From Making the Case to Generating a Response

The Answer lies Within

Monica Sharma, Director HIV/AIDS Group - UNDP

14,000 new infections in the world

In the 1 hour we talk: 600 new infection

All preventable through human actions

Every 6 seconds, someone, somewhere becomes HIV positive

Saturday, 26 June, 2004

HIV and AIDS in the Middle East and North Africa

At the end of 2003 an estimated:600,000 Adults aged 15-49 were living with

HIV/AIDS,55 000 People became newly infected with HIV, and 45 000 died due to .

In 2001250,000 Women aged 15-49 were living with

HIV/AIDS, and35,000 children were living with HIV/AIDS.

0 10 20 30 40 50 60 70

Cambodia

Haiti

Mozambique

Rwanda

Côte d'Ivoire

Zambia

Kenya

South Africa

Zimbabwe

Botswana

Life expectancy at birth (years)

Predicted life expectancy

Predicted loss in life expectancy due to HIV/AIDS in children born in 2000

Loss in life expectancy due to HIV/AIDS

8.3

17.9

29.4

22

33.3

girls

0 0

3.62.2

8.6

0

5

10

15

20

25

30

35

15 16 17 18 19Age in years

HIV

pre

vale

nc

e (%

)

boys

Source: National AIDS Programme, Kenya, and Population Council, 1999

HIV prevalence rate among teenagers in Kisumu, Kenya, by age

Where are we?

• Infections not leveling off: 40% of adults in Botswana are HIV positive 34% in Zimbabwe, 33% in Swaziland and 31% in Lesotho

• Russia: reported cases rise from 11,000 to 300,000 in last 4 years

• LAC: HIV prevalence of 1% or more in 12 countries, all Caribbean

• CIS, Asia experience fastest-growing HIV/AIDS epidemic

• Feminization of epidemic: in Sub-Saharan Africa women make 60% of HIV positive adults; globally this figure is 50% for the first time

• India: 95% of new infections in women were among married and monogamous

• Stigma & discrimination: Surveys reveal that majority of respondents do not want to work with people living with HIV/AIDS

• Lack of treatment: In Africa only 2% of PLWHA have treatment

• Vast secondary impacts: Orphans, basic social services, instability

HOPETRANSFORMATION

RESULTS

HIV/AIDS Epidemic

• SEX• FEAR• SHAME• DEATH• DENIAL• STIGMA• SILENCE• DISCRIMINATION

Generating an Extraordinary

Response, with Results

UNDP’s Goal

•Nation-wide

•Multisector

•Multi-level

•Gender sensitive

•Including PLWHA

“Governance is defined as the exercise of political, economic and administrative authority to manage a nation’s affairs. It is the complex mechanisms, processes, relationships and institutions through which citizens and groups articulate their interests, exercise their rights and meditate their differences… Governance embraces all methods that societies use to distribute power and manage public resources and problems… Effective democratic forms of governance rely on participation, accountability and transparency.”

UNDP, 1997

Governance Challenge of HIV/AIDS

INSTITUTIONAL ENERGY

TRANSFORMATION

RESULTS

Meeting the Governance Challenge

• Institutional inertia

• Often too medical

• National, Sub-national Disconnect

• Innovation stifled

• Medical, human rights responses not integrated

• Community voice not heard, decisions not supported

• Underlying causes often ignored (e.g., stigma, power, access)

2. Care & support

WHO, World Bank

4. Reduce vulnerability

Secretariat, NGOsWorld Bank, UNDP

5. Research & Development

WHO, World Bank

3. Mitigate socio-economic

impactWorld Bank, ILO

UNDP

Create enabling

environmentHope

ResultsTransformation

1. Prevention infection

15-25 by 25% UNICEF, UNFPA

UNODC, UNESCO

MDG: Halting & Reversing the Epidemic

Creating an Enabling Environment

Transfer of technology & economic growth

1950-60s Care: drugs available

Human rights & universal norms1970-80s

Care: near universal access to drugs; anti-discrimination

legislation

Transformation & reaching the human potential1990-2000 +

Care: with no stigma; where every person living with HIV/AIDS

contributes as a productive member of society

Development Practice Over TimeAre We Making the Difference We Can?

“The definition of insanity is to do the same thing over and over again, and expect different results.”

Rita Mae Brown

Subjective, Interior

Behavioral

Systems, Structures, Laws, Plans

Intention, Commitment, Values

Cultures, NormsValues

Individual

Collective

Objective, Exterior

Action

Based on Ken Wilber’s work

Integral Transformation if we are to produce results: HIV/AIDS and MDGs

Subjective, Interior

Individual

Collective

Objective, Exterior

Unavailability of testing facilities

I’m in denial of being at risk

I don’t go for testing

We are silent about the cause of death

Stimulating community decisions and actions to reverse

the HIV/AIDS epidemic (1)

Reversing HIV/AIDS through transformative leadership capacity development (1)

Strengthening systems, sectors, structures, studies, PRS,

policies and laws (2)

Arts & Media (3)

Integral Transformation if we are to produce results: HIV/AIDS and MDGs

Leadership Developmen

t Programme

Leadership for Results

L4R – A Synergistic Package for a Comprehensive Response to HIV/AIDS

Arts and Media

Development Planning &

Implementation

Community Capacity

Enhancement

• Each program is intricately linked to every other program

• The four programs work as a synergistic package and are mutually reinforcing

• The program is seen as a long term strategy that unfolds over time

Integral Transformative Leadership: A Different Approach

Leadership for Advocacy

Leadership for Results

Everyone, everywhere – leadership at all levels

Political and executive leaders

Starts with Self and self-awareness

Starts with the external

Commitment that produces results and self-

sustained initiatives

Producing understanding

Action with learning = ongoing

One-time effort

UNDP

Supporting sub-national and district level HIV/AIDS

responses

Development Planning and Implementation: Current Expectations

Mainstreaming HIV/AIDS into: National Dev Plans/Budgets,

Poverty Reduction Strat, Medium Term Expenditure Frameworks,

HIPC, UN processes (CCAs/UNDAFs and CCFs)

Mainstreaming HIV/AIDS into

sector Ministries, including planning,

finance, information, judiciary/law

Supporting strategies to address depletion of

human resources

Preparing sectoral studies responding to impact of HIV/AIDS on sectors –

education, health, agriculture, manufac-

turing, and environment

Development planning and implementation at national

level

UNDP’s Results

• Self-sustaining breakthrough initiatives and community decisions/actions through transformative leadership and community capacity enhancement

• Development and popularization of approaches to address the underlying causes of the epidemic (e.g., stigma, power relations)

• Strategies and approaches have enhanced governance and development practice, including HIV/AIDS and beyond

“The world we have made as a result of the level of thinking we have done thus far creates problems that we cannot solve at the same level at which we have created them... We shall require a substantially new manner of thinking if humankind is to survive. .”

Albert Einstein