1. October 2005cvincewhitman@edc.org Education Development Centre, Inc. Response to Change - Changing the Response: Increasing Donor Involvement in the Spectrum from Prevention to Care for HIV and AIDS Cheryl Vince Whitman GEG Tenth Annual Meeting Kiev, Ukraine

2. October 2005cvincewhitman@edc.org Overview of Presentation I. Interdependence of health with all aspects of life II. Need for comprehensive approach to HIV and AIDS III. Major barrier of stigma and discrimination IV. Schools, community agencies, PLWA must do more V. Countless opportunities for donors

3. October 2005cvincewhitman@edc.org EFC Goals for HIV and Health  HIV and AIDS Donor Group  European Partnership for Global Health (EPGH)  European commitment to the Millennium Development Goals  MDG #6. “Halt and begin to reverse the spread of HIV and AIDS”.

4. October 2005cvincewhitman@edc.org Slow Pace Donor Participation  Perceive a fit with mission?  Stigma through association with HIV  Label HIV and AIDS as health problem  Are prevalence rates perceived as threat for Europe: Eastern Europe?

5. October 2005cvincewhitman@edc.org Do Donors Perceive HIV/AIDS a Problem?  Approximately 1.4 million people living with HIV/AIDS (Eastern Europe & Central Asia)  Fastest growing rate in world  Young people <30 at high risk (80% Eastern Europe compared to 30% Western Europe)  Fewer than 5% young people have access to services

6. October 2005cvincewhitman@edc.org Tipping Point 5 %:Not Hypothetical Construct  Eastern Europe1% and less  Botswana37%  South Africa.5 -1% (5 years) 1 - 20% ( 7 years )

7. October 2005cvincewhitman@edc.org I. Health Interdependent with –  Academic Performance  Family & Community Stability  Workforce Productivity  Economic Development

8. October 2005cvincewhitman@edc.org International Definitions and Movements WHO: health is not absence of disease but physical, mental and social well-being.  WHO Ottawa Charter 1986: Health is created and lived by people where they learn, work, play and love.  WHO Bangkok Charter 2005: a globalized world health requires strong political action, broad participation and sustained advocacy.

9. October 2005cvincewhitman@edc.org II. Need for Comprehensive Response  Causes HIV and AIDS rooted in all facets of society and institutions: families, schools, employers, government.  All sectors must be involved in a comprehensive response from prevention to voluntary counselling and testing to care and bereavement and children affected and infected.  Response needs more donors involved -education, public health, mental health and social services, law enforcement, (ICT) information and communications technologies and media and all civil society.

10. October 2005cvincewhitman@edc.org Figure I: Societal Factors Contributing to Rising Rates of HIV and AIDS Comprehensive Approach: ARV Intervention Services Voluntary Counselling &, Testing for HIV Counselling Prevention General Population

11. October 2005cvincewhitman@edc.org Risk Factors: Substance Abuse IndividualFamilySchoolCommunity Friends who use Early problem behaviours Hopelessness Genetic pre- disposition Poor social adjustment & coping skills Chaotic home Poor family relations Parents/family members who Use alcohol and drugs Abuse/neglect Academic failure Peer rejection Low degree of commitment to school Highly authoritarian; harsh punishments Availability substances Exposure to violence Lenient laws, no enforcement Neighborhood Deterioration Few recreational activities and jobs

12. October 2005cvincewhitman@edc.org Spectrum of Response Universal: Awareness and skill building Norms of Tolerance Selected: Early screening & intervention Indicated: Clean needles, Condoms VCT Treatment ARV Primary Prevention Secondary Intervention Treatment and Care

13. October 2005cvincewhitman@edc.org III. Stigma and Discrimination  First and foremost barrier  Stands in way of prevention  Negatively affects preventive behaviours, such as condom use, diagnosis, and treatment  Disenfranchising people fuels the epidemic

14. October 2005cvincewhitman@edc.org Most Effective Strategies to Combat Stigma and Discrimination  Review of 22 studies: Contact with PLWA along with information about transmission  Significant effects of educational sessions given by someone who has disclosed status compared to someone who has not  Greater involvement of PLWA has positive impact on policies and programmes

15. October 2005cvincewhitman@edc.org IV. Schools, community agencies, together with PWLA must do more. The education sector must play more of a leadership role  Population in Eastern Europe very young; school plays key role  Schools workplaces for thousands of staff  School success and completion are preventive  Schools can identify and refer youngsters at risk early on

16. October 2005cvincewhitman@edc.org … continued  Education leaders influential in setting tone  Schools transmit culture formally and informally: set norms for tolerance in classrooms, hallways  Provide accurate information and skill development  Serve as coordinating mechanisms with community and civil society  By policies, change dynamics of acceptance

17. October 2005cvincewhitman@edc.org Schools working with civil society

18. October 2005cvincewhitman@edc.org Policy Elements  Information about epidemic in country  Mechanisms for cooperation health sector  Emphasis on prevention, staff training  Confidentiality of PLWA  Universal precautions  Access to services  Code of ethics, tolerant, non-discriminatory

19. October 2005cvincewhitman@edc.org UN AIDS IATT –Education Sector Global Readiness Survey 2004 Survey Question YES NO Does the MoE have a HIV/AIDS workplace policy? 43% (in process) 57% Guidelines for universal precautions for all staff? 0%100% Confidentiality of Ministry employees affected by HIV/AIDS? 100%0% HIV/AIDS Education Policies in 7 Eastern European Countries

20. October 2005cvincewhitman@edc.org UN AIDS IATT –Education Sector Global Readiness Survey 2004 Survey Question Yes No Has research been commissioned? 57%43% Does the Edu. sector have a shared strategy: fight against AIDS? 0%100% Does the MoE have a specific HIV/AIDS policy? 28.5%71.5% HIV/AIDS Education Policies in 7 Eastern European Countries

21. October 2005cvincewhitman@edc.org Summary  Health and HIV affect all society  Intervention with high risk groups essential but not enough  Barrier: stigma and discrimination  Changing social norms essential to halt or stem rising rates  Comprehensive approach: prevention -intervention - care  Schools with communities and PWLA key role to play  Need for multi sectoral involvement and support from donors

22. October 2005cvincewhitman@edc.org Many Opportunities for Donors  Across sectors: education, public health, mental health, youth development and employment.  Research, tracking and monitoring.  Leadership development and capacity building.  Prevention – early intervention – testing – treatment – bereavement  Young people’s involvement action research, use of technology.

23. October 2005cvincewhitman@edc.org Impact of Connecting Young People to PLWA I wish to share this poem with all countries. AIDS is not a disease, although the virus has killed millions. AIDS is not a set of statistics, although the numbers are horrific. AIDS is not a conference in Durban. AIDS is not a presidential PR problem. AIDS is not advertisements and education programmes, although these help. AIDS is a feeling of hopelessness and despair. AIDS is young people who believe they’re immortal. AIDS is a secret known by everyone. AIDS is not knowing what’ll happen to your children when you’re gone. AIDS is people who are part of families. AIDS is everyday life carrying on against the odds. ---a student from iEARN--Ukraine

24. October 2005cvincewhitman@edc.org Contact Information Cheryl Vince Whitman Senior Vice President Education Development Centre, Inc. Director, Health and Human Development Programmes Affiliated EDC-Europe 55 Chapel Street, Newton, MA, U.S.A. 02458-1060 cvincewhitman@edc.org 617-618-2300 http://www.hhd.org http://www.edc.org