1. Ghana’s HIV Response The Ghana Team: Richard N. Amenyah Matilda Owusu-Ansah Evelyn Awittor Lord Dartey Mercy Bannerman

2. Background 1985 – National Advisory Council on AIDS (NACA) – National Technical Committee on AIDS (NTCA) 1986 -First AIDS Case diagnosed in Ghana 1987 – National AIDS/STD Control Programme (NACP) Sept 2000 – Ghana AIDS Commission

3. Goals of the National Response To achieve Universal Access, the goals of the National Response as outlined in the NSF II are: Reducing new infections among vulnerable groups and the general population; Mitigating the impact of the epidemic on the health and socio-economic systems as well as infected and affected persons; and Promoting healthy life-styles, especially in the area of sexual and reproductive health.

4. Thematic areas Within the framework of Universal Access to prevention, treatment, care and support by 2010, the NSF II is programmed around 7 thematic areas: – Policy, Advocacy and Enabling Environment – Coordination and Management of the Decentralized Response – Mitigating the Economic, Socio-cultural and Legal Impacts – Prevention and Behavioral Change Communication – Treatment, Care and Support – Research, Surveillance, Monitoring and Evaluation – Mobilization of Resources and Funding Arrangement

5. National HIV Prevalence Source: NACP-Ghana

7. Ghana’s gains – Strategic planning [NSF I –(2001-2005) and NSF II-(2006- 2010), JPR (2004, 2007), 5-POW, APOW] – Policy formulation (National HIV Policy-2004) – Decentralized implementation of the National response – Prevention programmes (Near Universal awareness) – Treatment and care and support (5 th year of ART) – Human rights issues (anti-stigma campaigns) – Monitoring and evaluation (M&E Plans for all Levels) – Increased participation of CSOs and GIPA (Partnership Forum, TWG etc) – Impact mitigation (OVCs, NHIS for PLHIVs, IGAs)

8. UNIVERSAL ACCESS: NATIONAL TARGETS FOR GHANA Programmatic area Indicator Data Sources Baseline (year) 20082010Data Collection Type Impact target National HIV prevalence among people aged 15-49GHS2.20% (2003)2.10%1.90% NACP Technical Report (HSS/GDHS/Programme Data) HIV prevalence among young people aged 15-24GHS1.9% (2005)1.4%1.0%HSS Prevention Impact target% of HIV-infected infants born to HIV infected mothersGHS30% (2004)22%15% [1] [1] Routine data collection system Process target# of centers providing PMTCT servicesGHS135 (2005)190238Routine reporting system Impact target % of people aged 15-49 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission GSS GHS F-38% M-44% (2003) F-46% M-54% F-50% M-60% GDHS(2008) BSS(2006) MICS(2006) Treatment Impact target % of women, men and children with advanced HIV infection who are receiving antiretroviral combination therapy GHS6.5% (2005)42%66%Routine reporting system Process target# of centers providing ART servicesGHS5 (2005)50138Routine reporting system Process target# of centers providing VCT servicesGHS145 (2005)190238Routine reporting system Process target # of clients tested for HIV at VCT sites and receiving their serostatus results in the past 12 months GHS42,206 (2005)200,000300,000Routine reporting system Impact target % of HIV positive pregnant women who receive a complete course of antiretroviral therapy to prevent mother to child transmission in the last 12 months. GHS0.45% (2005)24.8%47.6%Routine reporting system Process target# of centers providing PMTCT servicesGHS135 (2005)190238Routine reporting system Care and support Impact target Ratio of current school attendance among orphans to that among non-orphans, aged 10-14 GSS0.79 (2003)0.90.95 GDHS MICS National commitment Impact target Amount of national funds disbursed by government on HIV/AIDS MoFEP Cedi 97 billion (2003) TBD NASA [2] [2] [1] [1] Impact target: UNAIDS estimated 50% reduction of the proportion of infants infected with HIV. [2] [2] National AIDS Spending Assessment (NASA). Abbreviations: GHS –Ghana Health Service, GSS – Ghana Statistical Service, TBD- To be determined, MoFEP- Ministry of Finance and Economic Planning, MICS – Multiple Cluster Study, BSS-Behaviour Surveillance Survey, HSS-HIV Sentinel Survey, NACP- National AIDS Control Programme, GDHS-Ghana Demographic Health Survey

9. Key issues in HIV response Prevention – An increasing trend in HIV new infections – Slow rate of behavior change – Low risk perception – Low uptake of prevention services – High levels of stigma – Weak link between community and health services – Weak integration of HIV programs into sexual reproductive health programs – Low priority for workplace HIV prevention programs – Inadequate Operational research on prevention services

10. Treatment care and support – 16% of adults who need HAART are on therapy – 10% of HIV infected children <15 years in need of HAART are on HAART – 10% of HIV infected pregnant women have received antiretrovirals to reduce the risk of mother to child transmission (past 12 months) New combination ARV prophylaxis introduced – Weak Home Based care programs – Inadequate human resource to support services

11. Coordination/Management Weak Coordination of the multi-sectoral response Weak M & E particularly on Prevention activities