Yes - unaids

HIV and STIs in Tuvalu. This committee under the guidance of the National StrategicPlan (NSP) coordinates all HIV and STI related activities in the country.Table 2. Core Indicators for the Declaration of Commitment Implementation (UNGASS)2008 reportingIndicatorsNational Commitment and ActionExpenditures1. Domestic and international AIDS spending bycategories and financing sourcesData Available andReported Yes or NoMethod of Data CollectionNational AIDS Spending AssessmentFinancial resource flowsPolicy Development and Implementation Status2. National Composite Policy Index Available; reported Key informant interviewsAreas covered: gender, workplace programmes, stigma and discrimination, prevention, care and support, human rights, civilsociety involvement, and monitoring and evaluationNational Programmes: blood safety, antiretroviral therapy coverage, prevention of mother-to-child transmission,co-management of TB and HIV treatment, HIV testing, prevention programmes, services for orphans andvulnerable children, and education.3. Percentage of donated blood units screened for Available; reportedPatient recordsHIV in a quality assured manner4. Percentage of adults and children with advanced Available; reportedPatient recordsHIV infection receiving antiretroviral therapy5. Percentage of HIV-positive pregnant women who Available; reportedPatient recordsreceive antiretrovirals to reduce the risk of motherto-childtransmission6. Percentage of estimated HIV positive incident TBcases that received treatment for TB and HIVAvailable; reportedPatient records7. Percentage of women and men aged 15-49 whoreceived an HIV test in the last 12 months and whoknow the results8. Percentage of most-at-risk populations that havereceived an HIV test in the last 12 months and whoknow the results9. Percentage of most-at-risk populations reachedwith HIV/AIDS prevention programmes10. Percentage of orphans and vulnerable childrenwhose households received free basic externalsupport in caring for the child11. Percentage of schools that provided life-skillsbased HIV/AIDS education within the lastacademic yearKnowledge and Behaviour12. Current school attendance among orphans andamong non-orphans aged 10–14*Available; reportedNot availableNot availableNot relevant and notavailableAvailable; reportedNot relevant and notavailablePopulation-based survey (2007 serosurveillancesurvey of antenatal clinicattendees)Behavioural surveysBehavioural surveysPopulation-based surveyCurriculum Unit, Ministry of EducationUNGASS 2008 Tuvalu 7

Table 1 Utilisation of WHO funding for HIV and AIDS, 2004-2007Year Projects Provisions 2004 2005 2006 2007 BalanceMaternal and Child Health aides on Health2004 villages (MCH) 5,542.00 5,542.00 -" Workshop on HIV surveys 4,290.00 1,242.00 3,027.90 20.10" Workshop on STI survey 8,580.00 5,360.50 3,219.502005 HIV Counselling 9,996.00 8,677.00 1,259.20 58.00 1.80" Sexually Transmitted Infection HIV/ AIDS 2,031.00 1,599.75 431.25 -" HIV- Counselling Training 3,000.00 1,900.00 932.32 167.00 0.68" HIV-Care and support for PLWHA 7,396.00 7,253.50 142.50Non-governmental organizations like TANGO, TUFHA receive specific financialsupport in the area of HIV.TUFHA as the leading non-governmental organization in the area of sexual andreproductive health receive funds from developmental partners to assist with in countryactivities on HIV (Table 2)Table 2. Tuvalu Family Health Association utilization of funds from various regional andinternational funding agencies.Year Projects Provisions 2005 2006 2007TotalexpenditureBalance2006Vision 2000 Fund Project (2006 Financialreport) 97,220.20 97,220.20 96,587.23632.97-2005 Pacific Regional HIV Project -1 st Grant 10,574.00 10,574.00 10,074.00 906.592006 Pacific Regional HIV Project -2 nd Grant 15,520.59 15,520.59 10,553.88 4,966.712006Marie Stopes International Pacific Project – 1 stQuarter 4,996.12 4,966.12 3,450.31 1,545.81"Marie Stopes International Pacific Project – 2 ndQuarter 7,111.86 7,111.86 1,364.62 5,747.242007 KAP Survey Project 16,000.00 16,000.00 15,983.02 16.98Source TUFHATANGO as the umbrella body for all NGOs in Tuvalu focuses on capacity building andempowerment of NGOs nationwide. One of their roles is the coordination of financialUNGASS 2008 Tuvalu 11

assistance from the Pacific Regional HIV Project based in Fiji, developing HIV relatedactivities for partner NGOs in country. (Table 3)Table. Tuvalu Association of NGOs utilization of funds from various regional andinternational funding agencies.TotalYear Projects Provisions 2005 2006 2007 expenditure Balance2006 Pacific Regional HIV Project 50,000 50,000 50,000 0NAC Grants 30,000 30,000 30,000 0Source: TANGODevelopmental partners like UNFPA, WHO, GFATM contribute largely to HIV inTuvalu.Indicator 2 National Composite Policy Index[Countries should specifically talk about the relationship between the existing policy,implementation of HIV programmes, proven behaviour change (from a survey) and HIVprevalence.National Programme IndicatorsIndicator 3. Percentage of donated blood units screened for HIV in aquality assured mannerThere is no blood bank in Tuvalu and people are recruited on the spot as the need arises.Donors are recruited by the Tuvalu Red Cross and screened annually for HIV and allother infections. When they are required to donate, they are again screened, but of coursethat may not detect all HIV.A register is kept in the Princess Margaret Hospital (the main national hospital inFunafuti) of all blood donations and the donors’ test results. However, this does not meetthe quality assurance standards required by UNGASS.Indicator 4. Percentage of adults and children with advanced HIVinfection receiving antiretroviral therapy100%. One (male, aged 30-39 yrs) of the 10 known people with HIV startedantiretroviral treatment in December 2007. As he is the only person who currently needsthis treatment, in fact all people in need of treatment in Tuvalu now receive it.UNGASS 2008 Tuvalu 12

Indicator 5. Percentage of HIV-positive pregnant women who receiveantiretrovirals to reduce the risk of mother-to-child transmissionThere were no known HIV-positive pregnant women in Tuvalu in 2006 or 2007 andtherefore no required treatment to reduce the risk of mother-to-child transmission. Therewas, however, no availability of antiretroviral treatment in Tuvalu during this period,treatment only coming available in December 2007.Indicator 6. Percentage of estimated HIV positive incident TB casesthat received treatment for TB and HIVThere were no known HIV-positive people with TB in Tuvalu in 2006 or 2007 andtherefore no required treatment for TB and HIV. There was, however, no availability ofantiretroviral treatment in Tuvalu during this period, treatment only coming available inDecember 2007.Indicator 7. Percentage of women and men aged 15-49 who receivedan HIV test in the last 12 months and who know the resultsThese figures cannot be fully decomposed by sex and age-group as these characteristics of peoplereceiving HIV tests were only recorded from August 2007.UNGASS 2008 Tuvalu 13

Table 2 People tested for HIV in Tuvalu, August-December, 2007MalesFemalesAge group Know Not know Know Not know> 15 yrs 4 615-24 yrs 70 4925-34 yrs 72 4335-49 yrs 94 22Total 240 120Source: Ministry of Health recordsIndicator 8. Percentage of most-at-risk populations that have receivedan HIV test in the last 12 months and who know the resultsThis indicator assesses progress in implementing HIV testing and counseling amongmost-at-risk populations. In order to protect themselves and to prevent infecting others, itis important for most-at-risk populations to know their HIV status. Knowledge of one’sstatus is also a critical factor in the decision to seek treatment. This indicator is calculatedseparately for each population that is considered most-at risk in a given country: sexworkers, injecting drug users and men who have sex with men.In Tuvalu, there are no recognized sex workers (although there are anecdotal reports ofinformal kinds of transactional sex) and there are no known injecting drug users. TheBSS survey reported on the existence of men who have sex with men but did not surveythem directly to find, for example, how many had been tested for HIV. From the youthBSS survey, 13.9% of males aged 15-24 years reported ever having sex with a male.There are, therefore, no data available about these groups.A recognised group of people at particular risk in Tuvalu are sea-farers: men who workaway from Tuvalu for months or years at a time on foreign-registered ships. This grouphas had tight surveillance and account for 70% of known HIV cases. This does notnecessarily reflect their higher prevalence but possibly their closer monitoring.Indicator 9. Percentage of most-at-risk populations reached withHIV/AIDS prevention programmesIn Tuvalu, there are no recognized sex workers (although there are anecdotal reports ofinformal kinds of transactional sex) and there are no known injecting drug users. TheBSS survey reported on the existence of men who have sex with men but did not surveythem directly to find, for example, how many had been tested for HIV. From the youthBSS survey, 13.9% of males aged 15-24 years reported ever having sex with a male.There are, therefore, no data available about these groups.Seafarers and their wives have been provided with specially-designed educationprogrammes by the Tuvalu Red Cross, funded by UNICEF. These education programsUNGASS 2008 Tuvalu 14

include awareness about HIV and STIs, information about protection, and life-skillstraining to counter family problems associated with long absences of men, problems thathave included family breakdowns and other social problems. Most of these programshave operated on the main island of Funafuti because of limited financial resources toconduct them on the other eight “outer” islands. This is an acknowledged short-comingand there are plans to improve national coverage.Indicator 10. Percentage of orphans and vulnerable children whosehouseholds received free basic external support in caring for thechildThere are no children as yet orphaned by AIDS in Tuvalu. Furthermore, the concept of‘orphans’ is not relevant to Tuvalu society. Children freely move between the householdsof their extended families and children who lose one or more parents are readily takeninto care by their other relatives.This indicator is therefore irrelevant to Tuvalu at present.Indicator 11. Percentage of schools that provided life-skills basedHIV/AIDS education within the last academic yearCoverage for primary schools: 100%Coverage for secondary schools: 100%Basic education from the age of 6 to 15 years is compulsory, there are schools on allislands, and enrolment in primary education in Tuvalu is therefore very close to 100%.Preschool and primary school curricula include lessons on health science, with languageand content appropriate to the children’s ages. The senior primary classes (ages 12-14)have full education on STIs and HIV. These classes are monitored by the Ministries ofEducation and Health, and there are plans to soon review the curricula on these subjects.At the two secondary schools in Tuvalu, all students participate in science classes, whichinclude human biology and topics relating to HIV and STIs. Different teachers may dealwith these topics in different ways.3.3 Knowledge and Behaviour IndicatorsIndicator 12. Current school attendance among orphans and amongnon-orphans aged 10–14*The Ministry of Education maintains a database on all children attending school inTuvalu, but collects no information as to whether these children have living parents ornot, or whether they reside with their biological parents.The concept of ‘orphans’ is not relevant to Tuvalu society. Children freely move betweenthe households of their extended families and children who lose one or more of theirbiological parents are readily taken into care by their other relatives.UNGASS 2008 Tuvalu 15

This indicator is therefore not relevant to Tuvalu and there is no information available.Indicator 13. Percentage of young women and men aged 15–24 whoboth correctly identify ways of preventing the sexual transmission ofHIV and who reject major misconceptions about HIV transmission*The 2005 - 2006 BSS survey of young people aged 15-24 found that 84% both reportedcorrect knowledge of HIV/AIDS prevention and no incorrect beliefs about HIV/AIDStransmission. 7 Furthermore, 71.6% reported having accepting attitudes towards peopleliving with HIV (%)This suggests that community education programmes have been successful, at least foryoung people.Table 3 HIV/AIDS knowledge, attitudes and access to HIV testing among 305 youths inTuvalu from August to November 2005.HIV/AIDS KNOWLEDGE GENDER TOTAL PERCENT(%)M F THeard of HIVYes 183 116 1 300 98.4No 4 1 0 5 1.6Chance of HIV reduced by using a Condom?Yes 160 99 1 260 85.2No 20 13 0 33 10.8Don’t Know 2 4 0 6 2.0No Answer/ Refuse 5 1 0 6 2.0Can a person get HIV from a mosquito bite?Yes 20 12 0 32 10.5No 156 90 1 247 81.0Don’t Know 6 14 0 20 6.6No Answer/ Refuse 5 1 0 6 2.0One Faithful PartnerYes 161 104 1 266 87.2No 16 6 0 22 7.2Don’t Know 4 6 0 10 3.3No Answer/ Refuse 6 1 0 7 2.3Chance of HIV reduced by not having sex (1)Yes 164 109 1 274 89.8No 17 6 0 23 7.5No Answer/ Refuse 6 2 0 8 2.6Do you think a healthy person can have HIV?Yes 152 97 1 250 82.0No 23 14 0 37 12.1No Answer/ Refuse 12 6 0 18 5.9Can a pregnant mother pass HIV to her unborn baby? (2)Yes 180 115 1 296 97.0No 1 0 0 1 0.3No Answer/ Refuse 6 2 0 8 2.6Is it possible to have a confidential HIV test?UNGASS 2008 Tuvalu 16

Yes 100 68 1 169 55.4No 65 41 0 106 34.8No Answer/ Refuse 22 8 0 30 9.8Have you ever tested for HIV?Yes 16 15 0 31 10.2No 166 101 1 268 87.9No Answer/ Refuse 5 1 0 6 2.0Find out resultsYes 13 13 0 26 83.9No 2 0 0 2 6.4Source: Homasi, 2007Indicator 14. Percentage of most-at-risk populations who bothcorrectly identify ways of preventing the sexual transmission of HIVand who reject major misconceptions about HIV transmissionIn Tuvalu, there are no recognized sex workers (although there are anecdotal reports ofinformal kinds of transactional sex) and there are no known injecting drug users. TheBSS survey reported on the existence of men who have sex with men but did not surveythem directly to find, for example, their understanding about HIV.There are, therefore, no data available about these groups.Seafarers and their wives are considered a group at special risk in Tuvalu. Out of 209seafarers covered by the SGS survey, only 27.8% had correct knowledge of HIV/AIDSprevention methods, and only 16.8% reported both correct knowledge of HIV/AIDSprevention and no incorrect beliefs about HIV/AIDS transmission ( see table below).Of the seafarers surveyed, none was found to be HIV positive but other STI rates werehigh: Chlamydia 8.1%; hepatitis B surface antigen 13.4%; syphilis 5.2%, suggesting thatthese men either did not understand about transmission of STIs or did not practice safesex.Consistent condom use was reported low between seafarers and all their partners. Amongthose infected with any STI, 57% were using condoms when having sex with acommercial partner and 16.6% with casual partner. On their return to Tuvalu these menengage in unprotected sexual contact with their regular partners, increasing the risk oftransmission of any STIs three fold in this population. Seafarers are therefore importantbridges for the spread of STIs and potentially HIV into Tuvalu. They have unprotectedsex with partners overseas and also with regular partners in Tuvalu. Seafarers aretherefore an important population for targeted interventions in this study. Thedevelopment of targeted behavioural interventions for seafarers may eventually exertpositive attitudes towards behavioural change leading to safer sexual behaviours andpractices.Table 4 Selected indicators of HIV and sexual behaviour among 209 seafarers attendingPrincess Margaret Hospital in Funafuti, Tuvalu from August 2005 to February 2006.UNGASS 2008 Tuvalu 17

Indicator N = 209HIV prevalence (%) 0Median age at first sex 18 (9-30)Median number of female sex partners in last 12 months 1 (0-10)Proportion having sex with female casual partners in last 12 months 14.4Median number of female casual partners in last 12 months 0 (0-10)Proportion of adult male using condoms at last sex with female casualpartner in last 12 months (%)Consistent condom use of adult male with female casual partners in last12 monthsProportion of adult male reporting having sex with female commercialpartners in last 12 monthsMedian number of female commercial partners in last 12 months 1 (0-5)Proportion of adult male using condoms at last female commercial sex(%)Consistent condom use of adult male with female commercial partner inlast 12 months (%)Proportion of adult males reporting sex with men in the last 12 months 0.0Proportion of adult males reporting use of condoms with last anal sexwith male partner (%)5.72.43.385.757.1Proportion who have ever received HIV testing and know the result 93.7Correct knowledge of HIV/AIDS prevention methods (%) 1 27.8No incorrect beliefs about HIV/AIDS transmission (%) 2 63.6Proportion who both report correct knowledge of HIV/AIDS preventionand no incorrect beliefs about HIV/AIDS transmission (%)Source: Homasi, 20070.014.8Indicator 15. Percentage of young women and men who have hadsexual intercourse before the age of 15The 2007 Behavioural Surveillance Survey of young people aged 15-24 years has beenanalysed only in regard to the age at which they first had sex, not as to whether they hadsex before the age of 15 years. The information required for this indicator is thereforecurrently not available.Almost one half (43.6%) of youths had ever had sex, 62% males and 14.5% females. Themedian age at first sex was 18 years and ranged from 15 to 24 years for both males andfemales. Among those who are sexually active, their partners are mostly young peoplearound the same age or younger, with only 20.3% reported using condoms at first sexualintercourse.Table 5 Selected FHI behavioural indicators for 305 youth in Tuvalu from August toNovember 2005.Indicator N=305Median age at first sex by genderUNGASS 2008 Tuvalu 18

TotalMaleFemaleSource: Homasi, 200718 (15-24)18 (15-24)18 (15-24)Table 6 Sexual experiences of 305 youths aged 15-24 years in Tuvalu from August toNovember 2005.SEXUAL EXPERIENCE GENDER TOTAL PERCENT(%)M F TEver had sexYes 116 17 0 133 43.6No 71 100 1 172 56.4Age at first sex18 32 10 0 42 31.6Age Difference between first sex partner10 years older 2 0 0 2 1.55-10 years older 5 5 0 10 7.5Less than 5 years older 36 6 0 42 31.6Same age 47 6 0 53 39.8Younger 26 0 0 26 19.5Is Condom used at first sexYes 23 4 0 27 20.3No 93 13 0 106 79.7Source: Homasi, 2007Indicator 16. Percentage of adults aged 15–49 who have had sexualintercourse with more than one partner in the last 12 monthsThese data are not available, but there is information of some relevance here.There are strong social mores against premarital and extramarital sexual activity inTuvalu. Evidence that many young people are sexually active comes from the 2005 -2006 BSS, and shown in the following table.Table 7 Sex with commercial and non-commercial partners among 305 youths in Tuvalufrom August to November 2005.COMMERCIAL SEX PARTNERS GENDER PERCENT(%)Sex with commercial sex partner M F TYes 3 0 0 1.0No 184 117 1 99.0No of sex with Commercial PartnerUNGASS 2008 Tuvalu 19

5 2 0 0 66.6Condom useYes 2 0 0 66.6No 1 0 0 33.3Condom use frequently over last 12 mthsEvery time 3 0 0 100Sometimes 0 0 0 0Never 0 0 0 0NON COMMERCIAL PARTNERSNon-Commercial PartnerYes 97 15 0 36.7No 90 102 1 63.3No of sex with Non-Commercial Partner5 53 4 0 50.9Don’t Know 2 0 0 1.7No Answer/Refuse 4 1 0 4.4Condom useYes 61 6 0 59.8No 35 8 0 38.4No Answer/refused 1 1 0 1.8Consistent condom use over last 12 mthsEvery time 11 2 0 11.6Almost every time 13 1 0 12.5Sometimes 58 6 0 57.1Never 15 5 0 17.8Source: Homasi, 2007Data from the seafarers SGS show that they too are sexually active, as evident in thefollowing table:UNGASS 2008 Tuvalu 20

Table 8 Sexual behaviours by age group among 209 seafarers attending Princess MargaretHospital in Funafuti, Tuvalu from August 2005 to February 2006.20-29 30-39 40-49 50-59 TotalNo No % No % No % No %Ever sex in lifeYes 71 67 100 50 100 18 100 206 98.6No 3 0 0.0 0 0.0 0 0.0 3 1.4Not stated 0 0 0.0 0 0.0 0 0.0 0 0.0Median age at first sex 18 18 18 18 18Sex in last 12 monthsYes 64 67 100 48 96 18 100 197 94.3No 10 0 0.0 2 4.0 0 0.0 12 5.7Not stated 0 0 0.0 0 0.0 0 0.0 0 0.0Median number offemale partners in thelast 12 months2 1 1 1 1Number of partners inthe last 12 months0 10 2 3.0 2 4.0 0 0.0 14 6.71 30 60 89.5 48 96 18 100 156 74.6≥2 34 5 7.5 0 0.0 0 0.0 39 18.7MSM in lifeYes 0 0 0.0 0 0.0 0 0.0 0 0.0No 74 67 100.0 50 100 18 100 209 100.0Ever diagnosed withSTD in last 12 monthsYes 5 0 0.0 0 0.0 0 0.0 5 2.4No 69 67 100.0 50 100 18 100 204 97.6Sex with commercialpartner in last 12monthsYes 6 1 1.5 0 0.0 0 0.0 7 3.3No 68 66 98.5 50 100 18 100 202 96.7Sex with casualpartner in last 12monthsYes 25 5 7.5 0 0.0 0 0.0 30 14.4No 49 62 92.5 50 100 18 100 179 85.6Source: Homasi, 2007Women in Tuvalu are more likely to meet social expectations of restrained sexualactivity. The survey of women attendees at the antenatal clinic reflects this, although thefact that they are pregnant may bias this information.UNGASS 2008 Tuvalu 21

Table 9 Behavioural characteristics of 114 pregnant women by age attending PrincessMargaret Hospital antenatal clinic in Funafuti, Tuvalu from August 2005 to February 2006.Outcome 25TotalyearsyearsNo % No % No %Median age at first 20 20 20Age at first sex18 50 78.1% 38 76% 88 77.2%Number of sexual partners in life1 56 87.5 37 74.0 93 81.6%>2 8 12.5 13 26.0 21 18.4%Number of sexual partners in last 12months1 63 98.4% 49 98% 112 98.2%>2 1 1.6% 9 2% 2 1.8%Sex for money or gift in last 12monthsYes 0 0 0 0 0 0No 64 100% 50 100% 114 100%Concurrent partner in last 12 monthsYes 2 3.1% 0 0.0 2 1.8%No 62 96.9% 50 100.0 112 98.2%Source: Homasi, 2007Indicator 17. Percentage of adults aged 15–49 who had more than onesexual partner in the past 12 months who report the use of a condomduring their last intercourse*There are no data available for the whole of this age-group and both sexes.Some relevant information was however provided by the SGS survey of seafarers.Table 10 Selected indicators of HIV and sexual behaviour among 209 seafarers attendingPrincess Margaret Hospital in Funafuti, Tuvalu from August 2005 to February 2006.Indicator N = 209Median number of female sex partners in last 12 months 1 (0-10)Proportion having sex with female casual partners in last 12 months 14.4Median number of female casual partners in last 12 months 0 (0-10)Proportion of adult male using condoms at last sex with female casualpartner in last 12 months (%)Consistent condom use of adult male with female casual partners in last12 monthsUNGASS 2008 Tuvalu 225.72.4

Proportion of adult male reporting having sex with female commercialpartners in last 12 monthsMedian number of female commercial partners in last 12 months 1 (0-5)Proportion of adult male using condoms at last female commercial sex(%)Consistent condom use of adult male with female commercial partner inlast 12 months (%)Proportion of adult males reporting sex with men in the last 12 months 0.0Proportion of adult males reporting use of condoms with last anal sexwith male partner (%)Source: Homasi, 2007Indicator 18. Percentage of female and male sex workers reportingthe use of a condom with their most recent clientWhile some transactional sex occurs in Tuvalu in an informal, disorganised way, nopeople are at all identifiable as sex workers. No healthcare workers were aware of any oftheir patients being sex workers.Indicator 19. Percentage of men reporting the use of a condom thelast time they had anal sex with a male partnerTwo SGS surveys conducted in 2007 reported information on men who have sex withmen. Of the two surveys, the youth BSS appears to provide the more accurateinformation on this topic. Among 187 male youths in this study, 26 (13.9%) reported everhaving sex with another male and 15 (8.0%) in the last 12 months. Anal sex was reportedby 16 (8.6%) with 10 (62.5) of them reporting the use of a condom. In the survey ofseafarers, none reported having sex with another male in the past 12 months, and this isnot considered to be reliable data.3.385.757.10.0Table 11 Sexual behaviours of 187 male youths in Tuvalu from August to November 2005.BEHAVIOUR Number Percent (%)Sex with male partner in lifeYes 26 13.9No 161 86.1Sex within last 12 monthsYes 15 8.0No 172 92.0Anal sex within last 12 monthsYes 16 8.6No 171 91.4Condom use with male sex partnerYes 10 62.5No 6 37.5Source: Homasi, 2007UNGASS 2008 Tuvalu 23

Table 12 Selected indicators of HIV and sexual behaviour among 209 seafarers attendingPrincess Margaret Hospital in Funafuti, Tuvalu from August 2005 to February 2006.Indicator N = 209Proportion of adult males reporting sex with men in the last 12 months 0.0Proportion of adult males reporting use of condoms with last anal sexwith male partner (%)Source: Homasi, 2007Indicator 20. Percentage of injecting drug users who reported usingsterile injecting equipment the last time they injectedThis is not relevant to Tuvalu. There are no known injecting drug users. There are other commonforms of substance abuse, particularly alcohol, but this does not involve greater risk of HIVtransmission.Indicator 21. Percentage of injecting drug users who report the use ofa condom at last sexual intercourseThis is not relevant to Tuvalu. See Indicator 20 above.0.0Impact indicatorsIndicator 22. Percentage of young women and men aged 15–24 whoare HIV infected*Data are not available. Serosurveillance in Tuvalu is limited. Testing is only available onthe main island, Funafuti. No seroprevalence surveys have been conducted for this agegroup.Indicator 23. Percentage of most-at-risk populations who are HIVinfectedThere are no data available for the population groups that are conventionally consideredto be most at risk, namely sex workers, men who have sex with men and injecting drugusers. There is however information available about seafarers, a population group inTuvalu that is considered to be at special risk.Among 209 seafarers, none were found to be HIV positive. The most common STI isChlamydia, 8.1%, followed by Syphilis 5.2% and Gonorrhoea 0.5% (Table 9). HepatitisB was found to be high in this population with 13.4 % positive for surface antigen. Theoverall prevalence for any STI (excluding Hepatitis B) among seafarer was 27.3%. Noneof the seafarers diagnosed with any of the STIs in this study reported any symptoms ofinfection.Most seafarers (94.3%) had sex in the previous 12 months. The median age at first sexwas 18 (range 9-30). Age was found to be associated with an increased risk of acquiringUNGASS 2008 Tuvalu 24

any STI (Chlamydia/Syphilis/Gonorrhoea) among those below 25 years (OR=1.55 95%CI 0.61, 3.96) and Hepatitis B infection (OR=2.1 95%CI 0.59, 7.23) but this finding isnot statistically significant.Approximately 82.8% of seafarers with any STI reported having sex with a regularfemale partner in Tuvalu in the last 12 months. About 3.3% reported having sex with acommercial female partner and 14.4% with casual female partner in the last 12 months.None of these encounters show any significant increase in risk of having Chlamydia andAny STI. However an increased risk was observed for Hepatitis B infection amongseafarers with partners on ships (OR=2.7 95%CI 0.49, 14.7) and casual partners(OR=2.18, 95% CI 0.22, 21.8) none of which is statistically significant.None of the seafarers in this study reported having sex with a male partner in the last 12months or in their lifetime.Among those who are infected with any STI, condom was never used when having sexwith a regular partner(s) in Tuvalu (100%) and overseas on ships (96.4%). Those whohad sex with a commercial female partner 85.7% reported using condoms but only 57%were using consistently. Among those who had sex with a casual partner in the last 12months 33.3% reported using condoms at last sexual encounter but very few 16.6% usedcondoms consistently. The risk of Chlamydia is three fold when condoms are not usedbut this finding is not statistically significant (OR=3.12 95%CI 0.94, 10.3).Seafarers who reside on Funafuti (urban) were at a higher risk of any STI, but notstatistically significant (p=0.56) Among the different levels of seafarers, ordinary seamanaccounted for 27.6% of all STIs in this population. Ordinary seafarers are usually new toseafaring and most have just completed one contract of work overseas.Knowledge of HIV prevention methods was poor among seafarers. Only 58 (27.8%) ofparticipants had all correct knowledge of HIV protection patterns of condom protection(62.5%), faithful partner (50%) and abstinence from sex (55%).Only 14.8% seafarers had both correct HIV protection knowledge and belief of HIVtransmission. Most (96.7%) of seafarers reported the possibility of a confidential HIV testin their community, Most (93.7%) had been tested for HIV and knew the result.Indicator 24. Percentage of adults and children with HIV known to beon treatment 12 months after initiation of antiretroviral therapyThis is not relevant at present for Tuvalu. Antiretroviral treatment only began here inDecember 2007.Indicator 25. Percentage of infants born to HIV infected mothers whoare infectedTo date, only one child has been born an HIV infected mother, well before this reportingperiod.UNGASS 2008 Tuvalu 25

Best practicesTuvalu is a small and fairly conservative Polynesian society where open discussion of sexualmatters is still inhibited by custom and sexual behaviour especially of young people isconstrained by social expectations, although this situation is changing.The main means of HIV transmission in Tuvalu is sexual intercourse. Public education hasbeen seen as the main means of addressing the threat of HIV to this society. Theseprogrammes have needed to work around the strong traditional constraints on discussingsexual issues and change public attitudes, both towards increasing use of safe sex methodsand away from prejudices against people with HIV and other STIs.Public education programmes have been implemented mainly by non-governmentorganisations: the Tuvalu Family Health Association (TUFHA), which is funded principallyby IPPF; the Tuvalu Association of NGOs (TANGO) which has received funding fromAusAID and SPC; and the Tuvalu Red Cross, funded mainly by UNICEF.• TANGO has been working with the Pacific Regional HIV Project to strengthen thecapacity of communities to address HIV issues, particularly in the design of publiceducation materials to more effectively communicate in the Tuvaluan culturalcontext and in Tuvaluan language.• TUFHA has conducted a variety of programs to raise awareness and improveunderstanding about family issues and sexual and reproductive health, including HIVand STIs, including group discussions, workshops, drama group productions, schoolprogrammes, and other presentations.• The Tuvalu Red Cross Society has focussed on education programmes and life-skillstraining for seafarers and their wives.These types of behavioural and attitudinal changes can be difficult to monitor. In late 2006,TUFHA conducted a KAP survey of unmarried youth aged between 14 and 25 years, tomeasure the impact of a three year program funded by IPPF and EU. Evidence from thissurvey and the WHO-funded youth BSS in 2006 point towards a high level of awareness ofand knowledge about STIs and HIV among young people, together with a moderate level ofcondom use. The 2006 sero-surveillance study of seafarers suggests that their behaviour andattitudes have been slower to change, possibly because of their older age.Another success has been the transfer of leadership of TUNAC from the Ministry of Healthto NGOs, enabling TUNAC to develop into an independent body, not a subsection of theMinistry.Major challenges and remedial actionsThe first national HIV/AIDS strategic plan (2001-2005) focussed on:UNGASS 2008 Tuvalu 26

1. Provision of access to treatment, quality care and support for PLWHA, their familiesand caregivers;2. Prevention and control of HIV and STIs through community education and VCCT;3. Reducing the vulnerability among specific groups (youth, seafarers) by promotingsafer sexual behaviour;4. Providing a safe supply of blood and blood products; and5. Coordinating a multi-sectoral response.These were the main areas of work that were successfully achieved throughout this period;1. Establishing health science education in primary schools, through the design andimplementation of health science curricula that includes HIV and STI topics;2. Establishing a youth centre at the TUFHA Office on Funafuti, which provides youthfriendly sexual and reproductive health services;3. Community education, with a variety of community health activities underway, butmostly on the island of Funafuti;4. Special projects for seafarers, focussing on alcohol abuse, HIV and STI prevention,and family life-skills;5. The involvement of the churches in HIV prevention activities;6. The development of a national policy on HIV and AIDS that was endorsed byCabinet in 2005. This included the establishment of an HIV/AIDS clinical team inthe Ministry of Health and commitment of funds from the national budget.7. A multi-sectoral approach, spearheaded by TUNAC, a body that comprisesrepresentatives of a wide body of stakeholders from both government and NGOagencies.The current national HIV strategy (2008-2012) focuses on four priority areas:1. Achieving an enabling environment2. Prevention of HIV and other STIs3. Treatment, care and support4. Program managementThe full work-programme for the current national HIV strategy is provided in Annex 3.UNGASS 2008 Tuvalu 27

Support from the country’s development partnersThe Tuvalu Government provides only a small annual allocation (A$7,000) to the Ministryof Health for HIV treatment. All other funds for activities specific to HIV and AIDS comefrom development partners. These principally are:1. GFATM through the SPC-implemented Pacific Regional HIV Project (PRHP).This funding is channelled through TANGO for community empowerment andeducation activities.2. AusAID, through the Australian Government’s bilateral aid programme to Tuvalu.This funding similarly is channelled through TANGO for community empowermentand education activities.3. International Planned Parenthood Federation (IPPF), which is channelledthrough TUFHA for community education activities;4. WHO, which assists the Ministry of Health; and5. UNICEF, which provides funding through the Tuvalu Red Cross Society foreducation programmes and lifeskills training for seafarers and their wives.Monitoring and evaluation environmentTUNAC is responsible for the overall monitoring and evaluation of the national response toHIV. There is no M&E framework but TUNAC aims at recruiting an M&E specialist todevise an M&E framework for the NSP with clear indicators. In the meantime TUNAC willreview the NSP annually to assess progress against targets, draft annual plan every year aftercompleting annual review of current year to include the HIV programs of NGOs and privatesector agencies.There is also a plan to recruit a TA to train M&E officers in CRIS Database and develop anational database for sero and behavioural surveillance enabling regular review and analysisin trends of the epidemic in Tuvalu.Monitoring of disease trend is currently the work of the Ministry of Health who reportsdirectly to the Tuvalu National AIDS Committee. M&E of disease was previously basedentirely on biological surveillance with the use of case reporting of HIV and AIDS in anational register, death registration and STI surveillance are among the other surveillancesystems still in use. The first Second Generation Surveillance was introduced in 2005, whichincludes STI surveillance to monitor the spread of STI in populations at risk of HIV andbehavioural surveillance to monitor trends in risk behaviours over time. Tuvalu will take partin the next rounds of SGS which will allow for better assessment of disease trends andbehaviour trends in Tuvalu. The introduction of CRIS database should improve the analysisof trends in Tuvalu.Tuvalu National AIDS Committee is responsible for the overall monitoring of HIV activitiescovering both Government and Civil society responses. The NSP details the variousmonitoring and evaluation tools that will monitor the various activities for differentUNGASS 2008 Tuvalu 28

• Support the implementation of Adolescent Health and Development(AHD) program focusing on reproductive and sexual health in youngpeople aged 9 to 19 years.12. Review current health promotion strategies in sexual health.• Review health messages – targeted but making sure it doesn’t promotedenial, shame and false sense of security.• Promote awareness of STI symptoms to improve treatment seekingbehaviour.• Revisit ‘the travel pack’ used in the early 1990s in Tuvalu where condomsand health messages were given as part of a ‘going away’ and ‘returnhome’ package to travellers.13. Review condom programs in terms of accessibility, availability and promotion inTuvalu.14. Improve laboratory capacity in the diagnosis of STIs.• Review current STI laboratory registers• Strengthen relationship with referral laboratories (Fiji and Australia)15. Surveillance and reporting of STIs• Improve syndromic case management reporting (especially in ruralsettings)• Improve methods of etiological reporting at Princess Margaret HospitalLaboratory.16. Evaluate in consultation with WHO the cost effectiveness of BSS. (Suggestingmoney better spent elsewhere e.g Chlamydia test kits)UNGASS 2008 Tuvalu 30

References1 Secretariat of the Pacific Community: The Pacific Regional Strategy on HIV/AIDS.20052 Buchanan-Aruwafu. H, Integrated Picture: HIV Risk and Vulnerability in thePacific. February 20073 UNAIDS website: Available atwww.unaids.org/en/Regions_Countries/Regions/Oceania.asp. Accessed Dec 13,2007.4 SPC website: Available at www.spc.int. Accessed Dec 13, 20075 Tuvalu 2002 Population and Housing Census vol 1- Analytical report, TuvaluGovernment, Funafuti, Tuvalu 2002;6 Strategic Plan to respond to HIV/AIDS and STI, 2001-2005, Ministry of HealthTuvalu Government, Funafuti, Tuvalu 2001.7 Homasi S M K, HIV/AIDS and other STIs in Tuvalu 2006.8 Annual Report. Ministry of Health, Tuvalu Government, 2003; Strategic Plan torespond to HIV/AIDS and STI, 2001-2005, Ministry of Health Tuvalu.9 Annual Report. Ministry of Health, Tuvalu Government, Funafuti, Tuvalu 200310 Department of Statistics.Tuvalu National Census, Tuvalu Government, Funafuti,Tuvalu, 2002.11 HIV and STI Situation Analysis report, Ministry of Health, Funafuti, Tuvalu 199912 Annual Report. Ministry of Health, Tuvalu Government, Funafuti Tuvalu 2003UNGASS 2008 Tuvalu 31

ANNEXESANNEX 1: Consultation and Preparation ProcessConsultation/preparation process for the Country Progress Report on monitoring thefollow-up to the Declaration of Commitment on HIV/AIDSWhich institutions/entities were responsible for filling out the indicator forms?a) NAC or equivalent Yes Nob) NAP Yes Noc) Others (please specify) Yes NoWith inputs fromMinistries:Education Yes NoHealth Yes NoLabour Yes NoForeign Affairs Yes NoOthers (please specify) Yes No(Finance)Civil society organizations Yes NoPeople living with HIV Yes NoPrivate sector Yes NoUnited Nations organizations Yes NoBilaterals Yes NoInternational NGOs Yes NoOthers Yes No(please specify)Was the report discussed in a large forum? Yes NoAre the survey results stored centrally? Yes NoAre data available for public consultation? Yes NoWho is the person responsible for submission of the report and for follow-up if there arequestions on the Country Progress Report?UNGASS 2008 Tuvalu 32

Name / title: DR STEPHEN MAFOA KAIMOKO HOMASIDate: 15 JANUARY 2008Signature: ___________________________Address: PRINCESS MARGARET HOSPITAL, FUNAFUTI, TUVALUEmail: skivi2001@yahoo.com Telephone: (688) 20765UNGASS 2008 Tuvalu 33

ANNEX 2: National Composite Policy Index 2007COUNTRY: TUVALUName of the National AIDS Committee Officer in charge:DR STEPHEN MAFOA KAIMOKO HOMASISigned:Postal address:PRINCESS MARGARET HOSPITALFUNAFUTITUVALUTel: (688) 20419Fax: (688) 20832E-mail: skivi2001@yahoo.comDate of submission: 15 JANUARY 2008UNGASS 2008 Tuvalu 34

ANNEX 2: National Composite Policy Index[INSERT NCPI document after you have had a meeting with civil society and governmentfor their feedback]Appendix 7. National Composite Policy Index (NCPI) 2007TUVALUName of the National AIDS Committee Officer in charge:DR STEPHEN MAFOA KAIMOKO HOMASISigned:Postal address: PRINCESS MARGARET HOSPITAL, FUNAFUTI,TUVALUTel: 688 20765Fax: 688 20832E-mail: skivi2001@yahoo.comDate of submission: 15 JANUARY 2008UNGASS 2008 Tuvalu 35

INSTRUCTIONSBACKGROUNDThe following instrument measures the UNGASS National Commitment and Action indicator, acomposite policy index designed to assess progress in the development and implementationof national HIV/AIDS policies and strategies. It is an integral part of the list of coreUNGASS indicators and is to be completed and submitted as part of the 2007UNGASS Country Progress Report.This third version of the National Composite Policy Index (NCPI) has been updated toreflect new HIV/AIDS programmatic guidance and to be consistent with new and agreed topolicy and implementation measurement tools. 14NCPI data were also submitted in previous UNGASS reporting rounds in 2003 and 2005.Countries are strongly advised to conduct a trend analysis on the key questions and include adescription of the findings in the 2007 Country Progress Report. 15STRUCTURE OF THE QUESTIONNAIREThe NCPI is divided into two parts:Part A to be administered to government officials.Part A covers five areas:1. Strategic plan2. Political support3. Prevention4. Treatment, care and support5. Monitoring and evaluationPart B to be administered to representatives from nongovernmental organizations,bilateral agencies, and UN organizations.Part B covers four areas:I. Human rightsII. Civil society involvementIII. PreventionIV. Treatment, care and supportThe overall responsibility for collating and submitting the information requested inthe NCPI lies with the National Governments, through officials from the NationalAIDS Committee (NAC) (or equivalent) with support from UNAIDS and other partners.14 Policy and Planning Effort Index or children orphaned and made vulnerable by HIV/AIDS, UNICEF 2005;Scaling up Towards Universal Access, UNAIDS 2006; Setting National Targets for Moving Towards UniversalAccess, UNAIDS 2006; Practical Guidelines for Intensifying HIV Prevention; UNAIDS 200715 see Guidelines on construction of core indicators, UNAIDS 2002 and UNAIDS 2005, respectively, for the keyquestions in previous NCPI questionnairesUNGASS 2008 Tuvalu 36

PROPOSED STEPS FOR DATA GATHERING1. Designation of two technical coordinators for the study (one for part A; one forpart B)Technical coordinators should be given responsibility to undertake the desk review andcarry out interviews to answer specific questions. Preferably, the technical coordinatorfor Part A should be from the NAC (or equivalent) and for Part B should be a personoutside the government. These persons should ideally have a monitoring and evaluationbackground and may request the assistance of consultant(s) with a similar background.2. Data gatheringEach section should be completed by (a) desk review and (b) interviewing key peoplemost knowledgeable about that topic:o Strategic Plan and Political Support: the Director or Deputy Director of the NationalAIDS Programme or National AIDS Council, the Heads of the AIDS Programme atprovincial and at district levels and UNAIDSo Monitoring and Evaluation: Officers of the National AIDS Committee or equivalent,Ministry of Health, HIV focal points of other ministries.o Human rights: Ministry of Justice officials, human rights commissioners, andrepresentatives of human rights nongovernmental organizations and legal aidcentres/institutions, persons living with HIV.o Civil society participation: key representatives of major civil society organizationsworking in the area of HIV and AIDS, persons living with HIV.o Prevention and treatment, care and support sections: Ministries and major implementingagencies/organizations in those areas, including nongovernmental organizations andpersons living with HIV.3. Data entry, analysis and interpretationOnce the NCPI is fully completed, the technical coordinators need to carefully review allresponses to determine if additional consultations or review of more documents areneeded. It is important to analyze the data for each of the NCPI sections and include awrite-up in the Country Progress Report in terms of progress made in policy/strategydevelopment and implementation of programmes to tackle the country’s HIV/AIDSepidemic. Comments on the agreements/discrepancies between overlapping questions inPart A and Part B should also be included, as well as a trend analysis on the key NCPIdata since 2003, where available. The NCPI findings need to be presented, discussed andagreed during the national UNGASS consultation workshop (see 4 below). It is stronglyencouraged to enter the final agreed data in the Country Response Information System(CRIS). If this is not possible, an electronic version of the completed questionnaireshould be submitted as an appendix to the Country Progress Report.4. Consultation workshop organized by the NAC (or equivalent)It is strongly recommended that the NAC (or equivalent) organizes a one-day broadconsultation forum to discuss and endorse the major findings of the UNGASS countryreport, including the results from the NCPI. It is expected that civil societyUNGASS 2008 Tuvalu 37

organizations, including faith-based organizations, gender equality groups, women’srights groups, human rights/legal advocacy organizations, and other majornongovernmental organizations are invited to participate.NCPI Respondents[Indicate all respondents whose responses were compiled to fill out (parts of) the NCPI in thebelow table; add as many rows as needed]NCPI - PART A [to be administered to government officials]Respondents to Part A[indicate which parts each respondentwas queried on]Organisation Name/Position A.I A.II A.III A.IV A.V1. Provisionof accesstotreatment,quality careandsupport forPLWHA,theirfamiliesandcaregivers;2. Preventionand controlof HIVand STIsthroughcommunityeducationand VCCT;Dr Stephen Homasi(Ag Director ofHealth)Ms Avanoa HomasiPaelate(Health Educator andPromotion Officer,Ministry of Health)Ms Maseiga Ionatana(National SchoolSupervisor, Ministryof Education)Ms Simalua Sopoaga(Research Officer,Ministry of Finance)Yes Yes Yes Yes YesUNGASS 2008 Tuvalu 38

3. Reducingthevulnerability amongspecificgroups(youth,seafarers)bypromotingsafer sexualbehaviour;4. Providing asafe supplyof bloodand bloodproducts;and5. Coordinating amultisectoralresponse.NCPI - PART B [to be administered to nongovernmental organizations, bilateralagencies, and UN organizations]Organisation Name/Position Respondents to Part BUNGASS 2008 Tuvalu 39

[indicate which parts each respondentwas queried on]B.I B.II B.III B.IVTuvalu Red CrossSocietyTuvalu Association ofNGOsTuvalu Family HealthAssociationMs Eseta Lauti(Secretary General)Mrs Annie Homasi(Coordinator)Ms Emily Koepke(Executive Director)Yes Yes Yes YesYes Yes Yes Yesyes Yes Yes YesTuvalu NationalCouncil of WomenMrs Pula Maatia(Secretary General)YesYesSeventh Day Adventist Mrs Pauke Maani Yes yesNote: In the NCPI answers, N/A stands for “Not Applicable”UNGASS 2008 Tuvalu 40

NATIONAL COMPOSITE POLICY INDEX QUESTIONNAIREI. STRATEGIC PLANPART A[to be administered to government officials]1. Has the country developed a national multi-sectoral strategy/action frameworkto combat HIV/AIDS?(Multi-sectoral strategies should include, but are not limited to, those developed byMinistries such as the ones listed under 1.3)YesPeriod covered: [write in]NSP 2001 – 2005NSP 2008 – 2012 (current)IF NO or N/A, briefly explain whyIF YES, complete questions 1.1 through 1.10; otherwise, go to question 2.1.1 How long has the country had a multi-sectoral strategy/action framework?Since the first NSP in 20011.2 Which sectors are included in the multi-sectoral strategy/action framework with aspecific HIV budget for their activities?Sectors includedStrategy / ActionframeworkEarmarked budgetUNGASS 2008 Tuvalu 41

Health Yes YesEducation Yes YesLabour Yes NoTransportation Yes NoMilitary/Police Yes NoWomen Yes YesYoung people Yes YesTuvalu Youth CouncilYesYesFinanceYESN0*Any of the following: Agriculture, Finance, Human Resources, Justice, Minerals andEnergy, Planning, Public Works, Tourism, Trade and Industry.IF NO earmarked budget, how is the money allocated?For those without earmarked budgets, the Ministry ofHealth and Developmental partners through specificprojects provide finance for their activities. But there is noset allocation from their recurrent budgets on an annualbasis.1.3 Does the multi-sectoral strategy/action framework address the following targetpopulations, settings and cross-cutting issues?Target populationsa. Women and girlsb. Young women/young menc. Specific vulnerable sub- populations 16d. Orphans and other vulnerable childrena. Yesb. Yesc. Yesd. No16 Sub-populations that have been locally identified as being at higher risk of HIV transmission (injecting drug users, men having sexwith men, sex workers and their clients, cross-border migrants, migrant workers, internally displaced people, refugees, prisoners, etc.).UNGASS 2008 Tuvalu 42

Settingse. Workplacef. Schoolsg. PrisonsCross-cutting issuesh. HIV/AIDS and povertyi. Human rights protectionj. PLHIV involvementk. Addressing stigma and discriminationl. Gender empowerment and/or gender equalitye. Yesf. Yesg. Yesh. Noi Yesj. Yesk. Yesl. Yes1.4 Were target populations identified through a process of a needs assessment or needsanalysis?YesIF YES, when was this needs assessment /analysis conducted?Year: 1999IF NO, how were target populations identified?1.5 What are the target populations in the country?Seafarers and Youths.1.6 Does the multi-sectoral strategy/action framework include an operational plan?Yes1.7 Does the multi-sectoral strategy/action framework or operational plan include:a. Formal programme goals? YesUNGASS 2008 Tuvalu 43

. Clear targets and/or milestones? Yesc. Detailed budget of costs perprogrammatic area?Yesd. Indications of funding sources? Yese. Monitoring and Evaluationframework?Yes1.8 Has the country ensured “full involvement and participation” of civil society 17 in thedevelopment of the multi-sectoral strategy/action framework?Active involvementThe Tuvalu National AIDS Committee who oversees the overall plan fHIVIs made up of all key stakeholders i.e. community based organization, faibased organization, seafarers organizations, youth and women, including kGovernment departments.17 Civil society includes among others: Networks of people living with HIV; women's organizations; young people’sorganizations; faith-based organizations; AIDS service organizations; Community-based organizations; organizations of keyaffected groups (including MSM, SW, IDU, migrants, refugees/displaced populations, prisoners); workers organizations,human rights organizations; etc. For the purpose of the NCPI, the private sector is considered separately.UNGASS 2008 Tuvalu 44

IF NO or MODERATE involvement, briefly explain :1.9 Has the multi-sectoral strategy/action framework been endorsed by most externalDevelopment Partners (bi-laterals; multi-laterals)?Yes1.10 Have external Development Partners (bi-laterals; multi-laterals) aligned andharmonized their HIV and AIDS programmes to the national multi-sectoralstrategy/action framework?Yes, some partnersNational framework has been developed in line with regional organizations,e.g. Secretariat of the Pacific Community (SPC) and WHO (WesternPacific Region)UNGASS 2008 Tuvalu 45

2. Has the country integrated HIV and AIDS into its general development planssuch as: a) National Development Plans, b) Common Country Assessments/United Nations Development Assistance Framework, c) Poverty ReductionStrategy Papers, d) Sector Wide Approach?Yes2.1 IF YES, in which development plans is policy support for HIV and AIDSintegrated?a)National Developmental Plans – Kakeega II, b). United Nations Devcelopment AssistanceFramework, c) Sector wide approach(Ministry of Health)2.2 IF YES, which policy areas below are included in these development plans?Check for policy/strategy includedDevelopment PlansPolicy Areaa) b) c) d) e)HIV Prevention Yes Yes YesTreatment for opportunistic infectionsYesART yes YesCare and support (including social security or Yes Yes Yesother schemes)HIV/AIDS impact alleviation Yes Yes YesReduction of gender inequalities as they relate toHIV prevention/treatment, care and/or supportReduction of income inequalities as they relate toHIV prevention/ treatment, care and /or supportYes Yes YesYesReduction of stigma and discrimination Yes YesWomen’s economic empowerment (e.g. access to Yes Yescredit, access to land, training)Other: [write in]3. Has the country evaluated the impact of HIV and AIDS on its socio-economicdevelopment for planning purposes?Yes3.1 IF YES, to what extent has it informed resource allocation decisions?LowHighUNGASS 2008 Tuvalu 46

0 1 2 3 4 54. Does the country have a strategy/action framework for addressing HIV andAIDS issues among its national uniformed services such as military, police,peacekeepers, prison staff, etc?Yes (Police and peacekeepers)4.1 IF YES, which of the following programmes have been implemented beyond thepilot stage to reach a significant proportion of one or more uniformed services?Behavioural change communicationCondom provisionHIV testing and counselling*STI servicesTreatmentCare and supportOthers: [write in]YesYesYesYesYesYesYes* What is the approach taken to HIV testing and counselling? Is HIVtesting voluntary or mandatory (e.g. at enrolment)? Brieflyexplain:HIV testing is voluntary with the appropriate pre-test andpost-test counselling procedures in place.5. Has the country followed up on commitments towards Universal Access madeduring the High-Level AIDS Review in June 2006?Yes5.1 Has the National Strategic Plan/operational plan and national HIV/AIDS budgetbeen revised accordingly?YesUNGASS 2008 Tuvalu 47

5.2 Have the estimates of the size of the main target population sub-groups beenupdated?Yes5.3 Are there reliable estimates and projected future needs of the number of adults andchildren requiring antiretroviral therapy?Estimates only5.4 Is HIV and AIDS programme coverage being monitored?Yes(a) IF YES, is coverage monitored by sex (male, female)?Yes(b) IF YES, is coverage monitored by population sub-groups?NoIF YES, which population sub-groups?(c) Is coverage monitored by geographical area?NoIF YES, at which levels (provincial, district, other)?Due to the smaller size of the country, monitoring isnationwide.UNGASS 2008 Tuvalu 48

5.5 Has the country developed a plan to strengthen health systems, includinginfrastructure, human resources and capacities, and logistical systems to deliver drugs?YesOverall, how would you rate strategy planning efforts in the HIV and AIDSprogrammes in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:• Targets more realistic and achievable• Better coordination of programs• Government support more evident in 2007II. POLITICAL SUPPORTStrong political support includes government and political leaders who speak out oftenabout AIDS and regularly chair important meetings, allocation of national budgets tosupport the AIDS programmes and effective use of government and civil societyorganizations and processes to support effective AIDS programmes.1. Do high officials speak publicly and favourably about AIDS efforts in majordomestic fora at least twice a year?President/Head of governmentOther high officialsOther officials in regions and/or districtsNoYesYes2. Does the country have an officially recognized national multi-sectoral HIV/AIDSmanagement / coordination body? (National AIDS Council or equivalent)?YesIF NO, briefly explain:UNGASS 2008 Tuvalu 49

Tuvalu National AIDS Committee (TUNAC) is thegoverning body overseeing the national response to HIV.2.1 IF YES, when was it created?Year: 19992.2 IF YES, who is the Chair?Mrs Emily Koepke, Executive Director of Tuvalu Family Health Association (TUNAC) – anNGO partner2.3 IF YES, does it:have terms of reference?have active Government leadership and participation?have a defined membership?include civil society representatives?IF YES, what percentage? 60%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 andduplication of effort in programming and reporting?YesYesYesYesNoYesYesYesYesYesYesYesYesUNGASS 2008 Tuvalu 50

3. Does the country have a national HIV/AIDS body or other mechanism thatpromotes interaction between government, people living with HIV, civil societyand the private sector for implementing HIV and AIDS strategies/programmes?Yes3.1 IF YES, does it include?Terms of referenceDefined membershipAction planFunctional SecretariatRegular meetingsYesYesYesYesYesFrequency of meetings: 2 monthlyIF YES,What are the main achievements?Development of the National Strategic PlanNational Coordination of the responseNational representation which includes civil society etcWhat are the main challenges for the work of this body?FundingLack of a fulltime personnel to work on a daily basis pureon HIV related work (This has been proposed for the NS2008-2012 and to be implemented in 2008)UNGASS 2008 Tuvalu 51

4. What percentage of the national HIV and AIDS budget was spent on activitiesimplemented by civil society in the past year?Percentage:N/A5. What kind of support does the NAC (or equivalent) provide to implementingpartners of the national programme, particularly to civil society organizations?a. Information on priority needs and services Yesb. Technical guidance/materials Yesc. Drugs/supplies procurement and distribution Yesd. Coordination with other implementing partners Yese. Capacity-building YesOther: [write in]Pacific Regional Project on HIV (PRHP) through the CDO6. Has the country reviewed national policies and legislation to determine which, ifany, are inconsistent with the National AIDS Control policies?No6.1 IF YES, were policies and legislation amended to be consistent with the NationalAIDS Control policies?YesNo6.2 IF YES, which policies and legislation were amended and when?Policy/Law: Year: [write in]Policy/Law: Year: [write in][List as many as relevant]UNGASS 2008 Tuvalu 52

Overall, how would you rate the political support for the HIV/AIDS programme in2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:There was minimal political support in 2005compared to 2007. Since 2006 the Government hasincluded financial allocation in its national budget specifically for HIV for the first time. Apart fromthis there is no other strong political push to control the spread of HIV apart from the Ministry ofHealth and partners in civil society.III. Prevention1. Does the country have a policy or strategy that promotes information, educationand communication (IEC) on HIV/AIDS to the general population?Yes1.1. IF YES, what key messages are explicitly promoted?Check for key message explicitly promotedUNGASS 2008 Tuvalu 53

Be sexually abstinentDelay sexual debutBe faithfulReduce the number of sexual partnersUse condoms consistentlyEngage in safe(r) sexAvoid commercial sexAbstain from injecting drugsUse clean needles and syringesFight against violence against womenGreater acceptance and involvement of peopleliving with HIVGreater involvement of men in reproductivehealth programmesYesYesYesYesYesYesYesYesYesYesYesYesOther: [write in]1.2 In the last year, did the country implement an activity or programme to promoteaccurate reporting on HIV and AIDS by the media?YesUNGASS 2008 Tuvalu 54

2. Does the country have a policy or strategy promoting HIV/AIDS-relatedreproductive and sexual health education for young people?Yes2.1 Is HIV education part of the curriculum inprimary schools?secondary schools?teacher training?YesYesNo2.2 Does the strategy/curriculum provide the same reproductive and sexual healtheducation for young men and young women?Yes2.3 Does the country have an HIV education strategy for out-of-school young people?Yes3. Does the country have a policy or strategy to promote information, education andcommunication and other preventive health interventions for vulnerable subpopulations?YesIF NO, briefly explain:3.1 IF YES, which sub-populations and what elements of HIV prevention do thepolicy/strategy address?Check for policy/strategy includedUNGASS 2008 Tuvalu 55

IDUMSMSexworkersClientsof sexworkersPrisoninmatesOther subpopulations*[write in]Targetedinformation on riskreduction and HIVeducationSeafarers,students,youths andadolescentsStigma &discriminationreductionCondom promotionAs aboveAs aboveHIV testing &counsellingAs aboveReproductive health,including STIprevention &treatmentAs aboveVulnerabilityreduction (e.g.,income generation)N/A N/AN/A N/A N/AUNGASS 2008 Tuvalu 56

Drug substitutiontherapyN/AN/A N/A N/A N/ANeedle & syringeexchangeN/AN/A N/A N/A N/AOverall, how would you rate policy efforts in support of HIV prevention in 2007 andin 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:There is plans to review legislations now.HIV testing policy has been developed.Legal Advisers is part of the Tuvalu National AIDS Committee who will facilitate work in thisarea.4. Has the country identified the districts (or equivalent geographical/decentralizedlevel) in need of HIV prevention programmes?YesIF NO, how are HIV prevention programmes being scaledup?UNGASS 2008 Tuvalu 57

UNGASS 2008 Tuvalu 58

IF YES, to what extent have the following HIV prevention programmes beenimplemented in identified districts* in need? Check the relevant implementation level for each activityor indicate N/A if not applicableHIV preventionprogrammesBlood safetyUniversal precautions inhealth care settingsPrevention of mother-tochildtransmission ofHIVIEC on risk reductionIEC on stigma anddiscrimination reductionCondom promotionHIV testing &counsellingHarm reduction forinjecting drug usersRisk reduction for menwho have sex with menRisk reduction for sexworkersalldistricts* inneedYesYesYesYesYesYesYesN/AN/AThe activity is available inmostdistricts* inneedsomedistricts* inneedYesUNGASS 2008 Tuvalu 59

Programmes for othervulnerable subpopulationsReproductive healthservices including STIprevention & treatmentSchool-based AIDSeducation for youngpeopleProgrammes for out-ofschoolyoung peopleHIV prevention in theworkplaceYesYesYesYesYesOther [write in]*Districts or equivalent geographical/de-centralized level in urban and rural areasOverall, how would you rate the efforts in the implementation of HIV preventionprogrammes in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:Better coordination in 2007 led to a better implemented program for that year.IV. TREATMENT, CARE AND SUPPORTUNGASS 2008 Tuvalu 60

1. Does the country have a policy or strategy to promote comprehensive HIV/AIDStreatment, care and support? (Comprehensive care includes, but is not limited to,treatment, HIV testing and counselling, psychosocial care, and home and communitybasedcare).Yes1.1 IF YES, does it give sufficient attention to barriers for women, children and mostat-riskpopulations?Yes2. Has the country identified the districts (or equivalent geographical/decentralizedlevel) in need of HIV and AIDS treatment, care and support services?YesIF NO, how are HIV and AIDS treatment, care and supportservices being scaled-up?:IF YES, to what extent have the following HIV and AIDS treatment, care andsupport services been implemented in the identified districts* in need? Check the relevant implementation level for each activityor indicate N/A if not applicableHIV and AIDS treatment, care andsupport servicesall districts*in needThe service is available inmostdistricts* inUNGASS 2008 Tuvalu 61somedistricts* in

needneeda. Antiretroviral therapy Yesb. Nutritional care Yesc. Paediatric AIDS treatment Yesd. Sexually transmitted infectionmanagemente. Psychosocial support for peopleliving with HIV and their familiesYesYesf. Home-based care Yesg. Palliative care and treatment ofcommon HIV-related infectionsh. HIV testing and counselling forTB patientsi. TB screening for HIV-infectedpeoplej. TB preventive therapy for HIVinfectedpeoplek. TB infection control in HIVtreatment and care facilitiesl. Cotrimoxazole prophylaxis inHIV-infected peoplem. Post-exposure prophylaxis(e.g., occupational exposures toHIV, rape)YesYesYesYesYesYesYesn. HIV treatment services in the YesUNGASS 2008 Tuvalu 62

workplace or treatment referralsystems through the workplaceo. HIV care and support in theworkplace (including alternativeworking arrangements)Yesp. Other programmes: [write in]*Districts or equivalent de-centralized governmental level in urban and rural areas3. Does the country have a policy for developing/using generic drugs or parallelimporting of drugs for HIV/AIDS?Yes4. Does the country have access to regional procurement and supply managementmechanisms for critical commodities, such as antiretroviral therapy drugs,condoms, and substitution drugs?Yes4.1 IF YES, for which commodities?: [write in]ARVs, condoms, HIV test kits5. Does the country have a policy or strategy to address the additional HIV/AIDSrelatedneeds of orphans and other vulnerable children (OVC)?N/A5.1 IF YES, is there an operational definition for OVC in the country?Yes No5.2 IF YES, does the country have a national action plan specifically for OVC?Yes No5.3 IF YES, does the country have an estimate of OVC being reached by existinginterventions?Yes NoIF YES, what percentage of OVC is being reached?% [write in]UNGASS 2008 Tuvalu 63

Overall, how would you rate the efforts to meet the needs of orphans and othervulnerable children?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:V. MONITORING AND EVALUATION1. Does the country have one national Monitoring and Evaluation (M&E) plan?In progress1.1. IF YES, was the M&E plan endorsed by key partners in M&E?YesNo1.2. Was the M&E plan developed in consultation with civil society, including peopleliving with HIV?YesNo1.3. Have key partners aligned and harmonized their M&E requirements (includingindicators) with the national M&E plan?No2. Does the Monitoring and Evaluation plan include?a data collection and analysis strategyYesbehavioural surveillanceHIV surveillancea well-defined standardized set ofindicatorsYesYesYesUNGASS 2008 Tuvalu 64

guidelines on tools for data collectionNoa strategy for assessing quality andaccuracy of dataNoa data dissemination and use strategyNo3. Is there a budget for the M&E plan?Yes3.1 IF YES, has funding been secured?Yes4. Is there a functional M&E Unit or Department?In progressIF NO, what are the main obstacles to establishing a functional M&EUnit/Department?UNGASS 2008 Tuvalu 65

4.1 IF YES, is the M&E Unit/Department basedin the NAC (or equivalent)? Yes Noin the Ministry of Health? Yes Noelsewhere?[write in]4.2 IF YES, how many and what type of permanent and temporary professional staff areworking in the M&E Unit/Department?Number of permanent staff:Position: [write in] Full time / Part time? Since when?:Position: [write in] Full time / Part time? Since when?:Etc.Number of temporary staff:4.3 IF YES, are there mechanisms in place to ensure that all major implementingpartners submit their M&E data/reports to the M&E Unit/Department for review andconsideration in the country’s national reports?YesNoIF YES, does this mechanism work? What are the major challenges?UNGASS 2008 Tuvalu 66

4.4 IF YES, to what degree do UN, bi-laterals, and other institutions share their M&Eresults?LowHigh0 1 2 3 4 55. Is there a M&E Committee or Working Group that meets regularly to coordinateM&E activities?No, plan in progressIF YES, Date last meeting:[write in]5.1 Does it include representation from civil society, including people living with HIV?YesNoIF YES, describe the role of civil society representatives and people livingwith HIV in the working group?6. Does the M&E Unit/Department manage a central national database?In progress6.1 IF YES, what type is it? [write in]UNGASS 2008 Tuvalu 67

6.2 IF YES, does it include information about the content, target populations andgeographical coverage of programmatic activities, as well as their implementingorganizations?Yes No6.3 Is there a functional* Health Information System?National levelYesSub-national levelIF YES, at what level(s)?Yes No[write in]National level(*regularly reporting data from health facilities which are aggregated at district level and sent to nationallevel; and data are analysed and used at different levels)6.4 Does the country publish at least once a year an M&E report on HIV/AIDS,including HIV surveillance data?No7. To what extent is M&E data used in planning and implementation?LowHigh0 1 2 3 4 5What are examples of data use?What are the main challenges to data use?UNGASS 2008 Tuvalu 68

8. In the last year, was training in M&E conducted?Not yet established in progress.- At national level? Yes No IF YES, Number trained: [write in]- At sub-national level? Yes No IF YES, Number trained: [write in]- Including civil society? Yes No IF YES, Number trained: [write in]Overall, how would you rate the M&E efforts of the HIV/AIDS programme in 2007and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:Tuvalu National AIDS Committee in its National Strategic Plan prioritise theestablishment of an M&E component. This should allow for better assessment of theresponse in future years.PART B[to be administered to representatives from nongovernmental organizations, bilateralagencies, and UN organizations]I. HUMAN RIGHTS1. Does the country have laws and regulations that protect people living withHIV/AIDS against discrimination? (such as general non-discrimination provisions orprovisions that specifically mention HIV, focus on schooling, housing, employment,health care etc.)No1.1 IF YES, specify:UNGASS 2008 Tuvalu 69

[write in]2. Does the country have non-discrimination laws or regulations which specifyprotections for vulnerable sub-populations?Yes2.1 IF YES, for which sub-populations?a) Women Yesb) Young people Yesc) IDU Nod) MSM Noe) Sex Workers Nof) Prison inmates Yesg) Migrants/mobile populations Yesh) Other: [write in]IF YES,Briefly explain what mechanisms are in place to ensurethese laws are implemented:There is a national task force on certain areas for instance,for Young people there is a taskforce on Convention of theRights of the Child. There is one for CEDAW. Then there’sthe legal systems.Describe any systems of redress put in place to ensure thelaws are having their desired effect:Strengthening the present system by empowering generalpublic and law enforcers.UNGASS 2008 Tuvalu 70

3. Does the country have laws, regulations or policies that present obstacles toeffective HIV prevention, treatment, care and support for vulnerable subpopulations?No3.1 IF YES, for which sub-populations?a) Women Yes Nob) Young people Yes Noc) IDU Yes Nod) MSM Yes Noe) Sex Workers Yes Nof) Prison inmates Yes Nog) Migrants/mobile populations Yes Noh) Other: [write in]IF YES, briefly describe the content of these laws,regulations or policies and how they pose barriers:4. Is the promotion and protection of human rights explicitly mentioned in anyHIV/AIDS policy or strategy?Yes5. Is there a mechanism to record, document and address cases of discriminationexperienced by people living with HIV and/or most-at-risk populations?NoUNGASS 2008 Tuvalu 71

IF YES, briefly describe this mechanism6. Has the Government, through political and financial support, involved most-atriskpopulations in governmental HIV-policy design and programmeimplementation?YesIF YES, describe some examplesFormulation of HIV/AIDS strategic planWorld AIDS Day activitiesOutreach program for community education on HIVCondom distributionMost of these programs involved the most at riskpopulation in the countryUNGASS 2008 Tuvalu 72

7. Does the country have a policy of free services for the following:(a) HIV prevention services(b) Anti-retroviral treatment(c) HIV-related care and support interventionsYesYesYesIF YES, given resource constraints, briefly describe whatsteps are in place to implement these policies:Raising public awarenessAdvocacy – non discriminationDistribution of IECProvision of free ARVFree counselling and testing facilitiesUNGASS 2008 Tuvalu 73

8. Does the country have a policy to ensure equal access for women and men, toprevention, treatment, care and support? In particular, to ensure access forwomen outside the context of pregnancy and childbirth?yes9. Does the country have a policy to ensure equal access for most-at-riskpopulations to prevention, treatment, care and support?Yes9.1 Are there differences in approaches for different most-at-risk populations?NoIF YES, briefly explain the differences:10. Does the country have a policy prohibiting HIV screening for generalemployment purposes (recruitment, assignment/relocation, appointment,promotion, termination)?No11. Does the country have a policy to ensure that HIV/AIDS research protocolsinvolving human subjects are reviewed and approved by a national/local ethicalreview committee?No (Ministry of Health is responsible)11.1 IF YES, does the ethical review committee include representatives of civil societyand people living with HIV?UNGASS 2008 Tuvalu 74

YesNoIF YES, describe the effectiveness of this review committee12. Does the country have the following human rights monitoring and enforcementmechanisms?- Existence of independent national institutions for the promotion and protection ofhuman rights, including human rights commissions, law reform commissions,watchdogs, and ombudspersons which consider HIV and AIDS-related issueswithin their workYes- Focal points within governmental health and other departments to monitorHIV-related human rights abuses and HIV-related discrimination in areas such ashousing and employmentYes- Performance indicators or benchmarks fora) compliance with human rights standards in the context of HIV/AIDS effortsYesb) reduction of HIV-related stigma and discriminationYesIF YES on any of the above questions, describe some examples:Human rights commissionLaw reform commissionUNGASS 2008 Tuvalu 75

Legal Rights Training Officer13. Have members of the judiciary (including labour courts/ employment tribunals)been trained/sensitized to HIV and AIDS and human rights issues that maycome up in the context of their work?Yes14. Are the following legal support services available in the country?- Legal aid systems for HIV and AIDS caseworkYes- Private sector law firms or university-based centres to provide free or reduced-costlegal services to people living with HIVYes- Programmes to educate, raise awareness among people living with HIV concerningtheir rightsYes(one on one basis)15. Are there programmes designed to change societal attitudes of stigmatizationassociated with HIV and AIDS to understanding and acceptance?YesIF YES, what types of programmes?- Media Yes- School education Yes- Personalities regularly speaking out Yes- Other Community workshops, out-reach programs]Overall, how would you rate the policies, laws and regulations in place to promote andprotect human rights in relation to HIV and AIDS in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:UNGASS 2008 Tuvalu 76

Since RRT was established in Tuvalu there has been progress in the development ofpolicies to promote human rights in general.The implementation of the National Plan –Te Kakeega IIOverall, how would you rate the effort to enforce the existing policies, laws andregulations in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:The NSP 2008-2012 will enforce work in this area.II. CIVIL SOCIETY 18 PARTICIPATION1. To what extent has civil society contributed to strengthening the politicalcommitment of top leaders and national policy formulation?LowHigh0 1 2 3 4 52. To what extent have civil society representatives been involved in theplanning and budgeting process for the National Strategic Plan onHIV/AIDS or for the current activity plan (e.g., attending planning meetingsand reviewing drafts)?LowHigh0 1 2 3 4 518 Civil society includes among others: Networks of people living with HIV; women's organizations; young people’sorganizations; faith-based organizations; AIDS service organizations; Community-based organizations; organizations ofvulnerable sub-populations (including MSM, SW, IDU, migrants, refugees/displaced populations, prisoners); workersorganizations, human rights organizations; etc. For the purpose of the NCPI, the private sector is considered separately.UNGASS 2008 Tuvalu 77

3. To what extent are the services provided by civil society in areas of HIVprevention, treatment, care and support includeda. in both the National Strategic plans and national reports?Low 3 High0 1 2 3 4 5b. in the national budget?LowHigh0 1 2 3 4 54. Has the country included civil society in a National Review of the NationalStrategic Plan?YesIF YES, when was the Review conducted? Year: 2006[write in]5. To what extent is the civil society sector representation in HIV/AIDS effortsinclusive of its diversity?LowHigh0 1 2 3 4 5List the types of organizations representing civil society in HIV and AIDSefforts:Tuvalu Association of NGO (TANGO)Tuvalu Family Health Association (TUFHA)Tuvalu Red Cross Society(TRCS)Faith Based organizationsWomen’s organizationsYouthMediaPrivate Sector6. To what extent is civil society able to accessa. adequate financial support to implement its HIV activities?LowHigh0 1 2 3 4 5b. adequate technical support to implement its HIV activities?LowHighUNGASS 2008 Tuvalu 78

0 1 2 3 4 5Overall, how would you rate the efforts to increase civil society participation in 2007and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:III. PREVENTION1. Has the country identified the districts (or equivalent geographical/decentralizedlevel) in need of HIV prevention programmes?YesIF NO, how are HIV prevention programmes being scaledup?:IF YES, to what extent have the following HIV prevention programmes beenimplemented in identified districts in need? Check the relevant implementation level for each activityor indicate N/A if not applicableHIV preventionThe activity is available inUNGASS 2008 Tuvalu 79

programmesalldistricts* inneedmostdistricts* inneedsomedistricts* inneedBlood safetyYesUniversal precautions inhealth care settingsYesPrevention of mother-tochildtransmission ofHIVYesIEC on risk reductionYesIEC on stigma anddiscrimination reductionyesCondom promotionYesHIV testing &counsellingYesHarm reduction forinjecting drug usersN/ARisk reduction for menwho have sex with menN?ARisk reduction for sexworkersN/AProgrammes for othermost-at-risk populationsYesReproductive healthservices including STIprevention & treatmentYesUNGASS 2008 Tuvalu 80

School-based AIDSeducation for youngpeopleProgrammes for out-ofschoolyoung peopleHIV prevention in theworkplaceYesYesYesOther [write in]*Districts or equivalent geographical/de-centralized level in urban and rural areasOverall, how would you rate the efforts in the implementation of HIV preventionprogrammes in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:National Strategic plan is in placeA coordinated response involving both government and non-governmental organization.Funding from National Budget 2007Expanded support from Developmental partnersIV. TREATMENT, CARE AND SUPPORT1. Has the country identified the districts (or equivalent geographical/decentralizedlevel) in need of HIV and AIDS treatment, care and support services?YesUNGASS 2008 Tuvalu 81

IF NO, how are HIV and AIDS treatment, care and supportservices being scaled-up?:IF YES, To what extent have the following HIV and AIDS treatment, care andsupport services been implemented in the identified districts* in need?orCheck the relevant implementation level for each activityindicate N/A if not applicableHIV and AIDS treatment, care andsupport servicesall districts*in needThe service is available inmostdistricts* inneedsomedistricts* inneeda. Antiretroviral therapy Yesb. Nutritional care Yesc. Paediatric AIDS treatment Yesd. Sexually transmitted infectionmanagemente. Psychosocial support for peopleliving with HIV and their familiesYesYesf. Home-based care YesUNGASS 2008 Tuvalu 82

g. Palliative care and treatment ofcommon HIV-related infectionsh. HIV testing and counselling forTB patientsi. TB screening for HIV-infectedpeoplej. TB preventive therapy for HIVinfectedpeoplek. TB infection control in HIVtreatment and care facilitiesl. Cotrimoxazole prophylaxis inHIV-infected peoplem. Post-exposure prophylaxis(e.g., occupational exposures toHIV, rape)n. HIV treatment services in theworkplace or treatment referralsystems through the workplaceo. HIV care and support in theworkplace (including alternativeworking arrangements)YesYesYesYesYesYesYesyessYesp. Other programmes: [write in]*Districts or equivalent de-centralized governmental level in urban and rural areasUNGASS 2008 Tuvalu 83

Overall, how would you rate the efforts in the implementation of HIV and AIDStreatment, care and support programmes in 2007 and in 2005?2007 Poor Good0 1 2 3 4 5 6 7 8 9 102005 Poor Good0 1 2 3 4 5 6 7 8 9 10Comments on progress made since 2005:2. What percentage of the following HIV and AIDS programmes/services isestimated to be provided by civil society?Prevention for youth 75%- IDU- MSMPrevention forvulnerable subpopulations25-50%- Sex workersCounselling and Testing 25-50%Clinical services(OI/ART)*Home-based care 25-50%Programmes for OVC***OI Opportunistic infections; **OVC Orphans and other vulnerable childrenUNGASS 2008 Tuvalu 84

3. Does the country have a policy or strategy to address the additional HIV/AIDSrelatedneeds of orphans and other vulnerable children (OVC)?N/A5.1 IF YES, is there an operational definition for OVC in the country?Yes No5.2 IF YES, does the country have a national action plan specifically for OVC?Yes No5.3 IF YES, does the country have an estimate of OVC being reached by existinginterventions?Yes NoIF YES, what percentage of OVC is being reached?% [write in]UNGASS 2008 Tuvalu 85

ANNEX 3: Tuvalu National HIV Strategy, 2008-2012Timing2008Ref Description Activities J F M A M J J A S O N D 2009 2010 2011 2012Activityimplem Locatioenter nIndicatorsIPriority Area 1 - Achieving an enabling environmentOutput1.AHigh level commitment to HIV response evident1.A.11.A.21.A.3Present final draft NSP 2008-12 tothe TuNAC , DCC then Cabinet forendorsementOrganise HIV and STI technicalbriefings for the Health Minister andthe MoH executive committee andgeneral information for othergovernment sectors twice a yearPublish summary of recentdevelopments in HIV responses fordistribution to political leaders at alllevels twice a yearTuNAC,MOHTuNAC,MediaDeptFunafutiFunafutiPMH,TuNAC FunafutiNSP 2008 – 12 endorsed OInformation disseminationmechanism in placeAnnual Health and HIVResponses ReportsBrOReUNGASS 2008 Tuvalu 86

Output1.B1.A.41.A.5Lobby leaders, policy makers andsenior officials in regards to a reviewof HIV-related policies TuNACInvolve political leaders and othernotable public figures to activelyengage in high profile events such asWorld AIDS DayStrategy for the reduction of stigma and discrimination of people infected and affected by HIV devised and implementedTuNACAllislandsAllislandsReport documentsNumber of leaderssupporting HIV issues inpublicLiPu1.C1.B.11.B.21.B.3Develop an advocacy strategy toaddress stigma and discriminationTuNAC TuvaluIdentify community leaders,celebrities, AIDS champions andother key people and train them inadvocacy for reducing stigma anddiscrimination in the community TuNAC TuvaluDraft national legislation forprevention of stigma anddiscrimination for presentation to lawmakers TuNAC TuvaluAdvocacy strategydocumentNumber of key peopletrained in advocacyLegislation documentPolicies, legislation and traditional laws that discriminate against vulnerable populations including women, sex workers and MSM reviewed and amendedOTrO1.C.11.C.2Assess existing policies & legislationto identify those discriminatingagainst vulnerable populationsincluding women, sex workers andMSM TuNAC FunafutiDraft revised policies to protect theirhuman rights in accordance withinternational law to which Tuvalu is apartyTuNACand AGOfficeFunafutiReport documentsStRevised policy documents StUNGASS 2008 Tuvalu 87

1.D1.C.31.C.4Present revised policies to supportivemembers of parliament who willchampion their progress throughparliament TuNAC FunafutiLobby parliamentarians and otherkey power brokers for the passing ofhuman rights-based HIV policiesMonitor human rights violations against people living with HIV and their family membersTuNAC FunafutiRevised policy documents PrreHuman rights-based HIVpolicies passed inparliamentLi1.D.1Workshop conducted for relevantparties to develop a human rightsmonitoring mechanismHuman rights monitoringmechanism establishedW1.D.2Awareness programs informing thepublic that there is a mechanism thataddresses human rights issuesTuNAC FunafutiTuNACandMediaAllislandsNews releases, brochures PrPriority Area 2 - Prevention of HIV and other STIs2.ABCC strategy developed2.A.12.A.2TUFHA,TuvaluBCCworkinggroupDesign National behaviour changeStrategyWorld AIDS Day campaigns in eachisland MOHFunafuti Strategy documentAllislandsWAD photos & report2.A.3Identify and train celebrity AIDSAdvocates and champions TUFHA Funafuti HIV Champion activitiesTuNACand2.A.4 TA for life skills program designMOE Funafuti TA recruitedStReAgCeTAUNGASS 2008 Tuvalu 88

2.A.52.A.62.A.72.A.82.A.92.A.102.A.112.A.12Design “life skills” training programfor teachers, health workers,community leaders, NGO personnel,young people and other suitable keyplayers incorporating communication,negotiation skills, sexuality, Genderrespect and responsibility, and safesexMoE,MoH,TUFHA FunafutiTraining programcurriculumMoE,Implement “life skills” trainingprogram based on design (see 2.A.5)MoH,TUFHA Funafuti Report from pilot programTrain church leaders and churchgroups to integrate HIV/STI into theirroutine work and church activities-Sermons TUNAC Funafuti Training activity reportsTrain community groups in theStepping Stones approach tocommunity educationImplement stepping stonesprogram across the communityProduce (print/record/make)culturally specific/ sensitive HIV andSTI behaviour change materialsDevise national distribution strategyfor BCC materialsDesign and implement campaign toeducate the community about riskbehaviours like tattooing and othertraditional practicesTUFHA,MOH Funafuti Training activity reportsFunafuti,Vaitupu,TUFHA, Nui andTANGO Nukufeta Stepping Stones activity, MOH ureportsTUFHA,TANGO, MOH,MOE Funafuti STI BCC MaterialsTUFHA,TANGO, MOH,MOE Funafuti Distribution strategyMoH,TUNACFunafuti,Nanumea,Nanumanga,NiutaoCampaign activity reportsLidoTrTrWAcLiStUNGASS 2008 Tuvalu 89

2.A.13 TA for media strategy TUNAC Funafuti TA recruitedTA andTUNAC Funafuti Strategy document2.A.14 Devise media HIV strategyTrain media personnel in basic HIVand STI knowledge, advocacy skillsand methods for reducing stigma &2.A.15discriminationDesign, produce and adopt mediakits that can help them tocommunicate effectively with the2.A.16public2.A.172.A.182.A.192.A.202.A.21Write and broadcast a series of radiomessages on HIV and STIs (withhelp from WSB)Devise and deliver HIV and STImessages using performing artistsArrange for the broadcasting ofrelevant documentaries on TV whenthere is a national channelSupport media outlets to ensure fullcoverage of national, regional andother relevant HIV eventsSupport radio stations to air paneldiscussions and educational radioprograms on HIV-related topicsTA andTUNAC FunafutiTA andTUNAC FunafutiFunafutiMOH, andTUFHA nationaland broadcasTUNAC tTUFHAandTUNACFunafuti,Nukulaelae andNiulakitaMedia training activityreportMedia kitsRadio messagesPerformance photos andreportsTUNACandMediaDept Funafuti TV documentariesTUNACandMediaDept Funafuti Media reportsTUNACandMediaDeptFunafutiandnationalbroadcastRadio programsTAStWMBrPe##UNGASS 2008 Tuvalu 90

2.B2.A.222.A.23Arrange with Telecom and designmobile phone spot messages for allto prevent HIV/STI andadvertisement of VCCT services.Design messages highlighting HIVrelatedservices and activitiesDistribute messages highlighting2.A.24HIV-related services and activitiesStrategy for HIV and STI prevention among Tuvalu youth devised and implementedPMH &TUFHA FunafutiPMH &TUFHA,Media NationwiDept deBrochures and radiomessagesNumber of radiomessages, brochuredistribution listsM#pu2.B.1TA for youth studiesUndertake appropriate studies todevelop the youth strategyTUNAC FunafutiNat Funafuti,Council Nukulaelof ae,Youth, VaitupuTUNAC, andEKT Niutao2.B.22.B.3 Develop a youth HIV strategy YouthCouncil,TUNAC,2.B.42.B.5Develop/adapt a peer educationtraining manualIdentify, train/ retrain youth peereducation teamsTA recruitedStudy reportEKT Funafuti Strategy documentTUFHA,YouthCouncil,MoE Funafuti Training manualTUFHA,YouthCouncil,MoE,EKTFunafuti,VaitupuandNanumeaTraining workshop reportsTAStStPeWUNGASS 2008 Tuvalu 91

2.B.62.B.72.B.82.B.92.B.102.B.112.B.122.B.13Devise Peer Educator supportmechanismsAdapt existing peer educationsupport materialsTUFHA,YouthCouncil,MoE,EKTTUFHA,YouthCouncil,MoE,EKTMonitor peer education activities TUNACEstablish a national committee tomake recommendations regardingHIV education in schools (underNAC)Review school-based HIV and sexeducation (Family Life Education)curricula from other Pacific countriesand those already existing in TuvaluUndertake advocacy to counteropposition to HIV and sexualityFunafutiSupport programdocumentsFunafuti Peer education materialsFunafuti,VaitupuandNanumea Monitoring reportsMOH,MOE,TUNAC Funafuti Recommendations reportMOE,TUNAC FunafutiReview reporteducation in schools TUNAC Funafuti Advocacy program reportsReview/ Produce materials toMOH,Resupport the teaching of HIV &MOE,Sexuality in Tuvalu schoolsTUNAC Funafuti New teaching materialsTrain secondary teachers for pilotimplementation of HIV and Sexualitycurriculum in selected schoolsMOH,MOE,TUFHAandTANGO Funafuti Training workshop reportsMLimAcColisReAdTrUNGASS 2008 Tuvalu 92

2.CImplement pilot program of HIVPi2.B.14education in two secondary schoolsPilot program in selectedover a 6 month period MOE Funafuti schoolsEvaluate pilot implementation of HIVEv2.B.15& Sexuality curriculum and makenecessary changes to the curriculumor the approach used TUNAC Funafuti Evaluation reportTrain teachers and parents forTUFHATr2.B.16nationwide implementation of HIV &andSexuality curriculumMOH Tuvalu Training workshop reports2.B.17Distribute supporting materials forcurriculum to schools throughoutTuvalu MOE Distribution listsPrevention strategies specifically targeting vulnerable groups designed and implemented2.C.12.C.2TA for KAPB studies with vulnerablegroups TUNAC Funafuti TA recruitedFunafuti,Vaitupu,Undertake KAPB studies to informNanumebehaviour change strategies witha andvulnerable groups TUNAC Niutao KAPB study reports2.C.3 TA for BCC materials development TUNAC Funafuti TA recruitedTUNAC, FunafutiMOE, andMOH, nationwi2.C.4TUFHA de BCC materials2.C.52.C.6Design, pre-test, publish anddistribute culturally specific BCCmaterials for vulnerable groupsImplement peer education programfor sex workers to provide condomsand safe sex educationReview seafarers HIV educationcampaignTAStTABCPeTUFHA,reTUNAC Funafuti Peer education activitiesReMaritimecollege,TUNAC FunafutiEducation campaignactivity reportsUNGASS 2008 Tuvalu 93

2.D2.C.7Design HIV prevention campaign forentertainment venues where riskbehaviours are known to beprevalent2.C.8Distribute condoms and informationon HIV in entertainment venues TUFHAIncreased condom and lubricant use among the sexually active populationTUFHA,TANGO FunafutiFunafuti,NiutaoandVaitupuCampaign strategyEntertainment venuereportsDeO2.D.1 TA for condom studies in Tuvalu TUNAC Funafuti TA recruitedUndertake national baseline study toidentify rates of condom use,together with attitudes towardscondom use (see surveillanceFunafuti,Vaitupu,Nukufetau &TUFHA Nanuma2.D.2activities)and TA ga Study outcomesFunafuti,Vaitupu,Nukufetau &TUFHA Nanuma2.D.3and TA ga Study outcomes2.D.4Undertake study to determine qualityand availability of condoms andlubricant in TuvaluDevise condom promotion strategyincorporating condom socialmarketing (CSM) based onpreliminary research, - condomprocurement, storage anddistribution; condom qualityassurance; community education oncondom use; measures to counterpotential opposition to condompromotion; and concurrent promotionof personal lubricantTUFHAand TAFunafuti,Vaitupu,Nukufetau &Nanumaga CP strategyCostUNGASS 2008 Tuvalu 94

2.E2.D.5 Secure funding for CSMEngage suitably experienced agencyto manage CSM / lubricant promotion2.D.6and commence program TUNAC2.D.7Routinely monitor CSM activities,particularly: condom availability; lubeavailability; condom / lube quality;condom/ lube cost; communityattitudes to condoms; condom use;and lubricant use TUFHA2.D.82.D.92.D.10Safe blood supply maintained throughout TuvaluImprove availability of good qualitycondoms and lubricant throughoutTuvalu including the outer islands TUFHAEngage in targeted condom andlubricant distribution campaign foridentified vulnerable groups TUFHAEngage in advocacy for condompromotion to counter opposition tothe campaign TUFHATUFHAandTUNAC Funafuti Amount of funds securedAllislandsAllislandsCP campaign activitiesCSM dataAllislands Condom availabilityFunafuti,VaitupuandNukulael Condom use amongae vulnerable groupsAllislandsCondom advocacycampaignBuCAcSuCAd2.E.12.E.2Implement strategy for maintainingBlsafe blood supply in the hospitalincorporating appropriate integrationof blood collection, testing, labelling,storage and delivery PMH Funafuti Safe blood supply strategyTrain all lab technicians in testingTrand other relevant technical skills,reporting results and laboratorymanagement PMH Funafuti # lab staff trainedUNGASS 2008 Tuvalu 95

2.F2.E.32.E.42.E.52.E.62.E.7Procure adequate supply of HIV andother BBV testing kits PMH FunafutiProcure all necessary laboratoryequipment to ensure a safe bloodsupply PMH FunafutiAvailability of HIV andother BBV test kitsAvailability of necessarylab equipmentDevise and implement an effectivesystem for ensuring blood specimentest results remain confidential PMH Funafuti Confidentiality protocolsIdentify and engage a suitableagency with capacity to implement allelements of a non-remuneratedblood donor supply systemEnsure all blood sample HIV testresults are recorded in national serosurveillancedata PMH FunafutiTUNAC,PMH Funafuti Agency recruitedHIV test recording andreporting procedures2.E.8National campaign to increasevoluntary blood donation TRC FunafutiTA for establishing a blood bank onTUNAC,2.E.9FunafutiPMH Funafuti TA recruitedEstablish national blood bank at2.E.10PMHUniversal precautions implemented in health care facilities and other relevant settings throughout TuvaluNumber of blood donationcampaignsPMH,TRC Funafuti Blood bank establishedHoEqCoplAgNadaCabl2.F.12.F.2Undertake a study of traditionalpractices that might enable bloodbornetransmission of HIV or otherBBVs (eg tattooing)Funafuti,VaitupuTUNAC and Nui Study undertakenDevelop a strategy to changedangerous traditional practices toprevent transmission of HIVAllTUNAC islandsstrategy developedUNGASS 2008 Tuvalu 96

2.G2.F.32.F.42.F.52.F.6Train tattooists and other traditionalhealth practitioners in safe practicesand waste disposalAllTUNAC islandsTrain health workers in universalprecautions PMHProvide funding (necessary supplies)for all health facilities enabling themto practice universal precautions MOHAllislandsAllislandsNumber of relevant peopletrainedNumber of HWs trainedFunds available for UPimplementationDevise safe and effective medicalwaste disposal strategy – MOH Funafuti Waste disposal strategy2.F.7Implement medical waste disposalstrategy MOHPost exposure prophylaxis policy developed and implementedAllislandsWaste disposal methodsTrBuStWre2.G.12.G.2Develop post-exposure protocols forhealth care and community settings PMH Funafuti Post exposure protocolsTrain relevant health personnel inPEP PMH Funafuti2.G.3 Equip hospital for PEP interventions PMH Funafuti2.G.4 Monitor PEP PMH Funafuti2.H Effective, voluntary and confidential counselling for HIV and STI testing and management available throughout TuvaluNumber of HWs trained inPEPAvailability of PEPmaterialsPEP protocolsimplementedPrTrEqPEUNGASS 2008 Tuvalu 97

2.H.1Review and adapt WHO/UNAIDSguidelines on voluntary, confidentialcounselling and testing (VCCT) foruse in Tuvalu TUNAC Funafuti Adapted guidelinesAdVC2.H.2 Identify suitable VCCT locations TUNAC Funafuti VCCT sitesAdapt/refurbish counselling rooms toensure adequate facilities and2.H.3privacy PMH Funafuti VCCT facilitiesTrain selected health workers fromeach island in voluntary and2.H.4confidential HIV counselling PMH Funafuti Number of HWs trainedPMHand2.H.5 Implement VCCT serviceTUFHA Funafuti Availability of VCCT2.H.6Provide IEC and other behaviourchange materials to support VCCTMOHandTUFHA FunafutiAvailability of relevantmaterials in VCCT sitesAvTrVCD2.H.72.H.8Undertake study to determineattitudes to HIV and STI counselling TUNAC Funafuti Study undertakenDesign and implement communityawareness campaign to promote useof HIV and STI counselling centres TUFHA Funafuti Campaign activitiesCaPriority Area 3 – Treatment Care and SupportA comprehensive national policy for treatment, care and support for people living with HIV developed3.A3.A.1Procure TA to review and finalise thenational policy and strategy for HIVtreatment and care development TUNAC FunafutiTA recruited, policydocument developedTAUNGASS 2008 Tuvalu 98

3.B3.A.2Disseminate policy to health careprofessionals and other relevantpersonnel MOHA trained multidisciplinary HIV care team operating in Tuvalu’s main hospitalAllislandsNumber distributed,number of health careprofessionalsimplementing policyPo3.B.13.B.2Undertake study of HIV-related careand support needs throughoutTuvaluFunafuti,TUNAC Vaitupu Needs analysis reportUpdate guidelines for the clinicalcare of people living with HIV inTuvalu and implement (TA)3.B.3 Design ART strategy for Tuvalu3.B.4Disseminate training needs analysisfor medical and multidisciplinary careof people with HIV and devisetraining programPMHHIVteamTA recruited, completedGuidelinesNeFunafutiTAPMHHIVteam Funafuti Strategy document StPMHHIVteamFunafutiNeeds analysis reportdistributed, and trainingreportNe3.B.5TA for training to relevant healthworkers in relevant treatment sites TUNAC FunafutiTA recruited, and trainingreportTA3.B.6Train health workers in diagnosis andmanagement of key opportunisticinfectionsPMHHIVteamFunafutiandVaitupuNumber of trainingconducted, training report TrUNGASS 2008 Tuvalu 99

3.B.73.B.83.B.9Integrate HIV and STI treatment intonursing curriculum and in-countrytraining for health workers MOH FunafutiCurriculum (document)that includes HIV and STItreatment, and in-countrytraining reportEvaluate multidisciplinary teamsapproach after one year of operation TUNAC Funafuti Evaluation report EvAssess availability of trained HIVcounsellors who can support peopleinfected and affected by HIV TUNAC FunafutiNumber of trained HIVcounsellorsNdoNco3.C Health facilities adequately resourced to enable treatment and care of people with HIV3.C.1 TA for ARV requirement estimates3.C.23.C.33.C.43.C.53.C.6TA for estimating ARV &opportunistic infection requirementsand design procurement anddistribution strategy accordingly TUNAC PMHDesign ARV distribution strategyProcure adequate ARV and othermedicines for opportunistic infectionsIdentify and procure additionalequipment and facilities required toprovide ART in the outer islandsTUNAC PMH TA recruited TATA recruited, procurementreportPMH PMH Strategy document SPMH PMH Procurement reports PProcurement reports,Medical Centre (outerislands) consolidatedreports (CMR)PMH PMHPAdd ARVs to the Essential DrugsList (EDL) PMH PMH EDL document listing ARV ETAUNGASS 2008 Tuvalu 100

3.D3.EComprehensive program of community-based support available for HIV infected and affected people3.D.13.D.23.D.3Establish peer support network forpeople infected and affected by HIVDesign a home-based carers trainingand support programDeliver home based carers trainingNationalHIVsupportgroup,Church,TUFHA FunafutiAllmedicalcentres,PMH,HIVteam FunafutiAllmedicalcentres,PMH FunafutiPeer support networkestablishedHome based careprogramNumber of training onHome based care3.D.4Engage the religious community incare and support initiatives TUNAC Funafuti TrStrategy for the reduction of stigma and discrimination of people infected and affected by HIV devised and implementedPereHoprTr3.E.13.E.2Design a community advocacyprogram to reduce stigma anddiscriminationTUNACandTUFHA FunafutiInvolve community leaders,celebrities, AIDS champions,religious leaders and other keypeople in advocacy for reducingstigma and discrimination in thecommunityAllTUNAC islandsCommunity advocacyprogram, IEC materialdevelopedAIDS campaigns?Campaign reports?AdAIUNGASS 2008 Tuvalu 101

3.F3.E.3Draft national legislation forprevention of stigma anddiscrimination for presentation to lawmakers TUNAC Funafuti National legislationEffective management of STIs on each island of TuvaluNado3.F.13.F.23.F.3Develop STI management trainingstrategy for health workers based onWHO STI treatment protocolsUndertake a STI training needsanalysis in TuvaluDeliver training to outer islandclinicians in effective STImanagement of prevalent STIsincorporating: syndromicmanagement; contact tracing;chemotherapy; Counselling aboutsafe sex; and condom use advicePublicHealthDeptPublicHealthDeptPublicHealthDeptPMHStrategy on STImanagement for healthworkersStFunafuti,VaitupuNukulaelae andNukufetau Needs analysis report NeAllislandsTraining reports ? numberof training conductedTr3.F.43.F.5Train hospital doctors, nurses andother health professionals incomprehensive STI managementEstablish a STI model clinic inFunafuti that offers comprehensivestandardised STI treatment that canbe used as a training facilityPMHandPublicHealthDeptAllislandsTraining reports, andnumber of healthprofessionals trainedPMH &TUFHA Funafuti STI model clinicTrSTUNGASS 2008 Tuvalu 102

3.G3.F.6Incorporate STI case recording andreporting within the nationalsurveillance program MOH3.F.7Train all health workers in STI caserecording and reporting procedures PMHLaboratory support for HIV and STI diagnosis and management enabled in the Princess Margaret HospitalAllislandsNational Surveillance Naprogram incorporating STI syAllislands Training report Tr3.G.13.G.23.G.33.G.43.G.53.G.6Undertake a review of HIV and STIlaboratory testing policy andprocedures in Tuvalu (TA)Assess the cost-effectiveness andother implications of implementingHIV confirmatory testing inFunafuti(TA)Devise and implement aprocurement plan for all necessaryequipment, reagents andconsumables to enable an ongoingprogram of STI testing in the outerislandsRevise testing policy regarding useof rapid tests, ELISA tests andconfirmatory testing based on reviewfindings and recommendations ofPacific Regional StrategyProcure necessary equipment basedon revised testing policyTrain laboratory staff in approvedforms of HIV & STIHIVteam,LaboratoryHIVteam,LaboratPMHTA recruited, HIV testingpolicy documentTAory PMH TA recruited TAPMHPharmacy/Laboratory,HIVteam Funafuti Procurement plan PrPMH,Laboratory, HIVteam PMH Review report RePMHPharmacy, HIVteam PMH Procurement report EqPMHlaboratory PMH Training report TrUNGASS 2008 Tuvalu 103

3.H3.G.7Train laboratory staff in ARTmonitoring techniques such as CD4counts and viral load countsEnsure policies are in place to3.G. 8maintain confidentiality of HIV resultsComprehensive program of prevention of parent to child transmission of HIV implementedPMHLaboratory PMH Training report TrHIVteam,TUNAC HIV Policy in place H3.H.13.H.2Inform NAC and other relevantpersonnel on latest PMCTdevelopments and internationalpolicy recommendationsHIVteam Funafuti TUNAC report/minutes TUFinalise PPTCT policy for Tuvalu TUNAC Funafuti Policy document Po3.H.33.H.4Disseminate strategy and train healthworkers in implementationProvide community education aboutthe importance of primary preventionof infection in women of childbearingageAllMedicalcentres Funafuti Numbers distributedPublicHealth,TUFHAAllislandsPPTCT EducationprogramNdoPP3.H.5Implement PPTCT policy acrossTuvaluIncorporate HIV counselling at ante3.H.6natal clinicsInform NAC and other relevantpersonnel on latest PMCTdevelopments and international3.H.7policy recommendations3.I Male circumcision practiced widely throughout TuvaluPublicHealthPMH,HIVteamAllislandsPPTCT Policyimplementation reportImFunafuti ANC HIV records/reports ANHIVteam Funafuti Repetition of 3H1UNGASS 2008 Tuvalu 104

3.I.1TA to undertake survey ofcircumcision prevalence andpractices among males in Tuvalu TUNAC Funafuti TA recruited TA3.J3.I.2Identify cultural or other obstacles touniversal acceptance of malecircumcisionAllTUNAC islandsProblematic culturaltaboos, religious beliefsidentifiedUndertake circumcision promotion3.I.3among health workers, religiousleaders and other key individualsAllTUNAC islands Health promotion report CEffective referral system between Tuvalu's TB and HIV programsH3.J.1Develop strategy for referral systembetween TB and HIV programs PMH PMH Strategy document St3.J.2 Provide VCCT service to TB patients PMH PMH TB program/referral report TBPriority Area 4 – Program Management4.AEffective multisectoral engagement in the NSP4.A.1Engage all government sectors in theResponse to HIV/AIDS TuNAC TuvaluGovernment sectoralplans4.A.2Work closely with other non-stateactors TuNAC Tuvalu Regular meetings’ minutesUNGASS 2008 Tuvalu 105

4.A.34.A.44.A.5Facilitate NAC meetings every twomonths to monitor progress on NSP TuNAC Funafuti Regular meetings’ minutesProvide media briefing on the NAC’srole and the NSP, with periodicupdates TuNAC FunafutiUpdate NAC members on HIVdevelopment in Tuvalu and theregionTuNAC,PMHHIVteamFunafutiNumber of media/pressreleases/reportsNumber of meetingreports4.B4.A.6Mainstream HIV interventions acrosssectors rather than introduce verticalHIV initiatives TuNAC TuvaluImproved coordination and management of the national HIV responseNumber of sectorsworking on HIVinterventions4.C4.B.1Recruit personnel to support thesecretariatTuNAC Funafuti Personnel engaged Co4.B.2Equip the secretariat with adequateresources to function effectivelyTuNAC Funafuti Functional Secretariat Re4.B.3Hold review workshops each year toanalyse progress on the planTuNAC Funafuti Workshop reports WHold planning workshop each yearwith broad representation from4.B.4stakeholders TuNAC Funafuti Workshop reports WComprehensive program of HIV and STI surveillance and research implemented and annual figures disseminated4.C.1TA to assist with a comprehensiveprogram of second generationsurveillance drafted TuNAC Funafuti TA recruitedCoUNGASS 2008 Tuvalu 106

4.C.2Identify national sero surveillancesites PMH Funafuti Sites identifiedLi4.C.34.C.4Equip and train personnel for serosurveillancein each site PMH Funafuti Trained personnel TTA for develop system for reportingsero-prevalence data to national HIVsurveillance office TuNAC FunafutiReporting systemdevelopedD4.C.54.C.64.C.74.C.8Ensure adequate funding for ongoingnational sero surveillance activities TuNACIdentify key target groups forbehavioural surveillanceTuNAC&TUFHAFinalise and distribute instrumentsfor behavioural surveillance TUFHATrain personnel in behaviouralsurveillance in each site TUFHAAllislandsFunafuti,Vaitupu,Nukulaelae &NanumeaFunafuti,Vaitupu,Nukulaelae &NanumeaNumber of proposalsfundedNumber of key targetgroups identifiedAvailability of BSinstrumentsFunafuti,Vaitupu,Nukulaelae &Nanume Number of qualifieda personnelReLiReTr4.C.9 Implement SGS in sentinel sitesPMH &TUFHAAllislands # sites undertaking SGS SuUNGASS 2008 Tuvalu 107

Co4.DDisseminate surveillance data4.C.10regularlyOne national monitoring and evaluation framework designed and implementedPMH, AllTUNAC islands Data availability Re4.D.1 Identify & recruit an M&E specialist TuNAC Funafuti Working M&E specialist4.D.24.D.3Devise monitoring and evaluationframework for the NSP with clearindicatorsTuNAC& TAM&E Frameworkdocument in placeFunafutiRecruit a suitable person toundertake monitoring andsupervision activities TuNAC Funafuti Suitable person recruitedMco4.D.44.D.54.D.6Review the NSP annually to assessprogress against targets TuNAC Funafuti NSP review reports CoDraft annual plan every year aftercompleting annual review of currentyear TuNAC Funafuti Annual plan document DIdentify & recruit an evaluationspecialist TuNAC FunafutiEvaluation specialist inplace4.D.7 Undertake mid term review of NSP TuNAC4.D.8Include the HIV programs of NGOsand private sector agencies inplanning and monitoring activities TuNACAllislands Review reportsAllislandsNumber of multi-sectoralHIV programsCo4.D.9TA to train M&E officer in CRISdatabase TuNAC Funafuti M&E Officer trainedUNGASS 2008 Tuvalu 108

4.E4.D.10Develop a national database for seroand behavioural surveillanceenabling regular review and analysisof trends in the epidemicProvide M&E training for NACsecretariat, focal personnel andPMHHIV unit FunafutiNational databasedocument4.D.11NGOs TuNAC Funafuti M&E training reports TrDevelop and maintain a current mapof all HIV response activities,incorporating the work of all players:government and non government4.D.12agencies TuNAC Funafuti Map producedEvidence based planning undertaken on annual basis4.E.1Collate and analyse implementationdata of the current program TuNAC FunafutiImplementation datareportsImre4.F4.E.2Conduct a national workshop todevelop a new annual plan TuNAC Funafuti Workshop reports WTuvalu’s national HIV response adequately resourced4.F.14.F.24.F.34.F.4Identify & recruit 1 staff for HIV unitProvide training for national level HIVUnit coordinators and staffSeek funding for additional healthstaff to deliver HIV-related (PMTCTadvisors; counsellors; antenatal clinicnurses; STI clinicians) interventionsin the Funafuti hospitalTuNAC Funafuti Staff recruited CoTuNAC Funafuti Training reports TrTuNAC Funafuti Funds available FuDevelop and implement training planfor health professionals PMH Funafuti Training plan developedDdeUNGASS 2008 Tuvalu 109

4.F.54.F.64.F.74.F.8Advocate for funding allocations forHIV activities from national budgetIdentify major and minor national,regional and international fundingsourcesDevelop fundraising strategy toenable NSP implementationEncourage and support partneragencies to apply for funding for HIVinterventionsTuNAC FunafutiFunding allocated in theNational budgetBudoTuNAC Funafuti List of funding agencies FuTuNAC Funafuti Funding strategy in place FuTuNAC FunafutiNumber of partneragencies fundedLisuUNGASS 2008 Tuvalu 110