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Synthesis Report ASSESSMENT OF IMPLEMENTATION OF THE NATIONAL AIDS PROGRAMME FOR YEARS 2009-2013 IN UKRAINE SYNTHESIS REPORT September 2013 The State Service for HIV/AIDS and Other Socially Dangerous Diseases. Assessment of the State Program to Ensure HIV Prevention, Treatment, Care, and Support to HIV-positive People and Patients with AIDS for Years 2009-2013 (the National AIDS Programme) in Ukraine: Synthesis Report (English original, September 2013). This report may be freely reproduced or distributed with appropriate acknowledgement. This report contains the collective views of the Assessment Team of the National AIDS Programme (NAP) in Ukraine and does not necessarily represent the decisions or stated policies of the organizations that have provided support to the Assessment. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of any organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All reasonable precautions have been taken to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Assessment Team or other organizations or individuals that have been involved in the development of this report be liable for damages arising from its use. Assessment was conducted with the assistance of the Joint United Nations Programme on HIV/AIDS in Ukraine (UNAIDS in Ukraine) www.unaids.org.ua TABLE OF Contents 1 EXECUTIVE SUMMARY ................................................................................... .................... 15 1.1 GOVERNANCE AND SUPPORT MECHANISMS .....................................................................................16 1.1.1 Legislation, rules and regulations ...............................................................................................16 1.1.2 Policies, strategies and plans .........................................................................................................16 1.1.3 NAP Organisation .............................................................................................................................17 1.1.4 Human resources ...............................................................................................................................17 1.1.5 Monitoring and evaluation ............................................................................................................18 1.1.6 Procurement supply management ...............................................................................................18 1.2 SERVICE COVERAGE, INTEGRATION AND QUALITY ..........................................................................18 1.2.1 Coverage, Outreach and Community level interventions ......................................................18 1.2.2 Penitentiary health care services ..................................................................................................19 1.2.3 Service integration and client focus ............................................................................................19 1.2.4 Quality of Service ..............................................................................................................................19 1.3 PROGRAM SUSTAINABILITY .........................................................................................................................20 1.4 POLITICAL WILL AND HUMAN RIGHTS ..................................................................................................20 2 BACKGROUND AND RATIONALE .................................................................. .....................22 3 OBJECTIVES ..................................................................................................... .....................22 4 METHODOLOGY .............................................................................................. .....................23 4.1 COORDINATION.................................................................................................................................................23 4.2 THEMatiC AREAS .............................................................................................................................................23 4.3 METHODS ............................................................................................................................................................23 5 STATUS OF THE EPIDEMIC ............................................................................. .....................24 5.1 POPULATION ......................................................................................................................................................24 5.2 INJECTING DRUGS USERS ............................................................................................................................24 5.3 FEMALE SEX WORKERS ..................................................................................................................................24 5.4 MEN HAVING SEX WITH MEN .....................................................................................................................25 5.5 PRISONERS ..........................................................................................................................................................25 5.6 PMTCT ...................................................................................................................................................................25 5.7 Youth ...................................................................................................................................................................25 6 STENGTHS AND ACHIEVEMENTS ................................................................. .....................26 6.1 PREVENTION .......................................................................................................................................................26 6.2 INJECTING DRUGS USERS ............................................................................................................................26 6.3 FEMALE SEX WORKERS ..................................................................................................................................26 6.4 MEN HAVING SEX WITH MEN .....................................................................................................................27 6.5 PMTCT ...................................................................................................................................................................27 6.6 PRISONERS ..........................................................................................................................................................27 6.7 Youth ...................................................................................................................................................................27 6.8 TESTING AND COUNSELLING .....................................................................................................................28 6.9 ART AND OST SERVICES ...............................................................................................................................28 6.10 PROGRAM ORGANISATION........................................................................................................................28 6.11 FUNDING ...........................................................................................................................................................28 6.12 POLITICAL ATTENTION ................................................................................................................................29 6.13 HUMAN RIGHTS ..............................................................................................................................................29 7 CRITICAL BARRIERS (bOTTLENECKS) .......................................................... .....................30 7.1 WEAK LEADERSHIP AND PROFOUND SOCIETAL STIGMA, DISCRIMINATION AND INEQUALITY ................................................................................................................30 7.1.1 No engaged leadership means no effective programme ......................................................30 7.1.2 High level of stigma, discrimination and inequality persists ...............................................30 7.2 WEAK GOVERNANCE & SUPPORT MECHANISMS ..............................................................................31 7.2.1 Legislation, rules and regulations hinder implementation ...................................................31 7.2.2 Insufficient Organisation and Management .............................................................................31 7.2.3 HR development capacity hampers implementation .............................................................32 7.2.4 M&E system not adequate, data use is moderate ...................................................................32 7.2.5 PSM is inadequate and causes disrupted supply that hinders service intensity, quality and coverage ..................................................................................................................................32 7.3 PROGRAM SUSTAINABILITY
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