Sustained Response to HIV: Financial Challenges

1. Dr. Socorro Gross-Galiano Assistant Director Sustained Response to HIV:Financial Challenges Ministerial Meeting on HIV and Development in Latin America and the Caribbean ECOSOC - Annual Ministerial Review Jamaica, 4-6 June 2009

2. Wheredoes the financing for the response come from? We should sustain our support to countrieswith funding gaps and avoid setbacks on what we have already achieved HIV financing in selected countries International Domestic Source: UNAIDS, 2008 ( last available year)

3. Sustained Response to HIV: Financial Challenges What is the roadmap ? • Prevention (Young People / Risk Groups, Vertical Transmission) • Early Detection • Interventions that address the social and epidemiological reality • PHC based Health Systems with positive synergies • Mechanisms to improve interventions, efficiency and reduce costs • Strengthen inter-sector collaboration • Eliminate stigma and discrimination

4. Protecting achievements (ART, blood safety) Making progress in areas lacking adequate attention(high-risk populations needs, stigma and discrimination,PMTCT, sexual transmission prevention, epidemiological surveillance, ) Components of a Sustained HIV Response Health sector Provides important role of the response – leads inter-sectoral work, key for a sustained & comprehensive response.

5. Innovations in therapeutic approaches (early adoption) Response should be maintained and expanded • New infections will require treatment • Sizable number of infected people are still without access totreatment IT IS URGENT! Prioritize prevention reducing rate of newinfections, targeting high-risk populations, work on stigma and discrimination and using resources rationally. • People receiving ART will continue needing them ( more expensive plans)

6. For what? Necessary to introduce mechanisms that reduce costs of providing services at all levels of the system and barriers to access - including out-of-pocket expenditures, stigma and discrimination • Estimates correspond to: • Human Resources • Materials • Equipment • Infrastructure Needed for the delivery of interventions that allow meeting of targets … thechallenge is not limited to financial resources!

7. Thefinancial crisis… • Finds us with some of our health systems fragmented • This has an impact on - • The rational use of resources • The response capacityby the health sector … including HIV!

8. HIV Reforms in the Re-orientation of PHC - based Health Systems UniversalCoverage Organization of Services Strong health systems = Robust response Leadership Reform PublicPolicies HIV is controlled, benefits are achieved, LIVES ARE SAVED

9. Due to insufficient coverage, an estimated 12,300 children were born in 2007 with the virus or were infected during lactation. Progress on ARV Access to prevent mother to child transmission in LAC • Impact on children: • Lack of opportunity from birth; • Vulnerability • Social responsibility and of health systems • Deliver Social Protection • Cover treatment costs % of HIV+ pregnant women that receive ARV for PMTCT

10. The cost of treatment with ARV for 15 years per infected childvaries Cost of preventing a case of mother to child transmission is estimated at US$500 Cost can be minimized if prevention is provided by an integrated maternal care network. Costs of not preventing Maternal-Child Transmission $25,483 to $140,222 (US) ARV range Cost totalin the Region: $313 million & $ 1.7 billions (US) Cost of ART per child from 2 months to 15 years of age (US $) Prices Strategic Fund Prices negotiated without the application of international reference pricing

11. Purchase of ARV - Two scenarios - Innovators (Chile) versus Generics (Peru), under the same centralized purchasingsystem Options to reduce and contain drug and resource costs US Dollars (US$)

12. Low access by most vulnerable populations Lack of regulation to improve access to drugs Insufficient strategies to ensure access to drugs within the PHC framework Limited dialogue among interested parties to promote universal access Difficulties in pharmaceutical markets

13. Critical points in the intersectoral collaboration Coordination and inter-sectoral collaboration Now more than ever! • EDUCATION Monitoring the Inter-ministerial Declaration of Mexico at the national level • LABOUR Links with the labor sector • CIVIL SOCIETY Coordination with civil society organizations • JUSTICE Protection of Human Rights • FINANCE & TRADE Protect public health & ensure equitable access to drugs & other products • SOCIAL SECURITY Include children orphaned by HIV • PRIVATE SECTOR Prevention, protection and inclusion of people affected by HIV We need to investin collaboration & coordination

14. To cooperation and financing partners: Promote utilization of strategies and coordination mechanisms Harmonize collaboration mechanisms and lessen demands on countries Collaborate with countries to improve cost & efficiency of preventive efforts Promote interventions and investments to strengthen local systems and capacity. Recommendations

15. To social policy makers : Include people affected by HIV, in social protection programsincluding children orphaned Allocate public spending to sustain achievements and bridge gaps Prioritize vulnerable & high risk populations in addressing health determinants Recommendations

16. To national actors Revisit PHC and coordinate an integrated health system response Re-prioritize preventiveinterventions targeting high-risk and vulnerable groups Mainstream sex education Establish an early warning system to minimize treatment interruption and reduce new infections. Recommendations

17. To national health authorities: • Revitalize leadership role in policy-making, coordination, and management of resources allocated to HIV • Revise model of care for HIV includingorganization & delivery; • Conduct critical analysis and data analysis to identify deficiencies, gaps, and opportunities for intervention in the short-term • Define needs for long-term reforms based on analysis results Recommendations

18. To health services management Coordinate complementary interventions, such as the promotion of sexual and reproductive health with the prevention/care of sexually transmitted infections Incorporate actions within comprehensive and integrated care framework Protect and develop Human Resources for Health to maintain its quality, competency and availability Recommendations

19. To Media Emphasis on prevention stigma and discrimination Promote voluntary testing and counseling Recommendations

20. Recommendations AT ALL LEVELS! PROMOTE solidarity respect and the elimination of stigma and discrimination

21. Thank You! ¡Gracias! Merci! Muito Obrigado!