I A S C H I V A I D S In Emergency Guidelines

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I A S C H I V A I D S In Emergency Guidelines

  1. 1. Guidelines for HIV/AIDS interventions in emergency settings GUIDELINES for HIV/AIDS interventions in emergency settings ���� ������������������������������� Page 1
  2. 2. GUIDELINES for HIV/AIDS interventions in emergency settings IASC Inter-Agency Standing Committee
  3. 3. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings section name name Acknowledgements Preface The Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings (IASC TF) wishes to thank all the people who have collaborated on the development of these The Inter-Agency Standing Committee (IASC) is issuing Guidelines for HIV/AIDS interventions Guidelines. They have given generously of their time and their experience. Special thanks are in Emergency Settings to help individuals and organizations in their efforts to address the special due also to the members of the IASC TF who have actively participated and worked hard on needs of HIV-infected and HIV-affected people living in emergency situations. The Guidelines the development of these Guidelines. We also would like to gratefully acknowledge the support are based on the experiences of organizations of the UN system and their NGO partners, and received from colleagues within the different agencies and all NGOs who participated in the reflect the shared vision that success can be achieved when resources are pooled and when all continuous review of the document. For further information on the IASC, please access the concerned work together. IASC website www.humanitarianinfo.org/iasc It is difficult to grasp the scale of devastation that HIV/AIDS engenders in stable societies. It These Guidelines were made possible through contributions from the following agencies: is even harder to gauge the impact of the pandemic on people whose lives have been uprooted by conflict and disaster. In January 2003, the IASC issued a statement in which it committed The Food and Agricultural Organization (FAO) itself to “redoubling our individual and joint agency responses to promote a comprehensive, The International Committee of the Red Cross (ICRC) multi-faceted approach to this unprecedented crisis” as it faced the impact of HIV/AIDS on The International Council of Voluntary Agencies (ICVA) food security and human survival, as evidenced in southern Africa. The International Federation of Red Cross and Red Crescent Societies (IFRC) The International Organization for Migration (IOM) Over the ensuing months, the IASC undertook to develop a practical handbook that could be United Nations Children’s Fund (UNICEF) put to immediate use for the benefit of those who most need our commitment and support. We United Nations Development Programme (UNDP) trust that these Guidelines will serve that aim. United Nations High Commissioner for Refugees (UNHCR) United Nations Office for the coordination of humanitarian affairs (OCHA) United Nations Population Fund (UNFPA) World Food Programme (WFP) World Health Organization (WHO), in the Chair Jan Egeland Emergency Relief Coordinator Joint United Nations Programme on HIV/AIDS (UNAIDS) and Under-Secretary-General for Humanitarian Affairs The Civil and Military Alliance (CMA) The International Centre for Migration and Health (ICMH) ffairs The Inter-Agency Standing Committee (IASC) was established in 1992 in response to General Assembly Resolution 46/182 that called for strengthened coordination of humanitarian assistance. The resolution set up the IASC as the primary mechanism for facilitating inter- agency decision-making in response to complex emergencies and natural disasters. The IASC is formed by the representatives of a broad range of UN and non UN humanitarian partners, including UN agencies, NGOs, and international organizations such as World Bank and the Red Cross Movement.1 These Guidelines are to be field tested. Users will be invited to provide comments to the Task Force. Page 2 Page 3
  4. 4. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Table of contents List of acronyms Acknowledgements 2 Preface 3 AIDS Acquired immune deficiency syndrome List of acronyms 5 ARV Antiretrovirals BCC Behaviour change communication Chapter 1: Introduction 6 The rationale for a specific HIV/AIDS intervention within complex emergencies: HIV/AIDS and crisis 6 CAP Consolidated appeal process Purpose of the guidelines 7 CBO Community based organization Target audience 7 CBR Crude birth rate Description of chapters, sectors and the Matrix 8 CHAP Common humanitarian action plan Use of the companion CD-ROM 8 CSO Country support offices Chapter 2: The context: addressing HIV/AIDS in emergency settings 9 EPI Expanded programme on immunization Risk of transmission in emergency contexts HIV Human immunodeficiency virus People already living with HIV/AIDS in emergencies HH Household(s) What is meant by an emergency? What should be done for HIV/AIDS in emergencies? IDP Internally displaced persons Emergency preparedness and response IDU Intra venous drug users Linking with a comprehensive response IEC Information, education communication Groups at risk: women, children, mobile populations, the rural poor MCH Mother and child health Chapter 3: The Matrix 15 MISP Minimum initial service package Principles 20 MOH Ministry of health Chapter 4: The Guidelines 20 NGO Non governmental organizations Action sheet 1.1: Establish coordination mechanisms 20 PEP Post exposure prophylaxis Action sheet 2.1: Assess baseline data 24 PTA Parent/teacher associations Action sheet 2.2: Set-up and manage a shared database 22 PLWHA People living with HIV/AIDS Action sheet 2.3: Monitor activities 30 Action sheet 3.1: Prevent and respond to sexual violence and exploitation 32 RH Reproductive health Action sheet 3.2: Protect orphaned and separated children 36 SGBV Sexual and gender based violence Action sheet 3.3: Ensure access to condoms for peacekeepers, military and humanitarian staff 3832 STI Sexually transmitted infections Action sheet 4.1: Include HIV considerations in water/sanitation planning 42 TB Tuberculosis Action sheet 5.1: Target food aid to affected households and communities 44 VCT Voluntary counselling and testing Action sheet 5.2: Plan nutrition and food needs for populations with high HIV prevalence 46 Action sheet 5.3: Promote appropriate care and feeding practices for PLWHA 50 Action sheet 5. 4: Support and protect food security of HIV/AIDS affected and at risk households and communities 52 Action sheet 5.5: Distribute food aid to affected households and communities 54 Action sheet 6.1: Establish safely designed sites 58 Action sheet 7.1: Ensure access to basic health care for the most vulnerable 60 Action sheet 7.2: Ensure a safe blood supply 64 Action sheet 7.3: Provide condoms and establish condom supplies 68 Action sheet 7.4: Establish syndromic STI treatment 72 Action Sheet 7.5: Ensure IDU appropriate care 76 Action sheet 7.6: Manage the consequences of sexual violence 80 Action sheet 7.7: Ensure safe deliveries 82 Action sheet 7.8: Universal precautions 86 Action sheet 8.1: Ensure children’s access to education 90 Action sheet 9.1: Provide information on HIV/AIDS prevention and care 92 Action sheet 10.1: Prevent discrimination by HIV status in staff management 96 Action sheet 10.2: Provide post exposure prophylaxis (PEP) for humanitarian staff 98 Endnotes 101 Page 4 Page 5
  5. 5. ; Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Chapter 1: Introduction AIDS prevalence levels, into contact. This Purpose of the guidelines does not mean that emergency response is especially true in the case of populations personnel in low-prevalence settings can be Over the last two decades, complex migrating to urban areas to escape conflict The purpose of these guidelines is to enable complacent. Even in low prevalence settings, emergencies resulting from conflict and or disaster in the rural areas. governments and cooperating agencies, advocacy is needed to raise awareness of natural disasters have occurred with including UN Agencies and NGOs, to the importance of integrating emergency increasing frequency throughout the world. As a consequence, the health infrastructure deliver the minimum required multi- responses and HIV/AIDS prevention and At the end of 2001, over 70 different may be greatly stressed; inadequate supplies sectoral response to HIV/AIDS during the care programming. At the very least, key countries experienced an emergency may hamper HIV/AIDS prevention efforts. early phase of emergency situations. These actors in any emergency response situation, situation, resulting in over 50 million During the acute phase of an emergency, this guidelines, focusing on the early phase of an along with the relevant authorities and affected persons worldwide. Sadly, the very absence or inadequacy of services facilitates emergency, should not prevent organizations existing response teams, should establish conditions that define a complex emergency HIV/AIDS transmission through lack of from integrating such activities in their coordination mechanisms to decide the - conflict, social instability, poverty and universal precautions and unavailability of preparedness planning. As a general rule, this appropriate minimum response for their powerlessness - are also the conditions that condoms. In war situations, there is evidence response should be integrated into existing geographic area based on these Guidelines favour the rapid spread of HIV/AIDS and of increased risk of transmission of HIV/ plans and the use of local resources should be and the existing response to the disease. other sexually transmitted infections. AIDS through transfusion of contaminated encouraged. A close and positive relationship blood. with local authorities is fundamental to Description of chapters, sectors and the Matrix The rationale for a specific HIV/AIDS intervention in the success of the response and will allow crises The presence of military forces, peacekeepers, strengthening of the local capacity for the This document consists of four chapters, or other armed groups is another factor future. the last being the Guidelines themselves. At the end of 2002, there were 42 million contributing to increased transmission Chapters 1 through 3 provide background people worldwide living with HIV/AIDS. of HIV/AIDS. These groups need to be Target audience and orientation information. Chapter 4, The long-term consequences of HIV/AIDS integrated in all HIV prevention activities. recognizing that any response to a disaster are often more devastating than the conflicts These guidelines were designed for use by will be multi-sectoral, describes specific themselves: mortality from HIV/AIDS Recent humanitarian crises reveal a complex authorities, personnel and organizations interventions on a sector-by-sector basis. each year invariably exceeds mortality from interaction between the HIV/AIDS operating in emergency settings at conflicts. Most people are already living in epidemic, food insecurity and weakened international, national and local levels. The The sectors are: precarious conditions and do not have sufficient governance. The interplay of these forces guidelines are applicable in any emergency 1. Coordination access to basic health and social services. must be borne in mind when responding to setting, regardless of whether the prevalence 2. Assessment and monitoring emergencies. of HIV/AIDS is high or low. For example, 3. Protection During a crisis, the effects of poverty, even in low prevalence settings, a breakdown 4. Water and sanitation powerlessness and social instability are There is an urgent need to incorporate in the health infrastructure can cause 5. Food security and nutrition intensified, increasing people’s vulnerability the HIV/AIDS response into the overall increased transmission of HIV/AIDS if 6. Shelter and site planning to HIV/AIDS. As the emergency and emergency response. If not addressed, health care workers do not follow universal 7. Health the epidemic simultaneously progress, the impacts of HIV/AIDS will persist precautions against blood-borne diseases. 8. Education fragmentation of families and communities and expand beyond the crisis event itself, Certainly the guidelines should be applied 9. Behaviour communication occurs, threatening stable relationships. influencing the outcome of the response and in emergency settings with high HIV/AIDS change (BCC) The social norms regulating behaviour are shaping future prospects for rehabilitation prevalence, where an integrated response 10. HIV/AIDS in the workplace often weakened. In such circumstances, and recovery. Increasingly, it is certain that, is urgently needed in order to prevent the women and children are at increased risk of unless the HIV/AIDS response is part of the epidemic from having an even greater and A Matrix, incorporating these sectors, violence, and can be forced into having sex wider response, all efforts to address a major more devastating impact. provides a quick-but-detailed overview of to gain access to basic needs such as food, humanitarian crisis in high prevalence areas the various responses. The Action sheets, water or even security. Displacement may will be insufficient. Although HIV/AIDS is not given as high one for each sector, provide more in-depth bring populations, each with different HIV/ a priority in low prevalence settings, this information. Page 6 Page 7
  6. 6. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings The Matrix, shown on pages 16 - 19, is Chapter 2: Addressing HIV/AIDS in of rape became infected because of the rape, divided into columns according to specific emergency settings or were already infected. Examples of this phases of the emergency: emergency situation can be found during the genocide preparedness, minimum response and in Rwanda and in Eastern Democratic comprehensive response. These Guidelines While the impact of HIV/AIDS is Republic of Congo today. give emphasis to the minimum required generally well documented and understood, actions needed in order to manage HIV/ considerably less attention has been given • In areas affected by natural disaster, the AIDS in the midst of an emergency. Each to the spread of HIV/AIDS in emergency impact of HIV depends on existing HIV of the bullet points in the sectors in the settings. prevalence rates and the capacity of the minimum response column corresponds to government, international agencies, donors an Action sheet that provides information In the past three years, however, spurred and civil society to respond. In 2002- on the minimum activities that should be by Security Council Resolution 1308 on 2003, when Southern Africa went through undertaken to consider HIV/AIDS in the HIV/AIDS and Peacekeepers (2000), and a food shortage, it is believed that people overall response to the crisis. It also shows the the Graça Machel’s study on the Impact with HIV, already poorer because of lost interaction between the different sectors. of Conflict on Children (2000), there have household income and greater medical been increased efforts to describe how HIV expenses incurred by the person living Use of the companion CD-ROM spreads in emergency settings. In addition, a with AIDS, suffered disproportionately number of humanitarian organizations have when faced with lack of food caused by the A companion CD-ROM disk is attached to made efforts to prevent new transmission regional shortage. the back inside cover of this book. It contains and provide support for those already many of the articles, documents, and training affected even in the midst of an emergency. It is important to remember, however, that materials mentioned here in the printed text. Little by little, data is being collected, lessons significant work remains to be done in Additionally, the entire text is reproduced in are being learned and practices shared. accurately assessing prevalence rates and other formats: Adobe Acrobat™, HTML information related to risk behaviours for (for users who wish to display the text within From the information available to date, the HIV in emergency settings. a web browser), and Microsoft Word. For thinking on HIV transmission in emergency PC users, the CD-ROM, upon insertion settings is that: Risk of transmission in emergency contexts into a CD-ROM player, will automatically launch itself in a browser such as Internet • The risk of HIV transmission appears to Although arriving at definitive conclusions Explorer or Netscape. From the top page, be low in places with low HIV prevalence is based on the scant HIV prevalence data users can navigate to materials cited in the rates at the beginning of an emergency, and available in emergency settings, we do know text, footnotes and reference sections of the where populations remain isolated. This that many of the conditions that facilitate text. There are also links to organizations appears to remain true even when there are the spread of HIV are common in these and other resources. The CD-ROM will high levels of risk behaviours such as rape. settings. be updated every year, with new materials Sierra Leone and Angola during the conflict added as they become available. years typify this scenario. Such conditions include but are not limited to: • War can accelerate the transmission of HIV • Rape and sexual violence, including in places where rape and sexual exploitation rape used as a weapon of war by fighting are superimposed on high levels of HIV forces against civilians. This is most often before the beginning of an emergency. exacerbated by impunity for crimes of sexual Causality, however, is difficult to determine, violence and exploitation as it is almost impossible to know if survivors • Severe impoverishment that often leads Page 8 Page 9
  7. 7. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings women and girls with few alternatives but droughts, earthquakes, and floods, as well the realization that HIV/AIDS must be dealt • defining which groups and communities to exchange sex for survival as situations of armed conflict. A complex with through a multi-sectoral response. are more at risk; • Mass displacement which leads to break emergency is a humanitarian crisis where • assessing strengths and coping mechanisms up of families and relocation into crowded a significant breakdown of authority has These Guidelines present such a multi- of vulnerable groups and their capacity to refugee and internally displaced camps resulted from internal or external conflict, sectoral approach to preparing for and respond to a threat; and where security is rarely guaranteed requiring an international response that responding to HIV in emergencies. • identifying gaps in government • Broken down school, health and extends beyond the mandate of one single They provide guidance for humanitarian preparedness plans and advocating with communication systems usually used to agency. Such emergencies have a devastating coordinators on what to do, and detail for policymakers to ensure that plans are programme against HIV transmission. effect on great numbers of children and implementing organizations on how to do developed that aim to reduce the disaster’s • Limited access to condoms and treatment women, and call for a complex range of it. They are based on the understanding impact on vulnerable populations. for sexually transmitted infections. responses. that all humanitarian actors involved have a degree of responsibility within their mandate Emergency preparedness plans are developed People already living with HIV/AIDS in emergencies What should be done for HIV/AIDS in emergencies? to prevent and mitigate HIV and AIDS. in order to minimize the adverse effects of a Effective implementation will rely on disaster, and to ensure that the organization In general, people already infected with HIV For years, humanitarian organizations have strong collaboration between international and delivery of the emergency response are at greater risk of physically deteriorating ignored HIV in emergencies, focusing their agencies, local authorities and local groups is timely, appropriate and sufficient. Such during an emergency because: attention on life-saving measures such as and NGOs who are instrumental in preparedness plans should be part of a health, water, shelter and food. HIV was reaching vulnerable populations. long-term development strategy and not • People living with HIV/AIDS are more not seen as a direct threat to life. Recently, introduced as a last-minute response to prone to suffer from disease and death as however, a number of humanitarian Emergency preparedness and response the unfolding emergency. In the case of a consequence of limited access to food, organizations have realized the importance HIV/AIDS, such preparedness means that clean water, and good hygiene than are of preventing HIV transmission early on in Emergency preparedness focuses on all relief workers would have received a basic people with functioning immune systems. an emergency. addressing the causes of the emergency with a training, before the emergency, in HIV/ • Caretakers may be killed or injured during view to avoiding its recurrence or mitigating AIDS, as well as sexual violence, gender an emergency leaving behind children The WHO, UNAIDS, UNHCR 1996 its impact and strengthening resilience, issues, and non-discrimination towards already made vulnerable by infection with Guidelines on HIV/AIDS in Emergencies, especially on vulnerable households and HIV/AIDS patients and their caregivers. It HIV/AIDS or loss of parents to AIDS. followed by the Minimum Initial Service communities, and building up local also implies that adequate and appropriate • Health care systems break down (attacks Package (MISP) on reproductive health, capacity to address the crisis (including supplies specific to HIV are pre-positioned. on health centres, inability to provide provided the first guidance on how to pre-positioning of relief items to shorten the These are crosscutting issues which are supplies, flight of health care staff ), and prevent HIV transmission during an time of the response). These efforts are often relevant to all sectors. populations have limited access to health emergency. However, little implementation linked to early warning systems, especially in facilities because roads are blocked or mined, of these guidelines occurred, often due to natural disaster prone areas. A disaster preparedness plan should put and financial resources are even more limited competing priorities, lack of funds, poor in place certain elements in order to bring than usual. coordination by humanitarian organizations, Disaster preparedness includes the about a successful response: and a lack of importance given to the continuous collection and analysis of What is meant by an emergency? issue. In addition, these guides provided a relevant information and activities in order • a solid needs assessments that will allow medicalized approach to the problem and to prepare for and reduce the effects of relief agencies to jointly determine who does An emergency is a situation that threatens did not sufficiently call for a multi-sectoral disasters such as: what and where, under the umbrella of a the lives and well-being of large numbers response to HIV in emergencies. comprehensive humanitarian action plan; of a population, extraordinary action being • predicting hazards by identifying and • staff properly trained and emergency required to ensure the survival, care and Since 2000, there has been a greater mapping key threats; response tools available on time; protection of those affected. Emergencies acceptance of HIV as an emergency concern • assessing the geographical distribution of • common tools for natural disasters and include natural crises such as hurricanes, in the humanitarian field accompanied by areas vulnerable to seasonal threats; complex emergencies; Page 10 Page 11
  8. 8. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings • funding mechanisms that ensure money is Groups at risk: women Groups at risk: mobile populations sources and disrupting their agricultural readily available, and and livelihood systems. Civil strife and • information management network In emergencies, women are highly vulnerable Emergencies often result in the movement or war further exacerbate both their poverty available to key decision-makers. to HIV/AIDS. In times of civil strife, war displacement of people. Displaced persons, and their vulnerability, leading to acute and displacement, women and children refugees, returnees and demobilised military emergencies where poor people endure Linking with a comprehensive response are at increased risk of sexual violence and personnel including children soldiers are starvation, fear for their survival, and may abuse. In acute emergency situations where among society’s most vulnerable. Most be forced to flee from their homes and land. The rehabilitation and recovery phases there is severe food insecurity and hunger, are separated from their families, spouses Forced migration of the rural poor towards of an emergency cycle permit a more women and girls may find themselves or partners. They are exposed to unique cities increases the risk of contracting HIV/ comprehensive response, built upon the coerced to engage in casual or commercial pressures, working constraints, and living AIDS, as sero-prevalence in urban areas is initial minimum response and enhancing sex as a survival strategy to gain access conditions. They are often seen as a threat higher. Rural populations are also less aware coverage and sustainability. to food and other fundamental needs. In to the cultural integrity or to job security of the means of prevention and might lack addition, the disruption of communities and of the hosting population, a misperception access to them. In the Matrix, presented below, the families, particularly when people flee from that often gives rise to xenophobia. They comprehensive response specifies the their land, involves the break-up of stable feel anonymous and tend to cluster on the activities to be undertaken following the relationships and the dissolution of social margins of cities, or are housed in camps initial phase. The rehabilitation phase and familiar cohesion, thus facilitating a that were intended to be temporary, or can last until the situation causing the context of new relationships with high-risk to have no homes at all. Vulnerability to emergency has returned to normal. During behaviour. HIV infection is greatest when people live the comprehensive phase, it is important and work in conditions of poverty, social to coordinate activities with the local Groups at risk: children exclusion, loneliness and anonymity. These authorities and among the various actors factors may provoke risk-taking behaviours providing services to the population. Emergencies also aggravate the vulnerable that would not have been exhibited prior to condition of children affected by the displacement. Since the present Guidelines concentrate on HIV/AIDS epidemic, including orphans, addressing the minimum required actions to HIV infected children, and child-headed Groups at risk: the rural poor address HIV/AIDS issues in an emergency, households. Displaced people and emphasis is given herein to necessary and refugee children confront completely People in the developing world, particularly feasible interventions. However, emergency new social and livelihood scenarios with the rural poor, are highly vulnerable to responses clearly should not be limited notable vulnerability, a circumstance that disasters. In fact, most emergencies involve to the minimum required actions; more facilitates HIV transmission and aggravates poor people living in rural areas. Poor comprehensive actions need to occur as AIDS impact on well being. Emergency communities and households have fewer soon as possible to ensure appropriate situations also deprive children of education means to protect themselves from, and to rehabilitation and recovery. In at-risk areas opportunities, including the opportunity to cope with, the consequences of natural ("chronic vulnerable areas," drought-prone learn about HIV/AIDS and basic health. disasters. Due to their poverty they also are areas) where crises are known to be recurrent Children in situations of armed conflicts, often forced to live in areas that are prone to or of slow onset, prevention and emergency and displaced, migrant and refugee children natural disasters such as landslides or floods. preparedness should be a priority. are particularly vulnerable to all forms of Access to basic health services is often sexual exploitation. minimal or non-existent. Climatic and agricultural disasters, such as drought and large-scale pest infestations, hit rural people hardest, devastating their food Page 12 Page 13
  9. 9. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Chapter 3: The Matrix • Where non-state entities have control or where the government no longer has the capacity to act, activities may be undertaken in the absence of national policies or The Matrix (shown on pages 16 - 19, programmes. and also as a separate sheet intended for • HIV/AIDS activities for displaced posting to a wall) provides guidance on populations should also service host key actions for responding to HIV/AIDS populations to the maximum extent in emergencies. The Matrix is divided possible. into three parts: Emergency preparedness, • When planning an intervention, cultural Minimum response, and Comprehensive sensitivities of the beneficiaries should be response. considered. Inappropriate services are more likely to cause negative reaction from the Each programmatic sector on the community rather than achieve the desired chart provides guidance on responding impact. appropriately to HIV/AIDS in emergency situations. Only the minimum response phase is presented in the Action sheets. The country’s or region’s situation and capacity assessment will help determine which additional HIV/AIDS responses should be undertaken. Detailed action points for each of the bullets of the Matrix are provided in the Action sheets on the subsequent pages. Principles • HIV/AIDS activities should seek to build on and not duplicate or replace existing work. • Interventions for HIV/AIDS in humanitarian crises must be multi-sectoral responses. • Establish coordination and leadership mechanisms prior to an emergency, and leverage each organization's differential strengths, so that each can lead in its area of expertise. • Local and national governments, institutions and target populations should be involved in planning, implementation and allocating human and financial resources. Page 14 Page 15
  10. 10. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Sectoral response Emergency preparedness Minimum response (to be conducted even in the Comprehensive response midst of emergency) (Stabilized phase) 1. Coordination • Determine coordination structures 1.1 Establish coordination mechanism • Continue fundraising • Identify and list partners • Strengthen networks • Establish network of resource persons • Enhance information sharing • Raise funds • Build human capacity • Prepare contingency plans • Link HIV emergency activities with development activities • Include HIV/AIDS in humanitarian action plans and train accordingly relief workers • Work with authorities • Assist government and non-state entities to promote and protect human rights4 2. Assessment and • Conduct capacity and situation analysis 2.1 Assess baseline data • Maintain database monitoring • Develop indicators and tools • Involve local institutions and beneficiaries 2.2 Set up and manage a shared database • Monitor and evaluate all programmes • Assess data on prevalence, knowledge attitudes and practice, and impact of HIV/AIDS 2.3 Monitor activities • Draw lessons from evaluations 3. Protection • Review existing protection laws and policies 3.1 Prevent and respond to sexual violence and • Involve authorities to reduce HIV-related discrimination • Promote human rights and best practices exploitation • Expand prevention and response to sexual violence and exploitation • Ensure that humanitarian activities minimize the risk of sexual violence, and exploitation, and HIV-related discrimination 3.2 Protect orphans and separated children • Strengthen protection for orphans, separated children and young people • Train uniformed forces and humanitarian workers on HIV/AIDS and sexual violence • Institutionalize training for uniformed forces on HIV/AIDS, sexual violence and • Train staff on HIV/AIDS, gender and non-discrimination exploitation, and non-discrimination 3.3 Ensure access to condoms for peacekeepers, • Put in place HIV-related services for demobilized personnel military and humanitarian staff • Strengthen IDP/refugee response 4. Water and sanitation • Train staff on HIV/AIDS, sexual violence, gender, and non-discrimination 4.1 Include HIV considerations in water/sanitation • Establish water/sanitation management committees planning • Organize awareness campaigns on hygiene and sanitation, targeting people affected by HIV 5. Food security and • Contingency planning/preposition supplies 5.1 Target food aid to affected and at-risk • Develop strategy to protect long-term food security of HIV affected people nutrition • Train staff on special needs of HIV/AIDS affected populations households and communities • Develop strategies and target vulnerable groups for agricultural extension • Include information about nutritional care and support of PLWHA in community nutrition education 5.2 Plan nutrition and food needs for population programmes programmes with high HIV prevalence • Collaborate with community and home based care programmes in providing • Support food security of HIV/AIDS-affected households 5.3 Promote appropriate care and feeding practices nutritional support for PLWHA • Assist the government in fulfilling its obligation to respect the human right 5.4 Support and protect food security of HIV/AIDS to food affected & at risk households and communities 5.5 Distribute food aid to affected households and communities 6. Shelter and site • Ensure safety of potential sites 6.1 Establish safely designed sites • Plan orderly movement of displaced planning Page 16 Page 17
  11. 11. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Sectoral response Emergency preparedness Minimum response (to be conducted even in the Comprehensive response midst of emergency) (Stabilized phase) 7. Health • Map current services and practices 7.1 Ensure access to basic health care for the most • Forecast longer-term needs; secure regular supplies; ensure appropriate • Plan and stock medical and RH supplies vulnerable training of the staff • Adapt/develop protocols • Palliative care and home based care • Train health personnel • Treatment of opportunistic infections and TB control programmes • Plan quality assurance mechanisms • Provision of ARV treatment • Train staff on the issue of SGBV and the link with HIV/AIDS • Determine prevalence of injecting drug use 7.2 Ensure a safe blood supply • Safe blood transfusion services • Develop instruction leaflets on cleaning injecting materials • Map and support prevention and care initiatives 7.3 Provide condoms and establish condom supplies • Ensure regular supplies, include condoms with other RH activities • Train staff and peer educators • Reassess condoms based on demand • Train health staff on RH issues linked with emergencies and the use of RH kits • Assess current practices in the application of universal precautions 7.4 Establish syndromic STI treatment • Management of STI, including condoms • Comprehensive sexual violence programmes 7.5 Ensure IDU appropriate care • Control drug trafficking in camp settings • Use peer educators to provide counselling and education on risk reduction strategies 7.6 Manage the consequences of SV • Voluntary counselling and testing • Reproductive health services for young people 7.7 Ensure safe deliveries • Prevention of mother to child transmission 7.8 Universal precautions • Enable/monitor/reinforce universal precautions in health care 8. Education • Determine emergency education options for boys and girls 8.1 Ensure children’s access to education • Educate girls and boys (formal and non-formal) • Train teachers on HIV/AIDS and sexual violence and exploitation • Provide lifeskills-based HIV/AIDS education • Monitor and respond to sexual violence and exploitation in educational settings 9. Behaviour change • Prepare culturally appropriate messages in local languages 9.1 Provide information on HIV/AIDS prevention • Scale up BCC/IEC communication and • Prepare a basic BCC/IEC strategy and care • Monitor and evaluate activities information education • Involve key beneficiaries communication • Conduct awareness campaigns • Store key documents outside potential emergency areas 10. HIV/AIDS in the • Review personnel policies regarding the management of PLWHA who work in humanitarian operations 10.1 Prevent discrimination by HIV status in staff • Build capacity of supporting groups for PLWHA and their families workplace • Develop policies when there are none, aimed at minimising the potential for discrimination management • Establish workplace policies to eliminate discrimination against PLWHA • Stock materials for post-exposure prophylaxis (PEP) 10.2 Provide post-exposure prophylaxis (PEP) • Post-exposure prophylaxis for all humanitarian workers available on regular available for humanitarian staff basis Page 18 Page 19
  12. 12. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Sector 1: Coordination • strengthen the capacity of mechanisms and procedures to ensure 6Raise awareness and/or train local Phase: Minimum response institutions working in affected areas; all stakeholders are informed. institutions in areas affected by HIV/AIDS • ensure the dissemination of relevant • Promote the incorporation of HIV/ • Joint field visits by representatives of Action sheet 1.1: information and facilitate provision of AIDS prevention, care and mitigation relevant national coordinating bodies3 technical assistance to users. into situation assessments, emergency to relevant administrative areas with the Establish coordination mechanisms preparedness plans and the overall aim of: Existing HIV/AIDS coordination humanitarian response. • exchanging information by mechanisms (including National AIDS • Review existing information and carry contacting local authorities and key programmes, UN theme groups on HIV/ out local needs assessments to identify humanitarian actors, and AIDS) should ensure that ongoing national populations most at risk and priority • organizing training and awareness 4Background policies and plans do not exclude emergency- areas for interventions. raising workshop for local institutions. affected areas, and that the special risks • Incorporate HIV/AIDS considerations (Duration: approximately 2 days, The main goal of all humanitarian and vulnerabilities of internally displaced into donor appeals (including CAP and which can be adjusted according to coordination efforts is to meet the needs of persons, refugees and other affected groups CHAP) and assist in the development of time constraints); the affected populations in an effective and are given proper consideration. Coordination specific HIV/AIDS related appeals. • Activities should ensure that: coherent manner. The presence of HIV/ is needed at the local, regional, national and • Maintain a constant dialogue with • HIV/AIDS in emergencies is AIDS adds a further dimension to both international levels. donors on the overall funding, including included on the agenda of relevant the crisis and its aftermath. The interplay monitoring and evaluation of activities local coordination mechanisms; between the epidemic and emergency Coordination works best when relevant funded. • Simple reporting and information- settings results in: organizations and stakeholders are involved • Identify and report shortfalls in sharing systems are set up at local • people affected by the crisis being at in the definition of a common set of ethical funding to the international community. level; greater risk of contracting HIV/AIDS; and operational standards. This allows for • Institute ongoing review of the • Complementary local needs • households affected by HIV/AIDS true complementarity with due mutual operating environment to ensure assessments are carried out to identify having to face the additional burden respect for each other’s mandates and roles. that effective contingency plans are populations most at risk and priority of the crisis and who may not be able elaborated for any possible change. areas for interventions; to benefit from emergency relief 4Key actions • Periodic support missions are interventions; 6Raise awareness of decision makers and undertaken by representatives of • disruption of existing HIV/AIDS 6Set up and strengthen coordination programme managers relevant coordinating bodies at programmes and activities; and mechanisms • Organize information and advocacy country level and/or national centre • individuals and organizations • Identify and ensure collaboration of seminars at central level. of expertise. external to the area (including existing regional, national and local • Promote the incorporation of HIV/ humanitarian and military personnel) coordination bodies (for HIV/AIDS AIDS in emergencies on agendas of 6Provide information and technical being more vulnerable to HIV/AIDS and for emergencies). This includes relevant coordination mechanisms at assistance and STI, and thereby contributing the Humanitarian coordinator and national level. • Ensure that appropriate support is further to the spread of the epidemic. the Office for the coordination of • Promote the review of HIV/AIDS provided to all stakeholders for strategic humanitarian affairs (OCHA) and national strategic plans to adjust to the planning, assessment, monitoring and It is therefore essential to: UNAIDS. Define and map the mandate evolving imperatives of responding to analysis in relation to HIV/AIDS in • identify the different actors, and to and strengths of each stakeholder to HIV/AIDS in emergencies. emergency-affected areas. ensure appropriate coordination; avoid duplication and identify gaps. • Collaborate with media organizations • Review, share, and discuss the existing • raise the awareness and • Identify an office or some central to explain to donors and partners the information with relevant stakeholders, motivation of decision-makers to point as the focal point for the links between HIV/AIDS and the and inform populations of the risks improve projects, programmes and coordination effort, and appoint staff emergency. posed by HIV/AIDS. policies; as needed. Put in place record-keeping • Ensure that regular and consistent Page 20 Page 21
  13. 13. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings reports are made available to all 4Key resources stakeholders on how HIV/AIDS is being addressed throughout Guidelines on how to integrate HIV/AIDS the humanitarian response. The in the Consolidated Appeals Process. focal point/coordination body is responsible for maintaining a network The impact of HIV/AIDS on food security. of communication between all www.fao.org/docrep/meeting/003/ stakeholders. Y0310E.htm • Ensure that information, reference material and tools are made available; Food security and HIV/AIDS: an update. • Ensure that national reference systems www.fao.org/DOCREP/MEETING/006/ and networks are set up to facilitate Y9066e/Y9066e00.HTM exchange of information and advice; The silent emergency: HIV/AIDS in • Develop central web page to conflicts and disasters, CAFOD. store and facilitate access to display relevant information and resources, if Websites: appropriate. www.unaids.org www.reliefweb.int www.fao.org/hivaids/ Page 22 Page 23
  14. 14. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Sector 2: Assessment and monitoring challenges in assessing baseline data in 4Key actions transmission; and Phase: Minimum response emergencies primarily due to limited data; • behavioural surveillance surveys. often proxy indicators must be used. 6Perform HIV/AIDS rapid risk and Action sheet 2.1: vulnerability assessment. Challenges to surveillance reporting As with any emergency, the assessment Assess level of existing risks and specific include: Assess baseline data should consider both interventions targeting factors that make the risk groups listed • difficult interpretation when emergency affected populations and those above more vulnerable to HIV transmission. antiretroviral (ARV) therapy has been available to local populations. In order for This information guides programme instituted; an intervention to work (for example, in a design and policy implementation. This • inconsistent mortality registration; and camp-based population), it will be necessary information can be obtained qualitatively • poor syndromic diagnosis and to become involved with the surrounding through key informant interviews and reporting of STI. 4Background population. focus group discussions that include health and community workers, community 6Other key baseline data In order to coordinate and cooperate with All groups at risk for HIV transmission • Trends in condom usage and religious leaders (displaced and host other organizations and authorities, it is must be included in the assessment. The • Incidence and trends of gender based populations), women and youth groups, essential to set up a standardized database. identification of such groups is often context violence government, UN and NGO workers, as well It will allow common understanding and specific; however, groups generally include • Acute and chronic nutrition status as by observation of the emergency setting follow up of the epidemiological situation. A (although are not limited to) the following: of population using population- and its environs. variety of factors influence the transmission • women, based surveys among different groups of HIV in emergency settings, including: • children and adolescents, (children 6-59 months of age, pregnant 6Undertake HIV/AIDS surveillance. • the existing sero-prevalence rates in • single headed households, women, adults) Existing baseline data may include: displaced populations and surrounding • certain ethnic and religious groups • If food aid is distributed, amount • voluntary blood donor testing; communities, (often minorities who are discriminated (kcal/person/day) and quality (food • trends of AIDS case surveillance • the prevalence and types of sexually against), basket) reporting; transmitted infections (STI), • persons with disabilities, and • Amount (litres/person/day) and • new TB cases; • the level and types of sexual • drug addicts. quality of water available • STI incidence (new cases/ interactions and sexually related • Information on coping strategies of 1,000 persons/month) and trends behaviour, and People living with HIV/AIDS are frequently food insecure people disaggregated by syndrome (male • the level and quality of available stigmatized and discriminated against. An urethral discharge, genital ulcer disease, health services, and assessment should include persons who 6Feedback syphilis at antenatal clinics); • the background information on are considered core transmitters, such • participating organizations and • percent and trends of hospital bed demographic and education levels. as commercial sex workers and armed governments; occupancy of persons between 15-49 military or paramilitary personnel. Finally, years of age; • sector workers; In emergency situations, it is often difficult interaction between displaced and local • affected populations • HIV/AIDS information from the areas to obtain epidemiological data (in particular populations and the local communities of origin of the displaced population; in conflict situations) or reliable data needs to be evaluated for the possibility of 6See also: Monitoring activities (Action • sentinel surveillance of pregnant (governments may be reluctant to agree on HIV/AIDS transmission. sheet 2.3) and shared database (Action sheet women (proxy for general population); releasing figures). Hospital data most likely 2.2). • sentinel surveillance of high-risk do not reflect the situation in rural areas. In Older persons, while not necessarily at risk subgroups (STI patients, intravenous addition, culturally-related factors pertaining for HIV/AIDS, are vulnerable to increased drug users, and commercial sex to the setting must be considered, as well as demands placed upon them, as they often workers); the maturity of the epidemic in both host have to take care of young children who • voluntary testing and counselling; and displaced populations. There are many have been orphaned. • prevention of mother to child Page 24 Page 25
  15. 15. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings 4Key resources UNHCR/WHO/UNFPA. Inter-agency field manual. Reproductive health in refugee situations. Geneva, 1999. Chapter 9. www.unhcr.ch/cgi WHO. Guidelines for sexually transmitted infections surveillance: WHO, 1999. www.who.int/emc-documents/STIs/ whocdscsredc993c.html UNAIDS/WHO. Guidelines for second generation HIV surveillance. Geneva: UNAIDS/WHO, 2000: 1-48. Demographic and Health Surveys at: www.measuredhs.com UNAIDS. Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections. www.unaids.org/hivaidsinfo/statistics/fact_ sheets/index_en.htm Page 26 Page 27
  16. 16. Guidelines for HIV/AIDS interventions in emergency settings Guidelines for HIV/AIDS interventions in emergency settings Sector 2 : Assessment and monitoring reporting, STI by syndrome, • affected population. Phase: Minimum response gender-based violence, and death reporting components; 6See also: Assess baseline data (Action Action sheet 2.2: • blood screening (HIV and syphilis); sheet 2.1) and Monitoring activities (Action Set-up and manage a shared database • orphan programmes; and sheet 2.3). • protection cases. 4Key resources Depending upon the situation and programme, there may be systems in place UNHCR/WHO/UNFPA. Inter-agency for: field manual. Reproductive health in 4Background • sentinel surveillance (antenatal and refugee situations. Geneva, 1999. Chapter high risk). 9. One component of coordination is the • Surveys: behavioural surveillance, www.unhcr.ch/cgi-bin/texis/vtx/home/ setting up of a shared and standardized nutrition, others. opendoc.pdf database of information. Each sector needs • Voluntary counselling and testing . to have a lead agency whose responsibility is • Prevention of mother to child WHO. Guidelines for sexually transmitted to coordinate and communicate with other transmission. infections surveillance: WHO, 1999. organizations and governments involved in • Supplemental and therapeutic feeding the emergency response. A database facilitates programmes. UNAIDS/WHO. Guidelines for second comparisons between various locations as generation HIV surveillance. Geneva: well as the aggregation and interpretation 6Develop standardized case definitions, as UNAIDS/WHO, 2000: 1-48. of information from the lowest level (clinics above. and camps) to the highest level (country or Websites regional level). Ideally, a database should be 6Achieve consensus with partners and www.unaids.org developed during the preparedness phase. actors on the items above, together with the However, if this has not occurred before the harmonizing of existing government forms, emergency, it should become a priority of if applicable. the emergency response. 6Provide housing of shared database with 4Key actions open access to users. 6Make inventory of existing data collection 6Provide training: forms and systems to examine possible • various sector workers involved in linkage with HIV/AIDS information reporting, collecting and analysing data; system. The forms can be sourced either in and the countries or neighboring countries. • designated “data specialist” to manage hardware and software with computer 6Develop standardized forms. The types aspects of data. of forms may vary according to available programmes, but include the following: 6Feedback at all levels: • health information system, including • participating organizations, confidential clinical AIDS case governments; • sector workers; Page 28 Page 29

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