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Achievements and future of the global aids response

Achievements and future of the global aids response. Peter Piot Imperial College London. Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007. Decline in adult mortality with introduction of ART: Botswana.

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Achievements and future of the global aids response

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  1. Achievements and future of the global aids response Peter Piot Imperial College London

  2. Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007

  3. Decline in adult mortality with introduction of ART: Botswana

  4. HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997–2007 Southern Africa Botswana 50 Burkina Faso Lesotho 40 Mozambique 30 Namibia NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) Median HIV prevalence (%) 20 South Africa Ghana Swaziland 10 Zimbabwe 0 1997– 1998 1997– 1998 1997– 1998 1999– 2000 1999– 2000 1999– 2000 2001 2001 2001 2002 2002 2002 2003 2003 2003 2004 2004 2004 2005 2005 2005 2006 2006 2006 2007 2007 2007 Eastern Africa West Africa 20 20 15 15 Ethiopia 10 10 Median HIV prevalence (%) Median HIV prevalence (%) Côte d'Ivoire 5 5 Kenya Senegal 0 0 2.9 Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS.  July 2008.

  5. Number and percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2004–2007 40 600 000 35 500 000 30 400 000 Number of HIV-positive pregnant women receiving anti-retrovirals % of HIV-positive pregnant women receiving anti-retrovirals 25 300 000 20 15 200 000 10 100 000 5 0 0 2004 2005 2006 2007 Year Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries. 4.13

  6. AIDS IS NOT OVER

  7. HIV prevalence (%) in adults (15–49) in Africa, 2007 2.8

  8. HIV infections among men having sex with men in Asia

  9. How did we get there? • Science and rights driven • Political approach • A global response • Focus on results for people • Prevention AND treatment • Multi-disciplinary, multi-sectoral • Community engagement

  10. 50 45 40 35 30 25 20 15 10 5 0 27 years of responding to AIDS First cases of unusual immune deficiency identified Global Fund to fight AIDS, Tuberculosis and Malaria US$10 billion for AIDS in developing countries Millions HIV identified as cause of AIDS The UN General Assembly Special Session on HIV/AIDS Four Frees and One Care WHO launches the Global Programme on AIDS Highly Active Antiretroviral Treatment First HIV antibody test becomes available First regimen to reduce mother-to-child transmission of HIV 3 million on ART in developing world President Bush announces PEPFAR UNAIDS created 1980 ‘81 ‘82 ‘83 ‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ’06 2007 People living with HIV

  11. Total annual resources available for AIDS1986‒2007 US$ million 10 billion 10 000 8.9 billion 9000 Signing of Declaration of Commitment on HIV/AIDS,UNGASS 8000 8.3 billion 7000 6000 World Bank MAP launch 5000 4000 Gates Foundation PEPFAR 3000 UNAIDS Less than US$ 1 million 2000 1623 1000 Global Fund 292 257 212 59 0 ‘06 2007 1986 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 Notes: [1] 1986-2000 figures are for international funds only [2] Domestic funds are included from 2001 onwards [i] 1996-2005 data: Extracted from 2006 Report on the Global AIDS Epidemic (UNAIDS, 2006) [ii] 1986-1993 data: AIDS in the World II. Edited by Jonathan Mann and Daniel J. M. Tarantola (1996)

  12. Treatment Action Campaign (TAC), South Africa

  13. Recorded female deaths in South Africa and Brazil for ages 15-64 years Brazil, 2004. South Africa, 1997. South Africa, 2004 Source: Nathan Geffen. Statistics South Africa and Instituto Brasileiro de Geografia e Estatistica.

  14. A global response • Human rights and strategic issue/smart power • Global public good • Role of United Nations • Global civil society and activism • International financing • Generation WE

  15. UN security Council Resolution 1308 (2000) on AIDS

  16. World Bank Multi-country AIDS Program (2000) • Global Fund to Fight AIDS, TB and Malaria (2002) • PEPFAR, (2003) • Unitaid (2005) • (PRODUCT) Red (2005) • Debt2Health (2007) New instruments for AIDS financing

  17. Netherlands 521 Sweden 462 Ireland 408 United Kingdom 328 United States 120 France 93 Germany 60 Canada 50 Japan 24 Italy 4 0 100 200 300 400 500 600 US$ Disbursements for HIV per US$ 1 Million GDP, 2006 Sources: UNAIDS and Kaiser Family Foundation analysis, June 2007; Global Fund to Fight AIDS, Tuberculosis and Malaria online data query May 2007; International Monetary Fund, World Economic Outlook Database, April 2007. H

  18. Prices (US$/year) of first-line antiretroviral regimen in Uganda: 1998-2003

  19. Focus on results for people • Targets • Know your epidemic and the society • Monitor and evaluate • Invest in information systems

  20. Know your epidemic

  21. A multi-disciplinary, multi-sectoral response • Health outcomes determined by multiple factors and interventions • Particularly key besides health: law, education, work place, trade, armed forces • Need to expand resource base • First genuine business engagement in health

  22. Percentage of countries with sectors included in the national AIDS strategy and earmarked budgets Military/police Sector included Labour Health Earmarked budget present Transportation Agriculture Minerals and energy Trade and industry Tourism Public works 0 20 40 60 80 100 Percentage of countries (%), N=126 Source: UNGASS Country Progress Reports 2008. 6.5

  23. Community engagement • From planning to implementation • Makes or breaks programmes • “Aids literacy” • National Aids Councils and Global Fund Country Coordination Mechanisms • Societal sustainability and resilience

  24. TASO, Uganda

  25. Opportunities for global health • Health diplomacy • Increased funding (ODA and research) • Collateral benefits (TB,malaria, health systems) • Culture of accountability • Tiered pricing • Engagement of non-medical sectors • Boost to research • Major interest by young people

  26. Challenges: the long term view • A still changing epidemic • Sustainability (leadership, funding, treatment) • An all out effort on hiv prevention • Links and synergies with health and development • Improve programme delivery and capacity • R&D

  27. Number of HIV infections each year by route of transmission in Cambodia, 1988-2004 Number of new HIV infections each year by route of transmission in Cambodia, 1988-2004 ( Source: Peerapatanapokin and Brown, using Asian Epidemic Model) 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Male clients Sex workers Wife from husband Husband from wife Mother to child Source: Peerapatanapokin and Brown, using Asia Epidemic Model

  28. Estimated Resource needs for AIDS, TB and malaria (2009 to 2015) Sources: UNAIDS, STB, RBM

  29. 45 40 35 30 25 20 15 10.0 8.9 10 8.3 6.1 5.0 5 3.2 1.6 1.4 0 Annual resources available 2000–2007 and funding gap between projected financial resources if current scale-up continues and a phased scale-up scenario to reach universal access between 2010 and 2015 (US$ billion) Resources available for HIV services Resource Needs: if current scale-up continues US$ Billion Resource Needs for phased scale-up to Universal Access 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 I

  30. Total health ODA commitments, 2001-2006 US$ Billions

  31. The PREVENTION GAPPersons at risk with access to selected prevention interventions, 2006 Source: Global HIV Prevention: the access and funding gap. June 2007

  32. Unmet need for dual treatment of incident tuberculosis cases in people living with HIV, by region, 2007 Unmet need Treated 1 000 000 10 000 8000 800 000 6000 Number 600 000 Number 4000 2000 400 000 0 Latin America Eastern Europe & Central Asia East Asia Caribbean Oceania Middle East & North Africa Western & Central Europe 200 000 0 South & South- East Asia (8) GLOBAL (76) Sub- Saharan Africa (22) Latin America (14) Eastern Europe & Central Asia (12) East Asia (2) Caribbean (10) Oceania (2) Middle East & North Africa (3) Western & Central Europe (3) (Number of countries reporting) Note: No data from North America Source: UNGASS Country Progress Reports 2008. 5.8

  33. Direct funding of health systems through Global Fund grants

  34. Cost Effectiveness

  35. aids2031 • Taking a long term view- stretching planning and funding horizons to achieve sustainability • Multi-disciplinary – bringing together bio-medical, social and political scientists, economists and activists to look at what should we do differently – or more of the same – now to change the future of AIDS • Key aids2031 report “Agenda for the Future” to be launched end of 2009

  36. CONCLUSIONS • Science AND justice as basis for policy • Nothing for the people without the people • Genuine multi-disciplinarity • Information for accountability and programming • Think long term • No magic bullet!

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