The Pacific Regional Strategy on HIV and other STIs for

Transcription

1 The Pacific Regioal Strategy o HIV ad other STIs for

2 Copyright Secretariat of the Pacific Commuity 2009 The Secretariat of the Pacific Commuity authorises the reproductio of this material, whole or i part, i ay form, provided that appropriate ackowledgemet is give. Origial text: Eglish Secretariat of the Pacific Commuity Cataloguig-i-publicatio data The Pacific Regioal Strategy o HIV ad other STIs for / Secretariat of the Pacific Commuity, HIV/STI Sectio. 1. AIDS (Disease) Prevetio Oceaia 2. HIV ifectios Prevetio Oceaia 3. Sexually trasmitted diseases Prevetio -- Oceaia I. Title. II. Secretariat of the Pacific Commuity AACR2 ISBN

3 1. Itroductio The diverse cultural ad commuity values ad support systems that are commoly foud i the Pacific Islads are uique, complex ad importat, ad should be take ito accout i iitiatives that affect the lives of people livig i the regio. Iitiatives that respod to HIV ad other sexually trasmitted ifectios (STIs) i the regio are o exceptio to this requiremet. That is, to be successful ad sustaiable, ay such respose must icorporate Pacific values ad support systems. Sice the first case of HIV i the regio was reported i 1984, there have bee various resposes at regioal ad atioal levels. Oe major ladmark was the edorsemet of the Pacific Regioal Strategy o HIV ad AIDS ( ) by the Pacific Leaders Forum i The edorsemet by the regio s leaders has facilitated the mobilisatio of resources to support the strategy s implemetatio. A review of the Pacific Regioal Strategy o HIV ad AIDS ( ) i 2006 oted that there had bee some positive movemet i stregtheig leadership. For example, seior political ad idividual leaders i a umber of Pacific Islad coutries ad territories (PICTs), ad civil society orgaisatios particularly those ivolvig people livig with HIV (PLHIV) had become icreasigly egaged i supportive roles. However, istitutioal goverace arragemets for programmes were ot strog, ad there was a lack of clarity i their multisectoral approaches ad roles. The regio s eviromet of stigma ad discrimiatio also created challeges to the task of maitaiig a supportive eviromet for PLHIV o the part of both service providers ad the commuity at large. The Pacific Regioal Strategy o HIV ad other STIs ( ) will build o the successes ad stregths of previous work ad address some of the challeges i supportig atioal efforts to prevet ad cotrol HIV. Simultaeously, because other STIs are a key risk factor for the trasmissio of HIV i the Pacific, the strategy will support atioal efforts to combat them. It will also stregthe work at the regioal level through improved coordiatio, collaboratio ad parterships betwee regioal orgaisatios ad atioal programmes. 3

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5 2. Visio, goal, purposes ad priciples 2.1 Visio for our Pacific regio Our Pacific regio is a place where the spread ad impact of HIV ad other STIs are halted ad reversed; where leaders are committed to leadig the respose to HIV; where people livig with ad affected by HIV are respected, cared for ad have affordable access to treatmet; ad where all parters commit themselves to these collective aims withi the spirit of compassio iheret i Pacific cultural ad religious values. 2.2 Goal The goal of the Pacific Regioal Strategy o HIV ad other STIs ( ) is to reduce the spread ad impact of HIV ad other STIs while embracig people livig with ad affected by HIV i Pacific commuities. 2.3 Purposes Icrease the capacity of PICTs to achieve ad sustai a effective respose to HIV ad other STIs. Stregthe coordiatio of the respose at the regioal level ad mobilise resources ad expertise to assist idividual PICTs i achievig their targets. Assist PICTs i achievig ad reportig o their atioal ad iteratioal targets i respose to HIV ad other STIs, i particular the Milleium Developmet Goals (MDGs), the Uited Natios Geeral Assembly Special Sessio o HIV/AIDS (UNGASS) ad Uiversal Access. 2.4 Overarchig priciples Ackowledges traditioal, cultural ad religious values of Pacific commuities that are based o compassio ad recociliatio. Affirms the protectio ad promotio of huma rights through iteratioal huma rights istrumets, icludig regioal ad atioal commitmets. Emphasises the eed for leadership ad o-partisa political support ad commitmet. Respects existig programmes ad structures that put people first. Ivolves affected idividuals ad commuities at all levels of the developmet ad implemetatio of services, programmes ad policy. Is effectively liked to other global, regioal ad atioal strategies, icludig commitmets made at UNGASS, the MDGs ad Uiversal Access. Is based o parterships ad a multisectoral approach, icludig evidece-based programmig. Advocates for the facilitatio of a cotiuum of care ad support for PLHIV, ad access to quality ad affordable treatmet, icludig for other STIs. Icludes a major focus o prevetio, health promotio ad behavioural chage commuicatio strategies, as captured i the themes of the Healthy Islads approach. Emphasises likages betwee HIV, STIs, adolescet sexual ad reproductive health, ad materal, ewbor ad child health services. Emphasises the eed for ogoig ad sustaiable fudig support. Icludes the itegratio of a approach sesitive to geder ad vulerable groups. 5

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7 3. Backgroud 3.1 HIV, AIDS ad other STIs i the Pacific Islads regio Sice the first reported case of HIV i the Pacific Islads regio i 1984, there have bee more tha 15,000 cofirmed HIV ifectios ad 3189 AIDS cases. 1 Over 95 per cet of HIV ifectios have occurred i five PICTs: Fiji Islads, Frech Polyesia, Guam, New Caledoia ad Papua New Guiea. I additio, there are almost certaily may ureported cases throughout the regio. Although the umber of cases remais low, there is a upward tred. Some coutries, such as Fiji Islads, have recetly reported a expoetial rise sice There are sigificat risk factors for HIV trasmissio i the Pacific. These iclude the large umber of youg people; sigificat movemet of people ito, through ad out of the regio; practices such as tattooig ad polygamy; ad, i particular, high rates of other STIs ad teeage pregacy. Limited ecoomic opportuities ad weak ecoomies compoud the vulerability of Pacific Isladers to HIV. HIV i the regio is mostly sexually trasmitted, although there is also some periatal trasmissio (Fig. 1). I PNG, reported routes of ifectio are almost etirely from heterosexual exposure. Across the remaider of the regio, approximately oe-half of all reported exposures are from heterosexual trasmissio, ad oe-third are due to male-to-male sexual trasmissio. Figure 1: HIV exposures i all PICTs from time of first exposure to December 2005 Blood 0.2 Periatal 5.1 Heterosexual 90.7 Other 0.3 MSM 3.1 IDU 0.5 Source: SPC HIV & STI Sectio accumulated HIV data, SPC HIV & STI Sectio. 7

8 3.2 Ecoomic impact ad implicatios Healthcare services i most PICTs have limited resources available to cope with the prevailig disease burdes of commuicable ad o-commuicable diseases i geeral. I this eviromet, the cost of treatig HIV ad AIDS itesifies the strai, thus icreasig healthcare costs sigificatly. Moreover, HIV ad AIDS are o loger just health issues. They have bee idetified as a serious threat to the socioecoomic developmet of PICTs ad, more recetly, as a security issue as well. HIV is a wider issue because first, the costs of HIV ad AIDS healthcare could divert resources away from activities related to socioecoomic developmet. Secod, i the Pacific Islads regio, which already faces challeges relatig to its small populatios ad arrow ecoomic base, HIV has the potetial to weake the limited workforce ad thus reduce ecoomic activity, which i tur would affect the delivery of essetial services such as educatio ad health. Providig such basic essetial services also requires reliable systems of commuicatios ad trasport i a regio vulerable to the effects of climate chage (e.g. risig sea level) ad atural disasters (e.g. cycloes, earthquakes, tsuamis), which have the potetial to damage ifrastructure. HIV i this cotext adds to the burde ad costrais progress towards sustaiable developmet. I regios where HIV has already become a geeralised epidemic, the impact o demographic dyamics has bee alarmig i some areas. For example, i Botswaa, life expectacy has dropped from 67.6 years to 44.4 years. 2 Amog PLHIV who are takig the ew lie of atiretroviral drugs, life expectacy has improved. However, give the limited health budgets of small islad states, this treatmet may ot be sustaiable as the drugs are costly. The movemet of people betwee their small islad states ad metropolita eighbourig coutries icreases the vulerability of PICTs to HIV. However, restrictig this movemet may ot be a favourable optio i PICTs, where tourism is a sigificat or the most sigificat form of reveue geeratio. 3.3 Risk factors While kow HIV prevalece is relatively low i most PICTs, sigificat risk factors for HIV trasmissio exist. As oted above, of particular cocer are the very high prevalece of other STIs ad high rates of teeage pregacies, both of which idicate that risk-takig behaviours are commo ad that codom use is ot. It is well established that, because a umber of STIs also assist i the trasmissio of HIV, better detectio ad treatmet of STIs, ad cosequetly a reductio i their icidece ad prevalece, ca substatially reduce HIV trasmissio. Strategies to improve the maagemet of STIs are therefore a importat compoet of plas for HIV ad AIDS prevetio ad cotrol i all PICTs. The high prevalece of other STIs was evidet i the fidigs of the secod-geeratio surveillace (SGS) surveys that were coducted i 2005 i six PICTs (Fiji Islads, Kiribati, Samoa, Solomo Islads, Toga ad 2 Overpopulatio.com. AIDS/HIV Effect o Life Expectacy. Retrieved from the Iteret 15 September

9 Vauatu). These targeted ad tailored cross-sectioal studies aimed to measure the prevalece of HIV ad other STIs i particular populatios, as well as behaviours that may cotribute to their trasmissio. The mai fidigs of the SGS surveys were a high prevalece of STIs (Fig. 2); limited kowledge of modes of HIV trasmissio; low rates of codom use, particularly amog youg people; a high umber of people with multiple sexual parters; ad the commo occurrece of commercial sex activities i most coutries surveyed. Figure 2: STI prevalece amog pregat wome i six PICTs, Vauatu (=288) Toga (=348) Solomo Islads (=241) Samoa (=299) Kiribati (=199) Fiji (=303) Prevalece Syphilis (%) Goorrhea (%) Chlamydia (%) Apart from the risks posed through the high prevalece of other STIs, commo risk factors i the Pacific Islads regio iclude a sigificat amout of travel ito, out of, ad withi the regio; ad practices such as tattooig ad polygamy. Further challeges are the ueve levels of developmet, the iequalities faced by wome i all aspects of their lives, the icreasig levels of violece agaist wome, ad the variable accessibility of health services (both prevetive ad curative). Large rural populatios add to the difficulty of providig access to services ad iformatio. Limited ecoomic opportuities ad high levels of uemploymet sometimes force people to egage i sex work as a meas of geeratig icome. I areas of coflict ad social urest, the prevalece of forced sex, icludig gag rapes, is high. Cultural taboos prevet ope discussio of sexual matters ad compoud the vulerability of people i the regio. Other customary practices ad cultural orms may codoe or ecourage multiple sex parters. Where religious beliefs are iterpreted i a way that discourages the use of codoms ad perpetuates miscoceptios about marriage protectig idividuals from HIV, they may cotribute to usafe sex ad uwated pregacies. 9

10 3.4 Tuberculosis i the Pacific Because tuberculosis (TB) is a commo co-ifectio with HIV ad AIDS, its relatively high prevalece i may PICTs (with low case detectio rates) for the past 10 years is a sigificat cause for cocer. It is estimated that 11,000 people i the 22 member PICTs of the Secretariat of the Pacific Commuity (SPC) become sick with TB every year, 50 per cet of whom are ifectious cases, although oly about 9000 ew TB cases have bee diagosed o average each year sice Strategies that recogise the relatioship betwee TB ad HIV should be implemeted. For example, there should be adequate HIV testig for all TB patiets i order to provide appropriate care ad support to those affected. 10

11 4. The Pacific regioal respose 4.1 Resposes ad challeges i the regio The Pacific Islads regio has respoded to HIV i varyig degrees sice the early 1980s. Major iitiatives have emerged as the result of iteratioal commitmets made i the regio. I August 2002, 11 PICTs agreed to put forward a proposal to the Global Fud to fight AIDS, Tuberculosis ad Malaria. This proposal was accepted, resultig i the sigig of the grat agreemet i Jue A regioal HIV ad AIDS iitiative supported by the Australia ad Frech govermets bega i Jauary 2004, ad assisted PICTs to develop the Pacific Regioal Strategy o HIV ad AIDS ( ); develop ad implemet atioal strategies; ad stregthe surveillace of HIV ad other STIs i the regio. With the developmet of the first regioal strategy leaders committed to oe visio ad oe goal. As articulated i the strategy the Pacific regio would be a place where the spread ad impact of HIV ad AIDS were halted ad reversed; where leaders were committed to leadig the fight agaist HIV; where people livig with ad affected by HIV were respected, cared for ad had affordable access to treatmet; ad where all parters committed themselves to these collective aims with the spirit of compassio iheret i Pacific cultural ad religious values. Various commitmets by Miisters of Health i a umber of small islad states were also reaffirmed through the Samoa Commitmet 2004 ad Vauatu Commitmet These commitmets arose at bieial meetigs of Pacific Miisters of Health, which iclude the small islad states ad are co-facilitated by the World Health Orgaizatio (WHO) ad SPC. There are however major challeges for the respose i the regio. For example, surveillace is iadequate, especially i idetifyig the critical dyamics ad determiats of the epidemic i the regio. I additio, cultural ad religious barriers that fuel stigma ad discrimiatio cotiue to pose a major challege. Other ogoig challeges are the limited absorptive capacities at both atioal ad regioal levels to implemet activities, coupled with limited stregtheig of health systems. Fially, coordiatio of various iitiatives i the regio remais a challege that eeds to be addressed. Regioal evets Early 1980s Most resposes ivolve geeral populatio awareess Mid-1990s Multisectoral approach through atioal multisectoral strategic plas ad actios st Regioal Coferece o HIV ad AIDS (February) 2001 UNGASS, New York (Jue) 2001 Iteratioal Cogress o AIDS i Asia ad the Pacific (ICAAP) Meetig Melboure (October) st Iformatio Workshop o Global Fud (Jue) Lauch of Pacific Islads AIDS Foudatio (July) Pacific Leaders Forum (August) 1st Meetig of Pacific Islads Regioal Multi- Coutry Coordiatig Mechaism (PIRMCCM) (October) UNICEF Regioal Youth Cogress, HIV ad AIDS (September) South Pacific Associatio of Theological Schools (SPATS) Regioal Coferece o HIV ad AIDS (September) 2003 WHO SPC Health Miisters Meetig (March) 2d Meetig of PIRMCCM (March) Approval of Fraco-Australia Pacific HIV ad AIDS ad STI Iitiative (July) Approval of Compoet 2 of AusAID-fuded Pacific HIV ad AIDS Project (August) Asia Pacific Leadership Forum (APLF) Pacific compoet discussios (July/August) ad APLF Shared Learig Workshop meetig i Madag (Samoa, Fiji, Kiribati, Solomo Islads ad PNG) (October) Pacific Forum Leaders Commuiqué (August) HIV ad AIDS/STI Adviser appoited (September) UNAIDS Coordiator takes up post (August/ September) 3rd Meetig of PIRMCCM (October) Sigig of grat agreemet for Global Fud (Jue) Regioal HIV ad AIDS stakeholders coordiatig meetig (October) 2004 UNAIDS Great Coucil of Chiefs Regioal Workshop o Acceleratig Actio Agaist AIDS i the Pacific (March) Edorsemet of Pacific Regioal Strategy o HIV ad AIDS ( ) by Pacific Islads Forum ad Committee of Represetatives of Govermets ad Admiistratios (CRGA) 2006 Additioal resources mobilised through ADB grat ad NZAID 2007 Work begis through a multi-door iitiative to establish the Pacific HIV & STI Respose Fud Approval of the GFATM Roud 7 multi-coutry proposal for 11 Pacific Islad coutries 2008 Formatio of Pacific Regioal NGO Alliace for HIV & AIDS 11

12 4.2 Lessos leared Major lessos leared i respodig to HIV ad other STIs relate to the sustaiability of the commitmet ad itervetios at both regioal ad atioal levels. Capacity stregtheig has various elemets such as traiig, techical support, huma resources ad provisio of fiacial resources. It is importat that these elemets are provided as a coordiated package rather tha as separate elemets. Access to atiretroviral therapy (ART) has bee progressed i a umber of PICTs. However, there remais a eed for further egagemet with the health system to reach out to HIV-positive people who require treatmet. Reachig out i this way will require strog political commitmet ad leadership; supportive legislative ad policy frameworks; ehaced access to treatmet, prevetio, care ad support for PLHIV; approaches based o huma rights to combat stigma ad discrimiatio; the promotio of geder equality; ad the active participatio of PLHIV ad affected commuities i the respose. As the experiece of other regios i the world has show, 3 approaches to prevetio, care ad treatmet, ad impact mitigatio, must be sustaied ad comprehesive i order to effectively address the pademic. Improvig access to ART does more tha improve the lives of PLHIV it also supports effective prevetio. Ultimately, whe health systems reach out to PLHIV i the ways idetified above, prevetio becomes icreasigly commo as people are provided with accurate iformatio ad tools so that they ca protect themselves. Several reports 4 have show that coutries that have icreased civil society orgaisatio (CSO) partership ad participatio are better able to respod to HIV tha those that have ot icreased CSO ivolvemet. I the Pacific, also it has bee oted that the ivolvemet ad capacity buildig of CSOs ehaces the implemetatio of regioal ad atioal strategic plas. 3 Natioal policy should comply with the Iteratioal Guidelies o HIV ad AIDS ad Huma Rights, Geeva, OHCHR & UNAIDS 1998, HIV ad AIDS ad Huma Rights Revised Guidelie 6, Geeva, OHCHR & UNAIDS For example, Meetig Report, DIFID, Civil Society, HIV ad AIDS ad Africa, UNAIDS; GFATM, Alliace, December

13 Experieces ad iitiatives i the regio ad lessos leart to date have helped to defie six major themes for the regioal respose to HIV ad other STIs. These themes, which are outlied i Table 1, highlight broad areas that must be stregtheed ad ehaced at the regioal level i light of challeges ad gaps idetified regioally. Although UNGASS commitmets are ot ecessarily specificially metioed i all of the themes they are ecompassed ad liked ito the strategy as outlied below. Table 1: Pacific themes i the respose to HIV ad other STIs ( ). Pacific theme Elemets of UNGASS commitmet 1 HIV ad STI prevetio programme Prevetio Reducig vulerability 2 HIV ad STI testig ad diagosis Prevetio Care, treatmet ad support 3 Care, treatmet ad support Cotiuum treatmet, care, ad supportive HIV ad AIDS ad disaster affected regio systems ad services Childre orphaed by AIDS 4 Leadership ad eablig eviromet Leadership HIV ad AIDS ad huma rights Alleviatig social ad ecoomic impact Prevetio 5 Strategic iformatio ad commuicatio Research ad developmet Follow-up 6 Goverace ad coordiatio Resources Partership 13

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15 5. Opportuities for a Pacific thematic respose The strategic resposes outlied i this documet are divided ito two parts: those that deal with programme delivery i regard to HIV ad other STIs, ad those that deal with programme support. Part Oe: HIV ad other STIs programme delivery Theme 1: Prevetio of HIV ad other STIs Objective To prevet the spread ad miimise the impact of HIV ad other STIs o idividuals, families ad commuities by stregtheig atioal ad regioal prevetio itervetios ad iitiatives. Strategy Support the developmet of ad stregthe effective ad sustaiable prevetative itervetios for HIV ad other STIs i the Pacific regio, icludig actios to address vulerability ad risk factors. Key actio areas: Package iformatio to target audieces. Idetify high-risk groups ad target itervetios (icludig tertiary studets). Support ad stregthe likages of orgaisatios ad others workig with groups that are particularly hard to effectively reach, icludig sex workers, me who have sex with me, ad migrat workers. Stregthe me s ivolvemet ad access to services ad iformatio. Promote the iclusio of prevetio educatio o HIV ad other STIs i formal school curriculums. Stregthe ad icrease comprehesive prevetio of paret-to-child trasmissio (PPTCT) that ecompasses progs 1 to 4 of the policy framework of PPTCT. Establish a Geder & HIV theme group to coordiate respose to geder ad HIV. Advocate for the icorporatio of HIV ad other issues ito atioal ad regioal policies ad programmes o geder, youth ad other vulerable groups. Stregthe ad maitai procuremet ad supply systems for male ad female codoms ad lubricats. Stregthe i-coutry distributio systems of codoms ad lubricats. Support the developmet ad implemetatio of safe blood strategy, icludig prevetig the trasmissio of blood-bore viruses i healthcare settigs. Theme 1: HIV ad other STI testig ad diagosis Objective To icrease the early detectio of HIV ad other STIs to reduce further ifectios ad facilitate early treatmet. Strategy Support the developmet of effective, user-friedly, cofidetial HIV ad other STI cousellig ad testig, icludig stregtheig atioal ad regioal laboratory services for HIV ad STI testig. 15

16 Key actio areas: Develop ad adopt guidelies for HIV ad STI testig ad diagosis, icludig cofidetiality ad cousellig, for the Pacific regio. Develop ad esure access to effective, user-friedly, cofidetial HIV ad other STI cousellig ad testig. Improve ad stregthe case detectio of HIV ad other STIs. Stregthe the regioal laboratory etwork to provide Level 2 laboratories i the regio ad improve moitorig of HIV treatmet, icludig through the procuremet of blood test kits such as CD4 couts. Stregthe health systems, focusig o laboratory proficiecy testig ad volutary cofidetial cousellig ad testig (VCCT). Theme 3: Cotiuum of treatmet, care ad support systems ad services Objective To achieve ad maitai the provisio of a comprehesive cotiuum of treatmet, care ad support for people livig with ad affected by HIV ad other STIs i PICTs. Strategy 1. Support PICTs i the provisio ad delivery of comprehesive care, ad improve access to quality, affordable services. 2. Stregthe commuity service orgaisatios ad PLHIV etworks to icrease the treatmet, care ad support available for people livig with ad affected by HIV. 3. Stregthe PICT health systems so that they ca effectively ad sustaiably respod to HIV ad other STIs. Key actio areas: Provide best practice iformatio ad techical support to PICTs for developig ad updatig treatmet protocols for HIV ad other STIs. Build capacity i geeral care services, icludig ifectio cotrol. Support programme developmet ad implemetatio for TB HIV co-ifectio. Develop guidelies for HIV ad STI case maagemet, occupatioal health, blood safety ad PPTCT (progs 3 ad 4). Establish likages ad explore the role of traditioal medicie i the case maagemet ad support of PLHIV. Improve ad stregthe cliical maagemet ad treatmet of other STIs. Develop traiig guidelies for commuity-based care of PLHIV. Stregthe likages ad/or itegratio of HIV ad STI services with broader sexual ad reproductive health services. Improve access to ART, with a emphasis o sustaiability, together with maagemet of opportuistic ifectios. 16

17 Part Two: HIV ad other STI programme support Theme 4: Leadership ad eablig eviromet Objective To achieve ad maitai commitmet ad egagemet from leaders at all commuity levels ad sectors to address the challeges of HIV ad other STIs. Strategy 1. Advocate for the maistreamig of HIV ito all relevat meetigs. 2. Advocate for the greater ivolvemet of people livig with, affected by ad vulerable to HIV. 3. Advocate for the developmet ad implemetatio of rights-based legislatio ad policy. 4. Promote a supportive social ad physical eviromet i commuities at regioal, atioal ad local levels. Key actio areas: Itegrate ad maistream HIV ad other STI programmes at regioal, atioal ad local levels. Stregthe ad maitai parterships at regioal ad atioal levels. Develop ad adopt advocacy packages targetig leaders i all sectors. Support ad itegrate HIV ad other STI programmes ito priority o-health sectors, icludig commuitybased orgaisatios (CBOs). Stregthe likages of huma rights mechaisms (where they exist) ad o-govermetal orgaisatios (NGOs) workig with people livig with ad affected by HIV. Support the developmet of legislatio, policies ad ethical guidelies that protect the rights of people ifected ad affected by HIV. Promote HIV workplace policies. Promote ad itegrate geder traiig ad awareess i all regioal ad atioal HIV ad AIDS programmes, icludig maistreamig of geder. Stregthe the ivolvemet of HIV-positive people i programmes across PICTs. 17

18 Theme 5: Strategic iformatio ad commuicatio Objective To attai effective plaig, moitorig, evaluatio, surveillace ad research at the atioal ad regioal levels, icludig strategic dissemiatio ad commuicatio of this iformatio. Strategy Assist PICTs i developig reportig, surveillace, research, moitorig ad evaluatio capacity through the provisio of techical ad fiacial assistace, icludig effective commuicatio of this strategic iformatio at both atioal ad regioal levels. Key actio areas: Stregthe operatioal research capacities i PICTs, icludig moitorig ad evaluatio. Facilitate the use of iformatio i programme plaig ad developmet. Support ad stregthe regioal research istitutios. Develop ad adapt tools for effective moitorig ad evaluatio, icludig research. Esure appropriate targetig of iformatio ad dissemiatio of lessos leart across the regio. Establish a effective commuicatio mechaism across the regio o issues related to HIV ad other STIs. Advocate for ad promote best practices for commuicatio o HIV, icludig behavioural chage commuicatio strategies, media practices, the Pacific Specific Regioal Coferece o HIV, ad traditioal commuicatio etworks. Theme 6: Goverace ad coordiatio Objective To attai good goverace ad effective coordiatio through collaborative, trasparet ad accoutable decisio-makig processes i both atioal ad regioal resposes to HIV ad other STIs. Strategy Create ad promote sustaiable mechaisms for effective coordiatio ad collaboratio betwee PICTs, regioal agecies ad other developmet parters, icludig resource mobilisatio for HIV ad other STI iitiatives. Key actio areas: Stregthe the multisectoral approach to the developmet of atioal ad regioal strategic plas i relatio to HIV ad other STIs. Stregthe coordiatio across various levels ad stakeholders. Stregthe parterships betwee sectors ad istitutios. Establish a mechaism for coordiatio ad iformatio sharig. Stregthe joit-plaig mechaisms betwee regioal agecies ad parters. Stregthe the coordiatio of iteratioal agreemets from global ad/or iteratioal, regioal ad atioal levels. Maitai support to NGOs ad other o-state actors. Stregthe ad coordiate resource mobilisatio for the implemetatio of atioal ad regioal resposes. 18

19 6. Implemetatio, review ad redevelopmet of the Regioal Strategy 6.1 Implemetatio The Pacific Regioal Strategy o HIV ad other STIs ( ) will be implemeted over a five-year period by govermets, NGOs ad stakeholders of the regio. The process will ivolve workig with PICTs to ecourage them to meet their leaders commitmets to actively play their part i implemetig the strategy. The first step is commuicatig the strategy to all stakeholders. The ext step will be coductig a meetig of the Regioal Strategy Referece Group o HIV ad other STIs to accept the implemetatio framework. Followig this meetig, the iitial strategy implemetatio will be facilitated ad led by SPC ad UNAIDS, workig with PICT govermets ad regioal stakeholders. 6.2 Review ad redevelopmet While SPC will be actively ivolved i facilitatig a idepedet review ad redevelopmet of the strategy, it is evisaged that a body comprisig various govermet represetatives, NGOs, regioal orgaisatios ad bilateral parters will be established to oversee ad support the process. The Regioal Strategy Referece Group o HIV ad other STIs will take o this role. The strategy ad its implemetatio will be reviewed at two poits durig the five-year period. The first poit will be a mid-term review i early The secod will be a fial review durig 2013, which is aticipated to be a key step i the developmet of a updated regioal strategy for the followig five-year period. 19

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21 7. Moitorig ad evaluatio Moitorig ad evaluatio of the Pacific Regioal Strategy o HIV ad other STIs ( ) will be coducted o three levels: 1. Overall goal ad thematic objectives 2. Key output levels 3. Work programme level. At the level of overall goal ad thematic objectives, the strategy s major idicator targets are liked to PICTs iteratioal commitmets to UNGASS ad the MDGs. The purpose of this approach is to assure PICTs that the Pacific thematic respose areas are meetig the goal ad objectives of the strategy as iteded, as well as global goals ad targets. For example, the regioal strategy sets out, as part of its overall goal, to reduce the spread ad impact of HIV ad AIDS. This high-level objective correspods to the MDG target to have halted by 2015 ad begu to reverse the spread of HIV ad AIDS. Workig together with atioal authorities, SPC will cotiue to collect, aalyse ad report the relevat statistics. At the key outcome ad output levels, the strategy idetifies a umber of activities that, whe implemeted, ca be moitored relatively easily. A separate moitorig ad evaluatio matrix has bee prepared, idetifyig appropriate idicators for each key actio (e.g. the umber of medical ad ursig staff traiig i case maagemet of HIV ad other STIs). Workig with its parters, SPC will cotiue to develop the strategy s moitorig ad evaluatio framework ad report o progress towards the key results aually. The aual joit implemetatio meetig, which brigs together regioal stakeholders, will be the mai vehicle for coordiatig ad overseeig the implemetatio of the regioal strategy at the work programme level. 21

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