Latin America and the Caribbean and The Global HIV/AIDS Program THE WORLD BANK Reducing HIV/AIDS Vulnerability in Central America: Honduras: HIV/AIDS Situation and Response to the Epidemic WW W . W ORLDBANK.ORG/AIDS Honduras F or mor e in f ormation , please contact: Human velopment Department Latin America and the Caribbean Regional Office The World Bank 1818 H St. NW, Washington, DC 20433 Tel: +1 202 458 9730 Fax: +1 202 614 0202 [email protected] December 2006 Reducing HIV/AIDS Vulnerability in Central America Honduras: HIV/AIDS Situation and Response to the Epidemic Latin America and Caribbean Region and Global HIV/AIDS Program THE WORLD BANK December 2006 World Bank Global HIV/AIDS Program Discussion Paper This series is produced by the Global HIV/AIDS Program of the World Bank's Human Development Network, to publish interesting new work on HIV/AIDS quickly, make it widely available, and encourage discussion and debate. 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This set of papers on Reducing HIV/AIDS Vulnerability in Central America was produced by the Latin America and the Caribbean Region. For questions related to this set of papers, please contact: Marcelo Bortman, LCSHD World Bank, 1818 H Street, NW, Washington DC, 20433. Tel. (202) 458-9730 – fax: (202) 614-0202 Email: [email protected] Cover photos: Honduras HIV/AIDS Situation and Response to the Epidemic Courtesy of World Bank Photo Library © 2006 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Reducing HIV/AIDS Vulnerability in Central America Honduras: HIV/AIDS Situation and Response to the Epidemic Marcelo Bortman;1 Luis B. Saenz;2 Isabel Pimenta;3 Claudia Isern;4 Antonia Elizabeth Rodríguez;5 Marianella Miranda, Leonardo Moreira, and Danilo Rayo.6 This study was undertaken by the Human Development Department, Latin America and the Caribbean Regional Office (LCSHD) of the World Bank with financial support from the Bank-Netherlands Partnership Program (BNPP). The main objectives of the study were to establish a baseline for measuring progress and identifying new challenges for the Central America HIV/AIDS Regional Project, and to support policy dialogue regarding the political leadership and commitment to prepare a regional HIV action plan with common policies and coordinated strategies. Keywords: HIV, AIDS, Central America, Honduras, World Bank The World Bank Vice President Pamela Cox Country Director : Jane Armitage Sector Director : Evangeline Javier Sector Manager : Keith Hansen Task Team Leader : Marcelo Bortman 1 Senior Health Public Specialist, LCSHH, World Bank. 2 Project Director for this study for Sanigest, Costa Rica. 3 Public Health Specialist, WBIHD, World Bank. 4 Administrative Assistant for Client Support, LCSHD, World Bank. 5 Coordinator for the Regional HIV/AIDS Project in Central America. 6 Consultants Team to Sanigest, Costa Rica. iii iv Acronyms and Abbreviations AED Academy for Educational Development and the Futures Group AIDS Acquired Immunodeficiency Syndrome ALCA Free Trade of the Americas ART Antiretroviral Therapy ARV Antiretroviral Medicines ASONAPVISIDAH Association of People who Live with HIV/AIDS BNPP Bank-Netherlands Partnership Program CA Central America CAFTA-DR Central American Free Trade Agreement – Dominican Republic CAI Integrated Care Clinics CDC Centers for Disease Control CEFAS Female Center of Social Adaptation CEPRESI Center for AIDS Education and Prevention (Nicaragua) CEPROSAF Center for Health Promotion and Family Assistance CESAMO Health Center with Physician and Dentist CIPE Center for International Private Enterprise CONADEH National Human Rights Commission of Honduras CODEH Commission for the Defense of Human Rights CONASIDA National Commission against AIDS (El Salvador) COGAYLESH Coalition of Gay Organizations of Honduras DDHH Human Rights EU Education Unit FEUH Federation of University Students of Honduras FONASIDA National AIDS Forum GTZ German Agency for Technical Cooperation HCP Health Communication Partnership HIV Human Immunodeficiency Virus IADB Inter-American Development Bank ICAS Central American Institute for Social Action IEC Information, Education and Communication IHSS Honduran Institute of Social Security IIDH Inter-American Institute of Human Rights LAC Latin American and the Caribbean Region LCSHD LAC Human Development Department LCSHH Health Sector MSM Men who have Sex with other Men NGO Non-Governmental Organization OPS Pan-American Health Organization (Spanish acronym) PAHO Pan-American Health Organization PASCA Central American AIDS Action Project PASMO Pan-American Association for Social Marketing PENSIDA Strategic National Plan to Fight HIV/AIDS PLWH People Living with HIV PNS National HIV/AIDS/STD Program v PPTMH Program for Prevention of HIV Transmission from Mother to Child SICA Central American Integration System SIDA Swedish International Development Cooperation Agency SIDALAC Latin American and Caribbean AIDS Initiative STD Sexually Transmitted Disease STI Sexually Transmitted Infection TF Trust Fund UARI Impact Reduction Unit UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund USAID United States Agency for International Development USASER Sexual Health and Reproductive Units UVEI Epidemiological Control and Research Unit VIH Human Immunodeficiency Virus WBIHD World Bank Institute Human Development Division WHO World Health Organization vi Table of Contents Acronyms and Abbreviations ..............................................................................................v Acknowledgements.......................................................................................................... viii Executive Summary – Regional Overview........................................................................ ix Main Findings, Conclusions and Recommendations...................................................x National Responses.................................................................................................... xi Hond uras: HIV and AIDS Situation and Response to the Epidemic...................................1 Vulnerable Groups.......................................................................................................3 The Nationa l Response to HIV and AIDS...........................................................................7 Legal and Regulatory Framework ...............................................................................7 Prevention and Care for Vulnerable Groups..............................................................11 Human Rights and HIV/AIDS Program ....................................................................11 Diversity and Integration for Prevention Project.......................................................14 Prevention of HIV/AIDS among Adolescent Ethnic Garífuna..................................16 HIV/AIDS Prevention Program in Garífuna Youth 15-24 years...............................18 IEC in Garifuna Communities ...................................................................................20 Program for Prevention of HIV Transmission from Mother to Child .......................20 Home Visits ...............................................................................................................23 Treatment ...................................................................................................................27 References..........................................................................................................................29 Annex 1. Form for Evaluating Discrimination .........................................................31 Annex 2. Form for Selecting Successful Interventions ............................................32 Annex 3. Summary Table of Successful Experiences in Honduras 2006..................34 Annex 4. Arbitrary Discrimination in Honduras 2006 .............................................35 Tables Table 1. HIV and AIDS Indicators in Honduras, 2003...................................................... 2 Table 2. Integrated Care Component of the Strategic National Plan (PENSIDA II) to Fight HIV/AIDS................................................................................................................ 23 Table 3. Integrated Care Centers where ASONAPVISIDAH Self-help Groups Operate26 Figures Figure 1. AIDS Prevalence Rate by Region in Honduras 1998-2005 ............................... 3 Figure 2. Prevalence of HIV among Female Sex Workers in