How to Make the Global HIV Response Sustainable Cuernavaca, Morelos, México

1. How to Make the Global HIV Response SustainableCuernavaca, Morelos, México Itete KARAGIRE, Data Analyst National AIDS Control Commission, Rwanda. Dr Agnès BINAGWAHO ExecutiveSecretary National AIDS Control Commission, Rwanda.

2. OVERVIEW OF PAPER/PRESENTATION • Background • Situation Today • The international response • Interface between international and national levels • The national response (Example of Rwanda) • Conclusion

3. Three stages in the history of the pandemic BACKGROUND From 80’s to 2003 ? National and International solidarity: (Exceptional assistance)

4. SITUATION TODAY • The number of people living with HIV continues to rise [33.2 million in 2007 from 29.0 million in 2001]. • For every two people who go on antiretroviral therapy (ART), there are 5 new HIV infections • [Some 2.5 million people were newly infected with the virus in 2007] • For the ones on ART it becomes a chronic disease • Increasing resistance to ART • No cure and no vaccine UNAIDS, Global Report 2007

5. No one, in any country, has a guaranteed way to ensure that AIDS will remain under control even in the western world

6. The international response • Reflection and researches example : « AIDS 2031 » • 9 work groups ( encourage region and global synergy) • Sustainability of finance • RED • 33 cents Euros by flight ticket (France) ect… • Prevention focus and invest on long term solution • Vaccine • Microbicide • Treatment • Encourage and finance researches

7. Exceptional assistance is only useful if there is integration at a national level • We will have to consider • The Paris declaration • National priorities • The 3 Ones EDPRS, NSP (NACC) Interface between national and international levels

8. 3 Ones • On national authority NACC • One National plan • One monitoring and evaluation system

9. At national level: Register the fight against AIDS as a top priority in the efforts for sustainable development. • 2. We must strengthen multi-sector: • Integrated into development plans and fight against poverty. • In Rwanda • All 12 sectors of PRSP2 or EDPRS (e.g. : Education, Justice, Health, Agriculture…Insist on budget support). • decentralized The national response (Example of Rwanda)

10. 3. Acknowledge its epidemic • Prevention the driving forces not to take international data • Treatment equity based on age, gender and geographical distribution. 4. Knowing the cost of the response and secure the funds The national response (Example of Rwanda) continued

11. Government is community-oriented • Participatory process • Transparency • Fight corruption • Effectives 3 ones : National coordination • GF, PEPFAR and others around One national Plan • One protocol for treatment, VCT, PMTCT etc… country wide • Geographic coverage for partners decided by National Institution • National Policy of Aid an NACC is in the monitoring comity • No tolerance for vertical programs The national response (Example of Rwanda : Why does it work)

12. Examples of Rwanda : Challenges • Full integration in development plan: • construction of health infrastructure; • Human resources ; • Workshops versus formal Education; • In the family planning • Multiple reporting and planning process

13. Rwanda results • Today, Rwanda under the leadership of the government which is beyond the 3 ones apply the 3 ones for Big 3: • Ensure that 50% of all pregnant women benefit from the program of the reduction of HIV transmission from mother to child (PMTCT), • Increasing access to antiretroviral treatment to over 70% • > 75 % of the population having health insurance • Increase in the last 2 years of the life expectancy to 4 years

14. Conclusions • Keep the exceptional sensitization globally • Integrating the national level BUT • Integrating at the global level • Development in the social sectors • Not vertical funds but budget support • A single national support plan (PRSP, MTF) • A single national reporting system

15. Tomorrow total integration and alignment GRACIAS