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How the current economic crisis might impact HIV in low and middle income countries ? AIDS Impact Conference,  Gaborone, B...
Where were we before the crisis  <ul><li>33,2 million of people living with HIV  </li></ul><ul><li>2,5 million of new infe...
How might the situation evolve ? Donor’s side <ul><li>Relationship ODA:eco growth=not straightforward  </li></ul><ul><li>b...
How might the situation evolve ?  Developing countries <ul><li>Outlook for LIC and MIC: remains challenging </li></ul><ul>...
Exposed countries <ul><li>Vulnerability of countries to the economic crisis: </li></ul><ul><ul><li>1. Exposure to the cris...
Lamontagne, Greener, UNAIDS, oct 2009
Worst scenario: if funding decreases <ul><li>Risks are </li></ul><ul><li>Interruption of current treatments (2 nd  line) <...
Worst scenario: consequences <ul><li>Increased mortality and morbidity </li></ul><ul><li>Increased vulnerability to HIV in...
Evidence <ul><li>Increased riskier behaviour </li></ul><ul><ul><li>58% of CSW entered into sex work in the wake of the eco...
Crisis: the unsustainable case for vulnerable PLWHIV HIV POVERTY EXTREME POVERTY Coping strategies     Debt   Destitut...
Reducing the impact of the crisis 1 <ul><li>Monitor the impact of the crisis on: </li></ul><ul><ul><li>ART </li></ul></ul>...
Reducing the impact of the crisis 2 <ul><li>2. Improve how funds are spent </li></ul><ul><ul><li>Repriorisation and reallo...
Reducing the impact of the crisis 3 <ul><li>3. Internalise the likely decrease in funding  </li></ul><ul><ul><li>Review th...
Conclusion <ul><li>The current crisis is having strong negative impact on households LWHIV </li></ul><ul><li>Short term im...
Thank you for your attention UNAIDS, Economics and Development Analysis Unit, Geneva Contact: Erik Lamontagne: lamontagneE...
<ul><li>annexes </li></ul>
Evolution of ODA <ul><li>No correlation between ODA and economic crisis  </li></ul>5 years of decrease of ODA while strong...
Correlation financial crisis –ODA
Current perception <ul><li>Quick assessment survey UNAIDS, WB WHO (03.2009) </li></ul><ul><li>Perception of UNAIDS country...
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Impact of the Economic Crisis on HIV AIDS

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

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

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