Mainstreaming HIV/AIDS

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Mainstreaming HIV/AIDS
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25 years of AIDS

• It is not purely medical problem
• Few are
• 1993 WB report
• AIDS as a cause and consequence of poor/ arrested
  development
• HIV infection impacts larger society, not only
  those who is ill
• Poverty and inequality are driving forces of the
  epidemics

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Cause and consequence

• Cause
• Barnaul CSW
• Edinburgh IDU
• 2006/2007 Russia HIV increase and Afghan-Tajik
  border defense

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Effect

• Household effect
• Single parent household
• Back to cause What can HIV infected young widow
  with a child do to sustain her?
• Orphaned children
• Medical/funeral expenses
• Economy effect
• Loss of labor force
• Loss of human capital (with decreased
  transmission of human capital)
• Decrease in savings rate

YKaH?(AL)1-a-?
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Impact of AIDS on GDP level
Sharp, 2005
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If such broad effect/determinants

• Need to address all personal/social determinants
  and consequences of the epidemics precisely
  where they exist (SWAp)
• Risk-Vulnerability-Impact

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Risk-Vulnerability-Impact

• Risk is determined by individual behaviour and
  situations such as having multiple sexual
  partners, having unprotected sex, sharing needles
  when injecting drugs or being under the influence
  of alcohol when having sex or having an untreated
  sexually transmitted infection.
• Vulnerability stands for an individual's or
  community's inability to control their risk of
  infection due to factors that are beyond the
  individual's control. Such factors could be
  poverty, illiteracy, gender, living in a rural
  area, being a refugee, etc.
• Impact is about the long-term changes that
  HIV/AIDS causes at an individual, a community or
  a society level. HIV/AIDS not only impacts on the
  physical and mental health of individuals and
  populations, but a full blown epidemic also
  changes socio-cultural structures and traditions
  and impacts on economies and many different
  sectors.

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All sectors determine

• how they may contribute to the spread of HIV
• how the epidemic is likely to affect their
  sector's goals, objectives and programmes
• where their sector has a comparative advantage to
  respond to and limit the spread of HIV and to
  mitigate the impact of the epidemic

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Three key questions

• How does HIV/AIDS affects organization and its
  work?
• How to do no harm?
• How can organization contribute to fighting
  HIV/AIDS by limiting the spread and mitigating
  the impact of epidemics?

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Definition

• Mainstreaming is a process that enables
  organsations to address the causes and effects of
  HIV/AIDS in an effective and sustained
  manner,both through their usual work and within
  their workplace
• (UNAIDS)

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Definition

• Mainstreaming HIV/AIDS can be defined as the
  process of analysing how HIV and AIDS impacts on
  all sectors now and in the future, both
  internally and externally, to determine how each
  sector should respond based on its comparative
  advantage.
• HIV/AIDS Mainstreaming Working Group

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Mainstreaming

• Internal
• Organization/workplace
• External
• Serviced populations

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What HIV/AIDS Mainstreaming is NOT

• It is NOT simply providing support for a Health
  Ministrys programme.
• It is NOT trying to take over specialist
  health-related functions.
• It is NOT changing core functions and
  responsibilities (instead it is viewing them from
  a different perspective and refocusing them).
• It is NOT business as usual some things must
  change.
• Smart, 2002

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Mainstreaming in Russia

• Education
• Defense
• Transport
• Church
• Health care (all levels)
• ???

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Economic Ministries

• Ministry of Economic Development and Trade
• Ministry of Regional Development
• Ministry of Finance

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Ministry of Economic Development and Trade

• Executive branch of the government charged with
  policy development regarding analysis and
  prognosis of social and economic development,
  enterprise development, economic development of
  regions, investments, emergency economic
  response, defense contracts, etc.
• Government Decree 443 (27.08.2007)

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Ministry of Economics and Trade

• Among other tasks is to
• Define economic effectiveness indicators for
  federal enterprises
• Develop methodology of preparedness (emergency
  economic response)
• Define custom duties
• Is charged with
• Monitoring of social and economical development
  of RF and its regions, and development of
  prognosis models

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Ministry of Regional Development

• Executive branch of the government charged with
  policy development regarding social and economic
  development, enterprise development or regions,
  division of authority, urban development and
  communal enterprises, national relation, etc.
• Government Decree 141 (19.03.2005)

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Ministry of Regional Development

• Among other tasks is to
• Develop regulations of urban development
• Prepare regional and territorial development
  plans
• Monitor social and economic development of
  regions and municipalities in Russian Federation

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Ministry of Finance

• Executive branch of the government charged with
  ensuring unified financial, budget and fiscal
  policy
• Government Decree 273 (06.03.1998)

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Ministry of Finance

• Among other tasks is to
• Concentrate financial resources on priority
  developmental targets
• Participate in development of prognostic models
  for Russian Federation social and economic
  development
• Develop price control measures
• Ensure financing of federal goal-directed
  programs
• Determine custom duties
• Ensure monetary stability

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Those ministries(mainstreaming entry points)

• Analyze situation and develop prognosis of social
  and economic development of Russian Federation
• Impact analysis
• Regulate custom duties
• ARV drugs
• Ensure monetary and macroeconomic stability
• Balance between private consumption, savings and
  taxes
• Regulate urban development and influence regional
  development policy
• Financial resources
• Financing treatment and care

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Impact

• Economical consequences of HIV/AIDS
• Not so simple
• for poor countries, there is a statistically
  significant negative relationship between AIDS
  mortality and economic growth, however this
  relationship reverses as nations growth
  wealthier. We hypothesize that the industry
  surrounding the AIDS epidemic is outweighing the
  negative impact from the depletion of growth
  enhancing resources.
• Edwards J., Al-Hmoud R. Aids Mortality and
  Economic Growth A Cross-Country Analysis Using
  Income-Stratified Data, 2002
• One cannot endlessly lament the scourge of high
  population growth in the developing world and
  then conclude that a reversal of such processes
  is an equal economic disaster. The AIDS epidemic
  is a humanitarian disaster of millenial
  proportions, one that cries for assistance. It
  is not, however, an economic disaster.
• A.Young. The Gift of the Dying The Tragedy of
  AIDS and the Welfare of Future African
  Generations, 2004

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Custom duties

• Custom duties on medicines
• But also (MEDT)
• Russian accession to WTO
• 6-year period of data closure for generic drugs
• What is better produce or purchase?

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Macroeconomic stability

• Flow of money to social sector as inflation
  danger
• Are higher spending of HIV/AIDS healthy for the
  economy?
• Dutch disease in developing countries due to
  international aids and some lessons for Russia

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Urban development

• Construction and HIV risk
• What is done in Sochi?
• Regional policy (inclusion of HIV indicators)

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Financial resources

• ARV treatment, 2006, persons
• Received 14 433 (71)
• Needed 20 270
• ARV treatment, 2007, persons
• National projects 20 905
• Global Fund 8 545
• ARV treatment, 2012
• gt280 000 ???
• Rospotrebnadzor, 2007

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Financial resources

• 2007
• Federal goal-directed program 350.2
• National project 7800
• Regional budgets 710
• Extra budgetary sources 21
• International loans 1334
• Totally 10267.11

• 2011
• Federal goal-directed program 1787.7
• Regional budgets 894.5
• Extra budgetary sources 41
• Totally 2723.2

mln. RUR, TPAA, 2006
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• And there are additional problems
• Ageing population
• Increasing chronic diseases of old age (CHD,
  dementias)
• Decreasing workforce population
• Decreasing health care staffing

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Consequently, need for mainstreaming

• To ensure macroeconomic stability state should
  prepare to function in case of rapidly shrinking
  workforce, increased demand for health care and
  welfare benefits, higher labor cost, higher
  demand for ARV treatment, etc.
• Road forward

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Mainstreaming steps
Develop shared goal commitment
Prepare HIV/AIDS profile
Evaluate
Formulate activity plan for mainstreaming
Implement planned activities
Cost mainstreaming activities
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Strategies for Mainstreaming

• the use of research and impact/predictive
  studies,
• the use of HIV/AIDS focal points,
• the use of training,
• influencing strategies,
• building structures for enabling high-level
  support

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The road forward

• Training to ensure understanding of the problem
  (HIV/AIDS is a developmental NOT medical
  problem)
• Securing high-level support outside MoH
• Appointing focal points
• Proceed with mainstreaming