AGAINST HIVAIDS

1
AGAINST HIV/AIDS
 
 
 
 
 
 
 
A MULTICULTURAL CARIBBEAN UNITED AGAINST
HIV/AIDS
 
HIV/AIDS IN THE CARIBBEAN
FIGHTING BACK THROUGH MAINSTREAMING
Karl Theodore Health Economics Unit (HEU) The
University of the West Indies Trinidad and
Tobago Santo Domingo, March 5-7, 2004  
 
 
 



 
 
  Santo Domingo, March 5-7,2004
2
TWO MAIN QUESTIONS

• The first obviously is why fight back against
  HIV/AIDS? Is it worth it?
• The second question is why mainstreaming of the
  fight back?

3
Why Fight Back?

• First, the epidemiological experience of HIV/AIDS
  suggests that this epidemic has the potential to
  annihilate the Caribbean.
• Second, the economic calculations tell us that if
  the epidemic is not contained, by 2005 it will be
  destroying our national income base at the rate
  of around 5 per year.
• The race extinction vs economic annihilation

4
MAINSTREAMINGUNAIDS DEFINITION

• Mainstreaming is an essential approach for
  expanding multi-sectoral responses to HIV/AIDS.
  Mainstreaming of HIV/AIDS is not an intervention
  per se. It constitutes a range of practical
  strategies for scaling up responses and
  addressing the developmental impacts of HIV and
  AIDS globally and regionally.

5
UNAIDS DEFINITION(Contd)

• Through mainstreaming, government sectors, NGOs,
  private sector entities, church organizations,
  etc., can both meet the needs of their own
  workplace environment, as well as apply their
  comparative advantage to support specific aspects
  of national HIV/AIDS responses.

6
AFRICA MULTI-COUNTRY DEFINITION

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

7
UGANDA DEFINITION

• These (mainstreaming) plans should describe the
  comparative advantages and planned interventions
  of each ministry in the fight against HIV/AIDS,
  including the problem of orphans in Uganda.
  (Uganda AIDS Commission, 2002)

8
TANZANIA DEFINITION

• In Tanzania,the concept of mainstreaming HIV/AIDS
  in practice has meant developing a community-led
  rights-based approach,where the community is
  encouraged to take the lead in bringing about
  AIDS competence. By promoting the role of the
  community,HIV/AIDS becomes fully mainstreamed
  into sustainable and relevant development plans.

9
Mainstreaming A Working Definitionfor the
Caribbean

• In a nutshell, by mainstreaming we will mean
  locating the activities and services constituting
  the national and regional response to HIV/AIDS as
  far as possible within existing systems and
  structures, and funding the response
  substantially through normal channels.

10
Five principles for introduction and
implementation of HIV/AIDS mainstreaming. (UNAIDS)

• Clearly defined and focused entry point or theme
• National frame of reference
• Advocacy, sensitization and capacity building
• Distinction between two domainsinternal and
  external
• Developing strategic partnerships based upon
  comparative advantage, cost
• effectiveness and collaboration.

11
Modalities of Mainstreaming
The Caribbean Framework
Caribbean Regional Strategic Plan of Action on
HIV/AIDS, 2000 2004. This Plan of Action has
become the model and the inspiration for national
strategic HIV/AIDS Plans across the region. The
Pan Caribbean Partnership, PANCAP, is charged
with responsibility for making the regional plan
relevant to each country in the region .
Essentially the Plan of Action identifies a
number Priority Areas.
12
The Priority Areas are listed as a.     
advocacy, policy development and
legislation b.      support of people living with
HIV/AIDS c.       prevention of HIV
transmission, with a focus on youth d.     
prevention of HIV transmission among vulnerable
groups-         men who have sex with men
(MSM)         sex workers        
prisoners         uniformed populations
(military and police)         mobile
populations         workplace populations e.     
  prevention of mother to child transmission of
HIV, and orphan support and f.       
strengthening national and regional response
capability  
13
Alignment with the Mainstreaming Experience of
Africa? 
Based on the experience of countries on the
African continent five strategies have been
acknowledged 1)      the use of research and
impact/predictive studies 2)      the
use of HIV/AIDS focal points 3)      the use of
training 4)      influencing strategies,and
5)      building structures for enabling
high-level support  
14
COMPARING TWO APPROACHES
This list is interesting because we can
immediately align each of the items with at
least two of the Priority Areas of the regional
Plan of Action. In the case of the item not
explicitly covered by the Plan of Action the
establishment of HIV/AIDS focal points in all
stakeholder organizations it is possible to
interpret actions planned as Being covered under
the existing Priority Areas
15
MAINSTREAMING The Caribbean Plan and the
African Experience
16
Mainstreaming the financing implications

• In theory there are essentially four potential
  sources of financing the HIV/AIDS response
• a)      domestic fiscal revenues
• b)      domestic private incomes
• c)      external bilateral assistance and
• d)      external multilateral assistance.

17
FEASIBILITY OF REGIONAL RESPONSE

• National income year 2000 estimate of US 49.8
  billion for the combined national income of the
  countries of the wider Caribbean
• Estimate of the annual cost of mounting a
  full-scale response to the epidemic in the wider
  region is close to US 300 million.
• Less than one percent!

18
THREE CAVEATS

• The first is the extent of the income inequality
  across the region. A case for resource pooling.
• The second is the even greater income equality
  within countries.
• The third, given the obvious role of the public
  sector in a successful response to HIV/AIDS, is
  the near intractability of resource mobilization
  in many countries of the region.

19
RESOURCE MOBILIZATION FOR MAINSTREAMING

• Two resource mobilization suggestions
• Begin by treating HIV/AIDS financing as an
  opportunity to improve the fiscal system in each
  of our countries.
• Invoke crisis status of HIV/AIDS funding by
• imposing a fight-back, awareness tax
• Ring fencing HIV/AIDS budget

20
CONCLUDING REFLECTIONS

• Mainstreaming can have economic significance both
  in terms of impact and cost of response
• Caribbean response framework is ready for
  mainstreaming- but some resource pooling will be
  necessary
• Significant dependence on external funding of
  programs will not foster mainstreaming
• External funding - a way of buying time to put
  our house in order
• Main role of external support neutralizing
  hostile market environment