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The effects of global HIV/AIDS initiatives (GHIs) in concentrated epidemics: findings from the Global HIV/AIDS Initiatives Network (GHIN) IAC, Mexico City,

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Presentation on theme: "The effects of global HIV/AIDS initiatives (GHIs) in concentrated epidemics: findings from the Global HIV/AIDS Initiatives Network (GHIN) IAC, Mexico City,"— Presentation transcript:

1 The effects of global HIV/AIDS initiatives (GHIs) in concentrated epidemics: findings from the Global HIV/AIDS Initiatives Network (GHIN) IAC, Mexico City, 5 th August 2008 Neil Spicer & Gill Walt, London School of Hygiene & Tropical Medicine Ruairi Brugha, Aisling Walsh & Regien Biesma, Royal College of Surgeons in Ireland Gulgun Murzalieva, Center for Health System Development, Kyrgyzstan Tetyana Semigina, Kyiv Mohyla Academy, Ukraine Xiulan Zhang, Beijing Normal University, China Carlos Caceres, Cayetano Heredia University, Peru Nguyen Thi Kim Chuc, Hanoi Medical University, Viet Nam Ketevan Chkhatarashvili, Curatio International Foundation, Georgia

2 Global HIV/AIDS Initiatives Network (GHIN) A network of 15 country studies on the national & sub-national effects of global HIV/AIDS initiatives on country health systems Generalised HIV epidemics: 10 African country studies Concentrated epidemics: Ukraine, Kyrgyzstan, Georgia, Peru, China, Vietnam Focus: Global Fund to Fight AIDS, Tuberculosis & Malaria PEPFAR World Bank Global HIV/AIDS Program

3 Context Epidemics concentrated among ‘risk groups’: IDUs, SWs, MSM, Prisoners Programmatic response: substantial resources for prevention Study methods Service provider/client interviews Semi-structured interviews with policymakers National & facility record analysis Findings A.Global Fund supported service scale-up & access B.Coordination of HIV/AIDS programmes

4 Scale up: numbers receiving ART 1 st December 2005 1 st December 2007 China 10,74728,884 Peru 4,88310,610 Ukraine 1,8134,060 Viet Nam 842,927 Georgia 94271 Kyrgyzstan 4262 Source: Global Fund ARV Fact Sheet 1 December 2005 & 2007

5 Source: International HIV/AIDS Alliance in Ukraine (2007)

6 How accessible are HIV/AIDS services? Stigma & discrimination undermine access ( all countries ) Family/community sanctions Provider discrimination e.g. withholding care/resources Criminalisation of drug use ( Georgia, Kyrgyzstan, Ukraine ) Outreach HIV/AIDS workers commonly arrested Illegal drug ‘storage’ – problem for needle exchange programmes Police officers arrest drug users

7 Financial barriers Global Fund commodities notionally free to users – but informal payments common (Georgia, Kyrgyzstan, Ukraine) Self payment for initial lab tests for poor clients (Vietnam) Information/knowledge Clients lack information about HIV, HIV services & eligibility criteria (Georgia, Ukraine, Kyrgyzstan, Peru) Information misleading, increases stigmatisation or culturally inappropriate (Peru, Kyrgyzstan)

8 Global Fund financed HIV/AIDS awareness poster, Kyrgyzstan

9 Global Fund – positive effects on stigma & access Community-based delivery: peer-to-peer & outreach services good engagement with clients ( Ukraine, Kyrgyzstan ) Global Fund programmes - improved government providers’ attitudes/ behaviour towards PLWHA ( Georgia ) HIV/AIDS awareness programmes – positive impact on public understanding/reduced stigma ( China )

10 Needle/syringe ‘exchange’ Odessa, Ukraine

11 Needle/syringe exchange/condom distribution, Osh, southern Kyrgyzstan

12 Coordination - positive effects & challenges Global Fund credited with promoting programme coordination ( China, Peru, Viet Nam, Kyrgyzstan, Ukraine ) Government (MoH + municipality) providing strong coordination & oversight of GHIs ( Viet Nam and China ) Lack of meaningful engagement of CSOs on CCM & other coordination bodies ( Peru, Kyrgyzstan, Ukraine ) Increasingly complex HIV/AIDS programme environment

13 HIV/AIDS programmes: increasingly complex environment International donors, organisations and initiatives working in Kyrgyzstan (2007) GFATM CAAP (WB & DfID) UNDP UNAIDS UNFPA UNODC CDC WHO Soros-Kyrgyzstan USAID KFW Bankgruppe, Germany Border Management Programmes for Central Asia Central Asia Drug Action Programme East-West Foundation UNICEF UNIFEM SDC 1,070 people registered as living with HIV or Aids 62 people receiving ARVs (2007) Source: Republican AIDS Centre (2007)

14 Verkhovna Rada (Parliament) of Ukraine The Cabinet of Ministry of Ukraine Ukrainian HIV/AIDS Centre Coordinating Monitoring and Evaluation National Coordination Council on issues of the prevention of HIV–infection/AIDS spreading Donor Organizations ) NGO (national ) Ministries of Ukraine Labour and Social Policy Family, Youth and Sports Issues FinanceDefenceEducati- on and Science Health Administration, structures, departments of local executive power bodies Regional AIDS Centres State Oblast Administrations NGO (regional) Government commission on issues to fight HIV/AIDS Interim Special Commission of Verkhovna Rada of Ukraine in Problems of HIV /AIDS, TB and Drug Addiction HIV Coordination mechanisms: Ukraine Committee on AIDS and TB ?

15 Sub-national coordination Local coordination bodies –Coordination imposed from above –Lack of transparency/information sharing –Limited engagement from all players; Poor coordination between services –Competition for grant money

16 Acknowledgements Study/Network funders: Irish Aid DANIDA Open Society Institute Alliance for Health Policy & Systems Research USAID EU-INCO Further details Neil Spicer London School of Hygiene & Tropical Medicine neil.spicer@lshtm.ac.uk Global HIV/AIDS Initiatives website http://www.ghinet.org/

17 Research Funders Country Studies Research Partners Network (GHIN) Funders Kyrgyzstan Ukraine Zambia United Kingdom Mozambique South Africa x 2 Angola Lesotho Ireland Belgium Portugal Vietnam Sweden Tanzania Uganda Peru China Georgia Malawi Ethiopia Benin Malawi Irish Aid DANIDA USAID United States AHPSR EU INCO OSI

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