Post 2015 agenda & aids coordination

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  • Reminder – the multiple activities convened by the UN
  • Thematic consultations: Hosted by UN & CSOs
    Country/Regl Consultations funded by UNDG
    The High-level Panel of Eminent Persons was appointed by the Secretary-General. Convened from July 2012 to provide recommendations on possible components of a post-2015 UN development agenda, as well as to contribute to the overall political process. The Panel will deliver its report in the second quarter of 2013. Meets end January in Liberia and March in Botswana.
    22 Jan – UN GA established Open Working Group tasked with developing a set of sustainable development goals – in line with Rio+20 recommendation. Considered an integral part of the post-2015 development framework. Group will produce a report to the General Assembly sometime between September 2013-September 2014. Group comprising 30 countries.
    The goals should address in a balanced way all three dimensions of sustainable development and be coherent with and integrated into the UN development agenda beyond 2015.
  • Talk through the thematics most relevant to UNAIDS
  • UNAIDS saw something of progress/victory concerning UHC, which had been promoted by WHO as overarching health goal. Necessary, yes, but not an end. Didnt address determinants, access.
  • 3 experts panels being convened around 3 questions to provide analytical, technical support
    Thanks UCCs and RSTs for support in identifying panelists and commissioners – and pushing for involvement
    Already a lot of excitement and confirmations for commission
  • Waiting for noise of current consultations to die down
    Bring visibility to AIDS and to new vision for the future of health at highest political level in otherwise very crowded environment
    Commission seeks to be as diverse as possible
  • 3 experts panels being convened around 3 questions to provide analytical, technical support
    Thanks UCCs and RSTs for support in identifying panelists and commissioners – and pushing for involvement
    Already a lot of excitement and confirmations for commission
  • Prompt if necessary – re
    UCCs and RSTs responsible to identify, target and support:
    Champions for UNAIDS vision and agenda
    Government and CS leads on P2015 at country level
    MS members of the Open Working Group
    MS delegations to Sept GA
    Lancet Commissioners
    Internal UNAIDS communication – UCOs/RST/Regional/Geneva [what do UCCs need, and what do RST and HQ need from them to work efficiently and strategically to demonstrate UNAIDS unique value added and to win needed UNGA support? - Opportunistic SI to whom in RST and HQ? Monthly top 3 bullets? Engagement strategy? ]
  • Let us simply look at the GDP changes.
    Angola for example has seen 20% change.
    It is time for the Growth dollars to become health dollars And we can help that happen at country. UNAIDS with high level political leadership drive this change.
    There is a new opportunity to shape the health agenda with a new Africa.
  • Post 2015 agenda & aids coordination

    1. 1. Overview of AIDS Epidemic in Eastern and Southern Africa and progress towards meeting the HLM Targets Pride Chigwedere, MD, PhD, Coordinator for Universal Access, UNAIDS Regional Support Team for Eastern and Southern Africa 25 April 2013, Johannesburg, SA
    2. 2. 34 million people living with HIV, 2011
    3. 3. International Commitments on HIV/AIDS Global Commitments 2001 UNGASS Declaration of Commitment 2006 Political Declaration - Universal Access 2011 Political Declaration - Elimination Continental Commitments 2001 Abuja Declaration on HIV/AIDS, TB & Other Related IDs 2006 Abuja Call: Common Position on Universal Access 2011 AU Consultative Process: Africa Common Position to HLM 2012 AU Roadmap on Shared Responsibility and Global Solidarity
    4. 4. 2015 targets in the UN Political Declaration 2011 1 2 Halve sexual transmission Halve infections among injecting drug users 6 Close the global resource gap and achieve annual investment of US$ 22-24 bn 7 Eliminate gender inequalities and sexual violence and increase capacities of women and girls 3 Eliminate new HIV infections among children and halve AIDS-related maternal deaths 8 Eliminate stigma and discrimination 4 15 million people on HIV treatment 9 Eliminate travel related restrictions 5 Halve tuberculosis deaths among people living with HIV 10 Eliminate parallel systems, for stronger integration
    5. 5. Reduce sexual transmission of HIV by 50% • In 2011, there were approximately 2.5 million new infections in adults globally; 1,2 million of them were in ESA. • Decline in New Infections from 2001 to 2011: – – – – – 7 countries in ESA achieved over 50%; 4 countries achieved 26-49%; 2 countries achieved 10-25%; 3 countries remained stable; 1 country showed an increase • All countries need to achieve 50% decline from 2009 to 2015
    6. 6. % Change in Incidence 2001 – 2011 2001 Prevalence 2001 Incidence 2011 Prevalence 2011 Incidence % Change in Incidence 2001-11 Malawi 13.8 1.74 10.0 0.49 -72 Botswana 27.0 3.48 23.4 1.00 -71 Namibia 15.5 2.39 13.4 0.77 -68 Eritrea 1.1 0.08 0.6 0.03 -67 Zambia 14.4 1.89 12.5 0.80 -58 Rwanda 4.1 0.31 2.9 0.15 -53 Zimbabwe 25.0 2.11 14.9 1.05 -50 South Africa 15.9 2.42 17.3 1.43 -41 Swaziland 22.2 4.11 26.0 2.60 -37 Kenya 8.5 0.66 6.2 0.45 -32 Mozambique 9.7 1.63 11.3 1.13 -31 Sudan South 2.6 0.41 3.1 0.33 -21 Angola 1.7 0.26 2.1 0.21 -19 Lesotho 23.4 2.67 23.3 2.47 -7 Tanzania 7.2 0.62 5.8 0.59 -5 Madagascar 0.3 0.04 0.3 0.04 10 Uganda 6.9 0.69 7.2 0.84 21 Comoros na na na na nd Mauritius na na na na nd Ethiopia na na na na nd Seychelles na na na na nd Country Source: UNAIDS Estimate 2012
    7. 7. Eliminate new infections among children and reduce AIDS-related maternal deaths • Global – approximately 330,000 babies were born with HIV in 2011; 55% or 180 000 were in ESA • Nearly 90% of all new HIV infections among children globally occur in 22 countries – 21 of those countries are in Africa, and 14 are in ESA • Global Plan aims to reduce new infections in infants by 90% from 2010 levels, by 2015; requires achieving >90-95% coverage for high quality PMTCT services in priority countries
    8. 8. Percentage Coverage of PMTCT Services 2011 (excluding SD Nevirapine) Countries 2 - 49% Countries 50 - 79% Countries >80% • ESA coverage for PMTCT services in 2011 was 72% (plus 13% coverage on SD Nevirapine).
    9. 9. Reach 15 million PLHIV with ART by 2015 • # of persons living with HIV in ESA 2011 – 17.1m • # of persons eligible for ART using CD4 350 guidelines – 8.1m • # of persons on ART 2011 – 5.2m (64% coverage) • Unmet need for ART – 2.9m • Epidemiological projection shows that if the 15x15 target is met by 2015, 80% of those in need of ART will be receiving therapy Source: UNAIDS & WHO Estimates, 2012
    10. 10. Estimated ART Coverage (CD4<350) 2011 Countries <50% Countries 50 - 79% Countries >80% • 5 countries Rwanda, Botswana, Namibia, Swaziland and Zambia have achieved > 80% coverage
    11. 11. Reduce TB deaths in PLHIV by 50% • TB is a leading killer of people living with HIV causing one quarter of all deaths. People living with HIV and infected with TB are 21 to 34 times more likely to develop active TB disease, compared to people without HIV. • In 2010 there were an estimated 1.1 million new cases of HIVpositive new TB cases globally; approximately 60% occurred in ESA • In 2010, about 350 000 people died of HIV-associated TB globally. Almost 250 000 deaths were in ESA, and 85 000 were in SA.
    12. 12. HIV Prevalence (Percent Estimate) in New TB Cases, 2009 < 25% 25 – 50% 50 – 83% In South Africa, Lesotho, Swaziland, Namibia, Botswana, Zimbabwe, Zambia, Mozambique, Malawi & Uganda, more than 50% of new TB patients are HIV positive
    13. 13. Global Investment of US$22-24b / year in low and middle income countries • By 2010, Africa had mobilised close to US $ 8bn from both International and Domestic Sources • The increase in domestic resources is smaller that that of international resources
    14. 14. Share of care and treatment expenditure originating from international assistance, African countries, 2009–2011
    15. 15. THIRD GENERATION NSPs • Changed epidemic context: from public health emergency to chronic disease • Changed global economic environment: austerity measures in donor capitals, growth in Africa, emphasis on ‘managing for results’ and ‘value for money’. • Scientific & technological advances: simpler testing, treatment availability, treatment as prevention, MC, PMTCT • Taking AIDS out of isolation: greater national and international interest in integrating AIDS into broader health and development efforts • Political Declaration on HIV: Three Zeros, HLM targets and the centrality of NSPs
    16. 16. Generations of NSPs • 1st generation of NSPs: 1980s/early 90s; mainly GPA times (Medium Term Plans); within the health sector • 2nd generation NSPs: mid-90s; multi-sectoral; NACs; increased availability of funding, little prioritization and allocative efficiency • 3rd generation NSP: post-2015 and the beginning of the End of AIDS, challenged by signs of donor funding slowdown
    17. 17. Lessons from NSP 2G • • • • Limited focus on implementation, Low prioritization (high levels of inclusiveness) Large budgets dedicated to low impact interventions Costly and complex processes (heavy on time money & documentation) • Weak results orientation (processes, not results) • High costs of stand alone coordination with little return in terms of effective management for investment.
    18. 18. What is NSP-3G? A new initiative from the UNAIDS family to: • Foster a national planning paradigm shift in response to the new environment • Prioritize resource allocation and maximize return to investment (Investment Thinking) • Respond to country demand and ownership/ leadership (Paris/Accra/Busan) • Drive progress towards the UNAIDS vision of the Three Zeros & meeting the HLM targets
    19. 19. Universal Principles • Country ownership, shared responsibility & global solidarity • Scientific evidence public health considerations are integral • Full engagement by CSOs and PLHIV • Universal and equitable access to AIDS services and eliminating marginalization • Advancing human rights and gender justice
    20. 20. n Applying Investment Thinking in Lesotho Changing environment : shifting priorities, donor fatigue, economic crisis, national ownership vs. dependency Business as usual is not an option: Prioritization Emphasis on results/ impact Value for Money/efficiency Return on Investment sustainability Investment Cases: How do we maximize the returns on the Investment
    21. 21. AIDS: investing strategically to maximize impact CRITICAL ENABLERS BASIC PROGRAMME ACTIVITIES • Social Advocacy Laws, policies, and practices Community mobilisation Stigma reduction Mass media Programme Community centred design and delivery Programme communication Management and incentives Procurement and distribution Research and innovation Behaviour change OBJECTIVES Condoms Stopping new infections Treatment & care Child infections & maternal mortality Keeping people alive Key populations Male circumcision SYNERGIES WITH DEVELOPMENT SECTORS
    22. 22. Priority Country Actions: Sexual Transmission • Assist countries identify who is getting infected / who is at risk of infection (KYE/R) • Prioritize relevant, effective, and impactful prevention strategies for different populations (IF) • Advocate for the scale up Basic Program Activities: – Increase # of people on ARVs (effect on transmission) – Scale up male circumcision as a priority – Behavior change programmes – Programmes for key populations (almost no data for MSM, sex work, IDU in region) – Condom promotion & distribution • Make smart investments that combine programs with critical enablers to exploit synergies
    23. 23. Estimate Number of VMMCs needed to prevent one HIV infection (PEPFAR Data)
    24. 24. Estimate of Number of Adults 15-49 yrs. VMMC needed to reach 80% coverage / country (PEPFAR Data)
    25. 25. Estimate Number of VMMC done / country as of October 2011 (PEPFAR Data)
    26. 26. A checklist for applying investment thinking
    27. 27. Returns on investment using the investment approach 2011–2020 Outcomes Total infections averted More than 12 million Infant infections averted 1.9 million Deaths averted 7.4 million Life years gained 29.4 million
    28. 28. South Africa has significantly reduced the cost of ARVs South African tender prices June 2010 January 2011 350 International benchmark 300 250 ) d n R ( k a p e c i r P 200 150 100 50 0 ABACAVIR 300mg EFAVIRENZ EFAVIRENZ LAMIVUDINE NEVIRAPINE TENOFOVIR 200mg 600mg 150mg 50mg/5ml 300mg
    29. 29. Community support keeps people on treatment CLINIC-BASED TREATMENT 70% still receiving treatment after two years Sub-Saharan Africa: people receiving ART from specialist clinics Source: Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in subSaharan Africa, 2007–2009: systematic review. Tropical Medicine and International Health, 2010, 15(Suppl. 1):1–15. COMMUNITY TREATMENT MODEL 98% still receiving treatment after two years Mozambique: self-initiated community model Source: Decroo T et al. Distribution of antiretroviral treatment through self-forming groups of patients in Tete province, Mozambique. Journal of Acquired Immune Deficiency Syndromes, 2010 [Epub ahead of print].
    30. 30. Optimized investment could lead to rapid declines in new HIV infections Current and projected HIV infections Cambodia Zimbabwe South Africa Current & projected HIV infections 1990 Source: UNAIDS 2011 2015 1990 2015 1990 Benefit of the investment framework 2015
    31. 31. Integrated services are more efficient US$ 40 The example of VCT: Costs per client 35 Stand-alone VCT clinics 30 Integrated into SRH services 25 20 15 10 5 0 Kenya (2002) Kenya (2008) India (2007) Uganda (2009)
    32. 32. Lesotho Investment Case? • What will the country do differently to maximize returns? • Within each of the program activities which critical enablers is the country prioritizing to improve access and scale up, which groups will receive special attention? Which synergies will the country prioritize? How will these be reflected in the investment package? • Efficiency gains? Effectiveness? • What additional investments are required? Where will they come from? Can they be sustained?
    33. 33. VISION ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS. 16 October 2006 UNAIDS
    34. 34. AIDS in the Post-2015 Development Agenda Brazey de Zalduondo Sonja Tanaka 24 March 2013
    35. 35. UNAIDS overarching messaging • Investing in health. Need a fresh narrative to convince leaders to invest more – health reduces inequality; health mobilizes people for building democratic accountability; health cooperation can be a tool for diplomacy; offers entry point for human rights. • AIDS is not over. Priority is to ensure HIV is prominently positioned in the post2015 agenda, including ambitious, measurable targets towards the end of AIDS. • End of AIDS. With political commitment, community mobilization, adequate funding and the right approaches, the end of AIDS can be a shared triumph of the post-2015 era. • Transforming health. Approaches from the AIDS response, including inclusive, people-centred, multi-sectoral action, can be applied to transforming the way countries and their partners do health and development.
    36. 36. The Post-2015 House: UN Process towards an agenda P2015 Development Agenda UN General Assembly P2015 ASG Secretariat Regional, Online, and Other UN Consultations 11 Thematic Consultations 86 National/Regional Consultations Open Working Group on SDGs (65 Member States) High Level Panel
    37. 37. UNAIDS engagement & advocacy targets  UNAIDS engaged in 7 / 11 Thematics: Inequalities, Education, Food security and nutrition, Governance, Conflict and fragility, Population dynamics & Health.  Joint UNAIDS paper w Cosponsors with key messages on health, human rights and social transformation.  UCOs have engaged in Country Consultations (completed or underway, led by UNCT)  Global online conversation on worldwewant2015.org and myworld2015.org  Civil Society Consultations  Lancet Commission  UN SG’s High Level Panel, chairs: President Yudhoyono (Indonesia), President Johnson Sirleaf (Liberia) and PM Cameron (UK)  Open Working Group on Sustainable Development Goals (incl. Algeria, Egypt, Morocco, Tunisia; Benin, Ghana, Congo; Kenya, Tanzania, Zambia & Zimbabwe)
    38. 38. 2012-2013 Consultation processes
    39. 39. EXD address in Botswana 1. Must recall that where we are today is thanks to the MDGs 2. Our world is entirely different than in was in 2000 3. Opportunity to integrate this transformation into new a narrative for global health – smarter argument for why to invest. Example of AU Roadmap: frames health as spurring industrial development, knowledge economy, innovation – with SS cooperation. 4. International community must not make same mistake twice. Millennium Declaration gave a central role to inclusiveness, equity, dignity, human rights. But those principles got lost in translation to goals. 5. Global goals demand global solutions we must address global determinants and global responsibility for health and development 6. We have never had better time to disrupt and rebuild a new model to advance global health 7. We should inspire the High Level Panel to be bold and demand new thinking on health governance – we can streamline functions into 3 global health institutions (norm setting, financing and accountability)
    40. 40. Outcomes of Botswana Health Consultation, 5 March  Future health goals need to reflect universal realities –be relevant in all countries (HICs as well) and address equity (distribution) and rights  Goals must be tracked globally but catalyse progress and monitor success in terms of the reality that each country faces  The MDG agenda must be accelerated to 2015 and continued with updated targets - including through target to realise an AIDS-free generation
    41. 41. Themes and concerns emerging from the consultations  Continued relevance of the MDGs (human development agenda)  Need also to incorporate key issues the MDGs left out – including  Over all: universality, equity, quality  In health – NCDs (“double burden” of IDs and NCDs)  Address social determinants – through policies and investments  Need to combat growing inequality – disparities within as well as between countries  Investment in data, and use of data, at national and sub-national levels. Aim for data disaggregated by sex, age, geography – and more.  Interconnectedness of goals – be smarter, prevent “stove-piping”  Human right are central; need national and regional mechanisms
    42. 42. UNAIDS and Lancet Commission: From AIDS to Sustainable Health  Hope that Commission will be seen to have legitimacy and influence to drive political movement for AIDS and health  High level political Commission with a dynamic programme to produce: o space for systematic analysis of evidence o sharp critique o robust recommendations  Co-Chairs: President Joyce Banda; Dr Nkosazana Dlamini Zuma (Chairperson, AUC); Dr Peter Piot (Director, LSHTM)  First meeting: Lilongwe, 28-29 June  Outcome: Lancet special issue early 2014
    43. 43. Commission will address three questions  What will it take to bring about the end of AIDS?  How can the experience of the AIDS response serve as a transformative force in our approach to global health?  If we imagine a more equitable, effective and sustainable global health paradigm, how must the national and global AIDS architecture be similarly modernised?
    44. 44. Country and regional consultations in ESA       Angola Ethiopia* Kenya* Malawi* Mauritius* Mozambique       Rwanda Senegal South Africa Tanzania* Uganda* Zambia*  UNECA, with partners, has convened three subregional consultations in Accra, Ghana; Mombasa, Kenya; and Dakar, Senegal. *Consultation reports available
    45. 45. Draft African Common Position 4 Pillars 1.Transformative Economic transformation and inclusive growth, 2.Innovative technology transfer and Research development, 3.Human development (incl. UA to quality healthcare and HIV, with focus on treatment and EMTCT) 4.Financing and Partnerships Mar April May Sept
    46. 46. Role of UCCs and RSTs moving forward  ESA must be leading voice for HIV in the next development agenda  Ultimately Member States will decide the agenda and framework  UCCs and RSTs responsible to identify, target and support:  Champions for UNAIDS vision and agenda  Government and civil society focal points on P2015 at country level  MS members of the Open Working Group  MS delegations to Sept UNGA  Lancet Commissioners
    47. 47. DISCUSSION  UCO and RST advocacy strategies  Connecting messaging to political priorities for regional political institutions  Upcoming political opportunities  Internal communication, support from Geneva
    48. 48. Impact of ART: Significant Decrease in Mother-toChild Transmission of HIV since 2010 Courtesy Birx, UNAIDS Global Report 2012
    49. 49. 2001-2011 : Declining incidence
    50. 50. New HIV infections G8 Okinawa Initiative 2006 Political Declaration Abuja Declaration 2011 Political Declaration 2001 Declaration of Commitment UNITAID Doha Declaration G8 Gleneagles Pledge Gates Foundation PEPFAR 52 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 The Global Fund 1997 1996 1995 1994 1993 1992 1991 Resources available for HIV in low- and middle-income countries US$ 16.8 billion Millenniunm Declaration 1990 3.5 million people 2001-2011 : Resources for HIV has shown impact
    51. 51. What is driving the change?
    52. 52. What is driving the change?
    53. 53. The prophecy…the reality Wall street Journal , 23 July 2012
    54. 54. 2015: the 10 Global AIDS targets REDUCE SEXUAL TRANSMISSION PREVENT HIV AMONG DRUG USERS CLOSE THE ELIMINATE RESOURCE GENDER INEQUALITY GAP ELIMINATE NEW HIV INFECTIONS AMONG CHILDREN 15 MILLION ACCESSING TREATMENT AVOID TB DEATHS ELIMINATE ELIMINATE TRAVEL STRENGTHEN HIV STIGMA AND RESTRICTIONS INTEGRATION DISCRIMINATION
    55. 55. Supporting countries: what will it take ? Focus Speed with evidence Smart Investments Innovation Human rights
    56. 56. HIV Incidence in Countries with Slow or Stalled Scale-Up of Combination Prevention Services Slow or No Decline in HIV Incidence Rates (2001, 2011) - 7% +22% - 5% - 14% - 19% 2001 Incidence 2009 Incidence 2011 Incidence Lesotho 2.67 2.58 2.47 Uganda 0.69 0.74 0.84 Tanzania 0.62 0.45 0.59 Nigeria 0.42 0.38 0.36 Angola 0.26 0.21 0.21 Countries Data source: UNAIDS Global Report 2012
    57. 57. Geographic prioritization - Kenya Nairobi & Nyanza Western & Central Rift Valley & Coast East & North-East
    58. 58. Speed: rapid acceleration, but even more is needed
    59. 59. Evidence: making the right choices
    60. 60. Innovation: current models will not take us to the finish line
    61. 61. Community support keeps people on treatment CLINIC-BASED TREATMENT 70% still receiving treatment after two years Sub-Saharan Africa: people receiving ART from specialist clinics Source: Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in subSaharan Africa, 2007–2009: systematic review. Tropical Medicine and International Health, 2010, 15(Suppl. 1):1–15. COMMUNITY TREATMENT MODEL 98% still receiving treatment after two years Mozambique: self-initiated community model Source: Decroo T et al. Distribution of antiretroviral treatment through self-forming groups of patients in Tete province, Mozambique. Journal of Acquired Immune Deficiency Syndromes, 2010 [Epub ahead of print]. Sources: Fox MP, Rosen S. Tropical Medicine and International Health, 2010; Decroo T et al. Journal of Acquired Immune Deficiency Syndromes, 2010.
    62. 62. Investments: Shared responsibility
    63. 63. Implementation compact
    64. 64. Activity 3: Next 1000 Infections • Where are your next 1000 infections likely to come from? – fill out the second thoughts column
    65. 65. Low- and middle-income countries are on track to reach 15 million people with antiretroviral treatment by 2015 Source: UNAIDS, 2012

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