Country situational analysis

The first case of AIDS in Mozambique was recorded in 1986. The following year, the first survey was carried in various urban centres, which recorded an average prevalence between 1.2% and 2%.

The civil war that engulfed Mozambique from 1975 to 1994 considerably hampered the national response to HIV as most resources were diverted toward financing the war. During this time limited surveillance of the epidemic made it difficult to measure its impact. Since 1992 returning refugees from neighboring countries fueled the rapid spread of the epidemic in Mozambique. HIV has also grown steadily but undetected within the country ever since the discovery of the first AIDS case.

At the end of 2009, there were 1.4 million people living with HIV, which corresponds to 11.5% prevalence.

There is great disparity between HIV prevalence in the northern (9%) and southern regions (21%).

In Mozambique as in most countries in eastern and southern Africa young women aged 15-24 are disproportionately more affected by HIV than men in the same age group. UNAIDS estimates 2010 show that HIV prevalence among young women at 8.6% compared to 3.1% among young men.

According to the UNAIDS Report on the AIDS epidemic, 128,330 people on antiretroviral treatment at the end of 2009, which equals 30% coverage. It is important to note that the number of sites providing antiretroviral treatment across the country has increased from 32 in 2005 to 211 in 2007. The percentage of HIV positive pregnant women who received antiretroviral treatment to prevent mother-to-child transmission of HIV was 70%.

Key elements of the national response

The national response to the HIV epidemic in Mozambique started in 1988 with the establishment of a prevention and control programme in the Ministry of Health. In 2000, the Government approved a National Strategy (PEN) and established the National Council to Combat AIDS (CNCS).

The first National Strategic Plan for the period 2000-2002 sought to slow the spread of HIV and mitigate the effects of the epidemic through a multi-sectoral approach focused mainly on prevention activities. Treatment and provision of antiretrovirals were not envisaged because of the high cost at that time and the complexity of implementation.

The second generation National Strategic Plan (PEN II) for the period 2005-2009 showed increased commitment to accelerating prevention and integrated care and treatment of people living with HIV with a human rights-based approach.

Since 2005 HIV has been mainstreamed into many national policy framework documents as well as the current Action Plan for the Reduction of Absolute Poverty 2006-2009 (PARPA II) which shows the government’s commitment to adopt a comprehensive approach to the HIV response.

2006 was marked by renewed political commitment to address HIV and the drivers of the epidemic in Mozambique.

The third National Strategic Plan (PEN III), 2010-2014 was launched in 2009. This saw the wide involvement of all stakeholders and was based on evidence provided by specific studies such as the Modes of HIV Transmission and HIV Prevention Study and the Data Triangulation Study conducted in 2008-09.

2009 was marked by the adoption of the Law on Defending Human Rights and the Fight against the Stigmatisation and Discrimination of People living with HIV and AIDS (Lei da Defesa dos Direitos Humanos e da Luta contra a Estigmatização e Discriminação de Pessoas vivendo com HIV e SIDA) - (law nr. 12/2009). This represents an important step for reinforcing the policy context for HIV prevention in Mozambique. The law reflects the commitment of the national government and civil society organizations to antidiscrimination measures, privacy rights, and access to free treatment provided by the state, obligations to provide HIV education including via school curricula, and protection of women’s property rights. However, it criminalises HIV transmission.

Key achievements

• The Presidential Initiative on HIV and AIDS led by President Guebuza in 2006 brought together community leaders from all levels, senior central government, provincial and district government, representatives from civil society, faith-based and youth organizations to discuss and renew their commitments to the national AIDS effort
• HIV prevention education was integrated in the basic education curriculum
• Increased availability of male condoms
• Integration of prevention of mother-to-child transmission in all other health services
• Approval of the National Communication Strategy and its operationalization at national and provincial level
• Ministry of Health has planned for a national HIV serobehavioural survey in 2009 which will call for the participation of all stakeholders
• Design of the "Response to HIV and AIDS Strategy within the Civil Service" (Estratégia de Resposta ao HIV & SIDA na Função Pública), 2009-2013
• Strategy for the Acceleration of Prevention of HIV Infection (Estratégia de Aceleração da Prevenção da Infecção pelo HIV) was designed and implemented for the period 2009-2010,
• Launch of the third National Strategic Plan (PEN III), 2010-2014. This saw the wide involvement of all stakeholders and was based on evidence provided by specific studies such as the Modes of HIV Transmission and HIV Prevention Study and the Data Triangulation Study conducted in 2008-09. 
• Implementation of the Law on Domestic violence against Women (Lei sobre a Violência Doméstica praticada contra a Mulher) in 2009
• Implementation of the Law on Defending Human Rights and the Fight against the Stigmatisation and Discrimination of People living with HIV and AIDS (Lei da Defesa dos Direitos Humanos e da Luta contra a Estigmatização e Discriminação de Pessoas vivendo com HIV e SIDA) in 2009.

Key challenges

• There is no HIV surveillance data or population size estimates for key populatios at higher risk which limits the possibility of assessing the scope of the problem and determine appropriate interventions
• Human resource constraints across the various sectors continue to be a major challenge to scaling-up services
• Providing timely and quality data continues to be a barrier to improved planning and budgeting
• Integration of HIV services with other essential services, especially tuberculosis and reproductive health remain a challenge an additional services such as home-based care continue to be very weak
• Education programmes on antiretroviral treatment to ensure adherence are still weak;
• Civil society has limited capacity, is fragmented and its involvement in national coordinating mechanisms is limited
• Lack of evidence about the drivers of the epidemic
• Limited evidence about the success of HIV prevention programmes and about 'what works'

Useful links

• Conselho Nacional de Combato ao HIV/SIDA (CNCS)
• National Strategic Plan
• National AIDS Spending Assessment
• PMTCT and Paediatric Care and Treatment Fact Sheet
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
PO Box 4595
Maputo
Mozambique
Tel: +258 21484510
Fax: +258 21492345

Conselho Nacional de Combate Ao HIV/SIDA (CNCS)
Eliseu Joaquim Machava (Gov.)
Teles Gemuce (Coord.)
Rua Antonio Bocarro, 106/114
Maputo
Mozambique
Tel: +258 272 20175
Email: npchiv.pmb@teledata.moz
Email: telesgemuce@yahoo.com.br

Mozambican Network of AIDS Service Organizations (MONASO)
Alice Ripanga
Executive Secretary
Avenida Ahmed Sekou Toure
425
Maputo
Mozambique
Tel: +258 21 425260
Fax: +258 21 425260
Email: monaso@tvcabo.co.mz

National Network of Associations Of People Living With HIV/AIDS (RENSIDA)
Julio Ramos Mujojo
Executive Secretary
Avenida Vladmir Lenin
1424
Maputo,
Mozambique
Tel: +254 20 2736415 +254 20 2736415
Email: rensida@tvcabo.co.mz
Website: www.rensida.org