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09 Uniting the World against AIDS

09 Uniting the World against AIDS. Catherine Hankins Chief Scientific Adviser to UNAIDS. 25 years of AIDS. People living with HIV. 50.

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09 Uniting the World against AIDS

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  1. 09 Uniting the World against AIDS Catherine Hankins Chief Scientific Adviser to UNAIDS UNAIDS

  2. 25 years of AIDS People living with HIV 50 9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries 1 First cases of unusual immune deficiency are identified among gay men in USA 45 Million 2 AIDS defined for the first time 40 3 HIV identified as the cause of AIDS 10 HAART launched 35 4 In Africa, a heterosexual AIDS epidemic is revealed 11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV 5 First HIV antibody test available 30 6 Global Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded 11 Children orphaned by AIDS in sub-Saharan Africa 12 UNAIDS is created 25 13 Brazil becomes first developing country to provide ARY through its public health system 7 WHO launches the Global Programme on AIDS 20 14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched 8 AZT is approved for use in USA 15 12 10 15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by end 2005 5 1 4 5 8 9 13 6 14 15 16 2 7 10 3 16 Global Coalition on Women and AIDS launched 0 2005 1980 1985 1990 1995 2000 1.1 UNAIDS

  3. Key statistics (2007 data) • 33 million people living with HIV • 2 million people died of AIDS • 2.7 million new HIV infections – 7,400 every day • 370,000 children newly infected – 1000+ every day • 12 million orphans in sub-Saharan Africa Uniting the world against AIDS UNAIDS

  4. A global view of HIV infection 33 million people [30–36 million] living with HIV, 2007 UNAIDS

  5. Regional HIV and AIDS statistics and features, 2007 Adults & children living with HIV Adults & children newly infected with HIV Adult prevalence (15‒49) [%] Adult & child deaths due to AIDS Sub-Saharan Africa 22.0 million [20.5 – 23.6 million] 1.9 million [1.6 – 2.1 million] 5.0% [4.6% – 5.4%] 1.5 million [1.3 – 1.7 million] Middle East & North Africa 380 000 [280 000 – 510 000] 40 000 [20 000 – 66 000] 0.3% [0.2% – 0.4%] 27 000 [20 000 – 35 000] South and South-East Asia 4.2 million [3.5 – 5.3 million] 330 000 [150 000 – 590 000] 0.3% [0.2% – 0.4%] 340 000 [230 000 – 450 000] East Asia 740 000 [480 000 – 1.1 million] 52 000 [29 000 – 84 000] 0.1% [<0.1% – 0.2%] 40 000 [24 000 – 63 000] Latin America 1.7 million [1.5 – 2.1 million] 140 000 [88 000 – 190 000] 0.5% [0.4% – 0.6%] 63 000 [49 000 – 98 000] Caribbean 230 000 [210 000 – 270 000] 20 000 [16 000 – 25 000] 1.1% [1.0% – 1.2%] 14 000 [11 000 – 16 000] Eastern Europe & Central Asia 1.5 million [1.1 – 1.9 million] 110 000 [67 000 – 180 000] 0.8% [0.6% – 1.1%] 58 000 [41 000 – 88 000] Western & Central Europe 730 000 [580 000 – 1.0 million] 27 000 [14000 – 49 000] 0.3% [0.2% – 0.4%] 8000 [4800 – 17 000] North America 1.2 million [760 000 – 2.0 million] 54 000 [9600 – 130 000] 0.6% [0.4% – 1.0%] 23 000 [9100 – 55 000] Oceania 74 000 [66 000 – 93 000] 13 000 [ 12 000 – 15 000] 0.4% [0.3% – 0.5%] 1000 [<1000 – 1400] TOTAL 33 million [30 – 36 million] 2.7 million[2.2 – 3.2 million] 0.8% [0.7% - 0.9%] 2.0 million [1.8 – 2.3 million] UNAIDS The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

  6. Estimated number of people living with HIV and adult HIV prevalence Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa, 1990–2007 Global HIV epidemic, 1990–2007 HIV epidemic in Sub-Saharan Africa, 1990–2007 Number of people living with HIV (millions) % HIV prevalence, adult (15–49) Number of people living with HIV (millions) % HIV prevalence, adult (15–49) 40 4.0 30 15.0 25 12.0 30 3.0 20 9.0 20 2.0 15 6.0 10 10 1.0 3.0 5 0 0 0 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 NOTE: Even though the HIV prevalence stabilized in Sub-Saharan Africa, the actual number of people infected continues to grow because of ongoing new infections and increasing access to antiretroviral therapy. Number of people living with HIV % HIV prevalence, adult (15–49) These bars indicate the range around the estimate UNAIDS

  7. 70 Sub-Saharan Africa 60 GLOBAL 50 Percent female (%) Caribbean 40 Asia 30 Latin America 20 Eastern Europe & Central Asia 10 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 Percent of adults (15+) living with HIV who are female 1990–2007 UNAIDS 2.4

  8. Over 7400 new HIV infections a day in 2007 • More than 96% are in low and middle income countries • About 1000 are in children under 15 years of age • About 6300 are in adults aged 15 years and older • of whom: • almost 50% are among women • about 45% are among young people (15-24) UNAIDS

  9. But, we are making progress… • Nearly 4 million people are receiving antiretroviral drugs – more than tenfold increase from five years before • Fewer people are becoming newly infected with HIV. Estimates declining from 3 million in 2001 to 2.7 million in 2007. • Fewer people are dying from HIV-related illnesses. Estimates declining from 2.2 million in 2005 to 2.0 million in 2007. • The total number of people living with HIV is increasing due to ongoing new infections, persons alive as a result of treatment, and population growth. • USD 14 billion was spent on AIDS last year Uniting the world against AIDS UNAIDS

  10. Who is funding the AIDS response?Resource Availability for HIV 2005-2008 UNAIDS

  11. About UNAIDS • UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations to respond to AIDS. • The Secretariat is based in Geneva, Switzerland and works on the ground in more than 80 countries. UNAIDS/S.NOORANI UNAIDS

  12. About UNAIDS • Established in 1994 by an ECOSOC resolution, launched in January 1996 • Innovative joint venture, combining the efforts and resources of the Secretariat and ten UN system organizations(Cosponsors) to respond to AIDS • Guided by a Programme Coordinating Board, consisting of: • Representatives of 22 governments from all geographic regions • the UNAIDS Cosponsors • Five representatives of NGOs from all geographic regions, including associations of people living with HIV UNAIDS

  13. Our Cosponsors • UNHCR • UNICEF • WFP • UNDP • UNFPA • UNODC • ILO • UNESCO • WHO • WORLD BANK UNAIDS

  14. UNAIDS five focus areas • Mobilizing leadership and advocacy for effective action on the epidemic • Providing strategic information and policies to guide efforts for the AIDS response worldwide • Tracking, monitoring and evaluation of the epidemic and the response • Engaging civil society and developing partnerships • Mobilizing resources to support an effective response UNAIDS/L.TAYLOR UNAIDS

  15. (N) (91,546) (118,279) (11,381) (76,315) (23,269) (74,263) 100 80 Percent new infections 60 40 20 0 Swaziland Lesotho Mozambique Uganda Zambia Kenya Incidence by Modes of Transmission Injecting drug users Other Partners of clients of female sex workers Clients of female sex workers Men having sex with men Casual heterosexual sex Partners (Casual heterosexual sex) Low risk heterosexual Sources: Draft results from Know your Epidemic project

  16. Our goals • Millennium development goals • Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality and empower women • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria and other diseases • Ensure environmental sustainability • Develop a global partnership for development • Through the 2001 Declaration of • Commitment on HIV/AIDS and the • Millennium Development Goals, the • world has a set of commitments, • actions and goals to stop and reverse • the spread of HIV. UNAIDS

  17. Universal access to HIV prevention, treatment, care and support • 3 by 5: the WHO/UNAIDS-led initiative to place 3 million people in low and middle-income countries on antiretroviral treatment by the end of 2005 • Universal Access (2010): a signpost on the road to…. • Millennium Development Goals (2015): to halt and reverse the HIV epidemic

  18. Principles for the coordination of national AIDS responses The Three Ones: Ownership, Alignment and Mutual Accountability • One agreed AIDS action framework that provides the basis for coordinating the work of all partners; • One national AIDS authority, with a broad-based multisectoral mandate; • One agreed country-level monitoring and evaluation system. UNAIDS

  19. Prioritization • We can prevent mothers from dying and babies from becoming infected with HIV. • We can ensure that people living • with HIV receive treatment. • We can prevent people living with • HIV from dying of tuberculosis. • We can protect drug users from • becoming infected with HIV. UNAIDS/S.NOORANI UNAIDS

  20. Prioritization (continued) • We can remove punitive laws, • policies, practices, stigma and • discrimination that block effective • responses to AIDS. • We can stop violence against women and girls. • We can empower young people to • protect themselves from HIV. • We can enhance social protection for people affected by HIV. UNAIDS

  21. Impact of the Economic Crisis on the response to AIDS • The crisis is affecting both advanced and developing countries • Financial conditions facing developing countries have deteriorated sharply, and the crisis will have long-term implications for them • The challenge is to protect or expand critical expenditures in the social sector – safety nets, human development and infrastructure • There is a strong need to expand assistance to developing countries to protect these expenditures and prevent the erosion of progress in reducing poverty UNAIDS

  22. What are the direct impact – early warning signals • Information collected in late March 2009 from 69 countries (in which 3.4 million people are under treatment) shows that: • In 12% of the surveyed countries, the crisis is already affecting treatment programmes. • In 32% of the countries—home to 61% of those under antiretroviral treatment—an impact is expected this year. UNAIDS

  23. The risks of reduced treatment • Increased mortality and morbidity Unnecessary death and disease (including increased tuberculosis) due to AIDS • Greater transmission risks as people off treatment become more infectious • Higher financial costs Interruptions of treatment make treatment failure more likely, requiring use of costly second-line regimen drugs • Increased burden on health systems. More HIV-related illnesses, and pressure on health services at a time when their budgets are being cut • Reversal of economic and social gains. Consequences for households, and costs to businesses and public agencies. UNAIDS

  24. Additional threats to sustaining antiretroviral treatment coverage and increasing access to effective regimens • HIV prevention using antiretroviral drugs • Double standard regimens in the global south and global north • Late diagnosis incurs high mortality in first 3 months of treatment (300x that of the general population) • Need to invest in testing and counselling and reduce stigma and discrimination – know your status • Possible changes in CD4 count level for treatment initiation UNAIDS

  25. Prevention Strategies (those using antiretroviral drugs in red) Prior to exposure Point of transmission After infection • Structural interventions • Behaviour change • Prevention for Positives • Male and femalecondoms (FC1 & FC2) • PMTCT (mother-to-child) • Post exposure prophylaxis (PEP) • TherapeuticVaccines • Male circumcision • Preventive Vaccines • Pre-exposure prophylaxis (PREP) • HSV2 suppression • Treatment of infected partner • Microbicides • Diaphragm, cervical barriers UNAIDS

  26. UNAIDS Egger, 2007

  27. Currently, the median CD4 count at ART initiation is well below 200 in Africa and South/South-east Asia. Raising the eligibility criteria will not affect numbers on treatment unless potential patients are identified earlier and access to treatment expands. Source: Matthias Egger, Outcomes of Antiretroviral Treatment in Resource Limited and Industrialized Countries, CROI 2007 UNAIDS

  28. www.unaids.org • Any questions? UNAIDS/L.TAYLOR UNAIDS

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