Regional Workshop on Vulnerable Populations

1. Regional Workshop on Vulnerable Populations Dr. Joana Mangueira NAC Mozambique Cape Town, 11-13 March

2. Mozambique Total Population (2007): 20.366.795 Illiteracy Rate (adults): 53.6% Literacy Rate among Women: 31% GDP per capta (2008): 473 USD Population below poverty line: 54% HIV Prevalence among adults: 14% HIV Prevalence among adult women: 16% HIV Prevalence among children (0-14): 3% These factors indicate that the country and its population is vulnerable. Despite the good progresses on development policies and interventions (ex: PARPA) work is still needed to catalyze substantial social change in order to face HIV epidemic.

4. Mozambique Responses to HIV Epidemic • In a context of generalized epidemic, the responses in place are based on: • Multisectorial approach – Government, Private, Civil Society and other Partners • Decentralization to all regions of the country, considering the socio-cultural contextualization of the actions • Priority to the combat of the feminization of HIV epidemic • Partnership and network building between public sector, private sector, civil society, international agencies and donors • Involvement of leaders in all levels • Encouragement of communities and civil society organization (CBO, FBO) • Balance between Prevention, Treatment and Mitigation initiatives • Capacity Building on public, private and civil society sector, with special emphasis at the local level

5. Balance between general and specific interventions • In generalized epidemic settings like Mozambique, it is primordial to develop actions towards the general population, but simultaneously it is necessary to develop interventions targeting specific populations (miners, sex workers, etc.) • UNAIDS: “Interventions with most-at-risk populations can be as important in generalized epidemics as in low-level and concentrated epidemics. (…) In generalized epidemics, a broader response is clearly needed, but this must still include effective efforts to reduce high transmission rates among other vulnerable populations. In addition, interventions should also be targeted to those most vulnerable to HIV infection for humanitarian reasons.” [1] • UNGASS Declaration of Commitment establishes the importance of Human Rights based interventions [2] [1]A Framework on Monitoring and Evaluating HIV Prevention Programmes for Most-at-Risk Populations. UNAIDS, 2007, 96p. [2] Declaration of Commitment on HIV/AIDS. Resolution Adopted by the United Nations General Assembly. 26th United Nations General Assembly Special Session. 2001.

7. HIV and Sex Work in Mozambique • >30.000 sex workers in the country (estimation) • 13.2% of men (15-49 years) pay for sex. Only 21% of men used condoms in commercial sex (DHS, 2003) • Sex Work concentrated in peripheral and urban areas, borders, corridors and tourist zones • Prevention activities not comprehensive and lack of coverage • Still insufficient information on sex works (dynamics, extension, particularities) “I started because of difficulties in my life, I lost the father of my first child, and then I was abandoned by the father of my second and third child, and my actual partner does not have any income and I need money to keep the family” (sex worker in Massinga)

8. Vulnerability of Sex Workers in Mozambique • Sex Workers have high risk practices (unprotected sex, number of sexual partners, drug use) • This high risk practices are directly influenced by vulnerability factors, such as: • Recurrent violation of fundamental Human Rights; • Gender values and roles; • Social beliefs and norms on sexuality; • Low literacy rate,; • Poverty and low access do working market; • Violence, rape and sexual coercion; • Social exclusion leaded by stigma, prejudice and discrimination; • Low negotiation skills for condom use and safe sex; • Lack of access to health, social and support services. When available, they do not contemplate sex workers specificities • Lack of legal protection mechanisms “…even us, married women, are not capable of negotiating sex with our husbands or lovers or friends, imagine those young girls. Even when our partners arrive ill (whichever type of illness) and wants to have sex we have to accept, we can’t say no.” (sex worker in Namaacha) “People do not respect us and call us names, some of the clients do not pay and abuse us, we are worried about when we get old and cannot do this work anymore – what will become of us and our children.” (sex worker in Massinga)

11. Actions in place • Sub-Regional Consultation on HIV and Sex Work jointly developed by NAC and UNFPA (Maputo – November 2007) • Regional vulnerability factors: • Mobility between countries is a primary factor to HIV transmission • Social and cultural beliefs linking neighboring countries • Sex work linked through informal commercial opportunities with strong women involvement • “Maputo Call for Action” • Reinforcement of the universal access to prevention, treatment, care and support services • Development of strategic plans on HIV and Sex Work as part of national responses • Advocacy to Sex Workers Human Rights guarantee, through reduction of stigma and prejudice • Coordination among regional actions, with emphasis on activities in border areas and development corridors • Empowerment of Sex Workers • Development of studies on Sex Work and HIV for the production of M&E indicators and adequate interventions

12. Actions in place • New National Strategy for the Acceleration of HIV Prevention (2009-2011), that emphasizes the necessity of activities focusing high risk groups, e.g. Sex Workers, Miners. Actions towards these groups and others, are based on the following pillars: • Multisectorial approach • Coordination of actions for coverage improvement; • Reinforcement of National Health System, to ensure access to health, information, prevention, treatment and mitigation services • Production and dissemination of knowledge and information on socio-cultural, behavioral and epidemiologic terms • Advocacy for reduction of stigma and prejudice, building community settings that encourage dialog and social change

13. Actions in place • MARP Technical Group • Multisectorial approach • Definition of a locally based concept of vulnerability to generate social and cultural adequate actions • 100% Life Project • Partnership between MoH, UNFPA, Pathfinder and PSI (2007-onwards) • Prevention, health care, mitigation and legal assistance activities, expanded to others risky groups already defined • Peer Educators Strategy • Income generation activities, through professional education and skills development • Increase male and female condoms access • Studies and research to subsidize and qualify adequate interventions as part of the national agenda • HIV and Sex Work Vulnerability in Mozambique (UNFPA, 2009)

16. Challenges • Implementation of National Strategy for HIV Prevention Acceleration (resources, technical assistance) • Building of social settings favorable to Human Rights protection • Expansion of interventions to all areas, specifically on borders, corridors and tourist zones • Address immediate priorities and catalyze long-term activities • Balance between short and long-term approaches • Male involvement in prevention efforts • Sex work affects children and adolescents overlapping with intergenerational and transactional sex • Regional integrated actions • Reduction of stigma and prejudice • Increasing and consolidation of partnerships and networks between Government, Donors, UN agencies, national and international organizations • Encouragement of sex workers empowerment activities

17. Reinforce adequate partnerships will help us We need to do more and better!