Regional strategy supporting the national strategic plans of countries Managing Change in Small Islands Room 203 – 204 Monday 21 July 2014 Dr. Jason Leo Iane Mitchell CEO-OSSHHM 20 th IAC Melbourne

Overview 1.Brief Pacific introduction 2.Historical overview Pacific response 3.HIV epidemic status 4 decades later 4.Lessons learnt 5.The change-Shared agenda

The Pacific in focus

The Pacific in focus 22 Countries in the Pacific 21 smaller Pacific Island Countries and Territories Population size 67 (2011) – 850,000 (2013) Religious and cultural diversity Third of the world’s languages 21 systems and governments to work with Country support provided regionally

History and Evolution of the Regional Response to HIV ‘A PERIOD OF FOUR DECADES’

Regional Response: 1 st Decade HIV is a non-issue for Pacific Focus more on public awareness Response driven by government First case of HIV diagnosed

Regional Response: 2 nd Decade Country leaders met to discuss the potential threat of HIV to PICTS HIV response treated as an emergency in many countries Engagement with national traditional and religious leaders

Regional Response: 3 rd Decade Pacific forum leaders acknowledge HIV as an important development issue 2004 Endorsement of the Pacific Regional Strategy on HIV/AIDS (2004–2008) 2008 Endorsement of the Pacific Regional Strategy against STIs and HIV ( ). Developed by Gov, NGO sectors and regional development partners

Pacific Regional Strategy on HIV/AIDS (2004–2008) Pacific Regional Strategic Implementation Plan (PRSIP I) 8-thematic areas organised into 4 components: 1.Leadership and governance 2.Access to quality services 3.Regional coordination 4.Programme management Scaling up of regional support to facilitate growing national efforts Largely government focused and driven Resourcing: Global fund, AusAID, NZaid, ADB and French funding Emerging evidence for HIV & STI

Pacific Regional Strategy on HIV and other STIs ( ) PRSIP II framework to respond to STIs & HIV nationally and regionally 6 Thematic areas (consistent with country NSPs): 1.Prevention programmes (MSM, SW, Seafarers, servicemen) 2.HIV and STI diagnosis (focus on STI and HIV) 3.Continuum of care, treatment and support systems and services (focus on STI and HIV) 4. Leadership and enabling environment 5.Strategic information and communication 6.Governance and coordination (Govt and NGO) Regional division of labor supporting national responses Resourcing: Global Fund R7 and the Response fund, minimal national resources Greater emphasis in CBO and community engagement

Partners working together-PRSIP II

Regional Response: 4 th decade Major funding mechanism for PRSIP II (GF and RF) came to an end Regional STI & HIV strategy ended Many countries left with little to no technical and financial support regionally Consultations for the development next regional response begins

Two regional strategies later Greater engagement with communities in planning and implementation of strategies and programmes nationally Greater evidence emerging –HIV focused in the general population – SGS x 2 –Key population- challenging stereotypes Few countries beginning to repeal draconian laws particularly around MSM Fiji, PNG and Palau have standalone HIV legislation Other countries continue to reform in support of enabling environments Prohibitive laws still exist MSM/TG, SWs and drug use

HIV epidemic status 4 decades later

Lessons learnt 3 decades later Need to link HIV, STI, gender, sexual and reproductive health programmes. Social research to inform policy and programming. Better evidence of the critical role that social, cultural and religious factors have on the effective implementation of: –HIV, STI and SRH programmes for all sectors of the community Need for more country-focused and country-led strategic planning. Greater engagement with other key population.

Rationale for a change in approach  Need for a strategic document to guide PICTs in responding to SRH issues as a whole.  Document should not prescribe a one size fits all approach but should be an overarching guidance document.  Stronger linkages/integration between HIV/STI and SRH.  Need for comprehensive approach which addresses the complexities of SRH.  Greater focus on most-at-risk and vulnerable populations.

Modifying the approach Extensive consultations:  Ministers & Directors of Health  National and regional stakeholders  Key populations  MSM/TG  M&F SWs  PLHIV  People living with disabilities  Youth  Women  Others

Conclusion The change: Move from 2 decades of disease focused approach Shared agenda hopes to improve access to comprehensive SRH for ALL The challenge: regional and national resources continue to decline (human and financial) What of the shared agenda? How do we carry on from here? 20

Acknowledgements: 1.Ms. Michelle O’Connor and Dr. Dennie Iniakwala-Secretariat of the Pacific Community-various slides 2.To the Australian Aid programme and ASHM for their ongoing support and for supporting my involvement in this programme

References 1.SPC, 2005, Pacific regional strategy on HIV/AIDS [ ], Noumea, SPC, 2012, Pacific HIV Report 2012, Noumea, New Caledonia: Secretariat of the Pacific Community. 3.History and Evolution of PRSIP: Adapted from the Presentations at the Development of Shared Agenda Consultation meetings ‘Making Waves’ PPT made by Dr. Dennie Iniakwala, HIV&STI Team Leader, Health Protection Programme, Public Health Division, SPC Nadi and Guam, March The Pacific Sexual Health and Wellbeing Shared Agenda 2015 – 2019, PPT presentation made Ms. Michelle O’Connor at the Directors of Health meeting, Nadi April, 2014.