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HIV AND DEVELOPMENT |
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| HIV/AIDS: A Fast Rising Development Crisis |
| HIV/AIDS, Marginalisation and Poverty - The
Vicious Cycle |
| Women: Powerless at the Centre of the Epidemic |
| HIV and Development: Challenges in Asia Pacific |
| The Region's Special Vulnerability |
| The Need for a Regional Response |
| UNDP's Response |
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| HIV/AIDS: A Fast Rising
Development Crisis |
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| “HIV is too central a development challenge. And we therefore have to focus on how HIV/AIDS affects capacity, affects development policy, affects budgets, affects delivery systems... The next generation of poverty reduction and national development strategies need to fully address the challenge of HIV/AIDS.” |
| Kermal Dervis, UNDP Administrator, January 2006 |
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| From an emerging health problem two decades ago, HIV/AIDS
has transformed itself into a devastating development challenge
facing the world today. In many parts of the world, the epidemic's
impact on the entire spectrum of human development has been
catastrophic: deepening poverty, reversing human development
achievements, worsening gender inequalities, eroding the ability
of governments to maintain essential services, killing millions
of people of productive age group, orphaning children, reducing
labour productivity and supply and, reversing economic growth.
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| A UNDP sponsored study in 1995 found that a one percent increase
in HIV/AIDS prevalence rates leads to 2.2 years lost in human
development as measured by the Human Development Index. Estimates
show that after two more decades, many economies will be about
20-40 percent smaller than they would have been in the absence
of HIV/AIDS and the population of the 45 most affected countries
will be 97 million smaller. The epidemic threatens to drive
the population growth of three countries in Africa negative
by 2003 and in Asia; it will slightly retard the population
growth of Myanmar, Thailand and Cambodia. In many countries,
life expectancy will fall to 30 to 40 years by 2010, levels
never seen since the beginning of the 20th century. |
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| HIV/AIDS, Marginalisation
and Poverty - The Vicious Cycle |
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| Though the genesis of the HIV/AIDS epidemic has been different
in different countries, over the years it has become starkly
clear that world over; bulk of the disease-burden is borne by
the poor and the socially marginalised. More than 90 per cent
of the people living with HIV/AIDS are in less developed countries.
Global experience has conclusively established that poverty-related
factors like lack of access to livelihoods, lack of information
and services, unequal power balance and marginalised environment
(of groups like men having sex with men, sex workers, Injecting
Drug Users (IDU) and trans-gendered communities) that encourage
risky behaviour directly increase one's vulnerability to HIV.
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| The worst affected are the countries of Sub-Saharan Africa
and South and South East Asia, which are among nations with
lowest human development indices, large pools of poverty, huge
gender inequity, powerlessness, social instability etc. Out
of the 38.6 million people living with HIV/AIDS in the world,
more than 24.5 million are in Sub Saharan Africa and Asia. Even
within these countries, the least privileged and the marginalised
account for majority of the infections. This vulnerability of
the "underclass" is visible even in low-prevalent,
rich countries. For instance, according to a study by the Centres
of Disease Control in 1999, African Americans and Hispanics
accounted for 67 per cent of the infections in the United States. |
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| At the same time, HIV itself exacerbates the vulnerability
factors through loss of livelihoods, high cost of healthcare,
stigma and discrimination, denial of human rights, neglect and
malnutrition of children and their withdrawal from school. This
mutually aggravating link between poverty and HIV/AIDS results
in a downward spiral with millions of disenfranchised people
trapped in it. HIV and poverty, thus become both the cause and
the consequence. |
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| HIV itself heightens the vulnerability factors through loss
of livelihoods, high cost of healthcare, stigma and discrimination,
neglect and malnutrition of children and their withdrawal from
school. Often this link has gone unnoticed in the responses
to the epidemic. The responses often tended to ignore the bigger
picture of the implications for development and poverty reduction.
While a global effort is needed to advance technical inputs
like vaccines or treatment to help control the epidemic, there
are no easy answers or simple technical and scientific solutions
to curb its spread and impact. The most effective response or
the best international "vaccine" against HIV/AIDS
is sustained, equitable development. |
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| Women: Powerless at
the Centre of the Epidemic |
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| Women make up almost two-thirds of the world's 876 million
illiterate people. Women receive an average of 30 to 40 per
cent less pay than men for the same work. Worldwide, there are
90 young women in secondary school for every 100 young men.
In some countries, there are only 60 young women in secondary
classes for every 100 young men (Gender and HIV: UNAIDS Fact
Sheet) |
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| The increased vulnerability of women to HIV/AIDS and the
profound impact of the epidemic on them are critical concerns
deserving expeditious attention. If women rarely figured among
the people infected in the beginning of the epidemic, at the
end of 2005, 17.3 million women were living with the virus in
the world. In South East Asia, women are the poorest
of the poor, 30 per cent of adult infections were among women. |
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| Women are especially vulnerable to HIV mainly because of
two reasons: anatomical differences from men, which make transmission
of the virus far more effective from men to women than vice
versa and, the interplay of a series of socio-economic and cultural
factors which make them powerless, violated and poor. Most of
the time, women are hardly in a position to control the risk
factors. |
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| The vulnerability caused by adverse gender bias and the low
socio-economic status of women makes them compromised in all
aspects of the epidemic: prevention, treatment, stigma and discrimination,
rights violation etc. Women's choices are often restricted by
their inability to insist on safe sex, society's acceptance
of different standards of behaviour for women and men and economic
dependence on men. For the same reasons, married women are the
largest group of women at the risk of HIV infection. Since most
infected women are of childbearing age, they also carry the
risk of infecting their children. |
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| Women and girls are silenced by fear, social isolation and
lack of education, limiting their knowledge of their own reproductive
systems and the health risks associated with sexual activity.
Violence against women, such as trafficking, forced sex work,
incest and rape, including marital rape, put women and girls
at higher risk. |
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| Lack of access to information and services, because of their
low status in society; hinder preventive efforts from reaching
them. If infected, women are often subjected to violence, both
physical and mental. In India, a UNIFEM survey revealed that
many women experienced neglect by the medical staff, which refused
to touch them or give them injections. On the other hand, when
it comes to caring for the infected and the affected, women
bear bulk of the burden. |
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| The Platform for Action adopted by the Governments at the
Fourth World Conference on Women in Beijing in 1995 recognizes
that low social status of women is at the root of the women's
vulnerability to HIV. Women's centrality to the epidemic is
now recognised unambiguously and global efforts place considerable
emphasis on addressing it, not merely by modifying the risk
factors, but by tackling the root-cause of their special vulnerability.
(Sources: Women, Gender and HIV/AIDS in East and Southeast Asia,
UNIFEM and UNIFEM Fact Sheet) |
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| HIV and Development:
Challenges in Asia Pacific |
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| The Scenario |
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| After Sub-Saharan Africa, South and South East Asia is the
worst affected region in the world. Out of the 38.6 million people
living with HIV/AIDS in the world, South and South East Asia
accounts for 7.6 million. In 2005 alone, about 5.6 million people
died. It
has one of the fastest growing infection rates in the world.
The epidemic in the region is varied, diverse and is composed
of several sub-epidemics. At some places it is concentrated
and in some, generalised. For countries like India, where the
national prevalence is still less than one per cent, some states
already experience generalised epidemics. Five states in India
have recorded a median prevalence rate of more than one per
cent among antenatal mothers and in one state; it has crossed
two percent. |
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| Similarly in China, seven provinces experienced serious local
epidemics in 2001, with prevalence higher than 70 per cent among
injecting drug users in a number of areas. In the first six
months of 2001, reported HIV infections rose by 67.4 per cent
compared to the previous year, according to health ministry
estimates. Unsafe blood practices led to serious epidemics in
Henan province in central China. Elsewhere in the region, Cambodia,
Myanmar and Thailand have recorded significant nationwide epidemics. |
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| Low HIV prevalence rates in the region hides huge numbers
of infected people. The overall prevalence rates of many countries
in the region still appear to be low, but the huge populations
translate them into a large number of infected people. For instance,
in India, though the national prevalence rate is still less
than one percent, it has 5.7 million people living with the
HIV/AIDS. |
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| The Region's
Special Vulnerability |
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| Much of the region's vulnerability arises from endemic poverty,
extremely poor status of women, social instability, and cultural
myths and practices associated with sex and sexuality, failing
social infrastructure, inadequate governance, lack of access
to information and services, inequitable distribution of wealth,
modernity and economic transition, unfavourable political climate
and, large populations of marginalized people. About 40 per
cent of the world's population, that too with nearly half of
the world's poor, lives here. Within the region, South Asia
has the world's highest adult illiteracy and about a third of
the world's maternal deaths. More than half of South Asia's
children under five are malnourished. Though the economic growth
of the region has been consistent, increasing inequality between
the poor and the rich is offsetting the benefits of growth.In
addition, the region has factors like large-scale internal and
external migration of people, both in search of livelihoods
and fleeing conflict situations; large number of women engaged
in commercial sex; large-scale use of Injecting drug use and
constant socio-political instability that make people more vulnerable
to HIV. |
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| There has been a dramatic increase of infection in vulnerable
and high-risk groups like sex workers, Injecting Drug Users
(IDU), STD patients and Men having Sex with Men (MSM). About
50 per cent of new infections in the region are in young people.
The Mother To Child Transmission (MTCT) is also on the rise.
For instance, nationwide prevalence in Myanmar has been put
at 2 per cent, yet national HIV rates as high as 60 per cent
are being registered among injecting drug users and almost 40
per cent among sex workers. There are also signs of heterosexually
transmitted HIV epidemics in at least three provinces (Yunnan,
Guangxi and Guangdong), with HIV rates reaching 4.6% (up from
1.6% in 1999) in Yunnan and 10.7% in Guangxi (up from 6%) among
sentinel sex worker populations in 2000. Upwards of 50% of injecting
drug users have acquired the virus in Myanmar, Nepal, Thailand,
China's Yunnan Province and Manipur in India.
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| The Need for a Regional
Response |
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| The common socio-economic, political and cultural background
of the region, the cross-border nature of the epidemic and the
common factors of vulnerability favour a regional approach to
tackling the epidemic. Many of the issues go beyond the national
borders and tackling them is not within the capacity of any
single country. Movement of people within the region, trafficking
and use of narcotic drugs, movement of women involved in sex
work, trafficking of women etc needs multi-sectoral and integrated
regional response to the epidemic. In addition, collaborating
with one another would help the countries tackle their collective
vulnerability, coordinate responses and learn from one another
and also from other regions. The UN system provides such a regional
platform and avenues for integration. Based on its mandate,
capacities, past experiences and lessons learned, UNDP, the
United Nations Development Programme, which has a network of
136 country-offices, has identified HIV and Development as an
area of regional programme collaboration. |
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| UNDP's Response |
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| HIV/AIDS affects people in their most productive years, and is uniquely devastating as it increases poverty and reverses human development achievements. In order to support countries to mitigate the impact of HIV/AIDS on Human Development, UNDP promotes multi-sector responses that mainstream HIV/AIDS in national development plans, sector programmes and decentralized plans. In partnership with the World Bank, UNDP provides technical support to assist countries to more effectively integrate HIV/AIDS into poverty reduction strategies and implementation modalities. In addition UNDP supports countries to generate enabling trade, health and intellectual property legislation for sustainable access to low-cost, quality AIDS medicines. |
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| Key areas of UNDP support include: |
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- Mainstreaming HIV/AIDS
- HIV/AIDS and MDG-based National Development and Poverty Reduction Strategies
- Trade, TRIPS and Access to ARVs
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| UNDP Regional HIV and Development Programme, based at the UNDP Regional Centre in Colombo, addresses the development and trans-border challenges of HIV and AIDS in the region and support integrated and rights based responses that promote gender equality, sustainable livelihood and community participation. Focus areas of work include: Policy Advocacy and Outreach, Migration, Trafficking and HIV, Capacity Development, Leadership, Governance and Human Rights. |
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| In line with the UNDP's corporate strategy on HIV/AIDS, UNDP's
Regional HIV and Development Programme, South and North East
Asia supports the objective of containing the spread and impact
of HIV/AIDS in the region through integrated responses that
promote gender equality, poverty reduction and good governance.
It assists countries in the region to work towards fulfilment
of the UNGASS and Millennium goals and achieve sustainable human
development through averting an HIV/AIDS crisis. Specifically
the programme: |
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- Advocates for policy change and build commitment among
key stakeholders in the region to address HIV/AIDS as a
development issue
- Strengthens knowledge and capacity for a sustained multi-sectoral
response linking livelihoods, gender and HIV issues and
- Protect dignity and human security of people infected
and affected by HIV through strengthened governance.
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| The programme addresses vulnerabilities of mobile
populations, trafficking of women and children and the reduction
of stigma and discrimination of people infected and affected
by HIV, identified through a participatory process of programme
formulation in consultation with civil society, UN partners
and Governments across the region. Special attention is paid
to the Greater Involvement of People Living with HIV/AIDS (GIPA).
The programme promotes and facilitates dialogue, sharing and
learning between the countries of the region and will proactively
seeks association and links with existing schemes and activities
of governments and others that enhance. The programme aims to
complement both the existing national initiatives and generate
new responses to HIV/AIDS and build partnerships between various
stakeholders at the regional and global level. |
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| REACH Beyond Borders: Partner
Countries |
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| South and South West Asian
countries |
North East Asian countries: |
- Afghanistan
- Bangladesh
- Bhutan
- India
- Iran
- Maldives
- Nepal
- Pakistan
- Sri Lanka
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- China
- DPR of Korea
- Mongolia
- Republic of Korea
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