Addressing HIV in Emergency SettingsAddressing HIV in Emergency Settings

Presentation to Food Security Cluster25 October 2012

South Sudan shares borders with countriesreported to have high HIV prevalence rates

4.9%4.9%

3.4%3.4%

6.5%6.5%

1.1%1.1%

6.3%6.3%

3%3%

47%47%

61%61%

8%8%

ARV Coverage

ARV Coverage

HIV prevalence

HIV prevalence

86%86%

14%14%

24%24%

49.5%49.5%

38.5%38.5%

40%40%

21%21%

41.9%41.9%63.2%63.2%

46%46%91%91%

93%93% 54%54%

X%X% Percentage of pupulation that have heard on HIV and AIDS

HIV, Emergencies and Vulnerability

Bi-directional Relationship: Bi-directional Relationship:

Vulnerability to HIV infection: Emergencies : Emergencies generategenerate situations situations ofof high high risk to HIV infectionrisk to HIV infection

Vulnerability to crisis: HIV and AIDS undermines existing : HIV and AIDS undermines existing coping strategiescoping strategies and may reduce social stability and and may reduce social stability and available services and resourcesavailable services and resources

The link to gender is evident

Why address HIV in humanitarian action?

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.

HIV Responses in Emergency SettingsResponse 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:

1.Restore and maintain HIV and AIDS services: condoms, treatment access, PMTCT, HBC and OVC support to ensure continuity of service provision.

2.Address HIV and AIDS service needs of PLWH: including food and nutritional needs of PLHIV and affected households;

3.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..

Available Guidance

IASC Guidelines for Addressing HIV in Humanitarian Settings

HIV in Humanitarian Action: Induction Manual for Humanitarian Workers

Integrating HIV in Humanitarian Action

An Induction Manual for Humanitarian Workers

www.aidsandemergencies.org

Induction Manual for Humanitarian Workers

Nine Chapters providing short, concise guidance on how to integrate HIV in various humanitarian processes and mechanisms:

1.Coordination2.Integration of HIV into Emergency Preparedness and Contingency Planning3.Integrating HIV into Humanitarian Needs Assessments 4.Integrating HIV Interventions into Cluster Activities – IASC Guidelines5.Monitoring - IASC Guidelines list of indicators6.HIV and Resource Mobilisation7.HIV and Humanitarian Advocacy8.HIV and Information Management9.Mainstreaming the HIV and Humanitarian dimensions in recovery/ development

GUIDELINES FOR ADDRESSING HIV IN HUMANITARIAN SETTINGS

Response Preparedness Minimum Initial Response Expanded response

MULTISECTORAL ACTIONS 

HIV Awareness Raising & Community Support      

HIV in the Workplace      

SECTORAL RESPONSES

Health      

Protection      

Food/nutritional support/ livelihoods      

Education      

CCCM      

Shelter      

Water & Sanitation and Hygiene      

Action Framework

Action SheetsAction Sheets

Minimum Initial Minimum Initial Response & Response &

Expanded ResponseExpanded Response

(+ Resource Materials)(+ Resource Materials)

Food Security, Nutrition, Livelihood Support Action Sheet

HIV

• 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

• 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

Food insecurity and malnutrition

Close relationship between HIV and food insecurity and malnutrition

Source(s): WFP analysis

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 & malnutrition Vicious cycle

To improve treatment access and adherence

To balance nutrients loss

To increase immune system

strength

To improve treatment

outcomes & effectiveness

1

3To foster weight

gain

2

4

5

& WHY FOCUS ON NUTRITION

Food and nutrition

interventions

Treatment outcomes

Nutritional stabilization/recovery

Access to treatment

1

2• Nutrition Assessment,

Education and Counselling’ (NAEC)

• Food supplements• Household support

• Faster weight gain (rebuilding of body tissues that were lost)

• Increased strength of immune system

• Increased drug effectiveness

• Reduced morbidity• Reduced mortality• Reduced transmission• Improved quality of life

• Increased treatment uptake• Increased treatment adherence

and retention in care

Food and nutrition supports treatment success by:

Source(s): WFP analysis

Food and nutrition interventions should include:

Source(s): WFP HIV policy

A

B

Beneficiaries Objectives

Care and treatment(Curative)

• 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

Mitigation and safety nets(Enabling/ preventive)

• 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)

Intervention

• Nutritional recovery

• Reduced mortality

• Improved adherence

• Mitigation of negative effects from HIV

• Prevention of negative coping behaviour

• Improved adherence

Food and nutrition interventions should leverage strengths from health sector and communities:

Source(s): WFP analysis

Health sector Community

Activities

‘Com-parative

advantage’

• Nutritional assessment– Decision on entry/exit to program

• Nutritional counselling 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

If done right, food and nutrition support plays a crucial role for treatment success

Before treatment After treatment

Source(s): WFP programme experience

LETS DISCUSS…

www.aidsandemergencies.org

Mumtaz Mia Strategic Intervention AdviserEmail: miam@unaids.orgMobile: 0912 112 299