Community based System in HIV treatment - CoBaSys Giovanni Guaraldi Rector's Delegate to Cooperation for Development in the Third Countries

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Title of the action: Community based system in HIV treatment - CoBaSys Empowering community to support antiretroviral delivery programmes for patients with HIV infection in Southern and Eastern African Countries: a regional network for policy advocacy targeting vulnerable groups. 3

4 antiretroviral delivery programmes for patients with HIV infection Empowering community regional network policy advocacy vulnerable groups

Il workshop ha l’obiettivo di lavorare insieme sulla tematica del progetto CoBaSys, attraverso una sua declinazione in chiave multidisciplinare. Cobasys mira alla costruzione di un network in grado di ottenere un “voce” piu’ autorevole sulla formulazione di politiche in tema di salute per la difesa dei gruppi piu’ vulnerabili. 5

Sessione 1 Moderatore: prof.ssa Elisabetta Genovese ore Saluti e Introduzione della giornata (prof. Giovanni Guaraldi, direttore CUSCOS) ore Accenni storico-politico-geografico dei paesi africani coinvolti nel progetto (prof. Mario Zamponi, Facolta’ di scienze politiche, Universita’ di Bologna) Ore Inizio relazioni tematiche Cobasys il punto di vista del medico prof. Giovanni Guaraldi Cobasys il punto di vista dell’economista prof. Enrico Giovannetti Cobasys il punto di vista dell’africanista dott.ssa Roberta Pellizzoli Cobasys il punto di vista del sociologo prof. Claudio Baraldi Cobasys il punto di vista dell’agronomo prof. Emilio Stefani pausa pranzo Sessione 2 Moderatore: dott.ssa Donatella Franzi ore Come si traduce un’idea in un progetto? Analisi delle Guide-Line ACP S&T dott.ssa Donatella Franzi Lavori di gruppo. Ogni focus group discutera’ su un singolo Work Package e dovra’ pianificare a una serie di possibili sub-attivita’ per garantire la realizzazione del progetto, sottolineando i rischi per ciascuna Restituzione in plenaria del lavoro dei gruppi e commento del lavoro svolto dott. Nicola Dorigo Conclusioni 6

Work Pakages 1.WP 1 Management and Coordination of the project + WP 7 Dissemination activities 2.WP 2 Start-up of local focus group 3.WP 3 Definition of a model for community based care system that will promote the local stakeholders advocacy 7

8 Relevance of the action: The African states involved in the project currently record the highest HIV/AIDS prevalence and incidence rates in the world The debate on ART in developing countries has irrevocably moved from the question of whether the introduction of ART is feasible to questions of how can best be delivered and sustained

A Global view of HIV infection, million people [30-36 million] living with HIV 9 The latest statistics on the world epidemic of HIV and AIDS were published by UNAIDS/WHO in July 2008, and refer to the end of More than 25 million people have died of AIDS since 1981

Regional statistics for HIV & AIDS, end of

Global HIV/AIDS estimates, end of The latest statistics on the world epidemic of HIV and AIDS were published by UNAIDS/WHO in July 2008, and refer to the end of 2007.

Speranza di vita e PIL The Millennium Preston curve in Marmot M., The Lancet, 2006; 368: Sierra Leone 34 y. Giappone 82 y.

HIV prevalence and GDP per capita (data from UNAIDS and the World Bank) 14 There is no systematic relationship between poverty and HIV, although malnutrition and economic vulnerability may well increase the risk of HIV infection in some contexts

15 A combined microfinance and training intervention can lead to reductions in levels of intimate- partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa. The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two, and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner

16 Strategies to alleviate poverty, whilst valuable in themselves, are unlikely to be effective in combating the HIV epidemic. Nicoli Nattrass, AIDS Behav (2009) 13:833–840

17 Of all the study participants, 32% of women and 22% of men had experienced food insufficiency in the preceding 12 months. “The results were striking”. Food insufficiency was associated with increased HIV risk behaviour, and this association was much more marked in women than men. Risk behaviour included inconsistent condom use, sex exchange, increased intergenerational sex, and lack of control over sexual relationships

18 The fact that most people living with HIV in the region today are poor simply reflects the fact that the epidemic has now spread throughout the generalized population in a region that has a high proportion of poor people Not to poverty itself but to economic and gender inequalities and weakened “social cohesion”

The link between extreme poverty and AIDS is mediated byvulnerable group in the comunity 19 Vulnerable Groups Vulnerable Groups AIDS Poverty

20 African women and AIDS Between 15 and 19 years old infection rate is 5-6 fold higher than men (UNAIDS, 2000). Biological, social and cultural factors involved: Frequent sexual intercourses between teenagers Lower access to instruction Lower monetary availability Lower access to prevention and to health services Social rights inequity between men and women is a risk factor.

AIDS orphans 79% of all AIDS orphans live in Africa 15 million children have lost one or both parents 5.8% of all children in africa are orphan Absolute number and percentage of children aged 6-14 years who have lost one or both parents to AIDS in sub- Saharan Africa years

HIV Prevalence and Income Inequality in Africa The Gini coefficient has a value between 0 and 1, representing the extremes of income distribution. A zero value corresponds to the situation where everyone in the population has exactly the same income, whereas a value of 1 would correspond to extreme concentration of income in one person. A high value indicates a more unequal income distribution.

Conclusions AIDS pandemic is a globalized problem and economic sustainability of ART is necessary to be found in a world global economic resources. We need to keep going in community sustainability of AIDS programs were Africans are actively involved in keeping prevention and treatment opportunity tightly linked. 23

: Gli obiettivi del Millennio 1) Eradicare la fame e l’estrema povertà 2) Raggiungere l’istruzione di base universale 3) Promuovere la parità di genere

: Gli obiettivi del Millennio 4) Ridurre la mortalità infantile -Ridurre di due terzi la mortalità <5 a 5) Migliorare la salute materna -Ridurre di 3/4 il tasso di mortalità materna 6) Combattere HIV/AIDS, malaria e altre malattie infettive - Interrompere ed iniziare a ridurre la diffusione dell’ HIV/AIDS - Interrompere ed iniziare a ridurre la diffusione della malaria e di altre malattie importanti

: Gli obiettivi del Millennio 7) Assicurare la sostenibilità ambientale Ridurre alla metà la percentuale della popolazione senza accesso ad acqua sicura 8) Costruire una partnership globale per lo sviluppo In cooperazione con le imprese farmaceutiche assicurare l’accesso a farmaci essenziali nei paesi in via di sviluppo In cooperazione con il settore privato, assicurare la disponibilità di nuove tecnologie, specialmente quelle dell’ informazione e della comunicazione

Il ruolo delle Università - Formazione - Ricerca - Comunità accademica - Coscienza critica

CENTRO UNIVERSITARIO DI SERVIZI PER LA COOPERAZIONE ALLO SVILUPPO