1. HIV/AIDS among Conflict Affected and Displaced Populations: Programmatic and Operational Challenges Dr Dieudonne Yiweza Senior HIV/AIDS Régional Coordinator, Central Africa

2. Displacement Cycle

3. Principles of Response Objectives: 1.Affected population lives in dignity, free from discrimination, and human rights respected 2.Reduced HIV Transmission 3.Access to prevention interventions linked to care and treatment programmes

4. Principles of Response cont Protection: –No mandatory testing –No persecution on basis of HIV status Coordination: –Multisectoral coordination –Inclusion of affected population Response: –Focused and hierarchical approach

5. Implementation: Phased and Hierarchical Approach IASC HIV Guidelines for Emergencies 1.Minimum essential HIV/AIDS interventions provided (e.g. blood, UP, STI, Condoms, IEC) 2.Comprehensive interventions (link prevention with care/treatment): e.g. VCT, PMTCT, PEP –Antiretroviral therapy (ART) when provided to surrounding host population –Consider repatriation/reintegration and availability in areas of return

6. Implementation: Realities, Challenges and Opportunities Often come from and arrive in rural, remote, inaccessible and underserved zones Majority: children, young people and women Little to no health and social facilities available Host population often as poor or poorer Level of interactions with local pop. important Govt institutions often non-existent or poorly functioning NGOs sometimes not in place due to lack of funds, logistical issues or security reasons

7. Realities, Challenges and Opportunities cont. Not included in host country/district plans Delay on external relief Multiple needs thus prioritising essential Cross-border aspects Urban vs. rural caseloads Scattered vs. concentrated groups New vs. protracted situations

8. Scattered vs. Concentrated Populations Much easier to develop strategies when population is considered When scattered, need innovative strategies including community approaches

9. Inclusion in Host Country and District Plans Often not included in various national strategic plans (e.g. development, HIV) Considered responsibility of international community Need continuous advocacy at national, regional and global levels Examples include: –World Bank MAP in DRC : HCR and DRC NAC agreement; programs for refs, IDPs and returnees –South Africa, Namibia, and Zambia: free ART to local and ref populations

10. Interaction with Surrounding Host Populations Often very close contact with host pop. Latter have similar needs, if not more Usually in both pop: majority of pop. are youth and women = at risk groups Often host pop. use displaced pops facilities Need to integrate the 2 groups in programmes, trainings, M&E and funding plans

11. Cross-border Aspects Surrounding countries often affected by conflict(s) Similar pop. have similar needs across borders Need sub-regional approach Continuity of services Similar testing algorithms and treatment Lower costs for prevention and treatment services Improved program efficiency Great Lakes Initiative on AIDS (GLIA) Oubangui-Chari Initiative Mano River Union Initiative

12. Repatriation HIV prevention package during repatriation (e.g. awareness, condoms, leaflets, F/U information) Affected pop. become human resources for HIV interventions in return areas: –Return areas often underserved w poor HIV programs –Trainings, knowledge acquired during asylum (NGOs, host country programmes) –F/U of PLWHAs and continuation of HIV activities in return areas Need cross border coordination and Preparation in return areas for F/U and continuation of programs including ART

13. Repatriation and Long-term ART In Host country: –Available to surrounding pop –When to start? –Who pays and duration of funding? In Country/area of return: –Availability of ART to local pop –Who pays and how much? –Treatment protocol issues Need sub regional approaches Advocacy in both countries: commitment and equity issues

14. ART in 2005: DRC case