Annual Progress Report, 1 Apr 2006 - 31 Mar 2007 Table of Contents Foreword 3 About this report 5 Highlights in Achievements 7 Progress and Achievements 9 ....... Access to services to prevent the sexual transmission of HIV improved 9 ....... Access to services to prevent transmission of HIV in injecting drug use ....... improved 18 ....... Knowledge and attitudes improved 27 ....... Access to services for HIV care and support improved 30 Fund Management 41 ....... Programmatic and Financial Monitoring 41 ....... Financial Status and Utilisation of Funds 43 Operating Environment 44 Annexe 1: Implementing Partners expenditure and budgets 45 Annexe 2: Summary of Technical Progress Apr 2004–Mar 2007 49 Annexe 3: Achievements by Implementing Partners Round II, II(b) 50 Annexe 4: Guiding principles for the provision of humanitarian assistance 57 Acronyms and abbreviations 58 1 Fund for HIV/AIDS in Myanmar UNAIDS 2 Annual Progress Report, 1 Apr 2006 - 31 Mar 2007 Foreword This report will be the last for the Fund for HIV/AIDS in Myanmar (FHAM), covering its fourth and final year of operation (the fiscal year from April 2006 through March 2007). Created as a pooled funding mechanism in 2003 to support the United Nations Joint Programme on AIDS in Myanmar, the FHAM has demonstrated that international resources can be used to finance HIV services for people in need in an accountable and transparent manner. As this report details, progress has been made in nearly every area of HIV prevention – especially among the most at-risk groups related to sex work and drug use – and in terms of care and support, including anti-retroviral treatment. While much more needs to be done, the FHAM has demonstrated that substantial progress is possible, working with a variety of partners, including the Government, inside Myanmar. During 2006, several shifts occurred in the strategic and funding environment in Myanmar leading to the closure and transformation of the FHAM. First, the Ministry of Health led, for the first time, a process involving national and international actors to develop collaboratively a National Strategic Plan that is inclusive of the work of all partners. The National Strategic Plan now overtakes the Joint Programme as the single reference document for partners working on HIV/AIDS. Secondly, donors, including those supporting the FHAM, saw that a modified version of the FHAM could be expanded to cover more than just HIV, but also tuberculosis and malaria. This was particularly important in the wake of the termination of the Global Fund grants, which left a serious funding gap. Thus was created the Three Diseases Fund. Third, in response to lessons learned largely from the FHAM but also as a result of the Global Fund termination, the Three Diseases Fund was set up more independently from existing United Nations organizations, which have their own programmatic and coordinating roles to play. As the Three Diseases Fund was being established, the FHAM was able, partly due to additional support in 2005 from the Netherlands and in 2006 from AusAID, to extend partners’ portfolios through to the end of April 2007 in order to accommodate the timing for the establishment of the Three Diseases Fund. Despite the good news of the establishment of the Three Diseases Fund, coverage of HIV prevention and care services in Myanmar remains insufficient. In most programme areas, only about 10 percent of people in need are receiving appropriate services, with sex workers being perhaps the most important exception, where coverage may be closer to 50 percent. Yet, UNAIDS estimates that total resources for 2007 for HIV will decline as compared to 2006, even with the funding from the Three Diseases Fund. Under these circumstances, service coverage will not increase. More resources are therefore required, both from international sources and from Government. This year the United Nations Theme Group on AIDS has put resource mobilization on the top of its list. This report shows that we can effectively combat the HIV epidemic in Myanmar - if the resources are adequate to meet the need. Daniel B. Baker, Chair UN Expanded Theme Group on AIDS 3 Fund for HIV/AIDS in Myanmar UNAIDS 4 Annual Progress Report, 1 Apr 2006 - 31 Mar 2007 About this report This report presents the achievements of FHAM, existing projects funded by Round II implementing partners of the Fund for HIV/AIDS (which was due to end on 31 March 2006), and in Myanmar (FHAM) for the fiscal year 1 April with a track record of performance, were given 2006 to 31 March 2007. This report is neither, the option of extension beyond 1 April 2006, therefore, a report on the HIV epidemic, nor a using unallocated FHAM resources, and final report on the wider national response to the donor commitments and contributions. This epidemic in Myanmar. was with the aim of ensuring uninterrupted delivery of essential services until the new fund The FHAM was established in 2003 to resource was operational. With this in mind, and with the Myanmar Joint Programme on HIV/AIDS, the consent of the FHAM’s donors, the projects and in the fiscal year 2006, donors contributing of most existing FHAM partners were extended to the FHAM were the United Kingdom’s until 30 April 2007. Most of the Three Diseases Department for International Development Fund’s agreed AIDS grants had a start date of (DFID), Sweden’s Agency for International 1 May 2007. Following this same rationale, in Development Cooperation (SIDA), the this fiscal year FHAM resources were used to Governments of the Netherlands and Norway, provide interim funding to extend service delivery and Australia’s AusAID. in six projects initiated with resources from the Global Fund AIDS grant, which was terminated The lifespan of the Joint Programme initially was from 21 August 2006. planned for the period 2003-2005. However its governing body, the UN Expanded Theme Group This fiscal year 2006 report therefore covers an on HIV/AIDS, agreed in December 2005 that extension of implementation of projects funded the response to HIV could continue to be in Round II of the FHAM with additional funds, resourced and monitored using this framework and the second year of implementation of until the new National Strategic Plan on HIV Round II(b) of the FHAM. At the beginning of had been established, and a new funding 2005, the FHAM issued a more targeted call mechanism was operational. for proposals for Round II(b) of funding, with a focus on scaling up prevention services to reach During this year, the existing donors to the key populations at higher risk of exposure to FHAM, with the European Commission, worked HIV. These key populations comprise sex towards the establishment of Three Diseases workers and their clients, injecting drug users, Fund to respond to AIDS, tuberculosis and and men who have sex with men. Round II(b) malaria in Myanmar. This funding mechanism of the FHAM also aimed to increase access to will supersede the FHAM. Therefore, instead AIDS care and support, including antiretroviral of making a further round of funding under the therapy. Funding rounds of the FHAM and their duration. 5 Fund for HIV/AIDS in Myanmar UNAIDS During this reporting period, the development Where possible, it is indicated in the text of of the Myanmar National Strategic Plan (with a this report how the outputs of the Joint targeted, costed Operational Plan) was Programme Components relate to the Strategic completed, from which prioritised activities were Directions of the Myanmar Strategic Plan on to be supported by the Three Diseases Fund. HIVAIDS (see box below). In the interim, in anticipation of the availability of the new funding mechanism, the FHAM While the Joint Programme aimed through continued to operate within the framework of Component 5, “to strengthen the essential the Joint Programme on HIV/AIDS in Myanmar. elements of the enabling environment for an The Joint Programme identified five priority areas effective expanded national response” - through (Components) for action, with five primary advocacy, improving monitoring and evaluation, outputs: capacity building, and improved coordination – 1. Access to services to prevent the this report focuses on the four main service- sexual transmission of HIV improved delivery Components and describes the 2. Access to services to prevent Component 5 strategies in the context of the transmission of HIV in injecting drug relevant Components 1 to 4. For example, use improved training for health care professionals on 3. Knowledge and attitudes improved substitution treatment for injecting drug users 4. Access to services for HIV care and has been reported in the related output, support improved prevention of transmission of HIV in injecting 5. Essential elements of the enabling drug use. Non-exhaustive lists of manuals and environment for an effective expanded guidelines developed with FHAM funding and national response strengthened not mentioned in earlier sections are included as an annexe. Strategic Directions Myanmar National Strategic Plan on HIV and AIDS 2006-2010 1. Reducing HIV-related risk, vulnerability and impact among sex workers and their clients 2. Reducing HIV-related risk, vulnerability and impact among men who have sex with men 3. Reducing HIV-related risk, vulnerability and impact among drug users 4. Reducing HIV-related risk, vulnerability and impact among partners and families of people living with HIV 5. Reducing HIV-related risk, vulnerability and impact among institutionalised populations 6. Reducing HIV-related risk, vulnerability and impact among mobile populations 7. Reducing HIV-related risk, vulnerability and impact among uniformed services personnel 8. Reducing HIV-related risk, vulnerability and impact among young people 9. Enhancing prevention, care, treatment and support in the workplace 10. Enhancing HIV prevention among men and women of reproductive age 11. Meeting needs of people living with HIV for Comprehensive Care, Support and Treatment 12.