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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: lamontagneE@unaids.org Robert Greener: greenerR@unaids.org
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)

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Impact of the Economic Crisis on HIV AIDS

  • 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. 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
  • 3. 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
  • 4. 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)
  • 5. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 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. 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)
  • 12. 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)
  • 13. 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
  • 14. 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)
  • 15. Thank you for your attention UNAIDS, Economics and Development Analysis Unit, Geneva Contact: Erik Lamontagne: lamontagneE@unaids.org Robert Greener: greenerR@unaids.org
  • 17. 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
  • 19. 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)