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Response Analysis: Lessons Learned
There are many dilemmas associated with the development of an effective response framework for mobility and HIV/AIDS issues. On the one hand, the approach should be inclusive, with an emphasis on the participation and involvement of a wide range of stakeholders. However, there must also be a degree of selectivity to ensure that key players are leading the response dynamic. Similarly, the response needs to be both comprehensive and yet targeted on a narrower range of priorities. This targeting will be accompanied by a sufficient assignment of resources and adequate follow-up to ensure substantive evidence-based results. Finally, national governments must aim to balance the interests of migrants, business and the general public in a fair way; while at the same time, taking action to reduce/remove legal, social and structural barriers to the provision of HIV/AIDS-related information, services and commodities to MMPs. At its first meeting in June 2005, the reconstituted UNRTF reviewed the lessons learned from the implementation of the Strategy on Mobility and HIV Vulnerability Reduction in the Greater Mekong Sub-Region, 2002-2004. Following are the main points which emerged from this review exercise:
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There has been a lack of regional support for country action on MMP HIV vulnerability issues. Country contextualization of the problem and support of key national authorities and programmes are crucial.
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Although the GMS countries signed an MOU in 2001 for Joint Action to Reduce HIV Vulnerability Related to Population Movement, and then renewed this MOU in 2005, little has been done so far to operationalize these MOUs.
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The strategy’s call for a community resilience approach and the establishment of Early Warning and Rapid Response Systems (EWRRS) may be too far-reaching for some countries who wish to retain the traditional emphasis on the health approach as the best way to fight the epidemic. Nevertheless, these elements of the strategy are in line with the multi-sectoral approach advocated by the United Nations.
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Two interventions which have proven useful in combating HIV and AIDS generally over the past years are the 100% condom use programme and peer education programmes aimed at such vulnerable populations as the military, the police, students and factory workers. Thailand and Cambodia have both had success with these two interventions. Mechanisms should be developed to replicate successful interventions such as these and to extend them to include MMPs across the region.
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The strategies outlined in the 2002-2004 Regional Strategy were not prioritized in relation to the dynamics of the epidemic among MMPs or their particular patterns of risky behaviours.
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Because most strategy-related research and action interventions have been undertaken in an ad hoc, uncoordinated fashion by NGOs and academic institutions, implementation of the strategy has lacked national ownership. Moreover, there has been a lack of mapping of target groups, interventions and players working in this particular area.
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The new Regional Strategy covering the period 2006-2008 will give a priority focus to the following areas:
* Resource Mobilization; * An enhanced enabling environment for response addressing the needs and rights of MMPs; * The greater involvement of MMPs and PLWHAs; * Increased coordination and collaboration; * Enhanced coordination and collaboraton mechanism between regional and national levels; * Greater emphasis on advocacy and communications/ documentation; * Greater influence on national strategic HIV/AIDS plans; * Capacity building; and * More emphasis on civil society partnerships.
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Coordination mechanisms must be increased and improved at the local, country and regional levels to help ensure the effective implementation of the Regional Strategy. Monitoring and evaluation mechanisms must also be strengthened, based on the Three Ones principles, i.e. one national AIDS programme, one NAA, and one HIV/AIDS monitoring and evaluation framework at the country level.
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The implementation of the 2006-2008 Regional Strategy will be supportive of the UN’s Millennium Development Goals (MDGs).
The UNRTF also re-affirmed the following three lines of reasoning [it is initially noted by Bimal Gosh in “Development, Migration: Citizenship, identity and rights”, Volume 46, No. 3, September 2003].
(a) The vulnerability of migrants can be external and internal. But the two often interact and create a vicious cycle. Inadequate recognition of migrants’ rights in law or their ineffective enforcement in practice acts as an external obstacle to migrants’ access to rights. This generates among them a sense of insecurity and inferiority, circumscribing their own ability, both as individuals and as a group, to fight for the recognition and the exercise of these rights.
(b) In many countries, there are important restrictions on non-nationals forming their own associations for fear this will threaten public order. Moreover, the term ‘association’ is usually defined in imprecise terms, leaving migrants in a somewhat precarious and uncertain situation, especially those without legal status.
(c) The success of a rights-based approach to migration depends largely on the timely initiation of proactive measures, including the systematic dissemination of objective information on migrants’ rights and the costs and benefits of migration, including migrants’ specific contributions to the receiving country, before the migration issue is hijacked by those who are opposed to it.
Finally, the UNRTF took note of the following observations made by the UN Secretary-General in his report on progress made in the implementation of the UNGASS Declaration of Commitment on HIV/AIDS:
- Stronger efforts are required to achieve the goal of ensuring comprehensive prevention services for mobile populations. In 2003, less than one half of countries had strategies in place to promote HIV prevention for cross-border migrants.
- Many governments have failed to prioritize initiatives that target the populations at greatest risk of infection, which remain stigmatized. A 2004 survey of national AIDS spending in 26 countries found that some countries preferred to direct their limited prevention resources toward less-effective initiatives that focus on the general population and people at lower risk. This approach misses the critical opportunity to prevent an epidemic that is concentrated in the most vulnerable populations from spreading to the population at large.
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