1 / 34

The Global Response to AIDS: Achievements and Challenges for the Long Term

The Global Response to AIDS: Achievements and Challenges for the Long Term. Peter Piot Institute for Global Health Imperial College London. Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007. Decline in adult mortality with introduction of ART: Botswana.

iniko
Download Presentation

The Global Response to AIDS: Achievements and Challenges for the Long Term

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Global Response to AIDS: Achievements and Challenges for the Long Term Peter Piot Institute for Global Health Imperial College London

  2. Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007

  3. Decline in adult mortality with introduction of ART: Botswana

  4. Improvements in life expectancy at infection due to the availability of ART: Resource-poor settings Source: Hallett T B, et al. PLoS Med. 2008 Mar 11;5(3):e53.

  5. HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997–2007 Southern Africa Botswana 50 Burkina Faso Lesotho 40 NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) Mozambique 30 Namibia Median HIV prevalence (%) 20 South Africa Ghana Swaziland 10 Zimbabwe 0 1997– 1998 1997– 1998 1997– 1998 1999– 2000 1999– 2000 1999– 2000 2001 2001 2001 2002 2002 2002 2003 2003 2003 2004 2004 2004 2005 2005 2005 2006 2006 2006 2007 2007 2007 Eastern Africa West Africa 20 20 15 15 Ethiopia 10 10 Median HIV prevalence (%) Median HIV prevalence (%) Côte d'Ivoire 5 5 Kenya Senegal 0 0 Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS.  July 2008.

  6. Changes in HIV Prevalence and Risk Behaviour: Zimbabwe (urban and semi-urban areas) Natural decline in incidence ~1990 Accelerated decline in incidence, due to behaviour change ~2000 Source: Hallett TB, et al. Epidemics 2009;1(2):108-117.

  7. Number and percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2004–2007 40 600 000 35 500 000 30 400 000 Number of HIV-positive pregnant women receiving anti-retrovirals % of HIV-positive pregnant women receiving anti-retrovirals 25 300 000 20 15 200 000 10 100 000 5 0 0 2004 2005 2006 2007 Year Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.

  8. AIDS IS NOT OVER

  9. HIV prevalence (%) in adults (15–49) in Africa, 2007

  10. HIV infections among men having sex with men in Asia

  11. HIV infections by mode of transmission in Thailand Source: Bertozzi SM, et al. Lancet. 2008 Sep 6;372(9641):831-44. http://data.unaids.org/pub/report/2008/thailand_2008_country_progress_report_en.pdf

  12. How did we get there? • Science and rights driven • A global response • Focus on results for people • Prevention AND treatment • Multi-disciplinary, multi-sectoral • Community engagement

  13. Total annual resources available for AIDS1986‒2007 US$ million 10 billion 10 000 8.9 billion 9000 Signing of Declaration of Commitment on HIV/AIDS,UNGASS 8000 8.3 billion 7000 6000 World Bank MAP launch 5000 4000 Gates Foundation PEPFAR 3000 UNAIDS Less than US$ 1 million 2000 1623 1000 Global Fund 292 257 212 59 0 ‘06 2007 1986 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 Notes: [1] 1986-2000 figures are for international funds only [2] Domestic funds are included from 2001 onwards [i] 1996-2005 data: Extracted from 2006 Report on the Global AIDS Epidemic (UNAIDS, 2006) [ii] 1986-1993 data: AIDS in the World II. Edited by Jonathan Mann and Daniel J. M. Tarantola (1996)

  14. Treatment Action Campaign (TAC), South Africa

  15. Recorded female deaths in South Africa and Brazil for ages 15-64 years Brazil, 2004. South Africa, 1997. South Africa, 2004 Source: Nathan Geffen. Statistics South Africa and Instituto Brasileiro de Geografia e Estatistica.

  16. A global response • Human rights and strategic issue • Global public good • Role of United Nations • Global civil society and activism • International financing

  17. World Bank Multi-country AIDS Program (2000) • Global Fund to Fight AIDS, TB and Malaria (2002) • PEPFAR, (2003) • Unitaid (2005) • (PRODUCT) Red (2005) • Debt2Health (2007) New instruments for AIDS financing

  18. Prices (US$/year) of first-line antiretroviral regimen in Uganda: 1998-2003

  19. Focus on results for people • Targets • Know your epidemic and the society • Monitor and evaluate • Accountability

  20. Need for new evaluation methods Simulated HIV epidemics (A) concentrated (B) in the general population Source: Boily M-C ,et al. Sex Transm Infect 2007;83:582-589

  21. A multi-disciplinary, multi-sectoral response • Health outcomes determined by multiple factors and interventions • Particularly key besides health: law, education, work place, trade, armed forces • Expand resource base • First genuine business engagement in health

  22. Percentage of countries with sectors included in the national AIDS strategy and earmarked budgets Military/police Sector included Labour Health Earmarked budget present Transportation Agriculture Minerals and energy Trade and industry Tourism Public works 0 20 40 60 80 100 Percentage of countries (%), N=126 Source: UNGASS Country Progress Reports 2008.

  23. Community engagement • From planning to implementation • Makes or breaks programmes • National Aids Councils and Global Fund Country Coordination Mechanisms • Societal sustainability and resilience

  24. TASO, Uganda

  25. Opportunities for global health • Health diplomacy • Increased funding (ODA and research) • Collateral benefits (TB, malaria, health systems) • Culture of accountability • Tiered pricing • Engagement of non-medical sectors • New blood

  26. aids2031 • Taking a long term view- stretching planning and funding horizons to achieve sustainability • Multi-disciplinary – bringing together bio-medical, social and political scientists, economists and activists to look at what should we do differently – or more of the same – now to change the future of AIDS • Key aids2031 report “Agenda for the Future” to be launched in 2010

  27. Estimated Resource needs for AIDS, TB and malaria (2009 to 2015) Sources: UNAIDS, STB, RBM

  28. Projected AIDS spending needs and per capita GDP, 2030

  29. The PREVENTION GAPPersons at risk with access to selected prevention interventions, 2006 Source: Global HIV Prevention: the access and funding gap. June 2007

  30. Effects of Prevention on Future Costs of ART

  31. Figure 3. Geographical distribution of HIV and tuberculosis infections in South Africa in 1995, 2000, and 2005. Reference: Karim. S, The Lancet, Special Issue: Health in South Africa August 2009 (Data from references 1 and 21.)

  32. Cost Effectiveness

  33. The long term view • A still evolving epidemic • Sustainability (leadership, funding, treatment) • An all out effort on hiv prevention • Improve programme delivery and capacity • Links and synergies with health services ( ART, PMTCTC) and community development • To stop aids, need for technological and structural game changers (but no magic bullet!) • Invest in R&D

More Related