My husband got infected with HIV/AIDS... After I found that I was positive, I told my relatives. They were very angry...They came and took my oldest daughter... A few months later my husband's condition became worse. He ordered me to call my relatives to see the face of his daughter before he died. But they ignored his plea. My husband said it did not matter if he died or lived as he had lost his daughter. My husband died on April 21, 2002. Dam Savy, 41 years old, Cambodia.
a policy environment… what works? what doesn’t? …examples in action Kevin Osborne, USAID ANE/ENE SOTA October 8 2002
…introduction what is an ideal policy environment? what are the steps for developing meaningful policy? what are some of the challenges and successes?
the POLICY project… POLICY facilitates development of comprehensive policies to promote and sustain access to high quality HIV/AIDS/FP/RH services by… developing political and popular support improving planning and finance ensuring informed decision-making enhancing local capacity
“Sometimes we are judged as bad people. Often those closest to us stop loving us. We see fear in their eyes…We are asked to leave our homes. We fear for our safety. I’m Cambodian. I know what ignorance and hatred can lead to.” January 2002 Heng Sok Rithy – Coordinator CPN & ‘Human Security and HIV/AIDS’ with HRH Princess Rattana Deve Norodom, Cambodia
…key elements of an hiv/aids program creating an enabling environment Leading the Way: USAID Responds to HIV/AIDS prevention mitigation
…an enabling policy environment Stigma & discrimination reduction Involvement of communities infected & affected Multisectoral engagement Human & institutional capacity development People level impact Policy dialogue Advocacy Quality information, research & economic impact Human rights protection Political commitment M&E
…levels of hiv/aids policy impact Political commitment Adequacy of financial resources Human resource capacity Key responses of government, civil society & donors Stigma and discrimination’s affect on design of prevention, care, support, and treatment policies Factors & behaviors impacting on HIV/AIDS transmission Operational policies Possession of condoms Needle exchange Blood testing
…key considerations challenging our notions of policy stakeholder involvement and ownership infected and affected communities rewarding our efforts
…the policy stakeholders * NB Success depends on meaningful involvement of all stakeholders, especially communities
…why has there been little involvement? Western Concepts Charity vs. Self- help Activism vs. Service provision Cultural and contextual issues Capacit y Gate keepers-increasing bureaucrazition Profound Sadness Value Added Mix of Communities Redefining notion of ‘experts’ Human Rights Stigma & discrimination
challenges … what is meaningful inclusion? when do you have it? when don’t you have it?
…when it fails police raid on the boeung salang brothels in phnom penh The official governmental policy is to gain the trust of both sex workers and brothel owners to have them all participating in the 100% Condom Use Programme and its consultations.
ironically, these brothels were the first to participate in the national 100% condom use programme in Phnom Penh. this raid and subsequent arrest of all sex workers and owners sends a negative signal to a community whose participation in medical programmes is essential when tackling HIV/AIDS. …when it fails
…when it works thailand 100% condom campaign the launch of the first pilot programme for 100% condom use in brothels in 1989 showed the programme was significantly effective in STI reduction HIV prevalence reduction Changing attitudes and practices regarding condom use preliminary results suggest that the programme could have prevented over 2 million HIV infections over a six years period. H owners and managers of commercial sex establishments agree to: H enforce condom use as a condition of commercial sex H Instruct sex workers to refuse sex with any customer who refuses to use a condom. H if all sex establishments enforce this policy, clients have no choice - they either use condoms or they don't have sex. H how the 100% condom use programme works
In August 2002, the South African Law Commission released an Issue Paper on Adult Prostitution. This paper is the first stage of a process that will ultimately result in recommendations on law reform being presented to Parliament. The paper sets out the many issues surrounding adult sex work and discusses various approaches to dealing with sex work. The paper also calls for public comment and suggestions on this issue. If new laws are to be developed for the sex industry, it is essential that role players in the industry be consulted. Sex workers are being encouraged to input to this process directly, to participate in this law reform process. law reform in south africa …when it works