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Adapting National HIV Strategy to a Socially and Geographically C oncentrated Epidemic :

Adapting National HIV Strategy to a Socially and Geographically C oncentrated Epidemic : The Case of Papua New Guinea Dr. Moale Kariko PNG National AIDS Council Secretariat. Outline of presentation. What adaptation means for PNG

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Adapting National HIV Strategy to a Socially and Geographically C oncentrated Epidemic :

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  1. Adapting National HIV Strategy to a Socially and Geographically Concentrated Epidemic: The Case of Papua New Guinea Dr. Moale Kariko PNG National AIDS Council Secretariat

  2. Outline of presentation • What adaptation means for PNG • Evolution in understanding of PNG epidemic and in its response • Current efforts and adaptation • Broad Challenges • Concluding Messages

  3. What adaptation means for PNG • Progressive understanding of epidemic. • Interrogation of interventions in light of improved understanding of epidemics. • Ongoing adjustment of interventions in light of new evidence. • Capacity development of implementers to adapt to the changing epidemic.

  4. PNG Epidemics in 2001 • Sharply increasing annual HIV diagnoses • Limited access to testing & treatment services • Little information on prevalence in general population and those at highest risk of infection • Declared as generalized by UNAIDS in 2004 • Speculation of a SS-African type epidemic • Interventions based on generalized epidemic

  5. PNG Epidemics in 2013

  6. PNG Response, 2001-2010 • Guided by MTP and NSP • Strategies based on generalized epidemics • Similar suit of interventions for all population groups and all provinces • Prevention synonymous with awareness • Little emphasis on STI • No explicit focus on MARPS- only 1% of total national response funding benefited MARPS.

  7. Turning Point • NHS 2011-2015: • Identifies top 10 interventions for resourcing • Gives some attention to MARPS • Identifies and prioritises high burden provinces • Mid Term Review of NHS May/June 2013: • Recommended a re-think of prevention approach • Prioritise MARPS • Different packages for high & low burden provinces • Adopt CoPCT model of service delivery • Recommends a review of architecture • NASA I & II: highlighted limited spend on MARPS

  8. Current Efforts and Adaptations (1) Improving evidence • Synthesis of program data and size Estimation for MARPS- underway; • Preparation for IBBS for MARPS and limited coverage of general population in selected high burden provinces. • Reviewing reporting templates to include MARPS specific indicators • Improving program reporting

  9. Current Efforts and adaptations (2) Programming Shifts • Rethinking prevention and adopting CoPCT model to strengthen link between clinical and non clinical interventions • Differentiated response- different package for different provinces and population sub-groups • Mapping of hotspots where MARPS converge • Comprehensive condom programming policy • Greater engagement with MARPS • Enhanced advocacy & rights based approach.

  10. Current Efforts and adaptations 3) Resource Realignment • Increase in resource allocation for MARPS activities (1% in 2009/10 to 9% in 2011/12) • Increase in number of implementing organization working on MARPS programs • More funding for activities in 9 high prevalence provinces

  11. Current Efforts and adaptations 4) Review of HIV architecture • Integration of National AIDS Council with the National Department of Health- underway • Greater decentralization of management and coordination functions to provinces • Capacity development for implementing partners.

  12. Broad Challenges • Inadequate evidence remains a concern • Legal barriers- same sex relationship and sex work are illegal in PNG • Transition from dual to single architecture • Funding uncertainty- 76% of the response is external • Tension between advocating for the rights of MARPS and widely held view that PNG is a Christian country • Capacity for evidenced based programming and implementation.

  13. Concluding Messages • Understanding of PNG epidemic has changed with improvement in evidence • Earlier prediction that it would follow the Sub-Saharan African trend was inaccurate • Current evidence point towards a concentration in key populations and in 9 of the country’s 22 provinces.

  14. Concluding Messages • The response has evolved with the evolution in understanding of the epidemic • Current efforts are aimed at improving evidence, creating the enabling environment and realigning resources to ensure more focus on MARPS. • Our greatest challenges lie in achieving legal and institutional reforms; improving implementation capacity and sustainability.

  15. Thank you Acknowledgement: NACS, NDoH, Donor Partners, Stakeholders UNDP – Country Office

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