Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit
- Workshop -Paul Sunga and Marian Casey
June 2, 2004
Addis Ababa
Objective of WorkshopGoal:
To enable a coherent response to the HIV epidemic in Ethiopia
Purpose: 1.Launch HIV Mainstreaming Toolkit
2. Facilitate the mainstreaming of HIV components into democracy and governance sector programmes
Workshop Agenda9:009:00 Welcome - CIDA Country Director-– M-A FredetteWelcome - CIDA Country Director-– M-A Fredette Keynote – V.Min. of Justice -Ato Ali Sulaiman Keynote – V.Min. of Justice -Ato Ali Sulaiman 9:509:50 HIV situation analysis and projections HIV situation analysis and projections 10:1010:10 HIV and democracy and governanceHIV and democracy and governance10:3010:30 COFFEE BREAKCOFFEE BREAK11:0011:00 CIDA’s HIV Mainstreaming Toolkit CIDA’s HIV Mainstreaming Toolkit 11:1511:15 Group exercise 1– Knowing about taboos & stigmaGroup exercise 1– Knowing about taboos & stigma11:50 Group exercise 2 – Knowing about HIV impacts12:30 LUNCH1:30 Group exercise 3 – case studies2:10 Group exercise 4 – case studies2::50 Group exercise 5 - Assessing HIV vulnerability and HIV impacts in DG
programming4:45 Conclusions
Take the HIV Test1. What do the terms HIV and AIDS stand for?2. Name three ways that HIV can be transmitted?3. How can HIV transmission be prevented?4. How many Ethiopians are living with HIV? 5. What is the most common infection that kills HIV
infected people in Ethiopia?6. Which group has the highest number of infections ?
Male or female? Age- 15-24 / 20-49 / 30-497. What percentage of commercial sex workers are HIV
infected in Addis?8. What percentage of rural people are affected by HIV? 9. Name three ways that HIV is affecting development in
Ethiopia?10. Can people be cured of HIV?
Situation Analysis
• HIV epidemic in Ethiopia at a glance
• Forecasts and impacts
• Critical links between HIV and democracy/ governance
Key Features of the HIV Epidemic in Ethiopia
• ‘generalized’ epidemic at 6.6% nationally• transmission - mainly heterosexual and mother to
child• peak prevalence - women 15-24 yr• urban concentration of 13.7% ( is it plateauing?)• rural prevalence estimated at 3.7% based on weak
rural surveillance • 50% of hospital beds are AIDS patients• lack of country specific studies in rural areas
HIV Prevalence in Pregnant Women- Bahir Dar -
Ministry of Health
0
5
10
15
20
25
30
1992/93 1999 2001
HIV
Pre
vale
nce
Features of Response to the Epidemic
• emphasis on public health response
• responses are urban and in selected regions
• emerging surveillance data
• emerging sector-specific strategies
Forecasts and Impacts
HIV prevalence in adults in sub-Saharan Africa, 1986-2001
20 – 39%
10 – 20%
5 – 10%
1 – 5%
0 – 1%
trend data unavailable
outside region
1986 1991
1996 2001
Projected HIV positive population in EthiopiaMinistry of Health, 2002
0
0.5
1
1.5
2
2.5
3
3.5
HIV + (millions)
1984 1989 1994 1999 2004 2009 2014
Projected number of deaths from AIDSin Ethiopia
Ministry of Health, 2002
0
50
100
150
200
250
300
350
Deaths x 1000
1984 1989 1994 1999 2004 2009 2014
Projected Number of AIDS OrphansMinistry of Health, 2002
0
0.5
1
1.5
2
2.5
3
1984 1989 1994 1999 2004 2009 2014
Millions
Changes in life expectancy in selected African countries
with high and low HIV prevalence: 1950-2005
with high HIV prevalence:ZimbabweSouth AfricaBotswana
with low HIV prevalence:MadagascarSenegalMali
Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision
30
35
40
45
50
55
60
65
Lif
e e
xp
ecta
ncy (
years
)
1950– 1955
1955- 1960
1960-1965
1965-1970
1970-1975
1975-1980
1980-1985
1985-1990
1990-1995
1995-2000
2000-2005
Percentage of workforce lost to AIDS by 2005 and 2020 in selected African
countries
0
10
20
30
40
50
%
2005 2020
BotswanaCameroon
CAR
Côte d’IvoireEthiopia
Guinea-Bissau
MozambiqueNigeria
South Africa
TogoUR Tanzania
Zimbabwe
Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision01 July 2002 slide number SSA-17
Impact of HIV/AIDS on urban households, Côte
d’Ivoire
Impact of HIV/AIDS on urban households, Côte
d’IvoireGeneral populationGeneral population Families living with AIDSFamilies living with AIDS
Monthly income per capita
Monthly income per capita
Monthly consumptionper capita
Monthly consumptionper capita
00
5 0005 000
10 00010 000
15 00015 000
20 00020 000
25 00025 000
– 5 000– 5 000
30 000 Francs CFA30 000 Francs CFA
Savings/DisavingsSavings/Disavings
Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997
Projected reduction in size of primary-school-age
population by 2010, in selected African countries
0
5
10
15
20
25
30
Zimbabwe Zambia
Kenya
Uganda
% r
ed
ucti
on
Source: World Bank, 2000
Number of reported rapes and convictions
in Botswana, 1984 to 1997
Source: Emang Basadi Women’s Association, Botswana, 1998
0
200
400
600
800
1000
1200
1400
1984 85 86 87 88 89 90 91 92 93 94 95 96 1997
reported rapes
convictions
Nu
mb
er
Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020
80757065605550454035302520151050
020406080100120140 0 20 40 60 80 100 120 140
Males Females
Deficits due to AIDS
Projected population structure in 2020
Population (thousands)
Ag
e in
yea
rs
Source: US Census Bureau, World Population Profile 2000
Interactions between HIV and Democracy/Governance
What is known…
HIV<--------------> D/G
Critical Links …
• Voice & accountability
• Political stability
• Social justice
• Rule of law
• Administration of public service
• Strengthening civil society
1. Voice & Accountability Factors Key Issues
• Participation• Transparency • Leadership• Gender Equity
• Consultation on HIV policy• Accessibility of HIV
information• Government leadership on
HIV• Gender specific strategies for
intervention
2. Political Stability Factors Key Issues
• Social Cohesion• Economic growth• National Security
• Socio-economic impact of epidemic
• Loss of key members of communities to HIV
• Loss of of family members• Loss of key government
officials and civil servants• Military vulnerability to HIV
3. Social JusticeFactors Key Issues
• Access to services• Equal representation• Legal literacy• Human rights
• Awareness of HIV/AIDS rights
• Human rights of women
• Human rights of HIV infected persons
• Entitlement to awareness of HIV/AIDS rights
4. Rule of LawFactors Key Issues
• Rights of the child• Property rights • Prisoners, etc.
• Child friendly detention and courts
• Juvenile friendly laws, courts etc.
• Rights of women to land
• Implementation of national laws
5. Administration of public services Factors Key Issues
• Effectiveness • Efficiency• Quality
• Regional differences in capacity to respond
• Diversion of public funds to respond to HIV epidemic
• Delivery of health services
• Transparent internal monitoring mechanisms
6. Strengthening Civil Society Factors Key Issues
• communication • transparency• participation of civil
society• community demand
for services
• information dissemination
• perceived role of civil society
• community awareness and mobilization
What is ‘HIV mainstreaming’?
HIV mainstreaming is the process of identifying and mitigating the effects of:
• Aspects of D/G on the vulnerability of Ethiopians to HIV
• the HIV epidemic on democracy and governance
Six Steps to HIV Mainstreaming in the DG Area
1. Knowing HIV and the epidemic2. Assessing the situation and the impact3. Planning to reduce or mitigate the impact4. Implementing the plan5. Monitoring 6. Evaluation of the effectiveness of
mainstreaming HIV
HIV Mainstreaming Toolkit
Features• 3 modules
– Module 1 is general and for everyone– Module 2 contains HIV mainstreaming tools
for food security programmes– Module 3 contains HIV mainstreaming tools
for democracy and governance programmes– The ‘tools’ are organized according to the Six
Steps.
You are the experts….
Proportion of young women who have heard of AIDS and have
at least one negative attitude towards people living with AIDS
Dominican Republic
Bosnia & Herzegovina
Note: Respondents were asked two hypothetical questions about men and women with HIV: (1) A teacher who looks healthy but is HIV- positive should be allowed to continue working and (2) Would they buy something from an HIV-positive shopkeeper.
0% 20% 40% 60% 80% 100%
NigerUkraine
PhilippinesSomaliaVietnam
Cote d'IvoireChad
Sierra LeoneGuinea Bissau
ComorosYugoslavia (FR)
AlbaniaMoldovaGambia
TajikistanAzerbaijan
Source: UNICEF (1999-2001) Multi-Indicator Cluster Surveys
Group exercise 1. Knowing about social taboos as barriers to
communication• Discuss your earliest sexual experience. • Why is it difficult to talk about this?• How do social taboos make the HIV epidemic
worse in rural Ethiopia?• How is taboo related to the stigma experienced by
people infected by HIV?• List three ways of reducing stigma, discrimination
and their impacts.
Group exercise 2: Knowing the impact of the HIV epidemic
• Discuss with your group one person you know who has HIV or AIDS, or who has died of AIDS?
• What were the impacts of that person’s illness? On family and friends? Workplace? Community? Other.
• Identify three things that might have been done to lessen the impact.
Mainstreaming Considerations• Consultation on HIV policies• Accessibility of HIV information• Government leadership on HIV• Gender specific strategies for intervention • Socio-economic impact of epidemic• Loss of key members of communities• Loss of of family members• Loss of key government officials and civil servants• Military vulnerability to HIV• Entitlement to awareness of HIV/AIDS rights
Mainstreaming Considerations• Vulnerability of women
• Discrimination against HIV +
• Regional disparities in response to the epidemic
• Diversion of public funds to respond to HIV epidemic
• Rate of spread of epidemic
• Lack of basic & essential health care for PLWHA
• Institutional and organizational capacity of key agencies and Ministries (MoJ, MoCB, Parliament, Auditor General, Prison & Police Administration, civil society, etc.)
Intervention points • HIV vulnerability analysis
• Gender analysis of policies & interventions
• Strengthening the health system
• HIV/AIDS Legal Framework
• Legal literacy
• HIV/AIDS code of ethics
• Application of HIV/AIDS in strategic initiatives
• Advocacy on political and civil leadership
• Protection of minority rights, e.g. prisoners
• HIV-adjusted national security plan
Institutional capacity (HIV competence)
Factors• discrimination against
HIV+ persons• unsupportive financial
and social response mechanisms
• weak HIV governance
Key issues • HIV stigma• level of HIV awareness and
understanding among leaders• level of local evidence re: HIV
impacts on development• Development of HIV strategy for
institutions/vulnerability assess...• Institutional code of ethics regarding
HIV positive employees, clients
Intervention pointsGovernance
• HIV vulnerability analysis
• Gender analysis of policies & interventions
• Strengthen the health system
• HIV/AIDS Legal Framework & legal literacy
• HIV/AIDS code of ethics
• Application of HIV/AIDS in strategic initiatives
• Advocacy on GoE leadership
• Protection of minority rights, e.g. prisoners
• HIV-adjusted national security plan
Group exercise 4: Case studies
• Discuss case studies found at the end of Module 3
Group exercise 5: Assessing an DG capacity development programme
through an HIV lensUsing the assessment tools, outline how you
would carry out an HIV assessment of the example provided of a DG capacity development programme.
Two example programmes or programme components will be provided.
NOTE that the assessment information is the basis for planning
Thanks for participating.
Facilitators:
Dr. Paul S.Sunga
Langara College
Vancouver, Canada
Marian Casey
PSU/CIDA
Addis Ababa
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