situation key partnerships in hiv & aids

Transcription

1 hiv and aids

2 situation Cambodia has made substantial progress in preventing and mitigating the impact of HIV and AIDS, receiving a prestigious award at the Millennium Development Goal summit in September This has been achieved through targeted prevention programmes that increase awareness of transmission and promote condom use, and the expansion of comprehensive care and treatment services throughout the country. As a result of this combined effort, fewer people from the general population are contracting HIV, with the country s 2010 prevalence rate estimated at 0.7 per cent among adults, compared with a high of around 2 per cent in 1997, according to government data. With a dramatic scale-up of care and treatment that started in 2003, Cambodia is now one of the first developing countries to have over 90 per cent of adults with advanced HIV infection already on antiretroviral therapy, up from 38 per cent in Despite the nation s success in controlling the HIV epidemic, more must be done to maintain the momentum in combating the spread of the virus. The maturing nature of the HIV epidemic left Cambodia with an estimated 75,131 adults living with HIV in Further, today, HIV has tightened its grip on the nation s most vulnerable and marginalized populations, which include more women, children and young people. Women now represent more than half of the people living with HIV 40,553 women compared to 34,578 men in Not only are women generally infected at a younger age than men, government estimates reveal that nearly half of all new infections are among married women. This has obvious consequences for children, not only due to the increased risk of infection through mother-to-child transmission, but also through the impact on children s lives because of the loss or chronic illness of their mothers. While it is loosely estimated that there are approximately 6,000 children living with HIV in Cambodia, 5,836 children (aged under 15) were reported to be receiving HIV-related care and treatment at public health facilities by the end of These trends reflect the underlying gender and cultural dynamics that drive the epidemic in Cambodia, where extra-marital sex is relatively acceptable for men, and women struggle to suggest condom use with their husbands. At the same time, a potential second wave of new infections among most-at-risk groups, including commercial sex workers and their clients, men who have sex with men, and injecting drug users threatens to undermine the nation s progress in controlling HIV and AIDS. Young people under the age of 24 within these sub-populations are among those most at risk. Compounding this situation further, the level of HIV and AIDS resources that Cambodia has enjoyed so far has begun to decline as a result of the worsening economic climate. The need for high impact, low cost HIV programmes in Cambodia is becoming more evident in the face of increasing financial resource constraints. Without harmonized and intensive efforts, the epidemic in Cambodia is showing strong potential for resurgence. key partnerships in HIV & AIDS UNICEF s contribution to the national HIV response is strategically situated within its health, nutrition and child protection programmes, which seek to integrally strengthen the health and social welfare systems. In these, UNICEF works closely with the government under the overall coordination of the National AIDS Authority. Our main government partners are: Ministry of Health Ministry of Social Affairs, Veterans and Youth Rehabilitation Ministry of Cult and Religion UNICEF contributes to national coordination efforts in HIV through its participation in the Joint Government-Donor Technical Working Group on HIV and the joint UN team on HIV and AIDS. UNICEF also collaborates with the World Health Organization, other UN agencies, the United States Centre for Disease Control and Prevention, the Clinton Foundation, and national and international development and civil society partners. Substantial assistance is provided to various technical working groups, including the Global Fund Principle Recipient Technical Review Team, to monitor national progress, recommend quality control measures to be put in place, and revise guidelines, protocols and training curricula.

3 Prevention among adolescents and young people The HIV epidemic breaches boundaries of gender, geography, race, religion and age to impact everyone and threaten families and communities. Risks multiply in urban settings, especially for Cambodia s young people and those in socially marginalized groups such as drug users, sex workers and men who have sex with men. A 2010 survey on most at risk young people carried out by the Government with UNICEF support, revealed that alcohol use was high among young people 70 per cent among young women and 91 per cent among young men and both female and male participants had used illicit drugs. While almost 14 per cent of sexually active females reported they had used drugs, only 0.4 per cent who had never had sex reported using drugs. Moreover, while more than 41 per cent of male and 23 per cent of female participants were sexually active, condom use with boyfriends or girlfriends was alarmingly low 31 per cent among females and 58 per cent among males. There are strong interactions between all risk behaviours with corresponding low use of health services and HIV prevention programmes. National targets by 2015: At least 90 per cent of sexually active young people aged used a condom when they last had sex. At least 60 per cent of young men and women (aged 15-24) correctly identify ways of preventing sexual transmission of HIV and reject major misconceptions about HIV transmission. Although the government has taken important steps forward in containing the spread of HIV, the national prevention programme is fragmented, and the overlapping risks and vulnerabilities affecting most at risk populations need to be urgently addressed. A potential resurgence of the epidemic among most-at-risk-populations, particularly involving adolescents and young people, is raising new concern. Evolving cultural norms add a new layer of danger for young people. Dating and premarital sex among the nation s youth have supplanted the traditional practice of arranged marriage. Lack of education and awareness regarding risks of HIV and other sexually transmitted diseases leaves many young couples to engage in unsafe sex. UNICEF supports the government in improving access to HIVrelated information and services for Cambodia s young people and conducting outreach to prevent the spread of HIV. What we do Advocate for and support improved age and sex disaggregation of national data on key populations at higher risk of HIV. Support the government and civil society organizations to expand coverage and quality of age-appropriate information, skills and services to most at risk young people. Support the expansion of targeted HIV communication efforts, including active promotion of information about PMTCT, voluntary, confidential counselling and testing sites and sexually transmitted infection facilities to promote positive health-seeking behaviours among those most at risk. Support the development of innovative interventions with most-at-risk young people, addressing overlapping risk behaviours such as drug use, low levels of condom use, multiple concurrent sex partners and low rates of STI treatment and HIV testing. With UN partners, advocate for a policy environment that enables pragmatic, integrated services for young people most at risk in urban hotspot areas. Support local non-government organizations to offer age appropriate harm reduction programmes for young people who use drugs through drop in centre and outreach services, and test programmes designed to reduce HIVrelated risks among women who use drugs, a traditionally neglected key population group. Utilize strategic information from the national most at risk young people survey carried out in 2009 to inform the development of Cambodia s HIV National Strategic Plan III ( ). Support national efforts to move from fragmented project approaches to a programme-based approach, including support to the proposed national prevention working group of government, civil society, UN and development partners. Impact More young people have correct knowledge of HIV and AIDS as a result of 12 new workplace committees established to provide HIV and AIDS education, reaching 5,114 young female workers through peer education by the end of An additional 82,423 workers were reached through general health promotion sessions. In tandem, the Inthanou (HIV and AIDS information) hotline has provided young people with ongoing HIV support and information, answering more than 60,000 calls per year with roughly 60 per cent of those calls from young people. Targeted prevention efforts with young people engaging in high-risk behaviours reached over 8,630 drug users, including 4,599 females, in the Phnom Penh area in Furthermore, HIV life skills education is now fully integrated into the government s Child-Friendly Schools programme, reaching 47,530 Grade 5 level young students in 521 primary schools in Prey Veng province. The approach was adopted as a model for the country under the leadership of the Ministry of Education, Youth and Sport and was rolled out to 13 other provinces with support from development partners.

4 Prevention of mother-to-child transmission of HIV Cambodian women are especially vulnerable to HIV, in part due to cultural norms that tolerate men who seek sex outside of marriage and return home to have unprotected sex with their wives. Although the country s epidemic remains largely male-driven, it is increasingly infecting more women and children, sparking new urgency in the need to reshape Cambodia s national response to the virus. Although HIV prevalence among adults is relatively low in Cambodia (estimated at 0.8 per cent in 2010), it is higher among pregnant women, at 1.1 per cent in Only 56 per cent of women and 34 per cent of men have comprehensive knowledge of mother-to-child transmission, according to the Cambodia Demographic and Health Survey 2010, revealing a critical gap in access to life-saving information. That lack of information increases the odds for mothers to inadvertently pass the HIV virus onto their babies. Limited access to and low quality of health services mean that many expecting mothers do not receive the support they need to break the chain of HIV transfer within families. By the end of 2010, only 49 per cent of the estimated number of HIV-infected pregnant women received antiretroviral prophylaxis/treatment to protect their babies from the virus. Prevention of mother-to-child transmission (PMTCT) initiatives combine HIV counselling and testing with antenatal care and education for pregnant women and their families, in addition to counselling on safe infant feeding practices and family planning. Timely referral for antiretroviral therapy also helps HIV-infected mothers cope with their illness and thrive, which in turn translates into better care for their babies. Without these interventions, 35 per cent of infants born to HIV-positive women will become infected with HIV each year, further impacting families. However, with appropriate services and care, this rate can fall to less than 5 per cent. Thus, in 2010, with support from UNICEF, the national PMTCT guidelines were updated to include the newly revised World Health Organization recommendations on Antiretroviral Therapy for HIV Infection in Infants and Children. As a result, highly effective interventions are being rolled out nationally to improve the health of mothers, substantially decrease mother-to-child transmission and improve HIV-free child survival. This represents a significant shift towards achieving the virtual elimination of HIV in children in Cambodia. Supporting the government and community based organizations to collaboratively provide parents with relevant knowledge, including knowledge of their HIV status, along with increasing their access to these highly effective interventions within the context of quality health and treatment services and psychosocial support, are central features of UNICEF s work in HIV and AIDS. National targets by 2015: At least 75 per cent of HIV-infected pregnant women receive antiretroviral prophylaxis/treatment to reduce the risk of mother-to-child transmission. The mother-to-child transmission rate is less than 5 per cent.

5 What we do With the National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Diseases and the National Maternal and Child Health Centre, scale up the provision of quality, comprehensive PMTCT services to reach pregnant women, their partners and infants, particularly among high risk groups. Support the government to expand provider-initiated testing and counselling for pregnant women and their male partners and strengthen linkages from prevention to care and treatment. Promote routine family-centred testing once a family member is identified as HIV-positive in an effort to promote early diagnosis and timely access to care. Support the government to expand labour ward testing to other Phnom Penh (higher prevalence) areas where large numbers of pregnant women with unknown HIV status exist. Provide ongoing technical support through site assessment and monitoring visits to ensure that quality PMTCT services are effectively integrated in maternal and child health services. Strengthen community awareness and understanding of PMTCT to increase demand for PMTCT services through targeted social mobilization and communication interventions with a focus on high risk groups. Work with the government to ensure all (known) HIVinfected pregnant women and their HIV-exposed infants receive antiretroviral treatment/prophylaxis, treatment for opportunistic infections, breastfeeding education, and follow up to reduce mother-to-child transmission of HIV. Test and scale up cost effective measures that help to reduce loss to follow-up and improve treatment adherence for both mothers and infants. Assist with the widespread application of the newly revised national PMTCT Guidelines through training, supervision and onthe-job support, and strengthening of data monitoring systems. Strengthen PMTCT programme planning, management, coordination, implementation and supervision at all levels in order to reach PMTCT targets by Impact Fewer babies are being infected with HIV through their mothers as a result of more pregnant women accessing PMTCT services before giving birth and more health facilities offering HIV testing and counselling. Across the country, 921 health facilities (92 per cent) offered HIV counselling and testing to pregnant women attending antenatal care in 2010 in comparison to only 30 in As a result 230,725 expecting mothers were tested for HIV in 2010 three times the number tested in 2008.

6 National targets by 2015: At least 15 per cent of individuals on antiretroviral therapy through the national programme are children and the proportion of people receiving antiretroviral therapy matches the gender and age group distribution of the epidemic in Cambodia. At least 95 per cent of children with advanced HIV infection are receiving antiretroviral therapy. Paediatric HIV care & treatment HIV is especially aggressive and harmful to children, leaving babies born with the virus to face an uphill battle at the earliest and most fragile stage of their lives. Lack of early treatment and care for HIV-affected infants damages their defence system, making them more prone to pneumonia, malnourishment and other childhood illnesses. Worldwide, an estimated 50 per cent of all infants who acquire HIV from their mothers die before their second birthday. In Cambodia, roughly 250 infants were born with HIV in 2010, according to government data. However, Cambodia s challenged public health system and fragmented HIV and AIDS response means that many HIV exposed babies (estimated at 2,000 per year) do not receive the care and treatment they need, reducing their quality of life and, in too many cases, resulting in death, whether HIV infected or not. Furthermore, by the end of 2009, it was estimated that only 68.2 per cent of children (3,638 children) with advanced HIV infection were receiving antiretroviral treatment in comparison to 95.8 per cent of adults. Although this increased to 4,102 children by the end of 2010, children are still lagging behind. Meanwhile, early infant diagnosis testing covers only 40 per cent of HIV exposed infants, with these tests often conducted too late averaging at five months of age, rather than the required six weeks after birth. Out of 100 infants who tested positive for HIV since 2007, only 33 were alive and on antiretroviral treatment by September 2009, according to a UNICEF-supported government study. Special attention also needs to be paid to assisting adolescents on treatment to transition safely to adulthood and adult care. UNICEF works with government health agencies to build a safe and supportive environment for HIV-infected children and adolescents that limits the virus heavy toll on their lives through access to antiretroviral therapy and improved health care. What we do Assist the government to adopt at scale the newly updated national paediatric antiretroviral therapy guidelines, which promote more effective antiretroviral regimens for children, in accordance with the new World Health Organization recommendations. This will be achieved through training, mentoring and supervision and on-the-job support, and the strengthening of data monitoring systems. Support the government to expand the coverage and quality of opportunistic treatment and antiretroviral therapy and other care for children with earlier initiation of treatment, including care for severely malnourished children and children living with HIV. This will be achieved by: Strengthening the national programme for screening and treating severely malnourished children, through establishing a better system for staff training and supervision and the refurbishment of paediatric care facilities. Developing, printing and disseminating educational materials for use by health care workers and caregivers at home and in health facilities. Maintaining support to the expansion of the Ministry of Health s Early Infant Diagnosis system and the early provision of antiretroviral therapy for confirmed HIV-infected infants. Intensifying efforts to improve the quality of care and adherence to treatment for children, especially infants and adolescents, which will help to address the increasing treatment failures and reduce the need for second line treatment. Impact More infants and children infected by HIV are receiving critical antiretroviral therapy and other relevant care and treatment to help them combat HIV-related disease and infection. By the end of 2010, paediatric HIV care was available at 32 public health facilities providing 4,102 children under the age of 15 with ART and 1,734 children with pre-art care. Sixty per cent of these facilities were supported by UNICEF. Moreover, a concerted effort to revive paediatric health care as a whole, through strengthened paediatric antiretroviral therapy services has led to the establishment of four new paediatric care sites in 2009 and 2010 with ward and outpatient facilities that focus on HIV-affected infants, but benefit all children with improved palliative, curative and severe malnourishment treatment services. Refresher training courses and on-the-job support for health care providers in early infant diagnosis and treatment and improved quality assurance measures have also ensured that an increasing number of HIV-affected babies receive proper medical attention and treatment as early as possible.

7 Protection & care of children affected by HIV and AIDS There are hundreds of thousands of orphans and vulnerable children are living in Cambodia, with up to 20,000 of them living or working on the streets of Phnom Penh. Some of these children are victims of forced labour and trafficking while others suffer from violence or abuse or are living with disabilities. Others an estimated 85,921 children are vulnerable due to HIV. In 2010, approximately 11,945 children lived in residential care the last stop for children whose families have been devastated by poverty or whose parents have died. National targets by 2015: At least 60 per cent of orphans and vulnerable children affected by HIV receive at least one type of free basic external support in caring for the child. For orphans and vulnerable children, HIV and AIDS can significantly change their lives. Almost 2 per cent of Cambodia s children have lost their parents to an AIDS-related illness or are living in an AIDS-affected household. Many more children are left in vulnerable situations due to HIV. Limited financial resources and even fewer social safety nets exist to support orphans and vulnerable children, including children affected by HIV and AIDS. Inadequate oversight at orphanages combined with an alternative care policy that lacks proper implementation has left many vulnerable children without proper care and with little hope to improve their lives. UNICEF works with the government to ensure these children have the necessary support to reverse the affects and impact of HIV and AIDS and to help children realize their rights to a safe, supportive environment in which to grow up. What we do Support the government to develop a routine monitoring and evaluation system to monitor, analyse and report on the scope and type of basic essential services delivered to orphans, children affected by HIV and AIDS and other vulnerable children. Work with the government and civil society, including Buddhist monks, to expand and support the provision of quality care and support to supplement the household s ability to care for vulnerable children. Promote access of vulnerable children and their caregivers to essential services, including social protection programmes. Assist the government to provide vulnerable children in need of alternative care, including children affected by HIV and AIDS, with access to safe, appropriate alternative care options. Support the government to improve coordination, linkages and referral among social, health, education and communitybased services at the local level, in line with local governance reform and the national social protection strategy. Impact National and provincial government and non-government partners with religious stakeholders implemented a largescale care and support programme for people living with HIV and their children. In 2010 alone, nearly 5,000 adults living with HIV and 3,358 children affected by HIV received spiritual, material and cash support from Buddhist monks in half of the nation s provinces. More communities are starting to take the initiative in caring for children impacted by HIV and AIDS, as 70 per cent of the nation s communes had at least one organization that provided HIV and AIDS-related care and support to families with orphans and vulnerable children.

8 UNICEF Cambodia P.O. Box 176, Phnom Penh Tel: +855 (0) All photos by: UNICEF Cambodia/Nicolas Axelrod Designed by Quinin Lab: