La Ope Op Les Democratic Republic 2010 Country Progress Report en 24-05-2010

Lao Peoples Democratic Republic
National Committee for the Control of AIDS
UNGASS Country Progress Report 2010
LaoPDRUNGASS2010CountryProgressReport
Foreword
LaoPeoplesDemocraticRepublicisuniqueinitsHIVsituation,andcanbeconsideredastheonly country in the Greater Mekong Region that has maintained a low HIV prevalence in the general population. However Lao PDRs low prevalence does not mean low risk. As Laos commitment to economic expansion transitions the country from a landlocked to a landlinked country the risk to HIVvulnerabilitiesisevident.Increasedmobilityacrossborderscoupledwiththeexistingsexworker clientvulnerabilitiesandtheseveralemerginghighriskgroups,placesLaoPDRonacontinuedalertof anewHIVthreat. InresponsetoitsprecariousHIVsituationtheGovernmentofLaoPDRhasprovidedstrongpolitical commitmenttosupportamultisectoralresponse.Theroleofkeyinternationalandnationalpartners has been invaluable, and coordination and collaboration have strengthened greatly since the first UNGASSCountryProgressreport. Lao PDR recognizes that the UNGASS Country Progress Report is an opportunity to reflect on advancementsandscrutinizegapstoplanforremedialactions.Theprocessofdevelopingthisreport has served as a first step in the evaluation of the current National Strategic and Action Plan for HIV/AIDS(NSAP)20062010whichiscomingtoclose. There has been much progress as this report will describe, from improved political commitment and enabling environment to scale up of HIV prevention and treatment services to major improvements in the HIV monitoring and evaluation system. The evidence points to the improved outputs,outcomesandduetotheseefforts. Despite the aforementioned accomplishments, Lao PDR still has many challenges to address. Developingthisreporthasalsoprovidedvaluableinputonwheretheprioritiesshouldbeplacedfor thecomingNSAP20112015.Increasingcapacitytomonitorandevaluatethecurrentresponseand thwartanyloomingpotentialforanacceleratedspreadoftheepidemicisparamountasthereisstill much that is not understood, particularly in newly emerging vulnerable groups. Prevention activities willneedtocontinuetotargetpastandcurrenthighriskgroups,butmostimportantlyextendtothe newly emerging vulnerable populations. As new antiretroviral treatment eligibility is incorporated, providingmedicinestotheexpandingpopulationinneedwillposeresourceconstraints. Maintainingaproactivemultistakeholderresponseinalowepidemiccountryisachallenge,and obtainingsupportandresourcesthroughbothinternalandexternalcommitmentswillrequiretheLao governmenttocontinuouslystayonestepaheadoftheepidemic.Theseconcernswillguidethemulti sectoral for the next 5 years as it works to obtain universal access, to achieve the 2015 Millennium DevelopmentGoalofhaltingandreversingthespreadoftheepidemic. Vientiane,24March2010 Chair,NationalCommitteefortheControlofAIDS
Acknowledgements Acknowledgements
The development of this report was prepared through an inclusive and consultative process, underthestrongleadershipoftheCenterforHIV/AIDS/STI(CHAS),withaguidancefromtheNational CommitteefortheControlofAIDS(NCCA).TheNCCAwouldliketothankCHAS,theUNGASSreporting team,andstaffswhoprovidedthesupport,workandsourcesofdatatopreparethisdocument. We would like to express our thanks to all the national partners both government and civil societywhohavecontributedandparticipatedinthenationalresponseandprovidedimportantinput to the report process. These include Ministry of Health, Education, Information and Culture, Labour andSocialWelfare,NationalDefence,PublicSecurityandMinistryofPublicWorkandTransportation, Lao Red Cross, Lao Youth Organization, Lao Womens Union, Lao Trade Union, and Lao Font for National Construction. We would also like to thank the civil society organizations, including LYAP, PEDA,andLNP+. We would like to thank our international partners UNICEF, UNFPA, UNDP, WHO, UNODC, UNIFEM,WB,IOM,WFP,AFD,ARC,BI,PSI,NCA,FHIandothersfortheircontinuedcollaborationand technical expertise, and invaluable input towards this report. A special thanks to UNAIDS for their financial support to develop this report and the international consultant for all their technical assistanceduringthedevelopmentofthisreport. 3
TableofContents
Foreword ............................................................................................................................................ 2 Acknowledgements ............................................................................................................................. 3 AcronymsandAbbreviations .............................................................................................................. 6 I.Statusataglance ............................................................................................................................. 8 A. PreparationofLaoPDRsUNGASS2010countryprogressreport ............................................. 8 B. Statusoftheepidemic.............................................................................................................. 9 C. Policyandprogrammaticresponse......................................................................................... 10 D. OverviewofUNGASSindicatordata....................................................................................... 11 II.OverviewoftheAIDSEpidemic ..................................................................................................... 16 A. OverallSummary.................................................................................................................... 16 B. Driversoftheepidemic .......................................................................................................... 18 MigrantWorkers............................................................................................................................... 19 Femalesexworkers .......................................................................................................................... 20 Menwhohavesexwithmen............................................................................................................ 21 InjectingDrugUsers.......................................................................................................................... 21 Generalpopulation ........................................................................................................................... 22 C. Overalldynamicsoftheepidemicandfuturetrends .............................................................. 23 III.NationalresponsetotheAIDSepidemic ...................................................................................... 25 A. Nationalcommitmentandaction ........................................................................................... 25 LaoPDRscommitmenttotheThreeOnesprinciple .................................................................... 25 OneNationalAIDSCoordinatingAuthority ...................................................................................... 25 OneagreedHIV/AIDSActionFramework ......................................................................................... 26 Politicalcommitment........................................................................................................................ 27 HumanRights.................................................................................................................................... 28 CivilSocietyInvolvement .................................................................................................................. 29 AIDSSpending ................................................................................................................................... 30 B. NationalPrograms.................................................................................................................. 32 1. PreventionPrograms ................................................................................................................. 32 2. Care,treatment,andsupportprograms ................................................................................... 38 IV.Bestpractices IV.Bestpractices............................................................................................................................... 44 A.ImprovedHIVoutcomesscaleupoftargetedprevention ....................................................... 44 B.ImprovedSTIoutcomesscaleupofSTIservices,asystemsapproachtoHIVmanagement ..... 45 C.Improvedcoverageoftreatmentscaleupofsupplyanddemandsideinterventions .............. 45 V.Majorchallengesandremedialactions V.Majorchallengesandremedialactions......................................................................................... 47 A. Progressiononpreviouskeychallenges.................................................................................. 47 B. Challengesfacedduring20082010 ........................................................................................ 47 C. RemedialActionstoachieveUNGASStargets......................................................................... 48 VI.Supportfromthecountrysdevelopmentpartners VI.Supportfromthecountrysdevelopmentpartners...................................................................... 53 4
A. Keysupportreceivedfromdevelopmentpartners ................................................................. 53 B. Actionsthatneedtobetakenbydevelopmentpartners ........................................................ 54 VII.Monitoringandevaluationenvironment .................................................................................... 56 A. OverviewofcurrentmonitoringandevaluationsystemstrengtheningthethirdOne ........ 56 B. ChallengesfacedinimplementationofcomprehensiveM&Esystem ..................................... 58 C. Remedialactionsplannedtoovercomechallenges................................................................. 59 D. NeedforM&Etechnicalassistanceandcapacitybuilding ...................................................... 59 Annex1: Annex1: Annex2: Annex2: Consultation/preparationprocess Consultation/preparationprocess................................................................................. 61 Nationalcompositepolicyindexquestionnaire Nationalcompositepolicyindexquestionnaire............................................................. 62
Annex3:AIDSSpendingMatrix ....................................................................................................... 99
AcronymsandAbbreviations
ADB:AsianDevelopmentBank AFD:FrenchDevelopmentAgency AIDS:AcquiredImmunoDeficiencySyndrome ANC:AntenatalCare ART:AntiretroViralTherapy ARV:AntiretroViral AusAID:AustralianGovernmentOverseasAidProgram BCC:BehaviorChangeCommunication CCM:GFATMCountryCoordinatingMechanism CDC:CentreforDiseaseControl CHAS:CenterforHIV/AIDS/STI CUP:CondomUseProgramme DCCA:DistrictCommitteefortheControlofAIDS FHI:FamilyHealthInternational FSW:FemaleSexWorker GFATM:GlobalFundtoFightAIDS,Tuberculosis,andMalaria GTZ:DeutscheGesellschaftfrTechnischeZusammenarbeit HIV:HumanImmunoDeficiencyVirus IDU:InjectingDrugUser IEC:Information,EducationandCommunication KABP:Knowledge,Attitude,BeliefandPractice LaoPDR:LaoPeoplesDemocraticRepublic LTU:LaoTradeUnion LRC:LaoRedCross LYU:LaoYouthUnion LWU:LaoWomenUnion M&E:MonitoringandEvaluation MCH:MaternalandChildHealth MoE:MinistryofEducation MoH:MinistryofHealth MoIC:MinistryofInformationandCulture MoLSW:MinistryofLaborandSocialWelfare MoND:MinistryofNationalDefense MoPS:MinistryofPubicSecurity MoPWT:MinistryofPublicWorkandTransport MSF:MedecinSansFrontiere MSM:MenwhohaveSexwithMen NASA:NationalAIDSSpendingAssessment NCCA:NationalCommitteefortheControlofAIDS NPFA:NationalPartnershipForumonAIDS 6
NSAP:NationalStrategyandActionPlan OI:OpportunityInfections OVC:OrphanvulnerableChildren PCCA:ProvincialCommitteefortheControlofAIDS PLHIV:PeoplelivingwithHIVandAIDS PMTCT:PreventionfromMothertoChildTransmission PPT:PeriodicPresumptiveTreatment PR:PrincipalRecipient PSI:PopulationServicesInternational RDT:RapidDiagnosticTest SOP:StandardOperationalProcedure STI:SexuallyTransmittedInfection TB:Tuberculosis TOR:TermofReference TWG:ThematicWorkingGroup/TechnicalWorkingGroup VCT:VoluntaryCounselingandTesting WHO:WorldHealthOrganization
I.Statusataglance
A. PreparationofLaoPDRsUNGASS2010countryprogressreport
Laos 2010 Country Progress report was prepared through an inclusive and consultative process, ledbytheCenterofHIV/AIDS/STI(CHAS),withguidancefromtheNationalCommitteefortheControl of AIDS (NCCA). Key stakeholders in the national response were closely involved, including, governmentinstitutions,civilsocietyorganizations,includingpeoplelivingwithHIV/AIDS(PLHIV),and development partners. The reports endorsement followed a threestage process with initial consensusbykeystakeholders,NCCAvalidation,andfinalapprovalfromMinisterofHealthwhochairs theNCCA. A roadmap was created in October 2009 identifying the overall activities, timeline, roles and responsibilities for developing the countrys UNGASS 2010 report. A team to oversee, manage and implementthecollectionofdata,analysis,andwritingofthereport,wasappointedconsistingofstaff from CHAS, the Department of Hygiene, and the Curative Department, with UNAIDS technical assistanceandaninternationalconsultant.DatacollectionandanalysistookplacebetweenOctober 2009andJanuary2010,includingthecompletionandanalysisoftheNationalCompositePolicyIndex (NCPI)andNationalAIDSSpendingAssessment(NASA).Aseriesofdatavalidationmeetingsattended bykeystakeholdersintheresponsewereheldinearlyFebruary2010. Data on the UNGASS and related indicators were collected from a range of sources, including published surveys (Behavioral Surveillance Survey, Integrated Behavioral and Biological Survey, ReproductiveHealthSurvey,etc.)androutinedatareportedtotheMinistryofHealthandotherline ministries such as the Ministry of Education. These data were analyzed and vetted extensively, includingtriangulationagainstotherindicatordata,theNCPI,andAIDSspendingresults.Partnerswere consultedforqualityissuesaswellascorroborationandinterpretationoffindings.Finalindicatordata valuesandkeymessageswerepresentedinadatavalidationmeetinginvolvingalltherelevantfocal pointsinordertoobtainconsensusandfeedback.Otherrelatedinformationforthereportsuchason programmingandstrategicdirectionwasobtainedfromdeskreviewandkeystakeholderinterviews. ThepartAoftheNCPIquestionnairewasadministeredtofourteenmultisectoralrepresentatives fromkeygovernmentministriesanddepartments 1 .ThepartBoftheNCPIwasadministeredtothree civilsocietyorganizations(CSO),nineinternationalNGOs(INGO),threebilateralagencies/multilateral agencies,andeightUNagencies 2 .TheUNagencieshadaconsultationmeetingtoobtainconsensus and provide one UN answer for the NCPI part B questions. Responses were collated and with the majorityanswerincludedinadraftwithallcompiledcomments.Aonedayconsultationwasheldfor allparticipatingstakeholderswheretheresultsofthequestionnaireweresummarized,inconsistencies
1PartA:MinistryofHealthincludingtheDepartmentofHygieneandPreventiveMedicineandtheDepartmentofCurative
Care,MinistryofEducation,MinistryofInformationandCulture,MinistryLabourandSocialWelfare,MinistryofNational Defence,MinistryofPublicSecurity,MinistryofPublicWorkandTransportation,LaoRedCross,LaoYouthOrganization, LaoWomensUnion,LaoTradeUnion,andLaoFrontforNationalConstruction. 2BurnetInstitute,FamilyHealthInternational,PopulationServicesInternational,APHEDA,NCA,PEDA,ARC,WorldVision, LNP+,LYAP,ESTHER,WorldBank,AFD,WFP,UNICEF,UNFPA,UNDP,UNODC,IOM,WHO,UNAIDS
addressed,mainmessagesidentifiedandanynewneededconsensusobtained.Thisexerciseproved particularly useful in identifying and understanding the basis for the areas in the national response where there were differences of opinion (see section on NCPI). In a number of cases, government respondentschangedtheiropinionafterfruitfuldiscussionwithnongovernmentalpartners,andvice versa. The NCPI results were analyzed, including trend data, and incorporated into appropriate sectionsofthereport. TheNationalAIDSSpendingAssessment(NASA)wasconductedforthefirsttimeinLaoPDRaspart ofthe2004UNGASSreportingprocess.Forthisround,government,nongovernmentalorganizations anddevelopmentpartnerswereaskedtocompletetheAIDSSpendingMatrix.Resultsweretabulated, analyzed,andkeymessagescorroboratedinthedatavalidationmeeting. A first complete draft of this Country Progress Report followed shortly which was distributed to stakeholdersthatparticipatedintheprocess.Aseconddraftincorporatedfeedbackandupdatedand waspresentedinmidMarchforendorsementbytheNCCAandotherpartners.Thefinalversionwas signedoffbytheNCCAChaironMarch24,2010. Note from the Data Hub: text to be deleted in final version. B. Statusoftheepidemic Lao PDR is unique in its HIV situation, and can be considered as the only country in the Greater Mekong Region (GMR) with a continuing low prevalence in the general population. Most recent estimatesofprevalencearecloseto0.2%among15to49yearolds(2009)withtheestimatednumber of people living with HIV (PLHIV) is 8000 (2009) with a trend of doubling every two years. The main mode of transmission is heterosexual and historically highrisk has been linked to the three Ms men,mobility,andmoneytypicalofthespreadofHIVinGMR 3 .Mobilemenaremorelikelytouse themoneytheyearnengaginginhighriskbehaviorsmakingthemvulnerabletoHIV.Whentheyreturn homeHIVpositivetheyexposetheirpartnersandultimatelytheirunbornchildren. Lao PDR appears to be in a latent epidemic stage 4 . But in fact it has a special historical epidemiology.AninterestingobservationisthatthenumberofindividualsreportedwithAIDSislarger than the estimated cases based on the current prevalence calculated from epidemiological models 5 . Thishigherthanexpectednumberofcasesisduetotheepidemicoccurringintwowaves.Apreviously hidden first wave occurred in the early 1990s following the three Ms scenario, with HIV positive malemigrantsreturningfromneighboringcountries,passingHIVtotheirpartners.Asecondwavetook placeintheearly2000sdrivenbyentertainmentestablishments,namelyfemalesexworkersandtheir clients, and has continued to be the major driver of Laos epidemic. The current epidemiological modelstakeintoaccountrecentdatafromrepresentativestudiesandhencedonotreflecthistorical episodesthatleadtothehigherthanexpectednumberofAIDscases. During the last decade, the level of HIV prevalence has mirrored the rate of sexually transmitted infections (STIs), particularly in female sex workers (FSW). Over the last decade STI prevalence in female sex workers has been of epidemic proportions with the first half of the decade experiencing very high STI rates and in 2004, the prevalence of HIV peaked at 2% in female sex workers, with a
Press,2008.
3HIVandtheGreaterMekongSubregion,StrategicDirectionsandOpportunities;AsianDevelopmentBank,2007.
4RedefiningAIDSinAsia,CraftinganEffectiveResponse;ReportoftheCommissiononAIDSinAsia;OxfordUniversity 5MethodologydescribedbyUNAIDS/WHOReferenceGrouponEstimatesModelingandProjections:
http://www.unaids.org/eng/HIV_data/Methodology/default.asp.
group of their potential clients, electricity workers at a prevalence of almost 1% (SGS, 2004) 6 . However, through the governments rapid response in joint STI/HIV targeted prevention efforts, the prevalenceofSTIs,albeitstillhigh,havealmosthalvedandHIVforboththesegroupshasdeclinedto lessthan0.5%each(SGS,2008) 7 . Most recently, men who have sex with men (MSM) have joined the most affected target population,withmigrantspotentiallyfollowing.ThecurrentHIVsituationinthesetwohighriskgroups isstillunclear.TwostudiesinMSMshowedconflictingrates,5.6%inthecapitalVientiane,versus0%in Louang Prabang (BBS 2007, BBS 2009) 8,9 . No recent prevalence data exist for migrants, but a study from2006pointtofemalemigrantsasanimportanttargetwithcloseto1%prevalence,andnoHIV foundinthemalemigrantssampled 10.MoreeffortsareneededtobetterunderstandtheHIVstatus andlevelofriskthesetwogroupshaveaspotentialdriversoftheHIVepidemicinLaoPDR. Increasing highrisk behaviors among the youth, in particular with increased use of drugs and alcohol,underlinestheneedtomonitorthevulnerabilitiesinthisgroup.Inaddition,themostrecent BSSsurveysinthedifferenthighriskgroupsdemonstratedincreaseduseofdrugs,particularlyinjecting drugs, across all populations sampled. If this behavior grows, it could threaten the recent stabilized rateinfemalesexworkersandexacerbatetherateinmenwhohavesexwithmenaswellasmigrants. Mostimportantly,withtheexceptionofFSWandtheirclients,preventivemeasureshavebeenlimited for most highrisk groups, and only recently have efforts started to expand targeted prevention to theseothervulnerablepopulations. Despite its seeming imperviousness to the HIV levels of its neighboring countries, Lao is continuouslyvulnerabletoanexpandingepidemic.Laoislandlockedbycountrieswhichreportdouble digitprevalencefortheirmostatriskpopulations,withthreeofthesecountriesonlyrecentlymoving outofageneralizedepidemic.Laosrecenteconomicexpansionhasincreasedtourismandmobility across borders. This increased access and movement, coupled with the existing sex workerclient vulnerabilities and the several emerging highrisk groups, places Lao PDR on the verge of a new HIV threat.
C. Policyandprogrammaticresponse
TheLaogovernmentisstronglycommittedtointegrationintheregionalandglobaltradesystem, andisthustransitioningfromalandlockedtoalandlinkedcountrythroughthecreationofeconomic corridorsacrossitsterritory.Withthiseconomicgrowth,therehasbeenrecognitionofthepotential increase in vulnerability, as described above, to an HIV epidemic similar to that of its neighbors. Political action has thus followed suit, and priority areas identified to address the determinants that arelikelytofueltheepidemic. Priority areas include establishment of legislation, focused resource generation for scaling up of quality HIV prevention, care and treatment programs to targeted populations, and strengthening of civil society in the response. All of these endeavors can ensure the sustainability of a successful HIV response while eliminating stigma and discrimination that can often hamper programmatic effort.
6SecondGenerationSurveillance2ndRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2004. 7SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 9BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009. 8BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007. 10HIVPrevalenceStudyamongMigrantWorkersat8BorderProvincesofLaoPeoplesDemocraticRepublic,2006.
10
There have been a number of advances in this regard since 2008, including but not limited to the draftingofanHIVlaw,thefundingapprovaloftwoGlobalFundtofightAIDS,TuberculosisandMalaria (GFATM) grants focused on HIV treatment and care efforts, continued inclusion of HIV in national policyprioritiesbeyondthehealthsector,theexpansionofPLHIVnetworksandtheirinvolvementin HIV policy and program decision making, and the development of a multisectoral monitoring and evaluationfiveyearstrategicplan. AstheNationalStrategyandActionPlan2006to2010forHIVandAIDS(NSAP)comestoaclose, LaoPDRhasbeenreassessingitsneedsandpriorityareasforthenextfiveyears.Inthepreviousplan, majorfocuswasplacedonpreventionthroughtargetedandcomprehensiveinterventions,inorderto respondtotherisingprevalenceinhighriskgroupssuchasfemalesexworkersandtheirclients 11 .This comprehensive package of interventions included behavior change through peer education, establishment of outreach and dropin centers, condom provision and social marketing, improved quality and provision of STI services, voluntary counseling and testing, enhancing enabling environments through local decision makers and community participation, as well as awareness via information, education, and communication (IEC) and mass communication efforts. In addition, prioritywasalsoplacedonscaleupARTcoverage,asthenumberofpeopleinneedofARTwasrising sharplyandtherehadexcessivenumberofdeathsduetoAIDS. A midterm review was conducted in 2008 to assess progress since 2006 and to identify continuingandnewchallenges,whicharedescribedinthisreport 12 .Resultsofthereviewshoweda majorexpansionofthecomprehensivepackageofinterventionstoprovinces.Testingratesincreased by two fold in conjunction with a 3fold rise in testing sites (2009). There has also been a major increaseinARTcoveragereachingover92%foradultsandchildreninneed.Thissuccessfulscalingup can be considered best practice as a result of effective resource allocation, clear commitment, and rapidresponsefromthegovernmenttosupportthemultistakeholderresponse. Despite the aforementioned accomplishments, Lao PDR still has many challenges to address. Increasingcapacitytomonitorandevaluatethecurrentresponseandthwartanyloomingpotentialfor anacceleratedspreadoftheepidemicisparamount.Althoughtherehasbeenmuchimprovementto increasedataavailabilitywiththeimplementationofseveralstudiesandsurveysinthelasttwoyears, thereisstillmuchthatisnotunderstood,particularlyinnewlyemergingvulnerablegroups.Prevention activities will need to continue to target past and current highrisk groups, but most importantly extend to the newly emerging vulnerable populations. Maintaining a proactive multistakeholder responseinalowepidemiccountryisamajorchallenge,andobtainingsupportandresourcesthrough both internal commitment and external commitments will require the government of Lao to continuouslystayonestepaheadoftheepidemic.TheseconcernswillguidethenewNSAPtobest addresstheprioritiesforthenext5years.
D. OverviewofUNGASSindicatordata
Lao PDR reported data for fourteen of the UNGASS indicators, including AIDS spending and NCPI.Theremainingindicatorseitherhavenodataavailableasitisnotyetcollected,orthedatawere not entirely consistent with the UNGASS definition. Table I provides the top level values for the
ControlofAIDS;20062010. 12ReportonmidtermreviewoftheNationalStrategicPlanonHIV/AIDS/STI20062010,LaoPeoplesDemocratic RepublicNationalcommitteefortheControlofAIDSandCenterforHIV/AIDS/STI;September2008.
11NationalStrategyandActionPlanonHIV/AIDS/STI,LaoPeoplesDemocraticRepublicNationalCommitteeforthe
11
indicatorswithavailabledata.PleaserefertoAnnex3forindicator1,AIDSspending,andAnnex2for indicator2,responsestotheNCPI. More detailed explanation is included below for each of the indicators with no data reported in table1. Nodata/notalldataavailable Indicator6indicatorisrelevant,andnumeratordataisavailableandhasbeenenteredin onlinetoolandreportedinnarrative,however2009denominatordatanotavailablefrom WHO,the2006valuefornumberofestimatedincidenceTBcasesinPLHIV=161. Indicators8,9,14,20,21and23forIDUindicatorsarerelevant,butcurrentlynostudies have been conducted which collect UNGASS indicators. This is however, planned for the future. Indicator7indicatorisrelevant,butnostudieshavecollectedthisdata,itwillbeincluded inthenextnationalreproductivehealthsurvey Indicator 12 indicator is relevant, but no studies have collected this data, it will be includedinthenextnationalhouseholdhealthsurvey. Indicators13,15,16,&17indicatorsarerelevant,butnostudieshavecollectedthisdata, it will be included in the next national reproductive health survey, related indicator data availableforadultwomenandmenfrom2005LaoReproductiveSurvey.QuestionsonHIV for the general population, including for collection of UNGASS indicator data will be includedinnextreproductivehealthhouseholdsurveyscheduledfor2010. Indicator 10 indicator is relevant in sense that Lao provides support to all OVC and program data is available, the value of which is estimated at 70%. Survey data not yet collected,butwillbeincludedinthenexthouseholdhealthsurvey.Itshouldbenotedthat HIVisnotmajorcontributortoorphansituationinLaoPDR. Indicator9forMSMindicatorisrelevant,andsimilardatacollectedintheBBSin2009. However, questions were not consistent with UNGASS definition, and reflect receiving condomsinlast3months,notinlast12months,andhencewouldunderestimateindicator value. No questions were asked on knowledge about where to get a test. Efforts will be madetoharmonizeindicatordefinitionsandincluderelevantquestionsinnextMSMstudy. Availabledatafor2009: Receivedcondominlast3months=37%
DataavailablebutnotconsistentwithUNGASSdefinition
Indicator 14 for MSM indicator is relevant & data are available in BBS 2007, however questions are not consistent with UNGASS definition & hence cannot calculate composite knowledge indicator. Efforts will be made to harmonize indicator definitions and include relevantquestionsinnextMSMstudy.Availabledataareavailablefortwooftheindividual questions: CanapersongetHIVbysharingmeal=80%correctknowledge
12
CanapersongetHIVfrommosquitoes=67%correctknowledge Indicator 19 for MSM indicator is relevant & data are available in BBS 2009, however questionsarenotconsistentwithUNGASSdefinition&reflectsthelast3months,notthe last 6 months as indicated in UNGASS, hence available data value would most likely underestimate indicator. Efforts will be made to harmonize indicator definitions and includerelevantquestionsinnextMSMstudy.Availabledata: Condomuseatlastanalsexwithcasualpartnerinpast3months=68%
Obtaining data for globally standardized indicators is part of the M&E systems strengthening andremedialplansoverthenextfewyears.Thegoalisattheminimum,tohavecomplete,qualityand timely data for all relevant UNGASS indicators. Ideally a set of comprehensive indicators will be availabletoexploredifferentaspectsoreachpriorityareaandhavegreaterabilitytolookdeeperinto trendsandpatterns.
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Table1 UNGASSCoreIndicators
DataValues
Targets 2010* 2015**
Comments
NationalCommitmentandAction 1.DomesticandinternationalAIDSspendingby categoriesandfinancingsources 2.NationalCompositePolicyIndex(NCPI) 2009:$5,997,398 2008:$5,017,038 2007:$5,146,613 PartsA&Bcompleted NationalPrograms 3.Percentageofdonatedbloodunitsscreened forHIVinaqualityassuredmanner. 4. Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy.*** 5.PercentageofHIVpositivepregnantwomen whoreceiveantiretroviralmedicinestoreduce theriskofmothertochildtransmission.*** 6. Percentage of estimated HIVpositive TB casesthatreceivedtreatmentforTBandHIV. 2009:100% 2007:100% 2009:92% 2008:79% 2007:63% 2006:48% 2009:14% 2008:12% 2007:14% 2006:15% Notavailable 100% 100% 6 blood units screened in EQA laboratorieseverysixmonths N/A N/A N/A N/A Pleaseseeannex3 PleaseseeAnnex2
>90%
>90% Disaggregation by regimen type isavailable.
Not available
Not available
Not available Not available
7. Percentage of women and men aged 1549 whoreceivedanHIVtestinthelast12months andwhoknowtheirresults. 8.Percentageofmostatriskpopulationsthat havereceivedanHIVtestinthelast12months andwhoknowtheresults.
The numerator is available=85, however the estimated denominator for 2009 is not availablefromWHOforLaoPDR Pleaseseetextsection1.D.
Notavailable FSW2009:14% FSW2008:15% FSW2004:9% MSM2009:14% IDU:Notavailable FSW2009:70% FSW2008:45% MSM2009:Not available IDU:Notavailable Notavailable
Not available
Not available
9.Percentageofmostatriskpopulations reachedwithHIVpreventionprograms. 10.Percentageoforphansandvulnerable childrenwhosehouseholdsreceivedfreebasic externalsupportincaringforthechild. 11.Percentageofschoolsthatprovidedlife skillsbasedHIVeducationwithinthelast academicyear.
Not available
Not available
FSW2009=BSS FSW2008=SGS3rdround FSW2004=SGS2ndround MSM2009=BSSLuangPrabang IDU:seetextsection1.D. FSW: 2009=BSS 2008=SGS3rdround MSM:seetextsection1.D. IDU:seetextsection1.D. Pleaseseetextsection1.D. Resultsfrom1,052Highschools surveyedintargetprovinces.
Not available 30%
74%
KnowledgeandBehavior 12.Currentschoolattendanceamongorphans andamongnonorphansaged1014.* 13.Percentageofyoungwomenandmenaged 1524whobothcorrectlyidentifywaysof preventinghesexualtransmissionofHIVand whorejectmajormisconceptionsaboutHIV transmission. 14.Percentageofmostatriskpopulationswho bothcorrectlyidentifywaysofpreventinghe sexualtransmissionofHIVandwhoreject majormisconceptionsaboutHIVtransmission. 15.Percentageofyoungwomenandmenwho Notavailable Not available Not available Not available Pleaseseetextsection1.D.
Notavailable
50%
Pleaseseetextsection1.D.
SW2009:45% SW2008:49% SW2004:20% MSM2009:Not available IDU:Notavailable Notavailable
Not available
SW:85% MSM: 85% Not
MSM:seetextsection1.D. IDU:seetextsection1.D.
Not
havesexualintercoursebeforetheageof15. 16.Percentageofadultsaged1549whohave hadsexualintercoursewithmorethanone partnerinthelast12months. 17.Percentageofadultsaged1549whohad morethanonesexualpartnerinthepast12 monthswhoreporttheuseofacondomduring theirlastintercourse.* 18.Percentageoffemaleandmalesexworkers reportingtheuseofacondomwiththeirmost recentclient. 19.Percentageofmenreportingtheuseofa condomthelasttimetheyhadanalsexwitha malepartner. 20.Percentageofinjectingdruguserswho reportedtheuseofacondomatlastsexual intercourse. 21.Percentageofinjectingdruguserswho reportedusingsterileinjectingequipmentthe lasttimetheyinjected.
available Notavailable Not available Not available
available Not available Not available Pleaseseetextsection1.D.
Notavailable
2008:94%
80%
95%
Notavailable
70% Not available 70%
80% Not available Not available
Notavailable
Notavailable ImpactIndicators
22.Percentageofyoungwomenandmenaged 1524whoareHIVinfected*
Notavailable FSW2008:0.43% FSW2004:2.02% FSW2001:0.9% MSM2009:0% MSM2007:5.6% IDU:Notavailable 2009 Adults:95% Children:100% 2007 Adults:90% Children:93% 15%
<1%
<1%
Pleaseseetextsection1.D. MSM:seroprevalencesurvey Vientiane(2007) LouangPrabang(2009) IDU:seetextsection1.D.
23.Percentageofmostatriskpopulationswho areHIVinfected.
SW:<5% MSM:<5%
SW:<2% MSM<3%
24.PercentageofadultsandchildrenwithHIV knowntobeontreatment12monthsafter initiationofantiretroviraltherapy. 25.PercentageofinfantsborntoHIVinfected motherswhoareinfected.
Not available
Not available
Not available
Not available
*N/A=notapplicable **Targetsarenotavailablefor2010becausedatawasnotavailabletodeterminebaseline. Targetsarenotavailablefor2015asthesewillbedeterminedduringthedevelopmentoftheNSAP20112015. ***Denominatorsarebasedonestimationwhichisstillneededtobevalidatedinthenearfuture.
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II.OverviewoftheAIDSEpidemic
A. OverallSummary
SincethefirstpersonwithHIVwasidentifiedin1990,atotalof3,659HIVnotificationshavebeen reported to CHAS, 189 of which were in children less than 15 (CHAS, 2009). The total estimated numberofpeoplelivingwithHIV(PLHIV)isapproximately8,000basedonestimationmodels,withthe current estimated prevalence of adults (1549) at 0.2% 13 . Eightyseven percent of transmission is through heterosexual contact, with mothertochild transmission following at 4.6%, and transmission through anal sex in men whohavesexwithmenemergingat1.3% [Figure 1] (CHAS, December, 2009). The majorityofcaseshavebeenidentifiedin three provinces, Savannakhet (40%), the greatercapitalVientianearea(33%),and Champasak (9.8%). All these provinces border Thailand with Savannakhet being the corridor between Thailand and Vietnam, and Champasak also bordering Cambodia. These provinces experience muchcrossbordermigration,bothofLao citizens and external migrants. The high amount of movement across the neighboring countries in conjunction with the observation that the largest proportion of notified cases are reported as migrant workers (19%), highlights the role migrationplaysinLaosepidemic.ThenexthighestreportedoccupationofPLHIVishousewives(18%). Althoughfemalesexworkersareconsideredasoneofthecurrentdriversoftheepidemic,only3%of cases reported themselves as sex workers, suggesting a bias in selfreporting of occupation. It is suspectedthisgroupmaybehiddenunderthelabelofmigrantsandhousewives. The majority of identified cases, 62%, are within the most productive age groups of 25 years to 39 years. The number of reported AIDS casesrisessteadilyfrom20yearsandthenpeaks in the mid 30s, falling sharply in older age groups. The pattern suggests that the most vulnerable age for onset of HIV is the early to midtwenties, which has implications for prevention targeting. On the surface there appears to be a fairly equal distribution of reportedcasesbetweenmales(56%)andfemales (44%), but further breakdown by age and sex reveals a discrepant pattern [Figure 2]. In the two older age groups males dominate at 59%
13MethodologydescribedbyUNAIDS/WHOReferenceGrouponEstimatesModelingandProjections:
http://www.unaids.org/eng/HIV_data/Methodology/default.asp.
(30y44y)and68%(45yandabove).However,theoppositeistrueintheyoungeragegroup15years to29years,wherethevastmajorities,61%,arefemale.Onepossibleexplanationisthatyoungermen donotseektestingasoftenasyoungerwomen.Althoughdifferentialtestingpatternsinthisyounger age group maybecontributing to the numberof reported male and female cases, one would expect lookinghistoricallyatthesexagedistributioninpastyears,toseeasimilarpattern.However,across allagegroups,HIVcasesinthe1990swereprimarilyinmen.Itisonlyfrom2001onwardsthatcasesin thisyoungeragegroupshifttofemales,suggestingwiderimplicationsonthehistoricalprogressionand currentepidemiologicalsituation.Thereappearsanemergenceatthebeginningofthelastdecadeofa newvulnerablegroup,youngfemales,asdriversofLaosepidemic.Likeitsneighboringcountries,the faceofHIV/AIDSinLaoPDRisincreasinglyfemale. ThefirstAIDScasewasreportedin1992,andsincethen2376AIDScaseshaveensuedand1038 deaths(CHAS,December2009).MostAIDScases(60%)anddeaths(65%)occurinmales.Inaddition, 70%ofHIVcasesinmaleshaveprogressedtoAIDSasopposedto58%offemalecasesprogressingto AIDS.Similarly,while33%ofmalecumulativecaseshavedied,thisvaluestandsat22%forfemales. ThishigherpercentageofAIDSprogressionanddeathsinmalesmaybepartlyduetothefactthatmen tendtoseekhealthcare(testingandtreatment)laterthanfemales,presentingtothehealthsystem oftenatCD4countlevelswaybelow200,henceloweringtheirsurvival[seesectionIII.B] 14 .Thislate presentationmakeaccountforthefactthatevenforpatientsonART,survivalissignificantlylowerin males(93%)thaninfemales(97%)(p<0.05). AnotherstrikingobservationisthatthereportednumberofcumulativeAIDScases,aswellasthe reportednumberofcumulativedeaths,surpassestheestimatedcumulativenumbersbasedonmodels ofacountrywithaprevalenceoflessthan0.2% 15 .Thehigherthanexpectednumberofdeathscould be partly attributed to initial low rates of antiretroviral (ART) coverage in the early years of the epidemic. Another contributor is most likely due to people living with HIV seeking care at the final stages of their illness. The aforementioned behavioral studies have shown overall that HIV testing ratestendtobelowinLao,soPLHIVaremostlikelydiscoveringtheirstatuswhentheyarealreadysick [see section III.B]. In fact a cohort study of HIV patients from 2003 to present found that 74% presentedforthefirsttimetotheHIVprogramatCD4+countsoflessthan200,while51%presented at CD4+ counts of less than 50, which significantly reduces their survival 16 . In addition, the more detectedthanestimateddeathsisalsorelatedtothefactthatthereisahigherthanexpectednumber ofAIDScases.
14SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 15EPPandSpectrumpackagehasbeenindicatedthatitcannotprovideaccuracyforlowprevalencecountry. 16SavannakhetHIVAdultCohortStudy,MinistryofHealthandCenterforHIV/AIDS/STI,2008.
17
Figure3illustratesthenumberofcumulativeAIDScases(excludingthosewhohavedied)thatwere detectedsince1990andthreeprojectedscenariosbasedmodeling.Thenumberofcumulativecases detectedrepresentedbytheredlineisclearlyhigherthanthenumberofprojectedcumulativecases basedonavailablesurveillancedataandanoverallprevalenceof0.2%(blueline).Thehighernumber of detected versus expected AIDS cases suggests that either a group with relatively high prevalence wasnotcapturedintheserosurveillancestudiesthusfar,and/orthatthespreadofHIV/AIDSinLao PDR started much earlier than assumed. Taking into account Laos historical agesex distribution of PLHIV, the more likely scenario is the idea that Lao PDR has in fact experienced its epidemic in two waves.TheonslaughtofHIVcamewithmalemigrantsinthemid1990s,corroboratedbythehigh2:1 malefemaleratioofHIVcasesduringthatdecade.Asecondsurgearrivedintheearly2000sdrivenby thefemalesexworkerclientrelationship.Thistheoryisconsistentwiththeobservedshifttoamore evenoverallmalefemaleratioamongHIVcasesaswellastheshiftoftheyoungeragegroupstobeing predominantlyfemale.Infigure3theblacklinerepresentsthe1stwavescenarioofamigrantdriven epidemic,whichupto2005,showsahighernumberofAIDScasesthanthereddetectedcasesline. Thisisnotsurprisingsincecasedetectionisknowntounderestimatethetruenumberofpeopleliving withAIDS,especiallyconsideringthelowoutreachandtreatmentavailabilityduringtheearlyyears.In 2005detectedcasessurpassthe1stwavecasesaspeopleinfectedinthe1990sandearly2000shave died and scale up of detection efforts started. The real life situation for the cumulative numbers of AIDScasesismostlikelyrepresentedbythegreenline,theadditionofprojectedcasesfromthe1stand 2ndwaveepidemicscenarios.
B. Driversoftheepidemic
The major risk factor for HIV in Lao PDR is risky sexual behavior, as evidenced by the high STI prevalence(Gonorrheaand/orChlamydia)acrossdifferentvulnerablegroups,whichrangesfrom9%in MSM to 22% in female sex workers (2009) 17,18 . Figure 4 shows the latest prevalence estimates availableforthegeneralpopulationandfourhighriskgroupsinLaoPDR.Menwhohavesexwithmen
17SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 18BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009.
18
sampledinVientianehavethehighestprevalencefollowedbyfemalemigrantworkers.Itisimportant to note that these data represent results based on small sample studies that are not nationally representative.ThesharpcontrastsinprevalencebetweenMSMintwocitiesandbetweenmaleand femalemigrantssuggestamorecomplexepidemiologicalstate.Inordertoformulateacomprehensive understandingofLaoPDRsHIVsituation, and how different vulnerable groups overlap and relate to the general population, it is necessary to, in addition to taking into account the historical context of the epidemic, examine the characteristicsofeachvulnerablegroup. MigrantWorkers Asmentionedearlier,thefirstwaveof the epidemic started in the early to mid 1990swithLaomigrantlaborersreturning home with HIV. Since many of these migrants came from rural areas where there exists a high degree of social control,theassumptionisthatthesemen hadminimalmultipartnerbehaviorwhentheyreturned,passingHIVmainlytotheirspouses. CasereportsindicatethateventhoughLaomigrantworkerscurrentlycompriseonefifthofallHIV cases,over50%ofallcaseshadreportedmigratingatleastonceintoanothercountryforwork.The factthatLaoisborderedbyfivecountrieshavingahighprevalenceintheirmostatriskpopulations andmigrationisacommonwayoflifehighlightstheimportanceofmigrationinLaosHIVriskscenario. ThishasbeenhistoricallyprovenconsideringhowHIVmadeitsdebutinLaoPDR. Thecaseofyoungfemalemigrantsacloserlookattheagesexdistributionofcumulativemigrant cases shows a similar pattern seen in the entire HIV case population. The younger age group is predominantly female, while males prevailintheolderagegroups(Figure5). There are a number of potential explanations for this observation. One possibleexplanationisthatyoungmigrant femalesaremorelikelytotestthanyoung migrant males. However, since targeted prevention efforts to migrants have not differed for males and females, this does notseemlikeamajorcontributingfactor. It is also possible that transmission to these young female migrants are from theirHIVpositiveoldermigranthusbands. Another scenario is that young migrant femalesareengagingmoreinhighriskbehaviorthantheirmalecounterparts,forexamplesexwork.It is hard to identify the reason and it maybe a combination of several, but it is clear they are an importantgrouptomonitor,conductmoreresearch,andtargetforintervention. 19
A biological and behavioral survey in 2006 on migrant workers in 8 border provinces further corroborates that young migrant women are an important subgroup to monitor 19 . The HIV prevalenceinfemalemigrantswasfoundtobe0.8%,withthemajoritybeingbelowtheageof30.No HIVwasdetectedinmalemigrants.Bothgroupsreportedengaginginhighriskbehaviors,buthalfof women reporting drug use had injected and of those with nonregular partners, almost none used condoms. These data coupled with case report data suggest that young migrant females are in fact engaginginhighriskbehaviormakingthemvulnerabletoHIV. The question is whether these young migrant women are engaging in sex work or IDU, or both. Thefactthatsexworkhassuchlowselfreportincases,thattraffickingofyoungwomenisaknown occurrence, and that groups of Lao young women are known to be engaged in sex work in several border towns in Thailand, all support the possibility that many of these young women might be sex workershiddenunderthelabelofmigrant. ExternalmigrantshaveinrecentyearsalsobecomeapotentialhighriskgroupasLaoexpandsits economic corridors. There is a steady flow of migration into the country for work on transportation routesandconstructionprojects,particularlyfromVietnamandChina.ArecentKAPBstudyin2008on ChineseandVietnamesemigrantworkersindicatedsomelevelofhighriskbehavior,renderingthemat riskforHIVandanimportantgrouptoincludeinupcomingprevalencestudies 20 . Femalesexworkers In Lao PDR, sex work is illegal and thus defining and identifying women who sell sex for money posesachallenge.Womenwhoworkinsmalldrinkshopsandnightclubsmayengageincommercial sex. These service women have till now been the population sample for 2nd generation surveillance surveys,whichhaveprovidedprevalencedata.Thelast2roundsrevealedthat96%ofservicewomen surveyedhadsoldsexinthelast3months,hencetheirresultsaredeemedagoodapproximateofthe HIVsituationoffemalesexworkersinthecountry. ForfemalesexworkersinLaoPDR,theHIVratesparalleltheSTIsrates.Since2001,therehasbeen asteadydeclineinbothSTIandHIVprevalenceinservicewomen(figure6).Thelatestseroprevalence results from the 2008 Integrated Behavioral Biological Surveillance (IBBS) study indicated an HIV prevalenceof0.43%inservicewomenallofwhichwerebetweentheagesof20and24 21 . Thereisevidencethatpotentialclientsoffemalesexworkersareexperiencingthesamestabilized rate as observed in female service women. Prevalence levels were 0.3% in male electricity workers (potentialclients)inthesamesurvey.
HIVPrevalenceStudyamongMigrantWorkersat8BorderProvincesofLaoPeoplesDemocraticRepublic,2006. Knowledge,Attitude,Behavior,andPractices(KABP)surveyamongChineseCommunitiesinLouangnamthaprovinceand VietnameseCommunitiesinChampasackandAttapeuprovinces,LaoPeoplesDemocraticRepublic,September2008. 21SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008.

20
19
20
EventhoughtheHIVresponseinfemalesexworkersandtheirclientsisconsideredasuccess,the growingnumberofmigrantfemalesexworkers,particularlyintheThaiborderregions,andgrowing number of male migrants as potential clientsposesanewchallengetomaintain thecurrentdeclineinprevalence 22 . Menwhohavesexwithmen Arecentlyemerginghighriskgroupis men who have sex with men. A 2007 study conducted in the capital Vientiane provided the first data on MSM HIV prevalence,witharesultof5.6% 23 .There were no significant differences in prevalenceacrossages.Theresultsfrom a study conducted in 2009 in Luang Prabang,anothermajorurbanarea,found a prevalence of 0% in respondents 24 . However,thesamestudyfoundthatSTIs were quite prevalent, with the existence of rectal Gonorrhea and/or Chlamydia in 9% of MSM. In addition,thesemenengageinhighriskbehaviors,with47%havingmultiplepartners,and33%having had sex casually with both men and women in the last three months. Only 33% used condoms consistentlywithcasualpartners(seesectionIII).Theconflictingprevalencedatapaintasomewhat confusing picture of the MSM epidemiologic situation and in conjunction with the existing high risk behaviors,highlighttheneedformorestudiestobetterunderstandtheextentriskandtheepidemicin thishighriskgroup. InjectingDrugUsers TheroleofinjectingdrugusersinLaosHIVriskscenarioisnotdeeplyunderstood.Thereareno studiestodatemeasuringHIVprevalenceamongdrugusers.Theaforementionedbehavioralstudies haveshowninjectingdrugusetobeprevalentinyoungpeopleandMSM,andasurprisingnumberof femalesexworkersandfemalemigrantshavereportedusingdrugs,includinginjecting(seesectionIII). IfHIVenterstheIDUpopulation,itcouldquicklyspreadamongIDUnetworks,especiallywithoutharm reductionstrategiesinplace.Itisimperativethatmoreresearchandsurveillancebeconductedinthis importantemerginggrouptobetterunderstandtheextentofinjectingpracticeandtheexistenceof HIVinthisgroup.
22TestimonyfromstakeholderinterviewswithkeyfocalpointsatCenterforHIV/AIDS/STI. 23BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007. 24BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009.
21
Generalpopulation The most recent antenatal care (ANC) sentinel surveillance data in 2008 from 3 hospitals in Vientianeshowedaprevalenceof0.3%.Thisestimateislimitedinitsinterpretationinthatitdoesnot capture the main highrisk groups or other affected parts of the country. In addition, since the majority of pregnant women, 72%, do not access health facilities for ANC, the group detected may have characteristics not representative of all Lao women of reproductive age 25 . For this reason the ANCdatahasbeenusedpredominantlytoassistinmodeledestimatesandprojections(Workbookand Spectrummethods,UNAIDS). Figure 7 shows the projected adult prevalence estimates taking into account all prevalence data andincludingthethecombinationof1stand2ndwavescenariosdescribedearlier.Ifweconsiderthe four scenarios of the HIV epidemic for prioritizing interventions as described by the Report of the CommissiononAIDSinAsia,atfirstglance,LaoPDRcouldbeconsideredtobeinalatentstageofthe epidemic, due to its low general prevalence 26 . However, this classification provides a superficial view of Laos HIV situation. In looking at the prevalence pattern, it is evident that the epidemic hasoccurredinstages,withacceleration, plateau and decline, even if on a smaller scale. The first acceleration of the epidemic has occurred, and a short levelingoffaround1998,mostlikelydue to people with AIDS dying. The second surge occurs between 2000 and 2004, which is most likely due to the rapid spread through sex workerclient relationships,againwithanotherlevelling offaround2005,duetoamajorscaleupintargetedpreventiontothesegroups.Prevalenceisthen projectedtoincreaseagainduetoincreasedsurvivalthroughprovisionofARTathigherlevelsofCD4 count(followingtheneweligibilityrequirementsforARTatCD4+350).Inaddition,newlyemerging highriskgroupssuchashardtoreachmigrants,MSMandIDUmaycontributetoasharperincrease prevalencefrom2011beyond. LookingatthenumberestimatednumberofnewinfectionsprovidesaclearerpictureofLaos HIVsituation.Figure8showsamodelcountryinthescenarioofadecliningepidemicasaresultof
DepartmentofStatistics. 26RedefiningAIDSinAsia,CraftinganEffectiveResponse;ReportoftheCommissiononAIDSinAsia;OxfordUniversity Press,2008.
25TheProvincialReportoftheLaoReproductiveHealthSurvey,2005.LaoPDRMinistryofPlanningandInvestment,
22
Figure8. Decliningepidemicscenario:Numberofnewinfectionsofmodelcountrycompared
tonewinfectionsforLaoPDR
successful prevention to sexworkers and their clients. The number of new infections rises early on and then dips as a result of prevention efforts. This is then followed by a number of scenarios depending on what group prevention efforts are targeted towards, with the best scenario being all vulnerable groups being targeted (orange line). Interestingly Laos estimated newinfection scenario followsasimilarpatternasthemodelonewithpreventiontargetedatsexworkers,clientsandtheir wives(yellowline),althoughonmuchsmallerscale.Thereisasmallpeakintheearly1990sduetothe firstwavemigrantspouseepidemic.Thespreadwasmostlikelycontainedduetoconservativesocial norms, and as cases died, the number of new cases also dipped. Another, more gradual rise in the early 2000s and peaking in 2006, was due to the second wave of sex workerclient infections. Soon after,asharpdipisseen,mostlikelyduetoaggressivepreventiontargetingofsexworkersandtheir clients.Asnewemerginghighriskgroupsenterthescene,withoutsimilartargetedpreventiontoall thesegroups,notjustsexworkers,thenumberofnewcaseswillriseagainasindicatedinthegreen, redandyellowlinesscenarios.
C. Overalldynamicsoftheepidemicandfuturetrends
As Lao has become more economically integrated into the Mekong region, increased travel and tourism,highermigration,andgreaterdisposableincomecanprovidetheforumforHIVtoincreasein the mostatrisk populations and spread to lowrisk population groups. Figure 9 illustrates the underlyingdynamicsofLaosHIVvulnerability.Highriskgroupsarenotexclusiveandinteractwiththe lowerriskgeneralpopulation.HIVmaystartinthemostvulnerable,andoftenhardtoreachorhidden populations, who often overlap as they share multiple highrisk behaviors. Through sexual contact and/orsharedriskybehaviorwithpersonsoutsidethisgroup,HIVcanpassthroughclientsoffemale sexworkers,femalepartnersofMSM,migrants,andyoungpeople.Youthareparticularlyvulnerable, especiallythoseoriginallycomingfromruralareas,whereoutreachislimitedandthusawarenessof HIVandrelatedrisksislow. Through these bridge populations HIV can spread to nonhighrisk groups such as partners of thesebridgepopulations,whichinturncanincreaseverticaltransmissiontochildren.Laohasalready experiencedthisdynamicduringthefirstwaveoftheepidemicinthe1990s.Itisimperativethatthe roleofnewlyemergingvulnerablegroupsischaracterizedtobetterunderstandhowtheycontributeto LaosHIVvulnerability.Verylittleisknownaboutinjectingdrugusers(dottedlineingraph),theextent 23
ofvulnerabilityofmigrants,andthetrueriskinyouth.Withoutactivemonitoringofthesegroupsit willbedifficulttotargetscaleupofpreventionmeasuresappropriatelytoavoidthespreadofHIV.
igure9:LaoPDRHIVVulnerability F
24
III.NationalresponsetotheAIDSepidemic
A. Nationalcommitmentandaction
LaoPDRscommitmenttotheThreeOnesprinciple LaohasbeencommittedtostrengtheningthenationalAIDSresponsethroughthepracticeofthe ThreeOnesprinciple 27 .ThelasttwoyearshasseenmuchadvancementforallthreeoftheOnesin policy, organization, increased resource generation, scale up of targeted prevention and treatment activities,andimprovedmonitoringandevaluation.ProgressonthefirsttwoOnesaredescribedbelow, the last One is described in section VIII. All these improvements exemplify the governments commitmentandpoliticalsupportaswellasthesuccessincoordinatingthemultisectoralpartners.These effortspavethewaytotackleanyfuturechallengesoftheepidemic. OneNationalAIDSCoordinatingAuthority Since2007,therehasbeenmuchimprovementinthecoordinationofthenationalresponseacross partners and within the government. The National Committee on the Control of AIDS is the official coordinating body for the national multisectoral response on HIV/AIDS. The NCCA as the oversight committeehasthekeyroleofguidingnationalpolicy,providingendorsementofnewHIV/AIDSinitiatives, andreviewingtheimplementationoftheNationalStrategyandActionPlan(NSAP).Inthepast,theNCCA wasnotasactiveororganizedtofulfillitsresponsibilities.Duringthelasttwoyears,theNCCAsTORhas beenupdatedtoclarifyrolesandresponsibilitiesandmembersaremeetingbiannually.Inaddition,more line ministries have taken NCCA membership to provide a wider sector contribution. The current multi sectoralmembershipoftheNCCAiscomprisedoffourteenmemberswithrepresentationfromsevenline ministries including Ministry of Health, Education, Information and Culture, Labour and Social Welfare, National Defense, Public Security and Ministry of Public Work and Transportation. There is also representationoffivemassorganizations,includingLaoRedCross,LaoYouthOrganization,LaoWomens Union,Lao TradeUnion,andLaoFontforNational Construction.AnewstructureofNCCAhasrecently beensubmittedtothePrimeMinistersofficeforconsiderationandapproval,withaddingmoremembers such as focal points of the National Assembly, National Chamber of Commerce and Industry, Buddhist AssociationandLNP+.
The NCCA has recently established its standing committee to provide guidance and regular monitoringfortheSecretariat.TheCenterforHIV/AIDS/STDs(CHAS)servesasthesecretariatwhichhas been entrusted with the responsibility to coordinate the implementation of the NSAP and report to the NCCAonprogressmade.CHASalsoservesastheNationalAIDSprogram,implementingmostofthehealth sectoractivitiesinthenationalresponse. ManagementofHIV/AIDSactivitiesreachesdowntothedistrictlevel.TheProvincialCommitteeon the Control of AIDS (PCCA), which sits in the Provincial Health Department (PHD) is also responsible for coordinatingHIV/AIDSactivitiesintheprovinces.TheDistrictCommitteeontheControlofAIDS(DCCA), whichsitsintheDistrictHealthOfficefunctionsthesamebutatthedistrictlevel.Thereisabottomup reportingmechanismfortheDCCAtothePCCAtoCHASandfinallytotheNCCA. BeyondtheDCCA,thereareVillageCommitteesontheControlofAIDS(VCCA)whomainlyfocuson outreachandeducationactivities.Anevaluationoftheireffectivenesswasconductedin2006andfound that the VCCAs are targeting highrisk groups, but that they needed more capacity, both in skills and
27TheThreeOnesinaction:Whereweareandwherewegofromhere.UNAIDS,2005.
resources, as well as better communication and coordination with the DCCAs 28 . A second review is scheduledaspartofthenewNSAP20112015. The NCCA functions at the policy level, whereas the National Partnership Forum on AIDS (NPFA) dealswiththetechnicalaspectsoftheresponse.TheNPFAistheumbrellaforallthethematicgroupsand reportregularlytostandingcommitteeoftheNCCA.ThematicgroupsexistundertheNPFAtofocuson particularareasofworksuchassexwork,preventionformenwhohavesexwithmen,andmonitoringand evaluation.
OneagreedHIV/AIDSActionFramework
The National Strategy and Action Plan 2006 to 2010 for HIV and AIDS (NSAP) has been the backbone for coordinating the work of all partners. With the overall goal to maintain the present low levelofHIV/AIDSinthegeneralpopulationandensureHIVprevalenceinmostatriskgroupsislowerthan 5%,theplandescribesfivepriorityareas:
1)Reachingfullcoverageoftargetedandcomprehensiveinterventionsinprioritized provinces/districtsinaphasedapproach 2)Establishmentofanenablingenvironmentforanexpandedresponseatalllevels 3)Increaseddataavailabilitytomonitorboththeepidemicandtheresponse(strategic information); 4)Capacitybuildingofimplementingpartnersatalllevels 5)Effectivemanagement,coordination,andmonitoringoftheexpandedresponse The plan incorporates all the roles and responsibilities of the multisectoral response for these priority areas.Thestrategiccomponentstoaddressarethefollowing: a. b. c. d. e. Targetedpreventionforvulnerablegroups Careandsupport Policy,legalreformandadvocacy Surveillanceandresearch Programmanagement
In2008,amidtermreviewwasconductedtodetermineprogresssince2006.Advancesweremade in all priority areas, and each had a set of constraints identified to work towards remediation by 2010. Section V discusses these in more detail. Beyond the national plan, sectoral HIV plans have been developed for the Lao Womens Union, The Ministry of Public Work and Transport, and the Ministry of PublicSecurity,toprovideanexpandedstrategyfortheirroleinthenationalresponse. The current NSAP will come to an end in 2010. The NCCA is now preparing for an end of term reviewtoinformthedevelopmentofthenextNSAP(20112015).Targetsarebeingreassessedandbased onchallengesidentifiedoverthelastreportingperiod,remedialactionswillhelptoguideactivitiesforthe nextfiveyears.TheultimategoalwillbereachingtheMDG2015targetsandtheprioritieswillbeinline withtheninepriorityareasdescribedintheUNAIDSOutcomeFramework 29 .
28PreventingHIVinYoungPeopleAffectedbyPopulationMobilityinLaoPDR,MidtermLearningReview;WorldVision LaoPDR,September,2006. 29JointActionforResults,UNAIDSOutcomeFramework20092011.UNAIDS,2009.
26
Politicalcommitment Thelevelofcommitmentbygovernmenthasalreadybeenexemplifiedthroughtheworkoverthe last two years to strengthen the Three Ones. Since 2003, government representatives have increased theoverallratingoftheirpoliticalsupportforHIVprogramsfrom6outof10to9(Figure10). There has been a concerted push to integrate HIV into all of the countrys general development plans, including, the Laos Poverty Reduction Strategy and the National Development Plan, all of which required mobilized efforts to ensure inclusionwith competing country priorities. Another major political stepforwardisdraftingofanHIVLaw.TheMOHandCHASappointedateamtodraftalawonHIV/AIDS thatwillbepresentedtotheLaoPDRnationalassemblyinJune2010.Thelawwillprovidetheframework for all sectors. There was also a review of the existing HIV policy that was updated and approved in December 2009. The policy now has added MSM & IDU as priority target population groups. In 2008, three policies were reviewed, screening and cotreatment of HIV/TB, nutrition, and MSM, to ensure consistencywiththenationalHIVpolicy. Politicalcommitmenttothenationalresponsealsoextendstoothersectors.TheMinistryofPublic Works & Transportation recently developed their sectoral strategy for HIV. They have one of the few programs in the region that applies the regional recommendation for all development infrastructure projects to dedicate up to 1% of their budget to HIV activities. Through these allocated resources the ministry has been very active in conducting IEC on HIV for infrastructure and construction employees. Evaluationofthisprogramisplannedinthenearfuture. Thereareanumberofexamplesofextendingpoliticalcommitmentthroughcollaborationwiththe private sector. The Lao Trade Union has a work based HIV project for factories and miningcompanies(seesectiononworkplace initiatives). In addition a novel partnership withtheILOin2009hasassistedtheprogram tocreateamoreenablingpolicyenvironment by promoting and sensitizing factory managers about the ILO Code of Practice on HIV/AIDS, the Trade Union Law, and the Labor Law. There is also the hotel project lead by the Ministry of Labor & Social Welfare. The project is a manifestation of a newTripartiteDeclarationonHIV/AIDSatthe Workplace human rights policy (see human rights section), which forbids discrimination intheworkplace.Theprojectisnowpiloting incollaborationwiththeLaoTradeUnionandtheNationalChamberofCommerceandIndustry,targeting tenhotelsinVientianeandfiveinLouangPrabangtoraiseawarenessanddevelophotelpolicyonHIVin theworkplace. TheseinitiativesnotonlyhighlighttheextentofpoliticalcommitmenttothenationalHIVresponse, theyalsopointtotheinterestinthehumanrightsaspectofthiscommitment,anareathathasseenmuch growthoverthepastfewyears.
27
HumanRights The overall consensus based on nongovernment responses to the NCPI is that the existence of human rights policies and efforts to enforce them has improved over the years(Figure11).Oneoftheareasof political commitment where Lao PDR has formerly lagged behind its neighboring countries is the legalizationofhumanrightsforpeople livingwithHIV.Althoughlawsdonot exist to protect mostatrisk populations, to date discrimination and stigmatization are addressed in the national HIV policy, and the Decree of the Prime Minister was issued to implement these policies. Therehasbeensignificantprogressin thelasttwoyearswiththedraftingof thenewHIVLaw,whichwillcontainprovisionstoprotectPLHIVright. Anewpolicywaslaunched,theTripartiteDeclarationonHIV/AIDSattheWorkplace,whichforbids discriminationintheworkplace.UnderthisruleworkerscanfileacomplaintdirectlytotheMinistryof LaborandSocialWelfareforanymisconduct,whichwouldthenbeinvestigated.Thispolicyisnowbeing pilotedinfifteenhotelsinthetwomajorcitiesVientianeandLouangPrabangwiththehopesofexpanding tootherworkplacesfollowinganassessment. PLHIV Since 2007, PLHIV have been much more involved in many aspects of HIV programming whichcanhelptoaddressstigmatization&discriminationandimprovehumanrightspractice.PLHIVhave beenrecruitedtoworkinARVtreatmentcentersaspeercounselorsandaremembersofthehomebased care team. Provincial bodies have significant interaction with PLHIV and provide an avenue for documentationofanydiscriminationacts.Recentlyrepresentativesofcivilsocietyhavebecomemembers oftheNationalEthicalHealthResearchCommittee(NEHRC)andmembersofmostatriskpopulationssit on their respective thematic working groups (TWG). There have been more efforts to disaggregate program data in order to monitor inequities. Some respondents to the NCPI felt that PLHIV need to be moreinvolvedintheactualdesignofHIVpoliciesinordertotrulycapturetheirneeds. Gender There has been movement in the area of gender, with a national commission for the advancementofwomenestablishedtomonitortheimplementationoftheinternationalCEDAW.TheLaw onProtectionofWomendirectsministriesandmassorganizationstoensurethatthepositionofwomenin Lao society is protected and enhanced. The Lao Womens Union (LWU) has the role to develop policy, monitoritsimplementation,andpromoteresearchforwomensroleinthecommunity.TheLWUworks closelywithCSOsinLaotopromotegendersensitiveandgenderresponsivepractice,withCSOsproviding testimonyandevidenceforsituationsweregenderdiscriminationistakingplace.Despitetheseadvances, therearestillconcernsfromcivilsocietyorganizationsthatnotenoughhasbeendonetoraiseawareness within the government on gender issues and mainstream gender into its programs and policies. In particular,CEDAWhasvoicedtheconcernthatthenumberofwomeninfectedwithHIVisincreasingatan averagerateof8%peryear,withcertaingroupsofwomensuchasmigrantwomenandsexworkersthe 28
mostvulnerable.Thisvulnerabilitymaybedueto genderspecificnormsinthecountrythat canhinder theirabilitytonegotiatesafesexualpracticesandincreasetheirriskforinfection. PrisonersAlthoughprogressinprotectivelegislationandenforcementhasbeenfruitful,thereare stillsomeareasofneed.Prisonersareanignoredgroup,bothwithregardstoprotectionaswellaswith regardstoHIVactivities.AformativeassessmentonprisonerpopulationshasbeenconductedbytheLao Red Cross and found that male prisoners reported having sex with other males while incarcerated. Interestingly, prevention activities have not been implemented as authorities were worried about the safetyofhealtheducatorsinteractingwiththeprisoners.However,ARTtreatmentisavailabletoprisoners undertheprovisionoftheNationalStrategyoftheMinistryofPublicSecurity.Thereisgeneralconsensus that this population group needs to be further addressed, first by understanding their risk through a situational assessment, and then by providing appropriate HIV policy. In addition, building prisoners capacityasoutreacheducatorscouldresolvepotentialsecurityconcerns. Orphans and vulnerable children The Ministry of Public Security is responsible for OVC in protectionoftheirrightsandprovidingsupport.Legalandpolicyenvironmentsarebeingestablishedto protectvulnerablechildrenincludingchildrenaffectedbyAIDS.ForexampletheenactmentofaLawon theProtectionoftheRightsandInterestsofChildrenpassedinlate2007andtheestablishmentofChild ProtectionNetworksasaformalgovernmentstrategywillberolledoutin2010.However,asHIVisnota major contributor to OVC, monitoring them as part of the HIV national response has been limited (see sectionIII.BonOVCsupport) Monitoringandenforcementmechanismsforhumanrightshaveimprovedoverall,yettheystillrate onlya7outof10,leavingroomforimprovement.Thefactthatthereiscurrentlynotrainingofjudiciary onHIVandhumanrightsissueswillfurtherhindertheabilitytoensurebetterenforcementmechanisms. Inaddition,thereneedstobemoreefforttocommunicateanddisseminateinformationtothepublicon nondiscriminationlawssovulnerablegroupsknowtheirrights. CivilSocietyInvolvement Untilrecently,civilsocietyorganizationscouldnotobtainlegalstatus.In2009,thePrimeMinisters Decree on Association passed and will provide an opportunity for legal establishment of civil society organizations in Lao. Despite this legal void, the national response to HIV/AIDS has overall been quite receptive of civil society engagement. According to the NCPI responses on the efforts to increase civil society participation, over the past three rounds of UNGASS, the score has remained an 8 out of 10 by nongovernmentrespondents. An extensive network of mass organizations participates in the planning and implementation of HIV/AIDSactivities,reachingfromthecentraltothevillagelevel.TheseincludetheLaoYouthUnion,which focusesonoutofschoolyoutheducation,theLaoWomensUnion,whichaddressesreproductivehealth among women with HIV/AIDS, the Lao Trade Union, which conducts IEC campaigns among factory workers, and the Lao Front for National Construction. Each mass organization at the central level has appointedanHIV/AIDSfocalperson. CurrentlyeightINGOsandfourlocalCSOsareactiveintheresponseindicatingsomesortofbalance betweensmallfieldbasedorganizationsandlargecapitalbasedorganizations.TheINGOsmainlyfocuson implementing large scale outreach programs and some service delivery, each in different parts of the country, to ensure greater coverage. Local NGOs mainly focus on smaller scale outreach and providing trainingandcapacitybuildingatthefieldlevel.IncludedinthisaretheLaoPDRsBuddhistmonkswho providespiritualhealingandalternativemedicineforPLWHA. 29
Figure 12 demonstrates that CSO activitiesinHIV/AIDSarealwaysincluded in the NSAP. CSOs for the most part are involvedintheplanningandbudgetingof the NSAP (4 out of 5 score), including participating in the midterm review of the last NSAP (20062010). In fact CSOs are main implementing partners, or sub recipients in GFATM supported activities, andimplementupto50%ofactivitiesfor targeted prevention to FSW and MSM, reduction of stigma and discrimination, homebasedcare,andprogramsforOVC. AllareasofCSOinvolvementhave improvedinthepasttwoyears,according tonongovernmentrespondentstotheNCPI(Figure12).Forexample,therehasbeenanincreaseinCSO contributiontostrengtheningpoliticalsupportforHIV/AIDS,movingfromascoreof3in2007to4in2009. CSOs had a major role in drafting the new HIV law. Members of CSO have become more visible in thematicgroupswithincreasedattendanceofnationalandregionalconsultations.Throughthisincreased interactionthevoicedneedscanbecomemorebalanced.CSOsrepresent33%ofNCCAmembership. ThereismorediverserepresentationofCSOssince2007,particularlywithreferencetoPLHIV.At theimplementationlevelPLHIVhaveexpandedtheirnetworksfrom6groupsin2007to12groupsin2009, and they are more active at national & provincial levels with networks linked to the PCCA secretariat, reporting to them on their activities and receiving feedback and supervisory support. At the steering committeeleveltherehavebeentwomajormilestonessince2007,thefirstbeingPLHIVmembershipin the NCCA, and the second being PLHIV membership in the GFATM Country Coordinating Mechanism (CCM). Considering the role PLHIV networks have in peer education activities and working directly with otherPLHIV,theirrepresentationcanprovideimportantinsightonpriorityareas.Oneissuestillpersists however, limited capacities can hinder the level of involvement by PLHIV and other CSOs on important appraisals such as GFATM proposal reviews, where documents are in English or information require certaintechnicalknowledgetounderstand.CSOaccesstoadequatetechnicalsupporthasimprovedinthe last two years, and CHAS has agreed to remediate via capacity building in communication, language, computerandotherrelatedskillssupport. Twoareasthatstillhavealowratingof2outof5,despitehavingincreasedfromaratingof1in 2007,arerelatedtoCSOactivitiesinclusioninthenationalbudgetandfinancialaccess.Eventhough20% ofnationalfundswereallocatedtoCSOsaccordingtotheNationalAIDSSpendingAssessment(NASA),the perceptionisthatthereisstillamajorgapbetweenavailablefundsandneed.Oneofthereasonsmaybe duetomorestringentscreeningfromdevelopmentagenciesastheeconomiccrisishastightenedavailable funds.Inaddition,relianceonGFATMgrantmoneyforHIVactivitieshasincreasedasdonorsstarttopull outoftheHIVarena,leavinglessfundstodrawfrom. AIDSSpending SpendingonHIV/AIDShasrisenabout5%sincethelastreportingperiod,from10.5millionUSDfor the years 2006 and 2007, to 11 million USD for the years 2008 and 2009. A National AIDS Spending AssessmentwasconductedinLaoPDRfortheyears2007to2009.ThetotalamountspentonHIV/AIDSin 30
2009 was 5.9 million USD, which rose from the 5.1 million USD in 2007. Most funding has come from donors(seesectionVI),asnationalspendingforHIV/AIDSprogramswaslimited2%ofallmoniesspent,or 213,260USDtotalfor2008and2009.In2007mostexpenditure,81%,wasforactivitiesattheprovincial anddistrictlevel,withonly19%spendingatthecentrallevel.Therehasbeenashiftinspendingsince,to 40%atthecentrallevelduetothemanagementcostsofprocuringtheincreasednumberofOIandARV drugs. Figure 13 shows the trends in spending by function category. Across all years, the predominant expenditureisonpreventionactivities,althoughithasdroppedsubstantiallyfrom50%in2007to36%in 2009(2.2millionUSD).Mostofthepreventionexpenditureswereintwoareas,bloodsafetyactivitiesand targetedcommunicationforsocialandbehavioralchangetomostatriskpopulations,migrants,andyoung people. The second largest spending category was in management and administration, at 24% of all expenditure in 2009, a nominal rise since 2007. Half of the expenditure in this category has been in planning,coordinationandprogrammanagement.Humanresourceshasmaintainedatlessthan20%of allHIVspending.Theotherdecreaseinspendingbesidespreventionisinenablingenvironmentsthrough advocacyactivities,almosthalvinginvaluefrom2007. In2008,thereappearedtobeasurgeinspendingonresearch,mainlyduetoimplementationof2 major biological and behavioral surveillance studies. The two areas experiencing the most dramatic increase in spending include treatment and care which almost tripled, rising from 330,095USD 2007 to 961,127USDin2009.MuchofthisscaleupcanbeattributedtoGFATMround6,whichprovidedjustover 1millionUSDforARVtreatmentandcarefor2008and2009.Theothermajorincrease,albeitquitesmall in absolute numbers, is seen with OVC, with an exponential jump from 0.3% of all spending in 2007 to 1.7% of all spending in 2009. An area of least investment is social protection and social services (which doesnotincludeOVC),withatotalspendingin2009of0.4%oftheentirebudget,mainlyonHIVspecific incomegenerationprojects.
31
B.
NationalPrograms
LaoPDRhasmadegreatprogressinthelasttwoyearsonthescaleoftheirnationalprograms,both in terms of range of activities and extent of persons reached. The prevention efforts have branched beyond service coverage for female sex workers and men who have sex with men, extending to the generalpopulationviatheworkplaceandschools.Inaddition,therehasbeenamajorrolloutofsupport and treatment programs for PLHIV, with expansion of facility based services and use of these services. Therearestillhighriskpopulationsthathaveyettobenefitfullyfromthescaleupexperience,including butnotlimitedtooutofschoolyouth,migrants,andinjectingdrugusers. PreventionPrograms GiventhenatureofLaosHIVsituation,targetedpreventionhasbeenthekeyfocusofLaoPDRs nationalresponse,inordertomaintainalowprevalenceofHIVinthegeneralpopulationandreversethe spread amongst mostatrisk population groups. Tailored prevention programs have been designed for each target population withatotal2.3millionUSDspentin2008and 2009 on these activities. For example, comprehensive interventions were designed forthemostatriskgroups,essentialelement packages for the general population, and prevention of mothertochild transmission for antenatal care attendees. Both government and nongovernment responses on the NCPI indicated improvement in the implementationofpreventionprogramssince 2003risingfromaratingof7toaratingof9 (figure 14). Most areas of prevention have seenscaleup,fromservicecoveragetoyouth interventions to work place initiatives, however as mentioned earlier, overall spending on prevention decreasedwithrespecttootheractivities,droppingfrom2.6millionUSDin2007to2.2millionUSDin2008. ProgramandServiceCoverage ComprehensivepackageofinterventionsTheNSAP(20062010)definedasetofcomprehensive interventionsandessentialelementspackagetoreachfullcoverageinprioritizedprovinces/districtsina phased approach. The set includes peerled behavior change communication (BCC) with frequent peer contactsinmarginalizedgroupslikeFSWandMSM,condomdistributionandsocialmarketing,improved quality and provision of STI services, referral to voluntary counseling and testing, creation of dropin centers. The peerled initiative of the comprehensive package started in late 2007 as the peer outreach program. For female sex workers, trained peers are accessed through beer bars, entertainment establishmentsanddropincenters.Thisprogramhasprovedamajorsuccessasthe2009BSSstudyon service women showed 46% reported received their HIV/STI prevention information from peers (BSS, 2009) 30 .
30Knowledge,Attitude,BehaviorandPractices(KAPB)SurveyonFemaleServiceWorkersinsixprovincesinLaoPDR. LaoPeoplesDemocraticRepublic,2009.
1.
32
The same program has been set up for MSM with a peer education manual developed. This populationgroupistargetedmainlythroughdropincentersandvenuestheyfrequentanditssuccessstill needstobeevaluated.Sincemostatriskpopulationsareoftenhardtoreach,trainingmembersofthese groups in HIV prevention creates a peer led BCC that can propagate within the cohort increasing the chanceforknowledgeandsafebehaviorstobeestablishedasnorm. 100%CondomUseProgramthe100%CUPwaspilotedin2003withsupportfrom.Thestrategy targetsthepreventionofsexualtransmissionofHIV/STIinthegeneralpopulationbyensuringahighlevel of condom use among sex workers and their clients. It enlists the aid of provincial administrative and healthauthorities,governors,thepolice,sexworkers,andtheownersandmanagersofsexestablishments to make it difficult for clients to purchase sexual services without using a condom. Implementation has been expanded to a total of 15 provinces in 2008 with plans to expand to the last 2 provinces pending acceptanceoftheGFATMround4rollingcontinuationchannel(RCC)grant.Unfortunately,untilthisgrant approval,thereiscurrentlyasubstantialgapinpledgedmoneyforthisprogram,anissueneedingpriority attention. HarmreductionAtaskforceonHIV&DrugUse,aspartoftheHAARPprojectcochairedbythe LaoNationalCommissionforDrugControlandSupervision(LCDC)&DepartmentofMedicalCareofMOH, was created to initiate programming for injecting drug users through the support of the Australian GovernmentandUNODC.However,overall,littleisknownabouttheexistingrisksofIDUsinLaotoHIV, makingitdifficulttodesignawelltargetedprogram.SupporthasbeengivenbySIDAandWHOtoconduct themuchneededstudiesondruguse&HIV,withthehopesofprovidingthestrategicinformationneeded forpolicyandpreventionprograms. MARPsreachedwithHIVpreventionprogramsAsthecomprehensivepackageofinterventions and outreach has been expanded, the number of marginalized MARPs having accessed to various interventions has increased. For female sex workers, a statistically significant difference in percent reachedwithHIVpreventionprogramsrosefrom45%in2008to70%in2009[Indicator9].Thisindicator has not been measured in men who have sex with men, however 65% of MSM reported receiving preventioninformationfromanoutreachworkerduringthepastyear(BBS,2009) 31 .Nodataisavailable forinjectingdrugusers,migrantworkers,oryouth. Blood safety Since 2007 the blood safety program has expanded, with increasing funds spent everyyeartojustoverhalfamillionin2009.In2009,22,539bloodunitsweredonated,100%ofwhich were screened in laboratories that follow standard operating procedures and participate in external qualityassuranceschemes[Indicator3].Althougheveryprovinceisscreeningbloodandbloodscreenings thattakeplaceatprovinciallevelarefollowingqualityassuredmanner,thereareonlyfivedistrictshave that have the same stringent level of screening and more effort is needed to ensure blood screening follows standard operating procedures for quality assurance. Out of all blood units screened, 12 were foundHIVpositive(0.05%).Despiteitsexpansioninscreening,bloodsafetystillcomesshortofresources everyyear,whichhaswiderimplicationsfortheoverallhealthsystemsstrengthening. WorkplaceInitiatives A number of projects of prevention in the workplace have been implemented since 2007, in particulartargetinginfrastructureworkers.Thousandsofworkers,mainlymen,oftenseparatedfromtheir families,liveandworktogetherandfrequent'beershops'thatusuallysetupnearbytheoperations.The relationship between the workers and the women working in the 'beer shops' can sometimes include transactionalsex,whichisahighriskactivityinthecontextoflowknowledgeofHIVandotherSTIs.
31BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009.
33
The Asian Development Bank has funded several projects that integrate awareness and risk prevention into road construction operations. The Northern Economic Corridor Project, a road constructionoperationfundedbyADBlinkingThailandwiththePeoplesRepublicofChina,hasdedicated approximately $340,459 USD of the 95.8million USD project to the HIV/STI, Drug and People Trafficking AwarenessandPreventionEducationProgram.Thegoalistomitigatepotentiallyadversesocialimpacts theseconstructionprojectshaveonincreasingtherisksofworkersandaffectedcommunitiestoHIV/STIs, drugs and human trafficking. Since its inception, a number of similar projects have followed dedicating almost1%oftheiroverallbudgettotheseeducationprograms. A general OccupationalHealthandSafety Project focusingprimarily on the wood processing and construction industries, as well as factory workers in border locations with Thailand has incorporated a vitalcomponentonHIVawareness.Theprojectalsoincludedforworkersworkingonmegaprojects,such astheNamTheunIIDam.Theawarenessandeducationalstrategiesincludetheatre,musicandgamesto teachsafersexbehavior. TheLaoTradeUnionisresponsibleforconductingIECcampaignsamongfactoryworkers.Todate, approximately29,328workers,or39%ofallfactoryworkers,in85factoriesinthreetargetprovinceshave beenreachedwithknowledgeandskillsonHIV/AIDS 32 .Despitethesepreventioneffortsintheworkplace, bothgovernmentandnongovernmentrespondentsintheNCPIfeltthiswasstillanareaofweaknessand moreneedstobedone,especiallytotargetmigrantworkers. YouthInterventions Asthemajorityofnewinfectionsareshiftingtoyoungeragegroups,ithasbecomeclearthatthe riskpotentialisalsostartingatanearlierage.Infactyouthstarttobecomeatriskbetweentheagesof10 24 years old, when they start engaging in the behaviors that put them at higher risk for HIV infection (UNICEF, 2009). Of particular concern are youth from rural and remote areas, with little exposure to outreach and education, who move to more urban locations that pose higher exposure to risks. It has becomewellacceptedbytheLaogovernmentthattargetingyouthwithHIVeducationeffortsinprimary and secondary school, as well as to those youth beyond the reach of the public system, is an effective prevention measure for reducing risky behaviors. The last two years has seen much progress in youth targetedinterventions. Lifeskillsbasededucation ThelifeskillsbasedcurriculuminLaoPDRwasoneofthefirsttobe implemented in South East Asia and with full support by the Ministry of Education. HIVrelated, reproductive,sexualhealthanddrugseducationisincorporatedintoteachertrainingsandatbothprimary andsecondaryschoolcurriculum.Since2007,11,anincreasefrom7,ofthe17provincesareprovidingthis education in their school systems. In addition, during this last reporting round, approximately 3,000 teachers have been trained and provided 294,000 boys and girls with the knowledge and skills to make safer life style choices 33 . In 2009, 74% of schools provided life skillsbased HIV education within the academicyear[Indicator11]. As a complement to the Ministry of Educations efforts, UNICEF implements Life Skills and LeadershipCampsforchildrenandyouthinChampasackandVientiane.Apilotproject,ledbytheRegional BuddhistInitiativeandsupportedbyUNICEF,hasdevelopedacomplementarycurriculatothelifeskills based in public school. Using Buddhist precepts, life skills are taught to make safer life style choices to secondary school students in 42 schools. The results of the pilot will be used to update the curricula to makeitmorewidespreadandeffective.
32CorrespondencewithLaoTradeUnion,January2010.
33CorrespondencewithUNICEF,LaoPeoplesDemocraticRepublicCountryOffice,January2010.
34
Thelasttwoyearshasseenadvancesinreachingchildrenintheschoolsystem,however,verylittle areknownaboutyouththatareoutoftheschoolsystem.Theseyounggirlsandboysbetweentheagesof 1024yearsoldareconsideredespeciallyvulnerabletoHIVinfectionincomparisontotheirpeersbecause theyhavelowaccesstoinformation,lowschoolenrollmentrates,maybeoutofschool,maybesubjectto economicandsexualabuseandexploitation,areonthestreets,aremobile(migrants)and/ordisplaced. TheirinaccessibilityhasnotstoppedtheLaogovernmenttoproceedwithcreativewaystoreachthem. TollfreeHotlineoutofschoolyouthprogram AfirstofitskindinLaoPDR,anationaltollfree gender sensitive Hotline was established in 2007 to reach out of school youth. The hotline provides accurate, emphatic, nonjudgmental and confidential information on HIV/AIDS, reproductive health and drugs, as well as referrals to related services. The Hotlines popularity has grown exponentially with monthlycallsjumpingbyover2000%withinthefirstyear,andreachingapproximately12,000boysand girls between the ages of 1024 years old 34 . The Hotline has successfully illustrated the keen interest of young people to access this information and highlighted their concerns with respect to their own reproductivehealthneeds,HIV,AIDS,STIsanddrugs. Whilethisaccessibleandfreesupporthasbeenprovidedtoyoungpeopleandchildrennationally, there has beena limited focus on programming for adolescents defined as most vulnerable, particularly thosewholiveinremoteareas.Inordertoachieveagreaterscaleupresponse tocoverthehardestto reachpopulationgroupssuchasruralyouth,willrequireadequateresources.Infactyouthprogramsfaced thehighestgapbetweenneededandpledgedfundsforactivitiesin2009(seesectionVII).Inaddition, bothgovernmentandnongovernmentrespondentsintheNCPIgavelowratingsforimplementationof HIVyouthprograms.Forthisreason,theNSAP20112015willprioritizeyouthtargetedpreventionbothin termsofprogrammingandresourcegeneration. Preventionoutcomesknowledgeandbehaviorchange Evenwiththemajorscaleupoftargetedprevention,theoutcomesofsucheffortsarenotsoclear. Lack of trend data makes it difficult to draw conclusions on whether knowledge and behavior have improved. However, there have been a series of 2nd generation surveillance on sex workers and their clients that allow some observation of change, with less trend information on other vulnerable groups suchasMSM,youth,andmigrants. Youth(1524years) verylittleisknownabouttheknowledgeandbehaviorofyouthinLaoPDR, withrespecttoatriskbehaviorandvulnerabilitytoHIV,asfewstudiesandresearchhavebeenconducted. AstudyoftheReproductiveHealthInitiativeforYouthinAsia(RHIYA)assessedthechangesinknowledge and behavior in youth 1524 years to determine effectiveness of their outreach and peer education program 35 .Thestudyfoundthatalthoughtherewasimprovementinknowledgeandbehaviorfrom2004 to2006,acrossallindicators,youthinruralareasscoredsignificantlyworsethaninthecapital(seetable 2). The study demonstrates that rural youth are particularly vulnerable to HIV risk, and many of these youth are moving to urban locations that provide more exposure to these risks. The study shows that althoughtargetedprogrammingcanimproveoutcomes,amoreaggressiveapproachisneededtoensure anadequateresponsetoprotectandequipthisimportantsubgroup.

34CorrespondencewithUNICEFLaoPDRsCountryOffice,February2010.
35BaselineEndlineComparativeReportLaoPDR,TheEU/UNFPAReproductiveHealthInitiativeforYouthinAsia,2006.
35
Vientiane Table2:Indicators 2004 KnowwaysofpreventingSTIs HeardofHIV/AIDS Sexuallyactiverespondentswhoused contraceptivemethod(including condoms)atlastintercourse 23% 87% 2006 50% 93% 2004 4% 53%
Rural 2006 20% 81%
55%
70%
38%
26%
Femalesexworkersandtheirclients Trend data in service women and their male clients 36 shows improvements in both knowledge and behavior over time. In comparing data from the same provinces, comprehensiveknowledgeonHIVprevention and misconceptions rose in service women from 20% in 2004 to 49% in 2008 (45% in 2009) [Indicator 14] (SGS 2004, 2008; BSS 2009) 37,38 . Knowledge of condom protection against HIV and use of condoms with last commercialsexincreasedinbothfemalesex workers (service women) and their male clients between 2004 and 2008 to over 95% (94% in 2009, Indicator 18) (Figure 14). However, consistent condom use remainslowat60%offemalesexworker using condoms every time with commercial partners in the last 3 months. In addition condom sue with casual partners is quite low for both groups(Figure14). Men who have sex with men Trend data are not available for MSM, since the two studies conducted on this populationwereinseparatepartsofthe country, 2007 in the capital Vientiane, and 2009 in LouangPrabang 39,40 .
36Maleclientsincludedlongdistancetransportworkers,militarymen,policeman,andstateenterpriseworkersfor2004,and 37SecondGenerationSurveillance2ndRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2004. 38SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 39BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007. 40BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009.
electricityworkersfor2008.
36
However, comparisons in knowledge and behavior can be made within age groups and with female sex workers(Figure16).KnowledgeaboutmisconceptionsonwhetherHIVcanbetransmittedviamosquitoes or through sharing a meal did not differ greatly between MSM and female sex workers. However, in comparingtheuseofcondomsduringlastcommercialsexwithamaleclient,theMSMfaredmuchworse thanFSW,66%versus95%respectively. Anotherinterestingobservationisthatacrossallindicators,forMSMyoungermenperformmuch worse than older men (statistically significant difference, p<.05). These age differences are not seen in FSWs.TheseagedifferenceswerefoundinmostoftheMSMknowledgeandbehaviorindicatorsbutnot in the FSWindicators. This observation has implications forthe implementation of preventionprograms targetedatMSM.Thesedifferencesbegthequestionifoutreachandeducationeffortsarenotreaching thissubgroupofMSM,ofifeffortsrequirespecifictypeofmessagingtobeeffective?Moreinvestigation is needed as to why younger men have lower outcomes in knowledge and behavior than their older counterparts. A series of operational research and qualitative studies could provide insight on how to changeprogrampracticetoimproveoutcomesintheseyoungmen. Migrants Dataisalsolimitedinthisimportanthighriskgroup.Notrenddataexistandonlyone prevalence study was conducted with limited questions on behavior and knowledge. The most recent studyonLaomigrantswasconductedin2006 41 .Itwasfoundthatriskybehaviorsexistinbothmalesand females,withmorethan75%offemalesand56%ofmaleshavingneverusedcondoms,evenwithnon regularpartners.Knowledgewasnotassessedinthisstudy.Moreresearchisneededtobetterunderstand theriskspresentinthisvulnerablegroup. External migrants had fairly high knowledge of HIV transmission routes and prevention methods with greater than 80% of Vietnamese migrants and over 75% of Chinese migrants having correct knowledge 42 . Condom use faired less well however, with 54% of Vietnamese migrants, and 60% of Chinese migrants having never used a condom. Questions on sexual behavior with type and number of partnerswerenotasked,butthelowcondomusewouldwarrantthisanimportantareatoresearch. InjectingdrugusersneitherdataonHIV,nortrenddatacurrentlyexistsforinjectingdrugusersin LaoPDR.ItisknownhoweverthattheLaoborderregionofVietnam,SonLahasaprevalenceof27%HIVin injecting drug users, which underscores the vulnerability of IDU in border regions or the cross over of thosefromSonLaintoLao. TheoverlapbetweenIDUandothervulnerablegroupsisevident.Injectingdrugusewasreported in4%ofMSMduringthepastyearinLouangPrabangand0.7%amongthe21%ofmenreportedofhaving takendrugsinthepast3monthsinVientiane.Almostallthesemenwerelessthan24yearsofage(BBS, 2007&2009) 43,44 .Interestingly22%ofthosereportinghavingeverusedinjectingdrugsdidntknowthat HIVcouldbetransmittedthroughstainedneedles.IDUwasreportedin1.5%offemalesexworkers(IBBS, 2008) 45 . The2009studyonexternalmigrantsfoundthat2%ofChinesemigrantsand0%oftheVietnamese migrantsengagedinIDU.The2006studyonLaomigrantworkersshowedthatofthe3.9%offemalesthat useddrugs,50%ofthesehadusedinjectingdrugs.Althoughtheuseofdrugswasmuchhigherinmale
41HIVPrevalenceStudyamongMigrantWorkersat8BorderProvincesofLaoPeoplesDemocraticRepublic,2006. 42Knowledge,Attitude,Behavior,andPractices(KABP)surveyamongChineseCommunitiesinLouangnamthaprovinceand
VietnameseCommunitiesinChampasackandAttapeuprovinces,LaoPeoplesDemocraticRepublic,September2008.
43BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007. 44BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009. rd 45
SecondGenerationSurveillance3 RoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008.
37
migrants (40%), only a small percentage of these, 3%, had used injecting drugs. This suggests that a subset of migrant women maybe susceptible to injecting drug use and need to be targeted to gain access to HIV harmreductionprograms. 2. Care,treatment,andsupport programs
Thereisunanimousagreementamong stakeholders in the national response, that implementation of HIV treatment, care and support programs has improved dramatically overthepastyears(Figure17).In2003,the NCPIoverallratingwasalow4,risingonlyin 2007 to a middle 6 rating. The last two years has seen substantial improvements in the provision of servicesandtreatmentforHIVandariseinratingto9.Throughrapidexpansionofvoluntarytestingand counselingandARTsites,morepeopleareabletogettheservicestheneed. Voluntarytestingandcounseling Voluntary testing has experienced an impressivescaleupsince2007.Thenumber of persons tested increased by 50% since 2007 to 37,900. Testing practice in mostat risk populations also increased substantially (Figure18).ThepercentofMSMeverhaving had a test more than tripled during this last reporting period to 22% in 2009, and almost doubled over a oneyear period to 33% in FSW(SGS2004&2008,BBS2007&2009,BSS 2009)32,33,34,46 .Thepercenthavinghadatest andknowingtheirresultalsotripledinMSM since2007to14%,anddoubledsince2004in FSWto18%in2009(15%for2008,UNGASS indicator8). There are a number of reasons that maybe contributing to the increase in testing practice. SpendingonVCTincreasedby2.5foldfrom2007.Oneareofthisspendingwasthemajorexpansionin thenumberofsitesavailableforHIVtesting.Figure19showsthatalongwiththeincreaseinnumberof personstesting,thenumberoftestingsitesrosefrom37in2007to110in2009,athreefoldincrease. Anotherreasonistherangeofsitesavailable,bothgeographicallyandintypeofsetting.Although the expansion in testing sites had been mainly focused for HIV hotspot areas, with only the most populatedprovinceshaving100%oftheirdistrictscovered,testingsitesarenowpresentinallprovinces and86districts.Testingisavailableinarangeofsettingsincludingallnationalandprovincialhospitals, some clinics, STI clinics, ANC sites and most recently, drop in centers. The latter have also expanded in
46SecondGenerationSurveillance2ndRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2004.
38
numbers to 7 dropin centers for FSW and 2 for MSM, allowing for a setting that can providemoretargetedinterventionsforthese mostatriskpopulations. Oneinitiativethathasallowedforthe increase in testing sites is the inception of rapid diagnostic tests (RDT) to test for HIV. Due to grant money from GFATM rounds 4 and 6, a large number of RDTs could be procured to facilities across the country, facilitatingtheincreaseintesting. Outreach efforts to mostatrisk populations as well as improved referral services in TB, STI and ANC, as well as in youth development centers also increased duringthisreportingperiod,withtheaimatincreasingtesting.Therearehoweverstillpriorityareasthat needspecialattention.Interestingly,inbothMSMandFSW,theolderpopulationgroupof25yearsand over was almost twice as likely to have ever had a test than the younger population group of 1524 years 47,48 .Thissuggeststhatyoungmostatriskgroupsmayrequireadifferentstrategyforoutreachin ordertoimprovetheirtestingpractice. Antiretroviraltreatment(ART) Coverage of ART in adults and children has experienced a magnitude of increase similar 93% 90% to that seen in HIV testing (Figure 20). In 81% 2009 1,250 adults and 95 children were 80% 79% receiving ART. Since 2006, ART coverage in 70% 71% 65% childrenrosetwofoldto80%in2009,andin 60% adults increased to 93%, for a total of 92% 50% 49% coverage [Indicator 4]. Scaleup of ART_Adults 41% ART_Child 40% treatment has been one of the foremost ARV_PregnantWomen 37% 30% priorities of the NSAP 20062010. Funds 20% provided by GFATM HIV round 6 grant have 14% 15% 14% providedmorethan1millionUSDtoprocure 10% 12% ARVs for this scale up, with another 1.5 0% 2006 2007 2008 2009 million USD pledged over the next three years. The number of available ART sites expandedfrom2to5,coveringthenorth(1),central(2),andsouth(2),aswellas2satellitesitesinthe north.
100%
Figure20.TrendsincoverageofARTtoadultsandchildrenandPMTCT
Beyond theexpansion of where anHIV positive person in needcan goto receiveART, there has also been a concerted effort to raise awareness regarding eligibility and the effectiveness of treatment. PLHIVhavebeenmobilizedandtrainedtoprovideoutreachtootherPLHIVcentrallyandintheprovinces. Inthepast,PLHIVwouldreceiveARTatlatestages,oftenatCD4+levelswaybelow200,whichwouldlead
47SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 48BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007.
PercentCoverage
39
tolowcoverageandlowsurvivalrates.Throughincreasedawareness,morePLHIVcometoARTsitesand theycomeearlier,increasingtheirsurvival.In2009,12monthsurvivalwas95%inadultsand100%in children[Indicator24].
Asmorepeopleareidentifiedandsurvivalratesincrease,thenumberofPLHIVinneedofARTwill alsorise.Inaddition,in2010,theeligibilityrequirementinLaoforARTincreasedfromCD4+countof250 to350,inlinewithWHOguidelines.Thischangeineligibilitywillalmostdoublethenumberofpeoplein needofARTcomparedtopreviousestimates.Figure21illustratesthefutureneedsofARTbasedonthe changeineligibilityrequirements.Theorangelinerepresentstheestimatedneedbasedonmodelingof availablesurveillancedata.TheseestimateshavebeenthebasisfordeterminingARTneedthusfar.The jump in numbers starting in 2010 is due to the increase of PLHIV qualifying for ART. The blue line demonstrates the need based on the addition of phase 1 and phase 2 scenarios described in section II. Consideringthatphase1PLHIVlevelsoffbytheendofthefirstdecadeof2000s,thechangeineligibility requirementscontinuestheincreaseinneedforARTatthesamepaceasthecombinedestimates. InordertomeetthisdemandforART,anewphaseofscaleupwillbenecessary.Humanresources both in number and capacity will need to increased and strengthened. Increased access to second line ARVandOItreatmentwillbenecessary.Alloftheseoutputswillrequireincreasedresourcesfromdonors andincreasedassistanceofimplementingpartners. Preventionofothertochildtransmission(PMTCT)
The percentage of HIV positive pregnant women receiving antiretrovirals to reduce the risk of mothertochild transmission has remained low in the last two years, 12% in 2008 and 14% in 2009 [Indicator5][Figure20].However,lookingatthisindicatoralonedoesnotprovidethetruepictureofthe significant achievements towards meeting comprehensive coverage of PMTCT. In recognition of the importanceofPMTCTinmaternalandchildhealth(MCH)care,oneofthemostsignificantachievements wastherecentintegrationofPMTCTintothenewlyapprovedFrameworkfortheIntegratedPackageof 40
MaternalNeonatalandChildHealthServices20092015.Tofollowuponthis,theNSAP20112015will asaprioritytask,includethedevelopmentofaPMTCTstrategyfortheNationalProgram. Ontheprogrammaticside,overthepasttwoyearssixprovincesweretargetedforestablishingand integrating PMTCT into all of their ANC/MCH clinics. Health care providers were trained to strengthen their capacity to promote voluntary confidential counseling and make referrals for testing, In addition, emphasiswasmadetodeliverHIV/AIDSandreproductivehealthinformationnotonlytopregnantwomen but also their husbands. Clinics and outreach teams were equipped with the requisite tools including equipment for outreach activities and information, education and communication materials. In 2008, 17,000pregnantwomen,50%ofallpregnantwomenattendingANCclinicsinthesixpriorityprovincesand 2,500oftheirhusbandswererecipientsofHIVoutreachactivitiesfromANCandMCHhealthfacilities. One program that has gained international recognition and interest is the innovative public information campaign launched by the MOH in 2007 in six target provinces to support an enabling environmenttofacilitatemaleinvolvementinPMTCT.Theconceptwasinspiredbythefactthatduring thepregnancyoftheirwives,menhavingsexwithsexworkersislegitimizedsincemanymenbelievethat sex with their wives may cause and lead to miscarriage. Rather than just one message the public campaign, Caring Dads took on a number of issues to dispel misconceptions and focus on the central themethatmenhaveanimportantroletoplayinchildcareandthewellbeingoftheirfamilies.Beyond IEC, thecampaign involved theestablishmentof Caring Dad spaces in ANC/MCH clinics. The program willbeevaluatedduringtheNSAP20112015. OverallthepercentageofinfantsbornwithHIVfromHIVinfectedmothersislowerthanseenin highprevalencecountries.In2009the15%ofinfantsborntoHIVpositivemotherswerealsoinfected withHIV[Indicator25].Althoughtheabsolutenumbersarelow,with25HIVpositiveinfantsbornto167 infectedmothers,thegoalistoreachallHIVpositivepregnantwomeninordertoprovidetheappropriate PMTCTcoverageandpreventfurthertransmissiontonewlyborninfants. ComanagementofHIVandTB
The collaboration between HIV and TB disease programs has been more of a challenge to implementthanthescalingupofotherserviceprograms.OneofthepriorityactivitiesforGFATMround6 wastoincreasethecollaborationbetweenTBandHIVprogramsstartingwiththecreationofaNational HIV/TB Coordination Committee in 2008. Since then, CHAS & the National TB Center have started to coordinateandcollaborateinordertoimprovemutualscreeningandtreatment.Atthetimeofwriting standardoperatingproceduresarebeingdraftedforthecomanagementofHIVandTB.
ThenumberofTBpatientsscreenedforHIVhasincreasedoverthelasttwoyearsfrom293in2008 to594in2009.CurrentpolicystipulatesthatallTBpatientsmustbetestedforHIV,andTBpractitioners havebeentrainedforreferralofpatientstoVCTsitesfortesting.IfthepatienthasaCD4+countofless than350,theyarefurtherreferredtoARTsitesfortreatment.Oftenpatientsarelosttofollowupasthey dontmakeittotheVCTsites.TomitigatelosstofollowupinreferringtotheVCTsitesthelongtermgoal istostartincludingRDTatTBclinics,apriorityactivityfortheNSAP20112015. ThenumberofHIVpatientsscreenedforTBhasincreasedoverthelasttwoyearsfrom388in2008 to 690 in 2009. For PLHIV, the current recommendation is that all should be screened for TB. Often patientsarefirstreferredtooneofthefiveARTsitesaspriority.Asthesesitesaregeographicallycloseto the TB clinics often in the same building, there is close collaboration between the two centers, and patientsareconsistentlyreferredforTBscreening.However,fromtheVCTsites,referralsarenotalways madeforTBscreeningandoftenwhentheyarethereislosstofollowup.Forexample,dropincenterswill 41
referanewlyidentifiedHIVpositivepersontodirectlytooneofthe142TBsites(eachdistricthospitalhas oneTBsite)forscreeningwhichthepersonmaynevervisit. There are plans to expand the TB/HIV comanagement policy. Cotreatment of HIV and TB was receivedby85peoplein2009[Indicator7].Estimatesarenotavailableforthenumberofpeopleliving with HIV who are also infected with TB for 2009 from WHO. The 2006 value for estimated number of incidentTBcasesinPLHIVwas161persons 49 . Careandsupport
In2009,CHAS,inpartnershipwithUNAIDSandUNICEF,establishedaThematicWorkingGroupon Community Care and Support, to better coordinate and monitor community care and support activities nationally. One of the key outputs stemming from the TWG was an advocacy push for a greater involvementofPLHIVcallingfortheirempowermenttoplayamoreactiveroleinthenationalresponse beyondjustbeingrecipientsoftreatment.
Mostoftheburdenoftheepidemicisconcentratedonpoorfamilieswhohavenocushionagainst the consequences of AIDSrelated illnesses, nor do they have the support of formal social protection systems.DuringthelasttwoyearsUNICEFLaohasfacilitatedsmallseedgrantfundstofamiliesaffected byHIVandAIDStoinitiatesmall,manageableincomegenerationactivitiesbenefitingchildren.Inaddition the program has supported two womens groups in the target provinces of Vientiane Capital and ChampasackwhoareeitherinfectedwithHIVorhavebeenaffected.Theseinitiativeshavealreadyhada positiveimpactontheoverallimprovedfinancialsecurityofthehouseholdsinvolved.Childrenhavebeen able to attend school regularly school and have health care visits. Since 2007, 150 income generation activitiesvaluingat67,000USDhavebeensupportedbenefittingapproximately500children. Support to orphans and vulnerable children Expenditure on OVC education increased 17fold from2007toapproximately58,000USDin2009,andforOVCsupporttoalmost100,000USDin2009.In addition,OVCcommunitysupporttripledinitsspendingfrom2007to35,000USD.Thenumberofchildren whohavelostoneorbothparentstoAIDSisnotknown.In2007,anassessmentcommissionedbyUNICEF todeterminethenumbersoforphansandchildrenaffectedbyHIV/AIDSandothervulnerablechildrenin thecountry.Itwasestimatedthattherewereapproximately85,000orphansunder15yearsoldinLao PDRor3.5%ofthechildpopulation,aportionofwhommayhavelostaparenttoAIDS(UNICEF,2007). TheresultsofaneedsassessmentonchildrenandadolescentsaffectedbyHIV/AIDSinthecountry completedin2006informedthedraftingofaFrameworkofActionforChildrenAffectedbyHIV/AIDSin 2009 50 . The study highlighted thatalthough families havetraditionally acceptedchildren who have lost parents, the stigma of AIDS and community isolation have made it more difficult for families to accept children infected with HIV or children affected by AIDS. Many families are already poor and have no supportformalsocialprotectionorwelfaresystem.Decreasedhouseholdincomesandadrainonfinancial resources have meant that children, in the place of parents have become the chief household income earners.SocialprotectionistheareawiththeleastamountofAIDSspendinginLao,comprisingonly0.4% ofallexpenditureandvaluinglessthan70,000USDfor2008and2009. Limited psychosocial support and family placement strategies exist, however, efforts have been madesince2007toscaleuppilotinitiativesthatincludesupportandcaretofamiliesaffectedbyAIDS,the
49GlobalTuberculosiscontrolsurveillance,planning,financing.2008WHO.WesternandPacificRegionalEstimates:
http://www.who.int/tb/publications/global_report/2008/en/index.html
SavetheChildren,2007.
50NeedsAssessmentandChildrenandAdolescentsAffectedbyHIV/AIDSinLaoPDR.UNICEF,LaoPDRMinistryofHealth,
42
establishment of income generating activities, stigma and discrimination campaigns and psychosocial supporttochildreninfectedwithHIVandaffectedbyAIDS.Theseincludelifeskillsbasedsummercamps andchildselfledsupportgroupsandnetworks.Thesepilotinitiativesareasteppingstonetogettingan increased commitment and understanding by government decision makers of the needs of children infectedwithHIVoraffectedbyAIDS. Coverage of support services to orphans and vulnerable children is estimated at 80% (UNICEF). Theseareprogramdataandnotcollectedviahouseholdsurveys,sodataarenotavailableforindicator 10,supporttoOVC.Dataarealsonotcollectedforindicator12,schoolattendancebetweenOVCand nonOVC.
43
IV.Bestpractices
Lao PDR is likely on the way to reach the MDG goal 6A of halting the spread and beginning to reverse HIV prevalence. In addition, Lao PDR has demonstrated great progress towards reaching MDG goal6Bofachievingby2010universalaccesstotreatmentforHIV/AIDSforallthosewhoneedit.When the epidemic started to take hold in the early 2000s, the Lao government responded promptly through increased political support, working closely with partners, and mobilizing of funds to expand the multi sectoralresponse.Themajorfocuswasinpriorityarea1oftheNSAP20062010reachingfullcoverage oftargetedandcomprehensiveinterventions.Acombinationoffactorsacrossthemultisectoralresponse hascontributedtothesuccessseensofar.Thescalingupofdifferentaspectsoftheresponseaswellas the synergy of the multisector efforts can be considered a best practice, particularly in light of the evidenceinimprovedoutcomesandimpact.Inaddition,asoutreachandaccesstotestingidentifiedmore peopleinneed,expansionofART,careandsupportfollowedsuit.
A.ImprovedHIVoutcomesscaleupoftargetedprevention
The comprehensive intervention package essentially has a twopronged approach, scaling up the supplysidewhichcoverstherangeofservicesincludingbehaviorchangeinterventions,condomprovision, STI services and VCT, and improving the demand side through increased awareness and an enabling environment, in particular peerled education outreach efforts by mostatrisk populations and PLHIV withintheirnetworks.
Figure22demonstrateshowthelastfewyearshasseensuccessinscaleupefforts.Allprovincesexcept one(16),havemorethanoneoftheirdistrictscoveredbythecomprehensivepackageofservices.This exceedstheplannedtargetsshowninMapAthatweresetoutintheNSAP20062010,whereonlyeleven provinces would have coverage. In addition, in provinces that have the comprehensive package implemented,allappeartohavemetorexceededtheirtargetsaswell,withthemajorityhavingatleast 50% of their districts covered by the comprehensive package. For example, Vientiane Province was targetedtoachieve27%to29%ofitsdistrictshavingthepackage,butinactuality,theyachievedbetween 76% and 100% district coverage in 2009. Such a scaleup demonstrates Lao PDRs commitment to achievinguniversalaccessofallinterventions. The expansion of the number of dropin centers, HIV testing sites, 100% CUP, and peerled outreach most likely contributed to the positive outcomes in percent reached withpreventionprograms,knowledge,testing behavior, condom use, and consequently, drop in prevalence. Figure 23 illustrates the trendsinseveralUNGASSindicatorsinfemale sex workers, all of which show improved results since 2004. In the past five years comprehensive knowledge more than doubled, with condom use at last sex rising despite already being quite high. HIV testing andknowledgeofresultsalsoalmostdoubled overthepastfiveyears.Accesstopreventionprogramsincreasedsubstantiallyinjustoneyear.
Similarpatternsareseeninpotentialclientsofsexworkers.Condomuseatlastsexwithfemalesex workerrosefrom81%in2004to95%in2008insampledelectricityworkers.Condomusewithlastcasual partner also rose, albeit at lower levels, from 35% in 2004 to 47% in 2008. Privatepublic partnerships have provided outreach and education efforts through work place programs in border factories and infrastructureprojects.Theseactivitieshavehelpedtoreachpotentialclientsofsexworkers. Itseemshardtoimaginesuchaquickanddramaticimpactjustfromscalinguppreventionefforts over a few years. However, the fact that until now the national HIV response was focused on a fairly homogeneouspopulation,andthatthehighrisktargetgroupsarelowintermsofabsolutenumbers,has probablyallowedfortheseeffortstopenetratemoreeasilyandpropagatechangemorequickly.Thisdoes not however preclude the fact that Lao PDR has experienced the positive effects of a successful multi sectoral response that targets both the supply and demand side of HIV services through synergistic and focusedplanning. Thisresponsehasextendedacrossthe healthsectorasdemonstratedbythesuccess reducingSTDrateswithscaleupofSTDservices.ThesuccessoftheHIVresponseisinterlinkedwiththat oftheSTIresponse.
B.ImprovedSTIoutcomesscaleupofSTIservices,asystemsapproachtoHIV management
Intheearly2000s,theSTIrates(infectionwithChlamydiaand/orGonorrhea)werereachingclose to45%infemalesexworkers.ItbecameobviousthatwithoutaddressingSTIs,anexponentialHIVspread was not far behind. The Lao government channeled resources to scaleup STI services through monies from GFATM round 1 and 4 grants as well as other donors. The focus was on improving STI services, increasing access of sex workers to STI services and improving health care seeking behavior including implementation of periodic presumptive treatment (PPT) for sex workers in all provinces. The interventions expanded its scope to include voluntary counseling and testing, behavior change communication among clients and STI services for men through kits. By 2005 dropin centers were established in collaboration with Family Health International (FHI) to complement the government STI services in five provinces, combining all the STI interventions under one roof. Soon after these dropin centers started to provide voluntary testing and counseling in conjunction with HIV outreach and peer education. Figure 24 highlights for FSWs the improvementsovertimeinbothuptakeofSTI services, particularly in dropin centers (red line), reduction in selftreatment and no treatment, and the decrease in STI rates. These improvements mirror the trends seen inHIVtestingandprevalence.Theexpansion of STI services in scope to include HIV preventionandtesting,isexemplaryofasystemswideapproachtomanagingHIVinterventions.
C.Improvedcoverageoftreatmentscaleupofsupplyanddemandsideinterventions
Scaleupoftreatmentalsoexperiencedamajorsuccessover50%increaseinARTcoverageinthe lastreportingperiod.OnthesupplysidethescaleupofARVdrugsduetoincreasedmobilizedfundshas 45
played a major role, but as is known, more drugs alone does not lead to improved coverage. The exponentialexpansionofVCT,has allowedformorecasestobedetectedandhencereceivetreatment. TheadditionofthreemoreARTsiteshasincreasedtheaccessibilitytotreatmentandsupportservices. Therehavealsobeeneffortstoimprovethedemandsidefortheseresources.Thelastfewyears have seen a major increase in the engagement of PLHIV in the national response, especially through outreach and awareness activities. The expansion of PLHIV networks across the country and in point of entrysettingssuchasdropincentersandtestingsitesallowedPLHIVtoreachandmobilizeotherPLHIVto seektreatment.Theirrolewillproveevenmoreimportantaseligibilityrequirementshavebeenrelaxedto includepersonswithCD4+countof350,andPLHIVcanfacilitatethecommunicationaspectsforseeking treatmentearlier. Addressinghealthsystemweaknessesonlycantalwaysachievetheresultswanted.Thesuccessof theARTprogramhasbeenpossiblebecauseofthemultilayeredapproachaddressingboththesupplyand thedemandsideofHIVcare.Byincreasingtheawarenessandneedforservices,thedemandiscreated andthemomentumneededtoensurethoseservicescontinue.

46
V.Majorchallengesandremedialactions
A.
Progressiononpreviouskeychallenges
The main challenge thus far in Lao PDR has been centered around maintaining the low HIV transmission. As the evidence in section II and III illustrates, all the right factors exist for concern of a loomingepidemic: active sex workerclient transactions without 100% consistent condom use, especially with migrantsandneartheborders, theincreasingemergenceofHIVinmenwhohavesexwithmen(MSM), increasing number of drug users including injecting users across all vulnerable groups and borderingcountrieswithmajorIDU/HIVproblem, continuedhighprevalenceofSTIinmenwithgradualdecreaseinwomen, openingofpathwayslinkingLAOPDRwithhighprevalencecountries, increasing influx of external labor migrants from surrounding countries for work on transportationroutesandconstructionprojects, continuousflowofmigrantworkersfromLaosintoandreturningfromcountrieshavinghigher HIVprevalence ThefocusforalleviatingthesepressureshasbeentoreachthetargetssetoutintheNSAP2006 2010, with the ultimate goal of obtaining universal access of interventions to thwart any potential HIV spread. There has been much progress over the last two years to overcome the obstacles in achieving thesetargets.Table3describesthemainchallenges,whethertheyhavebeenachievedandifnotwhy,and whatthefutureneedsaretoachievethetargets.Therearethreemainareasexperiencingimprovement overthelastfewyears: 1. Improvedresourcesandcapacitythelackofresourcesandcapacityweretheprimaryobstaclesat theonsetoftheNSAP.FundsfromtworoundsofGFATM(6and8)havebeenmobilizedtoprovide for the large scaleup seen in prevention and treatment interventions, provide training and supervision, and ensure a better M&E system to provide strategic information on planning and policy. 2. EnablingenvironmentInitiallypoliticalcommitmentwaslagging,butasdescribedinsectionIII, there has been a major turn to a supportive and enabling environment. Improved HIV focused legislation and increased participation of CSOs/PLHIV networks in decisionmaking has provided thesettingtoprogressinformerlyunaddressedareas. 3. Improved data it became clear that one of the major obstacles towards addressing these challengesandroadblockswasthelackofinformationforbothunderstandingtheHIVsituationand formakingevidencebasedprogramandpolicydecisions.Overthelastreportingperiodtherehas beenabigimprovementintheamountandbreadthofdataonHIV.Fivebehavioralstudieshave beenconductedjustinthelastthreeyears,withthreeofthemincludingseroprevalencedata.In additionafunctioningM&Esystemhasbeenestablished(seesectionVII).
B.
Challengesfacedduring20082010
Despitethemanysuccessesseenduringthelasttwoyears,withasubstantialnumberoftargets met or almost met, table 3 indicates that there are still many that have not been reached or it is not
knowniftheyhavebeenreached.Therearetwomainhiccupsinthesystemthatiscreatingbarriersfor achievingthesegoals: 1. Continuedlackofdataasisclearfromtable3,formanypopulationgroupsitisjustnotknownif thetargetshavebeenmet,becausedatahasnotbeencollected/availabletomonitorprogress. 2. Neglected priorities with regards to available resources many of the emerging issues such vulnerabilityinoutofschoolyouth,youthingeneral,mobilepopulations,andinjectingdrugusers arenotaddressedadequatelybecausetheresourcesarenotavailabletomonitorandrespondto theirneeds. There is no doubt of the impressive scale up of services and interventions seen in the past two years,howevermostofthisscaleuphasbeenfocusedonthemaindriversoftheepidemic.Thecontinued challengewillbetomaintainthelevelofservicesandmonitoringthatisalreadyinplacewhileexpanding toemergingvulnerablegroupsandhardtoreachpopulations.
C.
RemedialActionstoachieveUNGASStargets
EffortsareunderwaytofullyevaluatetheprogressmadeduringNSAP20062010,theresultsof whichwillinformthenewNSAP20112015.Table3brieflysummarizedtheinitialfindingswiththelast columndescribingspecificremedialactions.TheprioritiesforthenewNSAPwillbethreepronged: 1. AchievingtheObjective6ofMDGshaltingthespreadandbeginningtoreverseHIVprevalence. 2. AchievingUniversalAccessofinterventionsasameanstowardspriority1. 3. Addressingthechallengesthatthwartprogresstowardspriorities1and2. ThenewNSAPwilldescribethesetofobjectivesthatwillprovidetheframeworkforLaosHIVresponse overthenext5years.Therearesomeareasthatneedspecialattentionastheyarenewandimperativeto overcomingthecurrentchallengesthatarehinderingprogress.ThenewNSAPmustaddressthefollowing: A. More intensified gendersensitive and genderresponsive strategy like its neighbors, Lao PDRs epidemic is becoming increasingly female. With the exception of MSM, the evidence shows that themajorityoftheHIVburdenrestsinwomen(FSW,migrantwomen).Inordertoeffectivelyreach thispopulation,gendersensitiveandgenderresponsivestrategiesneedtobeincorporatedintothe programmaticresponse,fromtrainingtoservicedeliverytomonitoringandevaluation. B. Prioritizing strategic response to emerging vulnerable groups sections II and III described the emergingepidemiologicalsituationandvulnerabilitiestoHIV.Traditionallyresourcesandprogram strategy have been focused on the main players of the epidemic female sex workers and their clients.However,pocketsofevidencepointtootherhighriskgroupsthathavealreadyemerged, such as MSM, or are at the risk of emerging, such as migrants, and thus it is important to understandhowtoexpandinterventioneffortstoreachthesegroups.Specialfocusisneededon thefollowingpopulationsduringthenextNSAP: MigrantsoncethedrivingforceinLaosepidemic,theyarestillhighlyvulnerablegroup, inparticularyoungfemalemigrants. MSM now the highest prevalence group, services are not yet scaled up to provide universalaccess.SpecialfocusandstrategyisneededforyoungMSMastheyperform lessonoutcomeindicators. IDU very little is known about their numbers and level of risk in Lao. Efforts to understandtheirsituationisneededinordertoensureproperresponse. Youth young people are the gateway to HIV prevention. Little is known about HIV 48
knowledge, attitude, & behavior in general population youth. However, evidence has pointed to young migrants & MSM being the most vulnerable. Rural & out of school youthareparticularlyneglectedandvulnerable. C. Increased M&E, surveillance and research despite its improvements, data is still lacking, particularlyinemergingvulnerablegroups.TargetsweresetintheNSAP20062010withoutthe strategy to monitor their progress. It is imperative that this new NSAP have a detailed plan for M&E, surveillance and research, so that come 2015, it will be possible to fully understand the progresstowardsMDGtargetsanduniversalaccess.Thefollowingarehighpriority: SituationalanalysisonIDU Updatedstudyonmigrants,withparticularfocusonyoungfemales Studyongeneralpopulation&youth Specialoperationalresearch&specialsstudiestoassessprogramactivitiesandprovide deeperunderstandingofcertainpatterns(eg.whyyoungMSMscorelowerinknowledge &behaviorthanolderMSM,etc) Include global indicators (UNGASS) in data collection efforts to facilitate monitoring of global HIV priorities. Be sure to include UNGASS indicators in next reproductive health survey,aswellasSGSinMSM
D. Mobilizing resources for neglected/deficient priority areas maintaining the current level of responseinalowepidemiccountryisalreadyachallenge,buttherealdemandwillbetoobtain resources to address neglected and deficient priority areas, especially in response to the aforementioned emerging issues. In order to be successful it will require strategic thinking and reaching beyond primary donors such as GFATM. A resource mobilization plan is imperative in ordertoensurecontinuedandsustainedfundingasthe2015MDGdategetscloser. E. Mobilizing publicprivate partnerships to date, joint programs with the private sector have proved invaluable in reaching certain population groups that may not interact with the public sector.Migrantworkersandoutofschoolyouthcanbenefitfromprogramschanneledthroughthe privatesector,whetherprofitornotforprofitbased.ThegoalforthenextNSAPistofosterand expand relationships with private organizations and industry so that HIV education and outreach effortscanbestreamlinedintheirpoliciesandemployeeprograms,aswellasusetheirstrengths asameansofreachingcertainpopulationgroups(eg.media). Table3:Targetsfor 2010asdescribedin NSAP(20062010)
Astrongoverallmanagement structureexiststoguideand coordinateanexpanded responsetoHIV/AIDS AnationalM&Esystemis functioning Consistentcondomusein80% ofsexualinteractionsbetween femaleSWsandtheirclients HIVprevalenceamongSWs remainsbelow5%
Achieved
Comments
Challengesto achieving/ maintainingtarget

NCCAremainsin backgroundleavingdual roleforCHAS Stilllowcapacityand numberofstaff Nocentralizeddatabase HighmobilityamongFSW
Remedialactions plannedtoachieving/ maintainingtarget

Revisecoordinationstructure. Strengthensecretariatroleof theCHAS Continuetoensureresources
Almost
CHASservesasmain coordinator,NCCA developedclearTOR M&Esystemdeveloped withunit,guidelines&5 yearplan 70%consistentcondom use
Almost
Almost
Yes
Latestprevalenceat 0.43%
HighmobilityamongFSW
Becauseofhighmobility,need tomaintainoutreach&peer lededucationaswellasregular studies Becauseofhighmobility,need tomaintainoutreach&peer lededucationaswellasregular studies
49
STIprevalenceamongSWsis reducedto50%ofthe2004rate Almost Gonorrheadropped13% to7%, Chlamydiadropped26% to21% Currentlynodatahas beencollectedonthis populationgroup HighmobilityamongFSW Becauseofhighmobility,need tomaintainoutreach&peer lededucationaswellasregular studies Conductstudyonmigrants Developstrategyforoutreach tomigrants&theirpartners Needtargetedprevention strategyforfemalemigrants Conductstudyonmigrants Developstrategyforoutreach tomigrants&theirpartners Needtargetedprevention strategyforfemalemigrants Conductstudyonmigrants Developstrategyforoutreach tomigrants&theirpartners Needtargetedprevention strategyforfemalemigrants Expandreachoflifeskillsbased educationtoalldistricts
5%ofmobilemen/migrant workersandtheirpartnersuse VCT/STIservices
Notknown
Condomuseamongtargeted mobilemen/migrantworkers withintheLaoPDRwillincrease from55%(2004)to75%
Notknown
Currentlynodatahas beencollectedonthis populationgroup
STIprevalenceamongtargeted mobilemen/migrantworkers willbereducedby50%fromthe 2004rate
Notknown
Currentlynodatahas beencollectedonthis populationgroup
30%ofprimaryschoolsand30% ofsecondaryschoolsnationwide implementRH/HIV/AIDS/STI educationanddrugawareness lifeskillsbasededucation 40%ofoutofschoolyouthin theprioritizedprovincesare reachedbyawarenessraising campaigns Themostvulnerableoutof schoolyouthinprioritized provinceswillbereached throughpeereducation,IEC materialandcondom promotion,STIandVCTservices andreferralandcounseling 70%ofmaleSWsinselected locationsusecondoms consistentlywithclients 80%ofKathoyinselected locationsusecondoms consistently Evidencebasedinformationon MSMandKathoyisavailable andprogrammaticallyused
Yes
74%ofallschools implementinglifeskills basededucation(in11 targetedprovinces) 29%ofoutofschool youthreachedby awarenesscampaign (midtermreview2008) Nodataavailable Someactivitiescarried outthroughVTEYouth DropinCenterand outreachactivities
Hardtoreachpopulation; nocurrentdata Mobilewomenare importanttargetgroupas latestdatashow0.8% prevalence Hardtoreachpopulation; nocurrentdata Mobilewomenare importanttargetgroupas latestdatashow0.8% prevalence Hardtoreachpopulation; nocurrentdata Mobilewomenare importanttargetgroupas latestdatashow0.8% prevalence
Almost
Majorgapinfunding needs
Emphasizeaspriorityarea& mobilizefunds
Notknown
Majorgapinfunding needs
Emphasizeaspriorityarea& mobilizefunds
No
40%ofmaleSW/MSMuse YoungMSMhavemuch condomsconsistently lowerratesthanolder withclients MSM Currentlynodatahas beencollectedonthis populationgroup Evidencebased informationisavailable withtworecentstudies (BBS2007&BBS2009), howeveritisnotclearif beenusedtoinform programpractice Currentlynodatahas beencollectedonthis populationgroup Currentlynodatahas beencollectedonthis populationgroup Only1rapidassessment conductedwithminimal data;todatenoBSSor Noaggregateddataon MSM(e.g.maleSW, Kathoy) Notrenddataexists,just baseline;needupdated studyonKathoy;current MSMprevalencedata createsconfusingpicture
Developtargetedprevention strategyforyoungMSM
Notknown
Conductupdatedstudy
Almost
Conductupdatedstudyon Kathoy;conductSGSevery3 years;conductanotherSGSon MSMsamplingseveral provinces
Atleast70%ofinjectingdrug userswillusesterileinjecting techniques Atleast40%ofdruguserswill bereachedwithbehavior changeinterventionsand counseling Evidencebasedinformationon druguseavailableand programmaticallyused.
Notknown
AbigdatagaponIDU AbigdatagaponIDU
Conductsituationalanalysis; developstrategybasedonthis Conductsituationalanalysis; developstrategybasedonthis
Notknown
No
AbigdatagaponIDU
Mobilizeresourcestodomore situationalanalysisto determinerealsituation;
50
40%ofethnicgroupsin Notknown prioritizedlocationshavecorrect knowledgeonHIV/AIDS/STI 90%ofmilitaryandpolicein selectedprovinceshavecorrect knowledgeonHIV/AIDS/STI 70%ofmilitaryandpolice personnelinselectedprovinces reportconsistentcondomuse withcasualsexpartners HIV/AIDSpreventionisfully integratedintoMCHhospital andcommunityprograms Notknown BBSstudiesconductedon IDUinLaoPDR. 85%ofethnicgroupsin projectareasreachedby awarenesscampaign (Midtermreview2008) Nostudyduringthe reportingperiod(last studywasconductedin 2004) Manyofthesegroupsare remote&hardtoreach followupwithSGSstudyif groupexists Developoutreachstrategyfor thispopulationgroup;conduct studiesonthispopulation group
Fundinggap
Notknown
Fundinggap
Almost
PMTCTfullyintegratedin 6provincialhospitalsas partofpilotproject, expecttoexpandin2011 2015 AllsitesprovideARVsfor HIV+pregnantmothers Allprovinces(17 provincialbloodbanks and5districtbloodunits) screenbloodaccordingto SOP&throughquality assurancescheme 110VCTsitesasof2009
Atleast4sites(thosethatwill provideARVtreatment)also provideARVtherapyforPMTCT Safebloodservicesareprovided inallprovinces
Yes
StillverylowANCrates, soevenifPMTCT integrated,population maynotbenefit.No specificPMTCTstrategy exists.
DevelopPMTCTstrategywith2 yeargoals ExpandPMTCTintegrationto allMCHhospitalsby2015
Yes
Notclearaboutextentof availablesafebloodat districtlevel
Operationalresearchatdistrict leveltodeterminescreening practicesandextentofsafe blood
Atleast20VCTsitesin prioritizedprovincesare operationalandprovidinghigh qualityandconfidentialservices Inatleast9provincesVCT referralsystemsareestablished forvulnerablegroupswith specialneeds VCTservicesitesareknownand used
Yes
Yes
AllprovinceshaveVCT withreferral
Expandoutreach&referralto reachremote&hardtoreach populationgroups Expandtestingtoreachremote &hardtoreachpopulation groups
Yes
Alltargetdistrictshaveatleast1 sitewhichdelivershighquality, confidentialSTIservices 6,000,000condomssoldper year Generalawarenessand knowledgelevelsincreased
Yes
Yes Almost
94%ofFSWknowwhere togettestin2009; numberoftesting doubledinpast4years 164STIservicesites(78%) operated(Midterm review2008) PerGFATMfunding&PSI socialmarketing FSW&theirclients increased,nodataon otherpopulationgroups
Notdatatomeasurein generalpopulation,no trenddataonother MARPs Betteridentification& neweligibility requirementsmeanmore onART
Outreachprogramsneedtobe expandedtoothervulnerable groupslikeIDU,migrants& youth.Needtodostudieson thesepopulationgroups ExpandnumberofARTsites, ensurecontinuedfundingfor ARVs&OI,trainmedicalstaff onOI&2ndlineregimens
ARVtherapyisavailablein4 provinceswithatleast1000 treatmentslotsforadultsand children Homebasedcareandsupport servicesestablishedin4 provinces Stronglinksestablishedbetween preventionandcareprograms 4supportcentersforadultsand childrenlivingwithHIV/AIDSare
Yes
5ARVsitesand2 satellites,with1345on treatment Establishedin5provinces
Yes
Yes Yes
SeesectionIV,best practices Establishedin5provinces
PMTCTstillweak,no nationalstrategy
Developnationalstrategyfor PMTCT
51
establishedin4provinces. HIV/AIDSismainstreamedinall nationaldevelopmentplans AworkplacepolicyonHIV/AIDS fortheprivatesectoris developedandimplemented togetherwiththeMinistryof Labor,LaoTradeUnionsand Employers,andendorsedby privatecompanies Atleast5lineministriesand massorganizationshave developedtheirsectoral HIV/AIDSplans PLWHAareactivelyparticipating andhaveadvisoryrolesinall HIV/AIDSdecisionmaking bodies,includingNCCAandCCM Aneffectivesecondgeneration surveillancesystemis establishedandimplemented Yes Yes Tripartitehumanrights policy(seehumanrights section)whichforbids discriminationinthe workplace
Almost
3lineministries developedsectoralplans
Resourcesfor implementation
Mobilizeresourcestoput sectoralplansintoaction
Almost
MembersofNCCA,CCM andspecifyTWG
Limitedtechnicalcapacity ofsomePLHIVtobe activelyinvolved Notalldatacollected neededforprogramming andglobalreporting
Yes
3roundsSGS implementedinFSW;2 SGSstartedinMSM
Theknowledgebaseon behavioralandcontextual factorscontributingto vulnerabilitytowardsHIV/AIDS isexpanded.
Almost
HavemoreinfoonMSM &FSW&theirclients
NorecentstudiesonIDU, migrants,andyouth Dataarenoanalyzedor usedenoughforprogram decisions
Increasedtrainingandcapacity building,involvingPLHIVin areasindecisionmaking processtheycancontribute Harmonizeindicatorstoglobal standard;ensurecollectionof neededdatatoinformNSAP& programquestions;continue mobilizingresourcesformore SGSintargetpopulationslike MSM,IDU,migrants Conductmorestudieson emergingvulnerablegroups Increasecapacitytomine, analyzeandusedata strategically
52
VI.Supportfromthecountrysdevelopmentpartners
A. Keysupportreceivedfromdevelopmentpartners
Figure25illustratesthatthealmostall (98%)ofAIDSspendinginLaoPDRisfinanced by international development partners (Figure 25). In fact, essentially all HIV/AIDS program activities are supported through donor funding, since spending from national sources is predominantly on administration and transaction costs associated with managinganddisbursingfunds. The major development partners include the United Nations Organizations, multilateral donors such as the Asian Development Bank (ADB) and GFATM, bilateraldonors,andinternationalNGOssuch as CARE International and Family Health International (FHI). Figure 26 demonstrates shows the breakdown of AIDS spending by type of external donor agency. Across all years, the contribution by GFATM has been the largest and has steadily risen to 43% of all spent monies. UN Agencies are the second biggest contributor, but the level seems to vary by year. This is followed closely by bilateral donors such as AFD and GTZ. Spending of development bank funds has reduced by 3 fold to 3%, making them the smallest donor. Whatisevidentfromthespendingtrendsby donor, is that there is an increased dependency on GFATM to finance Laos HIV program, as other partners start to have smaller role and eventually pull out of financingforHIV. UnitedNationsduringtheearlyyearsoftheresponse,programdevelopmentandintervention weresupportedbytheWHOunderitsGlobalProgrammeonAIDS.Sincethenthepredominantfocushas beenprovidingsupportinthehealthsectorresponseandhasincludedIEC,laboratorydiagnosis,andbasic training for healthcare workers. There has been continued support in recent years for further strengthening of prevention program and establishment of treatment programs, providing technical assistanceandmedicinestotreatopportunisticinfectionsatprovincialhospitalsaswellaspromotionof the100%condomuseamongthepopulationsathighestrisk. UNAIDS and the United Nations Development Programme (UNDP) have complemented this support by strengthening the capacity of the multisectoral response, and in particular the political and
53
organizationalstructureoftheresponse.Technicalassistanceandfinancialsupporthasbeenprovidedto the National AIDS Center and PCCA staffs to implement, manage, and monitor the various programs. UNICEFsfocushasbeenwithassistingtheMinistryofEducationinintegratinglifeskillsandHIVeducation intheschoolcurriculum,providingsupporttoOVCs,aswellasworkingwithWHOtointegratePMTCTin MCHcare.UNFPAhasfocuseditssupportonreproductivehealth,includingthedistributionofcondoms. GlobalFundtoFightAIDS,TuberculosisandMalariaGFATMisthemajorcontributorinfunding andhasprovidedmoniesthrough4grantsinthepastsevenyears.GFATMmonieshavecontributedtoall functioncategories,pavingthewayforanumberofpreventioninitiativesandscaleupinservices.They arethemainfunderofARTdrugs.GFATMisalsothelargestdonoroffundingforprogrammanagement andhumanresources. Bilateral The German quasigovernmental development enterprise, Deutsche Gesellschaft fr TechnischeZusammenarbeit(GTZ),ispresentinthreeprovinces.TheAustralianagencyAusAIDsupports theLaoRedCross,whiletheBurnetInstitute,alsoofAustralia,hasworkedtodevelopthecapacityofthe LaomilitaryandpoliceinsevenprovincestorespondtothespreadofHIV/AIDS.TheSwedishInternational DevelopmentCooperationAgencyhasanHIVpreventionprogramalongthesiteofroadrehabilitation projects in Borikhamxay province. HIV, STI, and behavioral surveillance has been implemented with fundingfromtheUnitedStatesAgencyforInternationalDevelopment INGOsNorwegianChurchAidhassupportedPLWHAattheprovinciallevel,whileMdecinsSans FrontireshasassistedincareandsupporttoPLWHAinSavannakhetprovince.FamilyHealthInternational has conducted all three rounds of the Second Generation Surveillance surveys. During the survey implementation FHI provided highrisk male and female participants with condoms, HIV/STI prevention education,STIsyndromicmanagementandtreatment,andHIVcounselingandreferrals.FHIcontinuesto provideextensivetechnicalassistancetotheCHASfordatamanagement,analysis,andinterpretationof thesurveillancendings. Development Banks ADB aims to alleviate poverty by strengthening infrastructure in countries. ADB has supported many infrastructure projects that incorporate HIV outreach and education to reach migrantworkersandworkerswhoareatriskduetothenatureoftheseprojects(seeSectionIIIworkplace initiatives).
B.
Actionsthatneedtobetakenbydevelopmentpartners
Absorption of funds given by development partners has overall been quite high in Lao PDR. Comparing the spent funds in figure 27 (blue line) and the pledged funds (orange line), they are both almost spot on for 2007 and 2009. Another story presents itself in 2008, with an almost 2millionUSDdifferenceinwhatwaspledged andwhatwasspent.Thisappearstobedue to the fragility of soft pledges, where the fundsarenotdisbursedaspromised.Oneof the problems encountered in the utilization of foreign funds is that they are not always releasedinatimelywaytotheimplementers, which often results in delays in activities. Anothermajorchallengehasbeenthe limitedcoordinatingmechanismsbetweentheimplementingagenciesanddonors. LaoslowHIVprevalencecanmakeahardcaseforobtainingresources.Itsimminentvulnerability to HIV spread renders the need to adequate and continuous resources even more dire. Figure 28 also 54
shows the differential between the estimated need for HIV resources (green line) and the externally pledgedresources(orangeline).Between2007and2008therewasabouta1millionUSDgapinneeded andpledgedfunds,mostofwhichoccurredforbloodsafetyactivitiesandtargetedpreventiontouniform servicesandyoungpeople.Interestingly,in2008therewasa400,000USDgapinfundingforSTIservices, mostlikelyduetothefactthattheGFATMround4HIVgrant,whichwasfocusedonSTIservices,finished inAprilofthatyear.Movinginto2009,thegapbetweenpledgedandneedwidensgreatly,foradifference of almost 2million USD. Areas that suffer include blood safety, with almost half a million shortage, targetedpreventiontosexworkersandtheirclients,uniformedservices,andyoungpeople. One of the possible explanations for the increased gap is the increased dependency on GFATM funding in the past couple of years. Although contributions from GFATM are rising, they are not rising enoughtocoverthedropinfundingfromotherdonors,orthefactthatsomedonorswhousedtoprovide funding, are now recipients themselves of GFATM funds. In addition, GFATM grants tend to focus on thematic areas, rather than funding the entire program. If a grant runs out and an expected grant to continuefundingactivitiesisnotaccepted,therewillbemajorgapsinresourcesforcoreactivities.This wasseenfortherunoutofGFATM4asthemajorsourceoffundingforSTIservicesaswellasthe100% CUP. Figure 28 compares estimated funding needs and externally pledged funds for 2010 by spending category.Thegapbetweenneedsandpledgedincreasesfromlefttoright,withmorefundspledgedthan neededforPMTCT,targetedpreventiontoMSM,andcondomprogramming(redlineaboveblueline).On theotherextremeactivitiessuchastargetedpreventtosexworkersandtheirclients,bloodsafety,STI services and M&E are each at least 300,000USD short of needs. Targeted prevention to youths is consistentlyanunderfundedareaandneedstobeaddressedastheyareanincreasinglyvulnerablegroup. OfmajorconcernisthelargegapforSTIservicesthatcouldjeopardizethemajorscaleup.
TheaforementionedgapsinfundingfallwithinthestrategicprioritiesofthenewNSAP(20112015). It is imperative that efforts are made to fill financial gaps, particularly in high priority areas, through coordination with development partners. Financing the countrywide requirements for responses to HIV/AIDSisanenormousburdenforadevelopingcountrylikeLaoPDR,soaresourcemobilizationplanis neededtoensurecontinuoussupportfromexistingdevelopmentpartners.
55
VII.Monitoringandevaluationenvironment
A. OverviewofcurrentmonitoringandevaluationsystemstrengtheningthethirdOne
Lao PDR has made substantial progress since 2007 in the strengthening of their monitoring and evaluationsystemforthemultisectoralHIVresponse.ComparingresponsesovertimetotheM&Esection intheNCPI,therehasbeenanincreaseinratingofoverallM&Eeffortsfrom6outof10in2003to9outof 10 in 2009. In considering the twelve components of a comprehensive M&E system listed in Table 4, at leastelevenareashavebeenmarkedlyimprovedinthelasttwoyears(UNAIDSMERG,2008).
Oneofthemostsubstantialadvancementswasin2009withthedevelopmentoftheNationalM&E Plan by CHAS. This plan is the nucleus for the third One one agreed country level monitoring and evaluationsystem.TheM&Eplanprovidesguidanceoncoreindicatorstobecollected,describestheroles andresponsibilitiesofallpartnersinthemultisectoralresponse,andincludesacostworkplanuntil2012. InordertocoordinateandoverseethemultisectoralM&Eefforts,anationalfunctionalM&Eunit hasnowbeenestablishedandsitsinCHASwithanincreasefromtwotosixpermanentstaff,allofwhich have been trained in M&E skills. The M&E unit is responsible for providing direction to partners and strengthening the monitoring of the multisectoral response, systematically tracking the progress of the response through the M&E indicator framework, providing timely and accurate strategic information to meet national and international needs. CHAS recently started holding Annual Program Reviews and the NationalDisseminationForumtomonitorprogresstowardssettargetsbyreviewingnationaldata.
Figure29.ReportingStructure
Reporting System
MOH CHAS
TWG PCCAs/PHD
NCCA UN/Donors
NGOs/Partners Line Ministries Mass Organizations Civil Society
Central-
ART site
/Prov. Hospital
DCCAs/ DHO
PCCAs Members
Outreach Workers
Distric Hospital s
Health Centers
DCCAs Members
Drop in Center s
Peer Educator s
CHAS receives monthly reports on routine program data, STI, VCT, HIV, and comanagement of HIV/TB.CurrentlyHIVcasereportscomefrom17provincesand6centralhospitals.Figure29outlinesthe reporting structure. District health centers and hospitals report monthly to the DCCA. In some cases wherethereisdonorfundedprogramming,datafromtheprivatesectors,suchasdropincenters,arealso collected.TheDCCAcompilethesereportsandsendstotheProvincialCommitteefortheControlofAIDS (PCCA)onamonthlybasis. 56
NGOsandotherpartnersintheresponsereporttoPCCAsattheprovinciallevel,whilereporting directlytoCHASatthenationallevel.ThePCCAhasanumberofimportantresponsibilitiesintheM&E system,includingsupervisionsuch asdataqualityauditsandregularfeedbacktodistricthealthcenters. They are also responsible for holding semiannual workshops for data review and dissemination. Line ministries, mass organizations and other CSOs report directly to the CHAS M&E department, who then produceanannualreportwhichispresentedtotheNCCAandMOHforendorsement.
Table4:LaoPDRsstatuswith12componentsofcomprehensiveM&Esystem M&EComponent
1.OrganizationalstructureswithHIVM&E functions 2.HumancapacityforHIVM&E
Progresssince2007*
M&EunitnowhousedinCHAS&fully functional 13%ofHIVprogrambudgetforM&Eactivities 4newpermanentstaff Trainings@national&subnationallevel M&ETechnicalWorkingGroupestablished Effortstoalign&harmonizeM&Eindicators MultisectoralM&Eplandeveloped None AnnualM&Ereports MultisectoralmembershipinM&ETWG, includingPLHIV
Continuedchallenges
MuchofbudgetforM&Eisdependent onexternalfunds Stilllowskillcapacity,especiallyat provinciallevel Notrainingatservicedeliverylevel M&ETWGneedstomeetmore regularlyandsetpriorities Notallsectorsalignedorfollow Nocostedyearlyworkplanyet NotenoughmainstreamingofM&Ein HIVprogramactivities,particularlywith regardsofdatause MoreleadershiponM&Eadvocacyby NCCA AppearsparallelsystemforGFATMsub recipients NoHIVprevalencestudyinIDU NoupdatedHIVprevalence/KAPBstudy onLaomigrants NoupdatedHIVprevalence/KAPBstudy ongeneralpopulation Accessislimitedtofewstaff
3.Partnershipstoplan,coordinate,and managetheHIVM&Esystem. 4.NationalmultisectoralHIVM&Eplan 5.AnnualcostednationalHIVM&Ework plan 6.Advocacy,communicationsandculturefor HIVM&E
7.Routineprogrammemonitoring 8.Surveysandsurveillance
9.NationalandsubnationalHIVdatabase
10.Supportivesupervisionanddataauditing 11.HIVevaluationandresearch
Monthlyreportscollectedfromdistrictto provincialtoCHAS FSW:2008IBBS 2009BBS MSM:2009BBSLuangPrabang IDU:2009HARPAssessment Migrants:2008KAPBonexternalChinese& Vietnamesemigrants Nationalcentralizeddatabasehousingall nationalHIVdata Clinicalmanagementsoftwarebeingpiloted HIVCARE DevelopedstandardsforCSOdatacollection Planned&costedsupervisionvisits MidtermevaluationofNSAPin2008
12.Datadisseminationanduse
Useofmidtermevaluationtoguidenew NationalStrategicActionPlan ExtensiveuseofavailabledataforUNGASS 2010CountryProgressReport
Minimalfeedbackmechanismsto provinciallevel Needmoreresearchontarget populationgroups,suchasyoungfemale migrantworkers Evaluationneededonprogramssuchas 100%CondomUse Needmoreanalyticalcapacitytomine availablesurveillance&surveydata Notenoughuseofstrategicinformation forprogrammonitoring,program decisions&policyformulation Needmoreactiveuseofdatatoidentify vulnerablesubgroups&informprogram priorities
*BasedonanswerstotheNCPIandstakeholderinterview
Atotalof803,230USDhasbeencostedforM&Eactivitiesuntil2012.Overthelasttwoyears13% of the national HIV program budget was dedicated to M&E, underscoring the increased commitment to strengtheningtheM&Esystem.SomeoftheactivitiesincludedevelopmentofanationalM&Edatabase 57
which houses all M&E indicator data, including available UNGASS indicators, piloting of a clinical managementsoftware,CareARTManagement,in2ARTcenters,tobeexpandedto5,andtheonsetof annualM&Ereportsanddisseminationworkshops. Anotherareaofinvestmenthasbeenthemuchneededsurveillancesurveys.AnANCsurveywas conductedin3hospitalsinVientiane.Thefollowingstudieswereconductedsince2007: IDU Rapid Assessment and Response on Drug Use and IDU in Houaphanh Province, Lao PDF, HarmReductionProject,August2009
Migrants Knowledge, attitudes, practices, and behavior survey among Chinese communities in Louangnamtha province and Vietnamese communities in Champasack and Attapeu provinces,September2008 FSW SecondGenerationSurveillance3rdRoundonHIV,STIandBehavior,in6provinces,2008 BehavioralsurveyamongservicewomeninLaoPDR,in5provinces,2009 MSM Integrated biological behavioral survey among men who have sex with men in Vientiane, LaoPDR,2007 Integrated biological behavioral survey among men who have sex with men in Louang Prabang,LaoPDR,2009
B. ChallengesfacedinimplementationofcomprehensiveM&Esystem
Even though there is now a functional M&E unit with established guidelines and plan, the national M&Esystemisstillyoungandthechallengewillbetofosteritsgrowth.Mostoftheprogressmadewas possible because M&E was one of the objectives in the round 6 GFATM HIV proposal. Approximately 300,000USD were disbursed for M&E activities between 2008 and 2009. It is important to have a real understanding of where the gaps are in order to generate resources. Knowing the strengths and weaknessesoftheM&Esystem,requiresanM&Eassessmenttobeconductedsuchasthatrecommended byGFATMusingtheM&ESystemStrengtheningAssessmentTool.Thefollowingissuesarebasedondesk review,responsestotheNCPIquestionnaire,orfeedbackbroughtupintheNCPIstakeholderconsultation. Continuedchallenges NoformalM&Eassessmentconducted InsufficientM&Eskillsinpersonnel,particularlyattheprovincialanddistrictlevel NotrainingofCSOsinM&Edespitetheirroleinprovidingdata Reportingsystemisstillfragmentedandlagsbehindschedules M&ETWGmeetsirregularly FairlylowratingbyCSOregardinginvolvementindevelopingnationalM&Eplanandparticipating intheM&ETWG(3outof5). Stilllimitedornorecentdataonhighriskpopulations,especiallyIDUandmigrants Norecentdataongeneralpopulation NodataavailableforseveralkeyUNGASSindicators Difficulty to obtain reliable estimations and projections due to lack of data & sustainable knowledgeofmodelingtechniques 58
Nooperationalresearchorevaluationofprogramsconductedtodetermineeffectiveness Limitedcapacitytomineandanalyzedataformonitoringprogressandtrends Minimaluseofdataforprogramplanninganddecisionmaking Mostofthesepointsfallunderthreemainareas,dataavailability,quality,anduse.Althoughtheirhas been improvement in these areas and rating in the NCPI for use of data on strategic planning, resource allocation,andprogramimprovementscoredwell(4onscaleof5),Laostillneedstopushforwardinorder tohaveanM&Esystemthatcanprovidethestrategicinformationitneedstostayonestepaheadofthe epidemic. C. Remedialactionsplannedtoovercomechallenges Although responses to the NCPI on overall rating of the M&E system reflect the considerable progressmade(4/5),improvingfromthe2008reportrating(3/5),therearestillthesignificantchallenges mentionedabovethatneedtobeaddressedinordertoachieveacomprehensivesystem.
Many of the aforementioned challenges will be the focus of the newly established M&E TWG, which will provide much of the strategic thinking for strengthening the system. The first task will be to address these issues in the NSAP 20112015 that is currently being prepared. What will help to guide improvementisincludinganM&EstrategywithspecificobjectivesintheNSAP.Inordertokickstartthe progress,fundingwillberequestedinthenexttwoGFATMHIVproposals,withthehopethatmuchofthe routine activities will be integrated into the system and become sustainable over time. Some remedial actionsincludebutarenotlimitedtothefollowing: ConductingformalM&Eassessmentincludingmultistakeholdersystem ProvidingstandardizedM&Etrainingatalllevels&toCSOs InvolvingCSOsmoreintheM&Eprocess,fromdatacollection,toqualityassurance,dataanalysis anduse Expandingcapacitybuildingofstaffthroughknowledgeandskillstransferwithonthejobtraining, mentorship,andhandsontrainingforums Resourcegenerationformuchneededstudiesthroughclearpriorityonneededstrategic information(eg.specialstudyonyoungfemalemigrantworkers) IncorporatingregularoperationalresearchandevaluationsinNSAPworkplantodetermine programeffectiveness Encouragingevidencebaseddecisionmakingandpolicythroughmultistakeholderforumsand reviewofannualreports Providingsustainableanalyticalskillsthrough: trainingstaffwhowillthentrainothersindataanalysis,estimations,&projections continueduseofstrategicinformationinannualreportsandsemiannualprogress workshops
D. NeedforM&Etechnicalassistanceandcapacitybuilding
M&E technical assistance has proved invaluable in the past, resulting in the development of the M&E guidelines and plan. CHAS seeks technical assistance particularly in areas needing expanded expertise,buttodatehashadlimitedsupportfromtechnicalassistance.Muchoftheaforementioned remedial actions will require technical assistance initially until capacity is sustainable. Training curriculum, knowledge and skills transfer, improved strategic information analysis and use, will all benefitfromhighlevelexpertise.ItisimportantfortheNCCAandCHAStoincludetechnicalassistance 59
and capacity building as part of their core activities so as to ensure a continous funding stream and maintainthemomentumofstrengtheningseeninthislastreportingperiod.

60
Annex1: Consultation/preparationprocess
Table1:2010UNGASSreportingprocesstentativeroadmap
Timeframe 29Sep09 15Oct09 16Oct09 19Oct09 25Jan10 03Feb10 4Feb15Mar10 12Mar10 2426Mar10 29Mar10 Apr10 Process AttendingM&EMeetingfortheAsiaPacificRegioninBangkokbetween29thSeptember and2ndOctober2009 BriefingmeetingonUNGASScountryreportpreparationwiththekeypartners concernedatCHAS BriefingmeetingonUNGASScountryreportpreparationwiththeNCCAmembersatLao Plaza Collectingdataandinformationfromallexistingsources Preparationofthe1stDraftofUNGASScountryprogressreportincludingNCPIandNASA reports Consultationmeetingonthe1stdraftreportwithnationalandinternationalpartners Preparationofthe2nddraftofUNGASScountryprogressreport Consultationmeetingonthe2nddraftreportwiththeNCCAmembers(tobeapprovedby theNCCAChair) FinalizingtheUNGASScountryreportandsubmissionofthereporttoNCCAChairfor approval SubmissionoftheUNGASScountryreporttoUNAIDSHQ FollowingupandaddressingtherecommendationfromtheUNGASS2010.
Annex2: Nationalcompositepolicyindexquestionnaire
1) Country LaoPeople'sDemocraticRepublic(0)
2) NameoftheNationalAIDSCommitteeOfficerinchargeofNCPIsubmissionandwhocan becontactedforquestions,ifany: CenterforHIV/AIDSandSTI,MinistryofHealth 3) Postaladdress: Km3ThadeuaRoad,VientianeCapital,LaoPDR 4) Telephone: Pleaseincludecountrycode 85621315500,85621354014 5) Fax: Pleaseincludecountrycode 85621315500,85621354014 6) Email: gfachas.chansy@gmail.com 7) DescribetheprocessusedforNCPIdatagatheringandvalidation: BriefingmeetingonUNGASScountryreportpreparationwiththekeypartnersconcerned andforNCCAmember.DistributedtheNCPIformpartAtoGovernmentpartnersand NCPIformpartBforInternationalandNGOspartnersforansweringthequestion.Data collectionfrompartnersandenterdata,analysisdata.Consultationmeetingwithall partnersonresultofNCPI.Correctdatabycommentsandadvicesfrompartnersand finalysereport. Describetheprocessusedforresolvingdisagreements,ifany,withrespecttothe responsestospecificquestions: N/A
8)
9)
Highlightconcernsifany,relatedtothefinalNCPIdatasubmitted(suchasdataquality, potentialmisinterpretationofquestionsandthelike): N/A
10) NCPIPARTA[tobeadministeredtogovernmentofficials] RespondentstoPartA [Indicatewhichpartseach respondentwasqueriedon]
Organization
Names/Positions
Centerfor Respondent1 HIV/AIDS/STI 11) Respondent Centerfor
Dr.Chansy A.I,A.II,A.III,A.IV,A.V Phimphachanh,Director Dr.Chanthone A.I,A.II,A.III,A.IV,A.V 62
HIV/AIDS/STI
Respondent Centerforfor 3 HIV/AIDS/STI Respondent Centerfor 4 HIV/AIDS/STI
Khamsibounheuang, DeputyDirector Dr.Phouthone Souttalack,Deputy A.I,A.II,A.III,A.IV,A.V Director Dr.Keophouvanh Douangphachanh,Head A.I,A.II,A.III,A.IV,A.V ofAdministrativeand Technicalofficer
Ministryof Respondent LaborandSocial FocalpointforHIV/AIDS A.I,A.II,A.III,A.IV,A.V 5 welfare Ministryof Respondent Dr.Chanthaphone, National A.I,A.II,A.III,A.IV,A.V 6 NCCAmember Defence Mr.Vongdeuane Respondent Ministryof Sengsuriya,Focalpoint A.I,A.II,A.III,A.IV,A.V 7 PublicSecurity forHIV/AIDS Ministryof Mr.Xayabandith Respondent Publicworkand Insisiengmay,Focal A.I,A.II,A.III,A.IV,A.V 8 Transport pointforHIV/AIDS Respondent Dr.SoulanyChansy, LaoRedCross A.I,A.II,A.III,A.IV,A.V 9 FocalpointforHIV/AIDS Respondent LaoWomen Ms.Lavanh,Focalpoint A.I,A.II,A.III,A.IV,A.V 10 Union forHIV/AIDS Mr.Thondeng Respondent LaoYouthUnion Sanepraseuth,Focalfor A.I,A.II,A.III,A.IV,A.V 11 HIV/AIDS Respondent LaoFederation Mr.Vanhkham,Focal A.I,A.II,A.III,A.IV,A.V 12 TradeUnion pontforHIV/AIDS LaoNational Mr.Saysavath Respondent Front Sayasouth,Focalpoint A.I,A.II,A.III,A.IV,A.V 13 construction forHIV/AIDS Respondent Ministryof Ms.Phouangkham,Focal A.I,A.II,A.III,A.IV,A.V 14 Education pointonHIV/AIDS Ministryof Respondent Mr.ViyolinePhrasavanh, Informationand A.I,A.II,A.III,A.IV,A.V 15 FocalpointonHIV/AIDS Culture Departmentof Hygieneand Respondent Dr.VankeoRadsabud, A.I,A.II,A.III,A.IV,A.V Preventive, 16 Technical Ministryof Health Respondent Departmentof Dr.HongthongSivilay, A.I,A.II,A.III,A.IV,A.V 17 Curative, Technical 63
Ministryof Health Respondent 18 Respondent 19 Respondent 20 Respondent 21 Respondent 22 Respondent 23 Respondent 24 Respondent 25
12) IfthenumberofrespondentstoPartAismorethan25,pleaseentertherestof respondentsforPartAinbelowbox. N/A
NCPIPARTB[tobeadministeredtocivilsocietyorganizations,bilateralagencies,andUN 13) organizations] RespondentstoPartB [Indicatewhichpartseach respondentwasqueriedon] B.I,B.II,B.III,B.IV
Organization Names/Positions Dr.PascalStenier,Country coordinationofUNAIDS
Respondent1 UNAIDS 14) Respondent2 UNAIDS
B.I,B.II,B.III, B.IV B.I,B.II,B.III, Respondent3 UNDP Ms.TheresaDiouf,Programmeanalyst B.IV Dr.DominiqueRicard,Medicalofficeron B.I,B.II,B.III, Respondent4 WHO HIV/AIDS/STI B.IV B.I,B.II,B.III, Respondent5 UNICEF Ms.VerityRuston,ChiefHIV/AIDSsection B.IV Dr.LoretoRoquero,HIV/AIDSandRH B.I,B.II,B.III, Respondent6 UNFPA programmespecialist B.IV Dr.PhetdaraChanthala,Humandevelopment B.I,B.II,B.III, Respondent7 WorldBank operationsofficer B.IV B.I,B.II,B.III, Respondent8 UNODC Mr.SengdeuanePhomavongsa,NPO B.IV Dr.KhamlayManivong,SMA,UNAIDS 64
15) IfthenumberofrespondentstoPartBismorethan25,pleaseentertherestof respondentsforPartBinbelowbox. N/a
B.I,B.II,B.III, B.IV B.I,B.II,B.III, Respondent10 WFP AachalChand,Programmeofficer B.IV Burnet B.I,B.II,B.III, Respondent11 Dr.Niramon,ProjectManager Institute B.IV B.I,B.II,B.III, Respondent12 FHI MissPhayvieng,ProjectManager B.IV B.I,B.II,B.III, Respondent13 PSI Mr.RobGray,ProjectManager B.IV Mr.KhampasongSiharath,LaoProgramme B.I,B.II,B.III, Respondent14 APHEDA Manager B.IV B.I,B.II,B.III, Respondent15 AFD Dr.MarlonGarcia,Consultant B.IV B.I,B.II,B.III, Respondent16 NCA Ms.ManivanhPholsena B.IV B.I,B.II,B.III, Respondent17 PEDA Dr.SantyDouangpaseuth,Director B.IV B.I,B.II,B.III, Respondent18 ARC Ms.PhonsavanhManilath,ProgrammeOfficer B.IV B.I,B.II,B.III, Respondent19 WorldVision Mr.MikaNiskanen,HIV/AIDSCoordinator B.IV B.I,B.II,B.III, Respondent20 LNP+ Mr.KynoyPhongdeth,ChairofPLHIV B.IV B.I,B.II,B.III, Respondent21 LYAP Mr.ViengAkone,ProjectManager B.IV B.I,B.II,B.III, Respondent22 ESTHER Ms.Somchay,PrectCoordinator B.IV B.I,B.II,B.III, Respondent23 LNP+ KynoiPhongdeth,ChairofLNP+ B.IV Respondent24 Respondent25 Respondent9 IOM
Ms.MontiraINKOCHASAN,ActingHeadof ProjectOffice
16) 1.HasthecountrydevelopedanationalmultisectoralstrategytorespondtoHIV?
(Multisectoralstrategiesshouldinclude,butarenotlimitedto,thosedevelopedby Ministriessuchastheoneslistedunder1.2) Yes(0) 17) Periodcovered: 65
20062010 18) 1.1Howlonghasthecountryhadamultisectoralstrategy? NumberofYears 17 19) 1.2WhichsectorsareincludedinthemultisectoralstrategywithaspecificHIVbudgetfor theiractivities? Health Education Labour Transportation Military/Police Women Youngpeople Other* Includedinstrategy Yes Yes Yes Yes Yes Yes Yes Yes Earmarkedbudget Yes Yes Yes Yes Yes Yes Yes Yes
20) If"Other"sectorsareincluded,pleasespecify:
InformationandCulture,LaoFederationTradeUnion,LaoFrontforNationalConstruction, LaoRedCross
21) 1.3Doesthemultisectoralstrategyaddressthefollowingtargetpopulations,settingsand
crosscuttingissues?
Targetpopulations a.Womenandgirls b.Youngwomen/youngmen c.Injectingdrugusers d.Menwhohavesexwithmen e.Sexworkers f.Orphansandothervulnerablechildren g.Otherspecificvulnerablesubpopulations* Settings h.Workplace i.Schools j.Prisons Crosscuttingissues k.HIVandpoverty l.Humanrightsprotection m.InvolvementofpeoplelivingwithHIV
Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes
66
22) 1.4Weretargetpopulationsidentifiedthroughaneedsassessment? Yes(0)
n.Addressingstigmaanddiscrimination o.Genderempowermentand/orgenderequality
Yes Yes
23) IFYES,whenwasthisneedsassessmentconducted?
Pleaseentertheyearinyyyyformat 2005 24) 1.5WhataretheidentifiedtargetpopulationsforHIVprogrammesinthecountry? SexworkersandClients,Mobilepopulation/migrantworkers&families,Youngpeoples, MSM/MSW,Druguses,Ethnicgroups,Uniformedservices,&PMTCT 25) 1.6Doesthemultisectoralstrategyincludeanoperationalplan? Yes(0) 26) 1.7Doesthemultisectoralstrategyoroperationalplaninclude: a.Formalprogrammegoals? b.Cleartargetsormilestones? c.Detailedcostsforeachprogrammaticarea? d.Anindicationoffundingsourcestosupportprogramme? e.Amonitoringandevaluationframework? Yes Yes Yes Yes Yes
27) 1.8Hasthecountryensuredfullinvolvementandparticipationofcivilsociety*inthe developmentofthemultisectoralstrategy? Activeinvolvement(0) 28) IFactiveinvolvement,brieflyexplainhowthiswasorganised: Activeinallstepofdevelopmentofthenationalstrategyplanprovideinputs/commentsand thecostinstrategyandactionplanduringthemeetings 29) 1.9Hasthemultisectoralstrategybeenendorsedbymostexternaldevelopmentpartners(bi laterals,multilaterals)? Yes(0) 30) 1.10HaveexternaldevelopmentpartnersalignedandharmonizedtheirHIVrelated programmestothenationalmultisectoralstrategy? Yes,allpartners(0) 31) 2.HasthecountryintegratedHIVintoitsgeneraldevelopmentplanssuchasin:(a)National DevelopmentPlan;(b)CommonCountryAssessment/UNDevelopmentAssistance
67
Framework;(c)PovertyReductionStrategy;and(d)sectorwideapproach? Yes(0) 32) 2.1IFYES,inwhichspecificdevelopmentplan(s)issupportforHIVintegrated? a.NationalDevelopmentPlan b.CommonCountryAssessment/UNDevelopmentAssistanceFramework c.PovertyReductionStrategy d.Sectorwideapproach e.Other:Pleasespecify Yes Yes Yes Yes No
33) 2.2IFYES,whichspecificHIVrelatedareasareincludedinoneormoreofthedevelopment plans? HIVrelatedareaincludedindevelopmentplan(s) HIVprevention Treatmentforopportunisticinfections Antiretroviraltreatment Careandsupport(includingsocialsecurityorotherschemes) HIVimpactalleviation ReductionofgenderinequalitiesastheyrelatetoHIVprevention/treatment,care and/orsupport ReductionofincomeinequalitiesastheyrelatetoHIVprevention/treatment,care and/orsupport Reductionofstigmaanddiscrimination Womenseconomicempowerment(e.g.accesstocredit,accesstoland,training) Other:Pleasespecify Yes Yes Yes Yes Yes Yes Yes Yes No
34) 3.HasthecountryevaluatedtheimpactofHIVonitssocioeconomicdevelopmentforplanning purposes? Yes(0) 35) 3.1IFYES,towhatextenthasitinformedresourceallocationdecisions? 3(3) 36) 4.DoesthecountryhaveastrategyforaddressingHIVissuesamongitsnational uniformedservices(suchasmilitary,police,peacekeepers,prisonstaff,etc)? Yes(0) 37) 4.1IFYES,whichofthefollowingprogrammeshavebeenimplementedbeyondthepilotstagetoreach asignificantproportionoftheuniformedservices? Behaviouralchangecommunication Yes 68
38) IfHIVtestingandcounsellingisprovidedtouniformedservices,brieflydescribethe approachtakentoHIVtestingandcounselling(e.g,indicateifHIVtestingisvoluntary ormandatoryetc): AccordingtotheNationalPolicy,counsellingandtestingwillbevoluntarywithinformed consentandadheretostandardsofconfidentiality,privacyandnonstigmatization 39) 5.Doesthecountryhavenondiscriminationlawsorregulationswhichspecify protectionsformostatriskpopulationsorothervulnerablesubpopulations? Yes(0) 40) 5.1IFYES,forwhichsubpopulations? a.Women b.Youngpeople c.Injectingdrugusers d.Menwhohavesexwithmen e.SexWorkers f.Prisoninmates g.Migrants/mobilepopulations Other:Pleasespecify Yes Yes Yes Yes Yes Yes Yes Yes
Condomprovision HIVtestingandcounseling Sexuallytransmittedinfectionservices Antiretroviraltreatment Careandsupport Other:Pleasespecify
Yes Yes Yes Yes Yes Yes
41) IFYES,brieflyexplainwhatmechanismsareinplacetoensuretheselawsare implemented: EnhancecommunityawarenessStrengthencivilsocietiesNationalcommissionfor advancementofwomenhasbeenestablishedtomonitortheimplementationof CEDAWforotherregulationrelatedtotheadvancementofwomen 42) Brieflycommentonthedegreetowhichtheselawsarecurrentlyimplemented: Atalllevels:central,provincialanddistrictlevels
43) 6.Doesthecountryhavelaws,regulationsorpoliciesthatpresentobstaclestoeffectiveHIV prevention,treatment,careandsupportformostatriskpopulationsorothervulnerable subpopulations? No(0) 44) 7.Hasthecountryfolloweduponcommitmentstowardsuniversalaccessmadeduringthe 69
HighLevelAIDSReviewinJune2006? Yes(0) 45) 7.1HavethenationalstrategyandnationalHIVbudgetbeenrevisedaccordingly? Yes(0) 46) 7.2Havetheestimatesofthesizeofthemaintargetpopulationsbeenupdated? Yes(0) 47) 7.3Aretherereliableestimatesofcurrentneedsandoffutureneedsofthenumberof adultsandchildrenrequiringantiretroviraltherapy? Estimatesofcurrentandfutureneeds(0) 48) 7.4IsHIVprogrammecoveragebeingmonitored? Yes(0) 49) (a)IFYES,iscoveragemonitoredbysex(male,female)? Yes(0) 50) (b)IFYES,iscoveragemonitoredbypopulationgroups? Yes(0) 51) IFYES,forwhichpopulationgroups? SexworkersandtheirclientsMobilepopulation/MigrantworkersandfamiliesMSMDrug userYoungpeoplesUniformedservicesEthnicgroupsANCBlooddonors 52) Brieflyexplainhowthisinformationisused: Forfollowuptheprogressofimplementation 53) (c)Iscoveragemonitoredbygeographicalarea? Yes(0) 54) IFYES,atwhichgeographicallevels(provincial,district,other)? Provincialanddistrictlevels 55) Brieflyexplainhowthisinformationisused: Forfollowuptheprogressoftheimplementation 56) 7.5Hasthecountrydevelopedaplantostrengthenhealthsystems,includinginfrastructure, humanresourcesandcapacities,andlogisticalsystemstodeliverdrugs? Yes(0) 57) Overall,howwouldyouratestrategyplanningeffortsintheHIVprogrammesin2009? 9(9) 70
58) Since2007,whathavebeenkeyachievementsinthisarea: The current national strategy and action plan has been implemented. Many components identifiedintheplanhavefundsecuredandhavebeenimplementedwithcoveredallprovinces. Three sectoral plans have been developed (Lao Women Union, Public Work and Transport, MilitaryandPolice)UNintegratedsupportedplan 59) Whatareremainingchallengesinthisarea: Needsassessmenttoidentifytargetpopulationswereconductedin2005,andpartiallyrevised in2007and2009forGFATMproposaldevelopment Populationgroupsaddressinstrategicplan *IndicatesOVCareaddressed,butnotmentionedinNSAP*IDUneedtobeassessed LaoPDR hasevaluatedimpactofHIVonsocioeconomicdevelopment,butonlyrated3(60%)onusing this information for resource allocation decisions Comprehensive Provincial Strategic Plans needtobedeveloped 60) 1.DohighofficialsspeakpubliclyandfavourablyaboutHIVeffortsinmajordomesticforums atleasttwiceayear? President/Headofgovernment Otherhighofficials Otherofficialsinregionsand/ordistricts Yes Yes Yes
61) 2.DoesthecountryhaveanofficiallyrecognizednationalmultisectoralAIDScoordination body(i.e.,aNationalAIDSCouncilorequivalent)? Yes(0) 62) 2.1IFYES,whenwasitcreated? Pleaseentertheyearinyyyyformat 2003 63) 2.2IFYES,whoistheChair? Name HE.Dr.PonmekDalaloy Position/title MinisterofHealth
64) 2.3IFYES,doesthenationalmultisectoralAIDScoordinationbody: havetermsofreference? haveactivegovernmentleadershipandparticipation? haveadefinedmembership? includecivilsocietyrepresentatives? includepeoplelivingwithHIV? includetheprivatesector? Yes Yes Yes Yes Yes Yes 71
65) Ifyouanswer"yes"tothequestion"doestheNationalmultisectoralAIDScoordination bodyhaveadefinedmembership",howmanymembers? Pleaseenteranintegergreaterthanorequalto1 14 66) Ifyouanswer"yes"tothequestion"doestheNationalmultisectoralAIDScoordination bodyincludecivilsocietyrepresentatives",howmany? Pleaseenteranintegergreaterthanorequalto1 6 67) Ifyouanswer"yes"tothequestion"doestheNationalmultisectoralAIDScoordination bodyincludepeoplelivingwithHIV",howmany? Pleaseenteranintegergreaterthanorequalto1 1 68) 3.Doesthecountryhaveamechanismtopromoteinteractionbetweengovernment,civil societyorganizations,andtheprivatesectorforimplementingHIVstrategies/programmes? Yes(0) 69) IFYES,brieflydescribethemainachievements: Taskforceworkinggroupregularmeetingoftaskforceworking 70) Brieflydescribethemainchallenges: 71) 4.WhatpercentageofthenationalHIVbudgetwasspentonactivitiesimplementedbycivil societyinthepastyear? Pleaseentertheroundedpercentage(0100) 20 72) 5.WhatkindofsupportdoestheNationalAIDSCommission(orequivalent)providetocivil societyorganizationsfortheimplementationofHIVrelatedactivities? Informationonpriorityneeds Technicalguidance Yes Yes 72
haveanactionplan? haveafunctionalSecretariat? meetatleastquarterly? reviewactionsonpolicydecisionsregularly? activelypromotepolicydecisions? provideopportunityforcivilsocietytoinfluencedecisionmaking? strengthendonorcoordinationtoavoidparallelfundingandduplicationofeffortin programmingandreporting?
Yes Yes Yes Yes Yes Yes Yes
73) 6.Hasthecountryreviewednationalpoliciesandlawstodeterminewhich,ifany,are inconsistentwiththeNationalAIDSControlpolicies? Yes(0) 74) 6.1IFYES,werepoliciesandlawsamendedtobeconsistentwiththeNationalAIDSControl policies? Yes(0) 75) IFYES,nameanddescribehowthepolicies/lawswereamended: NationalpolicyonHIV/AIDS/STIandThepolicyreviewedinyear2008foradditionalon MSM,HIV/TBandNutrition 76) Nameanddescribeanyinconsistenciesthatremainbetweenanypolicies/lawsandthe NationalAIDSControlpolicies: N/A 77) Overall,howwouldyouratethepoliticalsupportfortheHIVprogrammesin2009? 9(9) 78) Since2007,whathavebeenkeyachievementsinthisarea: NCCA meeting end of 2009 agreed: Set up Standing committee, Designated Secretariat Expanded membership: National Assembly, Lao National Chamber Commerce and Industry (Rep.ofmigrant),BuddhistAssociation,MedicalDepartment,PLHIVUpdatedNationalpolicyto includeTB,MSM,NutritionIncreasedenablingenvironmentforadvocacy,addressingsensitive areas (MSM, IDU, etc.) which has allowed progress in addressing previously limited areas Incorporatingadvocacyeffortsintopolicysuchas100%condomuseprogram(CUP) 79) Whatareremainingchallengesinthisarea: NCCAmeetingshallmeetasplanned(twiceayear)Additionalsupportneedtostrengthen NCCAsSecretariat 80) 1.Doesthecountryhaveapolicyorstrategythatpromotesinformation,educationand communication(IEC)onHIVtothegeneralpopulation? Yes(0) 81) 1.1IFYES,whatkeymessagesareexplicitlypromoted? Checkforkeymessageexplicitlypromoted(multipleoptionsallowed) a.Besexuallyabstinent(0) b.Delaysexualdebut(0) 73
Procurementanddistributionofdrugsorothersupplies Coordinationwithotherimplementingpartners Capacitybuilding Other:Pleasespecify
Yes Yes Yes No
c.Befaithful(0) d.Reducethenumberofsexualpartners(0) e.Usecondomsconsistently(0) f.Engageinsafe(r)sex(0) g.Avoidcommercialsex(0) h.Abstainfrominjectingdrugs(0) i.Usecleanneedlesandsyringes(0) j.Fightagainstviolenceagainstwomen(0) k.GreateracceptanceandinvolvementofpeoplelivingwithHIV(0) l.Greaterinvolvementofmeninreproductivehealthprogrammes(0) m.Malestogetcircumcisedundermedicalsupervision(0) n.KnowyourHIVstatus(0) o.PreventmothertochildtransmissionofHIV(0) 82) Inadditiontotheabovementioned,pleasespecifyotherkeymessagesexplicitlypromoted: N/A 83) 1.2Inthelastyear,didthecountryimplementanactivityorprogrammetopromoteaccurate reportingonHIVbythemedia? Yes(0) 84) 2.DoesthecountryhaveapolicyorstrategypromotingHIVrelatedreproductiveandsexual healtheducationforyoungpeople? Yes(0) 85) 2.1IsHIVeducationpartofthecurriculumin: primaryschools? secondaryschools? teachertraining? Yes Yes Yes
86) 2.2Doesthestrategy/curriculumprovidethesamereproductiveandsexualhealtheducation foryoungmenandyoungwomen? Yes(0) 87) 2.3DoesthecountryhaveanHIVeducationstrategyforoutofschoolyoungpeople? Yes(0) 88) 3.Doesthecountryhaveapolicyorstrategytopromoteinformation,educationand communicationandotherpreventivehealthinterventionsformostatriskorothervulnerable subpopulations? Yes(0) 89) 3.1IFYES,whichpopulationsandwhatelementsofHIVpreventiondothepolicy/strategy address? Checkwhichspecificpopulationsandelementsareincludedinthepolicy/strategy 74
90) Youhavecheckedoneormorepolicy/strategyfor"Otherpopulations".Pleasespecifywhat are"otherpopulations". Promotionof100%condomused,OutreachactivitiesofsexworkersDistributionofcondom 91) Overall,howwouldyouratethepolicyeffortsinsupportofHIVpreventionin2009? 9(9) 92) Since2007,whathavebeenkeyachievementsinthisarea:
TargetedinformationonriskreductionandHIVeducation Otherpopulations Stigmaanddiscriminationreduction Otherpopulations Condompromotion Sexworkers HIVtestingandcounselling Sexworkers Reproductivehealth,includingsexuallytransmittedinfectionspreventionand Otherpopulations treatment Vulnerabilityreduction(e.g.incomegeneration) Otherpopulations Injectingdrug Drugsubstitutiontherapy user Injectingdrug Needle&syringeexchange user
Increasefrom37VCTsitesin2007to110VCTsitesin2009inallprovincesAlmostdoublingof HIVtestinginFSWsince2007100%CUPexpandedtocover15provincesEstablishedpeerled BCCAIDSpreventionmainstreamedintoseveraldevelopmentprojects:*Infrastructure/road work*Dams*Mining*Factories 93) Whatareremainingchallengesinthisarea: PreventioneffortsdontreachmostremotecommunitiesAwarenesscapacityislimitedto peereducatorsFinancialcommitmenttoforpreventioninterventionsonyearlybasis 94) 4.HasthecountryidentifiedspecificneedsforHIVpreventionprogrammes? Yes(0) 95) IFYES,howwerethesespecificneedsdetermined? EstablishedCommitteeforControlofAIDSatNational,provincialanddistrictlevels 96) 4.1TowhatextenthasHIVpreventionbeenimplemented? HIVpreventioncomponent Bloodsafety Universalprecautionsinhealthcaresettings PreventionofmothertochildtransmissionofHIV IEC*onriskreduction Agree Agree Agree Agree 75 Themajorityofpeopleinneed haveaccess
97) Overall,howwouldyouratetheeffortsintheimplementationofHIVpreventionprogrammes in2009? 9(9) 98) Since2007,whathavebeenkeyachievementsinthisarea: Manysectorshavefundsecuredfortheiractivities100%CUPhasbeenexpandedandcovered in15provincesVCThascoveredin17provinces,86districtsand1HealthcenterDropin centerforsexworkersandMSMhavebeenestablishedinmanyprovincesAIDSprevention programmehasbeenmainstreamedintomanyinfrastructuredevelopmentproject(eg:Road anddamconstructions)MSMpeereducationmanualdevelopedSurveillancehasincluded moretargetedpopulation:MSM,ANCNetworkPLWHAexpandedfrom6networksin2007to 12networksin2009,VCTsitesexpanded91sitesin2008and110in2009 99) Whatareremainingchallengesinthisarea: PreventioneffortsdontreachmostremotecommunitiesAwarenesscapacityislimitedto peereducatorsFinancialcommitmenttoforpreventioninterventionsonyearlybasis 100) 1.DoesthecountryhaveapolicyorstrategytopromotecomprehensiveHIVtreatment,care andsupport?(Comprehensivecareincludes,butisnotlimitedto,treatment,HIVtestingand counselling,psychosocialcare,andhomeandcommunitybasedcare). Yes(0) 101) 1.1IFYES,doesitaddressbarriersforwomen? Yes(0) 102) 1.2IFYES,doesitaddressbarriersformostatriskpopulations? Yes(0) 103) 2.HasthecountryidentifiedthespecificneedsforHIVtreatment,careandsupportservices? Yes(0) 76
IEC*onstigmaanddiscriminationreduction Condompromotion HIVtestingandcounselling Harmreductionforinjectingdrugusers Riskreductionformenwhohavesexwithmen Riskreductionforsexworkers Reproductivehealthservicesincludingsexuallytransmitted infectionspreventionandtreatment SchoolbasedHIVeducationforyoungpeople HIVpreventionforoutofschoolyoungpeople HIVpreventionintheworkplace Other:pleasespecify
Agree Agree Agree N/A Agree Agree Agree Agree Agree Don'tagree N/A
104) IFYES,howwerethesedetermined? ExpandARVtreatmentsites2sitesin2008and4sitesin2009. 105) 2.1TowhatextenthavethefollowingHIVtreatment,careandsupportservicesbeen implemented? HIVtreatment,careandsupportservice Antiretroviraltherapy Nutritionalcare PaediatricAIDStreatment Sexuallytransmittedinfectionmanagement PsychosocialsupportforpeoplelivingwithHIVandtheir families Homebasedcare PalliativecareandtreatmentofcommonHIVrelated infections HIVtestingandcounsellingforTBpatients TBscreeningforHIVinfectedpeople TBpreventivetherapyforHIVinfectedpeople TBinfectioncontrolinHIVtreatmentandcarefacilities CotrimoxazoleprophylaxisinHIVinfectedpeople Postexposureprophylaxis(e.g.occupationalexposuresto HIV,rape) HIVtreatmentservicesintheworkplaceortreatmentreferral systemsthroughtheworkplace HIVcareandsupportintheworkplace(includingalternative workingarrangements) Other:pleasespecify Agree Don'tagree Agree Agree Don'tagree Agree Agree Agree Agree Don'tagree Don'tagree Agree Agree Agree Don'tagree Themajorityofpeopleinneed haveaccess
N/A 106) 3.Doesthecountryhaveapolicyfordeveloping/usinggenericdrugsorparallelimportingof drugsforHIV? Yes(0) 107) 4.Doesthecountryhaveaccesstoregionalprocurementandsupplymanagement mechanismsforcriticalcommodities,suchasantiretroviraltherapydrugs,condoms,and substitutiondrugs? No(0) 108) Overall,howwouldyouratetheeffortsintheimplementationofHIVtreatment,careand supportprogrammesin2009? 9(9) 77
109) Since2007,whathavebeenkeyachievementsinthisarea: IncreaseinARTcoveragefrom63%to93%ExpansionofARTsitesfrom2in2007to5plus2 satellitesin2009DecreaseinHIV&STIprevalenceinFSWsince2004Establishmentof7drop incenterstargetedatfemaleserviceworkers,whichmirrorsincreaseintesting 110) Whatareremainingchallengesinthisarea: HIVservicesnotyetlinkedwithMCH,tobediscussedsoonbetweenCHASandMCHCto strengthenPMCTpackageMorehumanresourcesneededNeedtoensureaccesstoOI&2nd linetreatment 111) 5.DoesthecountryhaveapolicyorstrategytoaddresstheadditionalHIVrelatedneedsof orphansandothervulnerablechildren? Yes(0) 112) 5.1IFYES,isthereanoperationaldefinitionfororphansandvulnerablechildreninthe country? Yes(0) 113) 5.2IFYES,doesthecountryhaveanationalactionplanspecificallyfororphansandvulnerable children? Yes(0) 114) 5.3IFYES,doesthecountryhaveanestimateoforphansandvulnerablechildrenbeing reachedbyexistinginterventions? Yes(0) 115) IFYES,whatpercentageoforphansandvulnerablechildrenisbeingreached? Pleaseentertheroundedpercentage(0100) 70 116) Overall,howwouldyouratetheeffortstomeettheHIVrelatedneedsoforphansandother vulnerablechildrenin2009? 7(7) 117) Since2007,whathavebeenkeyachievementsinthisarea: ConductedqualitystudyofHIVimpactonOVCandthereweresomeinitiativeinterventionto addresstheOVCissues 118) Whatareremainingchallengesinthisarea: IndicatesOVCareaddressed,butnotmentionedinNSAP 119) 1.DoesthecountryhaveonenationalMonitoringandEvaluation(M&E)plan? Yes(0) 120) 1.1IFYES,yearscovered: 78
Pleaseenterthestartyearinyyyyformatbelow 2006 121) 1.1IFYES,yearscovered: Pleaseentertheendyearinyyyyformatbelow 2010 122) 1.2IFYES,wastheM&EplanendorsedbykeypartnersinM&E? Yes(0) 123) 1.3IFYES,wastheM&Eplandevelopedinconsultationwithcivilsociety,includingpeople livingwithHIV? Yes(0) 124) 1.4IFYES,havekeypartnersalignedandharmonizedtheirM&Erequirements(including indicators)withthenationalM&Eplan? Yes,allpartners(0) 125) 2.DoesthenationalMonitoringandEvaluationplaninclude? adatacollectionstrategy Yes awelldefinedstandardisedsetofindicators Yes guidelinesontoolsfordatacollection Yes astrategyforassessingdataquality(i.e.,validity,reliability) Yes adataanalysisstrategy Yes adatadisseminationandusestrategy Yes 126) Ifyoucheck"YES"indicatingthenationalM&Eplanincludeadatacollectionstrategy,then doesthisdatacollectionstrategyaddress: routineprogrammemonitoring behaviouralsurveys HIVsurveillance Evaluation/researchstudies Yes Yes Yes Yes
127) 3.IsthereabudgetforimplementationoftheM&Eplan? Yes(0) 128) 3.1IFYES,whatpercentageofthetotalHIVprogrammefundingisbudgetedforM&E activities? Pleaseentertheroundedpercentage(1100).Ifthepercentageislessthan1,pleaseenter"1". 13 79
129) 3.2IFYES,hasfullfundingbeensecured? Yes(0) 130) 3.3IFYES,areM&Eexpendituresbeingmonitored? Yes(0) 131) 4.AreM&EprioritiesdeterminedthroughanationalM&Esystemassessment? Yes(0) 132) IFYES,brieflydescribehowoftenanationalM&Eassessmentisconductedandwhatthe assessmentinvolves: Monthlyreportfrompartnersatbothcentralandprovinciallevels 133) 5.IsthereafunctionalnationalM&EUnit? Yes(0) 134) 5.1IFYES,isthenationalM&EUnitbased intheNationalAIDSCommission(orequivalent)? intheMinistryofHealth? Elsewhere?(pleasespecify) 135) Numberofpermanentstaff: Pleaseenteranintegergreaterthanorequalto0 8 136) Numberoftemporarystaff: Pleaseenteranintegergreaterthanorequalto0 0 137) Pleasedescribethedetailsofallthepermanentstaff: Permanent staff1 Permanent staff2 Permanent staff3 Permanent staff4 Permanent staff5 Permanent Position DeputyDirectorofCenterfor HIV/AIDS/STI Headofplanning,M&Eand Internationalcoordination ViceHeadofplanning,M&Eand Internationalcoordination Technicalstaffofplanning,M&Eand Internationalcoordination Technicalstaffofplanning,M&Eand Internationalcoordination Technicalstaffofplanning,M&Eand Sincewhen? Fulltime/Part (pleaseentertheyear time? inyyyyformat) Fulltime Fulltime Fulltime Fulltime Fulltime Fulltime 2006 2006 2006 2006 2008 2009 80 Yes Yes No
staff6 Permanent staff7 Permanent staff8 Permanent staff9 Permanent staff10 Permanent staff11 Permanent staff12 Permanent staff13 Permanent staff14 Permanent staff15
Internationalcoordination Localconsultant Localconsultant Fulltime Fulltime 2009 2009
138) 5.3IFYES,aretheremechanismsinplacetoensurethatallmajorimplementingpartners submittheirM&Edata/reportstotheM&EUnitforinclusioninthenationalM&Esystem? Yes(0) 139) IFYES,brieflydescribethedatasharingmechanisms: CollectmonthlyreportfrompartnersandPCCAsDevelopedNationalSoftwareforM&E 140) Whatarethemajorchallenges? ThecurrentnationalM&EsystemisatanearlystageInsufficientskilledpersonnelonM&E, especiallyattheprovinciallevelReportingsystemisfragmentedandlacksbehindschedules Limiteddataonhighriskpopulationleadingtoestimationandprojectiondifficulty 141) 6.IsthereanationalM&ECommitteeorWorkingGroupthatmeetsregularlytocoordinate M&Eactivities? Yes,butmeetsirregularly(0) 142) 6.1Doesitincluderepresentationfromcivilsociety? Yes(0) 143) IFYES,brieflydescribewhotherepresentativesfromcivilsocietyareandwhattheirroleis: Laoyouthunion,Laowomenunion,laotradeunion,nationalLaoFrontconstructionLaoYouth AIDSprevention(LYAP). 144) 7.IsthereacentralnationaldatabasewithHIVrelateddata? Yes(0) 81
145) 7.1IFYES,brieflydescribethenationaldatabaseandwhomanagesit M&Eunit 146) 7.2IFYES,doesitincludeinformationaboutthecontent,targetpopulationsandgeographical coverageofHIVservices,aswellastheirimplementingorganizations? Yes,alloftheabove(0) 147) 7.3Isthereafunctional*HealthInformationSystem? Atnationallevel Yes Atsubnationallevel Yes 148) ForQuestion7.3,youhaveindicated"Yes"to"subnationallevel",pleasespecifyatwhat level(s)? Provincialanddistrictlevels 149) 8.DoesthecountrypublishatleastonceayearanM&EreportonHIV,includingHIV surveillancedata? Yes(0) 150) 9.TowhatextentareM&Edataused 9.1indeveloping/revisingthenationalAIDSstrategy?: 4(4) 151) Provideaspecificexample: Draftofnewstrategyandactionplan20112015Monitortheprogressofthenational responseTrackthetrendoftheepidemicInformationsharingwithpartnersARVtreatment 152) Whatarethemainchallenges,ifany? InsufficiencyofdatasourcesLimitationofdataanalysisLimitationofQ&AandQ&Cofdata ExternalfundingdependencyNewsoftwarefornationalM&Eisearlystage 153) 9.TowhatextentareM&Edataused 9.2forresourceallocation?: 4(4) 154) Provideaspecificexample: ImprovecapacitybuildingatalllevelsAllocateoffinancialintherigthway 155) Whatarethemainchallenges,ifany? InsufficientM&Eskillsinpersonnel,particularlyatprovincialanddistrictlevelsStilllimited dataonhighriskpopulations 82
156) 9.TowhatextentareM&Edataused 9.3forprogrammeimprovement?: 4(4) 157) Provideaspecificexample: ImprovecapacitybuildingatalllevelsAllocateoffinancialintherigthway 158) Whatarethemainchallenges,ifany? HIVM&EsystemstillatearlystagesInsufficientM&Eskillsinpersonnel,particularlyat provincialanddistrictlevelsStilllimiteddataonhighriskpopulationsNeedmechanisms improveQA&QCofdata 159) 10.IsthereaplanforincreasinghumancapacityinM&Eatnational,subnationalandservice deliverylevels?: Yes,atalllevels(0) 160) 10.1Inthelastyear,wastraininginM&Econducted Atnationallevel? Yes Atsubnationallevel? Yes Atservicedeliverylevelincludingcivilsociety? No 161) Pleaseenterthenumberofpeopletrainedatnationallevel. Pleaseenteranintegergreaterthan0 22 162) Pleaseenterthenumberofpeopletrainedatsubnationallevel. Pleaseenteranintegergreaterthan0 28 163) 10.2WereotherM&Ecapacitybuildingactivitiesconductedotherthantraining? No(0) 164) Overall,howwouldyouratetheM&EeffortsoftheHIVprogrammein2009? 9(9) 165) Since2007,whathavebeenkeyachievementsinthisarea: NationalM&EunitestablishedinCHASM&ETWGestablishedM&Eplanfor2010developed 13%HIVprogramfundingtoM&EactivitiesTrainingsinM&E@national,subnational,service deliverylevel3rdroundof2ndgenerationsurveillance&severalotherstudiesMidterm reviewin2008ofNSAPNationalM&Edatabasedeveloped&housingindicatorsClinical managementsoftwarepilottestedin2hospitals(Setthathirath&Mahosot)Monthly&Annual M&EreportsAllpartnershavealigned&harmonizedM&Erequirements 166) Whatareremainingchallengesinthisarea: 83
HIVM&EsystemstillatearlystagesInsufficientM&Eskillsinpersonnel,particularlyat provincialanddistrictlevelsStilllimiteddataonhighriskpopulationsNeedmechanisms improveQA&QCofdata Page82 167) 1.DoesthecountryhavelawsandregulationsthatprotectpeoplelivingwithHIVagainst discrimination?(includingbothgeneralnondiscriminationprovisionsandprovisionsthat specificallymentionHIV,focusonschooling,housing,employment,healthcareetc.) No(0) 168) 2.Doesthecountryhavenondiscriminationlawsorregulationswhichspecifyprotections formostatriskpopulationsandothervulnerablesubpopulations? Yes(0) 169) 2.1IFYES,forwhichsubpopulations? a.Women Yes b.Youngpeople Yes c.Injectingdrugusers Yes d.Menwhohavesexwithmen Yes e.SexWorkers Yes f.prisoninmates No g.Migrants/mobilepopulations Yes Other:Pleasespecify No 170) IFYES,brieflyexplainwhatmechanismsareinplacetoensuretheselawsareimplemented: DecreeofthePresidentoftheLaoPDRwasissuedtopromulgatetheLawsDecreeofthe Prime Minister of the Lao PDR was issued to implement the Laws The Laws have been disseminated through various means to all sectors concerned and general public National commissionforadvancementofwomenhasbeenestablishedtomonitortheimplementation of CEDAW and other legislation regarding the development and protection of women and children The law on the protection of women directs all relevant ministries and mass organisationstoensurethatthepositionofwomeninLaosocietyisprotectedandenhanced .thearmofgovernmentwhichhasmostresponsibilityinthisareaistheLaowomensunion.it is their role to promote research ,policy development and monitor the role women in the community .Their links through membership,advocacy,projects, and position in the community,allows them to effectively monitor and report on how this law is being implemented and what future action need to be taken .in addition ,to the womens union, manyNGOsconductactivitiesaimedatpromotingtheroleofwomeninthecommunityand they are able to work with government an the womens union if there are any incidences which suggest that the law is not being implemented. The national strategy for HIV/STI prevention program has been delivering services to ensure that women and other group of population have access to health information, treatment and other social support . The government should disseminate the law and make it kwon in every setting including in 84
communitylevelsothatgeneralpublicwouldknow,ifpeopledontknowthelawtheywould dontknowwhattodoorwheretogotoclaimfortheirrights. 171) Brieflydescribethecontentoftheselaws: ConstitutionoftheLaoPDR:Article25.(New)TheStateattendstoimprovingandexpanding public health services to take care of the peoples health. The State and society attend to building and improving disease prevention systems and providing health care to all people, creatingconditionstoensurethatallpeoplehaveaccesstohealthcare,especiallywomenand children,poorpeopleandpeopleinremoteareas,toensurethepeoplesgoodhealth.Article 29. (New) The State, society and families attend to implementing development policies and supporting the progress of women and to protecting the legitimate rights and benefits of women and children. Law on Development and Protection of Women Article 16. Equal Cultural and Social Rights The State promotes and creates conditions for women to enjoy equalculturalandsocialrightsasmen,suchasrightstoparticipateinsocioculturalactivities, art performances, sports, education, public health, [and] in research and invention in socio culture,andscienceandtechnology.Societyandfamilyshouldcreateconditionsandprovide opportunitiesforwomentoparticipateinthesocioculturalactivitiesmentionedabove.Law ontheProtectionoftheRightsandInterestsofChildrenArticle6.NonDiscriminationagainst ChildrenAllchildrenareequalinallaspectswithoutdiscriminationofanykindinrespectof gender,race,ethnicity,language,beliefs,religion,physicalstateandsocioeconomicstatusof their family. Article 17. Care of Children Affected by HIV/AIDS The State and society shall create conditions for children affected by HIV/AIDS to have access to health care and education,tolivewiththeirfamilyandtobeprotectedfromallformsofdiscriminationfrom the community and society. The State must create conditions for children affected by HIV/AIDS to receive policies on health protection and care as follows: 1. Take measures to prevent transmission of HIV/AIDS, particularly mothertochild transmission of HIV/AIDS; 2. ProvidecounsellingforchildreninfectedwithHIV/AIDS.Childrenshouldnotbeforcedtobe testedforHIV/AIDS,andtheirHIV/AIDSstatusshouldbekeptconfidential;3.Providecareand treatment to children infected with HIV/AIDS, including providing them with antibiotics and other medicines; 4. Encourage the society and community to support and assist children infected with HIV/AIDS. Article 31. Education for Children Affected by HIV/AIDS The State createsconditionsforchildrenaffectedbyHIV/AIDStoreceiveeducationandtoparticipatein various activities in school without discrimination. Disclosure of the HIV/AIDS status of childrenisforbidden.Article42.AlternativeCareforChildrenChildcarehasmanyalternatives, and consideration of the use of such alternative care shall be based on the following conditions: 5. The best interests of the child shall be the main factor to be taken into consideration; 6. In appointing the guardian, preference shall be given to members of the family,andcloserelativeslivingnearthechild,exceptifitisinconflictwiththechildsbest interests;7.Theneedtopreservetheculture,language,religionandracialbackgroundofthe child; 8. Placement of the child in a residential care institution, such as an orphanage, boardingschoolorotherinstitutionalestablishmentshallbeameasureoflastresort;9.The viewsofthechildshallbetakenintoconsideration,basedonabalancingevaluationoftheage andthediscernmentofthechild;10.ChildrenaffectedbyHIV/AIDSshallbecaredforbytheir familyandshouldnotbeisolatedfromotherchildrenandsociety.Drugcontrol,Prevention ,protection,treatmentandrehabilitationforaddictArticle2ofthelawstartedthatchildren infected and /or affected by HIV/AIDS are among those children who are in need of special protectionTheLaonationalassemblyregularlymeetsandisabletodiscussissuerelatedto the implantation of this law .prominent member of the womens union are member of the 85
nation assembly and have a platform to argue for amendments in the law and in the implantation.Healthservicessuchas:dropincenterforSWinfourhotspotprovincesarean exampleofsysteminplacetoensure thatSWhaveaccesstohealthinformationandserviceas wellasreferraltootheroccupationaltrainings 172) Brieflycommentonthedegreetowhichtheyarecurrentlyimplemented: AlthoughthereisnospecificHIVlaw,theNationalResponsetoHIV/AIDS/STIiscoordinatedby theNationalCommitteefortheControlofAIDS(NACCA).TheNationalPolicyandtheNational StrategyandActionPlanonHIV/AIDS/STIformthebasisforanexpandedresponsetoHIVand AIDS, setting clearly defined priorities and targets for the national response. CEDAW recommendations(2009)statedthefollowing40.WhilenotingtheappointmentofaNational CommitteeAgainstAIDS,theestablishmentofanAntiAIDSCentreaswellasinformationona numberofexistingplans,programmesandmeasuresundertakentocombatingHIV/AIDS,the Committee is concerned that the number of women infected with HIV/AIDS reportedly increasesatanaveragerateof8percentperyear,thatwomenandgirlsmaybeparticularly susceptible to such infection owing to genderspecific norms, and that certain groups of women,includingwomeninvolvedinprostitutionandmigrantwomenworkersareatahigh risk of being infected with HIV/AIDS. The Committee is especially concerned that the persistenceof unequal power relations between women and men and the inferior status of womenandgirlsmayhampertheirabilitytonegotiatesafesexualpracticesandincreasetheir vulnerability to infection. It is also concerned that current policies and legislation may not adequatelytake into account genderspecific vulnerabilities and maynot sufficiently protect the rights of women and girls affected by HIV/AIDS. 41. The Committee recommends continued and sustained efforts to address the impact of HIV/AIDS on women and girls, as well as its consequences for society and the family. It urges the State party to enhance its focusonwomensempowermentandtoincludeaclearandvisiblegenderperspectiveinits policiesandprogrammesonHIV/AIDSandincreasetheroleofmeninallrelevantmeasures. TheStatepartyisencouragedtoundertakeawarenessraisingcampaignsamongGovernment personnel in the prevention of and protection against and maintenance of confidentiality in ordertosystemizeandintegrateapproachesformultiplegovernmentsectors.TheCommittee recommends that the State party include information on measures taken in this respect, obstaclesencounteredandresultsachievedinitsnextreport. 173) 3.Doesthecountryhavelaws,regulationsorpoliciesthatpresentobstaclestoeffectiveHIV prevention,treatment,careandsupportformostatriskpopulationsandothervulnerable subpopulations? No(0) 174) 4.IsthepromotionandprotectionofhumanrightsexplicitlymentionedinanyHIVpolicyor strategy? Yes(0) 175) IFYES,brieflydescribehowhumanrightsarementionedinthisHIVpolicyorstrategy: Current National Policy on HIV/AIDS/STI stated that: The Lao PDR constructs its HIV/AIDS/STD policy and control activities on the following universal principles: o non discrimination,ovoluntaryapproacheswithinformedconsent,oconfidentialityandprivacyin counseling,testingandcare,oempowermentofindividualstotakepersonalresponsibility,o 86
gender equity, o accessibility to affordable and acceptable services, o reduction of risk for vulnerableindividualsandcommunitygroups,andoinvolvementindecisionmakingofthose with and affected by HIV/AIDS. Discrimination against vulnerable groups is counterproductive to HIV/AIDS/STI control. People living with HIV or AIDS should not be stigmatized. People with AIDS can be safely cared for in all medical institutions and in the home.HomebasedcareforPLHIVwillbeencouragedforbothhumanitarianandcostreasons. Ministry of Labour and Social Welfare, the Lao Federation of Trade Unions and the Lao NationalChamberofCommerceandIndustrylaunchedtheTripartiteDeclarationonHIV/AIDS attheWorkplace,whichbasedonthekeyprinciplesstipulatedintheILOsCodeofPracticeon HIV/AIDS. The declaration will serve as a tool for the employers, workers and other stakeholders to develop its own measures on prevention, caretakers and cure as a tool to addresstheHIV/AIDSissuesattheworkplace. 176) 5.Isthereamechanismtorecord,documentandaddresscasesofdiscrimination experiencedbypeoplelivingwithHIV,mostatriskpopulationsand/orothervulnerable subpopulations? Yes(0) 177) IFYES,brieflydescribethismechanism: Existing mechanisms to record, document and address cases of discrimination include: ThematicWorkingGroupsonSexWorkers,MSMandCareandSupport;NetworkofPLHIV Lao National Network of PLHIV; Monthly meeting of PLWHA groups, 11 groups have been establishedandfunctionedregularly;Whilethereisnoformalantidiscriminationboardor equal opportunity commission in Laos there are still avenue for the recording, documenting and addressing of case of discrimination.chief among these would be the potential role of CHAS .As a national body it is charged with ensuring active and appropriate HIV rule and regulations and the implementation of these .in addition, it has provincial bodies who have significant contact with PLH and would provide an avenue for people to make complaints aboutdiscrimination.Inadditiontothese,discriminationexperiencedintheworkplaceisnow forbiddenintheTripartiesDeclaration,underthisdocumentworkersareabletocomplaintto theministryoflabourandsocialwelfareorLFTUaboutanydiscriminationandthesetobodies shouldinvestigatetheissue.AswellasformalLaoavenue,manyINGOsworkinHIVsectorin theHIVsectorandcomeintocontactwithPHLwhohaveexperienceddiscrimination.Their roleandcontactwithLaobodiesandagenciescanalsoprovideanavenueforthereporting ,addressingofcasesofdiscrimination.LocalorganizationssuchasLNP+wouldalsobeableto monitorissuerelatingtodiscrimination. 178) 6.HastheGovernment,throughpoliticalandfinancialsupport,involvedpeoplelivingwith HIV,mostatriskpopulationsand/orothervulnerablesubpopulationsingovernmentalHIV policydesignandprogrammeimplementation? Yes(0) 179) IFYES,describesomeexamples: MSM,Sexworkers,PLHIVrepresentedinthematicworkinggroupsRepresentativesof PLWHAarememberofCountryCoordinationMechanism(CCM)forGFATMandsomePCCAs Civilsociety(includingPLWHA)areactivelyinvolvedindevelopmentofthenationalAIDS strategy,policyandguidelinesPLWHAhavebeenempoweredandbuildtheircapacitiesin 87
variousaspects.(TocheckifthenewToRoftheNCCAincludesthePLWHA)The representativefromselfhelpgroupofPLWAanddrugusershavebeeninvitedtoparticipate numberofnationalworkshop,training,meeting.Thisillustratestheirparticipationindecision makingonHIV/AIDSrelatedmatters.ThegoodexampleofthisincludesaninclusionofSWin theplanning,ImplementationandmonitoringsupportforHIV/STIinterventionprogramm. Additionally,PLWAarealsoparticipatinginthenationalstrategicplanningandassistthe provisionofSTI/HIVserviceattheDropinCentreforSW.HIVpeoplenowbeingmore involvedinHIVworksuchusinimplementationofactivities,workinginthehospitaltoprovide peercounseling,speakincommunitytoraiseHIVawareness.HIVpeoplestillnotveryactively involveinHIVpolicydesign,HoweveroneLNP+memberwhoisapresentativeofPLHAhas becomeamemberofCCM(GF).Askpeopletobeinvolvedinplanningandevaluating programs. 180) 7.Doesthecountryhaveapolicyoffreeservicesforthefollowing: a.HIVpreventionservices Yes b.Antiretroviraltreatment Yes c.HIVrelatedcareandsupportinterventions Yes 181) IFYES,givenresourceconstraints,brieflydescribewhatstepsareinplacetoimplement thesepoliciesandincludeinformationonanyrestrictionsorbarrierstoaccessfordifferent populations: The national Strategic and Action Plan on HIV and AIDS forms the basis for an expanded response to HIV and AIDS, setting clearly defined priorities and targets for the national response. The targets are regularly revised, and the costed action plan forms the basis for resourcemobilizationinthecountry.Throughdonorfunding,governmenthaveestablished theARTcentreinVientiane,Luangprabang,SavanaketandChanpasackprovincesofLaos(ther aretheHIV/STI/AIDSfourhotspotprovincesincountry).Despitesomeresourceconstraint, CHAShasbuildupabroadnetwork throughoutthecountry,workingwithlocalhospitalto provide care and treatment for PLWA, while these are not the widely disbursed as needed, serviceareincreasing.theLaogovernmentisalsousingmanyINGOstohelpintheirdelivery of care, support, prevention and treatment for PLWA. HIV prevention and care support service should being promoted and extend to winder and remote communities. Awareness raising should be extended and on going activities Implementation of the HIV Prevention Policies: The NSAP identifies a minimum package of activities to increase safe sexual behaviouramongthekeypopulationsathigherrisk.Itconsistsofpeerledbehaviourchange communication, free condoms and lubricants, free STI services tailored to the needs of the respective groups, and referral to VCT. Other main prevention activities in implementation include, among others, social marketing of condoms, 100% Condom Use Programme in 15 provinces, life skills education at schools (which includes HIV messages) and reproductive health services for young people in and out of school. HIV prevention related restrictions: VCCTmightnotbeofexpectedqualityanduptakeremainstobeincreased.Counsellingand psychological support capacity is relatively low. Condom free distribution doesnt cover all areas. Implementation of ART Policies: ART started in 2003 with one treatment site in Savannakhetprovince.SincethenithasexpandedtotwomoresitesinVientianeCapital,and in2009,oneadditionaltreatmentsitewasopenedinLuangprabangprovince.Atpresent,all people who are known to be in need of ART and OI receive treatment. Community support 88
activitiesincludestrengtheningofPLHIVselfhelpgroupsandtheNationalNetworkofPLHIV (LNP+). Currently self help groups exist in 10 provinces, providing psychosocial support to PLHIV and their family members. The involvement of Buddhist Monks contributes to scaling upcommunitymobilizationactivitiesforHIVpreventionandtoreducestigmatowardsPLHIV. AntiretroviraltreatmentrelatedrestrictionsARVavailableonlyin4sites.ARVtreatmentis freebutdoesntcoverallpatients(e.g.:OItreatment) ARVservicedeliverymodelshouldbe finalized. Implementation Care and Support Policies: HIVrelated care and support interventions related restrictions Continuum of Care rarely implemented at district and communitylevelsMostoffundarefrominternationalassistancewhichmightcreatebarrier forsustainabilityandownership.Transportationisarecurrentissue. 182) 8.DoesthecountryhaveapolicytoensureequalaccessforwomenandmentoHIV prevention,treatment,careandsupport? Yes(0) 183) 8.1Inparticular,doesthecountryhaveapolicytoensureaccesstoHIVprevention, treatment,careandsupportforwomenoutsidethecontextofpregnancyandchildbirth? Yes(0) 184) 9.Doesthecountryhaveapolicytoensureequalaccessformostatriskpopulationsand/or othervulnerablesubpopulationstoHIVprevention,treatment,careandsupport? Yes(0) 185) IFYES,brieflydescribethecontentofthispolicy: Different official documents makes clear reference to equal access for MARPs, for example: TheneedsofwomenwillbeaddressedasregardscontrolofHIV/AIDS/STDs.Measuresthat promote gender equity and decrease the relative poverty of women are important in controllingHIV/AIDS/STDsandtodevelopmentingeneral.;FocusingHIVpreventionefforts on vulnerable groups has been shown to be effective in reducing transmission of HIV to general population. Discrimination against vulnerable groups is counterproductive to HIV/AIDS/STDcontrol.Nowdiscriminatoryandgenderequity,Promotepreventionservice atpublicheathfacilitiesbutanewprivate(Newlucrative,Nonprofitsector)Everyonehas access different organization ,How ever all men, women and children (PHA) can have equal access In the national strategy plan ,Vulnerable subpopulation are being focus on such as MSM, work worker ,how ever after groups are also equal access include men ,women and childrenandPHA 186) 9.1IFYES,doesthispolicyincludedifferenttypesofapproachestoensureequalaccessfor differentmostatriskpopulationsand/orothervulnerablesubpopulations? Yes(0) 187) IFYES,brieflyexplainthedifferenttypesofapproachestoensureequalaccessfordifferent populations: Tailoredservicesforspecificneedsofdifferentmostatriskpopulations(e.g.:STItreatment, STI kits, dropin centre for sex workers and MSM, male condom for sex worker clients and lubricantforMSM,andmasscampaignforgeneralpopulation).MARPspecificservice (i,e .VCT for MSM+STI/HIV service for FSW) Not written in the policy however in practice 89
people living in the more remote support areas are provided with additional transport ,accommodation to ensure equal access. Most at least risk population have given to first prioritytoreceivesupportfromaninterventionprogram. 188) 10.DoesthecountryhaveapolicyprohibitingHIVscreeningforgeneralemployment purposes(recruitment,assignment/relocation,appointment,promotion,termination)? Yes(0) 189) 11.DoesthecountryhaveapolicytoensurethatHIVresearchprotocolsinvolvinghuman subjectsarereviewedandapprovedbyanational/localethicalreviewcommittee? Yes(0) 190) 11.1IFYES,doestheethicalreviewcommitteeincluderepresentativesofcivilsociety includingpeoplelivingwithHIV? Yes(0) 191) IFYES,describetheapproachandeffectivenessofthisreviewcommittee: The ethical review committee reviewed and approved all research protocols on AIDS and STI. Members of the ethical committee include representatives from various sectors, e.g. Ministry of Health, University of Health Sciences, LWU, Central Party Office, Ministry of Justice,andNationalCouncilofSciences.Theviewcommitteehavesofarbeenensuringthat humanrightofpeopleparticipatinginthesurveyareprotectedandthattheywillnotbeharm by the research protocols .An example of research include the conduction of HIV/AIDS /STI surveillancesurveywhereallwrittenconsentareobtainedprocedureareclearlyunderstood andconfidentialityaremaintained. 192) Existenceofindependentnationalinstitutionsforthepromotionandprotectionofhuman rights,includinghumanrightscommissions,lawreformcommissions,watchdogs,and ombudspersonswhichconsiderHIVrelatedissueswithintheirwork No(0) 193) FocalpointswithingovernmentalhealthandotherdepartmentstomonitorHIVrelated humanrightsabusesandHIVrelateddiscriminationinareassuchashousingand employment No(0) 194) Performanceindicatorsorbenchmarksforcompliancewithhumanrightsstandardsinthe contextofHIVefforts No(0) 195) 13.Inthelast2years,havemembersofthejudiciary(includinglabourcourts/employment tribunals)beentrained/sensitizedtoHIVandhumanrightsissuesthatmaycomeupinthe contextoftheirwork? No(0) 196) LegalaidsystemsforHIVcasework 90
No(0) 197) Privatesectorlawfirmsoruniversitybasedcentrestoprovidefreeorreducedcostlegal servicestopeoplelivingwithHIV No(0) 198) Programmestoeducate,raiseawarenessamongpeoplelivingwithHIVconcerningtheir rights Yes(0) 199) 15.ArethereprogrammesinplacetoreduceHIVrelatedstigmaanddiscrimination? Yes(0) 200) IFYES,whattypesofprogrammes? Media Yes Schooleducation Yes Personalitiesregularlyspeakingout Yes Other:pleasespecify Yes 201) Overall,howwouldyouratethepolicies,lawsandregulationsinplacetopromoteand protecthumanrightsinrelationtoHIVin2009? 7(7) 202) Since2007,whathavebeenkeyachievementsinthisarea: OngoingactivitiessuchrevisionofnationalpolicyandpreparationofalawonHIVandAIDS arelikelytosubstantiallycontributetostigmaanddiscriminationreduction..Disaggregation of data and establishment of a national M&E framework will allow for closer follow up in policy implementation. The Increased involvement of network of people livingwith HIV. Policy update ,comity for law development More cooperation with UNAIDS ,Organization ,NGOs and the government this has reduced Quality of program have been improve since 2007,however program need to be improved What are remaining challenges in this area? Law,specificregulationforprivatesector(100%CUP),accreditationandqualityassuranceof heath product PHA access to service with out discrimination Law and regulation need become clear and better know Community work shop Support PHA self help group meeting 203) Whatareremainingchallengesinthisarea: NotrainingtomemberofjudiciaryonHIV&humanrightsNoworkplacepolicyforHIV MoreeffortneededtoaddressHIVandgenderPoliticalandfinancialsupportforlaw disseminationandenforcement
204) Overall,howwouldyouratetheeffortstoenforcetheexistingpolicies,lawsandregulations in2009? 7(7) 91
205) Since2007,whathavebeenkeyachievementsinthisarea: Severalsensitizingmeetings/trainingonHIV(includingpolicy)wereorganizedforvarious sectors(e.g.NationalAssembly,MinistryofPublicSecurity,)Specificactionsweretakenby thegovernmentanditspartnerstoaddresshumanrightandHIVOngoingrevisionof existinglawsandlegislationwhichmaypresentobstaclestoeffectiveHIVprevention, treatment,careandsupportformostatriskpopulationsandothervulnerablesub populations.ThereisapolicyandstrategicplanwithprotectiveprincipleHavecooperate between,Government,INGOtoreduceoverlappingandspreadingthesupportserviceto communityPHAinvolvemoreinHIVprogram,LNP+recognizeinHIVsector 206) Whatareremainingchallengesinthisarea: FinalizationoftherevisionofnationalpolicyisalengthyprocessRoleoftheNCCAshould befurtherexpandedsotobringmultisectoralpartnersuptospeed 207) 1.Towhatextenthascivilsocietycontributedtostrengtheningthepoliticalcommitmentof topleadersandnationalstrategy/policyformulations? 4(4) 208) Commentsandexamples: CShasbecomemorenoticeableinthematicgroups,nationalandregionalconsultations,etc. However, competency and English language remains a barrier for some CS in active participation. The application of peer approach in reach target group and delivering HIV prevention intervention Indicate that the view and network of the target group have been takenintoaccountwhenthestrategy/policywasdeveloped.Civilsocietyisnotgetobtain legal states in Laos and actively involve much strategy /policy formulation Association of PHA,promotetheirpointofnewcentral,provincialforumbutremainirregularandneedmore support 209) 2.Towhatextenthavecivilsocietyrepresentativesbeeninvolvedintheplanningand budgetingprocessfortheNationalStrategicPlanonHIVorforthemostcurrentactivityplan (e.g.attendingplanningmeetingsandreviewingdrafts)? 4(4) 210) Commentsandexamples: CSRepresentativeshaveactivelyparticipatedintheMidtermreviewoftheNSP.Anewfive year planning exercise will being launched early next year and participation of the CS Representativeisexpected 211) a.thenationalAIDSstrategy? 5(5) 212) b.thenationalAIDSbudget? 4(4) 213) c.nationalAIDSreports?
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2(2) 214) Commentsandexamples: ReferencetofundinganalysisoftheNSAP,aproportionoffundsallocatedtotheCivilSociety isaround20%oftotalbudget(for2008)communitybaseprogramconductedbyNGOtrough peerindicator/outreachactivitiesreporttoCHASandareincludedwhenupdatingNSAP 215) a.developingthenationalM&Eplan? 3(3)
216) b.participatinginthenationalM&Ecommittee/workinggroupresponsibleforcoordination ofM&Eactivities? 4(4) 217) c.M&Eeffortsatlocallevel? 4(4)
218) Commentsandexamples: M&EUNIT withintheCHASstructuralframeworkhasbeenestablishedandfunctionedsince early 2009. M&E framework was developed, which particularly focussed on the GFATM grantedprojectatthebeginningstage.TheCShasbeeninvolvedinalllevelofM&Eactivities, e.g.M&Eplanning,consultation,midtermreviewofNSAP.NationalM&Eplan,developed by public sector Some participation at the CCM level (meeting) Several NGO,association workatlocallevelandhaveM&Esystem Page106 219) 5.TowhatextentisthecivilsocietysectorrepresentationinHIVeffortsinclusiveofdiverse organizations(e.g.networksofpeoplelivingwithHIV,organizationsofsexworkers,faith basedorganizations)? 4(4) 220) Commentsandexamples: Overall,fewnumberofCivilSocietiesareregisteredintheLaoPDR.APrimeMinistersDecree onAssociationrecentlyissuedwillprovideanopportunityforestablishmentofthecivilsociety organization in the future. So far, the CS which have been involved in the national AIDS programme included: Lao Youth Union, Lao Women Union, Lao Trade Union, Lao Front for National Construction, Lao Red Cross, Faithbased organizations, Local NGO, and PLHIV groups/network 221) a.adequatefinancialsupporttoimplementitsHIVactivities? 1(1) 222) b.adequatetechnicalsupporttoimplementitsHIVactivities? 3(3) 93
223) Commentsandexamples: HumancapacityandtovariousdegreeexpertiseconstitutesabarrierforCSinaccessingfinancial support and implementing HIV related programme. The Government and its international partners(includingUN,andINGOs)providebothfinancialandtechnicalassistancetostrengthen the capacity of the CSO and substantial progress have been recorded while programme managementandAIDScompetencystillremainsachallenge 224) 7.WhatpercentageofthefollowingHIVprogrammes/servicesisestimatedtobeprovidedby civilsociety? Preventionforyouth Preventionformostatriskpopulations Injectingdrugusers Menwhohavesexwithmen Sexworkers TestingandCounselling ReductionofStigmaandDiscrimination Clinicalservices(ART/OI)* Homebasedcare ProgrammesforOVC** 2550% <25% 2550% <25% 2550% <25% 2550% 5175% 2550%
225) Overall,howwouldyouratetheeffortstoincreasecivilsocietyparticipationin2009? 8(8) 226) Since2007,whathavebeenkeyachievementsinthisarea: All existing CS has been encouraged to be part of the national AIDS programme.For example: the Country Coordinating Mechanism (CCM) for the GFATM has called for submission of expressions of interest (EOI) from all interested partners in scaling up HIV interventions. Civil societiesaremainimplementingpartnersinGFATMsupportedactivities 227) Whatareremainingchallengesinthisarea: Low capacity of the civil society Small number of civil society registered in the Lao PDR. Technicalandfinancialcapacityofthiscivilsocietyorganization.participationlimitedtomeeting 228) 1.HasthecountryidentifiedthespecificneedsforHIVpreventionprogrammes? Yes(0) 229) IFYES,howwerethesespecificneedsdetermined? Based on the available epidemiological information and the review of the 20022005 National StrategicPlan,thefollowingprioritiesaredefinedin thecurrentNSAP:Reachingfullcoverage of targeted and comprehensive interventions in prioritized provinces/districts in a phased approach;Establishmentofanenablingenvironmentforanexpandedresponseatalllevels; Increased strategic information availability to monitor both the epidemic and the response; 94
Capacitybuildingofimplementingpartnersatalllevels;Effectivemanagement,coordination, andmonitoringoftheexpandedpreventionresponse;Tailoredpreventionprogrammeshave been designed for each target populations. For example: comprehensive interventions were designed for the mostatrisk groups, essential element package for general population, PMCT forANCgroups,etc.Baseepidemicallystudiesandbehavioralstudiesandsurveillance. the findingofthesestudiesinformedthedecisionsonresponsetoHIVepidemics.eg,thestrategies outlinedinnationalstrategyandactionplanonHIV/AIDS/STI 230) 1.1TowhatextenthasHIVpreventionbeenimplemented? HIVpreventioncomponent Bloodsafety Universalprecautionsinhealthcaresettings PreventionofmothertochildtransmissionofHIV IEC*onriskreduction IEC*onstigmaanddiscriminationreduction Condompromotion HIVtestingandcounselling Harmreductionforinjectingdrugusers Riskreductionformenwhohavesexwithmen Riskreductionforsexworkers Reproductivehealthservicesincludingsexuallytransmitted infectionspreventionandtreatment SchoolbasedHIVeducationforyoungpeople HIVpreventionforoutofschoolyoungpeople HIVpreventionintheworkplace Other:pleasespecify Agree Don'tagree Agree Agree Agree Agree Agree Don'tagree Agree Agree Agree Agree Don'tagree Don'tagree Don'tagree Themajorityofpeopleinneed haveaccess
231) Overall,howwouldyouratetheeffortsintheimplementationofHIVpreventionprogrammes in2009? 8(8) 232) Since2007,whathavebeenkeyachievementsinthisarea: Fundshavebeenmobilizedandsecuredforscalingupcomprehensiveinterventions toreach the national targets of the mostatrisk populations, especially from the GFATM for SW and clientsandMSM,andrecentlyfromAustralianGovernmentforDU/IDUandHIVharmreduction programme.Bloodsafetyprogrammehasbeenexpanded.Otherinterventions(suchas:life skillseducationforinschoolyouth,PMCT,VCTandSTIservices,Dropincenters,100%condom promotionandcondomsocialmarketing,masscampaign,etc.)havebeenextendedwithquality improved. Peer educator targeted prevention In Vientiane access to information has improved
95
233) Whatareremainingchallengesinthisarea: AdditionalhumanresourcesareneededinordertoscalinguptheinterventionCapacityof the implementing partners needs to be strengthened. Awareness capacity limited to peer educatorMoreopenpoliticalsupportisneedAccesstoremotecommunitiesregularbasis CoordinatebetweendifferentorganizationworkingonHIVAlthoughtheinterventionhadbeen piloted before scaling up the meaningful M&E are required to ensure the effectiveness Financialcommitmentforpreventioninterventionshouldnotbeonyearlybasisiftheresultat impactlevelaretobeachieved 234) 1.HasthecountryidentifiedthespecificneedsforHIVtreatment,careandsupportservices? Yes(0) 235) IFYES,howwerethesespecificneedsdetermined? ThenationalAIDSauthorityhasputitseffort,inconsultationwithvariouspartnersinidentifying the specific needs for HIV treatment, care and support. The estimation and projection were madebasedonspectrumandothermethods(e.g.ARTneededassumptionmadebyBillClinton Foundationsexpertteam).Providethemostcosteffectiveandaccessiblecombinationofcare andsupportforadultsandchildreninfectedandaffectedbyHIV/AIDS,especiallycommunityand homebased care Ensure that all adults and children living with HIV/AIDS have access to adequate medical services and treatment Ensure that all health staff are fully aware of universal precautions and have the skills and means for protection. Gap analysis during GF proposal Strategic plan meeting CCM meetings According to regional estimation and projections Care and treatment unit are regionally distributed to increase access to most remote area. Specifically trained doctors and nurse on HIV treatment ARV and HIV/AIDS treatment center should extend to district level and cover all province . Confidentially and discriminationmedicalserviceshouldbetakenintoaccountmoreseriously. 236) 1.1TowhatextenthavethefollowingHIVtreatment,careandsupportservicesbeen implemented? HIVtreatment,careandsupportservice Antiretroviraltherapy Nutritionalcare PaediatricAIDStreatment Sexuallytransmittedinfectionmanagement PsychosocialsupportforpeoplelivingwithHIVandtheir families Homebasedcare PalliativecareandtreatmentofcommonHIVrelated infections HIVtestingandcounsellingforTBpatients TBscreeningforHIVinfectedpeople TBpreventivetherapyforHIVinfectedpeople Agree Don'tagree Agree Agree Don'tagree Don'tagree Don'tagree Don'tagree Don'tagree Don'tagree 96 Themajorityofpeopleinneed haveaccess
N/A 237) Overall,howwouldyouratetheeffortsintheimplementationofHIVtreatment,careand supportprogrammesin2009? 7(7) 238) Since2007,whathavebeenkeyachievementsinthisarea: IncreaseinARTcoveragefrom63%to93%ExpansionofARTsitesfrom2in2007to5plus2 satellitesin2009DecreaseinHIV&STIprevalenceinFSWsince2004Establishmentof7drop incenterstargetedatfemaleserviceworkers,whichmirrorsincreaseintesting 239) Whatareremainingchallengesinthisarea: HIVservicesnotyetlinkedwithMCH,tobediscussedsoonbetweenCHASandMCHCto strengthenPMCTpackageMorehumanresourcesneededNeedtoensureaccesstoOI&2nd linetreatment 240) 2.DoesthecountryhaveapolicyorstrategytoaddresstheadditionalHIVrelatedneedsof orphansandothervulnerablechildren? Yes(0) 241) 2.1IFYES,isthereanoperationaldefinitionfororphansandvulnerablechildreninthe country? Yes(0) 242) 2.2IFYES,doesthecountryhaveanationalactionplanspecificallyfororphansandvulnerable children? Yes(0) 243) 2.3IFYES,doesthecountryhaveanestimateoforphansandvulnerablechildrenbeing reachedbyexistinginterventions? Yes(0) 244) IFYES,whatpercentageoforphansandvulnerablechildrenisbeingreached? Pleaseenterthepercentage(0100) 70 245) Overall,howwouldyouratetheeffortstomeettheHIVrelatedneedsoforphansandother 97
TBinfectioncontrolinHIVtreatmentandcarefacilities CotrimoxazoleprophylaxisinHIVinfectedpeople Postexposureprophylaxis(e.g.occupationalexposuresto HIV,rape) HIVtreatmentservicesintheworkplaceortreatmentreferral systemsthroughtheworkplace HIVcareandsupportintheworkplace(includingalternative workingarrangements) Other:pleasespecify
Agree Agree Agree Don'tagree Don'tagree
vulnerablechildrenin2009? 4(4) 246) Since2007,whathavebeenkeyachievementsinthisarea: ConductedqualityofHIVimpactonOVCandthereweresomeinitiativeinterventiontoadress theOVCissues. 247) Whatareremainingchallengesinthisarea: IndicatesOVCareaddressed,butnotmentionedinNSAP
98
Annex3:AIDSSpendingMatrix
YEAR:2007 CalendarYear:No FiscalYear:1stSep.2006to30Oct.2007 CurrencyusedinMatrix:US$ AverageExchangeRatefortheyear:10,616Lak
NationalFundingMatrix AIDSSpendingCategoriesbyFinancingSources
PublicSources Dev.BankReimboursable (e.g.Loans) InternationalSubTotal Central/National PublicSubTotal
FinancingSources
InternationalSources
AllOtherMultilateral
AllOtherInternational
Multilaterals Dev.BankNon Reimboursable (e.g.Grants) Bilaterals UNAgencies GlobalFund
PrivateSectors(Optional forUNGASSReporting) Forprofit institution/Corporati on PrivateSubTotal AllOtherPrivate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HouseholdFunf
AIDSSpendingCategories
Total
1.Preventionrelatedactivities 1.01Communicationforsocialandbehaviouralchange 1.02Communitymobilization 1.03Voluntarycounsellingandtesting 1.04Riskreductionforvulnerableandaccessiblepopulations 1.05.PreventionYouthinschool 1.06PreventionYouthoutofschool 1.07PreventionofHIVtransmissionaimedatpeoplelivingwithHIV 1.08Preventionprogrammesforsexworkersandtheirclients 1.09Programmesformenwhohavesexwithmen 1.10Harmreductionprogrammesforinjectingdrugusers 1.11Preventionprogrammesintheworkplace 1.12Condomsocialmarketing 1.13Publicandcommercialsectormalecondomprovision 1.14Publicandcommercialsectorfemalecondomprovision 1.15Microbicides 1.16Prevention,diagnosisandtreatmentofsexuallytransmitted infections 1.17Preventionofmothertochildtransmission 1.18MaleCircumcision 1.19Bloodsafety 1.20Safemedicalinjections
2,581,581 393,042 49,294 25,832 8,220 125,655 176,089 149,748 407,827 26,057 9,500 78,761 517,393 43,557 0 0 5,385 188,796 0 372,310 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
AllOtherPublic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SocialSecurity
SubNational
2,581,581 393,042 49,294 25,832 8,220 125,655 176,089 149,748 407,827 26,057 9,500 78,761 517,393 43,557 0 0 5,385 188,796 0 372,310 0
596,736 80,271 3,270 0 8,220 75,151 118,297 0 309,011 0 0 0 0 0 0 0 0 0 0 0 0
519,955 0 689 25,832 0 50,504 14,812 149,748 0 0 9,500 61,377 0 0 0 0 5,385 187,108 0 15,000 0
1,266,323 223,594 21,600 0 0 0 41,894 0 85,975 0 0 0 492,393 43,557 0 0 0 0 0 357,310 0
91,713 55,914 22,958 0 0 0 0 0 12,841 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
106,854 33,263 777 0 0 0 1,086 0 0 26,057 0 17,384 25,000 0 0 0 0 1,688 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1.21Universalprecautions 1.22Postexposureprophylaxis 1.98Preventionactivitiesnotdisaggregatedbyintervention 1.99Preventionactivitiesnotelsewhereclassified 2.Treatmentandcarecomponents 2.01Outpatientcare 2.01.01Providerinitiatedtestingandcounselling 2.01.02Opportunisticinfectionoutpatientprophylaxisandtreatment 2.01.03Antiretroviraltherapy 2.01.04NutritionalsupportassociatedtoARVtherapy 2.01.05SpecificHIVrelatedlaboratorymonitoring 2.01.06DentalprogrammesforpeoplelivingwithHIV 2.01.07Psychologicaltreatmentandsupportservices 2.01.08Outpatientpalliativecare 2.01.09Homebasedcare 2.01.10Traditionalmedicineandinformalcareandtreatment 2.01.98Outpatientcareservicesnotdisaggregatedbyintervention 2.01.99OutpatientCareservicesnotelsewhereclassified 2.02Inpatientcare 2.02.01Inpatienttreatmentofopportunisticinfections 2.02.02Inpatientpalliativecare 2.02.98Inpatientcareservicesnotdisaggregatedbyintervention 2.02.99Inpatientservicesnotelsewhereclassified 2.03Patienttransportandemergencyrescue 2.98Careandtreatmentservicesnotdisaggregatedbyintervention 2.99Careandtreatmentservicesnotelsewhereclassified 3.OrphanandVulnerablechildrenOVC 3.01OVCEducation 3.02OVCBasichealthcare 3.03OVCFamily/homesupport 3.04OVCCommunitysupport 3.05OVCSocialservicesandadministrativecosts 3.06OVCInstitutionalcare 3.98OVCservicesnotdisaggregatedbyintervention 2,516 0 1,599 0 339,095 275,176 46,588 0 182,000 0 0 0 0 38,364 0 8,224 0 0 63,919 0 0 0 0 597 0 63,322 15,292 3,315 535 0 11,442 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,516 0 1,599 0 339,095 275,176 46,588 0 182,000 0 0 0 0 38,364 0 8,224 0 0 63,919 0 0 0 0 597 0 63,322 15,292 3,315 535 0 11,442 0 0 0 2,516 0 0 0 77,325 76,728 38,364 0 0 0 0 0 0 38,364 0 0 0 0 597 0 0 0 0 597 0 0 115 115 0 0 0 0 0 0 0 0 0 0 63,322 0 0 0 0 0 0 0 0 0 0 0 0 0 63,322 0 0 0 0 0 0 63,322 9,192 0 0 0 9,192 0 0 0 0 0 0 0 16,448 16,448 8,224 0 0 0 0 0 0 0 0 8,224 0 0 0 0 0 0 0 0 0 0 2,250 0 0 0 2,250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,599 0 0 182,000 0 0 182,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100
3.99OVCservicesnotelsewhereclassified 4.ProgramManagementandAdministration 4.01Planning,coordinationandprogrammemanagement 4.02Administrationandtransactioncostsassociatedwith managinganddisbursingfunds 4.03Monitoringandevaluation 4.04Operationsresearch 4.05Serologicalsurveillance(Serosurveillance) 4.06HIVdrugresistancesurveillance 4.07Drugsupplysystems 4.08Informationtechnology 4.09Patienttracking 4.10Upgradingandconstructionofinfrastructure 4.11MandatoryHIVtesting(notvoluntarycounsellingandtesting) 4.98ProgramManagementandAdministrationStrengtheningnot disaggregatedbytype 4.99ProgramManagementandAdministrationStrengtheningnot elsewhereclassified 5.Humanresources 5.01Monetaryincentivesforhumanresources 5.02FormativeeducationtobuildupanHIVworkforce 5.03Training 5.98IncentivesforHumanResourcesnotspecifiedbykind 5.99IncentivesforHumanResourcesnotelsewhereclassified 6.SocialProtectionandSocialServicesexcludingOrphansand VulnerableChildren(subtotal) 6.01Socialprotectionthroughmonetarybenefits 6.02Socialprotectionthroughinkindbenefits 6.03Socialprotectionthroughprovisionofsocialservices 6.04HIVspecificincomegenerationprojects 6.98Socialprotectionservicesandsocialservicesnotdisaggregated bytype 6.99Socialprotectionservicesandsocialservicesnotelsewhere classified 7.EnablingEnvironment 7.01Advocacy 7.02Humanrightsprogrammes 7.03AIDSspecificinstitutionaldevelopment 7.04AIDSspecificprogrammesfocusedonwomen 7.05ProgrammestoreduceGenderBasedViolence 0 1,065,492 634,812 132,172 119,359 40,507 0 0 78,934 21,584 0 21,863 0 0 16,261 668,018 108,205 0 414,795 36,200 108,818 1,279 0 0 0 1,279 0 0 368,895 252,581 0 0 0 0 0 67,602 0 67,602 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,602 0 12,602 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 55,000 0 55,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 997,890 634,812 64,570 119,359 40,507 0 0 78,934 21,584 0 21,863 0 0 16,261 668,018 108,205 0 414,795 36,200 108,818 1,279 0 0 0 1,279 0 0 368,895 252,581 0 0 0 0 0 112,306 33,418 16,039 18,225 4,822 0 0 0 3,584 0 21,863 0 0 14,355 83,754 13,017 0 62,379 4,785 3,573 0 0 0 0 0 0 0 137,549 137,549 0 0 0 0 0 256,508 254,008 0 2,500 0 0 0 0 0 0 0 0 0 0 301 0 0 301 0 0 1,279 0 0 0 1,279 0 0 116,314 0 0 0 0 0 0 314,480 170,423 0 68,707 0 0 0 75,350 0 0 0 0 0 0 233,237 49,577 0 47,000 31,415 105,245 0 0 0 0 0 0 0 0 0 0 0 0 0 0 55,754 33,621 7,419 11,130 0 0 0 3,584 0 0 0 0 0 0 213,668 9,209 0 204,459 0 0 0 0 0 0 0 0 0 11,705 11,705 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 584,985 202,166 100,283 41,112 12,488 28,936 0 182,000 0 18,000 0 0 0 0 141,373 70,687 36,402 0 34,284 0 0 0 0 0 0 0 0 17,178 15,589 1,589 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
101
7.98EnablingEnvironmentandCommunityDevelopmentnot disaggregatedbytype 7.99EnablingEnvironmentandCommunityDevelopmentnot elsewhereclassified 8.Researchexcludingoperationsresearch 8.01Biomedicalresearch 8.02Clinicalresearch 8.03Epidemiologicalresearch 8.04Socialscienceresearch 8.05Vaccinerelatedresearch 8.98Researchnotdisaggregatedbytype 8.99Researchnotelsewhereclassified GrandTotal 0 116,314 106,961 24,030 51,472 21,639 1,040 0 900 7,880 5,146,613 0 0 0 0 0 0 0 0 0 0 67,602 0 0 0 0 0 0 0 0 0 0 12,602 0 0 0 0 0 0 0 0 0 0 55,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 116,314 106,961 24,030 51,472 21,639 1,040 0 900 7,880 5,079,011 0 0 0 0 0 0 0 0 0 0 1,007,785 0 116,314 52,512 0 51,472 0 1,040 0 0 0 1,019,383 0 0 31,769 24,030 0 7,739 0 0 0 0 1,864,507 0 0 22,680 0 0 13,900 0 0 900 7,880 395,520 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 850,390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
YEAR:2008 CalendarYear:No FiscalYear:1stSep.2007to30Oct.2008 CurrencyusedinMatrix:US$ AverageExchangeRatefortheyear:9,600Lak

FinancingSources
PublicSources Dev.BankReimboursable(e.g. Loans) InternationalSubTotal
Multilaterals Dev.BankNon Reimboursable(e.g. Grants) AllOtherInternational AllOtherMultilateral
PrivateSectors (OptionalforUNGASSReporting) Forprofit institution/Corporation
Central/National
PublicSubTotal
AllOtherPublic
SocialSecurity
SubNational
PrivateSubTotal
Total
1.Preventionrelatedactivities 1.01Communicationforsocialandbehaviouralchange 1.02Communitymobilization 1.04Riskreductionforvulnerableandaccessiblepopulations 1.05.PreventionYouthinschool 1.06PreventionYouthoutofschool 1.07PreventionofHIVtransmissionaimedatpeoplelivingwith HIV 1.08Preventionprogrammesforsexworkersandtheirclients 1.09Programmesformenwhohavesexwithmen 1.10Harmreductionprogrammesforinjectingdrugusers 1.11Preventionprogrammesintheworkplace 1,571,338 211,348 41,384 78,994 0 191,866 240,660 42,930 74,089 27,723 5,000 89,977 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
1,571,338 211,348 41,384 78,994 0 191,866 240,660 42,930 74,089 27,723 5,000 89,977
366,287 3,677 0 15,327 0 191,866 6,231 0 0 0 5,000 89,977
1,102,063 146,067 0 63,667 0 0 234,429 42,930 74,089 27,723 0 0
102,988 61,604 41,384 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
AllOtherPrivate 0 0 0 0 0 0 0 0 0 0 0 0
HouseholdFunf
Bilaterals
UNAgencies
GlobalFund
102
1.12Condomsocialmarketing 1.13Publicandcommercialsectormalecondomprovision 1.14Publicandcommercialsectorfemalecondomprovision 1.15Microbicides 1.16Prevention,diagnosisandtreatmentofsexuallytransmitted infections 1.17Preventionofmothertochildtransmission 1.18MaleCircumcision 1.19Bloodsafety 1.20Safemedicalinjections 1.21Universalprecautions 1.22Postexposureprophylaxis 1.98Preventionactivitiesnotdisaggregatedbyintervention 1.99Preventionactivitiesnotelsewhereclassified 2.Treatmentandcarecomponents 2.01Outpatientcare 2.01.01Providerinitiatedtestingandcounselling 2.01.02Opportunisticinfectionoutpatientprophylaxisand treatment 2.01.03Antiretroviraltherapy 2.01.04NutritionalsupportassociatedtoARVtherapy 2.01.05SpecificHIVrelatedlaboratorymonitoring 2.01.06DentalprogrammesforpeoplelivingwithHIV 2.01.07Psychologicaltreatmentandsupportservices 2.01.08Outpatientpalliativecare 2.01.09Homebasedcare 2.01.10Traditionalmedicineandinformalcareandtreatment 2.01.98Outpatientcareservicesnotdisaggregatedbyintervention 2.01.99OutpatientCareservicesnotelsewhereclassified 2.02Inpatientcare 2.02.01Inpatienttreatmentofopportunisticinfections 2.02.02Inpatientpalliativecare 2.02.98Inpatientcareservicesnotdisaggregatedbyintervention 2.02.99Inpatientservicesnotelsewhereclassified 2.03Patienttransportandemergencyrescue 2.98Careandtreatmentservicesnotdisaggregatedby intervention 28,807 0 0 0 0 49,209 0 489,351 0 0 0 0 0 790,596 769,331 0 0 643,098 13,424 23,808 0 8,704 0 13,865 2,700 0 63,732 21,265 768 0 0 0 8,597 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,807 0 0 0 0 49,209 0 489,351 0 0 0 0 0 790,596 769,331 0 0 643,098 13,424 23,808 0 8,704 0 13,865 2,700 0 63,732 21,265 768 0 0 0 8,597 0 0 0 0 0 0 49,209 0 5,000 0 0 0 0 0 48,637 35,560 0 0 0 577 0 0 8,704 0 10,465 2,700 0 13,114 13,077 0 0 0 0 1,177 0 28,807 0 0 0 0 0 0 484,351 0 0 0 0 0 50,618 50,618 0 0 0 0 0 0 0 0 0 0 0 50,618 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 427,596 427,596 0 0 427,596 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,400 3,400 0 0 0 0 0 0 0 0 3,400 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 260,345 252,157 0 0 215,502 12,847 23,808 0 0 0 0 0 0 0 8,188 768 0 0 0 7,420 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103
2.99Careandtreatmentservicesnotelsewhereclassified 3.OrphanandVulnerablechildrenOVC 3.01OVCEducation 3.02OVCBasichealthcare 3.03OVCFamily/homesupport 3.04OVCCommunitysupport 3.05OVCSocialservicesandadministrativecosts 3.06OVCInstitutionalcare 3.98OVCservicesnotdisaggregatedbyintervention 3.99OVCservicesnotelsewhereclassified 4.ProgramManagementandAdministration 4.01Planning,coordinationandprogrammemanagement 4.02Administrationandtransactioncostsassociatedwith managinganddisbursingfunds 4.03Monitoringandevaluation 4.04Operationsresearch 4.05Serologicalsurveillance(Serosurveillance) 4.06HIVdrugresistancesurveillance 4.07Drugsupplysystems 4.08Informationtechnology 4.09Patienttracking 4.10Upgradingandconstructionofinfrastructure 4.11MandatoryHIVtesting(notvoluntarycounsellingandtesting) 4.98ProgramManagementandAdministrationStrengtheningnot disaggregatedbytype 4.99ProgramManagementandAdministrationStrengtheningnot elsewhereclassified 5.Humanresources 5.01Monetaryincentivesforhumanresources 5.02FormativeeducationtobuildupanHIVworkforce 5.03Training 5.98IncentivesforHumanResourcesnotspecifiedbykind 5.99IncentivesforHumanResourcesnotelsewhereclassified 6.SocialProtectionandSocialServicesexcludingOrphansand VulnerableChildren(subtotal) 6.01Socialprotectionthroughmonetarybenefits 6.02Socialprotectionthroughinkindbenefits 6.03Socialprotectionthroughprovisionofsocialservices 11,900 15,721 400 0 5,280 10,041 0 0 0 0 1,330,453 721,739 323,536 122,959 0 0 0 139,000 10,103 0 13,116 0 0 0 820,842 97,145 53,039 355,297 315,361 0 44,734 0 0 0 0 0 0 0 0 0 0 0 0 0 98,730 0 98,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,730 0 33,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 65,000 0 65,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,900 15,721 400 0 5,280 10,041 0 0 0 0 1,231,723 721,739 224,806 122,959 0 0 0 139,000 10,103 0 13,116 0 0 0 820,842 97,145 53,039 355,297 315,361 0 44,734 0 0 0 11,900 400 400 0 0 0 0 0 0 0 178,792 59,896 96,338 22,455 0 0 0 0 103 0 0 0 0 0 82,831 13,970 0 68,861 0 0 0 0 0 0 0 10,041 0 0 0 10,041 0 0 0 0 180,190 180,190 0 0 0 0 0 0 0 0 0 0 0 0 10,667 0 0 10,667 0 0 44,734 0 0 0 0 5,280 0 0 5,280 0 0 0 0 0 892,581 410,967 101,491 100,504 0 0 0 106,000 0 0 13,116 0 0 0 483,514 73,575 38,039 80,139 291,761 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,215 49,988 11,227 0 0 0 0 33,000 0 0 0 0 0 0 167,752 9,600 0 154,552 3,600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46,448 20,698 15,750 0 0 0 0 0 10,000 0 0 0 0 0 76,078 0 15,000 41,078 20,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
104
6.04HIVspecificincomegenerationprojects 6.98Socialprotectionservicesandsocialservicesnot disaggregatedbytype 6.99Socialprotectionservicesandsocialservicesnot elsewhereclassified 7.EnablingEnvironment 7.01Advocacy 7.02Humanrightsprogrammes 7.03AIDSspecificinstitutionaldevelopment 7.04AIDSspecificprogrammesfocusedonwomen 7.05ProgrammestoreduceGenderBasedViolence 7.98EnablingEnvironmentandCommunityDevelopmentnot disaggregatedbytype 7.99EnablingEnvironmentandCommunityDevelopmentnot elsewhereclassified 8.Researchexcludingoperationsresearch 8.01Biomedicalresearch 8.02Clinicalresearch 8.03Epidemiologicalresearch 8.04Socialscienceresearch 8.05Vaccinerelatedresearch 8.98Researchnotdisaggregatedbytype 8.99Researchnotelsewhereclassified GrandTotal 44,734 0 0 121,316 23,356 0 0 0 0 0 97,960 322,039 8,962 0 305,834 7,242 0 0 0 5,017,038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 98,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 65,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,734 0 0 121,316 23,356 0 0 0 0 0 97,960 322,039 8,962 0 305,834 7,242 0 0 0 4,918,308 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 676,947 44,734 0 0 85,361 3,101 0 0 0 0 0 82,260 15,015 0 0 9,015 6,000 0 0 0 1,498,689 0 0 0 15,700 0 0 0 0 0 0 15,700 221,623 8,962 0 212,661 0 0 0 0 2,149,282 0 0 0 2,255 2,255 0 0 0 0 0 0 78,745 0 0 78,745 0 0 0 0 346,367 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,000 18,000 0 0 0 0 0 0 6,656 0 0 5,413 1,242 0 0 0 407,526 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
YEAR:2009 CalendarYear:No FiscalYear:1stSep.2008to30Oct.2009 CurrencyusedinMatrix:US$ AverageExchangeRatefortheyear:8,540Lak PublicSources

Dev.BankReimboursable(e.g. Loans) InternationalSubTotal

FinancingSources
Dev.BankNon Reimboursable(e.g. Grants) AllOtherInternational Multilaterals AllOtherMultilateral
PrivateSectors (OptionalforUNGASS Reporting)

Forprofit institution/Corporation PrivateSubTotal AllOtherPrivate 0 0 0 HouseholdFunf 0 0 0
Central/National
PublicSubTotal
AllOtherPublic
SocialSecurity
SubNational
Bilaterals
UNAgencies
Total
1.Preventionrelatedactivities 1.01Communicationforsocialandbehaviouralchange 1.02Communitymobilization 2,159,991 405,978 8,824 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
2,159,991 405,978 8,824
381,620 105,185 2,493
674,200 23,000 0
891,762 158,869 0
GlobalFund
70,034 57,642 3,685
0 0 0
142,375 61,282 2,646
0 0 0
0 0 0
105
1.03Voluntarycounsellingandtesting 1.04Riskreductionforvulnerableandaccessiblepopulations 1.05.PreventionYouthinschool 1.06PreventionYouthoutofschool 1.07PreventionofHIVtransmissionaimedatpeoplelivingwithHIV 1.08Preventionprogrammesforsexworkersandtheirclients 1.09Programmesformenwhohavesexwithmen 1.10Harmreductionprogrammesforinjectingdrugusers 1.11Preventionprogrammesintheworkplace 1.12Condomsocialmarketing 1.13Publicandcommercialsectormalecondomprovision 1.14Publicandcommercialsectorfemalecondomprovision 1.15Microbicides 1.16Prevention,diagnosisandtreatmentofsexuallytransmitted infections 1.17Preventionofmothertochildtransmission 1.18MaleCircumcision 1.19Bloodsafety 1.20Safemedicalinjections 1.21Universalprecautions 1.22Postexposureprophylaxis 1.98Preventionactivitiesnotdisaggregatedbyintervention 1.99Preventionactivitiesnotelsewhereclassified 2.Treatmentandcarecomponents 2.01Outpatientcare 2.01.01Providerinitiatedtestingandcounselling 2.01.02Opportunisticinfectionoutpatientprophylaxisandtreatment 2.01.03Antiretroviraltherapy 2.01.04NutritionalsupportassociatedtoARVtherapy 2.01.05SpecificHIVrelatedlaboratorymonitoring 2.01.06DentalprogrammesforpeoplelivingwithHIV 2.01.07Psychologicaltreatmentandsupportservices 2.01.08Outpatientpalliativecare 2.01.09Homebasedcare 2.01.10Traditionalmedicineandinformalcareandtreatment 83,210 0 149,868 187,653 63,552 258,999 73,881 10,071 211,573 82,000 0 3,245 0 0 100,553 0 520,584 0 0 0 0 0 962,127 707,001 0 25,459 502,698 8,664 41,222 0 14,751 0 13,076 560 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83,210 0 149,868 187,653 63,552 258,999 73,881 10,071 211,573 82,000 0 3,245 0 0 100,553 0 520,584 0 0 0 0 0 962,127 707,001 0 25,459 502,698 8,664 41,222 0 14,751 0 13,076 560 0 0 0 0 0 250,402 0 10,071 10,224 0 0 3,245 0 0 0 0 0 0 0 0 0 0 291,669 39,163 0 664 0 150 518 0 10,500 0 13,076 560 18,141 0 143,949 182,208 0 0 0 0 201,349 0 0 0 0 0 100,553 0 5,000 0 0 0 0 0 98,393 98,393 0 0 11,517 0 0 0 0 0 0 0 40,069 0 0 5,445 63,552 5,809 67,434 0 0 35,000 0 0 0 0 0 0 515,584 0 0 0 0 0 491,181 491,181 0 0 491,181 0 0 0 0 0 0 0 0 0 5,919 0 0 2,788 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,000 0 0 0 0 0 6,447 0 0 47,000 0 0 0 0 0 0 0 0 0 0 0 0 80,884 78,264 0 24,795 0 8,514 40,704 0 4,251 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
106
2.01.98Outpatientcareservicesnotdisaggregatedbyintervention 2.01.99OutpatientCareservicesnotelsewhereclassified 2.02Inpatientcare 2.02.01Inpatienttreatmentofopportunisticinfections 2.02.02Inpatientpalliativecare 2.02.98Inpatientcareservicesnotdisaggregatedbyintervention 2.02.99Inpatientservicesnotelsewhereclassified 2.03Patienttransportandemergencyrescue 2.98Careandtreatmentservicesnotdisaggregatedbyintervention 2.99Careandtreatmentservicesnotelsewhereclassified 3.OrphanandVulnerablechildrenOVC 3.01OVCEducation 3.02OVCBasichealthcare 3.03OVCFamily/homesupport 3.04OVCCommunitysupport 3.05OVCSocialservicesandadministrativecosts 3.06OVCInstitutionalcare 3.98OVCservicesnotdisaggregatedbyintervention 3.99OVCservicesnotelsewhereclassified 4.ProgramManagementandAdministration 4.01Planning,coordinationandprogrammemanagement 4.02Administrationandtransactioncostsassociatedwithmanaging anddisbursingfunds 4.03Monitoringandevaluation 4.04Operationsresearch 4.05Serologicalsurveillance(Serosurveillance) 4.06HIVdrugresistancesurveillance 4.07Drugsupplysystems 4.08Informationtechnology 4.09Patienttracking 4.10Upgradingandconstructionofinfrastructure 4.11MandatoryHIVtesting(notvoluntarycounsellingandtesting) 4.98ProgramManagementandAdministrationStrengtheningnot disaggregatedbytype 4.99ProgramManagementandAdministrationStrengtheningnot elsewhereclassified 5.Humanresources 0 100,571 255,126 254,986 0 0 0 140 0 0 99,248 57,932 0 5,280 35,450 0 0 0 586 1,465,904 679,424 514,161 157,522 0 0 0 83,988 10,622 0 20,039 0 0 148 948,495 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 114,730 0 114,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,730 0 44,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70,000 0 70,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100,571 255,126 254,986 0 0 0 140 0 0 99,248 57,932 0 5,280 35,450 0 0 0 586 1,351,174 679,424 399,431 157,522 0 0 0 83,988 10,622 0 20,039 0 0 148 948,495 0 13,695 252,506 252,366 0 0 0 140 0 0 1,065 1,065 0 0 0 0 0 0 0 460,332 66,833 348,877 34,000 0 0 0 0 10,622 0 0 0 0 0 26,104 0 86,876 0 0 0 0 0 0 0 0 1,036 0 0 0 450 0 0 0 586 289,769 268,487 0 21,134 0 0 0 0 0 0 0 0 0 148 142,005 0 0 0 0 0 0 0 0 0 0 97,147 56,867 0 5,280 35,000 0 0 0 0 440,504 230,919 25,400 86,158 0 0 0 77,988 0 0 20,039 0 0 0 460,204 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,435 39,097 0 2,338 0 0 0 0 0 0 0 0 0 0 69,787 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,620 2,620 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 119,134 74,088 25,154 13,892 0 0 0 6,000 0 0 0 0 0 0 250,395 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107
5.01Monetaryincentivesforhumanresources 5.02FormativeeducationtobuildupanHIVworkforce 5.03Training 5.98IncentivesforHumanResourcesnotspecifiedbykind 5.99IncentivesforHumanResourcesnotelsewhereclassified 6.SocialProtectionandSocialServicesexcludingOrphansand VulnerableChildren(subtotal) 6.01Socialprotectionthroughmonetarybenefits 6.02Socialprotectionthroughinkindbenefits 6.03Socialprotectionthroughprovisionofsocialservices 6.04HIVspecificincomegenerationprojects 6.98Socialprotectionservicesandsocialservicesnot disaggregatedbytype 6.99Socialprotectionservicesandsocialservicesnot elsewhereclassified 7.EnablingEnvironment 7.01Advocacy 7.02Humanrightsprogrammes 7.03AIDSspecificinstitutionaldevelopment 7.04AIDSspecificprogrammesfocusedonwomen 7.05ProgrammestoreduceGenderBasedViolence 7.98EnablingEnvironmentandCommunityDevelopmentnot disaggregatedbytype 7.99EnablingEnvironmentandCommunityDevelopmentnot elsewhereclassified 8.Researchexcludingoperationsresearch 8.01Biomedicalresearch 8.02Clinicalresearch 8.03Epidemiologicalresearch 8.04Socialscienceresearch 8.05Vaccinerelatedresearch 8.98Researchnotdisaggregatedbytype 8.99Researchnotelsewhereclassified GrandTotal 257,112 37,440 441,332 212,611 0 23,047 0 0 918 22,129 0 0 177,593 90,688 0 0 0 0 0 86,905 160,993 0 0 117,523 41,969 0 1,501 0 5,997,398 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 114,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 257,112 37,440 441,332 212,611 0 23,047 0 0 918 22,129 0 0 177,593 90,688 0 0 0 0 0 86,905 160,993 0 0 117,523 41,969 0 1,501 0 5,882,668 17,976 0 8,128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,160,790 28,400 34,157 49,782 29,666 0 3,173 0 0 918 2,255 0 0 98,693 29,488 0 0 0 0 0 69,205 29,580 0 0 0 29,580 0 0 0 1,336,849 189,176 0 90,783 180,245 0 19,874 0 0 0 19,874 0 0 20,700 3,000 0 0 0 0 0 17,700 117,523 0 0 117,523 0 0 0 0 2,538,895 8,460 0 58,627 2,700 0 0 0 0 0 0 0 0 5,182 5,182 0 0 0 0 0 0 1,501 0 0 0 0 0 1,501 0 187,939 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,100 3,283 234,012 0 0 0 0 0 0 0 0 0 53,018 53,018 0 0 0 0 0 0 12,389 0 0 0 12,389 0 0 0 658,195 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
108

La Ope Op Les Democratic Republic 2010 Country Progress Report en 24-05-2010

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La Ope Op Les Democratic Republic 2010 Country Progress Report en 24-05-2010

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Lao Peoples Democratic Republic

National Committee for the Control of AIDS

UNGASS Country Progress Report 2010

Targets 2010* 2015**

>90% Disaggregation by regimen type isavailable.

Not available Not available

Not available Not available

9.Percentageofmostatriskpopulations reachedwithHIVpreventionprograms. 10.Percentageoforphansandvulnerable childrenwhosehouseholdsreceivedfreebasic externalsupportincaringforthechild. 11.Percentageofschoolsthatprovidedlife skillsbasedHIVeducationwithinthelast academicyear.

Not available 30%

Not available Not available

SW2009:45% SW2008:49% SW2004:20% MSM2009:Not available IDU:Notavailable Notavailable

SW:85% MSM: 85% Not

available Notavailable Not available Not available

available Not available Not available Pleaseseetextsection1.D.

70% Not available 70%

80% Not available Not available

Pleaseseetextsection1.D. MSM:seroprevalencesurvey Vientiane(2007) LouangPrabang(2009) IDU:seetextsection1.D.

24.PercentageofadultsandchildrenwithHIV knowntobeontreatment12monthsafter initiationofantiretroviraltherapy. 25.PercentageofinfantsborntoHIVinfected motherswhoareinfected.

*N/A=notapplicable **Targetsarenotavailablefor2010becausedatawasnotavailabletodeterminebaseline. Targetsarenotavailablefor2015asthesewillbedeterminedduringthedevelopmentoftheNSAP20112015. ***Denominatorsarebasedonestimationwhichisstillneededtobevalidatedinthenearfuture.

14SecondGenerationSurveillance3rdRoundonHIV,STI,andBehaviorLaoPeoplesDemocraticRepublic,2008. 15EPPandSpectrumpackagehasbeenindicatedthatitcannotprovideaccuracyforlowprevalencecountry. 16SavannakhetHIVAdultCohortStudy,MinistryofHealthandCenterforHIV/AIDS/STI,2008.

22TestimonyfromstakeholderinterviewswithkeyfocalpointsatCenterforHIV/AIDS/STI. 23BiologicalandBehavioralSurveyamongMSMinLuangPrabangProvinceLaoPeoplesDemocraticRepublic,2007. 24BiologicalandBehavioralSurveyamongMSMinVientianeLaoPeoplesDemocraticRepublic,2009.

DepartmentofStatistics. 26RedefiningAIDSinAsia,CraftinganEffectiveResponse;ReportoftheCommissiononAIDSinAsia;OxfordUniversity Press,2008.

28PreventingHIVinYoungPeopleAffectedbyPopulationMobilityinLaoPDR,MidtermLearningReview;WorldVision LaoPDR,September,2006. 29JointActionforResults,UNAIDSOutcomeFramework20092011.UNAIDS,2009.

Rural 2006 20% 81%

tolowcoverageandlowsurvivalrates.Throughincreasedawareness,morePLHIVcometoARTsitesand theycomeearlier,increasingtheirsurvival.In2009,12monthsurvivalwas95%inadultsand100%in children[Indicator24].

Challengesto achieving/ maintainingtarget

Remedialactions plannedtoachieving/ maintainingtarget

CHASservesasmain coordinator,NCCA developedclearTOR M&Esystemdeveloped withunit,guidelines&5 yearplan 70%consistentcondom use

Becauseofhighmobility,need tomaintainoutreach&peer lededucationaswellasregular studies Becauseofhighmobility,need tomaintainoutreach&peer lededucationaswellasregular studies

5%ofmobilemen/migrant workersandtheirpartnersuse VCT/STIservices

Condomuseamongtargeted mobilemen/migrantworkers withintheLaoPDRwillincrease from55%(2004)to75%

Currentlynodatahas beencollectedonthis populationgroup

STIprevalenceamongtargeted mobilemen/migrantworkers willbereducedby50%fromthe 2004rate

Currentlynodatahas beencollectedonthis populationgroup

Conductupdatedstudyon Kathoy;conductSGSevery3 years;conductanotherSGSon MSMsamplingseveral provinces

Conductsituationalanalysis; developstrategybasedonthis Conductsituationalanalysis; developstrategybasedonthis

Mobilizeresourcestodomore situationalanalysisto determinerealsituation;

Atleast4sites(thosethatwill provideARVtreatment)also provideARVtherapyforPMTCT Safebloodservicesareprovided inallprovinces

StillverylowANCrates, soevenifPMTCT integrated,population maynotbenefit.No specificPMTCTstrategy exists.

DevelopPMTCTstrategywith2 yeargoals ExpandPMTCTintegrationto allMCHhospitalsby2015

Notclearaboutextentof availablesafebloodat districtlevel

Operationalresearchatdistrict leveltodeterminescreening practicesandextentofsafe blood

Expandoutreach&referralto reachremote&hardtoreach populationgroups Expandtestingtoreachremote &hardtoreachpopulation groups

Alltargetdistrictshaveatleast1 sitewhichdelivershighquality, confidentialSTIservices 6,000,000condomssoldper year Generalawarenessand knowledgelevelsincreased

Notdatatomeasurein generalpopulation,no trenddataonother MARPs Betteridentification& neweligibility requirementsmeanmore onART

Outreachprogramsneedtobe expandedtoothervulnerable groupslikeIDU,migrants& youth.Needtodostudieson thesepopulationgroups ExpandnumberofARTsites, ensurecontinuedfundingfor ARVs&OI,trainmedicalstaff onOI&2ndlineregimens

5ARVsitesand2 satellites,with1345on treatment Establishedin5provinces

SeesectionIV,best practices Establishedin5provinces

Limitedtechnicalcapacity ofsomePLHIVtobe activelyinvolved Notalldatacollected neededforprogramming andglobalreporting

3roundsSGS implementedinFSW;2 SGSstartedinMSM

Theknowledgebaseon behavioralandcontextual factorscontributingto vulnerabilitytowardsHIV/AIDS isexpanded.

NorecentstudiesonIDU, migrants,andyouth Dataarenoanalyzedor usedenoughforprogram decisions

3.Partnershipstoplan,coordinate,and managetheHIVM&Esystem. 4.NationalmultisectoralHIVM&Eplan 5.AnnualcostednationalHIVM&Ework plan 6.Advocacy,communicationsandculturefor HIVM&E

Useofmidtermevaluationtoguidenew NationalStrategicActionPlan ExtensiveuseofavailabledataforUNGASS 2010CountryProgressReport

Highlightconcernsifany,relatedtothefinalNCPIdatasubmitted(suchasdataquality, potentialmisinterpretationofquestionsandthelike): N/A

10) NCPIPARTA[tobeadministeredtogovernmentofficials] RespondentstoPartA [Indicatewhichpartseach respondentwasqueriedon]

Centerfor Respondent1 HIV/AIDS/STI 11) Respondent Centerfor

Dr.Chansy A.I,A.II,A.III,A.IV,A.V Phimphachanh,Director Dr.Chanthone A.I,A.II,A.III,A.IV,A.V 62

Respondent Centerforfor 3 HIV/AIDS/STI Respondent Centerfor 4 HIV/AIDS/STI

12) IfthenumberofrespondentstoPartAismorethan25,pleaseentertherestof respondentsforPartAinbelowbox. N/A

NCPIPARTB[tobeadministeredtocivilsocietyorganizations,bilateralagencies,andUN 13) organizations] RespondentstoPartB [Indicatewhichpartseach respondentwasqueriedon] B.I,B.II,B.III,B.IV

Organization Names/Positions Dr.PascalStenier,Country coordinationofUNAIDS

Respondent1 UNAIDS 14) Respondent2 UNAIDS

N/A=notapplicable Targetsarenotavailablefor2010becausedatawasnotavailabletodeterminebaseline. Targetsarenotavailablefor2015asthesewillbedeterminedduringthedevelopmentoftheNSAP20112015. Denominatorsarebasedonestimationwhichisstillneededtobevalidatedinthenearfuture.