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Regional strategy supporting the national strategic plans of

countries

Managing Change in Small Islands

Room 203 – 204

Monday 21 July 2014

Dr. Jason Leo Iane Mitchell

CEO-OSSHHM

20th IAC Melbourne

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Overview

1. Brief Pacific introduction

2. Historical overview Pacific response

3. HIV epidemic status 4 decades later

4. Lessons learnt

5. The change-Shared agenda

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The Pacific in focus

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The Pacific in focus• 22 Countries in the Pacific • 21 smaller Pacific Island

Countries and Territories • Population size 67(2011) –

850,000 (2013)

• Religious and cultural diversity

• Third of the world’s languages • 21 systems and governments

to work with• Country support provided

regionally

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History and Evolution of the Regional Response to HIV

‘A PERIOD OF FOUR DECADES’

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Regional Response: 1st Decade 1980-1989

• HIV is a non-issue for Pacific

• Focus more on public awareness

• Response driven by government

• First case of HIV diagnosed 1984 1985

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Regional Response: 2nd Decade 1990-1999

• Country leaders met to discuss the potential threat of HIV to PICTS

• HIV response treated as an emergency in many countries

• Engagement with national traditional and religious leaders

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Regional Response: 3rd Decade 2000-2009

2002• Pacific forum leaders

acknowledge HIV as an important development issue

2004• Endorsement of the Pacific

Regional Strategy on HIV/AIDS (2004–2008)

2008• Endorsement of the Pacific

Regional Strategy against STIs and HIV (2009-2013).

• Developed by Gov, NGO sectors and regional development partners

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Pacific Regional Strategy on HIV/AIDS (2004–2008)• Pacific Regional Strategic Implementation Plan (PRSIP I) • 8-thematic areas organised into 4 components:

1. Leadership and governance

2. Access to quality services

3. Regional coordination

4. Programme management

• Scaling up of regional support to facilitate growing national efforts

• Largely government focused and driven • Resourcing: Global fund, AusAID, NZaid, ADB and

French funding • Emerging evidence for HIV & STI

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Pacific Regional Strategy on HIV and other STIs(2009-2013)

• PRSIP II framework to respond to STIs & HIV nationally and regionally

• 6 Thematic areas (consistent with country NSPs): 1. Prevention programmes (MSM, SW, Seafarers,

servicemen)2. HIV and STI diagnosis (focus on STI and HIV)3. Continuum of care, treatment and support

systems and services (focus on STI and HIV)4. Leadership and enabling environment 5. Strategic information and communication 6. Governance and coordination (Govt and NGO)

• Regional division of labor supporting national responses • Resourcing: Global Fund R7 and the Response fund,

minimal national resources • Greater emphasis in CBO and community engagement

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Partners working together-PRSIP II

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Regional Response: 4th decade 2010 +

2013 • Major funding mechanism for PRSIP II

(GF and RF) came to an end• Regional STI & HIV strategy ended• Many countries left with little to no

technical and financial support regionally • Consultations for the development next

regional response begins

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Two regional strategies later • Greater engagement with communities in planning and

implementation of strategies and programmes nationally • Greater evidence emerging

– HIV focused in the general population – SGS x 2 – Key population- challenging stereotypes

• Few countries beginning to repeal draconian laws particularly around MSM

• Fiji, PNG and Palau have standalone HIV legislation • Other countries continue to reform in support of enabling

environments • Prohibitive laws still exist MSM/TG, SWs and drug use

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HIV epidemic status 4 decades later

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Lessons learnt 3 decades later• Need to link HIV, STI, gender, sexual

and reproductive health programmes.• Social research to inform policy and

programming.• Better evidence of the critical role that

social, cultural and religious factors have on the effective implementation of: – HIV, STI and SRH programmes for

all sectors of the community • Need for more country-focused and

country-led strategic planning.• Greater engagement with other key

population.

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Rationale for a change in approach Need for a strategic document to guide PICTs in

responding to SRH issues as a whole. Document should not prescribe a one size fits all

approach but should be an overarching guidance document.

Stronger linkages/integration between HIV/STI and SRH.

Need for comprehensive approach which addresses the complexities of SRH.

Greater focus on most-at-risk and vulnerable populations.

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Modifying the approachExtensive consultations:

Ministers & Directors of Health

National and regional stakeholders

Key populations MSM/TG M&F SWs PLHIV People living with disabilities Youth Women Others

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Conclusion The change:• Move from 2 decades of

disease focused approach • Shared agenda hopes to

improve access to comprehensive SRH for ALL

The challenge:• regional and national

resources continue to decline (human and financial)

What of the shared agenda?

How do we carry on from here?

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Acknowledgements:

1. Ms. Michelle O’Connor and Dr. Dennie Iniakwala-Secretariat of the Pacific Community-various slides

2. To the Australian Aid programme and ASHM for their ongoing support and for supporting my involvement in this programme

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References 1. SPC, 2005, Pacific regional strategy on HIV/AIDS [2004-2008],

Noumea, 2005.

2. SPC, 2012, Pacific HIV Report 2012, Noumea, New Caledonia: Secretariat of the Pacific Community.

3. History and Evolution of PRSIP: Adapted from the Presentations at the Development of Shared Agenda Consultation meetings‘Making Waves’ PPT made by Dr. Dennie Iniakwala, HIV&STI Team Leader, Health Protection Programme, Public Health Division, SPC Nadi and Guam, March 2013.

4. The Pacific Sexual Health and Wellbeing Shared Agenda 2015 – 2019, PPT presentation made Ms. Michelle O’Connor at the Directors of Health meeting, Nadi April, 2014.