In 2016, Mozambique had 83 000 (73 000 - 96 000) new HIV infections and 62 000 (50 000 - 73 000) AIDS-related deaths. There were 1 800 000 (1 600 000 - 2 100 000) people living with HIV in 2016, among whom 54% (41% - 63%) were accessing antiretroviral therapy. Among pregnant women living with HIV, 80% (61% - >95%) were accessing treatment or prophylaxis to prevent transmission of HIV to their children. An estimated 13 000 (7000 - 20 000) children were newly infected with HIV due to mother-to-child transmission.
One of the key population most affected by HIV in Mozambique is:
Since 2010, new HIV infections have decreased by 24% and AIDS-related deaths have decreased by 46%.
Mozambique adopted the Fast-Track Targets in 2015, started a phased roll-out of test and start in 2016 and plans to extend antiretroviral therapy coverage to 81% of adults and 67% of children living with HIV by 2020. Plans are in place to revitalize HIV prevention, to identify gaps in the prevention of mother-to-child transmission of HIV cascade and implement appropriate corrective actions. There are also plans to enhance male engagement in HIV services in hotspot areas and to scale up differentiated care models, including community service delivery.
Focusing on key populations to reach UNAIDS’ ambitious 90-90-90 targets in Mozambique, the Joint United Nations Team on AIDS (Joint Team) continued to provide support to the Government and civil society organizations to improve the national AIDS response.
HIV testing and treatment
The Joint Team in Mozambique supported activities to increase the coverage of quality care, treatment and support services for people living with HIV (PLHIV) and TB patients, with a focus on those with unmet needs.
The Joint Team also worked together with PEPFAR to advocate for the implementation of Test and Treat strategy, which started in August 2016. WHO organized an international workshop for Portuguese Speaking Countries in Maputo to disseminate the WHO guidelines for prevention, treatment and care. Meanwhile the UNAIDS Secretariat provided technical assistance to the Ministry of Health for the selection of districts where Test and Treat would be piloted in 2016, using updated strategic information.
UNHCR also, ensured access to HIV prevention, treatment and care to refugees from the refugee camp of Maratane (Nampula) and surrounding host population. WFP provided treatment of moderate acute malnutrition among 7000 pregnant and lactating women in high HIV prevalence areas affected by the drought emergency.
Elimination of mother-to-child transmission (eMTCT)
UNICEF supported the Ministry of Health in the development of a National Communication Strategy for retention in prevention of mother-to-child (PMTCT) services and HIV paediatric treatment. This included the provision of funds for the training of more than 220 maternal and child health nurses in Option B+ and paediatric treatment protocols. They also supported the application of innovative Point of Care (POC) technology in Mozambique to expand access to HIV diagnostics, leading to the adoption of POC into national policy guidelines.
In addition, UNICEF conducted participatory research on paediatric barriers to retention in Gaza, Nampula and Tete provinces. The results guided development of key messages for specific groups, which have been incorporated in the communication strategy.
HIV prevention among young people and key populations
The Joint Team worked throughout 2016 on providing HIV prevention services to prisoners, mobile workers, teachers, migrants, refugees and asylum-seekers, miners and mine-sending communities, young girls and adolescents.
For example, UNICEF continued to support production of radio programmes on HIV prevention, sexual and reproductive health (SRH), child marriage and violence against children, which were broadcasted in 53 community radio stations and nine provincial broadcasters, reaching 1.5 million listeners.
ILO supported provision of voluntary counselling and testing (VCT) services in the workplace and surrounding communities and, in 2016, 23 000 people were tested for HIV and other non-communicable diseases along the Maputo Transport Corridor and in companies. At the same time, ILO worked with the University of British Columbia in piloting a tool to remove biological hazards and reduce the transmission of infectious diseases in the health sector workplace. IOM also worked in Ressano Garcia and Xai-Xai in HIV health promotion activities, targeting miners and their communities. Through this programme, almost 3000 students were reached by the school based agents; more than 5000 people were tested for HIV and around 8000 were screened for TB. All were referred to the nearest clinic.
UNESCO also capacitated 137 teachers in a life skills education programme so that they can integrate these cross-cutting issues in their pedagogical projects, benefiting adolescents and youth.
UNFPA has capacitated peer educators and health providers on SRH, HIV prevention, Behaviour Change Communication and techniques to improve adherence and retention to antiretroviral therapy (ART), reaching more than 26 000 girls. Through PSI organization, UNFPA also supported the MOBIZ to expand accesses to contraceptive amongst young population including adolescents. From January to November 2016 almost 113 000 adolescents were reached, a total of 303 545 peer educators sessions were recorded and 529 314 condoms were distributed. UNFPA remained one of the highest contributors of contraceptives in the country and procured 56% of the required contraceptives, including condoms. As a result of strong advocacy, the contribution of the State Budget towards contraceptive needs has also increased from 3% in 2015 to 9.5% in 2016.
Gender inequality and gender-based violence (GBV)
UN Women built the capacity of 432 people across various activities, to create a foundation for empowerment and choice for women who are particularly vulnerable to HIV and/or GBV. UN Women’s efforts served to expand understanding and to reduce the gender inequality of HIV risk, as well as to promote women's leadership in HIV response and prevention.
Through a partnership with the Ministry of Health and Ministry of Gender, Child and Social Affairs, UNHCR assured survivors of GBV from the Refugee Maratane Centre/Nampula benefited from psychosocial support and occupational therapy. A series of awareness raising activities were also promoted, such as a workshop with male leaders of the community, to agree on key messages on gender equality, committing to spread those messages in the community.
Human rights, stigma and discrimination
The UNAIDS Secretariat worked with civil society organizations, including of key populations, networks of people/women living with HIV, miners and youth, to promote their participation in national strategic planning processes and advocate for their rights.
The Joint Team also provided technical support to the National AIDS Council in developing an HIV and AIDS Law Regulation, based on the existing HIV Law 29/2014.
Secretariat functions
In 2016, the Joint Programme in Mozambique contributed to an effective coordination of the HIV multisectoral national strategy. For example, the Joint Team supported the operationalization of the National Strategic Plan IV, through the elaboration of sectoral plans from ministries of Youth and Sports, Education and Human Development, Women, Children and Social Affairs, Justice, State Administration and Public Function, Agriculture, and Home Affairs.
UNESCO and the UNAIDS Secretariat additionally provided technical support for the preparation of Mozambican Stakeholders in key meetings throughout 2016, such as the High Level Meeting and the International Conference on AIDS and Sexually transmitted infections in Africa (ICASA) Ministerial Commitment. As a follow up, the Secretariat supported the Government of Mozambique in the elaboration of the National position on the Declaration and the integration of its targets into National Strategic Plans.
In order to fast track the AIDS response, the UNAIDS Secretariat, in collaboration with UNDP and ILO, provided technical support to advance the Cities initiative. As a result, a Maputo City profile, along with Terms of Reference for the technical and reference group, was developed. Process for Xai-Xai and Matola City plans were also initiated.
The UNAIDS Secretariat also proactively supported the preparation of the elaboration of the Global Fund funding request, for 2018-2020, by mobilizing stakeholders and partners, leading the planning process and providing technical orientations to the Country Coordinating Mechanism.
Finally, aiming for an evidence-based HIV response in Mozambique, IOM produced Terms of Reference for a position paper on HIV in emergencies, to generate evidence on HIV vulnerability, prevention and treatment needs among migrants and internally displaced populations in selected areas with past humanitarian emergencies in Mozambique. This work will enable the investigation on how government structures address HIV/AIDS needs during and in the aftermath of humanitarian emergencies and how HIV is included in any of the sectors or pillars of the national emergency system.
Challenges
One of the main challenges identified in 2016 is ensuring retention of ART and PMTCT patients, especially children for paediatric ART and early infant diagnosis. To this end, UNICEF supported the Ministry of Health to develop a communication strategy for PMTCT and paediatric ART, while other agencies are supporting linkages with communities through national nongovernmental organizations.
It is also widely recognised that the external multisectoral HIV and AIDS environment, coordinated by the National AIDS Council, is not conducive to joint planning and programming. Therefore there is a need to support the National AIDS Council in better coordinating multisectoral response. In that respect, the Joint Team was actively involved in the National Strategic Plan IV operationalization, bringing expertise in the various multisectoral areas.
A financial gap for HIV and AIDS continues to exist and the Joint Team is actively working with the Government of Mozambique to mobilize Global Fund grants for 2018-2020, in coordination with the United States Government. Similarly, the lack of financial resources remains a challenge for the Joint Team. The termination of the UBRAF High Impact Countries funds and the absence of UBRAF resources to Mozambique further weaken the capacity of UN agencies to undertake joint activities in programmatic areas that are left behind.
There is also a need to improve Joint Team coordination to create more opportunities for regular technical discussions and joint positioning on key policy and dialogue issues, as well as joint resource mobilization.
Key future actions
Increasing demand for quality access to adolescent and youth SRH and HIV prevention services, through (i) the implementation of evidence-based policies and strategies on adolescent and youth SRH, HIV and GBV; (ii) the empowerment of adolescents and youth with life skills and improvement of knowledge on SRH and HIV; and (iii) the scale-up of adolescents and youth SRH and HIV prevention quality services. The Joint Team has designed its work plan for 2017 aiming at:
