Sustaining Jamaica s National HIV/AIDS Response. Dr. Kevin M. Harvey MB., BS., MPH., MSc. (I.D.) Director HPPB Ministry of Health Jamaica

Transcription

1 Sustaining Jamaica s National HIV/AIDS Response Dr. Kevin M. Harvey MB., BS., MPH., MSc. (I.D.) Director HPPB Ministry of Health Jamaica

2 State of HIV/AIDS In Jamaica

3 ANALYSIS OF BURDEN OF DISEASE Top 10 Causes of DALY loss by specific categories Estimates. HIV/AIDS 8.9 Violence 8.7 Unipolar depressive disorders 7.4 Ischaemic heart disease 5.6 Cerebrovascular disease 3.4 Chronic obstructive pulmonary disease 3.3 Maternal conditions 3.2 Diabetes mellitus 2.6 Drug use disorders 2.4 Prematurity and low birth weight

4 Number of Cases Reported 1.7% of the adult population infected Reported HIV Cases Reported AIDS Cases Reported Deaths

5 HIV Prevalence among selected populations HIV Prevalence 2008/ /11 Adults years ( Spectrum estimate) 1.6% 1.7% 17 in every 1000 ANC attendees (15 24 years) 1.1% (2009) 0.90%(2011) 9 in a 1000 Female sex workers 4.9% (2008) 4.1% (2011) 41 in a 1000 STI clinic attendees 2.4% (2009) 2.8% (2010) 28 in a 1000 Men who have sex with men 32% (2007) 32.9% (2011) 1 in 3; 330 in a 1000 Inmates 3.3% (2003) 2.46% (2011) 25 in a 1000 Homeless persons/drug users 8.82% (2009) 8.17% (2011) 81 in a

6 Number of Cases JAMAICA HIV BY AGE AND GENDER Male Female Unknown < 1 year '1-4 '5-9 Not Known - Paed ' >= 60 Not Known Male Female Unknown Age Group

7 Case Distribution By Gender Case Distribution By Gender Case Distribution By Gender Female 30% Male 70% Female 38% Male 62% Female 45% Male 55% JAMAICA

8 JAMAICA HIV BY TRANSMISSION CATEGORY NOT DETERMINED 26% HAEMOPHILIAC 0% BLOOD TRANSFUSION 0% VERTICAL 6% IV DRUG USE 0% SEXUAL 68%

9 Number of Cases JAMAICA Annual HIV Advance HIV AIDS Cases & AIDS Deaths HIV 2000 Adv HIV AIDS 1500 AIDS Death '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 HIV Adv HIV AIDS AIDS Death

10 Ten Leading Causes of Death in Jamaica: 2007 Rank Cause of Death Number Rate/100,00 0 population 1 Malignant Neoplasms 2, Cerebrovascular disease 2, Heart disease 1, Diabetes mellitus 1, Assault+ 1, Hypertension 1, Chronic lower respiratory tract infections Transport accidents** Human Immunodeficiency Virus (HIV) disease* Pneumonia and Influenza MOH HPPD 2009 Source: Vital Statistics Report, Registrar General s Department, except where otherwise indicated * Data from the National HIV/STI Control Programme substituted for registrations ** Data from the Road Safety Unit substituted for registrations + Data from the Jamaica Constabulary Force substituted for registrations

11 Current Mortality Profile Top 10 leading causes of death among men and women aged 5 years or older Rank Men % Women % 1 External causes 19.2 Diabetes Mellitus Cerebrovascular diseases 9.3 Cerebrovascular diseases Diabetes Mellitus 7.9 Hypertensive disease Malignant Neoplasm of the prostate 5.7 Ischaemic heart disease Ischaemic heart disease 5.4 Remainder of malignant neoplasms Hypertension disease 4.4 Malignant neoplasm of the breast Chronic lower respiratory diseases 3.0 Other heart diseases Other heart diseases 3.3 External causes Malignant neoplasm of the larynx, trachea, bronchus and lung 2.8 HIV disease HIV disease 2.8 Malignant neoplasm of the cervix uteri 2.1

12 Rate per 100,000 pop. JAMAICA Annual Paediatric Advance HIV Rates by Gender (Per 100,000 population): Male Female '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 Male Female

13 Factors Driving the Epidemic Behavioural surveillance of people living with HIV (PLHIV) reconfirmed that the main factors driving the epidemic since 1982 remained unchanged.

14 Males; 60.5% 15-24yrs: 52.4% * Females: 19.4% 25-49yrs; 32.9% Union status Married/cohabiting: 27% Not cohabiting: 50% No sex last 12 mths: 23% Hope Caribbean Co.Ltd.; 2012 KABP Survey Findings Presentation 14

15 JAMAICA MULTIPLE PARTNERSHIPS 63.3% used a condom the last time they had sex Hope Enterprises Ltd.; June 2008; 2008 KABP Survey Findings Presentation

16 Transactional Sex Among Persons Years Increased Significantly Transactional sex, defined as the exchange of gifts or money for sex Transactional sex within the last year was reported by 43% of persons years vs 39% previously. This compares to 36% among the older age group. Hope Caribbean Co.Ltd.; 2012 KABP Survey Findings Presentation 16

17 Condom use in Transactional Relationships increasing but only sometimes 59% vs 57% in 2008 used a condom the last time they had sex Frequency of condom use Never Sometimes (1-7 times) 13 Most times (8-9 times) 38 Everytime (10 times) Hope Caribbean Co.Ltd.; 2012 KABP Survey Findings Presentation 17

18 HIV Prevalence among CSW,

19 JAMAICA SW Condom Use By Type of Partner

20 Country MSMs Comparing Adult HIV Prevalence in 2007 and HIV Prevalence Among Caribbean MSM ( ) Adult HIV Prevalence Rate in 2007 HIV Prevalence Among MSM BHA 3% 8.2% GUY 2.5% 21% SUR 2.4% 6.7% JAM 1.6% 31.8% TNT 1.5% 20% DOR 1.1% % 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% HIV Prevalence Source: UNAIDS Global Report on AIDS.2008 and National HIV Seroprevalence Surveys.

21 HIV Prevalence among MSM, Prevalence (%) Murphy, Gibbs, Figueroa et al (JAIDS, 1988); 1995 Rossi et al (unpublished) 21

22 Percentage of young women and men aged who have had sexual intercourse before the age of Male Female

23 Intersection of Epidemics

24

25

26

27

28

29

30 HYPERTENSION

31 AIDS Case rates per 100,000 population

32

33 Successes - Jamaica Jamaica maintains a robust treatment program More than 90% of ANC clients access VCT Treatment coverage is 58%

34 Financing the Response to the Epidemic

35 Jamaica s Economic Burden Jamaica is classified as an Upper Middle Income Country with a GDP of USD13.9b in 2010 The country has a significant debt-burden with a debt to GDP ratio of almost 140% which has risen significantly from 117% in Standby Arrangement with the IMF to support the country s economic reform and recovery from mounting government debt, weak economic growth and the effects of the global economic crisis In fact the Country s Economy is in recession with negative growth for the last three quarters of 2012

36 Capital Expenditure GOJ Budget Colin F. Bullock

37 Per capita spending, US$ % GDP Situational Analysis (Major Financial Health Trends) Jamaica: total health expenditures (% GDP and per capita terms), Per capita (US$) % GDP

38 Situational Analysis (Major Financial Health Trends) Jamaica: composition of total health expenditures General government Out-of pocket Private prepaid Other sources

39 Public spending structure Category Home visits 0.35% 0.38% 0.42% Outpatient 2.04% 2.00% 1.89% Lab and Imaging 2.14% 2.57% 3.07% NHF Benefits 4.79% 3.18% 1.94% Administrative 4.92% 4.92% 4.77% Capital 4.92% 4.92% 4.77% Mental/Rehab 5.25% 8.29% 13.50% PHC and P&P 11.45% 11.33% 11.07% Pharmaceuticals 23.82% 22.19% 19.93% Hospital 40.34% 40.22% 38.65% Total % % %

40 % total health financing Situational Analysis (Major Financial Health Trends) Out of pocket expenditures as percentage of total health financing,

41 % total health funding Situational Analysis (Major Financial Health Trends) Participation of external resources in total health financing

42 NHP Main Funding Sources The Global Fund provides the principle financial support for the countries ARV programme. Round 7 Grant of USD39, 991,051 end 31 July TFM-USD2.5 M/Annum for two years NFM-USD3M The World Bank second HIV & AIDS Project for a loan of USD10M closed on March 31, USAID-HIV Prevalence in Most at Risk Populations Reduced and Effects mitigated. USD 2.5M/year Government of Jamaica J$570M+

43 GOJ HIV Budget

44 National HIV/STI Programme

45 FUNDING YEAR 2012/2013 (By Project)

46 Sustaining Jamaica s Response

47 Sustaining the Response National AIDS Spending Assessment Describes HIV/AIDS spending and identify areas where efficiency gains can be made

48 YEAR 2012/2013 FUNDING By Components

49 Treatment is Expensive The overall cost is increasing and could represent over 50 years of treatment resulting in an ever increasing economic burden on the government. The HIV infected population is also now aging. This has significant implications for the presence of co morbidities including Lipid Abnormalities, Diabetes, Cardiovascular and Peripheral Vascular disease among others- The associated cost.

50 Sustaining the Response Modes of Transmission Study Identify Main sources of new infections New HIV Infections, 2012 Casual hetero sexual sex CHS 23% Partners CHS 15% Low-risk heterosexual 15% Female partners of MSM 7% MSM 30% Sex workers 1% Clients 6% Partners of Clients 3%

51 Sustaining the Response Sustainability Study The study finds that the costs of the national response to HIV/AIDS will rise steeply, largely owing to cost of treatment

52 Projected Costs of National Response ( ) Scenario 1: Declining HIV incidence Scenario 2: Constant HIV incidence Scenario 3: Increasing HIV incidence

53 Projected Costs of National Response ( ) 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

54 Sustaining the Response Targeted National Strategic Plan The National HIV Strategic Plan (NSP) draws on the successes and lessons of the years Draws on the MOT The NASA MSM and CSW Strategies International trends

55 Sustaining the Response Financial Sustainability Plan Sustainability plan is geared towards identifying and documenting gaps and strategies for medium and long term funding options for the program

56 Financial Cost of Jamaica s National HIV/AIDS Program using 3 scenarios Financial Cost of Jamaica's National HIV/AIDs Program Using 3 Scenarios J$ Millions 2010/ / / / / / /17 Scenario 1 J$1, J$1, J$1, J$1, J$2, $2, J$2, Scenario 2 J$1, J$1, J$1, J$1, J$2, J$2, $2, Scenario 3 $1, J$1, J$1, J1, J$2, $2, $2, Scenario 4 NHP/NSP $2, J$2, J$2, J$2, J$2, $3, $3,284.60

57 Funding Gap Scenario 3 Sustainability Study Scenario 3 Funding Demand ** 2012/ / / / /17 J$ Million $1, $1, $2, $2, $2, USAID $ $ $ $ - $ - CDC $ $ $ - $- IBRD $ $ - $ - $ - $- NHF $ $ $ $ GOJ $90.00 $44.00 $44.00 $44.00 $44.00 Global Funds $1, $ $ $- $ - Total Available Funding * $1, $ $ $ $ Funding Gap ($ ) ($1,119.34) ($1,207.42) ($1,850.60) ($ 1,938.68)

58 Financing Jamaica's HIV/AIDS NSP 2013/ / / /17 J$ million Estimated Cost NSP $ 2, $ 2, $ 3, $ 3, USAID $ $ CDC $ $ NHF $ $ $ $ GOJ $ $ $ $ Global Funds $ $ Total Available Funding $ $ $ $ Funding Gap $ (1,876.90) $ (2,051.20) $ (2,781.70) $ (2,967.60)

59 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

60 GOJ Recurrent & Counterpart Funding (Last 5 Years) / / / / / Budget($M) / / / / /14

61 FUNDING SOURCE - YEAR 2013/2014 Funding Source (J$M) USAID 280 Global Fund GOJ % Funding Source (J$M) Total funding J$M 1, % 32% USAID Global Fund GOJ

62 Sustaining the Response Integration of NFPB/HIV Transfer the NHP as a programme from the central Ministry of Health to the NFPB. Cabinet has approved the integration of elements (Prevention, Enabling Environment and Human Rights, and Support to Treatment Care and Support) of the HIV Programme into the NFPB The designation of the NFPB as the NFPB-Sexual Reproductive Health Authority of Jamaica. Expansion of the Board to be more inclusive and multi-sectoral. The permanent inclusion of the Ministry of Education on the Board

63 New NSP Establish a Sexual Reproductive Health policy Review the Vision, Mission, Organisational Chart and Strategic and Corporate Plans of the NFPB, to ensure consistency with its strategic focus on SRH policy and programming. Guide integration at the level service delivery

64 Business Sector Response Jamaica Business Council on HIV/AIDS (JaBCHA) National AIDS Foundation in 2011

65 Projected Morbidity Forecast Forecast number of disease-specific discharges. Jamaica. 2012, 2020 and 2030 Disease Hypertensive diseases 4,832 6,183 8,810 Cerebrovascular diseases 3,202 3,937 5,308 Diabetes Mellitus 4,893 5,061 5,397 Other Heart Disease 2,804 3,007 3,395 Chronic Lower Respiratory Diseases 2,869 2,637 2,447 Ischaemic Heart Disease 1,561 1,809 2,249 HIV disease 1,714 1,970 2,301 Malignant neoplasm of the prostate 1,771 1,781 1,812 Malignant neoplasm of larynx, trachea, bronchus and lung 1,193 1,214 1,237 Forecasted hospital discharges for all causes 151, , ,977

66 Conclusion

67 Conclusion Despite the noble intentions and bold development goals articulated by the world s leaders, these remain in the main unachieved. The impact of this pandemic, at both micro and macro levels, continue to cause incalculable human suffering and threatens the social and economic infrastructure of countries like Jamaica;

68 Conclusion A large component of this being as a result of the broad economic challenges facing the country which both drive the epidemic and limit our ability to respond. Scientifically, the tools are available to reverse this epidemic, however bringing these interventions to scale remains challenging for most.