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Mainstreaming HIV/AIDS

Mainstreaming HIV/AIDS. It is not purely medical problem Few are… 1993 WB report AIDS as a cause and consequence of poor/ arrested development HIV infection impacts larger society, not only those who is ill… Poverty and inequality are driving forces of the epidemics. 25 years of AIDS.

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Mainstreaming HIV/AIDS

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  1. Mainstreaming HIV/AIDS

  2. It is not purely medical problem Few are… 1993 WB report AIDS as a cause and consequence of poor/ arrested development HIV infection impacts larger society, not only those who is ill… Poverty and inequality are driving forces of the epidemics 25 years of AIDS

  3. Cause Barnaul CSW Edinburgh IDU 2006/2007 Russia HIV increase and Afghan-Tajik border defense Cause and consequence…

  4. Household effect Single parent household Back to cause: What can HIV infected young widow with a child do to sustain her? Orphaned children Medical/funeral expenses Economy effect Loss of labor force Loss of human capital (with decreased transmission of human capital) Decrease in savings rate Effect Y=KaH(AL)1-a-

  5. Impact of AIDS on GDP level Sharp, 2005

  6. Need to address all personal/social determinants and consequences of the epidemics – precisely where they exist (SWAp) Risk-Vulnerability-Impact If such broad effect/determinants

  7. Risk is determined by individual behaviour and situations such as having multiple sexual partners, havingunprotected sex, sharing needles when injecting drugs or being under the influence of alcohol when having sexor having an untreated sexually transmitted infection. Vulnerability stands for an individual's or community's inability to control their risk of infection due to factorsthat are beyond the individual's control. Such factors could be poverty, illiteracy, gender, living in a rural area,being a refugee, etc. Impact is about the long-term changes that HIV/AIDS causes at an individual, a community or a society level.HIV/AIDS not only impacts on the physical and mental health of individuals and populations, but a full blownepidemic also changes socio-cultural structures and traditions and impacts on economies and many differentsectors. Risk-Vulnerability-Impact

  8. how they may contribute to the spreadof HIV how the epidemic is likely to affect theirsector's goals, objectives and programmes where their sector has a comparativeadvantage to respond to and limit thespread of HIV and to mitigate the impactof the epidemic All sectors determine

  9. How does HIV/AIDS affects organization and its work? How to do no harm? How can organization contribute to fighting HIV/AIDS by limiting the spread and mitigating the impact of epidemics? Three key questions

  10. Mainstreamingis a process that enables organsations to address thecauses and effects of HIV/AIDS in an effective and sustained manner,both through their usual work and within their workplace (UNAIDS) Definition

  11. Mainstreaming HIV/AIDS can be defined as the process of analysing how HIV and AIDS impactson all sectors now and in the future, both internally and externally, to determine how each sectorshould respond based on its comparative advantage. HIV/AIDS Mainstreaming Working Group Definition

  12. Internal Organization/workplace External Serviced populations Mainstreaming

  13. It is NOT simply providing support for a Health Ministry’s programme. It is NOT trying to take over specialist health-related functions. It is NOT changing core functions and responsibilities (instead it is viewing them from a different perspective and refocusing them). It is NOT business as usual – some things must change. Smart, 2002 What HIV/AIDS Mainstreaming is NOT

  14. Education Defense Transport Church Health care (all levels) ??? Mainstreaming in Russia

  15. Ministry of Economic Development and Trade Ministry of Regional Development Ministry of Finance Economic Ministries

  16. Executive branch of the government charged with policy development regarding analysis and prognosis of social and economic development, enterprise development, economic development of regions, investments, emergency economic response, defense contracts, etc. Government Decree 443 (27.08.2007) Ministry of Economic Development and Trade

  17. Among other tasks is to Define economic effectiveness indicators for federal enterprises Develop methodology of preparedness (emergency economic response) Define custom duties Is charged with Monitoring of social and economical development of RF and its regions, and development of prognosis models Ministry of Economics and Trade

  18. Executive branch of the government charged with policy development regarding social and economic development, enterprise development or regions, division of authority, urban development and communal enterprises, national relation, etc. Government Decree 141 (19.03.2005) Ministry of Regional Development

  19. Among other tasks is to Develop regulations of urban development Prepare regional and territorial development plans Monitor social and economic development of regions and municipalities in Russian Federation Ministry of Regional Development

  20. Executive branch of the government charged with ensuring unified financial, budget and fiscal policy Government Decree 273 (06.03.1998) Ministry of Finance

  21. Among other tasks is to Concentrate financial resources on priority developmental targets Participate in development of prognostic models for Russian Federation social and economic development Develop price control measures Ensure financing of federal goal-directed programs Determine custom duties Ensure monetary stability Ministry of Finance

  22. Analyze situation and develop prognosis of social and economic development of Russian Federation Impact analysis Regulate custom duties ARV drugs Ensure monetary and macroeconomic stability Balance between private consumption, savings and taxes Regulate urban development and influence regional development policy Financial resources Financing treatment and care Those ministries…(mainstreaming entry points)

  23. Economical consequences of HIV/AIDS Not so simple: for poor countries, there is a statistically significant negative relationship between AIDS mortality and economic growth, however this relationship reverses as nations growth wealthier. We hypothesize that the industry surrounding the AIDS epidemic is outweighing the negative impact from the depletion of growth enhancing resources. Edwards J., Al-Hmoud R. “Aids Mortality and Economic Growth: A Cross-Country Analysis Using Income-Stratified Data”, 2002 One cannot endlesslylament the scourge of high population growth in the developing world and then conclude that areversal of such processes is an equal economic disaster. The AIDS epidemic is a humanitariandisaster of millenial proportions, one that cries for assistance. It is not, however, an economicdisaster. A.Young. “The Gift of the Dying:The Tragedy of AIDS andthe Welfare of Future African Generations”, 2004 Impact

  24. Custom duties on medicines But also (MEDT) Russian accession to WTO 6-year period of data closure for generic drugs What is better – produce or purchase? Custom duties

  25. Flow of money to social sector as inflation danger Are higher spending of HIV/AIDS healthy for the economy? “Dutch disease” in developing countries due to international aids and some lessons for Russia Macroeconomic stability

  26. Construction and HIV risk What is done in Sochi? Regional policy (inclusion of HIV indicators) Urban development

  27. ARV treatment, 2006, persons Received 14 433 (71%) Needed 20 270 ARV treatment, 2007, persons National projects: 20 905 Global Fund: 8 545 ARV treatment, 2012 >280 000 ??? Rospotrebnadzor, 2007 Financial resources

  28. 2007 Federal goal-directed program: 350.2 National project: 7800 Regional budgets: 710 Extra budgetary sources: 21 International loans: 1334 Totally: 10267.11 2011 Federal goal-directed program: 1787.7 Regional budgets: 894.5 Extra budgetary sources: 41 Totally: 2723.2 Financial resources mln. RUR, TPAA, 2006

  29. And there are additional problems: Ageing population Increasing chronic diseases of old age (CHD, dementias) Decreasing workforce population Decreasing health care staffing

  30. To ensure macroeconomic stability state should prepare to function in case of rapidly shrinking workforce, increased demand for health care and welfare benefits, higher labor cost, higher demand for ARV treatment, etc. Road forward… Consequently, need for mainstreaming…

  31. Mainstreaming steps Develop shared goal & commitment Prepare HIV/AIDS profile Evaluate Formulate activity plan for mainstreaming Implement planned activities Cost mainstreaming activities

  32. the use of research and impact/predictive studies, the use of HIV/AIDS focal points, the use of training, influencing strategies, building structures for enabling high-level support Strategies for Mainstreaming

  33. Training to ensure understanding of the problem (HIV/AIDS is a developmental – NOT medical problem) Securing high-level support outside MoH Appointing focal points Proceed with mainstreaming The road forward…

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