Transcript Mainstreaming HIV/AIDS

Mainstreaming HIV/AIDS
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
Cause and consequence…
• Cause
– Barnaul CSW
– Edinburgh IDU
– 2006/2007 Russia HIV increase and AfghanTajik border defense
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
Y=KaH(AL)1-a-
Impact of AIDS on GDP level
Sharp, 2005
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
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.
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
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?
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)
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
Mainstreaming
• Internal
– Organization/workplace
• External
– Serviced populations
What HIV/AIDS Mainstreaming is NOT
• It is NOT simply providing support for a Health
Ministry’s programme.
• It is NOT trying to take over specialist healthrelated 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
Mainstreaming in Russia
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Education
Defense
Transport
Church
Health care (all levels)
???
Economic Ministries
• Ministry of Economic Development and
Trade
• Ministry of Regional Development
• Ministry of Finance
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)
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
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)
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
Ministry of Finance
• Executive branch of the government
charged with ensuring unified financial,
budget and fiscal policy
• Government Decree 273 (06.03.1998)
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
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
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
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?
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
Urban development
• Construction and HIV risk
– What is done in Sochi?
• Regional policy (inclusion of HIV
indicators)
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
– >280 000 ???
Rospotrebnadzor, 2007
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
• And there are additional problems:
– Ageing population
• Increasing chronic diseases of old age (CHD,
dementias)
– Decreasing workforce population
• Decreasing health care staffing
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…
Mainstreaming steps
Develop shared goal &
commitment
Prepare HIV/AIDS
profile
Evaluate
Formulate activity plan
for mainstreaming
Implement planned
activities
Cost mainstreaming
activities
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
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