Social Context of HIV/AIDS in Africa

1. Social Context of HIV/AIDS in Africa Lise Kaalund-Jørgensen March 10, 2009- Responding to the epidemic and itscost

2. Literatute • Tony Barnett and Allan Whiteside, Revised sec. edt 2006 • “AIDS in the twenty first Century” Chapt 13 Strategies, Tactics and Timing (341-373) • Mirjam Van Donk, 2006 • ”Positive” urban futures in sub-saharan Africa: HIV-AIDS and the need for ABC (a broader conceptualization) pp. 155-173. in Environment&urbanization, Vol. 18. • Jacob Bor, 2007. • The political economy of AIDS leadership in developing countries: An explanatory analysis. Soc. Scie. & Med. 64, pp. 1585-1599, 2007.  • Army Medley et al. • Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to child transmission programmes. Bulletin of the World Health Organisation, pp. 299-307, April 2004.  • UNAIDS.org • www.avert.org • Preventing mother-to – child transmission of HIV (PMTCT) 2007, 8 pages   • www.UNICEF.org • Prevention of mother to child transmission, 2 pages, 2002 • Stuart Rennie &Frieda Behets. • Desperately seeking targets: the ethics of routine HIV testing in low-income countries. Bulletin of WHO vol 84, pp. 52-55, Jan. 2006.

3. BertranAuvert et al. Randomized, controlled Intervention trial of Male Circumcission for reduction of HIV Infection Risk: The ANRS Trial. Medicine .plosjournals.org. 11 pages, 2005. • Ezekiel Kalipeni et al. Concern and practice among men about HIV/AIDS in low socioeconomic income areas of Lilongwe, Malawi. Soc. Sci & Med. 64, pp. 1116-1127, 2007. • Megan Klein Hattori et al. Cohabitating, marriage, and sexual monogamy in Nairobi slums. Soc. Sci. & Med. 64, 1067-1078, 2007. • NjeriMbugua. • Factors inhibiting educated mothers in Kenya from giving meaningful sex-education to their daughters. Soc. Sci & Med. 64 pp 1079-1089, 2007. • www.infoforhealth.org • Integrating Family Planning and HIV/AIDS services 19 pages • KatharinaKober et al. • Scaling up Access to antiretroviral treatment in Southern Africa: who will do the job? The lancet vol. 364 no 9428 pp. 103-107, July 2004

4. Responses- Policy, practice and costs from preventionthroughcare and treatment to impactmitigation • National Leadership • Stages of the epidemic • Information, observations or instructions • Advocacy, ownership and empowerment • Multisectoral response • Scaling up and sustainability

5. Responses • Biomedical • Treatment of sexualtransmittedinfections-STI • HAART • PMCT-motherchild • Microbicides • Vaccines • Male circumcission • Behaviour • Abstinence, Befaithfull, Condomuse-A, B, C. • Workplaceprogrammes • Intravenous drug users • Vulnerable groups-prostitutes, MSM • YOUTH-in/out of School and in the healthsector

6. Responses cont. • Multisectoralresponses • Health, Education, Agriculture, infrastructure • National international Organisation • National Aids Coordinatingbody-allactors • Province and districtlevels • UN-UNAIDS coordinatingUn-response-World and nat. level • PEPFAR • Bill&MelindaGate’sFoundation • Clinton Foundation • Int. NGOs – HIV/AIDS Alliance, IPPF

7. WHO INT NGO CIDA 3/5 UNAIDS GTZ RNE UNICEF Norad WB Sida USAID T-MAP MOF UNTG PMO 50 MUSD CF DAC GFCCP PRSP PEPFAR 60 MUSD HSSP GFATM MOEC MOH SWAP 290 MUSD CCM NCTP CTU CCAIDS 200 MUSD NACP LOCALGVT CIVIL SOCIETY PRIVATE SECTOR December 2007 e

8. The aid effectiveness pyramid From OECD/DAC December 2007 e

9. UNAIDS five focus areas • Mobilizing leadership and advocacy for effective action on the epidemic • Providing strategic information and policies to guide efforts for the AIDS response worldwide • Tracking, monitoring and evaluation of the epidemic and the response • Engaging civil society and developing partnerships • Mobilizing resources to support an effective response UNAIDS/L.TAYLOR December 2007 e

10. UNAIDS Cosponsors UNHCR UNICEF WFP UNDP UNFPA UNODC ILO UNESCO WHO WORLD BANK December 2007 e

11. Global Fund: Guiding Principles Operate as a financial instrument, not an implementing entity Make available and leverage additional financial resources Support programs that reflect national ownership Operate in a balanced manner in terms of different regions, diseases and interventions. Pursue an integrated and balanced approach to prevention and treatment Evaluate proposals through independent review processes. Establish a simplified, rapid and innovative grant-making process and operate transparently, with accountability December 2007 e

12. Global Fund: Status To date, the Global Fund has committed US$ 10.7 billion in 136 countries to support aggressive interventions against all three diseases. A Partnership between governments, civil society, the private sector and affected communities, The Global Fund represents an innovative approach to international health financing (performance-based funding). The Global Fund is an important contributor to scaling up towards universal access for prevention, treatment, care and support December 2007 e

13. PEPFAR: Background PEPFAR = US President’s Emergency Plan for AIDS Relief Announced and established in 2003 for 5 years PEPFAR Reauthorized in 2008 PEPFAR Five-Year Goal: Support prevention of 7 million new infections Support treatment for 2 million HIV-infected Support care for 10 million infected and affected by HIV/AIDS, including orphans and vulnerable children December 2007 e

14. PEPFAR: Financial Contributions to the Global AIDS Response December 2007 e

15. PEPFAR: Funding for 2007 (planned) December 2007 e

16. PEPFAR: Some Achievements Prevention: For pregnant women found to be HIV-positive, provided antiretroviral prophylaxis in more than 827,000 pregnancies, preventing an estimated 157,000 infant HIV infections U.S. Government has supplied nearly 1.9 billion condoms worldwide from 2004 through 2007 Treatment: Supported antiretroviral treatment for approximately 1.45 million men, women, and children through September 2007 — including more than 1.33 million in sub-Saharan Africa Treatment support is estimated to save nearly 3.2 million adult years of life through September 2009 December 2007 e

17. WHO INT NGO CIDA 3/5 UNAIDS GTZ RNE UNICEF Norad WB Sida USAID T-MAP MOF UNTG PMO 50 MUSD CF DAC GFCCP PRSP PEPFAR 60 MUSD HSSP GFATM MOEC MOH SWAP 290 MUSD CCM NCTP CTU CCAIDS 200 MUSD NACP LOCALGVT CIVIL SOCIETY PRIVATE SECTOR December 2007 e

18. National Ownership: a country example ”Government is only responsible for projects that are within the budget and that form part of a sector strategy approved by Government. Aid for projects not meeting these criteria will only be accepted if the proposal is shown to be sustainable. Where an off-budget project has long-term expenditure implications which are not sustainable (such as the need to maintain treatment for patients started on Anti retroviral Treatment) the donor must accept the responsibility for sustaining the projects that it has initiated” (Country example from April 2008: Draft Compact between a Government and Development Partners on scaling up to reach Health MDGs) December 2007 e

19. UA support care treatment prevention Making the Money Work: The Three Ones and the road to Universal Access GTT December 2007 e