Hiv and sub-saharan africa pdf

A large number of people remain unaware of their HIV status and therefore fail to be adequately linked to care and treatment programs. Prevention benefits of treatment will require large numbers of men to be tested and initiated on treatment - men who are not typical users of health services and less likely to initiate treatment. Notwithstanding gaps in our efforts, the confluence of science and knowledge of the HIV epidemic marks one of the most optimistic moments in our response.

What we do collectively will define what impact we make on epidemic control even as we continue our quest for a vaccine and cure for eradicating and ending the HIV epidemic. The authors confirm that this article content has no conflict of interest. National Center for Biotechnology Information , U. Published online Apr 8. Ayesha B.

Quarraisha A. Author information Article notes Copyright and License information Disclaimer. This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4. This article has been cited by other articles in PMC. Abstract Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment.

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Van Damme L. Abdool Karim Q. Marrazzo J. Rees H. Abstract Number: 26LB. Thigpen M. Baeten J. Abstract Number: 22LB. Illustrative Indicators for tracking progress at the project level List of Documents Reviewed Terms of Reference This represents about one-third of AIDS deaths recorded globally that year.

One of the main objectives is to ensure that the sustain- ability of AFTTR roads projects is protected. This is not an impact study, but rather an attempt to determine the extent to which the mainstreaming effort reached targeted populations, the lessons learned, and the outlook for the future, using a more flexible methodology. ALCO was recognized as an international agency, now able to receive funds from other donors.

It not only provided a sub-regional platform for HIV care and prevention interventions, but also provided a platform for the five member countries to address other epidemics in the sub-region. Variations of the countries experiences could be consulted on the Web link in the references list. But MAP remains the major funding source fuelling the response in the transport sector.

One national AIDS coordinat- ing authority, with a broad based multi-sector mandate. One agreed AIDS country-level monitoring and evaluation system.

Typically, this involves different institutions: host minis- try, parastatal or government agency; contractor companies, implementing Non Governmental Or- ganizations NGOs and other partners. By , about 3. In addition, about 12 million children below age 17 in sub Saharan Africa are also estimated to have lost one or both parents to AIDS.

Every year about , persons infected with HIV travel along the Abidjan-Lagos transport corridor alone. Because they maintain concurrent sexual relationships, the truck drivers, sex workers, and men in the communities along major transportation routes remain bridge populations for the spread of the epidemic. Donor support was often channeled directly to the private sector especially non governmental organizations, whose capacities were built to intervene with the truck drivers and sex workers.

While capacities grew in the private sector, the public sector, represented by the ministries of transport, lagged behind in the response. Only Burkina Faso has used credit funds to directly procure and provide ARVs to project beneficiaries. This is not an impact study, but rather an attempt to determine the extent to which the mainstream- ing effort had gone, the lessons learned, and the outlook for the future, using a less-rigorous method- ology.

The KIIQ was sent to 22 focal persons, and 13 59percent responded with written responses. The instrument was designed and used to gain an insight into the program, rather than generate quantitative data. Follow-up interviews were either conducted or emails sent to seek clarification, obtain more information or to strengthen existing information. On the other hand, the desk review included a wide range of documents that varied in length and areas covered.

They include activity reports, pro- ject review reports, quarterly project implementation report, power point presentation, and briefing notes.

In all, 54 documents were reviewed. Limitations Project reports from countries were not up to date and most of the reports found contained very little information about the project activities. Also, inconsistency in data collection in the client countries and the inability of majority of key informants to answer some of the questions in the questionnaire made it impossible to undertake any form of comparative analysis or determine any trend.

To What Extent was Mainstreaming Achieved? This represents 61percent success for projects under supervision and 67percent when projects under lending are approved See Figure 2. Interventions are being implemented at the organizational level and at the external level, and the host ministry in client countries have, through the transport sector projects been empowered to take the leadership role in developing policies to guide sector-wide response.

During the awareness campaigns, the facilitator emphasized that knowledge is power. Seeking help is paramount. The facilitator explained the benefits of VCT and encouraged all participants that had not tested to seek VCT services. He emphasized that knowing ones status early enough is very important. Figure 2 a. As result, the program received wider recognition and was later adopted by the Ethiopian Parliament as its workplace strategy.

The degree of mainstreaming differs from country to country. While a country like Kenya is at the early stage of the mainstreaming exercise, Ethiopia is at an advanced stage, having succeeded in get- ting management and staff to own the process See Box 2.

Ethiopia was on the fore front of addressing the disease; it developed and finalized the workplace policies which served as a road map for Malawi, Zambia, Kenya, Lesotho, and Uganda. Malawi and Zambia are now implementing their workplace policies. Workplace policies have been developed, and peer educators trained in all the institutions to facilitate HIV-risk reduc- tion education, and promote referral to treatment and care services including VCT ser- vices.

For example, the NDAZ conducts sensitization sessions in bus stops, reaching their members and passengers. In addition, through the mainstreamed projects, AFTTR is helping to activate the response in the transport sector of client countries by starting the process that empowered ministries of transport to coordinate the develop- ment of sector policies and strategies.

Upon the prompting of the Bank team, stakeholders in the sec- tor, especially the Anglophone countries, have developed sector level policies and strategies that draw from, and compliment the national strategic framework. The draft policies further clarify the priori- ties in the transport sector.

Contributing to the uptake of HIV voluntary counseling and testing In the Zambia project for example, 43 percent members of the target population took the HIV test , surpassing the national level, 37 percent. Increased knowledge of their HIV status is a major step in empowering project beneficiaries to further prevent HIV infection or enroll in treatment at some point.

Although the road sub-sector railways company and the regional public trans- is the predominant mode of transport for portation of Dakar. As a result of the program, the majority of Africans; the other sub- other companies started implementing prevention sectors should not be neglected. The road programs and now, all transport sub-sectors have sub-sector, however, took the lead in get- been reached. Today, Zam- testing and toward infected people.

In some of the client countries such as Ethiopia and Zambia where baseline studies were commissioned at some point, de- lays in the completion of assessment reports by consultants denied the projects the benefit of allow- ing the findings to appropriately guide implementation. Sometimes the reports arrived almost after the completion of the first phase of the project.

In countries where situational assessment or baseline was not done, lack of funds was mostly responsible for not undertaking the activity. The projects were constrained by inconsistent reporting perhaps due to lack of clear reporting requirements and guidelines on re- porting.

Guidelines and indicators for mainstreaming are not clear, and there is no specific budget allocated for monitoring and evaluation at the project site level.

See appendix A for detailed table showing challenges and limitations. Francophone countries should take a stand and adhere to these policies as well. Client countries do not fully contribute to the cur- rent data flow system depicted in Appendix C.

Because of the limited time devoted to the project by focal persons, consultants and NGOs should be tasked with both implementation and quality assurance. Develop evidence-based programs A better understanding of the impact of AIDS on the transport sector, levels of risks and vulnerabili- ties of the mobile populations in the sector, and behaviors that predispose people in the transport sec- tor in the client countries is needed.

Sexual transmission is understood to be the major mode of HIV transmission, but what are the determinants of HIV sexual transmission in the transport sector? Also, it is important to ensure that this analysis is done with the national strategic framework as a frame of reference. Move away from awareness creation to behavior change Where there is evidence that awareness is high, projects should focus more on behavior change in- stead of committing huge resources to awareness creation.

In Uganda, Ethiopia, Senegal, Tanzania, and Zambia where baseline studies or situation assessments were done, HIV awareness was extremely high, above 80 percent; yet a significant part of the interventions focused on awareness programs for the workers.

Also, as the projects expand into care and support, those with peer educators may have to retrain them to acquire fresh skills in these areas.

This will facilitate referral linkages. There is also the need to build synergy with other development part- ners in order to maximize resources meant to serve beneficiary populations. They implemented the program with a team of workers, thus avoiding the situation where one person is overburdened by the management of the program. If this is not done, the sectoral teams and the national coordinating teams may not see themselves as pursuing a common goal. The national council should not just see the sector team as data collection center, but as an integral part of the multisectoral response.

A short assessment could be done to determine the two countries best positioned to host the centers of excellence. Also, the hubs should be responsible for facilitating regular information exchange among focal per- sons, study tours or teams from different countries. Exchange visits and the development of a com- puter-based list service are recommended.