The HIV/AIDS The HIV/AIDS EpidemicEpidemic

A Guiding SnapshotA Guiding Snapshot

Rouzeh EghtessadiRouzeh EghtessadiPublic Health Specialist- Gender & Human Rights Public Health Specialist- Gender & Human Rights

Southern Africa HIV/AIDS Information Dissemination Southern Africa HIV/AIDS Information Dissemination Service (SAfAIDS)Service (SAfAIDS)17 Beveridge Rd, Avondale, Harare, Zimbabwe17 Beveridge Rd, Avondale, Harare, ZimbabweTel:Tel: +263 33 61 93/4+263 33 61 93/4Fax:Fax: +263 33 61 95+263 33 61 95Website:Website: http://http://www.safaids.org.zwwww.safaids.org.zw

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SummarySummary• Epidemiological OverviewEpidemiological Overview

• Key Determinant FactorsKey Determinant Factors: : risk, risk, vulnerability, susceptibilityvulnerability, susceptibility

• The CommitmentsThe Commitments: : promises honored vs promises honored vs dishonoreddishonored

• HIV/AIDS Response SpheresHIV/AIDS Response Spheres: : what we what we should be concerting efforts in unisonshould be concerting efforts in unison SAfAID

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Epidemiological OverviewEpidemiological Overview (1)(1)

• Southern Africa remains the global epicentre of the epidemic (1 in 3 people infected/globally live in SA)

• About 43% of all children (under 15 years) living with HIV are in southern Africa

• Approximately 52% of all women (15 years and older) living with HIV, live in s.Africa

• Abundant statistics around affected and infected groups call for joint developmental responses SAfAID

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Epidemiological OverviewEpidemiological Overview (2)(2)

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Source: Source: UNAIDS 2006 Report on thUNAIDS 2006 Report on the Global AIDS e Global AIDS Epidemic , May 2006Epidemic , May 2006

Source: Source: UNAIDS 2006 Report on thUNAIDS 2006 Report on the Global AIDS Epidemic ,e Global AIDS Epidemic , May 2006 May 2006

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Feminization of HIV/AIDS in Feminization of HIV/AIDS in selected Sub-Saharan Countries, selected Sub-Saharan Countries,

20052005

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Key Determinant FactorsKey Determinant Factors

……… ………..that fuel HIV/AIDS related Risks, ..that fuel HIV/AIDS related Risks, Vulnerability & SusceptibilityVulnerability & Susceptibility• Gender RelationsGender Relations• PovertyPoverty• MigrationMigration• Civil & Political UnrestCivil & Political Unrest• Natural DisastersNatural Disasters• Human Rights Violations –Human Rights Violations –vulnerable/ vulnerable/

marginalised populationsmarginalised populations• Access to Resources & Services Access to Resources & Services SAfAID

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Affected versus Affected versus Infected……. Impact cannot Infected……. Impact cannot

be ignored be ignored • ChildrenChildren• WomenWomen• Elderly Elderly

• Interrelationship of AIDS with other problems of Interrelationship of AIDS with other problems of human development has become clearerhuman development has become clearer

• MDGs- reversed MDGs- reversed

“ “ In countries , AIDS is undermining progress towards the MDGs In countries , AIDS is undermining progress towards the MDGs particularly those related with poverty reduction, achieving particularly those related with poverty reduction, achieving

universal primary education, promoting gender equality, reducing universal primary education, promoting gender equality, reducing child mortality and improving health of motherschild mortality and improving health of mothers” UNFPA, 2005” UNFPA, 2005

Key Impact Areas…Key Impact Areas…

• Population structurePopulation structure• Poverty and inequality Poverty and inequality (Bots,2005)(Bots,2005)

• Governance- PRSP, NSP Governance- PRSP, NSP (Mozambique, 2006)(Mozambique, 2006)

• Social and Traditional Structures & NetworksSocial and Traditional Structures & Networks• Households – “coping”- Households – “coping”- (Zambia, 2005, FAO, (Zambia, 2005, FAO,

2004)2004)

• Stigma & Discrimination Stigma & Discrimination (Bots & SA, 2003)(Bots & SA, 2003)

• World of WorkWorld of Work• Agriculture, Transport, Mining, Education, Agriculture, Transport, Mining, Education,

Fisheries, Health Systems Fisheries, Health Systems (ILO, 2004)(ILO, 2004)

HIV/AIDS Related HIV/AIDS Related CommitmentsCommitments (1) (1)

• UUnited Nations General Assembly Special nited Nations General Assembly Special Summit on HIV/AIDS (USummit on HIV/AIDS (UNGASSNGASS) Declaration ) Declaration (2001/2006)-(2001/2006)- Achieve Universal Access by 2010Achieve Universal Access by 2010

• UNAIDS GIPA Principles (2001)UNAIDS GIPA Principles (2001)• UN UN Millennium DeMillennium Declaration/MDGsclaration/MDGs (2000) (2000) – Goal – Goal

66, , linked closely with all other goals: linked closely with all other goals: child mortality, education, child mortality, education, gender, poverty, environmental sustainability [IWRM], maternal health, gender, poverty, environmental sustainability [IWRM], maternal health,

partnerships)partnerships) • International Labour Organisation International Labour Organisation –HIV/AIDS –HIV/AIDS

Employment CodeEmployment Code ( (20012001) ) • CConvention on the Elimination of All Forms of onvention on the Elimination of All Forms of

Discrimination Against Women (CDiscrimination Against Women (CEDAWEDAW) &) & Beijing Declaration & Platform for Action (1995) Beijing Declaration & Platform for Action (1995) SAfAID

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HIV/AIDS Related HIV/AIDS Related Commitments Commitments (2)(2)

• International Guidelines on HIV/AIDS International Guidelines on HIV/AIDS & & HumanHuman RightsRights

• SADC Code on SADC Code on EEmplmplooymeyment and nt and HIV/AIDS HIV/AIDS

• Abuja DeclarationAbuja Declaration:: AU Special Summit on HIV/AIDS, TB AU Special Summit on HIV/AIDS, TB

and Malariaand Malaria (2001/2006)(2001/2006) • COMESA Gender Policy (2002)COMESA Gender Policy (2002)

• Maseru Declaration – SADCMaseru Declaration – SADC (2003) (2003)

• AAU U Protocol on Rights of WomenProtocol on Rights of Women in Africa in Africa (2003)(2003)

• CCountry Strategies/Policies and Programmesountry Strategies/Policies and Programmes

• Jo’burg Summit (2002) recognized HIV/AIDS Jo’burg Summit (2002) recognized HIV/AIDS

• World Water Forum, Mexico (2006) did not !World Water Forum, Mexico (2006) did not !SAfAIDS

HIV/AIDS Response HIV/AIDS Response SpheresSpheres

Response is developmental, not HEALTH Response is developmental, not HEALTH SECTOR responsibility only : SECTOR responsibility only :

• PreventionPrevention - - ABC, gender based violence, PEP, VCTABC, gender based violence, PEP, VCT

• CareCare – – home based care, positive living, health system home based care, positive living, health system monitoring, nutrition & food securitymonitoring, nutrition & food security

• SupportSupport – – access to resources & services, peer support access to resources & services, peer support networks & groups, capacity buildingnetworks & groups, capacity building

• TreatmentTreatment – – ART, opportunistic infectionsART, opportunistic infections

• AdvocacyAdvocacy – – awareness raising, combat stigma & awareness raising, combat stigma & discrimination, community and policy maker mobilisation discrimination, community and policy maker mobilisation

• Research Research • Mitigation & LitigationMitigation & Litigation – – legal aid for human rights legal aid for human rights

violations, willful transmissionviolations, willful transmission

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So where do we So where do we penetrate ? penetrate ?

• Global levelGlobal level• Regional level- Regional level- developmental, multisectoral concerted developmental, multisectoral concerted

efforts’ policy making efforts’ policy making

• National level- National level- policy making, resource mobilisationpolicy making, resource mobilisation

• Sector level – Sector level – Water and Sanitation SectorWater and Sanitation Sector

• Sub-sector level – Sub-sector level – IWRMIWRM

• Organisational level – Organisational level – lobbying, researching, lobbying, researching,

implementing, mitigating implementing, mitigating IWRM ManagersIWRM Managers

• Community level – Community level – IWRM field workersIWRM field workers

• Individual level – Individual level – IWRM Practitioners, behaviour & IWRM Practitioners, behaviour & attitudinal change, support systemsattitudinal change, support systems

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How do we Penetrate ?How do we Penetrate ?

• Policy and Law Making LevelPolicy and Law Making Level

• Organisational Culture- Strategy and Organisational Culture- Strategy and Plan development Plan development

• Community based interventionCommunity based intervention

• Awareness Publications

• Curriculum adjustment

•Document ammendments

Knowledge Knowledge ManagementManagement : : A Strategy to Manage A Strategy to Manage Mainstreaming HIV/AIDS Mainstreaming HIV/AIDS

Identification Key Issues

Monitoring, Evaluation, Documentat

ion

Production of Materials

Utilisation of Information

Building Capacity

R.Eghtessadi – MPH(2006)

•Research

•Focus Groups/ Workshops

•Partner/donor Identification• Sit-in Sensitisation Trainings

•ICT (www) , Workplace Policies and Programs•Advocacy Campaigns

•Peer education, buddy systems, support groups, discussion forums

• Organisational events and culture shift (Programing, policy/legal reform)

•GIPA/MIPA/MIWA

•Monitoring, evaluation

•Documentation

•Dissemination towards empowerment and informed decision making

Mainstreaming HIV/AIDS Mainstreaming HIV/AIDS in Practice : in Practice : A A

Developmental ResponseDevelopmental Response

Rouzeh EghtessadiRouzeh EghtessadiPublic Health Specialist- Gender & Human Public Health Specialist- Gender & Human

Rights Rights

Southern Africa HIV/AIDS Information Southern Africa HIV/AIDS Information Dissemination Service (SAfAIDS)Dissemination Service (SAfAIDS)

17 Beveridge Rd, Avondale, Harare, Zimbabwe17 Beveridge Rd, Avondale, Harare, ZimbabweTel:Tel: +263 33 61 93/4+263 33 61 93/4Fax:Fax: +263 33 61 95+263 33 61 95Website:Website: http://http://www.safaids.org.zwwww.safaids.org.zw

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IWRM & Mainstreaming IWRM & Mainstreaming HIV/AIDS have one HIV/AIDS have one

important element in important element in common = common = both are fairly both are fairly new and rapidly evolving new and rapidly evolving

conceptsconcepts

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SummarySummary• HIV/AIDS & Knowledge Management Cycles HIV/AIDS & Knowledge Management Cycles

• Defining Mainstreaming Defining Mainstreaming

• Mainstreaming is not…….Mainstreaming is not…….

• Mainstreaming HIV/AIDS : The Basic StepsMainstreaming HIV/AIDS : The Basic Steps

• Essential Principles HIV/AIDS Essential Principles HIV/AIDS Mainstreaming Mainstreaming SAfAID

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• Awareness Publications

• Curriculum adjustment

•Document ammendments

Knowledge Knowledge ManagementManagement : : A Strategy to Manage A Strategy to Manage Mainstreaming HIV/AIDS Mainstreaming HIV/AIDS

Identification Key Issues

Monitoring, Evaluation, Documentat

ion

Production of Materials

Utilisation of Information

Building Capacity

R.Eghtessadi – MPH(2006)

•Research

•Focus Groups/ Workshops

•Partner/donor Identification• Sit-in Sensitisation Trainings

•ICT (www) , Workplace Policies and Programs•Advocacy Campaigns

•Peer education, buddy systems, support groups, discussion forums

• Organisational events and culture shift (Programing, policy/legal reform)

•GIPA/MIPA/MIWA

•Monitoring, evaluation

•Documentation

•Dissemination towards empowerment and informed decision making

Defining Mainstreaming Defining Mainstreaming (1)(1)

• How many of us are SINCERELY & How many of us are SINCERELY & URGENTLY concerned?URGENTLY concerned?

• Mainstreaming is Mainstreaming is a processa process that enables that enables development actors to address the development actors to address the causes and effectscauses and effects of HIV/AIDS in of HIV/AIDS in an an effective and sustained mannereffective and sustained manner, both , both through their usual work and within their through their usual work and within their workplace workplace (UNAIDS)(UNAIDS)

It means ‘wearing HIV/AIDS glasses” while working in all It means ‘wearing HIV/AIDS glasses” while working in all levels across all sectorslevels across all sectors SAfAID

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Reciprocal Relationship: HIV/AIDS & Development

Specific AIDS-focused interventions

Mainstreaming HIV/AIDS &

Defining MainstreamingDefining Mainstreaming (2)(2)

• Internal MainstreamingInternal Mainstreaming ((IM pre-requisite for EM IM pre-requisite for EM effectiveness)effectiveness) involves involves changing organisational policy and practice., to reduce the susceptibility to HIV infection and its vulnerability to the impact of AIDS. The focus is on HIV/AIDS and the organisation

• External MainstreamingExternal Mainstreaming (EM)(EM) refers to adapting programme work to take into account susceptibility to HIV transmission and vulnerability to the impact of AIDS. The focus is on core programme work in the changing context.

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Internal sphere (workplace, your

organisation)

External sphere (your cooperation

activities)

&

Mainstreaming Mainstreaming HIV/AIDSHIV/AIDS

Mainstreaming Assumes

•multi-disciplinary

•multi-level and

•multi-sector approaches

Mainstreaming HIV/AIDS Mainstreaming HIV/AIDS is not …….is not …….

• Changing core functions and Changing core functions and responsibilities in order to turn all org. responsibilities in order to turn all org. activities into HIV/AIDS programmesactivities into HIV/AIDS programmes

• Simply introducing HIV/AIDS awareness Simply introducing HIV/AIDS awareness raising in all activities - should be more to raising in all activities - should be more to it it

• All staff having to become HIV/AIDS All staff having to become HIV/AIDS specialistsspecialists

• Business as usual …………Business as usual ………… SAfAIDS

We need to be We need to be “Turning “Turning the Tide” the Tide” of our of our organisations – let HIV/AIDS organisations – let HIV/AIDS responses slip into our responses slip into our business business ‘main’ stream…‘main’ stream…

… automatic flow into all core business offshoots… ‘process’ not ‘event’

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HIV/AIDS ReponsesHIV/AIDS Reponses

MainstreamingMainstreaming HIV/AIDS HIV/AIDS (1) (1)

• Basic Steps in Mainstreaming HIV/AIDSBasic Steps in Mainstreaming HIV/AIDS : :– Context & Organisational Profile (HIV/AIDS Context & Organisational Profile (HIV/AIDS

Audit/Situational Analysis)Audit/Situational Analysis) - - How is HIV/AIDS How is HIV/AIDS

affecting your organisation? Your work?affecting your organisation? Your work?

– Impact of HIV/AIDS on IWRMImpact of HIV/AIDS on IWRM – – activity map activity map tracking HIV/AIDS influence tracking HIV/AIDS influence

– Impact of IWRM on HIV/AIDSImpact of IWRM on HIV/AIDS – – risk, vulnerability, risk, vulnerability, responses & entry point identification responses & entry point identification

– HIV/AIDS Transformative HIV/AIDS Transformative Strategy/Policy/ProgramStrategy/Policy/Program: : awareness raising-awareness raising-reflection-action, advocacy, S&D combated, universal access, reflection-action, advocacy, S&D combated, universal access, policy and support mechanism establishment, budget review, policy and support mechanism establishment, budget review, M&E plan, research & documentation, knowledge sharing M&E plan, research & documentation, knowledge sharing SAfAID

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MainstreamingMainstreaming HIV/AIDSHIV/AIDS (2)(2)•Simply : let’s ask ourselves Four Key Simply : let’s ask ourselves Four Key

questions:questions:– How does HIV/AIDS affect my organisation ?How does HIV/AIDS affect my organisation ?– How does HIV/AIDS affect my work?How does HIV/AIDS affect my work?– How can harm due to HIV/AIDS be avoided?How can harm due to HIV/AIDS be avoided?– How can I contribute to fighting HIV/AIDS by How can I contribute to fighting HIV/AIDS by

limiting the spread and mitigating the limiting the spread and mitigating the impact of the epidemic? impact of the epidemic?

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Step 1: Baseline AnalysisStep 1: Baseline Analysis

Internal sphereInternal sphere

Organisational analysisOrganisational analysis::– How are staff and their How are staff and their

families affected?families affected?– Impact of HIV/AIDS on Impact of HIV/AIDS on

human resources in the human resources in the sector?sector?

– What institutional What institutional instruments are available instruments are available to respond?to respond?

– What resources are What resources are available to respond?available to respond?

External sphereContext analysis: General HIV/AIDS

General HIV/AIDS situation?situation? Impacts of HIV/AIDS

Impacts of HIV/AIDS on the sector?on the sector? Policies and major

Policies and major responses?responses? Stakeholder

Stakeholder analysis?analysis?Resource analysis?

Resource analysis?SAfAIDS

Step 2: Use Baseline Analysis Step 2: Use Baseline Analysis Results to answer how HIV/AIDS Results to answer how HIV/AIDS affects your organisation and your affects your organisation and your workwork

Assess the impact of HIV/AIDS on:Assess the impact of HIV/AIDS on:• The workplace and your organisationThe workplace and your organisation• The beneficiaries of your programmeThe beneficiaries of your programme• What you want to do (including whether your What you want to do (including whether your

objectives are relevant and feasible in this objectives are relevant and feasible in this context)context)

Then discuss how vulnerable your cooperation activity is Then discuss how vulnerable your cooperation activity is to HIV/AIDS and what changes need to be madeto HIV/AIDS and what changes need to be made..

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Step 3: Analysis of Potential Step 3: Analysis of Potential negative implications of what you negative implications of what you do on HIV/AIDSdo on HIV/AIDS

How to do no harm? Do your How to do no harm? Do your cooperation activities increase:cooperation activities increase:

• Population mobilityPopulation mobility

• Gender inequalitiesGender inequalities

• Exclusion of people living with HIV/AIDS or Exclusion of people living with HIV/AIDS or other vulnerable groupsother vulnerable groups

• Risk situations for gender based violence/ sex Risk situations for gender based violence/ sex workwork

• Etc?Etc?Then anticipate by planning corrective actions.Then anticipate by planning corrective actions.

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Step 4a: Develop an HIV/AIDS Step 4a: Develop an HIV/AIDS workplace policy and programmeworkplace policy and programme

Source: ILOSAfAIDS

Step 4b: Plan and implement your Step 4b: Plan and implement your contribution to fighting HIV/AIDScontribution to fighting HIV/AIDS

Assess, where your comparative Assess, where your comparative advantage is highest for making a advantage is highest for making a difference, in terms of:difference, in terms of:

• RiskRisk: : helping people to behave safer and helping people to behave safer and avoid risk situationsavoid risk situations

• VulnerabilityVulnerability: : acting on developmental acting on developmental factors that increase the vulnerability of factors that increase the vulnerability of population groups to HIV/AIDSpopulation groups to HIV/AIDS

• Impact mitigationImpact mitigation: : help affected people help affected people and communities to cope with the effects of and communities to cope with the effects of HIV/AIDSHIV/AIDS SAfAID

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Step 4c: Monitoring - how to Step 4c: Monitoring - how to develop indicatorsdevelop indicators

– Outcome:Outcome: Has the behaviour of beneficiaries Has the behaviour of beneficiaries and/or the way of working of staff/partners and/or the way of working of staff/partners changed in the intended waychanged in the intended way

– Impact:Impact: What impact did this make in terms of What impact did this make in terms of changing the HIV/AIDS epidemic and its context? changing the HIV/AIDS epidemic and its context? (BUT: avoid the pitfall HIV prevalence or (BUT: avoid the pitfall HIV prevalence or mortality!)mortality!)

– Process:Process: Which process did you use with what Which process did you use with what effect? What works and what doesn't?effect? What works and what doesn't?

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Essential Principles in Essential Principles in HIV/AIDS MainstreamingHIV/AIDS Mainstreaming (1) (1)

• AdaptAdapt to your context- No standard approach to your context- No standard approach (varied (varied combinations of organisational, sociology, logframe elements)combinations of organisational, sociology, logframe elements)

• Relevant at all stagesRelevant at all stages of the epidemic, also in low of the epidemic, also in low prevalence contextsprevalence contexts

• ContinuousContinuous and integrated and integrated• GenderGender sensitive approach sensitive approach• MIPA MIPA - Involve people living with HIV/AIDS - Involve people living with HIV/AIDS • Networking Networking & coordination& coordination• AdvocacyAdvocacy• Share Share good practices and lessons learnt good practices and lessons learnt • Generate evidence Generate evidence through continuous monitoringthrough continuous monitoringSAfAID

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Essential Principles in Essential Principles in HIV/AIDS MainstreamingHIV/AIDS Mainstreaming

(2)(2)To be successful :To be successful :• Consider HIV/AIDS as Consider HIV/AIDS as a development issuea development issue

• Commitment and support of Commitment and support of decision makersdecision makers

• Clearly Clearly defined objectivesdefined objectives for mainstreaming for mainstreaming

• Knowledgeable, Knowledgeable, compassionatecompassionate and skilled and skilled staffstaff

• Document and share experiences through Document and share experiences through knowledge sharingknowledge sharing systems systems

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Essential Principles in Essential Principles in HIV/AIDS MainstreamingHIV/AIDS Mainstreaming

(3)(3)To be successful (cont) :To be successful (cont) :• Expertise and supportExpertise and support available and available and

made use ofmade use of

• Sufficient allocation of Sufficient allocation of resourcesresources (human, financial, technical)(human, financial, technical)

• WillingnessWillingness to learn, reflect and to learn, reflect and shareshare

Linking TheoryLinking Theory to Practiceto Practice SAfAIDS

Source: UNAIDS

References References • UNAIDS (2006) Global AIDS Epidemic ReportUNAIDS (2006) Global AIDS Epidemic Report• IRC International Water & Sanitation Centre IRC International Water & Sanitation Centre

website website http://http://www.irc.nlwww.irc.nl • UNAIDS(2004), Support to Mainstreaming UNAIDS(2004), Support to Mainstreaming

AIDS in DevelopmentAIDS in Development• Swiss Agency for Development and

Cooperation (SDC) (2004), Mainstreaming HIV/AIDS in Practice

• Oxfam International (2003), Tools to Support the Mainstreaming of HIV/AIDS

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Thank Thank you…you…

Lets translate these concepts Lets translate these concepts into excitingly effective IWRM into excitingly effective IWRM practice practice

……………… ………………

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