The second National Multi-sectoral Strategic Framework (NMSF) on HIV and AIDS covers the period 2008 to 2012. It builds on the achievements and strengths of the National Response to the HIV epidemic in the last five years (2003 to 2007) and proposes measures and strategies to overcome past barriers and constraints. This NMSF guides the approaches, interventions and activities which will be undertaken by all actors in the country. The Framework was developed through an extensive review and consultation process under the guidance of the National and International consultants.

The HIV epidemic in Tanzania still poses a major threat to the national development and has been declared a national disaster. Its impact causes widespread suffering among individuals, families and communities across the country. However, there are signs of hope. Based on latest available data, the HIV prevalence is stabilizing and even slightly decreasing in many parts of the country. Prevention efforts and the availability of effective treatment have reduced the impact of AIDS among the infected people. However, there are still over 1 million Tanzanians infected with HIV and new infections are occurring in the country every day. The magnitude of the epidemic and its cumulative effects over the past twenty years still provide major challenges to the country which can only be overcome through accelerated multi-sectoral efforts.

Achievements and challenges

The last five years of the National Response to HIV were guided by the first National Multi-sectoral Strategic Framework on HIV and AIDS (2003 to 2007). During these years, a number of achievements have been attained which have contributed to strengthen the National efforts. Among the major achievements in the four thematic areas are as follows:

Enabling environment (cross-cutting issues):

• Most MDAs started some HIV interventions for their employees and their sector;
• HIV and AIDS were integrated in the long-term poverty reduction strategy (MKUKUTA);
• TACAIDS became operational as the central coordinating structure for the National Response;
• Focal persons were appointed in all MDAs and AIDS Commitees established;
• Multi-sectoral AIDS Committees were established in all districts and in some wards, and villages and training was provided to committee members;
• Regional Facilitating Agencies were established covering all regions and providing substantial support for districts and communities;
• The portfolio of a Deputy Minister for Disasters and HIV and AIDS was created in the PMO;
• The Tanzania Parliamentarian AIDS Coalition was established;
• Many more Civil Society Organisations became involved in HIV providing a tighter net of coverage across the country, including more groups of PLHIV
• The funding for HIV and AIDS activities increased substantially from government and donor resources and far more funds reached communities;
• Further expansion of the HIV sentinel surveillance system;
• Regular studies on HIV and behaviour (inclusion of HIV and AIDS in the Demographic and Health Survey (DHS)); and the Tanzania HIV Indicator Survey (THIS);
• Consolidation of the reporting on HIV and AIDS in the health system;
• Development and initiation of a comprehensive monitoring system for non-health activities (TOMSHA).

Prevention:

• The coverage of STI treatment in the country increased to all hospitals, health centres and 60% of dispensaries;
• Substantially more (male) condoms were available in the country (from 50 to 150 million);
• The number of Voluntary Counselling Centres increased more than 3 times;
• PMTCT was scaled up from a pilot programme to more than 12% of health facilities;
• From different surveys there were indications that young people started to change their sexual behaviour (increased delay of sexual activities, fewer sexual partners etc.) and school-based health promotion programmes were expanded;
• The private and informal sectors became more actively involved, providing prevention and care programmes to its employees and members respectively.

Care and treatment:

• The roll-out plan for ART was implemented and more than 70.000 PLHIV are reported to be under treatment by the end of 2006;
• Home-based care projects were expanded mainly by CSOs;

Impact Mitigation:

• Increased support was provided to orphans, most vulnerable children and other vulnerable groups
• Involvement PLHIV in the National Response especially Advocacy and reduction of stigma and discrimination

However, in the overall response substantial challenges remain and need to be addressed in the coming years. Among these include the following:

• Inadequate middle and lower level political commitment and accountability for the HIV response;
• Weak and insufficient HIV programmes by the MDAs especially at regional, district and community outreach levels;
• Overburdened national coordination structure (TACAIDS);
• Non recognition and applications of the Three Ones principle at central and district levels;
• Insufficient involvement of CSOs and PLHIV especially at district and community level in planning and implementing HIV responses;
• Continual delays and difficulties in providing timely funding to districts and communities;
• Limited capacity in LGA to develop and implement comprehensive HIV and AIDS plans