1. Strengthening HIV/AIDS Programs Through Multisectoral Approaches Ishrat Z. Husain USAID/Bureau for Africa Office of Sustainable Development PHN Officers’ State of the Art Meeting June 10-15 Nairobi, Kenya

2. Overview n Progress since last SOTA n Looking ahead n Addressing constraints –Approaches –Funding –Organization

3. Progress Since Last SOTA n Agency Commitment – June 1, 2001 cable from the Administrator : “It is imperative that USAID staff in heavily affected countries consider HIV prevention programming in all sectors, not just as part of the Mission’s health programs. The design of activities in all sectors should take into account the impact of the HIV/AIDS pandemic on human and institutional capacity in the sector. In countries where there virus is not yet well established, Missions need to be cognizant of risk factors and should take the steps to prevent the spread of the disease.”

4. Country-level Progress n 15 USAID Missions have more than one sector involved in HIV/AIDS. Effective practices include: –South Africa - Economic Growth –Zambia - Organization and Coordination –Tanzania - Policy Dialogue and donor coordination –Guinea and Madagascar - Multisectoral Program in Low Prevalence Settings –Zimbabwe – Economic issues

5. Country-level Progress Cont. n All high prevalence countries have adopted multi-sectoral national HIV/AIDS programs n Even a few low prevalence countries are doing the same n World Bank Map Project provides $1billion with emphasis on multi- sectoral approach

6. Sectoral Progress/AFR/SD n Education: –Addressing Systemic Issues; number of countries growing each day. –Mobile Task Team approach n Democracy and Governance- Two excellent toolkits –Grassroot- leveraged considerable amount of money including global fund –Implementing Policy Change- very useful n Economic Growth- AGOA Papers and follow- up

7. Looking Ahead n Stimulate champions in each sector to: –Mitigate impact on the sector –Adopt policies and programs to reduce risk –Contribute to care and support

8. Central Role Sectoral Mitigation

9. Inequalities in Income Distribution and HIV 45 50 55 Gini Index Adult HIV prevalence end 1999 South Africa Central African Republic Lesotho Zimbabwe Nigeria Zambia 10   60 The Gini index measures the extent to which the distribution of income among individuals or households within an economy deviates from perfect equal distribution. A Gini index of zero would represent perfect equality, 100 would imply perfect in equality. Source: World Development Report, 2000/2001

10. Care and Support

11. Prevention Economic Mitigation Continuum of HIV/AIDS Program Components Economic Mitigation Care and Support Prevention

12. Sectoral Strengthening n Requires: –Review of impact on core objectives –Review of policies for their impact on HIV/AIDS –Address systemic problems

13. Addressing Constraints n Cost and funding. –CSD Guidelines – more research on effectiveness –Each sector should spend their own resources –3 categories of expenditures: no investment e.g. policy dialogue and co-location of activities, small investments e.g. large investments n Establish a special multi-sectoral fund n Coordination Mechanism – National, Mission and Washington level n Concerted and Rapid Response Actions –DART Model and Rapid Response Teams