1. COUNTRY PROGRESS REPORT ON UNITED NATIONS GENERAL ASSEMBLY SPECIAL SESSION ON HIV AND AIDS (UNGASS) 2010
Monitoring the Declaration of Commitment on HIV/AIDS
Presented By Dr. Agnes Dzokoto

2. Outline Introduction Methodology Indicators
National Programme Indicators
Knowledge and Behavior Indicators
Impact Indicators
National Commitment Indicators
Conclusion and Recommendations

3. UNGASS
United Nations General Assembly Special Session on HIV and AIDS (UNGASS) (25th – 27th June 2001)
189 Members adopted the declaration of commitment including Ghana
Under terms of the Declaration of the Commitment on HIV/AIDS success in the AIDS response is measured by the achievement of concrete time bound targets

4. “For there to be any hope of success in the fight against HIV/AIDS, the world must join together in a great global alliance. ….. My great hope is that it signals the emergence of a response to this deadly disease — by Governments, multilateral organizations, the private sector and civil society — that could soon match the scale of the epidemic itself.” Secretary General, Kofi Annan

5. Priorities of UNGASS in 2001
to ensure that people everywhere —particularly the young — know what to do to avoid infection
to stop perhaps the most tragic of all forms of HIV transmission — from mother to child;
to provide treatment to all those infected;
to redouble the search for a vaccine, as well as a cure;
and to care for all whose lives have been devastated by AIDS, particularly orphans.

6. Areas addressed at UNGASS
Leadership
Prevention
Care, support and treatment
HIV/AIDS and human rights
Reducing vulnerability
Children orphaned and made vulnerable by HIV/AIDS
Alleviating social and economic impact
Research and development
HIV/AIDS in conflict and disaster-affected regions
Resources
Follow-up

7. Purpose of UNGASS report
To provide key constituents who are active in a country response to AIDS with essential information on core indicators that measure the effectiveness of the national response
Identify problems and constraints and recommend action to accelerate achievement of the targets
Information provided by country reports represent the most comprehensive set of standardised data on the status of the epidemic and progress on the response.

8. Core Indicator of UNGASS
1. National Commitment and action
Expenditure on AIDS (NASA)
Policy , strategic and financial inputs (NCPI)
2. National Programmes
3. National Knowledge and behavior
Specific knowledge and sexual behavior outcomes, school attendance among orphans
4. Impact
Reduction in HIV prevalence, morbidity and mortality rates

9. Methodology Desk review Key informant Interviews
Stakeholder consensus building workshop
Stakeholder validation
Report Finalisation

10. National Commitment and Action
AIDS spending
Government and HIV and AIDS Policies

11. AIDS Spending Spending Category 5,339,318 Public spending 923,075
2009
Public spending
5,339,318
Private spending
923,075
International Funds
32,588,547
Grand Total
38,850,940

12. AIDS spending Spending Category Amount in US Dollars Percentage
Prevention
8,550,916
22.01
Care and treatment
9,554,075
24.59
OVC
425,999
1.10
Programme Management and Administration
11,603,866
29.87
Human Resources
4,661,299
12.00
Social Protection
754,620
1.94
Enabling Environment
2,138,620
5.50
Research
1,161,545
2.99
Grand total
38,850,940
100.00

13. NCPI
Area\Score
2005*
2007
2009
Strategic Planning 7 8
7.25
Political Support
7.3
Human rights
3.7 5
Enforce the existing policies laws and regulations 2
3.5
7.75
Policy efforts in support of HIV prevention
Efforts in implementation of HIV prevention programmes
3.8
7.1
6.75
Care and support
4.5
7.5
8.25
Efforts to meet needs of OVC 6
Civil society/ involvement
Monitoring and evaluation
7.2
Total 33
60.1
69.5
Average
5.5
6.68
6.95

14. National Composite Index 2005 - 2009

15. National Programme Indicators
Blood safety
Prevention of Mother to Child Transmission
Co-Management of Tuberculosis and HIV treatment
HIV testing in the General Population
HIV testing in Most at risk Populations
Support for Children affected by HIV and AIDS
Life skills based HIV education in schools

16. 3. Percentage of donated blood screened for HIV in a quality assured manner
100 % of blood is screened for HIV
Blood donation is decentralized
Blood screening is conducted for HIV, Hepatitis B, C and syphilis

17. 4. Percentage of women and men with advanced HIV infection receiving ART

18. Male and female clients enrolled on ART

19. 5. Percentage of HIV positive pregnant women who receive a complete course of ART to prevent mother to child transmission in the last 12 months

20. 6. Percentage of estimated HIV-positive incident TB cases that receive treatment for TB and HIV
A lot is being done in this area but data is not adequately collected 531 cases of TB /HIV were recorded and provided with co-management in 2009

21. 7. Percentage of respondents who received an HIV test result and know their results in the last 12 months.
2003
2008
Age group
Male
Female
15- 24
1.6%
1.7%
8.2%
4.9%
15-19
1.1%
1.0%
2.6%
20-24
2.4%
5.7%
7.6%
25-29
3.2%
4.7%
12.5%
30-39
4.2%
2.9%
8.0%
3.6%
1.8%
3.7%
overall
3.3%
2.3%
4.1%
6.8%

23. 9. Percentage of MARP reached with prevention programmes
8. Percentage of MARP who received an HIV test in the last 12 months and who know their status
No data available
9. Percentage of MARP reached with prevention programmes
16,742 FSW were reached from December 2008 to December 2009
Total estimated sex workers 34,990
Percentage sex workers reached 47.9%

24. 10. Percentage of OVC whose household received free basic external support in caring for a child
In 2008, 4,064 were supported through the Livelihood Empowerment Against Poverty (LEAP) project
2009, 10,722 OVC received support in 41 districts
This represents 7.36% of all OVC in the country

25. 11. Percentage of school that provided life-skills based HIV education in the last academic year
public
private
total
total number of schools
19,778
5,061
24,839
Schools with HIV FLHE
16,618
3.032
19,650
percentage of schools with HIV FLHE
84.0%
59.9%
overall percentage
79.1%

26. Knowledge and behavior Indicators
Orphans : School attendance
Young people : knowledge and HIV prevention
MARPS: knowledge about HIV transmission Prevention
Sex before the age of 15
Higher-risk sex
Condom use during higher risk sex
Sex worker condom use
MSM condom use
IDU condom use
IDU sexual practices

27. 12. Current school attendance among orphans and non-orphans aged 10–14
School attendance in children whose parents are both dead is 67%
School attendance in children whose parents are both living is 88%
The ratio of school attendance is 0.76

28. Trend of school attendance among orphans and non-orphans aged 10–14
2003
2006
2008
orphans
65%
88.9%
67%
non orphan
81%
85.8%
88%
Ratio
0.80
1.04
0.76

29. 13. Percentage of young people aged 15–24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission
In 2008, only 28.3% of female respondents and 34.2% of men had comprehensive knowledge in about HIV and AIDS.
In 2006, 25.1% of young women and 33% of young men aged years had comprehensive knowledge .
Little change has been noted in the comprehensive knowledge of young people

30. 14. Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission
Indicators
Seater
Roamer
% Change Δ
Correctly identified ways of preventing sexual transmission of HIV/AID
2006
2009
Seaters
Roamers
Abstinence
48.1
30.7
29.5
20.0
+17.4
+9.5
Use of condoms
46.7
32.6
29.6
18.4
+14.1
+11.2
Being faithful to one uninfected partner
47.4
31.7
29.8
18.9
+15.7
+10.9
And reject misconceptions about transmission:
HIV not transmitted by mosquitoes
48.6
35.3
30.6
18.6
+13.3
+12.0
HIV not transmitted through used needle
48.5
31.6
+16.9
+12.2
HIV transmitted to unborn
47.8
31.0
+16.1
+12.1
HIV not transmitted by healthy looking people
48.2
32.5
31.4
18.5
+12.9
Disease to newborn
50.5
32.0
18.8
+18.5
+13.2

31. 13. Percentage of young women and men aged 15–24 who have had sexual intercourse before the age of 15
Age
Females
Males
7.5%
4.4%
9.3%
2.5%
15 – 19
8.2%
3.6%
20 -24
7.2%
5.2%
15 – 24
7.8%
4.3%

32. Percentage of young women and men aged 15–24 who have had sexual intercourse before the age of 15 in 2003 and 2008

33. 16. Percentage of women and men aged 15–49 who have had sexual intercourse with more than one partner in the last 12 months
2003
2008
Age
Female
Male
15- 49
1.1%
9.9%
1.0%
11.3%
15 – 19
1.5%
2.4%%
1.2%
3.1%
20 – 24
1.9%
10.4%
1.6%
9.6%
25 – 29
0.4%
13.8%
1.7%
16.7%
13.5%
0.5%
15.5%
11.1%
0.2%
12.4%

34. Percentage of women and men aged 15–49 who had more than one partner in the past 12 months who used a condom during their last sexual intercourse
This indicator is not measured in the GDHS since the higher risk
sex is defined differently and the indicator is measured for men only
2003
2008
Age
Female
Male
15- 49
28%
44.8%
25.4%
45.1%
15 – 19
33.5%
46.2%
24.4%
40.3%
20 – 24
32%
54.7%
31.1%
48.9%
25 – 29
27.4%
43.3%
31.3%
49.3%
13.1%
37.1%
11.0%
45%
11.2%
37.5%
6.3%
27.1%

35. aged 15 -49 with more than one sexual partner.
Percentage of women and men aged 15–49 who had more than one partner in the past 12 months who used a condom during their last sexual intercourse
For men only
aged with more than one sexual partner.
26.2% used a condom in the last sexual act % % % % %

36. 18. Percentage of female and male sex workers reporting the use of a condom with their most recent client
95.6% of FSW
19. Percentage of men reporting the use of a condom the last time they had anal sex with a male partner
50.5% of MSM

37. Injecting Drug Users
Percentage of injecting drug users reporting the use of a condom the last time they had sexual intercourse
Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected
Data for these indicators are not available. A study must be commissioned for this purpose

38. Impact Indicators Reduction in HIV prevalence
MARPS reduction in HIV prevalence
HIV treatment after 12 months survival
Reduction of mother to child transmission

39. Percentage of young people aged 15–24 who are HIV infected
Year
HIV prevalence
2006
2.5%
2007
2.6%
2008
1.9%
2009
2.1%

40. HIV prevalence in 2006 – 2009 in 15 -24 years

41. Percentage of most-at-risk populations who are HIV-infected
Location and type category of sex worker
2006
2009
Accra
Roamers
28.5
17.4
Seaters
51.8
32.6
All Accra FSW
39.1
25.0
Kumasi
21.9
21.2
39.3
28.7
All Kumasi FSW
30.7
24.9
All roamers
25.2
19.3
All seaters
45.0
Overall
34.7

42. Impact indicators (continued)
Percentage of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy
89.8% of clients on first line are still on treatment after 12 months
Percentage of infants born to HIV-infected mothers who are infected
More detailed information required from Early infant diagnosis. Modeling required

43. Some Best Practices Models of Hope
Strategic Planning with greater stakeholder involvement
Mobile counselling and testing and Know your status campaign
Public Private Partnerships – workplace programmes

44. Some challenges Inadequate resources for implementation of activities
Inadequate numbers of skilled human resources at the decentralised level
Lack of comprehensive HIV prevention interventions targeted at addressing the gaps in knowledge and behavior
Stigma and discrimination
Slow progress at addressing policies and laws which are obstacles in HIV prevention and treatment

45. Conclusion and Recommendations for UNGASS reporting
Much progress has been made
Gaps have been seen especially in the area of HIV prevention
Ensure that research is commissioned on all indicators to address data gaps for better monitoring
Ensure that we use the data generated for future planning
Ensure that we monitor the implementation of the recommendations

46. Thank you for your attention