Strengthening the Strengthening the National HIV/AIDS National HIV/AIDS Control Program in Control Program in Post-War Angola Post-War Angola Cameron Macauley, PA-C, MPHCameron Macauley, PA-C, MPH

Cary Perry, RNP, Dr.PHCary Perry, RNP, Dr.PH

Angola:Angola: Provinces: 18Provinces: 18

Municipalities: 164Municipalities: 164

Population: 14,416,810Population: 14,416,810

Pop. < 15 years: Pop. < 15 years: 6,775,9016,775,901

Pop. < 5 years: Pop. < 5 years: 2,883,3622,883,362

Pop. < 1 year: 619,923Pop. < 1 year: 619,923

Literacy rate: 42%Literacy rate: 42%

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Post-Conflict Angola:Post-Conflict Angola: Extensive damage to infrastructure & Extensive damage to infrastructure &

economyeconomy

Lack of human resourcesLack of human resources

Lack of schools, health services, law Lack of schools, health services, law enforcement, employmentenforcement, employment

Widespread government corruptionWidespread government corruption

Strong dependence on external assistanceStrong dependence on external assistance

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Post-Conflict Angola:Post-Conflict Angola: Armed bandits, land mines interfere Armed bandits, land mines interfere

with travel; Large areas of the with travel; Large areas of the country still inaccessiblecountry still inaccessible

800,000 IDPs, 450,000 refugees 800,000 IDPs, 450,000 refugees returning homereturning home

HIV/AIDS considered as a lower HIV/AIDS considered as a lower priority problem when compared to priority problem when compared to other conflict-related problemsother conflict-related problems

55

5.5

22.5

21.5

38.833.7

7.2 4.9

20.1

13.0

7.8 15.0

8.35.0

15.0

6.4 1.012.911.8

5.8

31.033.4

HIV Seroprevalence in HIV Seroprevalence in Angola:Angola:

Few reliable statistics Few reliable statistics are availableare available

The situation is The situation is changing rapidlychanging rapidly

170,000 refugees 170,000 refugees returning from DR returning from DR Congo, Zambia, Congo, Zambia, Namibia in 2004Namibia in 2004

66

77

Epidemic Curve Epidemic Curve It is estimated that 18% of the population It is estimated that 18% of the population

will be infected by 2010will be infected by 2010

00.020.040.060.08

0.10.120.140.160.18

0.2

Low prevalenceHigh prevalenceLuandaHuilaBenguela

Source: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEFSource: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEF

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HIV Surveillance in HIV Surveillance in Angola:Angola:Discrepancy in 2003 figures:Discrepancy in 2003 figures:

– Angolan Govt estimates: 8.6%Angolan Govt estimates: 8.6%– UNAIDS: UNAIDS: 5.5%5.5%– WHO Afro: WHO Afro: 2.4 %2.4 %

GroupGroup Seroprevalence(%)Seroprevalence(%)CSWCSW 33.1(2001)33.1(2001)TB patients TB patients 10.4 (2001)10.4 (2001)Blood donors Blood donors 9.0 (2001) 9.0 (2001)Pregnant women Pregnant women 8.6 (2001) 8.6 (2001)VCTVCT 10.5 (2003) 10.5 (2003)Military personnelMilitary personnel 6.0 (2003)6.0 (2003)Prisoners Prisoners 4.5 (2003)4.5 (2003)Source: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEFSource: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEF

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Contributing Factors to HIV Contributing Factors to HIV Seroprevalence in Angola:Seroprevalence in Angola:

Massive, poorly controlled military Massive, poorly controlled military dispersed across the countrydispersed across the country

84,000 war orphans84,000 war orphans

Health services budget split between Health services budget split between malaria, TB, trypanosomiasis, and malaria, TB, trypanosomiasis, and HIV/AIDSHIV/AIDS

1010

Contributing Factors to HIV Contributing Factors to HIV Seroprevalence in Angola:Seroprevalence in Angola:

Lack of treatment options discourages Lack of treatment options discourages people from seeking testspeople from seeking tests

Only 5 VCT sites in operation, all in Only 5 VCT sites in operation, all in LuandaLuanda

Lack of publicity makes the pandemic Lack of publicity makes the pandemic appear distant and not a real threatappear distant and not a real threat

1111

Contributing Factors to HIV Contributing Factors to HIV Seroprevalence in Angola:Seroprevalence in Angola:

Lack of employment opportunities for women Lack of employment opportunities for women leads to Commercial & Barter Sex leads to Commercial & Barter Sex

Large numbers of construction workers, soldiers, Large numbers of construction workers, soldiers, and short-term laborersand short-term laborers

Lack of information about HIVLack of information about HIV Lack of condomsLack of condoms No safe blood supplyNo safe blood supply Lack of alternatives to breastfeeding for Lack of alternatives to breastfeeding for

seropositive mothersseropositive mothers

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How Can M&L Help?How Can M&L Help? Assist the National HIV/AIDS Control Program Assist the National HIV/AIDS Control Program

(PNLS) in decentralizing the National HIV/AIDS (PNLS) in decentralizing the National HIV/AIDS Strategic Plan (PEN) by:Strategic Plan (PEN) by:

• Disseminating a summary of the PEN to align Disseminating a summary of the PEN to align stakeholders & to be used as a basis for stakeholders & to be used as a basis for planningplanning

• Building management & leadership capacity Building management & leadership capacity to implement HIV/AIDS control programs in to implement HIV/AIDS control programs in priority municipalitiespriority municipalities

• Provide logistical and technical support for the Provide logistical and technical support for the PNLSPNLS

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Challenges Facing M&LChallenges Facing M&L in Angola: in Angola:

World’s most expensive countryWorld’s most expensive country

Uncertain funding from USAID, forcing Uncertain funding from USAID, forcing piecemeal planningpiecemeal planning

No field staff on the ground (yet)No field staff on the ground (yet)

PNLS has little technical capacity PNLS has little technical capacity

M&L’s strategy has yet to be clearly definedM&L’s strategy has yet to be clearly defined

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Proposed M&L Proposed M&L StrategyStrategy

Target selected municipalities in selected Target selected municipalities in selected provincesprovinces

Distribute PEN summary to all stakeholdersDistribute PEN summary to all stakeholders Workshops provide forum for strategic Workshops provide forum for strategic

planning, take participants through the M&L planning, take participants through the M&L framework (Egypt model)framework (Egypt model)

Follow-up after each workshop to provide Follow-up after each workshop to provide guidance & supportguidance & support

59 priority 59 priority municipalitiemunicipalities identified s identified during recent during recent polio polio immunizatioimmunization campaignsn campaigns

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M&L Angola Proposed Timeline, M&L Angola Proposed Timeline, 20042004

Mar Apr May Jun Jul Aug Sep Oct Nov DecMar Apr May Jun Jul Aug Sep Oct Nov Dec

Planning Meeting with PNLS

Preparatory meetings with: •local NGOs,•Angolan military,•Provincial & municipal health managers

1st HUAMBO District Workshop:•Identifying Challenges•Scanning & Focusing

2nd HUAMBO District Workshop:•Aligning & Mobilizing

3rd HUAMBO District Workshop:•Inspiring •Measuring Results

Huambo Municipal

Team meeting

Huambo Municipal

Team meeting

Huambo Municipal

Team meeting

1st BENGUELADistrict Workshop

2nd BENGUELA District Workshop

3rd BENGUELADistrict Workshop

Preparatory meetings

Benguela Municipal

Team meeting

Benguela Municipal

Team meeting

Follow-Follow-up & up & supportsupport

Huambo Huambo ProvinceProvince

Benguela ProvinceBenguela ProvincePreparatory meetings

1st BengoDistrict WorkshopBengo ProvinceBengo Province