HIV and AIDS In the SADC Region

1. HIV and AIDS In the SADC Region Dr Vitalis Goodwell Chipfakacha Technical Advisor Capacity Building and Mainstreaming HIV SADC Secretariat

2. R The combined population of the SADC Member States is about 4% of the world population The region accounts for more than 37% of people living with HIV. It is estimated that between 11.7 and 18.8 million people of the region are currently living with HIV

3. Statu EPIDEMIC STATUS SADC REGION • Epicenter – SADC with 4% of the world pop carries about 40% of HIV cases – Contributed 40% of new cases in 2010 • Epidemic levels varies – Ranges from .2% to >30% – Ferminization of the epidemic very significant • Epidemic Maturity Varies – Matured, maturing and less visible

4. DEFINTION OF TERMS • RISK: determined by individual behaviour and situations • VULNERABILITY: an individual’s or community’s inability to control their risk of infection • IMPACT: long-term changes that HIV and AIDS cause at all levels

5. sadc TYPES OF EPIDEMICS SADC REGION. Epidemic concentrated - Transmission largely among vulnerable groups and vulnerable group interventions would reduce overall infection: Madagascar, Mauritius, Seychelles and Zanzibar. Epidemic generalized - Transmission primarily outside vulnerable groups and would continue despite effective vulnerable group interventions; All 12 mainland states ;Angola, Botswana, DRC, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe.

6. So why is HIV Higher in SADC Region? Low male circumcision rates • Multiple concurrent partnerships (“nyatsi,” “lishende,” “small house,” “second office”... With inconsistent condom use) • Stigma/discrimination • Weak laws/lack of enforcement of laws to protect people esp. women, girls and other vulnerable populations • And various other factors, such as relatively developed/highly mobile societies, income inequality, gender dynamics, "dry sex,” etc. •

7. BIOLOGIGAL DRIVERS OF THE EPIDEMIC IN SADC BIOLOGIGAL DRIVERS –Low or incomplete male circumcision –Sexually transmitted infection – early age of sexual debut –Partners viral load –Blood transmission –Surface are of genital organs –Site of certain nerve sites with affinity for HIV.

8. BEHAVIOURAL DRIVERS OF THE EPIDEMIC IN SADC BEHAVIOURAL DRIVERS –Incorrect and inconsistent and low use of condoms –Multiple and concurrent partners –Alcohol and drug abuse –Stigma and discrimination –Transactional and commercial sex –Personal knowledge of HIV status

9. SOCIAL DRIVERS OF THE EPIDEMIC IN SADC SOCIAL DRIVERS –Intergenerational sex –Transactional sex –Male dominated gender norms –Sexual and gender based violence –Erosion of traditional values –Customary laws relating to polygamy and other customs and rites that negatively affect women.

10. STRUCTURAL DRIVERS OF THE EPIDEMIC IN SADC STRUCTURAL DRIVERS _Gender inequality – Income disparities – Migratory labour – cross border migration – Poverty and wealth – Capital development projects – Unequal access to prevention treatment etc – Late start on ART.

11. Applying and gender and human rights lens when mainstreaming HIV  Women 8 times more likely be infected with HIV than men  Women bear the burden of care for orphans  Gender-based discrimination hindering access to Sexual & Reproductive Health Services, justice, productive resources….

12. Applying and gender and human rights lens when mainstreaming HIV Women’s vulnerability to HIV further compounded by: Harmful traditional or customary practices affecting the reproductive health of women and children (such as early and forced marriage); Sexual violence; Lack of legal capacity and equality in family matters

13. SADC SADC DEFINITION OF MAINSTREAMING Understand the impact of the epidemic on development and the impact of development efforts on the epidemic, including the aspects of development efforts that facilitate and mitigate the spread of HIV • Place the response to HIV and AIDS in the core agenda of all sectors {public, NGO and private sectors} of all SADC Member States, so that it is mainstreamed into their normal and routine functions • Use the comparative advantage of different stakeholders to put in place strategies and programmes to address the epidemic • Recognise the complementarity amongst stakeholders and their mandates, as a pre-requisite for preventing duplication and ensuring that resources are utilised optimally •

14. Why Mainstreaming? We must move from treating the symptoms to treating the cause This means dealing with AIDS as a development issue Nothing less will be effective!

15. Critical steps in the mainstreaming process Know your epidemic Know your response Understand the ministry Strategy formulation Implement M&E •What kinds of preparations are needed for a smooth take off of the activities •How does the epidemic affect your ministry? • •Who is affected in the sector (Employees etc)? •What has your ministry done for the employees? •Demographics •What is the longer term strategy? •What is working or not working and why? •Mandates •Immediate actions the sector can take •How has the ministry responded to •What results are emerging: Qualitatively and quantitatively •Policies •When are we implementing what ? •Required budgets and sources •Planning process •The Risk Scenarios: How might the sector contribute to the spread of HIV and AIDS, or aggravate their impact. (Internally and externally) •Job categories •How are we measuring the results and what assistance do we need? •Linkages •Who is leading the implementation process •Who the stakeholders? •Results, indicators •Who will be implementing what Who will be the implementing partners if expertise does not exist in the ministry> •The Comparative Advantage: How can the ministry reduce susceptibility/vulner ability t to HIV and their impact •Who is documenting the results & how are we feeding this into the national strategic information system? Sector Strategic Planning Process

16. TERMINOLOGIES • MAINSTREAMING IS A MORE REFINED MULTI- SECTORAL APPROACH TO THE FIGHT AGAINST HIV AND AIDS. • COMPARATIVE ADVANTAGES ARE THE SKILLS AND OPPORTUNITIES THE SECTOR OFFERS.

17. In Sum, what mainstreaming is supposed to do? SECRET TO SUCCESS OF MAINSTREAMING Target both the workplace and serviced populations with responses, focusing on both policy change and implementation Respond to the epidemic based on the comparative advantages of the ministry and build partnerships for implementation Emphasise mainstreaming with the ministry’s own policies and programmes and issues of sustainability  Highlight the importance of continuous capacity building for integrated planning and implementation HIV strategies  Use evidence as a basis for responding to the epidemic    17

18. International commitments/Promises GUIDING Principles 2000 Millenium Declaration (targets to 2015) • 2001 UNGASS Declaration of Commitment • Maseru Declaration • 2006 Abuja Declaration: Common Position on UA • 2006 Political Declaration on UA (UNGA) • 2010 Kampala Summit: UA commitment extended to 2015 • 2011 AU Consultative Process: Africa Common Position to HLM • 2011 Political Declaration (targets to 2015) • 2012 African Road Map • 2013 Abuja +12 • Post 2015 Landscape •

19. 2011 Political Declaration (targets to 2015)

20. Reduce sexual transmission of HIV by 50% STATUS OF THE EPIDEMIC IN ESA • In 2010, there were approximately 2.7 million new infections in adults globally; 1,2 million of them were in ESA. • Decline in New Infections from 2001 to 2009: – 3 countries achieved over 50%; – 8 countries (including South Africa) achieved 30- 49%; – 3 countries achieved10% or less; – 1 country’s incidence increased by 4%. • All countries need to achieve 50% decline from 2009 to 2015

22. Why Mainstreaming is sooo important now than never before WHY INVESTMENT FRAMEWORK?  Decline in international funding begs for new approach  Major focus on efficiency, effectiveness and sustainability in countries and by key partners (World Bank, GFATM, USG, Gates, etc)  Prominent in 2011 Political Declaration on AIDS  Shared responsibility message critical

23. WH? LINKAGES CSLTC AND SADC APPROACHES. • RIDSP • SRH ESA COMMITMENT • NEW HIV STRATEGY • M & E PROJECT • New Food and Agricultural strategy • Maseru Declaration • Minimum Standards

24. THANK YOU MUITO OBRIGADO MERCI BEAUCOUP TATENDA