Addressing HIV in Emergency Settings

1. Addressing HIV in Emergency Settings Presentation to Food Security Cluster25 October 2012

2. South Sudan shares borders with countriesreported to have high HIV prevalence rates HIV prevalence ARV Coverage 1.1% 4.9% 3% 86% 8% 24% 6.3% 3.4% 61% 6.5% 14% 47%

3. 40% 63.2% 41.9% 49.5% 21% 38.5% 46% 91% 54% 93% X% Percentage of pupulation that have heard on HIV and AIDS

4.  Bi-directional Relationship: Vulnerability to HIV infection: Emergencies generate situations of high risk to HIV infection Vulnerability to crisis: HIV and AIDS undermines existing coping strategies and may reduce social stability and available services and resources HIV, Emergencies and Vulnerability The link to gender is evident

5. Emergencies can have significant impact on HIV-related vulnerability: Heightened risk of exposure to HIV infection: Negative coping mechanisms Sexual and gender-based violence Disruption of social networks Inaccessible HIV prevention commodities Most at risk group Increased vulnerability of PLHIV and affected populations Disruption of health care services Disruption of care and support services e.g. food & livelihoods to ART/TB patients; HBC and OVC Increase in disease burden Impact of humanitarian situation on HIV affected households. Why address HIV in humanitarian action?

6. Response should keep in mind the “do no harm” principle within a context of respect for human rights; prevention of stigma and discrimination and address gender-specific needs and gaps. Addressing HIV in humanitarian action aims to: Restore and maintain HIV and AIDS services: condoms, treatment access, PMTCT, HBC and OVC support to ensure continuity of service provision. Address HIV and AIDS service needs of PLWH: including food and nutritional needs of PLHIV and affected households; Reduce risk of new infections: protection (gender-based violence, sexual exploitation & abuse) and prevention programming within relevant sectors; addressing negative coping mechanisms (transactional sex) and other emergency-related risk factors …within the framework of the national AIDS response.. HIV Responses in Emergency Settings

7. Available Guidance www.aidsandemergencies.org • IASC Guidelines for Addressing HIV in Humanitarian Settings • HIV in Humanitarian Action: Induction Manual for Humanitarian Workers

8. Nine Chapters providing short, concise guidance on how to integrate HIV in various humanitarian processes and mechanisms: Coordination Integration of HIV into Emergency Preparedness and Contingency Planning Integrating HIV into Humanitarian Needs Assessments Integrating HIV Interventions into Cluster Activities – IASC Guidelines Monitoring - IASC Guidelines list of indicators HIV and Resource Mobilisation HIV and Humanitarian Advocacy HIV and Information Management Mainstreaming the HIV and Humanitarian dimensions in recovery/ development Induction Manual for Humanitarian Workers

9. GUIDELINES FOR ADDRESSING HIV IN HUMANITARIAN SETTINGS

10. Action Framework Action Sheets Minimum Initial Response & Expanded Response (+ Resource Materials)

11. Food Security, Nutrition, Livelihood Support Action Sheet

12. Close relationship between HIV and food insecurity and malnutrition • Increased nutritional needs through metabolic changes • Reduced appetite and ability to take food • Reduced ability of body to absorb nutrients • Reduced access to food due to morbidity/low productivity In high HIV prevalence countries (>10%) : - Nutrition surveys in have shown a strong correlation between orphans and malnutrition - High HIV prevalence among severely malnourished infants leading to high re-admittance and mortality rates - Vulnerability trends in chronically food insecure areas have shown higher vulnerability among households with member who has chronic illness HIV Food insecurity and malnutrition • Increased morbidity and mortality • Potentially negative coping behaviour that increases likelihood of HIV transmission (e.g., unprotected, transactional sex) • Food insecurity may prevent people from seeking a diagnosis and/or initiating and adhering to treatment Source(s): WFP analysis

13. HIV & malnutritionVicious cycle & WHY FOCUS ON NUTRITION 2 3 To increase immune system strength To foster weight gain 1 To balance nutrients loss 4 To improvetreatment outcomes & effectiveness 5 To improvetreatment access and adherence

14. Food and nutrition supports treatment success by: 1 Nutritional stabilization/recovery • Faster weight gain (rebuilding of body tissues that were lost) • Increased strength of immune system • Increased drug effectiveness Food and nutrition interventions Treatment outcomes • Nutrition Assessment, Education and Counselling’ (NAEC) • Food supplements • Household support • Reduced morbidity • Reduced mortality • Reduced transmission • Improved quality of life 2 Access to treatment • Increased treatment uptake • Increased treatment adherence and retention in care Source(s): WFP analysis

15. Food and nutrition interventions should include: Intervention Beneficiaries Objectives Care and treatment (Curative) • Nutritional recovery • Reduced mortality • Improved adherence • Nutrition assessment, education and counselling (NAEC) incl. infant feeding • Specialized food products for nutritional rehabilitation • NAEC for all PLHIV through- out life • Malnourished PLHIV on ART until recovery A Mitigation and safety nets (Enabling/ preventive) • Mitigation of negative effects from HIV • Prevention of negative coping behaviour • Improved adherence • Finite income transfer in the form of food, vouchers or cash • Finite income transfer in the form of food, vouchers or cash for HHs hosting OVCs • Peer support & community-based support to guarantee a continuum of care • HIV-sensitive safety nets • Affected HHs for duration of support to infected • Affected HHs hosting OVCs (based on need) • Peers and community (based on need) • All (longer-term) B Source(s): WFP HIV policy

16. Food and nutrition interventions should leverage strengths from health sector and communities: Health sector Community • Nutritional assessment • Decision on entry/exit to program • Nutritional counselling Activities Referral to community • Food support for finite period • Further education and counselling • Livelihood activities • Additional activities linked to F&N interventions, e.g., • psycho-social support • prevention activities Referral to broader social protection mechanisms • Infrastructure (e.g., equipment) • Training/knowledge of staff • Ability to steer, monitor centrally • Flexibility • Geographic proximity to patient • Trust • Knowledge of local setting • Integration with other community activities ‘Com-parative advantage’ Source(s): WFP analysis

17. If done right, food and nutrition support plays a crucial role for treatment success Before treatment After treatment Source(s): WFP programme experience

18. Mumtaz Mia Strategic Intervention Adviser Email: miam@unaids.org Mobile: 0912 112 299 www.aidsandemergencies.org Lets discuss…