The document discusses strengthening Angola's national HIV/AIDS control program in the post-war context. Key points: - Angola faces extensive post-war damage to infrastructure and economy, lack of resources, and widespread corruption. The HIV situation is changing rapidly as refugees return. - HIV prevalence estimates vary considerably. Risk factors include the military, sex work, lack of information/condoms, and no safe blood supply. - Management & Leadership International proposes assisting the national program by disseminating strategic plans, building local management capacity, and providing technical support in priority municipalities over 2004. Challenges include defining strategy with limited resources and capacity.

1. Strengthening theStrengthening the
National HIV/AIDSNational HIV/AIDS
Control Program inControl Program in
Post-War AngolaPost-War Angola
Cameron Macauley, PA-C, MPHCameron Macauley, PA-C, MPH
Cary Perry, RNP, Dr.PHCary Perry, RNP, Dr.PH

2. Angola:Angola:
 Provinces: 18Provinces: 18
 Municipalities: 164Municipalities: 164
 Population: 14,416,810Population: 14,416,810
 Pop. < 15 years: 6,775,901Pop. < 15 years: 6,775,901
 Pop. < 5 years: 2,883,362Pop. < 5 years: 2,883,362
 Pop. < 1 year: 619,923Pop. < 1 year: 619,923
 Literacy rate: 42%Literacy rate: 42%

3. 3
Post-Conflict Angola:Post-Conflict Angola:
 Extensive damage to infrastructure &Extensive damage to infrastructure &
economyeconomy
 Lack of human resourcesLack of human resources
 Lack of schools, health services, lawLack of schools, health services, law
enforcement, employmentenforcement, employment
 Widespread government corruptionWidespread government corruption
 Strong dependence on external assistanceStrong dependence on external assistance

4. 4
Post-Conflict Angola:Post-Conflict Angola:
 Armed bandits, land mines interfereArmed bandits, land mines interfere
with travel; Large areas of the countrywith travel; Large areas of the country
still inaccessiblestill inaccessible
 800,000 IDPs, 450,000 refugees800,000 IDPs, 450,000 refugees
returning homereturning home
 HIV/AIDS considered as a lowerHIV/AIDS considered as a lower
priority problem when compared topriority problem when compared to
other conflict-related problemsother conflict-related problems

5. 5
5.5
22.5
21.5
38.8
33.7
7.2 4.9
20.1
13.0
7.8 15.0
8.3
5.0
15.0
6.4 1.0
12.9
11.8
5.8
31.0
33.4
HIV Seroprevalence in Angola:HIV Seroprevalence in Angola:
 Few reliableFew reliable
statistics arestatistics are
availableavailable
 The situation isThe situation is
changing rapidlychanging rapidly
 170,000 refugees170,000 refugees
returning from DRreturning from DR
Congo, Zambia,Congo, Zambia,
Namibia in 2004Namibia in 2004

6. 6

7. 7
Epidemic CurveEpidemic Curve
It is estimated that 18% of the population willIt is estimated that 18% of the population will
be infected by 2010be infected by 2010
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
1985
1988
1991
1994
1997
2000
2003
2006
2009
Low prevalence
High prevalence
Luanda
Huila
Benguela
Source: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEFSource: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEF

8. 8
HIV Surveillance in Angola:HIV Surveillance in Angola:
Discrepancy in 2003 figures:Discrepancy in 2003 figures:
– Angolan Govt estimates: 8.6%Angolan Govt estimates: 8.6%
– UNAIDS:UNAIDS: 5.5%5.5%
– WHO Afro:WHO Afro: 2.4 %2.4 %
GroupGroup Seroprevalence(%)Seroprevalence(%)
CSWCSW 33.1(2001)33.1(2001)
TB patientsTB patients 10.4 (2001)10.4 (2001)
Blood donorsBlood donors 9.0 (2001)9.0 (2001)
Pregnant womenPregnant women 8.6 (2001)8.6 (2001)
VCTVCT 10.5 (2003)10.5 (2003)
Military personnelMilitary personnel 6.0 (2003)6.0 (2003)
PrisonersPrisoners 4.5 (2003)4.5 (2003)
Source: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEFSource: Study of HIV/AIDS Socio Economic Impact 2003 NACP-UNDP/UNICEF

9. 9
Contributing Factors to HIVContributing Factors to HIV
Seroprevalence in Angola:Seroprevalence in Angola:
 Massive, poorly controlled militaryMassive, poorly controlled military
dispersed across the countrydispersed across the country
 84,000 war orphans84,000 war orphans
 Health services budget split betweenHealth services budget split between
malaria, TB, trypanosomiasis, andmalaria, TB, trypanosomiasis, and
HIV/AIDSHIV/AIDS

10. 10
Contributing Factors to HIVContributing Factors to HIV
Seroprevalence in Angola:Seroprevalence in Angola:
 Lack of treatment options discouragesLack of treatment options discourages
people from seeking testspeople from seeking tests
 Only 5 VCT sites in operation, all inOnly 5 VCT sites in operation, all in
LuandaLuanda
 Lack of publicity makes the pandemicLack of publicity makes the pandemic
appear distant and not a real threatappear distant and not a real threat

11. 11
Contributing Factors to HIVContributing Factors to HIV
Seroprevalence in Angola:Seroprevalence in Angola:
 Lack of employment opportunities for women leads toLack of employment opportunities for women leads to
Commercial & Barter SexCommercial & Barter Sex
 Large numbers of construction workers, soldiers, andLarge numbers of construction workers, soldiers, and
short-term laborersshort-term laborers
 Lack of information about HIVLack of information about HIV
 Lack of condomsLack of condoms
 No safe blood supplyNo safe blood supply
 Lack of alternatives to breastfeeding forLack of alternatives to breastfeeding for
seropositive mothersseropositive mothers

12. 12
How Can M&L Help?How Can M&L Help?
Assist the National HIV/AIDS Control ProgramAssist the National HIV/AIDS Control Program
(PNLS) in decentralizing the National HIV/AIDS(PNLS) in decentralizing the National HIV/AIDS
Strategic Plan (PEN) by:Strategic Plan (PEN) by:
• Disseminating a summary of the PEN to alignDisseminating a summary of the PEN to align
stakeholders & to be used as a basis for planningstakeholders & to be used as a basis for planning
• Building management & leadership capacity toBuilding management & leadership capacity to
implement HIV/AIDS control programs in priorityimplement HIV/AIDS control programs in priority
municipalitiesmunicipalities
• Provide logistical and technical support for theProvide logistical and technical support for the
PNLSPNLS

13. 13
Challenges Facing M&LChallenges Facing M&L
in Angola:in Angola:
 World’s most expensive countryWorld’s most expensive country
 Uncertain funding from USAID, forcingUncertain funding from USAID, forcing
piecemeal planningpiecemeal planning
 No field staff on the ground (yet)No field staff on the ground (yet)
 PNLS has little technical capacityPNLS has little technical capacity
 M&L’s strategy has yet to be clearly definedM&L’s strategy has yet to be clearly defined

14. 14
Proposed M&L StrategyProposed M&L Strategy
 Target selected municipalities in selectedTarget selected municipalities in selected
provincesprovinces
 Distribute PEN summary to all stakeholdersDistribute PEN summary to all stakeholders
 Workshops provide forum for strategicWorkshops provide forum for strategic
planning, take participants through the M&Lplanning, take participants through the M&L
framework (Egypt model)framework (Egypt model)
 Follow-up after each workshop to provideFollow-up after each workshop to provide
guidance & supportguidance & support

15. 59 priority59 priority
municipalitiesmunicipalities
identifiedidentified
during recentduring recent
poliopolio
immunizationimmunization
campaignscampaigns

16. 16
M&L Angola Proposed Timeline, 2004M&L Angola Proposed Timeline, 2004
Mar Apr May Jun Jul Aug Sep Oct Nov DecMar Apr May Jun Jul Aug Sep Oct Nov Dec
Planning
Meeting
with
PNLS
Preparatory
meetings
with:
•local NGOs,
•Angolan
military,
•Provincial &
municipal
health
managers
1st HUAMBO
District
Workshop:
•Identifying
Challenges
•Scanning &
Focusing
2nd
HUAMBO
District
Workshop:
•Aligning &
Mobilizing
3rd
HUAMBO
District
Workshop:
•Inspiring
•Measuring
Results
Huambo
Municipal
Team
meeting
Huambo
Municipal
Team
meeting
Huambo
Municipal
Team
meeting
1st
BENGUELA
District
Workshop
2nd
BENGUELA
District
Workshop
3rd
BENGUELA
District
Workshop
Preparatory
meetings
Benguela
Municipal
Team
meeting
Benguela
Municipal
Team
meeting
Follow-Follow-
up &up &
supportsupport
Huambo ProvinceHuambo Province
Benguela ProvinceBenguela Province
Preparatory
meetings
1st
Bengo
District
WorkshopBengo ProvinceBengo Province