National Consultations on HIV Prevention UNAIDS | OCTOBER 2017 National Consultations on HIV Prevention First step to Global Coalition Road Map implementation Karl Dehne, Chief Prevention, UNAIDS

Process leading to the Coalition and Road Map Launch

Purpose of the national consultations To reaffirm and strengthen national leadership for primary prevention and help establish national prevention coalitions. To re-confirm/define national prevention (and related human rights) targets, in line with global targets, and identify key programme achievements, gaps and bottlenecks. To agree on commitments and milestones for strengthening prevention policies, programmes and implementation arrangements. To prepare country delegates for participating in the inaugural meeting of the global prevention coalition on 10-11 October 2017

Process and methods Guidance note circulated to 25 top HIV infection countries in July 2017. In-country stock taking exercise (desk review, key informant interviews, etc) National consultations in near 20 countries in near 20 countries by end of September 2017. Joint Agency HIV Prevention Country Assessment in 6 countries AIDS Alliance global consultation in Capetown with CSOs. Report and feedback received from 14 countries as of 07 October. Report receive from 14 countries: Uganda, Mozambique, Zambia, Lesotho, Cameroon, Pakistan, Malawi, DRC, Swaziland, Tanzania, Ukraine, Cote d’Ivoire, Brazil and Namibia as of 07 October. Some inputs from Indonesia country assessment.

Country Consultation Timeline Date of Nat’l Consultation Date of Nat’l consultation Tanzania 05 Sept Zambia 22 Sept Swaziland 14 Sept Ghana 26 Sept Uganda Kenya 26-28 Sept DRC Zimbabwe Pakistan 15 Sept India the week of 25 Sept Cameroon Malawi Lesotho 14 (CSO) & 18 (Public) Sept Mexico 1st week of Oct Cote d’Ivoire 18-19 Sept South Africa Different approach Mozambique Brazil Different Approach Ukraine 19 Sept Angola TBD Nigeria 20 Sept China Namibia 21 Sept Ethiopia Indonesia Planned after GC Bold: Consultation report received

Engagement of stakeholders in the national consultations Number of participants from 30 in Pakistan to 134 in Malawi): Government (NAC, Health, Education, Police, Defence, Prisons, Youth and sports; provinces in some countries) NGOs, INGOs, Faith-based organizations Community, positive networks and KPs UN agencies Development and implementing partners Private sector (insurance, chamber of commerce), foundations Academia and research institute Media Community positive networks, key population and young women participation between 10 and >40 of all participants In Uganda, 2 from Sex worker groups (WONETTA), 7 from positive groups, 1 from fisherman association out of 38 In Zambia, 1 MSM group (Friend of Rainka), 5 Youth groups attended out of 64 In Pakistan, 3 TG representatives, 2 MSM representatives, 3 positive representatives out of 30 In Tanzania, 3 positive networks (NACOPHA , ZAPHA+/Zanzibar, YNP+/Youth Network of PLHIV) and 4 KP groups (ZAYEDESA Zanzibar, CHESA, BIO Zanzibar representing MSM and FSW, TANPUD for PWID) out of 60 In Namibia, there were 4 representing TG, one representing MSM and 2 represents SWs, one represents youth and 2 positive groups, in total 10 out of 73 participants

Key gaps on program targets Result framework for HIV prevention to be developed in a number of countries Some countries do not have targets for all relevant prevention pillars areas, or targets not yet aligned with the political declaration 2016 Targets for key population interventions missing in many countries Most of 14 countries have VMMC targets, however largely driven by donors, not fully locally owned i.e. Ukraine does not have a IPWID target.

Key policy and program challenges Legal environment and stigma and discrimination, including in health care settings number one challenge for service provision to and access by key populations Lack of Standard Operational Procedures or Minimum Standards Age of consent preventing adolescent access to reproductive health and HIV services, contraception, condom and HIV testing Fragmented and un-coordinated AGYW programmes Condoms not allowed to be provided in prisons and in schools Logistic management and distribution of condom a challenge Lack of accountability of programme implementation and spending Lack of SOPs, definition of packages, eg Uganda, Ukraine, Swaziland, Malawi Age of consent prevent adolescent access to reproductive health and HIV services i.e. condom and HIV testing (Tanzania, Zambia, Namibia) Fragmented and un-coordinated (Uganda) Logistic management and distribution of condom a challenge: DRC, Malawi, Lesotho

Some overarching priorities Sensitize Policy maker and law enforcement for better support of the an-enabling environment Improve coordination and leadership on prevention Increase domestic investment i.e. Ukraine does not have a IPWID target.

Examples of key policy actions needed Legal and policy review and repeal un-enabling law and policies for key populations (Malawi, Uganda, Tanzania, Lesotho, Pakistan, DRC and Swaziland) Decriminalization of key populations (Ukraine, Cote d’Ivoire) Develop protective laws, regulation and policies for key populations (Mozambique) Revisit the age of consent and remove legal barrier for adolescent accessing reproductive services and commodities (Malawi, Swaziland, Zambia and Namibia) Remove excessive tax for lubricant importation (Mozambique) i.e. Ukraine does not have a IPWID target.

Key programmatic actions needed Improve strategic information for key populations, including population size estimation, costing to inform target setting and programme design Strengthen community-led programming (Pakistan); inclusion of communities in sensitization and training for officials at all levels (Brazil) Define SOP or Minimum Standard for key populations and AGYW programmes Improve service integration (Swaziland, Uganda, Lesotho, Brazil, Cameroon, and Cote d’Ivoire) Design programmes tailored to specific needs of Transgender people (Namibia) Establish mechanisms for contracting and transfer funds from government to CSOs (Indonesia and Brazil) and effectively implement KP cascade monitoring system, including using unique identifier to track and link beneficiaries across the continuum of servicei.e. Ukraine does not have a IPWID target.

Key programmatic actions continued - condoms Improve condom distribution network and making condom available in prison settings (Cote d’Ivoire, Cameroon) Increase number of community outlets to distribute public sector condoms, including to improve access by adolescent and young people (Tanzania, Cote d’Ivoire, Malawi and Cameroon) Promote condom Total Market Approach and improve condom logistic management (Malawi, DRC, Uganda) and effectively implement KP cascade monitoring system, including using unique identifier to track and link beneficiaries across the continuum of servicei.e. Ukraine does not have a IPWID target.

Prevention financing Increase domestic funding, particularly on primary prevention, aiming to reach the Quarter4Prevention on average Innovative ways of raising funds, HIV Prevention Levy (Pakistan) and HIV Prevention fund (Uganda) Speed up the release of public funding (Pakistan) Include prevention elements in health insurance (e.g. VMMC in Kenya) Institutionalize HIV prevention among key populations into the state governance system within the current health system reform (Ukraine, Brazil) Development partners need to continue providing the crucial technical and financial support to countries for ending AIDS during transition i.e. Ukraine does not have a IPWID target. Cameroon on track for a quarter 4 prevention

Examples of capacity strengthening and Technical Assistance needed Establish/strengthen national coordination and leadership, as well as Technical Working Group for Prevention (Cameroon and many countries) Target setting and result framework development Improve strategic information, i.e. key population size estimation, condom quantification for most of the countries Link Geo Information System with Logistic Information Management System and programming Development of services packages, minimum standards and standard operation procedures for service provision in line with WHO guidelines Strengthen condom total market approach, procurement and distribution Recruitment of staff to strengthen National coordination (Uganda) Establish cascade for KP intervention (Tanzania)

The 10 action points in road map Revisiting targets Strengthen national and local leadership and coordination on prevention Develop intervention packages and service delivery platform for HIV prevention Review policies Financing Technical assistance Improve monitoring & accountability i.e. Ukraine does not have a IPWID target.

Summary/Conclusion Timely and much needed exercise Mostly achieved objectives Inclusive consultative process for shared ownership, commitment and implementation needs to continue ! Re-visiting targets, especially coverage targets, as part of the result framework for prevention development, important priority Innovation needed (i.e. use of social media for messaging, out-reach, virtual mapping, etc) i.e. Ukraine does not have a IPWID target.

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