USAID Regional Development Mission Asia by olliegoblue31


Regional Development Mission Asia

                            Cathy Jane Bowes
                      Director, Office of Public Health

The views expressed in this presentation are the views of the author and do not necessarily reflect the views or
policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB
does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.


                                                                        Burma, China,
                                                                        Laos, Papua
                                                                        New Guinea
                                                                        and Thailand
                                                               HIV/AIDS in Asia

         Estimated number of people living with HIV/AIDS (end of 2007, UNAIDS)
         Country (prevalence rate)                                   # 2007    # 2001
         Burma     0.7% (CI: 0.4 – 1.1)                              240,000 (300,000)
         China    0.1% (CI: 0.0 – 0.2)                               700,000 (470,000)
         Lao PDR 0.2% (CI: 0.1 – 0.4)                                  5,500   (1,200)
         Thailand 1.4% (CI: 0.9 – 2.1)                               610,000 (660,000)
         PNG      1.5% (CI 1.4 – 1.6)                                  5,400   (1,000)

         General Population Prevalence is low (end of 2007): 0.1% - 1.5%

  HIV is Concentrated often at very high levels in Most at Risk Populations
  (MARPs) in Urban Hotspots:

  Female Sex Workers (Burma 28%?, China 0.3%; Laos <1%; Thailand 5%; PNG ?
  Injecting Drug Users: (Burma 38%?; China 8%; Laos ?; Thailand 29%; PNG ?
  Men who have sex with men: (Burma 30s?; China 2.1%*; Laos 5.6%; Thailand 24.7; PNG ?)

   Significant Emerging MSM Epidemics in SE Asia
**In the Asia region MSM have markedly greater risk of acquiring HIV (18.7 OR) as compared to the general population (Beyrer et al., 2008)
                     RDMA’S HIV/AIDS Strategic Approach

• Focus on developing, monitoring & evaluating, and
  replicating technical models for HIV prevention for
  MARPs linked to care and treatment services for
• Comprehensive prevention package includes
  supportive interventions necessary for success in
  reaching marginalized populations
• Strong emphasis on data for evidenced-based
• Leveraging Global Fund and other non-USG to
  achieve national scale-up

                            Cycles of Replicable Model

Phase I:               Phase II:            Phase III:
Development            Integration and      Quality
and Evaluation         Expansion            Assurance
 Implement              Monitor and          Post-expansion
                       evaluate expansion   monitoring
 Identify, develop
or adapt                Assess               Respond to
                       sustainability       changes in the
  Monitor and
                                            epidemic, new
evaluate for
                                            policies, etc.
effectiveness and
potential for
                               Replicable Models

• Replicable models for HIV prevention
   – Prevention with MARPs (MSM, IDU, female sex workers)
      • Comprehensive prevention package: behavior
        change communication, condom (and lube)
        distribution, HIV counseling testing, STI services, and
        referrals to substitution therapy and care and support
        for positives
      • Methods: Targeting hotspots with outreach, drop-in
        centers, clinics, targeted media
      • Organizational development and capacity building
        for indigenous NGOs
• Models for prevention with positives
   – PLHA-led, community-based
   – MARP-focused training and services (i.e., MSM-friendly)
   – Linking community to facility based approaches (goal w/

                             Replicable Models (2)

• Replicable models for HIV care
    – Positive Partnership Project - Income generation for
      people living with HIV/AIDS
        • Pairing HIV+ and HIV- persons together to develop
          microenterprise while reducing stigma and discrimination in
        • New models being developed for former injecting drug users
          (IDU) and other MARPs in China and Burma
                                    Strategic Information

Coverage +
  – Surveys which monitor HIV service utilization and
    associated risk behaviors in hot spots in Thailand,
    Burma, China, and Laos
      • This data informs us what programmatic
        components are needed for our clients at what
        intensity to reduce risk behaviors
  – Repeated surveys inform us of service delivery trends,
    such as greater proportions of outreach clients (FSW
    and MSM) who access clinical STI and VCT services

                                  Strategic Information (2)

• Supporting TA for enhanced surveillance, i.e., integrated
  biologic and behavioral surveillance (IBBS) in Laos with
  FSW which documented increased condom use and
  declines in both HIV and Sexually Transmitted Infections
                  Comparison of condom use at last commercial sex, by gender



                      90                                                   91

          % 85


                 FSW reporting condom w/ client       Client reporting condom w/ FSW
                       Strategic Information (3)

  • A2 - Modeling epidemiologic data and resource
    needs combined with advocacy for policy change
    (Yunnan and Guangxi in China, Hai Phong and
    HCMC in Vietnam, Bangladesh and Thailand)
  • Strengthened government capacity to implement data
    use models at sub-national level in Chonburi,
     – Adapted successful national model for provincial
       action planning and resource mobilization
     – Will be replicated in another 43 provinces in
       Thailand with support from the Global Fund

                    Building Regional Networks

• Giving visibility and a voice to marginalized
  populations through Regional Networks
   – Support capacity building for Asian Pacific
     Network for People living with HIV/AIDS
   – Developed Purple Sky Network (PSN) for MSM
     in Greater Mekong Sub-region
      • MSM now included in all HIV/AIDS National
        Strategic Plans
                        Future Role of RDMA

• PEPFAR 2 begins ($48b which includes TB
  and Malaria and GFATM contributions)
• New administration
• Potential for:
  – Stronger links with Global Fund and other donors
  – Stronger links with other USAID Bilateral Missions
    (i.e., Cambodia, India, Philippines, Indonesia,


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