1 subagreement funded • HIV/AIDS resource center, women’s clinic, youth center -- Resource center furnished and equipped; Repeat behavioral survey in SW done (’97, ’01, ’02) • 31% always use condoms • 38 % use regularly in last 3 years • 93% report history of STI

11. Small Grants – St. Petersburg • 1 subagreement funded • Linking three main harm reduction projects with existing health service providers, creating IDU-friendly referral network – ‘Doctors We Trust’ project – • 13% of 2118 “bus attendees” referred to specialists • 46% actually went to referred physician • 42 sought specialist care without referral • Potential impact for rest of NW Russia

12. The regional Knowledge Management System: • Improve and implement design and use of information technology at each site, including regional website design; • Facilitate production of essential best practice packages for potential skills building and replication at other sites; • Can serve as a clearinghouse for behavioral and biologic surveillance data and survey designs.

13. What will this look like? • Start-up = IT assessment, website development and management. • Primarily electronic-based, using e-bulletins for distribution of information and a network of interlinked websites to manage and maintain HIV/AIDS information. • Each website will be considered an information “node” for a specific theme or target group.

14. Knowledge Management System thematic ‘nodes’: Regional Advocacy, including links between Ministries of Justice, and work in prisons Youth methodologies Electronic dissemination and e-learning; facilitation of links between existing networks (youth, men-who-have-sex-with-men and IDU) . St Petersburg Estonia Latvia Lithuania Health systems responses Second generation surveillance IDU Behavior change M&E Kaliningrad

15. Products: best practice and essential tools packages. • Supplemented by technical training workshops to disseminate skills in addressing BSI goals and use of essential packages. • System could be accountable to the RAC. • Staff of the “nodes” could meet twice yearly concurrently with RAC. • Support the System by means of production of a regular publication – preferably an e-bulletin based in one of the “nodes”?

16. Building stakeholder commitment • Set-up and regional consensus building • Assessment and consensus-building = TOR of RAC and agreement on general goals • Site assessments, identifying local partners collaboratively, developing sub-agreements for most effective use of small grants • Local project director responds to USAID, Embassy and local counterpart needs on a daily basis, and liaises with other donors • Maintain the momentum • Facilitate regular RAC meetings • Encourage secondary collaboration and strategic thinking (links to other donors, Global Fund proposal development, ongoing TA) • Continue implementation of grants, expand coverage via new recipients • Value-added: global lessons adapted to local conditions = accelerated learning curve.

17. Constraints: • Dominant personalities = centralize donor and policymaker attention – how to spread the wealth? • Individual priorities overshadow regional interests • Lack of national strategies on HIV/AIDS • Competing interests – EU and NATO membership vs fighting low-prevalence HIV/AIDS.

18. Challenges for the Region: • Expanding coverage yet sustaining current project activities, services and institutions. • Defining next steps within national strategies. • Strengthening cross border links and regional cooperation. • Accessing increased international funding, to build on regional co-operation.

19. Lessons Learned and Recommendations • Regional team-building takes time. • Direct funding of selected national projects should occur early on in a regional initiative to: • Increase trust and motivation of individual countries; • Kick-start regional collaboration, through practical consensus-building around small grants allocations. • Benefits are clear: • Commitment beyond borders; • Regional goal setting • Better preparedness for access to larger funding sources than can be attracted by individual countries/states; • ‘The whole becomes more than the sum of its parts.’