Published using Google Docs
24267.doc
Updated automatically every 5 minutes

HIV Decision-Making Checklist for RC/HCs

HIV and Humanitarian Action

In 2006, 1.8 million people living with HIV (PLWH) were also affected by conflict, disaster or displacement; this represents over 5% of all people living with HIV worldwide

Emergencies impact on a large proportion of PLWH, who may become increasingly vulnerable if they can no longer access AIDS care and treatment. Emergencies also increase vulnerability to HIV transmission among the affected population, due to large-scale displacement, gender-based violence, and disrupted health services. Humanitarian action can facilitate delivery of essential HIV services to populations affected by crises, and should prioritise HIV interventions that are designed to avert new HIV infections, and reduce the vulnerability of PLWH.

Role of RC/HCs

The RC/HC should ensure that HIV is addressed in the humanitarian response, as necessary, to prevent new HIV infections and ensure a continuum of care for PLWH. As per the TOR for HCs, HIV should be included as a cross-cutting issue in CAP/ CHAP documents, needs assessments, contingency planning and other coordination tools.

Context

Dependent on the emergency context, including the HIV prevalence rate in the affected area and the levels of displacement, gender-based violence, and access to essential services among the affected population, HIV and AIDS may require significant attention in the humanitarian response.

In hyper-endemic settings (i.e. settings with HIV prevalence over 5% among the general population), HIV and AIDS will represent a chronic vulnerability among the emergency-affected population, and households affected by HIV will be a specifically vulnerable group. Examples include many sub-Saharan African countries, such as Zimbabwe, Swaziland, Malawi etc.

In other regions, such as Latin America, HIV epidemics are mostly concentrated in high risk sub-groups of the population, such as sex workers, injecting drug users and men who have sex with men. In these settings, emergencies may disrupt access to clean syringes or condoms, which could impact on the spread of the epidemic. The challenge will be to target interventions for those sub-groups most likely to be in need of HIV services or most likely to transmit HIV to others. Examples include: Pakistan, Nepal, India, Brazil, Nicaragua.

Key questions to consider include:

  1. Is the emergency taking place in a country/ area with significant HIV prevalence i.e. over 5% of the general population?

If yes, PLWH and their families and communities will be specifically vulnerable to disrupted health services, food shortages etc. Their needs must be addressed in the humanitarian response.  

  1. If No, are there significant levels of HIV in sub-groups of the population e.g. sex workers, men who have sex with men?

If yes, the National AIDS Council and/or UNAIDS can provide information on the location of these sub-groups and how to target them most effectively through the humanitarian response.

  1. Are existing HIV actors and programmes able to address the additional vulnerability related to HIV and AIDS as a result of the crisis?

In cases where IDPs/ refugees are not able to access national HIV services such as anti-retroviral treatment (ART) etc., or where health facilities are not providing sufficient post-rape care, including post-exposure prophylaxis (PEP), to victims of sexual violence, humanitarian actors may be required to respond to these HIV programming needs.

  1. Are the commodity needs among the emergency-affected population for HIV prevention (e.g. condoms, PEP etc.) and AIDS-related care and treatment (e.g. ART etc.) being met?

If not, the humanitarian response should address these needs. UNAIDS, the Joint Teams on AIDS and the National AIDS Council should be engaged in the planning and implementation of the humanitarian response.

  1. Have vulnerable groups been identified and are their needs being considered in the design of the humanitarian response?

Vulnerable groups requiring special consideration include:-

Coordination

  1. Is the UNAIDS Country Coordinator (UCC) a member of the Humanitarian Country Team?

The Joint Letter from John Holmes and Peter Piot to HCs/ UCCs on integrating HIV into humanitarian action recommends that the UCC becomes a member of and actively participates in the Humanitarian Country Team.

  1. Are clusters adequately addressing HIV programming needs among the affected population as required?

If no, consider requesting clusters to nominate HIV focal points (focal points may be drawn from the Joint UN Teams on AIDS). Also consider convening an HIV and Humanitarian Action sub-group/ task team of the Humanitarian Country Team to facilitate humanitarian HIV activities if required.

  1. Do clusters have adequate data/ information on HIV interventions for their cluster/ sector?

If no, refer to UNAIDS and the Joint UN Teams on AIDS for guidance on multi-sectoral HIV interventions, as well as the IASC Guidelines on HIV in Emergency Settings.

  1. Are humanitarian needs assessments collecting/ analysing information on HIV prevention and AIDS care and treatment needs among the affected population?

  1. Is there a multi-sectoral HIV humanitarian strategy, stating priority needs and population groups?

If no, support can be sought from UNAIDS and the Joint UN Teams on AIDS to ensure that humanitarian needs assessments, strategy development, planning, and resource mobilisation integrate HIV effectively across humanitarian clusters/ sectors and that identified HIV and AIDS priorities are addressed. The HCT may want to use the Inter-Agency HIV Diagnostic Tool in collaboration with UNAIDS and HIV actors to identify gaps and priorities in humanitarian HIV programming in a particular setting.

HIV in the Workplace

RC/HCs also have a responsibility for the well-being and safety of UN humanitarian staff under their authority. Ideally, all humanitarian workers should have been trained in basic knowledge on HIV and AIDS, including their rights and responsibilities regarding access to HIV services and contributing to an HIV-competent workplace.

Key questions to consider include:-

  1. Do humanitarian staff have adequate access to information on how to protect themselves from HIV transmission, and access to HIV prevention commodities including condoms?

Often there may be gaps in previous training on HIV in the workplace. In settings where the HIV risk is significant, consider a rapid familiarisation of all staff with basic HIV work place principles. When high-quality condoms are not reliably and consistently available from the private sector, access should be simple and discreet at the UN Workplace, either free or at low cost.

  1. Is post-exposure prophylaxis (PEP) available for humanitarian staff in case of occupational exposure to HIV and/or sexual assault?

PEP starter kits should be available to individuals with a United Nations agency contract (including long-term, short-term, SSA and others). UNICEF Geneva distributes PEP starter kits to all RCs for their duty station, which should be assigned to a designated PEP custodian.

  1. Are humanitarian staff aware of how to access PEP, including who is the PEP custodian for their duty station?

If no, ensure that the contact details of the PEP custodian are widely disseminated. Staff can also consult the UN Cares Global Database for HIV, which lists all PEP custodians for duty stations worldwide. (See www.uncares.org)

Tools and Resources

http://www.humanitarianinfo.org/iasc/content/products/docs/FinalGuidelines17Nov2003.pdf