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Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit - Workshop -

Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit - Workshop -. Paul Sunga and Marian Casey June 2, 2004 Addis Ababa. Objective of Workshop. Goal: To enable a coherent response to the HIV epidemic in Ethiopia Purpose: 1.Launch HIV Mainstreaming Toolkit

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Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit - Workshop -

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  1. Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit - Workshop - Paul Sunga and Marian Casey June 2, 2004 Addis Ababa

  2. Objective of Workshop Goal: To enable a coherent response to the HIV epidemic in Ethiopia Purpose: 1.Launch HIV Mainstreaming Toolkit 2. Facilitate the mainstreaming of HIV components into democracy and governance sector programmes

  3. Workshop Agenda 9:00 Welcome - CIDA Country Director-– M-A Fredette Keynote – V.Min. of Justice -Ato Ali Sulaiman 9:50 HIV situation analysis and projections 10:10 HIV and democracy and governance 10:30 COFFEE BREAK 11:00 CIDA’s HIV Mainstreaming Toolkit 11:15 Group exercise 1– Knowing about taboos & stigma 11:50 Group exercise 2 – Knowing about HIV impacts 12:30 LUNCH 1:30 Group exercise 3 – case studies 2:10 Group exercise 4 – case studies 2::50 Group exercise 5 - Assessing HIV vulnerability and HIV impacts in DG programming 4:45 Conclusions

  4. Take the HIV Test • What do the terms HIV and AIDS stand for? • Name three ways that HIV can be transmitted? • How can HIV transmission be prevented? • How many Ethiopians are living with HIV? • What is the most common infection that kills HIV infected people in Ethiopia? • Which group has the highest number of infections ? Male or female? Age- 15-24 / 20-49 / 30-49 • What percentage of commercial sex workers are HIV infected in Addis? • What percentage of rural people are affected by HIV? • Name three ways that HIV is affecting development in Ethiopia? • Can people be cured of HIV?

  5. Situation Analysis • HIV epidemic in Ethiopia at a glance • Forecasts and impacts • Critical links between HIV and democracy/ governance

  6. Key Features of the HIV Epidemic in Ethiopia • ‘generalized’ epidemic at 6.6% nationally • transmission - mainly heterosexual and mother to child • peak prevalence - women 15-24 yr • urban concentration of 13.7% ( is it plateauing?) • rural prevalence estimated at 3.7% based on weak rural surveillance • 50% of hospital beds are AIDS patients • lack of country specific studies in rural areas

  7. HIV Prevalence in Pregnant Women- Bahir Dar - Ministry of Health

  8. Features of Response to the Epidemic • emphasis on public health response • responses are urban and in selected regions • emerging surveillance data • emerging sector-specific strategies

  9. Forecasts and Impacts

  10. HIV prevalence in adults in sub-Saharan Africa, 1986-2001 1986 1991 20 – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable 1996 2001 outside region

  11. Projected HIV positive population in EthiopiaMinistry of Health, 2002

  12. Projected number of deaths from AIDSin Ethiopia Ministry of Health, 2002

  13. Projected Number of AIDS OrphansMinistry of Health, 2002

  14. Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950-2005 65 60 with high HIV prevalence: Zimbabwe 55 South Africa Botswana 50 Life expectancy (years) 45 with low HIV prevalence: 40 Madagascar Senegal 35 Mali 30 1950– 1955 1955- 1960 1960- 1965 1965- 1970 1970- 1975 1975- 1980 1980- 1985 1985- 1990 1990- 1995 2000- 2005 1995- 2000 Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision

  15. Percentage of workforce lost to AIDS by 2005 and 2020 in selected African countries 50 2005 2020 40 30 % 20 10 0 Botswana Côte d’Ivoire Togo Mozambique Ethiopia Cameroon Nigeria UR Tanzania CAR Zimbabwe Guinea-Bissau South Africa Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision 01 July 2002 slide number SSA-17

  16. Savings/Disavings Impact of HIV/AIDS on urban households, Côte d’Ivoire General population Families living with AIDS 30 000 Francs CFA 25 000 Monthly income per capita 20 000 15 000 Monthly consumption per capita 10 000 5 000 0 – 5 000 Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

  17. Projected reduction in size of primary-school-age population by 2010, in selected African countries 30 25 20 % reduction 15 10 5 0 Zimbabwe Zambia Kenya Uganda Source: World Bank, 2000

  18. Number of reported rapes and convictions in Botswana, 1984 to 1997 1400 reported rapes 1200 convictions 1000 800 Number 600 400 200 0 1984 85 86 87 88 89 90 91 92 93 94 95 96 1997 Source: Emang Basadi Women’s Association, Botswana, 1998

  19. Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 Projected population structure in 2020 75 Males Females 70 65 Deficits due to AIDS 60 55 50 Age in years 45 40 35 30 25 20 15 10 5 0 140 120 100 80 60 40 20 0 0 20 40 60 80 100 120 140 Population (thousands) Source: US Census Bureau, World Population Profile 2000

  20. Interactions between HIV and Democracy/Governance

  21. What is known… HIV<--------------> D/G

  22. Critical Links … • Voice & accountability • Political stability • Social justice • Rule of law • Administration of public service • Strengthening civil society

  23. Participation Transparency Leadership Gender Equity Consultation on HIV policy Accessibility of HIV information Government leadership on HIV Gender specific strategies for intervention 1. Voice & AccountabilityFactors Key Issues

  24. Social Cohesion Economic growth National Security Socio-economic impact of epidemic Loss of key members of communities to HIV Loss of of family members Loss of key government officials and civil servants Military vulnerability to HIV 2. Political StabilityFactors Key Issues

  25. Access to services Equal representation Legal literacy Human rights Awareness of HIV/AIDS rights Human rights of women Human rights of HIV infected persons Entitlement to awareness of HIV/AIDS rights 3. Social JusticeFactors Key Issues

  26. Rights of the child Property rights Prisoners, etc. Child friendly detention and courts Juvenile friendly laws, courts etc. Rights of women to land Implementation of national laws 4. Rule of LawFactors Key Issues

  27. Effectiveness Efficiency Quality Regional differences in capacity to respond Diversion of public funds to respond to HIV epidemic Delivery of health services Transparent internal monitoring mechanisms 5. Administration of public services Factors Key Issues

  28. communication transparency participation of civil society community demand for services information dissemination perceived role of civil society community awareness and mobilization 6. Strengthening Civil Society Factors Key Issues

  29. What is ‘HIV mainstreaming’? HIV mainstreaming is the process of identifying and mitigating the effects of: • Aspects of D/G on the vulnerability of Ethiopians to HIV • the HIV epidemic on democracy and governance

  30. Six Steps to HIV Mainstreaming in the DG Area • Knowing HIV and the epidemic • Assessing the situation and the impact • Planning to reduce or mitigate the impact • Implementing the plan • Monitoring • Evaluation of the effectiveness of mainstreaming HIV

  31. HIV Mainstreaming Toolkit Features • 3 modules • Module 1 is general and for everyone • Module 2 contains HIV mainstreaming tools for food security programmes • Module 3 contains HIV mainstreaming tools for democracy and governance programmes • The ‘tools’ are organized according to the Six Steps.

  32. You are the experts….

  33. Proportion of young women who have heard of AIDS and have at least one negative attitude towards people living with AIDS Azerbaijan Note: Respondents were asked two hypothetical questions about men and women with HIV: (1) A teacher who looks healthy but is HIV- positive should be allowed to continue working and (2) Would they buy something from an HIV-positive shopkeeper. Tajikistan Gambia Moldova Albania Bosnia & Herzegovina Yugoslavia (FR) Comoros Guinea Bissau Sierra Leone Chad Cote d'Ivoire DominicanRepublic Vietnam Somalia Philippines Ukraine Niger 0% 20% 40% 60% 80% 100% Source: UNICEF (1999-2001) Multi-Indicator Cluster Surveys

  34. Group exercise 1. Knowing about social taboos as barriers to communication • Discuss your earliest sexual experience. • Why is it difficult to talk about this? • How do social taboos make the HIV epidemic worse in rural Ethiopia? • How is taboo related to the stigma experienced by people infected by HIV? • List three ways of reducing stigma, discrimination and their impacts.

  35. Group exercise 2: Knowing the impact of the HIV epidemic • Discuss with your group one person you know who has HIV or AIDS, or who has died of AIDS? • What were the impacts of that person’s illness? On family and friends? Workplace? Community? Other. • Identify three things that might have been done to lessen the impact.

  36. Mainstreaming Considerations • Consultation on HIV policies • Accessibility of HIV information • Government leadership on HIV • Gender specific strategies for intervention • Socio-economic impact of epidemic • Loss of key members of communities • Loss of of family members • Loss of key government officials and civil servants • Military vulnerability to HIV • Entitlement to awareness of HIV/AIDS rights

  37. Mainstreaming Considerations • Vulnerability of women • Discrimination against HIV + • Regional disparities in response to the epidemic • Diversion of public funds to respond to HIV epidemic • Rate of spread of epidemic • Lack of basic & essential health care for PLWHA • Institutional and organizational capacity of key agencies and Ministries (MoJ, MoCB, Parliament, Auditor General, Prison & Police Administration, civil society, etc.)

  38. Intervention points • HIV vulnerability analysis • Gender analysis of policies & interventions • Strengthening the health system • HIV/AIDS Legal Framework • Legal literacy • HIV/AIDS code of ethics • Application of HIV/AIDS in strategic initiatives • Advocacy on political and civil leadership • Protection of minority rights, e.g. prisoners • HIV-adjusted national security plan

  39. Factors discrimination against HIV+ persons unsupportive financial and social response mechanisms weak HIV governance Key issues HIV stigma level of HIV awareness and understanding among leaders level of local evidence re: HIV impacts on development Development of HIV strategy for institutions/vulnerability assess... Institutional code of ethics regarding HIV positive employees, clients Institutional capacity (HIV competence)

  40. Intervention pointsGovernance • HIV vulnerability analysis • Gender analysis of policies & interventions • Strengthen the health system • HIV/AIDS Legal Framework & legal literacy • HIV/AIDS code of ethics • Application of HIV/AIDS in strategic initiatives • Advocacy on GoE leadership • Protection of minority rights, e.g. prisoners • HIV-adjusted national security plan

  41. Group exercise 4: Case studies • Discuss case studies found at the end of Module 3

  42. Group exercise 5: Assessing an DG capacity development programme through an HIV lens Using the assessment tools, outline how you would carry out an HIV assessment of the example provided of a DG capacity development programme. Two example programmes or programme components will be provided. NOTE that the assessment information is the basis for planning

  43. Dr. Paul S.Sunga Langara College Vancouver, Canada psunga@langara.bc.ca Marian Casey PSU/CIDA Addis Ababa humanitarian@psuaddis.org Thanks for participating.Facilitators:

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