From Making the Case to Generating a Response
The Answer lies Within
Monica Sharma, Director HIV/AIDS Group - UNDP
14,000 new infections in the world
In the 1 hour we talk: 600 new infection
All preventable through human actions
Every 6 seconds, someone, somewhere becomes HIV positive
Saturday, 26 June, 2004
HIV and AIDS in the Middle East and North Africa
At the end of 2003 an estimated:600,000 Adults aged 15-49 were living with
HIV/AIDS,55 000 People became newly infected with HIV, and 45 000 died due to .
In 2001250,000 Women aged 15-49 were living with
HIV/AIDS, and35,000 children were living with HIV/AIDS.
0 10 20 30 40 50 60 70
Cambodia
Haiti
Mozambique
Rwanda
Côte d'Ivoire
Zambia
Kenya
South Africa
Zimbabwe
Botswana
Life expectancy at birth (years)
Predicted life expectancy
Predicted loss in life expectancy due to HIV/AIDS in children born in 2000
Loss in life expectancy due to HIV/AIDS
8.3
17.9
29.4
22
33.3
girls
0 0
3.62.2
8.6
0
5
10
15
20
25
30
35
15 16 17 18 19Age in years
HIV
pre
vale
nc
e (%
)
boys
Source: National AIDS Programme, Kenya, and Population Council, 1999
HIV prevalence rate among teenagers in Kisumu, Kenya, by age
Where are we?
• Infections not leveling off: 40% of adults in Botswana are HIV positive 34% in Zimbabwe, 33% in Swaziland and 31% in Lesotho
• Russia: reported cases rise from 11,000 to 300,000 in last 4 years
• LAC: HIV prevalence of 1% or more in 12 countries, all Caribbean
• CIS, Asia experience fastest-growing HIV/AIDS epidemic
• Feminization of epidemic: in Sub-Saharan Africa women make 60% of HIV positive adults; globally this figure is 50% for the first time
• India: 95% of new infections in women were among married and monogamous
• Stigma & discrimination: Surveys reveal that majority of respondents do not want to work with people living with HIV/AIDS
• Lack of treatment: In Africa only 2% of PLWHA have treatment
• Vast secondary impacts: Orphans, basic social services, instability
HOPETRANSFORMATION
RESULTS
HIV/AIDS Epidemic
• SEX• FEAR• SHAME• DEATH• DENIAL• STIGMA• SILENCE• DISCRIMINATION
Generating an Extraordinary
Response, with Results
UNDP’s Goal
•Nation-wide
•Multisector
•Multi-level
•Gender sensitive
•Including PLWHA
“Governance is defined as the exercise of political, economic and administrative authority to manage a nation’s affairs. It is the complex mechanisms, processes, relationships and institutions through which citizens and groups articulate their interests, exercise their rights and meditate their differences… Governance embraces all methods that societies use to distribute power and manage public resources and problems… Effective democratic forms of governance rely on participation, accountability and transparency.”
UNDP, 1997
Governance Challenge of HIV/AIDS
INSTITUTIONAL ENERGY
TRANSFORMATION
RESULTS
Meeting the Governance Challenge
• Institutional inertia
• Often too medical
• National, Sub-national Disconnect
• Innovation stifled
• Medical, human rights responses not integrated
• Community voice not heard, decisions not supported
• Underlying causes often ignored (e.g., stigma, power, access)
2. Care & support
WHO, World Bank
4. Reduce vulnerability
Secretariat, NGOsWorld Bank, UNDP
5. Research & Development
WHO, World Bank
3. Mitigate socio-economic
impactWorld Bank, ILO
UNDP
Create enabling
environmentHope
ResultsTransformation
1. Prevention infection
15-25 by 25% UNICEF, UNFPA
UNODC, UNESCO
MDG: Halting & Reversing the Epidemic
Creating an Enabling Environment
Transfer of technology & economic growth
1950-60s Care: drugs available
Human rights & universal norms1970-80s
Care: near universal access to drugs; anti-discrimination
legislation
Transformation & reaching the human potential1990-2000 +
Care: with no stigma; where every person living with HIV/AIDS
contributes as a productive member of society
Development Practice Over TimeAre We Making the Difference We Can?
“The definition of insanity is to do the same thing over and over again, and expect different results.”
Rita Mae Brown
Subjective, Interior
Behavioral
Systems, Structures, Laws, Plans
Intention, Commitment, Values
Cultures, NormsValues
Individual
Collective
Objective, Exterior
Action
Based on Ken Wilber’s work
Integral Transformation if we are to produce results: HIV/AIDS and MDGs
Subjective, Interior
Individual
Collective
Objective, Exterior
Unavailability of testing facilities
I’m in denial of being at risk
I don’t go for testing
We are silent about the cause of death
Stimulating community decisions and actions to reverse
the HIV/AIDS epidemic (1)
Reversing HIV/AIDS through transformative leadership capacity development (1)
Strengthening systems, sectors, structures, studies, PRS,
policies and laws (2)
Arts & Media (3)
Integral Transformation if we are to produce results: HIV/AIDS and MDGs
Leadership Developmen
t Programme
Leadership for Results
L4R – A Synergistic Package for a Comprehensive Response to HIV/AIDS
Arts and Media
Development Planning &
Implementation
Community Capacity
Enhancement
• Each program is intricately linked to every other program
• The four programs work as a synergistic package and are mutually reinforcing
• The program is seen as a long term strategy that unfolds over time
Integral Transformative Leadership: A Different Approach
Leadership for Advocacy
Leadership for Results
Everyone, everywhere – leadership at all levels
Political and executive leaders
Starts with Self and self-awareness
Starts with the external
Commitment that produces results and self-
sustained initiatives
Producing understanding
Action with learning = ongoing
One-time effort
UNDP
Supporting sub-national and district level HIV/AIDS
responses
Development Planning and Implementation: Current Expectations
Mainstreaming HIV/AIDS into: National Dev Plans/Budgets,
Poverty Reduction Strat, Medium Term Expenditure Frameworks,
HIPC, UN processes (CCAs/UNDAFs and CCFs)
Mainstreaming HIV/AIDS into
sector Ministries, including planning,
finance, information, judiciary/law
Supporting strategies to address depletion of
human resources
Preparing sectoral studies responding to impact of HIV/AIDS on sectors –
education, health, agriculture, manufac-
turing, and environment
Development planning and implementation at national
level
UNDP’s Results
• Self-sustaining breakthrough initiatives and community decisions/actions through transformative leadership and community capacity enhancement
• Development and popularization of approaches to address the underlying causes of the epidemic (e.g., stigma, power relations)
• Strategies and approaches have enhanced governance and development practice, including HIV/AIDS and beyond
“The world we have made as a result of the level of thinking we have done thus far creates problems that we cannot solve at the same level at which we have created them... We shall require a substantially new manner of thinking if humankind is to survive. .”
Albert Einstein
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