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Ending the AIDS epidemic: Science, Policy and Community

Ending the AIDS epidemic: Science, Policy and Community. Peter Godfrey-Faussett UNAIDS, Geneva. Outline. The challenge of HIV The optimism of the MDGs The SDG era Fast-Track to end the AIDS epidemic Conclusions and Recommendations. The cooking pot sits on three stones. Science Policy

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Ending the AIDS epidemic: Science, Policy and Community

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  1. Ending the AIDS epidemic: Science, Policy and Community Peter Godfrey-Faussett UNAIDS, Geneva

  2. Outline The challenge of HIV The optimism of the MDGs The SDG era Fast-Track to end the AIDS epidemic Conclusions and Recommendations

  3. The cooking pot sits on three stones Science Policy Community

  4. Science 20 May 1983: Vol. 220 no. 4599 pp. 868-871

  5. 1990 Global Burden of Diseases : IHME, Seattle 2005 http://vizhub.healthdata.org/gbd-compare/

  6. Halt and begin to reverse, by 2015, the spread of HIV/AIDS

  7. Figure 3 Number of new HIV infections, global, 1990–2014 30 million new HIV infections averted from 2000-2014 through scale up of HIV treatment and prevention including 1.4 million among children Source: UNAIDS 2014 estimates.

  8. Figure 8 Number of AIDS-related deaths, global, 2000–2014 7.8 million deaths averted from 2000-2014 through scale up of antiretroviral treatment 8.9 million children not orphaned Source: UNAIDS 2014 estimates.

  9. Figure 24 Number of people receiving antiretroviral therapy, 2000–2015 Source: UNAIDS 2014 estimates. Numbers receiving antiretroviral therapy through March 2015 provided by selected countries in sub-Saharan Africa.

  10. Figure 9 Adult life expectancy trends, Kyamulibwa general population cohort, Uganda, 1991–2012 Source: Reniers et al, CROI 2015.

  11. Life expectancy at birth, selected countries and regions, 1960–2015 Source: World population prospects: the 2012 revision. The 2012 Revision. New York: United Nations, 2013 (available from hps://data.un.org/Data. aspx?q=life+expectancy&d=PopDiv&f=variableID%3a68, accessed 2 July 2015).

  12. Estimated number of tuberculosis-related deaths among people living with HIV, globally and in sub-Saharan Africa, 2004–2013 Source: WHO 2013 estimates.

  13. July 2010: CAPRISA 04 tenofovir gel trial

  14. July 2011: Oral PrEP prevents HIV transmission in discordant couples (PartnersPrEP) 4,758 HIV discordant couples in Kenya & Uganda Effect of TDF on HIV: 67% (CI: 44% - 81%) Effect of FTC/TDF on HIV: 75% (CI: 55% - 87%)

  15. ARV prophylaxis Treatment of STIs Male circumcision Microbicides for women Grosskurth H, Lancet 2000 Auvert B, PloS Med 2005 Gray R, Lancet 2007 Bailey R, Lancet 2007 Abdool Karim Q, Science 2010 Female Condoms Male Condoms HIV PREVENTION HIV Counselling and Testing Oral pre-exposure prophylaxis Coates T, Lancet 2000 Sweat M, Lancet 2011 Grant R, NEJM 2010 (MSM) Baeten J , NEJM 2012 (Couples) Paxton L, NEJM 2012 (Heterosexuals) Choopanya K, Lancet 2013 (IDU) Behavioural Intervention Post Exposure prophylaxis (PEP) Treatment for prevention • Abstinence • Be Faithful Scheckter M, 2002 Cohen M, NEJM, 2011 Donnell D, Lancet 2010 Tanser, Science 2013 Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is on sexual transmission

  16. Total resources for HIV/AIDS in low- and middle-income countries, 2000–2015 Source: UNAIDS estimates June 2015, based on UNAIDS-KFF reports on financing the response to AIDS in low- and middle-income countries until 2014; OECD CRS last accessed June 2015; UNGASS and GARPR reports; FCAA Report on Philanthropic funding Dec 2014.

  17. Figure 34 Global resource availability for HIV, by source, 2000–2015 Source: GARPR 2015.

  18. Domestic public spending in low- and middle-income countries, 2006–2014, in US$ million

  19. SDGs

  20. TARGETS for SDG 3 • 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births • 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births • 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases • 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being • 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol • 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents • 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes • 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all • 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination • 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate • 3.b Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all • 3.c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States • 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks

  21. Figure 26 Antiretroviral therapy coverage in adults and children, 2000–2014 Source: UNAIDS 2014 estimates.

  22. Global HIV prevalence of HIV in MSM compared with regional adult prevalence in 2011 Source: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer, The Lancet, 2012

  23. Global measures of HIV incidence among MSM

  24. Measures of HIV incidence among MSM in SE Asia region

  25. HIV infections in MSM and FSW in Viet NamAIDS Epidemic Model 2015

  26. Distribution of HIV-1 Subtypes in MSM by Region Mainland China Thailand Other (Taiwan, Singapore, Indonesia, Malaysia) Systematic Review, 2010-15

  27. Amsterdam Shanghai Taiwan

  28. Around 50% of transmission may occur within one year of infection

  29. Implications of phylogenetics for MSM prevention • Acute HIV infections are at least 30 times more infectious • Untreated or poorly treated HIV remains infectious for long periods • Infections caused by longstanding HIV can be prevented by good treatment of the HIV-positive partner as well as by good prevention for the HIV-negative partner. • Infections caused by acute infections can realistically only be prevented by Condoms, Behaviour and PrEP

  30. The Fast-Track approach Decline in new adult HIV infections Decline in AIDS-related deaths Source: Fast-Track: ending the AIDS epidemic by 2030. Geneva: UNAIDS; 2014.

  31. Investments for Fast-Track 1 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV status accessing treatment and 90% of people on treatment having suppressed viral loads, so they remain healthy.

  32. Science, Policy and Community • HIV response extraordinary • MDGs-SDGs- end of AIDS • Men who have sex with men need not be left behind. • Full range of combination prevention choices • New Science (PrEP) and next generation science (Vaccines, long-acting PrEP) need to be supported by enlightened Policies and engaged Communities

  33. Acknowledgements Chris Beyrer and Stef Baral Salim Abdool Karim and the UNAIDS Science Panel Rachel Baggaley and the WHO PrEP Team Rosalind Coleman and Celeste Sandoval, UNAIDS Science team

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