THE HEALTH SECTOR RESPONSE TO THE HIV/AIDS EPIDEMIC 1985-2008 Presentation to the Technical Review meeting for TACAIDS By Dr. Bennett Fimbo National AIDS Control Programme (NACP) 30th October 2008

The historical Background of the HIV/AIDS Response in the Health Sector

Programmatic Response Developments Decentralised IEC activities – Intensified information and education at district and local levels, (main players- appointed RACCs and DACCs; CBOs/NGOs etc), distribution of IEC materials. Established STD projects (syndromic management of STIs, STD drug procurement and supplies, Condom promotion and distribution Strategic programming and planning (MTP I – III: 1987-2002)

Programmatic Developments: II Blood Safety hospital based (1987) Disease Monitoring and Surveillance – through screening of donated blood, Antenatal (ANC) HIV and STI screening, periodical reporting through annual Epidemiological Reports 1987- 2005. PMTCT services. VCT services.

Prevalence of HIV infection among ANC attendees by region, Tanzania 2005/06

Achievements on prevention Increased access to information on HIV/AIDS - leading to high awareness levels (>90% in adult population) Condom use demystified – resulting into 30-40% among sexually active groups Targeted Education programs established – including AIDS education in schools Increased knowledge on STI management and control

Gaps and Challenges in prevention Awareness levels not transformed into appreciable (preventive) behaviour change Positive knowledge still poor with widespread stigma and discrimination Socio-cultural factors not fully understood as main drivers of the epidemic in different community groups MARPS poorly identified or denied leading to non-engagement or focus

Response Focus after 2002 The first Health sector on HIV/AIDS (2003-2006) included a major component on care support and treatment A Care and Treatment Plan (2003-2008) was formulated with a goal to reach 440,000 PLHAs by 2008. Main intervention being ARV access to all eligible patients. PMTCT was also piloted and introduced

Health Sector strategy for HIV/AIDS (2003-2006 Based on the NMSF 2003-2008 and the Health Sector Strategy (2003-2008) Three Major themes (Prevention; Care and Treatment; Cross-Cutting Issues) Resulted into formulation of the Care and Treatment Plan (2003-2008), with a focus on providing ARV drugs to >400,000 PLHAs by end of the plan

Achievements on Care and Treatment

Total Enrolees = 327,922: Total on ARVs = 166,639: Total not on ARV = 161,283: 12

HSS HIV/AIDS Strategy-II (2008-2012) Health Sector HIV strategy -II is a successor of Health Sector HIV/AIDS Strategy -I (2003-2006) Derives Guidance from the NMSF II -2008-2012 of TACAIDS and, Defines the contribution of the Health Sector to the National Multisectoral Response to HIV and AIDS for the period 2008-2012

Theme of the HSHS 20O8-2012 Universal access to HIV and AIDS preventive, care, treatment and supportive services.

Universal access- Levels Condom access (30-40%) Voluntary counseling and testing 30% of the population 15-49 years have been tested Services for the sexually transmitted services- hospitals 100%; health centres 90%; dispensaries 60- 70% Services for prevention of mother to child transmission of HIV services available in about 15% of existing health facilities and reaching - only 20% of the pregnant women Home based care available in only about 10-15% of all health facilities.

Universal access –ART access Antiretroviral Treatment (ART) for people living with HIV/AIDS – just over 320,000 of the estimated 440,000 patients have been enrolled by end of July 2008 and over 166,600 were on ARV drugs. Laboratory services to monitor patients on antiretroviral treatment still low Condom availability- 50-60%

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