Title

1. Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care and Support Title 2009-2015 NAME HERE

2. Outline • Background • What is new? • Findings • Challenges • Key issues • Next steps

3. Resource Needs estimates by UNAIDS since 2001 • June 2001-Prepared for UNGASS • $10 billion by 2005 ($5 prevention, $4.8 treatment) • Nov 2002-Prepared for Barcelona AIDS Conference • $10.5 in 2005 and $15.2 in 2007 • Estimates to 2007 (includes new interventions UP, PEP, med injections • Julio 2004-Prepared for Bangkok AIDS Conference • $11.6 2005 and $19.9 in 2007 • Used 3X5 public health model, decrease in ARV prices, OI Rx, PEP, nutritional support, increased T&C • Agosto 2005- Prepared for G-8 • $15 in 2006, $18 in 2007 and $22 in 2008 • Used increased rate of scale up consistent with reaching UA by 2010, now includes investments in human resources, physical infrastructure, community mobilization • Septiembre 2007- Prepared for the MDGs price tag • Financial requirements to attain the health-related Millennium Development Goals

4. Global Resource Needs 2009-2015: main features of the estimation process • A critical review of the current method and analysis of alternative and innovative methods was conducted • The process is build-up to ensure that adequate consideration is given to the concerns/advice from the different constituencies • Consultation and involvement of low- and middle-income country representatives is underway to validate and incorporate current data • Two different bodies supervise and guide the estimation process • Technical Working Group • Advisory Board

5. What is new about these estimates • Additional activities included • Prevention • Selected services to reduce violence against women • Male Circumcision • Opioid substitution treatment for Injecting Drug Users • Treatment • Provider Initiated Testing and Counselling • (extended targeted population and new coverage ) • Modification of the definition of the persons in need of • Antiretroviral treatment which results in starting treatment at an earlier stage • Program support costs • Global advocacy • Policy development, framing of HIV services within a human rights framework • and addressing of stigma • 3.Provision of Technical Support was made a separate intervention • within Programme Costs • Three scenarios

6. Financing Universal Access • What’s committed? • What’s needed? • What would this money buy?

7. What is Universal Access? “Requests ... that the UNAIDS Secretariat and its Cosponsors assist in facilitating inclusive, country-driven processes ...for scaling up HIV prevention, treatment, care and support, with the aim of coming as close as possible to the goal of universal access to treatment by 2010” UN General Assembly resolution (December 2005) “Commit ourselves to setting, in 2006… ambitious national targets…that reflect the commitment of the present Declaration and the urgent need to scale up significantly towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010” UN High Level Meeting on AIDS, 2006

8. Three approaches for the response: scenarios Universal access by 2010scale-up scenario envisions significant increases in available resources and an urgent and dramatic expansion of coverage in all countries, achieving universal access by 2010 in accordance with globally agreed goals and nationally set targets.

9. Three approaches for the response: scenarios Projected trends based on current scale-up • Assumes that the pace at which HIV services are now being expanded will continue into the foreseeable future. • An empirical projection of trend is one logical scenario for the future • Reflecting current logistical constraints • This continued scale up requires increases in financial resources, although it would not achieve universal access targets in 2010 nor in 2015

10. Treatment and ART coverage [Table 5]

11. Treatment and care components [Table 6]

12. Global prevention [Table 3]

13. AIDS programme costs by activity [Figure 6]

14. AIDS Resource Needs * The totals have been rounded to the first decimal place with the result that there may be small differences with the figures for sub-totals because of rounding. [Table 1]

15. Scenarios towards “Universal Access” in 132 low- and middle-income countries, 2007‒2015(US$ billion) US$B

16. Is this realistic? • Targets and coverage levels • Obstacles to reach UA • Investments for human resources, systems, physical infrastructure • Resource needed: not only money

17. Three approaches for the response: scenarios Phased scale-upscenario envisions that each country will reach universal access at different times. This scenario assumes different rates of scale- up for each country based on current service coverage and capacity, with essentially all countries reaching universal access by 2015 at the latest. Priority would be given to the most effective programmatic services as dictated by data derived from national efforts to ‘know and act on your epidemic’.

18. Scenarios towards “Universal Access” in 132 low- and middle-income countries, 2007‒2015(US$ billion)

19. Funding of health services will not stop AIDS Social change: tackle the structural drivers of the epidemic • HIV prevention largely outside health services • Tackle drivers of epidemic • Gender • HIV related stigma and discrimination (IVDU) • Sexuality, including homosexuality • Social and economic inequalities directly related to AIDS

20. AIDS Resource Needs by activity area [Table 1]

21. AIDS Resource Needs: programmes to prevent violence against women (US$ million) [Table 1]

22. Potential contribution by AIDS to broader health and social sector issues • Orphans and vulnerable children • All double orphans, near orphans, half of single orphans, who are living below poverty line in SSA, • Proportion of AIDS orphans elsewhere • Provision of “Universal Precautions” in health facilities • Recruitment, incentives and salaries of additional health care staff • Refurbishment of health centres and hospitals • Construction of additional health centers.

23. Costing the health related MDGs Produce information to support scaling-up of national responses and to contribute to the achievements of Millennium Development Goals (MDGs) • Child survival (pneumonia, diarrhoea, malaria, measles) • Maternal health • Tuberculosis • HIV/AIDS • Malaria

24. Challenges • Are the investments in capacity sufficient to address the “implementation gap?” • What are the diversions, enhancements and synergies? • What is a “fair share” for AIDS funding for improving health and social sectors? • Where will this funding come from?

25. Global Resource Needs 2009-2015: where the additional money is likely to come from • Middle-income countries Governments • Use of own revenues • Reimbursable loans from Development banks • Official Development Assistance • G8, other DAC member countries and Non-DAC governments • Direct bilateral, e.g. PEPFAR • Budget Support • Through Multilaterals, e.g. increased funding through GF and others • Innovative approaches • New ways of delivering services • Efficiencies, synergies and scale economies • International taxation systems • UNITAID

26. Next Steps • Review the current normative package of HIV services • Compile national RNE and validate UNAIDS country estimates • Extension of the current model: impact • Provide TA: costing NSP • Estimate financing gaps

27. http://www.unaids.org/en/KnowledgeCentre/HIVData/Tracking/Default.asphttp://www.unaids.org/en/KnowledgeCentre/HIVData/Tracking/Default.asp