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UNAIDS ISSUES BRIEF | 2011




     A NEW
INVESTMENT
FRAMEWORK
    FOR THE
 GLOBAL HIV
  RESPONSE
Copyright © 2011
Joint United Nations Programme on HIV/AIDS (UNAIDS)
All rights reserved

The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
UNAIDS does not warrant that the information published in this publication is complete and correct and
shall not be liable for any damages incurred as a result of its use.



UNAIDS/JC2244E (English original, October 2011)
UNAIDS ISSUES BRIEF




       A NEW INVESTMENT
FRAMEWORK FOR THE GLOBAL
            HIV RESPONSE


Over the past 30 years there have
been tremendous gains in the global
HIV response, but until now there
has been only limited systematic effort
to match needs with investments. The
result is often a mismatch of the two,
and valuable resources are stretched
inefficiently across many objectives.
To achieve an optimal HIV response,
countries and their international
partners must adopt a more strategic
approach to investments.
A new investment
framework for HIV

                                      The investment framework offers
                                      a realistic, achievable road map
                                      to decisively accelerate progress in
                                      the global HIV response

In June 2011 a policy paper was published          Aims of the investment
in The Lancet (Schwartländer et al) that laid      framework
out a new framework for investment for the
global HIV response. The new framework                   Maximize the benefits of the HIV
is based on existing evidence of what works              response
in HIV prevention, treatment, care and                   Support more rational resource
support. It is intended to facilitate more               allocation based on country
focused and strategic use of scarce resources.           epidemiology and context
                                                         Encourage countries to prioritize
Modelling of the framework’s impact shows                and implement the most effective
that its implementation would avert                      programmatic activities
12.2 million new infections and 7.4 million              Increase efficiency in HIV prevention,
AIDS-related deaths between 2011 and 2020.               treatment, care and support
                                                         programming
This modelling also indicates that
implementation of the investment                   Though much has been achieved in the
framework is highly cost-effective, with           global HIV response over the last 30 years,
additional investment largely offset by            important gaps remain. Currently, strategies
savings in treatment costs alone, and              are often implemented in parallel, regardless
enabling the HIV response to reach an              of how they might overlap or leave critical
inflection point in both investments and           gaps in coverage. Through a simplification
rates of HIV infection.                            and clarification of the different elements
                                                   of HIV efforts, as well as better support for
The framework was developed by an
                                                   countries to prioritise HIV programmes
international group of experts from the Joint
                                                   and assess the synergies between them, the
United Nations Programme on HIV/AIDS
                                                   framework presents a radical departure from
(UNAIDS), The Global Fund to Fights AIDS,
                                                   existing approaches to HIV investment and
Tuberculosis and Malaria, the US President’s
                                                   programming.
Emergency Plan for AIDS Relief, The Bill
& Melinda Gates Foundation, The World
Bank, the World Health Organization and
academic and policy institutions.



2                                                UNAIDS | A new investment framework for the global HIV response
Proposed Investment Framework
FIGURE 1: Proposed Investment Framework




  CRITICAL                      BASIC PROGRAMME ACTIVITIES                                                                  OBJECTIVES
  ENABLERS
                                      Key populations at
  Social enablers                     higher risk
                                                                          Eliminate new HIV
                                                                          infections
           advocacy                                                       among children
                                                       drugs)

           practices

     mobilization                                                                                                     Stopping new infections
            reduction
          media                  Behaviour change
          r                      programmes                       Condom promotion
                                                                  and distribution
     environment


  Programme enablers
                    center
                    delivery                                                                                            Keeping people alive
     Pr
     communication                                                              Voluntary
                                                                                medical male
     incentives                                                                 circumcision
     Procur
     distribution                                                               pr
                                       Treatment,
     Researc                           care and                                 circumcision)
     innovation                        support for
                                       people living
                                       with HIV




 SYNERGIES WITH DEVELOPMENT SECTORS
      pr                            refor           equality          r         Gender        violence,
                           tr                                                        practices.




                           Key components of the                                                Basic programme activities
                           investment framework                                                 Just six basic programme activities are essential to
                                                                                                an adequate HIV response and need to be delivered
                                Basic programme activities                                      at scale according to the size of the relevant
                                Critical enablers                                               population. These activities work together for
                                Synergies with development sectors                              maximum impact and should therefore be delivered
                                                                                                as a package, where each element reinforces the other.
                           The investment framework takes as its
                           starting point a human rights approach to the                        They are:
                           HIV response, to ensure that it is universal,                        1. Focused programmes for key populations
                           equitable, inclusive, and fosters participation,                        at higher risk (particularly sex workers and
                           informed consent and accountability.                                    their clients, men who have sex with men, and
                                                                                                   people who inject drugs);
                           The framework makes a distinction between                            2. Elimination of new HIV infections in children;
                           basic programme activities that have a direct                        3. Programmes that focus on the reduction of risk
                           effect on HIV risk, transmission, morbidity                             of HIV exposure through changing people’s
                           and mortality; the critical enablers that are                           behaviour and social norms;
                           crucial to the success of HIV programmes;                            4. Procurement, distribution and marketing of
                           and synergies with development sectors                                  male and female condoms;
                           (Figure 1).                                                          5. Treatment, care and support for people living
                                                                                                   with HIV;
                                                                                                6. Voluntary medical male circumcision in
                                                                                                   countries with high HIV prevalence and low
                                                                                                   rates of circumcision.




                                   A new investment framework for the global HIV response | UNAIDS                                                  3
Implementing the framework will avert
                                   12.2 million new infections and
                                   7.4 million AIDS-related deaths
                                   between 2011 and 2020.

The evidence base for the basic programmes        amenable to generic description, vary greatly
is strongest in relation to biomedical inter-     according to context and are underpinned by
ventions such as voluntary medical male           a weaker evidence base.
circumcision and the biomedical aspects
                                                  However, they increase the impact of
of eliminating new HIV infections among
                                                  basic programme activities by overcoming
children. Although behaviour change
                                                  barriers to the adoption of evidence-based
programmes tend to be more complex and
                                                  HIV policies and the factors that adversely
less clearly defined, changes in behaviour
                                                  affect HIV programmes by distorting
have been associated with declines in HIV
                                                  their priorities, including social stigma,
prevalence. Key populations, by definition,
                                                  poor health literacy and a punitive legal
predominate in concentrated epidemics.
                                                  environment.
However, they also contribute to generalized
(where HIV prevalence among pregnant              Examples of social enablers are outreach for
women consistently exceeds 1%) epidemics          HIV testing, stigma reduction, human rights
and in some cases account for a substantial       advocacy, and community mobilization.
proportion of the epidemic. Basic activities      Programme enablers include strategic
for key populations include focused commu-        planning, programme management and
nication, education and condom program-           capacity building for community-based
ming tailored to each population’s needs.         organizations. Community mobilization is
                                                  a key element of the investment framework
Access to antiretroviral therapy is a key
                                                  because it leads to improved uptake of
programme activity of the HIV response.
                                                  HIV programmes and promotes local-level
Not only does ART reduce morbidity and
                                                  advocacy, transparency and accountability.
mortality among people infected with HIV,
                                                  Community mobilization has been recognized
it also reduces the incidence of AIDS-
                                                  as a cornerstone of HIV programmes.
related tuberculosis, and has public health
benefits in terms of reducing the onward          Synergies with development
transmission of HIV. Community-led                sectors
delivery approaches to treatment are an
important component of the framework.             HIV programmes are not implemented
                                                  in isolation. The investment framework
Critical enablers                                 recognizes the need for the HIV response to
                                                  be aligned to country development objectives
Underlying the success of basic programme
                                                  and to support the strengthening of social,
activities are the enablers which make
                                                  legal and health systems.
programme access possible and success more
likely and respond to local context. Critical     Social protection, increasing access to
enablers can be divided into two categories:      education, legal reform, poverty reduction,
social enablers that create environments          reducing gender-based violence, and
conducive to rational HIV responses, and          improving health, community and
programme enablers that create demand             employment systems are all key areas where
for programmes and improve their                  there are synergies between HIV-specific
performance. Critical enablers are not always     efforts and development.


4                                               UNAIDS | A new investment framework for the global HIV response
TABLE 1: RETURN ON INVESTMENT IN THE PROPOSED FRAMEWORK

                                                      2011-2015                                    2011-2020

Total infections averted                               4 200 000                 12 200 000 (US$ 2450 each)
Infant and child infections averted                       680 000                 1 900 000 (US$ 2180 each)
Life years gained                                      3 700 000                29 400 000 ( US$ 1060 each)
Deaths averted                                         1 960 000                  7 400 000 (US$ 4090 each)




Resources needed to implement
the investment framework
Modelling of the framework’s impact                               There will also be efficiency gains such as
and cost demonstrates how it can lead                             cost-saving on treatment commodities and
to universal access to HIV prevention,                            a shift to community-based treatment and
treatment, care and support, and create                           testing.
a tipping point in both the rate of
HIV infection and investment in HIV                               Whereas basic programme costs in 2011
programmes.                                                       stand at US$7 billion, in the model they
                                                                  are US$12.9 billion in 2015, dropping to
Implementation of the investment                                  US$10.9 billion in 2020 (Table 2, Figure 2).
framework is estimated to avert 12.2 million
new HIV infections including 1.9 million                          The single largest cost is treatment, care and
HIV infections among children, 7.4 million                        support, accounting for 38% of the increase
AIDS-related deaths between 2011 and 2020,                        in resources (Figure 2). Other contributors
and result in a gain of 29.4 million life-years                   to the cost increase include doubling
(Table 1). At US$1060 per life-year gained,                       the coverage of outreach and needle and
the additional investment required would be                       syringe programmes and a 10-fold increase
largely offset by savings in future treatment                     in provision of drug substitution for
costs alone.                                                      injecting drug users, as well as increased
                                                                  coverage of prevention of mother-to-child
Costs are based on what is needed to                              transmission to reach 90% of all child-
increase present rates of coverage to                             bearing women living with HIV, so that
achieve universal access to HIV prevention,                       new HIV infections among children can be
treatment, care and support by 2015 and                           eliminated by 2015.
to maintain it at that level of access. The
investment framework model requires a                             Costs for critical enablers would fall from
scaling-up of HIV programme funding                               US$5.9 billion in 2011 to US$3.4 billion
from US$16.6 billion in 2011 to US$22.0                           in 2015 before increasing slightly to
billion in 2015, before declining to US$19.8                      US$3.7 billion in 2020 due to a shift from
billion in 2020 (Table 2, Figure 2).                              comparatively expensive facility-based
                                                                  voluntary HIV counselling and testing to less
Fewer resources will be needed because                            expensive and more focused community-
coverage will have reached target rates and                       based programmes (Table 2, Figure 2). In the
there will be fewer new HIV infections                            model 316 million people will receive HIV
requiring treatment and other services.                           testing in 2015.

A new investment framework for the global HIV response | UNAIDS                                                   5
TABLE 2: RESOURCES REQUIRED FOR THE INVESTMENT FRAMEWORK OVER TIME
(billions of US$)

                                                                2011                2015               2020

Basic programmes (total)                                           7.0               12.9               10.6
    Key populations at higher risk                                 1.0                 3.3                2.5
    Elimination of new infections in children                      0.9                 1.5                1.3
    Behaviour change programmes                                    0.1                 0.7                0.7
    Condom promotion and distribution                              0.4                 0.5                0.6
    Treatment, care and support for people living with             4.5                 6.7                5.5
    HIV
    Voluntary medical male circumcision                            0.1                 0.2                0.1
Critical enablers                                                  5.9                 3.4                3.7
Synergies with development sectors                                 3.6                 5.8                5.4

TOTAL                                                            16.6                22.0               19.8




Synergies with development sectors require         programme elements are effective and
an increase in funding from US$3.6 billion         ineffective. This, in turn, empowers the HIV
in 2015 to US$5.8 billion in 2015 and US$5.4       response to be based on fewer things done at
billion in 2020 (Table 2, Figure 2). These         a deeper level, and it offers clear incentives
estimates are based on the costs of a range        to maximise the synergies between the
of programmes such as those focussed on            different elements of HIV programmes.
gender-based violence, youth in schools,
workplace education and caring for children        One of the limitations of the investment
orphaned by HIV.                                   framework is that it lays out a defined set of
                                                   evidence-based basic programmes, but does
Strengths and                                      not explore what delivery models deliver
                                                   optimum results when interventions are
limitations of the                                 combined and expanded. It is crucial to
investment framework                               identify the best ways to scale up bundled
                                                   HIV interventions.
The investment framework offers a realistic,
                                                   Another shortcoming of the investment
achievable road map to decisively accelerate
                                                   framework is that while there is an ever
progress in the global HIV response. One
                                                   growing body of evidence on the effectiveness
of its major strengths is that it is based on
                                                   and cost-effectiveness of basic programmes,
the best available evidence on what works
                                                   there is more limited evidence available
in HIV prevention, treatment, care and
                                                   for critical enablers and synergies with
support. Moreover, the framework allows
                                                   development sectors. Further research is
adaptation as new evidence emerges,
especially if new technologies or approaches       needed to better understand the barriers to
show that they directly affect HIV incidence,      effective HIV responses and factors enabling
morbidity and mortality and can be                 them; to quantify key enabling interventions;
consistently scaled up.                            and to demonstrate their cost-effectiveness.
                                                   In particular, improved evidence is needed
The framework enables countries to respond         on the best approaches to community
to HIV based on their own priorities. It           mobilisation and community-led delivery of
simplifies the process of determining what         programmes, as well as their costs.

6                                               UNAIDS | A new investment framework for the global HIV response
FIGURE 2: ESTIMATED COST OF THE INVESTMENT FRAMEWORK, 2011-20
                                                      Synergies with development sectors
                                                      Critical enablers
                                                      Voluntary medical male circumcision
                                                      Treatment, care and support for people living with HIV
                                                      Condom promotion and distribution
                                                      Behaviour change programmes
                                                      Elimination of new infections in children
                                                      Key populations at higher risk
                      25




                      20
Cost (billions US$)




                      15




                      10




                      5




                      0
                            2011        2012         2013        2014         2015          2016    2017     2018      2019      2020
                                                                                     Year




                       Implementing the                                                 of existing HIV prevention, treatment, care
                                                                                        and support programmes as well as their
                       investment framework                                             costs, enabling factors and potential barriers
                                                                                        to implementation. With this information,
                       In countries, governments and their partners                     countries can then prioritize activities and
                       can apply the investment framework to                            implement a carefully focused and more
                       guide HIV responses and make the most of                         effective response. In most countries this will
                       their programmes.
                                                                                        mean changing investments in HIV and a
                       To implement the investment framework,                           re-programming of HIV efforts.
                       policy makers must make use of information
                                                                                        At the global level, the investment
                       on HIV incidence and prevalence as well as
                                                                                        framework will enhance present efforts to
                       the populations at highest risk of acquiring
                                                                                        make the most of HIV responses, including
                       HIV, the geographic distribution of HIV and
                                                                                        the Global Fund’s new approach to fund
                       the proximate and structural determinants of
                                                                                        countries on the basis of national strategy
                       transmission.
                                                                                        applications rather than discrete projects,
                       They must also have a nuanced                                    and PEPFAR’s new and explicit focus on
                       understanding of the scope and coverage                          increased country ownership.




                      A new investment framework for the global HIV response | UNAIDS                                                   7
20 Avenue Appia
CH-1211 Geneva 27
Switzerland

+41 22 791 3666
distribution@unaids.org

unaids.org




                                                                       UNHCR    UNODC
                                                                       UNICEF   ILO
                                                                       WFP      UNESCO
                                                                       UNDP     WHO
                                                                       UNFPA    WORLD BANK
                          Joint United Nations Programme on HIV/AIDS

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3 investment-framework-summary-unaids-issues-brief

  • 1. UNAIDS ISSUES BRIEF | 2011 A NEW INVESTMENT FRAMEWORK FOR THE GLOBAL HIV RESPONSE
  • 2. Copyright © 2011 Joint United Nations Programme on HIV/AIDS (UNAIDS) All rights reserved The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information published in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. UNAIDS/JC2244E (English original, October 2011)
  • 3. UNAIDS ISSUES BRIEF A NEW INVESTMENT FRAMEWORK FOR THE GLOBAL HIV RESPONSE Over the past 30 years there have been tremendous gains in the global HIV response, but until now there has been only limited systematic effort to match needs with investments. The result is often a mismatch of the two, and valuable resources are stretched inefficiently across many objectives. To achieve an optimal HIV response, countries and their international partners must adopt a more strategic approach to investments.
  • 4. A new investment framework for HIV The investment framework offers a realistic, achievable road map to decisively accelerate progress in the global HIV response In June 2011 a policy paper was published Aims of the investment in The Lancet (Schwartländer et al) that laid framework out a new framework for investment for the global HIV response. The new framework Maximize the benefits of the HIV is based on existing evidence of what works response in HIV prevention, treatment, care and Support more rational resource support. It is intended to facilitate more allocation based on country focused and strategic use of scarce resources. epidemiology and context Encourage countries to prioritize Modelling of the framework’s impact shows and implement the most effective that its implementation would avert programmatic activities 12.2 million new infections and 7.4 million Increase efficiency in HIV prevention, AIDS-related deaths between 2011 and 2020. treatment, care and support programming This modelling also indicates that implementation of the investment Though much has been achieved in the framework is highly cost-effective, with global HIV response over the last 30 years, additional investment largely offset by important gaps remain. Currently, strategies savings in treatment costs alone, and are often implemented in parallel, regardless enabling the HIV response to reach an of how they might overlap or leave critical inflection point in both investments and gaps in coverage. Through a simplification rates of HIV infection. and clarification of the different elements of HIV efforts, as well as better support for The framework was developed by an countries to prioritise HIV programmes international group of experts from the Joint and assess the synergies between them, the United Nations Programme on HIV/AIDS framework presents a radical departure from (UNAIDS), The Global Fund to Fights AIDS, existing approaches to HIV investment and Tuberculosis and Malaria, the US President’s programming. Emergency Plan for AIDS Relief, The Bill & Melinda Gates Foundation, The World Bank, the World Health Organization and academic and policy institutions. 2 UNAIDS | A new investment framework for the global HIV response
  • 5. Proposed Investment Framework FIGURE 1: Proposed Investment Framework CRITICAL BASIC PROGRAMME ACTIVITIES OBJECTIVES ENABLERS Key populations at Social enablers higher risk Eliminate new HIV infections advocacy among children drugs) practices mobilization Stopping new infections reduction media Behaviour change r programmes Condom promotion and distribution environment Programme enablers center delivery Keeping people alive Pr communication Voluntary medical male incentives circumcision Procur distribution pr Treatment, Researc care and circumcision) innovation support for people living with HIV SYNERGIES WITH DEVELOPMENT SECTORS pr refor equality r Gender violence, tr practices. Key components of the Basic programme activities investment framework Just six basic programme activities are essential to an adequate HIV response and need to be delivered Basic programme activities at scale according to the size of the relevant Critical enablers population. These activities work together for Synergies with development sectors maximum impact and should therefore be delivered as a package, where each element reinforces the other. The investment framework takes as its starting point a human rights approach to the They are: HIV response, to ensure that it is universal, 1. Focused programmes for key populations equitable, inclusive, and fosters participation, at higher risk (particularly sex workers and informed consent and accountability. their clients, men who have sex with men, and people who inject drugs); The framework makes a distinction between 2. Elimination of new HIV infections in children; basic programme activities that have a direct 3. Programmes that focus on the reduction of risk effect on HIV risk, transmission, morbidity of HIV exposure through changing people’s and mortality; the critical enablers that are behaviour and social norms; crucial to the success of HIV programmes; 4. Procurement, distribution and marketing of and synergies with development sectors male and female condoms; (Figure 1). 5. Treatment, care and support for people living with HIV; 6. Voluntary medical male circumcision in countries with high HIV prevalence and low rates of circumcision. A new investment framework for the global HIV response | UNAIDS 3
  • 6. Implementing the framework will avert 12.2 million new infections and 7.4 million AIDS-related deaths between 2011 and 2020. The evidence base for the basic programmes amenable to generic description, vary greatly is strongest in relation to biomedical inter- according to context and are underpinned by ventions such as voluntary medical male a weaker evidence base. circumcision and the biomedical aspects However, they increase the impact of of eliminating new HIV infections among basic programme activities by overcoming children. Although behaviour change barriers to the adoption of evidence-based programmes tend to be more complex and HIV policies and the factors that adversely less clearly defined, changes in behaviour affect HIV programmes by distorting have been associated with declines in HIV their priorities, including social stigma, prevalence. Key populations, by definition, poor health literacy and a punitive legal predominate in concentrated epidemics. environment. However, they also contribute to generalized (where HIV prevalence among pregnant Examples of social enablers are outreach for women consistently exceeds 1%) epidemics HIV testing, stigma reduction, human rights and in some cases account for a substantial advocacy, and community mobilization. proportion of the epidemic. Basic activities Programme enablers include strategic for key populations include focused commu- planning, programme management and nication, education and condom program- capacity building for community-based ming tailored to each population’s needs. organizations. Community mobilization is a key element of the investment framework Access to antiretroviral therapy is a key because it leads to improved uptake of programme activity of the HIV response. HIV programmes and promotes local-level Not only does ART reduce morbidity and advocacy, transparency and accountability. mortality among people infected with HIV, Community mobilization has been recognized it also reduces the incidence of AIDS- as a cornerstone of HIV programmes. related tuberculosis, and has public health benefits in terms of reducing the onward Synergies with development transmission of HIV. Community-led sectors delivery approaches to treatment are an important component of the framework. HIV programmes are not implemented in isolation. The investment framework Critical enablers recognizes the need for the HIV response to be aligned to country development objectives Underlying the success of basic programme and to support the strengthening of social, activities are the enablers which make legal and health systems. programme access possible and success more likely and respond to local context. Critical Social protection, increasing access to enablers can be divided into two categories: education, legal reform, poverty reduction, social enablers that create environments reducing gender-based violence, and conducive to rational HIV responses, and improving health, community and programme enablers that create demand employment systems are all key areas where for programmes and improve their there are synergies between HIV-specific performance. Critical enablers are not always efforts and development. 4 UNAIDS | A new investment framework for the global HIV response
  • 7. TABLE 1: RETURN ON INVESTMENT IN THE PROPOSED FRAMEWORK 2011-2015 2011-2020 Total infections averted 4 200 000 12 200 000 (US$ 2450 each) Infant and child infections averted 680 000 1 900 000 (US$ 2180 each) Life years gained 3 700 000 29 400 000 ( US$ 1060 each) Deaths averted 1 960 000 7 400 000 (US$ 4090 each) Resources needed to implement the investment framework Modelling of the framework’s impact There will also be efficiency gains such as and cost demonstrates how it can lead cost-saving on treatment commodities and to universal access to HIV prevention, a shift to community-based treatment and treatment, care and support, and create testing. a tipping point in both the rate of HIV infection and investment in HIV Whereas basic programme costs in 2011 programmes. stand at US$7 billion, in the model they are US$12.9 billion in 2015, dropping to Implementation of the investment US$10.9 billion in 2020 (Table 2, Figure 2). framework is estimated to avert 12.2 million new HIV infections including 1.9 million The single largest cost is treatment, care and HIV infections among children, 7.4 million support, accounting for 38% of the increase AIDS-related deaths between 2011 and 2020, in resources (Figure 2). Other contributors and result in a gain of 29.4 million life-years to the cost increase include doubling (Table 1). At US$1060 per life-year gained, the coverage of outreach and needle and the additional investment required would be syringe programmes and a 10-fold increase largely offset by savings in future treatment in provision of drug substitution for costs alone. injecting drug users, as well as increased coverage of prevention of mother-to-child Costs are based on what is needed to transmission to reach 90% of all child- increase present rates of coverage to bearing women living with HIV, so that achieve universal access to HIV prevention, new HIV infections among children can be treatment, care and support by 2015 and eliminated by 2015. to maintain it at that level of access. The investment framework model requires a Costs for critical enablers would fall from scaling-up of HIV programme funding US$5.9 billion in 2011 to US$3.4 billion from US$16.6 billion in 2011 to US$22.0 in 2015 before increasing slightly to billion in 2015, before declining to US$19.8 US$3.7 billion in 2020 due to a shift from billion in 2020 (Table 2, Figure 2). comparatively expensive facility-based voluntary HIV counselling and testing to less Fewer resources will be needed because expensive and more focused community- coverage will have reached target rates and based programmes (Table 2, Figure 2). In the there will be fewer new HIV infections model 316 million people will receive HIV requiring treatment and other services. testing in 2015. A new investment framework for the global HIV response | UNAIDS 5
  • 8. TABLE 2: RESOURCES REQUIRED FOR THE INVESTMENT FRAMEWORK OVER TIME (billions of US$) 2011 2015 2020 Basic programmes (total) 7.0 12.9 10.6 Key populations at higher risk 1.0 3.3 2.5 Elimination of new infections in children 0.9 1.5 1.3 Behaviour change programmes 0.1 0.7 0.7 Condom promotion and distribution 0.4 0.5 0.6 Treatment, care and support for people living with 4.5 6.7 5.5 HIV Voluntary medical male circumcision 0.1 0.2 0.1 Critical enablers 5.9 3.4 3.7 Synergies with development sectors 3.6 5.8 5.4 TOTAL 16.6 22.0 19.8 Synergies with development sectors require programme elements are effective and an increase in funding from US$3.6 billion ineffective. This, in turn, empowers the HIV in 2015 to US$5.8 billion in 2015 and US$5.4 response to be based on fewer things done at billion in 2020 (Table 2, Figure 2). These a deeper level, and it offers clear incentives estimates are based on the costs of a range to maximise the synergies between the of programmes such as those focussed on different elements of HIV programmes. gender-based violence, youth in schools, workplace education and caring for children One of the limitations of the investment orphaned by HIV. framework is that it lays out a defined set of evidence-based basic programmes, but does Strengths and not explore what delivery models deliver optimum results when interventions are limitations of the combined and expanded. It is crucial to investment framework identify the best ways to scale up bundled HIV interventions. The investment framework offers a realistic, Another shortcoming of the investment achievable road map to decisively accelerate framework is that while there is an ever progress in the global HIV response. One growing body of evidence on the effectiveness of its major strengths is that it is based on and cost-effectiveness of basic programmes, the best available evidence on what works there is more limited evidence available in HIV prevention, treatment, care and for critical enablers and synergies with support. Moreover, the framework allows development sectors. Further research is adaptation as new evidence emerges, especially if new technologies or approaches needed to better understand the barriers to show that they directly affect HIV incidence, effective HIV responses and factors enabling morbidity and mortality and can be them; to quantify key enabling interventions; consistently scaled up. and to demonstrate their cost-effectiveness. In particular, improved evidence is needed The framework enables countries to respond on the best approaches to community to HIV based on their own priorities. It mobilisation and community-led delivery of simplifies the process of determining what programmes, as well as their costs. 6 UNAIDS | A new investment framework for the global HIV response
  • 9. FIGURE 2: ESTIMATED COST OF THE INVESTMENT FRAMEWORK, 2011-20 Synergies with development sectors Critical enablers Voluntary medical male circumcision Treatment, care and support for people living with HIV Condom promotion and distribution Behaviour change programmes Elimination of new infections in children Key populations at higher risk 25 20 Cost (billions US$) 15 10 5 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Implementing the of existing HIV prevention, treatment, care and support programmes as well as their investment framework costs, enabling factors and potential barriers to implementation. With this information, In countries, governments and their partners countries can then prioritize activities and can apply the investment framework to implement a carefully focused and more guide HIV responses and make the most of effective response. In most countries this will their programmes. mean changing investments in HIV and a To implement the investment framework, re-programming of HIV efforts. policy makers must make use of information At the global level, the investment on HIV incidence and prevalence as well as framework will enhance present efforts to the populations at highest risk of acquiring make the most of HIV responses, including HIV, the geographic distribution of HIV and the Global Fund’s new approach to fund the proximate and structural determinants of countries on the basis of national strategy transmission. applications rather than discrete projects, They must also have a nuanced and PEPFAR’s new and explicit focus on understanding of the scope and coverage increased country ownership. A new investment framework for the global HIV response | UNAIDS 7
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