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ELIZABETH MZIRAY Health, Nutrition and Population Department World Bank

ELIZABETH MZIRAY Health, Nutrition and Population Department World Bank. Acknowledgements. Outline. Status of the Epidemic in Jamaica. Prevalence rate: 1.1% MSM (31.8%) CSW (4.9%) Crack cocaine users (4.5%) Prisoners (3.35%). Status of the Epidemic in Jamaica. Main achievements:

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ELIZABETH MZIRAY Health, Nutrition and Population Department World Bank

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  1. ELIZABETH MZIRAY Health, Nutrition and Population Department World Bank

  2. Acknowledgements

  3. Outline

  4. Status of the Epidemic in Jamaica • Prevalence rate: 1.1% • MSM (31.8%) • CSW (4.9%) • Crack cocaine users (4.5%) • Prisoners (3.35%)

  5. Status of the Epidemic in Jamaica • Main achievements: • Reduction in AIDS mortality • Reduction in MTCT • Improved prevention programs with increased focus on MARPs • Challenges: • Current prevention efforts have failed to impact the epidemic among MSM • Only 50% of PLHIV know their status

  6. Context - Jamaica • Jamaica maintains a robust treatment program • More than 90% of ANC clients access VCT • Treatment coverage is 58%

  7. Slowdown in donor financing globally IHP+ Gates Foundation Source: UNAIDS

  8. Financing of the National HIV/AIDS Response • Financing for the current national AIDS strategy (2007-2012) includes: • $10mil from the World Bank • $45mil from the Global Fund • $10mil from the US Government • Future donor financing is likely to decline substantially in the next 2 years • Challenge is how to sustain the national AIDS program, and finance the next NSP • The availability of domestic resources is and will be very tight, and • Fiscal space constrained by high public debt (139% of GDP) • Financing of the national response is under pressure both from the domestic fiscal adjustment and the shrinking external resources

  9. Purpose of the Study • Review and assess the current spending for HIV/AIDS and the sources of financing (both domestic and external) • Assess the future availability of financing for HIV/AIDS and the anticipated fiscal burden of an efficient and effective response • Project the course of the epidemic and the costs associated with different policy scenarios • Provide recommendations to inform policy decisions on sustaining the national HIV response

  10. Methodology – 3 Building Blocks

  11. Current Spending and Sources of Financing

  12. Projected Costs of National Response (2010-2030) Scenario 1: Declining HIV incidence Scenario 2: Constant HIV incidence Scenario 3: Increasing HIV incidence

  13. Projected Costs of National Response (2010-2030) • Little variance in projected costs of the national response across the three scenarios • Most significant cost of the national response is in treatment and care

  14. Costs Incurred by new HIV infections • Direct costs incurred by an HIV infection estimated at US$5,800 • Analysis shows disproportionate role in the spread of HIV by some population groups (taking into account downstream infections) • MSM: Almost 10X the direct costs • FSW: More than 4X the direct costs

  15. Fiscal Evaluation of the Costs of the HIV Program Spending needs rise from : 0.14% of GDP (2010) to 0.2% of GDP (2030)

  16. Implications of Reduced External Financing • Decline in external financing will result in even steeper increase in domestic financing needs • Declines from 67 to 45% will require a doubling of domestic financing by 2015, and more than triple by 2030 • Changes in financing needs across scenarios are subtle in the short run but more significant by 2030

  17. Perspectives on Sustainability • Analysis finds large differences in the cost caused by additional infections across population groups • Costs significantly higher for most at risk populations (MSM and Sex Workers) due to large share of current infections and disproportionate risk of onward infections • HIV spending is projected to remain at about 2-3% of public health spending which is in line with the burden of disease • Annual treatment costs (10-20% of GDP/capita) within range that could be reasonably supported through public health spending • Commitments on provision of treatment cannot be rescinded

  18. Perspectives on Sustainability • Total projected costs for the national response will remain below 0.2% of GDP • HIV/AIDS does not pose immediate challenges to fiscal sustainability. But will need to compete for scarce fiscal resources • The national response faces considerable financing challenges due to: • Rising costs of the program (mainly from the increasing need for treatment) • Uncertain outlook for the availability of financing with the end of the current sources of external financing

  19. Key Messages • A significant increase in domestic financing for HIV/AIDS is FISCALLY SUSTAINABLE • The bulk of the projected costs for the national AIDS response represent TREATMENT costs (both first and second line treatment) • For an efficient and effective national AIDS response there’s need to ACCELERATE PREVENTION EFFORTS particularly targeted prevention interventions for MARPs

  20. Thank You! www.worldbank.org/lacaids www.worldbank.org/aids

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