Conceptual Outline for developing KZN Provincial HIV & AIDS and TB Plan

KZN Background KZN Province with 21.4% of SA population accounts for 33% of national adult PLHIV burden Consistently recorded highest ANC HIV prevalence since 1990 KZN’s HIV epidemic is at the top end of levels of HIV dissemination into the general population ever seen in the world. HIV epidemic expanded fastest between 2002 and 2005, largely in young women (7.5% HIV+ in 2002, 23.3% in 2005) Life time HIV risk of about 78% at age 55 (males) and 75% (females), such that some people in KZN believe HIV is inevitable. faces worst dual epidemics of HIV and Tuberculosis (xxx provide HIV/TB data ) In 2009 highest health district HIV prevalence of 46.4% was recorded in uThukela and only 1 out of 11 districts had prevalence below 30% General population HIV prevalence at 25.8% compared to 17.8% nationally

Background 2 KZN HIV infections are clustered in Africans – in 2008, 26.2% were HIV+ Highest risk groups: adults in urban informal areas (33.8% HIV+) and rural formal areas (29.8%), never married but sexually active high-risk women (31.8%) and sex workers (60%) High prevalence in towns along major highway routes Some positive results emerging: HIV prevalence and incidence data suggest higher education has a protective effect. School attendance protects against early first sex Decrease in reported multiple partnerships in the past year (but not those in the past month)

Comparison SA and KZN data from 2009 ANC survey SAKZN HIV prevalence 15 – 49 years29.4%39.5% No. health districts recording HIV prevalence > 40% 55 No. health districts recording HIV prevalence between % 145 HIV incidence rate - adult population1.5%2.3% New infections 15 – 49 years New infections 0 – 14years No. AIDS related deaths No. orphans due to AIDS In need of PMTCT services214000

Drivers of KZN’s HIV epidemic The level of male circumcision is low (27%), Highest frequency of reported multiple sexual partners in the country, Marriage occurs later in life, Transactional sex is comparatively frequent, Relatively short partnerships of between 7 months to 2 years are more common than in other areas of South Africa

KZN Response Three Ones institutionalized  Coordinating structures – multisectoral and at Province, Districts and local levels (some not so functional)  Provincial plan (2007 – 2011) and being implemented  M&E plan However:  Major expenditure is on treatment  BCC activities receive very little funds  Limited efforts on combination prevention  MMC low despite its proven benefits

Future focus MMC Communication on partner reduction Communication on Risks of age-disparate sex (often transactional) as key components of combination prevention More investment in prevention Better disaggregation of prevention spending Education sector has a critical long-term role in HIV prevention and vulnerability reduction for children and youth as a complementary measure to what other sectors can provide

Why new PSP The current NSP ( ) expires this year Framework to include new medical evidence of what works and reflect new policy direction Urgent need to develop the new NSP 2012 – 16 The Deputy President also announced that the new NSP will be launched on December 1 st, 2011

PSP development process and Approach Results based planning approach to facilitate implementation accountability and ownership of results Evidence informed - use KYE/KYR and others Process will facilitate stakeholder alignment and harmonize with national planning cycles (Paris Declaration on aid effectiveness ) The PSP development process will be forward looking It will acknowledge the progress so far realized through implementation of the current NSP Take into account ongoing initiatives and processes

Objectives of the planning process To conduct an assessment of the provincial and / district responses To capture emerging issues and incorporate them in the new PSP ( ) To identify and agree on key priorities and milestones for the next five years in line with signed National Service Delivery Agreements. To develop provincial and national strategic plans for 2012 – 2016 aligned to the NSDAs To identify technical capacity gaps and develop a costed Technical Support Plan To document best practices in the response to the HIV and TB epidemics To develop costed operational plans of the new PSP in line with existing planning cycles. To develop a Resources Mobilization Plan for the national and provincial plans To develop harmonised and integrated M&E Plans based on objectives, targets and expected outcomes of the PSP

NSP development process deliverables Assessment report of the provincial and district responses Have the current NSP targets been met? Multisectoral participation in the implementation of the NSP – how was it? Role of SANAC, PACs, DACs and LACs in the national response Costed Provincial & National Strategic Plan for HIV/AIDS, TB and STIs and Provincial Strategic Plans for the period , Costed multi-sectoral Implementation Plans at national and provincial levels, Costed comprehensive M&E Plans , Costed demand-driven Technical Support Plans and Resource Mobilization Plans.

Guiding Principles.. Supportive leadership, especially political – at all levels Strong coordination Effective communication Effective partnerships including people living with HIV and AIDS at all levels Promote Greater Involvement of People living with HIV at all levels Sustainable programmes and financing Promoting social change and cohesion Gender equity Response is guided by ethically sound, current scientific and evidence- informed research

Guiding principles Promotion and protection of human rights– people centred and culturally sensitive; promotion of good governance, transparency and accountability Comprehensive and participatory multi-- sector engagement Local ownership and focus on local capacity development

NSP 2012 – 2016 Development Process Summary

Structures 1. Provincial steering committee The Provincial Council on AIDS will be the Provincial steering committee that will provide strategic direction and oversight for the whole process 2. Provincial Coordinating committee (PCC) The Interdepartmental Committee shall serve as the Provincial Coordinating committee that will provide technical and operational leadership for the whole process. Co-opted members will be drawn from CSOs - FBO, Men, Women, Youth, Children, Private sector and PLHIV organization, academia, traditional leadership and traditional health practitioners 3. The PCA Secretariat The secretariat - administrative and logistical arrangements

Structures Technical Working Groups / Technical Task Team (TTT) the present PSP Priority areas to ensure review of all the priority areas. Priority area Chair 1: Prevention - Biomedical (DOH) Social (DOE/DAC) Chair 2: Treatment, Care and Support Treatment, Care(DOH) and Care and Support (DSD)

Structures Chair 3. Priority area 3: Management, Monitoring, Research, and Surveillance of the response Co-ordination, Management, Monitoring of the response (OTP) Research and Surveillance of the response (DOH Academia and research institution) Chair 4. Priority area 4: Human rights, Access to Justice and Enabling environment Human rights (OTP) Access to Justice (DOJ) Enabling environment (CSO)

Recommendation The approval of the formation of the structures The approval of the PSP Development process. The chairs of the all structures including the technical working group.

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