HIV Australia | Vol. 8 No. 1 | April 2010

By Matthew Tyne and RD Marte

Laos Peoples Democratic Republic (PDR) shares borders with five other countries (Thailand, Cambodia, China, Myanmar and Vietnam). It is landlocked and one of the most sparsely populated and least developed countries in Asia.

Nearly 80% of the country’s population lives in rural areas and about half the country’s gross national product (GDP) comes from subsistence agriculture. ¹ Much of rural Laos is still directly affected by unexploded ordnance, a legacy of conflict between the United States and North Vietnam some forty years ago.

Laos PDR is a low HIV prevalence country. By the end of 2007, there were an estimated 5,500 people living with HIV and an adult prevalence rate of 0.2%. ² However, there is some evidence to suggest a growing epidemic among sex workers, their clients and men who have sex with men (MSM). Migrant workers are also a vulnerable group. While the rate of infection among sex workers remains relatively low, at 0.5% in 2008, a study of 540 MSM in Vientiane indicated that 5.6% of those surveyed were HIV-positive. ³

The country’s response to HIV is led by the National Committee for the Control of AIDS (NCCA). The NCCA is supported by Committees for the Control of AIDS at both the provincial and district levels. In 2006, the NCCA coordinated the development of the country’s current National Strategy and Action Plan (NSAP). The focus of the plan, which is currently under review in preparation for the next NSAP, is on scaling up Universal Access, especially for sex workers and their clients, and men who have sex with men. ⁴

Antiretroviral therapy (ART) was first made available in Laos in 2003 by Medecins Sans Frontiers. Treatments are currently available at three sites: Vientiane, the country’s capital; Luang Prabang in the north, and Savannaket in the south. ⁵ The Ministry of Health manages and operates treatment services. While by the end of 2008, there were approximately 1000 people receiving free ART, by 2012 it is expected that there will be 3,500 people on ART. ⁶

The NSAP aims to include people living with HIV as participants by appointing them to ‘advisory roles in all HIV/AIDS decision-making bodies, including NCCA and Country Coordinating Mechanisms (CCM)’. ⁷ In addition to scaling up prevention efforts and treatment access, the NSAP includes aims to put ‘supportive policies’ in place to facilitate ‘interventions focusing on the most vulnerable and marginalised groups’. ⁸

An important dynamic in the Laos HIV response is the way in which the dominant government sector interacts with civil society. As the current NSAP makes references to increasing the participation of people living with HIV and other affected communities, the relationship between government agencies and their non-government counterparts requires careful monitoring and negotiating.

In Laos, it is difficult to form autonomous community-based organisations (CBOs). Instead, government-sponsored mass organisations auspice many projects and organisations to work directly with communities. Civil society is represented by mass organisations, including Lao Women’s Union (LWU), Lao Revolutionary Youth Union (LYU), Lao Front for National Reconstruction (LFNR) and Lao Federation of Trade Unions (LTU). ⁹

The Laos Youth Union (LYU) has been particularly active in its support of community based groups working in HIV prevention, care, support and advocacy. LYU auspices the Laos Youth Action for AIDS Program (LYAP), the in-country partner of the Community Advocacy Initiative (CAI). The CAI is a three-year ¹⁰ program, which aims to expand and strengthen the capacity of local and regional CBOs. Funded by AusAID through the HIV Consortium for Partnerships in Asia and the Pacific, CAI is implemented by AFAO and APCASO in partnership with in-country CBOs. Currently CAI operates in Indonesia, Vietnam and Laos.

CAI implementation began in Laos in 2009. It was guided by the advice AFAO and the Asia Pacific Council of AIDS Service Organisations received from consultations with stakeholder groups: CBOs, international NGOs, government, the United Nations (UN) and funding agencies. A unique feature of the Laos program is the need to constantly keep in check the balance of having community groups as the focus and owners of the program, while keeping relevant government agencies involved and supportive of the program. The in-country experience, network base and expertise of the local implementing partners have proven valuable in negotiating this balance.

The program in Laos is led and coordinated by the Laos Youth Action for AIDS Program, a 12-staff and 60-volunteer members strong local organisation, which provides peer outreach programs to men who have sex with men and transgender people and care and support services to people living with HIV and their families. With the leadership of LYAP, the CAI program has brought together a diverse range of community-based groups whose members include men who have sex with men, people who identify as transgender, sex workers, women, young people, and people living with HIV. The program has also facilitated joint advocacy capacity development, identification of critical local HIV/AIDS issues, ¹¹ and the development and implementation of advocacy plans in response to these critical issues.

Program activities, to date, include a series of advocacy workshops and ongoing technical and financial support for CBOs to develop, refine and implement advocacy plans. The Laos translation of the CAI HIV Advocacy from the Ground Up toolkit serves as key reference material for the program. The toolkit is a practical resource for trainers of advocacy capacity development. It is intended to broadly elaborate on the concept of advocacy and how it plays a key role in effective HIV interventions and AIDS services and, wherever possible, builds on actual experiences and work already being carried out by local NGOs and CBOs.

Slowly, CAI is seeing the development of a very new and small but committed movement of community-based advocates in Laos. We are really beginning to, as the title of the toolkit suggests, do advocacy from the ground up.

References

1www.undplao.org (accessed 1 March, 2010).

2 UNAIDS. (2008). Epidemiological Fact Sheet in HIV and AIDS: Laos PDR, available at: http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_LA.pdf (accessed 1 March, 2010).

3 Phimphachanh, C. (2008). Programme Manager’s Point of View: Universal Access in a Low Prevalence Country: Opportunities and Challenges for Laos People’s Democratic Republic. In: HIV/AIDS Prevention and Care Newsletter 1 (2), World Health Organization Western Pacific Region.

4 Ibid.

5 Baldwin, R. (2009). Lao Red Cross Support to the Lao Network of PLHIV Programme: Mid-term Review.

6 Phimphachanh, C. (2008). Programme Manager’s Point of View: Universal Access in a Low Prevalence Country: Opportunities and Challenges for Laos People’s Democratic Republic. In: HIV/AIDS, Prevention and Care Newsletter 1 (2), World Health Organization Western Pacific Region.

7 Laos PDR National Strategic Action Plan on HIV/AIDS/STI 2006–2010, available at: http://www.undplao.org/whatwedo/respondhiv.php (accessed 1 March, 2010).

8 Ibid.

9 Laos PDR National Strategic Action Plan on HIV/AIDS/STI 2006–2010 (p1), available at: http://www.undplao.org/whatwedo/respondhiv.php (accessed1 March, 2010).

10 1 July, 2008 to 30 June, 2011.

11 These include mandatory HIV testing for staff in some foreign owned businesses; schooling for children living with HIV; and issues for MSM and female sex workers in three provinces.

RD Marte is a Program Manager for the Asia Pacific Council for AIDS Service Organisations (APCASO) based in Kuala Lumpur and Matthew Tyne is an International Program Officer at AFAO.

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