Integration of HIV Programming into Humanitarian Action

1. Integration of HIV Programming into Humanitarian Action CHAD OCHA-WHO Mission to Chad 03-13 Sept 2007

2. Mission Aim: To identify HIV programming gaps in current response and to determine priority HIV interventions for inclusion in 2008 CAP Approach: Joint mission to field-test a strategic planning exercise to strengthen integration of HIV into the humanitarian response in Chad Partners: UNAIDS country office, UNHCR, members of UN Joint Team on HIV, IMC, CAP participants, national AIDS authorities

3. CHAD CRISIS Humanitarian Caseload: 700,000 • Eastern Chad: • 239,163 Sudanese refugees • 179,519 Internally Displaced persons • 50,000 host communities • Southern region: • 45,115 CAR refugees • 30,000 host communities Source UNHCR monthly report

4. HIV among High risk Groups • The seroprevalence among pregnant women is around 7-8% (2002 report) • 26,4% among commercial sex workers in Sarh (1997) • 8,40% among military personnel in N’Djamena and Moundou (1997) • 2,84% among blood donors in N’Djamena and 4,97 in Moundou (2000) • 17,07% among STI patients in the 10 major cities (2000) • 20,75% among TB patients in N’Djamena (2000).

5. HIV situation in CHAD Source: http://www.who.int/globalatlas/predefinedReports/EFS2006/EFS_PDFs/EFS2006_TD.pdf

6. National Response to HIV • Free AIDS treatment • Global Funds reinstated after suspension of earlier funding • Lack of health personnel to deliver services • Government has reiterated HIV control as a priority Source: PNLS strategic plan 2004

7. HIV Situation in humanitarian settings East: 3% HIV prevalence (approx.) South: 10% HIV prevalence (approx.) • Limited health services exist; often centralized in district hospitals with limited access for humanitarian populations • Lack of systematic HIV testing and surveillance • Severe lack of human resource capacity e.g. 1 doctor trained in prescription of ARVs in Abeché district hospital • Socio-cultural resistance to HIV prevention programming

8. HIV in population of humanitarian concern in east and south Chad • The national plan aims to allow refugees and IDPs to access tertiary level health centres for testing, care and treatment. However, these health centres can be as much as 400km away from the camps and IDP sites • The only ARV site remains in Abéche for the east, but none for the south • There is a severe lack of HIV surveillance in Chad, with no testing of pregnant women, TB, malaria patients, or victims of sexual- and gender-based violence (SGBV) • Many NGOs including MSF did not include HIV in their package of services delivered to their target populations.

9. HIV TREATMENT NEEDS IN SOUTH AND EAST

10. STRATEGIC PLANNING APPROACH • Consultations with national authorities, national AIDS program, UN theme groups • Site visits in N’djamena and Gaga refugee camp • Adaptation of generic tool based on field realities • Use of tool during CAP workshop to identify: • Current situation • Gaps • Proposed interventions • Priorities for inclusion in the 2008 CAP

11. Outcomes of the Workshop Overall Strategic Priorities • Decentralization of HIV services to increase accessibility for populations of humanitarian concern • Expansion of HIV care and treatment services in the South • Build human resources capacity • Strengthen capacity among: 1.) UNAIDS for coordination of overall HIV programming in the humanitarian settings, 2.) WHO for the scale-up of HIV care and treatment (particularly training of medical personnel on the prescription of antiretroviral treatment, testing and counseling). • Nomination of HIV focal points within the clusters • Strong monitoring and evaluation system to track progress on integrating HIV into the humanitarian response.