UN Theme Group on HIVAIDS Zambia

1
UN Theme Group on HIV/AIDSZambia

• Review of 2004
• Meeting of UN Country Team with
• UN Secretary Generals Special Envoy on HIV/AIDS
• Mr. Stephen Lewis
• 25th January 2005

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Summary of presentation

• Country situation
• Joint UN action on HIV/AIDS
• Key results of
• Joint work plan
• Collaborative work plan
• Expanded Theme Group on HIV/AIDS
• UNCT Advocacy strategy on HIV/AIDS
• Accelerated action plan on women, girls and
  HIV/AIDS
• Support to 3 by 5
• OVC rapid appraisal analysis and action plan (OVC
  RAAAP)
• Challenges
• Way forward for 2005

3
HIV Prevalence rate16 Ages 15 to 49 DHS 2002
Male 13, Female 18 Urban 25
Rural 13
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ZAMBIA - situation

• Total population is 9,886,000 persons (revised
  Census 2000)
• National HIV prevalence rate of 16.5
• Number of adults currently infected with HIV
  775,080
• Total child population (below 18) 5,156,000
• 22,145 children infected with HIV per year
• Child mortality is high 1 out of 6 children die
  before the age of 5
• 53 of children
• 331,000 children (age 7-13) are not enrolled in
  school

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Gender

• Women major risk group
• HIV prevalence in women aged 15-24 11.2 as
  opposed to men in same age group 3
• HIV prevalence in girls 14-19 years 6x that in
  boys 14-19 years

HIV prevalence among young men and women aged
15-24 years in national population-based surveys,
Zambia and Zimbabwe, 2001-2002 Source HIV/AIDS
Epidemiological Surveillance Update for the WHO
African Region, WHO, Regional Officer for Africa.
Sept. 2003
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(No Transcript)
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Zambian National Response

• Cabinet Committee on HIV/AIDS
• National AIDS Council
• Provincial and District AIDS Task Forces
• National HIV/AIDS Intervention Strategic Plan
  2002-5
• National M E framework
• Joint Annual Review of NAISP May 2004
• Scaling up of all programme areas
• HIV/AIDS policy still to be adopted
• National Antiretroviral Therapy programme
  100,000 Zambians on ART by end 2005
• Increased financial resources multiple players

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Joint UN action on HIV/AIDS implementation
support plan

• Annual UN Work plan of the UN Theme Group on
  HIV/AIDS
• Reflects the contribution of the Joint Programme
  to the 3 Ones one Action Framework, One
  National AIDS authority and One ME system
• Consists of
• Activities of UNAIDS Cosponsors, other UN
  organizations and the UNAIDS secretariat
• Collaborative and joint activities
• Plans for 2005 include individual activities

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Key results of joint work plan activities - 2004

• Strengthened National AIDS Coordination at all
  levels
• HIV/AIDS policy adoption several meetings held
  
• 3 ones sensitisation done for donors and GRZ
• Support to the development of a national ME
  framework provided
• Support to the development of a national
  Communication strategy on HIV/AIDS provided
• Support to the NAC - financial technical
  resources
• Enhanced UN joint programming
• Common UN supported programming PAF 2004/5
  proposal to support the national ARV plan in
  process of being implemented
• UNCT advocacy strategy 2005-7 developed

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Key results 2004 (cont.)

• HIV/AIDS and gender mainstreamed
• Regional report launched by the Vice-President
• Supported the development of an accelerated
  action plan on women girls and HIV/AIDS in Zambia
• Gender In Development Division (GIDD) taken the
  national lead
• World AIDS Campaign events on same theme
  throughout the year

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Key result (contd)

• Financial technical resources mobilized in
  support of national responses
• Donor support database in process of being
  updated
• Development implementation of national ART
  scale-up plan supported by all UN agencies led by
  WHO, including a PAF proposal
• Development of GFATM proposal supported
• OVC rapid assessment appraisal and action plan
  supported

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Key results (cont.)

• UN learning strategy implemented
• Individual agency sessions
• UN learning strategy plan, UN HIV/AIDS policy
  PEP protocol disseminated to Human Resource and
  administration staff of all UN agencies at
  workshop in November 2004
• Learning plan for 2005 developed

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UN Collaborative programme (2003-5)

• 2004 activities included
• Mapping of UN HIV/AIDS activities (UNDP, UNFPA,
  IMF) in progress
• Document interlinkages between HIV/AIDS and food
  crisis (WFP, FAO, UNICEF, UNFPA) - completed
• Support to ME (UNAIDS, UNICEF, WORLD BANK) - in
  progress
• Workplace and HIV/AIDS in private sector (ILO,
  UNDP) in progress

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Expanded Theme Group on HIV/AIDS

• Convened 4 times in 2004
• Main agenda action plan on women, girls and
  HIV/AIDS NAC institutional capacity building
• Key result for 2005 support the formation of a
  government-led broad-based partnership forum
• Discussed with the Minister of Health, NAC
  Director General, UNTG and Expanded Theme Group

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UNCT Advocacy strategy on HIV/AIDS 2005-7
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UNCT Advocacy strategy 2005-7 principles

• HIV/AIDS in Zambia is a developmental crisis
  requiring an emergency response
• Poverty, especially amongst the most vulnerable
  populations and those living with HIV/AIDS must
  be addressed
• Respect and protection of the fulfillment of
  human rights together with compassion and active
  opposition to all forms of stigma and exclusion
  of PLWHAs must be retained
• To be effective requires improved information
  sharing aimed at collective action and a
  collective push fro results by the UNCT

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Advocacy strategy - objectives

• To strengthen the national efforts through the
  adoption of a national HIV/AIDS policy and a
  strengthened National AIDS Council by the end of
  2005
• To support the provision of adequate food and
  nutrition fro all people living with HIV/AIDS by
  end 2007
• To increase access to education and health care
  for OVCs in Zambia by 2007
• To improve access to prevention, care and
  treatment for all Zambians by end 2005

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Zambian Task Force on women, girls and HIV/AIDS
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Call to Action

• We must protect girls from the risk of HIV
  infection from older men
• We must take active measures to keep girls in
  school
• We must protect women and girls from the risk of
  exposure to HIV infection as a result of violence
• We must protect the rights of women and girls to
  own and inherit land
• Women and Girls as care-givers. We must have a
  volunteer charter
• We must remove the barriers that prevent women
  from gaining access to medical care and treatment

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Girls Education

• Objective
• To eliminate all gender disparities in primary
  and secondary education by 2005 and to give all
  school age children access to primary education
  by 2006.
•  Outcomes
• 1. Attainment of a 100 and 90 gross enrolment
  and completion rate of girls at upper basic level
  of education of education by 2006.
• 2. Schools made safer places for learning
  especially for girls

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Girls education

• Outputs
• Policy of free basic education in vulnerable
  communities.
• Expanded PAGE to 90 of all basic schools
• Schools develop and implement clear policies an
  guidelines for addressing child sex abuses,
  including by teachers
•  

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Girls educationoutputs

• Formalised life-skills education with emphasis on
  broad range of social competencies
• Extended life-skills education programme to cover
  out-of-school young men and women
• Estimated Cost 466,040 USD

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Budget

• Prevention.788,880.00
• Girls Education 466,040.00
• Violence . 75,000.00
• Property..1,430,860.00
• Women as carers452,080.00
• Care Treatment65,250.00
• Total------------3,278,110.00 USD

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3 by 5

• Status of ART Provisionin Zambia

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Status of ART Provision

• Public sector ART distribution took place in
  three phases
• Provision at the pilot sites at UTH and Ndola
  Central Hospital
• Provision at the remaining seven provincial
  centres and Kitwe Central Hospital
• Provision at district level
• Currently ART provision is in the 3rd phase, with
  inception of ART services in some districts
  (total 53 centres) including 8 clinics in the
  Lusaka DHMT, which provides free ARVs. This may
  explain why Lusaka DHMT has recorded a very steep
  increase in recruitment of clients.
• Phase III activities commenced earlier than
  planned in order to avoid the expiry of
  triomune-30 by August 2004.

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ART Centres in Zambia, Dec. 2004
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Zambia ARVs Jan Sept. 2004 by sex (Adult male
and female)
Lusaka 4 more ART Centres start
Lusaka 4 ART Centres start
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Zambia ARVs Jan Sept. 2004 by Sex (Children
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Major challenges 3 by 5 in Zambia

• Large number of people can not afford the K40,000
  monthly charge for ART
• Additional costs registration fee (K10,000, CD4
  Count (K20,000 K150,000), transportation costs,
  quarterly lab reviews
• No formal linkage between obvious entry points
  like home based care, TB STI clinics, out- and
  in-patients services, etc. and ART. Only 1 of
  home based care patients accessing ART
• Very little routine diagnostic testing done in
  hospital wards there has been an unfortunate
  confusion between mandatory and routine
  testing.

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Major challenges 3 by 5 in Zambia (2)

• No referral guidelines to link VCT to ART
• Inadequate information on ART services, benefits
  and adverse effects in the communities
  resulting in a lot of myths
• Very few institutions use non-laboratory
  personnel to do rapid HIV testing Clinicians
  still insist on using CD4 counts even when
  clients cannot afford and total lymphocyte counts
  are available
• Anecdotal information on MDR already in Lusaka.

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Key recommendations

• MoH/CBoH to ensure that there are no future
  stock-outs of ARVs
• Further reduction or abolition of the K40,000
  monthly levy
• Initiate community based counselling and testing
  services to link communities, especially home
  based care, to ART services
• Development of comprehensive ART referral
  guidelines for VCT centres
• Formalise routine diagnostic HIV testing in
  medical settings
• Develop comprehensive ART communication packages
  for communities.

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Vital Request for Support by MoH/Zambia

• Staff support in M E
• Advocacy by WHO and partners for lifting of
  employment freeze on health workers
• Assistance in recruiting and retaining health
  workers

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OVC Rapid Appraisal Analysis and Action planning
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OVC Rapid Appraisal Analysis Action Plan

• By 2010 an estimated 106 million children under
  15 years are projected to have lost one or both
  parents with 25 million of this group due to
  HIV/AIDS
• Children on the brink 2001
• UNAIDS UNICEF

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The worst is yet to comeEpidemic curves,
HIV/AIDS orphans
40
Millions
30
HIV Prevalence
20
10
0
Source UNAIDS/UNICEF, 2003, adapted from
Whiteside, A. and C. Sunter, 2000
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Main Findings

• Total number of orphans in Zambia 1,147,614
  (23)
• 1,328,000 OVC by 2010 - almost every third child
  in Zambia
• Grandparents now the largest group of OVC
  caregivers
• Proportion of orphans living in urban areas
  significantly higher than in rural areas
• Age group 10-14 years contains the highest number
  of orphans
• Paternal orphans than maternal orphans

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Main Findings

• Maternal orphans drop out of school more than
  paternal orphans
• Only 10 of children certificate (1.5 million children are not
  registered)
• Alarming increase of reported child sexual abuse
  cases
• Unmet need for care and psychosocial support for
  orphans
• Poorest households continue to care for largest
  proportion of orphans
• Households caring for orphans are slipping into
  poverty faster

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Opportunities

• Integration of CRC into new National Constitution
  under discussion by the Constitutional Review
  Committee
• National HIV/AIDS Council in place
• National Child Policy under review, draft
  National Plan of Action for OVC in place
• Numerous community level initiatives working
  in-country
• Two ministries (MSYCD, MCDSS) tasked with
  spearheading of OVC programming
• Data on OVC indicators now collected in all CSO
  surveys and data collection
• New PRSP due for Zambia in 2005 opportunity to
  build in strong focus on OVCs

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Way Forward - Action Plan

• Zambia needs to increase the level of political
  will and sense of urgency in dealing with orphans
• Empower National Steering Committee on OVC to
  undertake greater advocacy in Government and
  Parliament
• Ensure equitable access of OVC to quality
  education and health services
• Mobilize private sector involvement and FBOs in
  provision of schooling, health and other basic
  social services schemes
• National social safety net for OVCs falling
  through the cracks

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Way Forward - Action Plan

• Development and appropriate resource allocation
  for comprehensive social safety net
• Strengthen legal and policy environment
• Strengthen collaboration and coordination
  structures at all levels, particularly with NAC
• Improved HIV status awareness and enrolment in
  ART programmes
• Stronger OVC focus in Zambia HIPC, PRSP, Global
  Fund, World Bank Map, Presidential Emergency Fund
  

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Challenges and way forward
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Challenges for the UNCT

• Coordination NAC capacity
• Harmonisation of donor support
• Decentralisation, multisectoral scaling up of
  programmes
• Resource capacity gaps human financial
  resource
• Prevention, Care and Treatment
• Civil society involvement
• Poverty, household food insecurity

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Way forward for the UNTG 2005

• Implementation of the 3 ones
• Support to the 3 by 5
• Support to the prevention campaign
• Address implementation constraints
• Resource mobilization
• Support to the human capacity crisis
• Capacity of NGOs and civil society organizations
• Development of results based UN-ISP