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October 2005 cvincewhitman@edc.org
Education Development Centre, Inc.
Response to Change -Changing the Response:
Increasing Donor Involvement in
the Spectrum from
Prevention to Care for HIV and AIDS
Cheryl Vince WhitmanGEG Tenth Annual
MeetingKiev, Ukraine
October 2005 cvincewhitman@edc.org
Overview of Presentation
I. Interdependence of health with all aspects of life
II. Need for comprehensive approach to HIV and AIDS
III. Major barrier of stigma and discrimination
IV. Schools, community agencies, PLWA must do more
V. Countless opportunities for donors
October 2005 cvincewhitman@edc.org
EFC Goals for HIV and Health
HIV and AIDS Donor Group
European Partnership for Global Health (EPGH)
European commitment to the Millennium Development Goals
MDG #6. “Halt and begin to reverse the spread of HIV and AIDS”.
October 2005 cvincewhitman@edc.org
Slow Pace Donor Participation
Perceive a fit with mission?
Stigma through association with HIV
Label HIV and AIDS as health problem
Are prevalence rates perceived as threat for Europe: Eastern Europe?
October 2005 cvincewhitman@edc.org
Do Donors Perceive HIV/AIDS a Problem?
Approximately 1.4 million people living with HIV/AIDS (Eastern Europe & Central Asia)
Fastest growing rate in world
Young people <30 at high risk (80% Eastern Europe compared to 30% Western Europe)
Fewer than 5% young people have access to services
October 2005 cvincewhitman@edc.org
Tipping Point 5 %:Not Hypothetical Construct
Eastern Europe 1% and less
Botswana 37%
South Africa .5 -1% (5 years)
1 - 20% (7 years)
October 2005 cvincewhitman@edc.org
I. Health Interdependent with –
Academic Performance
Family & Community Stability
Workforce Productivity
Economic Development
October 2005 cvincewhitman@edc.org
International Definitions and Movements
WHO: health is not absence of disease but physical, mental and social well-being.
WHO Ottawa Charter 1986: Health is created and lived by people where they learn, work, play and love.
WHO Bangkok Charter 2005: a globalized world health requires strong political action, broad participation and sustained advocacy.
October 2005 cvincewhitman@edc.org
II. Need for Comprehensive Response
Causes HIV and AIDS rooted in all facets of society and institutions: families, schools, employers, government.
All sectors must be involved in a comprehensive response from prevention to voluntary counselling and testing to care and bereavement and children affected and infected.
Response needs more donors involved -education, public health, mental health and social services, law enforcement, (ICT) information and communications technologies and media and all civil society.
October 2005 cvincewhitman@edc.org
Figure I: Societal Factors Contributingto Rising Rates of HIV and AIDS
Comprehensive Approach:
ARV
Intervention Services
Voluntary Counselling &, Testing for HIV
Counselling
Prevention
HIV & AIDS
DestructiveBehaviours:
sex work,alcohol/ drug abuse
Mental health, mental illness,physical, psychological,
sexual abuse
Unemployment, poverty, school failure, dropout, gender inequality,
homophobia, family dysfunction
General Population
October 2005 cvincewhitman@edc.org
Risk Factors: Substance Abuse
Individual Family School Community
Friends who use
Early problem
behaviours
Hopelessness
Genetic pre-
disposition
Poor social
adjustment &
coping skills
Chaotic home
Poor family relations
Parents/family
members who
Use alcohol and drugs
Abuse/neglect
Academic failure
Peer rejection
Low degree of
commitment to
school
Highly
authoritarian;
harsh punishments
Availability
substances
Exposure to
violence
Lenient laws,
no enforcement
Neighborhood
Deterioration
Few recreational activities and jobs
October 2005 cvincewhitman@edc.org
Spectrum of Response
Universal: Awareness and skill building
Norms of Tolerance
Selected:Early screening &
intervention
Indicated:Clean needles,
CondomsVCT
Treatment
ARV
Primary Prevention
Secondary Intervention
Treatment and Care
October 2005 cvincewhitman@edc.org
III. Stigma and Discrimination
First and foremost barrier
Stands in way of prevention
Negatively affects preventive behaviours, such as condom use, diagnosis, and treatment
Disenfranchising people fuels the epidemic
October 2005 cvincewhitman@edc.org
Most Effective Strategies to Combat Stigma and Discrimination
Review of 22 studies: Contact with PLWA along with information about transmission
Significant effects of educational sessions given by someone who has disclosed status compared to someone who has not
Greater involvement of PLWA has positive impact on policies and programmes
October 2005 cvincewhitman@edc.org
IV. Schools, community agencies, together with PWLA must do more.
The education sector must play more of a leadership role
Population in Eastern Europe very young; school plays key role
Schools workplaces for thousands of staff
School success and completion are preventive
Schools can identify and refer youngsters at risk early on
October 2005 cvincewhitman@edc.org
… continued
Education leaders influential in setting tone
Schools transmit culture formally and informally: set norms for tolerance in classrooms, hallways
Provide accurate information and skill development
Serve as coordinating mechanisms with community and civil society
By policies, change dynamics of acceptance
October 2005 cvincewhitman@edc.org
Policy Elements
Information about epidemic in countryMechanisms for cooperation health sectorEmphasis on prevention, staff trainingConfidentiality of PLWAUniversal precautionsAccess to servicesCode of ethics, tolerant, non-discriminatory
October 2005 cvincewhitman@edc.org
UN AIDS IATT –Education SectorGlobal Readiness Survey 2004
Survey Question YES NO
Does the MoE have a
HIV/AIDS workplace policy? 43%(in process)
57%
Guidelines for universal
precautions for all staff? 0% 100%
Confidentiality of Ministry employees affected by HIV/AIDS?
100% 0%
HIV/AIDS Education Policies in 7 Eastern European Countries
October 2005 cvincewhitman@edc.org
UN AIDS IATT –Education SectorGlobal Readiness Survey 2004
Survey Question Yes No
Has research been commissioned?
57% 43%
Does the Edu. sector have a shared strategy: fight against AIDS?
0% 100%
Does the MoE have a specific HIV/AIDS policy?
28.5% 71.5%
HIV/AIDS Education Policies in 7 Eastern European Countries
October 2005 cvincewhitman@edc.org
Summary Health and HIV affect all society
Intervention with high risk groups essential but not enough
Barrier: stigma and discrimination
Changing social norms essential to halt or stem rising rates
Comprehensive approach: prevention -intervention - care
Schools with communities and PWLA key role to play
Need for multi sectoral involvement and support from donors
October 2005 cvincewhitman@edc.org
Many Opportunities for Donors
Across sectors: education, public health, mental health, youth development and employment.
Research, tracking and monitoring.
Leadership development and capacity building.
Prevention – early intervention – testing – treatment – bereavement
Young people’s involvement action research, use of technology.
October 2005 cvincewhitman@edc.org
Impact of Connecting Young People to PLWA
I wish to share this poem with all countries.AIDS is not a disease, although the virus has killed millions.AIDS is not a set of statistics, although the numbers are horrific.AIDS is not a conference in Durban.AIDS is not a presidential PR problem.AIDS is not advertisements and education programmes, although
these help.AIDS is a feeling of hopelessness and despair.AIDS is young people who believe they’re immortal.AIDS is a secret known by everyone. AIDS is not knowing what’ll
happen to your children when you’re gone.AIDS is people who are part of families.AIDS is everyday life carrying on against the odds.
---a student from iEARN--Ukraine
October 2005 cvincewhitman@edc.org
Contact Information
Cheryl Vince WhitmanSenior Vice President
Education Development Centre, Inc.Director, Health and Human Development Programmes
Affiliated EDC-Europe55 Chapel Street, Newton, MA, U.S.A.
02458-1060
cvincewhitman@edc.org617-618-2300
http://www.hhd.orghttp://www.edc.org