1. Strengthening the Focus of Municipal HIV Responses on Key Populations
African Cities and HIV
Strengthening the Focus of Municipal HIV Responses on Key Populations
Mesfin Getahun
Harare, Novembre 2015

2. 1. Urbanization in Africa
2. HIV in African Cities
3. Why focus on cities?
4. The African Cities and HIV Initiative
5. How effective are city responses
6. Lessons
7 Going forward
Outline 1
Context – rapid urbanization in Africa Background - HIV in African cities Rationale - why focus on cities? Response - the African cities and HIV initiative Progress - how effective are city responses? Lessons – what have we learned so far? Going forward – what is to be done? 2 3 4 5 6 7

3. Context – Rapid urbanization in Africa
2. HIV in African cities
3 Why focus on cities
4. The African cities and HIV initiative
5. How effective are city responses?
6. Lessons
7. Going forward
Context – Rapid urbanization in Africa
The average rate of urbanization in Africa is the highest in the world at 3.97% annually

4. Background – HIV in African cities
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Background – HIV in African cities

5. Rationale – why focus on cities
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Rationale – why focus on cities
HIV Prevalence in cities is generally up to 5 times higher than in rural and semi- urban areas but little is known about city specific HIV epidemics and responses due to significant gaps in data, analysis and city specific research.
Although HIV incidence in urban areas is decreasing the number of PLHIV in urban areas is expected to grow due to:
People living longer on treatment
New infections among vulnerable and key populations
Migration
Rapid expansion of urban slums and informal settlements, and
Vulnerability due to income and social inequalities

6. Rationale – why focus on cities
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Rationale – why focus on cities
Cities have concentrations of key populations at higher risk of HIV – sex workers, MSM, Transgender people and IDUs who bear disproportionately higher burden of HIV infection across all epidemic scenarios due to restrictive/punitive legal environment and stigma and discrimination
Cities present major opportunities for intensifying “urban responses” because they possess strong systems, resources, and technical capacity
Cities present an opportunity to reach a “significant portion” of the epidemic and ‘fast tracking’ cannot be achieved if cities do not intensify and scale up their responses.

7. Response - The African Cities and HIV Initiative
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Response - The African Cities and HIV Initiative
A Global Urban Health and Justice Initiative led by UNDP and UNFPA
Joint initiative of UN agencies, academic institutions and regional CSOs started in 2010 in Africa to:
Support development and implementation of comprehensive and innovative municipal HIV strategies, and
Support capacity development of municipal authorities and their partners to promote equitable, rights based HIV services for key populations

8. The African Cities and HIV Initiative - strategies
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
The African Cities and HIV Initiative - strategies
Support municipal authorities and their partners to:
Integrate HIV in local development plans - own the response, identify targets and establish accountability mechanisms.
Generate evidence and understand specific urban dynamics - produce evidence on size, prevalence, major drivers of the epidemic in cities (such as mobility, migration routes, urban poverty, informal settlement, etc)
Enhance participatory planning and implementation – municipal responses need to address the needs of the general population but pay particular attention to reaching KP groups
Advocate for increased resources – municipal responses need increased investment to cater for their residents as well as migrants and satellite communities.
Measure results – monitor progress, evaluate, and provide political leadership.

9. The African Cities and HIV Initiative – partner cities
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
The African Cities and HIV Initiative – partner cities

10. Analyses – how effective are city responses?
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Analyses – how effective are city responses?

11. The African Cities and HIV Initiative – results
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
The African Cities and HIV Initiative – results
Seven Municipalities (Kigali, Lusaka, Kitwe, Livingston, Ndola, Solwezi, Windhoek) developed comprehensive HIV plans
Five Municipalities (Lagos, Douala, Ouagadougou, Dar es Salam, Kampala) developed specific strategies for KPs
Two municipalities in the process of developing comprehensive municipal HIV strategies (Maputo and Katima Mulilo)
CS and KP groups capacity strengthened e.g. AMSHeR Utetezi project, Africa Key Population Experts Group, etc

12. Lessons – planning and implementation
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Lessons – planning and implementation
Role of municipalities in the HIV response not clearly defined
Few at-scale, targeted urban responses – despite efforts in many countries to decentralise the response and develop city HIV plans
Adequate data and analysis at city level not available even for big cities
Leadership/ownership of the HIV response by municipal leaders is limited
HIV remains a vertical programme in most cities
Resource allocation by municipal authorities is limited (even for coordination)

13. Lessons – key populations
1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Lessons – key populations
Majority of city strategies/plans recognize the necessity of focusing on KPs
Plans in general pay less attention to MSM than SW and
TGs and IDUs are to a large extent not included
City specific data on key populations is missing for most cities
Only one city (Kampala) conducted size estimation for KPs
Apart from cities having specific plan for KPs comprehensive municipal HIV plans do not make direct budget allocation for KP focused interventions
Interventions for KPs are not adequately monitored even in cities with specific strategies for KP groups

14. 1. Context - urbanization in Africa
2 HIV in African cities
3. . Why focus on cities?
4. The African cities and HIV initiative
5. How effective are city responses
6. Lesson
7. Going forward
Going forward
Ensure that the process of municipal HIV response planning and implementation:
Integrated in local development plans
Based on detailed analysis and adequate data including data on key populations
Includes clear operational plan with targets and indicators for all including KPs
Allocates resources for KP focused interventions
Promotes participation of all stakeholders including KPs

15. Thank You