The proportion of funding for prevention activities among different populations indicates that prevention programmes specifically for IDUs, including harm reduction and substitution therapy, received over 70% of all funding for MARPs. This proportion is consistent with the paramount importance of IDUs. However, the total amount of resources for prevention programmes among other MARPs, particularly MSM and prisoners, FSWs that do not inject drugs, MARA, and people living with HIV, are seriously inadequate and in some cases even non-existent. Main Recommendations Immediate: Ensure that the new National AIDS Programme allocates and earmarks proportionate funding for prevention programmes among MARPs broadly consistent with their role as the source of the majority of new HIV infections Medium-Term: MR.4.1.10 Increase the proportion of Government funding for prevention programmes among all MARPs, with the aim of ensuring that programmes, independent of implementation agent, are sustained by government support by 2013 MR.4.1.9
Targets Targets for prevention programmes among MARPs are largely consistent with international best practices, with high and ambitious targets for Universal Access set to cover the majority of largest MARPs. Targets were set in 2006 as part of the planning to scale up towards Universal Access, and reflect extensive consultation with partners at the national and subnational levels. National targets for MARPs were set according to robust, up-to-date, and scientifically-valid estimates of the size of these populations, and were not limited to the officially registered numbers of these groups, which are considerably smaller and underreported. In particular, targets for IDUs and sex workers aim to reach 60% of the estimated size of these populations by 2010. Targets for MSM and prisoners were slightly lower, at 45% and 50%, respectively. While targets for MARA and especially vulnerable children and adolescents were set at 60%, the estimates of size of these population groups are less robust than for the other MARPs and should be reviewed. Some stakeholders have expressed concern that the targets for MSM are significantly lower than those of other MARPs, suggesting discrimination and/or weaker support for scaling-up prevention programmes among this population. Given the extremely low level of current coverage of services for MSM, however, the evaluation regards the current target of 45% coverage as ambitious, and it will require unprecedented efforts to reach even this target. Emphasis should be placed on building the capacity of organizations to reach the existing targets, especially for MSM, rather than advocating for increasing targets that are unlikely to be achieved. However, the target for prisoners is considered to be too low as prisoners are easily accessible. There is no reason why the coverage of programmes among prisoners could not be increased to at least 80% in a very short period of time. Current targets were also based on a robust definition of coverage to include individual clients, and not the number of visits to services (which include repeat visits). The targets also refer to a minimum package of services that includes the provision of information, condoms and/or syringes (as required), access to VCT and referrals to other health and social services. However, current targets have five serious shortcomings: I. They do not clearly specify the frequency of service provision for a client to be counted as covered or reached. While it is assumed that the targets refer to the number and percentage of clients that access such services at least once within a period of 12 months, such frequency of coverage is seriously inadequate for all MARPs. In the absence of a clear international expert consensus on the optimal frequency and intensity 65