HIV and AIDS Working Group

•Established in 2001 to prepare common positions for the UN General Assembly Special Session (UNGASS) on HIV and AIDS

•Current Strategic Plan 2013 – 2015 at http://www.dochas.ie/our-work/working-groups/hiv-and-aids-working-group

Objectives: 1) Knowledgeable partner to Irish Aid and other key stakeholders; 2) Learning and information exchange on effective interventions; 3) Advocacy for continued investment in the global HIV and AIDS response aiming for –

Zero new HIV infections. Zero discrimination.

Zero AIDS-related deaths

Representative speaker: Breda Gahan, Concern Worldwide

23rd April 2015

Love, Behavior, and Incentives in the Time of HIV and AIDS (And a postscript on responding to Ebola)

(WB Webinar Feb 2015) at http://www.worldbank.org/en/events/2015/02/03/love-behavior-and-incentives-in-the-time-

of-hiv-aids

When Fear can be a Killer…….http://reliefweb.int/report/liberia/ebola-and-lessons-hiv

HIV in the world – to end of 2014

• Since the beginning of the epidemic, more than 78 million people worldwide have been infected with HIV and more than 39 million people have died from AIDS.

• Today, more than 35 million people are living with HIV and AIDS globally - about half do not know their HIV status

(over 350 million people are directly affected)

HIV is the leading cause of death among women of reproductive age globally (UNAIDS WAD Factsheet 2014)

AIDS-related illnesses are the leading cause of death among adolescents aged 10–19 years in Africa.

• In Ireland 384 HIV infections newly diagnosed in 2014

+43 compared to end of 2013 (HSE - HPSC).

Ebola in West Africa– to April 2015

HIV & Ebola – comparing some facts to guide our responses

HIV and AIDS Ebola

1981 First cases 1976 First cases

HIV & Ebola – comparing some facts to guide our responses

HIV and AIDS Ebola

Implications of differences to guide our responses

• Pool of (asymptomatic) infectious people much larger for HIV

• Normally, HIV and AIDS more difficult to contain than Ebola

• But recent outbreak in West Africa more difficult to contain than earlier. First outbreak affecting large cities.

• And very fast and high mortality of Ebola creates fear, panic: “aversion” behavior

• Prevention for Ebola must target a broader set of behaviors: isolation and contact tracing play a more important role

• Tracing / tracking LFU of PLHIV important to reduce ARV resistance

• Safer sex always for risky behaviour to avoid HIV; abstinence or safer sex for 90 days for Ebola survivors to reduce transmission

Implications of differencesto guide our responses

Ebola is a major threat in Guinea, Liberia and Sierra Leone, but, at this stage, not elsewhere in the world

The particular vulnerability of health-care workers to Ebola -

• Health workers leaving their posts because they are the first exposed and not protected: mortality among health workers very high (Liberia 300 cases, 179 deaths among health staff)

• In some villages, health workers have been attacked

As of April 12th 2015 there had been 864 cases among medical staff in the three west African countries, and 503 deaths (Economist 2015).

Fear creates aversion behaviour (Mead Over CGD)

• Schools closure in Guinea, Liberia, Sierra Leone

• Rwandan immigrants refused access to school in New Jersey!

• Soccer Africa Cup of Nations moved from Morocco to Equatorial Guinea

• Travel restrictions, quarantines, no entry to some countries,

- To some extent similar issues at the beginning of HIV and AIDS

- Restrictions on US visas for HIV positive individuals until 2008.

Economic impacts: visitor arrivals to 3 countries much reduced

Unicef Catalogs Ebola's Terrifying Impact on Children

(Mar. 2015) http://allafrica.com/stories/201503180572.html

Impact of Ebola on West Africa

Region’s per capita income is expected

to fall by US$18.00 per year between

2015 and 2017.

Increase in food insecurity in affected

and in neighbouring countries

Increase in people living below national

poverty line

Jan. 2015, Socio-Economic Impacts of Ebola in Sierra Leone (WB)-declines in employment especially affecting youth;-decrease in utilization of health services for non-EVD conditions in Freetown and lower post-natal clinic visits

Ebola and Lessons from the HIV and AIDS Response

- Stamp out Stigma firstly: critical to reduce discrimination by advocating for favourable legal & policy environments for protection

- Impact mitigation interventions early on

- Policy engagement – ‘three ones’ for national leadership

- Internal organisational development – build staff /partner staff capacity to protect their health security

- Networking & Learning to share ‘best practice’-PLHIV / PLP Ebola leading the response and affected families– build Ebola / AIDS competent communities- Share local and global learning & vice versa (South ->North)

(North ->South)

What we have Learned

Dochas INGO joint responses to Ebola and HIV - Build trust / reduce fear / educate

- No complacency

- Lobby for sustained resources to

address funding shortfalls to pay staff

- Strengthen health systems so that

healthcare is accessible, available and

affordabel - equitable for all

- Psycho-social support is essential

- Incorporate a gendered response and

activities to reduce GBV via SBC

- Local leadership to lead local responses

Protect -> Prevent -> Test early and Diagnose -> Treat -> Rehabilitate

-> Reduce impact -> Sustain livelihoods -> Save Lives

15

RiskReduction

ImpactReduction

VulnerabilityReduction

Aim to reinforce strategies of Ebola & HIV risk, vulnerability and impact mitigation in all our poverty reduction and emergency response efforts

Source: UNAIDS, The Global Strategy Framework on HIV/AIDS (Reinforcing strategies of risk, vulnerability and impact reduction: The expanded response to the epidemic), 2001

2004 Report on the Global AIDS Epidemic (Fig 18)

In an effort to build resilience and deliver on planned Programme Results & Outcomes in all sectors

Remain optimistic

Liberia Ebola Doctor: 'We're going to win very soon‘ (Mar. 2015)

Education is the ‘best vaccine’ to stop the spread of Ebola

Thank you.