October 2009 UNAIDS HIV prevention funding GFATM Rounds 5 and 6 HIV prevention activities in national funding requests to the GFATM.

October 2009UNAIDS

HIV prevention funding GFATM Rounds 5 and 6

HIV prevention activities in national funding requests to the

GFATM

October 2009UNAIDS


• Analysis of GFATM grants 5 and 6 HIV prevention component

• 26 countries Round 5• 32 countries Round 6 and one multi-country proposal in

West Africa• Three countries received grants in both Rounds 5 and 6:

China, Philippines & Peru

The analysis is not the total picture – it does not : include government and other donor & civil society

contributions show % of national response funded by GFATM grant

Analysis is based on funds requested - not on actual disbursements

October 2009UNAIDS


East Asia and Pacific: • Cambodia, China, Laos People’s Democratic Republic,

Mongolia, Philippines, Timor Leste, Viet Nam

Eastern Europe and Central Asia: • Albania, Bosnia & Herzegovina, Georgia, Moldova,

Montenegro, Romania, Russian Federation, Serbia, Tajikistan, Ukraine

Latin America and the Caribbean: • Cuba, Haiti, Paraguay, Peru, Suriname

South Asia: • Bangladesh, Bhutan, India, Maldives, Sri Lanka

October 2009UNAIDS


North Africa and the Middle East: • Djibouti, Egypt, Jordan, Mauritania, Morocco, Sudan, Tunisia

SUB SAHARAN AFRICAEast Africa: • Burundi, Eritrea, Rwanda, Zanzibar (United Republic of

Tanzania)West and Central Africa: • Benin, Burkina Faso, Cameroon, Congo (Republic of the),

Cote d’Ivoire, Ghana, Guinea, Liberia, Multi-country (West Africa Corridor Programme), Nigeria, Sao Tome & Principe, Senegal, Sierra Leone

Southern Africa:• Lesotho, Malawi, Mozambique, South Africa, Zimbabwe

October 2009UNAIDS

Methodological problems

Problems with • defining/classifying prevention – NASA, UNAIDSIn some proposals:• behaviour change communication (BCC)• condoms• services for sexually transmitted infections (STI), HIV Testing and

counselling/voluntary counselling and testing (VCT), post exposure prophylaxis (PEP) and the prevention of mother to child transmission of HIV (PMTCT)

• harm reduction services• safe blood and universal precautions• post exposure prophylaxis Some proposals include “structural prevention” activities such as,

advocacy, reduction of stigma and discrimination, partnerships and coordination, and capacity of civil society to be able to respond.

Some proposals multiple target groups & “shared” prevention and treatment activities - not possible to assign a budget to each component

October 2009UNAIDS


Methodological problems (2)

Some proposals refer to the setting in which the intervention takes place, e.g. Schools, community, the workplace or prisons, and the method used -through outreach or peer education.

Some proposals interventions are not specified, but are described in terms of the target group they are directed towards. China “Interventions targeting gaps in current prevention efforts for the most vulnerable female sex workers and their clients.”

In some cases two or more interventions are combined, such as “behaviour change communication and condom distribution”, “Youth friendly health services, life skill education and condom promotion” and “IEC/BCC, harm reduction and transmission prevention targeting high risk populations, PMTCT, STI, safe blood transfusion”.

• Target group – may not be specified• Risk & vulnerability ”special groups”

October 2009UNAIDS

Funds requested & disbursed

633,983,714

457,561,739

1,091,545,453

304,957,495

252,038,150

556,995,645

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

Requested Disbursed

Round 5 Round 6 TOTAL

October 2009UNAIDS

Interventions – East Asia & Pacific

4,209,663.95, 13%

4,139,476.60, 13%

24,646,400.56, 74%

Behavioural outcome Biomedical (Blood safety, UP, PEP)

Structural prevention/ enabling environment Research M&E

October 2009UNAIDS

Interventions - West & Central Africa

90%

5% 3%0%0% 2%

Behavioural outcome Biomedical (Blood safety, UP, PEP)

Structural prevention/ enabling environment Research M&E

Admin Human resources

October 2009UNAIDS

Interventions Latin America & the Caribbean – non medical

18%

12%

31%

22%

0%

17%

Communication & community mobilization VCT

Condoms STI

Harm reduction PMTCT

October 2009UNAIDS

Young people

Young people mentioned in 39 out of 59 proposals (66%)

MSM mentioned in only 10 proposals

In African sub-continent only Morocco & Zanzibar included MSM & IDUs

October 2009UNAIDS

Target groupCentral Eastern Europe & Commonwealth of Independent States

58%32%

2% 7% 1%

MARPs including interventions to more than one target group

MARPS plus other groups

Other target groups

Youth

Pregnant women

October 2009UNAIDS

Target group

33%

30%4%

17%

11% 1%0% 4%

MARPs (IDU, MSM, SW) MARPS plus other groups

General population & workers Pregnant women

Women Youth

Workers (workplace) Not specified

Latin America & Caribbean

October 2009UNAIDS

Target group

17%

3%

27%

1%

0%

52%

MARPs (IDU, MSM, SW) Other at-risk groups Young people

Teachers Religious leaders & monks Not specified

South Asia - 64% of interventions for young people in Bangladesh

October 2009UNAIDS

Case study

Commission on AIDS in Asia - over 95 per cent of all new HIV infections among young people occur among most at-risk adolescents/young people.

But their needs are not reflected in previous programme responses.

October 2009UNAIDS

Target group

36%

24%

32%

5% 3%

MARPs including interventions to more than one target group

MARPS plus other groups

Other target groups

Youth

Not specified

East Asia & Pacific

October 2009UNAIDS

Target groupMiddle East & North Africa

27%

5%

7%29%

3%

11%

18%

MARPs including interventions to more than one target group MARPS plus other groups

Vulnerable groups General population & IDPs

Pregnant women Youth

Not specified

October 2009UNAIDS

Southern Africa

17%

30%

14%6%

24%

3% 6%

General populationGeneral & vulnerable populationsPregnant womenPregnant women, youth, rual pop, TB & STI patientsWomen, youth, rural popYoung people & gen popNot specified

October 2009UNAIDS

West & Central Africa

30%

9%

1%18%

18%

1%

1%

4% 18%

SW and clients/partners/youth MARPS plus other groups Multiple target groups non MARPs

General population Pregnant women Youth in school

Youth out of school Youth plus Not specified

October 2009UNAIDS

Global level actions

1. Clearer definitions

2. Refined programme guidance

3. High level advocacy to create an enabling environment

October 2009UNAIDS

Clearer definitions

PreventionPrevention individual behaviour change (often only

knowledge not skills or behaviour)– targeted or notessential packages of prevention

Combination preventionStructural prevention - enabling protective environment

AgeYouth 15 -24Young people 10-24Children/adolescents 10 to 18/19

Most at-risk, high risk, vulnerable, specific, target groups

October 2009UNAIDS


• Refine guidance on programming based on epidemic scenario

October 2009UNAIDS

Evidence-based programming

Stage of the epidemic

Prevalence in affected groups

Programme Goals Most at-risk

Low < 5% Halt progress of the epidemic; keep it below 5% in these groups

IDU, SW, MSM PLHIV

Concentrated > 5%, but < 1% in pregnant women

Halt and reverse progress of epidemic to bring it to < 5% in these groups

All of the above plus Clients of SWs Migrant/ mobile population Uniformed services Prisoners Sexual partners of above

Generalised > 1% in pregnant women

Halt and reverse progress of epidemic to bring it to < 1%

All of the above plus General population Young people

Evidence-based programming

October 2009UNAIDS


• Provide guidance on legal, ethical and confidentiality issues as applied to most at-risk young people and in particular minors

• Revisit Optional protocol on CRC and develop guidance on social protection needs of MARA

• Report to UN Security Council on Res. 1308 – protective role of uniformed services

October 2009 UNAIDS HIV prevention funding GFATM Rounds 5 and 6 HIV prevention activities in national funding requests to the GFATM.

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