Analysis of Modes of HIV Transmission and National Response to HIV and AIDS synthesizes data to support evidenceinformed. HIV prevention in Mozambique

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1 The Global HIV/AIDS Program (GHAP) Global AIDS M&E Team (GAMET) Analysis of Modes of HIV Transmission and National Response to HIV and AIDS synthesizes data to support evidenceinformed HIV prevention in Mozambique INTEREST Workshop, Maputo, 26 May 2010 FAZENDA LEITE Gloria (Conselho Nacional de Combate ao HIV/SIDA, CNCS / NAC), LUNTAMO Mari (UNAIDS Maputo), THEMBA Pascoa (CNCS / NAC), CYSNE Mauricio (UNAIDS Maputo), FRASER Nicole (GAMET, World Bank)

2 Background Mozambique s HIV epidemic remains serious: 14% of adults estimated to be infected with HIV in 2008 Need to urgently intensify evidence-informed HIV prevention However, there is insufficient data on HIV prevalence and sexual behaviours in different populations Analysis of Modes of HIV Transmission and National Response to HIV and AIDS was undertaken to Improve the understanding of the epidemic and response in Mozambique Improve the relevance and comprehensiveness of the HIV prevention efforts

3 Materials & Methods The study synthesized data on the HIV epidemic and response in Mozambique Materials: Existing data compiled through wide consultations Two new studies: 1.Estimating the sources of new infections with UNAIDS incidence model 2.Mapping of HIV prevention programmes

4 Epidemiological review Know your epidemic Incidence data (modelled) Prevention policies, response and strategic info review Know your response Review of resources for prevention

5 Methods cont. The two syntheses were compared to - Understand the gaps in HIV prevention programming - Make recommendations for HIV policy and programme level The main limitation: lack of recent data

6 Results: Epidemiological synthesis Large regional differences in Mozambique s HIV epidemic Identified main drivers: Multiple and sometimes concurrent partnerships Low levels of male circumcision in many provinces Inadequate condom use Range of social norms

7 Example of analysis of the drivers: Relationship between reported multiple partners (last 12 months, 2003) and HIV prevalence by province (2007) ANC prevalence % sexually active men with 2+ partners (2003) Sources: DHS 2003; 2007 ANC surveillance report.

8 Partners of MPs 18% One sexual partner 47.3% Medical injections 1.7% Blood transfusions 0.1% Injecting Drug Use (IDU) 3% Partners IDU 0.3% Sex workers 2% Clients 7% Related to multiple partner behaviours: 24% Multiple partners (MPs) 6% Female partners of MSM 0.1% MSM 5.1% Partners of Clients 10% Sex work related: 19% Note: The results are based on mathematical modeling, and proxy data, estimates and assumptions were used due to insufficient local data. The model results should therefore be used with caution and triangulated with other epidemiological data.

9 Results: Response synthesis STRENGTHS: Multi-sectoral HIV prevention approach, including the establishment of a high-level Prevention Reference Group A commendable proportion of HIV expenditure for prevention (40%) Large investments in scaling-up prevention of mother-tochild transmission programme and antiretroviral treatment Behaviour change communication appears to show results in reducing multiple partners and increasing condom use CHALLENGES: Policy context for scale-up of male circumcision Quality assurance of counselling and testing

10 Conclusions More efforts are needed to Reduce multiple and concurrent partners, and transactional sex Increase condom use Promote testing, especially among couples Opportunities to strengthen the national response include Integrating HIV prevention activities into treatment and antenatal care services, including prevention with positives Scaling up of comprehensive male circumcision services Using family planning to prevent unintended pregnancies among HIV positive women The analysis highlighted the need to conduct studies to fill important data gaps to enable better planning and evaluation

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