UNAIDS
Assessment of progress
on the ten targets and
elimination
commitments of the
2011 United Nations
General Assembly
Political Declaration on
HIV/AIDS
EEP Division
1/25/2013
1.
REDUCE SEXUAL TRANSMISSION
1.0) Is this a priority target for your country?
If no, why not?
NATURE OF THE EPIDEMIC
1.1) What is the type of epidemic of the country? (Concentrated/Generalized/Mixed)
1.2) In what year has HIV incidence modelling been last carried out?
1.3) In what year did the country analyze incidence by Modes of Transmission (MOT)?
1.4) Which 3 groups account for most infections?
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Sex Workers and their Clients
Men Having Sex with Men
Stable Partnerships
Multiple Heterosexual Partners
1.5) Please provide the date and estimate of the last population size estimation:
Date of Estimate
Estimated Population Size
Men who have sex with men
Sex Workers
NATIONAL TARGETS
1.6) Does your country have a national target for reduction of sexual transmissions?
1.7) If yes, what is your national target for reducing sexual transmission by 2015?
1.8) How does this relate to the 2011 Political Declaration target? (higher, equal, lower)
1.9) What is the percentage of young people aged 15-24 who are living with HIV (GARPR 1.6)? Please
specify the year.1
1.10) Is the above percentage increasing, decreasing, or constant?1
1.11) What is the percentage of adults aged 15-49 who have had sexual intercourse with more than
one partner in the past 12 months (GARPR 1.3)?1
1.12) Is the above percentage increasing, decreasing, or constant?1
1.13) What is the percentage of adults aged 15–49 who had more than one sexual partner in the
past 12 months who report the use of a condom during their last intercourse (GARPR 1.4)?1
1.14) Is the above percentage increasing, decreasing, or constant?1
PREVENTION RESPONSE
1.15) Are the following strategies in place for reaching the target:
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1
ART for prevention
Male Circumcision1
Tailored behaviour change programs addressing multiple partnerships 1
Targeted condom distribution and promotion
Answer only if country is categorized as generalized epidemic
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Tailored intensive programmes for key populations
Other (Please Specify):
1.16) Does the country have laws, regulations or policies that present obstacles to effective HIV
prevention for key populations and vulnerable groups? (NCPI)
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Men who have sex with men
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Sex workers
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Young women, young men
1.17) Has the Number of adult male circumcisions performed increased over the past last 6
months?2
1.18) What is the estimated number of MSM reached with prevention interventions?
1.19) What was the estimated number of sex workers reached with prevention interventions?
RESOURCE ALLOCATION
1.20) What are the trends in AIDS Spending for selected prevention activities in the last year:
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key populations (Increasing, Decreasing, Constant)
condom promotion and distribution (Increasing, Decreasing, Constant)2
communication addressing multiple partnerships (Increasing, Decreasing, Constant)2
male circumcision (Increasing, Decreasing, Constant) 2
1.21) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
2
Answer only if country is categorized as generalized epidemic
2.
PREVENT HIV AMONG DRUG USERS
2.0) Is this a priority target for your country?
If no, why not?
NATIONAL TARGET
2.1) What is the last IDU population size estimate and date of estimation?
2.2) What is the estimated number of new HIV infection among IDU in the last year?
2.3) Do you have a national target for reducing HIV infection among IDUs by 2015?
2.4) If no, do you plan to establish a 2015 target this year?
2.5) If yes, what is your national target for reducing HIV transmission by 2015 (percentage reduction
as compared to 2011 levels)?
2.6) How does this relate to the the 2011 Political Declaration target (Reduce transmission of HIV
among people who inject drugs by 50% by 2015)? (higher, equal, lower)
NATIONAL STRATEGY
2.7) Which elements of HIV prevention does the national policy/strategy address?
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Needle & Syringe Exchange
Opioid Substitution Therapy (OST)
NEEDLE & SYRINGE EXCHANGE
2.8) What is the number of People Who Inject Drugs (PWID) reached with NSP?
2.9) Is the number of PWID reached by NSP increasing?
OPIOID SUBSTITUTION THERAPY
2.10) What is the number of injecting drug users enrolled in Opioid Substitution Therapy?
2.11) Is the number of PWID enrolled in OST increasing?
2.12) Do OST program clients receive recommended maintenance dose of 60mg of methadone per
day or 12mg of buprenorphine per day?
2.13) What is the proportion of PWID with HIV on ART?
RESOURCE ALLOCATION
2.14) What was the estimated proportion of HIV resources spent on programs targeting persons
who use drugs?
2.15) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
3.
ELIMINATE NEW HIV INFECTIONS AMONG CHILDREN
3.0) Is this a priority target for your country?
If no, why not?
NATIONAL TARGET
3.1) What is the estimated number of children who were newly HIV infected due to mother to child
transmission (including breastfeeding) in the last calendar year? (GARPR)
3.2) Does your country have a national target for elimination of infections among children?
3.3) How does the national target relate to the Political Declaration target - 90% reduction in new
infection among children (“elimination”) between 2011 and 2015?
3.4) Is there a defined national “elimination” plan or strategy?
KEY INDICATORS
3.5) What is the estimated number pregnant women living with HIV in the last calendar year (from
spectrum)?
3.6) What is the proportion of pregnant women attending ANC services at least once? (please use
nationally-representative household survey, if possible)
3.7) What is the percentage of HIV-positive pregnant women who received antiretrovirals to reduce
the risk of mother-to-child transmission in the last calendar year (GARPR 3.1)?
3.8) Has that percentage been increasing?
ARV PROPHYLAXIS OPTIONS
3.9) Which main ARV prophylaxis option is used according to national policy? Is Single-dose
Nevaripine used as a main ARV prophylaxis according to national policy?
3.10) What are the plans to switch to option A, B or B+?
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Phased out by the end of calendar year
To be phased out next year
Continued without other plans
3.11) What percent of pregant women living with HIV who are eligible for ART for their own health
are currently receiving ART?
3.12) Has that percentage been increasing?
EARLY INFANT DIAGNOSIS
3.13) What percentage of infants born to HIV positive women is receiving early infant diagnosis (EID)
within 2 months of birth?
3.14) Has that percentage been increasing?
3.15) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
4.
15 MILLION ACCESSING TREATMENT
4.0) Is this a priority target for your country?
If no, why not?
NATIONAL TARGET
4.1) Does your country have a national target for access to treatment by 2015?
4.2) How does this relate to the 2011 Political Declaration target (80%)?
COVERAGE
4.3) What is the estimated number of adults (+15) needing antiretroviral therapy based on 2010
WHO guidelines?
4.4) What is the number of adults (+15) receiving antiretroviral therapy?
4.5) Is the number of adults receiving ART increasing?
4.6) What are the numbers of patients under 1st line, 2nd line, and 3rd line (following WHO
definition)? (2011)
a. 1st Line:
b. 2nd Line:
c. 3rd Line:
4.7) What is the number of patients newly enrolled in ART in the first 6 months of 2012?
4.8) What is the percentage of adults (15+) with HIV known to be on treatment 12 months after
initiation of antiretroviral therapy (GARPR 4.2)?
ART REGIMENS
4.9) If stavudine based regimes are still used, are there plans to phase them out?
4.10) What is the proportion of patients treated with Fixed Dose Combination (1 pill today)? (<20%,
20-50%, 50-80%, >80%)
POLICIES
4.11) Are nurses licensed/allowed to …
a. initiate patients on ART?
b. maintain patients on ART?
4.12) Are Community Health Workers allowed to …
a. perform rapid HIV tests?
b. re-supply patients with ARV?
4.13) Have point-of-care HIV treatment monitoring tools been introduced? (no, only at small scale,
nationwide)
COSTS
4.14) What is the total treatment cost per patient per year?
4.15) What proportion of HIV Budget is allocated to treatment?
4.16) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
5.
AVOID TB DEATHS
5.0) Is this a priority target for your country?
If no, why not?
NATIONAL TARGET
5.1) What is your national target to reduce HIV related TB deaths?
5.2) How does this relate to the 2011 Political Declaration target (“reduce HIV related TB deaths by
50% by 2015”)?
NATIONAL POLICY AND GUIDANCE
5.3) Does the country have a policy on:
a. Isoniazid Preventive Therapy (IPT)?
b. TB Screening among people living with HIV?
5.4) Which of these guidelines/protocols/algorithms are followed for preventing TB among HIV
patients?
a. WHO policy on collaborative TB/HIV activities: guidelines for national programmes and
other stakeholders (WHO)
b. Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for
people living with HIV in resource-constrained settings (WHO)
c. c. Treatment of Tuberculosis: guidelines for national programmes (WHO)
d. d. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected
Adults and Adolescents (CDC)
e. e. Others (Please specify):
KEY INDICATORS
5.5) What was the number of people registered as HIV-positive given isoniazid prophylaxis
(treatment of latent TB infection) in the last calendar year?
5.6) Has this number been increasing?
5.7) What is the number of people registered as HIV-positive screened for TB at least once during
year?
5.8) Has this number been increasing?
5.9) What was the number of HIV-positive TB patients started or continued on ART?
5.10) Has this number been increasing?
5.11) What is the number of deaths due to TB among HIV-positive people, per 100 000 population
5.12) Has this number been increasing?
5.13) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
6.
CLOSING THE RESOURCE GAP
6.0) Is this a priority target for your country?
If no, why not?
FUTURE NEEDS
6.1) Have future HIV investment needs been estimated?
6.2) If so, what are the estimated investment needs for?
2013:
2014:
2015:
PAST EXPENDITURE
6.3) What was the latest estimated total HIV expenditure from all public, private & international
sources?
6.4) What proportion was domestic funding? (<20%, 20-40%, 40-60%, 60-80%, >80%)
DOMESTIC PUBLIC INVESTMENT
6.5) What was the amount budgeted by the country from domestic sources in the last year (2012)?
6.6) Has the national domestic budget allocation been increasing faster than national economic
growth during the last 3 years?
6.7) Is the national domestic budget allocation expected to increase in the next years?
6.8) Is the country planning specific actions to increase domestic HIV financing?
6.9) Are there plans for innovative financing of the HIV response, such as AIDS trust funds,
earmarked taxes or inclusion of HIV into national health insurance schemes? (If yes, please describe)
INTERNATIONAL ASSISTANCE
6.10) What was the estimated amount of international assistance in the past year?
6.11) Is the amount of international assistance expected to increase in the next three years?
ALLOCATIVE AND TECHNICAL EFFICIENCY
6.12) Do current HIV budget allocations match the distribution of infection by population group and
regional distribution in the country?
6.13) If not, are there plans for re-allocating HIV resources?
6.14) How are HIV commodity prices as compared to international prices in other low and mid
income countries (e.g. WHO drug price reporting mechanism)?
6.15) If higher, are there plans underway to review procurement practices with the aim to reduce
commodity prices?
6.16) Has there been a review of different HIV service delivery model options (e.g. integrated,
decentralized, community based) with the view to make services more accessible and reduce costs?
RESOURCE GAP
6.17) Do you believe that there is currently a significant resource gap?
6.18) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
7.
ELIMINATE GENDER INEQUALITIES
7.0) Is this a priority target for your country?
If no, why not?
GENDER INEQUALITIES
7.1) Has a gender assessment of the epidemic, context, response been undertaken?
7.2) Has the data from the assessment been used to inform the HIV strategy?
7.3) Does the National Strategic Plan (NSP):
a. include specific actions to address the needs and rights of women and girls and gender
equality?
b. include a specific budget to address the gender related aspects of HIV vulnerability?
c. address the needs and rights of transgender people?
d. address the needs and rights of women from key populations?
e. include activities to engage men and boys?
GENDER BASED ABUSE AND VIOLENCE
7.4) Are there mechanisms to track Gender Based Violence?
7.5) What is the proportion of ever-married or partnered women aged 15-49 who experienced
physical or sexual violence from a male intimate partner in the past 12 months?
7.6) What is the source and date of the data?
7.7) Is this data used to inform the HIV strategy or proposals development?
7.8) Does the NSP include specific actions to address the violence against women and girls?
7.9) Does the country have a policy, law or regulation to reduce violence against women, including
for example, victims of sexual assault or women living with HIV?
IMPACT
7.10) Is there evidence that gender inequality has been reduced as a result of the laws, policies and
programs that create an enabling environment and improve sexual and reproductive health?
7.11) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
8.
ELIMINATE STIGMA & DISCRIMINATION
8.0) Is this a priority target for your country?
If no, why not?
STIGMA AND DISCRIMINATION SITUATION
8.1) What mechanisms exist to document and redress human rights violations related to HIV in the
country? (Police records, court case records, special survey & studies, none)
8.2) Has there been an assessment of the level, nature and impact of HIV-related stigma and
discrimination on the HIV response (such as Stigma Index)?
8.3) What were the main findings?
People living with
HIV experienced
Key Populations
experienced
a. Stigma in family and community (e.g. excluded from family, social or
religious activities, gossiped about)
b. Violence (e.g. verbally insulted, assaulted or threatened, physically
harassed or assaulted because of HIV status).
c. Discrimination in health care settings (e.g. denied services, including
dental care, SRH and FP services)
d. Discrimination in the work place (e.g. loss of job or income,
employment opportunity refused)
8.4) Has there been an assessment of the legal, policy and social environment to identify the key
barriers to HIV response?
8.5) What were the findings of these assessments?
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Punitive laws against people living with HIV hinder their access to services
Punitive laws against members of key populations hinder their access to services
Enforcement of punitive laws hinder access to HIV services
Lack of enforcement of protective laws contributes to stigma and discrimination
RESPONSE
8.6) Have programmes to reduce HIV-related stigma and discrimination been implemented?
8.7) Do these programmes include:
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activities to increase acceptance & advance non-discrimination against people living with HIV or
members of key populations
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HIV-related legal services for people living with HIV and members of key populations
legal literacy (“know your rights”) programmes
sensitization of law-makers and law enforcement agents
training for health care providers on human rights and medical ethics related to HIV
activities to reduce discrimination against women in the context of HIV
IMPACT
8.8) Is there evidence that stigma and discrimination has been reduced as a result of the
implementation of these programs?
8.9) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
9.
ELIMINATE TRAVEL RESTRICTIONS
9.0) Is this a priority target for your country?
If no, why not?
9.1) Are there restrictions on the entry, stay or residence of people living with HIV based on their HIV
status?
9.2) Have there been any reports of people being denied entry, stay or residence, or being deported
based on their HIV status in the last 6 months?
9.3) If HIV-related travel restrictions exist, what are the actions undertaken by the national program
to remove them?
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Review of laws, regulations, policies and practices related to entry, stay, and residence for
people living with HIV
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Initiation of policy dialogue among different stakeholders (e.g. relevant ministries,
departments, parliamentary committees, cvil society and private sector) with the aim of
removing entry, stay and residence restrictions
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Initiation of formal process to remove entry, stay and residence restrictions from laws and
regulations, poplocuies and guidelines
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Initiation of formal process to remove questions about HIV status from visa application
forms
9.4) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
10.
STRENGTHEN HIV INTEGRATION
10.0)
Is this a priority target for your country?
If no, why not?
ALIGNMENT WITH MDGs 4 & 5
10.1) Are national targets, regarding HIV and child and maternal mortality aligned?3
INTEGRATION OF HIV WITH HEALTH & DEVELOPMENT PLAN
10.2) Are key populations, at increased HIV risk, mentioned in the national development plan?
10.3) Are national health and AIDS planning and budget cycles aligned?
INTEGRATION OF HIV FINANCING
10.4) What is the estimated proportion of HIV donor funds that is implemented outside the
government budget (off-budget)?
10.5) Which HIV services are covered by the national health insurance scheme?
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all HIV services
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HIV testing
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ART
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PMTCT
OI
No national health insurance scheme exists
INTEGRATION WITH OTHER HEALTH PROGRAMS & HEALTH SYSTEM
10.6) Which national PMTCT program elements are integrated into MNCH programs?
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Joint management
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Joint supervision
training
10.7) Are HIV-TB programs coordinated?
10.8) How is the HIV M&E system integrated with the Health Information System (HIS)?
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Joint staff
Joint data collection systems
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Joint database
Joint program reviews
Other elements:
10.9) Are HIV medicines and diagnostics procured and/or distributed through the same system as
commodities for other diseases?
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Joint procurement
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Joint warehousing
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Joint transport
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Joint stock control
10.10) How are HIV care providers remunerated as compared to other health workers?
INTEGRATION OF HEALTH SERVICES
10.11) Are health facilities providing HIV services integrated with other health services?
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ART and Tuberculosis
ART and chronic Non-Communicable Diseases
ART in general outpatients
PMTCT with Antenatal Care/Maternal & Child Health
Counselling & Testing with Sexual & Reproductive Health
10.12) DO YOU BELIEVE THE COUNTRY IS ON TRACK TO REACH THIS TARGET?
3
Answer only if country is categorized as generalized epidemic