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Workshop:Workshop:HIV/AIDS interventions in emergency settingsHIV/AIDS interventions in emergency settings

and the IASC Guidelinesand the IASC Guidelines

FIRST EDITION

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Session 1Session 1

Workshop overviewWorkshop overview

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Workshop OverviewWorkshop Overview

Five sessions:

1.

4.

Context

Challenges

Practical Measures

Introduction to theIASC Guidelines

+

Brief presentation

Participatory activities and/or group discussion

Introduction

2.

3.

5.

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Workshop PurposeWorkshop Purpose

To discuss:To discuss:• the the broader context for HIV/AIDS in emergency for HIV/AIDS in emergency

settings.settings.• the key challenges related to HIV/AIDS programming related to HIV/AIDS programming

in emergency settings.in emergency settings.• different interventions for addressing HIV/AIDS in for addressing HIV/AIDS in

emergency settings in a multisectoral approach.emergency settings in a multisectoral approach.

To introduce:To introduce:• information provided in the information provided in the IASC Guidelines

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Workshop ObjectivesWorkshop Objectives By the end of this workshop you should be able to…

1. Explain the relationship between HIV/AIDS and emergencies

2. Strategically address the challenges related to HIV/AIDS programming in emergency settings

3. Apply a multisectoral approach to HIV/AIDS interventions

4. Use the IASC guidelines for HIV/AIDS interventions in emergency settings

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Session 2Session 2

Introducing the HIV/AIDS ContextIntroducing the HIV/AIDS Context

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DiscussionDiscussion

• In small groups, reflect on your individual experiences In small groups, reflect on your individual experiences in a past or current emergency.in a past or current emergency.

• Did/do you Did/do you consider HIV/AIDS to be important in in this emergency? this emergency? – If yes, why? If yes, why? – If no, why not?If no, why not?

• Which individuals or groups do/did you view as Which individuals or groups do/did you view as most vulnerable to HIV/AIDS? Why? Why?

Could there be others?Could there be others?

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Context for HIV/AIDS Interventions in Context for HIV/AIDS Interventions in Emergency SettingsEmergency Settings

Purpose:Purpose:

To discuss the To discuss the broader context for HIV/AIDS in for HIV/AIDS in emergency settings.emergency settings.

To discuss To discuss vulnerability to HIV/AIDS in emergencies. Who is vulnerable? Why?. Who is vulnerable? Why?

To discuss the link between To discuss the link between HIV and emergencies

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• World leadersWorld leaders commitment – 2015. commitment – 2015.

• HIV/AIDS integral to the achievement of the MDGs.HIV/AIDS integral to the achievement of the MDGs.

• Goal 6 states:Goal 6 states:

‘‘to halt and begin to reverse the spread of HIV/AIDS to halt and begin to reverse the spread of HIV/AIDS by 2015’.by 2015’.

• HIV/AIDS in all contexts, includingHIV/AIDS in all contexts, including emergencies.emergencies.

The Global Context: HIV/AIDS andThe Global Context: HIV/AIDS and the Milennium Development Goalsthe Milennium Development Goals

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Global estimates of HIV Global estimates of HIV and AIDS as of end 2004and AIDS as of end 2004

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Countries in Conflict (2003)Countries in Conflict (2003)

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Countries in Crisis (2003)Countries in Crisis (2003)

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• HIV/AIDS HIV/AIDS inin emergency emergency

• HIV/AIDS HIV/AIDS asas emergency emergency

• HIV/AIDS HIV/AIDS asas emergency emergency

inin emergency emergency

Haiti

Swaziland

southern Africa famine

HIV/AIDS & Emergencies:HIV/AIDS & Emergencies:3 perspectives3 perspectives

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HIV/AIDS, Emergencies and VulnerabilityHIV/AIDS, Emergencies and Vulnerability

Vulnerability is defined as the conditions determined by physical, social, economic, and environmental factors or processes, which increase the susceptibility of a community or group to the impact of hazards.

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HIV/AIDS, Emergencies and VulnerabilityHIV/AIDS, Emergencies and Vulnerability

• Vulnerability to HIV infection: : Emergencies Emergencies generategenerate situations situations ofof high high risk risk to HIV infectionto HIV infection

• Vulnerability to crisis: HIV/AIDS : HIV/AIDS undermines existing coping strategiesundermines existing coping strategies and and may reduce social stability and available may reduce social stability and available resourcesresources

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Who is vulnerable to HIV/AIDSWho is vulnerable to HIV/AIDSin emergencies?in emergencies?

• Everyone is vulnerable to HIV/AIDS

• Groups that are vulnerable:women, children, the poor, mobile women, children, the poor, mobile populations, injured people (blood populations, injured people (blood transfusions)transfusions)

• Other groups at risk of HIV infection include:The armed forces, police,The armed forces, police, humanitarian workers, truck drivers.humanitarian workers, truck drivers.

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Disruption of social norms and care capacity

Services cannot manage HIV/AIDS related

requirements

Assets and social safetynets deplete

Risk of HIV infection increases

How do emergencies increase How do emergencies increase HIV/AIDS related vulnerability?HIV/AIDS related vulnerability?

• Reduce social stability/ supportReduce social stability/ support

• Overwhelm or destroy essential Overwhelm or destroy essential public servicespublic services

• Reduce household and Reduce household and community resourcescommunity resources

• Increase personal insecurity and Increase personal insecurity and risk of sexual assault.risk of sexual assault.

How do emergencies increase How do emergencies increase HIV/AIDS related vulnerability?HIV/AIDS related vulnerability?

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Conflict-affected populations:Conflict-affected populations:How does HIV/AIDS contribute?How does HIV/AIDS contribute?

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Chronic livelihood insecurity.

Shocks such as drought or conflict tip situation

into acute emergency.

Acute crisis develops, with increased risks to lives and livelihoods.

HIV/AIDS undermines HIV/AIDS undermines livelihood security.livelihood security.

HIV/AIDS increases vulnerabilityHIV/AIDS increases vulnerabilityto shocks.to shocks.

HIV/AIDS-affected people/householdsHIV/AIDS-affected people/householdshave less capacity to respond and have less capacity to respond and sustain more severe losses/impacts.sustain more severe losses/impacts.

The trajectory of a crisis:The trajectory of a crisis:How does HIV/AIDS contribute?How does HIV/AIDS contribute?

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Summary PointsSummary Points

Reduction of HIV/AIDS is Reduction of HIV/AIDS is integral to MDGs in all in all contexts, including contexts, including emergency situationsemergency situations

The The relationship between HIV/AIDS and emergencies is very is very articulatedarticulated

In emergencies, In emergencies, everyone is potentially is potentially at-risk from at-risk from HIV/AIDS.HIV/AIDS.

High HIV infection rates High HIV infection rates increase vulnerabilityto external shocks such to external shocks such as drought or conflictas drought or conflict

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Session 3Session 3

Key Challenges to HIV/AIDS Key Challenges to HIV/AIDS Programming in EmergenciesProgramming in Emergencies

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Session 3Session 3The Challenges in Implementing HIV/AIDS The Challenges in Implementing HIV/AIDS

Interventions in Emergency SettingsInterventions in Emergency Settings

Purpose:Purpose:

• To identify specific To identify specific HIV/AIDS- related problems that that apply in different emergency scenarios.apply in different emergency scenarios.

• To discuss HIV/AIDS as a key issue To discuss HIV/AIDS as a key issue in the workplace for responding personnelfor responding personnel

• To discuss the To discuss the key challenges related to HIV/AIDS related to HIV/AIDS programming in emergency situations.programming in emergency situations.

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Group Activity Group Activity (45-(45-60 min60 min) What are the challenges in implementing HIV/AIDS What are the challenges in implementing HIV/AIDS interventions in different emergency situations?interventions in different emergency situations?

1. Read your group’s specific emergency scenario.

2. Drawing on your experiences, identify the likely HIV/AIDS-related challenges in this situation.

3. Write each challenge on a separate card.

4. Cluster together cards with similar problems, and stick the card-clusters on flip chart(s).

5. Stick chart(s) on wall for a gallery walk

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Addressing HIV/AIDS in emergency settings:Addressing HIV/AIDS in emergency settings:challenges and problemschallenges and problems

• Collapsed/inadequate health and public services.Collapsed/inadequate health and public services.

• Limited financial, social & economic resources.Limited financial, social & economic resources.

• Lack of information (on infection levels, trends, target Lack of information (on infection levels, trends, target populations, ...).populations, ...).

• Special situations of emergency-affected populations Special situations of emergency-affected populations (access, security, language, culture, stigma..)(access, security, language, culture, stigma..)

• Institutional and human resource constraints.Institutional and human resource constraints.

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Health and public services collapse Health and public services collapse or are inadequateor are inadequate

• HIV/AIDS HIV/AIDS inin emergency emergency

• HIV/AIDS HIV/AIDS asas emergency emergency

• HIV/AIDS HIV/AIDS asas emergency emergency

inin emergency emergency

In conflicts, infrastructure isdestroyed/services collapse

High HIV infection rates and related infections overwhelm

existing services

Public services are doubly overwhelmed by HIV/AIDS and additional demands

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Financial, social & economic resources areFinancial, social & economic resources arestretched, depleted and constrainedstretched, depleted and constrained

Household/community Household/community resources deplete, especially in especially in recurrent or recurrent or protractedprotracted emergencies emergencies

Limited public service capacity constrains constrains rapid up-scaling of rapid up-scaling of responseresponse

Break-down in authority disrupts disrupts established social order established social order – – especially in especially in complexcomplex emergenciesemergencies

International aid is gearedInternational aid is gearedto to alleviate immediatecrisis and often does not and often does not ““bridge” the emergency bridge” the emergency phase with long term phase with long term developmentdevelopment

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Lack of informationLack of information(infection levels, trends, target populations, ...)(infection levels, trends, target populations, ...)

HIV infection rates are often unknown among among displaced population/ displaced population/ host populationhost population

Quality information about Quality information about affected population(s) at risk may not be may not be available.available.

Limited use of Limited use of available secondary data (health (health centre level, Health centre level, Health Management Systems, Management Systems, NGO programs, etc) NGO programs, etc)

HIV/AIDS may not be HIV/AIDS may not be included in included in rapid assessments

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Special situations of emergency-affected Special situations of emergency-affected populationspopulations

•Remote/inaccessible locations Remote/inaccessible locations •Ongoing hostilities/unsafe Ongoing hostilities/unsafe conditionsconditions•Lack of Lack of safe road/air accesssafe road/air access

Constrain access, limits coverage of target population and range of services

Increased risk of abuse and Increased risk of abuse and exploitation, exploitation, particularly of particularly of women and childrenwomen and children

Increase exposure ofwomen and children to HIV/AIDS

Language barriers, cultural Language barriers, cultural perception of certain issues, perception of certain issues, gender roles, stigma, etcgender roles, stigma, etc

Limit translation of existing interventions and reutilization of tools/ methods

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• Lack, attrition and death of skilled and support Lack, attrition and death of skilled and support personnel constrain personnel constrain program implementation and and human resource capacity building..

• Response to humanitarian assistance appeals Response to humanitarian assistance appeals biased in favour of biased in favour of ‘life saving’ interventions interventions

• Humanitarian assistance funding parameters Humanitarian assistance funding parameters often often do not link to long-term HIV/AIDS reduction HIV/AIDS reduction programmes.programmes.

Institutional and Human Resource Institutional and Human Resource ConstraintsConstraints

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Summary – Key PointsSummary – Key Points

HIV/AIDS programming HIV/AIDS programming in emergencies is in emergencies is affected byaffected by resource constraints (human, (human, infrastructural, financial)infrastructural, financial)

Quality information to to base implementation base implementation may be very limited, if at may be very limited, if at all available.all available.

The The characteristics of the target populations may require specific may require specific tools/ strategies/ human tools/ strategies/ human resourcesresources

HIV/AIDS may be seen HIV/AIDS may be seen as in as in competition with other ‘life saving’ priorities and be given priorities and be given low priority/ funding.low priority/ funding.

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Session 4Session 4

Practical measures:Practical measures:

The planning and The planning and response matrix response matrix

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Practical Measures for Implementing HIV/AIDS Practical Measures for Implementing HIV/AIDS Interventions in Emergency SettingsInterventions in Emergency Settings

Purpose:Purpose:• To To strengthen awareness of the multisectoral of the multisectoral

nature of HIV/AIDS interventions in emergencies.nature of HIV/AIDS interventions in emergencies.

• To To build skills in inter-disciplinary collaboration in in inter-disciplinary collaboration in reducing HIV/AIDS in emergenciesreducing HIV/AIDS in emergencies

• To introduce the To introduce the HIV/AIDS matrix for minimum response in emergencies. in emergencies.

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Previously, HIV/AIDS was viewedprimarily as a health-sector concern

We now know that HIV/AIDS isa multisectoral responsibility

HIV/AIDS priorities must be integrated into emergency planning/response

Reducing HIV/AIDS in emergency settingsReducing HIV/AIDS in emergency settingsWhy a multisectoral approach?Why a multisectoral approach?

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Introducing the Matrix for HIV/AIDS Introducing the Matrix for HIV/AIDS actions in emergenciesactions in emergencies

• Ten complementary clusters of sectoral responses.

• Three phases of response– Emergency preparedness– Minimum response– Comprehensive response

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Matrix for HIV/AIDS Matrix for HIV/AIDS

actions in emergencies: actions in emergencies: focus on minimum responsefocus on minimum response

Emergency Emergency preparednesspreparedness

Minimum Minimum responseresponse

ComprehensiveComprehensive responseresponseSector

Coordination

Assessment/monitoring

Protection

Water/sanitation

Food security

Site planning

Health

Education

Behaviour Change Com

HIV/AIDS at work

Focus on:Focus on:

MinimumMinimumResponseResponse

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Group Activity - Role Play (60-90 min)Group Activity - Role Play (60-90 min)Planning multisectoral HIV/AIDS responsesPlanning multisectoral HIV/AIDS responses

:1. Return to your group from the previous exercise. from the previous exercise.

Take your group’s flipchart with you.Take your group’s flipchart with you.

2. Distribute roles to group members – ensure there to group members – ensure there

is at least one observer / rapporteur.is at least one observer / rapporteur.

3. Conduct a meeting in which representatives of the in which representatives of the different sectors address identified challenges. different sectors address identified challenges.

4.4. Observers / rapporteurs Observers / rapporteurs document group process.group process.

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Coordination action priorities:Coordination action priorities:Minimum response requirementsMinimum response requirements

The goal of coordination efforts is to meet humanitarian needs effectively and coherently.

Coordination works best when all stakeholders work togetherto establish a shared set of ethical and operational standards

Establish

coordination

mechanisms

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Assessment and Monitoring:Assessment and Monitoring: Minimum response requirements Minimum response requirements

In emergencies, accurate information is often lacking, especially in conflicts.

This allows a shared/uniformunderstanding of health trendsand patterns. It strengthenscoordination across agencies

This allows progress to betracked and improves themanagement of HIV/AIDS

Assess baseline data

Set up and managea shared database

Monitor activities

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Protection:Protection:Minimum response requirementsMinimum response requirements

Prevent and respondto sexual violenceand exploitation

Protect orphaned &separated children

Gender-based violence intensifies in conflict. It increases the risk of Transmission of HIV and STIs.

Orphaned and separatedchildren face higher risks of abuse, exploitation andrecruitment into fighting forces.

Ensure access to condoms for military,peacekeepers andhumanitarian staff

Peacekeepers, humanitarianstaff and armed forces are vulnerable to STIs

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Water, Sanitation and Hygiene Protection:Water, Sanitation and Hygiene Protection:Minimum response requirementsMinimum response requirements

Consider HIV in water and sanitationplanning

People with weakened immunesystems are less able to managediarrhoeal diseases and otheropportunistic infections.

Access to safe and culturallyacceptable toilets and water points helps protect women andgirls from sexual harassment and abuse.

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Food Security and Nutrition:Food Security and Nutrition:Minimum response requirementsMinimum response requirements

Target food aid toaffected and at-riskhouseholds/communities.

Plan nutrition and foodresponses for populationswith high HIV infection.

Promote appropriate care and feeding practices for PLWHA.

Protect food security of HIV/AIDS affected and at-risk households andcommunities.

Distribute food aid to affected householdsand communities.

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Shelter and Site Planning:Shelter and Site Planning:Minimum response requirementsMinimum response requirements

Establish safelydesigned sites

Sites for displaced peopleshould reduce the vulnerability of female-headed households and separated children, especially girls.

It may be necessary to set up a specific safe place within thesite to protect separated children and female-headed households.

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Health:Health:Minimum response requirementsMinimum response requirements

Ensure access to basic health care for the mostvulnerable

Ensure a safe blood Ensure a safe blood supplysupply

Provide condoms andestablish condom supplies

Establish syndromic STI treatment

Ensure IDU appropriate care

Manage the consequencesof sexual violence

Ensure safe deliveries

Practise Universal Precautions

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Education:Education:Minimum response requirementsMinimum response requirements

Ensure children’s access to education

Schools are effective sites forHIV/AIDS awareness, promoting human rights, tolerance and non-violent conflict resolution

In HIV/AIDS-affected populations,parents may be less able toimpart essential life skills.

Children and young people who attend school are more likely to delay the age of first sex.

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Behaviour Change Communication:Behaviour Change Communication:Minimum response requirementsMinimum response requirements

Provide informationon HIV/AIDS prevention and care.

Communication in emergencieshelps people to maintain/adoptbehaviours that reduce the riskof contracting HIV/AIDS.

It also helps those affectedby or living with HIV/AIDS toaccess services and support.

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HIV/AIDS in the Workplace:HIV/AIDS in the Workplace:Minimum response requirementsMinimum response requirements

Prevent discriminationby HIV status in staff management

Provide post-exposureprophylaxis (PEP)for humanitarian staff

Workplace information and education help increase respect,tolerance and understandingof workers with HIV/AIDS

PEP is a short-term antiretroviraltreatment that reduces the riskof HIV infection after potential exposure.

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Summary – Key PointsSummary – Key Points

HIV/AIDS activitiesHIV/AIDS activitiesshould seek to should seek to build on and not duplicate or orreplace existing work.replace existing work.

Key stakeholders and Key stakeholders and affected populationsaffected populationsmust participate in in planning/implementationplanning/implementation

HIV/AIDS interventions HIV/AIDS interventions in humanitarian crises in humanitarian crises must be multisectoral.

HIV/AIDS activitiesHIV/AIDS activitiesfor displaced populationsfor displaced populationsshould should also service hostpopulations

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Session 5Session 5

Introducing theIntroducing theIASC GuidelinesIASC Guidelines

Additional IASCAdditional IASCHIV/AIDS resources HIV/AIDS resources

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Introducing the IASC GuidelinesIntroducing the IASC Guidelines

Purpose:Purpose:

• To provide To provide background and context for the for the development of the guidelinesdevelopment of the guidelines

• To To introduce the guidelines and their content and their content

• To introduce To introduce complementary HIV/AIDS resources developed by IASC developed by IASC

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WHO/What is the IASC?WHO/What is the IASC?

• Inter-Agency Standing Committee (IASC) was (IASC) was established in 1992 by GA Resolution 46/182.established in 1992 by GA Resolution 46/182.

• Primary mechanism for Primary mechanism for interagency decision-making in complex emergencies and natural in complex emergencies and natural disasters.disasters.

• IASC IASC Task Force on HIV/AIDS in Emergency Settings developed these guidelines. developed these guidelines.

http://www.humanitarianinfo.org/iaschttp://www.humanitarianinfo.org/iasc

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Why these Guidelines?Why these Guidelines?

• HIV/AIDS HIV/AIDS previously disregarded as a priority in as a priority in humanitarian crises.humanitarian crises.

• But, since 2000, increasing awareness of interplay But, since 2000, increasing awareness of interplay between between emergency conditions and HIV/AIDS..

• Also, awareness that HIV/AIDS emergency Also, awareness that HIV/AIDS emergency responses responses must be multisectoral. multisectoral.

‘Guidelines for HIV/AIDS interventions in emergency settings’

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Guidelines for HIV/AIDS interventions in Guidelines for HIV/AIDS interventions in emergency settingsemergency settings

HIV/AIDS now viewed asHIV/AIDS now viewed asan an emergency priority – and – and a a multisectoral responsibility.responsibility.

To ensure uniformity across To ensure uniformity across agencies and sectors - theagencies and sectors - theMatrix

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Focus for the GuidelinesFocus for the Guidelines

• Purpose

• Target audience

To ensure delivery of the requiredminimum multisectoral responseto HIV/AIDS in an emergency’searly phases.

National authorities, personnel and organisations operating in emergencies at international,national and local levels.

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How/when to use the guidelines?How/when to use the guidelines?

The Guidelines apply to The Guidelines apply to any emergency setting

In emergency settings In emergency settings with with high HIV/AIDS infection infectionratesrates

In emergency settings In emergency settings with with low HIV/AIDS infection infectionrates rates

Integrated HIV/AIDS actionis an urgent priority to avert even greater HIV/AIDSimpacts

Collapse of health services/Collapse of health services/infrastructure can infrastructure can increase increase HIV/AIDSHIV/AIDS transmission, if transmission, ifguidelines not applied.guidelines not applied.

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Reducing HIV/AIDS in emergency settingsReducing HIV/AIDS in emergency settings Introducing the IASC tools Introducing the IASC tools

1.1. Hard-copy and electronic guidelinesHard-copy and electronic guidelines

2. Learning Package:2. Learning Package:

A. A.

B.B.

C.C.Self-Study CD ROM: “HIV/AIDS “HIV/AIDS

interventions in emergency settingsinterventions in emergency settings””

Briefing Session: “HIV/AIDS : “HIV/AIDS interventions in emergency settings”interventions in emergency settings”

Workshop: “HIV/AIDS interventions “HIV/AIDS interventions in emergency settings and IASCin emergency settings and IASCGuidelines”Guidelines”

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DiscussionDiscussion

• How would How would you use these guidelines? these guidelines?– for programming, fund-raising, proposal-writing?for programming, fund-raising, proposal-writing?– for practical implementation?for practical implementation?

• What do you anticipate as What do you anticipate as constraints??

• Are there Are there success stories ... lessons learned? ... lessons learned?

• What are the What are the next steps?

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For follow-up resourcesFor follow-up resources

For more information on ...

Briefing Session: “HIV/AIDS : “HIV/AIDS interventions in emergency settings”interventions in emergency settings”

Workshop: “HIV/AIDS interventions in “HIV/AIDS interventions in emergency settings and IASC Guidelines”emergency settings and IASC Guidelines”

Self-Study CD ROM: “HIV/AIDS “HIV/AIDS

interventions in emergency settingsinterventions in emergency settings””

‘Guidelines for HIV/AIDS interventions interventions in emergency settings’in emergency settings’

Please contact UNAIDS… www.unaids.org

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Please also visit the UNAIDS HIV/AIDS in Emergency Settings web site:

www.aidsandemergencies.org