Taking the Pulse: Global Update on the Health Sector Response to HIV, 2014 Dr Gundo Weiler

1. Taking the Pulse: Global Update on the Health Sector Response to HIV, 2014 Dr Gundo Weiler Coordinator Strategic Information HIV Department World Health Organization WHO Satellite at AIDS2014, 20 July 2014

2. Global Health Sector Strategy on HIV/AIDS 2011-2015 - a new health sector agenda for HIV/AIDS Optimize HIV prevention, diagnosis, treatment and care Leverage broader health outcomes through HIV/AIDS responses ❶ ❷ Reduce vulnerabilities and remove structural access barriers Build strong and sustainable health systems ❹ ❸

3. Gauging recent progress in the global HIV response 2013 2009-2013 1.5 million HIV related deaths ▼ 25% [1.4 – 1.7 million] 320 000 TB-related deaths in PLWHA* ▼ 36%** [300 000 – 340 000] *2012 ** 2004-2012 2.1 million HIV infections ▼ 15% [1.9 – 2.5 million] 240 000 HIV infections in children ▼ 40% [210 000 – 280 000]

4. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers

5. Methodology Global AIDS Response Progress Reporting (GARPR) Annual reporting of programme data by countries (MoH, NAPs), electronic platform managed by UNAIDS, validated jointly by WHO, UNICEF, UNAIDS By June 2014, 131 out of 144 low- and middle income countries provided ART data, representing 99% of estimated total number of people on ART at end of 2013 Country policies and practices Real-time tracking of implementation of HIV health sector policies in practices in 58 focus countries, including UBRAF high impact countries and Global Plan countries Country submission through GARPR and validation/completion by WHO in-country staff.

6. Catalyse HIV treatment, care and support 12,9 million people on ART at the end of 2013 globally. 11,7 in low-and middle income countries - 2 million more than at the end of 2012 Actual and projected numbers of people receiving antiretroviral therapy in low-and middle-income countries, and by WHO Region, 2003–2015 Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS).

7. Catalyse HIV treatment, care and support Africa, with most people living with HIV, continues to drive global scale-up, but low-coverage Regions are catching up Total: 11.7 million in LMIC 36% 254 000 22% 402 000 32% 28 000 10% 1 100 000 33% 9 100 000 37% 788 000 44% Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

8. Catalyse HIV treatment, care and support Global scale-up driven by large increases in ART for adults + 21% 10,9 m Adults 9,0 m > 1 in 3 adults with HIV on ART (37%) Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

9. Catalyse HIV treatment, care and support The gap between access to ART for children and adults continues to widen + 21% 10,9 m Adults 9,0 m > 1 in 3 adults with HIV on ART (37%) + 15% Children 740 k 1 in 4 children with HIV on ART (23%) 640 k Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

10. Catalyse HIV treatment, care and support HIV has become the 2nd biggest cause of death for adolescents globally Source: Health of the world’s adolescent, WHO 2014

11. Catalyse HIV treatment, care and support Access to ART for people who inject drugs remains insufficient, the example of Eastern Europe People who inject drugs as a proportion of all people living with HIV with a known transmission route and The proportion of people who inject drugs Who received antiretroviral therapy in reporting countries, WHO European Region PWID among all PLWHA PWID among all on ART

12. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

13. Eliminate new HIV infections in children Close to 1 million pregnant women received ARVs, 500,000 still being missed Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

14. Eliminate new HIV infections in children Reaching the global target will depend on progress in some high burden countries with persisting low coverage Tanzania DR of the Congo Source: Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS) and 2013 UNAIDS estimates.

15. Eliminate new HIV infections in children Steady increase in roll-out of Early Infant Diagnosis, but still too few exposed children tested Pooled coverage of EID in 88 countries with data from 2011 and 2013 Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

16. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

17. Invigorate HIV Prevention Key populations are disproportionally affected by HIV, and disturbing news on outbreaks across all regions Average HIV prevalence in key population surveys and general population People who inject drugs Transgender people Men who have sex with men Sex worker Source: Unpublished literature review based on 88 country studies, 2007-2013

18. Invigorate HIV Prevention But still glaring gaps in addressing the needs of key populations in national HIV plans Percentage of 58 WHO HIV Focal Countries with explicit reference to specific key populations in their national HIV/AIDS Plan, June 2014

19. Invigorate HIV Prevention VMMC increased by 50% in 2013 to a total of 5.8 million, but its full potential is far from being exhausted

20. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

21. Service Integration Accelerating increase in ART coverage among notified TB patients to 70% Percentage of people coinfected with HIV and notified TB who initiated ART, 2007–2013 Source: provisional data from the Global Tuberculosis Programme Database, June 2014

22. Service Integration 85% of all ANC attendees were tested for syphilis - countries are targeting dual elimination Percentage of antenatal care attendees tested for syphilis at first visit, 2012 Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

23. Service Integration HIV is supporting an emerging hepatitis agenda Share among 58 WHO HIV focus countries offering hepatitis services in ART clinics, June 2014 Source: WHO HIV Country Intelligence Database, June 2014

24. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

25. Systems Integration Median prices of WHO-preferred first-line regimens per person per year, in US dollars, in low-and middle-income countries, 2004–2013 Prices continue to decrease, but stockouts remain of concern

26. Human Rights and Access Barriers In multiple countries laws, regulations or policies exist that can hinder service provision for key populations Sex workers PWID MSM Source: GARPR 2013 – “Countries reporting existence of laws, regulations or policies that can pose obstacles to effective HIV prevention, treatment, care and support services for key populations”

27. Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

28. Rapid uptake of 2013 ARV guidelines increases eligibility _ * * or 75% of 22 EMTCT Global Plan countries Percentage of 58 WHO HIV Focal Countries with confirmed adoption of select WHO 2013 ARV recommendations, June 2014 Source: WHO HIV Country Intelligence Database, June 2014

29. Ending the AIDS epidemic by 2030 Source: UNAIDS estimates (2014), Gap report

30. Conclusions: Main figures and messages Since 2009, 25% drop in mortality, but only 15% drop in incidence Failure in reaching key populations 12.9 million on ART globally, record 2 million increase in 2013 New eligibility criteria call for new ambitious treatment targets 740 000 children on ART, only 15% more than in 2012 Child – adult coverage gap is widening 40-50% of countries have adopted 2013 ARV guidelines Rapid uptake of new guidance, innovation is driving country responses Consolidation around integrated [HIV] service packages HIV response blazes the trail for universal health coverage

31. Acknowledgements Countries: Ministries of Health and National AIDS Programmes from 181 countries WHO: Andrew Ball, Txema Calleja, Michel Beusenberg, Chika Hayashi, Theresa Babovic (cons.), Hein Marais (cons.), Isabel Bergeri, Gottfried Hirnschall, Meg Doherty, Rachel Baggaley, Jos Perriens, Marco Vitoria, Nathan Shaffer, Vincent Habiyambere, Boniface Dongmo, Eyerusalem Negussie, Martina Penazzato, Tunga Namjilsuren, Haileyesus Getahun, Annabel Baddeley, Emil AsamoahOdei, Frank Lule, Ying-Ru Lo, Dongbao Yu, Amaya Maw, Massimo Ghidinelli, Monica Alonso, Gabriele Riedner, Hamida Khattabi, Martin Donoghoe, Irina Eramova, Annemarie Stengaard UN organizations: Peter Ghys, Mary Mahy (UNAIDS); Craig McClure, Chewe Luo, Priscilla Idele, Rosalind Carter (UNICEF) Partners: Lara Stabinski (OGAC); Laura Porter, John Aberle-Grass (CDC); Chris Duncombe (BMGF); Alvaro Bermejo, GitauMburu (AIDS Alliance); Asia Russell (HealthGAP); Tony Harries (Union); Ade Fakoya (GFATM); Mark Harrington (TAG); Vincent Wong (USAID); Tim Hallet (Imperial College); TsehayneshMessele(ASLM)