MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES HIV AND AIDS POLICY GUIDELINES March 2008 MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES HIV AND AIDS POLICY GUIDELINES March 2008 Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania Telephone:: (255-022)-2150302-6 &2150331 E-mail: [email protected] ©Muhimbili University of Health and Allied Sciences, 2008 i FOREWORD The HIV and AIDS pandemic in Tanzania, as elsewhere in sub-Saharan Africa, is among the leading causes of morbidity and mortality in all communities. This has led to diverse consequences, including loss of productive human resource; increased health costs to care for the sick; increase in the number of orphans and widows; decreased life expectancy; macro and microeconomic impact; psychosocial and socio-cultural impacts. Because of these devastating impacts, all national and international development agenda consider HIV and AIDS as a cross cutting issue that needs to be addressed in order to be able to achieve desired development goals. Higher learning institutions are expected to play a leading role in innovating workable interventions for this pandemic as well as serving as role models in implementing good practices for HIV and AIDS management and prevention. Institutions of Higher Learning in Tanzania have made efforts to develop strategies for prevention of HIV and AIDS including having in place committees dedicated to dealing with HIV and AIDS issues. MUHAS has in place a Technical AIDS Committee which is responsible for coordinating the various activities for HIV and AIDS control and prevention. However, these various efforts that are being pursued are hampered by lack of comprehensive guidelines to facilitate their implementation. Accordingly, it has been felt appropriate to develop institutional policy guidelines on HIV and AIDS which aim at preventing the spread of HIV infection, providing equal access to treatment, care and support services to people living with or affected by HIV and AIDS, generating and disseminating HIV and AIDS knowledge, and providing a strong and committed leadership in response to the pandemic at the MUHAS and the wider society. These guidelines provide a framework for implementing HIV and AIDS interventions at MUHAS and the surrounding community. It is therefore my sincere hope that both students and staff will find it useful in guiding the University’s response to the pandemic and contribute to the overall response by all sectors in the country. Prof. K. Pallangyo Vice Chancellor ii TABLE OF CONTENTS Foreword ii Table of contents iii List of abbreviations. v 1.0 BACKGROUND 1 1.1 Introduction 1 1.2 National Overview 2 1.3 Sectoral Overview 3 1.4 Institutional Overview 4 2.0 SOCIO- DEMOGRAPHIC PROFILE AND HIV/AIDS SITUATION 5 2.1 Socio-demographic Profile of the MUHAS Community 5 2.2 Nature and Magnitude of HIV and AIDS 5 2.3 Prevention of HIV Transmission 6 2.4 Treatment, care and support for HIV and AIDS patients 7 2.5 Gender, HIV and AIDS 7 2.6 Rights of Persons Living With or Affected by HIV and AIDS 9 2.7 HIV and AIDS Curriculum 10 2.8 Research on HIV and AIDS 11 3.0 RATIONALE FOR A MUHAS HIV/AIDS POLICY GUIDELINES 11 4.1 GOAL 13 4.2 OBJECTIVES 13 5.0 POLICY ISSUES AND STATEMENTS 15 5.1 Policy issue: Prevention of HIV Transmission 15 5.2 Policy issue: Treatment, Care and Support 15 5.3 Policy issue: Rights of Persons Living With or 16 Affected by HIV/AIDS iii 5.4 Policy issue: HIV and AIDS Integration into the Curricula 18 5.5 Policy issue: Research on HIV and AIDS 18 6.0 IMPLEMENTATION 20 6.1 Implementation Structure 20 6.2 Stakeholders: Roles and Responsibilities 20 6.2.1 Ministry responsible for Higher Education 20 6.2.2 Students 21 6.2.3 Staff 21 6.2.4 NGOs/CBOs/FBOs/ Partners in the Fight against HIV/AIDS 21 6.2.5 Communities 22 7.0 MONITORING AND EVALUATION 22 8.0 REVIEW OF POLICY 22 9.0 REFERENCES 23 iv LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ARV Antiretroviral CBO Community Based Organization FBOs Faith Based Organizations GDPC Gender Dimension Programme Committee HBC Home Based Care HIV Human Immunodeficiency Virus IEC Information Education Communication IJMC Institute of Journalism and Mass Communication MUHAS Muhimbili University of Health and Allied Sciences MNH Muhimbili National Hospital MUCHS Muhimbili University College of Health Sciences NACP National AIDS Control Programme NGO Non Government Organization PLHA People Living with HIV and AIDS RAAWU Researchers, Academicians and Allied Workers Union SSA Sub Saharan Africa STI Sexually Transmitted Infections SWAAT Society for Women and AIDS in Africa, Tanzania TAC Technical AIDS Committee TACAIDS Tanzania Commission for AIDS TASC Technical AIDS Sub-Committee THIS Tanzania Health Indicator Study UDSM University of Dar es Salaam UN United Nations UNAIDS Joint United Nation Programme on HIV and AIDS VCT Voluntary Counseling and Testing v 1.0 BACKGROUND 1.1 Introduction The HIV and AIDS pandemic is now a global crisis and constitutes one of the most formidable challenges to development and social progress. Out of the estimated 33.2 million people around the world who were living with the HIV during 2007, 26 million (65%) are workers and students aged 15-49, who are in the prime of their working and studying lives. Presently, Sub-Saharan Africa (SSA) is the most severely affected region in the world. According to the Joint United Nations Programme on HIV and AIDS (UNAIDS) pandemic update, at the end of 2007 an estimated 22.5 million adults and children were living with HIV in SSA accounting for two thirds (67%) of the global total of adults and children living with HIV (UNAIDS 2007). In the same year there were 1.7 (1.4- 2.4) million new HIV infections in SSA alone. Furthermore, although the population in SSA accounted for only 10% of the world’s population, Sub Sahara African countries experienced almost three times as many AIDS deaths in 2006 as the rest of the world combined. Tanzania is one of the countries in SSA which is seriously affected by HIV and AIDS. According to a population based survey conducted in 2003/2004 the overall HIV prevalence in this country was 7% (Tanzania HIV and AIDS Indicator Survey – THIS, 2003/2004). It is also estimated that about 2 million individuals aged 15 years and above were living with HIV in Tanzania during the year 2005 (HIV/AIDS/STI Surveillance Report, National AIDS Control Programme, Ministry responsible for Health in Tanzania, 2005). Evidence from studies shows that the HIV and AIDS epidemic in Tanzania, like elsewhere, has progressed differently in various population groups, with large geographical and gender differences. The population based study cited above, for example, showed a higher prevalence rate in the urban (10.9%) than rural areas (5.3%), and a higher prevalence among women (7.7%) than men (6.3%) (THIS 2003-2004). These data are concordant with those reported from antenatal clinic sentinel surveillance sites in Tanzania in 2005 (National AIDS Control Programme, Tanzania: Surveillance of HIV and Syphilis infections among antenatal clinic attendees, 2005/06) 1 In Tanzania, like in other most affected countries, the pandemic is eroding decades of development gains, undermining the economy, threatening security and destabilizing the society. Beyond the suffering it imposes on individuals and their families, the pandemic is profoundly affecting the social and economic fabric of the society. HIV and AIDS is a major threat to the world of work. It is affecting the most productive segment of the labour force and reducing earnings. It is imposing huge costs on enterprises in all sectors through declining productivity, increasing labour costs and loss of skills and experience. In addition, HIV and AIDS is affecting fundamental rights at work and elsewhere, particularly with respect to discrimination and stigmatization aimed at workers and people living with and affected by HIV and AIDS. The widespread abuse of human rights and fundamental freedoms associated with HIV and AIDS has also emerged in all parts of the world in the wake of the pandemic. Human rights that relate critically to reducing vulnerability to HIV and AIDS and mitigating the impact of the pandemic are found in existing human rights instruments. More specifically, the most relevant human rights principles for protecting the dignity of people infected and affected by HIV and AIDS, as well as preventing the spread of infection, include: non-discrimination; the right to health care; the right to equality between men and women; the right to privacy; the right to education and information; the right to work; the right to marry and found a family; the right to social security, assistance and welfare; the right to liberty; and the right to freedom of movement. In terms of employment, HIV and AIDS is threatening fundamental rights in the world of work. It jeopardizes fundamental principles of social justice and equality, as well as decent and productive work in conditions of freedom, equity, security and human dignity. 1.2 National Overview As a response to the pandemic, in 1985 the Government established the National AIDS Task Force (NATF) under the Ministry responsible for health. NATF formulated a short-term plan for AIDS (1987/88.In 1988 the National AIDS Control Programme (NACP) was established also under the Ministry responsible for health. Subsequently three 5-year medium term plans for AIDS, the last of which was completed in 2002 were developed and implemented. Initially, HIV and AIDS was perceived purely as a health problem and the campaign to deal 2 with it was left to the health sector alone.