Development Approach To Hiv-aids

I N T E R A C T I O N

ISSUE

brief

May 30, 2006

A Development Approach to HIV/AIDS EXECUTIVE SUMMARY InterAction 1717 Mass. Ave, NW Suite 701 Washington, DC 20036 www.interaction.org Tel: 202.667.8227 Fax: 202.667.8236 Contact: Nasserie Carew [email protected]

Communities, organizations and governments have more resources and knowledge available to fight HIV/AIDS than ever before. HIV/AIDS impacts many aspects of people’s lives, not just their health. Illness and death due to HIV/AIDS have meant less food and less food security. Workers in all sectors – social services, education, entrepreneurs, businessmen, and transport workers – are impacted by illness and death in families and throughout communities. HIV/AIDS clearly influences the social, economic and political dimensions of people’s lives: any effective response to the HIV/AIDS pandemic must take this into account. Currently, the global community is moving toward the adoption of a set of principles and practices for preventative programs, clinical care, social support and ensuring universal access to HIV/AIDS medicines by 2010.

This approach has two key, interrelated elements. It involves a wider range of actors to promote local ownership and build sustainable local capacity to provide HIV/AIDS services and programs over the long term and addresses a wider range of needs to affect the realities of people’s lives, including but not limited to the need for health care.

Along with caring for the increasing number of people infected and affected, addressing HIV/AIDS as it affects people’s lives remains a critical challenge. HIV/ AIDS should be confronted with a multi-sectoral, interdisciplinary containment strategy that resists the impulse to respond with only a medical focus and shortterm quantitative measures of progress. We must address the myriad of factors and circumstances that impact this pandemic, especially those outside of the traditional treatment of a disease. In January 2003, President Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR) to quickly provide treatment options in resource-poor communities, and to scale up prevention, care and support efforts. To realize this vision, he laid out three broad goals to be reached by 2008, known as the 2-7-10 Goals: >> Two million people on treatment; InterAction is the largest alliance of U.S.-based international development and humanitarian nongovernmental organizations. With more than 160 members operating in every developing country, we work to overcome poverty, exclusion and suffering by advancing social justice and basic dignity for all.

>> Seven million new HIV infections averted; and >> Ten million people infected and affected by HIV/AIDS, including orphans and vulnerable children (OVC), receiving care and support in focus countries. To achieve these goals, the Bush Administration created the Office of the Global AIDS Coordinator (OGAC) within the U.S. State Department. OGAC has primary responsibility for the oversight and coordination of all resources and activities of the U.S. Government (USG) to combat the HIV/AIDS crisis overseas.

INTERACTION

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ISSUE BRIEF  A DEVELOPMENT APPROACH TO HIV/AIDS

A development approach to HIV/AIDS addresses human health within the broader context of other essentials of human life, including nutrition, psychological well-being, child development, education and economic livelihoods. It also strengthens local technical and managerial capacity to shape sustainable, community and national structures to ensure that the views of the affected and inflected are integral to the response and that the response is locally managed, supported and sustained. With 55 percent of PEPFAR funding required to be spent on treatment, the USG has focused on developing a facility-based model to put two million people into treatment by 2008. While a heavy emphasis on treatment is understandable and necessary, with five million new infections annually, alternative approaches are clearly necessary to break the cycle of transmission, chronic illness, death, orphans and deeper poverty. These approaches must build on a broader based response that includes interventions that proactively work to turn around this pandemic rather than simply react to the health problems caused by the disease. InterAction urges OGAC to develop a more comprehensive, holistic approach and to allow PEPFAR money to be used more flexibly and to support interventions that could assure a truly comprehensive “wrap-around” response to the pandemic. For ease of understanding, we call this a “development approach” to HIV/AIDS. A development approach builds on many successful efforts already initiated through PEPFAR. The Assistance to Orphans and Other Vulnerable Children in Developing Countries Act, signed in late 2005, authorizes OGAC to implement a development approach in its OVC programming, broadening the response to HIV/AIDS beyond health care measures. The legislation focuses on children and families infected and affected by HIV/AIDS, and proposes a multi-sectoral response, including support for nutrition, education, economic livelihoods and psychosocial well-being. InterAction looks forward to working with the newly-appointed OVC Coordinator to ensure that OVC issues are funded to the full extent of their allocation and are expanded to ensure access to treatment, care and support.

A development approach to HIV/AIDS addresses human health within the broader context of other essentials of human life, including nutrition, psychological well-being, child development, education and economic livelihoods. It also strengthens local technical and managerial capacity to shape sustainable, community and national structures to ensure that the views of the affected and inflected are integral to the response and that the response is locally managed, supported and sustained. This approach has two key, inter-related elements: 1. Involve a wider range of actors to promote local ownership and build sustainable local capacity to provide HIV/AIDS services and programs over the long term. 2. Address a wider range of needs to affect the realities of people’s lives, including but not limited to the need for health care. One of the challenges for HIV/AIDS response is the need to strengthen capacity of people, organizations and government bodies fighting HIV/AIDS on the ground. InterAction welcomes OGAC’s recognition of the need to build local capacity that is represented in the New Partners Initiative (NPI). InterAction believes, however, there is still a need for strong intermediary organizations with long-standing experience working in partnership with local organizations. We support reaching small local organizations but believe that for these organizations to be successful, they need experience with USG funding mechanisms and the capacity to design, implement, monitor and report on funded programs. The extensive experience of U.S. NGOs working at the grassroots with local organizations to implement programs can assure both effective programs and capacity-building, while meeting all USG accountability requirements.

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RECOMMENDATIONS

The following measures would improve the return on USG HIV/AIDS investments. InterAction is hopeful that OGAC will engage actively with U.S. NGOs, particularly at the planning stage for a follow-on program to PEPFAR, given their knowledge gained through decades of on-the-ground development experience. Use a development approach to HIV/AIDS.

Support community organizations. 1. Provide support directly to national and local government officials to facilitate community development of structures and strategies to address HIV/AIDS. 2. Require and resource communities to identify vulnerable groups and adopt specific strategies for including such groups in activity definition and management.

1. Incorporate a development approach to prevention, treatment, care and support into strategic planning processes, program design, and indicators.

3. Provide PEPFAR funding to strengthen local community organizations and structures – both for management and HIV/AIDS-related technical capacity.

2. Use indicators that measure program impact, as well as the existing input and output indicators, to assess the long-term effects of USG HIV/AIDS programming in the country.

PEPFAR is a major success in several aspects of the global fight against HIV/AIDS. The next challenge is to ensure that OGAC takes an effective, long-term approach in its prevention, treatment, care and mitigation activities. A development approach can help ensure greater effectiveness of the USG program by ensuring that OGAC reaches its 2-7-10 treatment, prevention, and care goals while supporting the full spectrum of people’s HIV/ AIDS-related needs in areas such as the education, agriculture, nutrition and legal services. Taking this approach will magnify the excellent work that OGAC has completed to date.

3. Provide multi-year funding to ensure programming stability and stronger working relationships with community and government leaders. 4. Provide clearer guidance on how to use PEPFAR funding for more flexible and appropriate “wraparound” interventions. 5. Recognize that ending the HIV/AIDS pandemic will require a long-term commitment and commence planning with key stakeholder groups to ensure continuity of funding and programming beyond the current scheduled end of PEPFAR. Reinforce national, local and community government capacity. 1. Work with national structures on project design, oversight, implementation, financial management and identifying ways to better coordinate national response and overcome resource constraints. 2. Work with international bodies that are supporting multi-sector responses (e.g., the World Bank and UNAIDS) to assure greater engagement of national nonhealth actors, including ministries, in forming working relationships with local and community structures, civil society organizations and the private sector. 3. Support management and leadership training for district and provincial leaders.

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