Impact of the Economic Crisis on HIV AIDS
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Impact of the Economic Crisis on HIV AIDS



Presentation for AIDSImpact conference

Presentation for AIDSImpact conference
Gaborone (Botswana) 23 Sept. 2009



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Impact of the Economic Crisis on HIV AIDS Impact of the Economic Crisis on HIV AIDS Presentation Transcript

  • How the current economic crisis might impact HIV in low and middle income countries ? AIDS Impact Conference, Gaborone, Botswana, 23 September 2009 Economics and Development Analysis Unit, Geneva Erik Lamontagne, Robert Greener UNAIDS
  • Where were we before the crisis
    • 33,2 million of people living with HIV
    • 2,5 million of new infection each year
    • 2,1 million deaths each year
    • => despite a slower progression of the epidemic, there is an increasing number of PLWHIV
    • More than 4 million people under treatment (need=9.5)
      • represent 42% of people in need
    • Scaling down or status quo is not a possibility
  • How might the situation evolve ? Donor’s side
    • Relationship ODA:eco growth=not straightforward
    • but: ODA correlated with financial crisis (+5years)
    • increased difficulties to meet ODA commitments
      •  fiscal deficit due to:  recovery packages,  social countercyclical measures,  tax revenues
    • Downward trend exchange rate:  real ODA
    • All political engagement leading to commitment at G20, UN, parliaments, … = essential
  • How might the situation evolve ? Developing countries
    • Outlook for LIC and MIC: remains challenging
    • Social protection weak or inexistent
    • Public Fin. under pressure, no fiscal space
    • Incapability to finance/imple. countercyclical xpdture
    • Crisis: Poorest groups are hit disproportionally
      • More precarious employment, low revenues, low savings,…
    • Essential role of external aid to supplement social countercyclical measure (including for HIV)
  • Exposed countries
    • Vulnerability of countries to the economic crisis:
      • 1. Exposure to the crisis
      • 1.1 Level of poverty
      • 1.2 impact of the crisis on growth GDP pc
      • 2. Capacity to react and protect its population
      • 2.1 country’s ability to manage higher fiscal deficit
      • 2.2 country’s institutional capacity to reach vuln. pop.
      • 3. Economic share of HIV
      • 3.1 resource needs estimates for 2010 as a share of GNI
  • Lamontagne, Greener, UNAIDS, oct 2009
  • Worst scenario: if funding decreases
    • Risks are
    • Interruption of current treatments (2 nd line)
    • Freeze of ART (no scale-up, no new enrolment)
    • Cut on Prevention activities
    • Some MARP: if not a political priority: left aside the road
      • MSM, IDU, prisoners, … vs pregnant women
  • Worst scenario: consequences
    • Increased mortality and morbidity
    • Increased vulnerability to HIV infection
      • Riskier behaviour (transactional sex, alcohol)
      • Increased migrants, increased vulnerability of poorest
    • Increased pressure on health systems
      • financial, human resources, facilities
    • Persistent reversal of econ. & social gains
  • Evidence
    • Increased riskier behaviour
      • 58% of CSW entered into sex work in the wake of the economic crisis (Cambodia, UN study)
    • Decline in HIV vaccine R&D investment
      • AIDS Vaccine decline by 10% in 2008
    • Increased challenges to bring additional financing
      • GFTAM is currently facing a $5 billion shortfall in order to meet the growing demand from countries applying for funding
  • Crisis: the unsustainable case for vulnerable PLWHIV HIV POVERTY EXTREME POVERTY Coping strategies   Debt   Destitution  Out schooling  Riskier behaviour (CSW)  Migration … Loss of employment / income No social protection HIV => Catastrophic health expenditures Treatment inaccessibility  Food consumption
  • Reducing the impact of the crisis 1
    • Monitor the impact of the crisis on:
      • ART
      • Prevention activities, particularly for MARP
      • Resilience of civil society (NGO & communities)
  • Reducing the impact of the crisis 2
    • 2. Improve how funds are spent
      • Repriorisation and reallocation to top-priorities
        • Avoid ART or cash flow interruptions
      • tracking of the use of funds
      • Search for economies of scale and scope
      • Push for effective integration of HIV activities and health services
      • Lower the cost of treatment
        • Promote the use of generic drugs
        • Regional negotiations for prices of ART
        • TRIPS flexibilities (within internationally agreed measures)
  • Reducing the impact of the crisis 3
    • 3. Internalise the likely decrease in funding
      • Review the priority for long term response
      • Diversify the mix of external and domestic financing mechanisms for HIV programmes
        • Provide a more stable financing base for the long term
      • Bring HIV out of isolation:
        • Integration in health services; social protection
  • Conclusion
    • The current crisis is having strong negative impact on households LWHIV
    • Short term impact must be tracked and responded to
    • We must improve how (where) funds are spent
    • Diminution of HIV financing after the crisis is a scenario that must be considered
    • Political commitment is essential (global and national)
  • Thank you for your attention UNAIDS, Economics and Development Analysis Unit, Geneva Contact: Erik Lamontagne: Robert Greener:
    • annexes
  • Evolution of ODA
    • No correlation between ODA and economic crisis
    5 years of decrease of ODA while strong economic growth (3,2% yearly) 5-8 years to recover
  • Correlation financial crisis –ODA
  • Current perception
    • Quick assessment survey UNAIDS, WB WHO (03.2009)
    • Perception of UNAIDS country coordinators:
    • Already Impact on ART: 12% of countries surveyed
    • Within 12 Month potential impact on ART: 32% of countries (representing 61% plwhiv)
    • Within 12 Month potential impact on Prevention: 50% of countries (representing 75% plwhiv)