Japan's commitment, Human Security and JICA's action toward HIV/AIDS. HIV/AIDS and Human Security. Expenditure related to HIV/AIDS (by region)

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2 Rapid globalization in today s world has accelerated the cross-border movements of people, goods and information, for better and for worse. Both the HIV/AIDS pandemic and emerging infectious diseases such as SARS and avian influenza thrive in a borderless world and pose new and growing threats to the international community that can not be solved by any one country working alone. These threats are not only serious health concerns, but development challenges as well. The spread and devastating impacts of HIV/AIDS presents the immense probability of nullifying decades of efforts towards economic development, and crushing the hopes of future generations. Despite the startling progress made in health services around the world, 40 million people today are infected with HIV. Around 30 million people have already lost their lives to AIDS, and in regions where the disease is prevalent, the average life expectancy has been dramatically shortened by as much as 15 years. In order to counter the direct threats faced by people in the globalized world, we need to employ a new comprehensive approach based on human-centered perspectives, recognizing the interconnection of current global challenges. It is critical for the international community to take collective action to formulate strategies in regional and continental scale, and to pool our limited resources in response to HIV/AIDS. By doing so, we can support government institutions and systems to fulfill their responsibilities to protect the people, and to empower these individuals to protect themselves. It is pivotal to link top-down and bottom-up approaches to address today s multiple threats and challenges. This is the approach that realizes the concept of human security. HIV/AIDS and Human Security Message by Sadako Ogata, President Japan International Cooperation Agency (JICA) Japan's commitment, Human Security and JICA's action toward HIV/AIDS Japan International Cooperation Agency (JICA) has the responsibility to implement Japan s official development assistance (ODA) to enhance the capacity of people in developing countries so that they can solve their problems and sustain their development. To tackle HIV/AIDS in the 21 st century, international community agreed its direction through setting of the Millennium Development Goals (Goal 6: Combat HIV/AIDS, malaria and other diseases; Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS) in To build global momentum to intensifying response to HIV/AIDS, further commitment and goals with specific deadlines were set out in the Declaration of Commitment on HIV/AIDS adopted by the UN General Assembly Special Session on HIV/AIDS (UNGASS) in June With these global setting, Japan announces its commitment and several initiatives to strengthen its cooperation on HIV/AIDS for the protection of the people s health throughout the world. Japan adopts various approaches to achieve the targets effectively and efficiently: bilateral cooperation; contribution to Global Fund to fight AIDS, Tuberculosis and Malaria, International Organizations and NGOs. Japan's commitments related to HIV/AIDS JICA is, under these Japanese Government s commitments, accelerating and expanding its cooperation on HIV/AIDS emphasizing Human Security perspective which was declared as Japan s important perspective on development in ODA charter. - Health and Development Initiative announced in 2005 succeeding Okinawa Infectious Disease Initiative (IDI) announced at the Kyushu-Okinawa G8 Summit - The Tokyo International Conference on African Development (TICAD) Tokyo Action Plan since 1997 Expenditure related to HIV/AIDS (by region) JICA, the main body responsible for the implementation of Japan s Official Development Assistance (ODA), has emphasized capacity development for ensuring sustainability, and has provided assistance mainly to central and local Latin America and The Caribbean 4% Training in Japan 2% governments, but also at the community level. JICA's assistance to governmnets on HIV/AIDS is multi-faceted, including program support at country level, human resource development, strengthening laboratory network and health system Asia and Pacific 40% Africa 54% 1,526 million JPY US $ 13.9 million (FY 2004 tentative) capacity at district level, and expansion of quality services, such as sexual risk reduction, counseling and testing, prevention of mother-to-child transmission. At community level, JICA has promoted availability and accessibility of prevention and care services to reach people, through assistance to local NGOs and activities of volunteers. JICA's Cooperation HIV/AIDS is a growing global threat to human security in the developing world, requiring renewed efforts and cooperation on every level. International community has to work together for the people suffering from HIV/AIDS as JICA will work in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Health Organization (WHO); the Joint United Nations Program on HIV/AIDS (UNAIDS); and other international organizations and donors to response to the AIDS epidemic. JICA is always ready to extend its assistance to the people threatened by HIV/AIDS and those living with HIV/AIDS, by focusing on human security in its activities. Freedom from fear Freedom from want Capacity Development protection) The MDGs are the specific objectives of the development agenda outlined in the Millennium Declaration. JICA is working toward achieving the MDGs and sustaining the outcomes of that achievement by providing assistance based on the principle of human security. This principle has two aspects: (1) Perspective: addressing the need for not only freedom from want but also freedom from fear. (2) Approach: applying both top-down and bottom-up approaches to help development countries enhance their capacities for dealing with their own problems ( Capacity Development ). Underpinning these efforts is our cooperation in the area of infrastructure development. Through practical application of the principle of human security, JICA is contributing to the realization of the MDGs and the broader objectives of the Millennium Declaration. 1 2

3 JICA's Strategy in Response to HIV/AIDS (1) Targets - To reduce HIV infections - To improve Quality of Life of People living with HIV/AIDS and their families (2) Approaches - To expand support as part of comprehensive response to HIV prevention, treatment and care integrated into public health system, emphasizing prevention to protect people against infection - To approach both government (national and local) level and local community and people level to support the development countries and communities to sustain their appropriate response to HIV/AIDS - To facilitate the process of capacity development in human resource development, organization strengthening, and institution building based on Japan s development experiences to ensure that MDGs will be achieved and outcomes will be sustained for the long-term period - To formulate cooperation plans through dialogue with each developing country to fit with the national strategy and to ensure the ownership - To have greater impact through partnerships with international organizations, bilateral donors, and international and local NGOs - To expand support on HIV/AIDS linking with other programs in health sector, as well as intending response to HIV/AIDS in support of other sectors in the perspective, such as poverty reduction, community development, education, agriculture and social insurance (3) Main activities - Strengthen HIV prevention utilizing various approaches known effective (condom promotion, preventive education/bcc, PMTCT, blood safety, STI control, specific approaches to key populations such as youth etc.) - Expand and strengthen comprehensive voluntary counseling and testing services - Strengthen supportive environment for AIDS treatment (HIV testing, monitoring etc) and response to TB/HIV co-infection - Strengthen health system capacity at national and local level to support HIV/AIDS program - Promote Community based care and support for people living with HIV/AIDS VCT: Voluntary Counseling and Testing BCC: Behavior Change Communication PMTCT: Prevention of Mother-to-Child Transmission STI: Sexually Transmitted Infections TB: Tuberculosis JOCV: Japan Overseas Cooperation Volunteer Technical Cooperation Project Dispatch of JOCVs and/or Equipment Supply Program for AIDS Control and Blood Tests The Country Sending Trainees JICA's Response to HIV/AIDS SENEGAL Project for STI/HIV Prevention Among Youth This project is to enlighten preventive activities for STI and HIV in close collaboration with various actors of the project. JICA, USAID-FHI Senegal, and UNFPA, these three development partners support the Government of Senegal to set up VCT function at every youth counseling center under the Ministry of Youth, in accordance with a strategy of establish VCT functions in all health centers by the Ministry of Health, aiming at reducing new HIV infection. JICA is responsible for supply of necessary equipment for VCT centers, dispatch of experts and JOCV, and providing cost of necessary trainings and workshops for the staff in VCT centers. GHANA HIV/AIDS Control Program (in preparation) TANZANIA HIV/AIDS Control Program SENEGAL This program aims HIV prevention through expansion of quality VCT services and strengthening of STI program. It consists of: (1) trainings of VCT counselors and supervisors, (2) support of VCT services at community level through collaboration with NGOs, and (3) strengthening of central government. These are effectively combined with the grant aid project to procure commodities, such as HIV test kits, STI drugs, for whole the country. ZAMBIA Program on Measures Against HIV/AIDS and Infectious Disease Programming inputs in HIV/AIDS and TB control from Japan to Zambia is required for effective project implementation. Under this program, an advisor, HIV/AIDS and TB Program Coordinator, is dispatched to National HIV/AIDS/STD/TB Council (NAC) to coordinate ongoing technical cooperation projects such as HIV/AIDS and TB Control Project ( ) as a center of the program and Cross Border Initiative Project and Equipment Supply Program for AIDS Control and Blood Tests to be an effective program. SOUTH AFRICA HIV/AIDS Peer Education Project for Schools in the Ndwedwe Region of Kwazulu-Natal Province The project aims to: (1) disseminate correct information about HIV/AIDS mainly at schools in this region, where 36.3% of all people living with HIV are reported in South Africa, (2) train teachers, and (3) develop teaching materials. The implementing body of the project is the Japanese NGO Together with Africa and Asia Association. MOROCCO MAURITANIA COTE D'IVORE TOGO GHANA NIGER NIGERIA NIGERIA Country-focused Training Course on Preventive Measures Against HIV Transmission in Japan GABON CHAD ANGOLA NAMIBIA EGYPT International Training Course for Clinical Immunology of Infectious Diseases & Total Quality Management BURUNDI ZAMBIA BOTSWANA SOUTH AFRICA EGYPT UGANDA ZIMBABWE KENYA TANZANIA LESOTHO ERITREA ETHIOPIA MALAWI MOZAMBIQUE SWAZILAND Equipment Supply Program for AIDS Control and Blood Tests In 2004, rapid HIV test kits on home based care kits were provided to Kenya, Ethiopia, Botswana, Namibia, Lesotho and so on. In addition, JICA provided CD 4 counters to Ghana. The number of country supported by this program becomes total 17 countries. Dispatch of Japan Overseas Cooperation Volunteers MADAGASCAR JICA recruits JOCVs for HIV/AIDS prevention, care and support and dispatchs them to local governments, local NGOs, schools, youth centers and so on. JOCVs support agencies from government level to grass-root levels, for improved management and implementation of the HIV/AIDS program. KENYA Program for HIV Prevention Objective of the program is to increase number of HIV test in VCT and clinical setting to reduce new HIV infections in Kenya. JICA integrates the approaches of:(1) promotion of HIV/AIDS education through radio, (2) community empowerment on IEC/BCC activities through mobilizing JOCVs, and (3) strengthening advocacy activities and monitoring and evaluation system at national level. Blood Safety Project (to be started in 2006) Ministry of Health, Kenya is strengthening blood supply for transfusion through donor mobilization, establishment of blood centers, and improvement of blood screening in collaboration with US government. JICA's cooperation, with a slogan of Safe Blood, Save Blood, is planned to focus on improvement of safety and efficiency in use of blood products in the resource limited settings in order to strengthen national blood transfusion management system from user (patient) side. Research and Control of Infectious and Parasitic Diseases Project (HIV/AIDS, Opportunistic Infections, Viral Hepatitis) International Training Course on Blood Safety for Africa , 2003, MALAWI Project for Provision of Voluntary Counseling and Confidential Testing Services The objectives of this project are: (1) to increase those who receive services for prevention of HIV and STI by providing high quality service which mainly focuses on the vulnerables, and (2) to increase the number of persons who receive home-based care through strengthening appropriate educational activities, referral services and monitoring. SEYCHELLES MOZAMBIQUE Strengthening of Information, Education and Communication Activities on HIV/AIDS in Sofala Province (in preparation) MADAGASCAR VCT System Strengthening (in preparation) ZIMBABWE Project for Prevention of HIV Transmission in Mabvuku/Tafara Area in the City of Harare The objective of the project is to conduct HIV/AIDS awareness campaigns and provide VCT services in the Mabvuku/Tafara in the City of Harare. The implementation of the project is entrusted to two local NGOs. The Project for Prevention of Parent to Child Transmission of HIV in Masvingo Province This project aims to reduce parents to child transmission of HIV, the expected outputs are (1) increasing the utilization of the service by pregnant women who come to Antenatal Clinics (ANC), (2) increasing the number of health institutions which provide the service, and (3) strengthening the program management of the provincial and district team. 3 4

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5 Updates on JICA s Programs/ Technical Cooperation Projects (JFY ) The project aims to strengthen HIV prevention measures in Gansu Province. Activities are (1) to review the provincial strategy and strengthen preventive measures for high risk groups (STI patients and commercial sex workers) and tuberculosis patients, (2) to strengthen the surveillance of target groups, and (3) to introduce universal precautions at model health facilities. JICA supports GAC (Ghana AIDS Commission) to strengthen BCC (Behavior Change Communication) activity to reduce high risk behaviors among youth. The target of the project is youth aged in the Eastern and Ashanti Region. Activities are (1) to strengthen national and district capacities on coordination and M&E of BCC activities, (2) to increase awareness and knowledge on HIV/AIDS and related services (VCT and PMTCT) among targets through media campaigns and other BCC activities, and (3) to promote condom usage. The project aims to establish a comprehensive M&E system for Home Community Based Care (HCBC) of the Department of Social Development for HCBC service delivery improvement. JICA supports the activities for (1) integration of several existing M&E systems into a comprehensive M&E system, (2) human resource development on M&E at local governments, and (3) introduction of the comprehensive M&E system at national and local governments. The program aims to decrease the number of deaths from AIDS through strengthening the administrative management capacity and improvement of access and quality of testing, diagnosis, treatment and care services on AIDS and tuberculosis. Various approaches outlined below are strategically integrated in the Program. HIV/AIDS/TB Program Coordinator at the National HIV/AIDS/TB/STI Council A coordinator is supporting activities to strengthen the management capacity of HIV/AIDS/TB administration and the National HIV/AIDS/TB/STI Council (NAC), such as planning, coordination and M&E. This advisor also coordinates the overall activities of the JICA Program. National HIV/AIDS/TB/STI Council Ministry of Health Province District Community Prevention Activities for Prevention at schools and NGOs Testing Diagnosis Treatment Planning Coordination M & E Equipment supply for HIV/AIDS & TB Reagent supply External quality assurance Early detection Expansion of treatment Monitoring of treatment Care and Support Support to vocational training Care of People living with HIV/AIDS The Integrated HIV and AIDS Care Implementation Project at the District Level This aims to demonstrate the interventions to improve HIV/AIDS care service, especially in service quality and accessibility, at the district level. Project for Strengthening HIV/AIDS and TB Laboratory Network Service This project is being prepared to strengthen the Laboratory Quality Assurance Network covering the entire country for HIV testing, CD4 counting and sputum smear examination. Project to Combat Tuberculosis in Unplanned Settlement Areas of Lusaka City This is a collaboration with an NGO to control the tuberculosis epidemic in the target area through the establishment of community groups and training of DOTS supporters. JOCVs on HIV/AIDS prevention and care and support at communities

6 Report from JICA Volunteers A song composed with the famous singer Mr. Mlaka Maliro to empower AIDS prevention ranks no 1 on the Local Hit Chart! A way of reconstructing the VCT center with focus on establishing privacy for users without much spending is proposed. The Ministry of Health is currently reconsidering strategies that focus on changing people s perceptions and behavior. To achieve this, it is necessary to not only provide onesided information and knowledge, but to provide opportunities that catch people s attention, and promote interactive participation, as well as conducive environment. As a part of this point, we advertised a public invitation for "Slogans related to HIV/AIDS in a newspaper on last year s World AIDS Day, and received 133 responses from all over the country, which shows people s active participation. [ At an event for the World AIDS Day ] In China, about 650,000 people are currently said to be HIV positive. Sichuan Province, where I am assigned, is one of the provinces with the highest number of HIV-positive people. In March of this year, JICA President Ms. Sadako OGATA visited to take a look at the measures taken to prevent the rapid spread of HIV/AIDS. Apart from street publicity activities, the HIV/AIDS Advisory Center of the Liangshan Province Red Cross Society also offers consultations by telephone (including automatic voice services). The training of staff for on-campus educational activities to prevent HIV/AIDS by students (peer educators) at local universities is also an important work. [ Student volunteers attending a seminar on how to use condoms ] In Jamaica, the problem of HIV infections is becoming more and more serious every year. To deal with this situation, the Ministry of Education, Youth of Jamaica (MOEY) launched a preventive education plan for people involved with schools a few years ago. In the summer of 2004, 6 members of the HIV/AIDS Response Team were assigned to this ministry to promote the plan. Together with local workers, the team members hold workshops and visit schools, providing education to prevent HIV infection, etc. Team members activities can be characterized from their approach of tackling the issue of AIDS from the aspect of education. Another characteristic is the point that they collaborate with other international organizations such as UNESCO and UNICEF. This is the first group dispatch as the HIV/ AIDS Response Team, and their vision for the future is to create a good example here to serve as a model for other countries. Japan International Cooperation Agency