In Bolivia, the AIDS epidemic is characterized as “concentrated” among high-risk populations (men who have sex with men and intravenous drug users). From each ten women notified in the surveillance system, there are 18 men with HIV, nevertheless, the man-woman ratio is decreasing, meaning that more women are being reported with HIV, including pregnant women. National HIV prevalence is 0.15%, and the main means of transmission are: sexual (97%); mother-to-child (2%) and parenteral (1%). Adolescents and young people (15 to 24 years old) are the most affected population segment, whereby 27% of all HIV infections are among this age group. Cumulative distribution from notified cases per age shows that in people between 20-34 years are the most affected (56%), and according to data from regular surveillance cases among younger people are reported more frequently. Geographically, the most affected departments are Santa Cruz (52%), Cochabamba (20%) and La Paz (17%).
During the past few years, the country has made important progress aimed at achieving the MDGs, among them that of HIV and AIDS. Nevertheless, some indicators related to HIV, for children as well as women, are lagging behind, in particular in rural areas and among indigenous people, due to the fact that access to preventive measures and assistance is still limited.
Between 1984 and 2012, there were 9,296 reported cases of HIV / AIDS in Bolivia, of which 43% were reported in the last three years, indicating a sustained increase in new cases. This increase is largely due to HIV cases, whereas AIDS cases were maintained between 140 to 180 cases per year. To date, 1,410 cases receive ARV treatment. In terms of gender, men are the most affected group where 63% of HIV/AIDS cases are men, and 36% are women. In 2009, approximately 12,000 people were living with AIDS, but only 2% of the population had been screened. The coverage of prenatal HIV screening increased in 2010 to 40% of pregnant women. Programming of HIV/AIDS prevention, screening and treatment require significant improvements.
With regard to the Prevention of Mother-to-Child Transmission of HIV (PMTCT), Bolivia increased its coverage of rapid HIV testing by pregnant women from 4% in 2007 to 61% in 2012, however gaps exist in rural areas where coverages barely reach 18%, largely due to the fact that HIV/AIDS and PMTCT surveillance and control measures are in a decentralization process. The main factors contributing to the vertical transmission of HIV are unmet family planning needs and limited access to prenatal care. HIV PMTCT in rural, peri-urban areas and among indigenous populations is a priority that needs to be addressed urgently, particularly given the high levels of poverty, migration, illiteracy, alcohol use, gender-based discrimination, and low rates of prenatal care coverage among these populations – all factors that significantly increase risk.
In 2013, the Ministry of Health and Sports (MSD) developed and approved its National HIV/AIDS /STI Strategic Plan, prioritising the prevention of mother-to-child transmission of HIV (PMTCT) and the prevention of HIV/AIDS among adolescents and young people. As part of this new programming, further emphasis was placed on improving access to HIV promotion and prevention services for children and women, in particular in rural and indigenous areas with limited access to services, by using cultural and gender approaches to ensure inclusiveness and equity.
In order to adequately and effectively steer policies directed at improving HIV / AIDS outcomes of Bolivian children, the Government of Bolivia, through the technical assistance and institutional building offered by UNICEF, needs the continued support and cooperation of international networks made up of the international donor community and the United Nations.
To improve equitable use of proven HIV prevention and treatment interventions by indigenous pregnant women, girls and boys in Bolivia, UNICEF focuses on key actions:
With human rights, gender- mainstreaming and equity as overarching approaches, the programme will use a mix of the above-mentioned strategic lines of action.
Additionally, UNICEF will use innovative strategies and models such as situation analyses for equity (using UNICEF’s Monitoring Results for Equity System), investment case approach (using Marginal Budgeting for Bottlenecks) to better identify implementation constraints within the health system that should be removed in order to optimize expected outcomes.
Outcome: Improved and equitable use of proven HIV prevention and treatment interventions by indigenous pregnant women, girls and boys.
Output 2.1: Enhanced support to pregnant women, adolescents and children from the intervention areas for healthy behaviors related to HIV/AIDS prevention.
Output 2.2: Prioritized health networks are competent and providing quality and cultural appropriated HIV/AIDS services, especially to newborns, pregnant women and adolescents from rural and indigenous communities from the intervention areas.
Output 2.3: Sub national governments have allocated resources for prevention and care of HIV/AIDS for girls, boys, adolescents and pregnant women based on bottleneck analysis.
In line with its Strategic Plan 2014-2017 and aiming at the achievement of the above-mentioned results, the strategic approaches to the HIV / AIDS work of UNICEF in Bolivia includes: providing equitable delivery of interventions; increasing access to lifesaving and preventive interventions, including in humanitarian action; improving caregiver knowledge of high-impact interventions; strengthening health systems; improving the quality and use of data for making decisions; ensuring better integration of health services with other services and interventions being provided to mothers, newborns and children; promoting policy dialogue and advocacy and communication for development; harboring innovative approaches; and strengthening partnerships at all levels.
Being able to partner effectively and efficiently to enhance results for children, based on the UNICEF comparative advantage and shared commitments to common principles and results, has never been more important. Strategic partnerships will continue to play a central role in advancing results for children with equity and UNICEF will continue its long-standing practice of building capacity through partnerships with national and local governments, civil society, academic institutions and the private sector, reducing the dependence of governments and other actors on development assistance over time.
The main partners supporting the HIV /AIDS Component of the YCSD Programme are:
Global programme partnerships, such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, will also continue to be a cornerstone of UNICEF programmatic engagement, advocacy and leveraging of funds.
|Strategic Lines of Action||2016||2017||Total|
|Strengthening institutional competencies with an integrated approach with involvement of health and education sectors for prevention of HIV/AIDS, violence and unplanned pregnancies, with active participation of families, teachers, community leaders, and adolescents||0||0||0|
|Accelerating the expansion of human resources competencies on PMTCT, congenital syphilis, and pediatric care according to updated standards||60,000||0||60,000|
|Strengthening HIV/AIDS supplies management system||0||0||0|
|Advocating for strengthening the decentralization process for improving PMTCT surveillance system||204,540||103,807||308,347|
|Promoting and supporting the participation and empowerment of rural and indigenous-based organizations with a special focus on women and adolescent girls||60,000||0||60,000|
|Promoting and supporting adolescents’ participation for reducing discrimination and stigma towards adolescents MSM (men having sex with men)||0||0||0|
|Producing evidence for improving HIV/AIDS prevention, treatment and care, for effective plan, budget, implement, monitor and evaluate 0friendly, intercultural and gender-sensitive policies and programs for children and mothers at subnational levels||43,750||0||43,750|
|Strengthening South to South cooperation for producing evidence, interchange experiences, and document lessons learned, especially among indigenous communities.||0||0||0|
|Total Required Budget||$1,333,334||$666,666||$2,000,000|