Regional : HIV Prevention and Infrastructure:Mitigating Risk in the Greater Mekong Subregion

Health / Disease control of communicable disease

ADB's Regional Cooperation Strategy and Program (RCSP) for the GMS defines three priority program areas: the development of physical infrastructure, policy and institutional initiatives to maximize the benefits and opportunities from physical infrastructure, and initiatives to address common social development and environmental sustainability concerns.

Consistent with this strategy, ADB financing for infrastructure projects in the GMS is growing, particularly in road-related economic corridors. Given that the development of physical infrastructure potentially exacerbates the spread and impact of HIV and that this will limit the potential to benefit from opportunities arising and hinder social development (the second and third priority areas of the RCSP), ADB recognizes both an obligation to mitigate the HIV risks associated with infrastructure projects and an opportunity to contribute strategically and effectively to the fight against HIV and poverty in the region. In addition, it is recognized that the area of program activity in which this obligation and opportunity exists is specialized and an area where ADB, as a GMS development partner, has a growing comparative advantage.

In the area of HIV, two ADB strategy papers have outlined the priority for ADB in addressing the increased risk of HIV transmission that might arise in association with ADB-supported infrastructure development:

- ADB, 2005. Development, Poverty and HIV/AIDS: ADB's Strategic Response to a Growing Epidemic. Manila; and

- ADB, 2007. HIV and the Greater Mekong Subregion: Strategic Directions and Opportunities. Manila.

The trust fund established in 2005 with an initial grant of approximately $15 million from the Government of Sweden (HIV/AIDS in Asia and the Pacific Trust Fund) has facilitated actions under both these strategies in recent years. The RETA will further support and strengthen ADB experience and knowledge in these priority areas at the operational level. Moreover, this experience will help facilitate the knowledge and capacity needed for the longer term goal of having a program approach managed and enforced by Government rather than a project-by-project approach driven by donors/financiers.

Leadership support and associated institutional policies for addressing HIV risks in the context of infrastructure development

Improved awareness of HIV, AIDS and STI among the workforce of large infrastructure projects, infrastructure users, related line ministries, and affected local communities

Ready availability of HIV and STI prevention commodities (e.g. condoms) and associated social marketing programs

Improved and expanded HIV and STI testing, treatment and care services used by staff of construction worksites and affected communities

Improved HIV and STI monitoring and surveillance systems with M&E indicators for HIV prevention in infrastructure projects

Knowledge products (reports, web materials, etc.) and advocacy materials and events related to the benefits from and implementation mechnisms for HIV prevention in infrastructure projects

Functioning project management

Subproject 1: Expanded HIV Prevention Programs

in Lao Northern Economic Corridor

Status: Completed

Submitted Inception Report, Qualitative Baseline Report,

Quantitative Baseline Report, 3rd Quarter Progress Report, Quarter 4 Progress Report, Mid-Term Assessment Report, Quarter 5, 6 and 7 Progress Reports, Endline Survey Report; Completion Report

Key activities:

- Established multi-sectoral Provincial Working Teams (PWTs); held quarterly meetings of the extended multi-sectoral PWTs, and monthly meetings of core PWTs;

- Held monthly meetings with peer educators; expanded peer education activities and recruited new peer educators (village and workplace settings);

- Conducted outreach education activities for minivan drivers, truck drivers, men in uniform, construction company staff, coal mine workers and casino workers;

- Conducted IEC and distributed IEC materials and condoms for female Chinese sex workers, Chinese staff and Chinese taxi drivers in area around Boten;

- Loudspeaker activities in 2 villages which continues to date (post-project)

- STI training for health practitioners from Bokeo and Luang Namtha which was well appreciated by health authorities and the health workers themselves

- Condom distribution in all project areas;

- An exchange meeting for cross-border collaboration, between representatives of the Luang Namtha Health Department in Laos and their counterparts from Meuang Xieng Houng in PRC which yielded promising results (e.g., PRC side giving funds for the conduct of IEC in the casino complex.)

The Dissemination (end of project) Workshop was held on 6 May 2011. Provincial stakeholders, while concerned about continuity of initiatives, expressed resolve to integrate STI/HIV/AIDS prevention in other health programs, as appropriate.

Subproject 2: HIV Prevention on the EastWest Economic Corridor

Status: Completed

Submitted Inception Report; Revised Baseline Report and Implementation Report; 2nd Quarterly Report (embedded); 3rd Quarter Report; 6th Quarter Report, MidTerm Report, Endline Survey Report, Final Report

Key activities:

- Conducted training on syndromic management of STIs of mobile STI team and nurses, provincial, district and village health officers from Quang Tri, and district hospitals in Savannakhet on syndromic management of STIs;

- Trained village health volunteers, including village elders and Womens Union members on IEC/BCC,;

- Held cross border meeting and National Steering Committee meetings;

- IEC Lao side: Produced two radio drama CDs (titled The Tingtong Melody and Return of Tingtong) which was aired over local radio from October to November 2010. IEC Viet Nam side: A 60-minute DVD with 3 episodes, entitled Love Stories of the Mountain - Joined Patches of Life, and Love in the Modern Time was produced and approved by the Provincial Government Authority and well appreciated by the stakeholders and communities.

- IEC follow-thru activities in the communities (group discussion) using the materials that had been produced.

- Provision of STI services by the STI Mobile Team: twice on both the Lao and Viet Nam sides

The Dissemination (end of project) Workshop was held in 14 March 2011 in Hoi Anh attended by stakeholders from the Viet Nam and Lao PDR sides.

Subproject 3: Research Project A Comparative Analysis of Risk Settings in Infrastructure Projects

- International HIV/AIDS and Infrastructure Consultant engaged from 23 March;

- First draft report submitted in October;

- Final draft submitted in January 2011 and approved by ADB.

Subproject 4: Case Study on the Cross-Border Transport Agreement (Greater Mekong Subregion)

- International Consultant engaged, starting 15 September until 31 December 2008; Final report submitted 23 December 2008.

Subproject 5: Strengthening HIV Mitigation Associated with the Cambodia Road Improvement Project

Status: Completed

Submitted Inception Report; Baseline Survey Report; Implementation Report with 1st Bi-Annual Progress Report; 2nd Bi-Annual Progress Report; Mid-Term Report with 3rd Bi-Annual Progress Report

A review mission was held in February 2012. The Mission participated in the closing workshop which presented lessons learned and key successes.

Key activities:

- Developed BCC tools for the My Way risk mitigation package, with two new tools developed during the reporting period;

- Implementing subgrants with three NGOs: SEADO, WOMEN and BIG-C/BVST with very good progress in reaching target communities and migrant and mobile populations (MMPs); reached 40,390 MMP and 22,146 male and female community members with HIV vulnerability and risk reduction messages;

-Conducted training to carry out programmatic interventions; organized quarterly stakeholder meeting with participants from the Provincial Health Department, staff and peers from implementing agencies.

Subproject 6: HIV/AIDS Awareness and Prevention and Human Trafficking Program along the Southern Coastal Corridor

Status:

Subproject 7: HIV/AIDS/STD and Human and Trafficking Prevention Program (Lao Peoples Democratic Republic)

Subproject 8: HIV Prevention on the Phnom Penh-Ho Chi Minh City Highway

Status: Completed

Submitted Inception Report; Baseline Report and Qualitative Study and Implementation Report; 1st Bi-Annual Progress Report; Revised Implementation Report; Semi-Annual Progress Report; Mid-Term Report, Draft Baseline Survey Report; Draft Final Report

Key Activities:

- Under the community-based risk mitigation component, conducted inception workshops, coordination meetings, trainings of trainors, large scale and small scale workshops in Tay Ninh (thru the Women's Union) and in Svay Rieng and Prey Veng (thru the Partnership for the Development of Cambodia or PADEK) .

- Thru the Provincial Health Departments of Tay Ninh, Svay Rieng and Prey Veng, conducted workshops with entertainment workers, migrant factory workers, mobile populations (e.g., motor-taxi drivers) and meeting with owners or operators of entertainment establishments and managers of factories;

- Conducted program management training for both the Cambodia and Vietnam provincial partners.

The Dissemination (end of project) Workshop was held on 22 June 2011.

Subproject 9: HIV Prevention and Safe Migration Initiatives Associated with the Northwest Provincial Road Improvement Project

Status: Completed

Submitted Baseline Report and Revised Inception Report, First Bi-Annual Progress Report, Mid-Term Report combined with 2nd Bi-Annual Report, 3rd Bi-Annual Progress Report

A review mission was held in February 2012. The Mission participated in the closing workshop which presented lessons learned and key successes.

Key Activities:

- Subgrant implementation with two partners -- WOMEN and the Ministry of National Defense (MoND) with WOMEN working with 3 vulnerable groups in Samroang City and MoND conducting educational sessions and distributing condoms to uniformed service personnel

- Conduct of capacity building courses for implementing partners

- Conduct of initial training course on STI/RTI syndromic case management for health care providers

Subproject 10: Pre-Construction HIV Prevention associated with the Second Northern GMS Transport Network Improvement Project

Status: Completed

Contract signed on 1 June 2011 and commencement on 21 June 2011. Subproject 10's extension from January-June 2013 is deemed to be a transition phase' where assistance is now focused on ensuring sustained government provision of basic quality services for vulnerable populations affected by the proposed improvement of Road 6 in Houa Phanh Province, Lao PDR and the connecting Road QL217 in Viet Nam's Thanh Hoa Province. The results of the Final Review Mission in October 2012 showed substantial advances in local government capacity to deliver quality HIV prevention and STI services. The extension period intends to build on these gains, targeting local government's improved service delivery and preparation for the upcoming construction period after the completion of the subproject.

The baseline report on 8 December 2011. Endline and Final Reports submitted and accepted by ADB December 2012. Extension Phase Completion Report (January-June 2013) submitted and accepted by ADB July 2013.

Key activities:

- Inception Workshop held 8 July 2011 in Vientiane, attended by national and provincial government stakeholders from Viet Nam and Lao PDR.

- Provincial inception workshop held in Houapanh, Lao PDR on 27 July 2011. Final review mission conducted in October 2012 and Completion Workshop in December 2012.

- Re-engagement meetings and exit strategy workshops were conducted with Lao PDR and Viet Nam national and provincial authorities during the Extension Phase. Sustainability Planning Workshops held in Houaphanh province, Lao PDR and in Thanh Hoa province, Viet Nam.

A Mid-term Review was conducted in May 2012 and utilized a qualitative research methodology, which primarily included focus group discussions with target beneficiaries and interviews with key stakeholders (e.g. village authorities and government officers involved in the project). Data was collected from a sample of target villages which were carefully selected to ensure adequate representation of ethnicity, gender, population group, and age breakdown. Following data collection, a two day workshop was organized, bringing together the PWT members to discuss the results and identify the Subprojects key challenges, strengths and weaknesses.

A series of training was organised from December 2011 to May 2012 to strengthen the capacity of the PWTs to effectively implement HIV prevention program. These included trainings on BCC, STI syndromic management, voluntary confidential counseling and testing (VCCT), and drug related harm reduction. In addition, a cross border exchange between the Laos and Viet Nam PWTs was arranged in May in Houa Phanh. The exchange provided a good opportunity for the PWT members of the two countries to share their practical experiences of implementing and managing HIV prevention activities.

Proposals for sustainability were developed during the sustainability workshops conducted in the two provinces covered by the project. The proposals reflect the understanding and commitments of the District Project Working Teams about what needs to be done during the construction phase. They also indicate the current capacity of the Project Working Teams to understand what is happening, what will happen, and what will be the nature of effective responses both during and after road construction.

Subproject 11: Strengthening Local Response to Address HIV Risks along the Economic Corridors in Myanmar

Status: Ongoing

Discussion with Myanmar Department of Health and National AIDS Programme and screening of potential subproject implementers commenced.

Malteser International was engaged to implement community-based activities (Componets 2 and 3). Outreach activties in the township of Tachilek. An Inception report was submitted and accepted by ADB in December 2013 detailing Malteser's approach, process and project activities.

Engagement of IOM-Myanamr and UNAIDS-Myanamr has been initiated.

An Inception Mission was fielded from 24-30 October 2013 in Yangon and Nay Pyi Taw to discuss and agree on the SP11 start-up workplans with the implementing partners (Malteser, IOM and UNAIDS) and to present these workplans to the Department of Health and National AIDS Programme (DOH and NAP).

M&E:

RETA 6467 Project Completion Report (Subprojects 1-10) was submitted and accepted by AusAID on November 2013.

The Joint ADB-AusAID Mid-Term Review (MTR) of the RETA was conducted from 25 July to 4 August 2011. The findings of the MTR were discussed during the 4th GMS workshop in October 2011.

Closeout consultation workshops for subprojects 5 and 9 were held on February 2012 with participants from key national and local government agencies and development organizations. The workshops provided an opportunity for the subproject teams to present programmatic data, outputs and outcomes and to discuss issues infrastructure risk mitigation and HIV prevention initiatives across the GMS

A review mission was conducted in early February 2012 for Subproject 10 to gauge implementation progress and consult with target communities. After the review mission, improvements were made on Subproject 10 DMF, and the changes were reflected in the semi-annual progress report submitted in April 2012. Final review mission was conducted in October 2012, the results of which were used to inform the key activities for the 2012 last quarter project implementation. The results of the final review mission were also shared during the Completion Workshop conducted in December 2012. Post-project planning was done jointly by the national agencies, local health offices and project working teams and Burnet Institute during the Completion Workshop.

The Outcome-Based Evaluation has been submitted to and approved by ADB. The Evaluation was aimed to primarily (i) assess and document evidences of the effectiveness of the eight subprojects under RETA 6467; (ii) examine whether subproject activities and resulting outcomes have been consistent with the ADB Strategic Directions on HIV/AIDS; (iii) determine if the subproject activities have been strategically targeted and focused on key affected populations; (iv) whether the resources have been used optimally to support the objectives of the RETA; and (v) assess key factors to success or lessons learned in implementing the subprojects and the RETA in general. The evaluation included completed initiatives from 2008 until December 2012 and took cognizant of the recommendations and findings of the mid-term review conducted in 2011.

Proposed Resource Manual. The subprojects of RETA 6467 have provided sufficient information and lessons to inform HIV mitigation interventions associated with infrastructure projects. A resource manual is currently being developed that would provide DMF templates for pre, during, and post construction phase of HIV mitigation projects. The toolkit will also include the description of components and approaches for conducting baseline and endline assessments and sample terms of reference to be inserted in construction company contracts for HIV mitigation implementation, core indicators (with options for different types of service delivery) at outcome and output level for components and activities, among others.

Regional Coordination:

The 4th GMS Workshop on HIV Prevention and the Infrastructure Sector in the GMS was held on 26-27 October 2011 in Hanoi, Viet Nam. A post-workshop session among participating countries to discuss ongoing efforts to revise and renew the MOU for Joint Action to Reduce HIV Vulnerability Related to Population Movement was also held.

The 5th GMS Workshop on HIV Prevention and Infrastructure: Pre-Planning Workshop on Cross-Border Collaboration was held on 11 December 2012 in Ha Noi to discuss2012 to discuss/share lessons learned on cross-border collaboration based on SP10 implementation and similar initiatives under RETA 6467, agree on initial/indicative framework for regional and cross-border collaboration on HIV response in Lao PDR and Viet Nam, identify shared priority policy issues on regional and cross-border collaborations, and identify immediate next steps/measures and timelines for regional and cross-border HIV initiatives. The results of the workshop are used to inform current and forthcoming ADB-assisted projects on HIV in the context of regional and cross-border collaboration in Lao PDR, Viet Nam, and other GMS countries.

With RETA 6467 support, a satellite meeting on Roads, Connectivity and HIV was held during the 10th International Congress on AIDS in Asia and the Pacific (ICAAP 10) in Busan, Republic of Korea. The meeting highlighted good practices in the implementation of Subprojects 2 (EWEC) and 5/9 (CRIP/NRIP), as well as the ongoing regional initiative to renew the 2004 MOU on Joint Action signed by the six GMS countries.

Six-country Consultation Meeting on the Memorandum of Understanding (MOU) for Joint Action to Reduce HIV Vulnerability Related to Population Movement. ADB co-organized a six-country consultation meeting on the Memorandum of Understanding (MOU) for Joint Action to Reduce HIV Vulnerability Related to Population Movement in the GMS with the Joint United Nations Initiative on Mobility and HIV/AIDS (JUNIMA) in Bangkok on 11-13 July 2012. This activity was co-supported by the RETA 6321: Fighting HIV/AIDS in Asia and the Pacific. The meeting resulted in the agreed Joint Action Program and the draft country action plans. The draft JAP will be presented at the next GMS Working Group on Human Resource Development meeting to be held in October 2012 to explore the possible linkages with other sectors and to formulate the detailed activities at the multi-lateral and bi-lateral level.

Knowledge Management:

Initial video produced by the filming project (Road, Mobility, and HIV) has been approved by SEHS and DER and shown during an ADB-sponsored satellite session during the ICAAP 10.

Apart from the analytical studies three case studies on HIV risk mitigation in road corridor projects have been developed that will provide information on structural and operational factors that facilitated or impeded the success of HIV interventions introduced under RETA 6467: SP2 on the use of local ethnic media (DVD and radio dramas) for HIV prevention; SP8 on Cross-border interventions in special economic zones (SEZ); and Analysis on Integrating Pre-, During and Post-Construction Interventions. The case studies were disseminated during the November 2013 11th International Conference on AIDS in Asia and the Pacific (ICAAP) in Bangkok.

A compendium of short case studies describing each of the 10 subprojects was developed, and as of the end of this reporting period, is being finalized. The compendium contains information on each subproject, including the rationale, activities, results, lessons learned and, where relevant, suggestions for future action. The purpose is to show the success of each subproject, as well as the impact each has had on target populations.

Lessons in crossborder and pre-construction phase HIV initiatives in Lao PDR and Viet Nam were shared in the 11th ICAAP during ADB's Satellite Session on HIV Prevention in the GMS Economic Corridors.

I. Component 1: Capacity Building:

UNAIDS is responsible for the institutional development of the NAP to more effectively plan and manage HIV/AIDS response at the central and township levels. UNAIDS also facilitates the coordination among the implementing partners, and organizes coordination meetings and joint field missions; therefore ensuring harmonized activities. The cooperation agreement between UNAIDS and ADB was formalized in June 2014.

Training will be held from October to November 2014 to provide NAP staff with greater knowledge, skills and tools in program planning and project management, and on issues of HIV and migration.

Institutional development strategic plan, including M&E framework will be prepared and developed between October and November 2014.

UNAIDS, IOM and Malteserhave been organizing regular coordination meetings to share updates on implementation progress and agree on joint activities. In their June meeting, all 3 implementing partners agreed to do joint field visits in 3 townships on 22-26 September and another 2 townships in October.

Component 2: Service Delivery and Component 3:

Malteser was engaged to pilot work under components 2 and 3.

Basic and refresher trainings on STI, HIV and VCCT for health staff from rural health facilities have been conducted in cooperation with National AIDS Program (NAP) and National TB Program. As per work-plan the trainings has now been completed. Malteser's mobile teams continue to visit the rural health facilities to follow-up and to support health staff with on-the-job training.

Trainings for peer educators on basic HIV and STI referrals and on disseminating health messages are have started and will continue until November 2014. Trained peer educators act as focal person of the village for patient referral and lead dissemination of health messages.

Promotion of the Prevention of Mother-to-Child Transmission (PMTCT) service package continues, including referral and safe delivery support to Tachileik District Hospital or rural health facilities.

Malteser's mobile teams are conducting health education and awareness raising sessions for migrant and mobile population (in work places or living quarters), and for rural populations (in villages).

Home based care training for PLHIV self-help group members (including returnees and migrants) is on-going and will continue until November 2014.

Advocacy meetings with local authorities from different levels and leaders were held at district and township level in order to get access to HIV hot spots and facilitate interaction of Malteser with targeted populations.

Preparation is underway for the conduct of situation analysis and baseline survey to generate knowledge base on risks and vulnerabilities of local and mobile populations. The survey will be completed by October 2014 and the results will be submitted together with the final report on 7 December 2014. The information generated will provide initial data for future ADB projects on HIV/Health.

Component 4: Monitoring and Evaluation:

IOM has been engaged under SP11 in June 2014 to conduct mapping assessment and participatory action research activities in Myawaddy and Kawkareik townships. This assessment will consolidate the knowledge base to enable well-informed development of effective service provision and social safeguard packages addressing risk factors linked to proximity to economic corridors. Progress on results discussed during the meeting includes:

Research design and protocol have been presented to and approved by NAP-DOH through the M&E technical working group in June 2014.

Data collection, consolidation and analysis have started and will be completed by end-October 2014. Report writing and finalization will be in November 2014.

Dissemination meeting is scheduled on 12 December 2014.

Consultations through meetings, regional forum discussions and site visits have been held with the following stakeholders:

-Ministry of Transport, Viet Nam

-Vietnam Administration of HIV/AIDS Control (VAAC), Ministry of Health, Viet Nam

-UNAIDS Viet Nam

-Savannakhet Provincial Health Department (LAO)

-Bokeo Provincial Health Department (LAO)

-Ministry of Communication, Transport, Post, and Construction (MCTPC), Lao PDR

-Center for HIV/AIDS/STI (CHAS), Lao PDR

-Population Services International, Vientiane, Lao PDR

-UNAIDS Regional Support Team Asia and the Pacific, Bangkok (Thailand)

-Ministry of Public Works and Transport (Cambodia)

-National AIDS Authority (Cambodia)

-Canada South East Asia Regional HIV/AIDS Program (CSEARHAP), Bangkok

- Department of Health, Ministry of Health, Myanmar

-Ministry of Rail Transportation, Myanmar

-Ministry of Home Affairs, Myanmar

-UNAIDS-Myannmar

The project also links closely, and complements, other initiatives in the region such as the Joint UN Initiatives on Mobility and HIV/AIDS in Southeast Asia (JUNIMA), CSEARHAP and the AusAID Regional HIV and AIDS Regional Project. In implementation, SEHS will also liaise closely with RSDD in its coordination of ADB's involvement in the Joint Initiative for Mitigating HIV/AIDS in the Infrastructure Sectors as well as with the development partners to that initiative in the GMS region.