Mainstreaming HIV into CIDA’s Ethiopia Programme: A Toolkit

- Workshop -Paul Sunga and Marian Casey

June 2, 2004

Addis Ababa

Objective of WorkshopGoal:

To enable a coherent response to the HIV epidemic in Ethiopia

Purpose: 1.Launch HIV Mainstreaming Toolkit

2. Facilitate the mainstreaming of HIV components into democracy and governance sector programmes

Workshop Agenda9:009:00 Welcome - CIDA Country Director-– M-A FredetteWelcome - CIDA Country Director-– M-A Fredette Keynote – V.Min. of Justice -Ato Ali Sulaiman Keynote – V.Min. of Justice -Ato Ali Sulaiman 9:509:50 HIV situation analysis and projections HIV situation analysis and projections 10:1010:10 HIV and democracy and governanceHIV and democracy and governance10:3010:30 COFFEE BREAKCOFFEE BREAK11:0011:00 CIDA’s HIV Mainstreaming Toolkit CIDA’s HIV Mainstreaming Toolkit 11:1511:15 Group exercise 1– Knowing about taboos & stigmaGroup exercise 1– Knowing about taboos & stigma11:50 Group exercise 2 – Knowing about HIV impacts12:30 LUNCH1:30 Group exercise 3 – case studies2:10 Group exercise 4 – case studies2::50 Group exercise 5 - Assessing HIV vulnerability and HIV impacts in DG

programming4:45 Conclusions

Take the HIV Test1. What do the terms HIV and AIDS stand for?2. Name three ways that HIV can be transmitted?3. How can HIV transmission be prevented?4. How many Ethiopians are living with HIV? 5. What is the most common infection that kills HIV

infected people in Ethiopia?6. Which group has the highest number of infections ?

Male or female? Age- 15-24 / 20-49 / 30-497. What percentage of commercial sex workers are HIV

infected in Addis?8. What percentage of rural people are affected by HIV? 9. Name three ways that HIV is affecting development in

Ethiopia?10. Can people be cured of HIV?

Situation Analysis

• HIV epidemic in Ethiopia at a glance

• Forecasts and impacts

• Critical links between HIV and democracy/ governance

Key Features of the HIV Epidemic in Ethiopia

• ‘generalized’ epidemic at 6.6% nationally• transmission - mainly heterosexual and mother to

child• peak prevalence - women 15-24 yr• urban concentration of 13.7% ( is it plateauing?)• rural prevalence estimated at 3.7% based on weak

rural surveillance • 50% of hospital beds are AIDS patients• lack of country specific studies in rural areas

HIV Prevalence in Pregnant Women- Bahir Dar -

Ministry of Health

0

5

10

15

20

25

30

1992/93 1999 2001

HIV

Pre

vale

nce

Features of Response to the Epidemic

• emphasis on public health response

• responses are urban and in selected regions

• emerging surveillance data

• emerging sector-specific strategies

Forecasts and Impacts

HIV prevalence in adults in sub-Saharan Africa, 1986-2001

20 – 39%

10 – 20%

5 – 10%

1 – 5%

0 – 1%

trend data unavailable

outside region

1986 1991

1996 2001

Projected HIV positive population in EthiopiaMinistry of Health, 2002

0

0.5

1

1.5

2

2.5

3

3.5

HIV + (millions)

1984 1989 1994 1999 2004 2009 2014

Projected number of deaths from AIDSin Ethiopia

Ministry of Health, 2002

0

50

100

150

200

250

300

350

Deaths x 1000

1984 1989 1994 1999 2004 2009 2014

Projected Number of AIDS OrphansMinistry of Health, 2002

0

0.5

1

1.5

2

2.5

3

1984 1989 1994 1999 2004 2009 2014

Millions

Changes in life expectancy in selected African countries

with high and low HIV prevalence: 1950-2005

with high HIV prevalence:ZimbabweSouth AfricaBotswana

with low HIV prevalence:MadagascarSenegalMali

Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision

30

35

40

45

50

55

60

65

Lif

e e

xp

ecta

ncy (

years

)

1950– 1955

1955- 1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

Percentage of workforce lost to AIDS by 2005 and 2020 in selected African

countries

0

10

20

30

40

50

%

2005 2020

BotswanaCameroon

CAR

Côte d’IvoireEthiopia

Guinea-Bissau

MozambiqueNigeria

South Africa

TogoUR Tanzania

Zimbabwe

Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision01 July 2002 slide number SSA-17

Impact of HIV/AIDS on urban households, Côte

d’Ivoire

Impact of HIV/AIDS on urban households, Côte

d’IvoireGeneral populationGeneral population Families living with AIDSFamilies living with AIDS

Monthly income per capita

Monthly income per capita

Monthly consumptionper capita

Monthly consumptionper capita

00

5 0005 000

10 00010 000

15 00015 000

20 00020 000

25 00025 000

– 5 000– 5 000

30 000 Francs CFA30 000 Francs CFA

Savings/DisavingsSavings/Disavings

Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

Projected reduction in size of primary-school-age

population by 2010, in selected African countries

0

5

10

15

20

25

30

Zimbabwe Zambia

Kenya

Uganda

% r

ed

ucti

on

Source: World Bank, 2000

Number of reported rapes and convictions

in Botswana, 1984 to 1997

Source: Emang Basadi Women’s Association, Botswana, 1998

0

200

400

600

800

1000

1200

1400

1984 85 86 87 88 89 90 91 92 93 94 95 96 1997

reported rapes

convictions

Nu

mb

er

Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females

Deficits due to AIDS

Projected population structure in 2020

Population (thousands)

Ag

e in

yea

rs

Source: US Census Bureau, World Population Profile 2000

Interactions between HIV and Democracy/Governance

What is known…

HIV<--------------> D/G

Critical Links …

• Voice & accountability

• Political stability

• Social justice

• Rule of law

• Administration of public service

• Strengthening civil society

1. Voice & Accountability Factors Key Issues

• Participation• Transparency • Leadership• Gender Equity

• Consultation on HIV policy• Accessibility of HIV

information• Government leadership on

HIV• Gender specific strategies for

intervention

2. Political Stability Factors Key Issues

• Social Cohesion• Economic growth• National Security

• Socio-economic impact of epidemic

• Loss of key members of communities to HIV

• Loss of of family members• Loss of key government

officials and civil servants• Military vulnerability to HIV

3. Social JusticeFactors Key Issues

• Access to services• Equal representation• Legal literacy• Human rights

• Awareness of HIV/AIDS rights

• Human rights of women

• Human rights of HIV infected persons

• Entitlement to awareness of HIV/AIDS rights

4. Rule of LawFactors Key Issues

• Rights of the child• Property rights • Prisoners, etc.

• Child friendly detention and courts

• Juvenile friendly laws, courts etc.

• Rights of women to land

• Implementation of national laws

5. Administration of public services Factors Key Issues

• Effectiveness • Efficiency• Quality

• Regional differences in capacity to respond

• Diversion of public funds to respond to HIV epidemic

• Delivery of health services

• Transparent internal monitoring mechanisms

6. Strengthening Civil Society Factors Key Issues

• communication • transparency• participation of civil

society• community demand

for services

• information dissemination

• perceived role of civil society

• community awareness and mobilization

What is ‘HIV mainstreaming’?

HIV mainstreaming is the process of identifying and mitigating the effects of:

• Aspects of D/G on the vulnerability of Ethiopians to HIV

• the HIV epidemic on democracy and governance

Six Steps to HIV Mainstreaming in the DG Area

1. Knowing HIV and the epidemic2. Assessing the situation and the impact3. Planning to reduce or mitigate the impact4. Implementing the plan5. Monitoring 6. Evaluation of the effectiveness of

mainstreaming HIV

HIV Mainstreaming Toolkit

Features• 3 modules

– Module 1 is general and for everyone– Module 2 contains HIV mainstreaming tools

for food security programmes– Module 3 contains HIV mainstreaming tools

for democracy and governance programmes– The ‘tools’ are organized according to the Six

Steps.

You are the experts….

Proportion of young women who have heard of AIDS and have

at least one negative attitude towards people living with AIDS

Dominican Republic

Bosnia & Herzegovina

Note: Respondents were asked two hypothetical questions about men and women with HIV: (1) A teacher who looks healthy but is HIV- positive should be allowed to continue working and (2) Would they buy something from an HIV-positive shopkeeper.

0% 20% 40% 60% 80% 100%

NigerUkraine

PhilippinesSomaliaVietnam

Cote d'IvoireChad

Sierra LeoneGuinea Bissau

ComorosYugoslavia (FR)

AlbaniaMoldovaGambia

TajikistanAzerbaijan

Source: UNICEF (1999-2001) Multi-Indicator Cluster Surveys

Group exercise 1. Knowing about social taboos as barriers to

communication• Discuss your earliest sexual experience. • Why is it difficult to talk about this?• How do social taboos make the HIV epidemic

worse in rural Ethiopia?• How is taboo related to the stigma experienced by

people infected by HIV?• List three ways of reducing stigma, discrimination

and their impacts.

Group exercise 2: Knowing the impact of the HIV epidemic

• Discuss with your group one person you know who has HIV or AIDS, or who has died of AIDS?

• What were the impacts of that person’s illness? On family and friends? Workplace? Community? Other.

• Identify three things that might have been done to lessen the impact.

Mainstreaming Considerations• Consultation on HIV policies• Accessibility of HIV information• Government leadership on HIV• Gender specific strategies for intervention • Socio-economic impact of epidemic• Loss of key members of communities• Loss of of family members• Loss of key government officials and civil servants• Military vulnerability to HIV• Entitlement to awareness of HIV/AIDS rights

Mainstreaming Considerations• Vulnerability of women

• Discrimination against HIV +

• Regional disparities in response to the epidemic

• Diversion of public funds to respond to HIV epidemic

• Rate of spread of epidemic

• Lack of basic & essential health care for PLWHA

• Institutional and organizational capacity of key agencies and Ministries (MoJ, MoCB, Parliament, Auditor General, Prison & Police Administration, civil society, etc.)

Intervention points • HIV vulnerability analysis

• Gender analysis of policies & interventions

• Strengthening the health system

• HIV/AIDS Legal Framework

• Legal literacy

• HIV/AIDS code of ethics

• Application of HIV/AIDS in strategic initiatives

• Advocacy on political and civil leadership

• Protection of minority rights, e.g. prisoners

• HIV-adjusted national security plan

Institutional capacity (HIV competence)

Factors• discrimination against

HIV+ persons• unsupportive financial

and social response mechanisms

• weak HIV governance

Key issues • HIV stigma• level of HIV awareness and

understanding among leaders• level of local evidence re: HIV

impacts on development• Development of HIV strategy for

institutions/vulnerability assess...• Institutional code of ethics regarding

HIV positive employees, clients

Intervention pointsGovernance

• HIV vulnerability analysis

• Gender analysis of policies & interventions

• Strengthen the health system

• HIV/AIDS Legal Framework & legal literacy

• HIV/AIDS code of ethics

• Application of HIV/AIDS in strategic initiatives

• Advocacy on GoE leadership

• Protection of minority rights, e.g. prisoners

• HIV-adjusted national security plan

Group exercise 4: Case studies

• Discuss case studies found at the end of Module 3

Group exercise 5: Assessing an DG capacity development programme

through an HIV lensUsing the assessment tools, outline how you

would carry out an HIV assessment of the example provided of a DG capacity development programme.

Two example programmes or programme components will be provided.

NOTE that the assessment information is the basis for planning

Thanks for participating.

Facilitators:

Dr. Paul S.Sunga

Langara College

Vancouver, Canada

psunga@langara.bc.ca

Marian Casey

PSU/CIDA

Addis Ababa

humanitarian@psuaddis.org