: Organisation Vigilancia epidemiológica del PNVIH. MINSA : Name/Position Dra.Luz Ma.Romero. Resp. VE-VIH- SIDA

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1 Custom analysis extract of: UNGASS - National Composite Policy Index (NCPI) 2007 Latin America Nicaragua COUNTRY: Nicaragua Name of the National AIDS Committee Officer in charge: Valeria Bravo Delgado. Postal address: Complejo Concepción Palacios Tel: extensión 200 Fax: vbravo@minsa.gob.ni Date of submission: 2/1/2008 : Organisation Vigilancia epidemiológica del PNVIH. MINSA : Name/Position Dra.Luz Ma.Romero. Resp. VE-VIH- SIDA : respondents to Part A : respondents to Part A A.I / A.II / A.III / A.IV / A.V : Organisation Procuraduria de los Derechos Humanos : Name/Position Flor de María Alvarado Ramírez A.I / A.II / A.III / A.IV / A.V : Organisation CORLUSIDA RAAN : Name/Position Marisol Carlson Kinsman Page 1

2 : respondents to Part A : Organisation Instituto de Seguridad Social. INSS : Name/Position Dra. Galaxia Vasquez : respondents to Part A : Name/Position Sobeyda Morales Mendoza. : respondents to Part A : respondents to Part A A.I / A.II / A.III / A.IV / A.V : Organisation CEPRESI (Centro de Prevención y Educ.en SIDA) : Name/Position Lic. rman Gutiérrez Morgan. Director : respondents to Part B A.I / A.II / A.III / A.IV / A.V : Organisation Ministerio de Gobernación. MIGOB : Name/Position Esperanza Flores F. : respondents to Part A A.I / A.II / A.III / A.IV / A.V A.I / A.II / A.III / A.IV / A.V : Organisation Ministerio de la Familia. MIFAMILIA : Name/Position Ramiro Blanco : respondents to Part A : Organisation CONISIDA : Organisation INJUVE : Name/Position José Virgilio Vásquez Vega. : respondents to Part A A.I / A.II / A.III / A.IV / A.V : Name/Position Dra. Valeria Bravo Delgado : respondents to Part A A.I / A.II / A.III / A.IV / A.V A.I / A.II / A.III / A.IV / A.V : Organisation Ministerio de Educación. MINED A.I / A.II / A.III / A.IV / A.V : Organisation Responsable del PNVIH. MINSA : Name/Position Dra. Sara Moraga B.I / B.II / B.III / B.IV : Organisation CEPS/ CNLCSSC : Name/Position Lic. Esperanza Camacho Page 2

3 : respondents to Part B : respondents to Part B : Organisation Casa Alianza : Name/Position José Pachelli Gutiérrez Pascuas : respondents to Part B : respondents to Part B : respondents to Part B : Organisation PASMO/PSI : Name/Position Martha Carolina Ramirez : respondents to Part B Page 3 B.I / B.II / B.III / B.IV : Organisation ACAHUAL : Name/Position María Elena Bonilla B.I / B.II / B.III / B.IV B.I / B.II / B.III / B.IV : Organisation CNLCSSC : Name/Position Giovanni Campos : respondents to Part B Position: Full time/part time Full time Position: Full time/part time Full time Position: Full time/part time Full time B.I / B.II / B.III / B.IV : Organisation Puntos de Encuentro : Name/Position María Mercedes Alemán M. : Organisation Tesis B.I / B.II / B.III / B.IV B.I / B.II / B.III / B.IV : Name/Position Luis René López Gónzalez : respondents to Part B : Organisation Si Mujer : respondents to Part B B.I / B.II / B.III / B.IV : Name/Position Xiomara Luna B.I / B.II / B.III / B.IV : Organisation FUNDECOM : Name/Position Felícita Laínez D. B.I / B.II / B.III / B.IV

4 Position: Full time/part time Full time Position: Full time/part time Full time 1. Has the country developed a national multisectoral strategy/action framework to combat AIDS? IF YES, period covered: How long has the country had a multisectoral strategy/action framework? Which sectors are included in the multisectoral strategy/action framework with a specific HIV budget for their activities? Health: strategy/action framework Health: earmarked budget Education: strategy/action framework Education: earmarked budget Labour: strategy/action framework Labour: earmarked budget Transportation: strategy/action framework Military/Police: earmarked budget Women: strategy/action framework Women: earmarked budget Young people: strategy/action framework Young people: earmarked budget Agriculture: strategy/action framework Finance: strategy/action framework Human Resources: strategy/action framework Justice: strategy/action framework Minerals and Energy: strategy/action framework Planning: strategy/action framework Public Works: strategy/action framework Tourism: strategy/action framework Trade and Industry: strategy/action framework Page 4

5 Other*::Cuando hablamos de MIGOB, incluye Dirección General de Migración y Extranjería, Sistema Penitenciario Nacional,Dirección General Bomberos y Policía Nacional. Entre los jovenes se incluye la poblacion estudiantil (INJUvE). en otros se incluye: Sociedad Civil, organizaciones basada en la Fe, Empresa Privada (reciente), Procuraduria para la Defensa de los Derechos Humanos. Other*::Cuando hablamos de MIGOB, incluye Dirección General de Migración y Extranjería, Sistema Penitenciario Nacional,Dirección General Bomberos y Policía Nacional. Entre los jovenes se incluye la poblacion estudiantil (INJUvE). en otros se incluye: Sociedad Civil, organizaciones basada en la Fe, Empresa Privada (reciente), Procuraduria para la Defensa de los Derechos Humanos. strategy/action framework earmarked budget IF NO earmarked budget, how is the money allocated? Las instituciones señalan que no existe una partida presupuestaria especifica, que las actividades que realizan se adecúan a los componentes de promoción y prevención, pero la mayoría de las actividades se realizan con fondos de cooperación externa, porque en el presupuesto de la República no aparece el VIH-SIDA como tema específico. 1.6 Does the multisectoral strategy/action framework include an operational plan? 1.8 Has the country ensured full involvement and participation of civil society[4] in the development of the multisectoral strategy/action framework? Active involvement IF active involvement, briefly explain how this was done: La sociedad civil está integrada y representada por diferentes organizaciones. Los espacios de participación son amplios. Se realizó consulta a nivel nacional para la elaboración del PEN, Politica Nacional del VIH SIDA y consulta nacional del acceso universal del VIH-SIDA.Para la consulta se utilizaron mecanismos como foros, debates y entrevistas. Al plan se dio seguimiento mediante el Comité multisectorial. Actualmente le ejecución y monitoreo del PEN es una de las funciones de CONISIDA ejecutadas por el Comité de monitoreo y evaluación. 1.9 Has the multisectoral strategy/action framework been endorsed by most external Development Partners (bi-laterals; multi-laterals)? 1.10 Have external Development Partners (bi-laterals; multi-laterals) aligned and harmonized their HIV and AIDS programmes to the national multisectoral strategy/action framework?, all partners Page 5

6 2. Has the country integrated HIV and AIDS into its general development plans such as: a) National Development Plans, b) Common Country Assessments/United Nations Development Assistance Framework, c) Poverty Reduction Strategy Papers, d) Sector Wide Approach? 2.1 IF YES, in which development plans is policy support for HIV and AIDS integrated? a) National Development Plans: b) Common Country Assessments/United Nations Development Assistance Framework: c) Poverty Reduction Strategy Papers: d) Sector Wide Approach: 2.2 IF YES, which policy areas below are included in these development plans? HIV Prevention: development Plans a) / c) Treatment for opportunistic infections: development Plans c) Antiretroviral therapy: development Plans a) / c) Care and support (including social security or other schemes): Reduction of gender inequalities as they relate to HIV prevention/treatment, care and/or support: Reduction of income inequalities as they relate to HIV prevention/ treatment, care and /or support: 4.1 IF YES, which of the following programmes have been implemented beyond the pilot stage to reach a significant proportion of one or more uniformed services? Behavioural change communication: Condom provision : HIV testing and counselling(*): STI services : Treatment: Care and support : development Plans a) / c) development Plans c) development Plans c) Reduction of stigma and discrimination: development Plans a) / c) 3. Has the country evaluated the impact of HIV and AIDS on its socio-economic development for planning purposes? 4. Does the country have a strategy/action framework for addressing HIV and AIDS issues among its national uniformed services such as military, police, peacekeepers, prison staff, etc? Page 6

7 (*)If HIV testing and counselling has been implemented for uniformed services beyond the pilot stage, what is the approach taken? Is it voluntary or mandatory (e.g. at enrolment)? Briefly explain: En el MINSA la prueba es voluntaria y se basa en la consejería pre prueba, se le llena el Consentimiento informado a como lo establece la Ley 238. En el MIGOB es voluntario y se rige por la Ley 238. En el Ejército Nacional la prueba del VIH va ímplicita en los exámenes de rutina para realizar el ingreso a las fuerzas armadas. 5. Has the country followed up on commitments towards universal access made during the High-Level AIDS Review in June 2006? 5.1 Has the National Strategic Plan/operational plan and national AIDS budget been revised accordingly? 5.2 Have the estimates of the size of the main target population sub-groups been updated? 5.3 Are there reliable estimates and projected future needs of the number of adults and children requiring antiretroviral therapy? Estimates and projected needs 5.4 Is HIV and AIDS programme coverage being monitored? (a) IF YES, is coverage monitored by sex (male, female)? (b) IF YES, is coverage monitored by population sub-groups? IF YES, which population sub-groups? Mujeres, niños, adultos y adolescentes. (c) IF YES, is coverage monitored by geographical area? IF YES, at which levels (provincial, district, other)? Se vigila en base a la división político-administrativa de gobierno (Nación, departamento y municipios) y las Regiones autónomas constituidas por un departamento subdividido en rte(raan) y sur (RAAS ) que corresponde a la Costa Caribe. 5.5 Has the country developed a plan to strengthen health systems, including infrastructure, human resources and capacities, and logistical systems to deliver drugs? Page 7

8 Overall, how would you rate strategy planning efforts in the HIV and AIDS programmes in 2007 and in 2005? 2007: : 7 Comments on progress made in strategy planning efforts since 2005: Cuando nos referimos al Sistema de Salud se habla, de los diferentes sub sistemas que lo componen (público y privado), Ejército Nacional (EN),Ministerio de Gobernación (MIGOB), Instituto Nicaraguense de Seguridad Social (INSS), MIxtas y Ministerio de Salud (MINSA). Existe un incremento en la cobertura en TARV. Descentralización de la atención y de la TAR a los Hospitales Departamentales y Regionales. Aumento de cobertura con pruebas rápidas, con énfasis en la Prevención de la transmisión vertical madre niño. Promoción de prácticas saludables, dirigidas a adolescentes,mujeres y grupos de mayor vulnerabilidad. Capacitaciones en consejería, pruebas rápidas para el diagnóstico del VIH y manejo terapeútico del TARV. Mejorar el uso de la estrategia educativa, mediante la IEC (Información, educación y comunicación). 1. Do high officials speak publicly and favourably about AIDS efforts in major domestic fora at least twice a year? President/Head of government : Other high officials : Other officials in regions and/or districts : 2. Does the country have an officially recognized national multisectoral AIDS management/coordination body? (National AIDS Council or equivalent)? 2.1 IF YES, when was it created? Year: IF YES, who is the Chair? Name: Title/Function: Dr. Adrian Zelaya Blandón Secretario General Ministerio de Salud.Nicaragua Page 8

9 2.3 IF YES, does it: have terms of reference? : have active Government leadership and participation? : have a defined membership?: include civil society representatives? (*): include people living with HIV?: include the private sector?: have an action plan?: have a functional Secretariat? : meet at least quarterly?: review actions on policy decisions regularly?: actively promote policy decisions?: provide opportunity for civil society to influence decision-making?: strengthen donor coordination to avoid parallel funding and duplication of effort in programming and reporting?: (*) If it does include civil society representatives, what percentage? CONISIDA, creada en el año 2000 y conformada por 17 miembros, el 35.2% (6) corresponden a la Sociedad Civil, el 52.9% (9) a funcionarios Gubernamentales y el 11.9% (2) son la Comisiones mixtas representantes de la RAAN (CORLUSIDA) y la RAAS (CORESIDA) conformados por estado y sociedad civil. 3. Does the country have a national AIDS body or other mechanism that promotes interaction between government, people living with HIV, civil society and the private sector for implementing HIV and AIDS strategies/ programmes? 5. What kind of support does the NAC (or equivalent) provide to implementing partners of the national programme, particularly to civil society organizations? Information on priority needs and services : Technical guidance/materials: Drugs/supplies procurement and distribution : Coordination with other implementing partners : Capacity-building : 6. Has the country reviewed national policies and legislation to determine which, if any, are inconsistent with the National AIDS Control policies? Page 9

10 Overall, how would you rate the political support for the HIV and AIDS programmes in 2007 and in 2005? 2007: : 6 Comments on progress made in political support since 2005: El apoyo político inicia en el año 2005, donde se crean las bases que están permitiendo la consolidación durante el Does the country have a policy or strategy that promotes information, education and communication (IEC) on HIV to the general population? 1.1 IF YES, what key messages are explicitly promoted? Be sexually abstinent: Delay sexual debut: Be faithful: Reduce the number of sexual partners: Use condoms consistently: Engage in safe(r) sex: Use clean needles and syringes: Fight against violence against women: Greater acceptance and involvement of people living with HIV: Other::Las jeringas se refieren a cualquier medicamento inyectable, no a CDI, en el marco de Bioseguridad Other::Promoción de pruebas voluntarias. 1.2 In the last year, did the country implement an activity or programme to promote accurate reporting on HIV by the media? 2. Does the country have a policy or strategy promoting HIV-related reproductive and sexual health education for young people? 2.1 Is HIV education part of the curriculum in primary schools? : secondary schools? : teacher training? : 2.2 Does the strategy/curriculum provide the same reproductive and sexual health education for young men and young women? Page 10

11 2.3 Does the country have an HIV education strategy for out-of-school young people? 3. Does the country have a policy or strategy to promote information, education and communication (IEC) and other preventive health interventions for vulnerable sub-populations? 3.1 IF YES, which sub-populations and what elements of HIV prevention do the policy/strategy address? Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Targeted information on risk reduction and HIV education: Stigma & discrimination reduction: Stigma & discrimination reduction: Stigma & discrimination reduction: Condom promotion: Condom promotion: Condom promotion: Condom promotion: Condom promotion: Other sub-populations (*) HIV testing & counselling: HIV testing & counselling: HIV testing & counselling: HIV testing & counselling: (*)If Other sub-populations, indicate which sub-populations Clients of sex workers Prison inmates HIV testing & counselling: Other sub-populations (*) Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Reproductive health, including STI prevention & treatment: Militares, las y los uniformados del MIGOB, población móvil, mujeres embarazadas, adolescentes, población asegurada y escolares. MSM Sex workers Prison inmates MSM Sex workers Prison inmates MSM Sex workers Clients of sex workers Prison inmates MSM Sex workers MSM Sex workers Clients of sex workers Prison inmates Other sub-populations (*) Page 11

12 Overall, how would you rate policy efforts in support of HIV prevention in 2007 and in 2005? 2007: : 7 Comments on progress made in policy efforts in support of HIV prevention since 2005: Se ha avanzado considerablemente en haber : Desarrollado mayores actividades de promoción y prevención. Incorporado en la oferta de servicios las consejerías y pruebas rápidas del VIH en los diferentes sub sistemas de salud. Elaborado y distribuido materiales educativos de prevención del VIH-Sida. 4. Has the country identified the districts (or equivalent geographical/ decentralized level) in need of HIV prevention programmes? IF YES, to what extent have the following HIV prevention programmes been implemented in identified districts* in need? Blood safety: the activity is available in all districts* in need Universal precautions in health care settings: Prevention of mother-to-child transmission of HIV: Risk reduction for men who have sex with men: Risk reduction for sex workers: the activity is available in all districts* in need Programmes for other vulnerable subpopulations: Reproductive health services including STI prevention & treatment: School-based AIDS education for young people: Other::REVISAR MITRAB. reducción de riesgo en privados de libertad. the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in the activity is available in Overall, how would you rate the efforts in the implementation of HIV prevention programmes in 2007 and in 2005? 2007: : : : 6 most districts* in need all districts* in need IEC on risk reduction: the activity is available in all districts* in need IEC on stigma and discrimination reduction: the activity is available in all districts* in need Condom promotion: the activity is available in all districts* in need HIV testing & counselling: the activity is available in most districts* in need all districts* in need all districts* in need all districts* in need most districts* in need all districts* in need Page 12

13 Comments on progress made in the implementation of HIV prevention programmes since 2005: Se ha avanzado en prevención de la transmisión vertical, garantizar la sangre segura, elaboración y ejecución de planes de IEC en ITS-VIH-Sida y coo-infección con Tuberculosis, divulgación de la Ley 238, Política Nacional del VIH Sida y el Plan Estratégico Nacional. 1. Does the country have a policy or strategy to promote comprehensive HIV treatment, care and support? (Comprehensive care includes, but is not limited to, treatment, HIV testing and counselling, psychosocial care, and home and community-based care). 1.1 IF YES, does it give sufficient attention to barriers for women, children and most-at-risk populations? 2. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV and AIDS treatment, care and support services? IF YES, to what extent have the following HIV and AIDS treatment, care and support services been implemented in the identified districts* in need? Antiretroviral therapy: most districts* in need Nutritional care: some districts* in need Paediatric AIDS treatment: most districts* in need Sexually transmitted infection management: Psychosocial support for people living with HIV and their families: Nutritional care: N/A Paediatric AIDS treatment: some districts* in need Sexually transmitted infection management: Psychosocial support for people living with HIV and their families: Page 13 most districts* in need Home-based care: some districts* in need Palliative care and treatment of common HIV-related infections: HIV testing and counselling for TB patients: TB infection control in HIV treatment and care facilities: Cotrimoxazole prophylaxis in HIVinfected people: Post-exposure prophylaxis (e.g. occupational exposures to HIV, rape): all districts* in need all districts* in need most districts* in need TB screening for HIV-infected people: some districts* in need TB preventive therapy for HIV-infected people: all districts* in need all districts* in need some districts* in need some districts* in need Antiretroviral therapy: some districts* in need some districts* in need N/A

14 Home-based care: some districts* in need Palliative care and treatment of common HIV-related infections: HIV testing and counselling for TB patients: TB infection control in HIV treatment and care facilities: Cotrimoxazole prophylaxis in HIVinfected people: Post-exposure prophylaxis (e.g. occupational exposures to HIV, rape): HIV care and support in the workplace (including alternative working arrangements): 3. Does the country have a policy for developing/using generic drugs or parallel importing of drugs for HIV? Comments on progress made since 2005: El tratamiento antirretrovírico está descentralizado en 10 de 17 departamentos del país, correspondiendo a los de mayor prevalencia. 5. Does the country have a policy or strategy to address the additional HIV- or AIDS-related needs of orphans and other vulnerable children (OVC)? 1. Does the country have one national Monitoring and Evaluation (M&E) plan? In Progress HIV treatment services in the workplace or treatment referral systems through the workplace: some districts* in need some districts* in need TB screening for HIV-infected people: some districts* in need TB preventive therapy for HIV-infected people: 4. Does the country have access to regional procurement and supply management mechanisms for critical commodities, such as antiretroviral drugs, condoms, and substitution drugs? some districts* in need some districts* in need N/A some districts* in need Overall, how would you rate the efforts in the implementation of HIV treatment, care and support services in 2007 and in 2005? 2007: : 6 N/A N/A IF YES, Years covered: Page 14

15 1.1. IF YES, was the M&E plan endorsed by key partners in M&E? 1.2. IF YES, was the M&E plan developed in consultation with civil society, including people living with HIV? 1.3. IF YES, have key partners aligned and harmonized their M&E requirements (including indicators) with the national M&E plan?, most partners 2. Does the Monitoring and Evaluation plan include? a data collection and analysis strategy : behavioural surveillance : HIV surveillance : a well-defined standardized set of indicators : guidelines on tools for data collection : a strategy for assessing quality and accuracy of data : a data dissemination and use strategy : 3. Is there a budget for the M&E plan? 3.1 IF YES, has funding been secured? 4. Is there a functional M&E Unit or Department? In Progress 4.1 IF YES, is the M&E Unit/Department based in the NAC (or equivalent)? : in the Ministry of Health? : 4.2 IF YES, how many and what type of permanent and temporary professional staff are working in the M&E Unit/Department? Number of permanent staff: IF YES, are there mechanisms in place to ensure that all major implementing partners submit their M&E data/reports to the M&E Unit/Department for review and consideration in the country s national reports? Page 15

16 4.4 IF YES, to what degree do UN, bi-laterals, and other institutions share their M&E results? 5 5. Is there an M&E Committee or Working Group that meets regularly to coordinate M&E activities?, meets regularly IF YES, Date last meeting: Diciembre Does it include representation from civil society, including people living with HIV? IF YES, describe the role of civil society representatives and people living with HIV in the working group Retroalimentan la base del sistema de información Refieren información adicional Participación activa en el sistema de información 6. Does the M&E Unit/Department manage a central national database? 6.3 Is there a functional Health Information System (HIS)? National level : Sub-national level (*): (*)If there is a functional sub-national HIS, at what level(s) does it function? Nacional, departamental, municipal y Hospitales. 6.4 Does the country publish at least once a year an M&E report on HIV, including HIV surveillance data? 7. To what extent are M&E data used in planning and implementation? 4 What are examples of data use? Grupos de afectados, por sexo y por edad Afectados por procedencia Ocupación Preferencia sexual What are the main challenges to data use? Diseñar un sistema único de información, que recolecte datos de los diferentes sectores. Definir los indicadores de estructura, proceso y resultados para el monitoreo y evaluación. Page 16

17 8. In the last year, was training in M&E conducted At national level? : At national level? : IF YES, Number of individuals trained: 35 At sub-national level? : At sub-national level? : IF YES, Number of individuals trained: 140 Including civil society? : Including civil society? : IF YES, Number of individuals trained: 8 Overall, how would you rate the M&E efforts of the AIDS programme in 2007 and in 2005? 2007: : 4 Comments on progress made in M&E since 2005: Existe un plan estratégico Nacional en Vigilancia y se ha capacitado en todos los niveles sobre VIH-SIDA. 1. Does the country have laws and regulations that protect people living with HIV against discrimination? (such as general non-discrimination provisions or provisions that specifically mention HIV, focus on schooling, housing, employment, health care etc.) 1.1 IF YES, specify: Ley 238: Ley de promoción, protección y defensa de los derechos humanos ante el Sida y la Política Nacional de prevención y control de ITS, VIH y Sida. 2. Does the country have non-discrimination laws or regulations which specify protections for vulnerable sub-populations? 3. Does the country have laws, regulations or policies that present obstacles to effective HIV prevention, treatment, care and support for vulnerable sub-populations? 3.1 IF YES, for which sub-populations? Women : Young people : IF YES, briefly describe the content of these laws, regulations or policies and how they pose barriers: El Código Penal en el Arto. 164 aborda la penalización del aborto terapeútico y esto afecta la salud de las mujeres que viven con VIH o Sida al denegarles la solicitud de no continuar con su embarazo. 4. Is the promotion and protection of human rights explicitly mentioned in any HIV policy or strategy? Page 17

18 5. Is there a mechanism to record, document and address cases of discrimination experienced by people living with HIV and/or most-at-risk populations? IF YES, briefly describe this mechanism Esta función le corresponde al Comité de Etica y Derechos Humanos de CONISIDA y es hasta en el 2007 que se retoma. ASONVIHSIDA y la comision de DH de CONISIDA, dentro de sus planes contemplan la formación del cuerpo técnico Etico que permita darle seguimiento y respuesta a las demandas presentadas. La CNLCSSC está iniciando la implementación de un Sistema de información que documente las denuncias y procesos por la via administrativa y judicial. Otras instituciones que defienden y tratan los casos de discriminación son el CENIDH y la red legal Nacional que trabajan con ONG s en la defensa de los derechos humanos de estos grupos sociales. Existe la urgente necesidad de articular la información existente bajo un solo sistema nacional, que involucre a todos los sectores que trabajan el tema. 6. Has the Government, through political and financial support, involved most-at-risk populations in governmental HIV-policy design and programme implementation? 7. Does the country have a policy of free services for the following: HIV prevention services : Anti-retroviral treatment : HIV-related care and support interventions : IF YES, given resource constraints, briefly describe what steps are in place to implement these policies: Existen, pero no es una politica de estado, son proyectos de Cooperación Internacional los que garantizan su funcionamiento, y fueron creadas por demandas de la Sociedad Civil, no por inicitaiva del Estado. A pesar de garantizar la atención a los pacientes con VIH Sida, existen limitaciones para garantizar los insumos médicos para el tratamiento de las infecciones oportunistas y realizarles los exámenes especializados. 8. Does the country have a policy to ensure equal access for women and men, to prevention, treatment, care and support? In particular, to ensure access for women outside the context of pregnancy and childbirth? 9. Does the country have a policy to ensure equal access for most-at-risk populations to prevention, treatment, care and support? Page 18

19 9.1 Are there differences in approaches for different most-at-risk populations? 10. Does the country have a policy prohibiting HIV screening for general employment purposes (recruitment, assignment/relocation, appointment, promotion, termination)? 11. Does the country have a policy to ensure that AIDS research protocols involving human subjects are reviewed and approved by a national/local ethical review committee? 11.1 IF YES, does the ethical review committee include representatives of civil society and people living with HIV? 12. Does the country have the following human rights monitoring and enforcement mechanisms? - Existence of independent national institutions for the promotion and protection of human rights, including human rights commissions, law reform commissions, watchdogs, and ombudspersons which consider HIVrelated issues within their work: - Focal points within governmental health and other departments to monitor HIV-related human rights abuses and HIV-related discrimination in areas such as housing and employment: - Performance indicators or benchmarks for compliance with human rights standards in the context of HIV efforts: - Performance indicators or benchmarks for reduction of HIVrelated stigma and discrimination: IF YES, on any of the above questions, describe some examples: Existen instancias dede la sociedad Civil y las asociaciones de PVVS. A nivel del Estado funciona la CONISIDA a nivel Nacional y Departamentales y CORLUSIDA para la región del Atlántico Sur y CORESIDA en el Atlántico rte.en la mayoria de los departamentos las comisiones no están funcionando, las acciones se realizan de manera aisladas y por consiguiente no dan seguimiento a las denuncias, ni resuelven las situaciones de violación a los Derechos Humanos. 13. Have members of the judiciary (including labour courts/employment tribunals) been trained/sensitized to HIV and AIDS and human rights issues that may come up in the context of their work? Page 19

20 14. Are the following legal support services available in the country? Legal aid systems for HIV and AIDS casework: Private sector law firms or universitybased centres to provide free or reduced-cost legal services to people living with HIV: Programmes to educate, raise awareness among people living with HIV concerning their rights: 15. Are there programmes designed to change societal attitudes of stigmatization associated with HIV and AIDS to understanding and acceptance? IF YES, what types of programmes? Media : School education : Personalities regularly speaking out : Overall, how would you rate the policies, laws and regulations in place to promote and protect human rights in relation to HIV and AIDS in 2007 and in 2005? 2007: : 7 Comments on progress made in promoting and protecting human rights in relation to HIV and AIDS since 2005: Los avances son significativos y permiten a Nicaragua entrar en la lista de países que disponen de herramientas técnicas y jurídicas que garanticen: la protección y promoción de los DDHH, acceso universal e implementación de estrategias para la contención de la epidemia. Como medios de verificación tenemos los documentos: Politica Nacional de Prevención y Control de ITS,VIH y SIDA, el Plan Estratégico Nacional y la estrategia Nacional de SSR. Otros avances es la creación de CONISIDA y la instalación de las Comisiones Departamentales y Regionales. Estas herramientas permiten direccionar las acciones, armonizarlas y mejorar la respuesta Nacional ante el VIH de manera efectiva y eficiente. Overall, how would you rate the effort to enforce the existing policies, laws and regulations in relation to human rights and HIV and AIDS in 2007 and in 2005? 2007: : 3 Page 20

21 Comments on progress made in enforcing existing policies, laws and regulations in relation to human rights and HIV and AIDS since 2005: El año 2006, fue un año productivo en el aspecto del desarrollo técnico y lo jurídico, también se da inicio a la revisión de la Ley 238. La Ley 238 ha tenido mayor cumplimiento,en lo referido a la Política Nacional pero aun se presentan limitaciones en su aplicación,. La CNLCSS ha venido realizando esfuerzos por dar a conocer las politicas, a través de capacitaciones y distribución de estas en todo el territorio Nacional. A partir del 2007 el nuevo Gobierno, hace movilización de recursos humanos, teniendo que realizar nuevos esfuerzos para capacitarlos. 1. To what extent has civil society contributed to strengthening the political commitment of top leaders and national policy formulation? 5 2. To what extent have civil society representatives been involved in the planning and budgeting process for the National Strategic Plan on AIDS or for the current activity plan (e.g. attending planning meetings and reviewing drafts) 5 5. To what extent is the civil society sector representation in HIV-related efforts inclusive of its diversity? 5 6. To what extent is civil society able to access a. adequate financial support to implement its HIV activities?: b. adequate technical support to implement its HIV activities?: 3 4 Overall, how would you rate the efforts to increase civil society participation in 2007 and in 2005? 2007: : 10 Comments on progress made in increasing civil society participation since 2005: Los esfuerzos de la sociedad civil siempre han sido altos, con o sin apoyo del Gobierno, hemos sido la punta de lanza en los diferentes procesos para la contención de la epidemia. 1. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV prevention programmes? Page 21

22 IF YES, to what extent have the following HIV prevention programmes been implemented in identified districts in need? Blood safety: N/A Universal precautions in health care settings: Prevention of mother-to-child transmission of HIV: Risk reduction for men who have sex with men: Risk reduction for sex workers: most districts* in need Programmes for other vulnerable subpopulations: Reproductive health services including STI prevention & treatment: School-based AIDS education for young people: Programmes for out-of-school young people: Harm reduction for injecting drug users: some districts* in need most districts* in need IEC on risk reduction: most districts* in need IEC on stigma and discrimination reduction: most districts* in need Condom promotion: some districts* in need HIV testing & counselling: most districts* in need most districts* in need most districts* in need most districts* in need some districts* in need most districts* in need HIV prevention in the workplace: some districts* in need 1. Has the country identified the districts (or equivalent geographical/decentralized level) in need of HIV and AIDS treatment, care and support services? Overall, how would you rate the efforts in the implementation of HIV treatment, care and support services in 2007 and in 2005? 2007: : 6 Comments on progress made in the implementation of HIV treatment, care and support services since 2005: Hay mayor cobertura en el tratamiento ARV, pero falta calidad y humanización de la atención,asi como la integralidad de esta. Se necesita mayores esfuerzos organizativos, descentralización del TARV de manera efectiva y mejoramiento del sistema de información de todas y cada una de las unidades de salud donde se realizan la consejeria, pruebas y TAR. Los grupos de auto apoyo a personas que viven con VIH o Sida, son apoyados por la Sociedad Civil, en el MINSA no existe esta categoria de atención. Loe Equipos multidisciplinarios de los Hospitales no brindan atención integral, existiendo barreras estructurales para su funcionamiento. N/A Page 22

23 2. What percentage of the following HIV programmes or services is estimated to be provided by civil society? Prevention for youth : >75% Prevention for MSM : >75% Prevention for sex workers : >75% Counselling and Testing : 25-50% Programmes for OVC** : 3. Does the country have a policy or strategy to address the additional HIV and AIDS-related needs of orphans and other vulnerable children (OVC)? <25% Uniting the world against AIDS Page 23