Concept note multistakeholder meeting, closure workshp, May 2023
1. BACKGROUND
The second phase of the SADC PF SRHR, HIV and AIDS Governance Project, which is currently running over a 4-year period from 2019 to 2023, is being implemented in collaboration with 12 SADC Member States participating Parliaments namely Seychelles, Zambia, Zimbabwe, Eswatini, Lesotho, the Democratic Republic of Congo, Malawi, Botswana, Mozambique, Angola, Madagascar and Namibia. For recall, the central objective of the Project is to improve the oversight, representative, legislative and budgetary role of Parliamentarians in the SADC region in general, and female Parliamentarians in particular, in the field of Sexual and Reproductive Health Rights (SRHR) and HIV and AIDS Governance, with Human Rights and Democracy also recently added to the targeted outcomes. At the regional SADC-PF level, the Project falls under the ambit of the Human and Social Development and Special Programmes (HSDSP) Standing Committee working in collaboration with the Regional Women's Parliamentary Caucus of the SADC-PF, which both report to the Plenary Assembly of the Forum.
The Project was once again well received in Seychelles because the issue of SRHR, HIV and AIDS was still deemed to be of paramount importance, and thus especially necessitating the intervention of Parliament as an institution. Besides, it was clear from parliamentary interventions in the SADC region and around the world that Parliament is the right institution to target in view of addressing issues of SRHR, HIV and AIDS in a balanced and impartial manner, from a rights-based perspective. Moreover, since the rights to be protected within the SRHR, HIV and AIDS paradigm have a strong relationship with constitutional human rights and democracy, Parliament as the legislature is deemed to be the appropriate forum to consider and mainstream such issues into governance structures.
In the Seychelles context, the Project is being implemented by the SADC PF in collaboration with the National Assembly of Seychelles, more specifically the Committee on Communicable Diseases, HIV/AIDS and SRHR. Under the Project capacity building workshops, roundtable discussions, visits, interactions with line Ministries and stakeholders and participations in various regional and virtual forums have been organized for Parliamentarians and the SRHR Researcher in order to promote the SRHR, HIV and AIDS and the Democracy and Human Rights agenda and contribute to the fight against these same causes at the parliamentary level.
The SADC-PF Governance Project also operates in the backdrop of Model Laws developed for the SADC region, namely the Model Law on HIV in Southern Africa, the Model Law on Eradicating Child Marriage and Protecting Children Already in Marriage, Model law on Public Financial Management, SADC Model Law on Elections and the SADC Model Law on Gender Based Violence. Furthermore, the Project also stands guided by deliberations and Motions of the SADC PF Plenary Assembly in relation to SRHR, HIV and AIDS and democracy and human rights and best practices adopted by implementing countries. To promote Project coherence from the regional to the national level, themes from resolutions of the Plenary Assembly are as far as possible adapted for the national context. For instance, the Resolution pertaining to the Mahé Declaration following the Women's Parliament in Seychelles in 2017 made clear that there is a need to focus on the root causes of vulnerabilities of women and girl children in the context of HIV. Henceforth, the Project in Seychelles was implemented by keeping a close eye for SRHR infringements which expose the vulnerabilities of women and girl children and this aspect was included in ensuing activities.
2. STRENGTHENING OF THE PARTNERSHIP FRAMEWORK UNDER THE PROJECT
Considerable efforts have been made under the SRHR, HIV and AIDS Governance Project to strengthen the partnership framework between MPs, Line Ministries, CSOs and the National Assembly of Seychelles as an institution. By and large, there has been the required parliamentary response through the participation of MPs at the events under the Project. This positive parliamentary response was moreover reflected through parliamentary interventions in Parliament, both supporting proposals relating to SRHR, HIV and AIDS and Democracy and Human Rights, or being critical about them, thus showing that MPs harnessed interest on the theme and were sufficiently capacitated on live SRHR, HIV and AIDS and Democracy and Human Rights issues to make balanced interventions.
3. SOME KEY PROJECT ACTIVITIES THAT HAVE GROUNDED THE PROJECT IN SEYCHELLES
Since its inception during the first phase, to date, the Project in Seychelles has been marked by some key Project activities which have contributed to advance the SRHR, HIV and AIDS Governance and the Democracy and Human Rights framework of the Republic of Seychelles. The conduct of public hearings has allowed MPs and CSOs to engage directly with the citizenry and hear their views on SRHR related subjects, thus upholding participatory democracy and bridging the gap between the population, and especially Key Populations, and the Institution of Parliament; amendment to the Penal Code through a Bill culminating in decriminalising the act of sodomy; capacity building workshops on themes such as sex workers and the LGBTI community demonstrated the genuine involvement of representatives from the National Women Parliamentary Caucus and the SRHR & HIV/AIDS Parliamentary Committee to engage on authentic issues and bring them forward in Parliament; under the Project, representatives from the Parliament of Seychelles also engaged in cross-learning with other participating Parliaments in order to share the experiences of Seychelles following the enactment of the Misuse of Drugs Act which is largely seen as a modern drug related legislation that strikes the right balance between rehabilitation and the need for punishment of drug offenders; the SADC Model Law that requires countries to set the minimum age of marriage at 18, to register all marriages and take effective action, including through legislation, to eradicate child marriage has culminated in an amendment to the Civil Code setting the legal age for marriage at 18 years; a Motion tabled in the House has led to the free distribution of sanitary towels to all government school students and; two Motions were tabled and forwarded to the President asking for the decentralisation of HIV/AIDS services and also to bridge the gap between the age of consent to sex and access to contraceptives, to name but a few achievements.
4. PROCEEDING WITH PROJECT CLOSURE
As the Project comes to a fruitful close, it is thus deemed appropriate to assess the value gains once again under the Project in accordance with the partnership framework created and to give an opportunity to stakeholders to reflect on the Project for its winding up, and furthermore for the preparation of any Project of a similar nature to be operated under the auspices of the National Assembly.
HIV is the primary deadly sexually transmitted infection and a deficit in access to basic sexual and reproductive health and rights (SRHR) augments a person's risk of contracting HIV. Since it is clear that the AIDS epidemic and the sexual reproductive health and rights issues cannot come to an end both in Seychelles and worldwide without the needs of people living with and affected by HIV, and the determinants of health and vulnerability, being addressed, the project closure is an opportune time to reach out to other stakeholders to address this pertinent issue through a SWOT analysis involving Line Ministries and CSOs.
Observations in Seychelles have shown a considerable increase of HIV- positive persons being Lost to follow-up, especially during the peak of Covid 19, resulting in serious consequences as a result of discontinuation of treatment, drug toxicity, SRH complications, treatment failure due to poor adherence, and drug resistance resulting in an increased risk of co- infections and death.
It is crucial for HIV patients to have regular and long-term care in the form of antiretroviral therapy (ART) and SRH follow-up, important components of HIV care. Patients who are lost to follow-up (LTFU) while on treatment compromise their own health and the long-term success of ART programs. The extensive ART has positively changed national AIDS responses and has had an unquestionable impact on health with ART reducing transmission of HIV and HIV-related morbidity and mortality.
In spite of enhanced and effective programmatic coverage with ART, a noteworthy number of individuals still drop out of care at various points during their treatment and it is very important to identify the reasons for these dropouts since retention on ART and guaranteeing compliance to treatment are critical factors of successful long-term outcomes. ART programmes cannot be successfully implemented if LTFP remains high as patients who cease to follow treatment can very quickly see a rise in their viral load and depletion of CD4 count, putting them at risk of deteriorating SRH diseases and opportunistic infections and even early death.
There is an urgent need to implement strategies nationwide to better track services and minimise LTFU from HIV care. A modification in the way tracing is conducted may reduce LTFU since the lost to follow-up may potentially endanger not only HIV patients' lives, but also contribute to increased HIV drug resistance due to ART default.
Consequently the Committee on Communicable Diseases, HIV/AIDS & SRHR, has sought to work in partnership with the Ministry of Health and local NGO the HIV AIDS Support Organisation (HASO) in identifying gaps in the Lost to follow-up for HIV patients, with the aim of redressing the situation and to take a bold step closer to achieving the third Sustainable Development Goal which aims to end the epidemic of HIV/AIDS by 2030 and has the core principle that no one should be left behind.
The half-day Multi-stakeholder Meeting under the theme Theme: "Stronger Parliamentary SRHR Engagement - A lens on HIV AIDS Response in Seychelles" as the Project's closure activity with the partners under the Project, will speak to the issue of Lost to follow-up and will reflect on any shortfalls through a SWOT analysis to pave the way for future initiatives. The wrapping-up session will also mark an opportunity to express a vote of thanks towards the donor, Sweden, for its consistent support throughout.
5. SPECIFIC OBJECTIVES OF THE MEETING
a) Identifying the prevalence and magnitude of Lost to follow-up in Seychelles and understanding the factors contributing to it
b) Identifying and addressing problems associated with Lost to Follow-up
c) Avoiding and managing Lost to Follow-up
d) Incidence of Lost to follow-up
6. EXPECTED OUTCOMES OF THE MEETING
- Reflections are made in the light of shortfalls and participants gain a clear understanding on how to avoid Lost to Follow-up
- A clear understanding on what happens to HIV patients who are lost to follow-up and why they choose to discontinue treatment
- Devise strategies to reengage patients Lost to Follow-up in HIV care
- Conceive a comprehensive treatment Adherence Counselling and Retention Guide
- Creation of a platform for stakeholders to engage with and work together to identify gaps and find solutions
- The Project is wound up smoothly through this consultative process.
7. METHODOLOGY
This will be a physical in-person meeting with a mixture of PowerPoint presentations and interactive sessions.
8. COST OF THE MULTI-STAKEHOLDER MEETING
SADC-PF will cover conference cost including 1 tea break and lunch, air fares, accommodation, transport, per diem for participants, media person and rapporteur fee and the National Assembly will cover cost for PA system, banner and other minor and additional unforeseen costs.
9. VENUE AND DATE
The workshop will take place in the Republic of Seychelles on Monday 29th May at Savoy Seychelles Resort & Spa from 09000hrs to 1330hrs.
10. PARTICIPANTS
The participants will be 40 and will include SADC PF representatives, Members of Parliament, the HIV and AIDS Support Organisation (HASO), the Ministry of Education, the Ministry of Health inclusive of the National AIDS Council (NAC) and the Communicable Diseases Control Unit (CDCU), Seychelles Prison officers, Social Affairs Department, the Citizens Engagement Platform Seychelles (CEPS), the Seychelles National Youth Council (SNYC), Persons Living with HIV, and staff of the National Assembly.
Concept note multistakeholder meeting, closure workshp, May 2023
