Population: 33,333,216
Adult HIV/AIDS Prevalence Rate: 0.1%
People living with HIV/AIDS: 19,000
Country Assessment:
In Algeria, the national response to the AIDS epidemic began
after the first notified case in 1985 when a National AIDS Committee
(NAC) was established. Following the recommendation of the national
consensus workshop in 1994, this health committee became officially
multisectoral involving a wide range of institutional actors and nongovernmental
organizations. Nevertheless the NAC up to date has a limited consultative
mandate, no autonomy and no financial capacities to be operational.
The donor role is more or less quite limited, with the exception of the Global Fund grant which was approved for a three-year period in 2003 and for which the proposal was developed with the support of UNAIDS. The proposal was considerably delayed, due to the absence of a well-organized coordination entity.
There are both positive and negative aspects to the national response. Positively there is a high level of commitment from the national authorities around the “Three Ones” and universal access, and a better coordination of the United Nations support through the establishment of UN Joint Teams on AIDS with a unique programme of support. Negatively, the epidemiological distribution has changed considerably these last two years and reveals a concentration of the epidemic among vulnerable groups that has been confirmed through the results of social and behavioral surveys and via the sentinel surveillance group screened in 2004.
The 2004 study on the potential link between HIV and problematic drug use found at least 11% of the interviewed drug users stated that they were HIV positive, remunerated sexual intercourse (44%) and had unprotected sexual intercourse (61%).
The case notification up to December 2006, although limited, indicates clearly that women are more and more affected by the epidemic and the latest results of an important national family survey indicate that a high percentage of young people (> 50%) do not know how to protect themselves against sexually transmitted infections and HIV.
In Algeria although the HIV care and treatment centres (7 referee centres throughout the country offer free access to everyone, there is an urgent need to establish prevention services and to strengthen the capacities of the 54 voluntary counselling and testing centres established in 2006 by the Minister of Health.
There is also an urgent need to have a clear national strategy to address the needs of vulnerable and most at-risk groups through the implementation of a network between services and nongovernmental organizations responding to AIDS.
Population: 12,263,596
Adult HIV/AIDS Prevalence Rate: 3.7%
People living with HIV/AIDS: 320,000
Country Assessment:
Post-war Angola faces numerous challenges, including overcoming
poverty and hunger, reconstruction of infrastructures, reintroduction
of demobilized military personnel and displaced people into the civilian
population, and development of the national economy.
There is currently a window of opportunity for Angola to avoid the high HIV prevalence seen in other countries in sub-Saharan Africa.
Led by the President and receiving technical support from the National Institute to Fight HIV/AIDS, the National AIDS Council is a government body set up to coordinate HIV-related programmes and policies. At provincial level, the National AIDS Council is represented by provincial committees chaired by governors and composed of provincial directors.
Civil society organizations are coordinated through the Angola Network of AIDS Service Organizations (ANASO). It has been able to establish a solid partnership with the National Institute to Fight HIV/AIDS and the major programmes and grants, despite the lack of a well-defined space for the network in the institutional architecture of the National AIDS Council. A network of people living with HIV and a network of women living with HIV (‘Mwenho’ Network) have been created within the Angola Network of AIDS Service Organizations to ensure greater involvement of people living with HIV and a stronger participation of women in policy discussions.
The government has substantially increased the budget allocated to the national response, which has risen from US$ 7 million in 2002 to US$ 25 million in 2006. The major grants are from the Global Fund and the World Bank.
In order to improve donor support and coordination, following the Global Task Team’s recommendations, in 2006 the United Nations (UN) established the Joint UN Team on AIDS, composed of all UN staff working on HIV-related activities (43 members) within an organizational structure that has three levels of accountability.
- The UN Theme Group on AIDS, led by the Resident Coordinator, is responsible for overall policy and programmatic guidance.
- The Management Group of the Joint UN Team on AIDS, chaired by the UNAIDS Country Coordinator, is, responsible for coordination, national policy and implementation of the “Three Ones”.
- Four technical subgroups provide programmatic direction and technical assistance to government, donors and civil society and other stakeholders.
The expanded structure of the Joint UN Team on AIDS includes representatives of the National Institute to Fight HIV/AIDS, civil society, including people living with HIV, and donors.
HIV prevention has been focused on general population, young people, women, sex workers and personnel of the uniformed forces. Units to manage HIV infection and prevention of mother-to-child transmission with treatment for women are present in the 18 provincial capitals, covering 6.6% of those needing antiretroviral therapy. (Ministry of Health, National Institute to fight HIV&AIDS: National targets toward Universal Access, National Strategic Plan 2007 - 2010 (to be published)).
HIV-related activities of nongovernmental organizations, which are limited to primary prevention, are mainly centralized in Luanda and a few provincial capitals.
Resources: National AIDS Control Program (Programa Nacional de Luta contra o SIDA)
Population: 1,815,508
Adult HIV/AIDS Prevalence Rate: 24.1%
People living with HIV/AIDS: 270,000
Country Assessment:
The National AIDS Council met four times in 2006 to review
the progress of the national response and address key policy
issues.
The National AIDS Coordinating Agency, with support from UNAIDS, piloted the Country Harmonization and Alignment Tool to improve coordination of the AIDS response.
The National AIDS Coordinating Agency also organized a meeting to revive the Botswana HIV Partnership Forum. UNAIDS was assigned to provide secretariat support for future meetings and follow-up action.
A participatory mid-term review of the National Strategic Framework 2003 – 2009, led by the National AIDS Coordinating Agency, was embarked upon in the last half of the 2006 and will be continued in 2007.
In addition, the National AIDS Coordinating Agency with UNAIDS assistance conducted a National AIDS Spending Assessment for tracking of public and development partner spending on AIDS for 2003 – 2005. As a follow-up, National AIDS Spending Assessment will be institutionalized as a regular activity for monitoring and evaluation.
A two-day retreat of the Country Coordinating Mechanism in November 2006 was facilitated by the United Nations (UN) Country Team to improve governance and performance of the Country Coordinating Mechanism.
The World Bank undertook two missions for pre-project design consultations with the government and other partners, based on the National Strategic Framework. Follow-up and further work will be undertaken in 2007.
The Botswana Network of AIDS Service Organizations undertook initiatives to build and strengthen coalitions of nongovernmental organizations involved in HIV-related activities at district level, to improve coordination and dialogue.
Of the 52 750 orphans registered with the Ministry of Local Government, 50 505 received food baskets. The total number of people registered on community and home-based care stood at 7386 by the end of September 2006, of whom 6190 (84%) received food baskets.
Stigma and discrimination related to HIV require further analysis and appropriate measures to address them in a more comprehensive and effective way, with full involvement and participation of people living with HIV.
Resources: Botswana National AIDS Coordinating Agency
Population: 14,326,203
Adult HIV/AIDS Prevalence Rate: 2.0%
People living with HIV/AIDS: 150,000
Country Assessment:
The situation in 2005 was characterized essentially by the
acceleration of access to treatment (“3 by 5”) without
detriment to the achievements already made in respect to prevention.
National coordination is provided by a national council for
sexually transmitted infections/HIV/AIDS control, which the
President of Burkina Faso oversees. Since 2001, a permanent
secretariat has been responsible for running the Council, which
has a multisectoral composition and involves representatives
of all walks of national life and leaders. Mobilization of financial
resources increased by 30% in comparison with 2004 (US$38 million
in comparison with 29 million).
The leadership provided by the government, thanks to the foresight of the President of Burkina Faso, has been a valuable asset. The national response by the different sectors has been globally satisfactory, and has made it possible to achieve encouraging results and to stabilize the HIV epidemic.
The Global Fund and the implementation of “3 by 5” and of the Treatment Acceleration Project (TAP) and the Collegial Network for the Monitoring of the Status and Trends of the HIV/AIDS Pandemic (MAP) were strengthened in 2005, making it possible to quadruple the number (8130) of people living with HIV with access to treatment, including antiretroviral drugs. Prevention of mother-to-child transmission is provided in 67% of districts. Voluntary counselling and testing increased by 88% over 2004.
Commitment by civil society, customary and religious leaders, nongovernmental organizations, women's and young people’s associations increased considerably with the support of development partners. Implementation of the “Three Ones” Principles went ahead in 2005 with the development of new proposals for the National AIDS Council involving partners and the UNAIDS Theme Group, which contributed 45% of the overall funding.
There are still shortcomings in respect to the institutional and organizational capacity of government and nongovernmental organization entitities responsible for coordination. In primary and secondary schools, very few teachers have received training (less than 4–5%). The recent commitment by the private-sector may improve thanks to an ILO/United States Department of Labor (USDOL) project. Human resources for scaling up access to care are very limited.
Problems of poverty, inequalities of access to basic social services and gender issues, ignorance, illiteracy and sexually transmitted infections are recurrent. Proper case-management and support for orphans is very limited (less than 7% of orphans and vulnerable children receive support or free assistance). There is very limited knowledge about HIV among the main risk groups such as gold prospectors and lorry drivers (fewer than 50% have any knowledge), while an estimated 56%–85% of military personnel and sex workers know about the disease.
Resources: National AIDS Council
Population: 8,390,505
Adult HIV/AIDS Prevalence Rate: 3.3%
People living with HIV/AIDS: 150,000
Country Assessment:
High-level political commitment was achieved very early in
Burundi, making it possible to set up structures that allowed
an effective AIDS response. In 2002, Burundi introduced an institutional
framework comprising a ministry responsible for AIDS control
and a national AIDS Control Council with a permanent Executive
Secretariat. This institutional framework matches the country’s
administrative and community structure down to the colline,
the smallest peripheral unit before the household.
Civil society is organized into groups of associations, including the Burundian Alliance for AIDS control (grouping 150 nongovernmental organizations), an association of people living with HIV, the Association of Young People and the Network of Women’s Associations for AIDS Control. These associations are recognized, well organized into networks and spread throughout the country.
Ownership of the National AIDS Control Plan has been assumed by all the actors involved, and it has become their source of programming and financing.
Quarterly forums to coordinate the efforts of implementing agencies in the public sector and civil society are organized, together with annual evaluation and planning meetings. The content of the National AIDS Control Plan is consistent with the Interim Poverty Reduction Strategy Paper, which has identified HIV control as one of the six strategic lines of action having priority.
Coordination among partners is essentially the responsibility of the Expanded Theme Group on HIV/AIDS, which is presided over by the minister responsible to the Office of the President for AIDS control.
Resources: National AIDS Council of Burundi
Population: 18,060,382
Adult HIV/AIDS Prevalence Rate: 5.4%
People living with HIV/AIDS: 510,000
Country Assessment:
According to data from the 2004 Demographic Health Survey,
women and those aged 15 – 24 years are the most affected
by the epidemic in Cameroon. Other high-risk groups are uniformed
personnel, sex workers, truck drivers and the population living
along the Chad-Cameroon Pipeline. Unsafe heterosexual behaviour
is the most common path of transmission, but mother-to-child
transmission remains a concern. The number of paediatric infections
was estimated at 69 000 cases at the end of 2001 and 43 000
at the end of 2003. The number of orphans in 2005 was estimated
at 122 670.
In view of this situation, the government of Cameroon declared HIV a health emergency and HIV control a priority programme included in the Poverty Reduction Strategy Paper (PRSP). The country has a National AIDS Control Committee and has recently set up a partnership forum with wider representation of stakeholders. Partners have also created a coordination group dealing with operational issues co-chaired by the UN Theme Group Chair and a bilateral agency. The National Strategic Plan 2006 – 2010 launched in March 2006 includes universal access objectives and has been validated by all partners. The challenge is to mobilize more funds and to develop a sound human resources/capacity-building plan to be able to achieve the plan’s ambitious goals.
Although there has been significant progress in prevention and treatment, coverage of key services remains low. Some decisions made in 2006 will facilitate scale-up (cost of HIV testing reduced by nearly half; increase in the number of mobile units for testing; increase in the number of antiretroviral treatment centres).
Resources: National AIDS Council of Cameroon
Population: 4,369,038
People living with HIV/AIDS: 250,000
Adult HIV/AIDS prevalence rate: 10.7%
Rapport De Situation National A L’intention De L’ungass:
Janvier 2006-décembre 2007
Situation actuelle de l’épidémie Comme la plupart des pays de l’Afrique au Sud du Sahara, la République Centrafricaine continue de payer un lourd tribut à l’infection à VIH. Le rapport de l’ONUSIDA sur l’épidémie mondiale 2006 indique que le nombre de personnes vivant avec le VIH est estimé à 250 000, le nombre de décès chez les enfants et adultes est estimé à 24.000 et le nombre d’orphelins de 0 à 17 ans à 140.000. Dans ce même rapport, le taux de prévalence était estimé à 10,7%. L’enquête à indicateurs multiples couplée avec la sérologie VIH et l’anémie menée par l’Institut Centrafricain des Statistiques et des Etudes Economiques et Sociales (ICASES) en collaboration avec l’UNICEF, le PNUD, l’UNFPA, l’OMS, l’Union Européenne, l’ONUSIDA et le CNLS donne une prévalence nationale de 6,2% parmi les hommes et les femmes âgés de 15 à 49 ans. Avec ce taux de prévalence, l’infection à VIH est de type généralisé. En comparant ces données avec celles des pays de l’Afrique Centrale ayant conduit les mêmes enquêtes, la République Centrafricaine occupe toujours le premier rang des pays de l’Afrique Centrale les plus touchés par cette pandémie comme illustré dans la carte ci-dessous.(Sources : ONUSIDA )
L’enquête de séroprévalence par poste sentinelle de l’infection à VIH conduite auprès des femmes enceintes en 2006 et 2007 par le Ministère de la Santé Publique et de la Population en collaboration avec le Secrétariat Technique du CNLS avec l’appui financier de l’OMS et de la Banque Mondiale donne un taux médian de prévalence de 6% avec des limites inférieure et supérieure respectivement à 1,12% et 22,53%. Le SIDA est aujourd’hui l’une des principales causes de mortalité et de morbidité chez l’adulte centrafricain.(PNDS).
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Population: 3,800,610
Adult HIV/AIDS Prevalence Rate: 5.3%
People living with HIV/AIDS: 120,000
Country Assessment:
In 2006, the Congo project, amounting to US$ 45 million (over
five years, with US$ 9 million allocated for the first year)
was finally accepted by the Global Fund. This is in addition
to the US$ 19 million from MAP (over five years since December
2003). The United Nations will contribute US$ 4.9 million and
the European Union US$ 10.6 million for the Support Project
for the Congo Health System (PASCOB). The UNAIDS Office has
set up a think tank chaired by the UNAIDS Country Coordinator
to coordinate programmes by donors (the group met four times
in 2006).
An audit of the national response was carried out in November and December 2006 with funds provided by UNAIDS, WHO and UNDP. The purpose of the audit was to clarify the institutional roles and responsibilities of the different lead actors and to identify all malfunctions within the Ministry of Health.
The main obstacles identified to prevention, treatment, care and support were: insufficient services, which are moreover mainly restricted to the two main towns; lack of trained staff; numerous cultural factors that act as hurdles; lack of a legal framework and weak financing. A road map has been drafted to deal with these obstacles.
Resources: Conseil National de Lutte contre le Sida et les IST
Population: 18,013,409
Adult HIV/AIDS Prevalence Rate: 7.1%
People living with HIV/AIDS: 750,000
Country Assessment:
Coordination at the national level is the responsibility
of the National AIDS Control Council, which is presided over
by the President of the Republic. The Council's technical secretariat
is provided by the Ministry for AIDS Control, with the assistance
of the Ministry of Health and Population. The Council was established
in 2004 by presidential decree. It includes representatives
of all public-sector actors, of the private sector and of political
institutions. The Inter-Ministerial AIDS Control Committee,
which is chaired by the Prime Minister, ensures follow-up of
strategic orientation and coordination of all multisectoral
activities, while the Multipartite and Partnership Committee,
which is chaired by the Minister for AIDS Control, is responsible
for strengthening advocacy directed at decision-makers. There
are also sectoral, regional, departmental, communal and village
AIDS-control committees.
Support from donors is partly included in the strategic framework for AIDS control. A financial contribution is made by important sources of funding such as PEPFAR and the Global Fund. Coordination among donors is officially ensured by the Multipartite and Partnership Committee, chaired by the Minister for AIDS Control.
Within the United Nations system, coordination is the responsibility of the United Nations Theme Group, with the support of the expanded Technical Working Group. As a whole, coordination is still weak. The political and military crisis which has beset the country since 2002 has led to huge population movements, disarray of the social and health services, including health services in the war zones, and the slowdown or even halting of disease prevention and control programmes such as the AIDS programme. As a result of this crisis, there are disparities in both infrastructure and health coverage. Human resources for health have been considerably perturbed and staff of all categories are heavily concentrated in reception zones for displaced persons, while there has been a significant decline in the number of trained staff in towns in areas controlled by the new forces.
Resources: Ministere de la lutte contra la SIDA
Population: 65,751,512
Adult HIV/AIDS Prevalence Rate: 3.2%
People living with HIV/AIDS: 1,000,000
Country Assessment:
The country has been in numerous conflicts, which have dashed
development efforts and given rise to disastrous humanitarian
consequences. The country is now in a process of national reconstruction
under which AIDS control, which is considered a priority, is
part of the Poverty Reduction Strategy Paper (PRSP). This effort
also enjoys the support of partners. The Democratic Republic
of the Congo is in the grip of a widespread epidemic. Prevalence
varies from 1.7 to 7.6% depending on the region, and may be
as high as 20% among women who have suffered sexual violence
in areas of armed conflict. The epidemic is strongest among
young people between the ages of 15 and 24 and women consulting
at antenatal clinics, and is on the rise. By presidential decree,
national responsibility for the HIV response lies with the National
AIDS Control Programme. However, the decree does not clearly
determine the operational or structural links between National
Programme and the National Multisectoral Council for AIDS Control.
This situation is responsible for a weak national leadership
which is detrimental to coordination of programmes.
The lack of a national strategic plan which has been updated and budgeted for and of long-term vision is a hindrance to the involvement of civil society and of the different sectors, as well as to the harmonization and integration of interventions by all stakeholders. Women, young people, people living with HIV and the media are all highly active in the field but they still lack the capacity to ensure effective implication in and ownership of the control effort. The main obstacles identified, and which represent challenges to be overcome are:· insufficient and unpredictable funding;
- insufficient and poorly skilled human resources;
- prohibitive cost even of low-cost products and technology;
- failure to respect human rights, stigmatization, discrimination and gender inequality in respect to HIV;
- lack of communication regarding HIV;
- poor availability and use of health services; and
- poor coordination.
Population: 76,511,887
Adult HIV/AIDS Prevalence Rate: 0.9%-3.5%
People living with HIV/AIDS: 420,000-1,300,000
Country Assessment:
The response to the AIDS epidemic remains a priority issue
on Ethiopia’s development agenda. HIV is one of the
components of the national Plan for Accelerated Development
to End Poverty (Ethiopia’s Poverty Reduction Strategy
Paper). The strategic approach to the national response as
described in the national Plan for Accelerated Development
was informed by the Strategic Plan for Intensifying Multisectoral
HIV/AIDS Response, 2004 – 2008. Based on these two
plans, the national response to AIDS is built around six
strategic issues: capacity-building; community mobilization
and empowerment; integration with health programmes; leadership
and mainstreaming; coordination and networking; and targeted
response.
AIDS response targets, as set in the national Plan for Accelerated Development, were informed by the Millennium Development Goals needs assessment implemented in 2004 – 2005. The targets were based on the overall goal of reaching universal access to HIV prevention, treatment, care and support services.
Ethiopia is making every effort to fully implement the “Three Ones”. A good foundation has already been laid: the National Plan for Accelerated Development to End Poverty and the Strategic Plan for Intensifying Multisectoral Response to HIV/AIDS are recognized by all actors as a common framework for action; the HIV/AIDS Prevention and Control Office is viewed as national coordination authority; and a national monitoring and evaluation framework launched in 2003 is accepted by all stakeholders as a common monitoring and evaluation framework.
The National Partnership Forum established in March 2004 supports the HIV/AIDS Prevention and Control Office in bringing together all actors across sectors for a coordinated, coherent response. The Donors’ HIV/AIDS Forum, a subforum of the National Partnership Forum, is instrumental in ensuring donor coordination.
In recent years, financial resources available for the response to AIDS in Ethiopia have increased substantially. At the same time, however, management and implementation capacity in the country remains low, especially at district and community levels. There is a grave problem of understaffing and overall deficiency of technical skills manifested in low financial absorption capacity, leading to underspending of financial resources and delayed scale-up of services.
In the past two years, strong leadership on the part of the Ministry of Health has resulted in visible strengthening of the response to AIDS, in particular within the health sector. In all regions of the country, availability of voluntary counselling and testing and antiretroviral therapy is gradually increasing. However, effort needs to be put into strengthening the capacity of the health sector to deliver other HIV-related services. Effort also needs to be invested in building the capacity of other sectors in order to mainstream AIDS into their core activities. Special emphasis is required on strengthening the capacity of civil society.
Resources: HIV/AIDS Prevention & Control Office(HAPCO)
Population: 1,454,867
Adult HIV/AIDS Prevalence Rate: 7.9%
People living with HIV/AIDS: 60,000
Country Assessment:
In January 2006, in order to improve institutional arrangements
and enhance coordination, it was decided to set up the Ministry
for AIDS Control and AIDS Orphans. This ministry will be
established in 2007.
The National Strategic Plan 2001 – 2006, with nine objectives subdivided into 48 strategic areas of action, has reached the end of its cycle and is shortly to be reviewed in order to develop a new National Strategic Plan.
Thanks to the strong leadership of the Head of State, the efforts of the government have focused principally on care for people living with HIV, with the provision of the annually renewable Treatment Solidarity Fund and the opening of outpatient treatment centres in each of the country’s provinces.
Where HIV prevention is concerned, however, achieving greater involvement of other sectors and training civil society actors are challenges that remain to be addressed, in order to accelerate prevention.
Resources: L’organisation des Premieres Dames D’Afrique Contre Le VIH/SIDA
Population: 1,688,359
People living with HIV/AIDS: 20,000
Adult HIV/AIDS prevalence rate: 2.4%
Ungass Country Progress Report:
Reporting period: January 2006–December 2007
Submission date: 15th January 2008
Two decades after the first confirmed case, The Gambia continues to have a relatively low prevalence of HIV and AIDS. Preliminary reports from the National Sentinel Surveillance (NSS) indicate a prevalence of 2.8% for HIV-1 and 0.9% for HIV-2 among antenatal women between the ages of 15 and 49 years attending clinic. Data on HIV prevalence is routinely collected from pregnant women through the NSS. The first round of the HIV NSS among antenatal women was conducted between May 2000 and August 2001 in four health facilities in different parts of the country, namely Serre Kunda, Sibanor, Farafenni and Basse. In 2002, two additional sentinel sites were added (Brikama and Kuntaur) and in 2005 two more sites again added (Essau and Soma). In 2006 one more site (Poly Clinic in Banjul) was included. The total number of sentinel sites is now nine. These nine sites are distributed among the country’s eight local government areas (LGA), with the Brikama and Kerewan LGAs having 2 sites each. Only one LGA, Janjangbureh, is without a sentinel site. In The Gambia, as in the rest of Africa, two transmission mechanisms account for most new HIV infections in the country: heterosexual contact, accounting for nearly 80% of all new infections; and parent-to-child (PTCT) transmission, accounting of between 10-15% of new infections).
National Response To The AIDS Epidemic
The government of The Gambia is strongly committed to achieving the Millennium Development Goal for HIV and AIDS. The political resolve has been expressed by the President, who is the Chairman of the National AIDS Council, and senior government officials. HIV and AIDS continue to be a national concern and priority with multi-sectoral approach. The National HIV/AIDS Policy was updated in 2006 and this document reflects the agenda for the response. From the first PLHIV support group in the mid 90s there are now ten such groups nationwide and a network of AIDS support societies (GAMNASS). The period also witnessed the emergence of the private sector in the national response to HIV. A business coalition has been established in 2007 to provide the leadership role for private sector involvement in the HIV response. In 2007, however, there was a decrease in national spending on HIV and AIDS, attributed to the ending of the WB funded HARRP project. The HARRP was a major source of funds for civil society organizations, including national and international NGOs. Since the end of the project there has been a huge funding gap in the HIV response. This has significantly limited action in the fight against the epidemic.
The Gambia has a National Policy on Blood Transfusion, 2000. The aim according to the policy is: The provision of adequate and safe blood for appropriate treatment of patients. The policy provides guidelines for blood donor recruitment system through education and motivation of appropriately selected population groups and promotes appropriate use of blood and blood products. There is universal screening of donated blood with standard safety procedures. All donated blood is screened for HIV and VDRL. The National Health Laboratory Services (NHLS) is, however, not participating in an external quality assessment scheme for HIV screening. This is an important quality check in which external assessment of the NHLS’s performance is conducted using samples of known, but undisclosed, content to assess its quality system and assist in improving standards of performance.
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Population: 22,931,299
Adult HIV/AIDS Prevalence Rate: 2.3%
People living with HIV/AIDS: 320,000
Country Assessment:
Implementation of the second National Strategic Framework
for 2006–2010 for HIV/AIDS in Ghana began in 2006.
It is a jointly agreed coordination tool, including a plan
and budget for all the major HIV-related activities. Women
and young people were among the priorities for the year.
However, other people most likely to be exposed to HIV, such
as injecting drug users and men who have sex with men, had
limited coverage in the national response.
Implementation of the “Three Ones” was further strengthened in 2006.
- The establishment of a Partnership Forum strengthened the coordinating function of the Ghana AIDS Commission
- The second National Strategic Framework was operationalized through the first Annual Programme of Work.
- A new Monitoring and Evaluation Framework for the second National Strategic Framework was developed, with updated indicators, and data collection mechanisms and tools. Operational manuals on monitoring and evaluation are being finalized.
The Partnership Forum is the highest national stakeholder forum, including the government, development partners, civil society organizations and academic and research institutions. It promotes dialogue on programming, resource mobilization and reviews of the progress of the national response. Civil society organizations, such as faith-based organizations, nongovernmental organizations and people living with HIV, also have their own separate coordinating bodies that are represented in the forum.
For effective donor coordination on HIV-related activities, key donors have formed a Sector Group. This has helped establish joint positions on the national response, and effective engagement with the other major national development plans, such as the Ghana Poverty Reduction Strategy Paper. Working effectively with Sector Group, the United Nations (UN) agencies also met regularly in the UN Theme Group on HIV/AIDS and Joint UN Team on AIDS. This included discussions on joint programming within the UN (through the Joint UN Plan of Support) and coordination with other donors.
Implementation of the 2006 Annual Programme of Work faced challenges. Funding of activities in regions and districts was delayed because of late disbursement of pooled funds to the Ghana AIDS Commission. Projects funded directly by development partners also suffered delays, but for different reasons. Activities to expand antiretroviral therapy started late in the year and consequently targets for treating people living with HIV could not be met. However, due to heavy investments in training and infrastructure in 2006, the antiretroviral therapy scale-up is expected to take place in 2007.
The Monitoring and Evaluation Framework was complemented in 2006 by the setting of universal access targets for 2006–2010. These targets were agreed through national stakeholder consultations.
Resources: Ghana AIDS Commission
Population: 36,913,721
Adult HIV/AIDS Prevalence Rate: 6.1%
People living with HIV/AIDS: 1,300,000
Country Assessment:
Kenya has been able to demonstrate a clear trend of decreasing
HIV prevalence over the past several years. During the past
three years, critical HIV services have been scaled up. As
a result, general awareness and knowledge of HIV transmission
are nearly universal. In 2006, 760,000 adult Kenyans underwent
HIV testing, and 110,000 (35%) of those in need of treatment
had access to it, including about 6000 children. Up to 40%
of pregnant women attending antenatal care clinics in 2004
benefited from prevention of mother-to-child transmission
services.
Increased resources have been allocated to impact mitigation nationwide, specifically to programmes supporting orphans and other children made vulnerable by HIV.
The National AIDS Control Council has been able to establish itself as the one national coordinating authority on HIV, with a substantially enhanced public image and credibility.
The notable improvement in the political environment has resulted in a boost in available resources from international partners in support of Kenya’s efforts to curb the HIV epidemic, e.g. signing of the Global Fund Round 2, Phase 2 grant due to improved governance structures being put in place; the United States Government increased its HIV allocation by 30% between 2006 and 2007; and negotiations with the World Bank and United Kingdom’s Department for International Development are near to finalization, for considerable additional support to the national response, through the National AIDS Control Council.
Programme coverage for most interventions needs to be increased. Harmonizing and aligning donor activities in support of a nationally owned agenda with defined priorities remains a challenge. Multilateral institutions and international partners in Kenya must commit themselves to working with the National AIDS Control Council and to align their support to the national strategies, policies, systems and the National Strategic Plan.
There are weak linkages in the planning and implementation of programmes addressing women’s issues, with data often not disaggregated by gender. A comprehensive national HIV programme for young people is not yet available, although consultation is in progress.
The National AIDS Control Council has been proactive in ensuring that civil society engages in key national planning processes and mechanisms. There are continuing efforts to strengthen its participation in decentralized-level processes.
Mainstreaming HIV into development instruments and key sectors was prioritized in 2006 and progress was made, especially in regard to the Emergency Recovery Strategy, Medium-Term Expenditure Framework, Education sector and Home Affairs sector (Children’s Department and Prisons). HIV is increasingly integrated into core health service provision (tuberculosis, reproductive health services and antenatal care) and in the health Sector-Wide Approach and Programme proce
Resources: National AIDS Control Council of Kenya or http://www.health.go.ke/aids.htm
Population: 2,125,262
Adult HIV/AIDS Prevalence Rate: 23.2%
People living with HIV/AIDS: 270,000
Country Assessment:
In 2006, the country finalized and launched its National
AIDS Policy and Strategic Plan for 2006 –2011. The
National AIDS Commission has been established and is fully
operational. It is responsible for coordinating the multisectoral
response to HIV in Lesotho. A donor round-table meeting organized
in Maseru saw various donors pledging resources to the AIDS
response. Preliminary analysis indicates that the amount
pledged is very close to the total needs of the response,
as outlined in the National Strategic Plan.
The country has recently passed a bill providing equal status to married women, who had previously been considered minors. The enactment of this bill, along with full implementation of the Action Plan on Women, Girls and HIV, is considered key to removing barriers to access to HIV prevention, treatment, care and support services for women and girls.
HIV prevalence in Lesotho is generally higher in urban areas than in rural areas. The overall coverage of HIV-related services is very limited. Treatment is accessed by 19% of those in need, while coverage of prevention of mother-to-child transmission services is only 5%. Life-skills education programmes are just about to begin. In December 2006, the country approved a national policy on orphans and other children made vulnerable by HIV.
The major barriers to access to prevention, treatment, care and support are insufficient human resource capacity and the need to confront the population with sexuality and sexual norms.
Population: 3,195,931
Adult HIV/AIDS Prevalence Rate: N/A
People living with HIV/AIDS: N/A
Country Assessment:
The first case of AIDS in Liberia was reported in 1986. The
civil war, characterized by gender-based violence, including
rape and sexual slavery, massive population movements and
chronic deprivation, contributed to the spread of HIV.
There are currently no accurate data on HIV prevalence or its dynamics in Liberia, as a nationwide survey has yet to be conducted. In order to fill this gap, a panel of experts was convened to inform the development of a Global Fund Round 6 proposal submitted in August 2006.
In response to the AIDS epidemic, the government created the National HIV/AIDS/STI Control Programme in 1987 and established the National AIDS Commission. The latter was created to formulate policy and advocate resources under the authority of the Ministry of Health and Social Welfare, but it has not been very functional. In addition, the HIV/AIDS National Strategic Plan was developed in 2002, updated in 2004 and will expire in 2007.
The ushering in of the new government in January 2006 introduced a new dynamism in the response to AIDS. For the first time, the leadership of the country expressed interest in the response. In her inaugural address, the President referred to AIDS as “public enemy No.1” and promised to work in close collaboration with development partners.
Donor support is limited as the country is not eligible for World Bank grants. Women, young people and people whose behaviours puts them most at risk, e.g. sex workers, uniformed services’ personnel, miners and mobile populations, are insufficiently covered.
Less than 2% of pregnant women have access to prevention of mother-to-child transmission services and less than 5% of approximately 20.000 eligible are on antiretroviral therapy (National HIV/AIDS Control Program, 2006)
Liberia’s Interim Poverty Reduction Strategy Paper includes a section on the response to AIDS as one of the key areas for reducing poverty. Other developmental frameworks that feature AIDS include the health-sector developmental plan and the 2008 – 2012 United Nations Development Assistance Framework (UNDAF). Ministries other than Health (Education, Labour, Defence, and Gender), civil society organizations, faith-based organizations, people living with HIV and others affected by HIV are increasingly getting involved in the national response.
Major barriers to prevention, treatment care and support are limited resources.
Resources: National AIDS Control Programme
Population: 19,448,815
Adult HIV/AIDS Prevalence Rate: 0.5%
People living with HIV/AIDS: 49,000
Country Assessment:
National coordination is the responsibility of the National
AIDS Control Committee, attached to the Office of the President
of the Republic, which has an executive secretariat to coordinate
the overall control effort. The Committee includes governmental
partners, civil society and the private sector.
As part of decentralization of the HIV-control effort, regional control committees have been set up and regional coordinators appointed in each of the 22 regions. The activities of the regional committees are an integral part of the regional development plan. There are also local AIDS-control committees in 745 of the 1557 communes. Under the leadership of the Executive Secretariat for AIDS Control, the partners' forum provides a platform for coordinating and providing support for partners. CCM also helps ensure coordination, with the support of partners and donors. CCM is chaired by the Minister of Health, and its Vice President is the Executive Secretary.
Good coordination exists between the Committee and the Ministry of Health, which is responsible for technical activities within the health sector. The following changes were noted:
- the President of the Republic takes the opportunity offered by each formal event (summit of Indian Ocean Commission (IOC) Heads of State, inauguration of public buildings etc.) more vigorously to stress the importance of HIV; and
- more and more testimonies are being made by people living with HIV in Madagascar.
In Madagascar as elsewhere in the world, much of the work performed by women is unrecognized and unappreciated. In addition, their participation in economic activity has not been matched by a sharing of domestic chores. Women are an increasingly important part of the labour force. Nonetheless, there are still barriers to their entry, and the unemployment rate is higher among women than among men. The 2003 Gender and Human Development report on Madagascar showed that women suffer from problems of access to all areas of social and political life. In Madagascar, young people become sexually active at an early age, between 15 and 19 years (34%, source EDS 2003-2004). Casual sexual relations are also common and 10% of women aged 15–19 years have unprotected casual relations, making them particularly vulnerable to sexually transmitted infections/HIV.
Despite the existence of a law protecting vulnerable persons from stigmatization and discrimination, which helps to establish a favourable environment for AIDS control, there are still certain population groups, especially among women and young people, who are poor and vulnerable on whom the national programme is focusing attention.
Resources: National AIDS Control Committee
Population: 13,603,181
Adult HIV/AIDS Prevalence Rate: 14.1%
People living with HIV/AIDS: 940,000
Country Assessment:
A multisectoral Board of Commissioners made up of nominees
from key constituencies oversees the affairs of the National
AIDS Commission. The board reports to the President. Linkages
between the board and the recently established Department
of Nutrition and HIV and AIDS in the President’s Office
are yet to be clarified. The Malawi Global Fund Coordinating
Mechanism and the Malawi Partnership Forum are other multisectoral
and constituency-based coordination bodies. In the former,
the National AIDS Commission serves as the secretariat; the
latter was set up recently to enhance accountability. The
Malawi Business Coalition Against AIDS coordinates private-sector
response but is only present in big cities, and its membership
limited to large business enterprises, mainly multinational
organizations. Non-profit civil society response is coordinated
by umbrella organizations as well as faith-based forums.
Organizations for people living with HIV are coordinated
by two major networks: the Malawi AIDS Network and the National
Association of People Living with HIV/AIDS in Malawi.
Donor coordination takes place through the HIV and AIDS Development Group. Some donors pool their resources through the National AIDS Commission while others channel resources through other mechanisms. All donors finance implementation of the National AIDS Action Framework. The Global Fund, together with other donors, signed a memorandum of understanding.
On the one hand, an improved agricultural season in 2006 resulted in an improved food supply, thereby improving the general nutritional status of the population and stabilizing food prices. On the other hand, however, diverse views concerning the interpretation of section 65 of the constitution (floor-crossing rule), however, have tended to create an uncertain political situation that tends to overshadow the HIV situation.
The passage of the Domestic Violence Bill was a major achievement towards improving the situation of women. However, there have not been any major improvements in the situation of women, young people and other people most likely to be exposed to HIV.
Towards the end of 2006, there were major improvements in the coverage of services for women, especially those for prevention of mother-to-child transmission. Coverage of HIV testing for young people has also improved. Cash transfer was introduced to improve coverage of services for orphans and other children made vulnerable by HIV. There has been a major increase in antiretroviral therapy, reaching more than 85 000 by the end of 2006. However, limited capacity and the prevailing human resource crisis in key sectors including health, as well as limited involvement of district assemblies, are barriers to service delivery.
AIDS have been made a sixth pillar in the Malawi Growth and Development Strategy. This, along with the continuing strengthening of monitoring and evaluation systems and emphasis on decentralization, will no doubt strengthen linkages with development efforts.
Resources: National AIDS Commission, http://www.malawi.gov.mw/MoHP/index.health.htm
Population: 1,250,882
Adult HIV/AIDS Prevalence Rate: 0.6%
People living with HIV/AIDS: 4,100
Country Assessment:
In 2006, there has been a number of improvements in the national
response, including:
- increased high-level leadership governing the national response to AIDS, in order to improve coordination of the activities of multisectoral partners;
- increased capacity-development for increased programming scale-up;
- improved networking of partners, including civil society, to increase active multisectoral participation and collaboration in the national response;
- intensified United Nations (UN) system support, to respond to national priorities and identified country needs.
In the area of service delivery, a harmonized approach has been adopted for HIV prevention among people most likely to be exposed to HIV: injecting drug users, sex workers and prison inmates. In addition, a Care and Support Action Plan has been developed for people living with HIV to address the barriers to and improve holistic service delivery. The next phase will involve the development of comprehensive operational management.
Capacity-development initiatives have been set up to improve national monitoring and evaluation. These include a World Bank Institutional Development Fund proposal that aims at enhancing implementation of the national monitoring and evaluation system.
The Council of Religions interfaith project, for mainstreaming of HIV and related issues, using a collaborative multisectoral approach, has been implemented. Activities include capacity-building for leaders of faith-based groups and behavioural change advocacy, with a focus on empowering women to protect themselves against HIV infection.
Parliament passed a non-partisan, consensus HIV Preventive Measures Act, incorporating a human rights-based approach that includes unequivocal provision for needle-exchange programmes and increased access to HIV testing.The country has participated in the preparation of global progress reports (a review of the United Nations General Assembly Special Session on HIV/AIDS and the universal access initiative).
Resources: National AIDS Control Programme of Mauritius
Population: 20,905,585
Adult HIV/AIDS Prevalence Rate: 16.1%
People living with HIV/AIDS: 1,800,000
Country Assessment:
The National AIDS Council was created in 2000 by a ministerial
decree, with responsibility to coordinate the national multisectoral
response. The Board is chaired by the Prime Minister, with
the Minister of Health as Vice Chair. The second National
Strategic Plan (2005 – 2009) was approved in December
2004 and an operational plan is published annually. AIDS
has been integrated into the government’s five-year
plan for 2005 – 2009, into the second action plan for
the reduction of absolute poverty (2006 – 2009) and
the 2006 economic and social plan.
Activities being implemented by the National AIDS Council are financed by the Common Fund, supported by five external donors, the World Bank and Global Fund. A memorandum of understanding has been signed between the government and the Common Fund partners, the purpose of which is to harmonize and simplify the grant management system.
A National AIDS Spending Assessment was completed to collect information on government expenditure on AIDS in 2004.
In addition, the National Partners Forum, established in 2003 as the forum for dialogue between the National AIDS Council and its partners, signed a code of conduct and terms of reference, which seek to define the principles, mechanisms and regulate the functioning of the Forum.
The national monitoring and evaluation system was formally launched in March 2006 and is now being put into operation by the National AIDS Council; a report was published presenting baseline impact indicator data.
Throughout 2006, the national communication strategy was put into operation and World AIDS Day witnessed the launch of the national campaign ‘Window of Hope’. The main objective of the campaign is to reduce levels of HIV infections among children, mainly girls aged between 10 and 14 years.
Difficulties faced by Mozambique cannot be overstated: there is limited access to any kind of health care, with 70% of its citizens living in rural areas and food insecurity continues to affect the country. Coverage of services continues to increase but is still incommensurate with the problem. There is unequal access to HIV prevention, treatment, care and support and weak institutional capacity. It is widely acknowledged that there is an increasing feminization of the epidemic: a National Plan on Gender Policy and Implementation Strategy has been drawn up but awaits government approval. Approval of an action plan for orphans and other children made vulnerable by HIV has been given. Civil society organization is weak and insufficiently representative; the voice of the international civil society community is more strongly represented than that of national organizations.
Resources: National Council for the Fight Against HIV/AIDS
Population: 2,055,080
Adult HIV/AIDS Prevalence Rate: 19.6%
People living with HIV/AIDS: 230,000
Country Assessment:
Namibia has a generalized AIDS epidemic, with HIV primarily
transmitted through heterosexual contacts.
Between 2002 and 2004, HIV prevalence decreased marginally in all age groups except the group 35 – 39 years, in which it increased. HIV prevalence is highest in people between 25 and 39 years of age. The reduction in prevalence between 2002 and 2004 represents the first drop in prevalence since Namibia began biannual sentinel surveillance.
The government has demonstrated willingness to expand both political and financial resources to respond to AIDS. The national effort to act against HIV is rooted in the Namibian Constitution, which addresses the issue as one involving human rights. The national AIDS response is guided by five-year strategic frameworks (Medium Term Plans); the current framework runs from 2004 to 2009.
The National AIDS Committee is the highest policy-making decision body providing national leadership. Lower-level bodies include the National Multisectoral AIDS Coordination Committee (multisectoral response) and the National AIDS Executive Committee (implementation across the board).
Civil society organizations are active partners in the response through the Namibia Network of AIDS Service Organizations, a major umbrella body. Leadership and coordination of private-sector efforts is provided by the Namibia Business Coalition on AIDS. Due to the ranking of Namibia as a lower middle-income country, the donor base is relatively small and narrowing as donor agencies and governments phase out operations in the country. Current donors involved in the AIDS response include the United States Government through the President’s Emergency Plan for AIDS Relief, the European Union, the Global Fund, the United Nations (UN), Finland, Germany, Spain and Sweden, among others. Support from these and other partners has made it possible to make progress through a considerable increase in levels of financial resource commitments, expansion of prevention, treatment, care and support services, and an increase in geographical coverage. For example, all 35 public hospitals across the country provide antiretroviral therapy and prevention of mother-to-child transmission services. In 2006, an estimated 28 000 people living with HIV received antiretroviral therapy out of 58 000 in need; 4800 women received a complete course of antiretroviral therapy prophylaxis for prevention of mother-to-child transmission; and 76 000 people completed the counselling and testing process.
Women, young people, orphans and other children made vulnerable by HIV, and migrant workers remain by far the most likely to be exposed to HIV. Risk factors include poverty, mobility, high prevalence of other sexually transmitted infections, alcohol and substance abuse, and gender inequalities. Barriers to prevention, treatment, care and support include, among other things, limitations in human resources, access issues and stigma.
Resources: Namibia AIDS Coordination Programme
Population: 135,031,164
Adult HIV/AIDS Prevalence Rate: 3.9%
People living with HIV/AIDS: 2,900,000
Country Assessment:
The national response is characterized by a multisectoral
approach based on the implementation of the “Three
Ones”.
The legislative bill to transform the National Action Committee on AIDS into an established agency has been passed and is currently awaiting the final processes before implementation. Partners, including the United Nations (UN) system, have provided increased technical and institutional support to strengthen the National Action Committee on AIDS and enable it to better coordinate the national AIDS response. To help to achieve this, an institutional Support 2007 Workplan has been developed for consolidated support by the UN system, based on priorities areas identified by the National Action Committee on AIDS.
The process of scaling up towards universal access to HIV prevention, treatment, care and support by 2010 has begun: a national and state road map and set targets have been developed. Civil society took an integral part in the planning of the universal access road map; the contributions of civil society to setting and achieving the targets have been clearly defined.
In the past year, there has been increased collaboration between the Donor Coordination Group and the UN Theme Group on HIV/AIDS to ensure improved harmonization and alignment among donors and to address the need for improved coordination in line with the Paris Declaration and the Global Task Team’s recommendations.
Last year also saw the costing of the National Strategic framework for Action (2005–2009) and development of state strategic plans in four of the six focal states identified by the UN Theme Group on HIV/AIDS for joint programming. A workshop was held on National AIDS Spending Assessment, a resource-tracking algorithm designed to record the financial flows and expenditures.
During the 2006 World AIDS Day, the President took steps to ensure that all Nigerians know their HIV status by formally launching the National Counselling and Testing Programme, and set an example by being tested.
There is a need for an improved response to the situation of women, girls and people likely to be exposed to HIV, whose circumstances are worsened by factors such as poverty and limited empowerment. In addition, young people remain highly likely to be exposed to HIV, while men who have sex with men, sex workers and injecting drug users still remain highly stigmatized in Nigeria.
Resources: National Action Committee on AIDS
Population: 9,907,509
Adult HIV/AIDS Prevalence Rate: 3.1%
People living with HIV/AIDS: 190,000
Country Assessment:
The national response is coordinated by the National AIDS
Control Commission, which is also responsible for monitoring
the non-health component of the AIDS epidemic. The health
component is assured by the Treatment, Research and AIDS
Centre (TRAC), which also monitors malaria and tuberculosis
by an integrated system called TRACPlus.
The Ministry of Health oversees policy and operational decisions for health. Orphans and other children made vulnerable by HIV come under the Ministry of Family and Gender Promotion.
Donor support has been positive and strong: the United States President’s Emergency Plan for AIDS Relief budgeted US$ 94 million, the Global Fund Round 6 proposal netted an additional US$ 58 million, and the World Bank negotiated a US$ 10 million, one-year extension of the Multisectoral AIDS Programme.
Rwanda severed relations with France, but this does not seem to have had a noticeable impact on the national response to AIDS. There were population displacements from Burundi and the United Republic of Tanzania into Rwanda. Returnees from the United Republic of Tanzania reportedly had an HIV prevalence of 12%.
The United Nations (UN) family has led the drafting of an emergency response plan for AIDS. An appeal for funds will be launched early in 2007, for immediate implementation.
The results of Demographic and Health Surveys have highlighted gender imbalances in rates of infection. Health service delivery (in particular voluntary counselling and testing, prevention of mother-to-child transmission and antiretroviral therapy) continued the upward trend marked over the past three years. At the end of 2006, a total of 251 health centres provided voluntary counselling and testing, and provided antiretroviral therapy to 30 000 people.
Challenges continue in providing services and reducing physical barriers to access for people clustered on hills. During the 2006 World AIDS Day Campaign, 12 concrete actions were proposed to enable communities to understand the actions they can take at the community level.
Rwanda carried over the concept of the “Three Ones” (one coordinating authority, one strategic plan and one monitoring and evaluation framework) to tuberculosis and malaria services.
The process of producing an economic development and poverty reduction strategy was used as an opportunity to integrate the AIDS response into all sectors. Issues related to high fertility rates, population growth and sexual and reproductive health were prioritized within the national plan and in the United Nations Development Assistance Framework 2008 – 2012.
Rwanda also refined and defined the kind of minimum support that partners should be providing for care and support of people living with HIV.
Resources: National HIV/AIDS Control Commission
Population: 12,521,851
Adult HIV/AIDS Prevalence Rate: 0.9%
People living with HIV/AIDS: 61,000
Country Assessment:
HIV-1 and HIV-2 surveillance information on antenatal clinic
women is available from Senegal since the mid-1980s. In Dakar,
the capital, HIV-1 prevalence among antenatal clinic women
was 1 percent or less for all years up to 1998. HIV prevalence
rates among women attending ANC were 0.5 percent in 1998,
0.8 percent in 2001 and 1.1 percent in 2002. In 2002, the
median HIV prevalence among women attending antenatal care
clinics at 11 sites was 1.1 percent which was very similar
to the observed rate in 2001 (0.9 percent) Although, HIV-1
prevalence has remained very low among antenatal clinic women
in Dakar, prevalence among sex workers has increased gradually
from less than 1 percent in 1986 to 14 percent in 2002. HIV-1
prevalence among sex workers outside of Dakar, in Kaolack
and Ziguinchor, continues to increase, from 0 percent in
1986 to over 20 percent in 2002. Since 1989, HIV-1 prevalence
among male STI clinic patients in Dakar increased from 1
percent to nearly 5 percent in 1993. In 2002, 4 percent of
male STI clinic patients tested positive for HIV-1 or HIV-1+2.
Resources: National AIDS Council of Senegal
Population: 81,895
Adult HIV/AIDS Prevalence Rate: N/A
People living with HIV/AIDS: N/A
Country Assessment:
The national response is managed within the framework provided
by the National Strategic Plan 2005 – 2009, which highlights
a multisectoral response, involving ministries and civil
society, including people living with HIV. Coordination is
carried out through the National AIDS Council, with the secretariat
based in the Ministry of Health. The national response is
mainly driven by government funds and private contributions,
with some support from United Nations (UN) agencies (World
Health Organization, United Nations Development Programme
and UNAIDS).
Unprotected heterosexual sex, followed by unprotected sex between men who have sex with men are the main causes of the AIDS epidemic. The main drivers of the epidemic are:
- discrimination against and stigmatization of people living with HIV;• inadequate human and financial resources;
- poor perception of vulnerability to HIV;
- the national response being health-sector driven;
- family instability;
- limited accessibility and acceptability of condoms;
- inadequate HIV prevention services targeting men who have sex with men;
- an increasing trend of substance abuse among young people.
Access to safe reproductive health is an issue of concern in Seychelles, as evidenced by a high proportion of unsafe abortions.
Resources: National AIDS Council
Population: 43,997,828
Adult HIV/AIDS Prevalence Rate: 18.8%
People living with HIV/AIDS: 5,500,000
Country Assessment:
There are striking gender disparities in South Africa, with
females in younger age groups being four times more likely
to be HIV infected than males.
AIDS-related death rates are rising, with mortality among females aged 20 – 39 years more than tripling between 1997 and 2004. Over the same period, deaths due to AIDS-related conditions, such as tuberculosis, in the age group 25 – 29 years have increased six fold among females and tripled among males.
In spite of this serious epidemic, South Africa has a range of relevant comprehensive policies and interventions. Increased domestic resources have been invested in the national programme, with US$ 927 million committed for 2006 – 2007, and major donors are also committing significant resources. The government and civil society run major HIV prevention campaigns, especially among young people. Distribution of condoms free of charge has significantly increased. Access to voluntary counselling and treatment and prevention of mother-to-child transmission is expanding, although it has been slowed by health-system limitations. These policies and interventions, however, have not stemmed new HIV infections.
The expansion of antiretroviral therapy into the public sector, which commenced slowly in 2004, is continuing. In 2006, more than 300 000 people living with HIV had started treatment in public and private sectors, making it one of the largest programmes in the world. The outbreak of extensively drug-resistant tuberculosis in 2006, with high mortality among HIV-infected patients, adds complexity to the response.
Divisions and inadequate coordination between the government and civil society have been a major challenge. The conflict between government and civil society, especially the Treatment Action Campaign, came to the forefront in the run up to and during the 2006 High Level Meeting on AIDS in New York, United States of America, and at the 16th International AIDS Conference in Toronto, Canada. The government responded by taking steps to improve coordination, enhance communication, unify the response, and build partnerships with civil society. This shift in AIDS policy included reviving the Inter-Ministerial Committee on AIDS, under the leadership of the Deputy President, who is also the Chair of the National AIDS Council. This leadership and new direction have created an environment that is conducive for collaborative interaction. Within this framework, work is under way to strengthen two elements of the “Three Ones”, i.e. restructuring the National AIDS Council and developing a government-led inclusive National Strategic Plan 2007 – 2011. With these developments, the national response has taken a positive turn.
Resources: South African National AIDS Council
Population: 1,136,334
Adult HIV/AIDS Prevalence Rate: 33.4%
People living with HIV/AIDS: 220,000
Country Assessment:
Swaziland has systematically responded to HIV since the first
case was reported in 1986. The National AIDS Prevention and
Control Programme, which evolved into the Swaziland National
AIDS Programme within the Ministry of Health and Social Welfare
was established following identification of the first case.
In 1999, the King declared AIDS a national disaster, after which two committees were established to lead the national response, namely the Cabinet Committee on HIV and AIDS and the Crisis Management and Technical Committee. In September 2000, the Crisis Management and Technical Committee developed the first National Strategic Plan 2000 - 2005 and in 2001, the National Emergency Response Council on HIV and AIDS was established to coordinate the implementation of the National Strategic Plan. A Joint Review of the first National Strategic Plan was completed in March 2005, in which all partners, including civil society and the private sector, actively participated. This review process, which identified drivers of the epidemic, informed the development of the second multisectoral National Strategic Plan 2006–2008, the Action Plan and the National Multisectoral HIV and AIDS Policy. The latter serves as a basis for coordination of the national response. These documents were launched in July 2006.
The approach of using sectors and umbrella bodies to coordinate the national response was adopted in the process of implementing the second multisectoral National Strategic Plan. In 2006, support was obtained from the Global Fund, United Nations, European Union, Government of the United States of America, Italian Cooperation, and United Kingdom’s Department for International Development, World Bank, Stephen Lewis Foundation, Baylor College of Medicine and Bristol-Myers Squibb.
Women are doubly affected by the epidemic. Because of their biological and physiological make-up, they are easily infected. They often take care of their ailing partners and others living with HIV before becoming sick themselves. The number of children orphaned by AIDS has increased from 12 000 in 1999 to 70 000 in 2006 and is still rising (National Plan of Action for Orphans and Vulnerable Children, 2006 - 2010, The Kingdom of Swaziland). When combined with other vulnerable children whose parents are still alive but either too ill or are destitute, the figure reaches 130,000. The traditional extended family and other support systems are overwhelmed by this situation. The majority of these children have no extended family networks on which to rely on following the death of their parents. Elderly people have also been affected as a result of the AIDS-related deaths of their children who had previously supported them.
Major barriers to prevention, treatment, care and support include: limited coverage of behavioural change communications, particularly at chiefdom level; lack of empowerment for women, coupled with stigmatization of AIDS; limited access to services, insufficient focus on paediatric cases; inadequate laboratory services and lack of trained staff; and limited capacity for home-based care.
Resources: National Emergency Response Council on HIV/AIDS
Population: 39,379,358
Adult HIV/