Strengthening Partnerships and Strategies to Fast-Track Implementation

towards Ending AIDS by 2030.

Pride Chigwedere, MD, PhD

AWA CONSULTATIVE EXPERTS’ COMMITTEE MEETING OF

COMMISSION OF THE AFRICAN UNION,

VICTORIA FALLS, ZIMBABWE

4-5 MAY 2015

Calls for Ending AIDS

• Continental Calls

Abuja + 12 Special Summit

Common African Position for Post-2015 Agenda

• Global Calls

MDGs

2011 Political Declaration

• Is it possible to End AIDS?

Progress in last decade

Interventions available

Approach - Roadmap to End AIDS by 2030

• Define

Vision

Goal and components of the goal (sub-goals)

Strategy,

Targets, milestones, indicators

Costs and Financing

• Avoiding reinventing the wheel - leverage and incorporate existing strategies and plans to the extent possible

16 October 2006 UNAIDS

VISIONZERO NEW HIV INFECTIONS.

ZERO DISCRIMINATION.

ZERO AIDS-RELATED DEATHS.

Goal – End AIDS as a public health threat by 2030

• reduce new HIV infections

• AIDS-related deaths

• And discrimination to 10% of 2010 levels.

• Ending AIDS is not Ending, eliminating, eradicating HIV

• Africa-specific numbers; guidance to define what Ending epidemics of Malaria and TB mean

Existing Strategies - Global Plan Towards Elimination of New Infections Among Children by 2015 and Keeping their Mothers Alive

PMTCT was first successful programme in the AIDS response

EMTCT could be the first step in Ending AIDS

Clear Goals with timeline; Clear strategies – 4 prongs

Clear focus – Africa Plan plus India

Costs; Cost Effectiveness; Cost Benefit

Global Plan – Challenges and Future Emphasis

• Pace of decline in new infections decreasing; countries whose coverage in 2013 was lower than 2012 (Zambia, Lesotho, Ghana, Chad)

• Countries not making fast progress – Nigeria, Angola

• 50% transmission during breastfeeding

• Paediatric ART coverage – 22%; Cotrimoxazole

• Prong 1 progress – 17% reduction in new infections

• Prong 2 data – none from year to year

Targets for ending the AIDS epidemic

People receiving antiretroviral therapy, 2005 to June 2014, all countries

The treatment target

90% 90% 90%

tested on treatment virally suppressed

AIDS-related deaths in low- and middle-income countries, 2010–2030, with

achievement of ambitious Fast-Track Targets, compared to maintaining

2013 coverage

New HIV infections in low- and middle-income countries, 2010–2030, with

achievement of ambitious Fast-Track Targets, compared to maintaining

2013 coverage

Resource Needs for Treatment, Care and Support US$ Million

Resources available in 2013 and resources required 2015–2030, by level of

income in low- and middle-income countries

Worrying Issues - Treatment

• Not fully exploiting the benefits that we can derive from treatment

• Not utilizing bulk procurement and other ways to decrease the costs of drugs

• Not looking into the near future to start negotiating deals for 2nd line and 3rd line therapy

• Not leveraging the deals such as reduction in viral load assay price such as South Africa did

Fast-Track Strategy – Rethinking Prevention

• Prevention Targets

– 500,000 new infections by 2020

– 200,000 new infections by 2030

Fast-Track Strategy – Rethinking Prevention

• Builds on KYE KYR work, Investment Thinking etc.

– Renewed commitment for Prevention

– Focus – geographical (e.g. hotspots approach); population targeting (e.g. young women)

– Tools for Impact – ART, condoms, circumcision, behaviour change, cash transfers, synergies

– Innovation – PrEP, social media, self testing, new VMMC devices, cash transfers, female condoms

– Scale and Intensity – Coverage for Impact

– Accountability – Political, Financial, Programmatic

Fast-Track Strategy – Discrimination Targets

• By 2020, everyone, everywhere lives a life free from HIV-related discrimination.

• By 2030, all people living with HIV, key populations and other affected populations fully enjoy their HIV-related rights, including protection within their communities and equal access to health, employment, justice, education and social services.

Fast-Track Strategy – Discrimination Targets

• Crucial component for Ending AIDS

– Zero HIV-related discrimination in health settings

– Zero HIV-related discriminatory laws, policies and regulations

– Zero HIV-related discrimination and full access to justice

• Tools – Global Criminalization Scan, Stigma Index, DHS, GARP, Other Surveys

• Gender Indicators? Costs? Implementation Plan?

• How do we learn from, adapt and enrich this process for Africa’s Roadmap?

Additional Insights

• Workstreams on Financing, Cities, Social Protection

• UNAIDS Strategy Development; 2016 HLM on AIDS

• Post-2015 Negotiations; other global processes