Summaries

Track E: Policy&Program Implementation

There has been a rapid increase in funding for HIV/AIDS in recent times even though the gap between needs and availability of resources is still evident. Countries are adopting a series of strategies primarily focused on increased coordination involving donors to systematise financial management and minimize multiple reporting requirements which have proven to be quite onerous and counter- productive for both donors and recipients. More effective management of funds and rationalisation of the impact of these resources require a coordinated approach in the systems of governance. It also involves private and public sector collaboration and greater engagement of civil society, NGOs and PLWAs in strategic planning for scaling up the response to HIV/AIDS.

Designing policies to improve access

Policies have a more positive impact on access to the extent that they focus on capacity building and training. Hence for example focusing on training for health care workers as an integral part of the increased access to ARVs would complement policies aimed at more equitable access to VCT especially when accompanied by changing attitudes of health workers to PLWA through greater understanding and appreciation of the nature and scope of the disease.

The biggest barrier however to increased access is the price of ARVs, beyond the means of many countries. In addition consideration should be given to a Global Treaty that creates a new framework for WTO HIV pharmaceutical patents for developing countries.

Striving toward more innovative public/private partnerships

Mutual respect is an essential ingredient for sustainable partnerships especially where provision is made for flexibility in the sourcing and utilization of diverse human, technical and financial resources. Sustainability is also enhanced when mechanisms are put in place for greater institutionalised and transparent roles in the partnership. In this regard face to face contact, written accords or agreements on goals and operational procedures help to set the tone and mission at the onset, thereby preventing unnecessary or irreconcilable disagreements in the future.

Creative innovative Partnerships

The crux of the success factor lies in community based approaches that include those targeted for the intervention.

Mobilising multiple partners including PLWA in reducing stigma and discrimination in the workplace

The need for policies to address HIV/AIDS and for strong leadership and participation of employers and employees in the prevention of HIV/AIDS in the workplace. Emphasis should be placed on the involvement of PLWAs in the training programmes would help to reduce stigma and discrimination. There is also a need to involve faith based organisation in these workplace programmes. In addition, the establishment of a solidarity fund should be used to provide access to those in need.


TUESDAY
13 July

The day's session brought the theme of "Access for All" into sharp focus, whether considering how to link communities to resources, evaluating the effect of policies on program impact, understanding the role of research in informing policy and program decisionmaking, or analyzing and mobilizing resources for treatment scale up.

BRIDGING THE GAP: A common theme was the need to bridge gaps -- between goals and outcomes, research and policy/program development, policy and implementation, and national and community levels. While making progress, the world has fallen short of international prevention, treatment, and care and support goals. As the sessions demonstrated today, however, tools, resources, and information are becoming increasingly available that can help stakeholders from across sectors bridge these gaps.

NEW OPPORTUNITIES, NEW CHALLENGES: The emergence of the Global Fund, the US President's Emergency Plan for AIDS Relief, and other initiatives have added to the resources available for prevention, treatment, and care. With these new resources comes a need to prioritize programs, develop strategies that are cost effective and that will have the greatest impact, and improve coordination among stakeholders and across funding sources.

REDUCING BARRIERS TO ACCESS: Barriers to access come in a variety of forms, including stigma and discrimination against PLHA and vulnerable groups; policy constraints (e.g., lack of treatment guidelines); and logistic issues (e.g., drug shortages, lack of training). While we need to continue to research these issues and improve our understanding of them, there are several examples of successful models and approaches. The time to act is now. Strong leadership and meaningful involvement, from across sectors, is needed to break the silence surrounding HIV/AIDS and develop the policies and systems to ensure access for all.

EXPANDING OUR VISION OF ACCESS TO TREATMENT: The need to increase access to ARVs is a key theme of the conference. Increasing access to ARVs, however, involves several steps, including ensuring consistent drug supplies, monitoring adherence and drug-resistance, strengthening infrastructure to support scale up, and providing related services (e.g., referrals, voluntary counseling and testing, primary health care), among others. To establish sustainable, scaled up ARV initiatives, strategic policies and programs must be developed that address a range of resource, human capacity, infrastructure, and social and logistic issues. Increased sharing among communities and countries must take place so we can build on lessons learned. Policymakers and program managers must also remember the importance of developing a continuum of care, as prevention efforts are most successful when treatment and care are available and, likewise, successful prevention efforts reduce the burden on treatment and care programs.

INVOLVING AFFECTED COMMUNITIES: The importance of involving communities affected by HIV/AIDS cannot be stressed enough. The needs of affected communities must be placed high on the national agenda. Meaningful, active involvement of these communities not only improves policies and programs, it also empowers vulnerable groups.


WEDNESDAY
14 July

The panels focused on human rights as an essential factor for successful policies in HIV/AIDS programmes, HIV testing and counseling in policy and implementation, policies and programmatic actions affecting inclusion/exclusion within HIV/AIDS responses, and the use of legal redress to create a supportive social and political environment.

Human rights a critical component of successful care an treatment programmes

Across the globe, VCT is respected as a critical cornerstone to the HIV response. More and more, rapid testing is being integrated within the “culture” of the HIV response, especially as it is utilized in such a way as to make VCT more accessible to people in need. The rapid evolution of VCT programs has overtaken the slower processes of VCT policy development. In order to ameliorate the key VCT-related fears of HIV status disclosure and related stigma and repercussions, VCT policies must urgently be developed and enforced. All presentations revealed a very high desire of individuals to know their own HIV status; however, they also suffer from a paralysis of fear of negative social action.

Toward a more comprehensive approach to Testing and Counseling

There is need to consider all the elements in VCT and not focus primarily on testing which has implications for human rights violations.At the same time emphasis must be placed on sustainable government interventions to reduce human rights abuses. Community involvement is needed in microbicide development as well as in legal and ethical issues, related to good clinical practice, regulations,and licensing. In many African states human rights violations are prevalent against sexual minority groups , laws are outdated and there is no prevention, care and treatment programme that reaches sexual minority groups.

Changing attidues toward recognising PLWA as Stakeholders

Many communities tend to treat the HIV/AIDS infected as a social burden for whom they are obliged to provide social support . There is need to convert these negative attitudes into postive attributes of tolerance and commpassion. Such coversion is only possible if and when PLWAs are accepted as stakeholders in the formulation and implementation of a scaled up response.

Scaling up advocacy into activism for change

By utilising a human rights framework and creating a movement for social change activism can be a powerful instrument for initiatives that are intent on accelerating access to ARVs and community mobiliztaion for action on HIV/AIDS

Striving toward greater inclusion

Participatory processes for responding to HIV have become the expected social norm in the AIDS response. The issue of moving from principle to practice requires support at the highest level and may even require finding the necessary endorsement in laws and regulations.


THURSDAY
15 July

The panels focused on assessing programme effectiveness , communities in action, resource mobilization and human capacity development and, the impact of policies and programmes on prevention, treatment and care..

Assessment of programme effectiveness

:National HIV/AIDS programmes need to include monitoring and evaluation in the design phase of projects and programmes. More accurate understanding of the course of the epidemic requires more stringent efforts to establish trends through sentinel sites, new ways of monitoring incidence, systematic tracking of high-risk groups for HIV infection, and monitoring scaled up project and programmes to track changes over time. Further evaluations of NGO activties would facilitate "learning by doing."

Communities in Action

Policy on human capacity development should promote learning from and with local communities and expanding and scaling up the good practices.

Addressing stigma and discrimination requires enlisting the tangible support of opinion leaders. Peer support groups for PLWHA can help address isolation and social exclusion of PLWHAs.

Building human capacity

Low level of human capacity (in qualitiy and quantity) is a major challenge to HIV/AIDS prevention and scaling up treatments. However with limited resources effective activities can be implemented at the community level. The key themes that emerged suggest that in settings where resources are scare, community based activities, if they are developed with the full participation of community actors and aimed at maximizing the potential and contribution of each actor, can be successful. Attempts must be made to increase the role of sectors such as education and culture in providing essential HIV/AIDS services and information

Treatment and care

It is very important to develop strategies aimed at creating dialogue and understanding between stakeholders in order to develop effective HIV/AIDS policies. This is a prerequisite for successfully creating political sustainability as well as program impact or community participation. Transparency of dialogue and process is also required.