High Level Regional Consultation for Policy Makers to Enhance Leadership in Planning the National HIV & AIDS Response. HIV Prevention (PM1S4)

Transcription

1 High Level Regional Consultation for Policy Makers to Enhance Leadership in Planning the National HIV & AIDS Response HIV Prevention (PM1S4) Tomas Lundstrom UNAIDS RST/ESA

2 Overview Prioritization Low level to Hyper epidemics Case study Lesotho Challenges

3 Key message Ensure Leadership for HIV Prevention Know your epidemic and your response Know the who, what, where, how and why Match your response to your epidemic Focus resources where the need is Prioritize and Phase In Understand and address the drivers Set ambitious, realistic, and measurable targets Tailor your Prevention Plans to the Epidemic Scenario Use Strategic Information to Stay On Course

4 By Country Regional Comparison Swaziland 33.4 Botswana Lesotho Zimbabwe SADC 10.8 Namibia 19.6 South Africa Zambia Mozambique Malawi Eastern and southern Africa 8.9 Uganda Tanzania Kenya Angola Rwanda Djibouti Eritrea Mauritius SADC countries have adult HIV prevalence rates exceeding 15% Sub-Saharan Africa Globally Madagascar Percentage Sour ce: UNAI DS, Percentage Sour ce: UNAIDS, 2006

5 Prioritize your response Key in low level scenarios Collect and analyze reliable data on HIV, risk behaviours and drivers to support policy dialogue; Build knowledge of and implement programs for mostat-risk populations; Universal Access to comprehensive prevention, treatment, care and support is truly affordable Prioritize actions to promote combat stigma and discrimination and promote human rights and gender equality.

6 Additional in hyperendemic scenarios All sexually active adults should consider themselves at risk; Universal access to provider-initiated HIV counselling and testing; Highlight positive prevention ; Social movements to address social, cultural & economic practices; Full engagement of government sectors, civil society & people living with HIV

7 Key Drivers in Southern Africa (SADC TT-meeting, Maseru) Multiple and concurrent partners with low consistent, correct condom use and lack of male circumcision Also high viral STIs, lack of male involvement, intergenerational/age-disparate sex, high sexual violence Underlying context/drivers of gender and socioeconomic inequalities, mobility, and other structural factors

8 Lesotho 23.2% of population aged (official figure for 2005) Expected 29,000 new infections in 2007 (80/day) bringing the number of people living with HIV to total of over 270,000, of which over 16,000 are children (0-14) 57% are WOMEN - Double among women vs men under the age of 30 (est. 72,700 vs 34,600), Men prevail in the older age groups. Overall (15-49): 26.4%(f):19.3%(m) No direct correlation with education, wealth or religion

9 Allocation vs needs (Gap) Total allocations Total need Millions US$ Supportive environment Prevention Treatment Care and Support Impact Mitigation Infrastructure In-country technical assistance Not assigned

10 Lesotho and Multiple Concurrent Partners

11 Lesotho Identified Drivers MCP Condom use Sex work Alcohol Migration Sexual dialogue Sexual pleasure Knowledge/myths Culture Social norms Gender power relations Stigma Denial Low male involvement Violence Lack of ownership

12 Priority Problem (based on Lesotho NSP) Multiple sexual partners; Transactional sex Intergenerational sex Concurrent partners Long-term stable partners

13 Lesotho Identified Outcomes 50% reduction in number of multiple sexual partners in the last 12 months for men (20+) and girls (15+) by % of correct and consistent condom use in high-risk* penetrative sexual acts by % decrease in sexual acts with partners >10 year age gap for year olds. 80% of male circumcision in year old males* by % of all HIV positive pregnant women to receive a complete course of ARV prophylaxis by 2011.

14 Figure 1 Mismatch between funding and HIV epidemiology observed in a west African country 100% 80% 60% 40% 20% 0% Sex workers General population HIV rate Share of infections involving Share of funding Source: Courtesy of World Bank MAP, (2005)

15 Challenges Lack of clear national institutional framework A number of strategies by themes but no coherent overall HIV prevention strategy Translate what we know to sound programmatic interventions

16 Thank you!