1 Mobilizing Communities in the Middle East and North Africa to Respond to HIV/AIDS: Moving Forward Francisco S. Sy, MD, DrPH Editor AIDS Education and.

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Mobilizing Communities in the Middle East and North Africa to Respond

to HIV/AIDS:

Moving Forward

Francisco S. Sy, MD, DrPHEditor

AIDS Education and Prevention-An Interdisciplinary Journal

August 15, 2006 International AIDS Conference

Toronto, Canada

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OBJECTIVES

To discuss the principles, and concepts of community-based participatory research (CBPR) and its application in confronting HIV/AIDS

To identify the strategies and challenges in mobilizing communities in HIV/AIDS prevention and control

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HIV/AIDS in the Middle East & North Africa: The Costs of Inaction

“The risk of an increase in HIV/AIDS prevalence level in MENA/EM countries is real.Expected costs over the next 25 years could be considerable-on the order of 35% of current GDP even under conservative assumptions.Effective actions can be implemented to prevent the spread of the epidemic, and the costs of these actions would be more than compensated by the savings they generate.The time to act is today, when the prevalence levels are still low.”

Jenkins & Robalino, World Bank, 2003

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AIDS Epidemic Update: Middle East & North Africa

“HIV prevention programs and services remain sporadic in this region. Knowledge of AIDS is generally poor, and preventive practices are rare, even populations most at high risk of becoming infected.Substantive efforts are clearly needed to introduce more effective HIV prevention strategies in the Middle East and North Africa.” UNAIDS, December 2005

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25 Years of HIV/AIDS – U.S., 1981-2006

“Eliminating HIV/AIDS in the U.S. can not be achieved by any single agency or group, but will require public health partnerships comprising persons, communities, agencies, & the private sector.Strong partnerships are especially important to address stigma & discrimination and to promote greater acceptance of those living with HIV/AIDS.Religious & business communities…all need to be part of a national mobilization in the prevention of HIV transmission.Improved collaboration across government agencies is also required to provide a unified public health infrastructure dedicated to research, prevention, treatment, care & rehabilitative services for persons affected by HIV/AIDS.”

Fenton & Valdiserri, CDC, MMWR, June 2006

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Genetic & Biological Factors

PhysicalEnvironmental

FactorsMicrobe

Human

EcologicalFactors

Social,Political & EconomicFactors

Convergence Model For Emerging Diseases

Institute of Medicine, 2003

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“ The fight against AIDS will be won in the field, not in the laboratory.”

Francisco Sy

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Definition of CBPR

“ Collaborative approach to research that equitably involves all partners in the whole research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”

W.K. Kellogg Community Scholar’s Program, 2001

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Principles of CBPR

Recognizes community as a unit of identityBuilds on strengths and resources Facilitates partnership and capacity building in all research phases Emphasizes socio-ecological perspective of multiple determinantsDisseminates findings and knowledge to all Involves long-term process and commitmentSeeks balance between research and action

Israel, Schulz, Parker, 2003

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Research Control Community ControlCBPR

Challenge of Research/Community Relationships

Shared Research/

Community Control

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Future Direction of HIV/AIDS Epidemic Depends on: 7”C”

Strong leadership and political commitmentImplement and ensure access to comprehensive prevention and treatment programsincrease coordination of program activities and services at all levelsIncrease communication and collaboration with partners/stakeholdersInvest in and work with our communitiesProvide adequate resources and capacity building assistance Francisco Sy

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Social and Political Factors Influencing HIV Prevention

RacismPovertyHomophobiaCultureReligionGender inequalityStigma & discriminationSexual “code of silence”Misperception & myths Lack of access to treatment & careDisasters & wars

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Stages of Behavior Change

Providing informationMotivation and persuasion Teaching specific skills Increasing self-efficacy Maintaining changed behavior

Chesney & Coates

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Stages in Community Response to HIV/AIDS Epidemic

Denial

Struggle

Acceptance and Coping

Relapse

Franks

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Challenges For Communities

Community organizing Community empowermentCommunity planning Community developmentCommunity participation Community outreachCoalition buildingChanging community normsGenerating resourcesEnsuring continuity and sustainability

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Levels of Community Response to HIV/AIDS Epidemic

Bottom up vs. top downProactive vs. reactiveLong-term vs. short-term Skills-building vs. information-givingCultural competency vs. cultural sensitivityTargeted approach vs. general/non-specificAction-oriented vs. complacencyEmpowerment vs. dependency

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Elements of HIV Prevention Strategy

Develop an accurate surveillance system focused on new HIV infections

Allocate prevention resources to prevent as many new HIV infections as possible

Direct prevention services to HIV-infected persons, and integrate prevention activities into the clinical setting

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Elements of HIV Prevention Strategy

Translate the findings from prevention research into action at the community level

Invest in the development of new tools and technologies for HIV prevention

Strive to overcome social barriers and to remove policy barriers that impede HIV prevention

Institute of Medicine, 2001

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Bridging the Gap in HIV Prevention

“ The biggest gap of all is the gap between

what we know we can do today, and

what we are actually doing now.”

Peter Piot

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Global Mobilization for HIV Prevention

Substantially increase prevention fundingBuild capacity & expand proven prevention strategiesEncourage vocal political leadershipUse prevention resources more strategicallyExpand access to key prevention toolsAccelerate research into new prevention technologiesConfront social factors

Gates Foundation, 2002

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Lessons Learned from the Smallpox Eradication

Calculated Risks “The lesson is that we do not have the luxury of waiting

until we know everything before doing something. We are always called upon to make decisions with insufficient information and make corrections midcourse.”

Interdependence “It illustrates the value of working as global citizens rather

than as a collection of national programs. No country alone can prevent or control emerging infections.”

Knowledge “As organisms, the environment, people, and tools

change, programs must change. Appropriate response requires good epidemiologic analysis.”

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Lessons Learned from the Smallpox Eradication

Vision “With eradication, the vision is no more

cases. With emerging infections, the vision is rapid, appropriate, effective response, being prepared to protect the world because you are ready to act.”

Humility “We have trouble outthinking a virus. Even

smallpox humbled us until the very end. The emergence and reemergence of infections must be approached with humility.”

Optimism “Large problems should be approached with

optimism.” William H. Foege

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7 “P” in HIV/AIDS Interventions

Population – need for culturally competent providers & programsPolitical will –strong leadership at all levelsPartnerships – with all stakeholders Prevention – more focus on disease prevention & health promotionPolicy interventions – focus on increasing access to care & utilization of servicesProtection – against discrimination, racism, human rights violation etc.Participation – apply the principles of parity, inclusion and representation and increase community participation in all phases of disease intervention

Francisco Sy

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“The history of response to HIV has demonstrated that we can bring the best of traditional public health together with new societal insights and understanding.This brings us to the threshold of empowerment…to believe that the world can change…this step is at the heart of personal, and ultimately social transformation…Only we can empower ourselves.

Jonathan Mann, 1996

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“Despite the burden of death and illness, we bear together a message of hope and confidence:Confidence in our ability to continue learning and understanding;Confidence in our belief about the value of human rights and human dignity;These give us hope and confidence in our world, in each other, and ultimately, in ourselves.” Jonathan Mann, 1996

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“You must be the change you want to see in the

world.” — Mahatma Gandhi

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