1. 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

2. Process leading to the Coalition and Road Map Launch

3. 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 October 2017

4. 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.

5. 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

6. 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

7. 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.

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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

14. 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)

15. 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.

16. 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.

17. THANK YOU