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Latin America/Caribbean State of the Art HIV/AIDS Part Deux

Latin America/Caribbean State of the Art HIV/AIDS Part Deux. Paul R. De Lay, M.D. Chief, HIV/AIDS Division Global Bureau USAID March 13, 2001. HIV/AIDS. The Expanded Response Major Challenges/Issues PMTCT Condom supply OVC Care and Support.

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Latin America/Caribbean State of the Art HIV/AIDS Part Deux

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  1. Latin America/Caribbean State of the ArtHIV/AIDSPart Deux Paul R. De Lay, M.D. Chief, HIV/AIDS Division Global Bureau USAID March 13, 2001

  2. HIV/AIDS • The Expanded Response • Major Challenges/Issues • PMTCT • Condom supply • OVC • Care and Support

  3. HIV/AIDS and Infectious Disease FundingFY 1993-2001 ($ millions)

  4. Evolution of the HIV/AIDS Rapid Response • FY 2000 LIFE Initiative: An additional $100 million for an Interagency USG program with USAID, CDC, and DoD • Four Program Elements: • Primary prevention • Caring for children affected by AIDS • Home and community based care and treatment • Capacity and infrastructure development

  5. Evolution of the Rapid Response • FY 2001: USAID Receives $330 million for HIV/AIDS • Expanded Response Elements target for 2007: • Reduce HIV Prevalence rates among those 15-24 years of age by 50% in high prevalence countries • Maintain prevalence below 1% among 15-49 year olds in low prevalence countries

  6. Evolution of the HIV/AIDS Rapid Response • Targets continued: • Ensure that at least 25% of HIV/AIDS infected mothers in high prevalence countries have access to interventions to reduce HIV transmission to their infants • Help local institutions provide basic care and support services to at least 25% of HIV infected persons and to provide community support services to at least 25% of children affected by AIDS in high prevalence countries

  7. USAID is Scaling Up HIV/AIDS Activities • Three Country Designations: • Rapid Scale Up • Intensive Focus • Basic Programs Intensive Focus Countries (20) HIV/AIDS Basic Programs Countries (25) RapidScaleUpCountries(4)

  8. Basic Countries

  9. Criteria for Rapid Scale-Up &Intensive Focus Countries • The relative severity of the epidemic • The magnitude of epidemic • The impact on economic and social sectors • Enabling environment • The risk of a rapid increase in prevalence • Availability of other sources of funding • Return on investment • Security and safety issues • National Interest

  10. AFRICA Ethiopia (LIFE) Ghana Malawi (LIFE) Mozambique (LIFE) Namibia Nigeria (LIFE) Rwanda (LIFE) Senegal (LIFE) South Africa (LIFE) Tanzania (LIFE) West Africa Region (LIFE) ANE India (LIFE) ANE Region LAC Brazil Caribbean Sub-Region E&E Russia Intensive Focus Countries

  11. Rapid Scale-Up • Cambodia • Kenya (LIFE) • Uganda (LIFE) • Zambia (LIFE)

  12. Rapid Scale-up Rapid Scale-up LIFE Intensive Focus Intensive Focus LIFE Basic Basic LIFE

  13. USAID Funding for HIV/AIDS FY 2001By Account

  14. Estimating USG Resources for HIV/AIDS

  15. Funding Distribution for HIV/AIDS by BureauFY 2001 – CSD Account Only

  16. Funding Distribution for HIV/AIDS by Program TypeFY 2001 – CSD Account Only

  17. FY 2001 Legislative Directives on USAID’s HIV/AIDS Funding

  18. FY 2001 Authorization Directives

  19. New Directions/Confronting Obstacles • Commodities • Human Capacity Development • Faith Based Organizations • Rapid Response to Unsolicited Proposals • Increased emphasis on research • HIV vaccines • microbicides

  20. The “Big” Technical Challenges • Improved targeting • PMTCT • Condom supply • Orphans and vulnerable children • Care and support

  21. Preventing Mother to Child HIV Transmission • History • 076 Study (1994) • Short course Thai AZT (1998) • Uganda Nevaripene (1999) • Breast feeding

  22. Countries Providing Access to ARV HIV Care • Argentina • Brazil • Colombia • Costa Rica • Uruguay

  23. The Cost of Care • In Brazil, > 2/3 of pharmaceutical budget devoted to ARVs covering less than 20% of those infected. This $350 million is $20 million more than the annual USAID budget for HIV/AIDS • Treating all 36 million infected persons would cost $36 billion at the lowest price frame ($1000/p/y)

  24. Care: What Does It Involve: • Complex regimens (2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor) • Trained HCWs and minimal lab support • Life long intervention (sustainable, role of drug donations) • Misuse increases multi-drug resistance • Need for prevention remains • Equity of access ( most vulnerable, lottery, most productive, core transmitters, ability to pay)

  25. Advocates Compulsory licensing Parallel importing Expanded definition of generics (CIPLA) Pharmaceuticals Drug donations Individual negotiations Merck announcement (Crixovan: $600/yr, Stocrin $500/yr) Drug Access/Drug Prices

  26. Anti-retroviralsOne year course

  27. The Future: • New directions?: • New technologies?: improved condoms, vaccines, microbicides, simpler treatments,better diagnostics • Websites: www.synergyaids.com www.census.gov

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